Neck Solutions Blog

February 14, 2012

Long periods with uninterrupted muscle activity related to neck and shoulder pain

Filed under: Neck Pain,Shoulder Pain — Administrator @ 10:07 am

Long periods with uninterrupted muscle activity related to neck and shoulder pain

From: Work. 2012 Jan 1;41(0):2535-8

The aim was to analyze the relationship between periods with uninterrupted neck muscle activity for ≥4 min and neck and shoulder pain. The trapezius muscle activity was recorded bilaterally on 40 young workers and students during a full shift. Neck and shoulder pain, mechanical work load and decision control were reported at the same time as the muscle activity recording and 6 months later. A dose-response relationship was found between uninterrupted muscle activity and neck and shoulder pain, with a ten-fold higher risk for the group with more than half, compared to less than a third, of the shift with uninterrupted muscle activity. Self-reported mechanical work load showed a small but protective effect related to pain. Gender and decision control did not emerge as important risk factors in this model. In conclusion, this study indicates that work or other exposures that contains long periods with uninterrupted neck muscle activity of 4 min duration or longer should be minimized to reduce risk of neck and shoulder pain.

Long periods with uninterrupted muscle activity related to neck and shoulder pain

February 12, 2012

Notebook computer use with different monitor tilt angle: effects on posture, muscle activity and discomfort of neck pain users

Filed under: Neck Pain,Posture — Administrator @ 5:25 am

Notebook computer use with different monitor tilt angle: effects on posture, muscle activity and discomfort of neck pain users.

From: Work. 2012 Jan 1;41(0):2591-5

This study aimed to evaluate the posture, muscle activities, and self reported discomforts of neck pain notebook computer users on three monitor tilt conditions: 100°, 115°, and 130°. Six subjects were recruited in this study to completed typing tasks. Results showed subjects have a trend to show the forward head posture in the condition that monitor was set at 100°, and the significant less neck and shoulder discomfort were noted in the condition that monitor was set at 130°. These result suggested neck pain notebook user to set their monitor tilt angle at 130°.

February 10, 2012

Can a functional postural exercise improve performance in the cranio-cervical flexion test

Filed under: Neck Pain,Posture — Administrator @ 11:57 am

Can a functional postural exercise improve performance in the cranio-cervical flexion test? – A preliminary study.

Man Ther. 2012 Feb 4. [Epub ahead of print]

There is considerable evidence that neck pain is associated with alterations in spatial and temporal behaviors of the neck muscles and changes in muscle properties. Changes have been identified in various neck and axio-scapular muscles and the neck flexors have received particular attention. There is some functional specificity between superficial and deep flexors. Superficial muscles, sternocleidomastoid and anterior scalenes are major contributors to flexion torque while deep neck flexor muscles (longus capitis and colli) have an important role in supporting the normal neck curve and segments in posture and movement.

Of clinical and functional relevance, reduced activation of the deep neck flexor muscles has been identified in association with increased activation of the superficial flexor muscles in studies using the cranio cervical flexion test in patients with a variety of neck disorders. The evidence of reduced deep neck flexor activity comes from laboratory studies using a direct measure of electromyographic (EMG) amplitudes. A number of clinical studies have limited measurement to sternocleidomastoid activity using surface EMG electrodes and have indirectly inferred reduced deep neck flexor function on the evidence of an inverse relationship between sternocleidomastoid, anterior scalenes and deep neck flexor muscle activity from laboratory measures of neck pain patients.

Training the deep neck flexor muscles is regarded as an important component of neck rehabilitation programs because of the functional importance of the deep neck flexor and the evidence suggesting that the altered pattern of activation between the deep and superficial flexors (1) does not correct automatically with pain relief and (2) persists without specific training. Many factors influence the magnitude of neck pain. It is uncertain whether changes in muscle function are a cause or effect of pain, but a relationship has been shown between neck pain intensity and activity in the deep (lesser) and superficial (greater) neck flexor muscles. Concomitantly, the degree of pain reduction in patients with chronic neck pain has a relationship with the change in deep neck flexor activity following training. Clinical trials also support the effectiveness of training the deep neck flexor muscles and restoring their normal temporal relationship with the superficial flexors as a component of a multimodal program for the rehabilitation of neck pain disorders.

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February 7, 2012

Low back pain and neck pain as predictors of sickness absence among municipal employees

Filed under: Back Pain,Neck Pain — Administrator @ 9:45 am

Low back pain and neck pain as predictors of sickness absence among municipal employees

From: Scand J Public Health. 2012 Feb 3. [Epub ahead of print]

To study whether having ever had local low back pain, sciatica, neck pain, or some combination of low back pain and neck pain, predicts sickness absence among municipal employees. The study sample (n=6911, 80% women, response rate 67%) included employees of the City of Helsinki who reached the age of 40, 45, 50, 55, or 60 years between 2000-02. Survey data on pain, working conditions, and health behaviours were linked to register data on sickness absence for three subsequent years. Sickness absence was categorised as self-certified (lasting for 1-3 days) and medically certified (lasting for 4 days or more) and the number of spells during the follow up was analysed using Poisson regression analysis.

In women, medically certified sickness absence was predicted by sciatica, neck pain and the combination of sciatica and neck pain, allowing for working conditions, body mass index, and smoking. Local low back pain did not predict medically certified sickness absence. Self-certified sickness absence was modestly predicted by all pain categories and by neck pain alone and with local low back pain or sciatica in men.

Medically certified sickness absence was predicted by sciatica and neck pain, but not by local low back pain. The association was accentuated in those with both sciatica and neck pain. Pain combinations may have a stronger effect on work ability than pain in one location.

February 4, 2012

Cervical radiculopathy: Study protocol of a randomised clinical trial evaluating the effect of mobilisations and exercises targeting the opening of intervertebral foramen

Filed under: Neck Pain — Administrator @ 6:15 am

Cervical radiculopathy: Study protocol of a randomised clinical trial evaluating the effect of mobilisations and exercises targeting the opening of intervertebral foramen

From: BMC Musculoskelet Disord. 2012 Jan 31;13(1):10. [Epub ahead of print]

Cervical or neck pain is a general term used to designate any musculoskeletal disorder in the cervical region. Various pathologies encompass that generic definition and are most commonly related to degenerative changes or inflammation of cervical structures such as intervertebral discs, articular facets joints or nerve roots. Neck pain is a very common, disabling and costly condition. According to a review by the Neck Pain Task Force pertaining the prevalence of neck pain in industrialised countries, annual prevalence is situated within 30 to 50% in adult populations. In accordance with these results, in Canada, a bi-annual prevalence of 54% has been reported.

Cervical radiculopathy forms an important subgroup of neck disorders and, although less prevalent than general neck pain, it has been shown to lead to more severe pain and disability. Cervical radiculopathy primarily results from an inflammation of a cervical nerve root induced by a lesion reducing the intervertebral foramen. This reduction is primarily induced by a herniated disc or a degenerative lesion of zygapophysial joints. Typical symptoms of cervical radiculopathy include pain in the cervical or periscapular region and in the upper limb, as well as neurological signs such as paresthesia, numbness, weakness and loss of reflexes in the affected nerve root distribution.

The diagnosis of cervical radiculopathy is commonly made through patient history and physical examination. A a positive response to the following four clinical tests results in a high predictive value for a diagnosis of cervical radiculopathy: 1 – cervical distraction test, 2 – upper limb tension test, 3 – Spurling test, and 4 – ipsilateral cervical rotation reduced by more than 60 degrees. If all four of these tests are positive, the positive likelihood ratio (LR+) of having a cervical radiculopathy is 30. If three out of these four tests are positive, the LR+ decreases to 6. A LR+ superior to 10 is considered large, and between 5 and 10 moderate; thus, it increases the possibility that the impairment in question is present. Hence, by combining these clinical tests, the possibility of obtaining a good clinical diagnostic accuracy in patients presenting signs and symptoms compatible with cervical radiculopathy is high.

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February 2, 2012

Epidemiology: Spinal manipulation utilization

Filed under: Chiropractic,General Health — Administrator @ 8:04 am

Epidemiology: Spinal manipulation utilization

From: J Electromyogr Kinesiol. 2012 Jan 28. [Epub ahead of print]

The objectives of this article are to (1) describe spinal manipulation use by time, place, and person, and (2) identify predictors of the use of spinal manipulation. We conducted a systematic review of the English-language literature published from January 1, 1980 through June 30, 2011. Of 822 citations identified, 213 were deemed potentially relevant; 75 were included after further consideration. Twenty-one additional articles were identified from reference lists. The literature is heavily weighted toward North America, Europe, and Australia and thus largely precludes inferences about spinal manipulation use in other parts of the world.

In the regions covered by the literature, chiropractors, osteopaths, and physical therapists are most likely to deliver spinal manipulation, often in conjunction with other conservative therapies. Back and neck pain are the most frequent indications for receiving spinal manipulation; non-musculoskeletal conditions comprise a very small percentage of indications. Although spinal manipulation is more commonly used in adults than children, evidence suggests that spinal manipulation may be more likely used for non-musculoskeletal ailments in children than in adults. Patient satisfaction with spinal manipulation is very high.

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

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