There is solid evidence that physical exercise, physical training, fitness and wellness programs can sharply decrease absence at work, improving the quality of occupational performance, regardless of the type of job. In fact, in addition to the well-known health benefits of being physically fit, physical training interventions can prevent limitations in job performance due to inadequate muscle effectiveness as well as possible mismatches between job demands and physical capacities. In designing a physical training program for improving occupational performance, several fundamental program-design variables should be considered: exercise selection and order; equipment used; specificity; frequency; sets; repetitions; rest intervals; duration; variation; and progression [1
]. Because the physical training should be done during the workday, it should be fast, effective, and efficient; moreover, it would be useful if every company had at least a small gymnasium.
Neck and shoulder disorders are a considerable health problem in the working population with prevalence rates of equal or higher than 30% [4
]. Neck pain is common among adults in developed countries and contributes importantly to the demand for medical services and the economic burden of absence from work due to sickness [5
]. Although the etiology of work-related neck disorders is likely multidimensional, strong evidence has been found for a causal relationship between neck disorders and highly repetitive work, forceful exertions, a high level of static contractions, prolonged static loads and extreme postures, and combinations of these factors.
Altered trapezius activity has been linked to neck pain, and previous studies have shown that individuals with neck pain display altered trapezius activation patterns [7
]. In particular, the deleterious effect of sustained activity pattern in the upper trapezius (UT) muscle (which is the occurrence of continuous muscle activation without interruptions) has been proposed as a common mechanism for explaining neck and shoulder pain [4
Because the physical exercises that are proposed for exercising the lower trapezius (LT) muscle always make the UT work more than LT [9
], there is a need of a device that would involve synergistically the cervical-dorsal muscles. In particular, there is a need to emphasize the activity of the LT, while concurrently relaxing the UT to reduce the consequences of faulty posture and of excessive activation of the cervical-dorsal muscles. This physical exercise should be able to decouple and then fractionate the UT and the LT muscle activity.
In order to test this proposal, we used a specially designed device called the “Angel’s Wings” (patent number 0001401430). The device acts mainly on the axial muscles of the cervical-dorsal rachis, and thanks to a simple distribution of vectors of forces, it is possible to isolate the LT activity from that of the UT, so it can correct posture of this tract [10
]. In the present paper, we tested, for the first time, the ability of the Angel’s Wings to fractionate the UT and the LT muscle activity, and the impact of decoupling this muscle on posture over a period of 30 days. In a second stage, we tested the Angel’s Wings, and the method that we propose on a sample of 73 employees of Ferrari S.p.A. and the Scuderia Ferrari racing team division, based in Maranello, Italy, to determine whether there was neck and shoulder pain relief following one session of the proposed exercise.
The trapezius muscle is a very large muscle area that extends longitudinally from the occipital bone to the lower thoracic vertebrae and laterally to the spine of the scapula. The trapezius supports the shoulder as well as the neck. Being the primary actors in an upward scapular rotation, UT and LT should make adequate and relatively equal contributions to maintain normal biomechanics. Most commonly, the UT is believed to influence pain in the neck. In effect, individuals with neck and shoulder pain display altered trapezius activation patterns, with UT muscle more active than the LT [4
] and limited strength or endurance of LT muscle [11
]. The over-activity of UT will results in scapulothoracic muscle imbalance causing weakness of LT muscle with possible irradiation of the pain downward. For these reasons, it would be appropriate to emphasize LT strengthening with exercises that simultaneously induce a relaxation of the UT.
The Angel’s Wings represent the first device able to decouple the UT and the LT muscle activity, emphasizing the muscular activity of the LT and then the relaxation of the UT. This characteristic indeed distinguishes Angel’s Wings from other physical exercises that act simultaneously on all trapezius segments. The exercise with Angel’s Wings is absolutely not difficult and produces significant pain relief in the body portions on which it acts, namely, the neck, the shoulders, and the back. Since it is a physical exercise designed to make the obtained benefits stable and long-lasting, a hypothetical user should train with this device and protocol with constancy—for example, at least three times per week, as suggested by previous guidelines regarding physical training [13
]. However, an initial feeling of great relaxation and of pain decrease can be felt after only one session. Moreover, the fact that, regardless of gender, age, or level of training, the weight lifted was within a range between 1 and 7 kg indicates that the stimulated muscles in this performance by the proposed device have almost the same degree of training in all persons, corroborating the idea that this physical exercise is most likely suitable for everyone.
The most important phase of the motor task with the Angel’s Wings is the Phase 2, i.e.
, the contraction during lifting. The sEMG clearly show that, during Phase 2, a sharp contraction of the LT corresponds to a large relaxation of the UT. Since altered trapezius activity has been linked to neck pain and previous studies have shown that individuals with neck pain display altered trapezius activation patterns [7
], we hypothesize that this particular trapezius activity, obtained with the use of the Angel’s Wings, results in neck, shoulder, and dorsal pain relief. The device indeed permits the discharge of the force developed from the weight lift from the UT to the LT, relaxing the former muscle. Given that shoulder posture has the ability to both facilitate and suppress specific motor pathways [14
], the possibility that, during the proposed motor task, a facilitated pathway would, in principle, make the LT muscle fundamentally easier to activate than the UT, needs to be considered. Consequently, the appropriate selection of upper limb movement, combined with the Angel's Wings, may prove beneficial in rehabilitation environments to help selectively modulate the relative accessibility of specific muscles and thus retrain motor control.
It is important to consider that, in the tested population of employees, there were really different professionals, with different styles of life. A factor that is common for all categories of professionals, for physically demanding jobs and sedentary jobs, is the perception of pain in the portions of the body considered in this study. The pain frequently starts from the neck and then spreads to other parts of the body. Thus, for example, pilots and the pit stop laborer suffer from neck pain for different reasons. The neck of a pilot is frequently stressed for the types of accelerations and the forces to which they are subjected. Instead, the neck of a pit stop laborer is stressed for the type of movements they have to do during the changing of the tires in a Formula 1 race where time is a luxury they cannot afford. On the other hand, for example, the neck of a desk worker, i.e., a sedentary worker, is frequently stressed for an altered and repetitive posture assumed during the workday. In all of these circumstances, the use of the Angel’s Wings appears to be a good method to counteract the pain and to decrease it in the cases where the pain is already present.
Today, with the changing of lifestyles, many people, including several categories of workers, have "postural defects" characterized mainly by altered distribution of muscle mass. All of this becomes a tendency to assume a crouched, and in some cases painful, position forward, characterized by shoulders moved forward.
In subjects who perform motor tasks daily (morning and evening) for 30 days, via MRI images, we demonstrated a realignment of the cervico-dorsal column between the pre- and post-training phases due to a variation of only a few degrees in its curvatures. Moreover, an improvement in posture is shown because, additionally, the gibbus, caused by a kyphotic posture, appears blunt. This data is important, considering the fact that the training period was 30 days, a relatively short period of time.
In the VAS results, we can observe that, in general, in the sample of workers considered in this study (73 subjects), many people suffer from neck and shoulder pain, regardless of gender, age, level of training, or, of course, main occupation. In particular, in our experience, we found that most people in this study (60 in a group of 73) tend to suffer from neck pain in a moderate way—in many cases, radiating to the shoulders (49 in a group of 73). As reported in the graph in Figure 4
, the pain also sometimes radiates in the dorsal area. However, as reported in the graphs of the VAS results, there was pain relief, in the considered areas, reported by the population participating in this study after only one session of training. We consider these results important, but we think there is a need of a period of training with a larger number of sessions for each subject to see if the training with this device can effectively stabilize the results of the pain relief in the neck, shoulders, and dorsal area.
The main limits of our study are that we do not have a randomized control trial, and, in relation to time, we can only conclude for a maximum period of 30 days. Another limitation is that we did not compare the effect of this exercise with other exercises (i.e., the pull-down exercise). Yet another limit of this study is that three MRI cases are not statistically significant and that the data needs to be verified in a larger sample of subjects. One more limit of this study is that our results presentation is not based on physiological evidence (i.e., blood circulation) and is discussed in light of the many limitations of the time frame for tissue adaptation, longevity of the outcome, and possible placebo effects.