Neck Solutions

Relationship between disc injury and manual lifting

Relationship between disc injury and manual lifting: a poroelastic finite element model study.

From: Proc Inst Mech Eng [H]. 2008 Feb;222(2):195-207

Understanding how failure originates in a lumbar motion segment subjected to loading conditions that are representative of manual lifting is important because it will pave the way for a better formulation of the exposure-injury relationship. The aim of the current investigation was to use a poroelastic finite element model of a human lumbar disc to determine its biomechanical characteristics under loading conditions that corresponded to three different, commonly occurring lifting activities and to identify the most hazardous type of loading with regard to damage to the disc. The current study showed that asymmetric lifting may increase the risk of back injury and pain. Lifting that involved lateral bending (asymmetric lifting) of the trunk was found to produce stresses at a localized area in the annulus, annuluar fibres, end plates, and facet joints that were higher than their respective tissue failure strength. Thus asymmetric lifting, if performed over a large number of cycles, might help to propagate this localized failure of the disc tissue to a larger area, owing to fatigue. The analyses also showed that largest fluid exchange between the nucleus and the end plates occurred during asymmetric lifting. If the fluid exchange is restricted owing to end plate calcification or sclerosis of the subchondral bone, high intradiscal pressure might develop, leading to higher disc bulge causing back pain.

Neck injury in a rugby football player

Cervical stenosis in a professional rugby league football player

From: Chiropractic & Osteopathy 2005, 13:15

Recommendations from the available literature at the present time suggest that conservative management of cervical discogenic pain and disc protrusion, including chiropractic manipulation and ancillary therapies, can be successful in the absence of progressive neurological deficit. The current case highlights the initial successful management of a football athlete, and the later unsuccessful management. This case highlights the issues involvement in the management of a collision sport athlete with a serious neck injury.

This case outlines a series of cervical traumas producing neck, arm and head pain. The series of injuries involved forced flexion, compression and lateral deviation away from the painful side. This mechanism is in contrast to the mechanism of extension with lateral deviation towards the painful side as described in the majority of studies of neck injuries in American football and rugby. The clinical signs suggest a disc herniation following repeated trauma resulting in compression of the C7 nerve root.

Continue reading Neck injury in a rugby football player…

Eye movements related to chronic pain and disability following whiplash injuries

Are altered smooth pursuit eye movements related to chronic pain and disability following whiplash injuries? A prospective trial with one-year follow-up

From: Clinical Rehabilitation, Vol. 22, No. 5, 469-479 (2008)

Evaluating the ability of early smooth pursuit testing to predict chronic whiplash-associated disorders, and to study whether the presence of abnormal smooth pursuit eye movements at one-year follow-up is associated with symptoms at that time. The study was carried out at a university research centre and participants were recruited from emergency units and general practitioners.

In all, 262 participants were recruited within 10 days from a whiplash injury. Smooth pursuit eye movements were tested with electrooculography (EOG) an average of 12 days after a whiplash trauma and again after one year. Analyses of EOG recordings were computerized. Associations between test results both from baseline and one-year tests and self-reported neck pain, headache, neck disability and working ability one year after the car collision were determined.

Results of early eye movement tests were not associated with the prognosis. Reduced smooth pursuit performance when tested in static cervical rotation at the one-year follow-up was significantly associated with higher neck pain intensity at that time, but the association was too weak for the test to discriminate between recovered participants and those with lasting symptoms.

Although reduced smooth pursuit performance at one-year follow-up was associated with persistent neck pain, smooth pursuit eye movement tests are not useful as predictive or diagnostic tests in whiplash associated disorders.

Biomechanical analysis of cervical spondylolysis

Cervical spondylolysis in a judo player: a case report and biomechanical analysis

From: Archives of Orthopaedic and Trauma Surgery 2008 Apr 24 [Epub ahead of print]

A case report and a biomechanical study using a finite element method to report a case with the cervical spondylolysis and to understand the biomechanics of the cervical spine with spondylolysis at C6.

Cervical spondylolysis, although not a common spinal disorder, can occur in athletes. Presently, the exact pathology, natural history and biomechanics are not known. Thus, treatment strategies for this disorder in athletes are in controversy. To treat and/or advise patients with cervical spondylolysis, the cervical spine biomechanics regarding this disorder should be understood.

A case of a 12-year-old male judo player is presented. The patient presented with occipital and upper neck pain. Plain radiographs, reconstructed CT scan and MRIs of this patient were reviewed. Biomechanically, stress distributions were analyzed in response to 73.6 N axial compression and 1.5-Nm moment in flexion, extension, lateral bending, and axial rotation using a FE model of the intact ligamentous C3 to C7 segment. Bilateral spondylolysis was created in the model at C6. The stress results from the bilateral defect model were compared to the intact model predictions.

Continue reading Biomechanical analysis of cervical spondylolysis…

Stiff neck and shoulder related to stress and gender

Association of perceived stress and stiff neck and shoulder with health status: multiple regression models by gender.

From: Hiroshima J Med Sci. 2006 Dec;55(4):101-7.

It is well known that psychological stress affects health status. Stiff neck and shoulder in a broad sense is one of the major somatic complaints among Japanese. The objective was to determine how much perceived stress and stiff neck and shoulder are associated with health-related quality of life (HRQoL) by gender. Participants (n = 512) completed the Japanese version of Perceived Stress Scale, the SF-8 Japanese version and original questions on perceived stiff neck and shoulder. Muscle hardness around the shoulder also was measured with the muscle tension meter. The multiple regression model of the men demonstrated that perceived stress was associated with not only the mental component summary (MCS) (beta: -0.494), but also the physical component summary (PCS) (beta = -0.319) of the SF-8. Although, in the model of the women, perceived stress was also associated with MCS (beta: -0.632) more than in that of the men, stiff neck and shoulder and age group (beta: -0.231; -0.268, respectively), but not stress, were related to PCS. The subjective neck and shoulder stiffness was hardly correlated with the objective shoulder muscle hardness. This study revealed the associations between perceived stress, stiff neck and shoulder and HRQoL, and their difference by gender. The hypothesis of gender differences was discussed with a focus on kind of stressors, perception of stress, admission of negative symptoms and cause of stiff neck and shoulder.

Neck exercises and physiotherapy for tension headache

Efficacy of physiotherapy including a cranio cervical neck exercise training programme for tension type headache

From: Cephalalgia, 2006, 26, 983–991

Tension type headache is the most prevalent headache type. Almost 80% of the total population will experience a tension type headache at some time. Headache is one of the 10 major complaints of patients seen in primary care practices and 47% of all headaches are tension type headaches. ‘Tension-type’ labels a headache classification developed in 1988 by the International Headache Society. It can be divided into an episodic and a chronic version and is commonly more experienced by women (female:male ratio 5 : 4). Because of its high prevalence—1-year prevalence in women 86% and in men 63% and its wide spectrum of disability, tension type headache has a greater socioeconomic impact than any other headache type. In spite of this, only 15% of people with tension type headache seek medical attention and 60% of those reporting severe headaches use only over-the-counter medication, standing a chance of analgesic rebound. Instead of self-management, a therapeutic approach, incorporating both non-pharmacological and pharmacological intervention, shows a success rate of greater than 90% in patients with tension headaches.

Physiotherapy consisted of a threefold approach: conventional Western massage techniques, oscillation techniques and instruction on postural correction. Conventional massage techniques included the following modes: ‘effleurage’ (stroking), ‘petrissage’ (kneading) and ‘friction’ (deep pressure). Mode and intensity were determined by the physiotherapist in accordance with the diagnosis and the patient’s condition as a clinical routine. Oscillation techniques included the use of low-velocity, passive cervical joint mobilization, in which the cervical segments are rhythmically moved following a regimen described by Maitland. The two approaches described above are intended to reduce pain and musculotendinous tension.

Continue reading Neck exercises and physiotherapy for tension headache…

Operating heavy equipment vehicles and lower back pain

The impact of operating heavy equipment vehicles on lower back disorders

From: Ergonomics, Volume 51, Issue 5 May 2008 , pages 602 - 636

Literature reviews examining the relationship between heavy equipment vehicle operation and the development of lower back pain have generally been qualitative in nature and have not employed an evidence-based assessment procedure. This research determines the extent to which whole body vibration, shock and working postures are associated with lower back pain and neck problems among heavy equipment vehicle operators, while accounting for individual (i.e. age, gender, prior history of back or neck disorders) and occupational (i.e. material handling, climatic conditions, psychosocial factors) confounders. Published articles were obtained from a search of electronic databases and from bibliographies in the identified articles. A critical appraisal of these articles was conducted using an epidemiological appraisal instrument (Genaidy et al. 2007). The meta-analysis was conducted using statistical techniques employing fixed-effect and random-effect models. Eighteen articles reporting observational studies satisfied the inclusion criteria adopted for this research. The methodological qualities of the published studies ranged from marginal to average. The meta-relative risk was found to be 2.21, indicating that operators exposed to driving heavy equipment vehicles are at more than twice the risk of developing lower back pain in comparison to those not exposed to driving heavy equipment vehicles.

Therefore, it seems possible that there is a causal relationship between working as a heavy equipment vehicle operator and development of lower back disorders. Prospective cohort studies are urgently needed to confirm the outcomes of this evidence-based methodology (based in part on the meta-analysis) and the biological plausibility should be further explored. The reported findings point to a need for improved ergonomic design of heavy equipment vehicles to avoid lower back pain and neck problems.

Intermittent cervical traction in chronic neck pain

The efficacy of intermittent cervical traction in patents with chronic neck pain

From: Clin Rheumatol. 2008 Apr 23; [Epub ahead of print]

Previous studies about the usefulness of traction therapy have concluded with conflicting results. The aim of this study was to examine efficacy of neck traction in chronic neck pain. Forty-two patients with at least 6 weeks of nonspecific neck pain were selected for the study. Data about demographic characteristics including age, sex, body mass index, duration of cervical pain, working status, smoking status, and regular exercise were recorded. Each patient was randomly assigned to Group 1-receiving only standard physical therapy including hot pack, ultrasound therapy and exercise program and Group 2-treated with traction therapy in addition to standard physical therapy. The patients were reevaluated at the end of the therapy. The main outcome measures of the treatment were pain intensity by visual analog scale (VAS), disability by neck disability index, and quality of life assessed by Nottingham Health Profile (NHP). Twenty-four female and 18 male patients with mean age of 48.2 +/- 11.5 years and a mean disease duration of 4.3 +/- 2.9 years were included to the study. There were no differences between the groups in terms of age, sex, pain intensity, and scores of NHP and NDI at entry. There were 21 patients in both groups. Both groups improved significantly in pain intensity and the scores of NDI and physical subscles of NHP at the end of the therapies (p < 0.05). There was an association between neck disability index and VAS pain scores in both groups (p < 0.05). No correlation was observed between clinical variables and age and duration of disease. In conclusion, no specific effect of traction over standard physiotherapeutic interventions was observed in adults with chronic neck pain. We suggest the clinicians to consider this condition and to focus on exercise therapy in the management of patients suffering from this condition.

When patient selection is appropriate, neck traction can be effective especially with radicular complaints of radiating neck pain. Static neck traction products like the TracCollar are popular. There is a comprehensive list of literature relating to neck traction with positive results.

Whiplash classification and protocols not important for outcomes

Neither the Whiplash Associated Disorders classification nor the Quebec Task Force follow-up regimen seems to be important for the outcome after a whiplash injury.

From: Eur Spine J. 2008 Apr 22; [Epub ahead of print]

A classification of injury and a follow up schedule were proposed by the Quebec Task Force in 1995. No general agreement about the clinical usefulness of the Whiplash Associated Disorders classification or of the suggested follow up regimen exists. A series of 186 consecutive cases seen in the emergency room during the acute phase after a whiplash injury was prospectively studied for 1 year. All findings including history and physical findings were recorded using standardized Quebec Task Force protocols. In one group follow up visits were done according to the Quebec Task Force regimen: at 1, 3, 6, 12 weeks and 1 year after the accident; in a control group no visit was scheduled. The outcome variable was neck pain at 1 year after the accident. After 1 year, 18% of the total number of patients had significant neck pain. Risk factors for chronic neck pain at 1 year after whiplash injury were: neck pain before the accident and a high degree of emotional distress at the time of the accident; both factors independently associated with a tenfold increased risk of developing chronic neck pain. Neither the Whiplash Associated Disorders classification nor the Quebec Task Force follow-up regimen could be linked to a better outcome. In this study the outcome was associated with patient specific characteristics and not with physical signs of injury, the depth of the initial evaluation or the follow-up regimen.

Backpack use and back and neck pain among adolescents

Study on the relationship between backpack use and back and neck pain among adolescents

From: Nursing & Health Sciences Volume 8 Issue 4 Page 208-215, December 2006

Descriptive correlation study was conducted in Hobbs, New Mexico, USA, to find the relationship between backpack use and back and neck pain among adolescent boys and girls. A higher percentage of girls than boys rated their pain as being moderate to extremely strong. The correlation between pain and backpack weight per body mass index among girls was positive and significant, but negative and non significant among boys. The correlation between pain and backpack weight was positive and non-significant among both boys and girls. The correlation between pain and each of the variables of backpack weight per body weight, backpack weight per height, and backpack weight per body surface area was negative and non-significant among boys, but positive and non-significant among girls. Gender based research studies with additional variables, safe backpacks and education in schools regarding backpack use are recommended.