| 1. |
- Ahlgren, Christina, et al.
(författare)
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Effects on physical performance and pain from three dynamic training programs for women with work-related trapezius myalgia
- 2001
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Ingår i: Journal of Rehabilitation Medicine. - : Taylor & Francis. - 1650-1977 .- 1651-2081 .- 0000-0000. ; 33:4, s. 162-9
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Tidskriftsartikel (refereegranskat)abstract
- To compare training programs for women with trapezius myalgia regarding physical performance and pain, 102 women were randomized to strength, endurance, co-ordination and non-training groups. Before and after the intervention, static strength and dynamic muscular endurance in shoulder muscles were measured on a Cybex II dynamometer. Muscle activity in shoulder muscles was monitored via surface EMG. The signal amplitude ratio between the active and passive phase of repeated contractions indicated the ability to relax. Pain at present, pain in general and pain at worst were measured on visual analogue scales. After training, within group comparisons showed that the training groups rated less pain, and in the strength training group ratings of pain at worst differed from the non-training group. Using the non-training group as a reference, static strength increased in the strength and endurance training groups and muscular endurance in all training groups. The study indicates that regular exercises with strength, endurance or co-ordination training of neck/shoulder muscles might alleviate pain for women with work-related trapezius myalgia.
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| 2. |
- Björklund, Erika, 1972-, et al.
(författare)
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Discourses about electricians in vocational education
- 2018
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Konferensbidrag (refereegranskat)abstract
- Students in vocational education to become electricians have an increased risk of developing musculoskeletal disorders (MSDs) once in the workforce compared to most other blue collar professions (Toomingas et al., 2014). This increased risk comes from having to work in awkward body positions, with heavy and sometimes poorly adapted tools and with time constraints. Many end up with chronic disabilities, forcing them to change careers or to go on sickness pension. Besides the significant and damaging consequences for the individual concerned, losing electricians from the workforce is a significant loss for the building industry in which electricians these days are scarce, and for society that not only loses tax-incomes but also possibly need to pay sickness pension for these people during quite a few years. It is therefore important to find ways to prevent MSDs and to promote good ergonomics in the building industry in general and among electricians specifically. Electricians’ knowledge and habits regarding MSDs are first formed and shaped in school, during vocational education to become an electrician. Drawing on the ideas of bio-power and governmentality, as introduced and developed by Foucault (1988, 1990, 2003) and developed by Rose (1999; Rabinow and Rose, 2006), discourses govern how it is possible to think and act. From this standpoint, then, talk and discourses are not perceived as innocent or ‘mere’ talk (Hall, 2001) but as governing the production, regulation and representation of both bodies and subjects through the acquisition of specific dispositions, tastes and abilities (Foucault, 1988; Rose, 1999). Thus, discourses drawn on in school about electricians and the profession govern how it is possible to think and act about oneself and others in relation to both ergonomics and MSD and, by extension, have material effects on electricians’ health. This means that, to foster healthy ergonomics one needs to consider how electricians and the profession are conceived and thought about in school, i.e. how electricians and the profession are discursively conceived. The purpose of this paper is thus to explore discursive constructions of electricians and the profession as these are expressed in discussions about MSDs in the vocational education and school context. Methods used are four focus group interviews: two with students, one with teachers and one with school management at one senior high school program for electricians. In the focus group interviews the participants were asked to discuss ideas about causes and reasons to why electricians develop MSDs, consequences and effects of MSDs and ideas about what could be done to prevent MSDs. The interviews were then transcribed and discursively analyzed with questions in mind about how each group conceived of electricians and the profession.
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| 3. |
- Björklund, Erika, 1972-, et al.
(författare)
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Discursive constructions of electricians in discussions about musculoskeletal disorders among professionals in the field
- 2018
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Konferensbidrag (refereegranskat)abstract
- Electricians have an increased risk of developing musculoskeletal disorders (MSDs) compared to most other blue collar professions. Many end up with chronic disabilities, forcing them to change careers or to go on sickness pension. Besides negative consequences for the individuals concerned, MSDs also have a detrimental impact on the workforce (reduced number of professionals) and on society (financial costs). It is therefore important to find ways to prevent MSDs and to promote good ergonomic behavior. Electricians’ knowledge and habits regarding MSDs are first formed and shaped in school, during vocational education to become an electrician. In the course of this time the students have periods of internship during which they interact with professionals within the field. Drawing on the ideas of bio-power and governmentality, as introduced and developed by Foucault and developed further by Rose, discourses govern how it is possible to think and act. From this standpoint, then, talk and discourses are not perceived as innocent or ‘mere’ talk but as producing and regulating subjects through their acquisition of specific dispositions, tastes and abilities. Thus, discourses drawn on about electricians and the profession during the students’ internship will govern how it is possible for the students to think and act about themselves and others in relation to both ergonomic behavior and MSDs and, by extension, will have material effects on electricians’ health. This means that, to foster healthy ergonomic behavior one needs to consider how electricians are thought of within the field, i.e. how electricians and the profession are discursively conceived. The purpose of this paper is thus to explore discursive constructions of electricians and the profession as these were expressed in discussions about MSDs among professionals in the field. Two semi-structured focus group interviews and one individual interview with professionals in the field were conducted. The participants were asked to discuss ideas about i) causes as to why electricians develop MSDs, ii) consequences and effects of MSDs, and iii) ideas about what could be done to prevent MSDs. The interviews were transcribed and the material is currently being discursively analyzed with questions in mind about how the participants conceived of electricians and the profession. Results will be presented at the conference, but preliminary analyses suggests that predominant discourses are concerned with the masculinity of electricians as well as with their time pressured work situation, both contributing to casualness towards ergonomic behavior.
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| 4. |
- Björklund, Martin, et al.
(författare)
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Acute muscle stretching and shoulder position sense
- 2006
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Ingår i: Journal of athletic training. - 1062-6050 .- 1938-162X. ; 41:3, s. 270-274
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Tidskriftsartikel (refereegranskat)abstract
- Context: Stretching is common among athletes as a potential method for injury prevention. Stretching-induced changes in the muscle spindle properties are a suggested mechanism, which may imply reduced proprioception after stretching; however, little is known of this association. Objective: To evaluate whether acute stretching of the shoulder muscles affects position sense. Design: A crossover design with subjects randomized to 3 groups. Setting: A university human research laboratory. Patients or Other Participants: Nine male (age = 24 +/- 3 years) and 9 female (age = 21 +/- 2 years) healthy volunteers. Intervention(s): Stretching of shoulder (1) agonists or (2) antagonists or (3) nonstretching control. Main Outcome Measure(s): We determined position sense acuity of the right shoulder before and after the interventions by having subjects attempt to reproduce arm positions of 15 degrees and 30 degrees (shoulder adduction) while starting at 45 degrees to the sagittal plane. The outcome variables were response variability (variable error) and overall accuracy (absolute error). Results: The relative change in variable error (ie, variable error after/variable error before) was not significantly different between the interventions ( P = .38). Similarly, no change in absolute error was found ( P = .76). Furthermore, no differences were noted regarding test sequence or the interaction of intervention x sequence for either variable error ( P = .73 and .53, respectively) or absolute error ( P = .71 and .67, respectively). Conclusions: We found no effect on shoulder position sense after an acute bout of stretching of either agonist or antagonist shoulder muscles.
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| 5. |
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| 6. |
- Björklund, Martin, 1961-, et al.
(författare)
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Cervico-thoracic and cranio-cervical strength differences between women with and without neck pain and the diagnostic performance of neck-strength tests
- 2019
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Ingår i: World Confederation for physical Therapy Congress 2019, Geneva 10-13 May.
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Konferensbidrag (refereegranskat)abstract
- Background: Cervical strength and stability is often addressed in rehabilitation of people with neck pain. These functions may be associated with emergence and retention of neck pain in cases where the neck strength does not meet daily demands. However, clear empiric support for these notions are lacking, partly due to a scarcity of well controlled dynamometry studies with large samples. First, clarification is needed whether neck strength is in fact reduced in people with neck pain and to resolve the diagnostic performance of neck strength tests.Purpose: To compare neck muscle strength of women with non-specific long-term neck pain and healthy controls. Also, to assess the diagnostic performance of neck strength tests by assessing their discriminative ability to discern women with and without neck pain.Methods: The study had a cross-sectional design with data on cervical strength derived from the baseline measurement of a randomized controlled trial (RCT). 80 women with long-term non-specific neck pain (NP) were compared with 40 healthy women (CON). The NP group was a subsample from the RCT selected so that there were no group differences (NP-CON) for body weight and physical activity. Cervical strength assessment included dynamometry of cervico-thoracic extension (CTE) and flexion (CTF) in sitting and cranio-cervical flexion (CCF) in standing, all performed with isometric maximum voluntary contraction (iMVC). Independent samples Mann-Whitney U test and T-test were used to assess group differences for iMVC of the tests. Diagnostic accuracy was further assessed with a receiver operating characteristic (ROC) curve by plotting the true positive rate (sensitivity) as a function of the false positive rate (1 - specificity). The area under the ROC curve (AUC) with 95% confidence interval was used to determine discriminative ability of the tests. The optimal cut-off value to discern NP from CON with corresponding sensitivity and specificity was also determined.Results: Women with neck pain produced significant lower iMVC in CTE (28%), CTF (26%) and CCF (33%) (all p< 0.001). The ability of CTE, CTF and CCF to discriminate between NP and CON showed moderate accuracy (AUC 0.83, 0.78 and 0.73, respectively). The cut-off value of 165.7 N in CTE had a sensitivity of 0.725 and a specificity of 0.8. The corresponding values for CTF and CCF were 85.8 N (sensitivity 0.8; specificity 0.692) and 4.2 Nm (sensitivity 0.575; specificity 0.9).Conclusion(s): The neck pain group had less neck muscle strength than controls in all tests. The diagnostic performance of the neck strength tests, judged as discriminative ability to discern neck pain from control participants, were moderate. These results support earlier findings of reduced neck strength in people with neck pain. Also, neck strength tests may have a complementary value in the assessment of neck pain persons.Implications: The results highlights that impaired neck strength, both in global cervico-thoracic and deep cranio-cervical muscles, is most likely a characteristic of people with long-term neck pain. The study also shows that strength tests could be used with fairly good discriminative precision and may thereby be valuable assessment tools.
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| 7. |
- Björklund, Martin, et al.
(författare)
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Effects of tailored neck-shoulder pain treatment based on a decision model guided by clinical assessments and standardized functional tests : a study protocol of a randomized controlled trial
- 2012
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Ingår i: BMC Musculoskeletal Disorders. - : BioMed Central. - 1471-2474. ; 13
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Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND: A major problem with rehabilitation interventions for neck pain is that the condition may have multiple causes, thus a single treatment approach is seldom efficient. The present study protocol outlines a single blinded randomised controlled trial evaluating the effect of tailored treatment for neck-shoulder pain. The treatment is based on a decision model guided by standardized clinical assessment and functional tests with cut-off values. Our main hypothesis is that the tailored treatment has better short, intermediate and long-term effects than either non-tailored treatment or treatment-as-usual (TAU) on pain and function. We sub-sequentially hypothesize that tailored and non-tailored treatment both have better effect than TAU.METHODS: 120 working women with minimum six weeks of nonspecific neck-shoulder pain aged 20-65, are allocated by minimisation with the factors age, duration of pain, pain intensity and disability in to the groups tailored treatment (T), non-tailored treatment (NT) or treatment-as-usual (TAU). Treatment is given to the groups T and NT for 11 weeks (27 sessions evenly distributed). An extensive presentation of the tests and treatment decision model is provided. The main treatment components are manual therapy, cranio-cervical flexion exercise and strength training, EMG-biofeedback training, treatment for cervicogenic headache, neck motor control training. A decision algorithm based on the baseline assessment determines the treatment components given to the each participant of T- and NT-groups. Primary outcome measures are physical functioning (Neck Disability Index) and average pain intensity last week (Numeric Rating Scale). Secondary outcomes are general improvement (Patient Global Impression of Change scale), symptoms (Profile Fitness Mapping neck questionnaire), capacity to work in the last 6 weeks (quality and quantity) and pressure pain threshold of m. trapezius. Primary and secondary outcomes will be reported for each group with effect size and its precision.DISCUSSION: We have chosen not to include women with psychological ill-health and focus on biomedical aspects of neck pain. Future studies should aim at including psychosocial aspects in a widened treatment decision model. No important adverse events or side-effects are expected.Trial registration: Current Controlled Trials registration ISRCTN49348025.
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| 8. |
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| 9. |
- Björklund, Martin, 1961-, et al.
(författare)
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Effects of tailored versus non-tailored treatment on pain and pressure pain threshold in women with nonspecific neck pain : a randomized controlled trial
- 2014
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Konferensbidrag (refereegranskat)abstract
- Aim of the investigation: The evidence for physiotherapy treatments of nonspecific neck pain is modest despite a large increase of intervention studies the last decade. One reason could be different underlying causes for pain in individuals with nonspecific neck pain, and that identification of sub-groups or individual needs is seldom accounted for in studies. In the absence of causal treatment options, a tailored treatment approach based on an explicit clinical decision model guided by assessment of function, clinical signs and symptoms, should be considered. Our aim was to evaluate tailored treatment based on such a decision model, targeting women with nonspecific neck pain. Our main hypothesis was that the tailored treatment (T) would have better short, intermediate and long-term effects on pain intensity and pressure pain threshold for the trapezius muscles than either non-tailored treatment (NT) (same treatment components but applied quasi-randomly) or treatment-as-usual (TAU) (no treatment from the study, no restrictions). We further hypothesized that T or NT has better effect than TAU. For details, cf. Current Controlled Trials registration ISRCTN49348025 and published study protocol.Methods: 120 working women with minimum six weeks duration of neck pain were randomized to the T, NT or TAU groups. All participants had more than “no disability” but less than “complete disability” according to the Neck Disability Index, and reported impaired capacity on the quality or quantity to work the preceding month. Main exclusion criteria were trauma-related neck pain, specific diagnoses and generalized pain or concomitant low back pain. The decision model for tailored treatment was based on tests and symptoms with defined cut-off levels comprising the following main categories: reduced cervical mobility, impaired neck-shoulder strength and motor control, trapezius myalgia, cervicogenic headache and impaired eye-head-neck control (cf. published study protocol). Assessment was performed one week before and after the 11-weeks intervention, with follow-ups 6-months (intermediate-term) and 12-months (long-term) after the intervention. Outcome variables were pain intensity (Numeric Rating Scale, NRS, 0 – 10) and pressure pain threshold (PPT) of the upper trapezius muscles (kPa). PPT was not measured at long-term follow-up. Preliminary statistical analyses for the predefined hypotheses were performed with analysis of covariance (ANCOVA) with baseline outcome values as covariates. This was supplemented with pairwise Bonferroni-compensated comparisons in case of significance of factor group.Results: 86% of the participants completed the intervention, and the attrition was similar across groups. Preliminary results for the short term evaluation showed a reduction in NRS from an average of 4.4 and 4.5 to 2.5 in the T and NT groups, respectively, which was significantly greater compared to the TAU group (p=0.024 and p=0.014 for T and NT). For the PPT, there was no difference between T and NT groups at the short term evaluation, but close to a significantly increased threshold for the T compared to the TAU group (p=0,058). No differences were found between treatment groups on the intermediate and long-term evaluations for neither of the two outcome variables.Conclusions: The results indicate that tailored treatment for women with nonspecific neck pain may not be more effective, with respect to pain reduction, compared to non-tailored treatment. The hypothesis of superiority of tailored or non-tailored treatment over treatment-as-usual was partly supported for the short-term evaluation. However, the short-term results should be interpreted with caution since the impact of higher attention given to the participants in T and NT groups is not known. Reference:1. Björklund M, Djupsjöbacka M, Svedmark Å, Häger C. (2012) Effects of tailored neck-shoulder pain treatment based on a decision model guided by clinical assessments and standardized functional tests. A study protocol of a randomized controlled trial. BMC Musculoskeletal Disorders. May 20;13(1):75
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