An examination of coping styles and expectations for whiplash injury in Germany: comparison with Canadian data
From: Clin Rheumatol. 2011 Mar 30. [Epub ahead of print]
This study examined concurrent expectations and coping style for whiplash injury in injury naive subjects in Germany. Studies suggest the recovery rate from whiplash injury may be faster in Germany than in Canada. Canadians have a high expectation for chronic pain following whiplash injury and Germans do not. Expectation of recovery not only predicts recovery in whiplash victims but is also known to correlate with coping style.
The Vanderbilt Pain Management Inventory was administered to university students and staff in Germany. Subjects who had not yet experienced whiplash injury were given a vignette concerning a neck sprain (whiplash injury) in a motor vehicle collision and were asked to indicate how likely they were to have thoughts or behaviours indicated in the coping style questionnaire. Subjects also completed expectation questionnaires regarding whiplash injury. Sixteen percent of subjects held an expectation of chronic neck or back pain after whiplash injury. The mean active coping style score was 27.4 ± 3.6 (40 is the maximum score for active coping). The mean passive coping style score was 27.0 ± 6.3 (50 is the maximum score for passive coping).
Coping style scores and patterns were not different from those previously observed in Canadian studies, but there was no correlation between expectations and coping style among German subjects, a finding that differs from Canadian studies. Although expectations and coping styles may interact or be co-modifiers in the outcomes of whiplash injury in Canadian whiplash victims, in Germany, despite having similar coping styles to Canadians, the lack of expectation for chronic pain may be protective from the effect of passive coping styles. Further studies of coping style as an aetiologic factor in the chronic whiplash syndrome are needed.
Related Source: General Versus Specific Indicies In The Assessment Of Chronic Pain Coping
Are pre-season reports of neck pain, dizziness and/or headaches risk factors for concussion in male youth ice hockey players?
From: Br J Sports Med. 2011 Apr;45(4):319-20.
Concussion is a commonly encountered injury associated with potential long-term sequelae. No previous studies have evaluated dizziness, neck pain and headache as potential risk factors for concussion. The objective of this study is to determine the risk of concussion in male youth hockey players with preseason reports of neck pain, headaches and dizziness.
This study is a secondary data analysis of a prospective cohort study examining the risk of injury associated with body checking among paediatric ice hockey players. Setting Youth ice hockey in Alberta and Quebec, Canada. Participants A total of 3902 11-14 year old males from 282 teams participated. Assessment of risk factors Each participant completed a pre-season baseline demographic and injury history questionnaire. Preseason reports of neck pain, headache or dizziness were documented on the Sport Concussion Assessment Tool. Main outcome measurements Diagnosed concussions were recorded during the season of play via a previously validated, prospective injury surveillance system.
A total of 178 concussions occurred during the studies, with 11 players sustaining two concussions. Incidence rate ratios were calculated using Poisson regression, adjusted for exposure hours, cluster by team and potential covariates. Dizziness was not a significant predictor of concussion. Individuals reporting a headache or neck pain at the start of the season were 1.48 and 1.69 times more likely to suffer a concussion during the season than those not reporting these symptoms. Individuals reporting any two of dizziness, headache and neck pain were 1.99 times more likely to sustain a concussion.
Male youth athletes reporting headache or neck pain at baseline were at an increased risk of concussion during the season. From an injury prevention perspective, baseline testing may aid in identifying individuals at a higher risk for concussion.
The relative timing of trunk muscle activation is retained in response to unanticipated postural-perturbations during acute low back pain
From: Exp Brain Res. 2011 Mar 26. [Epub ahead of print]
The purpose of this study was to assess the activation of the erector spinae and external oblique in response to unanticipated, bi-directional postural perturbations before and after the induction of acute low back pain in healthy individuals. An experimental session consisted of a baseline, control, and an acute low back pain condition. For the control and acute low back pain condition, isotonic or hypertonic saline (HS), respectively, was injected into the right erector spinae muscle.
In each condition, participants stood on a moveable platform during which 32 randomized postural perturbations (8 repetitions of 4 perturbation types: 8 cm anterior slides, 8 cm posterior slides, 10° anterior tilts, and 10° posterior tilts) with varying inter-perturbation time intervals were performed over a period of 4-5 min. Bilateral surface electromyography (EMG) was recorded from the erector spinae and external oblique in addition to subjective pain records.
During the acute low back pain condition: (1) the onset time of the erector spinae and external oblique was delayed for the forward and backward sliding perturbations; (2) EMG amplitude was reduced bilaterally for all perturbations; (3) the order of activation and interval between the onset times of the erector spinae and external oblique were unaltered and (4) erector spinae, but not external oblique, activity was adjusted to account for the directional differences between the perturbations.
This study revealed that re-establishment of posture and balance was a result of the individuals’ ability to rapidly modulate erector spinae with respect to external oblique activity and that the bi-directional postural responses, although shifted in time and amplitude, retained temporal features in the presence of acute low back pain.
The effects of disc degeneration and muscle dysfunction on cervical spine stability from a biomechanical study
From: Proc Inst Mech Eng H. 2011 Feb;225(2):149-57
Disc degeneration and muscle dysfunction are common spinal degenerations in the elderly. This in vitro study was carried out to investigate the effects of these two degenerative changes on spinal stability. The stability of nine porcine cervical spines (C2-T1) with mechanically simulated cervical muscles (sternocleidomastoid, splenius capitis, semispinalis capitis) was tested before and after experiment-induced disc degeneration. The patterns of muscle recruitments included: no muscle recruitment, normal recruitment of sternocleidomastoid, splenius capitis, semispinalis capitis, and sternocleidomastoid, splenius capitis, semispinalis capitis muscle dysfunctions. The neutral zone and the range of motion in the sagittal plane were measured to determine spinal stability.
The results showed that the neutral zone and the range of motion of a degenerative spine were larger than those of an intact spine under no muscle recruitment, but not under muscle recruitments. For both intact and degenerative spines, the neutral zone and the range of motion were greatest under no muscle recruitment, followed by semispinalis capitis dysfunction, sternocleidomastoid dysfunction, and splenius capitis dysfunction, and smallest under normal muscle recruitment.
In conclusion, muscle recruitments stabilize both intact and degenerative cervical spines, while dysfunctional muscles do not maintain stability efficiently as normal muscles do. Thus, spinal stability is more significantly affected by muscle dysfunction than by disc degeneration. Muscle training is suggested for the elderly with spinal degeneration to improve stability.
Functional reorganization of cervical flexor activity because of induced muscle pain evaluated by muscle functional magnetic resonance imaging.
From: Man Ther. 2011 Mar 22. [Epub ahead of print]
Neck pain is a common and disabling health problem with up to 70% of individuals experiencing an episode in their lifetime. The prevalence of neck pain, and as a consequence the social burden of this problem, have been increasing during the past several years. Although all cervical muscles contribute to the support of the cervical spine, the deep cervical flexor muscles (longus colli and longus capitis) have particularly demonstrated changes in the morphology and neuromotor control in patients with painful neck pain disorders. Such changes include increased fatty infiltrates in the flexors of subjects with whiplash associated disorders as well as changes in the timing and activity levels of the flexors in neck pain patients.
The function of these muscles in healthy and clinical populations has mainly been investigated by use of a craniocervical flexion task, as this movement specifically targets the deep cervical flexors, with minimal activation of the superficial cervical flexor muscles such as the sternocleidomastoid muscles. Several studies have demonstrated that individuals with chronic neck pain exhibit increased activity in the sternocleidomastoid during the craniocervical flexion task which was assumed to be a compensation for reduced deep cervical flexor activation. Only Falla et al. (2004) has directly recorded a reduction in activity of the deep cervical flexors in neck pain patients by use of a nasopharyngeal electromyography (EMG) technique capable of reaching these deep-lying muscles. However, this technique is quite invasive, does not allow for the differentiation of signals between the longus colli and longus capitis muscles and is vulnerable to muscle cross-talk, which highlights the need for alternative techniques.
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A randomized controlled trial on the efficacy of intermittent cervical traction for patients with chronic neck pain.
From: Clin Rehabil. 2011 Mar 22. [Epub ahead of print]
To investigate the efficacy of intermittent cervical traction in the treatment of chronic neck pain over a 12-week follow-up, a randomized controlled trial in a hospital-based outpatient practice was done. Regarding the subjects: Seventy-nine patients with chronic neck pain.
Subjects were randomly assigned to either experimental group (n = 39, mean age = 50.5 ± 9.8) or control group (n = 40, mean age = 48.8 ± 9.1). Experimental group received intermittent cervical traction and control group received infrared irradiation alone; twice a week over a period of six weeks. Outcome measurements: The values of Chinese version of the Northwick Park Neck Pain Questionnaire, verbal numerical pain scale, and cervical active range of motion were measured at baseline, six-week and 12-week follow-up. No significant differences were found between the two groups in the Northwick Park Neck Pain Questionnaire, verbal numerical pain scale and cervical active range of motion.
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Intraindividual Variability in Daily Sleep and Pain Ratings Among Chronic Pain Patients: Bidirectional Association and the Role of Negative Mood
From: Clin J Pain. 2011 Mar 16. [Epub ahead of print]
Sleep disturbance is a common problem among chronic pain patients. Cross-sectional data from clinical populations and experimental studies have shown an association between sleep disturbance and pain. However, there has been little prospective research into the relationship between daily variability between sleep and pain among chronic pain patients.
In this study, twenty-two women with chronic pain (back pain, facial pain, fibromyalgia) completed a sleep diary and wore an actigraph for a 2-week period. Self-report measures of pain, mood, and sleep were also completed at baseline. Hierarchical linear modeling was used to examine intraindividual variability in sleep and pain ratings among these women. The impact of mood and baseline pain ratings was also examined as potential moderators.
Hierarchical linear modeling analyses supported a bidirectional relationship between sleep and pain, such that a night of poor sleep was followed by increased pain ratings the following day and a day of increased pain was followed by a night of poor sleep. Depression scores further influenced these relationships.
Prospective examination supported a bidirectional relationship between sleep and pain among a group of women with chronic pain. Depressive symptoms had a moderating impact on these relationships. These findings suggest that addressing sleep is important in the treatment of individuals with chronic pain.
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Determination of fibromyalgia syndrome after whiplash injuries: Methodologic issues
From: Pain. 2011 Mar 16. [Epub ahead of print]
Problems in diagnosing fibromyalgia syndrome among motor vehicle collision patients with whiplash include the following: the predominance of tender points in the neck and shoulder girdle region; the 3-month duration of widespread pain criterion; and, the stability of diagnosis.
The present study examined the prevalence of fibromyalgia syndrome in a cohort (N=326) patients with persistent neck pain 3 months after whiplash injury who were enrolled in a treatment program. Physical examinations were performed at baseline and at the end of treatment. Results indicated that whiplash patients had a greater proportion of neck and shoulder girdle tender points, relative to distal tender points. Compared with a matched cohort of treatment-seeking fibromyalgia syndrome patients, whiplash patients indicated less distal tender points (mean=7.3 tender points vs mean=5.6 tender points), but were equivalent on neck and shoulder girdle tender points (mean=9.0 tender points vs 9.2 tender points, NS). Baseline prevalence of fibromyalgia syndrome for the whiplash cohort based on ACR criteria was 14% (95% CI=10%-18%), adjusted tender points criterion discounting for neck and shoulder tenderness indicated a prevalence of fibromyalgia syndrome of 8% (95% CI=5%-11%).
Finally, 63% of patients meeting American College of Rheumatology fibromyalgia syndrome criteria at baseline did not meet this criterion at post-treatment (∼6-months after a motor vehicle collision). In conclusion, present criteria used in determining fibromyalgia syndrome may result in spuriously inflated rates of diagnosis among whiplash patients because of persistent localized tenderness after an motor vehicle collision.
Furthermore, the transient nature of fibromyalgia syndrome “symptoms” among whiplash patients should be taken into account before making a final diagnosis. The present criteria used in determining fibromyalgia may result in spuriously inflated rates of diagnosis among whiplash patients because of persistent localized tenderness after motor vehicle collisions.
Relationship Between Pressure Pain Thresholds and Pain Ratings in Patients With Whiplash-associated Disorders
From: Clin J Pain. 2011 Mar 16. [Epub ahead of print]
Increased sensitivity to pressure is commonly associated with painful musculoskeletal conditions, including whiplash associated disorders. Pressure pain thresholds close to the site of presumed tissue damage are thought to represent the degree of peripheral nociceptive sensitization. Pressure pain thresholds over healthy tissue, away from the site of injury, are a marker of central nervous system hyperexcitability. There is uncertainty, however, as to what extent does the sensitization of the nociceptive system, whether peripheral or central, contribute to the ongoing, habitual pain experienced by people with whiplash associated disorders.
One hundred patients with whiplash associated disorders were assessed within 4 weeks of their accident and followed after 3 months; 24-hour average neck pain score, pressure pain thresholds at the cervical spine and tibialis anterior, demographic factors, and psychological measures were collected.
Cervical pressure pain thresholds and neck pain score were significantly, but weakly correlated. There was no significant correlation between tibialis anterior pain pressure thresholds and pain score at any time point. Regression analyses indicated a strong influence of generalized psychological distress and fear avoidance on the relationship between pressure pain thresholds and pain report.
The competing explanations for these findings are that either pressure pain thresholds provide a poor marker of peripheral and central sensitivity or that these processes are only weakly related to the day-to-day pain experienced by patients with whiplash associated disorders. The latter explanation is supported by the confounding effect of psychological factors on pain score.
Pain-induced Changes in the Activity of the Cervical Extensor Muscles Evaluated by Muscle Functional Magnetic Resonance Imaging
From: Clin J Pain. 2011 Mar 16. [Epub ahead of print]
To investigate the effect of experimental neck muscle pain on the activation of the cervical extensor muscles during the performance of a cervical extension exercise by the use of muscle functional magnetic resonance imaging.
The activity of the multifidus, semispinalis cervicis, semispinalis capitis, and splenius capitis muscles was investigated bilaterally at 2 cervical levels (C2 to C3 and C7 to T1) in 15 healthy individuals. Measurements were taken at rest and after the performance of a cervical extension exercise without and with induced pain of the right upper trapezius (intramuscular injection of hypertonic saline).
In the pain condition, the activity of the multifidus/semispinalis cervicis was reduced bilaterally at the C7 to T1 level. For the semispinalis capitis, there were no significant differences between both conditions. The splenius capitis showed a significantly higher T2 shift at the left side at the C2 to C3 level and a lower T2 shift at the right side at the C7 to T1 level.
This is the first study that has shown pain to immediately affect the activity of both deep and superficial cervical extensor muscle layers during a cervical extension exercise. The findings support recommendations for evaluation of cervical extensor muscle function early in the management of painful cervical spine injuries.
