September/October 2011, Volume 4, Issue 5
“Two minutes of daily resistance training for ten weeks reduces headache frequency among office workers with neck/shoulder pain. The vast number of adult workers suffering from one or two days of weekly headaches and who could potentially comply with and benefit from brief exercise programs stresses the applicability of our findings.”


Editor’s Log: Chiropractic Identity:
Charting Our Future Roles »

Chiropractic in an Integrative Cancer
Center: Interview with Jeff Sklar, DC »

Yoga and Health: Interview with
Sandra McLanahan, MD »

Risks of Acetaminophen »

Chiropractic and Manual Therapies
Research »

Nutrition Update »

Exercise and Fitness Report

CAM in Review »

Mind-Body News »

Health News

The Daily HIT Blog

Exercise & Fitness Report
When reading reports on new research, it is important to remember that no single study should be seen as providing the whole truth. The following reports offer helpful clues but in most cases further research is needed before firm conclusions can be drawn.
Which Knee Exercises Help Knee Osteoarthritis?

Fitzgerald GK, Piva SR, Gil AB, Wisniewski SR, Oddis CV, Irrgang JJ. Agility and perturbation training techniques in exercise therapy for reducing pain and improving function in people with knee osteoarthritis: a randomized clinical trial. Physical Therapy. Apr 2011;91(4):452-469.

BACKGROUND: Impairment-based exercise programs have yielded only small to moderate benefits in reducing pain and improving function in people with knee osteoarthritis (OA). It has previously been proposed that adding agility and perturbation training to exercise programs for people with knee OA may improve treatment effects for pain and function. OBJECTIVE: The purpose of this study was to examine the effectiveness of adding agility and perturbation techniques to standard exercise therapy compared with the standard exercise program alone for people with knee OA. DESIGN: This was a single-blinded randomized controlled trial. SETTING: The study was conducted in the outpatient physical therapy clinic of a large, university-based health center. PARTICIPANTS: One hundred eighty-three people with knee OA (122 women, 61 men) participated. INTERVENTIONS: Participants were randomly assigned to either a group that received agility and perturbation training with standard exercise therapy or a group that received only the standard exercise program. MEASUREMENTS: The outcome measures were self-reported knee pain and function, self-reported knee instability, a performance-based measure of function, and global rating of change. RESULTS: Although both groups exhibited improvement in self-reported function and in the global rating of change at the 2-, 6-, and 12-month follow-up periods, there were no differences between groups on these outcomes. There was no reduction in knee pain or improvement in performance-based function in either group. LIMITATIONS: It is possible that more-intense application of the interventions or application of the interventions to participants with knee OA who were at greater risk for falling may have yielded additive effects of the agility and perturbation training approach. CONCLUSIONS: Both intervention groups exhibited improvement in self-reported function and the global rating of change. Our results, however, did not support an additive effect of agility and perturbation training with standard exercise therapy in our sample of individuals with knee OA. Further study is needed to determine whether there are subgroups of individuals who might achieve an added benefit with this approach.

Two Minutes of Daily Resistance Exercise Helps Headaches

Andersen LL, Mortensen OS, Zebis MK, Jensen RH, Poulsen OM. Effect of brief daily exercise on headache among adults - secondary analysis of a randomized controlled trial. Scandinavian Journal of Work, Environment & Health. May 26 2011.

OBJECTIVE: This paper investigates secondary outcomes (headache) in a randomized controlled trial with physical exercise among office workers with neck/shoulder pain. METHODS: A total of 198 office workers with frequent neck/shoulder pain were randomly allocated to either one of two intervention groups (10 weeks of resistance training with elastic tubing for 2 or 12 minutes per day, 5 times a week) or the control group, which received weekly health information. Secondary outcomes included changes in frequency, intensity, and duration of headache after ten weeks. RESULTS: Compared with the control group, headache frequency decreased in the 2- and 12-minute intervention groups [0.64 days/week (95% confidence interval [95% CI]) 0.23-1.0) and 0.79 (95% CI 0.37-1.2), corresponding to a 43% and 56% decrease from baseline, respectively]. Intensity and duration of the remaining headaches were unaffected. CONCLUSIONS: Two minutes of daily resistance training for ten weeks reduces headache frequency among office workers with neck/shoulder pain. The vast number of adult workers suffering from one or two days of weekly headaches and who could potentially comply with and benefit from brief exercise programs stresses the applicability of our findings.

Neck Pain from Computer Use Responds Well to Biofeedback

Ma C, Szeto GP, Yan T, Wu S, Lin C, Li L. Comparing biofeedback with active exercise and passive treatment for the management of work-related neck and shoulder pain: a randomized controlled trial. Archives of Physical Medicine and Rehabilitation. Jun 2011;92(6):849-858.

OBJECTIVES: To compare the effects of biofeedback with those of active exercise and passive treatment in treating work-related neck and shoulder pain. DESIGN: A randomized controlled trial with 3 intervention groups and a control group. SETTING: Participants were recruited from outpatient physiotherapy clinics and a local hospital. PARTICIPANTS: All participants reported consistent neck and shoulder pain related to computer use for more than 3 months in the past year and no severe trauma or serious pathology. A total of 72 potential participants were recruited initially, of whom a smaller group of individuals (n=60) completed the randomized controlled trial. INTERVENTIONS: The 3 interventions were applied for 6 weeks. In the biofeedback group, participants were instructed to use a biofeedback machine on the bilateral upper trapezius (UT) muscles daily while performing computer work. Participants in the exercise group performed a standardized exercise program daily on their own. In the passive treatment group, interferential therapy and hot packs were applied to the participants’ necks and shoulders. The control group was given an education booklet on office ergonomics. MAIN OUTCOME MEASURES: Pain (visual analog scale), neck disability index (NDI), and surface electromyography were assessed preintervention and postintervention. Pain and NDI were reassessed after 6 months. RESULTS: Postintervention, average pain and NDI scores were reduced significantly more in the biofeedback group than in the other 3 groups, and this was maintained at 6 months. Cervical erector spinae muscle activity showed significant reductions postintervention in the biofeedback group, and there were consistent trends of reductions in the UT muscle activity. CONCLUSIONS: Six weeks of biofeedback training produced more favorable outcomes in reducing pain and improving muscle activation of neck muscles in patients with work-related neck and shoulder pain.

High Intensity Aerobic Exercise Helpful for Chronic Low Back Pain

Murtezani A, Hundozi H, Orovcanec N, Sllamniku S, Osmani T. A comparison of high intensity aerobic exercise and passive modalities for the treatment of workers with chronic low back pain: a randomized, controlled trial. Eur J Phys Rehabil Med. May 23 2011.

BACKGROUND: In recent years, disability due to chronic low back pain (LBP) has steadily increased in all industrialized countries. In the treatment of chronic LBP, the objectives are to reduce pain, to improve function and minimize avoiding behavior. Exercise therapy is a management strategy that is widely used as a treatment for LBP. AIM: The aim of this study was to investigate the effects of high- intensity aerobic exercise on pain, disability, anxiety or depression in people with chronic LBP. DESIGN:This was a randomized controlled trial. SETTING:Institute of Occupational Medicine, Department of Physical Medicine and Rehabilitation - Outpatient Ward. POPULATION: Kosovo power plant workers. METHODS:Participants with chronic low back pain, excluding those with “red flag” criteria were assigned randomly to one of the two treatment groups: an aerobic exercise group (N.=50), and an passive modalities group (N.=51). Data on low back pain intensity (visual analogue scale), disability (Oswestry Low Back Pain Disability Questionnaire), fingertip-to-floor distance, and psychosocial factors (Hospital Anxiety and Depression Scale) were collected at baseline and after 12-weeks follow-up points. RESULTS: At 12-week follow-up, significant improvements in pain intensity and disability had occurred in the exercise group. We have verified significant improvements in comparison with basic values in pain intensity (6+/-2.6 vs. 2+/-1.7, diff. of mean=3.9, P<0.001), disability (31+/-17.4 vs. 15.8+/-12.7, diff. of mean=15.2, P<0.001), anxiety and depression (21.1+/-8.2 vs. 14+/-6.7, diff. of mean=7.1, P<0.001), and fingertip- to-floor distance (27.8+/--9.1 vs. 14.2+/--5.7, P<0.001). Whereas, differences in average pain, disability, anxiety and depression and fingertip-to-floor distance are not significant in the control group. CONCLUSION: High intensity aerobic exercise reduces pain, disability and psychological strain in patients with chronic low back pain. CLINICAL REHABILITATION IMPACT: This research is important for the fact that High Intensity Aerobic Exercise Programs are not so exploited in the current available literature for the treatment of LBP. Therefore, this is another modest contribution which can reinforce the need for more frequent use of High Intensity Aerobic Exercise Programs in the treatment of LBP.