ORIJINAL ARAŞTIRMA
Kronik Boyun Ağrılı Bireylerde Manuel Terapinin Servikal Kas Sertliği Üzerine Etkisinin İncelenmesi: Pilot Çalışma
Investigation of the Effects of Manual Therapy on Cervical Muscle Stiffness in Individuals with Chronic Neck Pain: Pilot Study
Received Date : 21 Jul 2020
Accepted Date : 07 Nov 2020
Available Online : 18 Jan 2021
Oğuzhan METEa, Berna ÖZKAN YILDIZb, Mehtap BALABANc, Deran OSKAYd,
Şeyda TOPRAK ÇELENAYa
aAnkara Yıldırım Beyazıt Üniversitesi Sağlık Bilimleri Fakültesi, Fizyoterapi ve Rehabilitasyon Bölümü, Ankara, TÜRKİYE
bAnkara Gazi Mustafa Kemal Devlet Hastanesi, Fiziksel Tıp ve Rehabilitasyon Kliniği, Ankara, TÜRKİYE
cAnkara Yıldırım Beyazıt Üniversitesi Tıp Fakültesi, Radyoloji ABD, Ankara, TÜRKİYE
dGazi Üniversitesi Sağlık Bilimleri Fakültesi, Fizyoterapi ve Rehabilitasyon Bölümü, Ankara, TÜRKİYE
Doi: 10.31609/jpmrs.2020-78176 - Makale Dili: TR
J PMR Sci. 2021;24(1):38-44
ÖZET
Amaç: Bu çalışmada, kronik boyun ağrısı (KBA) olan bireylerde
manuel terapi (MT)nin servikal kas sertliği üzerine etkisinin incelenmesi
amaçlandı. Gereç ve Yöntemler: Bu çalışma, prospektif bir klinik çalışma
olarak tasarlandı. Çalışmaya 10 KBA’lı birey (yaş: 43,30±4,92 yıl, beden
kitle indeksi: 26,82±4,30 kg/m2) dâhil edildi. Sternokleidomastoid (SKM),
levator skapula (LS) ve trapezin üst parçası (TRP) kaslarının sertliği gerilim
(kompresyon) elastografi ile istirahat, gece ve aktivite ağrı şiddeti vizüel
analog skala ile boyun ağrısına bağlı özür seviyesi Boyun Özür Göstergesi
Türkçe versiyonu (BÖG-T) ile tedavi öncesi ve sonrası değerlendirildi. Yumuşak
doku ve eklem mobilizasyon tekniklerini içeren MT, haftada 2 gün,
6 hafta boyunca yapıldı. Tedavi öncesi ve tedavi sonrası MT’nin etkisinin
karşılaştırması için parametrik test varsayımları sağladığında, eşleştirilmiş
örneklem t-testi sağlanmadığında, Wilcoxon işaretli sıralar testi kullanıldı.
Bulgular: Altı haftalık MT sonrasında, LS (p=0,180) ve TRP (p=0,317) kas
sertliği değişmezken, SKM (p=0,024) kas sertliği, istirahat (p=0,008), gece
(p=0,005) ve aktivite (p=0,005) ağrı şiddeti ve BÖG-T skoru (p=0,001)
azaldı. Sonuç: Bu pilot çalışmada, KBA’lı bireylerde 6 haftalık MT’nin
SKM kas sertliğini, boyun ağrı şiddetini ve boyun ağrısına bağlı özür seviyesini
azaltması üzerine olumlu etkileri olduğu görüldü. KBA’lı bireylerde,
MT’nin servikal kas sertliği üzerine etkisini inceleyecek daha büyük örneklem
gruplarında yapılacak randomize kontrollü çalışmalara ihtiyaç duyulmaktadır.
Anahtar Kelimeler: Boyun ağrısı; boyun kasları; elastografi; manuel tedaviler
ABSTRACT
Objective: It was aimed to investigate the effects of manual
therapy (MT) on cervical muscle stiffness in individuals with chronic
neck pain (CNP). Material and Methods: This study was designed as a
prospective clinical trial. Ten individuals with CNP (age: 43.30±4.92
years, body mass index: 26.82±4.30 kg/m2) were involved in the study.
Muscle stiffness of sternocleidomastoid (SCM), levator scapulae (LS), and
upper part of trapezius (TRP) with strain (compression) elastography, pain
intensity at rest and night, and during activity with visual analog scale,
and the disability level related to neck pain with Turkish Version of Neck
Disability Index (NDI-T) were assessed before and after treatment. MT,
included soft tissue and joint mobilization techniques, was carried out 2
days a week for 6 weeks. To compare the effect of MT before and after
treatment, the paired sample t-test was used when the parametric test assumptions
were provided and the Wilcoxon signed rank test when it is not
provided. Results: After 6-weeks MT, whereas stiffness of LS (p=0.180)
and TRP (p=0.317) muscles did not change, stiffness of SCM (p=0.024),
pain intensity at rest (p=0.008), night (p=0.005) and during activity
(p=0.005), and NDI-T score (p=0.001) were reduced. Conclusion: In this
pilot study, it was observed 6-weeks MT has favorable effects on reducing
SCM stiffness, pain intensity, and the disability level related to neck
pain in individuals with CNP. Randomized controlled studies with larger
sample groups that investigate the effects of MT on cervical muscle stiffness
in individuals with CNP were needed.
Keywords: Neck pain; neck muscles; elastography; manual therapies
REFERENCES
- Hoy DG, Smith E, Cross M, Sanchez-Riera L, Buchbinder R, Blyth FM, et al. The global burden of musculoskeletal conditions for 2010: an overview of methods. Ann Rheum Dis. 2014;73(6):982-9.[Crossref] [PubMed]
- Genebra CVDS, Maciel NM, Bento TPF, Simeão SFAP, Vitta A. Prevalence and factors associated with neck pain: a population-based study. Braz J Phys Ther. 2017;21(4):274-80.[Crossref] [PubMed] [PMC]
- Cohen SP. Epidemiology, diagnosis, and treatment of neck pain. Mayo Clin Proc. 2015;90(2):284-99.[Crossref] [PubMed]
- Hoy D, March L, Brooks P, Blyth F, Woolf A, Bain C, et al. The global burden of low back pain: estimates from the Global Burden of Disease 2010 study. Ann Rheum Dis. 2014;73(6):968-74.[Crossref] [PubMed]
- Hurwitz EL, Randhawa K, Yu H, Côté P, Haldeman S. The Global Spine Care Initiative: a summary of the global burden of low back and neck pain studies. Eur Spine J. 2018;27(Suppl 6):796-801.[Crossref] [PubMed]
- Cheng CH, Cheng HY, Chen CP, Lin KH, Liu WY, Wang SF, et al. Altered Co-contraction of Cervical Muscles in Young Adults with Chronic Neck Pain during Voluntary Neck Motions. J Phys Ther Sci. 2014;26(4):587-90.[Crossref] [PubMed] [PMC]
- De Pauw R, Coppieters I, Kregel J, De Meulemeester K, Danneels L, Cagnie B. Does muscle morphology change in chronic neck pain patients? - A systematic review. Man Ther. 2016;22:42-9.[Crossref] [PubMed]
- Jull G, Falla D. Does increased superficial neck flexor activity in the craniocervical flexion test reflect reduced deep flexor activity in people with neck pain? Man Ther. 2016;25:43-7.[Crossref] [PubMed]
- Ishikawa H, Muraki T, Morise S, Sekiguchi Y, Yamamoto N, Itoi E, et al. Changes in stiffness of the dorsal scapular muscles before and after computer work: a comparison between individuals with and without neck and shoulder complaints. Eur J Appl Physiol. 2017;117(1):179-187.[Crossref] [PubMed]
- Wami SD, Dessie A, Chercos DH. The impact of work-related risk factors on the development of neck and upper limb pain among low wage hotel housekeepers in Gondar town, Northwest Ethiopia: institution-based cross-sectional study. Environ Health Prev Med. 2019;24(1):27.[Crossref] [PubMed] [PMC]
- Damgaard P, Bartels EM, Ris I, Christensen R, Juul-Kristensen B. Evidence of Physiotherapy Interventions for Patients with Chronic Neck Pain: A Systematic Review of Randomised Controlled Trials. ISRN Pain. 2013;2013:567175.[Crossref] [PubMed] [PMC]
- Vernon H, Humphreys K, Hagino C. Chronic mechanical neck pain in adults treated by manual therapy: a systematic review of change scores in randomized clinical trials. J Manipulative Physiol Ther. 2007;30(3):215-27. Erratum in: J Manipulative Physiol Ther. 2007;30(6):473-8.[Crossref] [PubMed]
- Wise CH. Orthopaedic Manual Physical Therapy From Art to Evidence. 1st ed. Philadelphia, PA: FA Davis; 2015.
- Coulter ID, Crawford C, Vernon H, Hurwitz EL, Khorsan R, Booth MS, et al. Manipulation and Mobilization for Treating Chronic Nonspecific Neck Pain: A Systematic Review and Meta-Analysis for an Appropriateness Panel. Pain Physician. 2019;22(2):E55-E70.[PubMed] [PMC]
- Fredin K, Lorås H. Manual therapy, exercise therapy or combined treatment in the management of adult neck pain - A systematic review and meta-analysis. Musculoskelet Sci Pract. 2017;31:62-71.[Crossref] [PubMed]
- Taş S, Korkusuz F, Erden Z. Neck Muscle Stiffness in Participants With and Without Chronic Neck Pain: A Shear-Wave Elastography Study. J Manipulative Physiol Ther. 2018;41(7):580-88.[Crossref] [PubMed]
- General Assembly of the World Medical Association. World Medical Association Declaration of Helsinki: ethical principles for medical research involving human subjects. J Am Coll Dent. 2014 Summer;81(3):14-8.[PubMed]
- Cyriax JH, Cyriax P. Cyriax's Illustrated Manual of Orthopaedic Medicine. 2nd ed. Great Britain: Butterworth-Heinemann; 1996.[Link]
- İnci Y. Ortopedik Problemlerde Manuel Terapi. 1. Baskı. Ankara: Hipokrat Kitabevi; 2017.
- Lowe W. Orthopedic Massage E-Book: Theory and Technique: Elsevier Health Sciences. 2nd ed. Churchill Livingstone. 2009.[Link]
- Fernández-de-las-Pe-as C, Alonso-Blanco C, Fernández-Carnero J, Miangolarra JC. The immediate effect of ischemic compression technique and transverse friction massage on tenderness of active and latent myofascial trigger points: a pilot study. J Bodyw Mov Ther. 2006;10(1):3-9.[Crossref]
- Berko NS, Fitzgerald EF, Amaral TD, Payares M, Levin TL. Ultrasound elastography in children: establishing the normal range of muscle elasticity. Pediatr Radiol. 2014;44(2):158-63.[Crossref] [PubMed]
- Karcioglu O, Topacoglu H, Dikme O, Dikme O. A systematic review of the pain scales in adults: Which to use? Am J Emerg Med. 2018;36(4):707-14.[Crossref] [PubMed]
- Aslan E, Karaduman A, Yakut Y, Aras B, Simsek IE, Yaglý N. The cultural adaptation, reliability and validity of neck disability index in patients with neck pain: a Turkish version study. Spine (Phila Pa 1976). 2008;33(11):E362-5.[Crossref] [PubMed]
- Faul F, Erdfelder E, Buchner A, Lang AG. Statistical power analyses using G*Power 3.1: tests for correlation and regression analyses. Behav Res Methods. 2009;41(4):1149-60.[Crossref] [PubMed]
- Meltem U, İkidağ MA, Akbayrak T. [Acute effect of neck mobilization on the head neck blood flow, muscle stiffness, and neck range of motion in cervicogenic headache: a case report]. Journal of Exercise Therapy and Rehabilitation. 2020;7(1):74-9.[Link]
- Park SE, Kim BK, Lee SB, Choi WS, Yeum DM. Effects of central and unilateral posteroanterior mobilization on cervical lordosis, muscle stiffness and ROM in patient with ankylosing spondylitis: case study. J Phys Ther Sci. 2017;29(7):1276-80.[Crossref] [PubMed] [PMC]
- Kim SJ, Lee JH. Effects of sternocleidomastoid muscle and suboccipital muscle soft tissue release on muscle hardness and pressure pain of the sternocleidomastoid muscle and upper trapezius muscle in smartphone users with latent trigger points. Medicine (Baltimore). 2018;97(36):e12133.[Crossref] [PubMed] [PMC]
- Kogo H, Kurosawa K. Seeking the cause of myofascial pain syndrome by identifying which manual therapy is effective against muscle tenderness and stiffness. J Phys Ther Sci. 2010;22(2):173-6.[Crossref]
- Kisner C, Colby LA, Borstad J. Therapeutic Exercise: Foundations and Techniques. 6th ed. United States of America: F.A. Davis Company; 2017.
- Şendur HN, Yücel C. Kas İskelet Elastografi Uygulamaları. Türk Radyoloji Derneği. 2019;7:63-74.[Crossref]
