Neck Solutions Blog

May 31, 2011

Comparing biofeedback with active exercise and passive treatment for the management of work-related neck and shoulder pain

Filed under: Neck Pain,Shoulder Pain — Administrator @ 3:06 am

Comparing biofeedback with active exercise and passive treatment for the management of work-related neck and shoulder pain: a randomized controlled trial.

From: Arch Phys Med Rehabil. 2011 Jun;92(6):849-58.

The study objective was to compare the effects of biofeedback with those of active exercise and passive treatment in treating work-related neck and shoulder pain in a randomized controlled trial with 3 intervention groups and a control group.

Participants were recruited from outpatient physiotherapy clinics and a local hospital. All participants reported consistent neck and shoulder pain related to computer use for more than 3 months in the past year and no severe trauma or serious pathology. A total of 72 potential participants were recruited initially, of whom a smaller group of individuals (n=60) completed the randomized controlled trial.

The 3 interventions were applied for 6 weeks. In the biofeedback group, participants were instructed to use a biofeedback machine on the bilateral upper trapezius muscles daily while performing computer work. Participants in the exercise group performed a standardized exercise program daily on their own. In the passive treatment group, interferential therapy and hot packs were applied to the participants’ necks and shoulders. The control group was given an education booklet on office ergonomics.

Pain (visual analog scale), neck disability index, and surface electromyography were assessed preintervention and postintervention. Pain and neck disability were reassessed after 6 months.
Postintervention, average pain and neck disability scores were reduced significantly more in the biofeedback group than in the other 3 groups, and this was maintained at 6 months. Cervical erector spinae muscle activity showed significant reductions postintervention in the biofeedback group, and there were consistent trends of reductions in the upper trapezius muscle activity.

Six weeks of biofeedback training produced more favorable outcomes in reducing pain and improving muscle activation of neck muscles in patients with work-related neck and shoulder pain.

May 28, 2011

Signs and symptoms of temporomandibular joint disorders related to the degree of mouth opening and hearing loss

Filed under: TMJ Pain — Administrator @ 4:53 am

Signs and symptoms of temporomandibular joint disorders related to the degree of mouth opening and hearing loss.

From: BMC Ear Nose Throat Disord. 2011 May 25;11(1):5.

The temporomandibular joint is critical for normal mouth function, and thus plays a role in chewing, swallowing, speaking, oral health and nutrition. The temporomandibular joint is a synovial joint containing an articular disc which allows for hinge and sliding movements. The articular surfaces are covered by avascular andnon-innervated fibrocartilage which has a high regenerative capacity. The temporalis and masseter muscles control the joint’s motion.

The term temporomandibular disorders is a collective one, representing a sub-classification of muscle-skeletal disorders, and more specifically a number of signsand symptoms involving the masticatory muscles, the temporomandibular joint and associated structures. It is estimated that about one third of adults have temporomandibular disorders symptoms. Temporomandibular disorders has been related to stress, age, gender, personality and other systematic factors.

The maximum mouth opening distance is a generally accepted measurement to estimate temporomandibular joint mobility and function. Mouth opening can be measured using gauges or calipers, and while the normal range differs between populations, the critical functional opening is 35-40mm.

Aural symptoms such as tinnitus, otalgia, dizziness or vertigo, otic fullness sensation, hyperacousia or hypoacousia are thought to be associated with temporomandibular disorders, while their incidence reaches 85% in temporomandibular disorders patients. A causative role of temporomandibular disorders in otic symptomatology remains a matter of debate. Several studies have shown that aural symptoms may have no otic origin. Theories on the etiology of aural symptoms are based mainly on the common embryologic origin of the temporomandibular joint and the middle ear from Meckel cartilage, the presence of structures that connect the middle ear with the temporomandibular joint and the common innervation of the masticatory muscles and the ear.

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Effect of brief daily exercise on headache among adults – secondary analysis of a randomized controlled trial

Filed under: Headaches,Neck Pain,Shoulder Pain — Administrator @ 3:44 am

Effect of brief daily exercise on headache among adults – secondary analysis of a randomized controlled trial

From: Scand J Work Environ Health. 2011 May 26

This paper investigates secondary outcomes (headache) in a randomized controlled trial with physical exercise among office workers with neck/shoulder pain.

A total of 198 office workers with frequent neck/shoulder pain were randomly allocated to either one of two intervention groups (10 weeks of resistance training with elastic tubing for 2 or 12 minutes per day, 5 times a week) or the control group, which received weekly health information. Secondary outcomes included changes in frequency, intensity, and duration of headache after ten weeks.

Compared with the control group, headache frequency decreased in the 2- and 12-minute intervention groups [0.64 days/week and 0.79, corresponding to a 43% and 56% decrease from baseline, respectively]. Intensity and duration of the remaining headaches were unaffected.

Two minutes of daily resistance training for ten weeks reduces headache frequency among office workers with neck/shoulder pain. The vast number of adult workers suffering from one or two days of weekly headaches and who could potentially comply with and benefit from brief exercise programs stresses the applicability of these findings.

May 27, 2011

Altered postural sway in patients suffering from non-specific neck pain and whiplash associated disorder

Filed under: Neck Pain,Posture,Whiplash — Administrator @ 2:36 am

Altered postural sway in patients suffering from non-specific neck pain and whiplash associated disorder – A systematic review of the literature.

From: Chiropr Man Therap. 2011 May 24;19(1):13.

This study was a systematic literature review to assess differences in center of pressure measures in patients suffering from non-specific neck pain or whiplash associated disorder compared to healthy controls and any relationship between changes in postural sway and the presence of pain, its intensity, previous pain duration and the perceived level of disability.

Over the past 20 years, the center of pressure has been commonly used as an index of postural stability in standing. While several studies investigated center of pressure excursions in neck pain and whiplash associated disorder patients and compared these to healthy individuals, no comprehensive analysis of the reported differences in postural sway pattern exists.

Six online databases were systematically searched followed by a manual search of the retrieved papers. Papers comparing center of pressure measures derived from bipedal static task conditions on a force plate of non-specific neck pain and whiplash associated disorder sufferers to those of healthy controls. Two reviewers independently screened titles and abstracts for relevance. Screening for final inclusion, data extraction and quality assessment were carried out with a third reviewer to reconcile differences.

Eight papers met the inclusion criteria. Heterogeneity in study designs prevented pooling of the data and no direct comparison of data across the studies was possible. Instead, a qualitative data analysis was conducted. There was broad consensus that patients with either type of neck pain have increased center of pressure excursions compared to healthy individuals, a difference that was more pronounced in whiplash associated disorder sufferers. An increased sway in antero-posterior direction was observed in both groups.

Patients both types of neck pain exhibit greater postural instability than healthy controls, signified by greater center of pressure excursions irrespective of the center of pressure parameter chosen. Further, the decreased postural stability in neck pain sufferers appears to be associated with the presence of pain and to correlate with the extent of proprioceptive impairment, but appears unrelated pain duration.

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May 25, 2011

Myofeedback training and intensive muscular strength training to decrease pain and improve work ability among female workers on long-term sick leave with neck pain: a randomized controlled trial

Filed under: Neck Pain — Administrator @ 3:40 am

Myofeedback training and intensive muscular strength training to decrease pain and improve work ability among female workers on long-term sick leave with neck pain: a randomized controlled trial

From: Int Arch Occup Environ Health. 2011 Mar;84(3):335-46.

Neck pain is one of the most common disorders, with a lifetime prevalence of 45–71%, causing a major part of work disability and long-term sick leave in Sweden. Musculoskeletal pain and long-term sick leave is higher among women than among men workers, and among human service organization workers compared with other occupational groups. The high prevalence of long-lasting sick leave due to neck pain among female workers stresses the need for intervention methods that are easily applied and can increase work ability and return to work.

The rehabilitation activity among human service organization workers has been low in Sweden. Among the largest group of human service organization workers, nursing aides and assistants, few (2%) received occupational rehabilitation and few (3–5%) returned to work from 2 weeks of sick leave within 30 days. A number of studies have reported difficulties in rehabilitation and return to work from long-term sick leave in general and due to neck pain in particular. This points to the need for methods to better support return to work and regained work ability among female workers with musculoskeletal disorder, especially with neck pain. However, work ability is a broad concept comprising the physical, psychological, and social capability of a worker to perform and interact within their work, the individual’s specific work demands, health conditions, and mental resources. Thus, several dimensions of work ability need to be used to capture the effect of intervention on work ability, e.g. general perception of work ability, muscular strength, vitality, and other dimensions of health (i.e., both self-rated and laboratory assessed).

This randomized control study investigates whether 1 month’s intervention with myofeedback through an easy-to-wear electromyography (EMG) device, or a short intensive muscular strength training program both coached by an ergonomist at the participants’ homes, can increase work ability and decrease pain among female workers on long-term sick leave (exceeding 60 days). The theoretical framework is that muscle tension in the neck is related to insufficient rest, which is a risk factor for chronic pain and that an intervention that changes the muscle activation pattern will increase health by reducing pain and thereby increasing the work ability. One of the theories for the etiology of neck pain, which may have an association with the muscle activation pattern, is an overload of the low threshold motor units, i.e., the type 1 muscle fibers. At low level continuous load, such as at constrained work without variation, a relative overload may occur of the low threshold motor units that are the type 1 muscle fibers. Female employees with neck pain have also shown to have less muscle rest during work. Furthermore, prospective results have shown that perception of muscle tension is a strong risk factor to develop neck pain.

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May 24, 2011

Suppression of anger and subsequent pain intensity and behavior among chronic low back pain patients: the role of symptom-specific physiological reactivity

Filed under: Back Pain,Chronic Pain — Administrator @ 9:15 am

Suppression of anger and subsequent pain intensity and behavior among chronic low back pain patients: the role of symptom-specific physiological reactivity

From: J Behav Med. 2011 May 20. [Epub ahead of print]

Anger is related to both acute and chronic pain intensity. Findings suggest that the manner in which anger is regulated—either inhibition (anger-in) or expression (anger-out) of angry feelings—is a particularly reliable determinant of chronic pain severity.

Anger, hostility, and anger management style are related to physiological reactivity to stress (8–10). Although much research has focused on the cardiovascular components of sympathetic and parasympathetic nervous system reactivity, anger variables may also be related to activation of the skeletal muscles.

Suppression of anger may be linked to heightened pain report and pain behavior during a subsequent painful event among chronic low back patients, but it is not clear whether these effects are partly accounted for by increased physiological reactivity during suppression.

In this study, chronic low back pain patients (N = 58) were assigned to Suppression or No Suppression conditions for a “cooperative” computer maze task during which a confederate harassed them. During baseline and maze task, patients’ lower paraspinal and trapezius muscle tension, blood pressure and heart rate were recorded. After the maze task, patients underwent a structured pain behavior task (behaviors were videotaped and coded).

Results showed that: (a) Suppression condition patients revealed greater lower paraspinal muscle tension and systolic blood pressure increases during maze task than No Suppression patients (previously published results showed that Suppression condition patients exhibited more pain behaviors than No Suppression patients); (b) residualized lower paraspinal and systolic blood pressure change scores were related significantly to pain behaviors; (c) both lower paraspinal and systolic blood pressure reactivity significantly mediated the relationship between Condition and frequency of pain behaviors.

Results suggest that suppression-induced lower paraspinal muscle tension and systolic blood pressure increases may link the actual suppression of anger during provocation to signs of clinically relevant pain among chronic low back pain patients.

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May 20, 2011

Effective treatment of chronic low back pain in humans reverses abnormal brain anatomy and function

Filed under: Back Pain,Chronic Pain — Administrator @ 1:21 pm

Effective treatment of chronic low back pain in humans reverses abnormal brain anatomy and function

From: J Neurosci. 2011 May 18;31(20):7540-50.

Chronic pain is associated with reduced brain gray matter and impaired cognitive ability. In this longitudinal study, the authors assessed whether neuroanatomical and functional abnormalities were reversible and dependent on treatment outcomes.

MRI scans were acquired from chronic low back pain patients before (n = 18) and 6 months after (spine surgery or facet joint injections; n = 14) treatment. In addition, 16 healthy controls were scanned, 10 of which returned 6 months after the first visit. Cortical thickness analysis on structural MRI scans were performed, and subjects performed a cognitive task during the functional MRI. Patients and controls, as well as patients before versus after treatment were compared.

After treatment, patients had increased cortical thickness in the left dorsolateral prefrontal cortex, which was thinner before treatment compared with controls. Increased dorsolateral prefrontal cortex thickness correlated with the reduction of both pain and physical disability. Additionally, increased thickness in primary motor cortex was associated specifically with reduced physical disability, and right anterior insula was associated specifically with reduced pain. Left dorsolateral prefrontal cortex activity during an attention-demanding cognitive task was abnormal before treatment, but normalized following treatment.

These data indicate that functional and structural brain abnormalities, specifically in the left dorsolateral prefrontal cortex are reversible, suggesting that treating chronic pain can restore normal brain function in humans.

May 18, 2011

Tinnitus and depression

Filed under: Tinnitus — Administrator @ 2:35 am

Tinnitus and depression

From: World J Biol Psychiatry. 2011 May 13. [Epub ahead of print]

Depressive symptoms are common in individuals with tinnitus and may substantially aggravate their distress. The mechanisms, however, by which depression and tinnitus mutually interact are still not fully understood.

Here the authors review neurobiological knowledge relevant for the interplay between depression and tinnitus. Neuroimaging studies confirm the existence of neural circuits that are activated both in depression and tinnitus. Studies of neuroendocrine function demonstrate alterations of the HPA-axis in depression and, more recently, in tinnitus.

Studies addressing neurotransmission suggest that the dorsal cochlear nucleus that is typically hyperactive in tinnitus, is also involved in the control of attention and emotional responses via projections to the locus coeruleus, the reticular formation and the raphe nuclei. Impaired hippocampal neurogenesis has been documented in animals with tinnitus after noise trauma, as in animal models of depression.

Finally, from investigations of human candidate genes, there is some evidence to suggest that variant BDNF may act as a common susceptibility factor in both disorders.

These parallels in the pathophysiology of tinnitus and depression argue against comorbidity by chance and against depression as pure reaction on tinnitus. Instead, they stand for a complex interplay between tinnitus and depression. Implications for tinnitus treatment are discussed

May 17, 2011

Physiological and clinical changes after therapeutic massage of the neck and shoulders

Filed under: Neck Pain,Shoulder Pain — Administrator @ 3:38 am

Physiological and clinical changes after therapeutic massage of the neck and shoulders

Man Ther. 2011 May 11. [Epub ahead of print]

Therapeutic massage is often prescribed for musculoskeletal complaints even though little is known regarding the physiological mechanisms responsible for the reported clinical effects of this therapy. Chronic neck pain is one common and costly musculoskeletal disorder often treated with therapeutic massage. A multifaceted condition, the US National Health Interview Survey stated that over 34 million people reported experiencing neck pain in the three preceding months. Several studies have investigated the use of therapeutic massage for neck pain, however, a recent review of the literature on massage and neck pain led to the conclusion that no recommendations for practice could be made from the available research.

Research and clinical reports indicate therapeutic massage may decrease pain and muscle spasm, however, the physiological processes behind these reported effects are still in doubt. Therapeutic massage has been theorized to operate through a combined group of physiological processes which include changes in hormones, neurotransmitters, and blood flow. While some physiological processes (i.e. changes in cortisol level) have received extensive investigation, others critical to understanding the musculoskeletal effects of therapeutic massage have received less study. Research has investigated potential changes in the musculotendonous unit, central and peripheral nervous system effects, mechanical factors, and neurotransmitter influences, however, strong evidence for the physiological mechanisms of action for therapeutic massage remains elusive.

Several studies have suggested that therapeutic massage decreases muscle tension by stimulating sensory receptors which in turn reduce a-motoneurone pool excitability. Using the Hoffmann reflex (H-reflex) these studies have begun to examine the influence of therapeutic massage on the monosynaptic connections between the Ia sensory fibers and the spinal motoneurones. Modulation of afferent input into the spinal cord (with a probable effect on the ascending tracts) could have a direct effect on muscle fiber response. These past studies have provided a base of information on the effect of therapeutic massage on spinal reflexes, and further work in this area is warranted. Studies examining a more clinical therapeutic massage protocol with standardized H-reflex methods would add to our understanding of how a therapeutic massage session influences segmental spinal reflexes.

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May 15, 2011

mechanical hyperalgesia and active/latent muscle trigger points in neck-shoulder muscles

Filed under: Neck Pain,Shoulder Pain — Administrator @ 8:09 am

Elite swimmers with and without unilateral shoulder pain: mechanical hyperalgesia and active/latent muscle trigger points in neck-shoulder muscles

From: Scand J Med Sci Sports. 2011 May 12

Active trigger points are one of the major peripheral pain generators for regional and generalized musculoskeletal pain conditions. Trigger points are hyperirritable spots in skeletal muscle associated with palpable nodules in the taut bands of muscle fibers. When these palpable nodules are stimulated mechanically, local pain and referred pain can be induced together with visible local twitch response.

Trigger points can be either active or latent. An active trigger point is one that refers pain either locally to a large area and/or to another remote location, the local and referred pain can be spontaneous or reproduced by mechanical stimulation which elicits a patient-recognized pain. A latent trigger point does not reproduce the clinical pain complaint but may exhibit all of the features of an active trigger point to a minor degree.

Myofascial pain syndrome due to trigger points can be acute or chronic, regional or generalized; it can also be a primary disorder leading to local or regional pain syndromes or a secondary disorder as a consequence of other conditions. Active trigger points contribute significantly to the regional acute and chronic myofascial pain syndrome, such as lateral epicondylalgia, headache and mechanical neck pain and temporomandibular pain disorders. Active trigger points are also the main peripheral pain generator in generalized musculoskeletal pain disorders, such as fibromyalgia and whiplash syndrome.

The aim of this study was to investigate the presence of mechanical hypersensitivity and active trigger points in the neck-shoulder muscles in elite swimmers with/without unilateral shoulder pain. Seventeen elite swimmers with shoulder pain; 18 swimmers without shoulder pain; and 15 elite athletes matched controls were recruited. Pressure pain thresholds were assessed over the levator scapulae, sternocleidomastoid, upper trapezius, infraspinatus, scalene, subscapularis and tibialis anterior muscles. Trigger points in the levator scapulae, upper trapezius, infraspinatus, scalene, sternocleidomastoid and subscapularis muscles were also explored.

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