Physical Therapy and Manual Therapy for Prevention and Rehabilitation of Cervical Myofascial Pain and Headache, due to Spine Malposition in Users (Abusers) of Smart Phones
Introduction: Ultimately, the introduction of portable devices in the everyday life imposed the necessity to evaluate the possible consequences (of the abuse) on the position of the spine and correspondent structures of the nervous system. Medical specialists are responsible for the construction of programs for prevention of these consequences. The goal of the current article is to evaluate the impact of physical therapy and manual therapy in the treatment and the prevention of cervical myofascial pain and headache, due to spinal malposition in users (abusers) of smart phones. Materials and methods: We observed a total of 69 patients with cervical myofascial pain and headache. The age of the patients was between 19 and 49 years, with posture (position) alterations of the cervical spine, but without significant cervical pathology. All patients used a mobile device in their everyday activities (minimum 2 h daily) for at least 6 months. Functional evaluation was effectuated before, during and after treatment and one month after the end of the rehabilitation. In all patients we applied a complex physical-therapeutic program, including analytic exercises for paravertebral muscles and soft tissue techniques [massages, post-isometric relaxation (PIR) for the respective upper trapezius and sterno-cleido-mastoideus muscle] and stimulation of patients’ active participation in the process of prevention (education in principles of back-school, self-massage, auto-PIR). The patients in the first group effectuated only these procedures. In the second group we added elements of manual therapy (tractions, mobilizations, manipulations; and auto-mobilizations). Statistical evaluation was performed by SPSS program, version 17; using t-test (analysis of variances ANOVA) and Wilcoxon rank test (non-parametrical correlation analysis). Results and analysis: All patients reported a significant decrease in the intensity of cervical pain and headache (evaluated by Visual analogue scale of pain and by pressure dolorimetry). In all patients we observed amelioration of the static position of the cervical spine, reduced amount of paravertebral muscle spasm and of the sensibility of trigger and tender points; and augmentation of range of active motion of the cervical region of the spine. During the rehabilitation period the results were most important in the second group (with manual therapy), but one month later there is not statistical differences between both groups. Discussion and conclusion: Techniques of physical therapy and manual therapy are very useful for the prevention and the rehabilitation processes of cervical myofascial pain and headache. The program of care includes active (analytic) exercises, PIR and stretching techniques, tractions and mobilizations, education of the patient, and (in some cases) manipulations. We consider that every medical doctor - specialist in Physical and rehabilitation medicine and every physical therapist must adapt the general algorithm to the needs of the concrete patient.