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1.

Objectives

Work-related components are an essential part of rehabilitation programs to support return to work of patients with musculoskeletal disorders. In Germany, a guideline for work-related medical rehabilitation was developed to increase work-related treatment components. In addition, new departments were approved to implement work-related medical rehabilitation programs. The aim of our study was to explore the state of implementation of the guideline’s recommendations by describing the change in the delivered dose of work-related treatments.

Design

Nonrandomized controlled trial (cohort study).

Setting

Fifty-nine German rehabilitation centers.

Participants

Patients (N=9046) with musculoskeletal disorders were treated in work-related medical rehabilitation or common medical rehabilitation. Patients were matched one-to-one by propensity scores.

Interventions

Work-related medical rehabilitation in 2014 and medical rehabilitation in 2011.

Main Outcome Measures

Treatment dose of work-related therapies.

Results

The mean dose of work-related therapies increased from 2.2 hours (95% confidence interval [CI], 1.6-2.8) to 8.9 hours (95% CI, 7.7-10.1). The mean dose of social counseling increased from 51 to 84 minutes, the mean dose of psychosocial work-related groups from 39 to 216 minutes, and the mean dose of functional capacity training from 39 to 234 minutes. The intraclass correlation of 0.67 (95% CI, 0.58-0.75) for the total dose of work-related therapies indicated that the variance explained by centers was high.

Conclusions

The delivered dose of work-related components was increased. However, there were discrepancies between the guideline’s recommendations and the actual dose delivered in at least half of the centers. It is very likely that this will affect the effectiveness of work-related medical rehabilitation in practice.  相似文献   

2.

Objective

To estimate the prevalence of work-related musculoskeletal disorders from a snapshot sample of members of the Chartered Society of Physiotherapy (CSP); the trade union, educational and professional body for physiotherapists, physiotherapy assistants and physiotherapy students in the UK. The distribution of musculoskeletal disorders against different variables, including age of therapist, years in practice and clinical specialty, was also investigated. We set out to highlight the job tasks that injured physiotherapists associated with their complaint and to identify any preventive strategies that injured physiotherapists adopted to prevent re-injury.

Design

A self-administered questionnaire was posted to a randomly selected sample taken from the membership database of the CSP.

Participants

Ten percent (n = 3661) of registered physiotherapists, physiotherapy assistants and physiotherapy students on clinical placement.

Main instrument

Questionnaire based on the Standardised Nordic Questionnaire.

Results

Reported career prevalence of work-related musculoskeletal disorders in members of the CSP was 68%. Previous 12-month prevalence was 58%, and 42% reported musculoskeletal symptoms in the last 12 months that lasted for more than 3 days. The low back was the body area identified by 44% of injured respondents as their most significant injury. Nearly one-third (32%) of injured respondents first experienced their worst injury within 5 years of graduation. A greater number of respondents (59%) were aged 30 years or under when their most serious injury occurred. Injured respondents rated ‘performing the same tasks over and over’, ‘working in the same position for long periods’ and ‘treating a large number of patients in 1 day’ as the three most influential job risk factors contributing to injury.

Conclusions

Younger physiotherapists and newly qualified graduates appear to be most in need of intervention services aimed at reducing injury rates. Official action is undermined by injured physiotherapists seeking informal treatment from colleagues rather than reporting injury to their manager, helping to keep work-related injury a hidden problem. Physiotherapists should be encouraged to report workplace injury, and barriers to official reporting should be identified.  相似文献   

3.

Background

There is a hypothesis that the growing use of mobile phones in an inappropriate posture to text and read (text neck) could be a reason for the increasing prevalence of neck pain in the past decade. Before testing if there is an association between text neck and neck pain, it is necessary to develop reliable pragmatic tools appropriate to epidemiological studies.

Objectives

The primary aim of this study was to assess the reliability of the self-perception of text neck, as well as the reliability of physiotherapists’ classification of the text neck.

Methods

The convenience sample was composed of 113 high school students between 18 and 21 years old from a cross-sectional study. As their self-perceived posture, participants had to choose in a questionnaire one of four neck postures of a person texting on a mobile phone. The physiotherapists classified lateral photographs taken with the participants texting on a mobile phone in their habitual posture as 1 (normal), 2 (acceptable), 3 (inappropriate), and 4 (excessively inappropriate).

Results

The results showed that the test–retest reliability of the self-perception was substantial (kappa?=?0.73, 95% CI 0.54 to 0.86). The reliability of the physiotherapists’ responses, according to the photographic analysis considering the three raters, was moderate (kappa?=?0.5, 95% CI 0.39 to 0.61). Seventy-six percent of the participants with appropriate posture in the photographic analysis self-reported an inappropriate posture.

Conclusion

This study showed that the self-perception of the neck posture during mobile phone texting is reliable over time and that the physiotherapists’ classification based on photographic analysis was acceptable for epidemiological studies. Participants had a tendency to report that the posture was worse than it actually was in the photographic analysis performed by the physiotherapists.  相似文献   

4.

Background

The nation-wide epidemiological survey of psychiatric disorders in term of lifetime prevalence is not adequately known in Iran. The prevalence of lifetime psychiatric disorders was estimated among the population of aged 18 and over on gender, age group, educational level, occupational status, marital status, and residential area.

Methods

The subjects were 25,180 individuals selected through a clustered random sampling method. The psychiatric disorders were diagnosed on the bases of Diagnostic and Statistical Manual of Mental Disorders-IV criteria. It is the first study in which the structured psychiatric interview administered to a representative sample of the Iranian population age 18 and over by the 250 trained clinical psychologist interviewers. The data was entered through EPI-Info software twice in an attempt to prevent any errors and SPSS-11 statistical software was also used for analyses. The odds ratios and their confidence intervals estimated by using logistic regression.

Results and Discussion

The prevalence of psychiatric disorders was 10.81%. It was more common among females than males (14.34% vs. 7.34%, P < 0.001). The prevalence of anxiety and mood disorders were 8.35% and 4.29% respectively. The prevalence of psychotic disorders was 0.89%; neuro-cognitive disorders, 2.78% and dissociative disorders, 0.77%. Among mood disorders, major depressive disorder (2.98%) and among anxiety disorders, phobic disorder (2.05%) had the higher prevalence. The prevalence of psychiatric disorders among divorced and separated 22.31%; residents of urban areas 11.77%; illiterates 13.80%; householders 15.48%; unemployed 12.33% that were more than other groups.

Conclusion

The mental health pattern in Iran is similar to the western countries, but it seems that the prevalence of psychiatric disorders in Iran may be lower than these countries.It is estimated that at least about 7 millions of Iranian population suffer from one or more of the psychiatric disorders. It shows the importance of the role of the psychiatric disorders in providing preventive and management programs in Iran.
  相似文献   

5.

Objectives

To determine (1) agreement of musculoskeletal ultrasound (MSK-US) findings of shoulder pathology and related shoulder special test results in individuals with varied durations of manual wheelchair (MWC) use after spinal cord injury (SCI); and (2) whether shoulder musculoskeletal impairments, per MSK-US and clinical examination, differed in individuals with SCI and varying durations of MWC use.

Design

Cross-sectional cohort study.

Setting

Laboratory setting.

Participants

Adult volunteers (N=23) with SCI who used an MWC for community mobility. Individuals were stratified into 3 groups based on duration of MWC use: <5 years, 5 to 15 years, and >15 years.

Interventions

Not applicable.

Main Outcome Measures

Special tests for shoulder impingement and bicipital tendonitis were performed. Bilateral shoulder MSK-US was performed, with the Ultrasound Shoulder Pathology Rating Scale (USPRS) quantifying biceps tendon, supraspinatus tendon, and greater tuberosity cortical surface impairments.

Results

No agreement was found between MSK-US and related special tests. Special tests failed to identify impairment in 33.3% to 100% of those identified on MSK-US. The total USPRS score was highest in those with >15 years' MWC use. A higher proportion of dynamic impingement (supraspinatus and biceps) was found in those with >15 years' MWC use, with other MSK-US items having moderate effect sizes among duration-use groups.

Conclusions

MSK-US identified shoulder impairments more frequently than commonly used special tests. A significant increase in the presence of MSK-US shoulder impairments was identified in the longest-duration group. This was not the case for special tests or pain. MSK-US is an easily administered, low-cost, noninvasive method for determining shoulder impairments and should be used in routine screening of individuals who use an MWC after SCI.  相似文献   

6.

Background

Office workers have the highest incidence of neck pain of all occupations. However, the relationship between symptoms and the risk factors is unclear.

Objective

To examine the relationship between self-reported neck pain with a comprehensive range of individual and work-related risk factors.

Methods

This study utilised a cross-sectional study design. Office workers with and without neck pain (n = 763) were recruited. Participants completed a survey which included a Pain Numerical Rating Scale (dependent variable), and measures of independent variables including demographic, individual, work-related factors, neck/shoulder muscle strength, endurance, and range of motion (ROM). The relationships between the independent and dependent variables were analysed in a logistic regression model.

Results

Neck pain was significantly associated with more senior occupational categories, working more than six hours per day on the computer, female sex, greater fear avoidance beliefs for work, greater psychological distress, and reduced cervical flexion ROM. The low severity of neck pain of the participants in this study may limit a robust determination of their association with the risk factor variables, but the studied sample is a realistic representation of the office worker population.

Conclusion

Several potentially modifiable individual and work-related factors were identified to be associated with the presence of self-reported neck pain in office workers. Future studies will be needed to investigate whether strategies to alter these modifiable risk factors translate to changes in neck pain.Trial registration: ACTRN12612001154897 (https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=363209)  相似文献   

7.

Objective

This systematic review aimed to assess the methodological quality of articles about the prevalence of playing-related musculoskeletal disorders (PRMDs) in string players and to identify the rate of prevalence and associated factors of PRMD.

Methods

Cross-sectional studies describing data on separate string players published in 5 different languages between January 1, 1980, and January 31, 2014, were included. The following databases were searched: MEDLINE, sciELO, and LILACS. Other sources and reference lists of published papers also were searched. The Loney Scale was used by 2 independent reviewers to evaluate the methodological quality, and only studies that achieved high scores were included.

Results

Of 1910 retrieved articles, 34 cross-sectional studies were selected for methodological assessment. However, only 8 studies reached satisfactory methodological quality scores. The prevalence rate of PRMD was alarmingly high, ranging from 64.1% to 90%. Women and older musicians were more affected in comparison to other instrumentalists. There seems to be a predominance of symptoms in the left upper limb in violinists and violists, whereas cellists and bassists report injuries in the right upper limb.

Conclusions

Professional and amateur string players are subject to development of PRMD. Low response rates were the most observed source of bias, and there is still a lack of publications with high methodological quality in the literature.  相似文献   

8.

Background

As one of the most common work-related musculoskeletal disorders and postural deviations, forward head posture (FHP), is considered to lead to muscle imbalance.

Objectives

The aim of this study is to investigate the bilateral cross-sectional area (CSA) of the deep neck flexor muscles at rest and during five stages of the craniocervical flexion (CCF) test in individuals with FHP and the controls with normal head posture.

Methods

Eighteen students with FHP and 18 controls with normal head posture, all females aged 18–35 years, participated in this study. Participants were categorized into two groups based on their craniovertebral angle. The CSA of the deep neck flexors was measured using ultrasonography while participants lay supine on the table with a pressure biofeedback unit placed under their necks in order to let the examiner measure the CSA of the muscles during rest and five stages of the CCF test including 22, 24, 26, 28, and 30 mmHg of the pressure biofeedback unit.

Results

A significant effect of contraction level was observed in both groups, indicating significant increases of the CSA of the deep neck flexors during contraction (F = 64.37, P < 0.001). No significant difference was evident for the CSA of the deep neck flexors between the groups, although the increase in the CSA of the deep neck flexors was up to 28 mmHg in the normal head posture group compared to 26 mmHg in the FHP group.

Conclusions

The results of the present study showed no significant difference between the performance of the deep neck flexors during the CCF test in FHP and normal head posture individuals, which challenge the common belief of the deep neck flexors weakness in individuals sustaining FHP.  相似文献   

9.

Background

Many physiotherapists underuse evidence-based practice guidelines or recommendations when treating patients with musculoskeletal disorders, yet synthesis of knowledge translation interventions used within the field of physiotherapy fails to offer clear conclusions to guide the implementation of clinical practice guidelines.

Objectives

To evaluate the effectiveness of various knowledge translation interventions used to implement changes in the practice of current physiotherapists treating common musculoskeletal issues.

Data sources

A computerized literature search of MEDLINE, CINHAL and ProQuest of systematic reviews (from inception until May 2016) and primary research studies (from January 2010 until June 2016).

Study selection and eligibility criteria

Eligibility criteria specified articles evaluating interventions for translating knowledge into physiotherapy practice.

Data extraction and data synthesis

Two reviewers independently screened the titles and abstracts, reviewed full-text articles, performed data extraction, and performed quality assessment. Of a total of 13 014 articles located and titles and abstracts screened, 34 studies met the inclusion criteria, including three overlapping publications, resulting in 31 individual studies.

Results

Knowledge translation interventions appear to have resulted in a positive change in physiotherapist beliefs, attitudes, skills and guideline awareness. However, no consistent improvement in clinical practice, patient and economic outcomes were observed.

Limitations

The studies included had small sample sizes and low methodological quality. The heterogeneity of the studies was not conducive to pooling the data.

Conclusions and implication of key findings

The intensity and type of knowledge translation intervention seem to have an effect on practice change. More research targeting financial, organizational and regulatory knowledge translation interventions is needed.  相似文献   

10.

Objective

The aim of this study was to investigate short-term and long-term treatment effects of dry needling (DN) and manual pressure (MP) technique with the primary goal of determining if DN has better effects on disability, pain, and muscle characteristics in treating myofascial neck/shoulder pain in women.

Methods

In this randomized clinical trial, 42 female office workers with myofascial neck/shoulder pain were randomly allocated to either a DN or MP group and received 4 treatments. They were evaluated with the Neck Disability Index, general numeric rating scale, pressure pain threshold, and muscle characteristics before and after treatment. For each outcome parameter, a linear mixed-model analysis was applied to reveal group-by-time interaction effects or main effects for the factor “time.”

Results

No significant differences were found between DN and MP. In both groups, significant improvement in the Neck Disability Index was observed after 4 treatments and 3 months (P < .001); the general numerical rating scale also significantly decreased after 3 months. After the 4-week treatment program, there was a significant improvement in pain pressure threshold, muscle elasticity, and stiffness.

Conclusion

Both treatment techniques lead to short-term and long-term treatment effects. Dry needling was found to be no more effective than MP in the treatment of myofascial neck/shoulder pain.  相似文献   

11.

Background

Accurate diagnosis of musculoskeletal disorders relies heavily on the physical examination, including accurate palpation of musculoskeletal structures. The literature suggests that there has been a deterioration of physical examination skills among medical students and residents, in part due to increased reliance on advanced imaging. It has been shown that knowledge of musculoskeletal anatomy and physical examination skills improve with the use of ultrasound; however, the literature is limited.

Objective

To determine whether ultrasound can improve the ability of physicians in training (residents) to palpate the long head of the biceps tendon (LHBT) in the bicipital groove.

Design

Prospective study design.

Setting

Tertiary care center.

Participants

Ten physical medicine and rehabilitation residents served as subjects. Exclusion criteria included the presence of any condition that precluded their ability to palpate. Three volunteers were used as models. Model exclusion criteria included anything that distorted normal shoulder anatomy or inhibited examiner palpation. Three investigators with experience performing diagnostic musculoskeletal ultrasound were used to confirm palpation attempts.

Methods

Subjects attempted to palpate the LHBT bilaterally in the bicipital groove of each model. Investigators assessed the accuracy of the palpation attempt using real-time ultrasonography. Subjects participated in a 30-minute ultrasound-assisted training session learning how to palpate the LHBT in the bicipital groove with ultrasound confirmation. After the ultrasound training session, subjects again attempted to palpate the LHBT in the bicipital groove of each model with investigator confirmation.

Main Outcome Measurements

LHBT palpation accuracy rates preintervention versus postintervention.

Results

Pretraining LHBT palpation accuracy was 20% (12/60 attempts). Post-ultrasound training session accuracy was 51.7% (31/60 attempts; P ≤ .001).

Conclusions

Our findings demonstrate that palpation accuracy improves after ultrasound assisted LHBT palpation training. These data suggest that the use of ultrasound may be beneficial when teaching musculoskeletal palpation skills to health care professionals.

Level of Evidence

II  相似文献   

12.

Objective

The purpose of this study was to evaluate the effects of a 16-week resistance and stretching training program applied in physical education (PE) classes on forward head posture and protracted shoulder posture in Portuguese adolescents.

Methods

This prospective, randomized, controlled study was conducted in 2 secondary schools. One hundred and thirty adolescents (aged 15-17 years) with forward head and protracted shoulder posture were randomly assigned to a control or experimental group. Sagittal head, cervical, and shoulder angles were measured with photogrammetry and Postural Assessment Software. The American Shoulder and Elbow Surgeons Shoulder Assessment was used to assess shoulder pain, and neck pain during the last month was self-reported with a single question. These variables were assessed before and after a 16-week intervention period. The control group (n = 46) attended the PE classes, whereas the exercise group (n = 84) received a posture corrective exercise program in addition to PE classes.

Results

A significant increase in cervical and shoulder angles was observed in the intervention group from pretest to posttest (P < .05). For the shoulder pain scores in both groups, there were no significant changes after the 16 weeks.

Conclusions

A 16-week resistance and stretching training program decreased forward head and protracted shoulder postures in adolescents.  相似文献   

13.
14.
15.
16.

Objective

To identify the prevalence and risk factors for musculoskeletal pain in keyboard musicians.

Design

Systematic review

Methods

A systematic review was conducted according to the MOOSE recommendations and it was registered with the PROSPERO database under registration number CRD42016042913. We included observational studies through the electronic databases PubMed, Scopus, ScienceDirect, Web of Science, Répertoire International de Littérature Musicale (RILM), Retrospective Index to Music Periodicals (RIPM), Scielo, and Google Scholar, with combinations of the keywords pianists, keyboard players, musculoskeletal pain, muscular disease, tendinitis, tendinopathy, observational, case-control, prevalence, and risk factors. Data from population, information about pain, and risk factors were extracted from studies that fulfilled the eligibility criteria. The methodological quality of the studies was classified through the Newcastle-Ottawa Scale. The risk of bias and quality of evidence was assessed using the GRADE system.

Results

Twelve articles (case-controls) were included for the qualitative synthesis. The quality of the studies was classified as fair (n = 6) and good (n = 6). Prevalence was observed between 25.8% and 77.0% of musculoskeletal pain among keyboard musicians, with a higher prevalence in wrists and hands (13.8%-65.8%), neck (9.8%-64.2%), and shoulders (9.8%-59.8%). The only consistent risk factor found in the 4 studies was being female, with OR ranging from 1.05-1.90. Age greater than 18 years; weekly training more than 20 hours; training for more than 60 minutes without a rest break; not having a habit of practicing sports; and playing despite the pain were also described as risks factors for musculoskeletal pain. It was not possible to perform the meta-analysis due to the heterogeneity of the studies.

Conclusion

Keyboard musicians presented a high prevalence of musculoskeletal pain, especially in the upper extremity regions of the body. Female, ageing, playing behaviors, and sedentary lifestyle showed an increased likelihood to report musculoskeletal pain.

Level of Evidence

II  相似文献   

17.

Objective

To evaluate the effectiveness of exercise, ergonomic modification, and a combination of training exercise and ergonomic modification on the scores of pain in office workers with neck, shoulders, and lower back pain.

Methods

Participants (N = 142) in this randomized controlled trial were office workers aged 20–50 years old with neck, shoulders, and lower back pain. They were randomly assigned to either the ergonomic modification group, the exercise group, the combined exercise and ergonomic modification group, or the control group (no-treatment). The exercise training group performed a series of stretching exercises, while the ergonomic group received some modification in the working place. Outcome measures were assessed by the Cornell Musculoskeletal Disorders Questionnaire at baseline, after 2, 4, and 6 months of intervention.

Results

There was significant differences in pain scores for neck (MD ?10.55; 95%CI ?14.36 to ?6.74), right shoulder (MD ?12.17; 95%CI ?16.87 to ?7.47), left shoulder (MD ?11.1; 95%CI ?15.1 to ?7.09) and lower back (MD ?7.8; 95%CI ?11.08 to ?4.53) between the exercise and control groups. Also, significant differences were seen in pain scores for neck (MD ?9.99; 95%CI ?13.63 to ?6.36), right shoulder (MD ?11.12; 95%CI ?15.59 to ?6.65), left shoulder (MD ?10.67; 95%CI ?14.49 to ?6.85) and lower back (MD ?6.87; 95%CI ?10 to ?3.74) between the combined exercise and ergonomic modification and control groups. The significant improvement from month 4 to 6, was only seen in exercise group (p < 0.05).

Conclusion

To have a long term effective on MSDs, physical therapists and occupational therapists should use stretching exercises in their treatment programs rather than solely rely on ergonomic modification.

18.

Background

Wheelchair-dependent patients rely on their upper extremities for mobility and transfers. This entails the heavy use of upper extremities as weight-bearing joints, leading to shoulder overuse with increased prevalence of rotator cuff–related disorders and ultimately to challenging cases for shoulder surgeons when a joint replacement is needed.

Objective

To report the outcomes of reverse shoulder arthroplasty (RSA) in wheelchair-dependent patients with arthritis and rotator cuff tears.

Design

Retrospective case series/cross-sectional study.

Setting

Tertiary university hospital.

Patient (participants)

All wheelchair-dependent patients undergoing RSA between 2004 and 2013.

Methods/Interventions

Of the 22 wheelchair-dependent patients undergoing RSA, 18 of them had a minimum follow-up of 2 years. There were 9 men and 9 women, with a mean (standard deviation) age and length of follow-up of 68 (8.5) years and 36 (24-63) months. A retrospective chart review and cross-sectional phone calls were conducted to obtain all data.

Outcomes

Pain, range of motion, functional scores (Neer scale, simple shoulder test, and American Shoulder and Elbow Society), satisfaction, complications/reoperations, radiographic loosening, and 90-day mortality/morbidity.

Results

RSA resulted in a significant improvement in pain (P = .02) and nonsignificant improvements in forward flexion (P = .3) and external rotation (P = .07). There were 3 (16%) excellent, 12 (63%) satisfactory, and 4 (21%) unsatisfactory results. The mean (standard deviation) postoperative American Shoulder and Elbow Society score was 56.5 (16.5). All patients stated that they would undergo RSA again. There were no surgically related complications or reoperations. The 90-day mortality and morbidity rates were 0% and 26%, respectively.

Conclusions

RSA is a safe and effective procedure in wheelchair-dependent patients who use their shoulders for weight-bearing purposes. Although functional scores are not optimal and medical complications are not uncommon, 79% of patients had an excellent or satisfactory result.

Level of Evidence

III  相似文献   

19.

Objective

The purpose of this study was to perform a needs assessment to determine whether short-term use of BackJoy SitSmart Relief and Spine Buddy LT1 H/C chair supports influences neck, upper back, and lower back pain.

Methods

Forty-eight college students (age, 27.5 ± 6.3 years; height, 1.72 ± 0.08 m; body mass, 78.7 ± 19.8 kg; time seated that day, 4.3 ± 2.8 hours; means ± SD) were recruited for this study. The Nordic Musculoskeletal Questionnaire was used to measure pain for the neck, upper back, and lower back regions. Subjects were randomized to sit in a stationary office chair for a single 12-minute period under 1 of 4 conditions: office chair only (control group), BackJoy SitSmart Relief and chair, freezer-cooled Spine Buddy LT1 H/C and chair, or microwave-heated Spine Buddy LT1 H/C and chair. Participants then completed a posttest Nordic Musculoskeletal Questionnaire. A between-within repeated-measures analysis of variance using the between-subject factor intervention (group) and within-subject factor time (baseline and posttest) was used to analyze study data.

Results

The main effect of time across the whole sample was statistically significant for neck (P = .000), upper back (P = .032), and lower back (P = .000) pain; however, there was no statistically significant interaction effect between intervention and time. Thus, as long as participants sat down and rested, symptoms improved similarly across the different groups.

Conclusions

In this preliminary study, short-term and single use of a support product for an office chair had no additive effect on reducing neck and back pain.  相似文献   

20.

Background

Chronic fatigue syndrome (CFS) is a general term used to describe a number of medical conditions that lead to persistent levels of fatigue and distress.

Objectives

Osteopathic manipulative treatment (OMT) combined with shoulder exercises to resolve musculoskeletal sports injury may have also led to a reduction in pain and improved strength with the patient reporting a change in CFS levels.

Clinical features

19-year-old male student, (statue 194cm and mass 80kg) who had played county level cricket and hockey. Presented with a two-year history of left shoulder pain (VAS 8/10) and a diagnosis of chronic fatigue syndrome.

Intervention and outcomes

OMT was performed over four clinical visits throughout a four a month period. Management goal was pain reduction, neural regulation, and facilitation of breathing mechanics to improve lymphatic drainage and restoration of shoulder strength and control.

Conclusion

Clinically a reduction in pain (VAS 8/10–0/10) over four treatments appeared to correlate with improved shoulder strength. It was also reported that due to pain reduction, CFS might have improved.  相似文献   

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