Neck Solutions Blog

December 30, 2010

Driving with a chronic whiplash-associated disorder: a review of patients’ perspectives

Filed under: Neck Pain,Whiplash — Administrator @ 4:18 am

Driving with a chronic whiplash-associated disorder: a review of patients’ perspectives

From: Arch Phys Med Rehabil. 2011 Jan;92(1):106-10

The objective of this study was to document troublesome driving tasks and any changes in driving behavior reported by people with chronic whiplash associated disorders.

Outcome measures were Neck Disability Index, visual analog scale for neck pain at rest and while driving, exposure section of the Driving Habit Questionnaire, self-rating perceived current driving ability, semistructured interview about presenting symptoms, troublesome driving tasks, and perceived changes in driving behavior after a whiplash injury.

The results indicated subjects reported a decrease in driving ability (0, unable to drive; 10, driving at preinjury level). These subjects scored higher on the Neck Disability Index, experienced greater neck pain at rest and while driving, and reported decreased concentration more frequently than those who rated their driving ability at a preinjury level (ie, 10). The most frequently nominated troublesome driving tasks were checking blind spots, prolonged driving, and reversing/reverse parking, and the most frequently cited changes in driving behavior included more use of trunk rotation, altered steering wheel grip, more anxious/nervous while driving, and more cautious driving.

It was concluded that the chronic whiplash population appears to have unique troublesome driving tasks (eg, prolonged driving, checking blind spots) that are not readily detected in currently available driving ability/difficulty scales, suggesting that a new scale may be required for this population.

December 28, 2010

Head eye co-ordination and gaze stability in subjects with persistent whiplash associated disorders

Filed under: Neck Pain,Whiplash — Administrator @ 5:09 am

Head eye co-ordination and gaze stability in subjects with persistent whiplash associated disorders

From: Man Ther. 2010 Dec 22. [Epub ahead of print]

Symptoms of dizziness, unsteadiness and visual disturbances are frequent complaints in persons with persistent whiplash associated disorders. After pain, symptoms of dizziness, unsteadiness and visual disturbances are some of the most frequent complaints in individuals with persistent problems following a whiplash injury, with studies reporting an incidence of between 40 and 75%.

Visual disturbances demonstrated in subjects with persistent whiplash associated disorders are thought to reflect disturbances in these complex reflex and central connections between the eyes and the cervical afferents. Such disturbances include blurred vision, reduced visual field, photophobia and disordered fusion, reading and driving difficulties, disturbances in smooth pursuit eye movement with neck torsion, quick saccadic eye movements and the interaction between ocular stabilisation reflexes.

This study investigated eye, head co-ordination and gaze stability in subjects with persistent whiplash (n = 20) and asymptomatic controls (n = 20). Wireless motion sensors and electro-oculography were used to measure: head rotation during unconstrained head movement, head rotation during gaze stability and sequential head and eye movements. Ten control subjects participated in a repeatability study (two occasions one week apart). Between-day repeatability was acceptable for most measures.

(more…)

December 26, 2010

The prevalence of vitamin D deficiency in consecutive new patients seen over a 6-month period in general rheumatology clinics

Filed under: Arthritis,Chronic Pain,Disc Problems — Administrator @ 9:09 am

The prevalence of vitamin D deficiency in consecutive new patients seen over a 6-month period in general rheumatology clinics

Clin Rheumatol. 2010 Dec 24. [Epub ahead of print]

The objectives of this study are to assess: (a) the prevalence of vitamin D deficiency among new patients attending rheumatology outpatient departments, (b) the age profile of these low vitamin D patients and (c) whether any diagnostic category had a particularly high number of vitamin D-deficient patients. All new patients seen consecutively in general rheumatology clinics between January to June 2007 inclusive were eligible to partake in this study, and 231 out of 264 consented to do so.

Parathyroid hormone, 25-hydroxyvitamin D, creatinine, calcium, phosphate, albumin and alkaline phosphatase levels were measured. The authors defined vitamin D deficiency as ≤53 nmol/l and severe deficiency as ≤25 nmol/l. Overall, 70% of 231 patients had vitamin D deficiency, and 26% had severe deficiency. Sixty-five percent of patients aged ≥65 and 78% of patients aged ≤30 years had low vitamin D levels. Vitamin D deficiency in each diagnostic category was as follows: (a) inflammatory joint diseases and connective tissue diseases, 69%; (b) soft tissue rheumatism, 77%; (c) osteoarthritis, 62%; (d) non-specific musculoskeletal back pain, 75% and (e) osteoporosis, 71%. Seasonal variation of vitamin D levels was noted in all diagnostic groups apart from inflammatory joint diseases and connective tissue diseases group, where the degree of vitamin D deficiency persisted from late winter to peak summer.

Very high prevalence of vitamin D deficiency was noted in all diagnostic categories, and it was independent of age. The results suggest vitamin D deficiency as a possible modifiable risk factor in different rheumatologic conditions, and its role in inflammatory joint diseases and connective tissue diseases warrants further attention

December 24, 2010

Effectiveness of small daily amounts of progressive resistance training for frequent neck/shoulder pain: Randomised controlled trial

Filed under: Neck Pain,Shoulder Pain — Administrator @ 7:59 am

Effectiveness of small daily amounts of progressive resistance training for frequent neck/shoulder pain: Randomised controlled trial.

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

Regular physical exercise is a cornerstone in rehabilitation programs, but adherence to comprehensive exercise remains low. This study determined the effectiveness of small daily amounts of progressive resistance training for relieving neck/shoulder pain in healthy adults with frequent symptoms; 174 women and 24 men working at least 30h per week and with frequent neck/shoulder pain were randomly assigned to resistance training with elastic tubing for 2 or 12 minutes per day 5 times per week, or weekly information on general health (control group).

Primary outcomes were changes in intensity of neck/shoulder pain (scale 0 to 10), examiner-verified tenderness of the neck/shoulder muscles (total tenderness score of 0 to 32), and isometric muscle strength at 10weeks.

Compared with the control group, neck/shoulder pain and tenderness, respectively, decreased 1.4 points and 4.2 points in the 2-minute group and 1.9 points and 4.4 points in the 12-minute group. Compared with the control group, muscle strength increased 2.0 Nm to 3.5Nm, in the 2-minute group and 1.7Nm to 3.3 Nm, in the 12-minute group.

In conclusion, as little as 2 minutes of daily progressive resistance training for 10 weeks results in clinically relevant reductions of pain and tenderness in healthy adults with frequent neck/shoulder symptoms. In generally healthy adults with frequent neck/shoulder muscle pain, as little as 2minutes of daily progressive resistance training reduces pain and tenderness.

December 22, 2010

Qigong training and effects on stress, neck-shoulder pain and life quality in a computerised office environment

Filed under: Neck Pain,Shoulder Pain — Administrator @ 10:17 am

Qigong training and effects on stress, neck-shoulder pain and life quality in a computerised office environment.

Complement Ther Clin Pract. 2011 Feb;17(1):54-7. Epub 2010 Dec 3

Qigong is a Chinese health promoting exercise with a rhythmic pattern of slow movements and breathing affecting the autonomous nervous system. This study was to examine the implementation of Qigong for half an hour daily in a computerised office, and to study effects on health state, general health, neck-shoulder and lumbar spine symptoms and stress after six weeks training

A crossover intervention study with 37 employees randomised in two groups. A questionnaire was completed one week before starting study and every second week during the training period. After 6 weeks the first group stopped and the second group started the training.

There was a small significant improvement of neck pain and disability following therapy.
Qigong training may reduce neck disability in office workers. A longer training period might be needed in further Qigong studies in healthy, normal populations.

December 20, 2010

Risk factors of sciatic pain: A prospective study among middle-aged employees

Filed under: Back Pain,Neck Pain — Administrator @ 4:19 am

Risk factors of sciatic pain: A prospective study among middle-aged employees.

From: Eur J Pain. 2010 Dec 14. [Epub ahead of print]

To study the effects of occupational class, physical and psychosocial working conditions, health behaviours, and pain in the low back and the neck on sciatic pain among middle-aged employees.

The participants were municipal employees without previous sciatica, aged 40, 45, 50, 55, and 60years at baseline (n=5261, 80% women). Sciatica was defined as low back pain radiating to the calf or the foot. Data on occupational class, physical and psychosocial working conditions, body mass index, smoking, leisure-time physical activity, neck pain, local low back pain, and sciatica were obtained from baseline questionnaire surveys in 2000-2002. The question on sciatica was repeated in a follow-up survey in 2007. Logistic regression analysis was used.

In women, manual occupational class compared with managers/professionals), overweight, obesity, smoking, low leisure-time physical activity, previous acute and chronic local low back pain, and acute and chronic neck pain predicted the onset of sciatica in a multivariable model.
In men, semi-professionals and manual workers had an increased risk compared with managers/professionals; also acute and chronic local low back pain predicted sciatica.

Manual occupational class in both genders and semi-professional occupations in men, unhealthy behaviours and previous pain both in the neck and the lower back predicted sciatica, while physical and psychosocial working conditions had no independent effect.

December 17, 2010

Predictors of short-and long-term outcome in patients with chronic non-specific neck pain undergoing an exercise-based rehabilitation program

Filed under: Chronic Pain,Neck Pain — Administrator @ 10:09 am

Predictors of short-and long-term outcome in patients with chronic non-specific neck pain undergoing an exercise-based rehabilitation program: a prospective cohort study with 1-year follow-up

From: Intern Emerg Med. 2010 Dec 14. [Epub ahead of print]

The aim of this study was to describe the clinical course of patients with chronic, non-specific neck pain undergoing a public health covered, exercise-based rehabilitation program and to identify predictors of poor outcome. A prospective cohort study was carried out on patients with non-specific neck pain (6 months or longer), referred by their general practitioner to a 6-session program, including education and individually tailored exercise. The primary outcome measure for the course of neck pain was the Northwick neck pain questionnaire (NPQ) administered on baseline, discharge, and 1 year from discharge. Poor outcome was defined as NPQ score improving <30% (minimal clinically important difference-MCID-NPQ). The potential predictors included demographics, general health and psychological factors, neck pain history, and the clinical features described by NPQ. From January 2008 to June 2009, 212 patients were consecutively assessed for eligibility: 178 were enrolled and 162 completed follow-up (mean age = 65.3; 75% women). Baseline NPQ average score (40.7 + 17.1) improved by MCID on discharge (26.1 + 16.3) and at 1 year (28.5 + 17.3%). The poor outcome was reported by 45% patients on discharge and by 56% at follow-up. Pain-related medication intake independently predicted poor short and long-term outcome, and catastrophizing predicted poor outcome at 1 year. Our cohort of patients with chronic neck pain undergoing an exercise-based rehabilitation program reported improvement by or beyond MICD-NPQ in 55% cases on discharge and in 44% cases at 1 year. Poor outcome was predicted by pain-related medication intake in the short and long term, and by catastrophizing in the long term.

December 14, 2010

Reduction in disc and fiber stresses by axial distraction is higher in cervical disc with fibers oriented toward the vertical rather than horizontal plane: a finite element model analysis

Filed under: Disc Problems,Neck Pain — Administrator @ 4:38 pm

Reduction in disc and fiber stresses by axial distraction is higher in cervical disc with fibers oriented toward the vertical rather than horizontal plane: a finite element model analysis

From: J Manipulative Physiol Ther. 2010 May;33(4):252-60.

The purpose of this study was to quantify the biomechanical changes that occur in a compressed cervical disc with the application of axial distraction when the annular fiber orientation angles are varied between the horizontal and vertical planes.

A 3-dimensional finite element (FE) model of a cervical motion segment was developed. From this model, 3 FE models were developed and validated corresponding to 3 different fiber angles relative to the end plate-disk interface: +/-25 degrees (oriented toward the horizontal plane), +/-45 degrees (midway between the horizontal and vertical planes), and +/-65 degrees (oriented toward the vertical plane). Compression (50N), followed by an axial distraction (17N), was simulated. Annulus and nucleus stresses, von-Mises fiber stresses, annulus radial bulging, and nucleus radial displacement were computed. Hard tissue (cortical and cancellous bones and end plate) stresses were also quantified.

With increasing fiber angle (toward vertical), axial segmental stiffness increased, whereas annulus and nucleus stresses, fiber stresses, annulus radial bulging, and nucleus radial displacement decreased. Similar outcomes were observed when axial distraction was applied to the compressed segment. Hard tissues were not affected with varying fiber angles; however, their mechanics changed when axial distraction was applied on the compressed segment. We noted lower disc stress in axial distraction than in compression.

The results confirmed the hypothesis that fibers oriented toward the vertical plane reduce disc and fiber stresses and disc bulging. By aligning annular fibers toward the vertical plane axial distraction may help reduce disc and fiber stresses. Axial disc stresses decrease radially from outside to inside under compressive loading and that the anterior annulus is more stressed than the posterior-lateral annulus during both compression and distraction. Stresses decreased in both the annulus tissue matrix and fibers with increasing fiber angles and increasing fiber slope to 90 degrees (vertical fibers) is further anticipated to reduce the compressive disc stresses. The fibers in tension apply compression to the annulus tissue matrix, thus, decreasing annulus stresses in the axial and circumferential directions.

December 12, 2010

Clinical observation on improvement of motion range of cervical spine of patients with cervical spondylotic radiculopathy treated with rotation-traction manipulation and neck pain particles and cervical neck pain rehabilitation exercises

Filed under: Arthritis,Neck Pain — Administrator @ 6:02 am

Clinical observation on improvement of motion range of cervical spine of patients with cervical spondylotic radiculopathy treated with rotation-traction manipulation and neck pain particles and cervical neck pain rehabilitation exercises

From: Zhongguo Gu Shang. 2010 Oct;23(10):750-3.

The purpose of this article was to observe the effects of two different therapies on patients whose cervical function were restricted due to cervical spondylotic radiculopathy.

Form April 2008 to October 2009, 71 cases with cervical spondylotic radiculopathy were divided into group A (36 cases) and group B (35 cases). Among them, 22 cases were male and 49 cases were female, ranging in age form 45 to 65 years with an average of 52.27 years, course of disease was from 3 days to 5 years. The patients in group A were treated with rotation-traction manipulation, neck pain particles and cervical rehabilitation exercises; and the patients in group B were treated with cervical traction, Diclofenac sodium sustained release tablets and wearing neck collar. Theapeutic time was two weeks. The cervical anteflexion, extension, left and right lateral bending, left and right rotative activity were measured by helmet-style activities instrument before and after treatment (at the 1, 3, 5, 7, 9, 11, 13 days and 1 month after treatment respectively).

There were no difference between two groups in cervical activity in all directions before treatment. Compared with the beginning, cervical anteflexion and extension showed significant difference at the 5th day after treatment in group A. In group B, cervical anteflexion showed significant difference at the 13th day after treatment, but at the 1 month after treatment, the significant difference disappeared; cervical extension showed significant difference at the 7th day after treatment compared with the beginning. Compared with the beginning, left lateral bending showed significant difference at the 1st day after treatment in group A and at the 5th day after treatment in group B. Both in group A or B, right lateral bending, left and right rotative activity showed significant difference at the same time after treatment, either the 3rd day or the 5th day. Compared between groups, cervical anteflexion, left and right lateral bending, left and right rotative activity showed significant difference at the 1 month after treatment.

The rotation-traction manipulation and neck pain particles and cervical rehabilitation exercises in treating cervical spondylotic radiculopathy have quick effect to improve the activities of cervical anteflexion, extension, left lateral bending, and have durable effect to improve the activities of cervical spine in all directions.

December 7, 2010

Workers’ perspectives on low back pain recurrence: “It comes and goes and comes and goes, but it’s always there”

Filed under: Back Pain — Administrator @ 2:15 pm

Workers’ perspectives on low back pain recurrence: “It comes and goes and comes and goes, but it’s always there”

From: Pain. 2010 Nov 30. [Epub ahead of print]

Although various measures of low back pain recurrence have been proposed, none have been tested to determine if they are consistent with what those with low back pain perceive a “recurrence” to be. To further the understanding of low back pain recurrence and how to measure it, the authors examined how individuals with a history of low back pain describe their back pain experiences. A qualitative approach was chosen and six mixed-gender focus groups were conducted. Discussions were facilitated by two researchers and structured around predetermined questions. All four authors were involved in the data analysis and thematic congruence was achieved through an iterative process of coding and discussion. Participants included 31 individuals (14 female, 17 male), with ages ranging from early 20s to mid 70s.

When asked about low back pain recurrence, participants had difficulty understanding the concept. There was a sense that, although the pain may disappear, the condition was always there. Three states were defined: “normal,” “flared-up,” and “attack.” “Normal” could include experiencing pain, but generally represented a tolerable state. “Flared-up” was associated with increased pain, the use of strategies to overcome difficulties, and modified participation. “Attack” state was described as severely disabled: “I just have to lay there.”

Participants described their experiences in a way that is consistent with the idea that low back pain is a fluctuating and disabling health condition. Results cast doubt on the validity of currently available measures of low back pain recurrence. Focusing on recurrence of pain without consideration of broader contextual factors will result in an incomplete understanding of the meaning of the pain experience.

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