Neck Solutions Blog

November 29, 2011

Ergonomic practices within patient care units are associated with musculoskeletal pain and limitations

Filed under: Back Pain,Neck Pain — Administrator @ 3:08 am

Ergonomic practices within patient care units are associated with musculoskeletal pain and limitations

From: Am J Ind Med. 2011 Nov 23

With the high prevalence of musculoskeletal disorders for patient care unit workers, prevention efforts through ergonomic practices within units may be related to symptoms associated with typical work-related musculoskeletal disorders.

The authors completed a cross-sectional survey of patient care workers (n = 1,572) in two large academic hospitals in order to evaluate relationships between self-reported musculoskeletal pain, work interference due to this pain, and limitations during activities of daily living (functional limitations) and with ergonomic practices and other organizational policy and practices metrics within the unit. Bivariate and multiple logistic regression analyses tested the significance of these associations.

Prevalence of self-reported musculoskeletal symptoms in the past 3 months was 74% with 53% reporting pain in the low back. 32.8% reported that this pain interfered with their work duties and 17.7% reported functional limitations in the prior week. Decreased ergonomic practices were significantly associated with reporting pain in four body areas (low back, neck/shoulder, arms, and lower extremity) in the previous 3 months, interference with work caused by this pain, symptom severity, and limitations in completing activities of daily living in the past week. Except for low back pain and work interference, these associations remained significant when psychosocial covariates such as psychological demands were included in multiple logistic regressions.

Ergonomic practices appear to be associated with many of the musculoskeletal symptoms denoting their importance for prevention efforts in acute health care settings.

November 26, 2011

Reflecting on whiplash associated disorder through a QoL lens

Filed under: Whiplash — Administrator @ 7:33 am

Reflecting on whiplash associated disorder through a QoL lens: an option to advance practice and research

From: Disabil Rehabil. 2011 Nov 23. [Epub ahead of print]

The purpose of this study was to examine the constructs of quality of life as applied to whiplash associated disorder, its current state of measurement and suggestions for future application in a narrative literature review.

The burden of whiplash associated disorder on the healthcare system is substantive. Assessment of quality of life issues for people with whiplash associated disorder may provide a broader understanding of the patient experience. No consistent framework for quality of life in whiplash associated disorder has been adopted, nor has preference for any quality of life instrument been established. Inconsistent use of terminology for what is being measured, and the measures themselves hamper clarity on the issue. Options for assessing quality of life currently include a meaningful condition-specific scale that has not undergone sufficient psychometric evaluation (Whiplash Disability Questionnaire (WDQ), or generic scales with strong psychometric properties that have not undergone sufficient relevancy evaluation (e.g. SF-36, WHOQOL BREF). Generic measures can measure overlapping constructs including heath status, utility, health-related quality of life or generic quality of life. The inter-relationships between these in whiplash associated disorder have not been defined.

Given the impact of whiplash associated disorder on quality of life, additional clarity on tools and approaches are needed. There is a need for research on the relevance and clinical measurement properties of available condition-specific and generic tools to define a preferred measurement approach in whiplash associated disorder

November 23, 2011

Physiotherapy rehabilitation for whiplash associated disorder II

Filed under: Neck Pain,Whiplash — Administrator @ 5:34 pm

Physiotherapy rehabilitation for whiplash associated disorder II: a systematic review and meta-analysis of randomised controlled trials.

From: BMJ Open. 2011 Nov 14;1(2)

Road traffic accidents are the primary cause of whiplash, a soft tissue injury to the neck following an acceleration–deceleration mechanism of injury. The cumulative incidence of patients seeking healthcare post-whiplash from a road traffic accident has increased during the last 30 years to recent estimates of >3/1000 inhabitants in North America and Western Europe and 1.0–3.2/1000 inhabitants in Sweden. In the UK, insurance statistics indicate that 300 000 patients present per annum with whiplash associated disorders. Whiplash associated disorders are the resulting clinical presentations following the injury and can range in severity, clinical symptoms and physical findings. Many patients with whiplash associated disorders experience persistent pain and disability, with reports suggesting that 40–60% of those injured have chronic symptoms. The annual economic cost associated with management of whiplash associated disorders and associated time off work is estimated as $3.9 billion in the USA, and €10 billion in Europe.

Patients experiencing whiplash associated disorders may be regarded as a distinct group within the broader non-specific neck pain population, although following review of trial data (n=4 trials), recent evidence questions this distinction for a primary care population and has identified a need for further research. Whiplash associated disorders can be categorised as grades 0–IV, where a higher grade indicates increased severity. The classification system is widely used in clinical practice and guidelines. Patients with whiplash associated disorder II who experience neck pain accompanied by stiffness or tenderness, and musculoskeletal signs, for example a reduced range of available movement, form the major group of patients (93.4%) who might benefit from conservative management, commonly involving physiotherapy intervention. A recent best evidence synthesis recommended a focus of research to the most common whiplash associated disorder I and II classifications, excluding classification III and above (ie, patients with neurological signs and fracture and/or dislocation) and classification 0 (no complaint at the neck, and no physical signs) However, a classification of whiplash associated disorder I is less commonly seen by physiotherapists as there are no accompanying physical findings (neck pain, stiffness or tenderness but with no physical findings) and patients are known to recover within 6 months post-injury.

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November 21, 2011

A systematic review of musculoskeletal disorders among school teachers

Filed under: Back Pain,Neck Pain — Administrator @ 10:58 am

A systematic review of musculoskeletal disorders among school teachers.

From: BMC Musculoskelet Disord. 2011 Nov 17;12(1):260. [Epub ahead of print]

Musculoskeletal disorders represent one of the most common and important occupational health problems in working populations, being responsible for a substantial impact on quality of life and incurring a major economic burden in compensation costs and lost wages. musculoskeletal disorders decrease productivity at work due to sick leave, absenteeism and early retirement, and are also costly in terms of treatment and individual suffering. Moreover, musculoskeletal disorders represent a common health-related reason for discontinuing work and for seeking health care. In many occupations, musculoskeletal disorders include a wide range of inflammatory and degenerative conditions affecting the muscles, ligaments, tendons, nerves, bones and joints; and can occur from a single or cumulative trauma.

The work tasks of school teachers often involves significant use of a ‘head down’ posture, such as frequent reading, marking of assignments, and writing on a blackboard. Nursery school teachers, however, also perform a wide variety of tasks combining basic health childcare and teaching duties, and those that require sustained mechanical load and constant trunk flexion. Nursery school teachers have been found to have elevated prevalence of neck, shoulder, arm and low back disorders, and lower-extremity musculoskeletal disorders due to activities which require sustained periods of kneeling, stooping, squatting or bending.

School teachers in general, have been demonstrated relative to other occupational groups, to report a high prevalence of musculoskeletal disorders, with prevalence rates of between 40% and 95%. During the course of their work, teachers may be subjected to conditions that cause physical health problems. The work of a teacher does not only involve teaching students, but also preparing lessons, assessing students’ work and being involved in the extracurricular activities such as sports. Teachers also participate in different school committees. These may cause teachers to suffer adverse mental and physical health issues due to the variety of job functions. Despite this, the impact of musculoskeletal disorders specifically within the teaching profession has not been given sufficient attention in the literature. Furthermore, comparatively little research has investigated the prevalence of musculoskeletal disorders in the teaching profession.

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November 19, 2011

Characteristics of neck and shoulder pain among members of the nursing staff

Filed under: Neck Pain,Shoulder Pain — Administrator @ 6:06 am

Characteristics of neck and shoulder pain (called katakori in Japanese) among members of the nursing staff

From: J Orthop Sci. 2011 Nov 18. [Epub ahead of print]

The characteristics of neck and shoulder pain, called katakori in Japanese, have not been well documented to date. The aim of this study was to clarify the characteristics of neck and shoulder pain through a questionnaire survey of members of the nursing staff.

The study population consisted of 484 nursing staff members of Gunma University Hospital in Japan. The questionnaire involved information on age, body mass index (BMI), gender, psychological stress at work, musculoskeletal pain at other anatomic sites (elbow/wrist, lumbar and knee), smoking history, and hypertension. If subjects had neck and shoulder pain, they were asked about any coexisting symptoms, the utilization of health services, and the precise location of neck and shoulder pain.

The total study population included 393 persons after 91 persons were excluded for various reasons. The point prevalence of neck and shoulder pain was 68.1% (268 of 393). Age, BMI, smoking history, and hypertension showed no significant trend for the prevalence of neck and shoulder pain in the univariate analyses.

The occurrence of neck and shoulder pain was significantly higher in subjects with psychological stress, elbow/wrist pain, lumbar pain, and knee pain, respectively. A multivariate logistic regression analysis showed that gender, psychological stress, elbow/wrist pain, and lumbar pain were significantly associated with the occurrence of neck and shoulder pain. One hundred fifty-eight of those with neck and shoulder pain (58.9%) reported coexisting symptoms, and the most common was headache. Fifty-seven (21.2%) of the subjects with neck and shoulder pain had consulted medical or health practitioners, and bone setting was the most common service provider. The most common area of neck and shoulder pain was the superior part of the trapezius.

This study confirmed that neck and shoulder pain, katakori in Japanese, is a prevalent problem in a nursing staff, and several factors associated with neck and shoulder pain were identified.

November 17, 2011

Muscle onset can be improved by therapeutic exercise

Filed under: Back Pain,Neck Pain — Administrator @ 12:11 pm

Muscle onset can be improved by therapeutic exercise: A systematic review.

From: Phys Ther Sport. 2011 Nov;12(4):199-209

The objective of this study was to determine whether therapeutic exercise can improve the timing of muscle onset following musculoskeletal pathology, and examine what exercise prescription parameters are being used to achieve these effects in people with a musculoskeletal pathology by measuring muscle onset timing by electromyography.

Sixteen investigations were identified containing 19 therapeutic exercise groups. Three exercise modes were identified including: isolated muscle training, instability training, and general strength training. Isolated muscle training is consistently shown to have a positive effect on the muscle onset timing of transversus abdominus in people with low back pain. There is some evidence from cohort studies that instability training may change muscle onset timing in people with functional ankle instability, however controlled trials suggest that no effect is present. General strength training shows no effect on muscle onset timing in people with low back or neck pain, although one cohort study suggests that a positive effect on gluteus maximus may be present in people with low back pain.

Therapeutic exercise training is likely to improve muscle onset timing. Additionally, isolated muscle training appears to be the best exercise mode to use to achieve these effects.

November 15, 2011

Fluctuation of pain by weather change in musculoskeletal disorders

Filed under: Chronic Pain,General Health — Administrator @ 5:35 am

Fluctuation of pain by weather change in musculoskeletal disorders

From: Mymensingh Med J. 2011 Oct;20(4):645-51.

In order to find out the fluctuation of pain by weather change, a descriptive cross-sectional study was conducted among 138 individuals having musculoskeletal disorders (MSDs) attending the out patient department (OPD) of Physical Medicine and Rehabilitation, Bangabandhu Sheikh Mujib Medical University (BSMMU) Hospital, Dhaka, during March 2004 to June 2004. Data were collected by face to face interview employing a pre-tested interview schedule containing structured questions. Among 138 respondents, male were predominant (52.2%). Mean age of the respondents was 39.42±10.79 years, while the most common age group was found as ’31 to 40 years’. By occupation, majority were housewives (40.58%), followed by businessmen (29.71%), service holder (15.22%), laborer (7.97%), and students (6.52%). The primary sites of pain were back and low back (38.4%), knee (24.6%), leg (8.7%), ankle and heel (8.0%), hand and wrist (6.5%), neck (5.8%), shoulder (5.8%), and elbow (2.2%). Highest number (47.8%) patients reported aching pain, while one fifth (20.3%) of them experienced burning pain.

About 36.2 percent respondents mentioned ‘prolonged standing’ as the main cause of pain aggravation, while almost half (48.6%) of the patients perceived that ‘application of heat’ was the key relieving factor of their pain. About two third (63%) of the respondents were sensitive to weather change; among them 56.3 percent reported that their pain increased during cold weather. Moreover, more than two third (67.4%) study-patients experienced deterioration of pain due to seasonal variation; of them 59.1 percent reported that their pain was exacerbated in winter season. Of all respondents, less than one third (30.4%) experienced aggravation of pain due to lunar change; of them majority (85.7%) experienced increased pain during dark fortnights. The study concluded that weather change might have an important role in fluctuation of pain among individuals having musculoskeletal disorders.

November 12, 2011

Unpacking the burden: Understanding the relationships between chronic pain and comorbidity in the general population

Filed under: Arthritis,Back Pain,Chronic Pain,Neck Pain — Administrator @ 6:11 am

Unpacking the burden: Understanding the relationships between chronic pain and comorbidity in the general population

From: Pain. 2011 Nov 7. [Epub ahead of print]

The authors investigated the association of chronic pain with physical and mental comorbidity in the New Zealand population by measuring chronic pain status separate from comorbid conditions. Models of allostatic load provided a conceptual basis for considering multi-morbidity as accumulated comorbid load and for using both discrete conditions and cumulative measures in analyses. The nationally representative cross-sectional survey data included self-reported doctor-diagnosed chronic physical and mental health conditions, Kessler 10-item scale scores, an independent measure of chronic pain, and sociodemographic characteristics.

The population prevalence of chronic pain is 16.9%, and a quarter (26%) of the population report 2 or more comorbid physical conditions statistically associated with chronic pain. Results indicate that accumulated comorbid load is independently associated with chronic pain. Six physical conditions independently associated with chronic pain increase the risk of chronic pain in an additive manner, and residual accumulated load further increases risk for 2 or more conditions.

Anxiety and depression interacts synergistically with arthritis and neck and back disorders to increase the odds of reporting chronic pain beyond an additive model. This synergistic effect is not apparent for other conditions or for additional comorbid load. Results imply that measurement of chronic pain independent of comorbid conditions and adjustment for comorbid conditions is important for more accurate prevalence estimates and understanding relationships between conditions. Future epidemiological research might usefully incorporate independent measurement of chronic pain alongside adjustment for specific physical and mental health conditions as well as accumulated comorbid load.

November 10, 2011

Lumbar disc degeneration and genetic factors are the main risk factors for low back pain in women

Filed under: Back Pain,Disc Problems — Administrator @ 4:36 am

Lumbar disc degeneration and genetic factors are the main risk factors for low back pain in women: the UK Twin Spine Study

From: Ann Rheum Dis. 2011 Oct;70(10):1740-5

Low back pain is a common musculoskeletal condition in all ages worldwide and in Europe in particular. The lifetime prevalence of non-specific low back pain may reach 80%, with the annual prevalence ranging between 25% and 60% in different ethnic groups. Radiological features of lumbar disc degeneration are almost universal in adults, and have been proposed repeatedly as one of the main causes of low back pain. Although an association has been demonstrated, the individual risk factors for low back pain remain unclear and universal consensus regarding the extent of lumbar disc degeneration–low back pain association is lacking. The lack of standardised clinical criteria and radiological definitions has further hampered the undertaking of well-executed epidemiological studies. More sensitive imaging modalities, such as MRI, have fallen in cost and become more widely available and are paving the way for new, large-scale epidemiological studies of lumbar disc degeneration.

Obesity, smoking and occupation have been reported to be associated with prevalent low back pain, although the quantitative effect of the majority of them has been found to be negligible—even insignificant. On the other hand, several studies have consistently suggested the presence of a major genetic component underlying variation of low back pain, although data remain scarce.

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November 8, 2011

Does fear of movement mediate the relationship between pain intensity and disability in patients following whiplash injury

Filed under: Neck Pain,Whiplash — Administrator @ 8:46 am

Does fear of movement mediate the relationship between pain intensity and disability in patients following whiplash injury? A prospective longitudinal study.

From: Pain. 2011 Nov 2. [Epub ahead of print]

The aim of this study was to test the capacity of the Fear Avoidance Model to explain the relationship between pain and disability in patients with whiplash associated disorders. Using the method of Baron and Kenny [1], we assessed the mediating effect of fear of movement on the cross-sectional and longitudinal relationships between pain and disability. Two hundred and five subjects with neck pain due to a motor vehicle accident provided pain intensity (0 to 10 numerical rating scale), fear of movement (Tampa Scale of Kinesiophobia and Pictorial Fear of Activity Scale) and disability (Neck Disability Index) scores within 4weeks of their accident, after 3months, and after 6months.

The analyses were consistent with the Fear Avoidance Model mediating approximately 20% to 40% of the relationship between pain and disability. Contrary to the authors initial hypothesis, the proportion of the total effect of pain on disability that was mediated by fear of movement did not substantially change as increasing time elapsed after the accident. The proportion mediated was slightly higher when fear of movement was measured by Tampa Scale of Kinesiophobia as compared with Pictorial Fear of Activity Scale. The findings of this study suggest that the Fear Avoidance Model plays a role in explaining a moderate proportion of the relationship between pain and disability after whiplash injury.

Related Source: Assessing Fear in Patients with Cervical Pain: Development and Validation of the Pictorial Fear of Activity Scale – Cervical

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