Craniocervical orientation affects muscle activation when exercising the cervical extensors in healthy subjects.
From: Arch Phys Med Rehabil. 2010 Sep;91(9):1418-22
A Cross-sectional study in a University laboratory to evaluate the activity of neck extensor muscles during different extension exercises with muscle functional magnetic resonance imaging.
Participants were healthy subjects (N=11; 7 men, mean age +/- SD, 34+/-5.6y; 4 women, mean age +/- SD, 23.3+/-5.2y; group mean age +/- SD, 30.1+/-7.5y).
Functional magnetic resonance imaging measures of T2 relaxation were made for the multifidus, the semispinalis cervicis, the semispinalis capitis, and the splenius capitis at C2-3, C5-6, and C7-T1 in response to 2 head/neck orientations: craniocervical neutral and craniocervical extension. Subjects performed three 1-minute repetitions of each condition at 20% maximum voluntary contraction.
RESULTS: Significant shifts were observed in all muscle groups at the C5-6 and C7-T1 levels after both conditions except the splenius capitis muscle at C5-6 with craniocervical neutral. T2 shifts in the semispinalis capitis were significantly greater in response to craniocervical extension than craniocervical neutral at C2-3 and C5-6. Similarly, craniocervical extension resulted in larger shifts than craniocervical neutral in the multifidus/semispinalis cervicis at C7-T1. No segmental differences were observed between exercises for splenius capitis.
The results of this study provide some preliminary insight into the impact of craniocervical orientation on the differential response of the deep and superficial cervical extensor muscles during the performance of cervical extensor exercises.
Managing pain in the workplace: a focus group study of challenges, strategies and what matters most to workers with low back pain.
From: Disabil Rehabil. 2010 Sep 23. [Epub ahead of print]
Most working adults with low back pain continue to work despite pain, but few studies have assessed self-management strategies in this at-work population. The purpose of this study was to identify workplace challenges and self-management strategies reported by workers remaining at work despite recurrent or persistent low back pain, to be used as a framework for the development of a workplace group intervention to prevent back disability.
Workers with low back pain (n = 38) participated in five focus groups, and audio recordings of sessions were analysed to assemble lists of common challenges and coping strategies. A separate analysis provided a general categorisation of major themes.
Workplace pain challenges fell within four domains: activity interference, negative self-perceptions, interpersonal challenges and inflexibility of work. Self-management strategies consisted of modifying work activities and routines, reducing pain symptoms, using cognitive strategies and communicating pain effectively. Theme extraction identified six predominant themes: knowing your work setting, talking about pain, being prepared for a bad day, thoughts and emotions, keeping moving and finding leeway.
To retain workers with low back pain, this qualitative investigation suggests future intervention efforts should focus on worker communication and cognitions related to pain, pacing of work and employer efforts to provide leeway for altered job routines.
Neck motion patterns in whiplash-associated disorders: Quantifying variability and spontaneity of movement
From: Clin Biomech (Bristol, Avon). 2010 Sep 20. [Epub ahead of print]
Whiplash-associated disorders have usually been explored by analyzing changes in the cervical motor system function by means of static variables such as the range of motion, whereas other behavioural features such as speed, variability or smoothness of movement have aroused less interest.
Whiplash patients (n=30), control subjects (n=29) and a group of people faking the symptoms of whiplash-associated-disorders (Simulators, n=30) performed a cyclical flexion-extension movement. This movement was recorded by means of video-photogrammetry. The computed variables were: range of motion, maxima angular velocity and acceleration, and two additional variables that quantify the repeatability of a motion and its spontaneity. Two comparisons were made: Control vs. Whiplash Patients and Whiplash Patients vs. Simulators. At each comparison we used ANOVA to detect differences between groups and discriminant analysis to evaluate the ability of these variables to classify individuals.
Comparison between Controls and Whiplash Patients showed significant reductions in the range of motion, and both the maximum of angular velocity and acceleration in the Whiplash Patients. The most efficient discriminant model only included the range of motion and maximum angular velocity. Comparison between Whiplash Patients and Simulators showed a significant reduction in all measured variables in the Simulators. The best classification model was obtained with maximum angular velocity, spontaneity and repeatability of motion.
The results suggest that the pathological patterns differ from those of Controls in amplitude and speed of motion, but not in repeatability or spontaneity of movement. These variables are especially useful for detecting abnormal movement patterns.
Diagnosis and management of degenerative neck pain.
From: Br J Hosp Med (Lond). 2010 Sep;71(9):M137-41.
Neck pain is a common presenting complaint, but the precise patho-aetiology is often unclear. Broadly speaking, the cause of neck pain can be considered as degenerative or non-degenerative. While detailing the important non-degenerative causes the clinician should not miss, this article reviews the diagnosis and management of the common degenerative orthopaedic causes of neck pain. Spondylosis refers to the age-related degenerative changes within the spinal column involving bone and soft tissue structures. It is analogous to osteoarthritis except that it relates to the degenerative changes within intervertebral discs rather than at synovial joints and is very common, frequently presenting late with subtle clinical symptoms and signs. The posterior facet joints do develop osteoarthritis with age, as these are synovial joints, but for practical purposes, both of these conditions can be treated as degenerative joint disease.
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A Twelve-Item Symptom Intensity Rating Scale for Cervical Spine Dysfunction.
From: Spine (Phila Pa 1976). 2010 Sep 15. [Epub ahead of print]
To evaluate the internal consistency, construct validity, and test-retest reliability of the Symptom Intensity Rating Scale in a clinical sample of people with cervical spine dysfunction. The Symptom Intensity Rating Scale was developed by experienced clinicians at the Melbourne Whiplash Centre as an assessment tool and outcome measure for people with cervical spine dysfunction. The 12-item scale rates the severity of neck, shoulder, shoulder blade and arm pain, neck and arm weakness, headaches dizziness nausea neck stiffness, pins and needles, and numbness.
Internal consistency was explored by item-item and corrected item-total correlations, Cronbach alpha, and Principle Components analysis. Construct validity was examined by correlation of Symptom Intensity Rating Scale scores with Neck Disability Index scores, and with cervical range of motion. Test-retest reliability was determined by examining a subset of patients with Neck Disability Index scores that changed by less than 10% points.
A dataset of 397 cases was analyzed. Principle Components Analysis identified 2 correlated subscales. Symptom Intensity Rating Scale total scores were correlated with Neck Disability Index scores at initial and final assessment. Correlations between initial Symptom Intensity Rating Scale scores and cervical range of motion were absent or weak, and correlations between final Symptom Intensity Rating Scale and cervical range of motion were stronger. Test-retest reliability Intraclass Correlation Coefficient of the Symptom Intensity Rating Scale for a subset of 65 cases with unchanged Neck Disability Index scores was 0.858. The standard error of measurement was 8 points and the Minimum Detectable Change (90% confidence) 18.7 points.
The Symptom Intensity Rating Scale is a sufficiently reliable, internally consistent scale that can be used to make valid inferences about symptom severity in ambulatory patients with cervical spine dysfunction.
The Development of Sensory Hypoesthesia After Whiplash Injury.
From: Clin J Pain. 2010 Sep 8. [Epub ahead of print]
The objectives of this study were (1) to investigate the development of hypoesthesia from soon after the whiplash injury to 6 months postinjury and (2) to determine differences in detection thresholds between those with initial features of poor recovery and those without these signs.
Fifty-two participants with acute whiplash associated disorders (<1 mo) were classified as either "high-risk" (n=17; Neck Disability Index >30; sensory hypersensitivity) or “low risk” (n=35; without these signs). Detection thresholds to electrical, thermal, and vibration stimuli and psychological distress were prospectively measured within 1 month of injury and then 3 and 6 months postinjury. Detection thresholds were also measured in the 38 controls.
Both whiplash associated disorders groups showed hypoesthesia (vibration, electrical, and cold) at 1 month postinjury. Vibration and electrocutaneous hypoesthesia persisted to 3 and 6 months only in the high-risk whiplash associated disorders group. Heat detection thresholds were not different between the groups at 1 month postinjury but were elevated in the high-risk group at 3 and 6 months. Both whiplash associated disorders groups were distressed at 1 month but this decreased by 3 months in the low-risk group. The differences in the Impact of Event Scale did not impact on any of the sensory measures.
Sensory hypoesthesia is a feature of acute whiplash associated disorders but persists only in those at higher risk of poor recovery. These findings suggest the involvement of the central inhibitory mechanisms that may be sustained by ongoing nociception.
Neck Pain in Hong Kong: A Telephone Survey on Consequences and Health Service Utilization.
From: Spine (Phila Pa 1976). 2010 Sep 9. [Epub ahead of print]
A regionally representative telephone survey using a 2-stage randomization process was performed to investigate the prevalence and consequence of neck pain in terms of disability and rate of absenteeism from work and to describe the health services utilization pattern of neck pain subjects and to analyse the factors associated with neck pain and health services utilization pattern.
There has been a lack of reliable information on the health service utilization pattern of neck pain subjects, the consequences and the patient perceived effectiveness of neck pain management in Hong Kong and Asian countries. A total of 4640 subjects were interviewed. The 12-month prevalence was 64.6%. About 38.0% of these patients suffered from moderate to severe pain. Moreover, 17.7% of these subjects had to limit their social activities and 19% had to limit their work.
About 25% of those subjects had consulted medical or health practitioners. Medical consultation is the majority and physiotherapy came second. Self-massage was the most preferred (83.3%) mode of self-care. Physiotherapy was regarded as the most effective health service, with 60% of the respondents’ neck pain completely removed. Although most people chose self-massage to be the most effective self-care treatment, only one-third (30.2%) of them had their neck pain improved by less than a half.
Neck pain is highly prevalent with an increasing impact in Hong Kong. More than one-third of neck pain patients suffered from moderate to severe pain and around 20% of them had to limit their work. About 25% of neck pain patient have consulted medical or health professionals. Physiotherapy and private medical clinic were the 2 service providers with high percentage of perceived complete improvement. There was a general trend that more neck pain patients used complementary therapies.
The influence of occupational and non-occupational factors on the prevalence of musculoskeletal complaints in users of portable computers
From: Int J Occup Saf Ergon. 2010;16(3):337-43.
Portable computers are becoming an increasingly common main work tool; however, they are not properly adapted to the workstation. Musculoskeletal complaints are a very frequent complaint reported by workers who use computers in their work.
The aim of the study was to assess the prevalence and intensity of pain in the musculoskeletal system in workers who regularly use a portable computer in their work and to determine the influence of working conditions and duration of work with a portable computer.
The study covered 300 workers. Musculoskeletal complaints were assessed with the Nordic musculoskeletal questionnaire complemented with a visual analogue scale. Working conditions was assessed with a questionnaire developed as part of the study.
The most prevalent faults in the organization of workstations were lack of a computer desk with an adjustable keyboard tray/drawer, no adjustment of chair armrests and no possibility to use an additional keyboard. The most frequent complaints among computer operators were headaches, low-back pain and neck pain. The use of an additional keyboard reduced the intensity of shoulder pain.
The effectiveness of thoracic manipulation on patients with chronic mechanical neck pain – A randomized controlled trial
From: Man Ther. 2010 Aug 31. [Epub ahead of print]
Neck pain is a common musculoskeletal disorder in the general population. In Saskatchewan, Canada, Cote et al. reported that the age-standardized lifetime prevalence of neck pain was 66.7%. In a telephone survey performed in Hong Kong, Chiu and Leung reported that the lifetime prevalence of neck pain was 65.4% and the 12-month prevalence was 53.6% (41.0% in male, 59.0% in female). Neck pain is costly in terms of treatment, individual suffering, and time lost to work absentee.
Growing evidence has confirmed that the use of manipulation with exercise or the use of mobilization with exercise in treating neck pain has better clinical outcomes than other major and common modalities.
Owing to the intrinsic biomechanical linkage with the cervical spine, disturbances in the biomechanics of the thoracic spine could be a primary contributor to neck pain. Flynn et al. reported that with the use of thoracic manipulation, there was immediate improvement in neck pain. However the lack of comparative group in this trial renders the cause-and-effect relationship inconclusive. Many clinicians have intuitively adopted the use of thoracic manipulation to treat neck pain patients, although there is a lack of scientific evidence. Cleland et al. reported that thoracic spine is the area that is most often manipulated.
There are studies investigating the effect of thoracic manipulation in treating acute and subacute mechanical neck pain, but to date, no studies have investigated the effect in patients with chronic neck pain. In a randomized controlled trial, Cleland et al. demonstrated an immediate analgesic effect in patients with mechanical neck pain. However the study was limited to a short-term follow-up and the effects on disability and physical impairments e.g. cervical range of motion was not evaluated.
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Intervertebral disc degeneration: new insights based on “skipped” level disc pathology
From: Arthritis Rheum. 2010 Aug;62(8):2392-400
Typically, age and abnormal physical loading (“wear and tear”) have been associated with the development of intervertebral disc degeneration. In the past decade, various additional etiologic factors for disc degeneration have been sporadically reported in the literature; however, many investigators continue to place tremendous emphasis on the effects of age and biomechanics associated with disc degeneration. The aim of this study was to provide additional insight into the notion that age and biomechanics are key factors in the development of disc degeneration. To this end, we addressed the prevalence of and risk factors associated with a unique pattern of disc degeneration of the lumbar spine, “skipped” level (nonconsecutive) disc degeneration.
As part of a large genetics-based study in southern Chinese individuals (n = 1,989), a cross-sectional analysis was performed in subjects exhibiting disc degeneration in > or = 2 levels (n = 838) who were then categorized as having skipped level disc degeneration (n = 174) or non-skipped level disc degeneration (contiguous, multilevel; n = 664). Various radiographic parameters were assessed based on T2-weighted magnetic resonance imaging (MRI). Subject demographics were assessed, and univariate and multivariate logistic regression analyses were performed.
Overall, 8.7% of the whole population (n = 1,989) had skipped level disc degeneration, while it was present in 20.8% of subjects with multilevel disc degeneration (n = 838). Skipped level disc degeneration was more prevalent in male subjects. Skipped level disc degeneration was significantly associated with the presence of Schmorl’s nodes, which also presented in levels with no disc degeneration. A history of disc bulge/extrusion and/or a history of back injury was significantly associated with non-skipped level disc degeneration, and a greater degree of overall severity of disc degeneration was also associated with non-skipped level disc degeneration. Other demographic and MRI findings did not significantly differ between groups.
This report is the first to describe the prevalence and risk factors associated with skipped level disc degeneration. The study challenges the paradigm that age and biomechanics are the key factors associated with the development of disc degeneration. Although age and biomechanical factors may play a role in the manifestation of disc degeneration, the novel findings of skipped level disc degeneration patterns provide further awareness of and support for the notion that additional etiologic factors may play a role in the development of disc degeneration. Such factors warrant further investigation to shed light on the cause of disc degeneration.
