Neck Solutions Blog

July 30, 2011

Correlation between expectations of recovery and injury severity perception in whiplash-associated disorders

Filed under: Whiplash — Administrator @ 5:22 am

Correlation between expectations of recovery and injury severity perception in whiplash associated disorders

From: J Zhejiang Univ Sci B. 2011 Aug.;12(8):683-686.

To assess the correlation between expectations of recovery and whiplash patients’ perceptions of injury severity using a simplified instrument. Expectations of recovery have been shown to predict rate of recovery from whiplash injury in population-based studies. The perception of having more severe pathology or more ominous diagnostic labels has also been associated with a worse prognosis.

Consecutive patients with whiplash associated disorder grade 1 or 2, presenting in the acute stage to a primary care centre, were asked “do you think that your injury will…” with response options “get better soon; get better slowly; never get better; don’t know.” Injury severity perception was measured with a numerical rating scale which ranged from 0-10, on which subjects were asked to rate how severe (in terms of damage) they thought their injury was. The anchors were labeled “no damage” (0) and “severe, and maybe permanent damage” (10). The primary outcome measure was the correlation between the subject’s injury severity perception score and expectation of recovery.

A total of 94 subjects (34 males, 60 females, and mean age (40.6±10.0) years, range 19-60 years) were included. The initial responses to expectation of recovery were: get better soon (29/94); get better slowly (22/94); never get better (11/94); don’t know (32/94). The mean injury severity perception score was 4.9±1.7 (range 2-9 out of 10). There was a high correlation between expectations and injury severity perception scores (Spearman’s rank correlation coefficient 0.68). Those who expected to recover soon and those who expected to get better slowly had the lowest injury severity perception scores. The more slowly whiplash patients expect to recover, or the less sure they are of recovery, the more severe their initial perceptions of injury.

July 28, 2011

Occupational sitting time: employees’ perceptions of health risks and intervention strategies

Filed under: Posture — Administrator @ 3:09 am

Occupational sitting time: employees’ perceptions of health risks and intervention strategies.

From: Health Promot J Austr. 2011 Apr;22(1):38-43.

There is increasing interest in the potential association between sedentary behavior and poor health. This study examined office-based employees’ perceptions of the health risks associated with prolonged sitting at work, and strategies to interrupt and reduce occupational sitting time.

Four focus groups were conducted with a convenience sample of Australian government personnel (20 women and two men). Open-ended questions concerning health risks and sitting reduction strategies were posed by lead researchers and focus group participants invited to express opinions, viewpoints and experiences. Audio recordings and summary notes of focus group discussions were reviewed by researchers to identify key response themes.

Employees associated prolonged occupational sitting with poor health, primarily in terms of musculoskeletal issues, fatigue and de-motivation.This risk was seen as independent of physical activity. Workplace interventions tailored to occupational roles were viewed as important and considered to be the joint responsibility of individuals and organisations. Strategies included workload planning (interspersing sedentary and non-sedentary tasks), environmental change (e.g. stairwell access, printers away from desks), work tasks on the move (e.g. walking meetings) and purposive physical activity (e.g. periodic breaks, exercise/walking groups).The perception that these strategies would compromise productivity was identified as the primary barrier to implementation; team leaders were subsequently considered vital in enabling integration and acceptance of strategies into everyday workplace practices.

Prolonged occupational sitting was perceived as detrimental to health. Suggested strategies targeted individuals, workplaces, organisations and environments.

July 26, 2011

Is greater lumbar vertebral bone mineral density associated with more disc degeneration

Filed under: Arthritis,Disc Problems — Administrator @ 4:19 am

Is greater lumbar vertebral bone mineral density associated with more disc degeneration? A study using micro-CT and discography.

From: J Bone Miner Res. 2011 Jul 22.

It is well documented that osteoarthritis is associated with greater bone mineral density in peripheral extremities. Yet, the relationship between vertebral bone mineral density and disc degeneration remains controversial in the lumbar spine, which may be due largely to the inadequacies of bone mineral density and disc degeneration measures. Aiming to clarify the association between vertebral bone mineral density and adjacent disc degeneration, we studied 137 cadaveric lumbar vertebrae and 209 corresponding intervertebral discs from the spines of 48 Caucasian men, aged 21 to 64 years. disc degeneration was evaluated using discography. The vertebrae were scanned using a micro-CT system to obtain volumetric bone mineral density for the whole vertebra, the vertebral body, the vertebral body excluding osteophytes, and the vertebral body excluding osteophytes and endplates. A random effect model was used to examine the association between the different definitions of vertebral bone mineral density and adjacent disc degeneration.

No significant association was found between the bone mineral density of the whole vertebra and adjacent disc degeneration. However, when the posterior elements were excluded, there was a significant association between greater vertebral body bone mineral density and more severe degeneration in the disc cranial to the vertebra. This association remained after further excluding osteophytes and endplates from the vertebral body bone mineral density measurements. Also, a trend of greater bone mineral density of the vertebral body associated with more adjacent disc degeneration was evident. These results clarify the association between vertebral bone mineral density and disc degeneration, and specifically identified that it is higher bone mineral density of the vertebral body, not the entire vertebra, that is associated with more severe adjacent disc degeneration. This association may be obscured by the posterior elements, and is not confounded by osteophytes and endplate sclerosis

July 24, 2011

Prevalence and anatomical location of muscle tenderness in adults w ith nonspecific neck/shoulder pain

Filed under: Neck Pain,Shoulder Pain — Administrator @ 3:34 am

Prevalence and anatomical location of muscle tenderness in adults w ith nonspecific neck/shoulder pain.

From: BMC Musculoskelet Disord. 2011 Jul 22;12(1):169.

A high prevalence of upper extremity pain exists among adults working in sedentary occupations. Neck and shoulder pain is a risk factor for long-term sickness absence among whitecollar workers, and every other office worker experience neck and shoulder pain on a weekly basis. Pain symptoms are believed to worsen in response to prolonged static muscle activity and/or repetitive job tasks, causing muscle metabolic disturbances.

There is a strong correlation between reported neck and shoulder pain and clinically verified muscle tenderness. Especially, tenderness of the upper trapezius muscle often co-exists with neck and shoulder pain. The upper trapezius muscle is – due to its bulky and superficial nature – well suited for clinical research, and displays clear physiological differences between symptomatic and non-symptomatic individuals regarding electromyographic activity, muscle strength, muscle fiber morphology, stem cell content, and intramuscular metabolites. In spite of the inordinate focus on the upper trapezius, other muscles of the neck and shoulder complex may be affected as well and should therefore not be overlooked when treating neck and shoulder pain.

A clinical protocol for diagnosing disorders of the neck, shoulder and arm – e.g. tension neck syndrome, frozen shoulder and lateral epicondylitis has been extended to include the diagnosis of trapezius myalgia – frequent neck pain with co-existing tenderness and tightness of the upper trapezius muscle. The overall prevalence of these disorders is low to modest and many people experience non-specific neck and shoulder pain, i.e. pain in absence of the aforementioned clinically diagnosed disorders.

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July 22, 2011

Measured loads on a vertebral body replacement during sitting

Filed under: Back Pain,Posture — Administrator @ 4:57 am

Measured loads on a vertebral body replacement during sitting

From: Spine J. 2011 Jul 19. [Epub ahead of print]

Sitting is frequently assumed to cause high spinal loads because people with sedentary work often suffer from low back pain. It is assumed that the posture while sitting, as well as several seat parameters, also affects the spinal loads. To measure the loads on a spinal implant for different upper body inclinations, backrest declinations, seat heights, types of seat, and arm positions. loads on a vertebral body replacement during sitting were measured in five patients with telemeterized implants.

The telemeterized vertebral body replacement measures all six load components. It was implanted into five patients suffering from compression fractures of a lumbar vertebral body. Loads were measured when the patients were sitting on a stool and inclining their upper body between 15° flexion and 10° extension in steps of 5°; on a chair with an adjustable backrest that allowed declination angles between 108° and 180°; on an office chair while the seat height was varied between 40 and 60 cm in steps of 5 cm; and successively on seven different types of seats. The effect of the arm position was also studied.

The resultant implant force was increased on the average by 48% for 15° flexion and decreased by 19% for 10° extension of the trunk. When sitting on a chair with an adjustable backrest, the loads decreased with an increasing backrest declination angle. The seat height had in most cases only a minor effect on implant loads. In comparison to sitting on a stool, the loads were reduced when sitting on a bench (7%) or a stool with a padded wedge (9%), a knee stool (19%), a chair (35%), and an office chair (41%). Sitting on a physiotherapy ball increased the loads by 7%. Placing the hands on the thighs reduced the implant loads on the average by 19% in comparison to arms hanging on the sides.

Spinal loads can be reduced by leaning against the backrest, placing the arms on the armrest or the thighs, and by decreasing the flexion angle of the upper body.

July 19, 2011

Risk factors for the onset and persistence of neck pain in undergraduate students

Filed under: Neck Pain — Administrator @ 7:47 am

Risk factors for the onset and persistence of neck pain in undergraduate students: 1-year prospective cohort study.

FRom: BMC Public Health. 2011 Jul 15;11(1):566.

Neck pain is common among adults, affecting 14–71% of adults at some point in their lives. Its 1-year prevalence in adults ranges at 16–75%. A substantial 19–37% proportion of neck pain patients will develop chronic neck pain. Neck pain causes considerable personal discomfort due to pain, disability, and impaired quality of life, and may affect work. The economic consequences of treating disabling neck pain are significant. Bernaard et al recently postulated that the total yearly cost of neck and upper limb symptoms in the Netherlands due to decreased productivity, sick leave, chronic disability for work, and medical costs was 2.1 billion Euros.

Adolescents with neck pain are at high risk of having such symptoms in adulthood. Life-long chronic neck pain may have its origins in childhood. Thus to reduce the prevalence of neck pain in adults, knowledge regarding factors that can predict its onset and persistence in younger population is important.

Increasing evidence suggests a high prevalence of musculoskeletal symptoms in the neck and upper extremity among undergraduate students, ranging at 48–78%. In a Swedish cohort of university students 15% developed neck or upper back pain during 1-year follow-up. Neck pain is assumed of multi-factorial origin, indicating that individual, physical, and psychosocial factors can contribute to its onset and persistence. In the general population McLean et al systematically reviewed 14 prospective cohort studies and revealed that female, older age, high job demands, low social/work support, ex-smoker, and history of low back and neck disorders were linked to the onset of neck pain. In the working population, Côté et al in their systematic literature review reported that risk factors associated with neck pain included age, previous musculoskeletal pain, high quantitative job demands, low social support at work, job insecurity, low physical capacity, poor computer workstation design and work posture, sedentary work position, repetitive work, and precision work.

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July 16, 2011

Immigration, Acculturation and Chronic Back and Neck Problems Among Latino-Americans

Filed under: Back Pain,Neck Pain — Administrator @ 5:57 am

Immigration, Acculturation and Chronic Back and Neck Problems Among Latino-Americans

From: J Immigr Minor Health. 2011 April; 13(2): 194–201.

Among American adults, the three-month prevalence of having either back or neck pain is estimated to be as high as 31%. They are leading causes of disability and Americans who reported having either chronic back or neck problems had about 65% greater yearly health care expenditures than those who did not.

The three-month prevalence of back pain is lower in Latino-Americans than in white Americans. No studies in the US have examined whether the prevalence of chronic back or neck pain in Latino-Americans differs by acculturation. However, there is evidence that acculturation does affect the health of immigrants and of their descendants. Factors associated with chronic back or neck pain, such as increased body mass index, depression, smoking and heavy alcohol use have also been shown to be higher among more acculturated Latino-Americans.

In Europe, certain immigrant populations have had higher prevalence of pain compared to native-born subjects. Immigrants from southern Europe and the Middle East living in Sweden have higher odds of chronic widespread pain, higher pain associated psychosocial dysfunction, and higher rates of disability. Similarly, South Asian immigrants residing in the United Kingdom had 3.7 times higher odds of reporting widespread musculoskeletal pain than native-born British. Among these immigrants, higher acculturation was negatively associated with the report of widespread pain.

Very little is known about how culture affects the experience or report of chronic back or neck pain. One line of research suggests that the stress of the immigrant experience would lead to higher report of chronic back or neck problems among immigrant and less acculturated respondents. Alternatively, evidence of the deterioration of some health behaviors and outcomes in Latino-Americans with acculturation would lend support for the acculturation hypothesis which states that migrants from cultures with protective health practices experience worsening health with longer exposure to a host culture as they adopt the host culture’s unhealthy practices.

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July 14, 2011

Thermal Detection and Pain Thresholds but not Pressure Pain Thresholds Are Correlated With Psychological Factors in Women With Chronic Whiplash-Associated Pain

Filed under: Whiplash — Administrator @ 2:52 am

Thermal Detection and Pain Thresholds but not Pressure Pain Thresholds Are Correlated With Psychological Factors in Women With Chronic Whiplash-Associated Pain

From: Clin J Pain. 2011 Jul 11. [Epub ahead of print]

Whiplash associated disorders have been associated with sensory disturbances such as hypersensitivity or hypoesthesia. Different psychological factors seem to be important for prognosis and symptom presentation in whiplash associated disorders. Multivariate correlations between pain thresholds for pressure, cold and heat (cold pressure thresholds, heat pressure thresholds), detection thresholds for cold and warmth, pain intensity variables, and psychological aspects in women with chronic whiplash associated disorders (n=28) and in healthy pain-free controls (n=29) were investigated.

Quantitative Sensory Testing for thermal thresholds and algometry for pain thresholds for pressure at various sites in the body were used. Psychological aspects, including catastrophizing, anxiety, and depression were registered using a questionnaire. Whiplash associated disorders showed generalized decreased pain thresholds for pressure and cold pressure thresholds, altered heat pressure thresholds and cold detection thresholds in the upper part of the body, and a worse psychological situation.

Multivariate correlations were found between quantitative sensory testing and pain thresholds for pressure variables, habitual pain, and psychological factors in whiplash associated disorders. Different psychological variables were generally stronger predictors of cold pressure thresholds and heat pressure thresholds than pain intensity in whiplash associated disorders. Pain intensity aspects were generally the strongest predictors of pain thresholds for pressure in whiplash associated disorders.

In contrast, no correlations existed between quantitative sensory testing and pain thresholds for pressure variables and psychological variables in controls. These results indicate the need to consider that a blend of factors influences the pain thresholds in chronic whiplash associated disorders and emphasize the need for a biopsychosocial model when interpreting quantitative sensory testing and pain thresholds for pressure variables.

July 12, 2011

Classification and clinical features of headache patients: an outpatient clinic study from China

Filed under: Headaches — Administrator @ 4:04 am

Classification and clinical features of headache patients: an outpatient clinic study from China

From: J Headache Pain. 2011 Jul 9. [Epub ahead of print]

This study aimed to analyze and classify the clinical features of headache in neurological outpatients. A cross-sectional study was conducted consecutively from March to May 2010 for headache among general neurological outpatients attending the First Affiliated Hospital of Chongqing Medical University. Personal interviews were carried out and a questionnaire was used to collect medical records.

Diagnosis of headache was according to the International classification of headache disorders, 2nd edition (ICHD-II). Headache patients accounted for 19.5% of the general neurology clinic outpatients. A total of 843 (50.1%) patients were defined as having primary headache, 454 (27%) secondary headache, and 386 (23%) headache not otherwise specified (headache NOS). For primary headache, 401 (23.8%) had migraine, 399 (23.7%) tension type headache, 8 (0.5%) cluster headache and 35 (2.1%) other headache types.

Overall, migraine patients suffered (1) more severe headache intensity, (2) longer than 6 years of headache history and (3) more common analgesic medications use than tension type headache ones. Tension type headache patients had more frequent episodes of headaches than migraine patients, and typically headache frequency exceeded 15 days/month); 22.8% of primary headache patients were defined as chronic daily headache. Almost 20% of outpatient visits to the general neurology department were of headache patients, predominantly primary headache of migraine and tension type headache.

In outpatient headaches, more attention should be given to headache intensity and duration of headache history for migraine patients, while more attention to headache frequency should be given for the tension type headache ones.

July 10, 2011

Measurement properties of disease-specific questionnaires in patients with neck pain: a systematic review

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

Measurement properties of disease-specific questionnaires in patients with neck pain: a systematic review

From: Qual Life Res. 2011 Jul 7. [Epub ahead of print]

The purpose of this study was to critically appraise and compare the measurement properties of the original versions of neck specific questionnaires. Bibliographic databases were searched for articles concerning the development or evaluation of the measurement properties of an original version of a self-reported questionnaire, evaluating pain and/or disability, which was specifically developed or adapted for patients with neck pain. The methodological quality of the selected studies and the results of the measurement properties were critically appraised and rated using a checklist, specifically designed for evaluating studies on measurement properties.

The search strategy resulted in a total of 3,641 unique hits, of which 25 articles, evaluating 8 different questionnaires, were included in this study. The Neck Disability Index is the most frequently evaluated questionnaire and shows positive results for internal consistency, content validity, structural validity, hypothesis testing, and responsiveness, but a negative result for reliability. The other questionnaires show positive results, but the evidence for each measurement property is mostly limited, and at least 50% of the information on measurement properties per questionnaire is lacking.

The findings imply that studies of high methodological quality are needed to properly assess the measurement properties of the currently available questionnaires. Until high quality studies are available, we recommend using these questionnaires with caution. There is no need for the development of new neck specific questionnaires until the current questionnaires have been adequately assessed.

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