Neck Solutions Blog

August 29, 2011

Sagittal spino-pelvic alignment in chronic low back pain

Filed under: Back Pain,Chronic Pain — Administrator @ 10:43 am

Sagittal spino-pelvic alignment in chronic low back pain

From: Eur Spine J. 2011 Aug 26. [Epub ahead of print]

The eitiology of low back pain is usually multifactoral. Based on previous literature reviews, it was found that there are three main risk factors for recurrent and chronic low back pain: 1) history of low back pain with associated limitations and treatments, 2) dissatisfaction at work, and 3) poor general medical condition. Other risk factors such as socioeconomic and employment status, psychological status, and physically demanding work are also suggested.

The differences in sagittal spino-pelvic alignment between adults with chronic low back pain and the normal population are still poorly understood. In particular, it is still unknown if particular patterns of sagittal spino-pelvic alignment are more prevalent in chronic low back pain. The current study helps to better understand the relationship between sagittal alignment and low back pain.

To compare the sagittal spino-pelvic alignment of patients with chronic low back pain with a cohort of asymptomatic adults. Sagittal spino-pelvic alignment was evaluated in prospective cohorts of 198 patients with chronic low back pain and 709 normal subjects. The two cohorts were compared with respect to the sacral slope, pelvic tilt, pelvic incidence, lumbar lordosis, lumbar tilt, lordotic levels, thoracic kyphosis, thoracic tilt, kyphotic levels, and lumbosacral joint angle. Correlations between parameters were also assessed.

Sagittal spino-pelvic alignment is significantly different in chronic low back pain with respect to sacral slope, pelvic incidence, lumbar tilt, lordotic levels, thoracic kyphosis, thoracic tilt and lumbosacral joint angle, but not pelvic tilt, lumbar lordosis, and kyphotic levels. Correlations between parameters were similar for the two cohorts. As compared to normal adults, a greater proportion of patients with low back pain presented low sacral slope and lumbar lordosis associated with a small pelvic incidence, while a greater proportion of normal subjects presented normal or high sacral slope associated with normal or high pelvic incidence.

Sagittal spino-pelvic alignment was different between patients with chronic low back pain and controls. In particular, there was a greater proportion of chronic low back pain patients with low sacral slope, low lumbar lordosis and small pelvic incidence, suggesting the relationship between this specific pattern and the presence of chronic low back pain.

August 27, 2011

DNA methylation of SPARC and chronic low back pain

Filed under: Back Pain,Chronic Pain,Disc Problems — Administrator @ 8:12 am

DNA methylation of SPARC and chronic low back pain

From: Mol Pain. 2011 Aug 25;7(1):65. [Epub ahead of print]

Chronic low back pain is a complex continuum of painful conditions that includes both axial and radicular pain: Axial low back pain is defined as spontaneous or movement-evoked pain or discomfort localized to the spine and low back region. Non-axial, radiating low back pain is pain in one or both legs. Often referred to as radicular pain or sciatica, it usually follows the course of the sciatic nerve. Current diagnostic and therapeutic approaches to chronic back pain are limited by our narrow understanding of the underlying biological mechanisms. There are many potential causes of chronic low back pain including degenerative disc disease. While natural age-related degeneration of intervertebral discs is common, chronic low back pain is associated with increased signs of disc degeneration. Like most other conditions, back pain is the product of genetic and environmental influences.

SPARC (secreted protein, acidic, rich in cysteine; aka osteonectin or BM-40) is an evolutionarily conserved collagen-binding protein present in intervertebral discs. SPARC is known to influence bone remodeling, collagen fibrillogenesis, and wound repair. Decreased expression of SPARC has been associated with aging and degeneration in human intervertebral discs. Furthermore, targeted deletion of the SPARC gene results in accelerated disc degeneration in the aging mouse and a behavioral phenotype resembling chronic low back pain in humans. The genetic evidence from mice and the clinical observation that SPARC is down-regulated in humans with disc degeneration suggests that long-term down-regulation of SPARC expression may play a critical role in chronic low back pain. What are the mechanisms that could lead to lasting down-regulation of genes such as SPARC?

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August 25, 2011

Prevalence of facet joint degeneration in association with intervertebral joint degeneration in a sample of organ donors

Filed under: Arthritis,Back Pain,Disc Problems — Administrator @ 4:43 am

Prevalence of facet joint degeneration in association with intervertebral joint degeneration in a sample of organ donors

From: J Orthop Res. 2011 Aug;29(8):1267-74

Among the most common causes of low back pain are strain on the muscles and ligaments associated with the spine, degeneration of the intervertebral discs, and osteoarthritis of the facet joints. It is not clear, however, how these latter two conditions are related to each other in terms of their development during a patient’s lifetime. The facet joint is the sole synovial joint of the spine but because it is difficult to image its degenerative history as well as its relationship to other degenerative factors within the spine remain elusive.

The authors compared the gross and histologic characteristics of the lumbar spine from a sample of organ donors to the integrity of their associated intervertebral discs as assessed through magnetic resonance imaging. In this study sample, they found that facet joint degeneration was common, occurring as early as 15 years of age, while the intervertebral disc could still remain intact. Facet degeneration was more severe at the L4/5 level and progressed along with intervertebral disc degeneration with age. Because such early degenerative changes in the facet joint are somewhat surprising, degeneration of this joint should not be overlooked when assessing osteoarthritis of the spine and causes of lower back pain.

August 23, 2011

Validity and responsiveness of the Core Outcome Measures Index for the neck

Filed under: Neck Pain — Administrator @ 4:41 am

Validity and responsiveness of the Core Outcome Measures Index (COMI) for the neck

From: Eur Spine J. 2011 Aug 20. [Epub ahead of print]

Patient-orientated outcome questionnaires are essential to evaluate treatment success. To compare different treatments, hospitals, and surgeons, standardised questionnaires are required. The present study examined the validity and responsiveness of the Core Outcome Measurement Index for neck pain, a short, multidimensional outcome instrument.

Questionnaires were completed by patients with degenerative problems of the cervical spine undergoing cervical disc arthroplasty before (N = 89) and 3 months after (N = 75) surgery. The questionnaires comprised the EuroQol-Five Dimension, the North American Spine Society Cervical Spine Outcome Assessment Instrument and the Core Outcome Measurement Index for neck pain.

The Core Outcome Measurement Index for neck pain and North American Spine Society Cervical Spine Outcome Assessment Instrument scores displayed no notable floor or ceiling effects at any time point whereas for theEuroQol-Five Dimension, the highest or lowest values were reached in around 32.5% of patients at follow-up. With one exception (symptom-specific well-being), the individual Core Outcome Measurement Index for neck pain items and the Core Outcome Measurement Index for neck pain summary score correlated to the expected extent with the scores of the chosen reference questionnaires.

The area under the curve generated by ROC analysis was significantly higher for the Core Outcome Measurement Index for neck pain than for any other instrument/subscale when self reported treatment outcome was used as the external criterion, dichotomised as “good” (operation helped a lot/helped) versus “poor” (operation helped only a little/didn’t help/made things worse). The Core Outcome Measurement Index for neck pain had a high effect size (standardised response mean; SRM) for the good global outcome group and a low SRM for the poor outcome group. The EuroQol-Five Dimension and the North American Spine Society Cervical Spine Outcome Assessment Instrument lacked this ability to differentiate between the two groups, showing less distinct SRMs for good and poor outcome groups.

This study provides evidence that the Core Outcome Measurement Index for neck pain is a valid and responsive questionnaire in the population of patients examined. Further investigations should examine its applicability in other patient groups with less severe neck pain or undergoing other treatment modalities

August 20, 2011

Recruitment bias in chronic pain research: whiplash as a model

Filed under: Whiplash — Administrator @ 5:23 am

Recruitment bias in chronic pain research: whiplash as a model

From: Clin Rheumatol. 2011 Aug 19. [Epub ahead of print]

In science findings which cannot be extrapolated to other settings are of little value. Recruitment methods vary widely across chronic whiplash studies, but it remains unclear whether this generates recruitment bias. The present study aimed to examine whether the recruitment method accounts for differences in health status, social support, and personality traits in patients with chronic whiplash associated disorders.

Two different recruitment methods were compared: recruiting patients through a local whiplash patient support group (group 1) and local hospital emergency department (group 2). The participants (n = 118) filled in a set of questionnaires: the Neck Disability Index, Medical Outcome Study Short-Form General Health Survey, Anamnestic Comparative Self-Assessment measure of overall well-being, Symptom Checklist-90, Dutch Personality Questionnaire, and the Social Support List. The recruitment method (either through the local emergency department or patient support group) accounted for the differences in insufficiency, somatization, disability, quality of life, self-satisfaction, and dominance. The recruitment methods generated chronic whiplash associated disorders patients comparable for psychoneurotism, social support, self-sufficiency, (social) inadequacy, rigidity, and resentment.

The recruitment of chronic whiplash associated disorders patients solely through patient support groups generates bias with respect to the various aspects of health status and personality, but not social support. In order to enhance the external validity of study findings, chronic whiplash associated disorders studies should combine a variety of recruitment procedures.

August 17, 2011

Cupping and neck pain

Filed under: Neck Pain — Administrator @ 12:33 pm

The influence of a series of five dry cupping treatments on pain and mechanical thresholds in patients with chronic non-specific neck pain – a randomised controlled pilot study

BMC Complement Altern Med. 2011 Aug 15;11(1):63. [Epub ahead of print]

Neck pain is a very common condition, the average lifetime prevalence being 48.5%. The causes of chronic neck pain are manifold and can include inflammatory diseases, degenerative processes, trauma, space-occupying lesions, or systemic conditions. However, in most patients neck pain is not due to a serious disease, but rather to postural or mechanical factors. It is then commonly referred to as simple or non-specific neck pain. While non-specific neck pain usually resolves within three to six months, it recurs or persists even longer in 14% of patients, who are then considered to have chronic neck pain.

Although the pathogenesis of non-specific neck pain is not completely understood, it is agreed that physiological and psychological factors such as stress, poor mental health, long hours of work at a desk, an otherwise heavy workload, little exercise, and postural deficits may contribute to mechanical neck pain. Alterations in connective tissues, such as inflammation and fibrosis, or in muscles, such as impairment of the microcirculation of the trapezius, may occur, and motor control of the neck musculature may be affected.

Moreover, patients with chronic non-specific neck pain commonly show hyperalgesia, i.e., enhanced sensitivity to mechanical pain, although it is still under discussion whether the hyperalgesia is localized or widespread. Hyperalgesia in chronic non-specific neck pain also shows different patterns and seems to rely on different mechanisms than hyperalgesia in acute and traumatic neck pain respectively.

Conventional treatment of non-specific neck pain includes patient education and physical exercises, primarily as preventive methods. In more acute or severe cases, spinal manipulation, physical therapy, or medicinal or injection therapies may be applied. However, additional treatment options are needed, especially for patients with more severe pain or with low expectations of conventional treatment alone.

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August 15, 2011

Is there altered activity of the extensor muscles in chronic mechanical neck pain

Filed under: Neck Pain — Administrator @ 3:22 am

Is there altered activity of the extensor muscles in chronic mechanical neck pain? A functional magnetic resonance imaging study.

From: Arch Phys Med Rehabil. 2011 Jun;92(6):929-34

To compare the pattern of neck extensor muscle use in participants with chronic mechanical neck pain to that of healthy controls during 2 different extension exercises by use of muscle functional magnetic resonance imaging.

This was a cross-sectional in a University laboratory setting. Data recorded from subjects with chronic mechanical neck pain (n=12; 10 women, 2 men) were compared with previously recorded data from healthy subjects (n=11; 7 men, 4 women).

functional magnetic resonance imaging measures of shifts in T2 relaxation were made for the multifidus, semispinalis cervicis, semispinalis capitis, and splenius capitis muscles, at C2-3, C5-6, and C7-T1 levels, prior and immediately after 2 different exercises: cervical extension in craniocervical neutral and cervical extension in craniocervical extension. T2 shift values (difference between pre- and postexercise T2 relaxation values) for each muscle and exercise condition were used for analysis.

While there were observed differences in differential activation of the extensor muscles in participants with mechanical neck pain compared with controls, these differences were only evident for the craniocervical neutral exercise condition and were only observed for 3 out of the 7 muscle regions of interest during this exercise.

Results of this study suggest some alteration in the differential activation of the cervical extensors in patients with mechanical neck pain and indicate that further investigation of this muscle group in mechanical neck pain disorders is warranted

August 11, 2011

Absence of the inferior portion of the trapezius muscle in three family members

Filed under: General Health,Posture — Administrator @ 2:48 am

Absence of the inferior portion of the trapezius muscle in three family members

From: Man Ther. 2011 Aug 6. [Epub ahead of print]

Absence of the trapezius muscle is a relatively rare occurrence but instances have been recorded in both cadaveric and in vivo clinical case reports. The two main causes that have been proposed are congenital and embryonic. The absence of trapezius may occur in isolation or in combination with other muscles such as the sternocleidomastoid or the pectoralis major muscles. Where there is co-involvement with the pectoralis major muscle in particular, the condition is often thought to be a variant of Poland’s Syndrome, which is a rare congenital anomaly characterised by unilateral chest wall hypoplasia and ipsilateral hand deformities. From an embryological viewpoint, the trapezius and sternocleidomastoid muscles are both innervated by the accessory nerve, and are derived from the mesoderm of the occipital and cervical somites. This suggests that the absence of trapezius in isolation may be an incomplete failure of the myotome compartment of either the occipital or cervical somites. Potential genetic links have also been proposed in instances where identical muscle absences have been observed in siblings and in three generations of males within a family.

Observations of absences of the whole or portions of the tripartite trapezius muscle alone have also been reported. A search of the literature identified six cases (four males, two females) revealed in cadaveric dissections. In five cases, unilateral absences of the left trapezius were reported. All parts of the trapezius muscle were absent in two cases, the upper portion in one and the inferior portion in another two cases. One case of complete bilateral absence of the trapezii was also reported. Cadaveric studies, although informative, limit any comment on a possible genetic predisposition in these individuals or any functional or symptomatic relevance as a possible consequence of the absence.

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August 8, 2011

Work related complaints of neck, shoulder and arm among computer office workers: a cross-sectional evaluation of prevalence and risk factors in a developing country

Filed under: Neck Pain,Posture,Shoulder Pain — Administrator @ 8:24 am

Work related complaints of neck, shoulder and arm among computer office workers: a cross-sectional evaluation of prevalence and risk factors in a developing country

From: Environ Health. 2011 Aug 4;10(1):70. [Epub ahead of print]

Complaints of arms, neck and shoulders is defined as the presence of musculoskeletal complaints of the said region not caused by acute trauma or by any systemic disease. complaints of arms, neck and shoulders is common among computer office workers worldwide and is a well recognized cause of occupational illness leading to frequent absenteeism from work, reduction in overall productivity, poor quality of life and escalating medical expenses. In the United States, complaints of arms, neck and shoulders is a leading cause of occupational illness with annual costs related to absenteeism from work and treatment being $45-54 billion. The recent increase in computer-related work as a consequence of rapid industrialization has considerably increased the prevalence of complaints of arms, neck and shoulders among computer office workers not only in western developed countries but also in developing countries such as Sudan and Sri Lanka.

The aetiology of complaints of arms, neck and shoulders among computer office workers is complex and poorly defined. Recently several studies have defined and identified potential risk factors for complaints of arms, neck and shoulders, such as physical exposure resulting from static body postures, repetitive tasks and workplace design. In addition, psychosocial factors such as high quantitative job demands, minimal autonomy and limited peer support have also been implicated. Thus, it is important that an aetiological model for complaints of arms, neck and shoulders, consider both physical and psychosocial factors. A significant majority of risk factor studies are from western developed countries and at present there are no studies from developing countries in the South-Asian region. Sri Lanka is a rapidly developing nation in South Asia having a population of about 19 million people.

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August 6, 2011

Association between intensity of pain and impairment in onset and activation of the deep cervical flexors in patients with persistent neck pain

Filed under: Neck Pain — Administrator @ 6:25 am

Association between intensity of pain and impairment in onset and activation of the deep cervical flexors in patients with persistent neck pain

From: Clin J Pain. 2011 May;27(4):309-14

This study evaluates the relationship between clinical symptoms and the function of the deep cervical flexor muscles in women with persistent neck pain. Thirty-two women with a history of neck pain more than 6 months participated in the study. Measures for neck pain area, intensity, duration, and perceived disability were taken. Electromyography was acquired from the deep cervical flexor muscles by a nasopharyngeal electrode suctioned over the posterior oropharyngeal wall as the patients performed 2 tasks: rapid arm movements (shoulder flexion and extension) and isometric craniocervical flexion contractions.

The patients’ average score for the Neck Disability Index (0 to 50) was 11.0±2.6 and their average pain intensity rated on a visual analog scale (0 to 10) was 4.7±1.8. A correlation was observed between the average intensity of pain rated on the visual analog scale and the normalized electromyography amplitude recorded from the deep cervical flexors during the craniocervical flexion contractions. Furthermore, the relative onset of the deep cervical flexors during rapid shoulder flexion was positively correlated with the average intensity of pain. No significant correlations were identified between the amplitude and the onset of activation of the deep cervical flexors and the duration of pain, area of pain, or Neck Disability Index score of the patient.

This study shows a relationship between the levels of neck pain intensity and the function of the deep cervical flexor muscles in women with persistent neck pain but not in other clinical features, such as location or duration of the disorder. These findings may partially explain the heterogeneity in motor control impairments in patients with neck pain.

Related Source: Specificity in Retraining Craniocervical Flexor Muscle Performance

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