Neck Solutions Blog

September 8, 2011

Does the region of pain influence the presence of sensorimotor disturbances in neck pain disorders

Filed under: Neck Pain,Posture,Whiplash — Administrator @ 4:12 am

Does the region of pain influence the presence of sensorimotor disturbances in neck pain disorders?

From: Man Ther. 2011 Sep 2. [Epub ahead of print]

Neck pain disorders are common in society and are a significant source of activity limitation in workers. Impairments in sensorimotor features such as eye movement control, cervical joint position sense and postural stability, affecting balance, have been found in association with persistent neck pain of both insidious and traumatic origins. These symptoms can arise from disturbances of cervical afferent input to the sensorimotor control system.

There is anatomical and physiological evidence to suggest that cervical afferents from the upper cervical region make a greater contribution to sensorimotor control than the lower cervical region. Cervical afferents are abundant in the upper cervical region especially in the deep suboccipital muscles. For example, the suboccipital muscles have up to 240 muscle spindles per gram of muscle, far greater than the deep muscles of lower levels (C5–C7) such as longus colli (49 muscle spindles per gram) and multifidus (24 muscle spindles per gram). The deep suboccipital muscles are also quite unique in their morphology, demonstrating a marked number of slow twitch fibres when compared to the lower cervical region, which makes them highly suitable as proprioceptive monitors. Similarly, reflex connections between the neck, visual and vestibular systems, relating to head and eye movement control as well as postural stability, arise primarily from the upper cervical region. Connections between the cervical afferents and the central nervous system, such as the central cervical nucleus and cerebellum, are also predominantly influenced by receptors in the deep upper cervical suboccipital muscles and many descending systems implicated in the control of head movement have the most dense projections into the upper 2 cervical segments. In contrast, very few projections to and from the lower cervical segments have been identified. Thus it could be proposed that sensorimotor disturbances would be greater in patients with neck pain originating from the richly innervated upper cervical structures when compared to patients presenting with a pain condition originating from the lower cervical region.

To date, sensorimotor dysfunction purported to relate primarily to disturbed cervical afferent input, has been demonstrated in patients with both idiopathic and whiplash injury induced neck pain, with evidence that disturbances are greater in the latter. However to date, no investigation has been undertaken to determine whether there are any differences in impairments of balance, joint position sense or eye movement control in individuals with a disorder clinically attributable to the upper cervical region compared to those with a disorder clinically attributable to the lower cervical region. This study addressed this issue with the hypothesis that individuals with upper cervical region pain would have greater impairments in balance, joint position sense and eye movement control than those with lower cervical region pain, taking the onset of injury (traumatic or non-traumatic) into account. Such knowledge could help to understand the causes of sensorimotor disturbances associated with neck pain and may ultimately guide the assessment and management of these disturbances in patients with neck disorders.

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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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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 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.

June 28, 2011

Effects of passive correction of scapular position on pain, proprioception, and range of motion in neck-pain patients with bilateral scapular downward-rotation syndrome

Filed under: Neck Pain,Posture — Administrator @ 3:49 am

Effects of passive correction of scapular position on pain, proprioception, and range of motion in neck-pain patients with bilateral scapular downward-rotation syndrome

From: Man Ther. 2011 Jun 24. [Epub ahead of print]

Normal scapular alignment is required for optimal scapulohumeral motions. Scapular alignment is an indicator of possible changes in muscle length and joint position. Bunch and Siegel described a standard for scapular alignment, which specifies that the vertebral border of the scapula is parallel to the spine and is positioned approximately 3 inches from the midline of the thorax. The scapula is situated on the thorax between the second and seventh thoracic vertebrae; it lies flat against the thorax and rotates 30° anterior to the frontal plane.

Previous investigators have described how changes in alignment or movement in shoulder regions has the potential to alter the biomechanics of the cervical spine and produce neck pain. Impairments in scapular alignment are believed to be correlated with specific movement related diagnoses and they provide clues on the cervicoscapular muscle length. Impaired alignment of the scapula may be classified as scapular downward rotation, depressed, elevated, adducted, abducted, tilted, or winged. Scapular downward rotation is defined as a downwardly rotated scapula with the inferior border being more medial than the superior border; the shoulder is lower and slopes downward at the acromial end. Scapular downward rotation can contribute to prolonged compressive loading of the neck as a result of the transfer of the weight of the upper extremities to the cervical region through the attachments of the cervicoscapular muscles (upper trapezius and levator scapulae). Increased upper trapezius muscle length in scapular downward rotation does not effectively transfer the weight of an upper extremity load to the sternoclavicular joint, and increased levator scapulae muscle stiffness may contribute increased compressive load and shear force on the cervical spine during active neck movement. Repetitive and excessive stress in the neck structures has the potential to cause cumulative microtrauma to tissue in the cervical region, neck pain, and limited neck rotation range of motion. Together with pain, a common feature of neck disorders is reduced range of motion of the neck.

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June 18, 2011

Neck-upper extremity musculoskeletal disorders among workers in the telecommunications company at mansoura city

Filed under: Carpal Tunnel,Neck Pain,Posture,Shoulder Pain — Administrator @ 5:05 am

Neck-upper extremity musculoskeletal disorders among workers in the telecommunications company at mansoura city

From: Int J Occup Saf Ergon. 2011;17(2):195-205

Persisting neck pain is common in society. It has been reported that the prevalence of neck pain in office workers is much higher than in the general population. The costs to the worker, employer and society associated with work-related neck pain are known to be considerable and are escalating.

Neck and upper limb symptoms are frequently reported by computer workers. More than 50% of the computer workers report symptoms in neck, shoulders, arms, wrists or fingers. In the year 2002, 28% of the general Dutch working population suffered from pain or stiffness in the neck, shoulder, arms, hands or wrists in the previous 12 months. In Europe the prevalence for work-related neck/shoulder pain was 25% and 15% for work-related arm pain. The total yearly costs of neck and upper limb symptoms in the Netherlands due to decreased productivity, sick leave, chronic disability for work and medical costs were recently estimated at 2.1 billion euros.

The increase in computer and mouse use has been associated with an increased prevalence of disorders in the neck and upper extremities. Poor workstation design, continuous computer use for the entire workday and repetitive computer work, such as data entry, were associated with an increased risk of developing symptoms. It has also been shown that the musculoskeletal disorders associated with computer mouse use are increasing.

A positive relation has been found between various neck disorders and work related risk factors, such as static neck and arm postures, duration of sitting, as well as workplace design. Among other job characteristics, high quantitative job demands, having little influence on one’s work situation, and limited rest break opportunities have been found as predictors of neck pain.

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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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April 29, 2011

Effects of postural and visual stressors on myofascial trigger point development and motor unit rotation during computer work

Filed under: Neck Pain,Posture — Administrator @ 2:00 pm

Effects of postural and visual stressors on myofascial trigger point development and motor unit rotation during computer work

From: J Electromyogr Kinesiol. 2011 Feb;21(1):41-8. Epub 2010 Jun 26

The nature of modern work is changing and physically demanding jobs are now being replaced with many more service oriented jobs that require work at low levels of physical loading. More specifically, computer work at visual display terminals is becoming much more prominent in the workplace and at home. According to the Bureau of Labor Statistics (BLS), 77 million Americans use a computer at work. This represents over half of the total employed American public. In addition, with continual technological advances, future work trends indicate that this type of work is expected to represent an even greater percentage of jobs in the future.

Despite this shift, musculoskeletal complaint rates continue to be high among computer users. Studies have reported musculoskeletal disorder prevalence rates of 20% to over 75% among these types of workers. However, our understanding of the causal mechanisms leading to such high prevalence rates among computer users is lacking.

It is known that the physical demands for computer work are much different than those required during typical manufacturing and industrial tasks. Computer tasks typically require much lower levels of physical force and more mental processing than industrial work. In terms of physical demand, computer work imposes low-level static exertions on the musculoskeletal system. An important aspect of these types of exertions is that the muscle is rarely (if ever) able to relax completely; therefore, the duration of sustained contraction is thought to be a critical component for musculoskeletal disorder risk. Originally, it was thought that these low-level static exertions could be maintained for an unlimited amount of time. However, experience and research may contradict this belief.

There is growing concern that low-level static exertions (at any level) pose risk to workers, but there is no consensus as to ‘‘how much” force can be maintained for ‘‘how long”. This lack of consensus is believed to be due to the poor understanding of the underlying mechanisms through which the health effects occur.

In addition to physical demand, computer work also imposes high mental demands on users. Visual information must be processed, interpreted, and reacted to in a very short period of time, resulting in high cognitive demands on workers. Visual parameters such as glare, lighting, screen resolution, or text legibility may directly impact cognitive demands during computer work. However, it is not clear how these visual and mental demands might impact the musculoskeletal system, and translate into physical symptoms. Studies have shown that increased mental demand may result in greater muscle co-contraction and sustained muscle activation. However, such results do not fully explain the casual pathway for pain and discomfort during computer work.

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April 22, 2011

A Medical-Ergonomic Program for Symptomatic Keyboard/Mouse Users

Filed under: Neck Pain,Posture,Shoulder Pain — Administrator @ 4:21 am

A Medical-Ergonomic Program for Symptomatic Keyboard/Mouse Users.

From: J Occup Environ Med. 2011 Apr 19. [Epub ahead of print]

To describe the range of ergonomic stressors and effective interventions in otherwise healthy patients diagnosed with upper extremity disorders associated with occupational keyboard/mouse use. Work-related musculoskeletal disorders are widespread among computer users and costly to the health care system. Workstation setup and worker postures contribute to upper-extremity and neck symptoms among computer users. Ergonomic interventions such as work risk analysis and workstation modifications can improve workers’ symptoms

From patients treated in their Medical Ergonomic Program, they report demographic data, symptoms, signs, diagnoses and associated ergonomic stressors and response to medical/ergonomic interventions.

Fifty-six patients had a mean age (range) of 40 (23-61) years with 20 patients younger than 35 years. The most prevalent diagnoses were myofascial pain syndrome of shoulder and neck associated with poor posture, myofascial pain syndrome of forearm extensors followed by thoracic outlet syndrome and carpal tunnel syndrome. Common ergonomic stressors were typing/mousing technique, keyboard height, inadequate seating, and lack of breaks. Improvement occurred in 89% following medical/ergonomic intervention.

Ergonomic education/intervention must be combined with the medical treatment of work-related upper extremity disorders associated with keyboard/mouse use. This lends credence to the importance of examining the work habits and work-related postures of a patient who complains of upper-extremity and neck pain that is exacerbated by work. Providing an ergonomic intervention in concert with traditional physical therapy may be the most beneficial course of treatment.

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