Charles Sturt University

Transcription

1 Charles Sturt University Course: Master of Exercise Science (Rehabilitation) Subject: EHR505/EHR506 Applied Exercise Physiology & Health Care Practice Influence of Fascial unloading of the cervicothoracic region through exercise therapy and Kinesio Taping on chronic pain.

2 Daniel O'Sullivan Chief Investigator Dr Stephen Bird - Supervisor Dr Rob Reid - Supervisor

3 The Aspects of this Study Include: Chronic Pain Thoracic and Cervical Pain Exercise Therapy Fascia Questionnaires, Strength Testing, ROM Testing Kinesio Taping

4 IASP (1986) Chronic pain is an unpleasant sensory and emotional experience associated with actual and potential tissue damage or described in terms of such damage.

5 IASP (1986) Chronic pain is defined as pain that persists beyond normal healing time, >3 months.

6 Frouland & Frouland (1986) Pain > 3 months refereed to as problem cases, which the pain was unsolved or unsolvable.

7 The participants in my study have had many investigative interventions including: Physiotherapy Cortisone Injections Acupuncture Manipulations Massage Therapy Exercise Programs Pharmacological Interventions

8 Chronic Pain Physiology Nociceptors or pain receptors are the first responders to noxious stimulus Nociceptor stimuli is transmitted to the spinal chord and then to the brain. There are two types of fibres in pain transmission: Large A delta Fibres and Smaller c Fibres.

9 Chronic Pain Physiology Gate Control Theory Melzack & Wall (1999a) Melzack & Wall (1999b) The stimulation of non painful fibres can block the pain impulses at the gate, in the dorsal horn of the spine.

10 Chronic Pain Physiology Melzack & Wall (1999a) Melzack & Wall (1999b) Neuro-matrix Theory Body-self Neuro-matrix Pure ongoing peripheral nocigenic input Peripheral Sensitisation Wind-up Central sensitisation Neuro-plastic changes Referred Pain

11 Upper Back Anatomy Scaleni Splenius Capitis Rhomboid Minor Rhomboid Major Levator Scapular Upper Trapezius Middle Trapezius Lower Trapezius

12 Anterior Anatomy Scaleni Pectoralis Minor Sternocleidomastoid

13 Fascial Physiology (Grinnell, 2008) (Eagan, Meltzer, & Standley, 2007) (Myers, 2009) Fibroblasts Reticulum immature collagen common in embryos Elastin Ear, skin or where elasticity is required Collagen most common, prominent in the fascial net

14 Fascial Physiology (Myers, 2009) (Schleip, Klingler, & Lehmann-Horn, 2005) Piezoelectric Charge Mechanically stressed tissue which lays down new tissue in the line of stress. Muscle tissue will generally recoil back to resting length Fascial tissue will stretch and remain stretched like a plastic bag if stretched slowly If quickly stretched fascia will tear, which causes many undiagnosed pain symptoms

15 Fascial Physiology 1. A re-opening of the upper back/cervical tissue in question to help restore fluid flow, muscle, function, and connection with the sensory-motor system. This is hopefully achieved through Kinesio taping. 2. An easing of the biomechanical pull that caused the increased stress on that tissue in the first place. This is achieved through specific strength exercises. (Myers, 2009)

16 Kinesio Tape Application Applied before the beginning of each exercise session No more than 25% of tension when applied to the skin Site of tape application is dependant on the pain and/or accompanying tightness of the participant through palpation The tape alters the underlying fascia which in turn affects changes in the deep fascia

17 Strength Testing Protocol (Fishbain, Cutler, Rosomoff, & Rosomoff, 1999) (Harvey, 2000) (Jordan, et al., 1998, Itoi & Sinaki, 1994) The strength testing will occur before the start of the program and at the end of the program Left and Right Grip Strength Posterior Shoulder Strength Chest Strength Hanging pull contraction Prone 90/90 External Rotation

18 Range of Motion Testing (Chiu & Sing, 2002) (Harvey, 2000) Cervical Flexion Cervical Extension Cervical Lateral Flexion Cervical Rotation Thoracic Flexion Thoracic Extension Thoracic Lateral Flexion Thoracic Rotation Hand Behind the Back Hand Behind the Head

19 Strength Training Protocol (Bird, Tarpenning, & Marino, 2005) (Ylinen, et al., 2003) (Itoi & Sinaki, 1994) 6 Participants supervised 24 sessions (12 weeks) 2 sessions a week Protocol: 3 sets of 8-15 repetitions depending on weight and effort 60 second rest between sets and 2 minute rest between exercises

20 Strength Training Protocol Standing Cable Row 45 Cable Row Lat Pulldown Squat and Stand Dumbbell Scapula Retraction Standing Cable Chest Press Standing Shrug Squat Press

21 Questionnaires (Gay, Madson, & Cieslak, 2007) (Von Korff, Deyo, Cherkin, & Barlow, 1993) Neck Disability Index Questionnaire at the beginning and at the end of the program Quadruple Visual Analogue Scale before each exercise session

22 Summary Questions 1. Does strength training help elevate the symptoms of upper back chronic pain? 2. Can Kinesio Tape reduce the constant nociceptive input as experienced by my participants? 3. Can the use of Kinesio Tape accelerate the reduction in symptoms of someone with chronic upper back pain whilst exercising?

23 Thanks Special thanks to: Dr Stephen Bird Dr Rob Reid Katrina Staniforth Katherine Meade

24 References Bird, S. P., Tarpenning, K. M., & Marino, F. E. (2005). Designing resistance training programmes to enhance muscular fitness: a review of the acute programme variables. Sports Med, 35(10), Chiu, T. T., & Sing, K. L. (2002). Evaluation of cervical range of motion and isometric neck muscle strength: reliability and validity. Clin Rehabil, 16(8), Classification of chronic pain. Descriptions of chronic pain syndromes and definitions of pain terms. Prepared by the International Association for the Study of Pain, Subcommittee on Taxonomy (1986). Pain Suppl, 3, S Eagan, T. S., Meltzer, K. R., & Standley, P. R. (2007). Importance of strain direction in regulating human fibroblast proliferation and cytokine secretion: a useful in vitro model for soft tissue injury and manual medicine treatments. J Manipulative Physiol Ther, 30(8), Frolund, F., & Frolund, C. (1986). Pain in general practice. Pain as a cause of patient-doctor contact. Scand J Prim Health Care, 4(2), Fishbain, D. A., Cutler, R., Rosomoff, H. L., & Rosomoff, R. S. (1999). Chronic pain disability exaggeration/malingering and submaximal effort research. Clin J Pain, 15(4),

25 References Gay, R. E., Madson, T. J., & Cieslak, K. R. (2007). Comparison of the Neck Disability Index and the Neck Bournemouth Questionnaire in a sample of patients with chronic uncomplicated neck pain. J Manipulative Physiol Ther, 30(4), Grinnell, F. (2008). Fibroblast mechanics in three-dimensional collagen matrices. J Bodyw Mov Ther, 12(3), Harvey, D. (2000). Screening Test Protocols: Pre-participation screening of athletes. Canberra, Australia: Australian Sports Commission, Australian Institute of Sport. Itoi, E., & Sinaki, M. (1994). Effect of back-strengthening exercise on posture in healthy women 49 to 65 years of age. Mayo Clin Proc, 69(11), Jordan, A., Bendix, T., Nielsen, H., Hansen, F. R., Host, D., & Winkel, A. (1998). Intensive training, physiotherapy, or manipulation for patients with chronic neck pain. A prospective, single-blinded, randomized clinical trial. Spine (Phila Pa 1976), 23(3), ; discussion 319.

26 References Melzack, R. (1999a). From the gate to the neuromatrix. Pain, Suppl 6, S Melzack, R. (1999b). Pain--an overview. Acta Anaesthesiol Scand, 43(9), Myers, T. W. (2009). Anatomy Trains: Myofascial Meridians for Manual and Movement Therapists (2nd ed.): Churchill Livingstone Elsevier. Schleip, R., Klingler, W., & Lehmann-Horn, F. (2005). Active fascial contractility: Fascia may be able to contract in a smooth muscle-like manner and thereby influence musculoskeletal dynamics. Med Hypotheses, 65(2), Von Korff, M., Deyo, R. A., Cherkin, D., & Barlow, W. (1993). Back pain in primary care. Outcomes at 1 year. Spine (Phila Pa 1976), 18(7), Ylinen, J., Takala, E. P., Nykanen, M., Hakkinen, A., Malkia, E., Pohjolainen, T., et al. (2003). Active neck muscle training in the treatment of chronic neck pain in women: a randomized controlled trial. JAMA, 289(19),