Neck Solutions Blog

March 31, 2010

The Effect of Spinal Manipulation on the Efficacy of a Rehabilitation Protocol for Patients With Chronic Neck Pain: A Pilot Study

Filed under: Chiropractic,Chronic Pain,Neck Pain — Administrator @ 3:46 am

The Effect of Spinal Manipulation on the Efficacy of a Rehabilitation Protocol for Patients With Chronic Neck Pain: A Pilot Study.

From: J Manipulative Physiol Ther. 2010 March – April;33(3):168-177.

Chronic neck pain is a common problem in modern, industrialized countries. It has been estimated that 67% of people will experience neck pain at some point in their lives. A proportion of these individuals with neck pain do not experience complete resolution of their pain and disability, which can turn into a more complex chronic pain syndrome. What is not well understood is what causes neck pain to become chronic. An emerging school of thought in the mechanism of chronicity in nonspecific neck pain is that it is related to abnormal muscle recruitment patterns, which may put the spine at greater risk of further injury. Impaired neuromuscular function in patients with chronic neck pain is becoming increasingly recognized, most notably, an impaired ability to activate the neck flexor muscles during rapid limb movements and an impaired ability to relax the neck extensor muscles.

The solution proposed in previous research has been based on the idea of using specific exercise strategies to improve these impaired neuromuscular patterns. Recent research indicates that both exercise and chiropractic care involving spinal manipulation may also be able to improve these impaired neuromuscular patterns. Chiropractic techniques appear to be able to help normalize altered patterns of muscle recruitment and sequencing observed in the presence of musculoskeletal impairments and pain.

Contemporary research into the pathogenesis of nonspecific neck pain relates to the manifestation of abnormal muscle recruitment patterns. Impaired neuromuscular function in patients with chronic neck pain is becoming increasingly recognized, most notably the impaired activation of the neck flexor muscles during rapid upper limb movement. An additional measure that may be used for impaired neuromuscular function is the cervical flexion-relaxation response, a measure of the ability to relax the cervical extensors at full forward flexion. There is a lack of evidence for how commonly used interventions for chronic neck pain, such as spinal manipulation or exercise, may change these measures of impaired neuromuscular function in the neck.

(more…)

March 30, 2010

Neck pain patients’ preference scores for their current health

Filed under: Chronic Pain,Neck Pain — Administrator @ 3:23 am

Neck pain patients’ preference scores for their current health.

From: Qual Life Res. 2010 Mar 27. [Epub ahead of print]

To elicit neck pain patients’ preference scores for their current health, and investigate the association between their scores and neck pain disability. Rating scale scores and standard gamble scores for current health were elicited from chronic neck pain patients (n = 104) and patients with neck pain following a motor vehicle accident (n = 116).

Patients were stratified into Von Korff Pain Grades: Grade I (low-intensity pain, few activity limitations); Grade II (high-intensity pain, few activity limitations); Grade III (pain with high disability levels, moderate activity limitations); and Grade IV (pain with high disability levels, several activity limitations).

Multivariable regression quantified the association between preference scores and neck pain disability.
Mean standard gamble scores and rating scale scores were as follows: Grade I patients: 0.81, 0.76; Grade II: 0.70, 0.60; Grade III: 0.64, 0.44; Grade IV: 0.57, 0.39.

The association between preference scores and neck pain disability depended on type of neck pain and preference elicitation method. Chronic neck pain patients’ scores were more strongly associated with depressive symptoms than with neck pain disability. In both samples, neck pain disability explained little more than random variance in standard gamble scores, and up to 51% of variance in rating scale scores.

Health related quality of life is considerably diminished in neck pain patients. Depressive symptoms and preference elicitation methods influence preference scores that neck pain patients assign to their health.

March 27, 2010

Satisfaction of patients with mechanical neck disorders attended to by primary care physical therapists

Filed under: Neck Pain — Administrator @ 8:40 am

Satisfaction of patients with mechanical neck disorders attended to by primary care physical therapists

From: J Eval Clin Pract. 2010 Mar 10. [Epub ahead of print]

To describe the satisfaction and expectations of the patients with neck pain with relation to the physical therapy received and to analyse the relationship between the patient’s characteristics and his degree of satisfaction and expectation.

This study is performed in the setting of a random clinical trial. Subjects between 18 and 60 years of age with subacute mechanical neck disorders. Main variables Patient’s expectations and satisfaction with the received treatment (scale similar to Likert’s Scale). Other variables Pain intensity, episodes of previous neck pain, depression and anxiety symptoms (Goldberg Scale), age and gender, physical disability, general state of health, duration of the present episode of neck pain, regular exercise and regular consumption of medicines.

A total of 90 patients were studied. The mean age was 40.1 years and 88.9% were female. Thirteen per cent of the subjects expected partial relief, 60% expected good recovery and 27% expected complete recovery. Those patients who have not suffered previous episodes of neck pain and those who have a higher score on the Goldberg Scale have a higher expectation of recovering after the treatment. About patients’ satisfaction after the intervention, 2% totally unsatisfied, 1% very unsatisfied, 2% somewhat unsatisfied, 2% indifferent, 17% somewhat satisfied, 42% very satisfied and 30% totally satisfied.

Those patients who experienced a greater decrease in pain were more satisfied. It would be interesting to study in depth the measurement of patients’ satisfaction with the received physical therapy and to extend it to other pathologies.

March 26, 2010

Temporo-insular enhancement of EEG low and high frequencies in patients with chronic tinnitus

Filed under: Tinnitus — Administrator @ 3:49 am

Temporo-insular enhancement of EEG low and high frequencies in patients with chronic tinnitus.

From: BMC Neurosci. 2010 Mar 24;11(1):40. [Epub ahead of print]

Tinnitus is an auditory phantom perception, reported subjectively as a tone and/or a noise, in the absence of an external stimulus. Approximately 5-15 % of the general population experience tinnitus. In 1-3% of the general population the tinnitus affects the quality of life, involving sleep disturbance, work impairment and psychological distress. The underlying physiological mechanisms that lead to phantom sensation are still being explored. In most cases, tinnitus is accompanied by an audiometrically measurable hearing loss, and even in a majority of those cases with normal audiograms abnormal outer or inner hair-cell function has been reported correlating with the presence of tinnitus.

Contemporary views of tinnitus emphasize the role of the central auditory system. Studies in anaesthetized animals suggest enhanced firing rate and /or synchronized firing to be a necessary neurophysiological mechanism underlying tinnitus. A reduction of tinnitus intensity in patients has been correlated to reduction of delta band power.

Alterations in spontaneous central neuronal activity patterns after peripheral deafferentations have recently been proposed to be essential in the genesis of tinnitus. A relevance for peripheral deafferentation has also been proposed in the field of neurogenic pain, which prompted some authors to envisage that a similar mechanism might be at the source of tinnitus and neurogenic pain. Peripheral deafferentation leads to thalamic deactivation, which in turn disrupts normal thalamocortical interaction, thus leading to the appearance of tinnitus. The effects of an abnormal thalamocortical interaction can be analysed at the cortical level using magnetoencephalogram or electroencephalogram. This sequential view integrates both the induction in the periphery and the generation at the thalamocortical level of tinnitus. In the following, the authors refer to a mechanism that focuses on thalamocortical interplay. First evidence for this mechanism in tinnitus was the finding of low-threshold calcium spike bursts in the medial thalamus. 50% of neuronal activity in the medial thalamus (central lateral nucleus, central lateral nucleus) was characterized as low-threshold calcium spike bursts. Low-threshold calcium spike bursts displayed a delta/theta rhythmicity, with a mean interburst discharge rate of 4 Hz. low-threshold calcium spikes have been described intracellularly in in vitro and in vivo experiments and have been related to a state of membrane hyperpolarization. In tinnitus this would be a consequence of auditory deprivation caused by peripheral damage.

(more…)

March 24, 2010

Compensation claim lodgement and health outcome developmental trajectories following whiplash injury

Filed under: Neck Pain,Whiplash — Administrator @ 3:28 am

Compensation claim lodgement and health outcome developmental trajectories following whiplash injury: A prospective study.

From: Pain. 2010 Mar 20. [Epub ahead of print]

This study aimed to identify distinctive trajectories for pain, disability and posttraumatic stress disorder symptoms following whiplash injury and to examine the effect of injury compensation claim lodgement on the trajectories. In a prospective study, 155 individuals with whiplash were assessed at less than 1month, 3, 6 and 12 months post injury. Outcomes at each time point were Neck Disability Index and the Posttraumatic Stress Diagnostic Scale. Group-based trajectory analytical techniques were used to identify outcome profiles. The analyses were then repeated after including third party compensation claim lodgment as a binary time-changing covariate.

Three distinct Neck Disability Index trajectories were determined: (1) Mild: mild or negligible pain and/or disability for the entire 12 months (45%), (2) Moderate: initial moderate pain and/or disability that decreased to mild levels by 3 months (39%) and (3) Chronic-severe: severe pain and/or disability persisting at moderate/severe levels for 12 months (16%).

Three distinct posttraumatic stress disorder trajectories were also identified: (1) Resilient: mild symptoms throughout (40%), (2) Recovering: initial moderate symptoms declining to mild levels by 3months (43%) and (3) Chronic moderate-severe: persistent moderate/severe symptoms throughout 12 months (17%).

Claim submission had a detrimental effect on all trajectories except for the Chronic-severe Neck Disability Index trajectory. Following whiplash injury, there are distinct pathways of recovery for pain and/or disability and posttraumatic stress disorder symptoms. Management of whiplash should consider the detrimental association of compensation claim with psychological recovery and recovery of those with mild to moderate pain and/or disability levels. However, claim lodgement has no significant association with a more severe pain and disability trajectory.

March 22, 2010

Tinnitus Retraining Therapy for tinnitus

Filed under: Tinnitus — Administrator @ 3:18 am

Tinnitus Retraining Therapy (TRT) for tinnitus.

From: Cochrane Database Syst Rev. 2010 Mar 17;3:CD007330

Tinnitus is described as the perception of sound or noise in the absence of real acoustic stimulation. Although an outright cure for tinnitus remains elusive, various management strategies have been developed to help to lessen the impact of the symptom. Following the publication of a neurophysiological model of tinnitus, Tinnitus Retraining Therapy was developed. Using a combination of directive counselling and sound therapy in a strict framework, this is one of the most commonly used treatment modalities for tinnitus. Many studies refer to the use of Tinnitus Retraining Therapy where in fact a modified version of this therapy is actually being implemented. It is therefore important to confirm the use of authentic Tinnitus Retraining Therapy when reviewing any study that reports its use.

To assess the efficacy of Tinnitus Retraining Therapy in the treatment of tinnitus, the search included the Cochrane ENT Group Trials Register, the Cochrane Central Register of Controlled Trials (CENTRAL), PubMed, EMBASE and reference lists of identified publications. The date of the most recent search was 26 August 2009. Randomised controlled trials of Tinnitus Retraining Therapy versus no treatment, or other forms of treatment, in adult patients with tinnitus were selected. Both authors critically appraised the retrieved studies for risk of bias and extracted data independently. Where necessary, we contacted the original study authors for further information.

Only one trial (123 participants) was included in the review. Several excluded trials did not follow the strict protocol for Tinnitus Retraining Therapy, evaluating instead a modified form of Tinnitus Retraining Therapy. The included trial showed Tinnitus Retraining Therapy to be more effective than a tinnitus masking approach. In this study outcome data for tinnitus severity were presented using three instruments (Tinnitus Handicap Inventory, Tinnitus Handicap Questionnaire, Tinnitus Severity Index) for patients in three groups (participants’ tinnitus being a ‘moderate problem’, big problem’ or ‘very big problem’).

At 18 months, improvements for the three groups in the three scores (Tinnitus Retraining Therapy versus Tinnitus Masking) were respectively: ‘moderate problem’ – Tinnitus Handicap Inventory: 18.2 versus 4.6, Tinnitus Handicap Questionnaire: 489 versus 178, Tinnitus Severity Index 7.5 versus 1.6; ‘big problem’ – Tinnitus Handicap Inventory: 29.2 versus 16.7, Tinnitus Handicap Questionnaire: 799 versus 256, Tinnitus Severity Index: 12.1 versus 6.7; and ‘very big problem’ – Tinnitus Handicap Inventory: 50.4 versus 10.3, Tinnitus Handicap Questionnaire; 1118 versus 300, Tinnitus Severity Index: 19.7 versus 4.8.

A single, low-quality randomised controlled trial suggests that Tinnitus Retraining Therapy is much more effective as a treatment for patients with tinnitus than tinnitus masking.

Related Sources:

Tinnitus retraining therapy: implementing the neurophysiological model |
Guide to conducting tinnitus retraining therapy initial and follow-up interviews | Tinnitus Retraining Therapy | The TRT method in practice

March 20, 2010

Determination of backrest inclination based on biodynamic response study for prevention of low back pain

Filed under: Back Pain,Posture — Administrator @ 1:35 pm

Determination of backrest inclination based on biodynamic response study for prevention of low back pain

From: Med Eng Phys. 2010 Mar 16. [Epub ahead of print]

Whole-body vibration experiments with subjects under vertical vibration were performed to examine and evaluate effects of backrest inclination on vibration transmitted through seats to the human body by using biodynamic response parameters represented by apparent mass and vibration power absorption. The biodynamic response parameters of twelve male subjects, exposed to vertical random vibration at 0.8m/s(2) r.m.s., were characterized under three different backrest support conditions, with the upper body supported against backrest inclined at angles of 0 degrees (vertical), 10 degrees , and 30 degrees with respect to the vertical axis.

An increased backrest inclination angle resulted in reduction of the total power absorption calculated particularly the frequency range of 1-20Hz. Normalized apparent mass magnitudes showed a principal resonance at about 5Hz for each subject for a backrest supported vertically. A second resonant peak appeared at about 7.5Hz in addition to the primary resonant peak for a backrest inclined at an angle of 10 degrees and then became much steeper for a backrest inclined at angle of 30 degrees. For a backrest inclined at an angle of 30 degrees, the resonant peak at 5Hz was less apparent than in other backrest inclination postures. All subjects showed the second resonant peak at about 7.5Hz in the double-normalized vibration power absorption for a backrest inclined at an angle of 30 degrees. According to the evaluation of vibration absorption behavior performed in this study, backrest inclination angle is preferable between 10 degrees and 30 degrees from the viewpoint of prevention of low back pain disorder.

March 19, 2010

Tissue motion pattern of ventral neck muscles investigated by tissue velocity ultrasonography imaging

Filed under: Neck Pain — Administrator @ 2:53 am

Tissue motion pattern of ventral neck muscles investigated by tissue velocity ultrasonography imaging

From: Eur J Appl Physiol. 2010 Mar 18. [Epub ahead of print]

The authors designed this experimental study to investigate tissue motions and thus infer the recruitment pattern of the ventral neck muscles sternocleidomastoid, longus capitis, and longus colli at the C4-C5 level in healthy volunteers during isometric manual resistance of the head in flexion in a seated position. This exercise is used in the physiotherapeutic treatment of neck pain and is assumed to activate the deep ventral muscles, but the assumption has not been clearly evaluated. Neck flexors of 16 healthy volunteers (mean age 24 years, SD 3.7) were measured using ultrasonography with strain and strain rate tissue velocity imaging during isometric contraction of flexor muscles. Tissue velocity imaging involves using Doppler imaging to study tissue dynamics.

All three muscles showed a deformation compared to rest. Except for the initial contraction phase, longus colli exhibited a lower strain than longus capitis and sternocleidomastoid but was the only muscle with a significant change in strain rate between the phases. When the beginning of the contraction phase was analysed, longus colli was the first to be deformed among most volunteers, followed by longus capitis and then sternocleidomastoid. The exercise investigated seems to be useful as a stabilizing neck exercise for longus colli. The authors suggest that in further research, longus colli and longus capitis should be investigated as separate muscles. Tissue velocity imaging could be used to study tissue motions and thus serve as an indicator of muscle patterning between the neck flexors, with the possibility of separating longus colli and longus capitis.

March 17, 2010

Neck Pain During Combat Operations

Filed under: Neck Pain — Administrator @ 2:57 pm

Neck Pain During Combat Operations: An Epidemiological Study Analyzing Clinical and Prognostic Factors.

From: Spine (Phila Pa 1976). 2010 Mar 11. [Epub ahead of print]

This is an interesting prospective observational study among soldiers medically evacuated out of theaters of combat operations for neck pain, with retrospective analysis of variables associated with return to duty. The objectives of the study was to provide an epidemiological overview of the burden of neck pain in deployed soldiers involved in combat operations and to identify factors associated with return to duty.

Neck pain represents one of the leading causes of medical evacuation out of theaters of combat operations. Yet when compared to other diagnostic categories, treatment outcomes, militarily defined as returning a soldier to duty, remain appallingly low.

Demographic, military-specific, and outcome data were prospectively collected over a 2-week period at the Deployed Warrior Medical Management Center in Germany on 374 consecutive soldiers medically evacuated out of theaters of combat operations for a primary diagnosis pertaining to neck pain between 2004 and 2007. The 2-week period represents the maximal allowable time an evacuated soldier can spend in treatment before disposition (i.e., return to theater or evacuate to United States) is rendered. Electronic medical records were reviewed to examine the effect the following variables had on the categorical outcome measure, return-to-unit: age, gender, service-affiliation, rank and seniority, smoking history, coexisting psychiatric diagnosis, prior neck pain, mechanism of injury, whether or not the injury was combat-related, presence of headache, quality of symptoms, correlation with radiologic imaging, and referral to pain specialist.

The results of the study indicate only 14% of service members returned to their units. Significant correlations were found between female gender and non-army service affiliation, and a service member returning to their unit. Weak trends toward returning to duty were noted for nonsmokers, absence of prior neck pain, concomitant psychiatric diagnosis, corresponding complaints of headache, and referral to a pain specialist.

It was concluded that the treatment of service members medically evacuated for neck pain at the main receiving center, the level IV military treatment facility in Landstuhl, Germany, is associated with a low return to unit rate. Future studies should consider whether treating personnel predisposed towards a positive outcome with the limited resources available can improve return to duty rates.

March 16, 2010

Long-term return to work after a functional restoration program for chronic low-back pain patients: a prospective study

Filed under: Back Pain,Chronic Pain — Administrator @ 2:39 pm

Long-term return to work after a functional restoration program for chronic low-back pain patients: a prospective study

From: Eur Spine J. 2010 Mar 12. [Epub ahead of print]

Low back pain is a major health and socio economic problem. Functional restoration programs have been developed to promote the socio-professional reintegration of patients with important work absenteeism. The aim of this study was to determine the long-term effectiveness of functional restoration programs in a group of 105 chronic low back pain patients and to determine the predictive factors of return to work. One hundred-and-five chronic lower back pain patients with over 1 month of work absenteeism were included in a functional restoration program. Pain, professional status, quality of life, functional disability, psychological impact, and fear and avoidance beliefs were evaluated at baseline, after 1 year and at the end of follow-up. Main effectiveness criterion was return to work.

Fifty-five percent of the patients returned to work after mean follow-up time of 3.5 years, compared with 9% of the patients at work at baseline. Quality of life, functional disability, psychological factors, and fear and avoidance beliefs were all significantly improved. Three predictive factors were found: younger age at the onset of low back pain, practice of sports, and shorter duration of sick leave at baseline. Functional restoration programs show positive results in terms of return to work for chronic low back pain patients with prolonged work absenteeism. Efforts should be made to propose such programs at an earlier stage of the disease.

Older Posts »

Powered by WordPress