Neck Solutions Blog

Reduced head steadiness in whiplash compared with non traumatic neck pain

From: J Rehabil Med. 2010 Jan;42(1):35-41

While sensorimotor alterations have been observed in patients with neck pain, it is uncertain whether such changes distinguish whiplash associated disorders from chronic neck pain without trauma. The aim of this study was to investigate head steadiness during isometric neck flexion in subjects with chronic whiplash associated disorders, those with chronic non traumatic neck pain and healthy subjects. Associations with fatigue and effects of pain and dizziness were also investigated.

Head steadiness in terms of head motion velocity was compared in subjects with whiplash (n=59), non traumatic neck pain (n=57) and healthy controls (n=57) during 2 40-s isometric neck flexion tests; a high load test and a low load test. Increased velocity was expected to reflect decreased head steadiness.

The whiplash group showed significantly decreased head steadiness in the low load task compared with the other 2 groups. The difference was explained largely by severe levels of neck pain and dizziness. No group differences in head steadiness were found in the high load task.

Reduced head steadiness during an isometric holding test was observed in a group of patients with whiplash associated disorders. Decreased head steadiness was related to severe pain and dizziness.

More Information: Altered motor control patterns in whiplash and chronic neck pain

The main function of the neck is to work as a stable base of support for the head with simultaneous control of head movements. A number of studies have shown alterations in motor control and cervical movement patterns associated with neck pain conditions. There is consistent documentation of reduced standing balance and increased sway in patients with whiplash associated disorders compared with healthy subjects. Small differences have, however, been found between patients with whiplash associated disorders and non traumatic neck pain, but only for difficult balance tasks. It remains unclear whether whiplash associated disorders can be distinguished from non traumatic neck pain in terms of more neck specific motor control strategies. In patients with chronic neck pain, changes in cervical muscle activation patterns in terms of delayed onset in deep cervical flexors and increased activation of superficial neck muscles have been reported. During dynamic movements, patients with neck pain have shown more jerky cervical movement patterns and irregular motion curves compared with healthy controls. Stiffer neck movement patterns during cervical rotation were related to chronic neck pain but did not distinguish patients with whiplash associated disorders from those with chronic neck pain. During specific isometric loading, cranio-cervical flexor muscles have shown decreased contraction steadiness in patients with neck pain. These irregularities indicate sensorimotor control impairments in neck pain, but the effect of trauma is uncertain, as is the knowledge of motor control strategies during isometric holding.

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