Neck-rotation ROM data are listed in Table 2 and shown in Figure 4. On both sides, neck-rotation ROM increased significantly when performing the PSLM.
Table 2. Comparison of neck pain (N=15)
Figure 4. Neck pain with and without passive shoulder-lifting maneuver (PSLM).
Figure 5. Neck joint position error with and without passive shoulder-lifting maneuver (PSLM).
Figure 4. Maximal neck-rotation ROM with and without passive shoulder-lifting maneuver (PSLM).
Discussion
Scapular downward-rotation can contribute to prolonged compressive loading of the posterior cervical structures as a result of the transfer of the weight of the extremities to the cervical region through the attachments of the cervicoscapular muscles (upper trapezius and levator scapulae) (Van Dillen et al. 2007). To reduce mechanical stress on the cervical spine, modifying shoulder alignment currently is performed in the clinical field and researches (McDonnell, Sahrmann and Van Dillen 2005; Szeto, Straker, and Raine 2002; Schuldt et al. 1987; Straker, and Raine 2002; Van Dillen et al. 2007). However, no studies have examined the effects of the PSLM on pain, proprioception, and ROM in neck pain patients with SDRS. Accordingly, in the present study the effects of the PSLM on pain, proprioception, and ROM were investigated in neck-pain patients with SDRS. The study showed that the PSLM exerted a significant effect on pain, proproception, and maximal neck-rotation ROM.
The PSLM significantly decreased neck pain and JPE, and significantly increased neck ROM (p<0.05).
In the present study, the PSLM resulted in a significant reduction in neck pain, possibly by reducing the load on the pain-sensitive structure on the cervical facet joint.
The cervical facet joints have been documented as a source of nociception in the cervical structure (Bogduck, and Marsland 1988). Pain occurs because of a downward or asymmetric pull on the cervical vertebrae or facet by the levator scapulae muscle,
the upper trapezius muscle, and the weight of the upper extremity (Schuldt et al.
1987). The PSLM leads to changes in compressive loading by transferring the weight of the upper extremity to the sternoclavicular joint in neck-pain patients with SDRS during neck rotation.
Our results demonstrated that the PSLM significantly decreases JPE. Several possible mechanisms could explain this decrease. First, repositioning ability is determined primarily by the function of the muscle spindles of the contracting muscles (Gandevia, McCloskey, and Burke 1992). The PSLM might directly decrease extrinsic muscle participation and activate intrinsic muscles (deep suboccipital muscle) during neck rotation. Intrinsic muscles have a relatively high density of muscle spindles density (Kulkarni, Chandy, and Babu 2001), almost five times higher than that of the splenius capitis muscle and three times that of the semispinalis capitis muscle (Peck, Buxton, and Nitz 1984). These muscles are likely to play a primary role in signaling the cervical proprioceptive information involved in the conscious perception of equilibrium, position, and spatial orientation when vision is occluded (Rix, and Bagust 2001). These muscles also aid fine rotatory movement and maintain the stability of the neck (Peck, Buxton, and Nitz 1984). Although we did not measure intrinsic muscle activity directly by EMG, the activated intrinsic muscle contractions involved in the PSLM might improve muscle-spindle function, translating to a decrease in JPE. Second, the PSLM could decrease the stress placed on the joint and other structures of the cervical region. It has been suggested that abnormal joint stress affects the firing of cervical afferents, leading to changes in proprioceptive function.
Third, accurate control of movement is dependent on the sensory element of motor control system (Hodge, and Moseley 2003). Inaccurate afferent input would affect all aspects of motor control (Zedka et al. 1999). Especially, Pain leads to change in motor control (Ganevia, McCloskey, and Burke 1992). Numerous studies using experimental model of pain have provided support for this hypothesis (Arendt-Nielsen et al. 1996; Zedka et al. 1999). These include changes in excitability at the spinal or cortical level, change in proprioception (Hodge, and Moseley 2003).
Widespread changes in excitability of nervous system have been identified at many levels of motor system during pain (Hodge, and Moseley 2003). Also, muscle spindle sensitivity and muscle activation are alerted by pain (Gandevia, McCloskey, and Burke 1992; Pedersen et al. 1997). Thus, these changes may adversely affect perception of movement. The PSLM resulted in a significant reduction in neck pain.
Decreased pain may contributed improvement of proprioception during PSLM.
In present study the PSLM significantly increases the maximal neck-rotation ROM.
Previous studies have found that modification of scapula positioning can increase the maximal neck-rotation ROM in neck-pain patients (Van Dillen et al. 2007). One explanation for the increase in ROM is a change in the muscle length of the cervicoscapular muscles during the PSLM, which would reduce the passive stretch in these muscles. This might reduce the loading and posterior shear on the neck structures (Gajdosik 2001). The PSLM could thus increase the maximal neck-rotation ROM by reducing passive limitations to rotation ROM resulting from the loss of extensibility of the upper trapezius and levator scapulae muscles.
This study was subject to some limitations. First, we focused only on neck rotation because rotation dysfunction is associated with greater disability than other neck motions (Olson et al. 2000). Second, we did not confirm the occurrence of intrinsic muscle activation, and hence further studies are warranted to assess intrinsic muscle activity. Third, our results cannot be generalized to other populations because all of the subjects who participated in the study were men (most industrial workers are male). Additional research is therefore needed to establish whether these findings also apply to female subjects.
Conclusion
The effects of the PSLM on pain intensity, proprioception, and ROM were investigated in neck-pain patients with SDRS. The PSLM significantly increased the maximum neck-rotation ROM and decreased JPE and neck pain. The PSLM could therefore be an effective method of decreasing neck pain and improving neck ROM and proprioception during neck rotation in these patients.
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국문 요약
견갑골 하방회전 증후군을 가진 경부 통증 환자에게 수동적 어깨 거상이 경추의 통증과 고유수용성 감각,
관절 가동범위에 미치는 영향
연세대학교 대학원
재활학과(물리치료학 전공) 하 성 민
본 연구에서는 견갑골 하방회전 증후군을 가지고 있는 경부 통증 환자들 에게 수동적 어깨 거상을 시행했을 때, 경추의 관절 가동범위, 고유수용성 감각 및 통증에 어떠한 영향을 미치는지 알아보았다. 연구대상자는 산업체 에서 근무하는 근로자들 중에 견갑골 하방회전 증후군을 가지고 있는 경부 통증 호소자 15명을 선정하였다. 관절가동 범위와 관절 위치 재현 검사는 3차원 동작 분석 장비를 이용하였다. 그리고 통증은 통증 상사 척도를 이 용하여 측정하였다. 두 조건의 유의한 차이를 비교하기 위해 짝-검정을
실시하였고, 유의수준은 0.05로 하였다. 연구결과 수동적 어깨 거상은 관 절 위치 재현 오류와 통증을 유의하게 감소시켰으며 경추의 관절 가동범위 는 유의하게 증가됨을 알 수 있었다. 이러한 결과들은 견갑골 하방회전 증 후군을 가진 경부통증 환자에게 수동적 어깨 거상이 경부통증을 감소시키 고 관절 가동범위와 고유수용성 감각을 증진시키는데 효과적이라 할 수 있 겠다.
핵심 되는 말: 견갑골 하방회전 증후군, 경부 통증, 수동적 어깨 거상.