Servikal miyofasiyal ağrı sendromunun tedavisinde mobilizasyon tedavisinin etkinliği

Yıl 2018, Cilt: 5 Sayı: 1, 25 - 32, 04.06.2018

Emel Sönmezer , Emine Handan Tüzün Levent Eker İnci Yüksel

Öz

Amaç: Bu çalışmanın amacı, servikal miyofasiyal ağrı sendromunun (MAS) tedavisinde servikal mobilizasyonun anlık etkinliğini araştırmaktı.

Yöntem: MAS tanısı alan toplam 46 hasta rasgele olarak iki tedavi grubuna ayrıldı. Her iki gruba da hot pack, masaj ve ev egzersiz programı uygulandı. İkinci gruba bu modalitelere ek olarak servikal mobilizasyon teknikleri uygulandı. Tüm katılımcılar, ağrı şiddeti, tetik noktalarının sayısı ve hassasiyeti, eklem hareket açıklığı ve yetersizlik açısından tedavi öncesinde ve sonrasında değerlendirildi.

Bulgular: Başlangıçta gruplar birbirinden farklı değildi (p>0,05). Tedavi öncesi değerlerle karşılaştırıldığında, tedaviden sonra her iki grupta da ağrı yakınmalarında anlamlı iyileşme, eklem hareket açıklığında artma ve yeti yitiminde azalma saptandı (p<0,05). Ek olarak her iki grupta tetik nokta sayısında ve hassasiyetinde azalma bulundu (p<0,05).

Sonuç: Bu çalışmanın sonuçları, hot pack, masaj ve bir ev egzersiz programı içeren kombine bir fizyoterapi yaklaşımının servikal MAS’li hastalarda ağrıyı, tetik nokta sayısını ve hassasiyetini azalttığını, eklem hareket açıklığını ve kronik boyun ağrısından kaynaklanan yeti yitimini iyileştirdiğini gösterdi. Servikal omurga mobilizasyonunun tedavi protokolüne eklenmesi hastaların sonuçlarını değiştirmedi.

Anahtar Kelimeler

Boyun ağrısı, Manuel tedavi, Konservatif tedavi

Effectiveness of mobilization therapy for treating cervical myofascial pain syndrome

Öz

Purpose: The aim of this study was to investigate the initial effectiveness of cervical mobilization for treating cervical Myofascial Pain Syndrome (MPS).

Methods: A total of 46 subjects diagnosed with MPS were randomly allocated in two treatment groups. Hot pack, massage and a home exercise program were applied to both groups. Mobilization techniques were additionally applied to these modalities in the second group. All subjects were assessed before and after treatment for pain intensity, number and tenderness of trigger points, range of motion and disability.

Results: The groups were not different from each other at baseline (p>0.05). When compared with pre-treatment values, a significant decrease in pain complaints, increase in range of motion and reduce in disability was found in both groups after treatment (p<0.05). It was also found that the number and tenderness of trigger points were decreased in both groups.

Conclusion: The results of this study shows that combined physiotherapy applications including hot pack, massage and a home exercise program decrease the pain, number and tenderness of trigger point, and improve the range of motion and the disability caused by chronic neck pain in patients with cervical MPS. Adding cervical spine mobilization to this treatment protocol did not change patients’ outcomes.

Anahtar Kelimeler

Neck pain, Manual therapy, conservative treatment

Kaynakça

• 1. Han SC, Harrison P. Myofascial pain syndrome and trigger-point management. Reg Anesth. 1997;22:89-101.
• 2. Borg-Stein J, Simons DG. Myofascial pain. Arch Phys Med Rehabil. 2002;83:40-47.
• 3. Simons DG. Review of enigmatic MTrPs as a common cause of enigmatic musculoskeletal pain and dysfunction. J.Elektromyogr Kinesiol. 2004;14:95-107.
• 4. Testa M, Barbero M, Gherlone E. Trigger points: update of the clinical aspects. Eur Med Phys. 2003;39:37-43.
• 5. Bennett R. Myofascial pain syndromes and their evaluation. Best Pract Res Clin Rheumatol. 2007;21:427-445.
• 6. Gerwin RD. The management of myofascial pain syndrome. J Musculoskelet Pain. 1993;1:83-94.
• 7. Desai MJ, Saini V, Saini S. Myofascial pain syndrome: A treatment review. Pain Ther. 2013;2:21-36.
• 8. Borg-Stein J, Laccarino MA. Myofascial pain syndrome treatments. Phys Med Rehabil Clin. 2014;25:357-374.
• 9. Wheeler AH. Myofascial pain disorders. Drugs. 2004;64:45-62.
• 10. Woolf AD, Vos T, March L. How to measure the impact of musculoskeletal condition. Best Pract Ros Clini Rheumatal. 2010;24:723-732.
• 11. Kalichman L. Massage therapy for fibromyalgia symptoms. Rheumatology international, 2010;30:1151-1157.
• 12. Moyer CA, Rounds J, Hannum JW. A metaanalysis of massage therapy research. Psychol Bull. 2004;130:3-18.
• 13. Chatchawan U, Thinkhamrop B, Kharmwan S, et al. Effectiveness of traditional Thai Massage versus Swedish massage among patients with back pain associated with myofascial trigger points. J Bodyw Mov Ther. 2006;9:298-309.
• 14. Desai MJ, Bean MC, Heckman TW, et al. Treatment of myofascial Pain. Pain Manag. 2013;3:67-79.
• 15. Sterling M, Jull G, Wright A. Cervical mobilization: concurrent effects on pain, sympathetic nervous system activity and motor activity. Man Ther. 2001;6:72-81.
• 16. Fernandez-de-Las-Penas C, Alonso-Blanco C, Cleland JA, et al. Changes in pressure pain thresholds over C5-C6 zygapophyseal joint after a cervicothoracic junction manipulation in healthy subjects. J Manipulative Physiol Ther. 2008;31:332-337.
• 17. Fernandez-de-Las-Penas C, Perez-de-Heredia M, Brea-Rivero M, et al. Immediate effects on pressure pain threshold following a single cervical spine manipulation in healthy subjects. J Orthop Sports Phys Ther. 2007;37:325-329.
• 18. Natalia M. Oliveira-Campelo, José Rubens- Rebelatto, et al. The immediate effects of atlanto-occipital joint manipulation and suboccipital muscle inhibition technique on active mouth opening and pressure pain sensitivity over latent myofascial trigger points in the masticatory muscles. J Orthop Sports Phys Ther. 2010;40:310-317.
• 19. Kose G, Hepguler S, Atamaz F, et al. A comparison of four disability scales for Turkish patients with neck pain. J Rehabil Med. 2007;39:358-362.
• 20. Wolfe F, Smythe HA, Yunus MB, et al. The American College of Rheumatology 1990 Criteria for the Classification of Fibromyalgia. Report of the Multicenter Criteria Committee. Arthritis Rheum. 1990;33:160-172.
• 21. Saghaei M. Random allocation software for parallel group randomized trials. BMC Med Res Methodol. 2004;4:26.
• 22. Cyriax JH, Russell, G. Treatment by manipulation, massage and injection. Bailliere: Tindall; 1980.
• 23. Cyriax PJ. Cyriax’s Illustrated of Manual of Orthopaedic Medicin. Oxford: Butterworth Heinemann; 1993.
• 24. Dixon JS, Bird HA. Reproducibility along a 10 cm vertical visual analogue scale. Ann Rheum Dis. 1981;40:87-89.
• 25. Simons DG. Diagnostic criteria of myofascial pain caused by trigger points. J Musculoskelet Pain. 1999;7:111-120.
• 26. Gerwin RD, Shannon S, Hong CZ, et al. Interrater reliability in myofascial trigger point examination. Pain. 1997;69:65-73.
• 27. Gam AN, Warming S, Larsen LH, et al. Treatment of myofascial trigger-points with ultrasound combined with massage and exercise-a randomized controlled trial. Pain. 1998;77:73-79.
• 28. Youdas JW, Carey JR, Garrett TR. Reliability of measurements of cervical spine range of motion-comparison of three methods. Phys Ther. 1991;71:98-104.
• 29. Wheeler AH, Goolkasian P, Baird AC, et al. Development of the Neck Pain and Disability Scale: Item analysis, face, and criterion related validity. Spine.1999;24:1290-1294.
• 30. Bicer A, Yazici A, Camdeviren H, et al. Assessment of pain and disability in patients with chronic neck pain: reliability and construct validity of the Turkish version of the neck pain and disability scale. Disabil Rehabil. 2004;26:959-962.
• 31. Cohen J. Statistical power analysis for the behavioural sciences. New York: Academic Press; 1977.
• 32. Redmond A, Keenan AM. Understanding statistics: putting p values into perspective. Am J Prev Med. 2000;34:125-131.
• 33. Guyatt GH, Osoba D, Wu AW, et al. Methods to explain the clinical significance of health status measures. Mayo Clin Proc. 2002;77:371-383.
• 34. Gross A, Langevin P, Burnie SJ, et al. Manipulation and mobilisation for neck pain contrasted against an inactive control or another active treatment (Review). Cochrane Database Syst Rev. 2015 Sep 23;(9):CD004249.
• 35. van der Velde G, Hogg-Johnson S, Bayoumi AM, et al. Identifying the best treatment among common nonsurgical neck pain treatments: a decision analysis. Spine. 2008;33:184-191.
• 36. Wong JJ, Shearer HM, Mior S, et al. Are manual therapies, passive physical modalities, or acupuncture effective for the management of patients with whiplash-associated disorders or neck pain and associated disorders? An update of the Bone and Joint Decade Task Force on Neck Pain and Its Associated Disorders by the OPTIMa collaboration. Spine J. 2016;16:1598-1630.
• 37. Vernon H, Humphreys BK. Manual therapy for neck pain: an overview of randomized clinical trials and systematic reviews. Eura Medicophys. 2007;43:91-118.
• 38. Hurwitz EL, Carragee EJ, van der Velde G, et al. Bone and Joint Decade 2000-2010 Task Force on Neck Pain and Its Associated Disorders. Treatment of neck pain: noninvasive interventions: results of the Bone and Joint Decade 2000-2010 Task Force on Neck Pain and Its Associated Disorders. Spine. 2008;33:123-152.
• 39. Dugeny A, Cagnie B, Pitance L. The efficacy of manual therapy and exercise for treating nonspecific neck pain: A systematic review. J Back Musculoskelet Rehabil. 2017;30:1149-1169.
• 40. Kanlayanaphotporn R, Chiradejnant A, Vachalathiti R. The immediate effects of mobilization technique on pain and range of motion in patients presenting with unilateral neck pain: a randomized controlled trial. Arch Phys Med Rehabil. 2009;90:187-192.
• 41. Cassidy JD, Lopes AA, Yong-Hing K. The immediate effect of manipulation versus mobilization on pain and range of motion in the cervical spine: a randomized controlled trial. J Manipulative Physiol Ther. 1992;15:570-575.
• 42. Bronfort G, Evans R, Nelson B, et al. A randomized clinical trial of exercise and spinal manipulation for patients with chronic neck pain. Spine. 2001;26:788-797.
• 43. Gross A, Langevin P, Burnie SJ, et al. Manipulation and mobilisation for neck pain contrasted against an inactive control or another active treatment (Review). Cochrane Database Syst Rev. 2016;9:57-60