The effect of extremity strength training on fibromyalgia symptoms and disease impact in an existing multidisciplinary treatment program.

PURPOSE: The purpose of this study was to examine the effect of upper and lower body extremity strengthening exercise in patients with Fibromyalgia (FM) within an existing multidisciplinary treatment program. PARTICIPANTS: Patients between the ages of 18-65 with the medical diagnosis of FM. METHODS: Comparative study design. The control and experimental group received the same multidisciplinary treatment except that the experimental group performed upper and lower extremity strengthening exercises. OUTCOME MEASURES: The Fibromyalgia Impact Questionnaire (FIQ) was administered at evaluation and discharge from the program in order to measure change in quality of life (QOL). RESULTS: Statistically significant changes in FIQ scores were found for both groups. The addition of extremity strengthening in the experimental group produced an average 4 points greater reduction in FIQ score, however, these results are not considered statistically significant. CONCLUSIONS: This study appears to validate the success of a multidisciplinary approach in treating patients with FM, with the possibility for further benefit with the addition of extremity strengthening.

The use of functional and traditional mobilization interventions in a patient with chronic thoracic pain: a case report.

There is little information in the literature regarding the efficacy of spinal manual therapy (SMT) interventions for patients with chronic thoracic spinal pain. In addition, information regarding the clinical decision-making associated with the application of SMT for this patient population is deficient. The purpose of this case report is to present the rationale for and results of applying specific SMT interventions on a patient with chronic spinal pain. A 51-year-old female with 9 months of significant thoracic, chest, sternal, and left shoulder pain was managed with both mobilization with movement and spinal manipulative procedures. The report offers insight into the decisions that guided the selection of these SMT techniques in this case. The outcome provides preliminary support for using these specific SMT procedures in patients with chronic thoracic spinal pain.

A mechanical diagnosis and treatment (MDT) approach for a patient with discogenic low back pain and a relevant lateral component: a case report.

Patients with a lateral lumbar shift are often managed with a frontal plane, manual correction first described by McKenzie. However, there is a subset of patients that require a frontal plane correction who do not demonstrate a lateral shift. Both of these patient groups have what is termed a relevant lateral component (RLC). The subset of patients who have an RLC, without a shift, has received very little attention in the literature to date. This case report describes a patient with no shift who had a remarkable disc extrusion identified by magnetic resonance imaging (MRI). The patient responded nicely to a combination of frontal and transverse plane loading strategies in six treatments using the mechanical diagnosis and treatment (MDT) evaluation and treatment system. The case report is unique in the literature in that it describes a patient with no apparent frontal plane, lumbar deformity that had documented evidence of a large disc extrusion and who responded to a variation of McKenzie's flexion-rotation mobilization. The centralization phenomenon was demonstrated immediately when a non-weight bearing, multiplanar, loading strategy was administered.

Activation of the trapezius muscle during varied forms of Kendall exercises.

UNLABELLED: The trapezius muscle plays a crucial role in maintaining proper shoulder mechanics and is often considered a source of weakness and dysfunction in patients. OBJECTIVES: The purpose of this study was to investigate the activation patterns of the middle and lower trapezius during four prone horizontal abduction exercises of the glenohumeral joint (GHJ). METHODS: The muscle activation patterns of 19 female and 13 male volunteers were measured using surface EMG during horizontal arm abduction exercises commonly used in rehabilitative settings. Each subject performed 10 repetitions of horizontal abduction (ABD) at each position using only the weight of the arm. Function was assessed during shoulder horizontal abduction while positioned at: 75 degrees , 90 degrees , 125 degrees and 160 degrees of GHJ ABD. Electromyographic activity was collected during the concentric phase during each test repetition in the lower (LTRAP) and middle trapezius (MTRAP). A repeated measure ANOVA was performed followed by Bonferroni's post hoc test. RESULTS: The MTRAP had significantly greater recruitment at 90 degrees and 125 degrees , compared to 160 degrees . Similarly, results for the lower trapezius indicated that recruitment at 90 degrees and 125 degrees was significantly greater than 160 degrees . CONCLUSION: Most significant muscle activation for the middle and lower trapezius occurred at 90 degrees and 125 degrees of GHJ ABD. For the clinician, training at 90 degrees is easy to identify, and provides maximal activation, negating the need for multiple training angles.