Neck Solutions Blog

September 30, 2011

Pain-Related Emotions in Early Stages of Recovery in Whiplash-Associated Disorders

Filed under: Whiplash — Administrator @ 4:37 am

Pain-Related Emotions in Early Stages of Recovery in Whiplash-Associated Disorders: Their Presence, Intensity, and Association With Pain Recovery

From: Psychosom Med. 2011 Sep 23. [Epub ahead of print]

Psychological factors such as depression affect recovery after whiplash associated disorders. This study examined the prevalence of pain related emotions, such as frustration, anger, and anxiety, and their predictive value for postcrash pain recovery during a 1-year follow-up.

A population-based prospective cohort study design was used. Self reported pain related depression, anxiety, fear, anger, and frustration were assessed using 100-mm visual analog scales at 6 weeks after crash in 2986 persons with traffic related whiplash associated disorder. Multivariable logistic regression was used to assess the relationship between the intensity of these pain related emotions and pain recovery at 4 and 12 months after crash. Pain was measured at all time points on a 100-mm visual analog scales, and pain recovery was defined as a score of 10 or lower.

Pain related frustration was the most intense, with a mean score of 52. Only 3% of the cohort reported having no pain related frustration, and 4% reported no pain related anxiety. Multivariable logistic regression models revealed that each pain related emotion increased the risk of failing to recover. Specifically, with each 10-point increase in pain-related emotion, the odds of failing to achieve pain recovery at 4 months was increased by 14% for depression, 15% for anxiety, 11% for fear, 12% for anger, and 11% for frustration.

These findings suggest that it may be beneficial for health care providers to address emotional status related to pain in the first few weeks after a whiplash injury.

September 28, 2011

The association between a simple question about recovery and patient reports of pain intensity and pain disability in whiplash-associated disorders

Filed under: Whiplash — Administrator @ 3:19 am

How well are you recovering? The association between a simple question about recovery and patient reports of pain intensity and pain disability in whiplash-associated disorders.

From: Disabil Rehabil. 2011 Sep 22. [Epub ahead of print]

There is potential value in developing a brief assessment tool for assessing recovery after musculoskeletal injuries. Our goal was to investigate the association between a one-item global self-assessment of recovery and commonly used measures of recovery status. The authors followed a cohort of 6,021 adults with acute whiplash associated disorders for six months. Pain, depression, work status and physical health were assessed at baseline and follow-up. The question “How do you feel you are recovering from your injury?” (six response options from “all better” to “getting much worse”) and functional limitations were administered at follow-up.

Responses to the recovery question was associated with our other indices of recovery. Those “all better” had the lowest pain intensity, pain-related limitations, depression and work disability, and the best general physical health. Incrementally poorer recovery ratings on the recovery question were associated with greater pain, functional limitations and depression, poorer physical health and being off work, although “no improvement” and “getting a little worse” were similar. Recovery categories also reflected different degrees of actual improvements over the preceding follow-up period.

The findings suggest that a single recovery question is a useful tool for conducting brief global assessments of recovery of musculoskeletal injuries.

September 25, 2011

Implementation of neck shoulder exercises for pain relief among industrial workers

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

Implementation of neck/shoulder exercises for pain relief among industrial workers: A randomized controlled trial.

BMC Musculoskelet Disord. 2011 Sep 21;12(1):205. [Epub ahead of print]

Musculoskeletal disorders comprise a major burden on individuals and public health systems in North America and Europe. Neck and shoulder pains are among the most frequent health complaints among adults. Physical workplace factors such as repetitive work tasks, static contractions, and tiring postures are related to neck and shoulder pain. Studies have evaluated different types of physical exercise for treating neck and shoulder pain. While moderate to strong evidence for the effectiveness of strength training for relieving neck pain among office workers exists, evidence lacks among other occupational groups. Laboratory technicians – commonly exposed to high levels of strain in the neck and shoulders due to prolonged static loadings – show high prevalence of neck and shoulder pain. Based on previous research among office workers, investigating the effect of strength training on neck and shoulder pain among laboratory technicians is therefore relevant.

A British health survey reported that among the general population only 37% of men and 24% of women fulfilled public recommendations of physical activity. Thus, regular physical exercise is challenging for many people. In consequence, low adherence to exercise programs can negatively affect the outcome of randomized controlled trials, even in high quality studies. The major reason for not adhering to physical exercise is “lack of time”. Thus, workplace interventions with physical exercise during work hours and together with colleagues may reach people with low motivation for leisure physical exercise.

The present study has two major aims: Firstly, to evaluate the effect of strength training intervention at the workplace on non-specific neck and shoulder pain among industrial workers. Secondly, to describe the implementation process and adherence to the program.

(more…)

September 23, 2011

Aging affects response to cyclic tensile stretch: paradigm for intervertebral disc degeneration

Filed under: Back Pain,Disc Problems — Administrator @ 12:32 pm

Aging affects response to cyclic tensile stretch: paradigm for intervertebral disc degeneration

From: Eur Cell Mater. 2011 Sep 20;22:137-46

Much evidence supports a fundamental role for mechanical forces in modulating differentiation, homeostasis, and remodelling of musculoskeletal cells. Little is known, however, regarding mechanobiology and gene expression of intervertebral disc cells from older individuals. To characterise the effect of mechanical stimulation on cells from older discs, an in vitro study of intervertebral disc cells harvested from different aged pigs was conducted to measure extracellular matrix gene expression in response to cyclic tensile stress.

Gene expression of annulus fibrosus cells from intervertebral discs of mature and older pigs was quantified for the predominant extracellular matrix genes; type I collagen, type II collagen and aggrecan, and matrix metalloproteinase 1 (MMP-1), a collagenase that degrades fibrillar collagens. annulus fibrosus cells cultured on flexible-bottom plates were stretched 10 % at 0.5 Hz frequency. After 24 h, gene expression was assayed using reverse transcriptase polymerase chain reaction (RT-PCR). Basal mRNA levels without stretching for type II collagen and aggrecan were lower in older annular cells whereas MMP-1 levels were higher compared to mature cells. Following cyclic tensile stress, an adaptive response was elicited in annular cells from both age groups. Extracellular matrix protein genes were upregulated, whereas MMP-1 was downregulated. The magnitude of response was significantly greater in older cells as compared to mature cells.

These data suggest that the cells from the annulus fibrosus of older animals manifest lower basal levels of mRNA for type II collagen and aggrecan and higher levels of MMP-1 possibly due to decreased tensile stress experienced in vivo and is not the result of reduced capacity for response.

(more…)

September 20, 2011

Progressive disc degeneration at C5-C6 segment affects the mechanics between disc heights and posterior facets above and below the degenerated segment

Filed under: Disc Problems,Neck Pain — Administrator @ 10:43 am

Progressive disc degeneration at C5-C6 segment affects the mechanics between disc heights and posterior facets above and below the degenerated segment: A flexion-extension investigation using a poroelastic C3-T1 finite element model.

From: Med Eng Phys. 2011 Sep 16. [Epub ahead of print]

Disc degeneration is often accompanied by a height reduction of the anterior and posterior discs, and this affect the way in which articulating posterior facets come into contact during physiological motions. Any increase in the contact between overlapping articulating facet surfaces increases posterior facet loading. Development of adjacent segment disease is a significant clinical concern. It still is not clear how degenerative motion changes in anterior disc and posterior disc heights affect the mechanics of adjacent segment discs and facets.

The authors hypothesized that changes in axial height patterns (in the anterior disc and posterior disc) at the degenerated C5-C6 disc segment would affect axial height patterns (in the anterior disc and posterior disc) above and below the degenerated disc-segment. A previously validated poroelastic three-dimensional finite element model of a normal C3-T1 segment was used. Two additional C3-T1 models were built with moderate and severe disc degeneration at C5-C6. The three finite element models were evaluated in flexion and extension. With progressive C5-C6 disc degeneration, anterior disc and posterior disc flexibility (axial deformation or elongation per unit load) at C5-C6 decrease with a compensatory corresponding flexibility increase in adjacent segments (normal), whereas posterior facet loading increased at all segments only during extension.

Changes in anterior disc and posterior disc flexibility and posterior facet loading were higher at inferior segments than at superior segments. This study confirmed the hypothesis that the anterior and posterior discs and articulating facets of cervical spine segments are affected during flexion and extension motions when a disc segment degenerates. Motion changes involving a higher posterior disc height loss, both at the degenerated and adjacent segments, would further increase posterior facet loading along the posterior spinal column – a possible mechanism for the dysfunctioning of the facet joints.

September 19, 2011

Follow-Up MR Imaging of the Alar and Transverse Ligaments after Whiplash Injury

Filed under: Neck Pain,Whiplash — Administrator @ 3:38 am

Follow-Up MR Imaging of the Alar and Transverse Ligaments after Whiplash Injury: A Prospective Controlled Study.

From: AJNR Am J Neuroradiol. 2011 Sep 15. [Epub ahead of print]

The cause and clinical relevance of upper neck ligament high signal intensity on MR imaging in whiplash associated disorder are controversial. The purpose of this study was to explore changes in the signal intensity of the alar and transverse ligaments during the first year after a whiplash injury.

Dedicated high-resolution upper neck proton attenuation-weighted MR imaging was performed on 91 patients from an inception whiplash associated disorder 1-2 cohort, both in the acute phase and 12 months after whiplash injury, and on 52 controls (noninjured patients with chronic neck pain). Two blinded radiologists independently graded alar and transverse ligament high signal intensity 0-3, compared initial and follow-up images to assess alterations in grading, and solved any disagreement in consensus. The Fisher exact test was used to compare proportions.

Alar and transverse ligament grading was unchanged from the initial to the follow-up images. The only exceptions were 1 alar ligament changing from 0 to 1 and 1 ligament from 1 to 0. The prevalence of grades 2-3 high signal intensity in whiplash associated disorder was thus identical in the acute phase and after 12 months, and it did not differ from the prevalence in noninjured neck pain controls.

Alar and transverse ligament high signal intensity in patients with whiplash associated disorder 1-2 observed within the first year after injury cannot be explained by the trauma. Dedicated upper neck MR imaging cannot be recommended as a routine examination in these patients.

Related Source: Are MRI high-signal changes of alar and transverse ligaments in acute whiplash injury related to outcome?

Related Post: Are MRI high-signal changes of alar and transverse ligaments in acute whiplash injury related to outcome?

September 17, 2011

Does Cervical Muscle Strength in Youth Ice Hockey Players Affect Head Impact Biomechanics

Filed under: Neck Pain — Administrator @ 8:54 am

Does Cervical Muscle Strength in Youth Ice Hockey Players Affect Head Impact Biomechanics?

From: Clin J Sport Med. 2011 Sep;21(5):416-421.

This was a prospective cohort in a field setting to evaluate the effect of cervical muscle strength on head impact biomechanics. Thirty-seven volunteer ice hockey players (age = 15.0 ± 1.0 years, height = 173.5 ± 6.2 cm, mass = 66.6 ± 9.0 kg, playing experience = 2.9 ± 3.7 years).

Participants were equipped with accelerometer-instrumented helmets to collect head impact biomechanics (linear and rotational acceleration) throughout an entire playing season. Before the season, isometric cervical muscle strength was measured for the anterior neck flexors, anterolateral neck flexors, cervical rotators, posterolateral neck extensors, and upper trapezius. Data were analyzed using random intercept general mixed linear models, with each individual player as a repeating factor/cluster.

Dependent variables included linear and rotational head accelerations. Cervical strength data were categorized into tertiles, creating groups with high, moderate, and low strength. Strength measures were averaged and normalized to body mass.

Significant differences in cervical muscle strength existed across the strength groups. No differences were observed in linear or rotational acceleration across strength groups for the anterior neck flexors, anterolateral neck flexors, cervical rotators, posterolateral neck extensors, or upper trapezius.

The hypothesis that players with greater static neck strength would experience lower resultant head accelerations was not supported. This contradicts the notion that cervical muscle strength mitigates head impact acceleration. Because we evaluated cervical strength isometrically, future studies should consider dynamic (ie, isokinetic) methods in the context of head impact biomechanics.

September 15, 2011

The Tampa Scale of Kinesiophobia and neck pain, disability and range of motion

Filed under: Neck Pain,Whiplash — Administrator @ 3:55 am

The Tampa Scale of Kinesiophobia and neck pain, disability and range of motion: a narrative review of the literature.

From: J Can Chiropr Assoc. 2011 Sep;55(3):222-32.

The persistence of pain (or chronic pain) can lead to changes in behaviour for both physical and psychological reasons. The International Association for the Study of Pain has defined chronic pain as “… that which persists beyond the normal time of healing.” One source reported that up to 80% of the population will have musculoskeletal pain and that it is a major cause of disability and limitation of activity. In 1983 a concept known as the fear avoidance model was introduced by Lethem, Slade, Troup and Bentley which attempts to ““explain how and why some individuals develop a more significant psychological overlay than others do. The model explains that avoidance of pain because of fear and the avoidance of painful activities (cognitive and behavioural avoidance) lead to physical and psychological consequences. This model has been widely used and supported.

Kinesiophobia is a term that was introduced by Miller, Kori and Todd in 1990 at the Ninth Annual Scientific Meeting of the American Pain Society and describes a situation where “a patient has an excessive, irrational, and debilitating fear of physical movement and activity resulting from a feeling of vulnerability to painful injury or reinjury. The Tampa Scale for Kinesiophobia is a 17 item questionnaire used to assess the subjective rating of kinesiophobia or fear of movement.

The original Tampa Scale for Kinesiophobia questionnaire was developed to “discriminate between non-excessive fear and phobia among patients with chronic musculoskeletal pain.” Several studies have found the scale to be a valid and reliable psychometric measure. Initially used to measure fear of movement related to chronic low back pain, the Tampa Scale for Kinesiophobia has been used increasingly for pain related to different body parts including the cervical spine.

(more…)

September 13, 2011

Effect of Therapeutic Exercise Versus Manual Therapy on Athletes With Chronic Low Back Pain

Filed under: Back Pain,Chronic Pain — Administrator @ 8:08 am

Effect of Therapeutic Exercise Versus Manual Therapy on Athletes With Chronic Low Back Pain

From: J Sport Rehabil. 2011 Aug 8. [Epub ahead of print]

Rehabilitation professionals treat individuals suffering from chronic low back pain using a variety of treatment approaches including manual therapy and the prescription of therapeutic exercises. The use of manual therapy, specifically joint mobilization of the lumbar spine, may significantly decrease a patient’s pain and contribute to improvement in his or her functioning. Exercise may also improve pain and functioning, with some patients reporting gains up to 1 year after the last treatment session. Numerous investigations have assessed the potential benefits associated with either joint mobilization or therapeutic exercise for patients with acute or subacute low back pain or chronic low back pain.

Despite the literature to guide clinical decision making, clinicians often struggle to successfully or expeditiously treat patients with low back pain. A recent trend reported in the literature has been to use treatment-based classifications or clinical prediction rules. These reports provide evidence or clinical suggestions for treating patients with acute or subacute low back pain.

To the best of the authors’ knowledge, there is a lack of these types of reports that address evaluation and treatment for patients with chronic low back pain. When treating patients with chronic low back pain it is not uncommon for some rehabilitation professionals to use 1 treatment approach primarily or exclusively. Using a treatment program supported by the research literature should generate the most effective outcomes for patients with chronic low back pain.

September 10, 2011

The relationships between measures of stature recovery, muscle activity and psychological factors in patients with chronic low back pain

Filed under: Back Pain — Administrator @ 6:31 am

The relationships between measures of stature recovery, muscle activity and psychological factors in patients with chronic low back pain

From: Man Ther. 2011 Sep 6. [Epub ahead of print]

Patients with low back pain often demonstrate altered muscle function compared to asymptomatic controls. In particular, individuals with low back pain have been found to exhibit hyperactivity of the superficial paraspinal muscles during static postures such as standing.

The height of intervertebral discs changes in response to compressive forces (due to a combination of fluid flow and elastic deformation) and this is reflected in changes in stature. Stature change is therefore used as a proxy measure of the load on the spine and measurements have been shown to correlate with more direct measurements of changes in lumbar spine length assessed via Magnetic Resonance Imaging. It has also been shown that both chronic low back pain patients and asymptomatic individuals are able to produce stature measurements with a good level of repeatability. Healey et al. found significantly reduced stature recovery in individuals with mild low back pain compared to controls, with stature recovery negatively correlated with paraspinal muscle activity. The authors hypothesized that the elevated muscle activity observed in the low back pain group resulted in greater compressive loads on the spine that, in turn, prevented the intervertebral discs from regaining their initial height and consequently prolonged stature recovery. Reduced stature recovery may increase the risk of future back pain and increase loading on spinal structures such as the facet joints. Significant negative correlations between stature recovery and both pain and disability appear to support the clinical relevance of this relationship.

Psychological factors are known to play an important role in low back pain and are sometimes viewed as ‘obstacles to recovery’. It has been suggested that one of the ways psychological factors may affect the condition is via increased spinal loading resulting from altered paraspinal muscle activity. Furthermore, low back pain patients with high levels of pain-related fear generally exhibit elevated paraspinal muscle activity compared to low fearful patients, especially when confronted with movements which they believe to be harmful. It is proposed that pain-related fear may perpetuate pain and disability via this muscle guarding. Muscle activity may therefore be a contributory factor in the link between psychological factors and clinical outcome.

(more…)

Older Posts »

Powered by WordPress