December « 2008 « necksolutions.com Blog

December 31, 2008

Factors of neck pain in female office workers

Filed under: Neck Pain — Administrator @ 7:16 am

Contribution of individual, workplace, psychosocial and physiological factors to neck pain in female office workers

From: Eur J Pain. 2008 Dec 24; [Epub ahead of print]

This study investigated the relative contribution of individual, workplace, psychosocial and physiological features associated with neck pain in female office workers towards developing appropriate intervention programs. Workers without disability (Neck Disability Index (NDI) score8, n=33); workers with neck pain and disability (NDI9/100, n=52) and 22 controls (women who did not work and without neck pain) participated in this study. Two logistic regression models were constructed to test the association between various measures in (1) workers with and without disability, and (2) workers without disability and controls. Measures included those found to be significantly associated with higher Neck Disability Index in our previous studies: psychosocial domains; individual factors; task demands; quantitative sensory measures and measures of motor function. In the final model, higher score on negative affectivity scale (OR=4.47), greater activity in the neck flexors during cranio-cervical flexion (OR=1.44), cold hyperalgesia (OR=1.27) and longer duration of symptoms (OR=1.19) remained significantly associated with neck pain in workers. Workers without disability and controls could only be differentiated by greater muscle activity in the cervical flexors and extensors during a typing task. No psychosocial domains remained in either regression model. These results suggest that impairments in the sensory and motor system should be considered in any assessment of the office worker with neck pain and may have stronger influences on the presenting symptoms than workplace and psychosocial features.

Comments (0)

December 27, 2008

Neck coordination exercise with chronic non-specific neck pain

Filed under: Chronic Pain, Neck Pain — Administrator @ 7:59 am

A novel method for neck coordination exercise – a pilot study on persons with chronic non-specific neck pain

From: J Neuroeng Rehabil. 2008 Dec 23;5(1):36. [Epub ahead of print]

Chronic neck pain is a common problem and is often associated with changes in sensorimotor functions, such as reduced proprioceptive acuity of the neck, altered coordination of the cervical muscles, and increased postural sway. In line with these findings there are studies supporting the efficacy of exercises targeting different aspects of sensorimotor function, for example training aimed at improving proprioception and muscle coordination. To further develop this type of exercises we have designed a novel device and method for neck coordination training. The aim of the study was to investigate the clinical applicability of the method and to obtain indications of preliminary effects on sensorimotor functions, symptoms and self-rated characteristics in non-specific chronic neck pain.

Chronic neck pain is a common problem. Since the knowledge on the pathophysiology is scarce, treatment efforts are largely pragmatic, focusing on pain management and restoring functioning and abilities. In order to advance the efficacy of treatment and rehabilitation, new knowledge has to be integrated in clinical practice. One area that has generated much novel results over the last years is the research on sensorimotor functions in chronic neck pain. Thus, a wide range of changes in sensorimotor functions have been identified in these conditions, such as: reduced proprioceptive sensibility of the neck and shoulder; increased jerkiness of cervical rotations; impaired postural control in quiet stance; and altered activation patterns of cervical muscles. Based on such evidence from clinical research, along with data from experimental studies, several models on the pathogenesis of chronic musculoskeletal pain conditions includes mechanisms involving sensorimotor functions.

In line with studies on neck pain patients evaluating the efficacy of exercise regimes targeting cervical sensorimotor functions have shown promising results. Thus, specific exercises for eye-head-neck coordination were shown to reduce pain as well as to improve kinaesthetic sense and cervical range of movement at retests after interventions. To improve the neuromuscular coordination of the deep ventral cervical muscles, a specific cranio-cervical flexion exercise has been developed together with an adherent device. These type of neck exercises are shown to reduce headaches in patients suffering from cervicogenic headache as well as to reduce pain and improve kinaesthetic sense in chronic neck pain patients.

(more…)

Comments (0)

December 24, 2008

Impact of motor vehicle accidents on neck pain and disability

Filed under: Neck Pain, Whiplash — Administrator @ 4:57 pm

Impact of motor vehicle accidents on neck pain and disability in general practice

From: Br J Gen Pract. 2008 Sep;58(554):624-9

High levels of continuous neck pain after a motor vehicle accident are reported in cross-sectional studies. Knowledge of this association in general practice is limited. To compare the differences in perceived pain and disability in patients with acute neck pain due to a motor vehicle accident versus other self-reported causes. The secondary aim was to identify prognostic factors for continuous neck pain.

Prospective cohort study with 1-year follow-up. General practices in Rotterdam and its suburban region with non-specific acute neck pain were invited to participate. Questionnaires were collected at baseline and after 6, 12, 26, and 52 weeks. The numerical pain-rating scale and the neck disability index were measured. Regression analysis was used to identify prognostic factors for continuous neck pain.

A total of 187 patients were included. The motor vehicle accident subgroup (n = 42) was significantly younger, reported more sick leave, higher levels of headache and higher neck disability index scores at baseline but lower scores for previous neck pain compared to the remaining cohort. At follow-up the motor vehicle accident subgroup had higher scores for continuous neck pain (63% versus 40%) and at the neck disability index (11.0 versus 7.1). After multivariate analysis pain in the upper part of the neck, duration of complaints at baseline longer than 2 weeks, and a motor vehicle accident were significantly correlated with outcome. Individuals exposed to motor vehicle accidents constitute a relevant subgroup of patients with neck pain. A motor vehicle accident and a longer duration of complaints are prognostic factors for continuous neck pain.

Comments (0)

December 22, 2008

Modic type 1 change with disc degeneration

Filed under: Arthritis, Back Pain, Disc Problems — Administrator @ 5:00 pm

Relationship of Modic type 1 change with disc degeneration: a prospective MRI study

From: Skeletal Radiol. 2008 Dec 19; [Epub ahead of print]

The objective was to study the natural course of Modic type 1 change in relation to lumbar disc degeneration. Twenty-four chronic low back pain patients with Modic type 1 change on lumbar spine were selected from 1,015 patients with magnetic resonance imaging from a follow-up study lasting for 18-74 months. Exclusion criteria were any other specific back disorder, age greater than or equal to 60 years, or a recent spine operation. The association between the development of Modic type 1 change and degenerative disc changes was studied using multivariate modeling.

At baseline, 20 of 28 (71%) disc spaces with Modic type 1 change had a decreased disc height and 16 of 28 (57%) a dark nucleus pulposus, but ten of 28 (36%) a very dark annulus fibrosus and a paradoxically bright nucleus pulposus albeit decreased decreased disc height. During follow-up, decreased disc height decreased in 13 of 28 (46%) and signal intensity of nucleus pulposus in eight of 28 (29%) disc spaces with Modic type 1 change, but it increased in four (14%) discs. In those without Modic type 1 change, only few changes occurred. The larger the Modic type 1 change, the more likely was the decreased disc height low or decreased further. Both the presence and changes in Modic type 1 change were associated with a decrease in decreased disc height and changes in signal intensity of nucleus pulposus and bulges.

The degenerative process in discs with adjacent Modic type 1 change seems to be accelerated and leads to advanced and deforming changes with special morphologic features. Modic type 1 change may be a sign of a pathologic degenerative process in the discovertebral unit.

Comments (0)

December 20, 2008

Massage therapy for low back pain and sciatica

Filed under: Back Pain — Administrator @ 7:39 am

Massage therapy helps to increase range of motion, decrease pain and assist in healing a client with low back pain and sciatica symptoms

From: J Bodyw Mov Ther. 2008 Jul;12(3):281-9. Epub 2008 Apr 10.

This study evaluated the effectiveness of massage therapy as a component in increasing range of motion, decreasing pain and assisting in healing of a client with low back pain and sciatica symptoms. The client presented with an insidious onset of low back pain and pain that radiated into the right lower extremity (sciatica). The client had been experiencing this pain daily for the past 9 months. Frequency, duration, and intensity of symptoms were recorded in a daily diary beginning the day after the client’s first visit with the massage therapist. Manual therapy was administered once a week; each session lasted 45min and consisted of a structured protocol directed mainly toward muscles of the lumbar spine, pelvis, thigh, and leg regions.

The results of this study suggest that massage therapy was effective at reducing low back pain intensity and increasing range of motion for this particular client. LBP intensity was assessed at level one the first three assessment periods. The reduction in post massage low back pain intensity was maintained from week six until week 10 with the exception of week six (no change) and week seven (pain increase due to intense trigger point treatment). The client’s activities of daily living (ADLs) steadily increased throughout the 10-week study. The distinct techniques and stretches used during the course of this study have the possibility of becoming useful, non-pharmacological interventions for reducing or eliminating pain and sciatica symptoms associated with low back pain.

Comments (0)

December 19, 2008

Chronic neck pain and cervical strengthening

Filed under: Chronic Pain, Neck Pain — Administrator @ 12:32 pm

Assessment of chronic neck pain and a brief trial of cervical strengthening

From: Am J Phys Med Rehabil. 2008 Nov;87(11):903-9.

To determine the relationship among pain, disability, range of motion, isometric strength, and muscle tenderness in persons with chronic nonradicular neck pain and to compare them with healthy controls without neck pain, a cross-sectional study of 30 subjects with and 14 without chronic neck pain. All subjects were administered pain scales, the neck disability index, isometric cervical strength, cervical range of motion, and a quantitated muscle tenderness measure. In addition, an uncontrolled trial of neck strengthening was performed on a subset of 14 subjects with the same outcome variables.

Tenderness correlated with pain, neck disability index, and headache in the pain group, and statistically, significantly differed from the subjects without neck pain. Males were stronger than females. Strength was less in the group with neck pain, but did not reach statistical significance. Range of motion was less in the group with pain. Neither range of motion nor strength correlated with neck disability index or pain scores in the neck pain group. In the strengthening trial, strength in left and right rotation significantly improved. Range of motion, pain, and neck disability index changed in a positive direction, but did not reach statistical significance. Muscle tenderness did not change.

Muscle tenderness and disability (but not range of motion or muscle strength) is closely related to average pain in the previous week in neck pain subjects. Neck flexor muscle strengthening resulted in positive changes in pain, neck disability index, range of motion, and strength, but not tenderness.

Comments (0)

December 18, 2008

Prolonged standing and posture in chronic low back pain

Filed under: Back Pain, Chronic Pain, Posture — Administrator @ 5:20 pm

Postural control during prolonged standing in persons with chronic low back pain

From: Gait Posture. 2008 Dec 10; [Epub ahead of print]

Prolonged standing has been associated with the onset of low back pain symptoms in working populations. So far, it is unknown how individuals with chronic low back pain behave during prolonged unconstrained standing. The aim of the present study was to analyze the control of posture by subjects with chronic low back pain during prolonged unconstrained standing in comparison to matched healthy adults. The center of pressure position of 12 chronic low back pain subjects and 12 matched healthy controls was recorded in prolonged standing (30min) and quiet stance tasks (60s) on a force plate. The number and amplitude of center of pressure patterns, the root mean square, speed, and frequency of center of pressure sway were analyzed. Statistical analyses showed that chronic low back pain subjects produced less postural changes in the antero-posterior direction with decreased postural sway during the prolonged standing task in comparison to the healthy group. Only chronic low back pain subjects were influenced by the prolonged standing task, as demonstrated by their increased center of pressure root mean square, center of pressure speed and center of pressure frequency in the quiet standing trial after the prolonged standing task in comparison to the pre-prolonged unconstrained standing trial. The present study provides additional evidence that individuals with chronic low back pain might have altered sensory-motor function. Their inability to generate responses similar to those of healthy subjects during prolonged standing may contribute to chronic low back pain persistence or an increase risk of recurrent back pain episodes. Moreover, quantification of postural changes during prolonged standing could be useful to identify chronic low back pain subjects prone to postural control deficits.

Comments (0)

December 12, 2008

Inhibitive distraction on active range of cervical flexion in neck pain

Filed under: Headaches, Neck Pain — Administrator @ 8:16 am

Immediate effects of inhibitive distraction on active range of cervical flexion in patients with neck pain

From: J Man Manip Ther. 2007;15(2):82-92

Neck pain as well as headaches with a proposed neck related etiology or contribution are highly prevalent disorders. Doug lass and Bope reported a point-prevalence for neck pain in the general population of 9%. They further noted a 1 month, 6 month, and lifetime prevalence of 10%, 54%, and 66%, respectively. In a cross-sectional population survey, investigators found an 18% prevalence for chronic neck pain greater than months’ duration. Headache types associated with cervical spine dysfunction include tension type and cervicogenic headache, occipital neuralgia, and to a lesser extent migraine headaches. Tension type headache affects two-thirds of men and over 80% of women in developed countries. For the general population, the prevalence of cervicogenic headache varies between 0.4% and 2.5%; in those with chronic headaches, prevalence may be as high as 15% to 20%.

Neck pain and headache are not only highly prevalent but also frequent reasons for patients to seek medical or physical therapy care. In the United States, neck pain accounts for almost 1% of all primary care physician visits, and cervical spine diagnoses were the reason for referral in 16% of 1,258 outpatient physical therapy patients, second only to lumbar spine related diagnoses, which accounted for 19% of referrals. No data are available on the prevalence of headache as a cause for physical therapy management; however, an investigator reported headache as co-morbidity in 22% of 2,433 patients presenting for outpatient physical and occupational therapy, and headaches are reportedly the leading cause for visits to a neurologist.

Physical therapists place a diagnostic emphasis on identifying impairments that may be amenable to management with interventions within their scope of practice. In this context, impairments are defined as any loss or abnormality of body structure or of a physiological or psychological function. Studies have shown a strong correlation between neck pain and restricted cervical flexion-extension mobility, and limited motion may be the most relevant impairment associated with neck pain and headache of a proposed cervical etiology. An investigator attributed cervical hypomobility to either a voluntary or reflexogenic muscular restraint caused by pain or a purely mechanical restraint caused by degeneration of the joint surfaces and ligaments. Corresponding to said degenerative process, investigators described a fibrotic process in connective tissue, whereby it shrinks progressively, caused by arthrokinematic dysfunction, poor posture, overuse, habit patterns, or structural or movement imbalances. They further suggested that in many cases the surrounding musculature maintains a hypertonic recruitment pattern long after the inducing injury has healed, potentially immobilizing joints by the surrounding muscle hypertonicity.

(more…)

Comments (0)

December 11, 2008

Chronic neck pain and global posture reeducation

Filed under: Chronic Pain, Neck Pain, Posture — Administrator @ 6:35 am

Effect of global posture reeducation and of static stretching on pain, range of motion, and quality of life in women with chronic neck pain: a randomized clinical trial

From: Clinics. 2008 Dec;63(6):763-70

To compare the effect of conventional static stretching and muscle chain stretching, as proposed by the global posture reeducation method, in the manual therapy of patients with chronic neck pain. Thirty-three female patients aged 35 to 60 years old, 31 of whom completed the program, were randomly divided into two groups: The global posture reeducation group (n=15) performed muscle chain stretching, while the conventional stretching group (n=16) performed conventional static muscle stretching. Both groups also underwent manual therapy. Patients were evaluated before and after treatment and at a six-week follow-up appointment and tested for pain intensity (by means of visual analog scale), range of motion (by goniometry), and health-related quality of life (by the SF-36 questionnaire). The treatment program consisted of two 1-hour individual sessions per week for six weeks.

Significant pain relief and range of motion improvement were observed after treatment in both groups, with a slight reduction at follow-up time. Quality of life also improved after treatment, except for the global posture reeducation group in one domain; at follow-up, there was improvement in all domains, except that both groups reported increased pain. There were no significant differences between groups

Conventional stretching and muscle chain stretching in association with manual therapy were equally effective in reducing pain and improving the range of motion and quality of life of female patients with chronic neck pain, both immediately after treatment and at a six-week follow-up, suggesting that stretching exercises should be prescribed to chronic neck pain patients.

Comments (0)

December 10, 2008

TENS unit application in chronic tension type headache

Filed under: Headaches, Neck Pain — Administrator @ 7:04 pm

The effect of TENS on selected symptoms in the management of patients with chronic tension type headache: a preliminary study

From: Nig Q J Hosp Med. 2008 Jan-Mar;18(1):25-9.

Headache is one of the most frequent causes of consultation in both general medical practice and neurological clinics. It is the most common of all medical conditions causing pain and disability. Headache is experienced by 90% of the general population at some point in life, as a consequence of febrile illness. However, primary headache occur in some people on chronic basis such as tension headache, and require long-term relief.

This study was aimed at investigating the efficacy of Transcutaneous Electrical Nerve Stimulation (TENS) on Pain, Functional Disability and Cervical Range of Motion in patients with Chronic Tension Type Headache.

Eight subjects aged 20-50 years with diagnosis of Chronic Tension Type Headache participated in the study. The subjects were treated thrice weekly for ten weeks with a TENS unit, at a pulse rate of 4Hz and pulse width of 200micros. Pain level, Functional Disability and Cervical Range of Motion were determined using the Visual Analogue Scale, Headache Disability Index and Universal Goniometer respectively. Data was analyzed using the Wilcoxon Signed Ranks Test for pain and functional disability while unpaired t-test was used to analyze cervical range of motion.

The result showed a significant reduction in pain and functional disability with a significant improvement of cervical range of motion within the studied subjects. Based on the findings of this study, it was therefore concluded that a TENS unit application should be considered in the long-term management of patients with chronic tension type headache.

Comments (0)

Older Posts »