KRONİK BOYUN AĞRISINDA ELEKTROMYOGRAFİ BİOFEEDBACK İLE RELAKSASYON EĞİTİMİNİN AĞRI, DİSABİLİTE VE DEPRESYON ÜZERİNDEKİ ETKİSİ

Abstract

Amaç: Kronik boyun ağrısı olan bireylerde klasik fizyoterapi programı ve buna ek olarak uygulanan Elektromyografi Biofeedback ile gevşeme eğitiminin; ağrı, kas aktivasyon düzeyi, aktivite limitasyonu ve depresyon düzeyleri üzerindeki etkisini kıyaslamaktır. Yöntem: Çalışmada Grup 1’e (n=20, 17 kadın,3 erkek,  yaş ortalaması= 44,85 ±12,51) klasik fizyoterapiye (Transkutanöz Elektrik Sinir Stimulasyonu, ultrason, hotpack ve ev egzersizi) ek olarak Elektromyografi Biofeedback ile gevşeme eğitimi, Grup 2’ye (n=20, 15 kadın, 5 erkek,  yaş ortalaması=43,84±12,33) ise sadece klasik fizyoterapi programı uygulandı. Tedavi haftada beş gün, dört hafta yapıldı. Bireylere tedavi öncesi ve sonrasında Vizüel Analog Skala, gonyometrik ölçümler (fleksiyon, ekstansiyon, sağa ve sola lateral fleksiyon ve rotasyonlar), yüzeyel Elektromyografi Biofeedback, Boyun Özürlülük Sorgulama Anketi ve Beck Depresyon Ölçeği uygulandı. Sonuçlar: Tedavi sonrasında her iki grupta ağrının azaldığı ve tüm yönlerde eklem hareket açıklığının arttığı görüldü (p=0,00). Her iki grupta sol üst trapez kasında kas aktivasyon düzeyinin azaldığı (p=0,005), birinci grupta sadece sağ üst trapez kasında azalma olduğu görüldü (p=0,003). Özürlülük anketi (p=0,012) ve Beck Depresyon (p=0,001) skorlarında azalma belirtildi. Tartışma: Elde edilen sonuçlar, her iki grupta da gelişme olduğu görüldü. Ancak Grup 1’de ağrı, eklem hareket açıklığı, aktivite limitasyonu ve depresyon düzeyinde ki gelişmelerin daha fazla olduğuna işaret etmektedir. Burdan yola çıkarak, Elektromyografi Biofeedback ile gevşeme eğitiminin kliniklerde klasik fizyoterapi programına eklenmesi ile daha etkili tedavi sonuçlarının elde edilebileceği görüşüne varılmıştır.

Keywords

• Biofeedback,Boyun Ağrısı,Elektromiyografi,Rehabilitasyon

EFFICACY OF ELECTROMYOGRAPHY BIOFEEDBACK WITH RELAXATION TRAINING ON PAIN, DISABILITE AND QUALITY OF LIFE IN CHRONIC NECK PAIN

Abstract

Purpose: The aim of this study was to compare the effect of classical physiotherapy program in patients with chronic neck pain , in addition to relaxation training with electromyography biofeedback  on  pain, muscle activation level, activity limitation and depression levels. Methods: In addition to classical physiotherapy program (Transcutaneous Electrical Nerve Stimulation, ultrasound, hot pack and home exercise), Group 1 ((n = 20, 17 females, 3 males, mean age=44.85 ± 12.51) was treated with relaxation training with EMG-BF, and only classical physiotherapy program was applied to Group 2 (n = 20, 15 female, 5 male, mean age=43.84 ± 12.33). The treatment applied five days a week for four weeks. Visual Analogue Scale , goniometric measurements (flexion, extension, right and left lateral flexion and rotations), superficial electromyography biofeedback, Neck Disability Index  and Beck Depression Scale  were used to measure the activation levels of upper trapezius muscle before and after treatment. Results: There was a decrease in pain and increase all movement range of joint motion after treatment in both groups (p=0.00). In the muscle activation level, there was a significant improvement on the left trapezoid in both groups (p=0.005), but in the first group only the right trapezius muscle showed improvement (p=0.003). There was a decrease in the scores of disability (p=0.012) and depression (p=0.001).   Conclusion: After treatment, improvement was seen in both groups. But Grup 1 was found to be more effective in pain, range of motion, activity limit and depression level. It has been concluded that the relaxation training with electromyography biofeedback will provide more effective treatment results by adding classical physiotherapy programs in clinics.

Keywords

• Biofeedback,Electromyography,Neck Pain,Rehabilitation

References

1. Acedo AA, Antunes ACL, Dos Santos AB, De Olveira CB, Dos Santos CT. (2015), Colonezi GLT, Upper trapezius relaxation induced by tens and interferential current in computer users with chronic nonspecific neck discomfort: An electromyographic analysis. J Back Musculoskelet Rehabil,; 28(1):19–24
2. Apelyan A. (2002), Boyun Ağrılarında Biofeedback ile Kas Gevşetme Eğitiminin Etkinliği. M.Ü. Sağlık Bilimleri Enstitüsü, İstanbul, 115600.
3. Basmajian J V. (1988), Research foundations of EMG biofeedback in rehabilitation. Biofeedback and Self-regulation.; 13(4):275–98.
4. Baumueller E, Winkelmann A, Irnich D, Weigl M. (2017), Electromyogram Biofeedback in Patients with Fibromyalgia: A Randomized Controlled Trial. Complement Med Res. 24(1):33-39.
5. Belanger A (2008), Kanıta Dayalı Elektroterapi, Çeviri: Yakut E, Dalkılıç M, Kaya D. Pelikan Yayınları, Ankara,.
6. Bicer A., Yazici A, Camdeviren H, Erdogan C. (2004), Assessment of pain and disability in patients with chronic neck pain: reliability and construct validity of the Turkish version of the Neck Pain And Disability Scale. Disabil Rehabil. 26(16):959–62.
7. Brandt M, Sundstrup E, Jakobsen MD, Jay K, Colado JC, Wang Y( 2014), Association between neck / shoulder pain and trapezius muscle tenderness in office workers. Pain Research and Treatment.; 2090-1550.
8. Castelein B, Cools A, Bostyn E, Delemarre J, Lemahieu T, Cagnie B. (2015), Analysis of scapular muscle EMG activity in patients with idiopathic neck pain : A systematic review. J Electromyogr Kinesiol, 25(2): 371–86.

9. Chaikumarn M, Nakphet N & Janwantanakul P. (2018) Repeatability of electromyography normalization of the neck and shoulder muscles in symptomatic office workers. International Journal of Occupational Safety and Ergonomics, 24, 422–430.
10. Cho S, Lee J, Kim C. (2013), The Changes of electromyography in the upper trapezius and supraspinatus of women college students according to the method of bag-carrying and weight. J Phys Ther Sci.; 1129-31.
11. Crider AB, Glaros G. (1999), A Meta-Analysis of EMG biofeedback treatment of temporomandibular disorders. Journal of Orofarangial Pain. 13(1):29-37.
12. Falla D, Farina D, Jull G. (2011), Association between ıntensity of pain and ımpairment in onset and activation of the deep cervical flexors in patients with persistent neck pain. Clin J Pain, 27(4):309–14.
13. Fernández-de-las-Peñas C, Alonso-Blanco C, Miangolarra JC. (2007), Myofascial trigger points in subjects presenting with mechanical neck pain: a blinded, controlled study. Man Ther,12(1):29–33.
14. Findley JL, Monticone M, Pappas E, Campo M. (2015), Biofeedback for neck pain. Biofeedback for neck pain .Cochrane Database of Systematic Reviews. 10.1002.
15. Giggins OM, Persson UM, Caulfield B. (2013), Biofeedback in rehabilitation. Journal of Neuroengineering and Rehabilitation. 18; 10(1): 60.
16. Ma C, Szeto GP, Yan T, Wu S, Lin C, Li L. (2011) Comparing biofeedback with active exercise and passive treatment for the management of work-related neck and shoulder pain: A randomized controlled trial. Arch Phys Med Rehabil. 92(6):849–58.
17. Mercer SR. (2016) Surface electrode placement and upper trapezius short communication surface electrode placement and upper. Advances in Physiotherapy; 8196.
18. Nicoletti C, Spengler CM, Läubli T. (2014), Physical workload, trapezius muscle activity, and neck pain in nurses night and day shifts : A physiological evaluation. Appl Ergon. 45(3):741–
19. Otman AS., Köse N. (2016) Tedavi hareketlerinde temel değerlendirme prensipleri, Ankara; Pelikan Yayıncılık
20. Sayin YY. Akyolcu N.(2014), Comparison of Pain Scale Preferences and Pain Intensity According to Pain Scales among Turkish Patients: A Descriptive Study , Pain Management Nursing, 156-164.
21. Şengül YS. (2014), Bel boyun problemlerinde fizyoterapi, C. Algun. içinde: Fizik Tedavi ve Rehabilitasyon (s.271-287), İstanbul: Nobel Tıp Kitapevi.
22. Süt N. Boyun Ağrısının Epidemiyolojisi (2011), Türkiye Klinikleri J Neurosurg-Special Topics. 4(2):1-4.
23. Tali D, Menahem I, Vered E, Kalichman L. (2014), Upper cervical mobility, posture and myofascial trigger points in subjects with episodic migraine : Case-control study. J Bodyw Mov Ther.; 18(4):569–75.
24. Tsang SMH, So BCL, Lau RWL, Dai J, Szeto GPY. (2018), Effects of combining ergonomic interventions and motor control exercises on muscle activity and kinematics in people with work related neck–shoulder pain. Eur J Appl Physiol, 00421-018-3802-6.
25. Tunwattanapong P, Kongkasuwan R, Kuptniratsaikul V. (2016), The effectiveness of a neck and shoulder stretching exercise program among office workers with neck pain: a randomized controlled trial, Clin Rehabil.; 30(1):64–72.
26. Wang Y., Gorenstein C. (2013), Assessment of depression in medical patients : A systematic review of the utility of the Beck Depression Inventory-II, Clinics, (11):1274–87.
27. Westgaard RH, Mork PJ, Lorås HW, Riva R, Lundberg U. (2018), Trapezius activity of fibromyalgia patients is enhanced in stressful situations, but is similar to healthy controls in a quiet naturalistic setting: a case-control study. BMC Musculoskelet Disord. 18,14,97.
28. Westgaard RH. (2000), Work-related musculoskeletal complaints : some ergonomics challenges upon the start of a new century. Appl Ergon.; 31:569–80.
29. Viljanen M, Malmivaara A, Uitti J, Rinne M, Palmroos P, Laippala P. (2003), Effectiveness of dynamic muscle training, relaxation training, or ordinary activity for chronic neck pain: randomised controlled trial. BMJ.; 327,1–5.
30. Voerman G, Miriam MR. (2007) Changes in pain, disability, and muscle activation patterns in chronic whiplash patients after ambulant myofeedback training: Commentary. Headache. Clin J Pain. 47(3):458–9.
31. Ylinen J. (2007), Physical exercises and functional rehabilitation for the management of chronic neck pain. Europa Medicophysica, 43(1):119–32.
32. Zale EL, Lange KL, Fields SA, Ditre JW. (2013), The Relation between pain-related fear and disability. J Pain. 14(10):1019–30.