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Effects of Change in the Height of Therapy Tables on the Fatigue of Splenius Capitis Muscle and Trapezius Muscle

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Effects of Change in the Height of Therapy Tables on the Fatigue of Splenius Capitis Muscle and Trapezius Muscle J Int Acad Phys Ther Res 2013; 4(1): 479-544 www .iaptr .org ISSN 2092-8475 http :// dx .doi .org /10.5854/ JIAPTR .2013.05.25.516 Effects of Change in the Height of Therapy Tables on the Fatigue of Splenius Capitis Muscle and Trapezius Muscle The purpose of this study is to analysis of muscle fatigue in the upper Young Hoon Kim, Ji Bin Noh, trapezius and splenius capitis muscles according to therapy table height Sung Hoon Joo, Jung Hyun Choi, variation. The subjects were consisted of 15 healthy adults(10 males, 5 Jung Gyu Yoon, Sang Bin Lee females) who had no medical history of neurological and musculoskeletal problems. In experiment, wireless electrode EMG system was measured for Namseoul University, Cheonan, Korea each the upper trapezius and splenius capitis muscles during the treatment performed on table. the differences in the muscle fatigue was compared for Received : 2 November 2012 4 types of table height(-6cm, -3cm, 0, +3cm from elbow in 90° flexion Accepted : 25 Febrary 2013 position). Muscle fatigue according to therapy table height were significant difference except for left upper trapezius. And muscle fatigue of right upper Address for correspondence trapezius and splenius capitis showed significant decrease in +3cm table Sang Bin Lee, PT, Ph.D height compared to -6cm table height(p<.05). Muscle fatigue of right upper Department of Physical Therapy, trapezius and splenius capitis were the highest in -6cm table height, but Namseoul University, 21 Maeju-ri, those were the lowest in +3cm table height. This study propose to change Sunghwan-eup, Cheonan, Korea Tel: 82-41-580-2532 therapy table height higher than +3cm from elbow in 90° flexion position, if E-mail: [email protected] you hope to reduce muscle fatigue. Key words : Table Height; EMG; Muscle Fatigue INTRODUCTION to health related occupations as well, particularly a high rate in the nurses. Physical therapists are also Work related musculoskeletal disorders(WRMSD) exposed to work related musculoskeletal disorders have recently been increasing at a notable rate(1). such as low back pain(5) According to World Health Organization(WHO), Normally, the weight of the head should be 1/7 of WRMSD is defined as ‘painful disorders of muscle, the body, and muscles in neck and shoulders must tendon, peripheral nerve, and vascular system ’that efficiently work in order to maintain an ideal up- can be attributed to repeated or continuous use of right posture. The flexion position of cervical spine the body and can deteriorate over a period of time(2). increases the load to the cervical spine, which puts There is an agreement in human engineering that about 3.6 times the load on the cervical spine com - force, posture, and repetition are the 3 main causes pared to a standing posture(6). The forward head for work related musculoskeletal disorder(3). Grieco posture involves flexion of the lower cervical verte - et al. puts it, work related musculoskeletal disorder bra and extension of upper cervical vertebra, and can gradually develops through accumulation of constant be commonly seen in white collared workers. This stress on a specific body part over a period of posture can especially be seen in the patients with time(4). neck and shoulder pain in the clinical field(7). To take an example, there are more than 100,000 Constant forward flexion of the cervical vertebra people working in health related occupations in the increases the load to tissues in the neck area(6), and United Sates of America, and this group shows high - it lead to the increasing activity of electromyogram, er work related damage rate compared to people EMG in muscles in the cervical vertebra(8). working in other service related occupations. Particularly, increased danger on trapezius muscle is Musculoskeletal disorder seems to be more common obvious while working on the jobs that require visual 516 Effects of Change in the Height of Therapy Tables on the Fatigue of Splenius Capitis Muscle and Trapezius Muscle demands or precision(8). Eventually, increasing the - the subject group. Each subject was asked to read load on the muscle and joint on the neck from a for - the content and procedures of research, and sign a ward head posture will be the main cause of work- consent form to agree to voluntarily participate in related musculoskeletal disorder(9). this research. The subjects participated in 4 rounds As seen in the past research results, musculoskele - of experiments with each session using a different tal disorder can be caused by the wrong posture that height of the table. might result from inappropriate height of work sta - tion and chairs. Physical therapists also need to Table 1. Characteristics of subjects maintain an appropriate height of the therapy table and a proper distance between the patient and the Mean±SD therapist for a proper posture. The height of the Age(yrs) 24.2±2.00 table is the first determinant in efficiently delivering Weight(kg) 61.13±9.41 full force of the therapist to the patient. The height Height(cm) 169.33±8.69 of the table should be determined by a combination of various factors, such as the height of the thera - pists, the size of the patient, the posture of patient Measurement Equipment on the table, and applied techniques. The table must be set with a lower height when delivering pressure Research was conducted by applying myofascial and force to the patient with less power(10). release technique and using an orthopedic physical The myofascial release technique is a technique therapy table with varying heights. Muscle activity that helps create a more comfortable and stable pos - was measured by attaching wireless surface elec - ture by trying to lead an imbalanced body to a bal - trodes(Ag/AgCI Monitoring Electrode 2225, 3M, anced state, and it is one of the highly individualized South Korea) with 4 channels. sampling rate of EMG orthopedic physical therapy techniques based on the signal was set at 1,000Hz(1,000 samples/second), and request of the patients and skilled experience of the amplified wave was filtered by band pass filter of therapists. Although there are multiple methods and 20~500Hz. corresponding postures for myofascial release tech - nique, a generally used technique is to start with Procedure symmetric positions of both hands and apply direct and/or indirect power along fascial planes on the The subjects were well informed and oriented locations where contraction and relaxation of mus - before conducting the research, and the 15 subjects cles are perceived: one applies traction after waiting who have agreed to participate in the research were for relaxation of muscles(11). selected. The orthopedic physical therapy table with Accordingly, in order to conduct research on how an automatic height-adjuster was selected for the the height of therapy table affects muscle fatigue research. A fixed chair of 55cm without arm sup - during physical therapy, we chose myofascial release ports was used for the research. Also, the posture technique for an experimental activity and upper while sitting on the chair was standardized as trapezius and splenius capitis muscle for muscles maintaining up right waist with the hip on the back under analysis to measure the effect of the height of of the chair. Four different heights of the table were therapy tables. set as 6cm below the elbow, 3cm below the elbow, as high as the elbow, and 3cm above the elbow, respectively. The test sequence was identical for all METHODS the subjects, and EMG surface electrodes were attached to the agreed subjects to measure muscle Subjects fatigue of upper trapezius and splenius capitis mus - cle(Table 1). This research was conducted toward 15 male and In order to relax the occipital region, we let the female college students in the 20 ’s currently attend - patients lie flat on the back and let the subjects sit at ing N University located in Chungnam Providence of their bedside and solidly support the elbow on the Korea. The subjects did not have any lesion or any bed. The subjects were, then,asked to place spinous history of lesion on nervous system, muscular sys - process of cervical vertebra in between their fingers tem and skeletal system. Those who had external and move along the head until they reached the hard injury or pain in the back muscle were excluded from occipital ridge so that the fingers of the subjects 517 Y.H. Kim, J.B. Noh, S.H. Joo, et al. Table 2. Position of attaching electrode 3~4 times. Finally after rubbing off excessive oil with antiseptic alcohol, surface electrodes were Muscle Electrode position attached. Trapezius In between 7th spinous process muscle and acromion Data Analysis Splenius 2cm outside C interspine capitis muscle 4 The SPSS version 18.0 program for WINDOW was used for data analysis, and K-S test(Kolomogorov- were positioned in between the line of occipitial ridge Smirnov test)was used to confirm its normal distri - and spinous process of C 2. After adjusting the height bution. Descriptive statistics was used to identify the of the table based on the physical condition of the general characteristics of the research subjects. The subjects, 2 minutes of myofascial release technique statistical method used to analyze muscle fatigue was applied to the identical patient of each group. In based on changing heights was one way ANOVA for order to eliminate fatigue effect, 1 minute of static related designs. Also, when any significant difference rest was given after delivering myofascial release was found as the result of one way ANOVA analysis technique at each given height. Muscle fatigue of for related design, we appealed to the Scheffe test as back muscle was measured using RMS values of a posteriori test, and the level of significance was set EMG ’s while conducting myofascial release tech - at a=.05.
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