Kategoriarkiv: Head

treatment-article

Slipped disc in the nape of the neck

SportNetDoc

Herniated cervical intervertebralp discs with radiculopathy: an outcome study of conservatively or surgically treated patients.

Heckmann JG, Lang CJ, Zobelein I, Laumer R, Druschky A, Neundorfer B. J Spinal Disord 1999 Oct;12(5):396-401.

To study the functional outcomes of patients with cervical herniated intervertebral discs with radiculopathy but without signs of cervical myelopathy using a retrospective cohort study design. The patients were retrospectively identified by chart reviews. Inclusion criteria were (a) cervical radiculopathy with defined neurological disturbances (sensory disorder, reflex abnormalities, and motor weakness); (b) a spinal computed tomograph scan or magnetic resonance image demonstrating neuroradiologic abnormalities (soft or hard disc); and (c) completion of conservative physical and pharmacological treatment. Of 119 consecutive patients who were treated at the Departments of Neurology and Neurosurgery, University of Erlangen-Nuremberg, between January 1, 1985, and December 31, 1995, 60 patients met the inclusion criteria and were prospectively assessed, with an average follow-up time of 5.5 years. The patients were interviewed with regard to their daily activities, ability to work, and the surgical treatment they had undergone. A complete neurological examination also was performed. In 88.3%, the onset of disease was acute and in 11.7% subacute or chronic. The most common signs and symptoms were brachialgia (98.3%), neck pain (93.3%), sensory disorders (88.3%), reflex abnormalities (61.7%), and motor weakness (51.7%). The neuroimaging procedures demonstrated a disc prolapse (soft disc) in approximately 90% and spondylotic osteophytes (hard disc) in approximately 10%. During an average follow-up time of 5.5 years (range, 4.6 months-10.6 years) 39 (65%) patients had been treated using only conservative methods (COG = conservatively treated group), and 21 (35%) patients had undergone surgery (ventral discectomy) (SUG = surgically treated group). Brachialgia was completely or essentially improved in 100% of the COG and 95.1% of the SUG. Sensory disorders remitted completely or markedly in 97% of the COG and 75% of the SUG. The reflex abnormalities normalized or improved in 59.2% of the COG and in 53.3% of the SUG. Motor weakness improved in 94.1% of the COG and in 50% of the SUG. Neck pain was difficult to treat. It improved in only 36.1% of the COG and in 20% of the SUG. Occupational capacity was lost in 10% of the COG and in 38.9% of the SUG. In a self-rating scale, 89.7% of patients in the COG did not feel disabled in their everyday activities, compared with 66.7% of the patients in the SUG. Patients with a herniated cervical intervertebral disc with radiculopathy can be treated conservatively with good results, although a residual intermittent neck pain syndrome often persists. The patients in the SUG, who initially showed more severe and long-lasting neurological disturbances, were improved at the time of examination, although with more marked residual disorders. Surgery is indicated only when appropriate conservative treatment for a reasonable time has failed.

KONDITION

step4

Muscle infiltrations in the neck/shoulder

[Back]

Training ladder for:
MUSCLE INFILTRATIONS IN THE NECK/SHOULDER
(MYOSER)

STEP 4
KONDITION
Unlimited: Cycling. Swimming. Running.

UDSPÆNDING
(20 min)

Sit on a chair with your arms outstretched behind your back with hands together. Lift your arms up and backwards so that the front of the shoulders becomes increasingly stretched. Hold the position for 20 seconds and relax for 20 seconds before repeating.

Sit on a chair with one hand on your head and the other holding the chair seat. Slowly draw your head to the side while resisting with the opposite arm so that the muscles on the side of the neck become increasingly stretched. Draw your head in different directions so that all the muscles around the neck are stretched. Hold the position for 20 seconds and relax for 20 seconds before repeating.

Stand in a doorframe. Press your arms against the frame so that the front of your shoulders become increasingly stretched. Move your arms up and down the doorframe so that different parts of your muscles are stretched. Hold the position for 20 seconds and relax for 20 seconds before repeating.

Stand with your hands together behind your back. Draw your shoulder blades together (imagine trying to hold a pencil between your shoulder blades). Hold the position for 10 seconds and rest for 10 seconds before repeating.

Stand with the injured arm in front of your body. With the opposite hand, press the elbow of the injured arm towards the opposite shoulder, so that the upper part of the arm and the outer shoulder experiences increased stretching. Hold the position for 20 seconds and relax for 20 seconds before repeating.

Bend your injured arm behind your head and using the opposite hand, pull the elbow of the injured arm towards the opposite shoulder so that you feel increased stretching. Hold the position for 20 seconds and relax for 20 seconds before repeating.

Stand with right arm outstretched down by your side. Turn your hand inwards so that the thumb faces backwards, and move your arm back and down. Pull your chin in and bend your head the opposite way. Using your left hand, gently pull on the back of your head so that the neck and shoulder muscles on the right side become increasingly stretched. Hold the position for 20 seconds and relax for 20 seconds. Repeat the exercise for the opposite side.

Stretch your left arm down and outwards 30 degrees while bending the wrist upwards. Bend your head the opposite way and turn your chin upwards so that the neck and shoulder muscles on the left side become increasingly stretched. Hold the position for 20 seconds and relax for 20 seconds. Repeat the exercise for the opposite side.

Stretch your left arm down, back and outwards 30 degrees. Bend your head the opposite way and look down your shoulder so that the neck and shoulder muscles on the left side become increasingly stretched. Hold the position for 20 seconds and relax for 20 seconds. Repeat the exercise for the opposite side.

Sit on a chair holding the back of your hands under the lower part of the back. Press your elbows forwards and inwards so that the muscles on the back of the shoulder joint become increasingly stretched. Hold the position for 20 seconds and follow by pressing the elbows backwards so that increased stretching occurs on the front of the shoulder joint. Hold the position for 20 seconds.

STYRKE
(40 min)

Lie on the floor with instep stretched. Support on your toes and do push-ups without your stomach touching the floor.

Lie on your stomach on a bench or table with the injured arm hanging over the edge. Raise the injured arm stretched horizontally while drawing the shoulder blade in towards your body. A weight or bottle can be held in the hand to increase the load.

Lie on your stomach on a bench or table with the injured arm hanging over the edge holding a weight or bottle. Slowly draw the hand up to the shoulder joint.

Stand with the elastic under your foot. Hold the elastic with the injured arm and drawn the arm slowly back and upwards so that the elastic is taut.

Stand with the good shoulder against a wall. Hold the elastic with the injured arm and move the outstretched arm to the side and away from your body so that the elastic becomes taut.

Stand holding the elastic with the upper arm against your body and elbow bent at 90 degrees. Twist your lower arm outwards so that the elastic is taut and draw your arm slowly back again. The elbow must be held against your body the whole time.

Stand holding the elastic with the upper arm against your body and elbow bent at 90 degrees. Twist your lower arm in over your stomach so that the elastic is taut and draw your arm slowly back again. The elbow must be held against your body the whole time.

Hold the elastic with the injured arm with elbow bent and your hand at shoulder level. Stretch your arm forwards so that the elastic is tightened.

Stand with your side against a wall holding the elastic with the injured arm. Stretch the elbow with the upper arm at 90 degrees to your body and the hand above shoulder height. Draw the arm downwards and in over your stomach.

Stand with your side against the wall, holding the elastic with the injured arm. Move your arm away from your body so that the elastic becomes taut, before slowly drawing your arm in towards your body again.

Stretching is carried out in the following way: stretch the muscle group for 3-5 seconds. Relax for 3-5 seconds. The muscle group should subsequently be stretched for 20 seconds. The muscle is allowed to be tender, but must not hurt. Relax for 20 seconds, after which the procedure can be repeated. The time consumed for stretching, coordination and strength training can be altered depending on the training opportunities available and individual requirements.

KONDITION

step3

Muscle infiltrations in the neck/shoulder

[Back]

Training ladder for:
MUSCLE INFILTRATIONS IN THE NECK/SHOULDER
(MYOSER)

STEP 3
KONDITION
Unlimited: Cycling. Swimming. Running.

UDSPÆNDING
(20 min)

Sit on a chair with your arms outstretched behind your back with hands together. Lift your arms up and backwards so that the front of the shoulders becomes increasingly stretched. Hold the position for 20 seconds and relax for 20 seconds before repeating.

Sit on a chair with one hand on your head and the other holding the chair seat. Slowly draw your head to the side while resisting with the opposite arm so that the muscles on the side of the neck become increasingly stretched. Draw your head in different directions so that all the muscles around the neck are stretched. Hold the position for 20 seconds and relax for 20 seconds before repeating.

Stand in a doorframe. Press your arms against the frame so that the front of your shoulders become increasingly stretched. Move your arms up and down the doorframe so that different parts of your muscles are stretched. Hold the position for 20 seconds and relax for 20 seconds before repeating.

Stand with your hands together behind your back. Draw your shoulder blades together (imagine trying to hold a pencil between your shoulder blades). Hold the position for 10 seconds and rest for 10 seconds before repeating.

Stand with the injured arm in front of your body. With the opposite hand, press the elbow of the injured arm towards the opposite shoulder, so that the upper part of the arm and the outer shoulder experiences increased stretching. Hold the position for 20 seconds and relax for 20 seconds before repeating.

Bend your injured arm behind your head and using the opposite hand, pull the elbow of the injured arm towards the opposite shoulder so that you feel increased stretching. Hold the position for 20 seconds and relax for 20 seconds before repeating.

Stand with right arm outstretched down by your side. Turn your hand inwards so that the thumb faces backwards, and move your arm back and down. Pull your chin in and bend your head the opposite way. Using your left hand, gently pull on the back of your head so that the neck and shoulder muscles on the right side become increasingly stretched. Hold the position for 20 seconds and relax for 20 seconds. Repeat the exercise for the opposite side.

Stretch your left arm down and outwards 30 degrees while bending the wrist upwards. Bend your head the opposite way and turn your chin upwards so that the neck and shoulder muscles on the left side become increasingly stretched. Hold the position for 20 seconds and relax for 20 seconds. Repeat the exercise for the opposite side.

Stretch your left arm down, back and outwards 30 degrees. Bend your head the opposite way and look down your shoulder so that the neck and shoulder muscles on the left side become increasingly stretched. Hold the position for 20 seconds and relax for 20 seconds. Repeat the exercise for the opposite side.

Sit on a chair holding the back of your hands under the lower part of the back. Press your elbows forwards and inwards so that the muscles on the back of the shoulder joint become increasingly stretched. Hold the position for 20 seconds and follow by pressing the elbows backwards so that increased stretching occurs on the front of the shoulder joint. Hold the position for 20 seconds.

STYRKE
(40 min)

Sit on a chair with your hands behind your head. Keeping your chin level, press your head into your hands. Hold the position for 5 seconds. Turn your head upwards and backwards towards the left. Hold the position for 5 seconds. Repeat the exercise for the opposite side.

Turn your head down and to the right. Hold the pressure for 5 seconds before turning your head up, backwards and to the left. Hold the pressure for 5 seconds. Repeat the exercise for the opposite side.

Bend your head so that your ear is close to your shoulder and draw your chin in. Hold the pressure for 5 seconds. Turn your head the other way and hold the pressure for 5 seconds.

Go down on all fours. Lift your toes from the floor and do push-ups.

Sit on the floor with outstretched legs. Support with both hands on the floor, and lift yourself by using your arms. Both arms should be stretched.

Hold an elastic band with the injured arm at a 90-degree angle from the body. Slowly draw the elastic towards yourself so that it tightens.

Hold an elastic band in the good arm. Take hold of the other end of the elastic with the injured arm and draw the injured arm downwards.

Put the elastic under your foot, and with the injured arm draw the other end upwards by bending your arm.

Hold the elastic with the injured arm with elbow bent and your hand at shoulder level. Stretch your arm forwards so that the elastic is tightened.

Stand with your side against a wall. Hold the elastic with the injured arm with elbow bent, upper arm 90 degrees away from your body and your hand at shoulder height. The palm of your hand should face the floor. Drawn your arm downwards and in front of your stomach.

Stand with the elastic under your foot. Hold the elastic with the injured arm and drawn the arm slowly back and upwards so that the elastic is taut.

Stand with the good shoulder against a wall. Hold the elastic with the injured arm and move the outstretched arm to the side and away from your body so that the elastic becomes taut.

Stand holding the elastic with the upper arm against your body and elbow bent at 90 degrees. Twist your lower arm outwards so that the elastic is taut and draw your arm slowly back again. The elbow must be held against your body the whole time.

Stand holding the elastic with the upper arm against your body and elbow bent at 90 degrees. Twist your lower arm in over your stomach so that the elastic is taut and draw your arm slowly back again. The elbow must be held against your body the whole time.

Stand with your side against the wall, holding the elastic with the injured arm. Move your arm away from your body so that the elastic becomes taut, before slowly drawing your arm in towards your body again.

Stretching is carried out in the following way: stretch the muscle group for 3-5 seconds. Relax for 3-5 seconds. The muscle group should subsequently be stretched for 20 seconds. The muscle is allowed to be tender, but must not hurt. Relax for 20 seconds, after which the procedure can be repeated. The time consumed for stretching, coordination and strength training can be altered depending on the training opportunities available and individual requirements.

KONDITION

step2

Muscle infiltrations in the neck/shoulder

[Back]

Training ladder for:
MUSCLE INFILTRATIONS IN THE NECK/SHOULDER
(MYOSER)

STEP 2
KONDITION
Unlimited: Cycling. Swimming. Running.

UDSPÆNDING
(20 min)

Sit on a chair with your arms outstretched behind your back with hands together. Lift your arms up and backwards so that the front of the shoulders becomes increasingly stretched. Hold the position for 20 seconds and relax for 20 seconds before repeating.

Sit on a chair with one hand on your head and the other holding the chair seat. Slowly draw your head to the side while resisting with the opposite arm so that the muscles on the side of the neck become increasingly stretched. Draw your head in different directions so that all the muscles around the neck are stretched. Hold the position for 20 seconds and relax for 20 seconds before repeating.

Stand in a doorframe. Press your arms against the frame so that the front of your shoulders become increasingly stretched. Move your arms up and down the doorframe so that different parts of your muscles are stretched. Hold the position for 20 seconds and relax for 20 seconds before repeating.

Stand with your hands together behind your back. Draw your shoulder blades together (imagine trying to hold a pencil between your shoulder blades). Hold the position for 10 seconds and rest for 10 seconds before repeating.

Stand with the injured arm in front of your body. With the opposite hand, press the elbow of the injured arm towards the opposite shoulder, so that the upper part of the arm and the outer shoulder experiences increased stretching. Hold the position for 20 seconds and relax for 20 seconds before repeating.

Bend your injured arm behind your head and using the opposite hand, pull the elbow of the injured arm towards the opposite shoulder so that you feel increased stretching. Hold the position for 20 seconds and relax for 20 seconds before repeating.

Stand with right arm outstretched down by your side. Turn your hand inwards so that the thumb faces backwards, and move your arm back and down. Pull your chin in and bend your head the opposite way. Using your left hand, gently pull on the back of your head so that the neck and shoulder muscles on the right side become increasingly stretched. Hold the position for 20 seconds and relax for 20 seconds. Repeat the exercise for the opposite side.

Stretch your left arm down and outwards 30 degrees while bending the wrist upwards. Bend your head the opposite way and turn your chin upwards so that the neck and shoulder muscles on the left side become increasingly stretched. Hold the position for 20 seconds and relax for 20 seconds. Repeat the exercise for the opposite side.

Stretch your left arm down, back and outwards 30 degrees. Bend your head the opposite way and look down your shoulder so that the neck and shoulder muscles on the left side become increasingly stretched. Hold the position for 20 seconds and relax for 20 seconds. Repeat the exercise for the opposite side.

Sit on a chair holding the back of your hands under the lower part of the back. Press your elbows forwards and inwards so that the muscles on the back of the shoulder joint become increasingly stretched. Hold the position for 20 seconds and follow by pressing the elbows backwards so that increased stretching occurs on the front of the shoulder joint. Hold the position for 20 seconds.

STYRKE
(40 min)

Sit on a chair with your hands behind your head. Keeping your chin level, press your head into your hands. Hold the position for 5 seconds. Turn your head upwards and backwards towards the left. Hold the position for 5 seconds. Repeat the exercise for the opposite side.

Turn your head down and to the right. Hold the pressure for 5 seconds before turning your head up, backwards and to the left. Hold the pressure for 5 seconds. Repeat the exercise for the opposite side.

Bend your head so that your ear is close to your shoulder and draw your chin in. Hold the pressure for 5 seconds. Turn your head the other way and hold the pressure for 5 seconds.

Support with both hands against a wall. Move slowly towards the wall and push away again. The exercise is performed like standing push-ups.

Stand with the elastic under your foot. Hold the elastic with the injured arm and draw your shoulder upwards. The arm should be kept stretched in against your body the whole time.

Stand with the injured arm against a wall with elbow bent. Press the arm against the wall and hold the pressure for 10 seconds. Rest for 10 seconds before repeating. Repeat the exercise 10 times.

Hold an elastic band with the injured arm, with the arm by your side and the elbow bent. Slowly draw the elastic towards yourself so that the elastic tightens. The elbow must be bent the whole time.

Hold the elastic with the injured arm with your upper arm alongside your body with the elbow bent. Stretch your arm forwards so that the elastic tightens.

Stand holding the elastic with the upper arm against your body and elbow bent at 90 degrees. Twist your lower arm outwards so that the elastic is taut and draw your arm slowly back again. The elbow must be held against your body the whole time.

Stand holding the elastic with the upper arm against your body and elbow bent at 90 degrees. Twist your lower arm in over your stomach so that the elastic is taut and draw your arm slowly back again. The elbow must be held against your body the whole time.

Lie on your back with the injured arm raised upwards. Hold the elastic between your hands with the good arm against your chest. Stretch the injured arm further upwards so that the shoulder blade lifts from the floor.

Stand with your side against the wall, holding the elastic with the injured arm. Move your arm away from your body so that the elastic becomes taut, before slowly drawing your arm in towards your body again.

Stretching is carried out in the following way: stretch the muscle group for 3-5 seconds. Relax for 3-5 seconds. The muscle group should subsequently be stretched for 20 seconds. The muscle is allowed to be tender, but must not hurt. Relax for 20 seconds, after which the procedure can be repeated. The time consumed for stretching, coordination and strength training can be altered depending on the training opportunities available and individual requirements.

KONDITION

step1

Muscle infiltrations in the neck/shoulder

[Back]

Training ladder for:
MUSCLE INFILTRATIONS IN THE NECK/SHOULDER
(MYOSER)

STEP 1
The indications of time after stretching, coordination training and strength training show the division of time for the respective type of training when training for a period of one hour. The time indications are therefore not a definition of the daily training needs, as the daily training is determined on an individual basis.

KONDITION
Unlimited: Cycling. Swimming. Running.

UDSPÆNDING
(20 min)

Sit on a chair with your arms outstretched behind your back with hands together. Lift your arms up and backwards so that the front of the shoulders becomes increasingly stretched. Hold the position for 20 seconds and relax for 20 seconds before repeating.

Sit on a chair with one hand on your head and the other holding the chair seat. Slowly draw your head to the side while resisting with the opposite arm so that the muscles on the side of the neck become increasingly stretched. Draw your head in different directions so that all the muscles around the neck are stretched. Hold the position for 20 seconds and relax for 20 seconds before repeating.

Stand in a doorframe. Press your arms against the frame so that the front of your shoulders become increasingly stretched. Move your arms up and down the doorframe so that different parts of your muscles are stretched. Hold the position for 20 seconds and relax for 20 seconds before repeating.

Stand with your hands together behind your back. Draw your shoulder blades together (imagine trying to hold a pencil between your shoulder blades). Hold the position for 10 seconds and rest for 10 seconds before repeating.

Stand with the injured arm in front of your body. With the opposite hand, press the elbow of the injured arm towards the opposite shoulder, so that the upper part of the arm and the outer shoulder experiences increased stretching. Hold the position for 20 seconds and relax for 20 seconds before repeating.

Bend your injured arm behind your head and using the opposite hand, pull the elbow of the injured arm towards the opposite shoulder so that you feel increased stretching. Hold the position for 20 seconds and relax for 20 seconds before repeating.

Stand with right arm outstretched down by your side. Turn your hand inwards so that the thumb faces backwards, and move your arm back and down. Pull your chin in and bend your head the opposite way. Using your left hand, gently pull on the back of your head so that the neck and shoulder muscles on the right side become increasingly stretched. Hold the position for 20 seconds and relax for 20 seconds. Repeat the exercise for the opposite side.

Stretch your left arm down and outwards 30 degrees while bending the wrist upwards. Bend your head the opposite way and turn your chin upwards so that the neck and shoulder muscles on the left side become increasingly stretched. Hold the position for 20 seconds and relax for 20 seconds. Repeat the exercise for the opposite side.

Stretch your left arm down, back and outwards 30 degrees. Bend your head the opposite way and look down your shoulder so that the neck and shoulder muscles on the left side become increasingly stretched. Hold the position for 20 seconds and relax for 20 seconds. Repeat the exercise for the opposite side.

Sit on a chair holding the back of your hands under the lower part of the back. Press your elbows forwards and inwards so that the muscles on the back of the shoulder joint become increasingly stretched. Hold the position for 20 seconds and follow by pressing the elbows backwards so that increased stretching occurs on the front of the shoulder joint. Hold the position for 20 seconds.

STYRKE
(40 min)

Sit on a chair with your hands behind your head. Keeping your chin level, press your head into your hands. Hold the position for 5 seconds. Turn your head upwards and backwards towards the left. Hold the position for 5 seconds. Repeat the exercise for the opposite side.

Turn your head down and to the right. Hold the pressure for 5 seconds before turning your head up, backwards and to the left. Hold the pressure for 5 seconds. Repeat the exercise for the opposite side.

Bend your head so that your ear is close to your shoulder and draw your chin in. Hold the pressure for 5 seconds. Turn your head the other way and hold the pressure for 5 seconds.

Support with both hands against a wall. Put your weight on your hands and draw your shoulder blades backwards and forwards.

Stand with your arms outstretched at your sides with the palms of your hands facing forwards. Draw your shoulder blades together (imagine trying to hold a pencil between your shoulder blades). Hold the position for 10 seconds and rest for 10 seconds before repeating.

Sit at a table with the injured arm’s elbow on a ball. Press against the ball with a slow movement for 5 seconds. Rest for 5 seconds before repeating.

Lie on your back with the injured arm pointing upwards. Stretch the arm further up so that the shoulder blade lifts from the floor, and go down again. The arm must be outstretched the whole time.

Lie on your back with the injured arm by your side. Move the arm up and over your head before slowly retuning the arm again. The arm must be outstretched the whole time.

Lift both shoulders slowly upwards and down again.

Stand bending forward and supporting a chair back with one hand. Let the other arm hang freely downwards holding a weight. Move the shoulder backwards and forwards and from side to side. It is important that the arm hangs straight down the whole time.

Stand slightly bent over a chair, with your weight on the good arm and the injured arm hanging loosely downwards holding a weight or a filled bottle. Lift your arm/shoulder upwards by using the shoulder blade’s muscles. Using heavier objects or weights can increase the load.

Stand at a table with the injured arm on a ball. Move the ball in all directions while applying slight pressure on the ball.

Stretching is carried out in the following way: stretch the muscle group for 3-5 seconds. Relax for 3-5 seconds. The muscle group should subsequently be stretched for 20 seconds. The muscle is allowed to be tender, but must not hurt. Relax for 20 seconds, after which the procedure can be repeated. The time consumed for stretching, coordination and strength training can be altered depending on the training opportunities available and individual requirements.

treatment-article4

Muscle infiltrations in the neck/shoulder

SportNetDoc

Active neck muscle training in the treatment of chronic neck pain in women: a randomized controlled trial.

Ylinen J, Takala EP, Nykanen M, Hakkinen A, Malkia E, Pohjolainen T, Karppi SL, Kautiainen H, Airaksinen O. JAMA. 2003 May 21;289(19):2509-16.

CONTEXT: Active physical training is commonly recommended for patients with chronic neck pain; however, its efficacy has not been demonstrated in randomized studies. OBJECTIVE: To evaluate the efficacy of intensive isometric neck strength training and lighter endurance training of neck muscles on pain and disability in women with chronic, nonspecific neck pain. DESIGN: Examiner-blinded randomized controlled trial conducted between February 2000 and March 2002. SETTING: Participants were recruited from occupational health care systems in southern and eastern Finland. PATIENTS: A total of 180 female office workers between the ages of 25 and 53 years with chronic, nonspecific neck pain. INTERVENTIONS: Patients were randomly assigned to either 2 training groups or to a control group, with 60 patients in each group. The endurance training group performed dynamic neck exercises, which included lifting the head up from the supine and prone positions. The strength training group performed high-intensity isometric neck strengthening and stabilization exercises with an elastic band. Both training groups performed dynamic exercises for the shoulders and upper extremities with dumbbells. All groups were advised to do aerobic and stretching exercises regularly 3 times a week. MAIN OUTCOME MEASURES: Neck pain and disability were assessed by a visual analog scale, the neck and shoulder pain and disability index, and the Vernon neck disability index. Intermediate outcome measures included mood assessed by a short depression inventory and by maximal isometric neck strength and range of motion measures. RESULTS: At the 12-month follow-up visit, both neck pain and disability had decreased in both training groups compared with the control group (P<.001). Maximal isometric neck strength had improved flexion by 110%, rotation by 76%, and extension by 69% in the strength training group. The respective improvements in the endurance training group were 28%, 29%, and 16% and in the control group were 10%, 10%, and 7%. Range of motion had also improved statistically significantly in both training groups compared with the control group in rotation, but only the strength training group had statistically significant improvements in lateral flexion and in flexion and extension. CONCLUSIONS: Both strength and endurance training for 12 months were effective methods for decreasing pain and disability in women with chronic, nonspecific neck pain. Stretching and fitness training are commonly advised for patients with chronic neck pain, but stretching and aerobic exercising alone proved to be a much less effective form of training than strength training.

treatment-article3

Muscle infiltrations in the neck/shoulder

SportNetDoc

Treatment of myofascial trigger-points with ultrasound combined with massage and exercise–a randomised controlled trial.

Gam AN, Warming S, Larsen LH, Jensen B, Hoydalsmo O, Allon I, Andersen B, Gotzsche NE, Petersen M, Mathiesen B. Pain 1998 Jul;77(1):73-9.

The effect of treatment with ultrasound, massage and exercises on myofascial trigger-points (MTrP) in the neck and shoulder was assessed in a randomised controlled trial. The outcome measures were pain at rest and on daily function (Visual Analogue Scale, VAS), analgesic usage, global preference and index of MTrP. Long-term effect for treatment and control groups was assessed after 6 months using a questionnaire. The patients were randomised to three groups. The first group was treated with ultrasound, massage and exercise (A), the second group with sham-ultrasound, massage and exercise (B), while the third group was a control group (C). The duration of the study was 6 weeks. Treatment was given twice a week from the second to the fifth week. The number and index of MTrPs were recorded at each treatment session in groups A and B but only at entry as well as end of study in group C. VAS and analgesic usage was recorded in all three groups throughout the study period. Six months after the last treatment session a questionnaire was send to the patients. A total of 67 patients were included. Nine patients dropped-out during the study, which left 58 patients that could be included in the final analysis. Twenty patients were randomised to group A, 18 to group B and 18 to group C. A significant reduction in index were found between treatment groups (A and B) and control group (C), but no difference between group A and B. VAS scores, analgesic usage or global preference showed no difference between group A, B or C. The patients in the group C were offered treatment (ultrasound, massage, exercise) after the 6 weeks treatment period. At the questionnaire after 6 month 44 (87%) of the 52 patients from all three groups who had treatment responded. Sixty-four percent answered that they had had good or some effects, 68 percent were still doing the exercise programme and 17 percent had received other forms of therapy after they had completed the study. No difference between groups given ultrasound or sham ultrasound were found. It is concluded that US give no pain reduction, but apparently massage and exercise reduces the number and intensity of MTrP. The impact of this reduction on neck and shoulder pain is weak.

treatment-article2

Muscle infiltrations in the neck/shoulder

SportNetDoc

Rehabilitation of neck-shoulder pain in women industrial workers: a randomized trial comparing isometric shoulder endurance training with isometric shoulder strength training.

Hagberg M, Harms-Ringdahl K, Nisell R, Hjelm EW. Arch Phys Med Rehabil 2000 Aug;81(8):1051-8.

OBJECTIVES.
To study whether isometric shoulder endurance was more advantageous than isometric shoulder strength training in reducing pain and perceived exertion and to increase shoulder function through improved muscle endurance and strength.

DESIGN.
Randomized trial.

SETTING.
Three occupational health care centers. PARTICIPANTS: Women industrial workers with nonspecific neck-shoulder pain. The International Classification of Diseases, 10th Revision (ICD-10) diagnosis was “cervicobrachial syndrome” (M53.1). Thirty-eight patients completed the isometric shoulder endurance training and 31 patients completed the isometric shoulder strength training.

INTERVENTION.
Twelve weeks of training.

MAIN OUTCOME MEASURES.
Self-reported pain and rating of perceived exertion (RPE), arm motion performance test, shoulder muscle strength, shoulder muscle endurance, and shoulder functional tests, as well as follow-up after supervised training had ended.

RESULTS.
The isometric shoulder strength training resulted in an almost one-scale step decrease in RPE at work and a 5% to 15% improvement of arm motion performance compared with the endurance training. The isometric shoulder strength training more effectively improved left side shoulder abduction strength (p < .026), but no major differences were found for the other strength measurements. The isometric shoulder endurance training was not more successful than the strength training in the endurance test (p .51 to .81).

CONCLUSIONS.
Physical training programs for neck-shoulder pain may include isometric shoulder muscular strength exercise in addition to isometric shoulder endurance training, rather than endurance training only.

treatment-article1

Muscle infiltrations in the neck/shoulder

SportNetDoc

Perceived pain before and after three exercise programs–a controlled clinical trial of women with work-related trapeziusP myalgia.

Waling K, Sundelin G, Ahlgren C, Jarvholm B. Pain 2000 Mar;85(1-2):201-7.

The effect of exercise on neck-shoulder pain was studied in 103 women with work-related trapezius myalgia randomized into three exercise groups and a control group. One group trained strength, the second muscular endurance and the third co-ordination. The exercise groups met three times weekly for 10 weeks. Pain assessment was made on three visual analogue scales, indicating pain at present, pain in general and pain at worst. Pain thresholds were measured in the trapezius muscle with a pressure algometer. A pain drawing was completed. The rated pain decreased significantly (P<0.05) on the VAS describing pain at worst in the strength and endurance groups. Pressure sensitivity decreased significantly (P<0.05) in four triggerpoints in the exercise groups. No changes were seen in the extent of painful body area in any group. Comparison of exercisers (n=82) and controls (n=21) showed significantly larger pain reductions on VAS pain at present and VAS pain at worst among exercisers. All three exercise programs showed similar decreases of pain which indicates that the type of exercise is of less importance to achieve pain reduction.

bandage-article2

Fracture of the nasal bone

SportNetDoc

The incidence of sports-related facial trauma in children.

Perkins SW, Dayan SH, Sklarew EC, Hamilton M, Bussell GS. Ear Nose Throat J 2000 Aug;79(8):632-4, 636, 638.

We conducted a survey of physician members of the American Academy of Facial Plastic and Reconstructive Surgery to determine the incidence and nature of facial traumas seen in their practices. We solicited information on the anatomic location of each injury, the severity of the trauma, and whether the injury occurred during a sports activity. According to the responses, 21% of facial fractures and 29% of nasal fractures were experienced by patients aged 17 years and younger who were participating in sports. We believe that many such injuries can be prevented with greater use of protective equipment.