Cieľ práce: Hodnotenie účinku McKenzie metódy v porovnaní s klasickou fyzioterapiou u pacientov s chronickou bolesťou cervikálnej chrbtice. Sledovanie tonusu m. trapezius v zaťažení a stupňa dizability. V skupine liečenej McKenzie metódou súvis fenoménu centralizácie s hodnotami tonusu m. trapezius. Vzorka: Výskumná vzorka pozostávala z 55 pacientov, ktorí boli stratifikovaným výberom rozdelení do dvoch skupín. Skupina A bola liečená McKenzie metódou s pridaním klasickej fyzioterapie (n=30), skupina B bola liečená výlučne klasickou fyzioterapiou (n=25). Kontrolnú skupinu C predstavovali zdraví jedinci (n=24) bez liečebného zásahu. Metódy: Na hodnotenie dizability bol použitý Neck disability index/NDI/. Metódou na meranie tonusu m. trapezius z oblasti C7 bola povrchová EMG prostredníctvom 2-kanálového prístroja EMG - Biofeedback 2000 x-pert /Firma Schuhfried/, hodnoty tonusu boli merané v μV, v zaťažení, počas vykonávania opakovanej elevácie lopatiek. Hodnotený bol fenomén centralizácie prostredníctvom 4-stupňovej škály. Výsledky: V hodnotení celkového skóre dotazníka /NDI/ a v hodnotení tonusu m. trapezius v zaťažení medzi skupinami A, B neboli po celú dobu sledovania zaznamenané signifikantné rozdiely. Pred liečbou boli hodnoty tonusu m. trapezius u zdravých signifikantne nižšie (p<0,05) v porovnaní so skupinami A, B. V skupine A bol zaznamenaný fenomén centralizácie po týždni u 60 %, po mesiaci u 100 % pacientov. Po mesiaci v skupinách A a B došlo k signifikantnému ústupu disability (p<0,05). Nedošlo k signifikantnému poklesu tonusu m. trapezius. Tri mesiace po liečbe bol zaznamenaný u skupín A a B ďalší pokles disability(p<0,05). V hodnotení tonusu m. trapezius v zaťažení pred liečbou boli hodnoty tonusu m. trapezius u zdravých signifikantne nižšie (p<0,05). Tri mesiace po liečbe došlo k signifikantnému poklesu v skupinách A a B (p< 0,05) a zároveň neboli zistené signifikantné rozdiely oproti zdravým. Záver: V predkladanej štúdii sa nám podarilo signifikantne redukovať dizabilitu po mesiaci a ďalej po troch mesiacoch liečby v skupinách A a B a signifikantne redukovať tonus m. trapezius v zaťažení, po troch mesiacoch liečby u oboch skupín A a B. Nebola potvrdená dynamika fenoménu centralizácie s dynamickou poklesu tonusu m. trapezius v skupine A.

The objective of the work: The comparison of the effect of special rehabilitation the McKenzie method and classic physiotherapy in patients with chronic pain in cervical spine region, based on muscle tone reduction (m. trapezius) evaluated by means of the surface EMG, decline of disability. In the group of patients treated by McKenzie method the monitoring of the association of the centralization phenomenon with m. trapezius tone values was conducted. Patient sample: Our patient research sample consisted of 55 patients who were divided into two groups by a stratified selection. The group A was treated by McKenzie method (n=30). The group B was treated by classical physiotherapy (n=25). The control group C consisted of healthy individuals (n=24) without any therapeutic intervention. Methods used: For the measurement of disability we used Neck disability index /NDI/. For the measurement of muscle tone we used the surface EMG, applying two-channel EMG apparatus- Biofeedback 2000 x-pert. The muscle tone values were measured in μV, on loaded, during performing repetition elevation of shoulder blade. Assessment of centralization phenomenon was used. Results: Before treatment In overall score evaluation in both groups A, B there were no significant differences recorded. The m. trapezius muscle tone values in healthy individuals C, were significantly lower (p<0.05), in comparison with groups A, B. In the A group the centralization phenomenon was recorded after one week in 60 %, after one month in 100 % patiens. One month after the treatment in both groups A, B a significant decline of disability occurred (p<0.05). There was no significant decrease of m. trapezius tone. Three months after the treatment further disability decline was recorded in groups A, B. In the assessment of m. trapezius muscle tone in μV in both groups occurred (p<0.05). At the same time the measured muscle tone values in μV were comparable with values in healthy individuals without pain. Conclusion: In the presented study we report how we managed to significantly reduce the of disability one month and three month after the treatment in groups A,B( p< 0.05) and also to significantly reduce m. trapezius tone reduction under loading three months after the treatment in both groups A, B (p< 0.05). The association between the centralization phenomenon and m. trapezius tone decrease was not proven.

Klinika fyziatrie balneológie a liečebnej rehabilitácie LF UPJŠ Košice

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McKenzie Method in combination with (as a part of) the classic physiotherapy in the treatment of patients with chronic pain in the cervical region of the spine