Neck Solutions Blog

August 31, 2010

A Randomized Controlled Trial Comparing Manipulation With Mobilization for Recent Onset Neck Pain

Filed under: Chiropractic,Neck Pain — Administrator @ 2:20 pm

A Randomized Controlled Trial Comparing Manipulation With Mobilization for Recent Onset Neck Pain

From: Arch Phys Med Rehabil. 2010 Sep;91(9):1313-1318

To determine whether neck manipulation is more effective for neck pain than mobilization, a randomized controlled trial with blind assessment of outcome was undertaken by the authors. The setting was Primary care physiotherapy, chiropractic, and osteopathy clinics in Sydney, Australia.

Patients (N=182) with nonspecific neck pain less than 3 months in duration and deemed suitable for treatment with manipulation by the treating practitioner were randomly assigned to receive treatment with neck manipulation (n=91) or mobilization (n=91). Patients in both groups received 4 treatments over 2 weeks, from which the number of days taken to recover from the episode of neck pain.

The median number of days to recovery of pain was 47 in the manipulation group and 43 in the mobilization group. Participants treated with neck manipulation did not experience more rapid recovery than those treated with neck mobilization. The authors concluded that neck manipulation is not appreciably more effective than mobilization. The authors further noted that the use of neck manipulation therefore cannot be justified on the basis of superior effectiveness.

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August 17, 2010

A radiographic analysis of the influence of initial neck posture on cervical segmental movement at end-range extension in asymptomatic subjects

Filed under: Neck Pain,Posture — Administrator @ 5:32 am

A radiographic analysis of the influence of initial neck posture on cervical segmental movement at end-range extension in asymptomatic subjects

From: Man Ther. 2010 Aug 11. [Epub ahead of print]

In the management of neck pain disorders, McKenzie recommends performing neck extension exercises from a fully neck retracted position in order to achieve a maximum range of lower cervical extension. However, no study has investigated the impact of pre-positioning the neck prior to the extension exercise. This study compared end-range sagittal cervical segmental rotation and translation from three starting positions: the neck in neutral, retraction and protraction.

Twenty asymptomatic healthy volunteers were recruited. Lateral radiographs were taken in neutral and at each of the three end-range extension positions and differences in sagittal rotation angles and translation from the neck neutral posture were calculated at each segment.

The results indicated that there was a significant difference in the pattern of the sagittal segmental rotation but no difference in summed rotations (total extension) between the three conditions. Protraction generated significantly greater extension range at C1-2 and retraction produced significantly greater extension range at C6-7 than alternate conditions. In contrast, there was no significant difference in segmental translation values between the three conditions. These results indicate initial neck positions can influence cervical segmental extension range at C1-2 and C6-7.

August 15, 2010

Low-level laser therapy for acute neck pain with radiculopathy: a double-blind placebo-controlled randomized study

Filed under: Neck Pain — Administrator @ 2:07 pm

Low-level laser therapy for acute neck pain with radiculopathy: a double-blind placebo-controlled randomized study

Pain Med. 2010 Aug;11(8):1169-78

The objective of the study was to investigate clinical effects of low-level laser therapy in patients with acute neck pain with radiculopathy. This was a double-blind, randomized, placebo-controlled study. The study was carried out between January 2005 and September 2007 at the Clinic for Rehabilitation at the Medical School, University of Belgrade, Serbia.

Sixty subjects received a course of 15 treatments over 3 weeks with active or an inactivated laser as a placebo procedure. Low-level laser therapy was applied to the skin projection at the anatomical site of the spinal segment involved with the following parameters: wavelength 905 nm, frequency 5,000 Hz, power density of 12 mW/cm(2), and dose of 2 J/cm(2), treatment time 120 seconds, at whole doses 12 J/cm(2).

The primary outcome measure was pain intensity as measured by a visual analog scale. Secondary outcome measures were neck movement, neck disability index, and quality of life. Measurements were taken before treatment and at the end of the 3-week treatment period.

Statistically significant differences between groups were found for intensity of arm pain and for neck extension. Low-level laser therapy gave more effective short-term relief of arm pain and increased range of neck extension in patients with acute neck pain with radiculopathy in comparison to the placebo procedure.

August 10, 2010

Primary care randomized clinical trial: Manual therapy effectiveness in comparison with TENS in patients with neck pain

Filed under: Neck Pain — Administrator @ 3:26 am

Primary care randomized clinical trial: Manual therapy effectiveness in comparison with TENS in patients with neck pain

From: Man Ther. 2010 Aug 4. [Epub ahead of print]

This study investigated effectiveness of manual therapy with transcutaneous electrical nerve stimulation (TENS) to reduce pain intensity in patients with mechanical neck disorder. A randomized multi-centered controlled clinical trial was performed in 12 Primary Care Physiotherapy Units in Madrid Region. Ninety patients were included with diagnoses of subacute or chronic mechanical neck disorder without neurological damage, 47 patients received manual therapy and 43 TENS. The primary outcome was pain intensity measured in millimeters using the Visual Analogue Scale (VAS). Also disability, quality of life, adverse effects and sociodemographic and prognosis variables were measured. Three evaluations were performed (before, when the procedure finished and six months after). Seventy-one patients (79%) completed the follow-up measurement at six months. In more than half of the treated patients the procedure had a clinically relevant “short term” result after having ended the intervention, when either manual therapy or TENS was used. The success rate decreased to one-third of the patients 6 months after the intervention. No differences can be found in the reduction of pain, in the decrease of disability nor in the quality of life between both therapies. Both analyzed physiotherapy techniques produce a short-term pain reduction that is clinically relevant.

July 31, 2010

Prevalence of neck pain in subjects with metabolic syndrome – a cross-sectional population-based study

Filed under: General Health,Neck Pain — Administrator @ 5:51 am

Prevalence of neck pain in subjects with metabolic syndrome – a cross-sectional population-based study.

From: BMC Musculoskelet Disord. 2010 Jul 30;11(1):171.

Metabolic syndrome has become increasingly common worldwide. Metabolic syndrome is a cluster of risk factors defined by high fasting glucose and triglycerides, low HDL cholesterol, high blood pressure, and abdominal obesity that increases the risk for cardiovascular diseases, type 2 diabetes mellitus, and all-cause mortality. The prevalence of metabolic syndrome in the US population is approximately 35%. In Eastern Finland the corresponding prevalence has been found to be 37%. Neck pain is also a common symptom among the middle-aged population. In a large Finnish population-based study, 24% of men and 37% of women aged at least 30 years had suffered from neck pain during the preceding month.

There are few studies in which the prevalence of pain has been assessed in subjects with metabolic syndrome. In one study females with chronic pain from fibromyalgia were at an increased risk of metabolic syndrome. Another study found that subjects with metabolic syndrome were more likely to have problems with pain symptoms. It has been suggested that stress is related to both metabolic syndrome and neck pain. Low physical activity has been found to be associated with metabolic syndrome and musculoskeletal pain. Some studies have found an association between obesity and neck pain. Because visceral obesity is one of the main features of metabolic syndrome, it could be proposed that metabolic syndrome is also related to neck pain. It has been speculated that both metabolic syndrome and persistent chronic pain syndromes are related to hypothalamus-pituitary-adrenal stress axis dysfunction. Therefore, it could be expected that the prevalence of neck pain is elevated in subjects with metabolic syndrome. Thus, if there were common features in the background of these disorders, the authors hypothesized that neck pain is more prevalent among subjects with metabolic syndrome than among those without metabolic syndrome. In this study the authors aimed to analyse the prevalence of neck pain in subjects with metabolic syndrome.

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July 29, 2010

The effect of a scapular postural correction strategy on trapezius activity in patients with neck pain

Filed under: Neck Pain,Posture — Administrator @ 8:26 am

The effect of a scapular postural correction strategy on trapezius activity in patients with neck pain

From: Man Ther. 2010 Jul 19. [Epub ahead of print]

Extensive computer use amongst office workers has lead to an increase in work related neck pain. Aberrant activity within the three portions of the trapezius muscle and associated changes in scapular posture have been identified as potential contributing factors. This study compared the activity (surface electromyography) of the three portions of the trapezius in healthy controls (n=20) to a neck pain group with poor scapular posture (n=18) during the performance of a functional typing task.

A scapular postural correction strategy was used to correct scapular orientation in the neck pain group and electromyographic recordings were repeated. During the typing task, the neck pain group generated greater activity in the middle trapezius and less activity in the lower trapezius than the control group. Following correction of the scapula, activity recorded by the neck pain group was similar to the control group for the middle and lower portions.

These findings indicate that a scapular postural correction exercise may be effective in altering the distribution of activity in the trapezius to better reflect that displayed by healthy individuals.

July 27, 2010

Work and neck pain: A prospective study of psychological, social, and mechanical risk factors

Filed under: Neck Pain — Administrator @ 3:07 am

Work and neck pain: A prospective study of psychological, social, and mechanical risk factors

From: Pain. 2010 Jul 22. [Epub ahead of print]

To determine the impact of occupational psychological/social and mechanical factors on neck pain, a prospective cohort study with a follow-up period of 2years was conducted with a sample of Norwegian employees. The following designs were tested: (i) cross-sectional analyses at baseline (n=4569) and follow-up (n=4122), (ii) prospective analyses with baseline predictors, (iii) prospective analyses with average exposure over time [(T1+T2)/2] as predictor, and (iv) prospective analyses with measures of change in exposure from T1 to T2 as predictors. A total of 2419 employees responded to both the baseline and follow-up questionnaire. Data were analyzed using ordinal logistic regression. After adjustment for age, sex, neck pain at T1, and other exposure factors that had been estimated to be confounders, the most consistent risk factors were role conflict and working with arms raised to or above shoulder level. The most consistent protective factors were empowering leadership and decision control. Hence, psychological and social factors are important precursors of neck pain, along with mechanical factors. Although traditional factors such as quantitative demands and decision control play a part in the etiology of neck pain at work, in this study several new factors emerged as more important.

July 24, 2010

Computer work and musculoskeletal disorders of the neck and upper extremity: A systematic review

Filed under: Neck Pain — Administrator @ 1:37 pm

Computer work and musculoskeletal disorders of the neck and upper extremity: A systematic review

From: BMC Musculoskeletal Disorders 2010, 11:79

This review examines the evidence for an association between computer work and neck and upper extremity disorders (except carpal tunnel syndrome). A systematic critical review of studies of computer work and musculoskeletal disorders verified by a physical examination was performed. A total of 22 studies (26 articles) fulfilled the inclusion criteria. Results show limited evidence for a causal relationship between computer work per se, computer mouse and keyboard time related to a diagnosis of wrist tendonitis, and for an association between computer mouse time and forearm disorders. Limited evidence was also found for a causal relationship between computer work per se and computer mouse time related to tension neck syndrome, but the evidence for keyboard time was insufficient. Insufficient evidence was found for an association between other musculoskeletal diagnoses of the neck and upper extremities, including shoulder tendonitis and epicondylitis, and any aspect of computer work.

There is limited epidemiological evidence for an association between aspects of computer work and some of the clinical diagnoses studied. None of the evidence was considered as moderate or strong and there is a need for more and better documentation.

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July 21, 2010

Maintaining a balance: a focus group study on living and coping with chronic whiplash-associated disorder

Filed under: Chronic Pain,Neck Pain,Whiplash — Administrator @ 4:22 am

Maintaining a balance: a focus group study on living and coping with chronic whiplash-associated disorder.

From: BMC Musculoskelet Disord. 2010 Jul 13;11(1):158.

Whiplash was defined in 1995 by the Quebec Task Force as a neck injury mechanism and may result in injuries within the musculoskeletal and /or neurological system. The Quebec Task Force developed a system for grading Whiplash Associated Disorders : whiplash associated disorders I-II (symptoms without known pathology), III (symptoms and neurological signs), and IV (symptoms and cervical fracture and/or dislocation).

Grade I and II patients represent up to 90 % of “whiplash injury claims”. The proportion of patients who reports pain and disability six months after the accident (i.e. chronic whiplash associated disorders) varies substantially between studies and countries. However, a recent review suggests that approximately 50% of the patients with whiplash associated disorders will report neck pain symptoms one year after their injuries. Patients with chronic whiplash associated disorders report high levels of neck pain, headache, and shoulder pain often accompanied by neck stiffness, dizziness, fatigue, sleeping problems, concentration problems, allergy, breathing disorders, hypertension, cardiovascular disorders, digestive disorders, depression, anxiety, and impairment in cognitive performance. A recent study of a large population-based cohort of victims of car accidents, found that isolated neck pain was rare and that pain from multiple body areas was most commonly reported.

Expectations and coping styles might influence the outcome and prognosis after whiplash injuries. The Cognitive Activation Theory of Stress describes stress response as a general normal, healthy, and necessary alarm. There may be a risk of illness and disease only if the arousal is sustained. The level and duration of the alarm depends on the expectancy of the outcome of stimuli, as well as the results from specific responses available for handling the situation. Therefore, the cognitive activation theory of stress model emphasizes the importance of coping as positive response outcome expectancies. This means that if the individual expects to be able to handle a situation with a positive result (coping), the activation will be short and do no harm. Kivioja et al. found no evidence that early coping strategies influenced the prognosis after whiplash injuries. Others, however, found that high levels of passive coping strategies are associated with a slower recovery after whiplash injury, and that certain coping strategies for pain, such as catastrophizing, is associated with increased risk of disability, and that the importance of coping strategies seem to increase over time. In general, there is considerable controversy as to the importance of psychological factors for developing chronic whiplash associated disorders.

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July 19, 2010

Five years post whiplash injury: Symptoms and psychological factors in recovered versus non-recovered

Filed under: Neck Pain,Whiplash — Administrator @ 6:23 am

Five years post whiplash injury: Symptoms and psychological factors in recovered versus non-recovered

From: BMC Res Notes. 2010 Jul 13;3(1):190.

The incidence rate of whiplash injuries in Sweden is estimated to be 1.0-3.2/1000 /year. The injuries constitute a major health problem in Western society due to the large number of people with Whiplash associated disorder and the high economical costs associated with whiplash associated disorder. People with acute whiplash associated disorder, mainly complain of neck pain, stiffness, headache and dizziness. Other symptoms that may occur after the injury are fatigue, concentration and memory problems. Most subjects with acute whiplash associated disorder are reported to recover within three months of the trauma however, a significant number of persons experience symptoms several years after the accident. Persistent neck pain has been reported in 84-90% one to two year and in 55% 17 years after the injury.

It is still unclear why pain and related symptoms do not resolve after the expected time of healing and which factors are involved in the persistence of symptoms and impairments after the trauma. A bio-psycho-social model is often used to describe the complex interaction of physical and psychological factors in the development of chronic whiplash associated disorder. The long lasting problems after the injury may also interfere with occupational activities, the number of persons on sick-leave or unable to perform their ordinary duties six months after whiplash associated disorder have been reported to vary between 13 and 50%. In addition, chronic whiplash associated disorder may also affect leisure and daily life with social contacts and the total experience of life satisfaction.

Many studies of long-term problems after whiplash associated disorder have primarily focused on symptoms, especially neck pain in people seeking health care but fewer studies have investigated the long-term effects on activity/disability and life satisfaction. In addition, less is known about the differences between subjects who consider themselves as recovered and those who suffer from persistent disability. Sterling et al investigated post-traumatic stress in relation to disability on the Neck Disability Index during the first six months after whiplash injury. They found that persons who reported themselves to be recovered or to have mild disability six months post trauma reported decreased post-traumatic stress scores in comparison with early after the injury, whereas persons with moderate/severe disability reported persistent post-traumatic stress scores into the chronic stage.

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