Neck Solutions Blog

January 30, 2010

Reduced head steadiness in whiplash compared with non traumatic neck pain

Filed under: Neck Pain,Whiplash — Administrator @ 4:02 pm

Reduced head steadiness in whiplash compared with non traumatic neck pain

From: J Rehabil Med. 2010 Jan;42(1):35-41

While sensorimotor alterations have been observed in patients with neck pain, it is uncertain whether such changes distinguish whiplash associated disorders from chronic neck pain without trauma. The aim of this study was to investigate head steadiness during isometric neck flexion in subjects with chronic whiplash associated disorders, those with chronic non traumatic neck pain and healthy subjects. Associations with fatigue and effects of pain and dizziness were also investigated.

Head steadiness in terms of head motion velocity was compared in subjects with whiplash (n=59), non traumatic neck pain (n=57) and healthy controls (n=57) during 2 40-s isometric neck flexion tests; a high load test and a low load test. Increased velocity was expected to reflect decreased head steadiness.

The whiplash group showed significantly decreased head steadiness in the low load task compared with the other 2 groups. The difference was explained largely by severe levels of neck pain and dizziness. No group differences in head steadiness were found in the high load task.

Reduced head steadiness during an isometric holding test was observed in a group of patients with whiplash associated disorders. Decreased head steadiness was related to severe pain and dizziness.

More Information: Altered motor control patterns in whiplash and chronic neck pain

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January 29, 2010

Quality of life and psychological factors in chronic neck pain

Filed under: Neck Pain — Administrator @ 7:03 pm

Correlations between quality of life and psychological factors in patients with chronic neck pain

From: Kaohsiung J Med Sci. 2010 Jan;26(1):13-20

The purpose of this study was to investigate health related quality of life and associated factors in patients with chronic neck pain. The health related quality of life of patients with chronic neck pain was assessed by the Short Form-36 questionnaire in this cross-sectional study. To evaluate the psychological factors related to health related quality of life, the Eysenck Personality Questionnaire, Chinese Health Questionnaire, and Beck Anxiety Inventory were used. The scores for the eight subscales of Short Form-36 were all lower than the Taiwanese age-matched normative values.

The two most strongly affected subscales were the role-physical subscale and the bodily pain subscale; both scores were below half the score of the age/sex-matched normative values. The physical components summary score, a summary measure, was moderately correlated with age, education level and Beck Anxiety Inventory score. The mental components summary score was moderately to highly correlated with the Chinese Health Questionnaire score, the neuroticism domain of Eysenck Personality Questionnaire) and Beck Anxiety Inventory score. The health related quality of life of patients with chronic neck pain was worse than that of normal subjects across all domains. Furthermore, patients with a neurotic personality, minor psychiatric morbidity and higher anxiety status showed poor mental health, as measured by the Short Form-36.

The authors found that patients with chronic neck pain had multiple physical and mental health problems in terms of. The mental health of patients with chronic neck pain was strongly associated with various psychological factors. Comprehensive assessment of the physical and mental functioning of patients with chronic neck pain can improve the management and care of these patients.

Related Link: Symptoms and psychological factors five years after whiplash injury

January 28, 2010

Association between Smoking and Low Back Pain

Filed under: Back Pain — Administrator @ 3:37 pm

The Association between Smoking and Low Back Pain: A Meta-analysis.

From: Am J Med. 2010 Jan;123(1):87.e7-87.e35

To assess the association between smoking and low back pain with meta-analysis. The authors conducted a systematic search of the MEDLINE and EMBASE databases until February 2009. Eighty-one studies were reviewed and 40 (27 cross-sectional and 13 cohort) studies were included in the meta-analyses.

In cross-sectional studies, current smoking was associated with increased prevalence of low back pain in the past month, low back pain in the past 12 months, seeking care for low back pain, chronic low back pain and disabling low back pain. Former smokers had a higher prevalence of low back pain compared with never smokers, but a lower prevalence of low back pain than current smokers. In cohort studies, both former and current smokers had an increased incidence of low back pain compared with never smokers. The association between current smoking and the incidence of low back pain was stronger in adolescents than in adults.

These findings indicate that both current and former smokers have a higher prevalence and incidence of low back pain than never smokers, but the association is fairly modest. The association between current smoking and the incidence of low back pain is stronger in adolescents than in adults.

January 27, 2010

The prevalence of neck pain in migraine

Filed under: Headaches,Neck Pain — Administrator @ 2:38 pm

The Prevalence of Neck Pain in Migraine

From: Headache. 2010 Jan 20. [Epub ahead of print]

To determine the prevalence of neck pain at the time of migraine treatment relative to the prevalence of nausea, a defining associated symptom of migraine. This is a prospective, observational cross-sectional study of 113 migraineurs, ranging in attack frequency from episodic to chronic migraine. Subjects were examined by headache medicine specialists to confirm the diagnosis of migraine and exclude both cervicogenic headache and fibromyalgia. Details of all migraines were recorded over the course of at least 1 month and until 6 qualifying migraines had been treated. For each attack, subjects recorded the presence or absence of nausea as well as the intensity of headache and neck pain (graded as none, mild, moderate, or severe).

Subjects recorded 2411 headache days, 786 of which were migraines. The majority of migraines were treated in the moderate pain stage. Regardless of the intensity of headache pain at time of treatment, neck pain was a more frequent accompaniment of migraine than was nausea. Prevalence of neck pain correlated with chronicity of headache as attacks moved from episodic to chronic daily headache.

In this representative cross-section of migraineurs, neck pain was more commonly associated with migraine than was nausea, a defining characteristic of the disorder. Awareness of neck pain as a common associated feature of migraine may improve diagnostic accuracy and have a beneficial impact on time to treatment.

January 26, 2010

Short version of the Neck Pain and Disability Scale

Filed under: Neck Pain — Administrator @ 3:46 pm

Development of a short version of the Neck Pain and Disability Scale

From: Eur J Pain. 2010 Jan 20

Previous evaluations of the 20-item Neck Pain and Disability Scale Neck Pain and Disability Scale were indicative of excessive redundancy of the measure. The aim of this study was to develop a shortened version of the Neck Pain and Disability Scale based on results of item-to-total-score correlations and factor analysis as published by the developers of the original Neck Pain and Disability Scale. Two items with the highest item-to-total score correlation were selected per factor subscale with the exception of one factor consisting of only one item. This resulted in the selection of 9 items for the shortened version of the Neck Pain and Disability Scale.

The shortened version of the Neck Pain and Disability Scale was validated in a separate sample of 448 neck pain patients from 15 general practices in the area of Göttingen/Germany. Participants completed the 20-item Neck Pain and Disability Scale German version and gave additional sociodemographic and clinical information. Psychometric properties of the shortened version of the Neck Pain and Disability Scale were evaluated using Cronbach’s alpha, item-to-total-score correlation, and unrestricted principal factor analysis. Construct validity was evaluated by Pearson’s r with clinical characteristics. Discriminative validity was examined by comparing differences between subgroups stratified by psychosocial characteristics using t-tests for mean scores. Cronbach’s alpha of the shortened version of the Neck Pain and Disability Scale was 0.88. Item-to-total-scale correlations ranged between 0.628 and 0.815, and shortened version of the Neck Pain and Disability Scale items homogeneously loaded on a single factor. Correlation analysis showed high correlations with criterion variables. The shortened version of the Neck Pain and Disability Scale scores of patient subgroups were significantly different showing good discriminative validity.

In conclusion, the shortened version of the Neck Pain and Disability Scale demonstrated good validity and internal consistency in this general practice setting. The abbreviated version may facilitate applicability of the scale in clinical and research settings.

January 25, 2010

Temporomandibular disorders is associated with greater bodily pain

Filed under: TMJ Pain — Administrator @ 1:45 pm

Development of temporomandibular disorders is associated with greater bodily pain experience

From: Clin J Pain. 2010 Feb;26(2):116-20

The aim of this study is to examine the difference in the report of bodily pain experienced by patients who develop temporomandibular disorders and by those who do not develop temporomandibular disorders over a 3-year observation period.

This is a 3-year prospective study of 266 females aged 18 to 34 years initially free of temporomandibular disorders pain. All patients completed the Symptom Report Questionnaire (SRQ) at baseline and yearly intervals, and at the time they developed temporomandibular disorders (if applicable). The SRQ is a self-report instrument evaluating the extent and location of pain experienced in the earlier 6 months. Statistical analysis was carried out using repeated measures ANOVA.

Over the 3-year period, 16 patients developed temporomandibular disorders based on the Research Diagnostic Criteria for temporomandibular disorders. Participants who developed temporomandibular disorders reported more headaches, muscle soreness or pain, joint soreness or pain, back pain, chest pain, abdominal pain, and menstrual pain than Participants who did not develop temporomandibular disorders at both the baseline and final visits. Participants who developed temporomandibular disorders also reported significantly more headache, muscle soreness or pain, and other pains when they were diagnosed with temporomandibular disorders compared with the baseline visit.

The development of temporomandibular disorders was accompanied by increases in headaches, muscle soreness or pain, and other pains that were not observed in the Participants who did not develop temporomandibular disorders. Participants who developed temporomandibular disorders also report higher experience of joint, back, chest, and menstrual pain at baseline.

January 22, 2010

Manipulation or mobilisation for neck pain

Filed under: Chiropractic,Headaches,Neck Pain — Administrator @ 10:50 am

Manipulation or mobilisation for neck pain.

Cochrane Database Syst Rev. 2010 Jan 20;(1):CD004249

Manipulation and mobilisation are often used, either alone or combined with other treatment approaches, to treat neck pain.

To assess if manipulation or mobilisation improves pain, function/disability, patient satisfaction, quality of life, and global perceived effect in adults with acute, subacute and chronic neck pain with or without cervicogenic headache or radicular findings.

(The Cochrane Library 2009, issue 3) and MEDLINE, EMBASE, Manual Alternative and Natural Therapy, CINAHL, and Index to Chiropractic Literature were updated to July 2009. Randomised controlled trials on manipulation or mobilisation. Two review authors independently selected studies, abstracted data, and assessed risk of bias. Pooled relative risk and standardised mean differences (SMD) were calculated.

The authors included 27 trials (1522 participants). Cervical Manipulation for subacute and chronic neck pain : Moderate quality evidence suggested manipulation and mobilisation produced similar effects on pain, function and patient satisfaction at intermediate term follow-up. Low quality evidence showed manipulation alone compared to a control may provide short term relief following one to four sessions and that nine or 12 sessions were superior to three for pain and disability in cervicogenic headache.

Optimal technique and dose need to be determined. Thoracic Manipulation for acute/chronic neck pain : Low quality evidence supported thoracic manipulation as an additional therapy for pain reduction (NNT 7; 46.6% treatment advantage) and increased function (NNT 5; 40.6% treatment advantage) in acute pain and favoured a single session of thoracic manipulation for immediate pain reduction compared to placebo for chronic neck pain (NNT 5, 29% treatment advantage).

Mobilisation for subacute/chronic neck pain: In addition to the evidence noted above, low quality evidence for subacute and chronic neck pain indicated that 1) a combination of Maitland mobilisation techniques was similar to acupuncture for immediate pain relief and increased function; 2) there was no difference between mobilisation and acupuncture as additional treatments for immediate pain relief and improved function; and 3) neural dynamic mobilisations may produce clinically important reduction of pain immediately post-treatment. Certain mobilisation techniques were superior.

Cervical manipulation and mobilisation produced similar changes. Either may provide immediate or short term change; no long-term data are available. Thoracic manipulation may improve pain and function. Optimal techniques and dose are unresolved. Further research is very likely to have an important impact on our confidence in the estimate of effect and is likely to change the estimate.

January 20, 2010

Obesity and low back pain on spinal mobility

Filed under: Back Pain,Chronic Pain,General Health — Administrator @ 9:12 am

Effect of obesity and low back pain on spinal mobility: a cross sectional study in women

From: J Neuroeng Rehabil. 2010 Jan 18;7(1):3. [Epub ahead of print]

Obesity is nowadays a pandemic condition. Obese subjects are commonly characterized by musculoskeletal disorders and particularly by non-specific chronic low back pain. However, the relationship between obesity and chronic low back pain remains to date unsupported by an objective measurement of the mechanical behavior of the spine and its morphology in obese subjects. Such analysis may provide a deeper understanding of the relationships between function and the onset of clinical symptoms.

Objectively assessment of posture and function of the spine during standing, flexion and lateral bending in obese subjects with and without chronic low back pain and to investigate the role of obesity in chronic low back pain.

Cross-sectional study Patient sample: thirteen obese subjects, thirteen obese subjects with chronic low back pain, and eleven healthy subjects were enrolled in this study. The authors evaluated the outcome in terms of angles at the initial standing position (START) and at maximum forward flexion (MAX). The range of motion (ROM) between START and MAX was also computed. The authors studied forward flexion and lateral bending of the spine using an optoelectronic system and passive retroreflective markers applied on the trunk. A biomechanical model was developed in order to analyse kinematics and define angles of clinical interest.

Obesity was characterized by a generally reduced ROM of the spine, due to a reduced mobility at both pelvic and thoracic level; a static postural adaptation with an increased anterior pelvic tilt. Obesity with chronic low back pain is associated with an increased lumbar lordosis. In lateral bending, obesity with chronic low back pain is associated with a reduced ROM of the lumbar and thoracic spine, whereas obesity on its own appears to affect only the thoracic curve.

Obese individuals with chronic low back pain showed higher degree of spinal impairment when compared to those without chronic low back pain. The observed obesity-related thoracic stiffness may characterize this sub-group of patients, even if prospective studies should be carried out to verify this hypothesis.

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January 15, 2010

Flexion Relaxation Ratio in Sitting

Filed under: Back Pain,Chronic Pain — Administrator @ 3:21 pm

Flexion-Relaxation Ratio in Sitting: Application in Low Back Pain Rehabilitation.

From: Spine (Phila Pa 1976). 2010 Jan 12. [Epub ahead of print]

A multiple comparative study between normal and low back pain patients before and after rehabilitation. To examine whether there is a change in flexion relaxation phenomenon in sitting in low back pain patient following a rehabilitation treatment.

There is an association between low back pain and seated spine posture. Previous study has reported an absence of flexion relaxation phenomenon in low back pain patients during sitting. However, it is unknown whether there is a difference in flexion relaxation phenomenon in sitting in low back pain patients before and after rehabilitation treatment.

A total of 20 normal subjects and 25 chronic low back pain patients who underwent a 12 weeks rehabilitation program were recruited. Surface electromyography recordings during upright sitting and flexed sitting were taken from the paraspinal muscles (L3) bilaterally from the normal subjects, and in the low back pain patients before and after the rehabilitation treatment. The main outcome measures for patients include the visual analogue scale, Oswestry disability index, subjective tolerance for sitting, standing and walking, trunk muscle endurance, lifting capacity, and range of trunk motion in the sagittal plane. Flexion relaxation phenomenon in sitting, expressed as a ratio between the average surface electromyography activity during upright and flexed sitting, was compared between normal and patients; and in low back pain patients before and after rehabilitation.

Flexion relaxation ratio in sitting in normal subjects presented a significantly higher value than low back pain patients. An increase in flexion relaxation ratio in sitting was observed in low back pain patients after rehabilitation, together with a significant improvement in subjective tolerance in sitting and standing, abdominal and back muscle endurance, lifting capacity, and range of motion. There were no significant changes in disability and pain scores, and subjective tolerance in walking.

Flexion relaxation ratio in sitting has demonstrated its ability to discriminate low back pain patients from normal subjects, and to identify changes in pattern of muscular activity during postural control after rehabilitation.

More Information:

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January 12, 2010

Is compensation bad for health

Filed under: Whiplash — Administrator @ 2:48 pm

Is compensation “bad for health”? A systematic meta-review

From: Injury. 2010 Jan 7. [Epub ahead of print]

There is a common perception that injury compensation has a negative impact on health status, and systematic reviews supporting this thesis have been used to influence policy and practice decisions. This study evaluates the quality of the empirical evidence of a negative correlation between injury compensation and health outcomes, based on systematic reviews involving both verifiable and non-verifiable injuries.

Selection criteria were established a priori. Included systematic reviews examined the impact of compensation on health, involved adults, were published in English and used a range of outcome measures. Two investigators independently applied standard instruments to evaluate the methodological quality of the included reviews. Data on compensation scheme design (i.e., the intervention) and outcome measures were also extracted.

Eleven systematic reviews involving verifiable and non-verifiable injuries met the inclusion criteria. Nine reviews reported an association between compensation and poor health outcomes. All of them were affected by the generally low quality of the primary (observational) research in this field, the heterogeneous nature of compensation laws (schemes) and legal processes for seeking compensation, and the difficulties in measuring compensation in relation to health.

Notwithstanding the limitations of the research in this field, one higher quality review examining a single compensation process and relying on primary studies using health outcome (rather than proxy) measures found strong evidence of no association between litigation and poor health following whiplash, challenging the general belief that legal processes have a negative impact on health status. Moves to alter scheme design and limit access to compensation on the basis that it is “bad for health” are therefore premature, as evidence of such an association is unclear.

More Information: Is Injury Compensation Bad For Health From: ACERH, The University Of Queensland, 2009 Conference of Health Economists

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