The purpose of this study was to identify the effects of continuous muscle strengthening applied to the antagonist of the sternocleidomatoid, upper trapezius, and pectoralis major, which are the shortened muscles of forward head posture(FHP) subjects, and Evjenth-Hamberg stretching(EHS) applied to the shortened muscles on changes in pressure pain threshold(PPT). Twenty subjects were divided into the continuous antagonist strengthening( CAS) group(n=10) and the EHS group(n=10), and each group performed its respective exercise three times a week for a six week period. The results were as follows: The comparison of changes in PPT within each group before and after the treatment showed a statistically significant difference( p<.05) according to the treatment period and a statistically significant difference according to the treatment period and method(p<.05). While the comparison of the tests of between subjects effects between the groups did not show a statistically significant difference, the CAS group exhibited better effects. The above results suggest that the combined application of CAS and EHS generates better effects on changes in PPT than the single application of EHS. Given that stretching and muscle strengthening exercises even for the short research period of six weeks could change the PPT, continuous exercises and a correct postural habit for a longer period of time are likely to help prevent chronic pain and correct FHP

In the present study, the general characteristics, job stress, working conditions, and aspects of pain of some industrial workers working in Changwon-si, Gyeongsangnam-do, were surveyed. In analyzing the relationship between job stress and the existence of pain, the variables “working speed” and“ opportunities to develop abilities” were shown to have statistically significant relationships with the existence of pain (p≤.05). Regarding the relationship between working conditions and the existence of pain, the variables“ amount of work per hour,“” amount of work per day,“” number of parts handled during work,“” work production per person,” and“ inconvenient postures or motions during work” were shown to have statistically significant relationships with the existence of pain(P≤.05). Regarding aspects of pain“, within 1~3 years” was the most common answer to time of occurrence of symptoms, with a percentage of 27.6%“; appear almost always” was the most common answer to frequency of symptoms, with a percentage of 37.1%;“ slight pain” was the most common answer to degree of pain, with a percentage of 50.5%; and“ moderate” was the most common answer to encumbrance caused by pain to living and work, with a percentage of 41.2%. The aim of the present study was to determine the factors that affect pain due to musculoskeletal diseases in industrial workers and to define the aspects of pain in order to provide basic data for the preparation of measures to prevent musculoskeletal diseases. To control pain due to musculoskeletal diseases, factors that affect pain, as well as the aspects of pain, should be recognized early, and efforts should be made to supplement and improve systems for preventing recurrence.

The purpose of this study was to identify the effects of Pilates and Tai Chi as physical therapy interventions for pain and dysfunction in chronic lumbago patients. A total of 31 females who were at least 20 years old and diagnosed with chronic lumbago were divided into a Pilates group(PG) (n=10), Tai Chi group(TCG)(n=11), and conservative group(CG)(n=10), to measure their pain and dysfunction before and after a six week intervention. With regard to the changes in the lumbago consciousness scale before and after the six-week intervention, all three groups showed statistical significance(p<.05). The intergroup differences were significant between the PG and CG and between the TCG and CG. All three groups also showed statistical significance(p<.05) in the Oswestry Disability Index before and after the six-week intervention. Again, the intergroup differences were significant between the PG and CG and between the TCG and CG. Based on these results, the application of Pilates and Tai Chi with conservative treatment may be effective in reducing pain and improving dysfunction in chronic lumbago patients.

The purpose of this study is to investigate effects of Maitland orthopedic manipulative physiotherapy and stretching on pain, cervical range of motion, and muscle tone of adults with forward neck posture. A total 40 subjects were divided into a Maitland OMPT group(n=20) and a stretching group(n=20), performing joint mobilization exercise and stretching three times per week for six weeks. As for changes in pain, statistically significant decrease were found before and after the exercise within group comparison( p<.01), while no statistically significant difference was observed between-group comparison. In changes in cervical range of motion before and after the exercise, the Maitland OMPT group showed statistically significant increase(p<.01) in flexion, (left lateral flexion(p<.05), extension, left rotation, right rotation, and right lateral flexion, while the stretching group showed statistically significant increase(p<.05) in extension(p<.01), left rotation, left lateral flexion, right rotation, and right lateral flexion. However, no significant differences in between group comparison in flexion, extension, right rotation, left rotation, right lateral flexion and left lateral flexion. The results of measuring muscle tone changes showed that the Maitland OMPT group and the stretching group did not show significance in within and between group comparison(p<.05). In conclusion, the Maitland OMPT and stretching were effective on improving pain and range of motion.

Background: Chronic back pain shows a high correlation with lumbar disability, physical disability for daily activities, and psychosocial factors, such as depression. Object: The purpose of this study was to examine the correlation of the level of pain and disability with psychosocial factors, which are potential disturbance variables, in patients with chronic lumbar pain. Method: The sample included 258 patients, who had complained of chronic lumbar pain for more than three months. The Quadruple Visual Analogue Scale was used to measure the level of pain, and a Korean version of Oswestry Disability Index was used to measure the level of disability. Psychosocial factors were measured using the Tampa scale for Kinesiophobia-11, Fear Avoidance Beliefs Questionnaire, and Pain Self-Efficacy Questionnaire. The collected data was analyzed using PASW 18.0, and an independent samples t-test was used to examine frequency, percentage, mean, and standard deviation of sociodemographic characteristics and major variables. Pearson’s correlation coefficient was used to investigate the correlation between the level of pain and disability and psychosocial factors. Stepwise multiple regression analysis was done to determine the level of pain and psychosocial factors of functional disorder. The significance level was set at α=.05. Result: There is a strong correlation between the level of pain and functional disorder and psychosocial factors in patients with chronic lumbar pain. The study also revealed that as the levels of pain and fear avoidance increase, pain self-efficacy decreases. Conclusion: The results suggest that negative perceptions towards pain, limitations of physical movement, and severe fear avoidance directly affect the decrease in pain self-efficacy. Therefore, it is recommended to test pain self-efficacy when measuring the level of pain and disability in patients with chronic low back pain.

Background: Patients with chronic low back pain (CLBP) functionally adapt to decreased postural control due to impaired processing of sensory information. Standing postural control has been the focus of recent research in CLBP. Change in postural control may be a risk factor for CLBP, although available studies are not conclusive. Objects: This study aimed to identify the role of partial weight supported treadmill training (PWSTT) in improving balance, dysfunction, and pain in patients with chronic low back pain. Methods: The study included 22 patients with CLBP. Patients in the control group (n1=8) performed three 20 min stabilization exercise sessions per week, for 4 weeks. Patients in the full weight treadmill training group (n2=7) performed treadmill training for 30 min after stabilization exercise. Patients in the PWSTT group (n3=7) performed PWSTT with 20% of their body weight unloaded after stabilization exercises. By using the Biodex balance system, the dynamic balance abilities of the patients in the three groups were assessed in the quiet standing position under combined conditions of visual feedback (eyes open and closed) and platform stability (level 8). The Korean version of the Oswestry Disability Index and visual analogue scale score were used as the main measure. Results: The results of this study showed that dysfunction and pain were significantly improved in all groups. Although dynamic postural stability with eyes closed was significantly improved only in the PWSTT group (p<.05), no significant difference was found in the other groups. Conclusion: The results of this study indicate that PWSTT improved balance, dysfunction and pain in the patients with CLBP. Thus, this intervention is necessary for patients with CLBP with decreased postural control.

This case report describes the effectiveness of cervical corrective exercises in a patient with cervical radiculopathy (CR) who experienced radicular pain, upper limb paresis, and limited functional activity. A 39-year-old male with cervical radiculopathy performed the cervical corrective exercises for reducing pain. Pain intensity, cervical posture, and active range of motion of cervical intersegmental spine motion were measured baseline, after 4 weeks, and after 8 weeks with self-reported questionnaire and radiographs. After 8 weeks of intervention, the patient demonstrated alleviated radicular symptoms, improved neck posture and active range of flexion and extension of the cervical intersegmental spine. Especially in the angle between the cervical vertebra 6 and 7, the angle was changed from -4.69° to 3.30° during resting position after intervention. The present case indicates that the cervical corrective exercises might be a possible treatment to effectively reduce radicular symptoms, improve neck posture, and active cervical intersegmental motion for patient with CR.

The purpose of this study is to provide fundamental clinical data for the treatment plan and rehabilitation of patients with cervical hypolordosis by comparing the cervical headache and muscle activity after cervical stretching exercise and cervical traction, which are generally applied to patients with cervical hypolordosis. The research subjects included 20 patients without gender division who were diagnosed with cervical hypolordosis. After applying cervical stretching exercise and cervical traction for six weeks, cervical headache and the activity of the muscles around the cervical vertebra(upper trapezius muscle, sternocleidomastoid muscle, splenius capitis muscle, and anterior temporal muscle) were investigated and the following results were obtained. In a comparison of the within group intervention effects of the two groups, cervical pain statistically significantly decreased in the cervical stretching exercise group. According to the results of analyzing the change of muscle tension in the upper trapezius muscle, both the cervical traction group and showed a statistically significant within group difference in the left and right side. According to the results of analyzing the change in the muscle tension of the splenius capitis muscle, both groups showed a statistically significant within group difference in the left and right side. In a betweengroup comparison, a statistically significant difference in the right side was observed. These results confirm that cervical vertebra traction and cervical stretching exercise decrease the cervical headache and muscle activity of the upper trapezius muscle and the splenius capitis muscle among patients with cervical hypolordosis.

To develop an effective and efficient measurement system for tracking changes of functional status across two measures, it is essential to integrate information and communicate scores across two measures. The lack of communication between two measures leads to score incompatibility. A potential solution would be the development of a crosswalk table between those measures. Prior to creating a crosswalk table, selecting common items between two measures is critical. By using the Oswestry low back pain disability questionnaire (Oswestry) and a short form measuring disability resulting from low back pain, item level statistics as well as differential item functioning (DIF) using the Rasch measurement were investigated. Eighty-two participants with known group validity were recruited. Based on the application of the Rasch measurement model, item difficulties across the two measures were logically and hierarchically ordered. Ceiling effects for both measures were detected, which were not be able to be effectively measured with the two measures. The DIF analysis across the two measures confirmed that five paired items were found to have DIF and five common items were selected for common items. Although five paired items function differently across the Oswestry and the short form, all items of both measures were well targeted study participants. The common items selected by the Rasch measurement model may be effective when creating a crosswalk table between the Oswestry and the short form.

The purpose of this study was to apply the joint mobilization technique to the level of segments with pain and to the level of segments with hypomobility respectively and compare the immediate effects of the joint mobilization technique on the pain, the active cervical range of motion (ROM), and treatment satisfaction of patients with acute mechanical neck pain. After the baseline assessment, forty-two patients were randomized into two groups: a painful group (n1=21) that received joint mobilization at the most painful cervical spine level and a hypomobile group (n2=21) that received joint mobilization at the most hypomobile cervical level. The patients received an intervention that applied unilateral posterior-anterior gliding for 5 minutes and two repetitions of 10 times of active extension motion with distraction. In the Wilcoxon signed-rank test, the painful group and the hypomobile group were improved significantly in all pain variables (p<.001), while the painful group was improved significantly in the active cervical flexion (p<.001), extension (p<.001), left side-bending (p<.01), right side-bending (p=.001), left rotation (p<.001), and right rotation (p<.001). The hypomobile group was significantly improved in active cervical flexion (p=.001), extension (p<.001), left side-bending (p<.05), right side-bending (p=.001), left rotation (p=.001), and right rotation (p<.01) after intervention. In the Mann-Whitney U test, there was no significant difference in any of the dependent variables after the intervention between the two groups, but the painful group was slightly superior to the hypomobile group in all variables except for the right lateral flexion ROM and treatment satisfaction. These outcomes suggest that the cervical joint mobilization may be applied to either the level of painful segments or the hypomobile segments for the treatment of patients with acute mechanical neck pain.

The purpose of this study was to identify the effects of mechanical traction applied to the knee joint on pain, knee range of motion (ROM), timed up and go (TUG) and Western Ontario and MacMaster Universities Osteoarthritis (WOMAC) in patients with knee osteoarthritis (KOA) of Kellgren-Lawrence radiological rating scale Ⅱ or Ⅲ. Twenty three patients participated in the experiment for a period of four weeks. After baseline assessment, the patients with KOA were randomized into two groups: the traction group (n1=12), which received traction with general physical therapy; and the control group (n2=11), which received general physical therapy only on unilateral knee joints. Patients received interventions once a day, three times a week, for four weeks. Wilcoxon signed-rank test was used to analyze the change of dependent variances within the group during pre and post intervention. Mann-Whitney U test was used to analyze the change of dependent variances as TUG and passive ROM between the two groups. Analysis of covariance was used to analyze the change of dependent variances as numeric pain rating scale (NPRS) and WOMAC score between the two groups. In Wilcoxon signed-rank test, the traction group improved significantly with regard to NPRS (p<.01), passive knee flexion ROM (p<.01), passive knee extension (p<.05), TUG (p<.01) and WOMAC scores (p<.01) after intervention for four weeks, but not for the control group. In the Mann-Whitney U test and analysis of covariance, no significant difference was seen among all the dependent variances after intervention for four weeks between the two groups. These outcomes suggest that further studies should be carried out to determine the effects of mechanical traction prior to using it for the treatment of patients with knee osteoarthritis.

The purpose of this study was to investigate the effect of lumbar stabilization training and additional thoracic mobilization on pain, proprioception and static balance in patients with chronic low back pain. The subjects of this study were 48 chronic low back pain patients who were randomly allocated to an experimental group 1 (n1=16, lumbar stabilization and thoracic mobilization, thoracic hypomobility), experimental group 2 (n2=16, lumbar stabilization and thoracic mobilization, thoracic normal mobility), and a control group (n3=16, lumbar stabilization, thoracic hypomobility) after a thoracic mobility test. Both experimental groups underwent lumbar stabilization training and additional thoracic mobilization. The control group underwent only lumbar stabilization training. The intervention was performed 3 times per week, 30 minutes each time, for a total of 6 weeks. Thoraco-lumbar joint reposition error was measured using an electrogoniometer and static balance ability was measured using the Tetrax posture analysis system. Subjects’ pain level was measured using a 100 ㎜ visual analogue scale. Statistical analyses were performed using a one-way analysis of variance and a paired t-test. Post-hoc testing was carried out with a Bonferroni test. The pain level was significantly lower in both experimental groups compared to the control group. Both experimental groups showed significant reductions in joint reposition error angle (flexion, extension, and side bending) compared to the control group. The static balance level was significantly lower in both experimental groups than in the control group. In summary, lumbar stabilization exercises and additional thoracic mobilization significantly improved the pain level, proprioception, and static balance in patients with chronic low back pain.

The activation of glial cells in the spinal cord has been contribute to the initiation and maintenance of pain facilitation induced by peripheral inflammation and nerve injury. The present study investigated effects of botulinum toxin type A (BoNT-A), injected subcutaneously or intracisternally, on the expression of microglia and astrocytes in rats. Complete Freund’s Adjuvant (CFA)-induced inflammation was employed as an orofacial chronic inflammatory pain model. A subcutaneous injection of 40 μL CFA into the vibrissa pad was performed under 3% isoflurane anesthesia in SD rats. Immunohistochemical analysis for changes in Iba1 (a microglia marker) and GFAP (an astrocyte marker), were performed 5 days after CFA injection. Subcutaneous injection of CFA produced increases in Iba1 and GFAP expression, in the ipsilateral superficial lamia I and II in the medullary dorsal horn of rats. Subcutaneous treatment with BoNT-A attenuated the up-regulation of Iba1 and GFAP expressions induced by CFA injection. Moreover, intracisternal injection of BoNT-A also attenuated the up-regulated Iba1 and GFAP expressions. These results suggest that the anti-nociceptive action of BoNT-A is mediated by modulation activation of glial cells, including microglia and astrocyte.

The study targeted Japanese employees who have visited hospital for spinal disorder. The study analyzed work environment and pain relief methods of work-related back pain patients, and the relationship between back pain and other body parts. The purpose of this study was to provide draw up measures for patients with back pain and to provide basic data for the sustainable prevention program. The study result of back pain, in other words, employees suffering from lumbago, had disparity between occupations; the highest number of patients were made up of 16-years or above long-serving employees, and below 5-years of short-serving employees. There were more patients complaining of chronic lumbago than acute lumbago, and patients recognized poor posture as the primary cause of lumbago. Furthermore, 99.5% of spinal disorder patients complain back pain, 23.2% use only alternative therapy, and 15.2% visit clinic and hospital with alternative therapy. Patients showed pain reduction and high satisfaction after using alternative therapy. The study targeted Japanese employees where complement therapy is more generalized than that of Korea, and thus there should be multilateral management programs provided in Korea as well.

This study investigated the effect of a load of 15% body weight on trunk, pelvis and hip joint coordination and angle variability in subjects with and without chronic low back pain (CLBP) during an anterior load carriage task. Thirty volunteers participated in the study (15 without CLBP, 15 with CLBP). All participants were asked to perform an anterior carriage task with a load of 15% body weight. The outcome measures included the means and standard deviations for measurements of three-dimensional coordination and angle variability of the trunk, pelvis and hip joint. As CLBP patient group .06, control group .70, the correlation coefficient between the groups showed a significant difference only in trunk-pelvic in the sagittal plane (p<.05). Angle variability of CLBP patient group increased significantly in the trunk in frontal plane, the pelvis in all sagittal plane, frontal plane, transverse plane, and the hip in sagittal plane, the hip in frontal plane than angle variability of control group (p<.05). This results mean that the CLBP patient group showed a disconnected coordination pattern in the trunk-pelvis in the sagittal plane, an increased pelvic angle variability in all three planes, and hip angle variability in the sagittal, and frontal planes. The CLBP patient group may have developed a compensatory movement of the pelvis and hip joint arising from the changed stability due to the abnormal coordination patterns of the trunk-pelvic in the sagittal plane. Therefore, CLBP symptoms can potentially worsen in the pelvis and adjacent hip joint in CLBP patients who perform weight-related behaviors in their daily lives. Further research is needed to determine the three-dimensional characteristics of the electromyography and neuromuscular aspects of subjects with CLBP.

Pancreatic cancer is one of the most lethal malignancies. Despite the availability of newer and better antineoplastic combinations, the 5-year survival rate for all stages of pancreatic cancer remains only 6%. Palliative care represents an important aspect of care in patient with pancreatic cancer. Thus, optimal palliation of symptoms to maximize remaining quality of life is of primary importance to most patients. This review discusses highlights the most significant problems faced when caring for patients with advanced pancreatic cancer. Common problems include pain, pancreatic insufficiency, anorexia-cachexia and depression. To provide optimal and meaningful supportive care for patients with advanced pancreatic cancer is complex and requires ongoing close monitoring of the physical and emotional aspects of the patient. Prompt management of the many symptoms and problems associated with pancreatic cancer is essential to minimize distress and improve quality of life for patients with this fatal disease. Recognizing end-of-life concerns and patient preferences during the dying process helps clinicians find ways to alleviate suffering for patients and families.

Prolonged sitting can contribute to low back pain. The lumbar taping can be applied to correct the sitting posture. This study aimed to investigate the effect of lumbar taping on lumbar kinematics and the muscle activities of multifidus (MF) and internal oblique in the individuals with nonspecific chronic low back pain (NSCLBP) as they type for 30 minutes. Nineteen subjects with NSCLBP (9 people in non taping group and 10 people in taping group) were recruited. Lumbar taping was applied to the taping group before typing. Both groups started typing in a neutral sitting position with their feet on the floor. The change of posture and S2 posterior tilting (S2P) were measured to investigate kinematic data. Three sensors were attached on T12, L3, and S2 to identify the change of posture. Surface electromyography was used to measure the muscle activities. Palpation meter was used to standardize the angle of pelvic tilt in sagittal plane before typing. All instruments were used to measure each data before and after typing. Independent t-test was used to compare the changing values of lumbar kinematics and muscle activities before and after typing between both groups. The changing values of S2P and change of posture of L3 and S2 were significantly smaller in the taping group compared to the non taping group (p＜05). The changing value of muscle activities of MF between before and after typing was significantly smaller in the taping group compared to the non taping group (p＜05). In conclusion, the lumbar taping during the 30-minute typing task can be applied to maintain correct sitting posture in the lumbar and pelvis and to maintain activation of MF.

This study aimed to determine the effect of lower trapezius muscle strengthening exercises on pain, neck disability index (NDI), cervical range of motion (ROM), and lower trapezius muscle strength in patients with unilateral neck pain. Following baseline measurements, the subjects (N=40) with unilateral neck pain were randomized into one of two 5 weeks exercise intervention groups: a experimental group (EG, n1=20) that received strength training of the lower trapezius muscles or a control group (CG, n2=20) that received routine physical therapy program. Each group participated in the intervention for 30 minutes, 3 times a week, for 5 weeks. All participants performed 2 repetitions of each intervention per day. The numeric pain rating scale for pain, NDI, ROM, and lower trapezius strength were recorded both pre- and post-intervention for both groups. Paired t-tests were used to determine significant changes post-intervention compared with pre-intervention and independent t-tests were used to analyze differences in the dependent variables between the 2 groups. After the 5-weeks intervention, both groups experienced significantly decreased pain and disability level (p<.05) and significantly increased cervical flexion, extension, lateral flexion, and rotation ROM (p<.05). The EG that received strength training of the lower trapezius muscles showed greater improvements in pain and functional disability level, cervical rotation, and lower trapezius strength than the CG (p<.05). These results suggest that a lower trapezius strengthening exercises reduce neck pain and neck disability level and enhance cervical ROM and lower trapezius strength level in patients with unilateral neck pain.

This study aimed to investigate the effect of the abdominal drawing-in maneuver (ADIM) and abdominal expansion maneuver (AEM) on trunk stabilization, as well as trunk muscle activities and differences in quadruple visual analogue scale, Korean Oswestry Disability Index, and Fear Avoidance Beliefs Questionnaire scores, in patients with chronic low back pain and lumbar spine instability. To increase intra-abdominal pressure during the trunk stabilization exercise, the technique of pushing the abdomen out using diaphragmatic abdominal breathing suggested by Pavel Koral was used, which we termed the AEM. Fifty patients who tested positive on more than three of the five lumbar spine instability tests were separated from 138 patients with chronic low back pain of these patients, 16 were placed in the control group (trunk stabilization exercise), 17 were placed in the ADIM group (trunk stabilization exercise with ADIM), and 17 were placed in the AEM group (trunk stabilization exercise with AEM). Each group participated in the study for 30 minutes three times weekly for 4 weeks. Surface electromyography was used to measure the trunk muscle activities during the kneeling forward and supine bridging positions, and one-way repeated analysis of variance was used to determine the statistical significance of the trunk muscle activities in the rectus abdominis, internal oblique (IO), erector spinae, and multifidus (MF) muscles. The ADIM and AEM groups showed relatively larger improvements in psychosocial and functional disability level than control group. There were significant changes among the three groups, those from the measured values of the AEM group was significantly higher than the other two groups in changes in IO and MF trunk muscle activities (p＜05). This finding demonstrates that trunk stabilization exercises with AEM is more effective than ADIM for increasing trunk deep muscle activity of chronic low back pain patients with lumbar spine instability.

This study aimed to compare the characteristics of breast cancer surgery and shoulder surgery patients on the shoulder range of motion (ROM), degree of pain and dysfunction, and scapular position. This study was carried out with a total of 90 women: a breast cancer surgery group (BS, n1=30), a shoulder surgery group (SS, n2=30) and a control group (n3=30). Shoulder ROM, the Quadruple Visual Analogue Scale (QVAS), the Shoulder Pain and Disability Index (SPADI), and the Scapular Index (SI) were used to assess shoulder function. Statistical analyses were performed using a one-way analysis of variance, crosstab test, and independent sample t-test. Post-hoc testing was carried out with Bonferroni test. There were significant differences in shoulder ROM when the BS and the SS were compared with the control group. However, there was no significant difference in ROM between the BS and SS. Furthermore, there was a significant difference in shoulder pain between both surgery groups, and there was greater shoulder dysfunction in the SS than in the BS. There was also a significant difference in upper extremity posture when the BS and the SS were compared to the control group. Finally, there was no significant difference in upper extremity posture between the BS and the SS. This study compared shoulder ROM, pain, dysfunction, and upper extremity postures between the BS and SS. While there were no significant differences in shoulder ROM, pain, and upper extremity posture between both surgery groups, the level of dysfunction was found to be significantly different. Therefore, health professionals managing for breast cancer surgery or shoulder surgery patients should consider these outcomes.