🧻 KINESIOTAPING in NECK PAIN 🤕

 



Neck pain is a major public health care problem, with the prevalence of neck pain in the general population ranging from 16.7% to 75.1% (mean 37.2%) and a lifetime prevalence of 48.5% (1,2). Mechanical neck pain (MNP) was defined as generalized neck pain and/or shoulder pain with mechanical features including symptoms aggravated by maintained neck posture, movement or palpation of cervical musculature (3). The etiology of MNP is not clear, however, it is thought to be multifactorial.
 
Various cervical structures, such as uncovertebral and intervertebral joints, neural tissues, discs, muscles or ligaments may be the source of neck pain. It is also claimed that myofascial trigger points localized in different head, neck, shoulder or upper back muscles, and paracervical muscle spasm may be responsible for MNP (2).
 
 

Kinesiotaping

 
A popular treatment technique used by physiotherapist in the management of musculoskeletal pathologies is kinesiotaping (KT).
 
We want to know the effects of KT in MNP, so we found a paper which study thirty-six patients (10 men, 26 women) with regards to pain intensity, range of motion (ROM), disability, quality of life, and depressive symptoms.
 
(Information extracted from: Onat SS, Polat CS, Bicer S, Sahin Z, Tasoglu O. Effect of Dry Needling Injection and Kinesiotaping on Pain and Quality of Life in Patients with Mechanical Neck Pain. Pain Physician. 2019 Nov;22(6):583-589. PMID: 31775405)
 


 

KT Application

 
KT application is shown in Fig. 1. The first layer of tape, a Y-strip, was placed over the posterior cervical extensor muscles, from the insertion to the origin, by stretching it 15% to 25% of its original length (4).
 
Each tail of the first strip was applied with the patient’s neck bending and rotating to the opposite site from the dorsal (T1-T2) to the upper cervical region (C1-C2). The overlying tape, spaced-strip with openings, was placed perpendicular to the Y-strip, over the midcervical region (C3-C6), with the patient’s cervical spine in flexion to apply tension to the posterior structures (5,6).
 
Patients wore the KT for a 4-week duration (renewed once a week periodically in this time).
 

Fig. 1: KT Application

 

Evaluations

 
- Numeric Rating Scale (NPS-11) was used to measure pain intensity. The NPS-11 ranges between 0 and 10 (0: minimum pain, 10: maximum pain). It has been shown to be a reliable and valid tool for the assessment of pain (7).
 
- The ROM was measured by using the universal goniometer (8). Neck Disability Index (NDI) was used to detect functional disability. The NDI consists of 10 questions, and total score is between 0 and 50 (9).
 
- For quality of life, the Short Form-36 Quality of Life Scale (SF-36 QOLS) was used. SF-36 QOLS consists of 8 subscores: physical function, physical role difficulties (PRD), body pain, general perception of health, vitality/energy, social function, mental status role, and mental health. The subscores were calculated separately between 0 and 100 (0: the worst, 100: the best health status). The scores of the 2 main components (physical score and mental score) were also evaluated. The Turkish validation was performed by Kocyiğit et al (10).
 
- Depressive symptoms were assessed by the Turkish version of the Beck Depression Inventory (BDI). The total score was between 0 and 63. Higher total scores indicate more severe depressive symptoms (11,12).
 



 

Discussion

 
This study revealed that KT is effective treatments for pain, quality of life, and depression in patients with MNP. We also found that KT may positively influence pain, disability, and ROM similar to the findings of others (5,6).
 
It may be possible that the application of KT provides a proper sensory feedback to the patients, decreasing fear of movement and thus improving ROM. Because the traction in KT lifts the epidermis relieving the pressure on the mechanoreceptors below the dermis, therefore decreasing nociceptive stimuli. Tension in the tape also provides afferent stimuli facilitating pain inhibition mechanisms, thereby contributing to reducing pain levels (5).
 
 

Conclusions

 
This study showed that both KT had a positive impact on pain, disability, quality of life, mood and ROM.
 
 
 

 
 
 

References

 
1. Fejer R, Ohm-Kyvik K, Hartvigsen J. The prevalence of neck pain in the world population: A systematic critical review of the literature. Eur Spine J 2006; 15:834-848.
 
2. Munoz-Munoz S, Munoz-Garcia MT, Alburquerque-Sendin F, Arroyo-Morales M, Fernandez-de-las-Penas CJ. Myofascial trigger points, pain, disability and sleep quality in individuals with mechanical neck pain. Manipulative Physiol Ther 2012; 35:608-613.
 
3. Castaldo M, Ge HY, Chiarotto A, Villafane JH, Arendt-Nielsen L. Myofascial trigger points in patients with whiplashassociated disorders and mechanical neck pain. Pain Med 2014; 15:842-849.
 
4. Saavedra-Hernández M, Castro-Sánchez AM, Cuesta-Vargas AI, Cleland JA, Fernández-de-las-Peñas C, Arroyo-Morales M. The contribution of previous episodes of pain, pain intensity, physical impairment, and pain-related fear to disability in patients with chronic mechanicalneck pain. Am J Phys Med Rehabil 2012; 91:1070-1076.
 
5. González-Iglesias J, Fernández-de-Las- Peñas C, Cleland JA, Huijbregts P, Del Rosario Gutiérrez-Vega M. Short-term effects of cervical kinesio taping on pain and cervical range of motion in patients with acute whiplash injury: A randomized clinical trial. J Orthop Sports Phys Ther 2009; 39:515-521.
 
6. Saavedra-Hernández M, Castro-Sánchez AM, Arroyo-Morales M, Cleland JA, Lara- Palomo IC, Fernández-de-Las-Peñas C. Short term effects of kinesio taping versus cervical thrust manipulation in patients with mechanical neck pain: A randomized clinical trial. J Orthop Sports Phys Ther 2012; 42:724-730.
 
7. Jensen MP, Turner JA, Romano JM, Fisher LD. Comparative reliability and validity of chronic pain intensity measures. Pain 1999; 83:157-162.
 
8. Fletcher JP, Bandy WD. Intrarater reliability of CROM measurement of cervical spine ac tive range of motion in persons with and without neck pain. J Orthop Sports Phys Ther 2008; 38:640-645.
 
9. Macdemid JC, Walton DM, Avery S, et al. Measurement properties of the neck disability index: A systematic review. J Orthop Sports Phys Ther 2009; 39:400-417.
 
10. Koçyiğit H, Aydemir Ö, Fişek G, Ölmez N, Memiş A. The reliability and validity of Turkish version of Short form 36 (SF 36). J Drug Treat 1995; 12:102-106.
 
11. Beck AT, Ward CH, Mendelson M, Mock J, Erbaugh J. An inventory for measuring depression. Arch Gen Psychiatry 1961; 4:561-571.
 
12. Hisli N. Beck Depresyon Envanterinin geçerliği üzerine bir çalışma. Psikoloji Dergisi 1988; 6:118-122.

LOWER BACK PAIN: EXERCISES AND STRETCHES

      ANATOMY

The lumbar spine is an area of ​​the back located between the dorsal vertebrae and the sacrum. It consists of 5 vertebrae that form a lordosis or anterior curvature in the back. They support the weight of the body and give mobility to the spine in flexion, extension, inclination and slight rotation. Between each vertebra is the articular disc formed by a fibrous ring and a nucleus pulposus, its function is to allow movement and acts as a shock absorber. The lumbar spinal discs are larger than the rest of the spine as they have to bear more load, their nucleus pulposus is slightly posterior, which generates a greater number of hernias in this area.

Lumbar Vertebrae

MUSCULATURE

·         Lumbar erector spinae: They are located in the posterior area of ​​the back and are responsible for extending the spine and staying upright. Their contracture is usually painful.

·         Abs: When they are strengthened, they reduce the load that the lumbar curve receives. They frequently atrophy with age and obesity, causing hyperlordosis (increased curvature of the spine).

·         Iliopsoas: the lumbar spine is inserted in the anterior area; its function is flexor and internal rotator and its contraction increases the lumbar curvature.

·         Gluteus and Pyramidal: Located in the posterior area they extend the lower limbs, perform external rotation and support the pelvis so that it does not fall with the only support of one foot.

·         Hamstrings: They range from the hamstrings of the pelvis to the femur and fibula through the back. Various lumbar problems are related to shortened hamstrings, due to the fact that they perform a positional change of the pelvis, leading to retroversion and affecting the curvature of the back.

Musculature lower back

 

  LOWER BACK PAIN

Low back pain is defined as pain or discomfort in the back of the body, located between the margin of the twelve ribs and the lower gluteal region, which may worsen until it limits habitual activities. It is a very common health problem and represents the main cause of activity limitation, disability, loss of productivity and absenteeism in the world, which generates enormous economic burdens for social security. Ten years ago, it was considered a problem limited to western countries. Since then, however, a large number of studies have shown that low back pain is a major problem in countries with lower and middle development levels.

Low back pain syndrome is one of the most common conditions in clinical practice, up to 84% of adults experience a low back pain episode at a certain period of their life. It can have a major negative impact on quality of life and function, and is often associated with depression and anxiety.

Analysis of the incidence of lower back pain showed that the majority of our sample population suffered from pain in the lower back. Nonspecific lower back pain is frequently encountered in primary care, with 25-50% of cases following a chronic course. Over recent decades, a large body of research has focused on the effectiveness of both pharmacological and non-pharmacological treatments.

The origin of low back pain can be classified as mechanical, neuropathic and secondary due to another disease. Mechanical back pain implies that the source of the pain originates from the spine or its associated structures. Neuropathic pain indicates that the presence of symptoms is due to irritation of the spinal nerve root. There are several ways to distinguish mechanical pain from neuropathic pain in the lower back when taking an anamnesis. Patients often describe neuropathic pain at the tip of the finger by pointing to the nerve path, while mechanical pain can often be transmitted to the buttocks and upper leg, while pain below the knee is more common in the root pain.

In this report I will speak about some exercises for to stretch and strengthen that zone and minimize possible pains. In accurate pain, I recommend you begin stretching and doing simple movements of pelvic, and after start strength your abdominal area.

 

  STRETCHES

1. LUMBAR ERECTOR SPINAE

On your back on a firm surface, extend one leg towards the ground and the other bring the knee to the chest with the help of the arms to stretch the posterior musculature of the back. Stay 30 seconds in this position and change legs.

Lumbar erector spinae stretch

2. GLUTEUS

Same position as in the previous exercise, but the knee that previously went towards the chest now goes towards the opposite shoulder until tension is felt in the buttock. Hold 30 seconds.

Gluteus stretch

3. QUADRATUS LUMBAR

Sitting on heels, hands fully forward and back stretched. Lean to both sides and stay in position for 30 seconds.

Gluteus stretch

4. ILIOPSOAS

On your knees take a big step forward with one leg, your trunk straight, carry the weight forward until you feel tension in your groin. Hold 30 seconds.

Iliopsoas stretch

5. HAMSTRINGS

On your back or standing, raise the leg to stretch raised to a height with the knee flexed, flex the hip forward but without bending the spine and stretch the knee until you feel tension in the back of the thigh. Hold the position for 30 seconds.

Hamstrings stretch

 

  STRENGTHENING

      6. PELVIS GIRDLE

Face up, you should begin with a good static position so lie on your back with a bent towel under your head. Do movements of your pelvic arching your lower back and then touching it with the floor, trying to be aware of your hip position and try to keep an intermediate position between these two, called the neutral pelvic position. Do it 10 times

Pelvic girdle

 7. TRANSVERSE ABDOMINIS

Face up with both legs flexed, put your hand on you between your belly button and your hip, inhale with your noise and exhale with your mouth trying to hid your belly button and you should feel abdominal area get stronger.

If we feel the palpation area harder, we have successfully activated the deep muscles of the abdomen. The pelvis must be in a neutral position. Perform 3 sets of 12 repetitions.

Transverse abdominis

 From here, we can perform different exercises that increase abdominal tension to help strengthen it:

·         Face up, raise one leg to 90 degrees and then stretch it to 45 degrees.
·         Face up, raise both arms towards the ceiling and bring them back 45 degrees.

Variations to increase abdominal tension

 8. GLUTEUS

Shoulder bridge. Face up, perform retroversion of the pelvis, squeeze the gluteus and raise it to a straight line with the shoulders, pelvis and knees. And go back down. Perform 3 sets of 12 repetitions.

Shoulder bridge

   Of course that exercises have a lot of variations and complications, be careful but don´t be scared in to follow your progression.

EXAMPLES OF VARIATIONS

Shoulder Bridge Variation

Two Legs Raise

Shoulder Bridge Variation 2

Exercises for lower back pain

Physiotherapy exercises for lower back pain

CERVICAL PAIN: EXERCISES AND STRETCHES

Cervical pain is one of the most common injuries in people of all ages, being one of the most prevalent conditions in Western society. This problem can be derived from a seating during long periods of time, aggravated by a greater tendency to the use of smartphones, of the computer, use of chairs and tables not suitable for each person and a sedentary lifestyle.

This medical condition can be caused by maintaining an forward head posture (FHP), it is characterized by an excessively advanced position of the head with respect to the neck and an internal rotation of the shoulders.

FHP is associated with low cervical flexion (C4-C7) and high cervical hyperextension (C1-C3), generating musculoskeletal changes at the cervical level. The deep neck muscles are considered very important in the stability, support and adjustment of the neck posture. Generally, there is a weakness of the deep flexor neck muscles in addition to a lack of strength of the external retractors and rotators of the shoulder. To solve this weakness, the body must generate compensations producing a shortening of the high fibers of the trapezium, sternocleidomastoid, scapula elevator, pectoralis major and minor and extensor musculature of the head.

Bad cervical posture can lead to a limitation of mobility and cause excessive tension of muscles and soft tissues. People with neck pain tend to move their head forward with respect to the neck without realizing it. In addition, previous studies have associated FHP and shoulders in internal rotation with cervical and headaches.

To correct this posture, it has been observed that proper activation of the deep flexor muscles of the neck during craniocervical flexion helps maintain an upright posture of the head. Therefore, the strengthening of weakened muscles and stretching of the trapezius, sternocleidomastoid and scapula lift can have positive effects on FHP and cervical pain.

Given the aforementioned consequences of the FHP, it seems correct to create and disseminate an exercise program to correct these dysfunctions.

Video on YouTube with explanation about the exercises and stretching that we explain below:

https://www.youtube.com/watch?v=Lxjzfj0Ma04

Strength exercises

Perform 3 sets of 10 repetitions in each exercise, the shoulders and neck should be at the beginning in a relaxed position. That is, open chest, shoulders away from the ears and slight cervical flexion

1. Cervical flexion

Face up with the head resting on the floor, perform a cervical flexion reducing the distance between the chin and the sternum. We activate and train the deep neck muscles. (Image 1)

Image 1: Deep neck flexors exercise

2. External rotation

In lateral recumbency with the elbow resting on the side, perform an external shoulder rotation movement making a movement towards the side of the hand that moves away from the body. Use a hand-held weight to get more training in the rotator muscles of the shoulder. (Image 2)

Image 2: External shoulder rotators exercise

3. T shape

When standing with legs bent, trunk tilted forward, back straight and arms stretched to the ground, abduct both arms with elbows extended to a position of 90º with respect to the body forming a T. Use weights on both arms to improve strength in the external abductor and rotator musculature of the shoulder, in addition to scapula approximators and stabilizers (Image 3 and 4)

Image 3: Abduction shoulder exercise with extended elbows (front view)

Image 4: Abduction shoulder exercise with extended elbows (sagittal view)

4. W shape

Standing with your legs bent, trunk tilted forward, back straight, shoulders adducted on your chest, elbows bent 100 ° and palms up, abduct your shoulders to back height forming a W. Use weights on both arms to increase training in the external abductor, flexor and rotator muscles of the shoulder, as well as scapula approximators and stabilizers. (Image 5 and 6)

Image 5: Abducted shoulder elbow flexion exercise (front view)

Image 6: Abduction shoulder exercise flexed elbows (sagittal view)

Stretching

Perform each stretch 30 seconds.

1. Pectoral

With the forearm resting on a wall and the shoulder at 90 °, make a rotation with the body in the opposite direction to the arm so that we achieve a separation between the origin and insertion of the pectoral muscle. (Image 7)

Image 7: Pectoral stretching (anterior and posterior view)

2. Upper trapezius

Perform a cervical flexion (look down), contralateral tilt (bring the ear to the shoulder) and homolateral rotation, with the contralateral hand increase the position of the neck to help increase tension in the trapezius. (Image 8)

Image 8: Trapeze Stretch

3. Neck Extenders

Perform a pure cervical flexion (look down), with both hands passively increase the position of the neck until tension is felt in the posterior area of ​​the neck. (Image 9)

Image 9: Stretching the neck extenders

FIBROMYALGIA IMPROVES WITH STRENGTH TRAINING

Fibromyalgia (FM) is a chronic disease characterized by generalized skeletal muscle pain (1, 2), and other common symptoms include fatigue, sleep disorders, depression, and excessive anxiety (3–6). The pathogenesis of FM is still not well understood (7), and FM is considered by some researchers to be a neurobiological disease caused by abnormal processing of pain (8).

There is currently no cure for FM, but palliative treatments are available. One type of treatment is strength training (ST). The aim of this study was to analyze the effects of ST in the treatment of FM through a systematic review of experimental research. Twenty-two studies were included in the review. Women aged 18–65 years comprised the total sample and the main variables analyzed were pain, strength, muscular activity, functional capacity, fatigue, quality of life, and sleep. 

Information extracted from: (Andrade, A., de Azevedo Klumb Steffens, R., Sieczkowska, S. M., Peyré Tartaruga, L. A., & Torres Vilarino, G. (2018). A systematic review of the effects of strength training in patients with fibromyalgia: clinical outcomes and design considerations. Advances in Rheumatology, 58(1). doi:10.1186/s42358-018-0033-9). 

 

Results

 The analysis of the results revealed that ST reduced the symptoms of patients with FM, such as pain, fatigue, number of tender points, depression, and anxiety, with improved functional capacity and quality of life (9, 10, 11, 12, 13, 14, 15, 16), despite the different training protocols used.

 Pain

Pain was the most studied variable, showing a reduction after ST (11, 12, 17, 18, 19–21). No study reported increased pain after or during the intervention period

 Muscle Strength

With regard to muscle strength, increases between 33 and 63% were observed after 21 and 16 weeks (15, 22).

 Quality of life and Functionality

Studies analysing quality of life and functionality showed that ST is effective in improving these variables (23, 12, 24, 15, 16, 18).

 Depression

The most investigated psychological variable was depression. The studies of Jones et al. (18), Gavi et al. (12), and Assumpção et al. (25) showed that ST reduces depressive symptoms; however, the study of Ericsson et al. (10) did not find a significant difference after 15 weeks of intervention.

 Sleep Quality

We also analyzed the results related to sleep quality. Andrade et al. (9) found that sleep disorders were reduced after ST and that sleep correlated with pain. The results of Ericsson et al. (10) also disclosed that ST yielded better results than relaxation sessions in improving sleep quality. In addition, another important result is that patients with FM presented similar responses to those of healthy persons; thus, they recommended ST to assist in the treatment of patients.

  

Training Protocol

It was observed that there is no specific training protocol for patients with FM; thus, the researchers developed their own protocol.
 Intervention protocols should start at low intensity (40% of 1RM) and gradually increase the intensity. ST should be performed 2 or 3 times a week to exercise the main muscle groups.  The current studies showed that ST is a safe and effective method of improving the major symptoms of FM and can be used to treat patients with this condition.  

Example of Training Protocol, Rooks et al. (18)

The intervention was designed to gradually increase the volume and intensity of exercise a person performed, to involve all major muscle groups of the body, and to include all 3 aspects of fitness— cardiovascular endurance, muscle strength, and joint flexibility.
 The exercises began with a low volume of exercise performed at a low intensity, because of the expected lower levels of cardiovascular fitness and muscle strength reported in women with Fibromyalgia, and the lower threshold for postexercise muscle pain and fatigue seen in this population. Participants exercised for 60 minutes per session, 3 times per week for 20 weeks. The intervention was composed of 2 phases of exercise.

 The first phase (4 weeks) was performed in a pool, and focused on active range of motion of the body’s major joints. Movements were controlled single-joint motions.

 The second phase (16 weeks) involved land-based exercises for improving cardiovascular endurance, muscle strength, and joint range of motion. Each exercise session was divided into 3 sections—cardiovascular, strength training, and flexibility—and was always performed in the same order.

 - Cardiovascular exercises incorporated walking on a treadmill (Life Fitness), an elliptical device (Precor, Bothell, WA), and walking on a track.

 - Strength training exercises included static contractions for pelvic and lumbar spine stabilization, and dynamic movement of large muscles and multijoint actions: hip flexion/extension, knee extension/flexion, ankle plantar/dorsiflexion, shoulder flexion, extension, abduction and horizontal adduction and abduction, elbow flexion and extension, and trunk flexion and rotation.
Strength training exercises were performed using a combination of machines (Life Fitness), hand weights, and body weight. Subjects began with resistance levels they could do easily, and progressed in an 8-10-12-12 repetition format when appropriate.

 - Flexibility was developed using a complete range of motion during strength training movements, traditional stretches, and a flexibility device (Precor).

 The land-based exercise program was revised after 3 months to prevent boredom and reduce the chance of dropout.  

Conclusion

In conclusion, ST had positive effects on physical and psychological symptoms, in terms of reducing pain, the number of tender points, and depression, and improving muscle strength, sleep quality, functional capacity, and quality of life.  

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