Altered Trapezius Muscle Behavior in Individuals With Neck Pain and Clinical Signs of Scapular Dysfunction

Electromyographic Activity of Cervical Muscles in Patients with Neck Pain and Changes After Dry Needling: A Narrative Review

Neck pain can be associated with specific conditions, such as neurological disorders, vascular or inflammatory diseases, fractures, herniated discs, etc. However, the majority of neck pain cases cannot be attributed to a specific cause. The objective of this review is to describe the muscle dysfunctions associated with neck pain, as measured by electromyography, and to determine the effectiveness of dry needling in improving these muscular dysfunctions. The research was conducted using the following databases: PubMed, Alcorze, and Google Scholar. The next conclusions have been extracted after the revision of the 65 selected manuscripts. The current scientific evidence supports electromyographic pathological findings in individuals with chronic neck pain, especially during general upper limb movement, repetitive work, violin playing, cervical force, and cervical movement tasks. Dry needling applied to an active myofascial trigger point in the upper trapezius can be suggested as an intervention to enhance the performance in the cranio-cervical flexion. Dry needling applied to latent myofascial trigger points in the upper trapezius after typing tasks in healthy subjects resulted in decreased upper trapezius activity and fatigue in the short term. In women with trapezius myalgia, dry needling applied to the upper trapezius led to a lower increase in electromyography activity compared to no intervention.

Are cervical curvature and axioscapular muscle activity associated with disability in patients with chronic nonspecific neck pain? - a cross sectional exploratory study

Purpose

To ascertain the relationship between cervical curvature, neck muscle activity and neck disability in patients with chronic nonspecific neck pain (CNNP).

Methods

Ninety participants (mean age = 27.2, female/male ratio = 7/2) with CNNP volunteered. The Neck Disability Index was used to assess neck disability. To indicate the electromyographic characteristics of the axioscapular muscles, the root mean squares and median frequencies of upper trapezius and levator scapula were used. Cervical curvature was measured with a flexible ruler.

Results

Disability of the neck was significantly correlated with curvature (r = -0.599, p < 0.001), upper trapezius root mean square (RMS) (r = 0.694, p < 0.001) and levator RMS (r = 0.429, p < 0.05). Multiple regression analysis produced a significant predictive equation that could predict disability: 33.224- 0.515 × Curvature + 0.156 × Levator RMS - 0.059 × Upper trapezius median frequency + 0.636 × upper trapezius RMS + 0.020 × levator median frequency, with R2 = 0.622.

Conclusion

Cervical curvature as well as different axioscapular muscle activity were found to be related to level of disability. These findings have implications for clinical management of CNNP.

Effects of slouched sitting posture on clavicular and scapular orientations and movements in individuals with neck pain with scapular dysfunction

BACKGROUND

It has been suggested that sitting posture affects clavicular, scapular and spinal kinematics, however its effects in people with neck pain and scapular dysfunction remain unknown. The study aimed to determine the clavicular and scapular kinematics in different sitting postures in patients with neck pain and scapular dysfunction.

METHODS

Thirty-four participants with neck pain and scapular dysfunction were recruited into the study. Kinematics of the clavicle and scapula were recorded using motion analysis at rest and during arm elevation (at 30, 60, 90, and 120 degrees) in a slouched and upright sitting posture.

RESULTS

Compared to the upright sitting posture, the slouched sitting posture had increased clavicular protraction and elevation as well as scapular internal rotation and anterior tilt at rest and during the arm raising and lowering phases (at 30, 60, 90, and 120 degrees) (p < 0.05). The slouched sitting also had increased scapular upward rotation in the lowering phase at all angles (p < 0.05).

SIGNIFICANCE

The slouched sitting posture has a significant influence on clavicular and scapular kinematics. Awareness of good sitting posture should be encouraged in patients with neck pain and scapular dysfunction.

Instrument Assisted Soft Tissue Mobilization versus Integrated Neuromuscular Inhibition Technique in Nonspecific Chronic Neck Pain: Single-blinding Randomized Trial

Objective

This study aimed to compare the effects of instrument-assisted soft tissue mobilization (IASTM) vs integrated neuromuscular inhibition technique (INIT) on pain intensity, pressure pain threshold, neck disability, and electrophysiological properties in nonspecific chronic neck pain.

Methods

We performed a pre-post prospective randomized controlled trial on 90 participants with nonspecific chronic neck pain. The participants were chosen randomly from physical therapy out-patient clinics in the Giza governorate and allocated randomly by permuted block to the following 3 groups: Group A received INIT on the upper trapezius in addition to supervised traditional therapy (STT) as hot pack, stretching and strengthening exercises, Group B received IASTM on the upper trapezius in addition to STT, and Group C received STT only. Treatment was 3 times per week for 4 weeks. Pain intensity by visual analog scale (VAS), pressure pain threshold (PPT) by commander algometer, neck disability by Arabic Neck Disability Index (ANDI), and electrophysiological properties in the form of muscle amplitude by root mean square (RMS), and fatigue by median frequency (MDF) were measured at baseline and after 4 weeks.

Results

In the within-group analysis, there was a statistically significant decrease in VAS, ANDI, and RMS% values within each group with favor to INIT. In PPT and MDF, there was a significant increase within each group with regard to INIT as P value <.05. In the between-group analysis at posttreatment, the results reported a statistically significant difference between INIT and STT, and also between IASTM and STT in all variables. Between INIT and IASTM, there was no statistically significant difference in VAS and NDI, but there was a statistically significant difference in PPT, RMS%, and MDF. The post hoc test reported improvement in all variables in all groups, with more favor to the INIT group in PPT and electrophysiological properties only.

Conclusion

In this study, we found no statistically significant differences between INIT and IASTM in VAS and ANDI posttreatment, but there were differences between INIT and STT group and IASTM and STT group.

Cervical sensitivity, range of motion and strength in individuals with shoulder pain: A cross-sectional case control study

OBJECTIVES

To assess whether cervical sensitivity, range of motion (ROM) and strength are impaired in individuals with shoulder pain and how they interact with sociodemographic and clinical data.

METHODS

Forty-eight individuals with shoulder pain and 48 asymptomatic matched ones were included. Pressure pain thresholds (PPTs) in cervical region and tibialis anterior muscles, ROM of cervical flexion, extension, lateral flexions and rotations and cervical muscle strength of flexion, extension and lateral flexions were assessed. Between-groups comparisons and a logistic multiple regression model were performed.

RESULTS

The symptomatic group showed lower and not meaningful PPTs in trapezius of the unaffected/unmatched side, both sternocleidomastoid muscles, and tibialis anterior and reduced ROM in cervical extension (MD = -9.00°) when compared to the asymptomatic group. No differences were identified in muscle strength. Reduced PPT of the trapezius and reduced cervical extension ROM together accounted for 40.2% of the variance of the chance of presenting shoulder pain.

CONCLUSION

Individuals with shoulder pain have more, but not clinically relevant, cervical sensitivity and lower cervical extension than asymptomatic individuals. The lower the PPT of the upper trapezius and the cervical extension ROM, the higher was the chance to present shoulder pain. Regional interdependence between cervical spine and shoulder may explain cervical physical function alterations in shoulder pain.

Assessment of pain, scapulothoracic muscle strength, endurance and scapular dyskinesis in individuals with and without nonspecific chronic neck pain: A cross-sectional study

INTRODUCTION

This study is aimed to evaluate pain, muscle strength, scapular muscular endurance and scapular kinesis in individuals with Nonspecific Chronic Neck Pain and to compare them with asymptomatic individuals. In addition, to investigate the effect of mechanical changes in the scapular region on neck pain.

METHOD

40 individuals who applied to Kırıkkale University Faculty of Medicine Hospital Physical Therapy and Rehabilitation Center and diagnosed with NSCNP and 40 asymptomatic individuals for the control group were included the study. Pain was evaluated with Visual Analogue Scale, pain threshold and pain tolerance with algometer, cervical deep flexor group muscle strength with Stabilizer Pressure Biofeedback device, and neck and scapulothoracic muscle strength with Hand Held Dynamometer. Scapular Dyskinesia Test, Scapular Depression Test and Lateral Scapular Slide Test were used to evaluate scapular kinesis. A timer was used to evaluate scapular muscular endurance.

RESULT

Pain threshold and pain tolerance values of the NSCNP group were lower (p < 0.05). Muscle strength around neck and scapulothoracic region of the NSCNP group were lower than the asymptomatic individuals (p < 0.05). NSCNP group had more scapular dyskinesia (p < 0.05). Scapular muscular endurance values of the NSCNP group were lower (p < 0.05).

CONCLUSION

As a result, pain threshold and pain tolerance decreased, muscle strength of the neck region and the scapular region decreased, scapular endurance values decreased and the incidence of scapular dyskinesia increased in the individuals with NSCNP compared to the asymptomatic individuals. It is thought that our study will provide a different perspective in the evaluation of neck pain and including the scapular region to the evaluations.

Axioscapular and neck extensor muscle behavior during isometric shoulder exertions in patients with nonspecific neck pain with and without a scapular downward rotation posture

BACKGROUND

A common observation in persons with neck pain is scapular downward rotation (SDR) with altered muscle behavior. Evidence of changes in axioscapular muscles in neck pain patients remains inconclusive, which may reflect population heterogeneity in previous studies.

RESEARCH QUESTION

Are there differences in behavior of the axioscapular (upper trapezius: UT, lower trapezius: LT and serratus anterior: SA) and neck extensor (NE) muscles during isometric shoulder tasks in patients with neck pain with SDR, patients with no scapular dysfunction and healthy controls?

METHODS

Sixty participants with nonspecific neck pain (30 with SDR and 30 without scapular dysfunction) and 30 controls were recruited. Electromyographic signals were recorded unilaterally from the UT, LT, SA and NE during different isometric shoulder tasks (30° flexion, 30°abduction and 30°external rotation) at 20%, 50% and 100% maximal voluntary contraction (MVC). Activity of UT, LT, SA and NE was normalized with respect to reference contractions. The UT/LT, UT/SA and LT/SA ratios were calculated for each task.

RESULTS

The neck pain group with SDR had increased UT activity in 30°flexion (20%MVC) and 30°abduction (20% and 50%MVC) compared to the neck pain and control groups without scapular dysfunction (p < 0.05). There were no between group differences in LT and SA activity (p > 0.05). The neck pain groups had greater NE activity in all tasks (p < 0.001). Finally, the neck pain group with SDR had higher UT/LT and UT/SA ratios in a few tasks at low force levels (p ≤ 0.01).

SIGNIFICANCE

Greater UT activity and UT/LT and UT/SA ratios during particularly low force isometric shoulder tasks suggest that SDR is associated with altered axioscapular motor control. Greater NE activity in both neck pain groups suggests altered motor control related to neck pain. Changes in the NE and UT behavior should be considered in management of patients with neck pain with observable SDR.

Pain, Anxiety, and Quality of Life of COVID-19 Survivors with Myofascial Pain Syndrome: A cross sectional study

BACKGROUND

People who have survived COVID-19 may develop chronic pain.

AIMS

To investigate the difference in pain level, anxiety, functional status, and quality of life in COVID-19 survivors with myofascial pain syndrome (MPS) in the trapezius muscle compared with MPS patients without COVID-19.

DESIGN

Cross-sectional observational study.

SETTINGS

Physical medicine and rehabilitation outpatient clinics of a single tertiary-care hospital.

PARTICIPANTS/SUBJECTS

Eighty patients (40 patients with MPS and 40 patients with MPS + COVID) who were diagnosed with chronic MPS in the trapezius muscle were evaluated.

METHODS

Pain level of the patients was evaluated using the visual analogue scale (VAS), the functional status with the Neck Pain and Disability scale, the psychosocial effects of the pain with the Beck Anxiety Inventory, and the quality of life with the Nottingham Health Profile tests, and the two groups (MPS and MPS + COVID) were compared.

RESULTS

A significant difference was observed between the groups in terms of pain, anxiety, and disability (p < .001). MPS + COVID group showed significantly greater pain intensity on VAS and higher mean total scores on Nottingham Health Profile, Beck Anxiety Inventory, all Nottingham Health Profile subdomains (pain, emotional reactions, sleep, social isolation, physical mobility, energy) compared with the MPS group (p < .001).

CONCLUSIONS

After recovering from COVID-19, patients with MPS showed increased pain, anxiety, disability, and decreased quality of life.

Lower trapezius muscle function in people with and without shoulder and neck pain: a systematic review

CONTEXT

Shoulder and neck pain are leading causes of disability worldwide. Rotator cuff pathology has strong associations with such pain and is extensively targeted by healthcare practitioners. A dysfunctional lower trapezius muscle has also been shown to contribute to neck and shoulder pain, yet it is often overlooked.

OBJECTIVES

This systematic review analyzes those with a history of, or who are currently managing, shoulder or neck pain to indicate differences in measures of lower trapezius function when compared to subjects without that pain.

METHODS

Studies with no age restrictions were included in the study. Studies could determine lower trapezius muscle function with any quantifiable measurement tool or clinical assessment. If the study included a control group (no pain) and a comparator group (pain), and if lower trapezius muscle function was assessed in both, the study was typically included. The significance of the lower trapezius muscle function change was summarized in these pain patients. From a final total of 18 studies identified, level of muscle activity, muscle activation, time to onset, muscle strength, and muscle thickness were reported.

RESULTS

The 18 included articles involved 485 participants with shoulder and/or neck pain and 455 without. Half of the shoulder pain studies (6/12), and all of the neck pain studies (6/6), demonstrated that the lower trapezius had a noticeable impact. The lower trapezius muscle in participants with shoulder and neck pain tended to show decreased muscle strength, and decreased time to onset/latency.

CONCLUSIONS

The findings from this systematic review should be taken into consideration when assessing and treating patients with shoulder and neck pain. Future studies that define the type and duration of shoulder and neck pain, as well as prospectively assessing lower trapezius muscle function in those with and without that pain, are needed.

3D measurement of clavicular and scapular orientations: The association with clinical characteristics and responsiveness to scapular repositioning in patients with neck pain

BACKGROUND

Clavicular and scapular orientations vary between neck pain patients as do clinical features and responses (changes in pain and rotation range) to scapular repositioning. Associations between these factors are unknown.

OBJECTIVES

To identify subgroups of neck pain patients based on three-dimensional (3D) measures of clavicular and scapular orientations and differences between subgroups in clinical characteristics and responses to scapular repositioning.

DESIGN

Cross-sectional study.

METHODS

Eligible participants were recruited as part of a larger study. The 3D clavicular and scapular orientations were analyzed on the more painful side of the neck using a hierarchical cluster analysis. Clinical characteristics were neck pain location, intensity, duration, disability and presence of headache. Responses to scapular repositioning were classified as "yes and no".

RESULTS

Fifty-eight participants (29 responsive; 29 non-responsive to scapular repositioning) participated in the study. Analysis identified two distinct subgroups: subgroup1 had greater clavicular retraction and scapular downward rotation (n = 26) and subgroup2 had greater clavicular elevation and scapular internal rotation and anterior tilt (n = 32). Headache and dominant pain in the upper neck were more frequent in subgroup 1 while dominant pain in the lower neck was frequent in subgroup 2 (p < 0.01). Most participants who responded positively to scapular repositioning (88.5%) were in subgroup1 and most non-responsive participants (81.2%) in subgroup2.

CONCLUSIONS

The 3D clavicular and scapular orientations identified two subgroups of neck pain patients. Participants with predominantly downward scapular rotation were distinguished by pain in the upper neck, presence of headache and a positive response to scapular repositioning.

Influence of adding strain-counterstrain to standard therapy on axioscapular muscles amplitude and fatigue in mechanical neck pain: a single-blind, randomized trial

BACKGROUND

Strain-counterstrain technique (SCS) or positional release therapy is strongly recommended for patients with mechanical neck pain (MNP) because this method has excellent benefits, but the clinical significance of this method is unclear.

AIM

The aim of this study was to investigate the influence of adding the SCS technique to standard therapy on pain, pressure pain threshold, disability according to Neck Disability Index (NDI), and electrophysiological characteristics (amplitude and fatigue) of the upper part of trapezius in the axioscapular muscles of patients with mechanical neck pain.

DESIGN

Single-blind, randomized clinical trial.

SETTING

Outpatient clinic.

POPULATION

Sixty patients (19-38 years old) with mechanical neck pain participated in this study and were recruited from the outpatient clinic at the faculty of physical therapy after a referral from an orthopedist.

METHODS

Patients were randomly assigned by opaque sealed envelope to two treatment groups: group A received SCS, standard therapy in form of active range of motion, stretching exercises, and postural correction exercises (PCES), whereas group B, received standard therapy only; therapeutic sessions were performed three times/week for 4 weeks. The visual analogue scale, pressure pain threshold, NDI, upper trapezius median frequency, and root mean square were used to evaluate the patients' pretreatment and post-treatment status.

RESULTS

Multiple pairwise comparisons within each group revealed statistically significant differences in all outcome variables with favor to the SCS group.

CONCLUSIONS

The Strain-counterstrain technique combined with traditional standard therapy is an effective method more than traditional standard therapy alone for the management of patients with MNP.

CLINICAL REHABILITATION IMPACT

The present study has implications, especially for clinical decision-making about therapy of choice in MNP to reduce pain, improve function as measured through SCS technique and its impact on normal lifestyle, and to highlight the need for active intervention.

Scapular Dyskinesis in Elite Boxers with Neck Disability and Shoulder Malfunction

Background and Objectives: Neck and shoulder injuries commonly occur during boxing, and scapular dyskinesis is related to those injuries. This study investigated scapular dyskinesis with neck disability and shoulder malfunction in elite boxers. Materials and Methods: Seventy-two elite boxers participated in this study. Scapular dyskinesis was evaluated as normal, subtle, and obvious. Neck disability index (NDI), shoulder internal (IR), and external (ER) range of motion (ROM), isometric strength of IR and ER, and pectoralis minor length were measured and compared with the severity of scapular dyskinesis. Results: Thirty-eight boxers (52.7%) showed scapular dyskinesis. NDI score was significantly different (normal = 3.89 ± 3.08, obvious = 7.36 ± 4.95, p = 0.025). Isometric IR strength was significantly different (normal = 10.48 ± 2.86, obvious = 8.46 ± 1.74, p = 0.01). The length of the pectoralis minor was significantly different (normal = 10.17 ± 0.67, subtle = 9.87 ± 0.79, obvious = 9.47 ± 0.85; p = 0.001), and the dominant and non-dominant arm IR ROM was significantly different (dominant = 57.43 ± 11.98, non-dominant = 64.62 ± 10.3, p = 0.001). Conclusions: The prevalence of scapular dyskinesis is high among elite boxers. Boxers with scapular dyskinesis presented shoulder malfunction as well as neck disability. Further investigation is necessary to examine the relationship between scapular dyskinesis and neck disability in boxers.

An investigation of neck pain in older adults, and its relation with shoulder position sense and upper extremity function

PURPOSE

Neck pain is a musculoskeletal problem increasing with age. The disorders that occurs in the neck region may also affect the upper extremity due to its close anatomical relationships. The aim of this study was to determine whether neck pain affects shoulder position sense and upper extremity function in the older adults.

METHODS

This cross-sectional study was carried out in nursing homes. The older adults over 65 years of age with chronic neck pain for the last 6 months were included. Pain intensity was evaluated with a Visual Analog Scale. Acumar dual digital inclinometer was used for the evaluation of shoulder position sense. 9-Hole Peg Test was used for the measure of upper extremity function.

RESULTS

It was found dominant side shoulder position sense and the function of both upper extremities were different between the three groups (p < 0.05). Pain was correlated with dominant and non-dominant 60ᵒ flexion shoulder position sense and 60ᵒ abduction shoulder position sense (p < 0.05). Additionally, a relationship was found only between pain and non-dominant side upper extremity function (p < 0.05).

CONCLUSION

In conclusion, we found that in older adults with neck pain, position sense and function decreased in upper extremities. The findings from this study support that detailed evaluation of anatomically related regions as well as the cervical region where pain is felt is important in creating a more effective rehabilitation program.

Exercise Programs Targeting Scapular Kinematics and Stability Are Effective in Decreasing Neck Pain: A Critically Appraised Topic

Clinical Scenerio: Neck pain is a costly symptom in both civilian and military worlds. While traditional treatments include deep neck flexor stabilizing exercises, manual therapy, electrical therapy, and other nonsurgical interventions, scapular orientation and stability training has emerged as a possible tool to reduce neck pain severity. Methods that can be coached at a distance could be of value in virtual appointments or circumstances where access to a qualified manual therapist is limited. Focused Clinical Question: What is the effectiveness of including exercise programs targeting scapular kinematics and stability to decrease neck pain? Summary of Key Findings: Exercise programs targeting scapular kinematics and stability, with coaching and individualized progressions, appear to reduce neck pain severity. Clinical Bottom Line: Evidence supports the inclusion of exercises for scapular kinematics and stability at a prescription of 3 sessions per week, with a duration of 4 or 6 weeks. Exercise programs should include a "learning" or coaching phase to ensure exercises are performed as intended, and exercise progressions should be based on participant ability rather than predetermined timelines. Further research is needed to better understand the benefits of this potential strategy and the statistical impact of scapular-focused exercise interventions on neck pain in specific populations like military and athletes. Strength of Recommendation: There is 'Fair' to 'Good' evidence from 2 level 1b single-blind randomized control studies and 1 level 2b pre-post test control design study supporting the inclusion of exercise programs targeting scapular kinematics and stability to decrease chronic neck pain severity.

Effects of scapular stabilization exercises in patients of chronic neck pain with scapular dyskinesis: A quasi-experimental study

Objectives

This study aims to investigate the effectiveness of scapular stabilization exercises in patients with chronic neck pain and scapular dyskinesis.

Patients and methods

This single-center, prospective study included a total of 36 patients (17 males, 19 females; mean age: 41±12.8 years; range, 25 to 57 years) with chronic neck pain and scapular dyskinesis between April 2018 and September 2018. The patients were randomly assigned to three treatment groups. Group 1 (n=13) consisted of those receiving scapular stabilization exercises by a physiotherapy specialist control in addition to the routine physiotherapy and rehabilitation program; Group 2 (n=12) consisted of those receiving the routine physiotherapy and rehabilitation program in addition to scapular stabilization exercises in-home training program; and Group 3 (n=11) consisted of those receiving the routine physiotherapy and rehabilitation program alone. The assessments were made using the Visual Analog Scale (VAS) and Northwick Park Neck Pain Questionnaire (NPQ).

Results

Significant differences were found in the pre- and post-treatment VAS scores, and Group 1 and Group 2 created this significant difference (p<0.05). A significant difference was also observed in the pre- and post-treatment NPQ scores among the groups (p<0.05). Group 1 showed the most significant improvement of the NPQ scores (p<0.05).

Conclusion

Our study results suggest that addition of scapular stabilization exercises to the routine physiotherapy components may be an effective method for improving pain and functional results.

Musculoskeletal applications of infrared thermography on back and neck syndromes: a systematic review

INTRODUCTION

Thermography is a noninvasive method to detect temperature changes on or near the surface of the body. Despite its utility has not yet been fully verified, it may be used as a complementary method to screening and/or monitoring treatment effectiveness. This systematic review evaluates the role of infrared thermography as a helpful outcome measure tool in subjects with back and neck syndromes.

EVIDENCE ACQUISITION

A literature search was conducted across the National Library of Medicine (MEDLINE), Web of Science and Scopus databases for studies that evaluated the role of infrared thermography as a helpful outcome measure tool in subjects with back and neck syndromes. The review was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-analysis (PRISMA).

EVIDENCE SYNTHESIS

The search strategy and selection criteria yielded 812 articles. From these, 268 duplicates were removed, and only 16 were in line with the aim of this review. Ultimately, only seven precisely fulfilled the inclusion and exclusion criteria and were included in the review. According to the articles reviewed, thermography seems to give an objective notion of change in inflammatory activity, which can corroborate the usefulness of treatment or the improvement/worsening of the patient's symptoms. The overall quality of research was uneven in the study design, endpoint measures, and sample characteristics.

CONCLUSIONS

The number of high-quality studies of the role of infrared thermography in patients with back and neck syndromes remains limited. More than a diagnostic tool, thermography can be an objective tool for monitoring the effectiveness of treatment by identifying deviations from a healthy state.

Efficacy of Kinesio Taping and Postural Correction Exercises on Levator Scapula Electromyographic Activities in Mechanical Cervical Dysfunction: A Randomized Blinded Clinical Trial

OBJECTIVE

Mechanical neck dysfunction (MND) is a major health burden. Although postural correction exercises (PCEs) are commonly used for its treatment, efficacy of Kinesio Taping (KT) has received considerable attention. This study was conducted to determine the effect of KT and PCEs on levator scapula (LS) electromyography.

METHODS

Ninety-one patients with MND were randomly assigned into 1 of 3 groups that received 4 weeks' treatment: group A, KT; group B, PCE; and group C, both interventions. Neck pain, LS root mean square (RMS), and median frequency (MDF) were measured pretreatment and post-treatment with the Numerical Pain Rating Scale and surface electromyography, respectively, by an assessor blinded to the patients' allocation.

RESULTS

Multivariate analysis of variance indicates a statistically significant group-by-time interaction (P = .000). Pain intensity was significantly reduced in group C more than in group B (P = .001). Mean values of RMS were significantly reduced in group C compared to both group A (P = .001) and group B (P = .022), whereas MDF was significantly increased in group C compared to either group A (P = .00) or group B (P = .026), and in group B compared to group A (P = 0.26). A paired t test revealed that there was a significant decrease in pain and RMS, and a significant increase in MDF in all groups (P < .01).

CONCLUSION

Application of both KT and PCE combined can significantly reduce neck pain and normalize LS activities in patients with MND more than the application of either intervention.

Alterations in the 3-dimensional scapular orientation in patients with non-specific neck pain

BACKGROUND

Although it is thought that there is a relationship between neck pain and scapular dysfunction, there are controversial results and no clear information in the literature regarding this issue. This study aimed to investigate the alterations in the 3-Dimensional scapular orientation on patients with non-specific neck pain.

METHOD

Thirty-four patients with chronic non-specific neck pain [age, 29.1 (5) years; height, 165.3 (6.1) centimeters; weight, 62.1 (9.6) kilogram] and 29 healthy controls [age, 28.2 (3.3) years; height, 166.8 (8.1) centimeters; weight, 60.9 (8.5) kilogram] were included in the study. 3-Dimensional scapular kinematics were obtained during arm elevation and lowering trials in the sagittal, scapular, and frontal planes.

FINDINGS

Compared to healthy controls, the patients with neck pain demonstrated significantly reduced upward scapular rotation on both the dominant and non-dominant sides in all three planes. Patients with neck pain had increased internal rotation in the sagittal and frontal planes on the dominant side and increased external rotation in the frontal plane on the non-dominant side. No difference was observed between groups considering posterior scapular tilt.

INTERPRETATION

There are alterations in the 3-Dimensional scapular orientations in patients with chronic non-specific neck pain compared to healthy controls. Therefore, the scapular control may also be examined in patients with neck pain and it can be included in the rehabilitation program if needed.

Is Scapular Stabilization Exercise Effective for Managing Nonspecific Chronic Neck Pain?: A Systematic Review

Scapular stabilization is thought to have an important role in improving pain and dysfunction around the neck and shoulders, but evidence of this is lacking. We aim to systematically review the effect of a scapular stabilization exercise (SSE) on pain and dysfunction in patients with nonspecific chronic neck pain (NP). We searched the PubMed, EMBASE, CINAHL, and Cochrane Library databases using the terms (NP [MeSH] OR NP OR cervical pain OR neck ache OR cervicalgia) AND (scapular exercise OR periscapular exercise OR SSEs). We included suitable studies that met the study's inclusion criteria. Among the 227 studies identified by our search strategy, a total of four (three randomized controlled studies and one prospective study) met the inclusion criteria. The SSE was intense. It included three sets of 10 repetitions. In most of the studies, the exercises were conducted 3 times per week. Most studies reported that the SSE improved pain and dysfunction in patients with nonspecific chronic NP; however, the reviewed articles did not use the same variables for measurement. Additionally, the sample size was small. Although several studies show that SSE might improve NP and dysfunction, the effects of SSE on pain and dysfunction in the neck region remain unclear because the number of studies was small. Further high-quality studies are necessary to identify the detailed effects of SSE in patients with NP.

Immediate Effect of Acupuncture on Electromyographic Activity of the Upper Trapezius Muscle and Pain in Patients With Nonspecific Neck Pain: A Randomized, Single-Blinded, Sham-Controlled, Crossover Study

OBJECTIVE

The objective of this study was to assess changes in upper trapezius myoelectric activity and pain in patients with nonspecific neck pain after a single session of acupuncture (ACP).

METHODS

A blinded randomized clinical trial was conducted. Fifteen patients with nonspecific neck pain and 15 healthy participants were enrolled in a randomized, single-blinded, crossover study. Each participant was subjected to a single session of ACP and sham acupuncture (SACP). The electromyography (EMG) signal of the upper trapezius muscle was recorded during different step contractions of shoulder elevation force (15%-30% maximal voluntary contraction) before and after ACP treatment.

RESULTS

Significant effects were confirmed after the treatment (ACP and SACP) for Numeric Rating Scale scores (F_1,28 = 51.61; P < .0001) and pain area (F_1,2 = 32.03; P < .0001). Significant decreases in the EMG amplitude were identified for the nonspecific neck pain group (NPG) (F_1,112 = 26.82; P < .0001) and the healthy participant group (HPG) (F_1,112 = 21.69; P < .0001) after ACP treatment. No differences were identified between the ACP and SACP treatment protocols for Numeric Rating Scale score (NPG: F_1,28 = 0.95; P = .33), pain area (NPG: F_1,28 = 1.97; P = .17), or EMG amplitude (NPG: F_1,112 = 0.47; P = .49; HPG: F_1,112 = 0.75; P = .38).

CONCLUSION

The effect of ACP at acupoints triple energizer 5 and large intestine 11 triple energizer 5, or in close proximity, contributes to pain relief among patients with nonspecific neck pain. The electromyographic analysis indicated a greater resistance to muscle fatigue and decrease of activity of the upper trapezius muscle among healthy participants and patients with nonspecific neck pain.

Review of scapular movement disorders among office workers having ergonomic risk

BACKGROUND

Work-related musculoskeletal disorders are the most common health problems which affect millions of office workers.

OBJECTIVE

The objective of this study is to determine scapular positioning at rest and different anatomical planes, the assessment of pain, postural changes and the functionality of upper extremity that is caused by the lack of ergonomic principles among office workers of civil servants in TRNC (Turkish Republic of Northern Cyprus).

METHODS

183 individuals participated in the study and 2 groups were created by grand scores of Rapid Upper Limb Assessment (RULA) tool. Scapular dyskinesis, pain of upper extremity and back, physical functions and symptoms of upper extremity, the self-rated neck disability, cervical and upper thoracic posture of workers were assessed.

RESULTS

The difference between pain situation and the results of upper extremity and neck disability scores of the participants among the groups was significant (p< 0.05). No significant difference has been found statistically among the postural angle values of individuals (p> 0.05). A significant statistical difference has been found among the groups when the results of Lateral Scapular Slide Test (LSST) is examined (p< 0.05).

CONCLUSIONS

Working environment and conditions cause the wrong of working posture and thus, lead individuals to spend more energy together with physical difficulty, and consequently affect general health.

Neck and Scapula-Focused Exercise Training on Patients With Nonspecific Neck Pain: A Randomized Controlled Trial

OBJECTIVES

The purpose of this study was to investigate the effects of additional 6-week scapular stabilization training in patients with nonspecific neck pain (NNP).

MATERIALS AND METHODS

A total of 30 patients with NNP were randomly allocated to the study. Fifteen participants in the intervention group received neck-focused exercise and scapular stabilization training, whereas 15 participants in the control group received neck-focused exercise training. All groups were evaluated at baseline and after 6 weeks of rehabilitation. The pain intensity on the neck was measured with the visual analog scale (VAS). The self-reported disability status was measured with the neck disability index (NDI). Three-dimensional scapular kinematics were recorded during dynamic shoulder elevation trials using an electromagnetic tracking device, and data were further analyzed at 30°, 60°, 90°, and 120° of humerothoracic elevations.

RESULTS

Comparisons revealed that, regardless of the received treatment, after 6 weeks of training both groups showed significant improvements in VAS (P < .001) and NDI (P < .001) scores. Both VAS and NDI outcomes have a large effect size (r = .618 and r = .619, respectively). For scapular kinematics, there were no group differences, especially for scapular upward-downward rotation and anterior-posterior tilt (P > .05). However, in the intervention group, the scapula was more externally rotated at 120° humerothoracic elevation (P = .04).

CONCLUSION

Findings of this study showed that both manual therapy and active interventions, including neck-focused exercise and scapular stabilization training, are effective in decreasing pain and disability level in patients with NNP. More comprehensive studies with longer follow-up durations are needed to better understand the potential effects of scapular stabilization training in patients with NNP.

Correlation Between Skin Temperature Over Myofascial Trigger Points in the Upper Trapezius Muscle and Range of Motion, Electromyographic Activity, and Pain in Chronic Neck Pain Patients

OBJECTIVE

The purpose of this study was to assess the correlation between skin temperature over a myofascial trigger point in the upper trapezius muscle and range of motion of the cervical spine, electromyographic activity, and pain in patients with chronic neck pain.

METHODS

This is a single-blind cross-sectional study. Forty participants of both sexes, aged 18 to 45 years, with chronic neck pain and myofascial trigger points in the upper trapezius muscle were included in the study. The participants were assessed using the Numeric Rating Scale, the Neck Disability Index, infrared thermography, algometry, fleximetry, and electromyographic activity.

RESULTS

A positive association was observed between skin temperature to the right with the range of motion of cervical flexion (r = 0.322, P = .043), the median frequency of isometrics to the right (r = 0.341, P = .032), and the median frequency of rest to the left (r_s = 0.427, P = .006); as were a negative association between skin temperature to the right and the root mean square of rest to the right (r_s = -0.447, P = .004), and a positive association of skin temperature to the left with the median frequency of isometrics to the right (r = 0.365, P = .020), and the median frequency of rest to the left (r_s = 0.573, P < .001).

CONCLUSION

Patients with chronic neck pain who had reduction of skin temperature over myofascial trigger points in the upper trapezius muscle had reduced cervical range of motion for flexion, reduced median frequency at rest and during isometric contraction, and increased root mean square at rest.

The influence of a depressed scapular alignment on upper limb neural tissue mechanosensitivity and local pressure pain sensitivity

BACKGROUND

A depressed scapular alignment could lead to prolonged and repetitive stress or compression of the brachial plexus, resulting in sensitization of neural tissue. However, no study has investigated the influence of alignment of the scapulae on sensitization of upper limb neural tissue in otherwise asymptomatic people. In this case-control study, we investigate the influence of a depressed scapular alignment on mechanosensitivity of the upper limb peripheral nervous system as well as pressure pain thresholds (PPT).

METHODS

Asymptomatic individuals with neutral vertical scapular alignment (n = 25) or depressed scapular alignment (n = 25) participated. We measured the upper limb neurodynamic test (ULNT1), including assessment of symptom response and elbow range of motion (ROM), and PPT measured over upper limb peripheral nerve trunks, the upper trapezius muscle and overlying cervical zygapophyseal joints.

RESULTS

Subjects with a depressed scapular reported significantly greater pain intensity (t = 5.7, p < 0.0001) and reduced elbow extension ROM (t = -2.7, p < 0.01) during the ULNT1 compared to those with a normal scapular orientation. Regardless of the location tested, the group presenting with a depressed scapular had significantly lower PPT compared to those with a normal scapular orientation (PPT averaged across all sites: normal orientation: 3.3 ± 0.6 kg/cm², depressed scapular: 2.1 ± 0.5 kg/cm², p < 0.00001).

CONCLUSIONS

Despite being asymptomatic, people with a depressed scapular have greater neck and upper limb neural tissue mechanosensitivity when compared to people with a normal scapular orientation. This study offers insight into the potential development of neck-arm pain due to a depressed scapular position.

Are chronic neck pain, scapular dyskinesis and altered scapulothoracic muscle activity interrelated?: A case-control study with surface and fine-wire EMG

OBJECTIVES

The function of the scapula is important in normal neck function and might be disturbed in patients with neck pain. The surrounding muscular system is important for the function of the scapula. To date, it is not clear if patients with idiopathic neck pain show altered activity of these scapulothoracic muscles. Therefore, the objective of this study was to investigate differences in deeper and superficial lying scapulothoracic muscle activity between patients with idiopathic neck pain and healthy controls during arm elevation, and to identify the influence of scapular dyskinesis on muscle activity.

METHODS

Scapular dyskinesis was rated with the yes/no method. The deeper lying (Levator Scapulae, Pectoralis Minor (Pm) and Rhomboid major) and superficial lying (Trapezius and Serratus Anterior) scapulothoracic muscles' activity was investigated with fine-wire and surface EMG, respectively, in 19 female subjects with idiopathic neck pain (age 28.3±10.1years, average duration of neck pain 45.6±36.3months) and 19 female healthy control subjects (age 29.3±11.7years) while performing scaption and towel wall slide. Possible interactions or differences between subject groups, scapular dyskinesis groups or phases of the task were studied with a linear mixed model.

RESULTS

Higher Pm activity during the towel wallslide (p=0.024, mean difference 8.8±3.3% MVIC) was shown in patients with idiopathic neck pain in comparison with healthy controls. For the MT, a significant group∗dyskinesis interaction effect was found during scaption which revealed that patients with neck pain and scapular dyskinesis showed lower Middle Trapezius (MT) activity in comparison with healthy controls with scapular dyskinesis (p=0.029, mean difference 5.1±2.2% MVIC).

CONCLUSIONS

In the presence of idiopathic neck pain, higher Pm activity during the towel wallslide was found. Patients with neck pain and scapular dyskinesis showed lower MT activity in comparison with healthy controls with scapular dyskinesis during scaption. Scapular dyskinesis did not have a significant influence on scapulothoracic muscle activity.

Scapulothoracic muscle strength in individuals with neck pain

BACKGROUND

People with neck pain often present with weakness in the scapulothoracic muscles. Few studies have examined lower trapezius (LT), middle trapezius (MT) and serratus anterior (SA) muscle strength in individuals with neck pain, nor compared strength to asymptomatic individuals.

OBJECTIVES

The aim of this study was to examine LT, MT and SA muscle strength in individuals with chronic neck pain.

METHODS

Descriptive cross sectional design. Twenty two individuals with chronic neck pain and 17 asymptomatic individuals were included. Participants were asked to complete a screening questionnaire, Neck Disability Index, and underwent manual muscle testing for the LT, MT, and SA muscles bilaterally. Data analyses included paired and comparative independent t-tests.

RESULTS

For individuals with neck pain, significant within subject differences in strength between sides for the LT (P< 0.01) and MT (P< 0.01) were present. In contrast, no within subject difference between sides for the asymptomatic group was found for any muscle. Individuals with neck pain were significantly weaker than asymptomatic individuals for the LT (p= 0.02), MT (p= 0.03), and SA (p= 0.01) on their side of neck pain, but not on their non-painful side.

CONCLUSIONS

Significant within subject differences were found between sides for the LT and MT while significant between group differences were identified for all three muscles tested.

A Comparison of the Effects of Stabilization Exercises Plus Manual Therapy to Those of Stabilization Exercises Alone in Patients With Nonspecific Mechanical Neck Pain: A Randomized Clinical Trial

STUDY DESIGN

Randomized clinical trial.

BACKGROUND

Little is known about the efficacy of providing manual therapy in addition to cervical and scapulothoracic stabilization exercises in people with mechanical neck pain (MNP). Objectives To compare the effects of stabilization exercises plus manual therapy to those of stabilization exercises alone on disability, pain, range of motion (ROM), and quality of life in patients with MNP.

METHODS

One hundred two patients with MNP (18-65 years of age) were recruited and randomly allocated into 2 groups: stabilization exercise without (n = 51) and with (n = 51) manual therapy. The program was carried out 3 days per week for 4 weeks. The Neck Disability Index, visual analog pain scale, digital algometry of pressure pain threshold, goniometric measurements, and Medical Outcomes Study 36-Item Short-Form Health Survey were used to assess participants at baseline and after 4 weeks.

RESULTS

Improvements in Neck Disability Index score, night pain, rotation ROM, and the Medical Outcomes Study 36-Item Short-Form Health Survey score were greater in the group that received stabilization exercise with manual therapy compared to the group that only received stabilization exercise. Between-group differences (95% confidence interval) were 2.2 (0.1, 4.3) points for the Neck Disability Index, 1.1 (0.0, 2.3) cm for pain at night measured on the visual analog scale, -4.3° (-8.1°, -0.5°) and -5.0° (-8.2°, -1.7°) for right and left rotation ROM, respectively, and -2.9 (-5.4, -0.4) points and -3.1 (-6.2, 0.0) points for the Medical Outcomes Study 36-Item Short-Form Health Survey physical and mental components, respectively. Changes in resting and activity pain, pressure pain threshold, and cervical extension or lateral flexion ROM did not differ significantly between the groups. Pressure pain threshold increased only in those who received stabilization exercise with manual therapy (P<.05).

CONCLUSION

The results of this study suggest that stabilization exercises with manual therapy may be superior to stabilization exercises alone for improving disability, pain intensity at night, cervical rotation motion, and quality of life in patients with MNP.

LEVEL OF EVIDENCE

Therapy, level 1b.

Scapulothoracic Muscle Strength Changes Following a Single Session of Manual Therapy and an Exercise Programme in Subjects with Neck Pain

INTRODUCTION

Scapulothoracic muscle weakness has been associated with neck pain (NP). Little evidence exists regarding lower trapezius (LT), middle trapezius (MT) and serratus anterior (SA) strength in this population. LT strength changes have been observed following thoracic manipulation in healthy subjects. The purpose of the present study was to examine scapulothoracic strength changes following cervical manipulation in subjects with NP.

METHODS

Twenty-two subjects with NP and 17 asymptomatic control (AC) subjects underwent strength testing of the LT, MT and SA using a hand-held dynamometer. Subjects with NP were treated with passive intervertebral neck manipulation and neck range of motion exercises. The AC group received no intervention. Strength testing was repeated after manipulation, then 48 and 96 hours later. Change scores were calculated for strength over time. Paired t-tests were done for strength change between painful and non-painful sides in the NP group. Independent t-tests were done for strength change between the NP group and AC group.

RESULTS

There was no significant difference between groups for age, gender, hand dominance or body mass index. Mean (standard deviation) symptom duration for subjects in the NP group was 43.27 (62.71) months. There was no significant difference in strength change over time between painful and non-painful sides in the NP group for any muscle; however, there was a significant difference in strength change over time between those in the NP group and AC group for the LT (p < 0.01), SA (p < 0.01) and MT (p < 0.01).

DISCUSSION

Scapulothoracic muscle strength improvements were observed in both extremities following passive intervertebral neck manipulation and neck range of motion exercises. Improvements lasted up to 96 hours following manipulation, even though no strengthening exercises were prescribed.

CONCLUSIONS

Manipulation and range of motion should be considered as a component of intervention programmes for patients with NP and scapulothoracic muscle weakness. Future studies should compare manipulation alone to exercise alone to determine impact on strength. Copyright © 2016 The Authors Musculoskeletal Care Published by John Wiley & Sons Ltd.

Decreased thickness of the lower trapezius muscle in patients with unilateral neck pain

INTRODUCTION

Thickness of the lower trapezius muscle in patients with neck pain has not been established. We examined the thickness of the lower trapezius muscle in patients with and without unilateral neck pain.

METHODS

Twenty women with unilateral (right) neck pain and 20 matched controls participated in the study. Thickness of the lower trapezius muscles was measured bilaterally at rest (0 ° and 120 ° of shoulder abduction) and during contraction (120 ° of shoulder abduction) using ultrasound imaging.

RESULTS

The neck pain group had smaller thickness of the lower trapezius muscle on the painful side compared with controls both at rest and during contraction (P < 0.05). However, the percentage change in the lower trapezius thickness from rest to contraction (120 ° of shoulder abduction) was not different between groups (P > 0.05).

CONCLUSIONS

Patients with neck pain had smaller thickness of the lower trapezius muscle on the painful side compared with healthy controls. Muscle Nerve 54: 439-443, 2016.

Comparison of Dry Needling versus Orthopedic Manual Therapy in Patients with Myofascial Chronic Neck Pain: A Single-Blind, Randomized Pilot Study

Objective. The aim of this study was to compare the efficacy of three interventions for the treatment of myofascial chronic neck pain. Methods. Thirty-six patients were randomly assigned to one of three intervention groups: orthopedic manual therapy (OMT), dry needling and stretching (DN-S), and soft tissue techniques (STT). All groups received two treatment sessions with a 48 h time interval. Outcome measures included neck pain intensity measured using a visual analogue scale, cervical range of motion (ROM), pressure pain threshold for measuring mechanical hyperalgesia, and two self-reported questionnaires (neck disability index and pain catastrophizing scale). Results. The ANOVA revealed significant differences for the group × time interaction for neck disability, neck pain intensity, and pain catastrophizing. The DN-S and OMT groups reduced neck disability. Only the OMT group showed decreases in mechanical hyperalgesia and pain catastrophizing. The cervical ROM increased in OMT (i.e., flexion, side-bending, and rotation) and DN-S (i.e., side-bending and rotation) groups. Conclusions. The three interventions are all effective in reducing pain intensity. Reduction in mechanical hyperalgesia and pain catastrophizing was only observed in the OMT group. Cervical ROM improved in the DN-S and OMT groups and also neck disability being only clinically relevant for OMT group.

Evaluation of the Immediate Effect of Auricular Acupuncture on Pain and Electromyographic Activity of the Upper Trapezius Muscle in Patients with Nonspecific Neck Pain: A Randomized, Single-Blinded, Sham-Controlled, Crossover Study

Background. The aim of the present study was to assess the immediate effects of auricular acupuncture (AA) on the electromyographic (EMG) activity of the upper trapezius muscle and pain in nonspecific neck pain (NS-NP) patients. Twelve patients with NS-NP (NS-NP group) and 12 healthy subjects (HS Group) were enrolled in a randomized, single-blinded, crossover study. Each subject received a single session of AA and sham AA (SAA). Surface EMG activity was measured in the upper trapezius muscle at different "step contractions" of isometric shoulder elevation (15%, 20%, 25%, and 30% MVC). The outcome measure in patients with NS-NP was based on the numerical pain rating scale (NRS). AA treatment led to a significant decrease in EMG activity in both groups (NS-NP group: p = 0.0001; HS group: p < 0.0001-ANOVA test). This was not the case for the SAA treatment (NS-NP group: p = 0.71; HS group: p < 0.54). Significant decreases (p < 0.001) in the NRS were found for both treatments (AA and SAA). This study demonstrated the immediate effect of auricular acupuncture on the electromyographic activity of the upper trapezius muscle but the effect of this intervention on pain symptoms in patients with nonspecific neck pain was inconclusive.

Influence of pectoralis minor and upper trapezius lengths on observable scapular dyskinesis

OBJECTIVES

Although a relationship between short pectoralis minor and upper trapezius and scapular dyskinesis has been postulated, no studies have investigated this theory. Understanding the effect of these muscle lengths on observable scapular dyskinesis may aid in determining risks and therefore making treatment decisions. Being aware of the magnitude of this effect would help gauge the significance of risks involved. Our aim was to evaluate the influence of pectoralis minor and upper trapezius lengths on scapular dyskinesis.

DESIGN

Cross-sectional study.

SETTING

University research laboratory.

PARTICIPANTS

Asymptomatic participants (n = 148; 296 arms) were evaluated.

MAIN OUTCOME MEASURES

Scapular Dyskinesis Test (SDT) was used to identify scapular dyskinesis, Pectoralis Minor Index (PMI) and Upper Trapezius Length Testing were used to determine muscle length.

RESULTS

SDT+ arms had shorter pectoralis minor resting length (PMI: 7.49 ± 0.38) (p < 0.001) and greater incidence of short upper trapezius (ISUT) (66.7%) (p < 0.001) compared to SDT- arms (PMI:8.58 ± 0.75, ISUT:22.5%). With each decrease in PMI, the likelihood of having scapular dyskinesis increased 96% (p < 0.001). Arms with short upper trapezius were 2.049 times more likely to exhibit scapular dyskinesis than those with normal length (p = 0.042).

CONCLUSIONS

Having a shorter pectoralis minor and upper trapezius length substantially increased the likelihood of having visually observable scapular dyskinesis.

Evaluation of the immediate effect of acupuncture on pain, cervical range of motion and electromyographic activity of the upper trapezius muscle in patients with nonspecific neck pain: study protocol for a randomized controlled trial

Background

Nonspecific neck pain can cause considerable suffering, possible disability and reductions in quality of life and productivity. The aim of the proposed study is to evaluate the immediate effect of acupuncture on pain, cervical range of motion and electromyographic activity of the upper trapezius muscle in patients with nonspecific neck pain.

Methods/Design

A total of 12 patients with nonspecific neck pain and 12 healthy subjects will be enrolled in a randomized, single-blind crossover study. Each subject will receive two forms of treatment in random order: a single session of traditional acupuncture (acupoints: triple energizer 5, ‘Wai-guan’ and large intestine 11, ‘Qu-chi’) and sham acupuncture. To eliminate carry-over treatment effects, a one-week wash-out period will be respected between sessions. Surface electromyography will be used to determine motor control in the upper trapezius muscle before and after treatment. The outcome measures in the group with neck pain will be a numerical pain rating scale (range: 0 (no pain) to 10 (maximum pain)), documentation of the pain area on a body chart and cervical range of motion. Comparisons before and after acupuncture treatment will demonstrate whether acupoints affect the activity of the upper trapezius muscle, pain and cervical range of motion.

Discussion

The purpose of this randomized clinical trial is to evaluate the immediate effect of acupuncture on pain, cervical range of motion and electromyographic activity of the upper trapezius muscle in patients with nonspecific neck pain. Data will be published after the study is completed. The study will support the practice of evidence-based physical therapy for individuals with nonspecific neck pain.

Trial registration

This trial was registered with Clinicaltrials.gov (identifier: NCT0984021) on 7 November 2013 (https://clinicaltrials.gov/ct2/show/NCT01984021).

Analysis of scapular muscle EMG activity in patients with idiopathic neck pain: a systematic review

It is proposed that altered scapular muscle function can contribute to abnormal loading of the cervical spine. However, it is not clear if patients with idiopathic neck pain show altered activity of the scapular muscles. The aim of this paper was to systematically review the literature regarding the differences or similarities in scapular muscle activity, measured by electromyography ( = EMG), between patients with chronic idiopathic neck pain compared to pain-free controls. Case-control (neck pain/healthy) studies investigating scapular muscle EMG activity (amplitude, timing and fatigue parameters) were searched in Pubmed and Web of Science. 25 articles were included in the systematic review. During rest and activities below shoulder height, no clear differences in mean Upper Trapezius ( = UT) EMG activity exist between patients with idiopathic neck pain and a healthy control group. During overhead activities, no conclusion for scapular EMG amplitude can be drawn as a large variation of results were reported. Adaptation strategies during overhead tasks are not the same between studies. Only one study investigated timing of the scapular muscles and found a delayed onset and shorter duration of the SA during elevation in patients with idiopathic neck pain. For scapular muscle fatigue, no definite conclusions can be made as a wide variation and conflicting results are reported. Further high quality EMG research on scapular muscles (broader than the UT) is necessary to understand/draw conclusions on how scapular muscles react in the presence of idiopathic neck pain.

Effectiveness of dry needling on the lower trapezius in patients with mechanical neck pain: a randomized controlled trial

OBJECTIVE

To evaluate the effect of dry needling into a myofascial trigger point (MTrP) in the lower trapezius muscle of patients with mechanical idiopathic neck pain.

DESIGN

A single-center, randomized, double-blinded controlled study.

SETTING

Patients were recruited from the student population of a local hospital by advertisement in the university clinic from January 2010 to December 2011.

PARTICIPANTS

Patients (N=72) with unilateral neck pain, neck pain for ≥3 months, and active trigger points in the lower trapezius muscle were randomly assigned to 1 of 2 treatment groups. All the patients completed the study.

INTERVENTIONS

Dry needling in an MTrP in the lower trapezius muscle, or dry needling in the lower trapezius muscle but not at an MTrP.

MAIN OUTCOME MEASURES

The visual analog scale (VAS), Neck Pain Questionnaire (NPQ), and pressure-pain threshold (PPT) were assessed before the intervention and 1 week and 1 month postintervention.

RESULTS

Treatment with dry needling of the lower trapezius muscle close to the MTrP showed decreases in pain and PPT as well as an improvement in the degree of disability (P<.001) compared with the baseline and control group measurements (P<.001). The dry-needling technique performed in the MTrP showed more significant therapeutic effects (P<.001).

CONCLUSIONS

The application of dry needling into an active MTrP of the lower trapezius muscle induces significant changes in the VAS, NPQ, and PPT levels compared with the application of dry needling in other locations of the same muscle in patients with mechanical neck pain.