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      Effect of Global Posture Reeducation and of Static Stretching on Pain, Range of Motion, and Quality of Life in Women with Chronic Neck Pain: A Randomized Clinical Trial

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          Abstract

          PURPOSE

          Compare the effect of conventional static stretching and muscle chain stretching, as proposed by the global posture reeducation method, in the manual therapy of patients with chronic neck pain.

          METHODS

          Thirty-three female patients aged 35 to 60 years old, 31 of whom completed the program, were randomly divided into two groups: The global posture reeducation group (n=15) performed muscle chain stretching, while the conventional stretching group (n=16) performed conventional static muscle stretching. Both groups also underwent manual therapy. Patients were evaluated before and after treatment and at a six-week follow-up appointment and tested for pain intensity (by means of visual analog scale), range of motion (by goniometry), and health-related quality of life (by the SF-36 questionnaire). The treatment program consisted of two 1-hour individual sessions per week for six weeks. Data were statistically analyzed at a significance level of p<0.05.

          RESULTS

          Significant pain relief and range of motion improvement were observed after treatment in both groups, with a slight reduction at follow-up time. Quality of life also improved after treatment, except for the global posture reeducation group in one domain; at follow-up, there was improvement in all domains, except that both groups reported increased pain. There were no significant differences between groups

          CONCLUSION

          Conventional stretching and muscle chain stretching in association with manual therapy were equally effective in reducing pain and improving the range of motion and quality of life of female patients with chronic neck pain, both immediately after treatment and at a six-week follow-up, suggesting that stretching exercises should be prescribed to chronic neck pain patients.

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          Most cited references96

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          Clinical measurement of range of motion. Review of goniometry emphasizing reliability and validity.

          Clinical measurement of range of motion is a fundamental evaluation procedure with ubiquitous application in physical therapy. Objective measurements of ROM and correct interpretation of the measurement results can have a substantial impact on the development of the scientific basis of therapeutic interventions. The purpose of this article is to review the related literature on the reliability and validity of goniometric measurements of the extremities. Special emphasis is placed on how the reliability of goniometry is influenced by instrumentation and procedures, differences among joint actions and body regions, passive versus active measurements, intratester versus intertester measurements, and different patient types. Our discussion of validity encourages objective interpretation of the meaning of ROM measurements in light of the purposes and the limitations of goniometry. We conclude that clinicians should adopt standardized methods of testing and should interpret and report goniometric results as ROM measurements only, not as measurements of factors that may affect ROM.
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            The effect of time and frequency of static stretching on flexibility of the hamstring muscles.

            Frequency and duration of static stretching have not been extensively examined. Additionally, the effect of multiple stretches per day has not been evaluated. The purpose of this study was to determine the optimal time and frequency of static stretching to increase flexibility of the hamstring muscles, as measured by knee extension range of motion (ROM). Ninety-three subjects (61 men, 32 women) ranging in age from 21 to 39 years and who had limited hamstring muscle flexibility were randomly assigned to one of five groups. The four stretching groups stretched 5 days per week for 6 weeks. The fifth group, which served as a control, did not stretch. Data were analyzed with a 5 x 2 (group x test) two-way analysis of variance for repeated measures on one variable (test). The change in flexibility appeared to be dependent on the duration and frequency of stretching. Further statistical analysis of the data indicated that the groups that stretched had more ROM than did the control group, but no differences were found among the stretching groups. The results of this study suggest that a 30-second duration is an effective amount of time to sustain a hamstring muscle stretch in order to increase ROM. No increase in flexibility occurred when the duration of stretching was increased from 30 to 60 seconds or when the frequency of stretching was increased from one to three times per day.
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              A randomized clinical trial of exercise and spinal manipulation for patients with chronic neck pain.

              A randomized, parallel-group, single-blinded clinical trial was performed. After a 1-week baseline period, patients were randomized to 11 weeks of therapy, with posttreatment follow-up assessment 3, 6, and 12 months later. To compare the relative efficacy of rehabilitative neck exercise and spinal manipulation for the management of patients with chronic neck pain. Mechanical neck pain is a common condition associated with substantial morbidity and cost. Relatively little is known about the efficacy of spinal manipulation and exercise for chronic neck pain. Also, the combination of both therapies has yet to be explored. Altogether, 191 patients with chronic mechanical neck pain were randomized to receive 20 sessions of spinal manipulation combined with rehabilitative neck exercise (spinal manipulation with exercise), MedX rehabilitative neck exercise, or spinal manipulation alone. The main outcome measures were patient-rated neck pain, neck disability, functional health status (as measured by Short Form-36 [SF-36]), global improvement, satisfaction with care, and medication use. Range of motion, muscle strength, and muscle endurance were assessed by examiners blinded to patients' treatment assignment. Clinical and demographic characteristics were similar among groups at baseline. A total of 93% of the patients completed the intervention phase. The response rate for the 12-month follow-up period was 84%. Except for patient satisfaction, where spinal manipulative therapy and exercise were superior to spinal manipulation with (P = 0.03), the group differences in patient-rated outcomes after 11 weeks of treatment were not statistically significant (P = 0.13). However, the spinal manipulative therapy and exercise group showed greater gains in all measures of strength, endurance, and range of motion than the spinal manipulation group (P < 0.05). The spinal manipulation with exercise group also demonstrated more improvement in flexion endurance and in flexion and rotation strength than the MedX group (P < 0.03). The MedX exercise group had larger gains in extension strength and flexion-extension range of motion than the spinal manipulation group (P < 0.05). During the follow-up year, a greater improvement in patient-rated outcomes were observed for spinal manipulation with exercise and for MedX exercise than for spinal manipulation alone (P = 0.01). Both exercise groups showed very similar levels of improvement in patient-rated outcomes, although the spinal manipulation and exercise group reported greater satisfaction with care (P < 0.01). For chronic neck pain, the use of strengthening exercise, whether in combination with spinal manipulation or in the form of a high-technology MedX program, appears to be more beneficial to patients with chronic neck pain than the use of spinal manipulation alone. The effect of low-technology exercise or spinal manipulative therapy alone, as compared with no treatment or placebo, and the optimal dose and relative cost effectiveness of these therapies, need to be evaluated in future studies.
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                Author and article information

                Journal
                Clinics
                Clinics (Sao Paulo, Brazil)
                Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo
                1807-5932
                1980-5322
                December 2008
                : 63
                : 6
                : 763-770
                Affiliations
                [I ] Physical Therapy Department, Universidade Estadual de Londrina (UEL) – Londrina/PR, Brazil
                [II ] Department of Speech, Physical and Occupational Therapy, Faculdade de Medicina, Universidade de São Paulo - São Paulo/SP, Brazil. Email: pasqual@ 123456usp.br , Tel.: 55 11 3091.8423
                Article
                cln63_6p0763
                10.1590/S1807-59322008000600010
                2664276
                19060998
                39a168cf-9fe2-4832-b15a-0698de5b3176
                Copyright © 2008 Hospital das Clínicas da FMUSP
                History
                : 26 May 2008
                : 26 August 2008
                Categories
                Research

                Medicine
                neck pain,physical therapy,muscle stretching exercises
                Medicine
                neck pain, physical therapy, muscle stretching exercises

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