Neck Solutions Blog

April 30, 2010

Neck disorders among construction workers

Filed under: Neck Pain,Posture — Administrator @ 3:19 am

Neck disorders among construction workers: understanding the physical loads on the cervical spine during static lifting tasks

From: Industrial Health. 2010;48(2):145-53

Frequent material handling activities found in construction work environments put substantial stress on the neck, shoulder, and lower back resulting in pain and discomfort. A number of studies have evaluated the prevalence of different types of musculoskeletal disorders among construction workers. A study of workers compensation claims in Washington (US) show that masonry and residential construction are among the top five industries having the highest risk of injuries. Among Swedish construction workers studied by Holmström et al., 41.1% had neck and shoulder disorders. Building construction is listed among the top ten high-risk industries for musculoskeletal disorders among the Taiwanese working population by Guo et al. Neck and shoulder disorders affect 26.3% of male and 32.1% of female among the Taiwanese construction workers.

Manual material handling activities are an inseparable part of any construction project. Epidemiologically, several review studies have clearly established a strong relationship between work activities requiring forceful arm exertions and the occurrence of neck disorders. Common neck disorders associated with work activities involving forceful arm exertions include degenerative disc disorders such as disc herniation or cervical spondylosis and in some cases more muscle specific disorders such as tension neck syndrome. Even though these disorders are prevalent among construction workers, very few studies have evaluated the underlying pathomechanism.

The purpose of this study was to evaluate physical risk factors (force and posture) associated with neck disorders among construction workers. The role of the major neck muscles during lifting tasks at shoulder height was evaluated biomechanically by studying muscle activity in the cervical region.

(more…)

April 28, 2010

Cognitive determinants of pain and disability in patients with chronic whiplash-associated disorder: a cross-sectional observational study

Filed under: Chronic Pain,Whiplash — Administrator @ 3:33 am

Cognitive determinants of pain and disability in patients with chronic whiplash-associated disorder: a cross-sectional observational study

From: Physiotherapy. 2010 Jun;96(2):151-9. Epub 2010 Jan 21

To delineate the relative extent to which specific cognitive factors are related to levels of pain and disability in patients with chronic whiplash associated disorder. This was a cross-sectional observation study by three secondary care physiotherapy departments in the Greater Manchester region of the UK. All patients with chronic whiplash associated disorder referred to the participating departments were invited to take part in the study. In total, 124 patients were invited to participate, and 63 (51%) agreed to do so. Complete data were available for 55 (44%) of those invited to participate in the study. Pain and disability ws as assessed by the Neck Disability Index.

Cognitive factors were strongly related to levels of disability. Specifically, greater catastrophising and lower functional self-efficacy beliefs were significantly related to greater levels of disability. Significant univariate correlations were seen between the cognitive factors and current pain intensity. However, no significant associations were seen between the cognitive factors and current pain intensity in the multivariate analysis.

Interventions which aim to reduce catastrophising and enhance functional self-efficacy beliefs should be included alongside conventional physiotherapy interventions when treating patients with chronic whiplash associated disorder.

April 24, 2010

Cardiovascular and muscle activity during chewing in whiplash-associated disorders (WAD)

Filed under: TMJ Pain,Whiplash — Administrator @ 3:41 pm

Cardiovascular and muscle activity during chewing in whiplash-associated disorders (WAD).

From: Arch Oral Biol. 2010 Apr 20. [Epub ahead of print]

The present study aimed to elucidate possible physiological mechanisms behind impaired endurance during chewing as previously reported in whiplash associated disorders. We tested the hypothesis of a stronger autonomic reaction in whiplash associated disorders than in healthy subjects in response to dynamic loading of the jaw and neck motor system.

Cardiovascular reactivity, muscle fatigue indicies of EMG, and perceptions of fatigue, exhaustion and pain were assessed during standardised chewing. Twenty-one whiplash associated disorders subjects and a gender/age matched control group participated. Baseline recordings were followed by two sessions of alternating unilateral chewing of a bolus of gum with each session followed by a rest period.

More than half of the whiplash associated disorders subjects terminated the test prematurely due to exhaustion and pain. In line with our hypothesis the chewing evoked an increased autonomic response in whiplash associated disorders exhibited as a higher increase in heart rate as compared to controls. Furthermore, we saw consistently higher values of arterial blood pressure for whiplash associated disorders than for controls across all stages of the experiment. Masseter EMG did not indicate muscle fatigue nor were there group differences in amplitude and mean power frequency. Pain in the whiplash associated disorders group increased during the first session and remained increased, whereas no pain was reported for the controls.

More intense response to chewing in whiplash associated disorders might indicate pronounced vulnerability to dynamic loading of the jaw and neck motor system with increased autonomic reactivity to the test. Premature termination and autonomic involvement without EMG signs of muscle fatigue may indicate central mechanisms behind insufficient endurance during chewing.

(more…)

April 23, 2010

Effect of pain on the modulation in discharge rate of sternocleidomastoid motor units with force direction

Filed under: Chronic Pain,Neck Pain — Administrator @ 3:30 am

Effect of pain on the modulation in discharge rate of sternocleidomastoid motor units with force direction

From: Clin Neurophysiol. 2010 May;121(5):634-5

To compare the behavior of sternocleidomastoid motor units of patients with chronic neck pain and healthy controls. Nine women (age, 40.4+/-3.5 yr) with chronic neck pain and nine age and gender matched healthy controls participated. Surface and intramuscular EMG were recorded from the sternocleidomastoid muscle bilaterally as subjects performed isometric contractions of 10-s duration in the horizontal plane at a force of 15 N in eight directions (0-360 degrees ; 45 degrees intervals) and isometric contractions at 15 and 30 N force with continuous change in force direction in the range 0-360 degrees . Motor unit behavior was monitored during the 10-s contractions and the subsequent resting periods.

The mean motor unit discharge rate depended on the direction of force in the control subjects but not in the patients. Moreover, in three of the nine patients, but in none of the controls, single motor unit activity continued for 8.1+/-6.1s upon completion of the contraction. The surface EMG amplitude during the circular contraction at 15N was greater for the patients (43.5+/-54.2 microV) compared to controls (16.9+/-14.9 microV).

The modulation in discharge rate of individual motor units with force direction is reduced in the sternocleidomastoid muscle in patients with neck pain, with some patients showing prolonged motor unit activity when they were instructed to rest. These observations suggest that chronic neck pain affects the change in neural drive to muscles with force direction.

April 20, 2010

Neck Disability Index

Filed under: Neck Pain,Whiplash — Administrator @ 7:02 am

Neck Disability Index

Neck pain is a common problem and represents a formidable financial burden in industrialized countries. The annual incidence of neck pain in the general population is approximately 15%, and its course is often one of remission and exacerbation or chronic pain and disability. Although acute neck pain often improves, as much as 19% of the population has chronic, longstanding neck pain at any given time.

The Neck Disability Index is the oldest and most widely used instrument for self-reporting of disability due to neck pain. Its internal psychometric properties have been well established in numerous cultural groups with neck pain: it is highly reliable, strongly internally consistent, and with a 1-factor structure for “physical disability.” It has strong and well-documented convergent and divergent validity with other instruments used in the evaluation of patients and subjects with neck pain. Clinicians can confidently apply a “minimum clinically important change” value of 3 to 5 points in their practice settings, whereas researchers can make use, in future clinical trials, of the large number of reports of the responsiveness of the instrument to various therapies over various time frames and according to various indices of responsiveness.

The Neck Disability Index is explicitly endorsed as the instrument of choice in the following guidelines for the treatment of whiplash-associated disorder (WAD):

1.NHS Library:

-Clinical Knowledge Summaries
-Prodigy Guidelines

http://www.cks.library.nhs.uk/neck_pain

2.Transport Accident Commission, Victoria State, Australia http://www.tac.vic.gov.au/jsp/corporate/homepage/home.jsp

3.New South Wales Motor Accidents Authority, Guidelines for the Management of Acute Whiplash-Associated Disorders, 2nd Edition, 2007. https://www.cebp.nl/media/m393.pdf

4.Clinical Practice Guidelines for the Physiotherapy treatment of Patients with Whiplash-Associated Disorders. Leigh et al, 2004. British Columbia Physiotherapy Association http://www.bcphysio.org/pdfs/wad.pdf

5.Clinical Practice Guidelines for Physical Therapy in Patients with Whiplash-Associated Disorders. Bekkering et al, 2003, Royal Dutch Society for Physical Therapists. http://www.ifomt.org/pdf/Guidelines/WhiplashGln.pdf

April 16, 2010

Chiropractic claims in the English-speaking world

Filed under: Back Pain,Chiropractic,Headaches,Neck Pain,Whiplash — Administrator @ 2:54 am

Chiropractic claims in the English-speaking world.

From: N Z Med J. 2010 Apr 9;123(1312):36-44

Some chiropractors and their associations claim that chiropractic is effective for conditions that lack sound supporting evidence or scientific rationale. This study therefore sought to determine the frequency of World Wide Web claims of chiropractors and their associations to treat, asthma, headache, migraine, infant colic, colic, ear infection, earache, otitis media, neck pain, whiplash (not supported by sound evidence), and lower back pain (supported by some evidence).

A review of 200 chiropractor websites and 9 chiropractic associations’ World Wide Web claims in Australia, Canada, New Zealand, the United Kingdom, and the United States was conducted between 1 October 2008 and 26 November 2008. The outcome measure was claims (either direct or indirect) regarding the eight reviewed conditions, made in the context of chiropractic treatment.

The authors found evidence that 190 (95%) chiropractor websites made unsubstantiated claims regarding at least one of the conditions. When colic and infant colic data were collapsed into one heading, there was evidence that 76 (38%) chiropractor websites made unsubstantiated claims about all the conditions not supported by sound evidence. Fifty-six (28%) websites and 4 of the 9 (44%) associations made claims about lower back pain, whereas 179 (90%) websites and all 9 associations made unsubstantiated claims about headache, migraine. Unsubstantiated claims were made about asthma, ear infection, earache, otitis media, neck pain.

The majority of chiropractors and their associations in the English-speaking world seem to make therapeutic claims that are not supported by sound evidence, whilst only 28% of chiropractor websites promote lower back pain, which is supported by some evidence. The authors suggest the ubiquity of the unsubstantiated claims constitutes an ethical and public health issue.

(more…)

April 14, 2010

Comparison of randomized treatments for late whiplash

Filed under: Whiplash — Administrator @ 3:21 am

Comparison of randomized treatments for late whiplash

From: Neurology. 2010 Apr 13;74(15):1223-30

To compare 4 different treatment strategies in patients with late whiplash syndrome, patients were randomly assigned to one of the following treatment groups: infiltration, physiotherapy, or medication. Group allocation was stratified according to gender, age, and education. Additionally, patients of each group were randomized 1:1 to cognitive behavioral therapy or no cognitive behavioral therapy. Patients were assessed at baseline, after an 8-week treatment period, and 3 and 6 months later. Main outcome measures were subjective outcome rating, pain intensity, and working ability.

Of 91 enrolled patients, 73 completed the study; 62% were women. After treatment, 47 patients (64%) were subjectively improved (48%), or free of symptoms (16%), with a preponderance of women (73% vs 50%). There was no difference regarding outcomes among the 3 treatment groups in men and women. The most robust difference was achieved with cognitive behavioral therapy, associated with a higher rate of recovery (23% vs 9%), and improvement (53% vs 42%), and with a gender difference. All treatments significantly improved pain intensity and working ability.

Intensive therapy in late whiplash syndrome can achieve improvement of different outcome measures including working ability in two-thirds of patients, more effective in women, persisting beyond 6 months in half. Additional cognitive behavioral therapy was the most effective treatment modality. Classification of evidence: This interventional study provides Class III evidence that cognitive behavioral therapy used as an adjunct to infiltration, medication, or physiotherapy increases improvement rates in persons with late whiplash syndrome.

April 12, 2010

Toward Characterization and Definition of Fibromyalgia Severity

Filed under: Back Pain,Chronic Pain,Neck Pain — Administrator @ 3:31 am

Toward Characterization and Definition of Fibromyalgia Severity

From: BMC Musculoskelet Disord. 2010 Apr 8;11(1):66. [Epub ahead of print]

Fibromyalgia is a disorder of unknown etiology that is generally diagnosed according to the American College of Rheumatology (ACR) criteria, which include chronic, widespread pain for at least 3 months, and the presence of 11 out of 18 tender points. Prevalence estimates for the United States suggest that approximately 5 million individuals have this condition, with a higher prevalence among women (3.4%) than men (0.5%). Although chronic widespread pain is the hallmark of fibromyalgia, core symptoms of fibromyalgia also include sleep disturbance, fatigue, mood disorders, and localized pain (headache, back and/or neck pain). These core symptoms are included among the domains that have been identified and recognized by OMERACT (Outcomes Measures in Rheumatology) as important for assessment in fibromyalgia.

Fibromyalgia has a substantial negative impact on quality of life, resulting in health status that is poorer than other chronic pain conditions such as rheumatoid arthritis and osteoarthritis. The burden imposed by core fibromyalgia symptoms translates into limitations of productivity, personal and family life, as well as a reduced ability to complete simple activities of daily living.

This multidimensional nature of fibromyalgia has made it difficult to define and assess the severity of fibromyalgia as a condition. The indeterminate etiology and lack of specific disease markers exacerbate the problem of assessing fibromyalgia severity. While several studies investigated the potential use of biologic markers for fibromyalgia (e.g. cytokines, antipolymer antibodies), correlation of these markers with symptoms was equivocal at best, rendering them ineffective as indicators of severity. Similarly, although tender points and a total myalgic score have been evaluated as measures of severity, they demonstrate inherent variability over time, show little correlation with other outcome measures, and importantly, neither is of clinical relevance to patients. A recent comprehensive review of potential fibromyalgia biomarkers highlighted the lack of appropriate evaluation of objective biomarkers of fibromyalgia, although limited data from a longitudinal study suggested that the results obtained during experimental pain testing were associated with clinical status improvements. However, it should be noted that in addition to sensitivity to change with clinical improvement, biomarkers need to demonstrate change with worsening disease if they are to be considered indicators of disease severity.

(more…)

April 11, 2010

What Factors Have Influence on Persistence of Neck Pain After a Whiplash?

Filed under: Neck Pain,Whiplash — Administrator @ 12:11 pm

What Factors Have Influence on Persistence of Neck Pain After a Whiplash?

From: Spine (Phila Pa 1976). 2010 Apr 1. [Epub ahead of print]

A Prospective longitudinal study to identify prognosis factors that allow us to identify patients with risk of developing chronic symptoms and disabilities after a whiplash injury.

The prognosis factors for poor recovery in acute whiplash are not conclusive. The authors included 557 patients who suffered whiplash injury after road traffic accident and visited the Department of Physical Medicine and Rehabilitation of Mataró Hospital (Spain) for medical evaluation and rehabilitation treatment. The variables were collected following a protocol designed for the study, and all patients were assessed through the Visual Analogue Scale for the intensity of neck pain, the Goldberg Depression and Anxiety Scale and the Northwick Park Neck Pain Questionnaire for cervical column functionality at initial evaluation and 6 months later.

Factors related with Visual Analogue Scale 6 months after the whiplash injury were women, age, number of days of cervical column immobilization, previous neck pain, self-employed workers, housewives, pensioners, students, presence of headache or dizziness, and Visual Analogue Scale, Goldberg Depression and Anxiety scale, and Northwick Park Neck Pain Questionnaire scores at initial evaluation.

In multivaried analysis, it had been found that the variables that had influence on Visual Analogue Scale 6 months after the whiplash injury were statistically significant for age, presence of dizziness, self-employed workers, and Visual Analogue Scale and Northwick Park Neck Pain Questionnaire scores at initial evaluation.

The findings indicate that factors that allow us to identify patients at risk for poor recovery are age, dizziness, and initial evaluation of neck pain with Visual Analogue Scale and cervical column functionality with Northwick Park Neck Pain Questionnaire.

April 8, 2010

Association of the Polymorphisms of Vitamin D Receptor and Aggrecan Genes with Degenerative Disc Disease

Filed under: Arthritis,Disc Problems — Administrator @ 3:59 am

Association of the Polymorphisms of Vitamin D Receptor and Aggrecan Genes with Degenerative Disc Disease.

From: Genet Test Mol Biomarkers. 2010 Mar 31. [Epub ahead of print]

The aim of this study was to investigate the association between the polymorphisms of vitamin D receptor and aggrecan genes and degenerative disc disease in young Turkish patients. Aggrecan and vitamin D receptor proteins are the main components of bone and cartilage. In our study, the polymorphisms of vitamin D receptor and aggrecan genes were investigated in a total of 300 individuals regarding disc degeneration and herniation.

An association was found in the patients having vitamin D receptor gene TT, Tt, FF, and Ff genotypes with the protrusion type of disc herniation, whereas the patients having tt and ff genotypes were associated with extrusion/sequestration types of the disease. Also, an association was observed between TT and FF genotypes of vitamin D receptor gene and mild forms of disc degeneration; and tt, ff, and Ff genotypes and severe forms of the disease. There was also an association between shorter, normal, and longer alleles of the aggrecan gene and a protrusion type of disc herniation. An association was found between short alleles and multilevel and severe disc degeneration, as well as normal and long alleles and mild disc degeneration. This study revealed that the polymorphisms of vitamin D receptor and aggrecan genes are associated with disc degeneration and herniation.

(more…)

Older Posts »

Powered by WordPress