Neck Solutions Blog

April 30, 2009

Individual, physical and psychological risk factors for neck pain

Filed under: Neck Pain — Administrator @ 11:00 am

Individual, physical and psychological risk factors for neck pain in Australian office workers: a 1-year longitudinal study

From: Eur Spine J. 2009 Apr 28. [Epub ahead of print]

Neck pain is common in the general population. Reposts of 1-year prevalence of neck pain vary from 15 to 44%. Prevalence of neck pain is even higher in office workers than in the general community, reaching levels of 50 to 60%. Neck pain can impact on the ability to perform daily activities, and the treatment costs and work loss contribute to a substantial economic burden for both individual and society. Data about the incidence of neck pain in office workers are lacking, as previous studies have reported on estimates of prevalence.

It is unclear which factors place office workers in particular high risk of develloping neck pain. Postulated factors include: individual factors (e.g. gender) work environment factors (e.g. repetitive work, exposure level) and psychosocial factors (e.g. stress, high job demands, low decision latitude).

Neck pain is more prevalent in office workers than in the general community. To date, findings from prospective studies that investigated causal relationships between putative risk factors and the onset of neck pain in this population have been limited by high loss to follow-up. The aim of this research was to prospectively evaluate a range of risk factors for neck pain in office workers, using validated and reliable objective measures as well as attain an estimate of 1-year incidence. We assembled a cohort of 53 office workers without neck pain and measured individual, physical, workplace and psychological factors at baseline. We followed participants for 1 year to measure the incidence of neck pain. We achieved 100% participant follow-up. Cox regression analysis was applied to examine the relationship between the putative risk factors and the cumulative incidence of neck pain. The 1-year incidence proportion of neck pain in Australian office workers was estimated in this study to be 0.49. Predictors of neck pain with moderate to large effect sizes were female gender and high psychological stress. Protective factors included increased mobility of the cervical spine and frequent exercise. These results reveal that neck pain is common in Australian office workers and that there are risk factors that are potentially modifiable.

April 27, 2009

Chronic whiplash and central sensitization

Filed under: Neck Pain,Whiplash — Administrator @ 2:03 pm

Chronic whiplash and central sensitization; an evaluation of the role of a myofascial trigger points in pain modulation

From: J Brachial Plex Peripher Nerve Inj. 2009 Apr 23;4(1):2. [Epub ahead of print]

It has been established that chronic neck pain following whiplash is associated with the phenomenon of central sensitization, in which injured and uninjured parts of the body exhibit lowered pain thresholds due to an alteration in central pain processing. It has furthermore been hypothesized that peripheral sources of nociception in the muscles may perpetuate central sensitization in chronic whiplash. The hypothesis explored in the present study was whether myofascial trigger points serve as a modulator of central sensitization in subjects with chronic neck pain.

Seventeen patients with chronic and intractable neck pain and 10 healthy controls without complaints of neck pain. Intervention: symptomatic subjects received anesthetic infiltration of myofascial trigger points in the upper trapezius muscles and controls received the anesthetic in the thigh. Outcome measures: pre and post injection cervical range of motion, pressure pain thresholds (ppt) over the infraspinatus, wrist extensor, and tibialis anterior muscles. Sensitivity to light (photophobia) and subjects’ perception of pain using a visual analog scale (vas) were also evaluated before and after injections. Only the ppt was evaluated in the asymptomatic controls.

Immediate (within 1 minute) alterations in cervical range of motion and pressure pain thresholds were observed following an average of 3.8 injections with 1-2 cc of 1% lidocaine into carefully identified trigger points. Cervical range of motion increased by an average of 49% in flexion and 44% in extension, 47% and 28% in right and left lateral flexion, and a 27% and 45% in right and left rotation. Pressure pain thresholds were found increased by 68% over the infraspinatus, by 78% over the wrist extensors, and by 64% over the tibialis anterior. Among 11 subjects with photophobia, only 2 remained sensitive to light after the trigger point injections. Average vas dropped by 57%, from 6.1 to 2.6. No significant changes in pressure pain thresholds were observed in the control group following lidocaine infiltration of the thigh.

The present data suggest that myofascial trigger points serve to perpetuate lowered pain thresholds in uninjured tissues. Additionally, it appears that lowered pain thresholds associated with central sensitization can be immediately reversed, even when associated with long standing chronic neck pain. Although the effects resulting from anesthesia of trigger points in the present study were temporary, it is possible that surgical excision or ablation of the same trigger points may offer more permanent solutions for chronic neck pain patients. Further study is needed to evaluate these and other options for such patients.

April 24, 2009

Neck pain in working males without ergonomic risks

Filed under: Neck Pain — Administrator @ 11:02 am

Cervical disorders in a group of male workers not exposed to physical ergonomic risk

From: Med Lav. 2009 Mar-Apr;100(2):151-7

[Article in Italian]

The aim of our study was to assess the prevalence of neck pain in the working population not exposed to ergonomic risks. A total of 373 male workers were recruited in the Venice area of Italy. The inclusion criterion was the absence of exposure to ergonomic risk factors at the workplace. We collected the data via interviews between March 2004 and December 2006 conducted by properly trained operators. The prevalence of neck pain episodes was calculated after selecting 347 subjects without functional outcomes for severe trauma or genetic and degenerative diseases involving the same anatomical area. The strength of the association of neck pain with the collected variables was tested by means of logistic regression analysis.

The group had a good attitude to doing physical activity in their free time. Exposure to high stress at work involved 12% of the sample. Multivariate analysis suggested a more than 3-fold level of risk among individuals with high levels of stress at work. The O.R. was 3.51 for those suffering from back pain at the same time and 6.85 for those who reported shoulder pain.

This study, in agreement with the scientific literature, showed evidence of increased risk of neck pain in subjects exposed to stress. There was a clear association with neck pain and joint disorders of other areas of the spine and shoulder. The results showed that the quantification of painful joint disorders, considering the numerical importance and the brief latency, is well suited to models of cross sectional studies.

April 20, 2009

Questionnaire to predict sick leave in patients with acute neck pain

Filed under: Back Pain,Neck Pain — Administrator @ 11:29 am

The ability of the acute low back pain screening questionnaire to predict sick leave in patients with acute neck pain

From: J Manipulative Physiol Ther. 2009 Mar-Apr;32(3):178-83

The aim of this study was to investigate the use of the acute low back pain screening questionnaire in patients with acute neck pain in general practice. The acute low back pain screening questionnaire is a biopsychosocial screening questionnaire containing 20 items concerning mainly psychosocial variables. Although originally developed for patients with low back pain, it may also be applicable for patients with neck pain. We evaluated its reliability and determined an optimal cutoff point for predicting future sick leave.

A prospective study was conducted on consecutive patients with acute neck pain in general practice with a follow-up period of 1 year. Reliability was determined by means of a test-retest procedure with a 1-week interval. The total number of days on sick leave was added up based on self-reported questionnaires.

One hundred eighty-seven patients were included in the study, of which 180 patients were included in the analysis. Almost half of the patients were better or much improved within the first week. Test-retest reliability was high. Almost 40% of the patients reported sick leave because of neck pain during the follow-up period. An optimal cutoff score of 72 was calculated for predicting future sick leave, with a sensitivity of 77% and a specificity of 62%. The area under the curve of the receiver operator characteristics curve was regarded doubtful.

The acute low back pain screening questionnaire has shown to be a reliable instrument and potentially useful in a screening procedure for future sick leave in patients with acute neck pain in general practice.

From the Clin J Pain. 2001 Sep;17(3):256-63, How effective is the acute low back pain screening questionnaire for predicting 1-year follow-up in patients with low back pain? The findings of this study demonstrate that scores on the acute low back pain screening questionnaire were positively correlated with patients’ levels of pain and functional disability at 1-year follow-up and correctly classified all patients reporting some degree of work loss but had minimal predictive strength for the other patient-centered variables evaluated.

April 19, 2009

Population based estimates of whiplash injury

Filed under: Neck Pain,Whiplash — Administrator @ 12:29 pm

Population based estimates of whiplash injury using nass cds data

From: Biomed Sci Instrum. 2009;45:244-9

Clinical investigations identified occupant related factors that may predispose specific populations to increased whiplash injury susceptibility. However, clinical studies represent a specific patient population and are not representative of the population at large. The present objective was to analyze nationally-representative data to assess the association between gender and whiplash in motor vehicle rear end impacts. A cohort of front seat occupants in rear impacts (5-7 o’clock) from 1998-2007 were acquired using the National Automotive Sampling System (NASS) Crashworthiness Data System database. Outcome measure was “cervical spine strain” without fracture or dislocation. Differences between injured population proportions were analyzed using Chi-Square test of independence. 1,973 rear impacts were selected, representing 936,439 weighted crashes from across the United States. Females accounted for 69% of the weighted whiplash injuries, and the proportion of females sustaining whiplash was 10% higher than males. Furthermore, gender was associated with acquiring whiplash in rear impacts. Although NASS data is inherently weighted toward more severe impacts (i.e., tow-away collisions), this population based study has demonstrated increased female susceptibility to whiplash injury. The importance of gender suggests that specific safety measures for female front seat occupants should be addressed separately from males.

April 18, 2009

Backback and computer use among children

Filed under: Back Pain,Neck Pain,Posture — Administrator @ 12:21 pm

Backback and computer use among children and related musculoskeletal disorders

These abstracts are from: Work. 2009;32(3)

Effect of backpack load placement on posture and spinal curvature in prepubescent children

From: Work. 2009;32(3):351-60

Parents, educators and researchers have expressed concern about the long term impacts of children carrying excessive loads in their backpacks on a daily basis. Although many researchers have investigated appropriate weight limits for children’s packs, little research has been conducted on the design of children’s backpacks. The purpose of this study was to evaluate the changes in children’s trunk forward lean, cranio-vertebral angle and spinal lordosis angle that occurred with high, medium and low load locations during standing and walking. Ten-year-old children (n = 15) completed a repeated measures designed study while carrying 15% of each child’s body weight in a typical backpack with only shoulder straps. A special instrumented backpack was designed that allowed the weight to be placed in the proper location and continuously measure changes in spinal curvature. Trunk forward lean and cranio-vertebral angle postures were captured on digital video at five intervals including: standing without a backpack prior to a 1000 m walk; standing with a backpack at the beginning and end of a 1000 m walk; and walking with a backpack at the beginning and end of a 1000 m walk. Results indicated that significant changes occurred in trunk forward lean and cranio-vertebral angle when the backpack was loaded to 15% body weight. The low load placement in the backpack produced fewer changes in cranio-vertebral angle from the initial standing baseline measure than the high and mid placements. When all measures were assessed collectively, there were fewer changes in spinal lordosis angle in the low load placement. These findings indicate that future backpack designs should place loads lower on the spine in order to minimize children’s postural adaptations.

Backpack load limit recommendation for middle school students based on physiological and psychophysical measurements

From: Work. 2009;32(3):339-50

The load of student’s backpacks has raised questions over the safety and health of schoolchildren everywhere. The purpose of this study is to use electromyography (EMG), posture evaluation, heart rate, and ratings of perceived exertion and perceptions of pain to find an acceptable backpack load limit for middle school students. Twenty middle school students aged 11 to 14 (10 female and 10 male) volunteered for the study. The subjects completed two tests, standing stationary and walking on a treadmill, where they carried 5% incremental loads from 0% body mass to 20% body mass. The study indicated that the Borg-CR10 ratings and trunk flexion angle for the walking trial indicated a possible load limit of 10% body mass due to the non-significant difference between 0 and 10% body mass and the significant difference between 10 and 15% body mass.

Computer use in school: Its effect on posture and discomfort in schoolchildren

From: Work. 2009;32(3):321-8

The aim of the study was to investigate the posture and musculoskeletal discomfort of secondary school students while working at computers in school. Students (n = 40) were observed while working at a computer during their designated computer class. The Rapid Upper Limb Assessment Tool was used to assess posture. A Body Discomfort Chart and Visual Analogue Scale were used to record the area(s) and intensity of musculoskeletal discomfort, if any, experienced by the students at the beginning and end of the computer class. None of the students’ posture was in the acceptable range (Action Level 1) according to Rapid Upper Limb Assessment Tool. The majority (65%) were in Action Level 2, 30% were in Action Level 3, and 5% were in Action Level 4. There was a statistically significant increase in reported discomfort from the beginning to the end of the computer class. Longer class length (80 minutes) did not result in greater reporting of discomfort than shorter class length (40 minutes).

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April 16, 2009

Cervical range of motion and changes in head and neck posture

Filed under: Neck Pain,Posture — Administrator @ 7:35 pm

The relationship between the active cervical range of motion and changes in head and neck posture after continuous computer screen work

From: Ind Health. 2009 Apr;47(2):183-8

Poor posture is a common finding in physical therapy evaluations of patients with musculoskeletal complaints. The upper spine has been of particular interest to physical therapists treating disorders of the cervical and thoracic spine, the shoulder, and the temporomandibular region. Many studies have attempted to identify head and neck postures that would reduce the risk of developing musculoskeletal pain of the neck and trunk.

The effects of the head and neck posture depend on the characteristics of a task. Visual display terminal (computer screen) work typically involves remaining for a long time in a fixed position. Sezto et al. found that individuals increase their forward head posture during computer screen work, which involves an excessive anterior position of the head in relation to the theoretical plumb line perpendicular to the body’s center of gravity, and can be considered similar to a protracted position of the cervical spine in which the lower cervical vertebrae are flexed in a forward glide and the upper cervical vertebrae are extended. This causes a shortening of the posterior cervical and suboccipital muscles, lengthening and weakness of the anterior neck muscles, weakness of the scapula retractor muscles, and increased stress on the ligaments. The imbalances created by this position decrease muscular efficiency, and extra muscular action is needed to hold the head and neck in a stable position. Fredriksson et al. reported that neck and shoulder pain was associated with computer screen work in both men and women.

The head and neck posture of an individual can influence soft-tissue relationships in the cervical region. Neck postural changes can lead to neck pain via associated changes in cervical movement patterns, so it is necessary to evaluate cervical spine kinematics in both normal subjects and in patients with neck pain. Reductions in the cervical range of motion (ROM) have implications for the safety and efficiency of functional activities and lead to a loss of corrective or protective reactions, which contribute to a loss of balance in the soft tissue extensibility around a joint. A study has also shown that a decreased cervical ROM is associated with poor sitting postures, such as forward head posture. ROM losses can occur from inactivity and structural changes of the tissues in the cervical spine, and result in an increase in connective-tissue density, shortening of collagen tissue, and muscle fibrosis.

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April 15, 2009

Symptoms and psychological factors five years after whiplash injury

Filed under: Neck Pain,Whiplash — Administrator @ 9:09 pm

Relationship between symptoms and psychological factors five years after whiplash injury

From: J Rehabil Med. 2009 Apr;41(5):353-9

Whiplash injuries have become a major health problem because of their high frequency and increasing economic costs. In Western countries, the incidence is 1.0–3.2/1000 per year. The term whiplash describes a mechanism of energy caused by acceleration being transferred to the neck, which results in soft tissue injury/distortion of the neck. Most whiplash trauma is the result of traffic accidents, but other trauma mechanisms have also been described. The distortion of the neck usually decreases over subsequent days or weeks, but the injury may lead to a number of clinical symptoms known as whiplash associated disorder. The dominating complaints after the injury are neck pain and headache. Other symptoms commonly associated with whiplash associated disorder are fatigue, dizziness, irritability, concentration and memory disturbances, sleep disturbance and anxiety. Although many patients with whiplash trauma recover within a few months after the accident, a significant proportion experiences prolonged symptoms. The frequency of long-term symptoms after whiplash injuries varies. Mayou et al. reported that 35% of subjects had physical problems 5 years after the injury, and persistent neck pain has been demonstrated in 84–90% of patients 1–2 years after the injury and in as much as 50% of whiplash patients 17 years after the injury. Moreover, patients may also have psychological issues after the injury, such as post-traumatic stress or depression, which can influence recovery.

Although studies have identified risk factors such as increased age, gender and initial neck pain intensity, the literature is inconsistent, making it unclear which factors lead to the development of persistent symptoms and related disability after whiplash injuries. During the last years some studies have looked at both physical and psychological aspects as causes of prolonged recovery. However, most studies of long-term outcome after whiplash associated disorder have focused on neck pain after the injury, while the persistence of other symptoms, together with psychosocial and psychological aspects, is less well investigated. Recently, Williamson et al., in a systematic review, identified the need for further research with respect to psychological factors in the development of late symptoms after whiplash injury. Moreover, in several studies attention has been paid to the influence of gender as a potential prognostic factor after whiplash injuries, and female gender has been identified as a factor related to poor recovery. In contrast, some studies have failed to show any gender differences regarding long-term symptoms after the injury. The inconsistent results may be due to differences in study populations and the investigated variables.

The conditions after whiplash injury may often affect several aspects of daily life, such as work, leisure and the total experience of satisfaction with life. Since people live in a social context with social relationships, the influence of social support after the trauma seems to be important for the injured persons. However, few studies have focused on these factors. The consequences of the injury may also be reflected in difficulties with return to usual occupation. In a previous study Bylund & Björnstig. found that most people on sick leave due to traffic accidents were injured by whiplash trauma and, recently, Berglund et al. reported increased sick leave several years after motor vehicle injuries. Moreover, attempts have been made to find factors related to sick leave and time off work following a whiplash injury, but the underlying causes remain unclear. However, since the follow-up time after whiplash injury differs between studies, and the length of time after injury in most studies has been rather short, it is difficult to compare the long-term outcome.

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April 14, 2009

Aging of the cervical spine

Filed under: Arthritis,Disc Problems,Neck Pain — Administrator @ 3:02 pm

Aging of the cervical spine in healthy volunteers: a 10-year longitudinal magnetic resonance imaging study

From: Spine. 2009 Apr 1;34(7):706-12

Prevalence of back and neck problems is high among general populations, and it has been estimated that neck pain is recognized in 9,000,000 and both neck and low back pain in 19,000,000 people in the United States. The total cost for the treatment of neck pain in Netherlands in 1996 was estimated to be US $686 million.

Aging of the cervical spine can inevitably occur in anyone. Recent advances in basic researches on disc degeneration have revealed its possible mechanisms including a decrease in proteoglycan contents and water concentration, involvement of inflammatory cytokines such as interleukin-15 and iTNF-α, and some genetic factors. Since the intervertebral disc is one of the tissues subject to early aging processes starting as early as 20 years of age, and is often the source of cervical spinal disorders causing neck pain and related symptoms, it is important to ascertain the processes of aging when considering treatments for age-related cervical spinal diseases. There have been a few studies on aging of the cervical spine in healthy subjects using plain x-ray, computed tomography, or magnetic resonance imaging (MRI). In particular, MRI has excellent tissue resolution and can sharply visualize degeneration of the intervertebral discs. However, the majority of these studies were cross-sectional, and have only been able to determine the prevalence of age-related degenerative changes in the cervical spine, but failed to clarify the sequential processes of aging. Thus, long-term longitudinal studies following the same individuals are necessary to elucidate the accurate aging processes of the cervical spine.

We conducted a cross-sectional study of MRI findings of the cervical spine in 497 asymptomatic healthy subjects between 1993 and 1996,11 and showed that the incidence of degenerative changes in the cervical spine increased with age; the incidence of degenerative findings on MRI was 17% and 12% in male and female teenagers, respectively, and was 86% and 89% in male and female subjects in their 60s, respectively.

In the present study, which was conducted approximately 10 years after the previous study, a part of the same cohort was recruited and underwent follow-up MRI. The objectives of this longitudinal study were to investigate the processes of the progression of intervertebral disc degeneration and to clarify correlations between the progression of intervertebral disc degeneration and the development of clinical symptoms.

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April 12, 2009

Direction of anterior lumbar vertebral osteophytes

Filed under: Arthritis,Back Pain,Disc Problems — Administrator @ 12:22 pm

Direction of the formation of anterior lumbar vertebral osteophytes

From: BMC Musculoskelet Disord. 2009 Jan 13;10:4

X-ray images of lumbar degenerative diseases often show not only claw osteophytes, but also pairs of osteophytes that form in a direction away from the adjacent disc. We have investigated the direction of the formation of anterior lumbar vertebral osteophytes across the lumbar vertebrae using a sufficient number of lumbar radiographs, because osteophytes images can provide essential information that will contribute to the understanding of the pathology and progress of lumbar spine degeneration.

Kirkardy-Willis et al. reported that lumbar degenerative diseases began with disc degeneration, and, during a period characterized by the development of different pathologies including disc herniation, spinal instability and spinal canal stenosis, ended with the formation of anterior lumbar vertebral osteophytes that would stabilize the spinal column. According to the radiographic Nathan’s classification of anterior lumbar vertebral osteophytes, in a claw osteophyte, a bone bridge forms across the intervertebral disc space as a result of the curve and extension of a cranial osteophyte and a caudal osteophyte across the adjacent disc.

Actually, X-ray images of lumbar degenerative diseases often show not only claw osteophytes, but also pairs of osteophytes that form in a direction away from the adjacent disc. The latter type is called traction osteophytes or traction spurs, and have been described as indicators of intervertebral instability on a plain radiographic image by Macnub et al. Besides, Pate et al. reported from their studies in 200 cadavers that both claw and traction osteophytes had the same histology, and that traction osteophytes could turn into claw osteophytes during the lumbar degenerative process. In 1998, Heggeness demonstrated that both claw and traction osteophytes formed as a result of the same degenerative process. For a decade after these reports, researchers have no longer paid attention to the types of osteophytes and the direction of their formation. We have investigated the direction of the formation of anterior lumbar vertebral osteophytes across the lumbar vertebrae using a sufficient number of lumbar radiographs, because osteophytes images can provide essential information that will contribute to the understanding of the pathology and progress of lumbar spine degeneration.

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