INTEGRATED WATER TREATMENT INTEGRATED WATER TREATMENT REHABILITATION IN OCCUPATIONAL NECK REHABILITATION IN OCCUPATIONAL NECK

PAIN, MYOMETRY AND EMGs INVESTIGATIONPAIN, MYOMETRY AND EMGs INVESTIGATION

Raoul Saggini, Professor, M.D.

Unit of Physical and Rehabilitative Medicine

Chair of the Specialization School in Physical and Rehabilitation Medicine

Dept. of Basic and Applied Medical Science, University G. d'Annunzio, Chieti, Italy

The related musculoskeletal disorders of the upper limbs are growing rapidly in the

industrialized world and one of the major topics of interest and intervention in the field

of health protection of workers.

Gründemann, R.W.M., Winter C.R. de & Smulders, P.G.W. (1994). Absenteeism in the European Union. Fondazione europea per il miglioramento delle condizioni di vita e di lavoro, Dublino (doc.di lavoro n. WP/92/22/EN).

ABSENT FROM WORK PLACE:Temporary incapacity, resulting from prolonged or

permanent illness or infirmity.

BAD HEALT

Occupation of the upper limbs

In patients who play or have played in the past work activities characterized by repetitive movements of upper limbs.

NECK PAINPain syndrome, concerning the

back of the neck,The shoulder girdle and

 The upper limb

The cervicobrachialgia workers may be accentuated and exacerbated by various predisposing factors:

PREVIOUS TRAUMA OsteoarthritisDegeneration of intervertebral discsRepeated movements and efforts of the upper limbs

 30 patients, 45-60 years, female, all suffering from neck pain

Randomly divided in two groups: Group W was treated for 8 sessions, 2wk, each

lasting about 45 minutes of therapy in water and 15 minutes of stretching exercise program pre-treatment

Group D was treated with the use of neck support such as "Doctor Disk" (Smart Hospital, Italy) for 1 months to 3+3 hours per day.

Material and method

At the beginning and end of rehabilitation program all subjects were tested with

Myometry Algometer EMGs of the trapezius muscle in different

experimental situations: at rest, the head twisted right and left, during isometric contraction of left and right, back to sleep .

Material and method

TERAPIA RIABILITATIVA

RIEDUCAZIONE ALLA DEAMBULAZIONE:

Rappresenta un momento importante della fase di adattamento alle costrizioni imposte dalle proprietà fisiche dell’acqua

GALLEGGIAMENTO IN COORDINAZIONE RESPIRATORIA:

il soggetto è in posizione verticale con il tubolare sotto le braccia, con l’acqua a livello dei pettorali. Esegue esercizi di respirazione naso-bocca, per controllare le variazioni del proprio galleggiamento.

PASSAGGI DI POSIZIONE: cerchiamo di rendere il paziente protagonista in vasca, dei suoi movimenti e sulla propria spazialità in base alla forza di gravità e pressione idrostatica.

PENDOLO PASSIVO: il soggetto viene messo in posizione supina con i tubolari a livello del collo, delle ascelle, a livello popliteo e delle caviglie. Il fisioterapista effettua delle prese ed esegue dei movimenti oscillatori sul corpo del paziente.

Nell’EMG di S. gli elettrodi sono stati posizionati sul ventre del muscolo trapezio di entrambi gli emisomi. Partendo dall’occipite:

o a 8 cm è stato posizionato l’elettrodo nero;o a 12 cm è stato posizionato l’elettrodo rosso;o l’elettrodo verde o Terra è stata posizionata sul rachide dorsale.

Il muscolo trapezio è stato valutato in diverse fasi:• a riposo guardando un punto fisso;• torsione del capo a destra ;• torsione del capo a sinistra;• registrazione durante attivazione muscolare contro resistenza;• riposo dopo sforzo.

Results- Myometry Group W

Significant improvement of the myometric elastic component of muscle at rest (T0 1.23 ± 0.13 vsT1 1.01 ± 0.01) and isometric contraction (1.27 ± 0.29 VS1, 04 ± 0.12).

Muscle Stiffness decreased after treatment of 11.5%.

Muscle tone does not show significant changes (17.04 ± 1.15 vs16, 19 ± 0.72).

Results- EMGs

The data showed EMGs after rehabilitation treatment, a decrease of the antagonist muscle during the twisting movements of the head and during isometric contraction.

You notice an improvement in both right and left trapezius muscle.The track is more consistent showing that the electrical activity of muscle has been a positive change.

Obvious reduction of the path of muscle examined during torsion (right) which is associated with a marked reduction and normalization of the route of the contralateral antagonist muscle.

The route is reduced more in the muscle Rated (SN) and more slightly in the contralateral (right).

Before treatment, the layout is irregular dysfunctional sign of electrical activity. After treatment we see a regularization of the track is in the right trapezius than in the left.

Stiffness decreases both in the right trapezius than in the SN with an improvement of 11, 5%, both at rest and in that of contraction. After treatment we find a clear balance between the two part of body not present at the beginning of therapy.

In terms of average percentage of the 15 patients Elasticity varies:

DS from 1.23% + / - 0.13 at T0 to 1.01% SD + / - 0.01 at T1 in the muscle relaxed;

DS from 1.27% + / - 0.29 at T0 to 1.04% SD + / - 0.12 at T1 in muscle during contraction.

As for the tone we highlight major changes, both during relaxation and during contraction. Indeed, in terms of average percentage in the 15 patients, the tone is:17.04 + / - 1.15 SD at T0 compared to 16.09 + / - 0.72 SD at T1.However, there is a tendency to decrease.

Results- Myometry Group D

Improvement of the myometric elastic component of muscle at rest (T0 1.21 ± 0.11 vsT1 1.11 ± 0.05) and isometric contraction (1.25 ± 0.19 VS T1 1.18 ± 0.12).

Muscle Stiffness decreased after treatment of 4%.

Muscle tone does not show significant changes (16.03 ± 1.14 vs 16.01 ± 0.62).

In conclusion we can say that the rehabilitation treatment in water in patients

with cervicobrachialgia is an excellent remedy is to reduce the pain of the region affected by the disease, both to achieve better conditions conducive to healing.

Grazie