Does folk medicine work? A randomized clinical trial on patients with prolonged back pain.

OBJECTIVE: To determine whether traditional bone-setting or continuous light exercise therapy could case back pain and improve function better than ordinary physiotherapy. DESIGN: Observer-blinded, randomized clinical trial with a 6-month follow-up. SETTING: An outpatient institution for folk medicine research. PATIENTS: Of 147 back pain patients recruited from local health centers and by newspaper announcements, 132 were found eligible (non-retired-no contraindications to manipulation) and entered. A final 114 (one dropout) with back pain for longer than 7 weeks were included in this intent to treat analysis. INTERVENTIONS: Bone-setting, guidance for continuous light back movements or physiotherapy for up to ten 1-hour sessions during 6 weeks. MAIN OUTCOME MEASURES: Spinal mobility and muscular performance. Back pain assessed by visual analog scales (VAS). RESULTS: The physical measures changed only modestly, from one tenth to half of standard deviation, while the VAS was halved. The thoracolumbar side-bending, the modified Schober, and the VAS were significantly better improved by bone-setting than by exercise but not better than by physiotherapy. CONCLUSION: Neither bone-setting nor exercise differed significantly from physiotherapy, but bone-setting improved lateral and forward bending of the spine and back pain more than did exercise.

Neck and shoulder symptoms of high school students and associated psychosocial factors.

PURPOSE: The aim of this study was to describe the prevalence of neck and shoulder symptoms among high school students and associated psychosocial factors. METHODS: High school students (718) completed a questionnaire concerning neck and shoulder pain and psychosocial factors such as stress symptoms, depressive symptoms, and self-efficacy. A participant was classified into the "no disturbing symptoms" group or into the "disturbing symptoms" group according to the frequency of the neck and shoulder symptoms. The sum of mean scores of stress symptoms, depressive symptoms, and self-efficacy were compared between these groups. RESULTS: Twenty-one percent of the girls and 10% of the boys suffered from disturbing neck and shoulder symptoms. Stress symptoms and depressive symptoms were more common among the girls than the boys. For both sexes, the sum of stress scores and those of depressive symptom scores were significantly higher in the "disturbing symptoms" group than the "no disturbing symptoms" group. Among the girls, the sum of the self-efficacy scores was lower in the "disturbing symptoms" group than in the "no disturbing symptoms" group. CONCLUSIONS: Neck and shoulder symptoms are common among adolescents and psychosocial factors such as stress and depressive symptoms seem to be associated with these symptoms, especially among girls. More knowledge about the etiologic factors associated with neck and shoulder symptoms in adolescents may result in preventive programs with the potential for reducing morbidity of neck and shoulder symptoms in adulthood.

Patients with neck and shoulder complaints and multisite musculoskeletal symptoms--a prospective study.

OBJECTIVE: To examine reasons for and extent of health services utilization in patients seeking care for neck and shoulder pain in a population based primary care setting. METHODS: Patients seeking care for neck and shoulder pain were identified from medical records of 6526 patients visiting 6 primary care centers during a 2 week period. The extent of and reasons for health care utilization over the subsequent 12 month period were examined. RESULTS: Of 440 patients who consulted primary health care physicians for neck and shoulder pain, one-half had one or more additional episodes of care due to musculoskeletal (MSK) pain over the subsequent 12 months. One-quarter had additional episodes of care for pain in other sites than in the neck and shoulder. The total number of visits was twice the annual average for patients visiting the health centers, MSK symptoms accounting for half the visits. Twenty percent of the women and 7% of the men visited primary care physicians 10 times or more per year. CONCLUSION: The pattern of reasons for visits for MSK pain suggests that in about one-quarter of patients visiting primary care physicians for neck and shoulder pain, the local symptomatology is part of multisite MSK symptoms, resulting in frequent utilization of health services.

Neck and shoulder symptoms and leisure time activities in high school students.

There is a lot of evidence in the adult population to show that neck and shoulder symptoms are associated with static working postures. It has also been suggested that dynamic load reveals neck and shoulder symptoms. The purpose of this study was to describe the occurrence of neck and shoulder pain and its association with static and dynamic load in various types of leisure time activity in high school students. Seven hundred eighteen students filled out a questionnaire concerning neck and shoulder pain, leisure time activities, and utilization of health services. The participants were classified into three groups according to the severity of neck and shoulder symptoms, which was based on frequency of symptoms. The girls had significantly more neck and shoulder symptoms, and they sought medical care more often than the boys. The girls participating in sports involving dynamic use of the upper extremities had significantly fewer symptoms than those having hobbies involving static postures of the upper limbs or those practicing other types of physical activity.

Repeatability of measurement of tenderness in the neck-shoulder region by a dolorimeter and manual palpation.

OBJECTIVE: The aim of this study was to test the repeatability of dolorimeter measurements in subjects with and without neck-shoulder symptoms and interobserver agreement in manual palpation. The second aim was to analyze how subjects, measures, and the order of attempt influenced the repeatability of pain threshold (PT) measurements. DESIGN: Repeated measurements in 100 female volunteers who were office workers. SETTING: Interobserver repeatability was tested by examining 60 female office employees twice during the same day, and intraobserver repeatability was tested by examining 40 female office employees at an interval of 2 days. PATIENTS: Their mean age was 38 (20-55) years; height was 163 (149-174) cm; and weight was 60 (44-115) kg. MAIN OUTCOME MEASURES: PT measurement by dolorimeter and manual palpation findings of four defined palpation points. RESULTS: The inter- and intraobserver repeatability coefficients of the dolorimeter varied from 0.87 to 0.65; they were lower in subjects with neck-shoulder symptoms (DS) than in subjects with no or occasional symptoms (NOS). The sensitivity and specificity of dolorimeter for neck-shoulder symptoms was poor. The interobserver repeatability of manual palpation at trigger areas of trapezius and levator muscles varied from 0.15 to 0.62. CONCLUSIONS: The repeatability of dolorimeter is good, but sensitivity and specificity for neck-shoulder symptoms are poor. The dolorimeter is a good device for measurement of cervicobrachial tenderness when the subject acts as his or her own control. The repeatability of manual palpation is poor.

Manual palpation and pain threshold in female office employees with and without neck-shoulder symptoms.

OBJECTIVE: The aim of this study was to quantify myofascial tenderness by using manual palpation and the dolorimeter on female office employees with disturbing neck-shoulder symptoms (DS) and no or occasional neck-shoulder symptoms (NOS). The association among neck-shoulder symptoms, pain threshold, and age was also analyzed. DESIGN: The cross-sectional study of female office employees selected on a voluntary basis from two offices. SETTING: The manual palpation of neck-shoulder muscles was analyzed at 16 palpation points defined before the examination. The pain threshold (PT) was measured at four trigger areas of trapezius and levator muscles. PATIENTS: 160 female office employees with mean age 41 (21-60) years; height was 163 (149-178) cm; and weight was 62 (45-115) kg. MAIN OUTCOME MEASURES: Manual palpation findings of neck-shoulder muscles at 16 defined palpation points and PT measurement of trigger areas in trapezius and levator muscles by a dolorimeter. RESULTS: The mean number of tender points was 7.25 (SD, 4.5) in subjects with DS and 3.44 (SD, 3.8) in subjects with NOS; the difference was significant (p < 0.0001). Suboccipital and trapezius muscles were tender in most cases in both symptom groups. The PTs of trapezius and levator muscles were significantly lower in subjects with DS than in subjects with NOS (p < 0.0001-0.0005). The PT of the trapezius muscles in subjects > or = 39 years old with DS was significantly lower than in those with NOS (p < 0.0007-0.0402). The PT of subjects with DS was lower in subjects 39 years old and older than in younger subjects, while the PT in subjects with NOS was higher in older subjects than in younger ones; the differences were statistically nonsignificant. CONCLUSIONS: Suboccipital and trapezius muscles are often tender in subjects with DS and in those with NOS. The finding that the PT of the trapezius muscle in older subjects with DS decreases while the PT in subjects with NOS increases is interesting and needs further investigation.

Active or passive physiotherapy for occupational cervicobrachial disorders? A comparison of two treatment methods with a 1-year follow-up.

In this study 169 female office employees were interviewed and examined to determine the occurrence and severity of neck and shoulder symptoms. Forty-seven of those with symptoms who fulfilled the criteria taken as indicating need for treatment were enrolled in a controlled clinical trial and divided into two groups. One group participated in dynamic muscle training of neck and shoulder muscles (active physiotherapy). The other patients were treated by means of surface heat, massage, and stretching (passive physiotherapy). Pain in the neck and shoulder regions disappeared significantly more often just after active treatment as compared to passive treatment. Symptoms returned within three months in both groups. However, after 12 months, the incidence of headache was significantly less in the group that had received active physiotherapy. Maximal isometric muscle strength in relation to cervical lateral flexion and extension and grip strength and endurance force of shoulder muscles improved significantly after active physiotherapy, but only maximal isometric extension force increased significantly after passive physiotherapy. Numbers of tender points in neck and shoulder muscles decreased significantly after both types of physiotherapy. Pressure threshold levels increased but not significantly in both groups during treatment.

Reliability of a simple method of measuring isometric neck muscle force.

A new measurement device was constructed to measure the maximal isometric neck muscle forces. In this study the repeatability of the measurements was evaluated in 34 healthy reserve flying conscripts from Finnish Defence Forces. The measurements of the maximal isometric forces were done in four directions: flexion, extension, and right and left lateral flexions. The intraobserver and intraobserver reliability coefficients were calculated for repeated measurements. The system achieved satisfactory repeatability of lateral flexion and extension force measurements. The total variation was small in lateral flexions and extension, and for these directions was only to a small extent dependent on the examiner and the time of measurement.