Maximal voluntary isometric neck strength deficits in adults with whiplash associated disorders and association with pain and fear of movement.
From: J Orthop Sports Phys Ther. 2009 Mar;39(3):179-87
This was a controlled laboratory study using a cross-sectional, repeated-measures design to quantify maximal voluntary isometric neck forces in healthy subjects and individuals with whiplash associated disorder, using an objective measurement system to evaluate the test-retest properties of these strength measurements and to assess the links between neck strength, pain, kinesiophobia, and catastrophizing in patients with whiplash associated disorder.
The prognosis of whiplash associated disorder is difficult to predict due to a lack of objective measurement methods and to our limited understanding of the role of psychological factors in the development of chronic whiplash associated disorder symptoms.
Fourteen subjects with chronic whiplash associated disorder grade I or II and an age-matched, healthy group (n = 28) participated in this study. Cervical strength was measured with the Multi-Cervical Unit in 6 directions, and pain was measured with a visual analog scale. Individuals in the whiplash associated disorder group completed the Neck Disability Index, the Tampa Scale for Kinesiophobia, and the Pain Catastrophizing Scale.
Significant deficits in strength were observed for the individuals in the whiplash associated disorder group compared to the healthy group, particularly in extension, retraction, and left lateral flexion. The Multi-Cervical Unit demonstrated good intratester reliability for the healthy group and the whiplash associated disorder group, and small standard errors of measurement for both groups. No significant association was found between neck strength and Neck Disability Index, Tampa Scale for Kinesiophobia, and Pain Catastrophizing Scale.
The Multi-Cervical Unit demonstrated good test and retest properties for healthy subjects and individuals with whiplash associated disorder. Neck strength was lower in individuals with whiplash associated disorder; however, the strength deficits were not clearly linked with psychological factors.
Deceleration during ‘real life’ motor vehicle collisions – a sensitive predictor for the risk of sustaining a cervical spine injury?
From: Patient Saf Surg. 2009 Mar 8;3(1):5. [Epub ahead of print]
Whiplash injuries remain a barely understood phenomenon. The economic damage caused by whiplash amounts to some 10 billion Euros a year in Europe and 29 billion US Dollars a year in the USA. As whiplash occurs as a result of motor vehicle accidents, questions inevitably arise regarding who is liable for these costs.
Biomechanical considerations have been based on the assumption that damage to a given material only occurs when the energy that acts on this material is high enough. Thus, energy doses below a defined threshold have been considered harmless. In this context, the parameter delta v (DV), which describes the velocity change of a motor vehicle during a collision with another vehicle, has become a widely accepted criterion for the energy that acts on the vehicle during a collision.
In numerous sled or car crash test studies, volunteers were subjected to acceleration forces in order to define a threshold below which a cervical spine injury could be excluded. The results of these studies are rather inconclusive and sometimes contradictory. Thus the scientific community has not yet reached consensus regarding the threshold value for cervical spine injuries after whiplash. Nonetheless, DV threshold values were adopted very early in the history of insurance law as a criterion to accept or deny the claim settlement for whiplash associated disorders.
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Musculoskeletal disorders among university student computer users
From: Med Lav. 2009 Jan-Feb;100(1):29-34
Musculoskeletal disorders are a common problem among computer users. Many epidemiological studies have shown that ergonomic factors and aspects of work organization play an important role in the development of these disorders. The authors carried out a cross-sectional survey to estimate the prevalence of musculoskeletal symptoms among university students using personal computers and to investigate the features of occupational exposure and the prevalence of symptoms throughout the study course. Another objective was to assess the students’ level of knowledge of computer ergonomics and the relevant health risks.
A questionnaire was distributed to 183 students attending the lectures for second and fourth year courses of the Faculty of Architecture. Data concerning personal characteristics, ergonomic and organizational aspects of computer use, and the presence of musculoskeletal symptoms in the neck and upper limbs were collected. Exposure to risk factors such as daily duration of computer use, time spent at the computer without breaks, duration of mouse use and poor workstation ergonomics was significantly higher among students of the fourth year course.
Neck pain was the most commonly reported symptom (69%), followed by hand/wrist (53%), shoulder (49%) and arm (8%) pain. The prevalence of symptoms in the neck and hand/wrist area was signifcantly higher in the students of the fourth year course. In this survey we found high prevalence of musculoskeletal symptoms among university students using computers for long time periods on a daily basis. Exposure to computer related ergonomic and organizational risk factors, and the prevalence of musculoskeletal symptoms both seem to increase significantly throughout the study course. Furthermore, they found that the level of perception of computer related health risks among the students was low. Our findings suggest the need for preventive intervention consisting of education in computer ergonomics.
The impact of orofacial pain on the quality of life of patients with temporomandibular disorder
From: J Orofac Pain. 2009 Winter;23(1):28-37
To evaluate the relationships between gender, diagnosis, and severity of temporomandibular joint disorders with self-reports of the impact of temporomandibular joint disorders on the quality of life, eighty-three individuals seeking temporomandibular joint disorders treatment at the Dental School of Pontifical Catholic University Minas from May to August 2005 were evaluated by a single examiner who was trained and calibrated for diagnosis according to criteria of Axis I of the Research Diagnostic Criteria for temporomandibular joint disorders. The severity of temporomandibular joint disorders was established by the Temporomandibular Index and the impact on quality of life by the Oral Health Impact Profile. Complete data were available for 78 of the 83 initial patients and evaluated by the Mann-Whitney test and Spearman correlation analysis.
Except for one patient, all individuals showed some impact related to physical pain. Of the seven aspects evaluated on the Oral Health Impact Profile, women presented a greater impact than men only for functional limitations. Patients presenting with diagnoses of muscular disorders (group I) or osteoarthritis (group III) reported a greater impact than those without. The Spearman test demonstrated a significant correlation between impact on quality of life and severity of temporomandibular joint disorders. Orofacial pain had a great impact on the quality of life of individuals with temporomandibular joint disorders, without group difference between genders. The presence of muscular disorders (group I) and osteoarthritis (group III) was related to greater impact on quality of life, which was not observed for diagnoses of disc displacement (group II). A correlation between severity of temporomandibular joint disorders and impact on quality of life was clearly observed.
Clinical assessment of the deep cervical flexor muscles: the craniocervical flexion test
From: J Manipulative Physiol Ther. 2008 Sep;31(7):525-33
The craniocervical flexion test is a clinical test of the anatomical action of the deep cervical flexor muscles, the longus capitis, and colli. It has evolved over 15 years as both a clinical and research tool and was devised in response to research indicating the importance of the deep cervical flexors in support of the cervical lordosis and motion segments and clinical observations of their impairment with neck pain.
The craniocervical flexion test could be described as a test of neuromotor control. The features assessed are the activation and isometric endurance of the deep cervical flexors as well as their interaction with the superficial cervical flexors during the performance of five progressive stages of increasing craniocervical flexion range of motion. It is a low-load test performed in the supine position with the patient guided to each stage by feedback from a pressure sensor placed behind the neck. While the test in the clinical setting provides only an indirect measure of performance, the construct validity of the craniocervical flexion test has been verified in a laboratory setting by direct measurement of deep and superficial flexor muscle activity.
Research has established that patients with neck pain disorders, compared to controls, have an altered neuromotor control strategy during craniocervical flexion characterized by reduced activity in the deep cervical flexors and increased activity in the superficial flexors usually accompanied by altered movement strategies. Furthermore, they display reduced isometric endurance of the deep cervical flexor muscles. The muscle impairment identified with the craniocervical flexion test appears to be generic to neck pain disorders of various etiologies. These observations prompted the use of the craniocervical flexion action for retraining the deep cervical flexor muscles within a motor relearning program for neck pain patients, which has shown positive therapeutic benefits when tested in clinical trials.
A clinical prediction rule for classifying patients with low back pain who demonstrate short term improvement with mechanical lumbar traction
From: Eur Spine J. 2009 Mar 3. [Epub ahead of print]
The objective of the study was to develop a clinical prediction rule for identifying patients with low back pain, who improved with mechanical lumbar traction. A prospective, cohort study was conducted in a physiotherapy clinic at a local hospital. Patients with low back pain, referred to physiotherapy were included in the study. The intervention was a standardized mechanical lumbar traction program, which comprised three sessions provided within 9 days. Patient demographic information, standard physical examination, numeric pain scale, fear avoidance beliefs questionnaire and Oswestry low back pain disability index (pre and post intervention) were recorded. A total of 129 patients participated in the study and 25 had positive response to the mechanical lumbar traction. A clinical prediction rule with four variables (non involvement of manual work, low level fear avoidance beliefs, no neurological deficit and age above 30 years) was identified. The presence of all four variables increased the probability of response rate with mechanical lumbar traction from 19.4 to 69.2%. It appears that patients with low back pain who were likely to respond to mechanical lumbar traction may be identified.
Correlation between MRI evidence of degenerative condylar surface changes, induction of articular disc displacement and pathological joint sounds in the temporomandibular joint
From: Gerodontology. 2008 Dec;25(4):251-7. Epub 2008 Feb 27
The relationship of bony changes in the condylar surfaces in articular disc displacement without reduction in temporomandibular joint was investigated using diagnostic imaging. The study also evaluated whether the bony changes in the condylar surfaces limit disc and condyle motion, and produce pathological joint sounds.
Thirty seven temporomandibular joints in 28 patients diagnosed with degenerative bony changes in the condylar surfaces radiographically and anterior disc displacement without reduction using magnetic resonance imaging (MRI) were studied. The bony changes were assessed by radiographic examination and classified into two types: pathological bone changes including erosion, osteophyte formation and deformity, and adaptive bone changes including flattening and concavity. MRI was performed on the temporomandibular joint to examine the configuration and position of the discs. Joint sounds in the temporomandibular joint were determined using electrovibratograghy with a joint vibration analysis.
The articular disc motion to the condyle in the pathological bone changes group was smaller than in the adaptive bone changes group irrespective of the configuration of the disc, even though there were no significant differences between the two types of bony changes in the disc position during jaw closing. The joint vibration analysis of the temporomandibular joint showed that joint sounds with a higher frequency were observed in the pathological bone changes group than in the adaptive bone changes group. High energy levels needed to produce the higher frequencies were observed only in the pathological bone changes group.
Ergonomic Intervention in the Treatment of a Patient With Upper Extremity and Neck Pain
From: Phys Ther. 2009 Feb 26. [Epub ahead of print]
Work related musculoskeletal disorders are widespread among computer users and costly to the health care system. Workstation setup and worker postures contribute to upper extremity and neck symptoms among computer users. Ergonomic interventions such as work risk analysis and workstation modifications can improve workers’ symptoms. However, ergonomic interventions do not appear to be a common component of traditional physical therapy treatment. The patient was a 26-year-old woman with right upper extremity and neck pain referred for physical therapy. A course of traditional physical therapy treatment was performed followed by an ergonomic intervention.
Following 4 weeks of traditional physical therapy, the patient showed a 1.0-cm improvement in her resting pain level but no change in her pain level during exacerbations on the visual analog scale. An ergonomic intervention was performed following traditional physical therapy. At the conclusion of the full course of treatment (traditional physical therapy plus ergonomic intervention), resting pain level decreased by 4.6 cm and exacerbation pain level decreased by 3.2 cm. Improvements in Rapid Upper Limb Assessment and Workstyle scores also were realized. This case report demonstrates the importance of examining the work habits and work related postures of a patient who complains of upper-extremity and neck pain that is exacerbated by work. Providing an ergonomic intervention in concert with traditional physical therapy may be the most beneficial course of treatment.
Prevalence of neck pain and headaches: impact of computer use and other associative factors
From: Cephalalgia. 2009 Feb;29(2):250-7
Headaches and neck pain are reported to be among the most prevalent musculoskeletal complaints in the general population. A significant body of research has reported a high prevalence of headaches and neck pain among adolescents. Sitting for lengthy periods in fixed postures such as at computer terminals may result in adolescent neck pain and headaches. The aim of this paper was to report the association between computer use (exposure) and headaches and neck pain (outcome) among adolescent school students in a developing country. A cross-sectional study was conducted and comprehensive description of the data collection instrument was used to collect the data from 1073 high-school students. Headaches were associated with high psychosocial scores and were more common among girls. This study found a concerning association between neck pain and high hours of computing for school students, and have confirmed the need to educate new computer users (school students) about appropriate ergonomics and postural health.
