An investigation to determine the association between neck pain and upper limb disability for patients with non-specific neck pain: A secondary analysis.
From: Man Ther. 2011 Feb 21. [Epub ahead of print]
It is recognized that neck pain can result in symptoms being referred into the upper limbs. For example, in the presence of cervical radiculopathy, pain in the neck and upper limbs is frequently accompanied by specific sensory, motor and reflex changes, which may be identified by a neurological examination of the upper limb. Non-specific neck pain may also be associated with symptom referral into the upper limbs though the pattern of referral is often more diffuse and less readily investigated by neurological examination. A survey of UK patients with mechanical neck pain found that 67% presented with associated upper limb symptoms without neurological deficit. Referred symptoms to the arms or hands may be functionally limiting e.g. dropping things, may predict the progression of an associated neck disorder and can have a significant impact on overall health status. Clinically it is common that patients with non-specific neck pain report problems with upper limb function. High quality longitudinal cohort studies identify that co-existing shoulder disorders predicts the progression of neck pain to recurrent, persistent or disabling neck pain. In addition, the presence of more subtle upper limb disorders, e.g. upper limb weakness which is associated with neck problems, could also influence the progression or the management of neck disorders, though further investigation would be required to confirm this. Consequently it seems possible that the holistic management of neck pain would require adjustment to reflect the nature of any co-existing or associated upper limb disorder. Little is known about the extent to which patients with non-specific neck pain report problems with upper limb function. The aim of this study was to investigate the relationship between neck pain, neck disability and upper limb disability in a patient population with non-specific neck pain.
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Facet Joint and Disc Kinematics During Simulated Rear Crashes with Active Injury Prevention Systems
From: Spine (Phila Pa 1976). 2011 Feb 18. [Epub ahead of print]
This was an experimental and computational biomechanical analyses of simulated rear crashes. The objectives were to determine cervical facet joint and disc kinematics and ligament strains during simulated rear crashes with the Whiplash Protection System and active head restraint and to compare these data to those obtained with no head restraint.
Whiplash injuries of the neck, caused by relative acceleration between the head and thorax during motor vehicle collisions, produce acute and chronic neck pain, headache, dizziness, vertigo, and parasthesias in the upper extremities. MRI and autopsy studies have correlated chronic symptoms with injuries to the cervical discs, ligaments, and facet joints in whiplash patients. Previous clinical studies have targeted the cervical facet joint and capsule, including the capsular ligament, as sources of chronic pain in whiplash patients. These studies administered blockage of the facet joint afferents, including the capsular ligament nerves, in whiplash patients. Results demonstrated pain relief in up to 60% of the patients. Single or cumulative micro-trauma due to overstretching of capsular ligaments causing subfailure injuries and increased ligament laxity have been hypothesized to injure embedded ligament mechanoreceptors. The effect of injured ligament mechanoreceptors on spine stability has not been studied. However, in vivo animal models have demonstrated that stimulation of spinal ligaments initiated activity of spinal musculature. Corrupted signals from the injured mechanoreceptors may potentially elicit abnormal muscle response patterns causing excessive facet loading and capsular ligament strains, further increasing the capsular ligament laxity and injury and preventing or delaying ligament healing.
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A comparison of neck movement in the soft cervical collar and rigid cervical brace in healthy subjects
From: J Manipulative Physiol Ther. 2011 Feb;34(2):119-22.
The soft cervical collar has been prescribed for whiplash injury but has been shown to be clinically ineffective. As some authors report superior results for managing whiplash injury with a cervical brace, we were interested in comparing the mechanical effectiveness of the soft collar with a rigid cervical brace. Therefore, the purpose of this study was to measure ranges of motion in subjects without neck pain using a soft cervical collar and a rigid brace compared with no orthosis.
Fifty healthy subjects (no neck or shoulder pain) aged 22 to 67 years were recruited for this study. Neck movement was measured using a cervical range of motion goniometer. Active flexion, extension, right and left lateral flexion, and right and left rotation were assessed in each subject under 3 conditions: no collar, a soft collar, and a rigid cervical brace.
The soft collar and rigid brace reduced neck movement compared with no brace or collar, but the cervical brace was more effective at reducing motion. The soft collar reduced movement on average by 17.4%; and the cervical brace, by 62.9%. The effect of the orthoses was not affected by age, although older subjects had stiffer necks.
Based on the data of the 50 subjects presented in this study, the soft cervical collar did not adequately immobilize the cervical spine.
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Pain neurophysiology education improves cognitions, pain thresholds, and movement performance in people with chronic whiplash: A pilot study
From: J Rehabil Res Dev. 2011;48(1):43-58.
A whiplash trauma of the neck can result in bony or soft-tissue injuries that produce a large variety of clinical manifestations grouped under the term whiplash associated disorders. Using the Quebec Task Force on whiplash associated disorders (QTF-whiplash associated disorders) guidelines, whiplash associated disorders can be classified into five grades of severity: grade 0 = no neck symptoms or physical sign(s); grade I = neck pain, stiffness, or tenderness but no physical sign(s); grade II = neck symptoms and musculoskeletal sign(s) such as decreased range of motion and point tenderness; grade III = neck symptoms and neurologic sign(s); and grade IV = neck symptoms and fracture or dislocation. Between 10 and 42 percent of patients who sustain a whiplash injury develop chronic pain and approximately 10 percent of patients experience constant severe pain. The main pain complaints that persist 6 months after the accident are neck pain (10%-45%), headache (8%-30%), and pain in the shoulder and arm (5%-25%). Additional complaints by patients with chronic whiplash associated disorders are depression, fear, difficulty concentrating, fatigue, and irritability.
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Long-term functioning following whiplash injury: the role of social support and personality traits
From: Clin Rheumatol. 2011 Feb 16. [Epub ahead of print]
Transition from acute whiplash injury to either recovery or chronicity and the development of chronic whiplash associated disorders remains a challenging issue for researchers and clinicians. The roles of social support and personality traits in long-term functioning following whiplash have not been studied concomitantly.
The present study aimed to examine whether social support and personality traits are related to long-term functioning following whiplash. One hundred forty-three subjects, who had experienced a whiplash injury in a traffic accident 10-26 months before the study took place, participated. The initial diagnoses were a ‘sprain of the neck’ (ICD-9 code 847.0); only the outcome of grades I-III acute whiplash associated disorder was studied. Long-term functioning was considered within the biopsychosocial model: it was expressed in terms of disability, functional status, quality of life and psychological well-being. Participants filled out a set of questionnaires to measure the long-term functioning parameters (i.e. the Neck Disability Index, Medical Outcome Study Short-Form General Health Survey, Anamnestic Comparative Self-Assessment measure of overall well-being and the Symptom Checklist-90) and potential determinants of long-term functioning (the Dutch Personality Questionnaire and the Social Support List).
The results suggest that social support (especially the discrepancies dimension of social support) and personality traits (i.e. inadequacy, self-satisfaction and resentment) are related to long-term functioning following whiplash injury. Within the discrepancy dimension, everyday emotional support, emotional support during problems, appreciative support and informative support were identified as important correlates of long-term functioning. Future prospective studies are required to confirm the role of social support and personality traits in relation to long-term functioning following whiplash. For such studies, a broad view of long-term functioning within the biopsychological model should be applied.
Assessing Fear-Avoidance Beliefs in Patients With Whiplash-Associated Disorders: A Comparison of 2 Measures
From: Clin J Pain. 2011 Feb 11. [Epub ahead of print]
The fear avoidance model postulates that fear of pain or reinjury is a risk factor for persistent pain and disability, because it leads to avoidance of physical activity. To examine the development of fear avoidance behaviours following whiplash injury using two different measures of fear avoidance, the Pictorial Fear of Activities Scale-Cervical, and the Tampa Scale of Kinesiophobia. Secondarily we assessed the capacity of these measures to predict recovery status at long term follow up and initial cervical range of movement.
The Pictorial Fear of Activities Scale-Cervical consists of a set of photographs depicting movements in which 4 factors that determine biomechanical demands on the neck are systematically varied – Direction of Movement, Arm Position, Weight Bearing, and Extremity of Movement.
The etiology of persistent cervical pain following motor vehicle collisions is poorly understood. However, psychological factors have been shown to be important predictors of chronicity. Fear of activities that might cause increased pain or re-injury represents one such factor. The fear avoidance model postulates that cognitive responses (e.g., excessive negative thinking) following painful experiences lead to fear of movement. This fear of movement induces the person to avoid activities believed to aggravate the injury and cause additional pain. In the long run, however, it may reinforce “catastrophizing”, fear responses, and continued avoidance of movement and promote de-conditioning and disability.
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Tinnitus and its risk factors in the Beaver Dam Offspring Study
From: Int J Audiol. 2011 Feb 10. [Epub ahead of print]
To assess the prevalence of tinnitus along with factors potentially associated with having tinnitus. Data were from the Beaver Dam Offspring Study, an epidemiological cohort study of aging. After a personal interview and audiometric examination, 3267 participants were classified as having tinnitus if in the past year they reported having tinnitus of at least moderate severity or that caused difficulty in falling asleep.
The prevalence of tinnitus was 10.6%. In a multivariable logistic regression model adjusting for age and sex, the following factors were associated with having tinnitus: hearing impairment, currently having a loud job, history of head injury, depressive symptoms, history of ear infection, history of target shooting, arthritis, and use of NSAID medications. For women, ever drinking alcohol in the past year was associated with a decreased risk of having tinnitus.
These results suggest that tinnitus is a common symptom in this cohort and may be associated with some modifiable risk factors.
Management of neck pain in Royal Australian Air Force fast jet aircrew.
From: Mil Med. 2011 Jan;176(1):106-9.
Military aircrew who fly modern, high performance combat aircraft, commonly called fast jet aircrew routinely operate in altered lateral and gravitational force environment. Both acute neck pain and chronic neck pain are common complaints of fast jet aircrew, often resulting in lost workdays and reduced functional performance. The cause of neck pain in most cases is musculoskeletal injury. Spinal pathology, such as fractures of the cervical vertebrae, stenosis of the spinal canal, disc herniation and premature spinal degeneration have been attributed to exposure to altered gravitational force.
The underlying mechanism of neck pain in fast jet aircrew has been attributed to a combination of altered gravitational force environment, inadequacies of the human neck to tolerate these high loads and adopting head postures that can injure the neck during aerial combat maneuvers. Strategies including prefight stretching, in flight bracing and neck strengthening exercises have been suggested to possibly prevent neck pain in fast jet aircrew, few studies have evaluated the effectiveness of these preventative strategies on reducing the incidence and severity of flight related neck pain.
Little is known about the effective management and rehabilitation of neck pain in fast jet aircrew. Injury management and rehabilitative strategies are, however, well researched in other forms of neck pain and injury including chronic neck pain and whiplash like disorders. This study documents the strategies used by fast jet aircrew to manage and rehabilitate flight related neck pain.
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A randomised controlled trial of preventive spinal manipulation with and without a home exercise program for patients with chronic neck pain
From: BMC Musculoskelet Disord. 2011 Feb 8;12(1):41. [Epub ahead of print]
Non-specific neck pain is frequent, with an annual prevalence estimated to be 30% to 50%. Often persistent or recurrent, neck pain is still being reported by 50% to 85% of patients 1 to 5 years after initial onset. Its course is usually episodic, and improvement is of variable degrees between episodes, but complete recovery is unusual for most patients. Manual therapy (mobilisation or manipulation), exercise intervention, low level laser therapy and, to a lesser extent, acupuncture, are more effective than no treatment, sham, or alternative interventions to stop episodes of neck pain. None of these strategies is, however, superior to any other. Evidence also indicates that supervised exercises with or without manual therapy are better than usual or no care and that a multimodal care approach combining exercise with manual therapy seems to be beneficial for non-specific chronic neck pain. Based on care episodes of 6 to 8 weeks with various blends of non-invasive interventions, no particular course of care improves the prognosis or appreciably affects the natural history of neck disorder or its recurrence. Evidence for the effectiveness of neck pain prevention strategies is therefore lacking.
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Does cervical kyphosis relate to symptoms following whiplash injury?
From: Man Ther. 2011 Feb 2. [Epub ahead of print]
Abnormal postures have been investigated as a possible link offering an explanation for the development of long-lasting neck pain following whiplash injuries, but the loss of cervical lordosis – i.e. a straight column or a kyphosis – on MRI was not found to be associated with the prognosis. It has not, however, been investigated whether the presence of specifically a kyphotic deformity has any influence on the development of symptoms or non-recovery after whiplash injuries. This phenomenon was suggested to be of greater importance than loss of lordosis as early as in the 1970’s, and the notion that a kyphotic cervical posture is associated with more pain and other local problems – disregarding previous whiplash injury or not – as compared to a normal lordotic curvature is often heard among clinicians. Several explanatory models have been provided: the patient adopts a kyphotic posture of the neck in order to avoid pain due to certain disc ruptures; the kyphotic posture of the neck stabilizes the facet joint in the least painful and least compressed position; the dystonic neck muscles are responsible for the posture changes as described in the so-called post traumatic dystonia. These factors may co-exist and combine. A kyphotic posture could therefore be hypothesized to be a sign of tissue damage that may relate to a poor prognosis.
Patients seen at an emergency unit or by their general practitioner, who had developed symptoms from the neck-/shoulder region after rear-end or frontal car collisions, were potential participants. Patients with whiplash associated disorder grade 1–3 were included. Inclusion criteria were: Age 18–70 years, whiplash associated disorder related symptoms within 3 days after the motor vehicle accident and a maximum of 10 d from the motor vehicle accident to inclusion. Exclusion criteria were: Fractures or dislocations of the cervical spine disclosed by standard procedures at the emergency unit, retrograde and/or anterograde amnesia or unconsciousness in relation to the accident, injuries other than the whiplash injury, self reported average neck pain during the preceding 6 months exceeding 5 on a box scale from 0 to10, where 0 = no pain and 10 = worst imaginable pain, significant pre-existing somatic or psychiatric disease, and known alcohol- or drug abuse. Subjects were also excluded if they were unable to speak or read Danish.
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