Neck Solutions Blog

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.

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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.

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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

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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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January 10, 2012

Clinical and medicolegal characteristics of neck injuries

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

Clinical and medicolegal characteristics of neck injuries

From: Coll Antropol. 2011 Sep;35 Suppl 2:187-90

The predominance in performing surgery of major spine injuries by neurosurgeons usually has the consequence of treating all types of spine injuries by neurosurgeons – neurotraumatologists. In the neurosurgical wards of Clinical Hospital Rijeka, the authors take care of the majority of these patients, following both the major, as well as minor whiplash injuries of the neck. The article overviews patients admitted in the one year period (October 1st 2009-October 1st 2010) where 1077 cases of neck injuries were analyzed. Vast majority of these injuries were due to traffic accidents (over 94%), and only a small proportion were serious injuries that needed a surgical approach decompression and stabilization (c1%). The authors analyzed minor neck injuries thoroughly both because of the increasing number of whiplash neck injuries and because more complicated diagnostic and therapeutic protocols occupy too much time in the ambulatory practice of neurotraumatologists each year thus representing a growing financial burden to the health organizations and to the society as a whole.

The results proved that the majority of the injured are male (over 60%), young and active (almost two thirds 21-40 years of age), had commonly sustained a Quebec Task Force (QTF) injury of grades 2 and 3 (almost 90%), and, if properly treated, recovered completely after a mean therapy period of ten weeks. Only a minority complained of prolonged residual symptoms, some of them connected with medico-legal issues (less than 20%). The results shown are in contrast with the general opinion that malingerers in search of financial compensation prevail in these cases, and leads to the conclusion that minor neck injuries (including whiplash) as well as Whiplash Associated Disorder are real traumatological entities, that have to be seriously dealt with.

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January 8, 2012

Prevalence, characteristics, and work-related risk factors of low back pain among hospital nurses in Taiwan

Filed under: Back Pain — Administrator @ 5:40 am

Prevalence, characteristics, and work-related risk factors of low back pain among hospital nurses in Taiwan: A cross-sectional survey

From: Int J Occup Med Environ Health. 2012 Mar;25(1):41-50. Epub 2012 Jan 5

Low back pain is a common health problem among hospital nurses. However, the prevalence, characteristics, and work-related risk factors of low back pain have not been widely investigated in Taiwan.

This study used a cross-sectional survey of 217 hospital nurses to gather self-reported information on the prevalence of back pain, demographic and pain characteristics, and work-related risk factors from 178 respondents who indicated a past history of back pain. The association between the characteristics of back pain and work-related risk factors was also examined.

The lifetime prevalence of back pain was 82.03%, and the point prevalence of back pain was 43.78%. The mean pain score is 41.67. The number of years at work was significantly associated with the pain score for an individual’s most recent episode of back pain, the extent of bothersomeness of back pain and leg pain, and the extent to which back pain interfered with normal work.

Back pain is common among hospital nurses in Taiwan. Years at work are significantly associated with pain severity and disability caused by back pain.

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January 6, 2012

Spinal Manipulation, Medication, or Home Exercise With Advice for Acute and Subacute Neck Pain

Filed under: Neck Pain — Administrator @ 11:29 am

Spinal Manipulation, Medication, or Home Exercise With Advice for Acute and Subacute Neck Pain A Randomized Trial

From: Ann Intern Med. 2012 Jan 3;156

Neck pain is a prevalent condition that nearly three quarters of persons experience at some point in their lives. One of the most commonly reported symptoms in primary care settings, neck pain results in millions of ambulatory health care visits each year and increasing neck health care costs. Although it is not life-threatening, neck pain can have a negative effect on productivity and overall quality of life.

Chiropractors, physical therapists, osteopaths, and other neck health care providers commonly apply spinal manipulation, a manual therapy, for neck pain conditions, and home exercise programs and medications are also widely used. Recent Cochrane reviews report insufficient evidence to assess the effectiveness of commonly used medications or home exercise programs for the treatment of acute neck pain. The evidence for spinal manipulation is similarly limited, with only low-quality evidence supporting its use for neck pain of short duration.

The goal was to test the hypothesis that spinal manipulation therapy is more effective than medication or home exercise with advice (neck exercises) for acute and subacute neck pain.

Neck exercises with advice was provided in two 1-hour sessions, 1 to 2 weeks apart, at the universityaffiliated outpatient clinic. Six therapists provided instruction to participants. The primary focus was simple selfmobilization exercise (gentle controlled movement) of the neck and shoulder joints, including neck retraction, extension, flexion, rotation, lateral bending motions, and scapular retraction, with no resistance. The delivery method was 1-on-1, and the program was individualized to each participant’s abilities, tolerance, and activities of daily living.

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January 3, 2012

Chronic trauma-induced neck pain impairs the neural control of the deep semispinalis cervicis muscle

Filed under: Neck Pain — Administrator @ 10:04 am

Chronic trauma-induced neck pain impairs the neural control of the deep semispinalis cervicis muscle

From: Clin Neurophysiol. 2011 Dec 27. [Epub ahead of print]

The deep cervical extensors show structural changes in patients with neck pain however their activation has never been investigated in patients. This study is the first to present neurophysiological data from the deep semispinalis cervicis muscle in patients.

Ten women with chronic neck pain and 10 healthy controls participated. Activity of the semispinalis cervicis was measured as subjects performed isometric contractions at 15 and 30N force with continuous change in force direction in the range 0-360°. Tuning curves of the EMG amplitude (average rectified value, ARV) were computed and the mean point of the ARV curves defined a directional vector, which determined the directional specificity of the muscle activity.

Patients displayed reduced directional specificity of the semispinalis cervicis. Furthermore, the EMG amplitude during the circular contraction was lower for the patients compared to controls.

The activity of the semispinalis cervicis muscle is reduced and less defined in patients with neck pain confirming a disturbance in the neural control of this muscle. This finding suggests that exercises that target the deep semispinalis cervicis muscle may be relevant to include in the management of patients with neck pain.

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