Neck Solutions Blog

June 29, 2010

The Cervical Flexion-Relaxation Ratio: Reproducibility and Comparison Between Chronic Neck Pain Patients and Controls.

Filed under: Neck Pain — Administrator @ 3:20 am

The Cervical Flexion-Relaxation Ratio: Reproducibility and Comparison Between Chronic Neck Pain Patients and Controls.

From: Spine (Phila Pa 1976). 2010 Jun 24. [Epub ahead of print]

To determine the reproducibility of the cervical flexion-relaxation ratio measured 4 weeks apart in a group of chronic neck pain patients and healthy control group and to compare the flexion-relaxation ratio between the 2 groups. The cervical flexion-relaxation ratio measures the ability of the neck extensor muscles to relax during forward flexion, similar to the lumbar flexion-relaxation ratio. The flexion relaxation phenomenon is commonly defined as a decrease in superficial paraspinal muscle electromyography (EMG) signals that occur just before full trunk flexion. Its reliability and ability to discriminate neck pain patients from controls has not been investigated.

Fourteen participants with chronic neck pain and a control group of 14 individuals with no neck pain were recruited via advertisement and word of mouth. The cervical flexion-relaxation ratio was determined at baseline and 4 weeks later using standardized electromyographic data collection and analysis procedures. The mean flexion-relaxation ratio value for the combined left and right side data for the neck pain groups was 1.93 +/- 0.8, and 1.73 +/- 0.61 at 4-week follow-up. The intraclass correlation coefficient (ICC) was 0.83 (95% CI = 0.67-0.92). Three participants in the control group developed neck pain in the 4 weeks and their data were not included in the reliability calculation. For the control group, the combined (left and right side) mean flexion-relaxation ratio value was 4.09 +/- 1.58 at baseline and 4.27 +/- 1.71 on retest 4 weeks later. The ICC (intraclass r) was 0.89 (95% confidence interval = 0.76-0.95). The overall ICC for the combined groups was 0.92 (95% confidence interval = 0.86-0.95). An independent 2 group t test revealed a significant difference in the baseline flexion-relaxation ratio data between the control group and the neck pain group (P < 0.001).

The cervical extensor muscles exhibit a consistent flexion-relaxation phenomenon in healthy control subjects and the measurement is highly reproducible when measured 4 weeks apart in both controls and chronic neck pain patients. The flexion-relaxation ratio in neck pain patients is significantly higher than in control subjects suggesting that this measure may be a useful marker of altered neuromuscular function.

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June 27, 2010

Assessing audiological, pathophysiological and psychological variables in tinnitus patients with or without hearing loss

Filed under: Tinnitus — Administrator @ 5:48 am

Assessing audiological, pathophysiological and psychological variables in tinnitus patients with or without hearing loss.

From: Eur Arch Otorhinolaryngol. 2010 Jun 25. [Epub ahead of print]

The aim of this work is to study the characteristics of tinnitus both in normal hearing subjects and in patients with hearing loss. The study considered tinnitus sufferers, ranging from 21 to 83 years of age, who were referred to the Audiology Section of Palermo University in the years 2006-2008. The following parameters were considered: age, sex, hearing threshold, tinnitus laterality, tinnitus duration, tinnitus measurements and subjective disturbance caused by tinnitus. The sample was divided into Group1 (G1), 115 subjects with normal hearing, and Group2 (G2), 197 subjects with hearing loss. Especially for G2, there was a predominance of males compared to females; the highest percentage of tinnitus resulted in the decades 61-70 and >70 with a significant difference for G2 demonstrating that the hearing status and the elderly represent the principal tinnitus-related factors.

The hearing impairment resulted in most cases of sensorineural hearing loss type and was limited to the high frequencies; the 72.1% of the patients with sensorineural hearing loss had a high-pitched tinnitus, while the 88.4% of the patients with a high-frequency sensorineural hearing loss had a high-pitched tinnitus. As to the subjective discomfort, the catastrophic category was the most representative among G1 with a significant difference between the two groups; no correlation was found between the level of tinnitus intensity and the tinnitus annoyance confirming the possibility that tinnitus discomfort is elicited by a certain degree of psychological distress as anxiety, depression, irritability and phobias.

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June 23, 2010

Whiplash associated disorder predictors, treatment, social, economic and cultural aspects and definitions

Filed under: Whiplash — Administrator @ 2:36 pm

Whiplash

The following appear in Ugeskr Laeger. 2010 Jun 14 Articles in Danish

Predictors of chronic sequelae in whiplash trauma. 2010 Jun 14;172(24):1821-1824.

Prognostic factors for chronic whiplash associated disorder are identified. In whiplash associated disorder grade I-III, 50% report neck pain after one year (30% in background population). There is a female preponderance among WAD cases. 10% develop a work disability, but no gender differences are found. Age, crash issues, magnetic resonance imaging of the neck and smooth pursuit neck torsion test are of no prognostic value. While reduced active neck mobility is associated with a 4.6 times raised risk for work disability after one year, the impact-of-event score yielded an increase in OR of 3.3, and intense pre-injury distress was associated with a 2.1 OR for pain after one year and a 2.8 OR for work disability. Intense headache/neck pain and a multitude of non-painful complaints were both associated with a 3.5 to 4.0 times raised risk of work disability after a year.

Treatment of whiplash associated disorders. 2010 Jun 14;172(24):1818-1820.

Treatment of whiplash associated disorders starts with a thorough clinical examination, which may be repeated after 1-3 weeks. For optimal results it is essential that the patient receives clear information about the condition and that any pain is treated effectively with analgesics. Risk factors for persistent symptoms can often be identified early and should be addressed adequately. If symptoms persist and conservative treatments are chosen, these should be active and they should focus on sustaining or regaining usual activities.

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Polysomnographic and quantitative electroencephalographic correlates of subjective sleep complaints in chronic tinnitus

Filed under: Tinnitus — Administrator @ 2:39 am

Polysomnographic and quantitative electroencephalographic correlates of subjective sleep complaints in chronic tinnitus.

From: J Sleep Res. 2010 Jun 16. [Epub ahead of print]

Chronic tinnitus, or the perception of hearing sounds without the presence of external stimulation, is estimated at about 10-15% of the population, with highest prevalence after 50 years of age. Sleep complaints are among the most prominent complaints accompanying tinnitus, but objective data are rare. In this study, we examined prospectively the subjective and objective sleep parameters of this patient population in order to determine differences in sleep disturbances associated with chronic tinnitus compared to matched controls. Forty-four subjects (22 with tinnitus and 22 controls without tinnitus), unselected with respect to sleep complaints, participated in this study. The analysis involved 1-week sleep diaries, subjective sleep questionnaires and 1 night of polysomnographic (PSG) assessment. Compared to matched controls, the tinnitus group showed lower subjective sleep quality as measured with the Pittsburgh Sleep Quality Index (PSQI) and sleep diaries, but no significant difference in objective polysomnograph sleep parameters (i.e. sleep latency, efficiency). However, quantitative non-rapid eye movement sleep analysis revealed lower spectral power in the delta frequency band in the tinnitus group compared to controls, and this decrease was correlated with subjective sleep complaints (the lower the delta spectral power, the greater the complaints). This is the first report of an electrophysiological correlate of sleep difficulties supportive of subjective sleep complaints in the tinnitus population.

June 21, 2010

Magnetic resonance imaging and stadiometric assessment of the lumbar discs after sitting and chair-care decompression exercise: a pilot study

Filed under: Back Pain,Disc Problems — Administrator @ 9:49 am

Magnetic resonance imaging and stadiometric assessment of the lumbar discs after sitting and chair-care decompression exercise: a pilot study

From: Spine J. 2010 Apr;10(4):297-305. Epub 2010 Feb 26

Sitting is associated with loss of the lumbar lordosis, intervertebral disc compression, and height loss, possibly increasing the risk of lower back pain. With a trend toward more sitting jobs worldwide, practical strategies for preventing lumbar flattening and potentially associated low back pain are important. The purpose of this study was to determine the feasibility of using upright magnetic resonance imaging (MRI) and stadiometry to measure changes in height and configuration of the lumbar spine before and after normal sitting and a sitting unloading exercise intervention.

This is a hospital-based pilot study involving pre-post assessments in a single group. The sample comprises six asymptomatic hospital employees involved in either general patient care or research writing/data collection. The outcome measures were lumbar total midsagittal cross-sectional intervertebral disc area, vertical height, lordotic angle derived from digitized MRI examinations, and seated body height measured directly with a stadiometer. Midsagittal MRI scans were performed before sitting, after 15 minutes of relaxed sitting (“postsitting”), immediately after seated unloading exercises, and approximately 7 minutes after exercise. Subsequently, seated stadiometry assessments were performed after 10 minutes of supine recumbency, 15 minutes of relaxed sitting, and every 10 seconds after seated unloading exercises until three consecutive height measurements were identical. Digitized midsagittal images were used to derive MRI based outcome measures.

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June 18, 2010

Effect of different seat support characteristics on the neck and trunk muscles and forward head posture of visual display terminal workers

Filed under: Neck Pain,Posture — Administrator @ 3:34 am

Effect of different seat support characteristics on the neck and trunk muscles and forward head posture of visual display terminal workers.

From: Work. 2010 Jan;36(1):3-8

This study was designed to identify the effect of seat support characteristics on the neck and trunk muscles and forward head posture of visual display terminal (VDT) workers working at computers. 22 VDT workers with forward head posture were asked to perform computer work. Surface electromyography recorded the five neck and trunk muscles Forward head angle was analyzed with a 3-D motion analysis system. The significance of differences in the seat supports (hard, spongy, unstable) was tested.

Computer work seated on an unstable cushion-ball as compared to a spongy soft-cushion seat support showed significantly lower midcervical and L5 paraspinal muscle activity and significantly higher lower trapezius and internal oblique abdominal muscle activity. The mean forward head angle decreased in the order of spongy, hard, and unstable seat supports.

An unstable cushion-ball seat support may prevent work-related neck and upper limb disorders associated with forward head posture.

June 15, 2010

Interactive effects from self-reported physical and psychosocial factors in the workplace on neck pain and disability in female office workers

Filed under: Neck Pain — Administrator @ 3:24 am

Interactive effects from self-reported physical and psychosocial factors in the workplace on neck pain and disability in female office workers.

From: Ergonomics. 2010 Apr;53(4):502-13.

This study explored the interaction between physical and psychosocial factors in the workplace on neck pain and disability in female computer users. A self-report survey was used to collect data on physical risk factors (monitor location, duration of time spent using the keyboard and mouse) and psychosocial domains (as assessed by the job content questionnaire). The Neck Disability Index was the outcome measure. Interactions among the physical and psychosocial factors were examined in analysis of covariance.

High supervisor support, decision authority and skill discretion protect against the negative impact of (1) time spent on computer-based tasks, (2) non-optimal placement of the computer monitor and (3) long duration of mouse use. Office workers with greater neck pain experience a combination of high physical and low psychosocial stressors at work. Prevention and intervention strategies that target both sets of risk factors are likely to be more successful than single intervention programmes.

The results of this study demonstrate that the interaction of physical and psychosocial factors in the workplace has a stronger association with neck pain and disability than the presence of either factor alone. This finding has important implications for strategies aimed at the prevention of musculoskeletal problems in office workers.

June 12, 2010

Heat or cold packs for neck and back strain: a randomized controlled trial of efficacy

Filed under: Back Pain,Neck Pain — Administrator @ 4:22 am

Heat or cold packs for neck and back strain: a randomized controlled trial of efficacy.

From: Acad Emerg Med. 2010 May;17(5):484-9.

Acute back and neck strains are very common. In addition to administering analgesics, these strains are often treated with either heat or cold packs. The objective of this study was to compare the analgesic efficacy of heat and cold in relieving pain from back and neck strains. The authors hypothesized that pain relief would not differ between hot and cold packs.

This was a randomized, controlled trial conducted at a university-based emergency department with an annual census of 90,000 visits. Emergency department patients >18 years old with acute back or neck strains were eligible for inclusion. All patients received 400 mg of ibuprofen orally and then were randomized to 30 minutes of heating pad or cold pack applied to the strained area. Outcomes of interest were pain severity before and after pack application on a validated 100-mm visual analog scale (VAS) from 0 (no pain) to 100 (worst pain), percentage of patients requiring rescue analgesia, subjective report of pain relief on a verbal rating scale (VRS), and future desire for similar packs. Outcomes were compared with t-tests and chi-square tests. A sample of 60 patients had 80% power to detect a 15-mm difference in pain scores.

Sixty patients were randomized to heat (n = 31) or cold (n = 29) therapy. Groups were similar in baseline patient and pain characteristics. There were no differences between the heat and cold groups in the severity of pain beforeor after therapy. Pain was rated better or much better in 16/31 (51.6%) and 18/29 (62.1%) patients in the heat and cold groups, respectively. There were no between-group differences in the desire for and administration of additional analgesia. Twenty-five of 31 (80.6%) patients in the heat group and 22 of 29 (75.9%) patients in the cold group would use the same therapy if injured in the future.

The addition of a 30-minute topical application of a heating pad or cold pack to ibuprofen therapy for the treatment of acute neck or back strain results in a mild yet similar improvement in the pain severity. However, it is possible that pain relief is mainly the result of ibuprofen therapy. Choice of heat or cold therapy should be based on patient and practitioner preferences and availability.

June 11, 2010

What Influences Positive Return to Work Expectation?: Examining Associated Factors in a Population-Based Cohort of Whiplash-Associated Disorders

Filed under: Neck Pain,Whiplash — Administrator @ 3:35 am

What Influences Positive Return to Work Expectation?: Examining Associated Factors in a Population-Based Cohort of Whiplash-Associated Disorders.

From: Spine (Phila Pa 1976). 2010 Jun 8. [Epub ahead of print]

This was a cross-sectional study of population based traffic cohort to determine which factors are associated with both positive and negative expectations for returning to work after vehicle collision resulting in neck pain. Positive expectations predict better outcomes for a variety of health conditions, including return to work from soft-tissue injury (including whiplash associated disorders. However, we know little about those with negative expectations who may be at risk for poor whiplash associated disorder outcomes.

The authors assessed expectations for return to work in a population-based cohort of 2335 individuals with traffic related whiplash associated disorder. They used logistic regression analysis to model factors associated with expecting to return to work (compared with not expecting to return to work or being unsure).

Depressive symptomatology, lower education, lower income, male sex, and greater initial pain (greater percentage of body in pain and greater intensity of neck pain) were associated with lower return to work expectation. A number of demographic, socioeconomic, and injury-related factors were associated with expectations for return to work in whiplash associated disorder. Two of the strongest associated factors were depressive symptomatology and postcollision initial neck pain intensity. These results support using a biopsychosocial approach to evaluate expectancies and their influence on important health outcomes.

This confirms an earlier study in J Rehabil Med. 2010 Jan;42(1):66-73. Factors associated with recovery expectations following vehicle collision: a population-based study. It was concluded, “A number of demographic, socioeconomic and injury-related factors were associated with expectations for recovery in whiplash associated disorders. Two of the strongest associated factors were depressive symptomatology and initial neck pain intensity. These results support using a biopsychosocial approach to evaluate expectancies and their influence on important health outcomes.” This study found depressive symptomatology, lower education, lower income, male gender, younger age, being a passenger in the vehicle, history of neck pain, and greater initial pain (greater percentage of body in pain, greater intensity of neck pain and presence of low back and/or headache pain) were associated with poor expectations for recovery.

June 10, 2010

Are coping and catastrophising independently related to disability and depression in patients with whiplash associated disorders?

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

Are coping and catastrophising independently related to disability and depression in patients with whiplash associated disorders?

From: Disabil Rehabil. 2010 Jun 7. [Epub ahead of print]

The aim is to study how pain coping strategies and catastrophising are related to disability and depression in patients with whiplash associated disorders. Specifically, the authors wanted to test if they are independent predictive variables, after controlling for pain severity, sociodemographic and crash-related variables.

A convenience sample of 147 patients with whiplash associated disorders of less than 3 months of duration was recruited. They were requested to complete the Pain Catastrophising Scale, the two-item version of the Chronic Pain Coping Inventory and to report sociodemographic and crash-related information, pain intensity, disability and depression.

Although several pain coping strategies were related with disability in univariate analyses, only asking for assistance was a marginally significant predictive variable in a multiple regression analysis after controlling for catastrophising. Catastrophising was a significant predictive variable after controlling for pain coping strategies. With depression as the outcome, resting and task persistence were the only pain coping strategies which were related in univariate analyses. However, none of them were predictive variables after controlling for catastrophising. Again, catastrophising was a significant predictive variable after controlling for pain coping strategies.

The results show that catastrophising about pain is more important than pain coping strategies in patients with whiplash associated disorders of a short duration. These results can contribute to the conceptual distinction between pain coping strategies and catastrophising.

Source: The Pain Catastrophizing Scale Development and Validation

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