Kinetic therapy in the treatment of cervical discogenic pain syndrome.
Cervical discogenic pain syndrome is a disease of the arthrosis localised in the cervical segment of the spine, charaterised by pain which limits mobility and causes discomfort (Cotman, 2006)
Cervical pain is often due to degenerative diseases of intervertebral discs and posterior tubercles of traverse process and the hypertrophy of the apophyses at a vertebral level.
Pain irradiates locally or at a distance and leads to contraction of skeletal muscles, which itself could produce pain over time and the positioning of fibre locally. (Cretu, 2003)
* fighting inflammation and articular pain
* improving articular mobility
* correcting and recovering motor ability
* preventing deformations, stiffness and muscular atrophy
* maintaining functional capacity of usual movement and work;
* improving quality of life;
* slowing the evolution of articular lessions.
* Consulting the literature, in order to establish how new this topic is in the field of research;
* Establishing research hypotheses as well as ways of checking them.
* Selecting the two experimental cases in compliance with the purpose of the research and application of the necessary tests in order to establish their functional state;
* Structuring and applying the kinetic programme, by respecting pedagogic principles in a logical and progressive manner;
* Recording and interpreting the results;
* Completing research by drafting this study in order to highlight the effects of the kinetic programme in cases of cervical discogenic pain syndrome;
* Establishing the conclusive elements concerning the results obtained after the experiment and in applying the methods of exploration and evaluation.
1. We consider that kinetic methods could be used to treat inflammation and articular pain and improve muscle force.
2. We propose that the kinetic programme has a key role in improving the functional state of persons with cervical discogenic pain syndrome.
Reading the specialised literature
Examination (exploration and evaluation)
Methods of exploration and evaluation used:
--scale of numerical evaluation
--scale of evaluation articular morning stiffness
Recording, processing and graphically representing the data
Finishing the experiment
The experiment consists in applying the specific methods for the important elements as well as using certain kinetic programmes in order to:
* Treat pain and inflammation
* Improve mobility and articular stability
* Combat articular morning stiffness
For this purpose, we have identified two clinical cases of cervical discogenic pain syndrome who accepted to use the specific recovery programme and also we have elaborated a set of methods of recovery from this syndrome.
The main therapeutic methods we used in the recovery process from this syndrome are: medical, kinetic, balneo-physical.
For every case of cervical discogenic pain syndrome, it is necessary to establish an individual treatment plan which is to be discussed in detail with the patient. The diagnosis and the therapeutic options must be specified, as well as the time necessary for the therapeutic effect to appear, the spectre of adverse reactions, monitoring them, the cost of therapy as well as the patients preferences.
Educating the patient is essential in order to establish the doctor-patient relation, the kinetic therapist significantly contributes to the patients independence. Physical medicine, recovery and re-education, occupational therapy and psychology are all intended to contribute to preserving the functional integrity of the locomotor system.
Kinetic therapy and re-education are extremely important in recovering the articular function post-operation. A certain strategy is necessary in order to maintain a good state of health generally.
Examining the patient suffering from cervical discogenic pain syndrome involved a detailed medical history, a complete body check as well as highlighting any change in the spinal column, as well as possible extra-articular problems, as well as a full set of medical and imagery tests.
We have evaluated:
* The amount of pain;
* Articular mobility;
* Morning articular stiffness.
1. Establishing the amount of pain;
Establishing the amount of pain was done by using a Numerical evaluation scale which is the most used method. Patients evaluate their pain level on a scale from 0 to 5, where 0 represents "no pain" and 5 "most acute pain".
Initial pain in the first case was registered at 4 and the second case at 5, after finishing the kinetic programme supported by the medical treatment we registered a degree of 1 in the first case and a degree of 2 in the second case.
2. Articular mobility
Testing the articular mobility by using 3 tests:
The Menton-Stern Test
Initial testing in clinical case 1 registered a value of 5 cm while in clinical case 2 this value is 6 cm, upon final testing case one registered 3 cm while case two registered 4 cm.
The Wall Occiput Test
Checking the distance between the occiput and the wall, we registered a value of 10 cm in case 1 and 8 cm in case 2, upon final testing case 1 registered 5 cm while case 2 registered 6 cm.
The Tragus Test-Acromion
While testing the distance between the tragus and the acromion, case 1 initial recorded a value of 7 cm while case 2 recorded 8 cm, upon the final test case 1 registered 4 cm while case 2 registered 6 cm.
3. Articular Morning Stiffness
In order to evaluate the level of articular morning stiffness we used the Womac (Western Ontario and McMaster Universities) Likert subscale divided into 5 steps from 0 to 4.
Upon initial evaluation, case 1 was at level 3 while case 2 at level 2 and after finishing the experiment both cases registered the following progress:
--case 1 was at 1
--case 2 at 0
Among other authors who have carried out researches concerning the kinesitherapy role in the recovery from algo-functional cervical syndrome was Kiss (2004); in his book "Fizio-kinetoterapia si recuperarea medicala" (Physiokinesitherapy and medical recovery) he carried out a study on kinesitherapy's role in the recovery from algofunctional cervical syndrome by kinetic means.
Windsor Robert also makes reference to this subject; he carried out a study in which he shows the incidence of this syndrome in his work "Cervical Discogenic Pain Syndrome", which has been published in Medscape magazine.
Reducing pain and inflammation are the two objectives which must be met to use the optimum kinetic programme.
Kinetic therapy consists in a series of movements, physical exercises, vertical positions which lead to an improvement of the two studies.
Concerning the evaluation of the amount of initial pain, case 1 registered a value of 4 while case 2 a value of 5, after finishing the kinetic programme case 1 registered a drop to 1 while case 2 experienced a drop to 2.
The kinetic programme has had a positive effect and in the case in the Menton-Stern test both clinical cases registered a value of 2 cm.
Concerning the wall occiput test, clinical case 1 registered an increase of 5 cm while clinical case 2 had 4 cm.
In initial testing of the difference between the tragus and the acromion, case 1 registered a value of 3 cm while case 2 only 2 cm.
Kinetic therapy has had en effect on the level of articluar morning stiffness by reducing it to a value of 3 in case 1 and in case 2 the stiffness disappeared.
Following our research and the results obtained from this experiment and application of initial and final tests with our two clinical cases, we may state that our original hypotheses have been confirmed. We base this on the following conclusions:
Finishing the kinetic programme has led to treating articular morning stiffness, increasing mobility and articular stability.
Well-selected, structured kinetic exercises, which efficiently play a part in reaching our objectives, contribute to optimizing the functional state and improving the health of people with cervical discogenic pain syndrome.
The patients consciously and actively took part in the proposed kinetic programme and have managed to acquire corretly and easily execute the kinetic exercises.
Cretu, A., 2003, Ghid clinic si terapeutic fizical-kinetic in bolile reumatice, Edit. Bren, Bucuresti, pag. 223.
Cotoman, R., 2006, Kinetoterapie, Edit. Fundatiei Romania de Maine, Bucuresti, pag. 59.
Kiss, I., 2007, Fiziokinetoterapia si recuperarea medicala, Editura Medicala, Bucuresti,
Sbenghe, T., 1981, Recuperarea medicala a sechelelor posttraumatice ale membrelor, Edit. Medicala, Bucuresti;
Sbenghe, T., 1999, Bazele teoretice si practice ale kinetoterapiei, Editura Medicala, Bucuresti.
Sbenghe, T., 1987, Kinetologie profilactica, terapeutica si de recuperare, Edit. medicala, Bucuresti.
Windsor R., Cervical Discogenic Pain Syndrome--emedicine. medscape.com/article/93761-overview
FIEROIU EMIL (1)
(1) The Department Of Medical Assistance And Kinetic Therapy, The University Of Piteti, ROMANIA
Chart. 1--Evaluating the amount of pain Case 1 Case 2 Initial test 4 5 Final test 1 2 Chart. 2--Evaluating the mobility of the cervical section of the spine Initial test Final test Clinical case 1 5 2 Clinical case 2 6 4 Chart. 3--Evaluating cervical mobility in the spine Initial test Final test Clinical case 1 10 5 Clinical case 2 8 6 Chart. 4--Improving cervical mobility in the spine Initial test Final test Clinical Case 1 7 8 Clinical case 2 4 6 Chart 5--Distribution of stiffness in the two experimental cases Initial test Final test Clinical case 1 3 2 Clinical case 2 1 0
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|Publication:||Ovidius University Annals, Series Physical Education and Sport/Science, Movement and Health|
|Date:||Jun 1, 2013|
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