The Effect of Evoked Temporal Summation in the Lateral Elbow Region on Cervical Muscle Endurance and Fatigue Characteristics
试验速览
- 阶段
- 不适用
- 状态
- 已完成
- 入组人数
- 55
- 试验地点
- 2
- 主要终点
- Change from baseline Sternocleidomastoid muscle normalized median frequency of the slope at 20 minutes
研究概览
简要总结
Central sensitization (CS) is a common feature in chronic musculoskeletal pain conditions including rheumatoid arthritis, chronic whiplash syndrome, fibromyalgia, temporomandibular joint disorders, low back pain and lateral elbow pain. CS is defined as "an amplification of neural signaling within the central nervous system that elicits pain hypersensitivity". Clinical signs are allodynia, hyperalgesia and widespread pain, originating from the enhanced activity of central nervous system to peripheral afferent input from unimodal and polymodal receptors.
CS not only induces abnormal pain processing, it may also lead to motor performance dysfunction in chronic pain population. CS induce cortical reorganization including changes in gray matter, cortical representation and cortical excitability both in motor and somatosensory cortex. This process ultimately generates sensorimotor conflict that described as a mismatch between motor intention and sensory feedback, and may directly effect on motor performance. The structural changes in basal ganglia and reduced GABAergic activity in the motor cortex contribute to the alteration of the motor performance. It has been known that CS and fatigue, another indicator of the motor performance, has a bidirectional effect and fatigue is predicted by CS, independently of the presence of pain. CS affect fatigue via causing disrupted reward process, increased effort and pain expactation.
The increased cervical spine hypersensitivity in patients with LEP even if there is no accompanied neck or upper limb pain may also indicate of the fatigue as pain does not always suggest an injury and biomechanical damage to a tissue does not always suggest that an individual will experience pain. If neck muscle fatigue is effected by central sensitization in patients with LEP, it can be important to develop therapeutic strategies to prevent neck muscle fatigue as there is a relationship between fatigue and increased risk of injury. Despite the fact that central sensitization effect on neck pain has been well documented in patients with LEP, its role on fatigue had not gain enough clinical and research attention. To know about central sensitization effect on motor performance can also be useful for determine subgroup of population who have central sensitization. However, it is unknown whether remote body endurance alteration occur in lateral elbow pain or not.
详细描述
EMG assessment Electrode Placement Before electrode placement, the skin will be cleaned with alcohol to reduce skin impedance.
Sternocleidomastoid Muscle (SCM) Electrode Placement Electrodes will be placed to the the sternal head of the SCM while participants were sitting in a erect position. A line will be drawn from the sternal notch to the mastoid process and marked at 1/3 of the distance from the sternal notch. Electrodes initially will placed adjacent to the this point with 20 mm apart and over the muscle belly based on the muscle palpation during manually resisted neck flexion contractions. This location is anticipated to place between the innervation zone and the tendon. In supine, the head will be placed in a neutral anatomic position that craniocervical and cervical spine is in a mid position. It will be ensured visually by examiner that cervical spine is in the neutral position which means from the middle of the subject's forehead to the middle of the chin is horizontal and a line bisecting the neck longitudinally is parallel to the treatment plinth. Participants will asked to completely relax in this position. For normalization, isometric neck flexor contraction will be carried out in supine position via applying manual resistance on frontal region by gradually increasing force that reached maximum force level in 2 second and then contracted maximally for 5 second. This procedure will be repeated 3 times with a 30 second time interval.
Upper Trapezius (UT) Muscle Electrode Placement Electrodes will be attached 20% laterally to the midpoint between the dorsal processes of C4 and the posterior lateral third of the clavicle. For normalization, manual resistance will be given neck extensor while participant lying in prone position. Contraction will be lasted 5 second for 3 times with 30 interval.
After electrode placement, a 5 seconds rest recording will be performed for eliminating basal noise from recording. During the endurance test, participants will asked not to cough, laugh or talk and head position will be controlled by inclinometer adapted to EMG system. Participants will be given 3 minutes resting time between neck flexor/extensor endurance tests for the experimental group.
Neck Flexor Endurance Test An examiner will place her hand under the occiput of the participant, while the participant is lying in supine position with the knees bend and the arms resting on the abdomen. Cranicervical flexion will be taught to the participants. For this, participants will asked to place tongue on roof of the mouth, with lips together and teeth slightly apart while cervical spine is in neutral position. Participants will not be allowed to open mouth during the test. Participants will be requested to perform gentle head nodding as if saying "yes" via sliding head in caudal and cephalic directions on the bed and concentrate feeling of back of the head. After learning of the craniocervical flexion, the participant will be requested to head off from the examiners hand (approximately 2.5 cm from the plint) vhile maintaining the craniocervical flexion and then sustain this position as long as possible. The holding time will be recorded with a stopwatch. The test will be ended once the participant is unable to hold their head in a correct position that chances occur more than 5 degree for more than one second, can no longer maintain craniocervical flexion or head position due to fatigue.
研究设计
- 研究类型
- Interventional
- 分配方式
- Randomized
- 干预模型
- Parallel
- 主要目的
- Other
- 盲法
- Single (Participant)
入排标准
- 年龄范围
- 18 Years 至 60 Years（Adult）
- 性别
- All
- 接受健康志愿者
- 是
入选标准
- •To be healthy
排除标准
- •have suffered pain at an intensity of more than 2/10 for more than 8 days in the preceding year;
- •having had a pain condition in the last 6 months for which treatment was sought;
- •have undergone surgery in the neck or elbow region in the preceding year;
- •suffer major depression or psychiatric illness (diagnosed by a psychiatrist and being in medical or psychiatric treatment);
- •be diagnosed with life threatening, metabolic, cardiovascular, neurologic, systemic diseases;
- •be pregnant or have given birth in the preceding year.
结局指标
主要结局
Change from baseline Sternocleidomastoid muscle normalized median frequency of the slope at 20 minutes
时间窗: Baseline and minutes 20
It shows fatigue characteristic of the muscle
次要结局
- Change from baseline upper trapezius muscle normalized median frequency of the slope at 20 minutes(Baseline and minutes 20)
- Changes from baseline mean amplitude of the sternocleidomastoid muscle at 20 minutes(Baseline and minutes 20)
- Changes from baseline mean amplitude of the upper trapezius muscle at 20 minutes(Baseline and minutes 20)