Neck Solutions Blog

February 17, 2009

Patient education for neck pain with or without radiculopathy

Filed under: Neck Pain — Administrator @ 7:12 pm

Patient education for neck pain with or without radiculopathy

From: Cochrane Database Syst Rev. 2009 Jan 21;(1):CD005106

Neck disorders are common, disabling, and costly. The effectiveness of patient education strategies is unclear. The object of this review was 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 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 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 and 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.

February 16, 2009

neck and shoulder pain associated with work and lifestyle

Filed under: Neck Pain,Shoulder Pain — Administrator @ 3:27 pm

Four-year incidence of sick leave because of neck and shoulder pain and its association with work and lifestyle

From: Spine. 2009 Feb 15;34(4):413-8

Musculoskeletal disorders are one of the important health problems in the world. With the exception of back pain, neck and shoulder pain is one of the prevalent disorders in workplaces and a common reason for abseentism, job change, and disability pension.

The incidence and prevalence of neck and shoulder pain have a broad range in different studies, depending on which data collection method is used (self-reported questionnaire, medical examination, sickness absence). Neck and shoulder pain is a dynamic entity that can change over time, but few longitudinal studies have been performed on workplace populations to address the above-mentioned issues.

The relation between neck and shoulder pain and physical as well as psychosocial factors at work have been studied and approved (with different consistency) in different surveys. Most of these studies are cross-sectional and related to high-income and industrialized countries. There is little information about neck and shoulder pain in the general population in developing and low-income countries. There are even fewer studies in working populations.

The main aim of this longitudinal investigation was to determine the incidence of sick leave because of neck and shoulder pain in a large population of Iranian workers, and to study its relation with physical and psychosocial factors at work, lifestyle, and previous pain. An additional aim was to compare risk factors for future sick leave versus risk factors for self-reported neck and shoulder pain in the cross-sectional baseline study.

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February 14, 2009

Neck dysfunction in elders with headache

Filed under: Headaches,Neck Pain — Administrator @ 10:23 pm

Cervical musculoskeletal impairment is common in elders with headache

From: Man Ther. 2009 Feb 10. [Epub ahead of print]

There is an opinion that with increasing cervical degenerative joint disease with ageing, cervicogenic headaches become more frequent. This study aimed to determine if cervical musculoskeletal dysfunction was specific to headache classifiable as cervicogenic or was more generic to headache in elders. Subjects (n=118), aged 60-75 years with recurrent headache and 44 controls were recruited. Neck function measures included range of motion (ROM), cervical joint dysfunction, cranio-cervical flexor muscle function, joint position sense (JPS) and cervical muscle strength. A questionnaire documented the characteristics of headaches for classification. A cluster analysis based on three musculoskeletal variables aligned previously with cervicogenic headache, divided headache subjects into two groups; cluster 1 (n=57), cluster 2 (n=50). Dysfunctions were greater in cluster 1 than in 2 for extension range and C1-2 joint dysfunction. Most cervicogenic headaches were grouped in cluster 1, but musculoskeletal dysfunction was also found in headaches classifiable as migraine or tension type headache. Neck dysfunction is not uniquely confined to cervicogenic headache in elders. Further research such as headache responsiveness to management of the neck disorder is required to better understand about the neck’s causative or contributing role to elders’ headache.

February 13, 2009

Multidisciplinary management study of tinnitus

Filed under: Tinnitus — Administrator @ 9:26 pm

Cost effectiveness of multidisciplinary management of Tinnitus at a specialized Tinnitus centre

From: BMC Health Serv Res. 2009 Feb 11;9(1):29. [Epub ahead of print]

Subjective tinnitus is the involuntary perception of the concept of a sound without the presence of an external source. It is a chronic condition that is highly prevalent, especially among hearing impaired individuals. Studies show a prevalence of 10% to 20% in the general population and among hearing impaired individuals prevalence has been estimated at 75% to 80%. Of the Dutch population at least 2 million individuals suffer from some form of tinnitus, 340,000 individuals indicate to hear the tinnitus continuously and 60,000 individuals claim to be severely impaired in their daily activities. Among severe sufferers it causes disability associated with severe affective problems, major declines in concentration, sleeping difficulties, hypersensitivity to sounds and problems in re-directing attention. The combination of these complaints makes them feel exhausted and frustrated resulting in diminished quality of life. Tinnitus is known to occur as a concomitant of almost all the dysfunctions that involve the human auditory system and it is postulated that the aetiology of tinnitus is diverse and that different activation circumstances can be present. Little is known about the pathophysiology and there is no known drug or curative therapy at present though considerable research effort has been expended in this regard.

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February 12, 2009

Whiplash associated disorders and postural reactions during sitting

Filed under: Neck Pain,Posture,Whiplash — Administrator @ 12:27 pm

Whiplash associated disorders affect postural reactions to antero-posterior support surface translations during sitting

From: Gait Posture. 2009 Feb 6. [Epub ahead of print]

Previous studies have shown that individuals with whiplash associated disorders display decreased postural stability during standing and walking tasks. However, their ability to maintain seated upright posture has never been investigated. The objective of this study was to characterize kinematic and electromyographic postural stabilization patterns in individuals with chronic whiplash associated disorders and to compare these patterns with those in an able-bodied control group.

Ten individuals with whiplash associated disorders and an age and gender matched group of healthy individuals were exposed to sudden forward and backward support surface translations while they were seated. Neck and trunk muscle activity and angular displacements as well as centers of mass linear displacements at four levels of the head and trunk were computed. The displacement onset of the combined head, arms and trunk centers of mass was significantly delayed in persons with whiplash associated disorders. However, their peak trunk angles were smaller and were reached sooner.

In the whiplash associated disorders group, the activation onset of the lumbar erector spinae was less affected by perturbation direction and the sternocleidomastoid muscle, a neck flexor, showed a trend towards being activated later, compared to the healthy group. These results suggest that individuals with whiplash associated disorders may alter stretch reflex threshold and/or elicit a learned response for pain avoidance that may be direction specific. Such findings highlight the importance of assessing both spatial and temporal characteristics across different levels of the spinal musculoskeletal system to evaluate multidirectional postural responses in whiplash associated disorder individuals.

February 11, 2009

The rising prevalence of chronic low back pain

Filed under: Back Pain,Chronic Pain — Administrator @ 7:24 pm

The Rising Prevalence of Chronic Low Back Pain

From: Arch Intern Med. 2009 Feb 9;169(3):251-258

National or state-level estimates on trends in the prevalence of chronic low back pain are lacking. The objective of this study was to determine whether the prevalence of chronic low back pain and the demographic, health-related, and health care-seeking characteristics of individuals with the condition have changed over the last 14 years.

A cross-sectional, telephone survey of a representative sample of North Carolina households was conducted in 1992 and repeated in 2006. A total of 4437 households were contacted in 1992 and 5357 households in 2006 to identify noninstitutionalized adults 21 years or older with chronic (>3 months), impairing low back pain or neck pain that limits daily activities. These individuals were interviewed in more detail about their health and health care seeking.

The prevalence of chronic, impairing low back pain rose significantly over the 14-year interval, from 3.9% in 1992 to 10.2% in 2006. Increases were seen for all adult age strata, in men and women, and in white and black races. Symptom severity and general health were similar for both years. The proportion of individuals who sought care from a health care provider in the past year increased from 73.1% to 84.0%, while the mean number of visits to all health care providers were similar (19.5 [1992] vs 19.4 [2006]).

The prevalence of chronic, impairing low back pain has risen significantly in North Carolina, with continuing high levels of disability and health care use. A substantial portion of the rise in low back pain care costs over the past 2 decades may be related to this rising prevalence.

Head eye co-ordination measurement in whiplash injury

Filed under: Neck Pain,Whiplash — Administrator @ 11:13 am

Head Eye Co-ordination Using Simultaneous Measurement of Eye in Head and Head in Space Movements: Potential For Use in Subjects With a Whiplash Injury

From: J Clin Monit Comput. 2009 Feb 7. [Epub ahead of print]

The article describes reproducibility of a measurement method to investigate deficits in eye-head co-ordination. Combined recordings of head and eye rotation using wireless motion sensors and electro-oculography (EOG) were used as an initial step towards a method to quantify eye-head co-ordination deficits. Head rotation to the side during gaze fixation and sequential head and eye movements were studied on 20 asymptomatic control subjects and six subjects with chronic whiplash disorders. All included whiplash subjects reported eye disturbances according to a vision symptom questionnaire. Results. The trial-to-trial reproducibility was moderate to high for 24 of 28 variables (Intraclass Correlation Coefficient 0.44 to 0.87). Velocity gain (ratio of eye and head velocities) was on average close to unity in both groups. Head stability was high in control subjects, while three of six whiplash subjects demonstrated head instability during eye movement. Whiplash subjects also demonstrated a decreased range of head movement during gaze fixation and lower head velocities as compared with the asymptomatics.

The method of combined head and eye motion appears to give accurate, repeatable measurements. Case studies of whiplash subjects indicated deficits in head eye co-ordination. The method could be useful in further clinical research into eye and head movement in those with neck disorders.

February 10, 2009

Disc degeneration and tensile strains for complex loads

Filed under: Arthritis,Back Pain,Disc Problems — Administrator @ 12:41 pm

Dependency of disc degeneration on shear and tensile strains between annular fiber layers for complex loads

From: Med Eng Phys. 2009 Feb 2. [Epub ahead of print]

One of the first signs of disc degeneration is the formation of circumferential tears within the annulus fibrosus. It is assumed that high shear and tensile strains between the lamellae mainly cause the initiation of these failures. However, it is not known which load application and which degree of disc degeneration could lead to the highest strains and therefore, might induce the formation of tears. Therefore, the aim of this finite element (FE) study was, to find load combinations that would yield highest shear and tensile strains in differently degenerated discs.

A three-dimensional FE-model of a motion segment L4-5 was utilized in different degrees of disc degeneration (healthy, mild, moderate, and severe). The degenerated models consider the reduction of disc height, endplate curvatures, the osteophyte formation, the increase of nucleus compressibility, and the decrease of fiber and ligament stiffness. An axial compression load of 500N together with moments of 7.5Nm in single and combined load directions were simulated.

High strains for the healthy and degenerated discs were predicted for load combinations, particularly for the combination of lateral bending plus flexion or extension. The maximum strains were located in the postero-lateral region of the disc. In comparison to the healthy disc, the maximum strains increased slightly for the mildly and moderately degenerated disc. Strains decreased strongly for the severely degenerated disc. With progressive degeneration, the size of the region of maximum strains diminished and the location transferred from the inner annulus to the adjacent bony endplates.

The results could be a possible explanation for the initiation of circumferential tears. The mildly degenerated disc model, which represents early stages of life, suggests that circumferential tears could primarily occur at these stages, especially for the load combinations of lateral bending plus axial rotation and lateral bending plus flexion.

February 9, 2009

Clinical aspects of the acute facet syndrome

Filed under: Back Pain,Chiropractic — Administrator @ 2:30 pm

The clinical aspects of the acute facet syndrome: results from a structured discussion among European chiropractors

From: Chiropr Osteopat. 2009 Feb 5;17(1):2. [Epub ahead of print]

The term ‘facet joint’ became common in the 1970s, when surgeons developed an interest in the small joints of the lumbar spine as a source of low back pain. The formal name for these joints is the zygapophyseal joints, as endorsed by The International Anatomical Nomenclature Committee. They were suggested as a source of pain as early as 1911 and the term ‘facet syndrome’ was introduced by Ghormley in 1936. However, due to the discovery of the lumbar disc as a source of low back pain, the facet joints did not receive much further attention until the 1970s. In 1976, Mooney and Robertson demonstrated that the facet joints could be a source of pain and that certain patients could be relieved from pain by anesthetizing these joints. These findings were later reproduced and thus confirmed the basis for the concept of ‘facet syndrome’, ‘facet joint pain’ or ‘zygapophyseal joint pain’. The term ‘facet syndrome’ is really a contradiction in terms. A syndrome is characterized by a set of detectable characteristics, usually used when the pathophysiology has not yet been discovered. In the case of ‘facet syndrome’, the source of pain is identified but the clinical presentation is poorly defined. Nevertheless, the term is widely used.

During the past three decades, there have been numerous studies of the frequency of facet joint pain in chronic low back pain patients. In these studies, various types of facet joint injections were used to determine whether the facet joints were the source of pain. These included injection of local anaesthetic into the joint itself or the nerves that innervate them, resulting in relief from pain if the pain originated from these joints (diagnostic blocks). Prevalence rates of facet joint pain among those patients with chronic low back pain vary widely in the literature, ranging from 5% to 90% but there is a problem with a high false positive rate in many studies. Therefore, when confirmatory blocks are used, the prevalence rates are somewhat lower, ranging from 9% to 45%. As these studies investigated chronic low back pain, these prevalence rates indicate that the facet joints might be important contributors to the burden of chronic low back pain. However, there does not appear to be any studies describing the prevalence of facet joint pain in acute low back pain.

The etiology of pain from the facet joints has been investigated from several perspectives. Osteoarthrosis has been considered as a source of facet joint pain. Facet joint osteoarthrosis is very common in the general population; the frequency increases with age and the highest prevalence is at the L4-5 spinal level. However, the presence of osteoarthrosis in the facet joints, as seen on plain radiography, does not seem to be associated with low back pain. In contrast, facet joint oedema visualised by MRI correlated with back pain intensity in at least two studies. A common explanation in chiropractic textbooks is that small meniscoids formed of synovial folds and continuous with the periarticular tissues become entrapped or extrapped and through a cascade of events lead to acute locked low back. This is described as being amenable to manipulative therapy. Garges, White and Koestler offer an alternative or supplementary explanation of pain from the facet joints. They describe how inflammatory adhesions of the facet joints and their capsules may cause a painful reduction in motion.

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February 7, 2009

Back muscle dysfunction in remission from recurrent back pain

Filed under: Back Pain,Chronic Pain — Administrator @ 10:29 pm

Why do some patients keep hurting their back? Evidence of ongoing back muscle dysfunction during remission from recurrent back pain

From: Pain. 2009 Jan 29. [Epub ahead of print]

Approximately thirty-four percent of people who experience acute low back pain will have recurrent episodes. It remains unclear why some people experience recurrences and others do not, but one possible cause is a loss of normal control of the back muscles. We investigated whether the control of the short and long fibres of the deep back muscles was different in people with recurrent unilateral low back pain from healthy participants. Recurrent unilateral low back pain patients, who were symptom free during testing, and a group of healthy volunteers, participated. Intramuscular and surface electrodes recorded the electromyographic activity of the short and long fibres of the lumbar multifidus and the shoulder muscle, deltoid, during a postural perturbation associated with a rapid arm movement. Electromyographic activity onsets of the short and long fibres, relative to that of deltoid, were compared between groups, muscles, and sides. In association with a postural perturbation, short fibre electromyographic activity onset occurred later in participants with recurrent unilateral low back pain than in healthy participants. The short fibres were active earlier than long fibres on both sides in the healthy participants and on the non-painful side in the low back pain group, but not on the previously painful side in the low back pain group. Activity of deep back muscles is different in people with a recurrent unilateral low back pain, despite the resolution of symptoms. Because deep back muscle activity is critical for normal spinal control, the current results provide the first evidence of a candidate mechanism for recurrent episodes.

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