Neck Solutions Blog

January 31, 2012

The association of lumbar intervertebral disc degeneration on MRI in overweight and obese adults

Filed under: Disc Problems,General Health — Administrator @ 8:03 am

The association of lumbar intervertebral disc degeneration on MRI in overweight and obese adults: A population-based study.

From: Arthritis Rheum. 2012 Jan 27. doi: 10.1002/art.33462. [Epub ahead of print]

This study addressed the association of overweight and obesity to the presence, extent, and severity of lumbar disc degeneration on MRI in adults. A population-based cross-sectional study of 2,599 Southern Chinese volunteers. Radiographic and clinical assessment, including weight and height, was conducted. Sagittal T2-weighted MRIs of the lumbar spine were obtained. The presence, extent, and severity of disc degeneration as well as additional radiographic and clinical findings were assessed. Asian-modified BMI (kg/m2) categories were utilized.

There were 1,040 males and 1,559 females (mean age= 41.9 years). Disc degeneration was noted in 1,890 (72.7%) subjects. BMI was significantly higher in subjects with disc degeneration compared to subjects without degeneration. A significant increase in the number of degenerated levels, global severity of disc degeneration, and end stage disc degeneration with disc space narrowing was noted with elevated BMI, in particular in overweight and obese individuals. In the adjusted multivariate logistic regression model, there was a positive linear trend between BMI categories and the overall presence of disc degeneration for overweight and obese. End stage disc degeneration with disc space narrowing was significantly more pronounced in obese individuals.

In one of the largest studies to systematically assess lumbar disc degeneration on MRI, our study noted a significant association between the presence, increased extent, and global severity of disc degeneration in overweight and obese adults.

January 29, 2012

Triggers for an episode of sudden onset low back pain: study protocol

Filed under: Back Pain — Administrator @ 6:22 am

Triggers for an episode of sudden onset low back pain: study protocol.

From: BMC Musculoskelet Disord. 2012 Jan 24;13(1):7.

Nearly 4 million people in Australia suffer from back pain at any one time, with total treatment costs exceeding $1 billion a year. In the US, the figure is an astonishing US$32 billion a year. Back complaints are the seventh most common condition in patients consulting general practitioners in Australia, and the most common musculoskeletal condition. It is also the most common health problem for which an imaging test is ordered by a general practitioner.

A potential solution to managing the problem of low back pain is the identification and control of modifiable risk factors. This approach is appealing and seemingly logical and there are notable examples where such an approach has provided major improvements in public health. For back pain this approach has not yet been fruitful: Cochrane reviews of workplace interventions, insoles and lumbar supports have failed to support these traditional back pain prevention approaches. Prevention strategies have to date been largely based on controlling long-term exposure to risk factors, for example, modifying seats to control vibration in truck drivers. However it is likely that the full potential of prevention will not be reached unless we also consider commonly occurring, modifiable risk factors that happen just before the onset of back pain. In this regard the authors see this proposed research as complementary to, rather than in conflict with, research evaluating long term risk factors.

The existence of short term risk factors or ‘triggers’ is consistent with the time course of back pain. It is well established that most people will experience low back pain in their lifetime, that pain is typically recurrent and that episodes are usually of sudden onset. For example research conducted by this group demonstrated that in an inception cohort of 969 subjects, 82% reported that their onset of low back pain was sudden. This pattern of low back pain suggests that rather than solely looking at long term exposure to risk factors it would be instructive to also look closely at events occurring immediately prior to the episode to identify modifiable triggers to the episode. This information is routinely sought by health practitioners when a patient with low back pain seeks care. The treating clinician commonly asks the patient what activity they were performing just prior to the onset of pain, in essence, “was the episode triggered by something unusual that happened just before?” The scientific method best suited to answer this question is the case-crossover design.

The authors will use the case-crossover design to provide the first accurate estimates of the transient increase in risk of low back pain associated with transient exposure to various triggers. It is possible that they will identify several factors that are not modifiable but this information will be extremely important to our understanding and explanation of the causes of low back pain.

January 27, 2012

Lack of Endogenous Pain Inhibition During Exercise in People With Chronic Whiplash Associated Disorders

Filed under: Chronic Pain,Whiplash — Administrator @ 10:14 am

Lack of Endogenous Pain Inhibition During Exercise in People With Chronic Whiplash Associated Disorders: An Experimental Study.

From: J Pain. 2012 Jan 24. [Epub ahead of print]

A controlled experimental study was performed to examine the efficacy of the endogenous pain inhibitory systems and whether this (mal)functioning is associated with symptom increases following exercise in patients with chronic whiplash associated disorders. In addition, 2 types of exercise were compared. Twenty-two women with chronic whiplash associated disorders and 22 healthy controls performed a submaximal and a self-paced, physiologically limited exercise test on a cycle ergometer with cardiorespiratory monitoring on 2 separate occasions. Pain pressure thresholds, health status, and activity levels were assessed in response to the 2 exercise bouts.

In chronic whiplash associated disorders, pain pressure thresholds decreased following submaximal exercise, whereas they increased in healthy subjects. The same effect was established in response to the self-paced, physiologically limited exercise, with exception of the pain pressure thresholds at the calf which increased. A worsening of the chronic whiplash associated disorders symptom complex was reported post-exercise. Fewer symptoms were reported in response to the self-paced, physiologically limited exercise.

These observations suggest abnormal central pain processing during exercise in patients with chronic whiplash associated disorders. Submaximal exercise triggers post-exertional malaise, while a self-paced and physiologically limited exercise will trigger less severe symptoms, and therefore seems more appropriate for chronic whiplash associated disorders patients.

The results from this exercise study suggest impaired endogenous pain inhibition during exercise in people with chronic whiplash associated disorders. This finding highlights the fact that one should be cautious when evaluating and recommending exercise in people with chronic whiplash associated disorders, and that the use of more individual, targeted exercise therapies is recommended.

January 25, 2012

Cervical neural space narrowing during simulated rear crashes with anti-whiplash systems

Filed under: Whiplash — Administrator @ 8:52 am

Cervical neural space narrowing during simulated rear crashes with anti-whiplash systems

From: Eur Spine J. 2012 Jan 24. [Epub ahead of print]

Chronic radicular symptoms have been documented in whiplash patients, potentially caused by cervical neural tissue compression during an automobile rear crash. The goals of this study were to determine neural space narrowing of the lower cervical spine during simulated rear crashes with whiplash protection system and active head restraint and to compare these data to those obtained with no head restraint. We extrapolated our results to determine the potential for cord, ganglion, and nerve root compression.

The model, consisting of a human neck specimen within a BioRID II crash dummy, was subjected to simulated rear crashes in a whiplash protection system seat (n = 6, peak 12.0 g and ΔV 11.4 kph) or active head restraint seat and subsequently with no head restraint (n = 6, peak 11.0 g and ΔV 10.2 kph with AHR; peak 11.5 g and ΔV 10.7 kph with no head restraint). Cervical canal and foraminal narrowing were computed and average peak values statistically compared (P < 0.05) between whiplash protection system, active head restraint, and no head restraint.

Average peak canal and foramen narrowing could not be statistically differentiated between whiplash protection system, active head restraint, or no head restraint. Peak narrowing with whiplash protection system or active head restraint was 2.7 mm for canal diameter and 1.6 mm, 2.7 mm, and 5.9 mm(2) for foraminal width, height and area, respectively.

While lower cervical spine cord compression during a rear crash is unlikely in those with normal canal diameters, these results demonstrated foraminal kinematics sufficient to compress spinal ganglia and nerve roots. Future anti-whiplash systems designed to reduce cervical neural space narrowing may lead to reduced radicular symptoms in whiplash patients.

A simple and proven method of improving head restraints for whiplash protection that is user friendly and effective - proven in crash test results and highly recommended by heath care professionals is the add on headrest

January 22, 2012

Differences in end-range lumbar flexion during slumped sitting and forward bending between low back pain subgroups and genders

Filed under: Back Pain,Posture — Administrator @ 6:53 am

Differences in end range lumbar flexion during slumped sitting and forward bending between low back pain subgroups and genders

From: Man Ther. 2012 Jan 17. [Epub ahead of print]

Low back pain may be related to patterns of lumbar postures and movements used to perform different tasks, but it is unclear which patterns with which tasks contribute to low back pain. For example, increases in both lumbar flexion and extension have been linked to low back pain. Some studies have reported increased lumbar flexion in people with low back pain during activities involving flexion, such as golfing and cycling. Other studies have reported that increased lumbar extension is associated with low back pain during sitting. Inconsistent findings regarding the direction of increased lumbar movement or the presence of flexed versus extended postural alignment potentially associated with low back pain may be due to the inclusion of subjects with widely varying movement patterns in a single low back pain group. Several researchers have proposed that there are subgroups of people with low back pain whose symptoms are associated with different direction related postures or movement patterns (e.g., flexion or extension related).

If multiple low back pain subgroups are studied as a single population, differences between subgroups demonstrating patterns in opposite directions could average out to suggest no difference in motion between people with and without low back pain. When subgrouping was not included in the study design, several studies found no differences in lumbar postural alignment and motion between people with and without low back pain. Still other studies found that decreased lumbar motion is associated with low back pain. Lumbar postural alignment and motion characteristics associated with low back pain may be more clearly identified when people with low back pain are subgrouped based on lumbar patterns associated with symptoms.

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January 20, 2012

Modic type I change may predict rapid progressive, deforming disc degeneration

Filed under: Back Pain,Disc Problems — Administrator @ 11:20 am

Modic type I change may predict rapid progressive, deforming disc degeneration: a prospective 1-year follow-up study

From: Eur Spine J. 2012 Jan 17. [Epub ahead of print]

This prospective magnetic resonance imaging (MRI) study in chronic low back pain patients evaluated the natural course of degenerative lumbar spine changes in relation to Modic 1 type changes within 1 year. From 3,811 consecutive chronic low back pain patients referred to lumbar spine MRI 54 patients with a large Modic 1 type changes were selected using strict exclusion criteria to exclude specific back disorders. Follow-up MRI was obtained within 11-18 months.

At baseline Modic 1 type changes was associated with an adjacent endplate lesion in 96% of the cases. In follow-up, an unstable Modic 1 type change was associated both with an increase of endplate lesions, decrease of disc height and change in disc signal intensity, most found at L4/5 or L5/S1. In disc spaces without Modic 1 type changes, progression of degenerative changes was rare. Endplate deformation, decreasing disc height and change of disc signal intensity appear essential features of accelerated degenerative process associated with Modic 1 type changes.

January 18, 2012

Effect of backpack load carriage on cervical posture in primary schoolchildren

Filed under: Neck Pain,Posture — Administrator @ 9:43 am

Effect of backpack load carriage on cervical posture in primary schoolchildren

From: Work. 2012 Jan 1;41(1):99-108

This study examined the effects of various backpack loads on elementary schoolchildren’s posture and postural compensations as demonstrated by a change in forward head position. A convenience sample of 11 schoolchildren, aged 8-11 years participated. Sagittal digital photographs were taken of each subject standing without a backpack, and then with the loaded backpack before and after walking 6 minutes (6MWT) at free walking speed. This was repeated over three consecutive weeks using backpacks containing randomly assigned weights of 10%, 15%, or 20% body weight of each respective subject. The craniovertebral angle was measured using digitizing software, recorded and analyzed.

Subjects demonstrated immediate and statistically significant changes in craniovertebral angle, indicating increased forward head positions upon donning the backpacks containing 15% and 20% body weight. Following the 6MWT, the craniovertebral angle demonstrated further statistically significant changes for all backpack loads indicating increased forward head postures. For the 15 & 20% body weight conditions, more than 50% of the subjects reported discomfort after walking, with the neck as the primary location of reported pain. Backpack loads carried by schoolchildren should be limited to 10% body weight due to increased forward head positions and subjective complaints, primarily neck pain, at 15% and 20% body weight loads.

January 16, 2012

Does lumbar spinal degeneration begin with the anterior structures

Filed under: Back Pain,Disc Problems — Administrator @ 5:07 am

Does lumbar spinal degeneration begin with the anterior structures? A study of the observed epidemiology in a community-based population

From: BMC Musculoskelet Disord. 2011 Sep 13;12:202

The importance of spine stability is a central paradigm in spine care. Maintenance of spine stability, through decreasing excessive or abnormal spinal movement, is the rationale for many commonly used treatments ranging from ‘lumbar stabilization’ rehabilitation to spinal fusion surgery. The spinal degenerative cascade is an important theory related to the concept of spine stability, and was originally popularized by Kirkaldy-Willis. Kirkaldy-Willis described a ‘cascade’ of degenerative changes affecting the three joint complex comprised of the intervertebral disc anteriorly and the lumbar zygapophyseal (‘facet’) joints posteriorly. This degenerative cascade consists of three sequential clinical stages: 1) dysfunction, 2) instability, and 3) stabilization. Kirkaldy-Willis described a mutual interrelationship of the intervertebral disc and facet joints, and pointed out that precipitating events in degeneration could begin not only with the intervertebral disc, but also with the facet joints.

Over time, however, the sequence of spinal degeneration has often been viewed from a more limited standpoint, with the perspective that anterior structure changes affecting the intervertebral disc largely precede- and lead to- posterior structure changes affecting the facet joints. The notion that degeneration begins with the intervertebral disc is described in textbooks of spine care and has been supported by some research studies. Vernon-Roberts conducted a landmark study of fewer than 100 cadaveric specimens that found that degenerative disc changes were always accompanied by facet joint degenerative changes. This study concluded that disc degeneration was the primary event leading to degenerative spondylosis. In an imaging study of 68 subjects with low back pain, Butler et al. also found that facet joint degeneration did not occur in the absence of disc degeneration, but disc degeneration frequently occurred without facet joint degeneration. Butler concluded that discs degenerate before facets. These conclusions were further supported by a recent cross-sectional MRI study of individuals with low back pain. Some authors, however, have questioned the view that disc degeneration necessarily precedes facet degeneration. A prior report notes that facet arthrosis on MRI precedes disc degeneration in 20% of men. Furthermore, in a large study of skeletal specimens (n = 647), Eubanks et al. found that facet joint osteoarthritis often preceded changes of disc degeneration in younger individuals.

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January 14, 2012

Neck pain: manipulation of your neck and upper back leads to quicker recovery

Filed under: Chiropractic,Neck Pain — Administrator @ 5:23 am

Neck pain: manipulation of your neck and upper back leads to quicker recovery

From: J Orthop Sports Phys Ther. 2012;42(1):21.

Neck pain is very common and fortunately resolves quickly in most individuals. However, in certain cases neck pain can last longer and result in chronic pain, limited neck motion, and disability. In fact, chronic neck pain is the second leading cause of workers’ compensation claims in the United States. Treatments that can quickly reduce pain, increase motion, and improve the ability of the muscles to protect the neck may help decrease long-term disability associated with neck pain. A variety of manual therapy treatments are currently used to manage neck pain. These treatments include mobilization, which slowly and repeatedly moves the neck joints and muscles, and manipulation, which delivers a single, small, quick movement to the joints and muscles.

Researchers treated 107 patients. About half of these patients received a manipulation of the neck, on the part closest to the head, and of the upper back. The other patients received manual therapy that mobilized the spine without using manipulation. After 48 hours, the patients who received the manipulation treatment experienced a 58% decrease in pain and a 50% decrease in disability. By contrast, patients who received the mobilization treatment only had a 13% decrease in pain and actually showed a 13% increase in disability. In addition, the patients who received the manipulation had increased motion and improved control of their neck muscles compared to the patients in the mobilization group. The researchers concluded that the combination of upper neck and back manipulation was more effective in the first 48 hours of treatment than the mobilization treatment. Potential benefits include less pain, better neck motion, and improved ability to perform daily activities.

Chiropractors have known this for decades! Unfortunately, assimilation by the medical profession is a priority and ultimately relates to greed through political means.

Source: Neck pain: manipulation of your neck and upper back leads to quicker recovery

January 12, 2012

Ten-year survey reveals differences in GP management of neck and back pain

Filed under: Back Pain,Neck Pain — Administrator @ 11:51 am

Ten-year survey reveals differences in GP management of neck and back pain

From: Eur Spine J. 2012 Jan 8. [Epub ahead of print]

Clinical guidelines provide similar recommendations for the management of new neck pain and low back pain but it is unclear if general practitioner’s (GP) care is similar. While GP’s management of low back pain is well documented, little is known about GP’s management of neck pain. We aimed to describe GP’s management of new neck pain and compare this to GP’s management of new low back pain in Australia between April 2000 and March 2010. All GP-patient encounters for a new (i.e. first visit to any medical practitioner) neck pain or low back pain problem were compared in terms of treatment delivered, referral patterns and requests for laboratory and imaging investigations.

General practitioners in Australia have managed new neck pain and low back pain problems at a rate of 3.1 and 5.8 per 1,000 GP-patient encounters, respectively. GP’s primarily utilised medications, in particular non-steroidal anti-inflammatory drugs, to manage new neck and low back pain problems and referred approximately 25% of all patients for imaging. Patients with new neck pain are more frequently managed using physical treatments and were referred more often to allied health professionals and specialists. In comparison, patients with new low back pain were managed more frequently with medication, advice, provision of a sickness certificate and ordering of pathology tests.

This is the first time GP management of a new episode of neck pain has been documented using a nationally representative sample and it is also the first time that the management of back and neck pain has been compared. Despite guidelines endorsing a similar approach for the management of new neck pain and low back pain, in actual clinical practice Australian GPs manage these two conditions differently.

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