Neck Solutions Blog

February 28, 2010

Effects of Anma therapy (traditional Japanese massage) on body and mind

Filed under: Neck Pain,Shoulder Pain — Administrator @ 8:28 am

Effects of Anma therapy (traditional Japanese massage) on body and mind.

From: J Bodyw Mov Ther. 2010 Jan;14(1):55-64.

Anma therapy is a traditional style of Japanese massage, one of touch and manual therapies, and one of the most popular complimentary alternative therapies therapies in Japan. It was brought from China in the 6th century and, while based on the theory of Chinese medicine, it developed in Japan according to Japanese preference and has recently come to include theories of Western medicine. The purpose of this study was to clarify the physical and psychological effects of Anma therapy.

Fifteen healthy female volunteers in their fifth decade, with chronic muscle stiffness in the neck and shoulder, received two interventions: 40-min Anma therapy and 40-min rest intervention. The design was cross-over design. Participants were randomly divided into two groups. Group A was started on Anma therapy from the first day followed by the rest intervention after a 3-day interval. The order of the Anma therapy and the rest intervention reversed for Group B. Visual Analogue Scale score for muscle stiffness in the neck and shoulder, state anxiety score, and salivary cortisol concentration levels and secretory immunoglobulin A were measured pre- and post-interventions.

Anma therapy significantly reduced Visual Analogue Scale scores and state anxiety scores. Secretory immunoglobulin A concentration levels increased significantly across both groups. Anma therapy reduced muscle stiffness in the neck and shoulder and anxiety levels in this pilot study of 50-year-old females

February 27, 2010

Bilateral dorsolateral prefrontal cortex modulation for tinnitus by transcranial direct current stimulation

Filed under: Back Pain,Chronic Pain,Tinnitus — Administrator @ 5:41 am

Bilateral dorsolateral prefrontal cortex modulation for tinnitus by transcranial direct current stimulation: a preliminary clinical study.

From: Exp Brain Res. 2010 Feb 26. [Epub ahead of print]

Tinnitus is considered as an auditory phantom percept. Preliminary evidence indicates that transcranial direct current stimulation of the temporo-parietal area might reduce tinnitus. Transcranial direct current stimulation studies of the prefrontal cortex have been successful in reducing depression, impulsiveness and pain. Recently, it was shown that the prefrontal cortex is important for the integration of sensory and emotional aspects of tinnitus. As such, frontal transcranial direct current stimulation might suppress tinnitus as well. In an open label study, a total of 478 tinnitus patients received bilateral transcranial direct current stimulation on dorsolateral prefrontal cortex (448 patients anode right, cathode left and 30 anode left, cathode right) for 20 min. Treatment effects were assessed with visual analogue scale for tinnitus intensity and distress.

No tinnitus suppressing effect was found for transcranial direct current stimulation with left anode and right cathode. Analyses show that transcranial direct current stimulation with right anode and left cathode modulates tinnitus perception in 29.9% of the tinnitus patients. For these responders a significant reduction was found for both tinnitus related distress and tinnitus intensity. In addition, the amount of suppression for tinnitus related distress is moderated by an interaction between tinnitus type and tinnitus laterality. This was, however, not the case for tinnitus intensity. This study supports the involvement of the prefrontal cortex in the pathophysiology of tinnitus.

Related: Chronic Back Pain Is Associated with Decreased Prefrontal and Thalamic Gray Matter Density There was a relationship between the dorsolateral prefrontal cortex and perceived pain. The authors suggested that the pattern of brain atrophy is directly related to the perceptual and behavioral properties of chronic back pain. Gray matter density was reduced in bilateral dorsolateral prefrontal cortex and right thalamus and was strongly related to pain characteristics in a pattern distinct for neuropathic and non-neuropathic chronic back pain.

Is there a relationship between chronic pain and tinnitus?

February 26, 2010

The effect of therapeutic exercise on activation of the deep cervical flexor muscles in people with chronic neck pain

Filed under: Chronic Pain,Neck Pain,Posture — Administrator @ 10:14 am

The effect of therapeutic exercise on activation of the deep cervical flexor muscles in people with chronic neck pain.

From: Man Ther. 2009 Dec;14(6):696-701. Epub 2009 Jul 25

Deep cervical flexor muscle activation is impaired with neck pain. This study investigated the effects of low load cranio-cervical flexion and neck flexor strengthening exercises on spatial and temporal characteristics of deep cervical flexor muscle activation during a neck movement task and a task challenging the neck’s postural stability.

Forty-six chronic neck pain subjects were randomly assigned to an exercise group and undertook a 6-week training program. Electromyographic activity was recorded from the deep cervical flexor muscle, sternocleidomastoid and anterior scalene muscles pre and post intervention during the cranio-cervical flexion test and during perturbations induced by rapid, unilateral shoulder flexion and extension. Cranio-cervical flexion neck exercises for training increased deep cervical flexor muscle electromyographic amplitude and decreased sternocleidomastoid and anterior scalene electromyographic amplitude across all stages of the cranio-cervical flexion test.

No change occurred in deep cervical flexor muscle electromyographic amplitude following strength training. There was no significant between group difference in pre-post intervention change in relative latency of deep cervical flexor muscle but a greater proportion of the cranio-cervical flexion group shortened the relative latency between the activation of the deltoid and the deep cervical flexor muscle during rapid arm movement compared to the strength group. Specific low load cranio-cervical flexion exercise changes spatial and temporal characteristics of deep cervical flexor muscle activation which may partially explain its efficacy in rehabilitation.

February 25, 2010

Sleep continuity and architecture: associations with pain-inhibitory processes in patients with temporomandibular joint disorder

Filed under: Chronic Pain,TMJ Pain — Administrator @ 5:38 am

Sleep continuity and architecture: associations with pain-inhibitory processes in patients with temporomandibular joint disorder.

From: Eur J Pain. 2009 Nov;13(10):1043-7. Epub 2009 Jan 24

Recent research suggests bi-directional interactions between the experience of pain and the process of sleep; pain interferes with the ability to obtain sleep, and disrupted sleep contributes to enhanced pain perception. Our group recently reported, in a controlled experimental study, that sleep fragmentation among healthy adults resulted in subsequent decrements in endogenous pain inhibition. The present report follows up that observation by extending this line of research to a sample of patients experiencing persistent pain. Patients with chronic temporomandibular joint disorder pain were studied using polysomnography and psychophysical evaluation of pain responses. The authors assessed whether individual differences in sleep continuity and/or architecture were related to diffuse noxious inhibitory controls, a measure of central nervous system pain inhibition. Among 53 temporomandibular joint disorder patients, higher sleep efficiency and longer total sleep time were positively associated with better functioning of diffuse noxious inhibitory controls. These results suggest the possibility that disrupted sleep may serve as a risk factor for inadequate pain-inhibitory processing and hint that aggressive efforts to treat sleep disturbance early in the course of a pain condition might be beneficial in reducing the severity or impact of clinical pain.

Related:

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February 24, 2010

Update on current care guidelines. Neck pain

Filed under: Neck Pain — Administrator @ 11:22 am

Update on current care guidelines. Neck pain

From: Duodecim. 2009;125(24):2759-61. [Article in Finnish]

Neck pain is very common. Age, female gender, obesity, and several physical and psychological work related factors increase the risk while physical activity appears to decrease it. Non-specific neck pain is most common but serious or specific illness must be ruled out and neural compression identified. Patients are encouraged to remain active and improve their ergonomics. Acute neck pain often disappears without any special treatment. Paracetamol (acetaminophen) is the primary pain medication. Multidisciplinary treatment is recommended if disabling pain has lasted for two months, and intensive muscle exercises in chronic neck pain. Progressive muscle weakness and myelopathy indicate a surgical assessment.

February 23, 2010

Manipulative Therapy in Addition to Usual Care for Patients With Shoulder Complaints: Results of Physical Examination Outcomes in a Randomized Controlled Trial

Filed under: Chiropractic,Neck Pain,Shoulder Pain — Administrator @ 5:10 am

Manipulative Therapy in Addition to Usual Care for Patients With Shoulder Complaints: Results of Physical Examination Outcomes in a Randomized Controlled Trial

From: J Manipulative Physiol Ther. 2010 Feb;33(2):96-101

The purpose of this study was to examine the effect of manipulative therapy on the shoulder girdle, in addition to usual care provided by the general practitioner, on the outcomes of physical examination tests for the treatment of shoulder complaints.

In clinical practice, a dysfunction of the shoulder girdle can be treated by manipulative therapy, which aim is to restore normal functioning of the shoulder girdle. To date, with only 1 randomized trial favoring manipulative therapy for the shoulder girdle, the evidence for the effectiveness of manipulative treatment in the treatment of shoulder complaints is scarce. Therefore, the authors conducted a randomized trial to study the effect of manipulative therapy for the shoulder girdle in addition to usual care by the general practitioner in the treatment of shoulder complaints. The design of this study and the main patient-experienced results are already published. The results indicate that additional manual therapy for the structures of the shoulder girdle accelerates recovery of patient-experienced shoulder symptoms and reduces their severity. In the present article, the results for the physical examination outcome measures are presented.

In the clinical research of musculoskeletal complaints, physical testing of pain and mobility by the physician are important outcomes. However, this concerns mostly multiple physical examination tests and multiple outcome measures. This requires multiple statistical testing. Together with small study sizes (more outcomes than patients), this may lead to spurious significant results from randomized trials affecting the interpretability of the outcome of the trial.

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February 21, 2010

The distressed (Type D) personality is independently associated with tinnitus: a case-control study

Filed under: Tinnitus — Administrator @ 9:30 am

The distressed (Type D) personality is independently associated with tinnitus: a case-control study.

From: Psychosomatics. 2010 Jan;51(1):29-38.

Tinnitus is a common and disturbing condition, reported by 10% to 20% of the general population. The authors sought to determine personality characteristics associated with tinnitus patients versus a control group of ear-nose-throat (ENT) patients without tinnitus. Adult chronic tinnitus sufferers (N=265) and ENT patients without tinnitus (N=265) participated in a cross-sectional study. The authors evaluated personality characteristics with tests for distressed personality (Type D), neuroticism, extraversion, and emotional stability.

As compared with control subjects, tinnitus patients had statistically significant and clinically relevant higher levels of neuroticism, negative affectivity, and social inhibition, on one hand, and lower levels of extraversion and emotional stability on the other hand. Also, tinnitus patients were more likely to have a type D personality.

Neuroticism, reduced extraversion, and reduced emotional stability were associated with tinnitus, but the level of prediction of the model improved with the addition of type D personality to the single traits. This might indicate that personality characteristics, and type D personality, in particular, are associated with having tinnitus and might contribute to its perceived severity.

Related:

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February 19, 2010

Lumbar spine movement patterns during prolonged sitting differentiate low back pain developers from matched asymptomatic controls

Filed under: Back Pain,Posture — Administrator @ 5:11 pm

Lumbar spine movement patterns during prolonged sitting differentiate low back pain developers from matched asymptomatic controls.

From: Work. 2010 Jan 1;35(1):3-14.

Little is known about how lumbar spine movement influences mechanical changes and the potential injurious effects of prolonged flexion associated with seated postures. The purpose of this study was to examine the postural responses and pain scores of low back pain sufferers compared with asymptomatic individuals during prolonged sitting in order to understand the biomechanical factors that may be associated with sitting induced low back pain.

Sixteen participants with sitting aggravated low back pain were age and gender matched with 16 asymptomatic participants. Tri-axial accelerometers were used to monitor lumbar spine angles during 90 minutes of seated computer work. Lumbar spine postures were examined using a movement pattern analysis of two types of postural adjustments, termed shifts (step-like adjustments larger than 5 degrees and fidgets (small change and return to approximately the same position).

The low back pain group reported large significant increases in low back pain while asymptomatic individuals reported little to no pain. On average, every participant fidgeted every 40 to 50 seconds. However, only the low back pain sufferers demonstrated a significant increase in the number of shifts over 90 minutes of seated work; the low back pain group shifted every 4 minutes in the last 30 minutes of sitting compared to every 10 minutes for the asymptomatic group. Low back pain sufferers also demonstrated larger amplitudes of shifts and fidgets when compared to the asymptomatic group.

Greater and more frequent movement was not beneficial and did not reduce pain in individuals with pre-existing low back pain. Future work to understand the biomechanical effects of proactively inducing movement may help to explain the paradox of the relationship between movement and pain.

Were the shift and fidget increases used to prevent further lower back pain. The article seems to relate sitting causes increased shifting and fidgeting in low back pain sufferers, however, the relationship is not clear. We note decreased pain associated with low back pain when using devices meant to increase movement like the backtivator and the active seat.

February 18, 2010

The effectiveness of bibliotherapy in alleviating tinnitus related distress

Filed under: Tinnitus — Administrator @ 4:08 pm

The effectiveness of bibliotherapy in alleviating tinnitus related distress.

From: J Psychosom Res. 2010 Mar;68(3):245-251. Epub 2009 Nov 3

The present study examined the efficacy of bibliotherapy in assisting individuals experiencing distress related to tinnitus. One hundred sixty-two tinnitus sufferers from Australia participated in a study designed to examine the effectiveness of a cognitive-behaviorally based self-help book in reducing distress. To maximize the ecological validity of the findings, the authors excluded no individuals interested in treatment for tinnitus related distress.

The experimental condition lost 35% of participants at postassessment, compared to 10% in the control group. In an analysis of participants who completed postintervention assessment, those assigned to the intervention condition, who received a tinnitus self-help book, showed significantly less tinnitus related distress and general distress 2 months later compared to those assigned to the waiting list control condition. The intervention group’s reduction in tinnitus related distress and general distress from preintervention to postintervention 2 months later was significant, and these participants maintained a significant reduction in distress on follow-up 4 months after they received the tinnitus self-help book. A long-term follow-up of all participants, who at that time had received the book at least a year previously, showed a significant reduction in tinnitus distress.

Although these group differences and pre-post changes were significant, effect sizes were small. Intention-to-treat analyses showed no significant effect for between-groups analyses, but did show a significant effect for the 1-year follow-up pre-post analysis.

Information on the effectiveness of using a self-help book, without therapist assistance, in alleviating distress is important, as bibliotherapy can provide inexpensive treatment that is not bound by time or place.

More on this study: Self Help Books for Tinnitus

Resource: Tinnitus: A Self-Management Guide for the Ringing in Your Ears, by Jane L. Henry, Ph.D., and Peter H. Wilson, Ph.D. (2001)

February 16, 2010

The craniocervical flexion test: intra-tester reliability in asymptomatic subjects

Filed under: Chiropractic,Neck Pain — Administrator @ 2:34 pm

The craniocervical flexion test: intra-tester reliability in asymptomatic subjects

From: Physiother Res Int. 2010 Feb 9. [Epub ahead of print]

The deep neck flexor muscles stabilize the cervical spine and cervicogenic pain appears to adversely affect their endurance capacity. They are inaccessible to direct palpation, thereby making assessment difficult. However, the cranio-cervical flexion test provides an indirect method of assessing the endurance capacity of the deep neck flexor muscles. The purpose of the present study was to evaluate the intratester reliability of the cranio-cervical flexion test in asymptomatic subjects.

The clinical protocol of the cranio-cervical flexion test was measured on two occasions with 7 days between measurements. Prior to testing, participants were trained and compensation strategies were corrected. Nineteen asymptomatic participants (mean age 24.9 years; range 22-36) were recruited.

The test had excellent intratester reliability (intraclass correlation coefficient = 0.983; standard error of the mean = 8.94; smallest real difference = 24.7). A Bland and Altman’s limits of agreement analysis confirmed the high reliability of the test.

The cranio-cervical flexion test results demonstrated excellent intra-tester reliability in asymptomatic subjects, thus contributing to the normative data regarding the test.

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