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 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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December 13, 2009

Correction of neck posture in computer users

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Evaluation of a single accelerometer based biofeedback system for real-time correction of neck posture in computer users.

From: Conf Proc IEEE Eng Med Biol Soc. 2009;1:7269-72

There is sound evidence available showing the association between computer use and the risk of developing neck pain and musculoskeletal disorders. Consistent use of computers is one of the major risk factors for neck and shoulder disorders in the workplace. One of the most recent forecasts of computer adoption estimates that there were more than a billion computers in use at the end of 2008. This report also forecasts a 12.3% compound annual growth rate between 2003 and 2015. Driven by lower prices and global demand especially in developing countries it is expected that there will be over 2 billion computer users by 2015. A study of 512 office workers found the 12 month prevalence of neck pain to be 45.5%. Reports of the lifetime prevalence of neck pain in the general population range from 67-80%. As computer adoption increases we can expect a corresponding increase in the prevalence of neck pain if appropriate countermeasures are not employed.

Over time poor neck posture results in pain, muscle aches, tension and headache and can lead to long term complications such as osteoarthritis. Physiological and biomechanical stress due to sustained postures limit important musculoskeletal stimuli that are essential for normal musculoskeletal development. Most upper extremity disorders and symptoms (neck, shoulder, elbow and wrist pain) are associated with computer use at workstations in positions of poor posture. Along with the sitting position, placement of computer monitors and keyboards and the number of hours spent working at computer workstations are important factors in the etiology of cervical disorders associated with computer use. Other workplace risk factors include the number of hours per week of computer use and the time spent in a non-neutral posture at a computer.

A detailed survey at Harvard University showed that more then half of students experienced pain and discomfort while using a computer. The three factors significantly associated with computer-related upper extremity and neck pain among the students were female gender, eight or more years of using a computer 10 or more hours a week, and using a computer for more than 20 hours per week. Most of the students in the study reported that pain in the neck and upper extremity was related to computer use and the posture assumed while using a computer. Most of them adopted a better posture by adjusting the workstation and keyboard, while some took a break when feeling uncomfortable during their work on the computer. Workplace studies, of both cross-sectional and prospective design, consistently identified a relationship between the number of hours per week of computer use and musculoskeletal pain and disorders or the upper extremity and neck.

Trapezius Myositis/Spasm, Paraspinal/Rheomboid Spasm, Cervical Radiculopathy, Thoracic Outlet Syndrome, Bicipital Tendonitis, and Rotator Cuff Tendonitis are all common upper extremity and cervical musculoskeletal disorders associated with use of computers in poor posture. Tension neck syndrome and thoracic outlet syndrome are the most common problems associated with computer use and the major cause is prolonged sitting with the neck and back in flexed positions. These conditions are commonly reported for a person sitting in front of a computer for more then 4 hours which is common in office environments.

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November 2, 2009

Arm, neck, and shoulder complaints in general practice

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Management decisions in nontraumatic complaints of arm, neck, and shoulder in general practice

From: Ann Fam Med. 2009 Sep-Oct;7(5):446-54

Complaints of arm, neck, and shoulder pain are very common in Western societies. In the Netherlands the estimated 12-month prevalence in the general population was 31% for neck pain, 30% for shoulder pain, 11% for elbow pain, and 18% for wrist or hand pain. Studies have reported that of the respondents with noninflammatory musculoskeletal pain, about 30% to 45% contacted their general practitioner. In Dutch general practice, incidence data for patients with nontraumatic arm, neck, or shoulder complaints show 97 consultations per 1,000 registered persons annually.

Common management options for patients with nontraumatic arm, neck, and shoulder complaints are watchful waiting, additional diagnostic tests, prescription of medication, referral for physiotherapy, a corticosteroid injection, and referral for medical specialist care. Use of these 6 management options shows wide variation, however, both between and within diagnostic groups. Until now, no studies have evaluated the determinants that contribute to variation in the management of these complaints. Part of this variation may be explained by the diagnosis, which, because of its natural course and available treatment, usually guides management. Also, patient and complaint characteristics may influence management. In the Netherlands guidelines issued by the Dutch College of General Practitioners are available for epicondylitis and shoulder complaints; in both guidelines, management advice is partly based on differences in the levels of hindrance (pain severity and functional limitations). In other study populations, patient and complaint characteristics reported to be associated with management options are distress, poor perceived health, age, and sex. Additionally, indicators of poor prognosis can play a role in management decisions. In our earlier study in this population, indicators of poor prognosis were long duration of the complaints at baseline, having musculoskeletal comorbidity, recurrent complaint, low social support, and a high somatization level.

The authors wanted to evaluate associations between diagnosis and characteristics of the patient, complaint, and general practitioner, as well as 6 common management decisions, in patients with nontraumatic arm, neck, and shoulder complaints at the time of the first consultation with their physician. They undertook an observational cohort study set in 21 Dutch general practices, including 682 patients with nontraumatic complaints of arm, neck, and shoulder. The outcome measure was application (yes/no) of a specific management option: watchful waiting, additional diagnostic tests, prescription of medication, corticosteroid injection, referral for physiotherapy, and referral for medical specialist care. Separate multilevel analyses showed that overall, the diagnostic category, having long duration of complaints, and reporting many functional limitations were most frequently associated with the choice of a management option. For watchful waiting, only complaint variables played a role (long duration of complaints, high complaint severity, many functional limitations, recurrent complaint). All these variables were negatively associated with watchful waiting. When opting for 1 of the 5 other management options, several physician characteristics played a role as well. Less clinical experience was associated with additional diagnostic tests and referral to a medical specialist. General practitioners working in a solo practice more frequently referred to a medical specialist. General practitioners working in a rural area more frequently referred for physiotherapy. Female General practitioners prescribed medication less frequently. Physicians with special interest in musculoskeletal complaints gave corticosteroid injections more frequently.

Diagnostic category, long duration of complaints, and high functional limitations were key variables in management decisions with arm, neck, and shoulder complaints complaints. In addition, several physician characteristics played a role as well.

September 29, 2009

Megafibers in trapezius myalgia

Filed under: Chronic Pain,Neck Pain,Shoulder Pain — Administrator @ 2:59 am

Increased proportion of megafibers in chronically painful muscles

From: Pain. 2008 Oct 31;139(3):588-93

Trapezius myalgia – chronic pain from the upper trapezius muscle – is frequent in female employees in monotonous stressful jobs, potentially due to chronic overload of type I muscle fibers. In this study, the authors investigated the intra-individual distribution of trapezius muscle fiber size, and hypothesized that females with myalgia compared with matched healthy controls have a higher percentage of grossly hypertrophied type I fibers with poor capillarization.

Forty-two female office workers with trapezius myalgia and 20 healthy matched controls participated in the study. Standard histochemical methods were used to determine fiber size, fiber type, and capillarization. Type I megafiber were defined as at least twice the size of the median type I fiber size of each individual. The main finding was that trapezius myalgia had a significantly higher proportion of type I megafibers than healthy matched controls, in spite of no significant difference in overall type I fiber size. In trapezius myalgia and healthy matched controls type I megafibers were located in 46% and 11% of the females, respectively. Capillarization of the overall type I fiber pool was not different between healthy matched controls and trapezius myalgia, but was significantly lower in type I megafibers of both groups. The percentage of megafibers was positively related to age and weekly working hours, indicating an effect of long-term exposure. In conclusion, this study shows that trapezius myalgia is associated with a significantly higher percentage of grossly hypertrophied type I muscle fibers with poor capillarization – type I megafibers.

August 1, 2009

Prevalence of Self Reported Neck, Shoulder, Arm Pain

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Prevalence of Self Reported Neck, Shoulder, Arm Pain and Concurrent Low Back Pain or Psychological Distress: Time-Trends in a General Population, 1990-2006

From: Spine: 2009 Aug 1;34(17): 1863-8

Nonspecific neck, shoulder, arm pain is a very common symptom in the general population. It causes suffering for individuals as well as high societal costs in form of sick leave, disability pensions, health care utilization, and loss of productivity. Reviews have reported that the 12-month prevalence of neck pain range from 14% up to 78% and that the 12-month prevalence of shoulder pain range from 5% to 47%. It is important to understand whether the magnitude of different pain conditions are changing in order to plan and provide appropriate health care as well as preventive measures. However, differences in case definitions and study methodologies are considerable, making it difficult to establish time trends for neck, shoulder and arm pain. The authors are not aware of any published studies that have attempted to investigate time trends by repeatedly following the prevalence in a given geographical area.

Neck, shoulder, arm pain is more common among females. A summary of data from epidemiological studies in the general population found a median ratio between females and males of 1.4 for neck pain and 1.3 for shoulder pain. Treaster and Burr concluded that females do have higher prevalence than males for many types of upper extremity musculoskeletal disorders, even after controlling for the type of data source self reporting, plant/worker compensation records or physical examinations and confounders such as age. The reasons behind the prevalence differences are poorly understood, and it is still unclear whether this gender gap has been constant over time, or is increasing or decreasing.

Several studies have reported that both comorbid low back pain and comorbid psychological distress are common. Both a national study and a cross national study have shown that about two-third of individuals with musculoskeletal pain reported pain in at least 2 regions. The link between symptoms in different bodily regions may involve shared pathology, common mechanical risk factors, or some aspects of psychological distress. To the authors knowledge, no studies have reported whether the prevalence of neck, shoulder, arm pain with concurrent low back pain or psychological distress has changed over time.

This article presents data on the prevalence of neck, shoulder, arm pain, neck, shoulder, arm pain with concurrent low back pain, and neck, shoulder, arm pain with concurrent psychological distress, from the Stockholm Public Health Surveys that have been carried out every 4 years since 1990.

It has been hypothesized that the prevalence of musculoskeletal pain is increasing, but the evidence has been both sparse and equivocal. In contrast to an earlier study that found a 2 to 4 fold increase of pain in 2 surveys conducted 40 years apart, the results in the present article indicated a slight rise in the prevalence of neck, shoulder, arm pain, which may indicate a similar but weaker time trend.

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June 12, 2009

Neck and shoulder hyperalgesia in chronic tension type headache

Filed under: Headaches,Neck Pain,Shoulder Pain — Administrator @ 7:36 pm

Generalized neck and shoulder hyperalgesia in chronic tension type headache and unilateral migraine assessed by pressure pain sensitivity topographical maps of the trapezius muscle

From: Cephalalgia. 2009 Jun 8. [Epub ahead of print]

Spatial changes in pressure pain hypersensitivity are present throughout the cephalic region (temporalis muscle) in both chronic tension type headache and unilateral migraine. The aim of this study was to assess pressure pain sensitivity topographical maps on the trapezius muscle in 20 patients with chronic tension type headache and 20 with unilateral migraine in comparison with 20 healthy controls in a blind design. For this purpose, a pressure algometer was used to assess pressure pain thresholds over 11 points of the trapezius muscle: four points in the upper part of the muscle, two over the levator scapulae muscle, two in the middle part, and the remaining three points in the lower part of the muscle. Pressure pain sensitivity maps of both sides were depicted for patients and controls.

Chronic tension type headache patients showed generalized lower pressure pain thresholds levels compared with both migraine patients and controls. The migraine group had also lower pressure pain thresholds than healthy controls. The most sensitive location for the assessment of pressure pain thresholds was the neck portion of the upper trapezius muscle in both patient groups and healthy controls. Pressure pain thresholds was negatively related to some clinical pain features in both chronic tension type headache and unilateral migraine patients. Side-to-side differences were found in strictly unilateral migraine, but not in those subjects with bilateral pain, i.e. chronic tension type headache. These data support the influence of muscle hyperalgesia in both chronic tension type headache and unilateral migraine patients and point towards a general pressure pain hyperalgesia of neck and shoulder muscles in headache patients, particularly in chronic tension type headache.

May 21, 2009

Relation between spinal pain and temporomandibular disorders

Filed under: Back Pain,Neck Pain,Shoulder Pain,TMJ Pain — Administrator @ 9:48 am

Does a dose-response relation exist between spinal pain and temporomandibular disorders?

From: BMC Musculoskelet Disord. 2009 Mar 2;10:28

Temporomandibular disorders are musculoskeletal pain conditions characterised by pain and dysfunction in the jaw-face muscles and/or the temporomandibular joint. Musculoskeletal pain conditions occurring at various locations may share pathophysiological mechanisms. Co-morbidity between temporomandibular disorders, headaches and neck/shoulder pain has been reported in temporomandibular disorders patient samples as well as in samples drawn from the general population. Low back pain, one of the most common pain conditions in humans, has been associated with other pains such as neck pain and headaches, which has been interpreted as a tendency for symptoms to cluster in some individuals. The source of these patterns is not known, but neurobiological sensitization processes, genetically determined vulnerability and psychological factors are commonly given as possible explanations. Results of a 3-year prospective study showed a significantly increased risk of developing a new pain condition with presence of a pain condition at baseline. A more recent prospective study based on patients with non-painful temporomandibular disorders indicated a dose-response relationship between the number of pain sites at baseline (head, back, chest, stomach) and the risk of onset of dysfunctional temporomandibular disorders pain among women. Frequency of headaches was found to have a dose-response relationship with occurrence of musculoskeletal symptoms (e.g. pain in neck, shoulders and low back) in a Norwegian population.

The authors have recently shown that patients with long-term spinal pain (neck, shoulder and/or low back) significantly more often have signs and symptoms of temporomandibular disorders than do matched controls. The associations remained statistically significant also after exclusion of those who reported jaw pain. It is not known whether co-morbidity between temporomandibular disorders and neck pain, shoulder pain and/or low back pain occurs within the whole range of variation in symptom frequency and severity. Most analyses in this field have involved dichotomized samples, not taking variations of symptom severity into consideration. The aim of the present study was to test whether a reciprocal dose-response relation exists between frequency and severity of neck pain, shoulder pain and/or low back pain and temporomandibular disorders. The authors tested the following null hypotheses:

1. Occurrence of frequent temporomandibular disorders symptoms and headaches does not differ significantly between study groups with varying frequency and severity of neck pain, shoulder pain and/or low back pain.

2. Presence of frequent neck pain, shoulder pain and/or low back pain does not differ significantly between study groups with varying frequency and severity of temporomandibular disorders symptoms.

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March 9, 2009

Musculoskeletal disorders among university student computer users

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Musculoskeletal disorders among university student computer users

From: Med Lav. 2009 Jan-Feb;100(1):29-34

Musculoskeletal disorders are a common problem among computer users. Many epidemiological studies have shown that ergonomic factors and aspects of work organization play an important role in the development of these disorders. The authors carried out a cross-sectional survey to estimate the prevalence of musculoskeletal symptoms among university students using personal computers and to investigate the features of occupational exposure and the prevalence of symptoms throughout the study course. Another objective was to assess the students’ level of knowledge of computer ergonomics and the relevant health risks.

A questionnaire was distributed to 183 students attending the lectures for second and fourth year courses of the Faculty of Architecture. Data concerning personal characteristics, ergonomic and organizational aspects of computer use, and the presence of musculoskeletal symptoms in the neck and upper limbs were collected. Exposure to risk factors such as daily duration of computer use, time spent at the computer without breaks, duration of mouse use and poor workstation ergonomics was significantly higher among students of the fourth year course.

Neck pain was the most commonly reported symptom (69%), followed by hand/wrist (53%), shoulder (49%) and arm (8%) pain. The prevalence of symptoms in the neck and hand/wrist area was signifcantly higher in the students of the fourth year course. In this survey we found high prevalence of musculoskeletal symptoms among university students using computers for long time periods on a daily basis. Exposure to computer related ergonomic and organizational risk factors, and the prevalence of musculoskeletal symptoms both seem to increase significantly throughout the study course. Furthermore, they found that the level of perception of computer related health risks among the students was low. Our findings suggest the need for preventive intervention consisting of education in computer ergonomics.

February 16, 2009

neck and shoulder pain associated with work and lifestyle

Filed under: Neck Pain,Shoulder Pain — Administrator @ 3:27 pm

Four-year incidence of sick leave because of neck and shoulder pain and its association with work and lifestyle

From: Spine. 2009 Feb 15;34(4):413-8

Musculoskeletal disorders are one of the important health problems in the world. With the exception of back pain, neck and shoulder pain is one of the prevalent disorders in workplaces and a common reason for abseentism, job change, and disability pension.

The incidence and prevalence of neck and shoulder pain have a broad range in different studies, depending on which data collection method is used (self-reported questionnaire, medical examination, sickness absence). Neck and shoulder pain is a dynamic entity that can change over time, but few longitudinal studies have been performed on workplace populations to address the above-mentioned issues.

The relation between neck and shoulder pain and physical as well as psychosocial factors at work have been studied and approved (with different consistency) in different surveys. Most of these studies are cross-sectional and related to high-income and industrialized countries. There is little information about neck and shoulder pain in the general population in developing and low-income countries. There are even fewer studies in working populations.

The main aim of this longitudinal investigation was to determine the incidence of sick leave because of neck and shoulder pain in a large population of Iranian workers, and to study its relation with physical and psychosocial factors at work, lifestyle, and previous pain. An additional aim was to compare risk factors for future sick leave versus risk factors for self-reported neck and shoulder pain in the cross-sectional baseline study.

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