Neck Solutions Blog

April 29, 2011

Effects of postural and visual stressors on myofascial trigger point development and motor unit rotation during computer work

Filed under: Neck Pain,Posture — Administrator @ 2:00 pm

Effects of postural and visual stressors on myofascial trigger point development and motor unit rotation during computer work

From: J Electromyogr Kinesiol. 2011 Feb;21(1):41-8. Epub 2010 Jun 26

The nature of modern work is changing and physically demanding jobs are now being replaced with many more service oriented jobs that require work at low levels of physical loading. More specifically, computer work at visual display terminals is becoming much more prominent in the workplace and at home. According to the Bureau of Labor Statistics (BLS), 77 million Americans use a computer at work. This represents over half of the total employed American public. In addition, with continual technological advances, future work trends indicate that this type of work is expected to represent an even greater percentage of jobs in the future.

Despite this shift, musculoskeletal complaint rates continue to be high among computer users. Studies have reported musculoskeletal disorder prevalence rates of 20% to over 75% among these types of workers. However, our understanding of the causal mechanisms leading to such high prevalence rates among computer users is lacking.

It is known that the physical demands for computer work are much different than those required during typical manufacturing and industrial tasks. Computer tasks typically require much lower levels of physical force and more mental processing than industrial work. In terms of physical demand, computer work imposes low-level static exertions on the musculoskeletal system. An important aspect of these types of exertions is that the muscle is rarely (if ever) able to relax completely; therefore, the duration of sustained contraction is thought to be a critical component for musculoskeletal disorder risk. Originally, it was thought that these low-level static exertions could be maintained for an unlimited amount of time. However, experience and research may contradict this belief.

There is growing concern that low-level static exertions (at any level) pose risk to workers, but there is no consensus as to ‘‘how much” force can be maintained for ‘‘how long”. This lack of consensus is believed to be due to the poor understanding of the underlying mechanisms through which the health effects occur.

In addition to physical demand, computer work also imposes high mental demands on users. Visual information must be processed, interpreted, and reacted to in a very short period of time, resulting in high cognitive demands on workers. Visual parameters such as glare, lighting, screen resolution, or text legibility may directly impact cognitive demands during computer work. However, it is not clear how these visual and mental demands might impact the musculoskeletal system, and translate into physical symptoms. Studies have shown that increased mental demand may result in greater muscle co-contraction and sustained muscle activation. However, such results do not fully explain the casual pathway for pain and discomfort during computer work.

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April 28, 2011

Using a psychosocial subgroup assignment to predict sickness absence in a working population with neck and back pain

Filed under: Back Pain,Chronic Pain,Neck Pain — Administrator @ 3:39 am

Using a psychosocial subgroup assignment to predict sickness absence in a working population with neck and back pain.

From: BMC Musculoskelet Disord. 2011 Apr 26;12(1):81. [Epub ahead of print]

Neck and low back pain is a common cause of long term sickness absence as well as exclusion from the labor market, both in Sweden and internationally. In Sweden alone, the cost of neck and low back pain has been estimated to 1.3% of GNP. Thus, the prevention of chronicity has become important, in order to reduce costs and to lessen the suffering for individuals with neck pain and low back pain. It has been suggested that early preventive interventions may reduce future problems as well as selection criteria are of outmost importance for the outcome.

Psychological factors have long been associated with chronic pain and they also seem to exacerbate the clinical component of pain. In fact, psychosocial factors have shown not only to be pivotal in the transition from acute and subacute neck pain and low back pain to chronicity but also have a strong influence on the onset of pain. Furthermore, coping or elements of coping have been shown to be a strong to moderate predictor for future low back pain.

Attempts have been made to classify patients into subgroups to better understand which subtypes of patients would benefit from what particular treatment. The Multidimensional Pain Inventory was originally developed for chronic pain patients and is widely used to derive subgroups of patients. Three different subgroups derived empirically from the Multidimensional Pain Inventory have been labeled: dysfunctional, interpersonally distressed and adaptive copers. The dysfunctional subgroup are characterized by high pain severity, disability and affective distress, and interpersonally distressed individuals are characterized by low levels of social support, while the adaptive copers subgroup report a more successful adjustment to chronic pain.

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April 27, 2011

Catechol O-methyltransferase haplotype predicts immediate musculoskeletal neck pain and psychological symptoms after motor vehicle collision

Filed under: Chronic Pain,Neck Pain,TMJ Pain,Whiplash — Administrator @ 3:29 am

Catechol O-methyltransferase haplotype predicts immediate musculoskeletal neck pain and psychological symptoms after motor vehicle collision.

From: J Pain. 2011 Jan;12(1):101-7.

Pain sensitivity varies substantially among humans. A significant part of the human population develops chronic pain conditions that are characterized by heightened pain sensitivity. The association of COMT polymorphism with human pain perception and persistent pain conditions is of considerable importance. One of the genes in which variability is believed to contribute to differences in pain sensitivity and response to analgesics is the catechol-O-methyltransferase (COMT) gene. The COMT enzyme metabolises catecholamines such as dopamine, noradrenaline and adrenaline. Genetic variation contributes to differences in pain sensitivity and response to different analgesics. Catecholamines are involved in the modulation of pain and are partly metabolized by the catechol-O-methyltransferase (COMT) enzyme. It is shown that a polymorphism in the COMT gene, influence pain sensitivity in human experimental pain and the efficacy for morphine in cancer pain treatment.

A pathological pain condition that appears to be associated with COMT activity is myogenous temporomandibular joint disorder. This condition is characterized by persistent facial pain, impaired oral function and heightened sensitivity to pain-evoking stimuli (e.g. mechanical, thermal and ischemic) at numerous body sites. Myogenous temporomandibular joint disorder impacts 5–15% of the adult population and incurs billions of dollars in health care costs. In 1976, Marbach and Levitt reported that patients with facial pain conditions comparable to myogenous temporomandibular joint disorder show increased urinary levels of catecholamine metabolites and express diminished erythrocytic COMT activity, suggesting a role for COMT in this persistent pain condition. There is a relationship between COMT polymorphism, pain sensitivity and the risk of TMD development.

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April 26, 2011

Exercise therapy for office workers with nonspecific neck pain: a systematic review.

Filed under: Neck Pain — Administrator @ 3:09 am

Exercise therapy for office workers with nonspecific neck pain: a systematic review.

From: J Manipulative Physiol Ther. 2011 Jan;34(1):62-71.

Normal neck function underpins successful performance of activities of daily living. In the general population, neck pain and dysfunction are common, affecting up to 67% of the general population at some time during their life.

Neck pain may arise from any of the innervated structures in the neck, such as intervertebral discs, muscles, ligaments, zygapophyseal joints, dura or nerve roots. However in the majority of cases, the pathophysiological mechanisms underlying neck pain are unclear. Such “nonspecific” neck problems are costly in terms of disability and work loss. Estimates indicate that the economic consequences of treating disabling chronic neck pain are significant.

Physical risk factors (such as prolonged sitting and neck flexion) have been identified as predictive of neck pain in the study of a mixed population of workers from various industry, health and professional settings.

We know that sitting at work for more than 95% of the working time seems to be a risk factor for neck pain and there is a trend for a positive relation between neck flexion and neck pain. There is an increased risk of neck pain
for people who are working with the neck flexed more than 20° for a major part of their working day. A low endurance time of the neck muscles seems to play an important part in the development of neck pain due to neck flexion at work.

Exercise interventions are deemed essential for the effective management of patients with neck pain. Patients with chronic neck pain demonstrate reduced motion and altered patterns of muscle control in the cervical flexor and upper trapezius muscles during specific tasks.

The purpose of this study in JMPT was to evaluate the effectiveness of various types of exercise for prevention and cure of nonspecific neck pain in office workers.

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April 24, 2011

What are the reliable radiological indicators of lumbar segmental instability?

Filed under: Back Pain,Disc Problems — Administrator @ 7:56 am

What are the reliable radiological indicators of lumbar segmental instability?

From: J Bone Joint Surg Br. 2011 May;93-B(5):650-657.

Intervertebral instability of the lumbar spine is thought to be a possible pathomechanical mechanism underlying low back pain and sciatica and is often an important factor in determining surgical indication for spinal fusion and decompression.

The spine is made up of segments, described as “motion segments,” consisting of two vertebrae and the interconnecting soft tissue. Spinal stability is defined as the ability for the vertebrae to maintain their relationship and limit their relative displacements during physiologic postures and loads. The requirement of stability is essential to the spinal column to prevent premature mechanical and biologic deterioration of its components. It is also fundamental to protect the spinal cord and nerve roots and to minimize energy expenditure.

One important mechanical function of the lumbar spine is to support the upper body by transmitting compressive and shearing forces to the lower body during the performance of everyday activities. To enable the successful transmission of these forces, mechanical stability of the spinal system must be
ensured.

Stability of the lumbar spine as a whole is maintained by the cooperation of discs, joints, ligaments, and muscles. Degenerative processes in the disc and facet joints affect the stability of the motion segment.

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April 23, 2011

Changed activation, oxygenation, and pain response of chronically painful muscles to repetitive work after training interventions: a randomized controlled trial

Filed under: Neck Pain,Shoulder Pain — Administrator @ 5:58 am

Changed activation, oxygenation, and pain response of chronically painful muscles to repetitive work after training interventions: a randomized controlled trial.

From: Eur J Appl Physiol. 2011 Apr 22. [Epub ahead of print]

Trapezius myalgia – chronic pain from the upper trapezius muscle – is the most
frequent type of neck pain among office workers. Myalgia localized to the neck and shoulder in women is a growing problem both in the general population and in the industrial world. The prevailing view is that sustained low-level activity of the upper trapezius muscle day after day leads to overload of muscle fibers of low-threshold motor units, and eventually pain develops. As a consequence, maximal muscle strength and neural activation may be impaired.

The main criteria for a positive clinical diagnosis of trapezius myalgia are
1) pain in the neck area
2) tightness of the trapezius muscle,
3) palpable tenderness of the trapezius muscle.

Having trapezius myalgia was associated with decreased strength capacity and
lowered activity of the painful trapezius muscle.

The aim of this randomized controlled trial was to assess changes in myalgic trapezius activation, muscle oxygenation, and pain intensity during repetitive and stressful work tasks in response to 10 weeks of training. In total, 39 women with a clinical diagnosis of trapezius myalgia were randomly assigned to: (1) general fitness training performed as leg-bicycling; (2) specific strength training of the neck and shoulder muscles or (3) reference intervention without physical exercise. Electromyographic activity (EMG), tissue oxygenation (near infrared spectroscopy), and pain intensity were measured in trapezius during pegboard and stress tasks before and after the intervention period.

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April 22, 2011

A Medical-Ergonomic Program for Symptomatic Keyboard/Mouse Users

Filed under: Neck Pain,Posture,Shoulder Pain — Administrator @ 4:21 am

A Medical-Ergonomic Program for Symptomatic Keyboard/Mouse Users.

From: J Occup Environ Med. 2011 Apr 19. [Epub ahead of print]

To describe the range of ergonomic stressors and effective interventions in otherwise healthy patients diagnosed with upper extremity disorders associated with occupational keyboard/mouse use. Work-related musculoskeletal disorders are widespread among computer users and costly to the health care system. Workstation setup and worker postures contribute to upper-extremity and neck symptoms among computer users. Ergonomic interventions such as work risk analysis and workstation modifications can improve workers’ symptoms

From patients treated in their Medical Ergonomic Program, they report demographic data, symptoms, signs, diagnoses and associated ergonomic stressors and response to medical/ergonomic interventions.

Fifty-six patients had a mean age (range) of 40 (23-61) years with 20 patients younger than 35 years. The most prevalent diagnoses were myofascial pain syndrome of shoulder and neck associated with poor posture, myofascial pain syndrome of forearm extensors followed by thoracic outlet syndrome and carpal tunnel syndrome. Common ergonomic stressors were typing/mousing technique, keyboard height, inadequate seating, and lack of breaks. Improvement occurred in 89% following medical/ergonomic intervention.

Ergonomic education/intervention must be combined with the medical treatment of work-related upper extremity disorders associated with keyboard/mouse use. This lends credence to the importance of examining the work habits and work-related postures of a patient who complains of upper-extremity and neck pain that is exacerbated by work. Providing an ergonomic intervention in concert with traditional physical therapy may be the most beneficial course of treatment.

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April 20, 2011

Changes of bioelectrical activity in cervical paraspinal muscle during gait in low and high heel shoes

Filed under: Neck Pain,Posture — Administrator @ 4:04 am

Changes of bioelectrical activity in cervical paraspinal muscle during gait in low and high heel shoes

From: Acta Bioeng Biomech. 2011;13(1):27-33

High heel footwear may be destructive for the spine because of an increased erector spinae muscle bioelectrical activity and increased ground reaction forces affecting lower limbs and the spine. The aim of this study was to evaluate the changes of bioelectrical activity in cervical paraspinal muscle during gait in low and in high heel shoes in different age groups. In 31 women aged 20-25 years and in 15 women aged 45-55 years without neck pain, the bioelectrical activity of the cervical paraspinal muscle was assessed during gait on flat surface with natural speed in three conditions: without shoes, in low (4 cm) and in high (10 cm) heel shoes. Higher bioelectrical activity cervical paraspinal muscle was noted during gait in high heel shoes in comparison to gait without shoes. The changes were more pronounced in the group of subjects aged 45-55 years. The prolonged wearing of shoes with stiletto type heels by individuals without neck pain is not safe for their spine and may lead to chronic paraspinal muscle fatigue.

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April 19, 2011

The effectiveness of participatory ergonomics to prevent low-back and neck pain – results of a cluster randomized controlled trial

Filed under: Back Pain,Neck Pain,Posture — Administrator @ 3:26 am

The effectiveness of participatory ergonomics to prevent low-back and neck pain – results of a cluster randomized controlled trial

From: Scand J Work Environ Health. 2011 Apr 15. pii: 3163. doi: 10.5271/sjweh.3163. [Epub ahead of print]

The aim of this randomized controlled trial (RCT) was to investigate the effectiveness of the Stay@Work participatory ergonomics program to prevent low back and neck pain.

A total of 37 departments were randomly allocated to either the intervention (participatory ergonomics ) or control group (no participatory ergonomics). During a six-hour meeting, working groups followed the participatory ergonomics steps and composed and prioritized ergonomic measures aimed at preventing low back and neck pain. Subsequently, working groups were requested to implement the ergonomic measures in the departments. The primary outcomes were low back and neck pain prevalence and secondary outcomes were pain intensity and duration. Data were collected by questionnaires at baseline, and after 3-, 6-, 9-, and 12-months follow-up. Additionally, the course of low back and neck pain (transitions from no symptoms to symptoms and from symptoms to no symptoms) was modeled.

The randomization procedure resulted in 19 intervention departments (N=1472 workers) and 18 control departments (N=1575 workers). After 12 months, the intervention was not more effective than the control group in reducing the prevalence of low back and neck pain or reducing pain intensity and duration. Participatory ergonomics did not increase the probability of preventing low-back pain or neck pain. However, participatory ergonomics increased the probability of recovering from low back pain, but not from neck pain.

Participatory ergonomics neither reduced low back and neck pain prevalence nor pain intensity and duration nor was it effective in the prevention of low back and neck pain or the recovery from neck pain. However, participatory ergonomics was more effective in the recovery from low back pain.

Related Source: Stay@Work: Participatory Ergonomics to prevent low back and neck pain

April 18, 2011

A Randomized Trial Comparing Acupuncture and Simulated Acupuncture, for Sub-acute and Chronic Whiplash

Filed under: Neck Pain,Whiplash — Administrator @ 3:33 am

A Randomized Trial Comparing Acupuncture and Simulated Acupuncture, for Sub-acute and Chronic Whiplash

From: Spine (Phila Pa 1976). 2011 Apr 7. [Epub ahead of print]

A randomized controlled trial with 3 and 6 months follow up to compare the effectiveness of acupuncture with simulated acupuncture in patients with sub-acute and chronic whiplash associated disorders.

Acupuncture is widely used for the treatment of neck pain and other musculoskeletal pain and there is some evidence supporting its effectiveness for short term pain relief. The effectiveness of acupuncture in the treatment of whiplash associated disorders is not clear.

124 patients between 18 and 65 years with chronic (85%) or sub-acute whiplash associated disorders (grade I or II) were randomly allocated to real or simulated electro-acupuncture treatment for 12 sessions during a six week period. Both treatments involved skin penetration with acupuncture needles and were provided by a single university trained acupuncturist in a University Clinic in Sydney, Australia. Primary outcome measures were pain intensity (10cm Visual Analogue Scale), disability (Neck Disability Index), and health related quality of life (SF36). Secondary outcomes were patient specific activity scales, and the McGill Pain Rating Index.

Mean initial pain intensity for all participants was 5.6 cm. Participants receiving the real electro-acupuncture treatment had significantly greater reduction in pain intensity at 3 and 6 months, 0.9 cm and 1.3 cm respectively in comparison to the sham electro-acupuncture group. After adjustment for baseline status there was no significant reduction in disability, or improvement in health related quality of life. There was an improvement in the activity scales of a similar size to the reduction in pain, but no difference in the McGill Index.

Real electro-acupuncture was associated with a significant reduction in pain intensity for whiplash associated disorders over at least 6 months. This reduction was probably not clinically significant. There was no improvement in disability or quality of life.

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