EMG Biofeedback and Exercise for Treatment of Cervical and Shoulder Pain in Individuals with a Spinal Cord Injury: A Pilot Study

Abstract

Background: Chronic or recurrent musculoskeletal pain in the cervical and shoulder region is a common secondary problem after spinal cord injury (SCI), reported by 30% to 70% of individuals. Objective: The purpose of this study was to investigate the effect of electromyographic (EMG) biofeedback training, in addition to a standard exercise program, on reducing shoulder pain in manual wheelchair users with SCI. Methods: Fifteen individuals with SCI, C6 or lower, who were manual wheelchair users with shoulder pain were randomly assigned to 1 of 2 interventions. The Exercise group (n = 7) received instruction on a standard home-based exercise program. The EMG Biofeedback plus Exercise group (n = 8) received identical exercise instruction plus EMG biofeedback training to improve muscle balance and muscle relaxation during wheelchair propulsion. Shoulder pain was assessed by the Wheelchair Users Shoulder Pain Index (WUSPI) at baseline, at posttest 10 weeks after the start of intervention, and at follow-up 16 weeks after posttest. Results: The number of participants per group allowed only within-group comparisons; however, the findings indicated a beneficial effect from EMG biofeedback training. Shoulder pain, as measured by WUSPI, decreased 64% from baseline to posttest for the EMG Biofeedback plus Exercise group (P = .02). Shoulder pain for the Exercise group decreased a nonsignificant 27%. At follow-up, both groups showed continued improvement, yet the benefit of EMG biofeedback training was still discernible. The EMG Biofeedback plus Exercise group had an 82% reduction in shoulder pain from baseline to follow-up (P = .004), while the Exercise group showed a 63% reduction (P = .03) over the same time period. Conclusions: This study provides preliminary evidence that EMG biofeedback has value when added to an exercise intervention to reduce shoulder pain in manual wheelchair users with SCI. These findings indicate that EMG biofeedback may be valuable in remediating musculoskeletal pain as a secondary condition in SCI. This preliminary conclusion will need to be studied and verified through future work.

The Effects of EMG Biofeedback Training on Shoulder Pain and Muscle Tone of Upper Trapezius in Patients with Spinal Cord Injury

“…In this study, we conducted with EMG biofeedback training for the shoulder pain and muscle overactivity and demonstrated the effect of EMG biofeedback as well as the exercise program consisting of the stretching and strengthening. This results supported the previous research by Ma et al (2011) and by Middaugh et al (2013), which showed the advantages for reducing a pain and decreasing a muscle tone of the neck extensor and the upper trapezius in EMG biofeedback training group as compared with general physiotherapy of pain or active exercise group. In addition, there also demonstrated a significant reduction of pain in exercise group (P<0.001), which is consistent with other previous studies that perform the programs of stretching and strengthening in wheelchair users with a chronic SCI [5][6][7][8][9][10] .…”

“…Manual wheelchair propulsion in chronic SCI, with its highly repetitive muscle activity, puts the wheelchair users at irregular work/rest cycles, and which results in secondary pain. In this case, EMG biofeedback to improve muscle balance and relax muscle tone of the shoulder was effective in pain control, decreasing to 64% compared with pre-treatment 6) .…”

“…Preceding researches have mentioned the needs of standard program, suggesting problems of the various degrees of comprehension and continuance of exercise 5,6) . For that reason, we applied with a modified exercise position for the comfort, considering the level of injury to encourage a maximal participation.…”

“…Also, compressive stress such as weight bearing in the acute SCI phase has proven as one of the causes of the shoulder, elbow, wrist, and hand pain 4) . Many previous studies have suggested muscle strengthening and stretching exercises, which reported that muscle imbalance and repetitive use related to self-care and wheelchair were causes of shoulder pain in the SCI patients [5][6][7][8][9][10] . In addition to muscle strengthening and stretching exercises, biofeedback training have offered to control the pain due to overactive muscle 11) .…”

Effects of a therapeutic exercise program for injuries prevention in wheelchair basketball (WB) players = Efectividad de un programa de ejercicios terapéutico para la prevención de lesiones de jugadores de baloncesto en silla de ruedas (BSR)

“…Different studies suggest that exercise is a useful tool to prevent and treat SP in wheelchair users (Nawoczenski et al, 2006;Van Straaten et al, 2014). The effectiveness of exercise interventions has been studied using programs for stretching and strengthening relevant muscle groups (Curtis et al, 1995a;Nawoczenski et al, 2006;Nash et al, 2008;Mulroy et al, 2011;Middaugh, Thomas, Smith, McFall, & Klingmueller, 2013;Van Straaten et al, 2014). In these studies,…”