Neck Solutions Blog

January 1, 2012

Predictors of neck pain after motor vehicle collisions

Filed under: Neck Pain,Whiplash — Administrator @ 10:05 am

Predictors of neck pain after motor vehicle collisions: a prospective survey.

From: J Orthop Surg (Hong Kong). 2011 Dec;19(3):317-21

Neck pain is the most frequent injury sustained by motor vehicle occupants in the USA. In developed countries, claims for whiplash injury cost billions of dollars each year. Neck pain after motor vehicle injury may involve the intervertebral discs, facet joints, and the spinal cord, and is associated with atypical manifestations of carpal tunnel syndrome.

No theory for whiplash based on physical damage has been widely accepted. The prevalence of neck pain in uninjured controls is similar. Changes in the incidence of whiplash has been noted after legislative changes. Such observations have led to the proposal of alternative theories implicating psychosocial factors in neck pain after motor vehicle collisions.

Non-physical factors attributing to the development of whiplash include compensation, litigation and legislation, blame, post-traumatic stress, and symptom expectation. Many related studies have been retrospective, have used insurance data that may be unreliable, have used secondary outcomes measures (return to work or case closure), and were prone to selection bias by only including patients seeking compensation.

The authors identified possible psychosocial predictors of neck pain in patients with acute injuries following motor vehicle trauma.

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December 29, 2011

Tinnitus severity and its association with cognitive and somatic anxiety

Filed under: Tinnitus — Administrator @ 4:48 am

Tinnitus severity and its association with cognitive and somatic anxiety: a critical study.

From: Eur Arch Otorhinolaryngol. 2011 Dec 23. [Epub ahead of print]

Tinnitus has been defined as a phantom auditory perception. Research indicates the necessity to make a distinction between the physical symptom and the subjective severity of the tinnitus symptom, since especially the latter seems to vary among patients. The relationship between tinnitus severity and psychological variables has been well established. Anxiety is considered to be an important variable for understanding the differences in the subjective tinnitus severity. Although many studies confirm the relationship between anxiety and tinnitus severity, most studies do not take the possibility of shared method variance and content overlap between questionnaires into account. Furthermore, anxiety is a broad concept and contains both a cognitive and somatic dimension.

Research including both dimensions of anxiety in tinnitus population is rare. According to the authors two conditions must be fulfilled before theorization on the relation is useful: (1) the presence of clinically relevant cognitive and/or somatic anxiety, (2) evidence of a substantial or “real” relationship. In this sample, almost 60% reported more than average cognitive anxiety and 40.8% reported clinical relevant somatic anxiety. After controlling for content overlap between the questionnaires used, the relation between tinnitus severity and cognitive and somatic anxiety remains significant. Two hypothetical models concerning this relationship that deserve future research attention are described in this article.

Tinnitus is a common problem in the population. With the aging of the population, the prevalence of tinnitus will increase. The prevention of tinnitus should focus on hearing impairment screening, otitis media treatment, and noise exposure reduction.

December 26, 2011

The impact of back problems on retirement wealth

Filed under: Back Pain — Administrator @ 2:56 pm

The impact of back problems on retirement wealth

From: Pain. 2012 Jan;153(1):203-10

This study undertook an economic analysis of the costs of early retirement due to back problems, with the aim of quantifying how much lower the value of accumulated wealth of individuals who exit the workforce early due to back problems is by the time they reach the traditional retirement age of 65years – compared to those who remained in the workforce. This was done using the output dataset of the microsimulation model Health&WealthMOD.

It was found that over 99% of individuals who are employed full time will have accumulated some wealth at age 65 years, whereas as little as 74% of those who are out of the labour force due to back problems will have done so. Those who retire from the labour force early due to back problems will have a median value of total accumulated wealth by the time they are 65 of as little as $3708 (for women aged 55-64years). This is far lower than the median value of accumulated wealth for those women aged 55-64 years who remained in the labour force full time, who will have $214,432 of accumulated wealth at age 65 years.

Not only will early retirement due to back problems limit the immediate income available to individuals, but it will also reduce their long-term financial capacity by reducing their wealth accumulation. Maintaining the labour force participation of those with back problems, or preventing the onset of the disease, should be a priority in order to maintain living standards comparable with others who do not suffer from this condition.

December 24, 2011

Screening of patients suitable for diagnostic cervical facet joint blocks

Filed under: Neck Pain — Administrator @ 5:21 am

Screening of patients suitable for diagnostic cervical facet joint blocks – A role for physiotherapists

From: Man Ther Journal, February 2012, Vol. 17, No. 1

The cervical facet joint is a prevalent source of pain in patients with chronic cervical spine pain. Patients with persistent, disabling neck pain, are increasingly being referred for diagnostic facet joint blocks, with the aim of assessing their suitability for interventional procedures such as radiofrequency neurotomy. A positive response to the block is an indicator of more substantive benefits from radiofrequency neurotomy. Physiotherapists and medical practitioners are challenged to make appropriate referrals for diagnostic facet joint blocks. This lack of selection contributes to lengthy wait-lists, unnecessary invasive procedures for those who have a negative response and significant costs to the health care system. Physiotherapists use manual examination to identify the facet joint as the primary source of a patient’s pain but its diagnostic accuracy and reliability is variable. It is reasoned that a combination of findings of a physical, manual and psychological assessment may better indicate that a patient will respond positively or negatively to a diagnostic facet joint block. Clinical prediction guides allow practitioners to use the results of the patient history, self-report measures and physical examination toward optimal diagnostic and therapeutic decisions. It is proposed that the development and validation of a clinical prediction guides may aid in the appropriate selection of patients for this diagnostic procedure

Cervical spine pain is a common condition encountered by physiotherapists and other medical professionals. Based on clinical examination alone, the specific etiology of neck pain can be difficult to diagnose. Nonetheless, in studies involving diagnostic facet joint blocks, the prevalence of facet joint mediated neck pain has been reported to range from 36% to 67%.

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December 22, 2011

Relative importance of expertise, lifting height and weight lifted on posture and lumbar external loading during a transfer task in manual material handling

Filed under: Back Pain,Posture — Administrator @ 3:23 pm

Relative importance of expertise, lifting height and weight lifted on posture and lumbar external loading during a transfer task in manual material handling

From: Ergonomics. 2012 Jan;55(1):87-102

The objective of this study was to measure the effect size of three important factors in manual material handling, namely expertise, lifting height and weight lifted. The effect of expertise was evaluated by contrasting 15 expert and 15 novice handlers, the effect of the weight lifted with a 15-kg box and a 23-kg box and the effect of lifting height with two different box heights: ground level and a 32 cm height. The task consisted of transferring a series of boxes from a conveyor to a hand trolley.

Lifting height and weight lifted had more effect size than expertise on external back loading variables (moments) while expertise had low impact. On the other hand, expertise showed a significant effect of posture variables on the lumbar spine and knees. All three factors are important, but for a reduction of external back loading, the focus should be on the lifting height and weight lifted.

The objective was to measure the effect size of three important factors in a transfer of boxes from a conveyor to a hand trolley. Lifting height and weight lifted had more effect size than expertise on external back loading variables but expertise was a major determinant in back posture.

December 20, 2011

Cervico-ocular coordination during neck rotation is distorted in people with whiplash-associated disorders

Filed under: Whiplash — Administrator @ 3:33 am

Cervico-ocular coordination during neck rotation is distorted in people with whiplash-associated disorders

From: Exp Brain Res. 2011 Dec 17. [Epub ahead of print]

People with whiplash associated disorders not only suffer from neck/head pain, but commonly report deficits in eye movement control. Recent work has highlighted a strong relationship between eye and neck muscle activation in pain-free subjects. It is possible that whiplash associated disorders may disrupt the intricate coordination between eye and neck movement. Electromyographic activity (EMG) of muscles that rotate the cervical spine to the right (left sternocleidomastoid, right obliquus capitis inferior, right splenius capitis and right multifidus) was recorded in nine people with chronic whiplash associated disorders. Cervical rotation was performed with five gaze conditions involving different gaze directions relative to cervical rotation.

The relationship between eye position/movement and neck muscle activity was contrasted with previous observations from pain-free controls. Three main differences were observed in whiplash associated disorders. First, the superficial muscle right splenius capitis was active with both directions of cervical rotation in contrast to activity only with right rotation in pain-free controls. Second, activity of right obliquus capitis inferior and right multifidus varied between directions of cervical rotation, unlike the non-direction-specific activity in controls. Third, the effect of horizontal gaze direction on neck muscle EMG was augmented compared to controls.

These observations provide evidence of redistribution of activity between neck muscles during cervical rotation and increased interaction between eye and neck muscle activity in people with whiplash associated disorders. These changes in cervico-ocular coordination may underlie clinical symptoms reported by people with whiplash associated disorders that involve visual deficits and changes in function during cervical rotation such as postural control.

December 17, 2011

Alteration in Sleep Quality in Patients with Mechanical Insidious Neck Pain and Whiplash-Associated Neck Pain

Filed under: Neck Pain,Whiplash — Administrator @ 4:55 am

Alteration in Sleep Quality in Patients with Mechanical Insidious Neck Pain and Whiplash-Associated Neck Pain

From: Am J Phys Med Rehabil. 2011 Dec 14. [Epub ahead of print]

This study aimed to determine differences in sleep quality between patients with mechanical neck pain, patients with whiplash pain, and healthy controls and to determine the relationship between the intensity of ongoing pain, disability, and sleep quality.

Nineteen patients with mechanical neck pain (4 men, 15 women; age, 40 ± 16 yrs), 22 with whiplash (4 men, 18 women; age, 38 ± 15 yrs), and 18 comparable controls (4 men, 14 women; age, 41 ± 13 yrs) completed the Pittsburgh Sleep Quality Index to assess sleep quality. A numerical pain rate scale (0-10) and the Neck Disability Index (0-50) were collected for assessing neck pain and disability.

Significant differences in sleep quality, sleep latency, sleep efficiency, sleep disturbances, use of sleeping medication, daytime dysfunction, and total Pittsburgh Sleep Quality Index score but not for sleep duration were found; patients with mechanical neck pain and whiplash pain exhibited higher scores in all components compared with healthy controls. Seventeen (77%) patients with whiplash and 13 (68%) with mechanical neck pain reported poor sleep quality (Pittsburgh Sleep Quality Index score, >8). Significant positive correlations between mean intensity of ongoing pain with sleep quality; sleep duration; sleep efficiency and total Pittsburgh Sleep Quality Index score were found in patients with whiplash pain; the higher the intensity of ongoing pain, the worse the sleep quality.

Sleep disturbances are a common finding in individuals with neck pain and are associated with the intensity of ongoing pain in whiplash. It seems essential to address the ongoing cycle of pain and sleep disturbances as an integral part of the treatment of patients with neck pain.

December 15, 2011

Lumbosacral facet syndrome: functional and organic disorders of lumbosacral facet joints

Filed under: Back Pain — Administrator @ 10:34 am

Lumbosacral facet syndrome: functional and organic disorders of lumbosacral facet joints

From: Lijec Vjesn. 2011 Sep-Oct;133(9-10):330-6

Disorders of lumbosacral facet joints are manifested by low back pain with or without referred leg pain and decreased mobility of the lumbosacral spine (lumbosacral facet syndrome). The most frequent causes of lumbosacral facet syndrome are functional disorders (functional blockade or dysfunction of facet joint=reversible restriction of facet joint movements caused by meniscoid entrapment) and degenerative changes of facet joints while the others are less frequent (spondyloarthropathies, infection, tuberculosis, synovial cyst, injury). Although it has been proven that the facet joints are one of the most frequent sources of chronic low back pain (15-45%), the fact is that the facet syndrome has been frequently overlooked in patients with chronic low back pain.

Following are the main reasons for explaining why the facet syndrome has been overlooked in patients with chronic low back pain:

1. Facet joints disorders are manifested by non-specific clinical picture.

2. Diagnosis of facet syndrome cannot be established by either the conventional clinical examination or radiological examinations.

3. A very small number of doctors are practicing manual functional examination which can establish the diagnosis of facet joint dysfunction.

4. Diagnostic anesthetic block which can confirm the facet syndrome diagnosis is not a widely accessible method.

There is a lack of research in frequency of facet syndrome in patients with acute low back pain. Chronic mechanical low back pain caused by dysfunction of several structurally unchanged facet joints can have the same features as the inflammatory pain which can result in misdiagnosis of spondyloarthropathy. Acute lumbosacral facet syndrome caused by dysfunction of facet joints responds very well to manual therapy. The most important therapeutic options in patients with chronic lumbosacral facet syndrome caused by degenerative changes and/or dysfunction of facet joints are manual therapy, kinesiotherapy (flexion exercises), therapeutic blocks and radiofrequency denervation. The article describes etiopathogenesis, clinical manifestations, diagnosis, differential diagnosis and therapy of lumbosacral facet syndrome with emphasis on functional disorders of facet joints that can cause particular diagnostic and therapeutic problems.

December 13, 2011

The role of educational and learning approaches in rehabilitation of whiplash-associated disorders in lessening the transition to chronicity

Filed under: Whiplash — Administrator @ 11:11 am

The role of educational and learning approaches in rehabilitation of whiplash-associated disorders in lessening the transition to chronicity

From: Spine (Phila Pa 1976). 2011 Dec 1;36(25 Suppl):S280-5.

The aim of this study was to illustrate and discuss educational and learning perspectives in the rehabilitation of patients with acute whiplash associated disorders. Whiplash associated disorders is a major problem for the individual and the society. Several treatment options have been studied without giving convincing results for lessening the transition to chronicity. Current management of acute whiplash associated disorders include among other things advice of exercise and educational activities.

A literature search on the PubMed database was conducted with additional topic discussions with the research colleagues at a symposium. These resulted the present state-of-the-art review. There are several possible cognitive factors and behavioral learning processes such as self-efficacy, fear of movement and (re)injury, and catastrophizing that are important to focus on in decreasing acute whiplash associated disorders to becoming a chronic condition. Learning based on behavioral medicine approach in physiotherapy framework has gained evidence in other musculoskeletal pain conditions.

Exercise, education, and learning with a behavioral medicine approach should be focused on in the future studies of acute whiplash associated disorders management.

December 10, 2011

Neck exercises, physical and cognitive behavioural-graded activity as a treatment for adult whiplash patients with chronic neck pain

Filed under: Neck Pain,Whiplash — Administrator @ 5:54 am

Neck exercises, physical and cognitive behavioural-graded activity as a treatment for adult whiplash patients with chronic neck pain: Design of a randomised controlled trial

From: BMC Musculoskelet Disord. 2011 Dec 2;12(1):274. [Epub ahead of print]

Most studies suggest that patients with Whiplash Associated Disorders report chronic neck symptoms one year after the injury. The main problems in whiplash patients with chronic neck pain are cervical dysfunction and abnormal sensory processing, reduced neck mobility and stability, impaired cervicocephalic kinaesthetic sense, in addition to local and possibly generalised pain. Cervical dysfunction is characterised by reduced function of the deep stabilising muscles of the neck.

Besides chronic neck pain, patients with whiplash associated disorders may suffer from physical inactivity as a consequence of prolonged pain. This influences physical function and general health and can result in a poor quality of life. In addition, whiplash associated disorders patients may develop chronic pain followed by sensitisation of the nervous system, a lowering of the threshold for different sensory inputs (pressure, cold, warm, vibration and electrical impulses). This can be caused by an impaired central pain inhibition – a cortical reorganisation. Besides central sensitisation, the group with whiplash associated disorders may have poorer coping strategies and cognitive functions, compared with patients with chronic neck pain in general.

Studies have shown that physical training, including specific exercises targeting the deep postural muscles of the cervical spine, is effective in reducing neck pain for patients with chronic neck pain, albeit there is a variability in the response to training with not every patient showing a major change. Physical behavioural-graded activity is a treatment approach with a focus on increasing general physical fitness, reducing fear of movement and increasing psychological function. There is insufficient evidence for the long-term effect of treatment of physical and cognitive behavioural-graded activity, especially in chronic neck pain patients. Educational sessions, where the focus is on understanding complex chronic pain mechanisms and development of appropriate pain coping and/or cognitive behavioural strategies, have shown reduced general pain.

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