Pillow use: The behaviour of cervical pain, sleep quality and pillow comfort in side sleepers
From: Man Ther. 2009 May 6. [Epub ahead of print]
Pillow performance research has largely involved testing pillows of novel shape and design, comparing contour and noncontour shaped pillows and comparing contour pillows with the participants’ usual pillow. Shields et al. who undertook a systematic review regarding the effect of contour or cervical pillow use on neck pain, highlighted the methodological flaws in these studies and concluded that there was insufficient evidence to support the use of contour pillows in the management of chronic neck pain. Helewa et al. reported that contour pillows were ineffective in the management of chronic neck pain unless combined with active neck exercises.
The paucity of research has caused health professionals to provide patient advice regarding neck pillows based on the anecdotal suggestions of expert colleagues and professional associations. This advice has included the use of malleable pillows, a cervical roll, a contour pillow or a down or urethane pillow. Furthermore the range of marketing advice provided by pillow manufacturers is confusing for consumers, although details regarding this statement by the authors was not substantiated by evidence.
This paper reports the performance of commonly used type of pillows from specific manufacturers and their association with neck pain behavior. This pillow field trial was undertaken to:
Compare the frequency of waking cervical pain reported when subjects slept on their own pillow and on five trial pillows;
Examine temporal symptom reports, to determine if pillow content or shape was related to overnight abolition of retiring symptoms or overnight production of waking symptoms; and
Compare pillow comfort and sleep quality ratings for participants’
usual pillow and the trial pillows.
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Analyzing musculoskeletal neck pain, measured as present pain and periods of pain, with three different regression models
From: BMC Musculoskelet Disord. 2009 Jun 19;10(1):73. [Epub ahead of print]
In the literature there is a discussion on the choice of outcome and the need for more longitudinal studies of musculoskeletal disorders. The general aim of this longitudinal study was to analyze musculoskeletal neck pain, in a group of young adults. Specific aims were to determine whether psychosocial factors, computer use, high work/study demands, and lifestyle are long term or short term factors for musculoskeletal neck pain, and whether these factors are important for developing or ongoing musculoskeletal neck pain.
Perceived stress was a risk factor for present pain, for developing pain and for number of years with pain. High work/study demands was associated with present pain; and with number of years with pain when the demands negatively affect home life. Computer use pattern (number of times/week with a computer session [greater than or equal to] 4h, without break) was a risk factor for developing pain, but also associated with present pain and number of years with pain. Among life style factors smoking was found to be associated to present pain. The difference between men and women in prevalence of musculoskeletal pain was confirmed in this study, but was smallest for the outcome ongoing pain compared to present pain and developing pain.
Pain was more prevalent among women than men for all outcome measurements, except for ongoing pain where result were indistinct. Perceived stress was a risk factor regarding developing pain, and was both a short term and a long term risk factor. Moreover, the results showed that high work/study demands were a short term and long term risk factor for neck pain. Computer use pattern was a risk factor for developing pain, but also both a short and a long term risk factor. The above findings, regarding type of factor and direction of association, are consistent with a systematic review concerning neck pain and with results in more recent studies. Smoking was a risk factor for pain at present. Less certain results regarding possible risk factors were that smoking was, in the simple model, associated with number of years with pain. High home life demands were, in the simple models, associated with pain at present and with number of years with pain. Asthma was, in the simple models, associated with developing pain and number of years with pain. In an earlier study, association between asthma and low back pain was shown. Results for ongoing pain were more uncertain, possibly due to the lower number of observations as only those reporting a period of pain in the baseline questionnaire were included. For ongoing pain perceived stress was a risk factor in the simple model, but only close to statistical significance in the multiple model. In the simple model gender was associated with ongoing pain, but in the multiple model the result was inconclusive.
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Changes in Spinal Height Following Sustained Lumbar Flexion and Extension Postures: A Clinical Measure of Intervertebral Disc Hydration Using Stadiometry
From: J Manipulative Physiol Ther. 2009 Jun;32(5):352-7
Throughout the course of the day, the spinal intervertebral discs display viscoelastic creep properties that determine an individual’s overall stature. These properties were demonstrated by Tyrrell et al who used in vivo stadiometry measurements to detect 19.3 mm (1.1% of stature) variation in height between first arising and the end of the day.
Contributions to the total diurnal stature loss from structures other than the intervertebral disc are minimal. Kanlayanaphotporn et al used stadiometer measurements to assess the contribution of soft tissue structures below the sacrum and concluded that these structures accounted for 19% of the height change during the first 5 minutes of sitting. Based on these findings, stadiometry is considered to provide an accurate measure of spinal height changes after various loading conditions.
The 2 primary methods of measuring spine height changes are magnetic resonance imaging (MRI) and stadiometry. Stadiometry has been shown to be a valid and reliable tool to assess spinal height when compared to objectifiable measures made from MRI. Stadiometry assessment has advantages over MRI in terms of costs, use in clinical setting, as well as the ability to measure subjects that simultaneously sustain compressive loads of the trunk.
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Comparison of the intervertebral disc spaces between axial and anterior lean cervical traction
From: Eur Spine J. 2009 Jun 16. [Epub ahead of print]
One of the main function of the intervertebral disc is to damp the compressive loadings during daily activities. Disc injury or degeneration could lead to mechanical compression or chemical irritation of the nerve root causing neurological deficits. Spinal traction is generally regarded as a conservative management in treating various types of neck or back disorders. Several mechanisms have been proposed for the possible therapeutic effects of neck traction. DeLacerda et al. reported that the axial traction reduced pain by improving circulation or preventing adhesions and contractures of spinal structures. Spinal traction could widen the intervertebral disc space reflecting a stretching of the posterior longitudinal ligaments. This condition might be associated with the suction effect of the negative intradiscal pressure and the pushing effect of the posterior longitudinal ligament.
The insufficient investigations on the changes of spinal structures during traction prevent further exploring the possible therapeutic mechanism of cervical traction. A blind randomized crossover-design study was conducted to quantitatively compare the intervertebral disc spaces between axial and anterior lean cervical traction in sitting position. A total of 96 radiographic images from the baseline measurements, axial and anterior lean tractions in 32 asymptomatic subjects were digitized for further analysis. The intra and inter examiner reliabilities for measuring the intervertebral disc spaces were in good ranges. With the application of anterior lean traction, the statistical increases were detected both in anterior and in posterior disc spaces compared to the baseline and axial traction.
The greater intervertebral disc spaces obtained during anterior lean traction might be associated with the more even distribution of traction forces over the anterior and posterior neck structures. The neck extension moment through mandible that generally occurred in the axial traction could be counteracted by the downward force of head weight during anterior lean traction. This study quantitatively demonstrated that anterior lean traction in sitting position provided more intervertebral disc space enlargements in both anterior and posterior aspects than axial traction did. These findings may serve as a therapeutic reference when cervical traction is suggested.
An earlier article in Spine. 1992 Feb;17(2):136-8 noted; The separation of facet joint surfaces was found after traction at 15 degrees extension, but not in the neutral or flexion positions.
Rolfing structural integration treatment of cervical spine dysfunction
From: J Bodyw Mov Ther. 2009 Jul;13(3):229-38
Misalignments in the body compromise the architectural integrity. At the tissue level, fascia shortens and thickens as the body engages in compensatory strategies to maintain itself upright; these changes are known as myofascial contractions. In physical therapy, there are several methods by which practitioners treat neck dysfunction. However, studies showing the effect of those techniques are limited. The purpose of this study was to investigate the effect of rolfing structural integration in neck motion and pain levels of 31 subjects who received rolfing structural integration. Rolfing structural integration is a type of therapy that focuses on aligning the human body with gravity.
This retrospective study, over a period of 3 years of clinical practice, analyzes changes in motion and pain levels at the neck for 31 subjects who completed the rolfing structural integration in 10 basic sessions. Participants were evaluated before and after they received rolfing structural integration. The data collected included: age, sex, occupation, referral source, diagnosis, height, weight, photographs of postural views, range of motion, pain, and functional complaints. Range of motion was assessed with the use of an arthordial protractor.
The mean pain levels and active range of motion of the neck before rolfing structural integration significantly changed after the treatment: there was a decrease in pain and an increase in active range of motion. Pain levels/active range of motion-age within-subject effect demonstrated significant difference only in pain at best and rotation right; the mean pain levels in the older group decreased by 67%, and the mean active range of motion for rotation right in the younger group increased by 34%. In this sample, pain now was reduced more than pain best and pain worst. Increased motion for lateral flexion was more than rotation, extension, and flexion. This investigation demonstrates that the basic 10 sessions of rolfing structural integration, when applied by a physical therapist with advanced rolfing structural integration certification, is capable of significantly decreasing pain and increasing active range of motion in adult subjects, male and female, with complaints of neck dysfunction regardless of age.
Measurement properties of the neck disability index
From: J Orthop Sports Phys Ther. 2009 May;39(5):400-17
Patient completed questionnaires are commonly used to measure clinical outcome in efficacy studies. Outcome questionnaires for neck pain should measure the effect of treatment on pain, motion, disability, activities of daily living, social function, and work function. The Neck Disability Index is a commonly used neck pain questionnaire. It is modeled after the Oswestry Back Disability questionnaire and includes 10 self-report items covering activities of daily living (7 items), concentration (1 item), and pain (2 items). Responses are on a 0-to-5 Likert scale with total score ranging from 0 (no pain or disability) to 50 (severe pain and disability). It has been studied in patients with whiplash associated symptoms and in groups with mixed causes for neck pain. It has excellent test-retest properties and good convergent validity when compared with the McGill Pain Questionnaire and a global improvement scale. Item analysis suggested that the Neck Disability Index measures a single domain.
Systematic review of clinical measurement to find and synthesize evidence on the psychometric properties and usefulness of the neck disability index. The neck disability index is the most commonly used outcome measure for neck pain, and a synthesis of knowledge should provide a deeper understanding of its use and limitations. Using a standard search strategy (1966 to September 2008) and 4 databases (Medline, CINAHL, Embase, and PsychInfo), a structured search was conducted and supplemented by web and hand searching. In total, 37 published primary studies, 3 reviews, and 1 in-press paper were analyzed. Pairs of raters conducted data extraction and critical appraisal using structured tools. Ranking of quality and descriptive synthesis were performed.
Horizon estimation suggested the potential for 1 missed paper. The agreement between raters on quality assessments was high(kappa = 0.82). Half of the studies reached a quality level greater than 70%. Failures to report clear psychometric objectives/hypotheses or to rationalize the sample size were the most common design flaws. Studies often focused on less clinically applicable properties, like construct validity or group reliability, than transferable data, like known group differences or absolute reliability (standard error of measurement or minimum detectable change. Most studies suggest that the neck disability index has acceptable reliability, although intraclass correlation coefficients range from 0.50 to 0.98. Longer test intervals and the definition of stable can influence reliability estimates. A number of high-quality published (Korean, Dutch, Spanish, French, Brazilian Portuguese) and commercially supported translations are available. The neck disability index is considered a 1-dimensional measure that can be interpreted as an interval scale. Some studies question these assumptions. The minimum detectable change is around 5/50 for uncomplicated neck pain and up to 10/50 for cervical radiculopathy. The reported clinically important difference is inconsistent across different studies ranging from 5/50 to 19/50. The neck disability index is strongly correlated to a number of similar indices and moderately related to both physical and mental aspects of general health.
The neck disability index has sufficient support and usefulness to retain its current status as the most commonly used self report measure for neck pain. More studies of clinically important difference in different clinical populations and the relationship to subjective/work/function categories are required.
Cauda equina syndrome: a review of clinical progress
From: Chin Med J (Engl). 2009 May 20;122(10):1214-22
The spinal cord terminates at the level of the intervertebral disc between the first and second lumbar vertebrae, forming the conus medullaris, below which is the filum terminale and a bundle of nerve roots constituting the cauda equina. Cauda equina syndrome, a rare neurological disorder, is a combination of signs and symptoms resulting from lesion of the nerves in the cauda equina. Typical manifestations can be associated variably with the disorders characterized by low back pain, unilateral or usually bilateral sciatica, bilateral weakness of the lower extremities, saddle or perianal hypoesthesia or anesthesia, sexual impotence, together with rectal and bladder sphincter dysfunction.
The term “cauda equina” was first described by a French anatomist Lazarius more than four centuries ago. Three centuries later, Mixter and Barr gave the definition of cauda equina syndrome in the English-language literature.
Cauda equina syndrome is rare, both atraumatically as well as traumatically. Males and females are equally affected, and it can occur at any age but primarily in adults. The incidence of cauda equina syndrome is variable, depending on the etiology of the syndrome. The prevalence among the general population has been estimated between 1:100 000 and 1:33 000. The most common cause of cauda equina syndrome is herniation of a lumbar intervertebral disc. It is reported by approximately 1% to 10% of patients with herniated lumbar discs. The prevalence among patients with low back pain is approximately four in 10 000.
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