tp 1 astri - final

Massage Therapy for

Neck PainSupervised by:

DR. dr. Tirza Z. Tamin, SpKFR-KPresented by:

Setia Wati Astri Arifin

Tinjauan Pustaka-1

Neck pain is pain felt on the neck, indicating that

there are malfunction of joints, muscles or

other structural part of the neck

Neck pain is a very common problemwith

prevalence in the community is about

40%

Introduction

There are various treatment for

neck pain, such as rest,

medication, physical

modalities and exercise

Medication and referral to

physiotherapist is the most common

treatment given in primary healthcare

setting

In US, massage therapy is one of

the most frequent therapy

used for neck pain, as a single

therapy or in combination with other therapies &

become the 2nd most frequent reason to visit

physiotherapist

Massage therapy also become more popular lately as many

studies conducted to

investigate effectiveness of

massage therapy for neck pain

NECK

Cervical Vertebral Column

Spinal Nerves

Ligaments

MusclesBlood Vascular

Lymphatic System

Range of Motion

Cervical Vertebral Column

Cervical ROM

MovementDegree (°)

Total AOJ AAJ C2-C7

Flexion 60 10 5 45Extension 80 25 10 45Rotation (each side) 75 - 45 30Lateral flexion (each side) 45 5 10 30

Cervical Spinal Nerves

Cervical Plexus•C1 – C5

Brachial Plexus•C4 – T1

Ligaments•Ligamentum flavum •Ligamentum supraspinatum •Ligamentum interspinatum •Ligamentum intertransversum •Ligamentum longitudinal anterior•Ligamentum longitudinal posterior•Ligamentum nuchae

Arteries•A. Temporalis Superficialis•A. Aurikularis Posterior•A. Oksipitalis•A. Vertebralis•A. Fasialis•A. Lingualis•A. Tiroid Superior •Trunkus Tiroservikalis •A. Jugularis Interna•A. Jugularis Eksterna•A. Jugularis Komunis•A. Brakiosefalika

Veins•V. Oksipitalis•V. Postaurikularis•V. Retro-mandibular•V. External Jugular•V. Komunikans •V. Jugularis Interna•V. Jugularis Komunis•V. Jugularis Anterior•V. Brakiosefalika

Deep Cervical Lymph Nodes

Jugular Trunk

RetroauricularNodes

Superficial Cervical Lymph Nodes

Superficial

• Platysma• Trapezius

Anterior

• SCM• Scalenes group• Prevertebral

group

Posterior

• Erector spinae group

• Splenius capitis• Splenius

cervicis• Suboccipital

group

Muscles of The Neck

http://www.slideshare.net/ananthatiger/muscles-of-the-neck-1

Superficial

Superficial

Anterior

SCM

Scalenus

Spinalis

Posterior

Muscles Flexion Extension Lateral Flexion

Axial Rotation

Sternocleidomastoideus XXX X (upper) XXX XXX (CL)

Scalenus anterior XX - XXX X (CL)

Scalenus medius X - XXX -

Scalenus posterior - - XX -

Longus colli XX - XX -

Longus capitis XX - XX -

Rectus capitis anterior XX (AOJ) - X (AOJ) -

Rectus capitis lateralis - - XX (AOJ) -

Splenius capitis - XXX XX XXX (IL)

Splenius cervicis - XXX XX XXX (IL)

Rectus capitis posterior mayor - XXX (AOJ & AAJ) XX (AOJ) XX (IL) (AAJ)

Rectus capitis posterior minor - XX (AOJ) X (AOJ) -

Oblikus capitis inferior - XX (AAJ) - XXX (IL) (AAJ)

Oblikus capitis superior - XXX (AOJ) XXX (AOJ) -

Keterangan: AOJ : atlanto-oksipital joint AA J : atlanto-aksial joint

CL : contralateralIL : ipsilateral

Flexion

• SCM• Scalenus

Anterior• Longus Colli• Longus Capitis• Rectus Capitis

Anterior • Scalenus

Medius

Extension • Splenius Capitis

• Splenius Cervicis

• Rektus Capitis Posterior Mayor

• Oblikus Capitis Superior

• Oblikus Capitis Inferior

• Rektus Capitis Posterior Minor

• Upper SCM

Lateral Flexion• SCM• Skalenus

Anterior• Skalenus Medius• Oblikus Capitis

Superior• Skalenus

Posterior• Longus Colli• Longus Capitis• Splenius Kapitis• Splenius Cervicis• Rectus Capitis

Lateralis• Rectus Capitis

Mayor• Rectus Capitis

Minor • Rectus Capitis

Inferior

Axial Rotation

• Ipsilateral:• Splenius

Kapitis• Splenius

Cervicis• Contralateral:• Sternokleidom

astoideus

NECK PAIN

Definition

The International Association for the Study of Pain (IASP)

• In its classification of chronic pain, defines cervical spinal pain as pain perceived anywhere in the posterior region of the cervical spine, from the superior nuchal line to the first thoracic spinous process

The Bone and Joint Decade 2000-2010 Task Force on Neck Pain and Its Associated Disorders

• Describes neck pain as pain located in the anatomical region of the neck with or without radiation to the head, trunk, and upper limbs

The Burden and Determinants of Neck Pain in the General Population (Results of the Bone and Joint Decade 2000 –2010 Task Force on Neck Pain and Its Associated Disorders)

• Neck pain is common in the adult general population, with prevalence estimates from 30% to 50%

• Among children and adolescents, prevalence estimates range from 21% to 42%.

Epidemiology

EtiologyMechanicalTraumatic

Nontraumatic

NonmechanicalRheumatologic/Inflammatory

Neoplastic

Neurologic

Infections

Miscellaneous

Nontraumatic •Neck Strain •Postural •Tension •Torticollis (acquired) •Spondylosis* (degenerative arthritis) •Myelopathy* •Cervical Fracture* (see neoplasm)

Traumatic •Whiplash Syndromes* •Disc Herniation* •Neck Sprain •Sports*

Mechanical

Rheumatologic/Inflammatory

•Rheumatoïd Arthritis •Ankylosing Spondylitis •Fibromyalgie •Polymyalgia Rheumatic •Reiter's Syndrome •Psoriatic Arthritis

Neoplastic •Osteoblastoma •Osteochondroma •Giant Cell Tumor •Metastases •Hemangioma •Multiple Myeloma •Chondrosarcoma •Glioma •Syringomyelia •Neurofibroma

Neurologic

•Peripheral Entrapment •Brachial Plexitis •Neuropathies •Reflex Sympathetic Dystrophy

Referred •Thoracic Outlet Syndrome •Pancoast Tumor •Esophagitis •Angina •Vascular Dissection •Carotidynia

Infections •Osteomyelitis •Discitis •Meningitis •Herpes Zoster •Lyme Disease

Miscellaneous

•Sarcoidosis •Paget Disease

•The most common neck pain is non-specific mechanical neck pain caused by muscle strain, ligament sprain, spasm, or a combination

•No specific lesions, or findings•Usually caused by daily activities

Etiology

Philip D. Sloan, Essentials of the family medicine , Chapter 37 Introduction , Wolters Kluwer , 6th edition

Patophysiology

Irritation or inflammation on cervical tissue can produce pain

The nociceptive sites on cervical area are:1. Anterior & Posterior

Longitudinal Ligament2. Outer Annulus Fibrosus 3. Duramater4. Spinal Nerve Root 5. Facet Joint Capsule 6. Muscles

Caillet R. Neck and Arm Pain, 3rd ed., Philadelphia: F.A.Davis, 1991.

Patophysiology

• Two major mechanisms of neck pain are trauma and arthritis

Trauma:1.External trauma2.Postural trauma3.Tension trauma

Arthritis: 1. Degenerative

arthritis 2. Sequelae of acute

inflammation arthritis

Patophysiology

External Trauma: • The neck received external forces that cause

abnormal cervical vertebrae position or movement that leading to injury and pain

Patophysiology

Postural Trauma:• Wrong posture can

cause various trauma to the musculoskeletal system, especially the vertebral column:1.Forward head

posture2.Dropping shoulder

Caillet R. Neck and Arm Pain, 3rd ed., Philadelphia: F.A.Davis, 1991. Image Source: Quora.com

Patophysiology

Tension Trauma: • Emotional factor hypothalamic limbic system

physiologic & neuromuscular system • Tension within the neuromuscular system manifest as

a sustained isometric muscular contraction No period of relaxation • blood flow Ischemic pain• lymphatic flow • nutrient & O2• metabolic waste, lactic acis

Acute Neck Pain

Lasts less than 7 days

Subacute Neck Pain

Lasts more than 7 days but less than 3 months

Chronic Neck Pain

Lasts more than 3

months

Classification by Onset

Classification by ICD-10

Classification by ICF

Clinical Manifestation• Pain on neck or pain from neck,

with or without radiation to the head, back, shoulder and upper extremity

• Fatigue• Sleep disturbance• Headache • Pain with movement• Limited ROM• Palpated trigger point

• Radicular pain: • Sharp or dull, burning

sensation or shocking pain depend on ventral or dorsal nerve root involvement

• Distributes according to the dermatomal or myotomal area

• Neurologic symptoms such as tingling sensation, paresthesia, numb or weakness

X-Ray

CT Scan

Diagnosis

HistoryPhysical

ExaminationAdditional Tests

1. Trunk or lower extremity neurologic symptoms, especially long-tract signs.

2. Bilateral upper extremity pain. 3. Remote symptoms with neck

movements (lower extremity). 4. Signs of sphincter dysfunction,

bowel or bladder dysfunction or incontinence.

5. Fever, unrelenting nocturnal pain, weight loss, chronic fatigue.

6. Recent infection or surgery. 7. Polyarthralgia. 8. Dysphagia. 9. Nuchal flexion or extension rigidity,

especially in the absence of trauma.

10. Cranial neurologic deficit or central nervous system symptoms.

11. Cervical pain related to general exertion (i.e., after climbing stairs).

12. Symptoms unchanged or progressive, despite previous functional management.

13. Onset of cervical pain associated with direct head trauma, loss of consciousness.

14. Sudden onset of cervical pain without trauma or incident.

15. Neck or occipital pain with a sharp quality and severe intensity, or severe and persistent headache, which is sudden and unlike any previously experienced pain or headache

Precautions Symptoms that Should Raise Suspicion That The

Presenting Cervical Pain Is Not Of Mechanical Origin

(McMillin)

Flynn TW, Cleland JA, Whitman JM. User’s Guide to the Musculoskeletal Examination: Fundamentals for the Evidence Based Clinician. Evidence in Motion. 2008.

The Scientific Evidence Strongly Supports the Use of:

• Screening protocols in emergency care in low risk patient with blunt trauma to the neck

• CT-scanning in emergency care for high-risk patients with blunt trauma to the neck

For non-emergency neck pain:– Manual provocation tests in patients

with neck pain and suspected radiculopathy

– The combination of history, physical examination, modern imaging techniques, and needle EMG to diagnose the cause and site of cervical radiculopathy

– Self-reported patient assessment to evaluate perceived pain, function, disability, and psychosocial status

Nordin M, Carragee EJ, Hogg-Johnson S, Weiner SS, Hurwitz EL, Peloso PM, et al. Assessment of Neck Pain and Its Associated Disorders. Eur Spine J. 2008 Feb 29;17(1):101–22.

TreatmentPharmacologicAcetaminophen

NSAIDMuscle relaxant

Non-PharmacologicEducation

Heat TherapyTENS

Traction Orthosis Massage

Manipulation Stabilisation

FlexibilityPostureExercise

Neck Exercise

Isometric Neck Exercise

Evaluation

• Physical Examination:– Palpation of trigger point & tenderness– Cervical Range of Movement (CROM)– Manual Muscle Testing (MMT)

• Pain Perception:– Visual Analog Scale (VAS)

• Functional Assessment:– Neck Disability Index (NDI)46,47

Cervical ROM Examination

Image Source: http://www.slideshare.net/ssuser33ed1c/neck-trunk-rom-measurement

Image Source: annals.org

Image Source: womenhealth.us

Vernon H, Mior S. The neck disability index: a study of reliability and validity. J Manip Physiol Ther 1991; 14:407-415.

THERAPEUTIC MASSAGE THERAPY

Massage Therapy

• Massage Therapy a group of procedures, which are usually done with the hands, and include friction, kneading, rolling, and percussion of the external tissues of the body in a variety of ways, either with a curative, palliative, or hygienic purpose

Prentice WE. Therapeutic Massage. In: Prentice WE. Therapeutic Modalities in Rehabilitation. 4th ed. 2002. McGraw-Hill. New York.Braddom RL, ed. Physical medicine and rehabilitation 4th ed. Philadelphia : Saunders Elsevier 2011; 439-44

Delisa, Joel A, ed. Physical medicine and Rehabilitation : principle and practice, 5th ed. Lippincott, 2010; 1725-30

Purpose of Massage Therapy

• pain• Flexibility• pain threshold • blood circulation• lymphatic drainage • lactic acid• muscle spasm• muscle tension

Prentice WE. Therapeutic Massage. In: Prentice WE. Therapeutic Modalities in Rehabilitation. 4th ed. 2002. McGraw-Hill. New York.

Reflexive•Slow, gentle, rhythmical, and superficial stroke relieve tension & relax muscles•Local effect on sensory and motor nerves•CNS response sedation

Mechanical•Superficial direct force Produce mechanical or histologic changes in myofascial structures

Physiologic Effect of Massage


Effects on Pain

Gate control theory• Massage non-

nociceptive cutaneous stimulation of large diameter afferent nerve fibers (Aβ) block transmission of pain carried in smaller diameter nerve fibers (Aδ & C)

Effects on Pain

Release of β-endorphins from pituitary gland & hipotalamus effect in the transmission of pain-associated signal in descending spinal tracts

Effects on Pain

•Release of enkephalin from inhibitory interneuron on dorsal horn of medulla spinalis block the pain signal transmission

Effects on Circulation

• Blood circulation• lymphatic flow• removal of edema & metabolit wastes• temperature

Effects on Metabolism

• circulation dispersion of waste products and supply of fresh blood and O2

•Mechanical movement removal and hastens resynthesis of lactic acid

Effects on Muscle

•Mechanical stretching of intramuscular connective tissue•Relieve pain and discomfort• Blood flow to skeletal muscle• venous return• ROM

Effects on Skin• skin temperature• sweating•Remove dead cells•Stretches and breaks down the fibrous tissue on scar tissue

Psychologic Effect of Massage

• The “hands-on” effect a feeling of being helped

• Lower psychoemotional and somatic arousal (e.g. tension and anxiety)

• General sedative effect• Minasny (2009) touching, stretching &

massage will induce relaxation through the parasympathetic system & activate CNS

Prentice WE. Therapeutic Massage. In: Prentice WE. Therapeutic Modalities in Rehabilitation. 4th ed. 2002. McGraw-Hill. New York.Minasny, B., 2009. Understanding the process of facial unwinding. International journal of therapeutiv massage and bodywork 2 (3), 10-17.

Patient Preparation• Patient should be in relaxed

comfortable position lying down is most beneficial to assist in venous flow

• Part being involved in treament must be adequately supported elevated (depending on pathology)

• The body areas not being treated should be covered to prevent from chilling


General Consideration

• Comfortable and relax position• Begin and end with effleurage,

increase maneuver progressively• Sufficient lubricant• Start superficial stroking at joint/just below the joint

finish above the joint• Pressure in line with venous flow return stroke

without pressure, in centripetal direction


General Consideration

• Avoid bony prominences and painful joints• Pressure regulation, determined by type and amount

of tissue present• Steady and even rhythm• If swelling present treatment begin from proximal

part• Massage should never be painful• Forces applied in the direction of muscle fibers


Indication of Massage

• Musculoskeletal disorders • Muscle spasm, sprain, and

postural strain of the back • Arthralgias and various

arthrities• Fibromyalgia• Lymphedema• Anxiety, stress and sleep

disorders• Sports-related injuries

• As an adjunct treatment for:• Burn care• Chronic pain• Exercise-induced injury• Headaches• Cancer care• HIV and AIDS

Braddom RL. Physical Medicine and Rehabilitation. 4th ed. 2011

Contraindication of Massage

Absolute• Malignancy• Thrombus• Atherosclerotic plaques• Infected tissue• Areas of trauma/recent bleeding• Open wound • Severe varicose veins• Acute phlebitis• Cellulitis

Relative • Scar tissue that is

not fully healed• Receiving

anticoagulant• Calcified soft tissues• Skin grafts• Atrophic skin• Acute inflammatory

conditions

Braddom RL. Physical Medicine and Rehabilitation. 4th ed. 2011

Techniques

• Effleurage• Petrissage• Tapotement• Vibration• Friction Massage• Manual Lymphatic

Drainage (MLD)

• Transverse Friction Massage

• Myofascial Release• Trigger Point Massage• Strain/Counterstrain


Effleurage (Stroking) Massage

• The focus of pressure is moved by the hands gliding over the skin• To gain initial relaxation,

diagnose regions of spasm and tightness• Lubricants is used to

reduce the friction between hands and skin

Brault, et al. Manipulation, traction and massage. In: Braddom RL. Physical Medicine and Rehabilitation: Expert Consult-Online and Print, 4th Edition. 4th edition. Philadelphia, PA: Saunders; 2010. p439-444.

Superficial Stroke Massage• Compressive force is

relatively light • energizes cutaneus

receptor acts by neuroreflexive or vascular reflexive mechanism

• Increase blood flow• Can be any direction

Brault, JS, Kappler, RE, Grogg, BE. Manipulation, Traction and Massage. In: Braddom RL, ed. Physical medicine and rehabilitation 4 th ed. Philadelphia: Saunders Elsevier 2011; 439-44Wieting, JM, et al. Manipulation, Massage, and Traction. In: Delisa, Joel A, ed. Physical medicine and Rehabilitation: principle and practice, 5th ed. Philadelphia: Lippincott Williams & Wilkins,

Deep Stroke Massage• Compressive force is relatively

heavy • Mechanically mobilizing fluid in the

tissue beneath the area• Lymphatic drainage, relieve

sprain, strain and bruising, vascular congestion

• Should be in the direction of venous or lymphatic flow

Effleurage (Stroking) Massage

Wieting, JM, et al. Manipulation, Massage, and Traction. In : Delisa, Joel A, ed. Physical medicine and Rehabilitation : principle and practice, 5th ed. Philadelphia: Lippincott Williams & Wilkins, 2010; 1725-30

Petrissage (Kneading) Massage

• Compression of the underlying skin and muscle between the fingers and thumb or between the two hands of the practitioner.• Main mechanical effect is

compression & subsequent release of soft tissue, reactive blood flow & neuroreflexive response to that flow

Petrissage

Kneading on the Hand, for Contracted Tendons and Muscles. Kneading with Both Hands, Called Squeezing.

Petrissage- wringingRolling

Superficial Technique• Promote relaxation

Brault, JS, Kappler, RE, Grogg, BE. Manipulation, Traction and Massage. In: Braddom RL, ed. Physical medicine and rehabilitation 4th ed. Philadelphia: Saunders Elsevier 2011; 439-44Wieting, JM, et al. Manipulation, Massage, and Traction. In: Delisa, Joel A, ed. Physical medicine and Rehabilitation: principle and practice, 5th ed. Philadelphia: Lippincott Williams & Wilkins,

Deeper Technique• Increase blood flow• Mobilize fluid and

tissue deposits• Decrease adhesions

and increase tissue pliability

Petrissage (Kneading) Massage

Tapotement (Percussion)

• Applying rapid & rhythmic alternating contact of varying pressure between the hands and the body’s soft tissue

• The frequency about 3x/second• The effect of tapotement is

thought to be stimulatory


• Using the ulnar aspect of the hands to alternately strike the body tissue

Hacking

• Using a clenched fist to repetitively pummel the tissue

Beating

• Using the finger pads, typically of the index and middle fingers, to strike the underlying tissue in rapid succession usually done over sinuses

Tapping

Slapping

• Uses the volar surface of all the fingers

Pincement

• The thumb and index finger do a light pinch on contact

Cupping

• Involves the use of a cupped palm, which is percussed against the chest wall frequently used to loosen bronchial secretions

Vibration• Fine tremulous

movement, made by the hand or fingers placed firmly against a part, this causes the part to vibrate

• Commonly used for patients who require postural drainage, such as individuals with cystic fibrosis


Friction Massage• Circular, longitudinal or

transverse pressure applied by the fingers, thumb or hypothenar region of the hand to the small area

• Fingers is moved with constant pressure in small circular motions for several cycles

• Goal : to breakdown adhesions in scar tissue, loosen ligaments and disable trigger points

Wieting, JM, et al. Manipulation, Massage, and Traction. In : Delisa, Joel A, ed. Physical medicine and Rehabilitation : principle and practice, 5th ed. Philadelphia: Lippincott Williams & Wilkins, 2010; 1725-30

Manual Lymphatic Drainage (MLD)• Gentle & superficially focused

massage where lymph is moved from areas of lymphatic vessel damage to watershed regions

• Massage of the proximal region of the extremity to be treated to dilate the watershed lymph vessels & allows them to accept fluid from distal areas

• Then a more rythmic massage is performed from a distal to a proximal part of extremity


MASSAGE THERAPY FOR NECK PAIN

Ottawa Panel Evidence-Based Clinical Practice Guidelines on Therapeutic Massage for Neck Pain Systematic Review by Brosseau L, et al. (2012):

• Therapeutic massage can decrease pain, tenderness and improve ROM for sub-acute and chronic neck pain

• Effective for relieving immediate post-treatment pain symptoms

Cochrane Database Systematic Review by Patel, et al. (2012)

• As a stand-alone treatment, massage for MND was found to provide an immediate or short-term effectiveness or both in pain and tenderness

Topolska M, et al. (2011)Evaluation of the Effectiveness of Therapeutic Massage in Patients with Neck Pain

• Therapeutic massage CROM• The effectiveness of therapeutic massage is comparable

to the effectiveness of rehabilitation physical therapy

Sherman KJ, et al. (2014)RCT of Therapeutic Massage for Chronic Neck Pain

• Massage is safe and may have clinical benefits for treating chronic neck pain

Topolska M, Chrzan S, Sapuła R, Kowerski M, Soboń M, Marczewski K. Evaluation of the effectiveness of therapeutic massage in patients with neck pain. Ortop Traumatol Rehabil. 2012 Apr 3;14(2):115–24.Sherman, K. J. et al. Five-week outcomes from a dosing trial of therapeutic massage for chronic neck pain. Ann. Fam. Med. 12, 112–120 (2014).

Topolska M, et al. (2011) Evaluation of the Effectiveness of Therapeutic Massage in Patients

with Neck Pain

Objective

• To evaluate the effectiveness and impact of therapeutic massage on the range of motion in patients with neck pain

Subject• 60

patients• Aged 37-

82 years• Treated

for neck pain at the Rehabilitation Department of Zamość University of Management and Administration.

Method

• 2 groups:• Kinesioth

erapy + physiotherapy (n=30)

• Kinesiotherapy + physiotherapy + therapeutic massage (n=30)

• Outcome assessment:

• Saunders digital inclinometer

• Neck Disability Index (NDI)

• Visual Analogue Scale (VAS)

Sherman KJ, et al. (2012) A Dosing Trial of Therapeutic Massage for Chronic Neck Pain

Objective

• To evaluate the optimal dose of massage for individuals with chronic non-specific neck pain

Subjects• 228 persons

• Aged 20 to 64

• Chronic non-specific neck pain

• Lasting at least 3 months

• Primary health care clinics in Seattle

• From June 2010 through August 2011

Method

• Randomized into 6 groups :

• a wait list control group for 4 weeks

• 1 x 60 min /week






Sarrafzadeh J, et al. (2012)

• The pressure release (PR) massage, phonophoresis of hydrocortisone (PhH) 1%, and ultrasound therapy (UT) were effective for treating patients with an upper trapezius latent myofascial trigger point (MTP)

Aguilera FJ, et al. (2009)

• The ischemic compression (IC) massage and ultrasound (US) were shown to have an immediate effect on latent myofascial trigger points (MTrPs) in the trapezius muscle.

• The use of IC show a short-term positive effects among C-A-ROM, Basal Electrical Activity of the trapezius muscle, and MTrP sensitivity of the trapezius muscle

Sarrafzadeh J, Ahmadi A, Yassin M. The effects of pressure release, phonophoresis of hydrocortisone, and ultrasound on upper trapezius latent myofascial trigger point. Arch Phys Med Rehabil. 2012 Jan;93(1):72–7. Aguilera FJM, Martín DP, Masanet RA, Botella AC, Soler LB, Morell FB. Immediate effect of ultrasound and ischemic compression techniques for the treatment of trapezius latent myofascial trigger points in healthy subjects: a randomized controlled study. J Manipulative Physiol Ther. 2009 Sep;32(7):515–20.

Ruiz-Molinero C, et al. (2014)

• Ultrasound (US) is effective in reducing pain and mobility limitation in the treatment of traumatic cervical sprain

• High-active ultrasound treatment is more effective than placebo in reducing pain.

Walker MJ, et al. (2008)

• An impairment-based manual physical therapy and exercise (MTE) program resulted in clinically and statistically significant short- and long-term improvements in pain, disability, and patient-perceived recovery in patients with mechanical neck pain when compared to a program comprising advice, a mobility exercise, and ultrasound

Ruiz-Molinero C, Jimenez-Rejano JJ, Chillon-Martinez R, Suarez-Serrano C, Rebollo-Roldan J, Perez-Cabezas V. Efficacy of therapeutic ultrasound in pain and joint mobility in whiplash traumatic acute and subacute phases. Ultrasound Med Biol. 2014 Sep;40(9):2089–95. Walker MJ, Boyles RE, Young BA, Strunce JB, Garber MB, Whitman JM, et al. The effectiveness of manual physical therapy and exercise for mechanical neck pain: a randomized clinical trial. Spine. 2008 Oct 15;33(22):2371–8.

Ay S, et al. (2011)

• Compare the effect of phonophoresis, ultrasound and placebo ultrasound therapies in the treatment of myofascial pain syndrome (MPS).

• After treatment, there were statistically significant improvements in pain severity, NTP, pressure pain threshold (PPT), ROM and NPDI scores both in phonophoresis and in ultrasound therapy groups (P < 0.05).

• Statistically significant increase in cervical lateral flexion and rotation was observed in the placebo US group. • No statistically significant improvement in the cervical flexion-extension joint movement, pain levels, number

of trigger points and NPDI score, pressure pain threshold (P > 0.05), also there were no significant differences in all parameters between group 1 and 2 (P = 0.05).

• Both diclofenac phonophoresis and ultrasound therapy were effective in the treatment of patients with MPS. • Phonophoresis was not found to be superior over ultrasound therapy.

Ay S, Doğan SK, Evcik D, Başer OC. Comparison the efficacy of phonophoresis and ultrasound therapy in myofascial pain syndrome. Rheumatol Int. 2011 Sep;31(9):1203–8.

Bokarius, et al. (2010), Bronfort et al. (2010)

• Therapeutic massage more effective when combined with exercise or other interventions

Rocio Llamas-Ramos, et al. (2014)

• 2 sessions of TrP-dry needling and TrP massage therapy resulted in similar outcomes in terms of pain, disability and CROM for chronic mechanical neck pain Bokarius, A.V., Bokarius, V., 2010. Evidence-based review of manual therapy efficacy in treatment of chronic musculoskeletal pain. World Institute of Pain 10 (5), 79-89

Bronfort, G., Evans, R., Nelson, B., Aker, P.D., Goldsmith, C.H., Vernon, H., 2001. A randomized clinical trial of exercise and spinal manipulation for patient with chronic neck pain. Spine 26(7), 788-799.Rocio Llamas-Ramos DP-M. Comparison of the Short-Term Outcomes Between Trigger Point Dry Needling Versus Trigger Point Manual Therapy for the Management of Chronic Mechanical Neck Pain: A Randomized Clinical Trial. J Orthop Sports Phys Ther. 2014;44(11):1–34.

Recommended Dose

•2 or 3 times per weekFrequency

•60-minuteDuration•4 weeks of treatmentTotal Treatment

Time

The efficacy increase with increase dose

Sherman KJ, et al. (2012)

Sherman, K. J. et al. Five-week outcomes from a dosing trial of therapeutic massage for chronic neck pain. Ann. Fam. Med. 12, 112 –120 (2014).

1) CROM Assessment

(A/P/R-ROM)

2)Hands-on Check-in &

tissue warming

3) Lymphatic Drainage

4) Neck work

(Part 1)

5) Addressing compensat

ory patterns

6) Neck Work

(Part 2)

7) Integration

8) Completion

60 Minutes


Recommended Massage Protocol

The Recommended Strokes of Neck Work

e. Deeper longitudinal stripping techniques running parallel to muscle fibers to encourage muscle lengthening

f. Treatment of scar tissue wherever found (friction or myofascial techniques)

g. Effleurage or petrissage of the trapezius, paraspinals (splenius cervicis & capitis), levator scapula and SCM muscles

h. Stretching to finish and enhance soft tissue manipulation

a. Friction on base of skull b. Long slow repetitive

strokes down the lamina from base of skull with thumb to both sides of spine

c. Slow friction of the anterior neck muscles

d. Slow friction & other strokes to scalenes group


Complication• Very rarely associated with any serious complications, most

common mild complications:– Discomfort or pain during massage treatments– Increased soreness after treatment – Dizziness – Nausea

• Started less than 12 hours after the massage • Lasted for 36 hours or less• Massage appears relatively safe when provided by

appropriately trained therapists, but can be associated with transient increases in pain

1..Paanalahti K, Holm LW, Nordin M, Asker M, Lyander J, Skillgate E. Adverse events after manual therapy among patients seeking care for neck and/or back pain: a randomized controlled trial. BMC Musculoskelet Disord. 2014 Mar 12;15:77–77. 2. Sherman KJ, Cherkin DC, Hawkes RJ, Miglioretti DL, Deyo RA. Randomized Trial of Therapeutic Massage for Chronic Neck Pain. Clin J Pain. 2009;25(3):233–8.3. Cambron et al, 2007, J Altern Complement Med [Internet]. PainScience.com. [cited 2015 May 19]. Available from: https://www.painscience.com/bibliography.php?cam4

Advantages• Effective for neck pain (chronic, non-specific, mechanical)• Has multiple physiologic & psychologic effect• Relatively mild and rare complication• Suitable for patient who has contraindication for other

therapeutic modality (eg. patient with pacemaker, metal implant)

• Don’t need sophisticated device• Good cost-effectiveness • Feasible schedule and place of therapy

– Schedule can be adjusted to meet patient’s & therapist’s schedule– Can be performed not only at healthcare center but also in patient’s

house (as home program)

Disadvantages

• Skill-dependent a registered skilled therapist • Not suitable for person hypersensitive to touch • Not suitable for acute phase • Mild complication : transient in pain during/after

massage therapy

Conclusion

Further study needed to investigate long term effect of massage therapy,Massage therapy is an effective

therapy for neck pain with various benefit & minimal riskRecommended dose: duration of 60 minutes, frequency of 2-3 times per week, for 4 weeks

Thank You

• Rheumatol Int. 2011 Sep;31(9):1203-8. doi: 10.1007/s00296-010-1419-0. Epub 2010 Mar 31.• Comparison the efficacy of phonophoresis and ultrasound therapy in myofascial pain syndrome.• Ay S1, Doğan SK, Evcik D, Başer OC.• Author information• Abstract• The aim of this study is to compare the effect of phonophoresis, ultrasound and placebo ultrasound therapies in the

treatment of myofascial pain syndrome (MPS). This is a randomized, double-blind placebo controlled study. Sixty patients (48 women, 12 men, mean age 37.9 ± 12.2 years) with MPS were included in this study. Patients were allocated into three groups. Group 1(n = 20) was received diclofenac phonophoresis, group 2(n = 20) was received ultrasound and group 3(n = 20) was received placebo ultrasound therapies over trigger points, 10 min a day for 15 session during 3 weeks (1 MHz-1,5 watt/cm²). Additionally, all patients were given neck exercise program including isotonic, isometric and stretching. Patients were assessed by means of pain, range of motion (ROM) of neck, number of trigger points (NTP), algometric measurement and disability. Pain severity was measured by visual analog scale (VAS) and Likert scale. The neck pain disability index (NPDI) was used for assessing disability. Measurements were taken before and after treatment. After treatment, there were statistically significant improvements in pain severity, NTP, pressure pain threshold (PPT), ROM and NPDI scores both in phonophoresis and in ultrasound therapy groups (P < 0.05). Statistically significant increase in cervical lateral flexion and rotation was observed in the placebo US group. While there was no statistically significant improvement in the cervical flexion-extension joint movement, pain levels, number of trigger points and NPDI score, pressure pain threshold (P > 0.05), also there were no significant differences in all parameters between group 1 and 2 (P = 0.05). Both diclofenac phonophoresis and ultrasound therapy were effective in the treatment of patients with MPS. Phonophoresis was not found to be superior over ultrasound therapy.

• PMID: 20354859 [PubMed - indexed for MEDLINE]

Ay S, Doğan SK, Evcik D, Başer OC. Comparison the efficacy of phonophoresis and ultrasound therapy in myofascial pain syndrome. Rheumatol Int. 2011 Sep;31(9):1203–8.

• Spine (Phila Pa 1976). 2008 Oct 15;33(22):2371-8. doi: 10.1097/BRS.0b013e318183391e.• The effectiveness of manual physical therapy and exercise for mechanical neck pain: a randomized clinical trial.• Walker MJ1, Boyles RE, Young BA, Strunce JB, Garber MB, Whitman JM, Deyle G, Wainner RS.• Author information• Abstract• STUDY DESIGN: • Randomized clinical trial.• OBJECTIVE: • To assess the effectiveness of manual physical therapy and exercise (MTE) for mechanical neck pain with or without unilateral upper

extremity (UE) symptoms, as compared to a minimal intervention (MIN) approach.• SUMMARY OF BACKGROUND DATA: • Mounting evidence supports the use of manual therapy and exercise for mechanical neck pain, but no studies have directly assessed its

effectiveness for UE symptoms.• METHODS: • A total of 94 patients referred to 3 physical therapy clinics with a primary complaint of mechanical neck pain, with or without unilateral UE

symptoms, were randomized to receive MTE or a MIN approach of advice, motion exercise, and subtherapeutic ultrasound. Primary outcomes were the neck disability index, cervical and UE pain visual analog scales (VAS), and patient-perceived global rating of change assessed at 3-, 6-, and 52-weeks. Secondary measures included treatment success rates and post-treatment healthcare utilization.

• RESULTS: • The MTE group demonstrated significantly larger reductions in short- and long-term neck disability index scores (mean 1-year difference -

5.1, 95% confidence intervals (CI) -8.1 to -2.1; P = 0.001) and short-term cervical VAS scores (mean 6-week difference -14.2, 95% CI -22.7 to -5.6; P = 0.001) as compared to the MIN group. The MTE group also demonstrated significant within group reductions in short- and long-term UE VAS scores at all time periods (mean 1-year difference -16.3, 95% CI -23.1 to -9.5; P = 0.000). At 1-year, patient perceived treatment success was reported by 62% (29 of 47) of the MTE group and 32% (15 of 47) of the MIN group (P = 0.004).

• CONCLUSION: • An impairment-based MTE program resulted in clinically and statistically significant short- and long-term improvements in pain, disability,

and patient-perceived recovery in patients with mechanical neck pain when compared to a program comprising advice, a mobility exercise, and subtherapeutic ultrasound.


Walker MJ, Boyles RE, Young BA, Strunce JB, Garber MB, Whitman JM, et al. The effectiveness of manual physical therapy and exercise for mechanical neck pain: a randomized clinical trial. Spine. 2008 Oct 15;33(22):2371–8.

• Arch Phys Med Rehabil. 2012 Jan;93(1):72-7. doi: 10.1016/j.apmr.2011.08.001. Epub 2011 Oct 7.• The effects of pressure release, phonophoresis of hydrocortisone, and ultrasound on upper trapezius latent myofascial trigger point.• Sarrafzadeh J1, Ahmadi A, Yassin M.• Author information• Abstract• OBJECTIVE: • To compare the effects of pressure release (PR), phonophoresis of hydrocortisone (PhH) 1%, and ultrasonic therapy (UT) in patients with an

upper trapezius latent myofascial trigger point (MTP).• DESIGN: • Repeated-measure design.• SETTING: • A pain control medical clinic.• PARTICIPANTS: • Subjects (N=60; mean±SD age, 21.78±1.76y) with a diagnosis of upper trapezius MTP participated in this study. Subjects were randomly

divided into 4 groups: PR, PhH, UT, and control (15 in each group). All patients had a latent MTP in the upper trapezius muscle.• INTERVENTIONS: • PR, PhH, UT.• MAIN OUTCOME MEASURES: • Subjective pain intensity, pain pressure threshold (PPT), and active cervical lateral flexion range of motion were assessed in 6 sessions.• RESULTS: • All 3 treatment groups showed decreases in pain and PPT and an increase in cervical lateral flexion range of motion (P<.001) compared

with the control group. Both PhH and PR techniques showed more significant therapeutic effects than UT (P<.001).• CONCLUSIONS: • Our results indicate that all 3 treatments used in this study were effective for treating MTP. According to this study, PhH is suggested as a

new method effective for the treatment of MTP.• Copyright © 2012 American Congress of Rehabilitation Medicine. Published by Elsevier Inc. All rights reserved.• PMID: 21982324 [PubMed - indexed for MEDLINE]

Sarrafzadeh J, Ahmadi A, Yassin M. The effects of pressure release, phonophoresis of hydrocortisone, and ultrasound on upper trapezius latent myofascial trigger point. Arch Phys Med Rehabil. 2012 Jan;93(1):72–7.

• J Manipulative Physiol Ther. 2009 Sep;32(7):515-20. doi: 10.1016/j.jmpt.2009.08.001.• Immediate effect of ultrasound and ischemic compression techniques for the treatment of trapezius latent myofascial

trigger points in healthy subjects: a randomized controlled study.• Aguilera FJ1, Martín DP, Masanet RA, Botella AC, Soler LB, Morell FB.• Author information• Abstract• OBJECTIVE: • The purpose of this study was to determine immediate effects of ischemic compression (IC) and ultrasound (US) for the

treatment of myofascial trigger points (MTrPs) in the trapezius muscle.• METHODS: • Sixty-six volunteers, all CEU-Cardenal Herrera University, Valencia, Spain, personnel, participated in this study. Subjects

were healthy individuals, diagnosed with latent MTrPs in the trapezius muscle. Subjects were randomly placed into 3 groups: G1, which received IC treatment for MTrPs; G2, which received US; and G3 (control), which received sham US. The following data were recorded before and after each treatment: active range of motion (AROM) of cervical rachis measured with a cervical range of motion instrument, basal electrical activity (BEA) of muscle trapezius measured with surface electromyography, and pressure tolerance of MTrP measured with visual analogue scale assessing local pain evoked by the application of 2.5 kg/cm(2) of pressure using a pressure analog algometer.

• RESULTS: • The results showed an immediate decrease in BEA of the trapezius muscle and a reduction of MTrP sensitivity after

treatment with both therapeutic modalities. In the case of IC, an improvement of AROM of cervical rachis was also been obtained.

• CONCLUSION: • In this group of participants, both treatments were shown to have an immediate effect on latent MTrPs. The results

show a relation among AROM of cervical rachis, BEA of the trapezius muscle, and MTrP sensitivity of the trapezius muscle gaining short-term positive effects with use of IC.


Aguilera FJM, Martín DP, Masanet RA, Botella AC, Soler LB, Morell FB. Immediate effect of ultrasound and ischemic compression techniques for the treatment of trapezius latent myofascial trigger points in healthy subjects: a randomized controlled study. J Manipulative Physiol Ther. 2009 Sep;32(7):515–20.

• J Bodyw Mov Ther. 2011 Jul;15(3):348-54. doi: 10.1016/j.jbmt.2010.04.003. Epub 2010 May 13.• Immediate effect of electric point stimulation (TENS) in treating latent upper trapezius trigger points: a double blind randomised placebo-

controlled trial.• Gemmell H1, Hilland A.• Author information• Abstract• OBJECTIVE: • The purpose of this study was to investigate the immediate effect of electric point stimulation in treating latent upper trapezius trigger

points compared to placebo.• DESIGN: • Double blind randomised placebo-controlled trial.• SETTING: • Anglo-European College of Chiropractic.• PARTICIPANTS: • Sixty participants with latent upper trapezius trigger points.• INTERVENTIONS: • Electric point stimulator type of TENS, or detuned (inactive) electric point stimulator type of TENS.• MAIN OUTCOME MEASURES: • The three outcome measures were pressure pain threshold at the trigger point, a numerical rating scale for pain elicited over the trigger

point, and lateral cervical flexion to the side opposite the trigger point.• RESULTS: • On the outcome of pressure pain threshold the electric point stimulator group had a mean change of 0.49 (0.99) kg/cm(2), while the

placebo group had a mean change of 0.45 (0.98) kg/cm(2) (t = 0.16, df = 58, p = 0.88). For change in pain over the trigger point, the electric point stimulator group had a mean decrease of 0.93 (0.87) points, while the placebo group had a mean decrease of 0.23 (0.97) points (t = 0.70, df = 58, p = 0.005). On the outcome of change in lateral cervical flexion the electric point stimulator group had a mean increase of 2.87 (4.55) degrees, while the placebo group had a mean increase of 1.99 (2.49) degrees (t = 0.92, df = 58, p = 0.36).

• CONCLUSION: • Electric point stimulator type of TENS is superior to placebo only in reduction of pain for treating latent upper trapezius trigger points.• Copyright © 2010 Elsevier Ltd. All rights reserved.• PMID: 21665112 [PubMed - indexed for MEDLINE]

Gemmell H, Hilland A. Immediate effect of electric point stimulation (TENS) in treating latent upper trapezius trigger points: a double blind randomised placebo-controlled trial. J Bodyw Mov Ther. 2011 Jul;15(3):348–54.

• Ultrasound Med Biol. 2014 Sep;40(9):2089-95. doi: 10.1016/j.ultrasmedbio.2014.04.016. Epub 2014 Jul 9.

• Efficacy of therapeutic ultrasound in pain and joint mobility in whiplash traumatic acute and subacute phases.

• Ruiz-Molinero C1, Jimenez-Rejano JJ2, Chillon-Martinez R2, Suarez-Serrano C2, Rebollo-Roldan J2, Perez-Cabezas V3.

• Author information• Abstract• To determine if ultrasound (US) is effective in reducing pain and mobility limitation in the treatment of

traumatic cervical sprain, we performed an experimental study. The sample comprised 54 diagnosed subjects with a mean age of 36.54 y (standard deviation = 12.245), assigned by simple random selection to an experimental group with ultrasound treatment and a control group with placebo ultrasound. Treatment consisted of 10 sessions of an ultrasound treatment protocol, followed by 15 sessions of a protocol identical for both groups without ultrasound. The variables assessed were pain and joint mobility. There was no significant difference (p > 0.05) between groups in the first 10 sessions of treatment. However, there was a statistically significant difference (p < 0.05) between groups on the pain variable, 20 days after completion of the US. High-active ultrasound treatment is more effective than placebo in reducing pain.

• Copyright © 2014 World Federation for Ultrasound in Medicine & Biology. Published by Elsevier Inc. All rights reserved.

• KEYWORDS: • Mobility limitation; Pain; Ultrasonic therapy; Whiplash injuries• PMID: 25023094 [PubMed - indexed for MEDLINE]

Ruiz-Molinero C, Jimenez-Rejano JJ, Chillon-Martinez R, Suarez-Serrano C, Rebollo-Roldan J, Perez-Cabezas V. Efficacy of therapeutic ultrasound in pain and joint mobility in whiplash traumatic acute and subacute phases. Ultrasound Med Biol. 2014 Sep;40(9):2089–95.

• J Manipulative Physiol Ther. 2013 Jun;36(5):300-9. doi: 10.1016/j.jmpt.2013.04.008. Epub 2013 Jun 12.• Short- and medium-term effects of manual therapy on cervical active range of motion and pressure pain sensitivity in latent myofascial

pain of the upper trapezius muscle: a randomized controlled trial.• Oliveira-Campelo NM1, de Melo CA, Alburquerque-Sendín F, Machado JP.• Author information• 1Department of Physical Therapy, Escola Superior de Tecnologia de Saúde, VN Gaia, Portugal. [email protected]• Abstract• OBJECTIVE: • The purpose of this study was to investigate effects of different manual techniques on cervical ranges of motion and pressure pain

sensitivity in subjects with latent trigger point of the upper trapezius muscle.• METHODS: • One hundred seventeen volunteers, with a unilateral latent trigger point on upper trapezius due to computer work, were randomly divided

into 5 groups: ischemic compression (IC) group (n=24); passive stretching group (n=23); muscle energy technique group (n=23); and 2 control groups, wait-and-see group (n=25) and placebo group (n=22). Cervical spine range of movement was measured using a cervical range of motion instrument as well as pressure pain sensitivity by means of an algometer and a visual analog scale. Outcomes were assessed pretreatment, immediately, and 24 hours after the intervention and 1 week later by a blind researcher. A 4×5 mixed repeated-measures analysis of variance was used to examine the effects of the intervention and Cohen d coefficient was used.

• RESULTS: • A group-by-time interaction was detected in all variables (P<.01), except contralateral rotation. The immediate effect sizes of the

contralateral flexion, ipsilateral rotation, and pressure pain threshold were large for 3 experimental groups. Nevertheless, after 24 hours and 1 week, only IC group maintained the effect size.

• CONCLUSIONS: • Manual techniques on upper trapezius with latent trigger point seemed to improve the cervical range of motion and the pressure pain

sensitivity. These effects persist after 1 week in the IC group.• Copyright © 2013 National University of Health Sciences. Published by Mosby, Inc. All rights reserved.• KEYWORDS: • Articular; Pain Perception; Pain Threshold; Physical Therapy Modalities; Range of Motion; Trigger Points• PMID: 23769263 [PubMed - indexed for MEDLINE]

Oliveira-Campelo NM, de Melo CA, Alburquerque-Sendín F, Machado JP. Short- and medium-term effects of manual therapy on cervical active range of motion and pressure pain sensitivity in latent myofascial pain of the upper trapezius muscle: a randomized controlled trial. J Manipulative Physiol Ther. 2013 Jun;36(5):300–9.

http://www.ncbi.nlm.nih.gov/pubmed/23769263





http://www.ncbi.nlm.nih.gov/pubmed/?term=Oliveira-Campelo%20NM%5BAuthor%5D&cauthor=true&cauthor_uid=23769263



http://www.ncbi.nlm.nih.gov/pubmed/?term=de%20Melo%20CA%5BAuthor%5D&cauthor=true&cauthor_uid=23769263



http://www.ncbi.nlm.nih.gov/pubmed/?term=Alburquerque-Send%C3%ADn%20F%5BAuthor%5D&cauthor=true&cauthor_uid=23769263

http://www.ncbi.nlm.nih.gov/pubmed/?term=Alburquerque-Send%C3%ADn%20F%5BAuthor%5D&cauthor=true&cauthor_uid=23769263

http://www.ncbi.nlm.nih.gov/pubmed/?term=Machado%20JP%5BAuthor%5D&cauthor=true&cauthor_uid=23769263


• Arch Phys Med Rehabil. 2011 Sep;92(9):1353-8. doi: 10.1016/j.apmr.2011.04.010.• Effects of burst-type transcutaneous electrical nerve stimulation on cervical range of motion and latent myofascial trigger point pain sensitivity.• Rodríguez-Fernández AL1, Garrido-Santofimia V, Güeita-Rodríguez J, Fernández-de-Las-Peñas C.• Author information• Abstract• OBJECTIVE: • To assess the effects of a burst application of transcutaneous electrical nerve stimulation (TENS) on cervical range of motion and pressure point

sensitivity of latent myofascial trigger points (MTrPs).• DESIGN: • A single-session, single-blind randomized trial.• SETTING: • General community rehabilitation clinic.• PARTICIPANTS: • Individuals (N = 76; 45 men, 31 women) aged 18 to 41 years (mean ± SD, 23 ± 4y) with latent MTrPs in 1 upper trapezius muscle.• INTERVENTIONS: • Subjects were randomly divided into 2 groups: a TENS group that received a burst-type TENS (pulse width, 200 μs; frequency, 100 Hz; burst frequency, 2

Hz) stimulation over the upper trapezius for 10 minutes, and a placebo group that received a sham-TENS application over the upper trapezius also for 10 minutes.

• MAIN OUTCOME MEASURES: • Referred pressure pain threshold (RPPT) over the MTrP and cervical range of motion in rotation were assessed before, and 1 and 5 minutes after the

intervention by an assessor blinded to subjects' treatment.• RESULTS: • The analysis of covariance revealed a significant group × time interaction (P < .001) for RPPT: the TENS group exhibited a greater increase compared

with the control group; however, between-group differences were small at 1 minute (0.3 kg/cm²; 95% confidence interval [CI], 0.1-0.4) and at 5 minutes (0.6 kg/cm²; 95% CI, 0.3-0.8) after treatment. A significant group × time interaction (P=.01) was also found for cervical rotation in favor of the TENS group. Between-group differences were also small at 1 minute (2.0°; 95% CI, 1.0-2.8) and at 5 minutes (2.7°; 95% CI, 1.7-3.8) after treatment.

• CONCLUSIONS: • A 10-minute application of burst-type TENS increases in a small but statistically significant manner the RPPT over upper trapezius latent MTrPs and the

ipsilateral cervical range of motion.• Copyright © 2011 American Congress of Rehabilitation Medicine. Published by Elsevier Inc. All rights reserved.• PMID: 21878204 [PubMed - indexed for MEDLINE]

Rodríguez-Fernández AL, Garrido-Santofimia V, Güeita-Rodríguez J, Fernández-de-Las-Peñas C. Effects of burst-type transcutaneous electrical nerve stimulation on cervical range of motion and latent myofascial trigger point pain sensitivity. Arch Phys Med Rehabil. 2011 Sep;92(9):1353–8.




http://www.ncbi.nlm.nih.gov/pubmed/?term=Rodr%C3%ADguez-Fern%C3%A1ndez%20AL%5BAuthor%5D&cauthor=true&cauthor_uid=21878204

http://www.ncbi.nlm.nih.gov/pubmed/?term=Rodr%C3%ADguez-Fern%C3%A1ndez%20AL%5BAuthor%5D&cauthor=true&cauthor_uid=21878204

http://www.ncbi.nlm.nih.gov/pubmed/?term=Garrido-Santofimia%20V%5BAuthor%5D&cauthor=true&cauthor_uid=21878204

http://www.ncbi.nlm.nih.gov/pubmed/?term=Garrido-Santofimia%20V%5BAuthor%5D&cauthor=true&cauthor_uid=21878204

http://www.ncbi.nlm.nih.gov/pubmed/?term=G%C3%BCeita-Rodr%C3%ADguez%20J%5BAuthor%5D&cauthor=true&cauthor_uid=21878204

http://www.ncbi.nlm.nih.gov/pubmed/?term=G%C3%BCeita-Rodr%C3%ADguez%20J%5BAuthor%5D&cauthor=true&cauthor_uid=21878204

http://www.ncbi.nlm.nih.gov/pubmed/?term=Fern%C3%A1ndez-de-Las-Pe%C3%B1as%20C%5BAuthor%5D&cauthor=true&cauthor_uid=21878204





1) Cervical ROM

Assessment (A/P/R-ROM)

2)Hands-on Check-in/tissu

e warming

3) Lymph Drainage 4) Neck work

5) Address compensatory

patterns 6) Integration

7) Completion

30 Minutes

Massage Protocol

Fejer, et al. (2006)

• Neck pain is one of the most common and painful musculoskeletal conditions with point prevalence ranges from 6% to 22% and up to 38% of the elderly population, while lifetime prevalence ranges from 14,2% to 71%

Hoy DG, et al. (2010)• The estimated 1 year incidence of neck pain from available studies ranges

between 10.4% and 21.3% with a higher incidence noted in office and computer workers

• Between 33% and 65% of people have recovered from an episode of neck pain at 1 year, most cases run an episodic course over a person's lifetime and, thus, relapses are common

• The overall prevalence of neck pain in the general population ranges between 0.4% and 86.8% (mean: 23.1%); point prevalence ranges from 0.4% to 41.5% (mean: 14.4%); and 1 year prevalence ranges from 4.8% to 79.5% (mean: 25.8%)

• Higher incidence of neck pain among women and an increased risk of developing neck pain until the 35-49-year age group, after which the risk begins to decline

Epidemiology

Recommended Dose

Sherman KJ, et al. (2012) • The recommended dose are:–4 weeks of treatment–2 or 3 times per week–60-minute massages

Sherman, K. J. et al. Five-week outcomes from a dosing trial of therapeutic massage for chronic neck pain. Ann. Fam. Med. 12, 112–120 (2014).

• Massage is mechanical stimulation of tissue by means of rhythmically applied pressure and stretching

• It allows the therapist, to assist a patient to overcome pain and to relax through the application of the therapeutic massage techniques

• Massage has effects on the circulation, the lymphatic system, nervous system, muscles, myofascia, skin, scar tissue, psychologic responses, relaxation feelings, and pain

Effectiveness of Massage Therapy for Neck Pain

• 4 SR assessed the effect of massage on pain and function (Haraldsson et al. 2006; Ezzo et al. 2007; Gross et al. 2007; Vernon et al. 2007)

• All reviews identified major methodological weaknesses of the individual studies, e.g. often a lack of uniform definition of the technique, dosage, the mode of performance and indication for the management

tp 1 astri - final

Health & Medicine