Effect of two contrasting types of physical exercise on chronic neck muscle pain

Abstract

Objective. The prevalence of neck muscle pain has steadily increased and especially pain from the descending part of the trapezius muscle has been associated with monotonous work tasks such as computer work. Physical exercise is generally recommended as treatment, but it is unclear which type of training is most effective. Our objective was to determine the effectiveness of specific strength training of the painful muscle versus general fitness training without direct involvement of the painful muscle (leg bicycling) on work-related neck muscle pain. Methods. We conducted a randomized controlled trial and recruited subjects from 7 workplaces characterized by monotonous jobs (e.g., computer-intensive work). Forty-eight employed women with chronic neck muscle pain (defined as a clinical diagnosis of trapezius myalgia) were randomly assigned to 10 weeks of specific strength training locally for the affected muscle, general fitness training performed as leg bicycling with relaxed shoulders, or a reference intervention without physical activity. The main outcome measure was an acute and prolonged change in intensity of neck muscle pain (100-mm visual analog scale [VAS]). Results. A decrease of 35 mm (ϳ79%; P < 0.001) in the worst VAS pain score over a 10-week period was seen with specific strength training, whereas an acute and transient decrease in pain (5 mm; P < 0.05) was found with general fitness training. Conclusion. Specific strength training had high clinical relevance and led to marked prolonged relief in neck muscle pain. General fitness training showed only a small yet statistically significant acute pain reduction.

Poderia a atividade física induzir analgesia em pacientes com dor crônica?

“…O aumento na concentração das três primeiras está correlacionado com a intensidade de dor percebida. Dessa forma, há redução no limiar de ativação dos nociceptores (81,82) . Porém, o paradoxo da hiperalgesia induzida pelo exercício (HIE) é um fenômeno que ocorre somente no SNP e não no SNCl, onde o mecanismo é relativamente menos complexo e mais compreendido.…”

“…Estudos clínicos demonstram que a atividade física reduz a intensidade da dor relatada por pacientes com dores osteoarticulares (17) , lombares (86,87) , fibromiálgicas (15,88) , cervicais (82) , entre outras. Embora haja destaque aos benefícios clínicos do exercício reduzindo a intensidade da dor crônica, os efeitos fisiológicos envolvidos ainda são incertos; algumas vezes, o efeito analgésico é contraditório.…”

“…A exacerbação da dor, com exercícios de alta intensidade, é confirmada por outros autores (22,89) . Para atingir o efeito analgésico, estudos clínico-científicos (15,82,90) destacam a importância da adaptação dos exercícios às condições físicas e fisiológicas dos pacientes (91) , que, além de favorecer a atividade física sem a exacerbação do sintoma álgico, tendem a reduzir a taxa de abandono da atividade.…”

Avaliação da qualidade de vida e do tratamento fisioterapêutico em pacientes com cervicalgia crônica

“…A fisioterapia pode desempenhar um papel importante no tratamento do paciente com dor crônica cervical, pois busca diminuir a dor, recuperar a mobilidade e fortalecer a musculatura, proporcionando, dessa forma, melhora na qualidade de vida (5,6).…”

Authors' Response to Commentary by Drs Sueki and Achhnani on the Article, “Does Exercise Decrease Pain via Conditioned Pain Modulation in Adolescents?”

“…This is an important distinction because pain that occurs with exercise initiation may not reflect pain relief that occurs with exercise training. 12 When starting an exercise program for pain management or other rehabilitation exercise protocols, clients frequently report pain with exercise. Consequently, pain with exercise may not be avoided and should be addressed by physical therapists.…”