Can Modified Neuromuscular Training Support the Treatment of Chronic Pain in Adolescents?

Thomas, Staci; Kashikar‐Zuck, Susmita; Myer, Gregory D.

doi:10.1519/ssc.0b013e31829206c1

Cited by 14 publications

(16 citation statements)

References 25 publications

(25 reference statements)

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“…Integrative neuromuscular training programs have been shown to improve deficits in patients who have lower extremity injuries (21, 26, 58–62). Similarly, biomechanical measures can be used as an innovative method to assess the effectiveness of integrative training programs in improving physical functioning in patients with JFM (63, 64). For youth with JFM, an integrative neuromuscular program should involve specialized instruction in fundamental movements and strength building while minimizing pain flare-ups and delayed-onset muscle soreness, which can contribute to reduced physical performance and activity avoidance (63, 65).…”

Section: Discussionmentioning

confidence: 99%

“…Similarly, biomechanical measures can be used as an innovative method to assess the effectiveness of integrative training programs in improving physical functioning in patients with JFM (63, 64). For youth with JFM, an integrative neuromuscular program should involve specialized instruction in fundamental movements and strength building while minimizing pain flare-ups and delayed-onset muscle soreness, which can contribute to reduced physical performance and activity avoidance (63, 65). Such a treatment approach may improve the motor skills and confidence that youth with JFM require to engage in activity while simultaneously addressing psychological contributors to enhance motivation and adherence, thus affording them the opportunity to integrate regular exercise into their lifestyle and achieve better pain management.…”

Section: Discussionmentioning

confidence: 99%

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Preliminary Evidence of Altered Biomechanics in Adolescents With Juvenile Fibromyalgia

Thomas

DiCesare

Strotman

et al. 2014

Arthritis Care & Research

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Objective Juvenile Fibromyalgia (JFM) is characterized by chronic musculoskeletal pain and marked reduction in physical activity. Despite recommendations for exercise to manage JFM pain, exercise adherence is poor. Due to pain and activity avoidance, adolescents with JFM are at risk for altered joint mechanics that may make them susceptible to increased pain and reduced tolerance for exercise. The primary aim of this study was to assess functional deficits in patients with JFM compared to healthy controls using objective biomechanical assessment. Methods Female adolescent patients with JFM (n=17) and healthy controls (n=14) completed biomechanical assessments including gait analysis and tests of lower extremity strength (isokinetic knee extension/flexion, hip abduction) and functional performance (Drop Vertical Jump) along with self-report measures of disability (Functional Disability Inventory), pain intensity, depressive symptoms (Children’s Depression Inventory), and fear of movement (Tampa Scale of Kinesiophobia). Results Patients with JFM demonstrated mild deficiencies in walking gait and functional performance (p’s <. 05), significantly lower left knee extension and flexion strength (19–26% deficit) and bilateral hip abduction strength (33–37%) compared to healthy controls (p’s < .008). Patients with JFM reported significantly higher functional disability, pain intensity, depressive symptoms, and fear of movement relative to controls (p’s < 0.01). Conclusions This study showed that adolescents with JFM exhibited objective alterations in biomechanics, and self-reported fear of movement which may reinforce their activity avoidance. Interventions for JFM should include a focus on correcting functional deficits and instilling greater confidence in adolescents with JFM to engage in exercise to improve functional outcomes.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Preliminary Evidence of Altered Biomechanics in Adolescents With Juvenile Fibromyalgia

Thomas

DiCesare

Strotman

et al. 2014

Arthritis Care & Research

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“…The specialized resistive training protocol used in neuromuscular training progressed through four levels focusing on a different muscle action; Level 1: Holding Exercises, Level 2: Creating Movement Exercises, Level 3: Resisting Movement Exercises, and Level 4: Functional Movement Exercises (see Table 1. for a description of each level of progression along with an illustrative example; complete protocol published in Thomas et al [46]). The progression of exercises was collectively designed in order to reduce muscle pain and delayed-onset muscle soreness by moving from most basic isometric “hold” exercises to concentric “muscle shortening” exercises to eccentric “muscle lengthening” exercises to the full range of motion for “functional movement”.…”

Section: Methodsmentioning

confidence: 99%

A Qualitative Examination of a New Combined Cognitive-Behavioral and Neuromuscular Training Intervention for Juvenile Fibromyalgia

Kashikar‐Zuck

Tran²,

Barnett³

et al. 2016

The Clinical Journal of Pain

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Objectives Adolescents with juvenile fibromyalgia (JFM) are typically sedentary despite recommendations for physical exercise, a key component of pain management. Interventions such as cognitive behavioral therapy (CBT) are beneficial but do not improve exercise participation. The objective of this study was to obtain preliminary information about the feasibility, safety, and acceptability of a new intervention - Fibromyalgia Integrative Training for Teens (FIT Teens), which combines CBT with specialized neuromuscular exercise training modified from evidence-based injury prevention protocols. Methods Participants were 17 adolescent females (ages 12–18) with JFM. Of these, 11 completed the 8-week (16-session) FIT Teens program in a small-group format with 3–4 patients per group. Patients provided detailed qualitative feedback via individual semi-structured interviews after treatment. Interview content was coded using thematic analysis. Interventionist feedback about treatment implementation was also obtained. Results The intervention was found to be feasible, well-tolerated, and safe for JFM patients. Barriers to enrollment (50% of those approached) included difficulties with transportation or time conflicts. Treatment completers enjoyed the group format and reported increased self-efficacy, strength, and motivation to exercise. Participants also reported decreased pain and increased energy levels. Feedback from participants and interventionists was incorporated into a final treatment manual to be used in a future trial. Discussion Results of this study provided initial support for the new FIT Teens program. An integrative strategy of combining pain coping skills via CBT enhanced with tailored exercise specifically designed to improve confidence in movement and improving activity participation holds promise in the management of JFM.

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“…This new approach is currently being tested in a small-scale clinical trial by our research group to see if neuromuscular training, when combined with psychological coping skills training, facilitates increased activity levels and more engagement with vigorous exercise in adolescents with JFM. 119 …”

Section: Treatment and Managementmentioning

confidence: 99%

Juvenile fibromyalgia: current status of research and future developments

Kashikar‐Zuck

Ting

2013

Nat Rev Rheumatol

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Juvenile-onset fibromyalgia (JFM) is a poorly understood chronic pain condition most commonly affecting adolescent girls. The condition is characterized by widespread musculoskeletal pain and other associated symptoms, including fatigue, nonrestorative sleep, headaches, irritable bowel symptoms, dysautonomia and mood disorders such as anxiety and/or depression. In the past few years, there has been a greater focus on understanding JFM in adolescents. Research studies have provided insight into the clinical characteristics of this condition and its effect on both short-term and long-term psychosocial and physical functioning. The importance of early and effective intervention is being recognized, as research has shown that symptoms of JFM tend to persist and do not resolve over time as was previously believed. Efforts to improve treatments for JFM are underway, and new evidence strongly points to the potential benefits of cognitive–behavioural therapy on improving mood and daily functioning. Research into pharmacotherapy and other nonpharmacological options is in progress. Advancements in the understanding of adult fibromyalgia have paved the way for future studies on diagnosis, assessment and management of JFM. This Review focuses on our current knowledge of the condition, provides an update of the latest research advances, and highlights areas for further study.

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Can Modified Neuromuscular Training Support the Treatment of Chronic Pain in Adolescents?

Cited by 14 publications

References 25 publications

Preliminary Evidence of Altered Biomechanics in Adolescents With Juvenile Fibromyalgia

Preliminary Evidence of Altered Biomechanics in Adolescents With Juvenile Fibromyalgia

A Qualitative Examination of a New Combined Cognitive-Behavioral and Neuromuscular Training Intervention for Juvenile Fibromyalgia

Juvenile fibromyalgia: current status of research and future developments

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