Study on Electromyographic Characteristics of Neck Muscles in College Students with Chronic Neck Pain

Objective:To provide new insights for the evaluation and diagnosis of chronic neck pain(CNP).Methods:22 patients with CNP and 22 healthy individuals were recruited from South China Normal University,who were all college students.The subjects'neck extensor muscle strength in the head neutral position,the natural anteversion position,and the maximum forward flexion position were measured by an isometric muscle strength tester respectively.The neck extensor strength of CNP patients and healthy subjects were compared.Results:In the neutral position,the maximum isometric muscle strength of neck extensor muscles was 12.31 kg for CNP patients and 15.16 kg for healthy individuals,resulting in a ratio of 81%strength in patients compared to healthy subjects.This difference was highly significant(P<0.000).In the natural anteversion position,the respective values were 12.6 kg for CNP patients and 15.05 kg for healthy individuals,with a ratio of 83%,and a significant difference between groups(P<0.001).In the maximum forward flexion position of the head,the values were 13.36 kg for CNP patients and 16.15 kg for healthy individuals,with a ratio of 82%,and a highly significant difference(P<0.000).Conclusion:The neck extensor muscle strength levels in college students with CNP were significantly lower compared to healthy college students across all measured positions.

Comparative pilot study on the effects of pulsating and static cupping on non-specific neck pain and local skin blood perfusion

Objective:To compare the effects of pulsating and static cupping on non-specific neck pain and local skin microcirculation blood perfusion,which is a pilot study.Methods:Seventy participants with non-specific neck pain were randomized to the following groups:low-frequency pulsating cupping(LF,n=20);high-frequency pulsating cupping(HF,n=20);static cupping(SC,n=20),or waiting list(WL,n=10).The LF,HF,and SC received a bilateral 10-minute cupping treatment at Jianzhongshu(SI 15).Outcomes were pain intensity(visual analog scale,VAS),functional status(Neck Disability Index,NDI),and skin blood perfusion at the SI 15,Dazhui(GV 14),and Shenzhu(GV 12)acupoint areas,measured using Laser Speckle Contrast Analysis technology.Results:Both LF and HF groups showed a significant reduction in VAS scores compared with the SC group(9.00,95%Cl 1.05-16.95,P=.027;8.75,95%CI 0.80-16.70,P=.031).There was no significant difference in VAS scores between the LF and HF groups(P>.05)and between NDI scores measured 3 days after intervention among the four groups(P>.05).In the SI 15 area,blood perfusion in the three treatment groups was higher than that in WL group(P<.01),and the perfusion unit(PU)of the HF pulsating group at 5 minutes after intervention was significantly higher compared with the SC group(P<.05).In the GV 14 area,blood perfusion in the two pulsating cupping groups was higher compared with the WL and SC groups after cupping(P<.05).In the GV 12 area,the PU of the LF group was higher compared with the other three groups only at the time of cup removal(P<.05).Conclusion:This study showed that pulsating cupping may have more favorable analgesic effects on non-specific neck pain compared with static cupping,which may be related to its better effect on improving the local skin blood perfusion.

Research progress of non-specific neck pain in traditional Chinese medicine and western medicine

Non-specific neck pain is a common disease in clinic,and its pathogenesis is not clear.With the progress of the times and the change of living and working habits,the incidence of non-specific neck pain is increasing year by year,which has a great impact on people’s physical and mental health,work and life.Traditional Chinese medicine mainly treats non-specific neck pain by acupuncture and massage,while western medicine generally uses exercise and manipulation therapy,but the quality of clinical evidence of all kinds of therapy is not high,which needs to be verified.This paper summarizes the research progress of traditional Chinese medicine and western medicine in the treatment of non-specific neck pain from the aspects of pathogenesis,etiology and pathogenesis of traditional Chinese medicine,and treatment of traditional Chinese medicine and western medicine,so as to provide reference for doctors in clinical treatment of this disease.

Thermal Therapy in Patients Suffering from Non-Specific Chronic Low Back Pain—A Systematic Review

Thermal therapy is frequently used as an adjunct to treatment in patients suffering from chronic low back pain. It is also an inherent part of patients’ self-administered pain treatment. This review aims to update the evidence for thermal therapy treatments in non-specific chronic low back pain patients and to rate the methodological quality of the corresponding clinical trials. Previous studies have reported contradictory evidence for the effectiveness of thermal therapy. An electronic search on MEDLINE (PubMed), PEDro, CENTRAL and CINHAL databases was conducted between May 2016 and February 2018. Clinical trials comparing local thermal therapy to conservative or no treatment were assessed for eligibility. Pain, physical function and global health were defined as outcome parameters. A total of n = 9 studies met the inclusion criteria. All of them applied an electrophysical agent as the thermal treatment: continuous ultrasound (n = 6), short-wave diathermy (n = 2), microwave diathermy (n = 1). Out of the n = 6 studies on ultrasound treatment, n = 2 reported significant within and between-group results for pain reduction after 4 to 6 weeks of treatment. Both short-wave diathermy studies demonstrated significant between-group results for pain reduction after 3 weeks of treatment. Contradictory results for all other observed outcome parameters were reported regardless of the intervention. Moreover, significant within-group results for the control groups questioned the effectiveness of the intervention treatments. Therefore, the effect of thermal therapy, (electrophysical agents), is not superior to any control treatment except for ultrasound treatment on short-term pain reduction.

Spinal accessory neuropathy in patients with chronic neck pain

AIM: To assess the presence of spinal accessory neuropathy in patients with chronic neck pain.METHODS: Patients with pain either regional or focal in the neck or shoulders for at least 6 mo(chronic neck pain) were recruited randomly from the Rheumatology and Rehabilitation Outpatient Clinic at the Faculty of Medicine-Suez Canal University. Two groups were compared: 30 patients with chronic neck pain with mean age(36.97 ± 12.45 years) and 10 apparently healthy controls. Trapezius muscle examination including inspection and range of motion both active and passive was performed. A full clinical neurological examination was carried out to exclude peripheral neuropathy and motor neuron disease. According to the subject's type of work, cases were categorized into labor-intensive and non-labor intensive tasks. A nerve conduction study(NCS) was performed on spinal accessory nerves at both sides for all patients and controls. Parameters including latencies and amplitudes of compound motor action potential(CMAP) were compared with the chronicity of neck pain using the neck disability score. This cross sectional study was carried in the Rheumatology and Rehabilitation Department, at Suez Canal University Hospital, Ismailia, Egypt.RESULTS: Physical examination revealed that 80% of cases had spinal trapezius muscle spasm. Restricted neck motion was present in 16.6% of cases. No one suffered from muscle wasting or weakness. Pain was bilateral in 18 patients(60%), localized to the right side in six patients(20%) and localized to the left side in six patients(20%). The causes of neck pain in the patients studied were nonspecific, due to physical stresses, cervical spondylosis and mild cervical disc herniation. Mean disease duration in patients with labor-intensive tasks was(3.9 ± 2.1 years), which was longer than that in patients with non-labor intensive tasks(3.1 ± 1.9 years); however, this difference was statistically insignificant. Spinal accessory NCSs were performed while subjects were in sitting positions and relaxed with naturally suspended arms to minimize muscular movement. The results of electrophysiological studies revealed that mean right and left latencies of the spinal accessory nerve were 2.96 ± 0.69 ms, 2.98 ± 0.61 ms in the patient group and 2.44 ± 0.38 ms, 2.33 ± 0.36 ms in control group respectively. These differences were statistically significant with P = 0.028 and 0.006 respectively. Spinal accessory NCS showed normal CMAP amplitude in both patients and controls. Comparing the results of the neck disability index(NDI) to different characteristics in patients with chronic neck pain, showed that patients with labor-intensive work had a higher NDI score mean(34.7 ± 9.5) compared to those with non-labor-intensive work, with significant statistical difference(P = 0.011). In addition, mean NDI scores were higher in males, and patients aged over 40 years and this difference was statistically significant(P = 0.007 and P = 0.009 respectively). Correlation studies between right and left spinal accessory nerve latencies and disability percent calculated using the NDI revealed a positive correlation. Moreover, there was a positive correlation between age and disability percent.CONCLUSION: This study demonstrates electrophysiological evidence of demyelination in a significant proportion of patients with chronic cervical pain.

The characteristics and correlative research of“Jin Shang”associated with chronic neck pain in young adults based on ultrasound imaging

Objective:To investigate the characteristics of'Jin Shang',a specialized term in traditional Chinese medicine(TCM)theory,in young adults with chronic neck pain(CNP)and investigated the correlation of'Jin Shang'with pain intensity and living disabilities using cross-section study.Methods:The thickness of the bilateral splenius capitis and semispinalis capitis were measured by ultrasound imaging(USI)as the objective performance of'Jin Shang'.The visual analogue scale(VAS)and Northwick Park Questionnaire(NPQ)were used to assess pain intensity and living disability.The Student's t test was used to investigate the difference in neck extensor muscle(NEM)thickness between CNP patients and healthy controls.Pearson's correlation and multiple linear regression were applied to investigate the relationship between NEM thickness,pain intensity and disability.Results:Fifty-nine young adult CNP patients and 16 healthy controls were recruited in this study,in accordance with specific inclusion and exclusion criteria.The student's t test showed that in CNP patients,the thickness of the semispinalis capitis during isometric contraction was significantly thinner than that of healthy controls(P=.04).Pearson's correlation analysis also revealed significant relationships between NEM thickness,VAS,and NPQ,while multiple linear regression showed that the thickness of the NEM in CNP patients was a significant predictor of pain intensity and disability.Conclusion:There was a significant difference in the thickness of the NEM in young adults with CNP when compared to healthy controls.Alterations in the NEM thickness in both rest and contraction are moderately related to neck pain and living disabilities.Our results investigated the characteristics of'Jin Shang'using USI and revealed a correlation between'Jin Shang'and CNP symptoms,which demonstrates that NEM plays an important role in CNP.

Resolving Specific Psychological Stressors Can Instantly Reduce or Relieve Chronic Neck Pain and Upper Back Pain: Case Reports

Introduction: The goal of this study was to use a novel approach to pain relief which includes a participant using their mind to reduce or relieve their neck pain in a matter of minutes and taking continuous thermal medical imaging scans during the process to capture any concurrent temperature changes at the location of the self-reported pain. Previous studies using multidisciplinary approaches have shown that it is possible for a person to achieve a moderate reduction in pain over a period of time (typically two or more months). However, in this innovative study, the goal was to demonstrate rapid pain relief (in a matter of minutes) using only the mind. Case report: For this study, six subjects were selected, all of whom were experiencing long-term chronic neck pain. The subjects consisted of five adult females and one adult male. Several of the subjects also had pain that radiated into their upper back region. Each subject participated in one talk therapy session during which the subject’s neck was actively scanned by a thermal imaging (TI) camera that was programmed to take a new thermal image every thirty (30) seconds. The goal of the talk therapy session was to create a strong emotional shift by encouraging the subject to let go of negative emotions and replace buried painful feelings with feelings of positive expectation and optimism. Then, as the subject created this emotional shift, the goal was to observe if this change affected the subject’s self-reported physical pain, as well as noting any visible effects in thermal images. Results: All six subjects reported that they were able to relieve some or all of their pain by the end of the talk therapy session. As they did, there was simultaneously a significant decrease in temperature recorded on the TI images in the corresponding location in their neck and upper back region. This suggested that the pain relief the subjects reported was not merely “mind over matter”, since there were marked physiological changes taking place. Discussion and Conclusion: It’s worth noting that three of the subjects had moments during their talk therapy session where they thought about a specific painful memory that increased their negative emotions. At that moment, their self-reported pain also increased, and simultaneously, the infrared camera detected an increase in temperature in the corresponding location where the subjects reported increased pain. Subsequently, when the subjects were able to change the painful memory and once again move towards feelings of optimism, they reported pain relief, and simultaneously, the TI camera reported a decrease in temperature. Neither this potential outcome nor any other potential outcome was discussed with the subjects before or during the session. This research shows that talk therapy may be used as a new therapeutic option for people not only with neck pain, but possibly other types of pain, and that under certain circumstances, the results can be rapid.

Results of Chronic Neck Pain Rehabilitation at Cotonou

Background: Neck pain is a real public health problem. Its treatment uses different techniques, such as functional rehabilitation, whose results are not widely popularized, from developing countries in Black Africa. Objective: To assess the result of rehabilitation of chronic common neck pain (CCNP) at the CNHU-HKM in Cotonou. Methods: Cross-sectional, retrospective, descriptive and analytical study. It was carried out from May to September 2020, based on the files of former patients followed in functional rehabilitation department at CNHU-HKM in Cotonou, from 2015 to 2019, for CCNP. The result of rehabilitation was assessed based on the progress, between the start and the end of the rehabilitation sessions, of pain intensity, mobility of the cervical spine, muscle strength and functional capacity of the patient. Anova and chi-square tests were used for the analysis of factors associated with the result of rehabilitation. Results: The sample consisted to 73 patients. They were predominantly female (58.90%), with a mean age of 53.60 ± 14.08 years. The neck pain, at least of moderate intensity (97.26%), was present since 12.54 ± 8.54 months, on average. Patients have done 10 to 20 functional rehabilitation sessions, the result of which was satisfactory in 67.12%. This result was mainly associated with patient’s age, sports practice and the seniority of pain progression. Discussion-Conclusion: Rehabilitation results in the management of CCNP are interesting. They prove the need to sensitize patients and prescribers on the importance of early treatment of CCNP.

Effect of extracorporeal shock wave combined with hot magner therapy on nonspecific chronic neck pain

Objective:Toobserve the clinical effect of extracorporeal shock wave combined with hot magner therapy for nonspecific chronic neck pain.Methods:A total of 60 patients with nonspecific chronic neck pain were randomly divided into treatment group and control group.Patients in the treatment group were treated with extracorporeal shock wave combined with hot magner therapy,and patients in the control group were treated with hot magner therapy.Visual analogue scale(VAS)and Neck disability index(NDI)were used before treatment,2 weeks after treatment,and 3 months after treatment.Results:Two weeks after treatment,the VAS and NDI scores were improved(P<0.05),and the VAS and NDI scores of the treatment group were lower than those of the control group(P<0.05),and the improvement rate of the treatment group was significantly better than that of the control group(P<0.05).3 months after follow up treatment,VAS and NDI scores in the treatment group showed statistically significant differences with those before treatment(P<0.05),and those at 2 weeks after treatment(P﹥0.05),while VAS and NDI scores in the control group showed no statistically significant differences with those before treatment(P﹥0.05),and those at 2 weeks after treatment(P<0.05).The VAS and NDI scores in the treatment group were significantly better than those in the control group(P<0.05).Conclusion:The clinical efficacy of extracorporeal shock wave combined with hot magner treatment for nonspecific chronic neck pain is better than that of hot magner therapy.

Efficacy and safety of thermobalancing therapy with Dr Allen’s Device for chronic low back pain:A randomised controlled trial

BACKGROUND Lumbar disc herniation and non-specific low back pain are common conditions that seriously affect patients’health-related quality of life(HRQoL).Although empirical evidence has demonstrated that novel Thermobalancing therapy and Dr Allen’s Device can relieve chronic low back pain,there have been no randomised controlled trials for these indications.AIM To evaluate the efficacy of Dr Allen’s Device in lumbar disc herniation(LDH)and non-specific low back pain(NSLBP).METHODS A randomised clinical trial was conducted investigating 55 patients with chronic low back pain due to LDH(n=28)or NSLBP(n=27),out of which 15 were randomly assigned to the control group and 40 were assigned to the treatment group.The intervention was treatment with Dr Allen’s Device for 3 mo.Changes in HRQoL were assessed using the Numerical Pain Rating Scale and the Japanese Orthopedic Association Back Pain Questionnaire.RESULTS Thermobalancing therapy with Dr Allen’s Device showed a significant reduction in pain in the treatment group(P<0.001),with no recorded adverse effects.Both pain assessment scales showed a significant improvement in patients’perception of pain indicating improvement in HRQoL.CONCLUSION The out-of-hospital use of Thermobalancing therapy with Dr Allen’s Device for Low Back Treatment relieves chronic low back pain significantly and without adverse effects,improves the level of activity and HRQoL among patients with LDH and NSLBP.This study demonstrates the importance of this safe first-line therapy that can be used for effective at-home management of chronic low back pain.

Exercise-induced hypoalgesia in chronic neck pain: A narrative review

Chronic neck pain(CNP)is a worldwide health problem with several risk factors.One of the most widely used treatments for managing this condition is therapeutic exercise,which could generate a response called exerciseinduced hypoalgesia(EIH).There is no consensus on the best exercise modality to induce hypoalgesia.Therefore,this review aims to analyze and synthesize the state-of-the-art about the hypoalgesic effect of exercise in subjects with CNP.We included articles on EIH and CNP in patients older than 18 years,with pain for more than three months,where the EIH response was measured.Articles that studied CNP associated with comorbidities or measured the response to treatments other than exercise were excluded.The studies reviewed reported variable results.Exercise in healthy subjects has been shown to reduce indicators of pain sensitivity;however,in people with chronic pain,the response is variable.Some investigations reported adverse effects with increased pain intensity and decreased pain sensitivity,others found no clinical response,and some even reported EIH with decreased pain and increased sensitivity.EIH is an identifiable,stimulable,and helpful therapeutic response in people with pain.More research is still needed on subjects with CNP to clarify the protocols and therapeutic variables that facilitate the EIH phenomenon.In addition,it is necessary to deepen the knowledge of the intrinsic and extrinsic factors that influence EIH in people with CNP.

Effectiveness of pulsed radiofrequency on the medial cervical branches for cervical facet joint pain

BACKGROUND Cervical facet joint pain(CFP)is one of the most common causes of neck pain and headache.Persistent CFP deteriorates the quality of life of patients and reduces their productivity at work.AIM To investigate the effectiveness of pulsed radiofrequency(PRF)stimulation of cervical medial branches in patients with chronic CFP.METHODS We retrospectively included 21 consecutive patients(age=50.9±15.3 years,range 26-79 years;male:female=8:13;pain duration=7.7±5.0 mo)with chronic CFP,defined as≥4 on the numeric rating scale(NRS).We performed PRF stimulation on the cervical medial branches.The outcomes of the PRF procedure were evaluated by comparing the NRS scores for CFP before treatment and 1 and 3 mo after treatment.Successful pain relief was defined as a≥50%reduction in the NRS score at 3 mo when compared with the pretreatment NRS score.RESULTS No patient had immediate or late adverse effects following PRF.The average NRS score for CFP decreased from 5.3±1.1 at pre-treatment to 2.4±0.6 at the 1 mo follow-up,and 3.1±1.1 at the 3 mo follow-up.Compared to the NRS scores before PRF stimulation,those at 1 and 3 mo after PRF stimulation had significantly decreased.Eleven of the 21 patients(52.4%)reported successful pain relief 3 mo after the PRF procedure.PRF stimulation on cervical medial branches may be a useful therapeutic option to control chronic CFP.CONCLUSION PRF stimulation of the cervical medial branches may be used as an alternative treatment method in patients with CFP.PRF can effectively alleviate CFP,and is safe to perform.

悬吊训练结合针刺对慢性非特异性颈痛的疗效

目的 探讨悬吊训练结合针刺治疗慢性非特异性颈痛的效果。方法 2022年3月至2023年3月选取望京医院康复门诊单侧慢性非特异性颈痛患者81例,随机分为悬吊组(n=27)、针刺组(n=27)和联合组(n=27)。悬吊组进行常规悬吊训练,针刺组接受常规针刺治疗,联合组进行悬吊训练和针刺结合治疗,共6周。治疗前后,分别进行视觉模拟评分(VAS)和颈椎功能障碍指数(NDI)评价,采用超声成像评价颈长肌和多裂肌的横截面积。结果 治疗后,3组VAS、NDI评分以及颈长肌和多裂肌横截面积均显著改善(|t|> 4.473, P <0.001),且联合组优于悬吊组和针刺组(P <0.05)。结论 悬吊训练和针刺均可改善慢性非特异性颈痛的疼痛症状和功能,增加颈长肌和多裂肌横截面积,结合应用效果更优。

杭州市基层医疗卫生机构慢性颈肩痛患者社区中医师信任度调查

目的:了解杭州市基层医疗卫生机构慢性颈肩痛患者对社区中医师的信任度及影响因素。方法:采用自制基线调查表、维克森林医师信任度量表中文版、自制满意度量表和长海痛尺表对杭州市3家社区中的244名慢性颈肩痛患者开展信任度调查。用t检验和方差分析比较差异,采用多元线性逐步回归分析信任度得分的影响因素。结果:社区中医师平均信任度得分为(39.59±3.23)分,仁爱维度、技术能力维度得分分别为(19.32±1.96)分、(20.27±1.61分)。多因素分析结果显示,随访是否有效、文化程度、自我健康状况评分、满意度评价、中医体质以及长海痛尺评分影响对医生的信任度。结论:杭州市基层卫生机构慢性颈肩痛患者对社区中医师总体信任度处于较高水平。社区中医师要加强医学人文关怀,积极引导患者参与到诊疗过程中,重视和提高慢性病患者随访时的技术水平和关怀程度。基层医疗卫生机构应当进一步完善诊后随访流程,加大慢性病中医健康管理优势的宣传,树立分级诊疗意识,完善诊疗环境建设,形成医患信任关系的良好循环。

ICF框架下运动疗法对慢性非特异性颈痛效果的Meta分析

目的 基于《国际功能、残疾和健康分类》(ICF)框架,系统评价运动疗法对慢性非特异性颈痛(CNSNP)患者身体结构、功能、活动和参与等方面的干预效果。方法 构建PICO架构,系统检索CBM、万方、维普、中国知网、Cochrane Library、Embase、PubMed和Web of Science等中、英文数据库,纳入有关运动疗法干预CNSNP患者的随机对照试验,时间范围为建库至2024年3月。采用Cochrane偏倚风险评估工具和物理治疗证据数据库(PEDro)量表对纳入文献进行质量评价,采用GRADE对结局指标进行证据质量评价,采用RevMan 5.3进行数据合并和分析,采用Stata 18.0进行偏倚风险评估。结果 最终纳入11篇文献,共668例患者。PEDro量表评分5~8分。运动疗法类型包括肌力训练、稳定性训练、本体感觉训练、瑜伽和普拉提等;对照组包括空白对照、物理因子治疗和健康教育。运动疗法可显著增加患者颅椎角(SMD=0.84, 95%CI 0.42~1.26, P <0.001),降低疼痛视觉模拟量表评分(SMD=-2.05,95%CI-2.58~-1.52, P <0.001),提高压力疼痛阈值(MD=112.27, 95%CI 75.03~149.50, P <0.001),提高颈椎前屈(SMD=1.24, 95%CI 0.34~2.15, P=0.007)、侧屈(SMD=1.52, 95%CI 0.40~2.65, P=0.008)关节活动度,提高颈深屈肌耐力(SMD=1.02, 95%CI 0.10~1.94, P=0.03),改善颈椎关节位置觉(SMD=-1.00,95%CI-1.47~-0.53, P <0.001),但对于改善后屈(SMD=0.85, 95%CI-1.04~2.75, P=0.38)、旋转(SMD=1.65, 95%CI-0.35~3.65, P=0.11)关节活动度的效果不显著;运动疗法还能降低患者颈椎功能障碍指数评分(MD=-11.88, 95%CI-16.09~-7.68, P <0.001),对健康调查简表评分效果不显著(MD=19.04, 95%CI-3.00~41.08, P=0.09)。结论 运动疗法可以改善CNSNP患者的异常姿势、疼痛、前屈和侧屈运动、颈屈肌耐力和关节位置觉,改善功能障碍,但对提高颈部后屈和旋转运动,改善生活质量方面仍需进一步的研究。

颈椎光疗仪改善慢性颈痛患者颈部疼痛及相关功能的作用

背景:红光治疗具有无创、性价比高等特点,在临床上被广泛应用于治疗各种急慢性疼痛,但目前临床上使用的光疗设备成本昂贵、具有一定的场地限制,因此有必要探索更加便捷经济的光疗应用途径。目的:观察居家型颈椎光疗仪对于慢性颈痛的临床疗效。方法:于2022年11月至2023年2月在上海交通大学医学院附属第九人民医院康复医学科招募慢性颈痛患者24例,其中女18例,男6例;年龄(29.67±6.40)岁;体质量指数为(21.39±3.52)kg/m^(2)。每日使用颈椎光疗仪2次,每次20 min,持续4周。观察治疗前、治疗2周及治疗4周后的疼痛目测类比评分、肌肉压痛阈值、颈部主动活动度、颈部功能障碍指数及匹兹堡睡眠质量指数变化情况。结果与结论:①与治疗前相比,治疗4周后目测类比评分、压痛阈值、颈部功能障碍指数及匹兹堡睡眠质量指数均有显著改善(P<0.05),同时部分颈椎部分活动度(后伸及左右旋转)出现改善(P<0.05);②其中双侧目测类比评分、左斜方肌压痛阈值、C_(5)C_(6)压痛阈值及颈部功能障碍指数在治疗2周后即出现改善(P<0.05);③提示该颈椎光疗仪的应用在短期内可以改善慢性颈痛患者的疼痛评分、肌肉压痛、睡眠质量、功能水平及部分主动活动度,是一项便捷有效安全的治疗方法。

肌肉能量技术联合常规康复治疗对慢性非特异性颈痛患者的影响

目的观察肌肉能量技术(MET)联合常规康复治疗方法对慢性非特异性颈痛(CNSNP)患者的影响。方法选取2022年5月—2023年3月在四川大学华西医院康复医学中心门诊诊治的CNSNP患者54例,采用随机数字软件分为对照组和观察组,每组27例。治疗过程中共有3例患者因依从性不强而退出研究,其中对照组脱落2例,观察组脱落1例,最终对照组、观察组分别纳入25例、26例。对照组接受常规康复治疗(物理因子治疗和运动训练)联合拉伸训练,物理因子治疗主要包括磁热理疗和中频脉冲电理疗,每项20 min/次,1次/d,连续治疗,3次/周,共治疗1周;运动训练包括等长收缩训练和颈部深层屈肌群训练,3次/d,连续治疗,3次/周,共治疗1周;拉伸训练,1次/d,连续治疗,3次/周,共治疗1周。观察组在对照组常规康复治疗基础上接受MET治疗,治疗师将目标肌肉牵伸至引发疼痛或能够感觉到软组织阻力点的位置,双手分别固定肌肉起止点处并施加中等的阻力,让患者的目标肌肉进行等长收缩(强度为最大力的20%)并持续10 s后放松,然后继续拉伸该目标肌肉并到达下一个阻力点的位置,以该阻力点作为开始位置,重复3~5次,1次/d,连续治疗,3次/周,共治疗1周。分别于治疗前、治疗后采用视觉模拟疼痛评分法(VAS)评估患者疼痛程度;采用颈椎功能障碍指数调查问卷(NDI)评估患者颈椎功能障碍情况;采用田中靖久颈椎病症状量表20分法(CSR20)评估患者颈椎功能;采用《非特异性颈痛的物理治疗指南》评价临床疗效;观察治疗过程中出现的不良反应(颈部疼痛加重、恶心、呕吐、头晕、心率加快等)。结果与治疗前比较,2组治疗后VAS评分、NDI指数均明显降低(P<0.05),CSR20评分明显升高,差异均具有统计学意义(P<0.05)。与对照组比较,观察组治疗后VAS评分明显更低,CSR20评分明显更高,差异均具有统计学意义(P<0.05);观察组有效率(92.31%)高于对照组(28.00%),差异具有统计学意义(P<0.05)。在治疗过程中,2组均未发生不良反应。结论MET联合常规康复治疗可有效改善CNSNP患者疼痛、颈椎功能,值得临床推广应用。

不同姿势颈部抗阻训练对慢性非特异性颈痛的干预研究

目的:比较不同姿势颈部抗阻训练对慢性非特异性颈痛(chronic non-specific neck pain,CNSNP)的干预效果,为CNSNP探寻一种更高效的运动疗法。方法:51例CNSNP患者(年龄41.0±5.0岁)随机分为3组:俯卧姿颈部抗阻训练组(A组,n=17)、坐姿颈部抗阻训练组(B组,n=17)和俯卧姿对照组(C组,n=17)。测试指标包括视觉模拟评分(visual analog score,VAS)、颈椎功能障碍指数(neck disability index,NDI)、颅颈角(craniocervical angle,CVA)、颈椎活动度(range of motion,ROM)和均方根振幅(root mean square,RMS)。所有指标均在干预前和干预4周后进行测量。结果:A组的干预效果优于B组和C组。A组的颈部疼痛评分(VAS)、颈椎功能障碍指数(NDI)、颅颈角(CVA)、颈椎屈曲活动度(ROM)、颈椎伸展活动度(ROM)、RMS(斜方肌上束,屈曲;胸锁乳突肌,静息;胸锁乳突肌,伸展)较B组和C组均存在显著性差异(P<0.05)。A组的RMS(斜方肌上束,静息)较B组无显著性差异(P>0.05)、较C组存在显著性差异(P<0.05)。结论:俯卧姿颈部抗阻训练能更有效地降低颈部肌肉的VAS和RMS,增加颈部ROM和CVA。

Changes in sternocleidomastoid and descending portion of trapezius muscles in terms of electromyography and pressure pain threshold: women with chronic neck pain after acupuncture treatment

OBJECTIVE:To evaluate the sternocleidomastoid and the descending portion of the trapezius muscles in terms of electromyographic activity and pressure pain threshold in women with chronic cervical pain after acupuncture treatment.METHODS:Twenty-five women,aged 18-50 years[(31±3)years],with chronic neck and temporomandibular disorder participated in the study.The electromyographic activity of the sternocleidomastoid muscle and the descending portion of the trapezius muscle were recorded at rest,during shoulder elevation,(left and right)rotation of the neck and crucifix position.Maximum voluntary contraction was used to normalize the electromyographic activity data.The points used for acupuncture were Jiache(ST 6),Xiaguan(ST 7),Quanliao(SI 18),Tinggong(SI 19),Yifeng(TE-17),Fengchi(GB 20),Renzhong(GV 26),Yangbai(GB-14),and points of the lower and upper limbs:Tai chong(LV 3),Zusanli(ST 36),Sanyinjiao(SP 6),Kunlun(BL 60),He Gu(LI4)and Yanglingquan(GB 34).The treatment course was 10 sessions,30 min long per session,and twice a week.The final electromyographic activity and pressure pain threshold data collection were performed 15 d after treatment completion.RESULTS:The normalized electromyographic activity and pressure pain threshold data were tabulated and submitted to statistical analysis using t-test(P<0.05).Significant difference was observed during shoulder elevation for the left trapezius muscle,during neck rotation from the right side to the left,and pressure pain threshold for the trapezius and sternocleidomastoid muscles,bilaterally,after the acupuncture treatment.CONCLUSION:The acupuncture treatment improved the neck muscles in terms of electromyographic activity and increased the tolerance to chronic pain in women.

基于“肝郁气滞”探讨颈肩综合征病机及针灸治疗

[目的]运用五脏气机理论的“肝郁气滞”观点,对颈肩综合征的病机和治疗进行阐发。[方法]从五脏气机理论的“肝郁气滞”观点及颈肩综合征病因病机出发,探讨二者的理论契合性,同时基于此观点确定颈肩综合征的论治原则及针灸处方,并列验案一则加以佐证。[结果]“肝郁气滞”观点源于五脏气机理论中肝主气机,以肝郁为本,气滞为标。颈肩综合征病机特点在于标本虚实兼夹,主要是肝失疏泄,气机郁滞,在实的基础上化生或合并瘀、湿等实邪。从“肝郁气滞”分析颈肩综合征病机,针灸论治不仅要重视肝胆,兼顾气滞,也要重视其所演变出的瘀、湿等实邪,这些因素均与颈肩综合征发病关系密切。以“肝郁气滞”及相关理论指导颈肩综合征的治疗,应以疏通肝胆和气机为要,从针灸调和经络气机出发,并配合刃针,其针方运用的合理性获得了临床实践的支持。文中医案辨证为肝郁气滞证,治以疏肝行气止痛,运用毫针和刃针治疗,取得了较好的临床疗效。[结论]“肝郁气滞”观点与颈肩综合征病机具有契合性,为治疗颈肩综合征开辟了新思路。