JOURNAL WATCH

RANDOMIZED TRIAL OF THERAPEUTIC MASSAGE FOR CHRONIC NECK PAIN. Sherman KJ, Cherkin DC, Hawkes RJ, et al. Clinical Journal of Pain 2009;25:233–238

Sixty-four patients were randomised to receive either up to ten massages over 10 weeks or a self-care book. Follow-up telephone interviews after 4, 10, and 26 weeks assessed outcomes including dysfunction and symptoms on a symptom-bothersomeness scale at

each time point.

Results: At 10 weeks, more participants randomised to massage experienced clinically significant improvement on a neck disability index (39% vs. 14% of book group) and on the symptom-bothersomeness scale (55% vs. 25% of book group). After 26 weeks, massage group members tended to be more likely to report improved function but not symptom bothersomeness. Mean differences between groups were strongest at 4 weeks and not evident by 26 weeks. No serious adverse experiences were reported.

sportEX comment Any paper that uses a scale going from 0 being ‘Am I bothered?’ to 10 being ‘I am extremely

bothered’ has to be worth a look. To be fair, Chaitow uses it in his 2006 Muscle Energy Technique book, so it has a pedigree. This study is gold dust for those who need to prove an evidence base for treatments. It’s a randomised control trial that suggests that massage is safe and may have clinical benefits for treating chronic neck pain, at least in the short term.

COMPRESSION ON TRIGGER POINTS IN THE LEG MUSCLE INCREASES PARASYMPATHETIC NERVOUS ACTIVITY BASED ON HEART RATE

VARIABILITY. Takamoto K, Sakai S, Hori E, et al. Journal of Physiological Sciences 2009;59:191–197

Six healthy young adult females whose daily working routine was carried out predominantly in a standing position were enrolled in the study cohort. After a day’s work, the subjects were asked to rest supine. Electrocardiograms (ECGs),

instantaneous lung volume (ILV) and systolic and diastolic blood pressures (SBP, DBP) were measured before and after the application of pressure over trigger points (TPs) in those lower limb muscles where the subjects felt muscle fatigue or discomfort. The subjects were also asked to coordinate breathing with rhythmic beeping sounds. The therapeutic effects of TP compression were assessed by a subjective fatigue scale. Parasympathetic nervous activity was also assessed by spectral analysis of heart rate (HR) variability. The transfer function from ILV to HR was evaluated using linear analysis. Results: TP compression (i) decreased HR, SBP and DBP, (ii) increased parasympathetic

activity, (iii) increased the gain from ILV to HR and (iv) improved the fatigue scores.

sportEX comment ]Unfortunately, this is another

promising study with very low participation numbers. How much of the reported effects are attributable to the trigger point compression or the breathing technique is open to debate, but the results indicate a reduced level of perceived fatigue. What this study should be commended for is the use of the word ‘massotherapy’, meaning the therapeutic use of massage.

STRETCHING POSITIONS FOR THE POSTERIOR CAPSULE OF THE GLENOHUMERAL JOINT STRAIN MEASUREMENT USING CADAVER SPECIMENS. Izumi T, Aoki M, Muraki T, et al. American Journal of Sports Medicin e 2008;36:2014–2022

Using eight fresh-frozen cadaver shoulders (average age 82.4 years), eight

stretching positions for the posterior capsule were simulated by passive internal rotation. The following stretching positions were adopted: 0°, 30°, 60° and 90° of elevation in the scapular plane; 60° of flexion; 60° of abduction; 30° of extension; and 60° of flexion and horizontal adduction. Strain was measured in the upper, middle and lower parts of the capsule. Results: With internal rotation, the mean strain on the upper capsule was 3.02% at 0° of elevation and 3.35% at 30° of

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extension. Strain on the middle capsule at 0° and 30° elevation was 0.78% and 4.77%, respectively; on the lower capsule, it was 5.65% and 2.24% at 30° and 60° of elevation, respectively, and 2.88% at 30° of extension. The increases in strain of the upper, middle and lower capsule with internal rotation at 0°, 30° and 60° of elevation were statistically significant. Other shoulder positions demonstrated no positive strain values.

sportEX comment Various stretches have been introduced

for the posterior shoulder. However, little quantitative analysis to measure stretching of

the posterior capsule has been performed. This is a cadaver study, and the age group was not really one that reflects an active population, but it does prove differences in strains at varying positions, the optimum being at a stretching position of 30° of elevation in the scapular plane with internal rotation for the middle and lower capsule, while a stretching position of 30° of extension with internal rotation was effective for the upper and lower capsule. The practical relevance of this is that one stretch does not fit all and in vivo you need to alter positions for maximal coverage.

sportEX dynamics 2009;21(Jul):4-6