Neck Solutions Blog

October 18, 2008

Walking alterations in temporomandibular joint disorders

Filed under: TMJ Pain — Administrator @ 5:39 am

The analysis of walking in subjects with and without temporomandibular joint disorders

From: Minerva Stomatol. 2008 Sep;57(9):399-411.

The aim of this study was to determine if stomatognathic functions correlate with alterations in walking function, that are detectable through the analysis of walking. The study enrolled 24 Caucasian adult females, asymptomatic for temporomandibular and muscular disorders and 20 Caucasian adult females with temporomandibular joint disorders (TMDs). The analysis of walking was performed under three different experimental conditions: 1) mandibular rest position; 2) habitual dental occlusion; 3) cotton rolls between the upper and the lower dental arches.

The mean pressure during walking, the percentage of loading on the left and the right feet and the loading surface were recorded as posturographic parameters. Generally, no difference was found in any of these parameters in the mean pressure during walking in the different considered conditions; only when two cotton rolls were positioned between the dental arches the load pressure was found to be significantly higher in the TMD patients than in the control subjects. In addition, in the same condition, TMD subjects showed a significantly smaller loading surface than control subjects, both under the right and the left feet.

TMDs seem to be associated to detectable alterations of the walking function.

October 17, 2008

Catastrophizing and causal beliefs in whiplash

Filed under: Neck Pain,Whiplash — Administrator @ 2:28 pm

Catastrophizing and Causal Beliefs in Whiplash

From: Spine. 2008 Oct 15;33(22):2427-33;

In recent decades, whiplash has become the most common diagnosis following motor vehicle accidents. In its acute phase whiplash is defined as myogenic neck complaints after a sprain of the neck.

Although the majority of patients show spontaneous recovery within the first few months after a traffic accident, in as many as 40% of cases these acute complaints lead to a chronic syndrome with neck pain and often cognitive complaints. This chronic syndrome is often referred to as late or postwhiplash syndrome, characterized by unexplained physical and cognitive symptoms. Although still subject to debate, a general consensus is building that postwhiplash syndrome should be regarded as a functional somatic syndrome in which cultural as well as psychological factors play a major role.

Postwhiplash syndrome can lead to invalidating effects and long term work disability. It is therefore of paramount importance to gain insight into the factors responsible for this chronic course.

Earlier work in the context of other chronic disorders characterized by unexplained physical complaints, such as chronic low back pain, provided evidence to suggest that pain catastrophizing and attributional bias are of crucial importance in the development of chronic complaints. In the Fear Avoidance model for chronic musculoskeletal pain, the pathway from pain experience to fear, anxiety, and avoidance, leading ultimately to disuse and disability, is modulated by catastrophizing and threatening illness beliefs. Similar mechanisms may also apply to chronic neck complaints. Preliminary support for this comes from recent studies showing that fear of pain and the presence of relatively intense anxiety symptoms are related to poor prognosis of neck complaints following motor vehicle accidents.

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Degenerate intervertebral disc and discogenic back pain

Filed under: Back Pain,Disc Problems — Administrator @ 5:58 am

The cellular pathobiology of the degenerate intervertebral disc and discogenic back pain

From: Rheumatology (Oxford). 2008 Oct 14; [Epub ahead of print]

In 2007, three times as many peer reviewed publications covering the biology and biotherapeutics of intervertebral disc disease appeared in the literature than in 1997. This is testimony to the upsurge in interest in the intervertebral disc, mainly driven by the openings that modern molecular pathology has generated to investigate mechanisms of human disease and the potential offered by novel therapeutic technologies to use data coming from these studies to positively influence chronic discogenic back pain and sciatica. Molecular pathology has shown intervertebral disc degeneration, a major cause of low back pain, to be a complex, active disorder in which disturbed cytokine biology, cellular dysfunction and altered load responses play key roles. This has translated into a search for target molecules and disease processes that might be the focus of future, evidence based therapies for back pain. It is not possible to describe the totality of advances that have been made in understanding the biology of the intervertebral disc in recent years, but in this review those areas of biology that are currently influencing, or could conceivably soon impinge on, clinical thinking or practice around intervertebral disc degeneration and discogenic back pain are described and discussed.

October 16, 2008

low back pain focus on whole body vibration

Filed under: Back Pain — Administrator @ 5:32 pm

Case control study of low back pain referred for magnetic resonance imaging, with special focus on whole body vibration

From: Scand J Work Environ Health. 2008 Oct 14; [Epub ahead of print]

This study investigated risk factors for low back pain among patients referred for magnetic resonance imaging (MRI), with special focus on whole body vibration. A case control approach was used. The study population comprised working aged persons from a catchment area for radiology services. The cases were those in a consecutive series referred for a lumbar MRI because of low back pain. The controls were age and gender matched persons X-rayed for other reasons. Altogether, 252 cases and 820 controls were studied, including 185 professional drivers. The participants were questioned about physical factors loading the spine, psychosocial factors, driving, personal characteristics, mental health, and certain beliefs about low back pain. Exposure to whole body vibration was assessed by six measures, including weekly duration of professional driving, hours driven in one period, and current root mean square A(8). Associations with whole body vibration were examined with adjustment for age, gender, and other potential confounders.

Strong associations were found with poor mental health and belief in work as a causal factor for low back pain, and with occupational sitting for 3 or more hours while not driving. Associations were also found for taller stature, consulting propensity, body mass index, smoking history, fear avoidance beliefs, frequent twisting, low decision latitude, and low support at work. However, the associations with the six metrics of whole body vibration were weak and not statistically significant, and no exposure response relationships were found.

Little evidence of a risk from professional driving or whole body vibration was found. Drivers were substantially less heavily exposed to whole body vibration than in some earlier surveys. Nonetheless, it seems that, at the population level, whole body vibration is not an important cause of low back pain among those referred for MRI.

October 11, 2008

TMJ disorder innovations in diagnostics and therapeutics

Filed under: TMJ Pain — Administrator @ 5:13 pm

TMJ disorders: future innovations in diagnostics and therapeutics

From: J Dent Educ. 2008 Aug;72(8):930-47

The phrase temporomandibular disorders is a collective term embracing a number of clinical problems that involve the masticatory musculature, the temporomandibular joint (TMJ) and associated structures, or both. These disorders are accompanied by pain in the masticatory muscles, in the TMJ, and in the associated hard and soft tissues. Other symptoms include limitation or deviation in the mandibular range of motion, TMJ sounds, and/or headaches and facial pain. Symptoms of temporomandibular joint disorders occur in approximately 6 to 12 percent of the adult population or approximately ten million individuals in the United States. It is estimated that 17,800,000 workdays are lost each year for every 100,000,000 full-time working adults in the United States due to disabling temporomandibular joint disorders.

The epidemiologic predilection of temporomandibular joint disorders in women is striking. In the general population, temporomandibular joint disorders are two times more prevalent in women than in men, whereas in patient populations these diseases have a female-to-male preponderance as high as 10:1. Furthermore, unlike similar diseases of other joints, which also have a greater female predilection but occur postmenopausally, a large proportion of women with temporomandibular joint disorders are between eighteen and forty-five years of age. The reasons for this marked sexual dimorphism and age distribution remain unclear.

Of the patients with temporomandibular joint disorders, approximately 80 percent present with signs and symptoms of joint disease, including disc displacement, arthralgia, osteoarthrosis, and osteoarthritis, indicating that an understanding of the underlying pathobiology of diseases of the TMJ itself would be beneficial to a large proportion of patients with temporomandibular joint disorders. These degenerative TMJ diseases are characterized by an imbalance in the synthesis and degradation of matrices, which are mediated by chondrocytes and fibrochondrocytes in the cartilage and fibrocartilages of the TMJ, resulting in a progressive loss of extra-cellular matrix components of the articular cartilage and/or subchondral bone. Due to a poor understanding of the etiology or pathogenesis of these diseases and the lack of definitive diagnostic or therapeutic approaches, patients often have to tolerate symptoms, including debilitating pain, that substantially impact their quality of life over extended periods of time. While little is known about the etiology or factors that predispose to degenerative diseases of the TMJ, recent findings employing both basic biomedicine and new imaging and computer technologies are beginning to provide important insights that may help in deriving rational diagnostic and therapeutic strategies. The focus of this review is to provide a basic foundation on degenerative disorders of the TMJ and to discuss current biomedical and technological advances in the understanding of these conditions. The implications of these advances for prevention, diagnostic, and therapeutic strategies are described.

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Patient education for neck pain

Filed under: Neck Pain — Administrator @ 6:10 am

Patient education for neck pain with or without radiculopathy

From: Cochrane Database Syst Rev. 2008 Oct 8;(4):CD005106

Neck disorders are common, disabling, and costly. The effectiveness of patient education strategies is unclear. To assess whether patient education strategies, either alone or in combination with other treatments, are of benefit for pain, function, global perceived effect, quality of life, or patient satisfaction, in adults with neck pain with and without radiculopathy.

Computerized bibliographic databases were searched from their start up to May 31, 2008. Eligible studies were quasi or randomized trials (RCT) investigating the effectiveness of patient education strategies for neck disorder. Paired independent review authors carried out study selection, data abstraction, and methodological quality assessment. Relative risk and standardized mean differences (SMD) were calculated. The appropriateness of combining studies was assessed on clinical and statistical grounds. Because of differences in intervention type or disorder, no studies were considered appropriate to pool.

Of the 10 selected trials, two (20%) were rated high quality. Advice was assessed as follows: Eight trials of advice focusing on activation compared to no treatment or to various active treatments, including therapeutic exercise, manual therapy and cognitive behavioural therapy, showed either inferiority or no difference for pain, spanning a full range of follow-up periods and disorder types. When compared to rest, two trials that assessed acute whiplash associated disorders showed moderate evidence of no difference for various forms of advice focusing on activation. Two trials studying advice focusing on pain & stress coping skills found moderate evidence of no benefit for pain in chronic mechanical neck disorder at intermediate/long-term follow-up. One trial compared the effects of ‘traditional neck school’ to no treatment, yielding limited evidence of no benefit for pain at intermediate-term follow-up in mixed acute/subacute/chronic neck pain.

This review has not shown effectiveness for educational interventions in various disorder types and follow-up periods, including advice to activate, advice on stress coping skills, and ‘neck school’. In future research, further attention to methodological quality is necessary. Studies of multimodal interventions should consider study designs, such as factorial designs, that permit discrimination of the specific educational components.

October 9, 2008

Temporomandibular joint dysfunction in whiplash injury

Filed under: Neck Pain,TMJ Pain,Whiplash — Administrator @ 5:29 am

Temporomandibular joint dysfunction : A consequence of whiplash injury

From: HNO. 2008 Oct 3; [Epub ahead of print] [Article in German]

In 10-20% of patients with a simple whiplash injury without severe structural lesions, a chronification of the complaints occurs. The question is whether some unidentified pathogenic factors exist. Investigations have demonstrated that mandibular and head and neck movements are coordinated and centrally controlled and that a craniocervical neck dysfunction can lead to a temporomandibular joint dysfunction by reflex action and vice versa. This study investigated whether a whiplash injury can lead to a temporomandibular joint dysfunction. A total of 187 patients with whiplash associated disorders were examined for temporomandibular joint dysfunction. Simple tests with and without loading of the mandible were used to initially diagnose temporomandibular joint dysfunction and the diagnosis was confirmed electrophysiologically. Temporomandibular joint dysfunction could be verified in all patients with whiplash associated disorders. According to these investigations a craniocervical neck dysfunction was regularly found in patients with whiplash associated disorders and relief from suffering can often not be achieved without treatment of the craniocervical neck dysfunction.

October 7, 2008

Postural stability and balance testing for neck pain

Filed under: Neck Pain,Posture,Whiplash — Administrator @ 5:42 am

Cervical outcome measures: testing for postural stability and balance

From: J Manipulative Physiol Ther. 2008 Sep;31(7):540-6

Clinical tests assessing a correlation between structural pathology and cervical pain have been unsuccessful, leading the way for the development of functionally based tests. The purpose of this narrative is to review 4 promising functional tests for the assessment of sensorimotor dysfunction in patients with neck pain. The Joint Position Error/Head Repositioning Accuracy tests, and the Rod and Frame Test were reviewed. The SPNTT was developed to test proprioceptive mechanisms in the neck by applying torsion to mainly mechanoreceptors in the cervical spine. The Joint Position Error and Head Repositioning Accuracy test cervicocephalic kinesthesia or the ability to perceive both movement and position of the head in space related to the trunk. The Rod and Frame Test assesses patients’ perception of the vertical orientation of their head in 3-dimensional space. All of these tests evaluate important mechanisms responsible for maintaining postural stability and balance and are thought to be applicable for use in mechanical neck pain patients.

All of the reviewed tests show clinical promise because they are able to distinguish patients with neck pain, particularly those with whiplash trauma and dizziness from asymptomatic controls. All of the tests assess cervical sensorimotor dysfunction, although considerably more research is needed to more clearly establish the psychometric properties for each test including minimal clinical important difference. Although these tests can be used in routine clinical practice, they should be used in combination with other related tests.

October 4, 2008

Questionnaires for chronic and non traumatic neck pain

Filed under: Neck Pain — Administrator @ 6:01 am

Validity of the Neck Disability Index and Neck Pain and Disability Scale for measuring disability associated with chronic, non traumatic neck pain

From: Man Ther. 2008 Sep 26; [Epub ahead of print]

Neck pain has a lifetime prevalence of about 70% in the general population. Although acute neck pain often resolves, about 19% of the population may suffer from chronic neck pain at any given time. Measurement of the impact of neck pain on the sufferer presents a challenge due to the variability between patients in pain intensity, and the effect of the disorder on physical and psychological functions. Measures of pain intensity and tissue sensitivity have been used to quantify the sensory dimension of neck pain disorders, while range of motion and muscle function has been used to measure impairments of physical function. However, recent recommendations place greater emphasis on functional status and quality of life more broadly, in the evaluation of neck pain disorders.

Measurement of function has been a developing theme in neck pain research as this shifts the focus away from signs and symptoms towards the specific effects of the symptoms on patient function. In relation to neck pain, this includes neck function, physical function more generally, and psychological function. A range of neck pain specific questionnaires have been developed for this purpose, and have been incorporated into recent clinical studies. The value of questionnaires is dependent on a range of factors but of primary importance is the validity, particularly in relation to construct and content. A recent review of neck pain specific questionnaires concluded that most have not been extensively validated, and recommended a comparative study to better define the psychometric properties of the commonly used instruments.

The Neck Disability Index is the most commonly used questionnaire for the measurement of neck pain disability. It was originally developed to evaluate the activities of daily living in patients with disabling neck pain, particularly that resulting from whiplash trauma. The Neck Disability Index includes 10 questions of which 7 examine functional activities, 2 ask about symptoms and the final question considers concentration. The Neck Pain and Disability Scale was developed to provide clinicians with a tool to assess the multi dimensional effects of the neck pain disorder. The scale consists of 20 questions relating to 4 domains (neck function, pain intensity, emotion/cognition and activities of daily living) which look at the effects of the neck pain disorder on patients’ physical and emotional functions. The potential limitation of these questionnaires, and others with fixed questions, is that they constrain the scope of the evaluation to the specific issues included. Therefore, the questionnaire may include questions not relevant to some patients, and may not include issues of importance.

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October 3, 2008

Neck pain and cervical spine active range of motion

Filed under: Neck Pain — Administrator @ 4:56 am

Intrarater Reliability of CROM Measurement of Cervical Spine Active Range of Motion in Persons With and Without Neck Pain

From: J Orthop Sports Phys Ther. 2008 Oct;38(10):640-5

Clinical measurement, intrarater reliability study to determine the intrarater reliability of cervical active range of motion (AROM) measurement of subjects with and without neck pain using the cervical range of motion device (CROM). Cervical spine cervical active range of motion data are used by physical therapists to assist in identifying movement impairment, monitor patient progress, and evaluate the effectiveness of intervention. Presently, insufficient literature exists regarding the intrarater reliability of cervical active range of motion measurements using the cervical range of motion device. Twenty-five adult subjects without neck pain and 22 adult subjects with neck pain volunteered for the study. Two trials of cervical active range of motion measurement (6 movements) were performed for each subject. Practice sessions, methods of measurement, and rest time between trials were standardized; order of measurement was randomized.

The intraclass correlation coefficients for the subjects without neck pain ranged from 0.87 for flexion to 0.94 for left rotation. The standard error of the measurement ranged from 2.3 degrees to 4.0 degrees. The intraclass correlation coefficients for the subjects with neck pain ranged from 0.88 for flexion to 0.96 for left rotation. The standard error of the measurement ranged from 2.5 degrees to 4.1 degrees. Minimal detectable change ranged from 5.4 degrees for left rotation in the subjects without neck pain to 9.6 degrees for flexion in the subjects with neck pain.

Intrarater reliability for cervical active range of motion measurement of persons with and without neck pain is sufficient to consider use of the cervical range of motion device in clinical practice, although changes between 5 degrees to 10 degrees are needed to feel confident that a real change in spine mobility has occurred.

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