Stretching and muscle-performance exercises for chronic nonspecific neck pain: who may benefit most?

BACKGROUND

Although exercise is the mainstay of treatment for neck pain (NP), uncertainty remains over optimal decision-making concerning who may benefit most from such, particularly in the long term.

OBJECTIVE

To identify the subgroup of patients with nonspecific NP most likely to benefit from stretching and muscle-performance exercises.

METHODS

This was a secondary analysis of treatment outcomes of 70 patients (10 of whom dropped out) with a primary complaint of nonspecific NP in one treatment arm of a prospective, randomized, controlled trial. All patients performed the exercises, twice weekly for 6 weeks, and a home exercise program. Blinded outcome measurements were collected at baseline, after the 6-week program, and at a 6-month follow-up. Patients rated their perceived recovery on a 15-point global rating of change scale; a rating of "quite a bit better" (+5) or higher was defined as a successful outcome. Clinical predictor variables were developed via logistic regression analysis to classify patients with NP that may benefit from exercise-based treatment.

RESULTS

NP duration since onset≤6 months, no cervicogenic headache, and shoulder protraction were independent predictor variables. The pretest probability of success was 47% after the 6-week intervention and 40% at the 6-month follow-up. The corresponding posttest probabilities of success for participants with all three variables were 86% and 71%, respectively; such participants were likely to recover.

CONCLUSION

The clinical predictor variables developed in this study may identify patients with nonspecific NP likely to benefit most from stretching and muscle-performance exercises in the short and long terms.

Effects of dry needling and stretching exercise versus stretching exercise only on pain intensity, function, and sonographic characteristics of plantar fascia in the subjects with plantar fasciitis: a parallel single-blinded randomized controlled trial

OBJECTIVES

Plantar fasciitis is a common problem in the foot region which has negative considerable impact on foot function.

METHODS

In this parallel blinded randomized controlled trial, a total of thirty-seven subjects with plantar fasciitis (forty feet) were enrolled randomly to either the control group (stretching exercise) or the experimental group (stretching exercise plus dry needling). All interventions lasted six weeks and both groups were followed for two weeks. Primary outcomes were first step pain, pain, and activity daily function subscales of the FAOS questionnaire and secondary outcomes were plantar fascia thickness, and echogenicity.

RESULTS

The mixed model ANOVAs showed significant group × time interactions for all primary outcomes. In both groups, first step pain and both subscales of the FAOS questionnaire were improved compared to baseline measurements. There were considerable differences between the two groups and the experimental group experienced more improvements in primary outcomes compared to the control group. For secondary outcomes, plantar fascia thickness at insertion significantly decreased, and the echogenicity in the two regions significantly increased in the experimental group compared to the control group.

CONCLUSION

These results suggest that the combination of dry needling and stretching exercises can be an effective conservative treatment for plantar fasciitis subjects.

Short- and Intermediate-Term Results of Extracorporeal Shockwave Therapy for Noninsertional Achilles Tendinopathy

BACKGROUND

Earlier randomized controlled trials (RCTs) reported only midterm (3-4 months) results of extracorporeal shockwave therapy (ESWT) as a treatment for noninsertional Achilles tendinopathy (NAT). This study compared the effectiveness of an eccentric loading program followed by stretching exercises combined with ESWT (study group) or sham ESWT (control group) for treating chronic NAT in both the short and long term.

METHODS

This double-blind RCT was conducted between 2018 and 2020. Adult patients with unilateral NAT who failed standard conservative treatment were randomly allocated to either group. Function and pain were assessed at baseline, 1 month, and 16 months using the Victorian Institute of Sport Assessment-Achilles questionnaire (VISA-A) and visual analog scale (VAS), respectively. Mixed-design analysis of variance and nonparametric statistics were performed. Twenty-two men and 28 women aged 18 to 40 years were allocated into 2 equally matched groups.

RESULTS

Function and pain scores in the study group were not significantly different from control group scores at baseline (VISA-A: 22.2 ± 6.5 vs 21.0 ± 5.2 and VAS: 8 ± 1 vs 8 ± 1, respectively). Both groups significantly improved posttreatment (VISA-A: 85 ± 6.2 vs 53.4 ± 7.7 and VAS: 1 ± 2 vs 7 ± 2, respectively). At the 16-month follow-up, outcome scores declined slightly but significantly in the study group (VISA-A: 80 ± 5.3; VAS: 3 ± 2) and improved in the control group (VISA-A: 67 ± 5.6; VAS: 5 ± 1). However, both groups were significantly better than baseline. At both time points, the study group had significantly superior scores (statistically and clinically) than the control group (P = .0001).

CONCLUSION

Combining calf eccentric loading with stretching exercises resulted in significant improvements in the pain and functional scores in patients with NAT. Adding ESWT to this combined protocol resulted in significantly greater improvements in both the short and long term.

LEVEL OF EVIDENCE

Level I, randomized controlled trial.

Effect of 4 Weeks of Cervical Deep Muscle Flexion Exercise on Headache and Sleep Disorder in Patients with Tension Headache and Forward Head Posture

The purpose of this study was to investigate the effect of flexion exercise of the deep cervical muscles on headache and sleep disorders in patients with tension headaches and forward head posture. A total of 32 patients with tension headaches and forward head posture were randomly assigned to two groups: an experimental group (n = 16) and a control group (n = 16). The experimental group performed cervical deep muscle flexion exercises for 4 weeks, whereas the control group performed stretching exercises for the same period. The Henry Ford Hospital Headache Disability Inventory (HDI) was used for headache assessment, and the Korean version of the Pittsburgh Sleep Quality Index (PSQI-K) was used for sleep disorder assessment. The experimental group showed a significant reduction in both HDI and PSQI-K score after 4 weeks of intervention (p < 0.001), while no significant difference was found in the control group (p > 0.05). On comparing the experimental and control groups, we found a significant difference in changes in the HDI and PSQI-K between the groups (p < 0.05). The results indicate that flexion exercise of the deep cervical muscles in patients with tension headache and forward head posture will improve the quality of life and activities of daily life by mitigating headaches and sleep disorders.

Efficacy of Specified Manual Therapies in Combination with a Supervised Exercise Protocol for Managing Pain Intensity and Functional Disability in Patients with Knee Osteoarthritis

Purpose

The current study aimed to determine the efficacy of specified manual therapies in combination with a supervised exercise protocol for managing pain intensity and functional disability in patients with knee osteoarthritis.

Methods

The study was based on a two-arm parallel-group randomized controlled trial design, including a total of 32 participants with knee osteoarthritis randomly divided into groups A and B. Group A received a supervised exercise protocol; however, group B received specified manual therapies in combination with a supervised exercise protocol. Pain and functional disability were measured with the numeric pain rating scale (NPRS) and the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC), respectively. Data were collected at baseline (pre-intervention), 2 weeks, and 4 weeks post-intervention. To evaluate the efficacy of specific manual therapies with supervised exercise compared to supervised exercise alone, an unpaired t-test and repeated measures ANOVA were used to analyze the data, keeping the level of significance at p<0.05.

Results

A significant (p<0.05) mean difference (∆MD) was found within group A and group B for both outcomes when we compared their baseline scores with 2-week (group A, NPRS: ∆MD=−1.56 and WOMAC: ∆MD=14.94; group B, NPRS: ∆MD=2.06 and WOMAC: ∆MD=22.19) and 4-week post-intervention scores (group A, NPRS: ∆MD=0.62 and WOMAC: ∆MD=6.75; group B, NPRS: ∆MD=0.75 and WOMAC: ∆MD=11.12). In addition, significant mean differences (p<0.05) reported for both outcomes when we compared their scores between groups A and B at 2 weeks (∆MD: NPRS=0.69; WOMAC=10.87) and 4 weeks post-intervention (∆MD: NPRS=0.31; WOMAC=8.00). Furthermore, a post hoc Scheffe analysis for the outcomes NPRS and WOMAC revealed the superiority of group B over group A.

Conclusion

The specified manual therapies, in combination with a supervised exercise protocol, were found to be more effective than a supervised exercise protocol alone for improving pain and functional disability in patients with knee osteoarthritis.

Radiographic Remodeling of the Proximal Phalangeal Head Using a Stretching Exercise in Patients With Camptodactyly

PURPOSE

The aims of this study were to verify proximal phalangeal head normalization after a stretching exercise in patients with infantile-type camptodactyly and to propose radiographic indices for quantifying bony deformities.

METHODS

Forty-eight fingers of 20 patients with camptodactyly were enrolled in this study. All patients and their parents received instruction on how to perform the stretching exercise. The qualitative assessments of proximal phalangeal head remodeling were conducted by consensus of 2 hand surgeons. Two radiographic parameters, head triangle ratio (HTR) and head angle (HA), were measured on finger lateral radiographs taken at the initial visit and at 12-month follow-up. The intra- and interobserver reliability of both parameters was assessed. Those parameters of the patients were compared with those of 177 fingers of 80 children without camptodactyly. The extent of proximal interphalangeal (PIP) joint flexion contracture was used to evaluate clinical outcomes resulting from nonsurgical treatment.

RESULTS

Qualitative assessments of proximal phalangeal head remodeling exhibited meaningful improvements. Both radiographic parameters showed significant change between their status before and after intervention and had excellent intra- and interobserver reliability. Average PIP joint flexion contracture significantly improved. In the noncamptodactyly group, neither parameter showed significant differences in accordance with finger types and age ranges.

CONCLUSIONS

Stretching improved movement within the proximal phalangeal joint and helped to restore proximal phalangeal head roundness and concentricity in patients with infantile-type camptodactyly. The HTR and HA would be useful indices for objectively assessing the degree of bony deformity in patients with camptodactyly.

TYPE OF STUDY/LEVEL OF EVIDENCE

Therapeutic IV.

A Systematic Review on the Effect of Mechanical Stretch on Hypertrophic Scars after Burn Injuries

Objective/Background

To review the effect of mechanical stretch on hypertrophic scars after burn injuries.

Methods

A systematic review of all controlled trials related to the effect of mechanical stretch on post burn hypertrophic scars was conducted. Studies of conservative scar managements that applied mechanical forces parallel to the scar surface, including stretching exercise, massage, and splinting, were appraised. Eligible studies published in English between 1995 and 2016 were extracted from The Cochrane Library, MEDLINE, CINAHL, Science direct, SPORTDiscus, and Physiotherapy Evidence Database Scale (PEDro). The journals were further screened with inclusion and exclusion criteria. PEDro was selected for further analysis and appraisal.

Results

There were 853 articles identified. After a standardized screening mechanism stipulated, only nine full-text articles were selected for critical appraisal using PEDro. There were five articles of high quality, two of fair quality, and two of poor quality. Detailed training regime and outcomes of nine studies were summarised, including two studies with stretching exercise, six studies with massage, and one study with splinting. The physical parameters of scar assessments and the range of motion on affected areas were compared.

Conclusion

From extensive literature search, there was no strong evidence indicating the positive effect of mechanical stretch using stretching exercise, massage, or splinting on hypertrophic scars. A firm conclusion cannot be drawn for the discrepancy of outcome measures and varied effectiveness. Most of the included studies lacked objective evaluation or control group for comparison. Further high quality studies with larger sample size and using standardized measurements are needed.

Effectiveness of the multidimensional ergonomic intervention model to reduce musculoskeletal discomfort among street sweepers in Chiang Rai Province, Thailand

The aim of this study was to evaluate the effectiveness of multidimensional ergonomic intervention (MEI) model to reduce musculoskeletal discomfort (MSD) among street sweepers. A quasi-experimental study was conducted in Chiang Rai Province. The MEI model was designed on the basis of four core components: cognitive behavior therapy, ergonomic education training, stretching exercise, and the foam sleeve broom handle grip. Seventy-five street sweepers volunteered for the screening process on MSD of having level score ≥4 by physiotherapist. Face to face interviews were used mainly in order to diagnose MSD. Physical examination was performed by physiotherapist and physical performance by sports scientist. The findings showed that the MEI model among the intervention group significantly reduced MSD compared with that among control group at exit model and follow-up (P<0.01). This research suggests that the MEI model was appropriate to reduce MSD associated with repetitive movement and awkward postures on task.

Acute Effects of Foam Rolling, Static Stretching, and Dynamic Stretching During Warm-ups on Muscular Flexibility and Strength in Young Adults

CONTEXT

Foam rolling has been proposed to improve muscle function, performance, and joint range of motion (ROM). However, whether a foam rolling protocol can be adopted as a warm-up to improve flexibility and muscle strength is unclear.

OBJECTIVES

To examine and compare the acute effects of foam rolling, static stretching, and dynamic stretching used as part of a warm-up on flexibility and muscle strength of knee flexion and extension.

DESIGN

Crossover study.

SETTING

University research laboratory.

PARTICIPANTS

15 male and 15 female college students (age 21.43 ± 1.48 y, weight 65.13 ± 12.29 kg, height 166.90 ± 6.99 cm).

MAIN OUTCOME MEASURES

Isokinetic peak torque was measured during knee extension and flexion at an angular velocity of 60°/second. Flexibility of the quadriceps was assessed by the modified Thomas test, while flexibility of the hamstrings was assessed using the sit-and-reach test. The 3 interventions were performed by all participants in random order on 3 days separated by 48-72 hours.

RESULTS

The flexibility test scores improved significantly more after foam rolling as compared with static and dynamic stretching. With regard to muscle strength, only knee extension peak torque (pre vs. postintervention) improved significantly after the dynamic stretching and foam rolling, but not after static stretching. Knee flexion peak torque remained unchanged.

CONCLUSIONS

Foam rolling is more effective than static and dynamic stretching in acutely increasing flexibility of the quadriceps and hamstrings without hampering muscle strength, and may be recommended as part of a warm-up in healthy young adults.

The importance of exercise in lung cancer treatment

There is emerging evidence that exercise can help in a variety of different ways for people with lung cancer. Exercise can be beneficial at any stage of the patient journey through increasing strength, endurance and decreasing emotional issues. A recovery fitness program is described and provides guidance on breathing, stretching, aerobic exercise and strength training. There are more people surviving lung cancer with services needing to cater for the varying requirements of each patient. Promoting physical activity is an important facet of health care management and collaboration between providers of services is required.

The effect of stretching exercise and walking on changes of blood pressure in nulliparous women

BACKGROUND

Hypertension in pregnancy is one of the prevalent disorder resulting in maternal death. The aim of this study was to investigate the effect of stretching exercise and walking on changes of blood pressure in nulliparous women during pregnancy.

MATERIALS AND METHODS

This was a quasi-experimental trial that consisted three groups of women who took part in pre- and post-tests. We used a simple randomized sample, including 118 pregnant females (walking: 29 subjects, stretching exercise: 30 subjects control: 59 subjects). The data were collected using the demographic checklist and blood pressure was measured every week. SPSS 16 was used to analyze the data by one-way analysis of variance (ANOVA) and repeated measure ANOVA.

RESULTS

No significant difference was found in the demographic characteristics of the three groups of women. Mean systolic and diastolic blood pressure in the three groups (stretching exercises, walking, and routine care) at three intervals (pre-test, first post-test, and second post-test) were significantly different (P < 0.05). In this case, Tukey's test showed significant improvement of systolic and diastolic blood pressure in stretching exercise group. Walking and control groups showed no change or significant reduction (P < 0.05). No significant difference was found between the walking and control groups (P > 0.05).

CONCLUSIONS

The results of the study showed that stretching exercise versus walking reduces systolic and diastolic blood pressure in the second trimester of pregnancy and controls it in the third trimester of pregnancy. In contrast, walking has no effect on blood pressure during pregnancy.