Effects of high frequency strengthening on pain sensitivity and function in female runners with chronic patellofemoral pain.

OBJECTIVE: To investigate the effects of a high frequency strengthening program on function, pain, and pain sensitization in female runners with chronic patellofemoral pain (PFP). DESIGN: Cross-sectional study. SETTING: University laboratory. PARTICIPANTS: Thirty female runners (mean age 32 ± 8.1 years) with chronic PFP completed an 8-week home strengthening program. MAIN OUTCOME MEASURES: Variables assessed at baseline, 8-weeks, and 12 weeks included single leg step down test (SLSD), pain, Anterior Knee Pain Scale (AKPS), University of Wisconsin Running Injury and Recovery Index (UWRI), and quantitative sensory testing. RESULTS: There was large and statistically significant improvement at 8 and 12 weeks for average knee pain (ηp2 = 0.334, p < 0.001), worst knee pain (ηp2 = 0.351, p < 0.001), SLSD (ηp2 = 0.161, p = 0.001), AKPS (ηp2 = 0.463, p < 0.001), and UWRI (ηp2 = 0.366, p < 0.001). A medium to large effect and statistically significant improvement in pressure pain threshold testing was found for all local and remote structures (ηp2 range, 0.110 to 0.293, range p < 0.001 to p = 0.009) at 8 and 12 weeks. CONCLUSIONS: There was a significant decrease in local and remote hyperalgesia via mechanical and thermal pain sensitivity testing in female runners with chronic PFP. There was a large effect and significant improvement in self-reported pain and function.

The relationship of behavioral and psychological traits with pain sensitivity in females with patellofemoral pain: A cross-sectional study.

OBJECTIVE: The purpose of this study was to describe the relationship between behavioral and psychological traits with indicators of central sensitization in female runners with patellofemoral pain (PFP), and to determine if behavioral and psychological traits improve with strength training. DESIGN: Cross-sectional study. SETTING: University laboratory. PARTICIPANTS: Twenty-eight active females (mean age 32 ± 8.1 years) with PFP completed testing at baseline, 8 weeks (post intervention), and 12 weeks. MAIN OUTCOME MEASURES: Behavioral and psychological questionnaires included the General Anxiety Disorder-7, Patient Health Questionairre-9, Pain Catastrophizing Scale, Tampa Scale of Kinesiophobia-11, and Central Sensitization Inventory. Quantitative sensory testing (QST) measures were also collected. After baseline testing, subjects were instructed in a hip and knee strengthening intervention to be completed twice daily over 8 weeks. RESULTS: A statistically significant improvement was found at 12 weeks for anxiety (p = .015; ηp (Boling et al., 2010) = 0.099) and kinesiophobia (p = .041; ηp (Boling et al., 2010) = 0.076). There was no significant improvement for depression, catastrophizing, or subjective central sensitization. No significant correlations were found between any of the behavioral and psychological questionnaires with baseline QST variables. CONCLUSIONS: No relationship was found for behavioral and psychological characteristics with QST measures in female runners with persistent PFP.

Signs of Nervous System Sensitization in Female Runners with Chronic Patellofemoral Pain.

Background: Patellofemoral pain (PFP) is a common overuse injury among runners, affecting females at a higher rate than males. PFP can often become chronic, with evidence suggesting it may be linked to both peripheral and central sensitization of the nervous system. Sensitization of the nervous system can be identified through quantitative sensory testing (QST). Hypothesis/Purpose: The primary objective of this pilot study was to quantify and compare pain sensitivity as identified through QST measures, in active female runners with and without PFP. Study Design: Cohort Study. Methods: Twenty healthy female runners and 17 female runners with chronic PFP symptoms were enrolled. Subjects completed the Knee injury and Osteoarthritis Outcome Score for Patellofemoral Pain (KOOS-PF), University of Wisconsin Running Injury and Recovery Index (UWRI), and the Brief Pain Inventory (BPI). QST consisted of pressure pain threshold testing to three local and three distant sites to the knee, heat temporal summation, heat pain threshold, and conditioned pain modulation. Data was analyzed utilizing independent t-tests for comparison of between-group data, effect sizes for QST measures (Pearson's r), and Pearson's correlation coefficient between pressure pain threshold values at the knee and functional testing. Results: The PFP group exhibited significantly lower scores on the KOOS-PF (p<0.001), BPI Pain Severity and Interference Scores (p<0.001), and UWRI (p<0.001). Primary hyperalgesia, identified through decreased pressure pain threshold at the knee, was detected in the PFP group at the central patella (p<0.001), lateral patellar retinaculum (p=0.003), and patellar tendon (p=0.006). Secondary hyperalgesia, a sign of central sensitization, was observed via differences in pressure pain threshold testing for the PFP group at the uninvolved knee (p=0.012 to p=0.042), involved extremity remote sites (p=0.001 to p=0.006), and uninvolved extremity remote sites (p=0.013 to p=0.021). Conclusion: Compared to healthy controls, female runners with chronic PFP symptoms exhibit signs of both peripheral sensitization. Despite actively participating in running, nervous system sensitization may contribute to continued pain in these individuals. For female runners with chronic PFP, physical therapy management may need to include interventions which address signs of central and peripheral sensitization. Level of Evidence: Level 3.

Self-Reported Disability in Persons With HIV-Related Neuropathy Is Mediated by Pain Interference and Depression.

OBJECTIVE: The purpose of this study was to compare disability in people with HIV and peripheral neuropathy with those without neuropathy and explore how neuropathy and other relevant factors are associated with disability. METHODS: In this cross-sectional study, participants completed the Brief pain inventory, Beck Depression Inventory II, World Health Organization Disability Assessment Schedule (WHODAS 2.0), and a health and demographic questionnaire. Additional data were extracted from the medical record. A raw score of ≥1 on the Subjective Peripheral Neuropathy Screen questions about lower extremity numbness or paresthesia was used to identify peripheral neuropathy. Predictors of disability (as determined by association with World Health Organization Disability Assessment Schedule 2.0 scores) were evaluated bivariately and in a multivariable model. Path modeling was used to identify a parsimonious model to elucidate the mediated effects of peripheral neuropathy on disability. RESULTS: Participants with peripheral neuropathy had more depression symptoms, more pain (severity and interference), and higher disability scores compared with participants without neuropathy. The relationship between neuropathy and disability was mediated by pain interference and depression (standardized root mean residual = .056). CONCLUSION: In this sample of people with HIV, those with lower extremity peripheral neuropathy reported more severe disability, worse pain, and more depression symptoms than those without neuropathy. The relationship between peripheral neuropathy and disability may be mediated though pain interference and depression. IMPACT: Distal sensory polyneuropathy is a common comorbidity experienced by people living with HIV and frequently causes pain. This study can help providers direct care toward lessening disability experienced among people with HIV and peripheral neuropathy by targeting interventions for treatment of pain and depression. LAY SUMMARY: People living with HIV may experience disabling painful neuropathy. Treatment for pain and depression may help reduce the disability associated with painful neuropathy.

PAIN SENSITIVITY IN CHRONIC ACHILLES TENDINOPATHY.

BACKGROUND: Achilles tendinopathy is a common overuse injury sustained by athletes (including runners) that often becomes chronic. There is evidence that chronic musculoskeletal pain conditions exhibit signs of nervous system sensitization. HYPOTHESIS/PURPOSE: The objective of this study was to compare pain sensitivity (pressure pain threshold [PPT], heat pain threshold [HPT], and heat temporal summation [HTS]) between active healthy adults with and without chronic Achilles tendinopathy in order to determine if signs of peripheral and/or central sensitization exist in chronic Achilles tendinopathy. STUDY DESIGN: Cohort study. METHODS: Seventeen participants with chronic ( ≥ 3 months) Achilles tendinopathy (39.0 years ± 10.81) and 24 healthy controls (31.83 years ± 8.92) were included. All participants completed the Pain Catastrophizing Scale (PCS). Participants in the Achilles group also completed the Lower Extremity Functional Scale (LEFS) and the Victorian Institute of Sport Assessment-Achilles (VISA-A). Pain processing was quantified using PPT, HPT and HTS tests. RESULTS: There were no significant differences in PCS scores between groups. In the Achilles tendinopathy group, the mean VISA-A score was 58.5 ± 18.4; the mean LEFS was 63.7 ± 8.0. Primary hyperalgesia (decreased pain threshold at injury site) was detected in the Achilles tendinopathy group, as evidenced by lower PPT (p<0.0001) and lower HPT (p = 0.028). Mechanical secondary hyperalgesia, a sign of central sensitization, was found in the Achilles tendinopathy group at the tibialis anterior (p = 0.042) and non-involved Achilles (p = 0.025), but not at the thenar eminence (p = 0.276). The degree of HTS was not different between groups (p = 0.981). CONCLUSION: Active participants with chronic Achilles tendinopathy showed signs of both peripheral and central sensitization; however, widespread hyperalgesia into the upper extremities and elevated temporal summation were not observed. Evidence of differences in pain sensitivity lend support to the theory for a multifactorial model of tendinopathy, which consists of an impaired motor system, local tendon pathology, and changes in the pain/nociceptive system. Physical therapy management of chronic Achilles tendinopathy may need to address potential changes in the nervous system. Interventions used to treat chronic tendinopathies should be investigated for their potential to resolve peripheral and central sensitization. LEVEL OF EVIDENCE: Therapy, level 2b.

Effectiveness of Manual Therapy for Pain and Self-reported Function in Individuals With Patellofemoral Pain: Systematic Review and Meta-analysis.

Study Design Systematic literature review with meta-analysis. Background Management of patellofemoral pain (PFP) may include the utilization of manual therapy (MT) techniques to the patellofemoral joint, surrounding soft tissues, and/or lumbopelvic region. Objectives To determine the effectiveness of MT, used alone or as an adjunct intervention, compared to standard treatment or sham for reducing pain and improving self-reported function in individuals with PFP. Methods An electronic literature search was conducted in the PubMed, Ovid, Cochrane Central Register of Controlled Trials, and CINAHL databases for studies investigating MT for individuals with PFP. Studies published through August 2017 that compared MT (local or remote to the knee), used alone or in combination with other interventions, to control or sham interventions were included. Patient-reported pain and functional outcomes were collected and synthesized. Trials were assessed via the Cochrane risk-of-bias tool, and a meta-analysis of the evidence was performed. Results Nine studies were included in the review, 5 of which were rated as having a low risk of bias. The use of MT, applied to the local knee structure, was associated with favorable short-term changes in self-reported function and pain in individuals with PFP, when compared to a comparison (control or sham) intervention. However, the changes were clinically meaningful only for pain (defined as a 2-cm or 2-point improvement on a visual analog scale or numeric pain-rating scale). The evidence regarding lumbopelvic manipulation was inconclusive for pain improvement in individuals with PFP, based on 3 studies. Conclusion The data from this review cautiously suggest that MT may be helpful in the short term for decreasing pain in patients with PFP. Several studies integrated MT into a comprehensive treatment program. Changes in self-reported function with the inclusion of MT were shown to be significant, but not clinically meaningful. The limitations in the studies performed to date suggest that future research should determine the optimal techniques and dosage of MT and perform longer follow-up to monitor long-term effects. Level of Evidence Therapy, level 1a. J Orthop Sports Phys Ther 2018;48(5):358-371. Epub 6 Jan 2018. doi:10.2519/jospt.2018.7243.

Evolution of an International Research Collaborative in HIV and Rehabilitation: Community Engaged Process, Lessons Learned, and Recommendations.

BACKGROUND: Human immunodeficiency virus (HIV) is increasingly considered a chronic illness. Rehabilitation can address some of the health challenges of people living with HIV (PLWHIV); however, the field is emerging. OBJECTIVES: We describe our experience establishing an international collaborative in HIV and rehabilitation research using a community engaged approach. METHODS: The Canada-UK (now Canada-International) HIV and Rehabilitation Research Collaborative (CIHRRC) is a network of more than 85 PLWHIV, researchers, clinicians, and representatives from community-based organizations collectively working to advance knowledge on HIV and rehabilitation. RESULTS: Activities and outcomes include facilitating knowledge transfer and exchange (KTE), establishing and strengthening multistakeholder partnerships, and identifying new and emerging priorities in the field. Collaboration and support from community organizations fostered mechanisms to raise the profile of, and evidence for, rehabilitation in the context of HIV. Considerations of scope, partnership, and sustainability are important. We offer recommendations for developing an international community-academic-clinical research collaborative using a community-engaged approach. CONCLUSIONS: Research networks involving community-academic-clinical partnerships can help to promote KTE and establish a coordinated response for addressing priorities in an emerging field.

Mobile input device type, texting style and screen size influence upper extremity and trapezius muscle activity, and cervical posture while texting.

This study aimed to determine the effects of input device type, texting style, and screen size on upper extremity and trapezius muscle activity and cervical posture during a short texting task in college students. Users of a physical keypad produced greater thumb, finger flexor, and wrist extensor muscle activity than when texting with a touch screen device of similar dimensions. Texting on either device produced greater wrist extensor muscle activity when texting with 1 hand/thumb compared with both hands/thumbs. As touch screen size increased, more participants held the device on their lap, and chose to use both thumbs less. There was also a trend for greater finger flexor, wrist extensor, and trapezius muscle activity as touch screen size increased, and for greater cervical flexion, although mean differences for cervical flexion were small. Future research can help inform whether the ergonomic stressors observed during texting are associated with musculoskeletal disorder risk.

Dry needling for management of pain in the upper quarter and craniofacial region.

Dry needling is a therapeutic intervention that has been growing in popularity. It is primarily used with patients that have pain of myofascial origin. This review provides background about dry needling, myofascial pain, and craniofacial pain. We summarize the evidence regarding the effectiveness of dry needling. For patients with upper quarter myofascial pain, a 2013 systematic review and meta-analysis of 12 randomized controlled studies reported that dry needling is effective in reducing pain (especially immediately after treatment) in patients with upper quarter pain. There have been fewer studies of patients with craniofacial pain and myofascial pain in other regions, but most of these studies report findings to suggest the dry needling may be helpful in reducing pain and improving other pain related variables such as the pain pressure threshold. More rigorous randomized controlled trials are clearly needed to more fully elucidate the effectiveness of dry needling.

Quality of life and self-reported lower extremity function in adults with HIV-related distal sensory polyneuropathy.

BACKGROUND: Distal sensory polyneuropathy (DSP) is a common complication of HIV disease. Its effects on quality of life (QOL) and function have not been well described. OBJECTIVE: The study objectives were: (1) to compare QOL and lower extremity function in people with HIV-related DSP and people with HIV disease who do not have DSP, (2) to determine the extent to which function predicts QOL, (3) to evaluate the agreement of 2 function scales, and (4) to describe the use of pain management resources. DESIGN: This was a cross-sectional survey study with predictive modeling and measurement tool concordant validation. METHODS: A demographic questionnaire, the Medical Outcomes Study HIV Health Survey, the Lower Extremity Functional Scale (LEFS), the Lower Limb Functional Index (LLFI), and a review of medical records were used. General linear modeling was used to assess group differences in QOL and the relationship between function and QOL. Bland-Altman procedures were used to assess the agreement of the LEFS and the LLFI. RESULTS: Usable data for analyses were available for 82 of the 94 participants enrolled. The 67% of participants who reported DSP symptoms tended to be older, had HIV disease longer, and were more likely to receive disability benefits. Participants without DSP had better LLFI, LEFS, and physical health summary scores. In multivariate models, lower limb function predicted physical and mental health summary scores. The LLFI identified participants with a lower level of function more often than the LEFS. Participants with DSP were more likely to use medical treatment, physical therapy, and complementary or alternative treatments. LIMITATIONS: A sample of convenience was used; the sample size resulted in a low power for the mental health summary score of the Medical Outcomes Study HIV Health Survey. CONCLUSIONS: Quality of life and function were more impaired in participants with HIV disease and DSP. The LLFI was more likely to capture limitations in function than the LEFS. Participants with DSP reported more frequent use of pain management resources.

Effectiveness of dry needling for upper-quarter myofascial pain: a systematic review and meta-analysis.

STUDY DESIGN: Systematic review and meta-analysis. BACKGROUND: Myofascial pain syndrome (MPS) is associated with hyperalgesic zones in muscle called myofascial trigger points. When palpated, active myofascial trigger points cause local or referred symptoms, including pain. Dry needling involves inserting an acupuncture-like needle into a myofascial trigger point, with the goal of reducing pain and restoring range of motion. OBJECTIVE: To explore the evidence regarding the effectiveness of dry needling to reduce pain in patients with MPS of the upper quarter. METHODS: An electronic literature search was performed using the key word dry needling. Articles identified with the search were screened for the following inclusion criteria: human subjects, randomized controlled trial (RCT), dry needling intervention group, and MPS involving the upper quarter. The RCTs that met these criteria were assessed and scored for internal validity using the MacDermid Quality Checklist. Four separate meta-analyses were performed: (1) dry needling compared to sham or control immediately after treatment, (2) dry needling compared to sham or control at 4 weeks, (3) dry needling compared to other treatments immediately after treatment, and (4) dry needling compared to other treatments at 4 weeks. RESULTS: The initial search yielded 246 articles. Twelve RCTs were ultimately selected. The methodological quality scores ranged from 23 to 40 points, with a mean of 34 points (scale range, 0-48; best possible score, 48). The findings of 3 studies that compared dry needling to sham or placebo treatment provided evidence that dry needling can immediately decrease pain in patients with upper-quarter MPS, with an overall effect favoring dry needling. The findings of 2 studies that compared dry needling to sham or placebo treatment provided evidence that dry needling can decrease pain after 4 weeks in patients with upper-quarter MPS, although a wide confidence interval for the overall effect limits the impact of the effect. Findings of studies that compared dry needling to other treatments were highly heterogeneous, most likely due to variance in the comparison treatments. There was evidence from 2 studies that lidocaine injection may be more effective in reducing pain than dry needling at 4 weeks. CONCLUSION: Based on the best current available evidence (grade A), we recommend dry needling, compared to sham or placebo, for decreasing pain immediately after treatment and at 4 weeks in patients with upper-quarter MPS. Due to the small number of high-quality RCTs published to date, additional well-designed studies are needed to support this recommendation. LEVEL OF EVIDENCE: Therapy, level 1a-.

Aging contributes to inflammation in upper extremity tendons and declines in forelimb agility in a rat model of upper extremity overuse.

We sought to determine if tendon inflammatory and histopathological responses increase in aged rats compared to young rats performing a voluntary upper extremity repetitive task, and if these changes are associated with motor declines. Ninety-six female Sprague-Dawley rats were used in the rat model of upper extremity overuse: 67 aged and 29 young adult rats. After a training period of 4 weeks, task rats performed a voluntary high repetition low force (HRLF) handle-pulling task for 2 hrs/day, 3 days/wk for up to 12 weeks. Upper extremity motor function was assessed, as were inflammatory and histomorphological changes in flexor digitorum and supraspinatus tendons. The percentage of successful reaches improved in young adult HRLF rats, but not in aged HRLF rats. Forelimb agility decreased transiently in young adult HRLF rats, but persistently in aged HRLF rats. HRLF task performance for 12 weeks lead to increased IL-1beta and IL-6 in flexor digitorum tendons of aged HRLF rats, compared to aged normal control (NC) as well as young adult HRLF rats. In contrast, TNF-alpha increased more in flexor digitorum tendons of young adult 12-week HRLF rats than in aged HRLF rats. Vascularity and collagen fibril organization were not affected by task performance in flexor digitorum tendons of either age group, although cellularity increased in both. By week 12 of HRLF task performance, vascularity and cellularity increased in the supraspinatus tendons of only aged rats. The increased cellularity was due to increased macrophages and connective tissue growth factor (CTGF)-immunoreactive fibroblasts in the peritendon. In conclusion, aged rat tendons were overall more affected by the HRLF task than young adult tendons, particularly supraspinatus tendons. Greater inflammatory changes in aged HRLF rat tendons were observed, increases associated temporally with decreased forelimb agility and lack of improvement in task success.

Exposure to repetitive tasks induces motor changes related to skill acquisition and inflammation in rats.

The authors elucidate exposure-response relationships between repetitive tasks, inflammation, and motor changes with work-related musculoskeletal disorders. Using a rat model of reaching and handle pulling, they examined effects of performing a high-repetition, low-force (HRLF); low-repetition, high-force (LRHF); or high-repetition, high-force (HRHF) task (2 hr/day, 3 days/week, 12 weeks) on reach rate and force, percentage of successful reaches, duration of participation, and grip strength. Reach rate and reach force improved with HRLF, and percentage success increased in all groups in Week 9, and in HRLF and HRHF in Week 12, indicative of skill acquisition. Duration and grip strength showed force-dependent declines with task performance. A subset of HRHF rats received ibuprofen in Weeks 5-12. Ibuprofen significantly improved reach rate, reach force, and duration in treated rats, indicative of an inflammatory influence on reach performance. Ibuprofen improved percentage of successful reaches in Week 9, although this increase was not sustained. However, declines in grip strength, a nocifensive behavior, were not prevented by ibuprofen. Examination of cervical spinal cords of untreated and ibuprofen treated HRHF rats showed increased IL-1beta, an inflammatory cytokine, in neurons. These findings suggest that only a preventive intervention could have addressed all motor declines.

Peripheral and central changes combine to induce motor behavioral deficits in a moderate repetition task.

Repetitive motion disorders, such as carpal tunnel syndrome and focal hand dystonia, can be associated with tasks that require prolonged, repetitive behaviors. Previous studies using animal models of repetitive motion have correlated cortical neuroplastic changes or peripheral tissue inflammation with fine motor performance. However, the possibility that both peripheral and central mechanisms coexist with altered motor performance has not been studied. In this study, we investigated the relationship between motor behavior changes associated with repetitive behaviors and both peripheral tissue inflammation and cortical neuroplasticity. A rat model of reaching and grasping involving moderate repetitive reaching with negligible force (MRNF) was used. Rats performed the MRNF task for 2 h/day, 3 days/week for 8 weeks. Reach performance was monitored by measuring reach rate/success, daily exposure, reach movement reversals/patterns, reach/grasp phase times, grip strength and grooming function. With cumulative task exposure, reach performance, grip strength and agility declined while an inefficient food retrieval pattern increased. In S1 of MRNF rats, a dramatic disorganization of the topographic forepaw representation was observed, including the emergence of large receptive fields located on both the wrist/forearm and forepaw with alterations of neuronal properties. In M1, there was a drastic enlargement of the overall forepaw map area, and of the cortex devoted to digit, arm-digits and elbow-wrist responses. In addition, unusually low current amplitude evoked digit movements. IL-1 beta and TNF-alpha increased in forearm flexor muscles and tendons of MRNF animals. The increases in IL-1 beta and TNF-alpha negatively correlated with grip strength and amount of current needed to evoke forelimb movements. This study provides strong evidence that both peripheral inflammation and cortical neuroplasticity jointly contribute to the development of chronic repetitive motion disorders.

Peripheral neuritis and increased spinal cord neurochemicals are induced in a model of repetitive motion injury with low force and repetition exposure.

Performance of high repetition tasks with or without force is associated with peripheral tissue inflammation, decreased nerve function and motor dysfunction. Here, we examined whether a low repetition task with negligible force (LRNF) produces fewer tissue and behavioral pathologies than previously observed with high repetition tasks using our rat model of repetitive motion injury (RMI). Thirty-seven rats were randomized into control or LRNF groups, the latter reaching and grasping a 45 mg food pellet at a rate of 3 reaches/min. This task was performed in 4, 0.5 5 h sessions with 1.5 5 h rest periods for 3 days/week for up to 12 weeks. Examination of distal median nerve, forelimb flexor tendons and bones for ED1-positive cells (macrophages and osteoclasts) revealed increases in nerve and bone in week 12. The nerve also contained increased TNF-alpha expressing cells in week 12. Examination of spinal cord dorsal horns revealed increased immunoexpression of Substance P in week 8 and neurokinin-1 in weeks 8 and 12 in the superficial lamina. Motor behavioral analyses showed no changes in reach rate across weeks, slightly reduced task duration (a measurement of voluntary task participation) in week 12, but significantly increased extra arm movement reversals during reaching in week 8. These extra movement reversals were corrections for missed food pellets during a reach. Thus, performance of even a low repetition, negligible force upper extremity task for 3 months can induce mild peripheral tissue inflammation, neurochemical increases in spinal cord dorsal horns, and declines in fine motor control.

Effects of at-work exercises on computer operators.

At-work exercises are commonly recommended for computer operators. This randomized control trial assessed adherence, pain and satisfaction after 4 weeks of at-work exercise. Subjects (n=72) were randomized into 3 groups: resistance exercise, stretching, and control. Outcomes included a satisfaction survey, a visual analogue pain scale (VAS), a pain drawing, and the Neck Disability Index (NDI). The VAS, the drawing, and NDI were analyzed together as a composite variate referred to as Pain Impact. Exercise frequency was similar across the 3 groups (median=1.5 times per day). No differences were found between groups on Pain Impact p=0.714) or individual pain variables. Most satisfaction survey item scores did not differ between groups. However, a significant difference between groups on the survey item related to discomfort. The resistance and stretching group differed from the control group with regard to their perception that the exercises were helpful in reducing discomfort in the back and neck (p<0.001). We conclude that most subjects found the resistance and the stretching exercises easy to do, performed them 1 to 2 times daily, and said they reduced discomfort. To determine optimal type and frequency of at-work exercises, further study is needed.