Neck Solutions Blog

August 1, 2010

Low back pain may be caused by disturbed pain regulation: a cross-sectional study in low back pain patients using tender point examination

Filed under: Back Pain,Disc Problems — Administrator @ 2:08 pm

Low back pain may be caused by disturbed pain regulation: a cross-sectional study in low back pain patients using tender point examination

From: Eur J Pain. 2010 May;14(5):514-22

Widespread pain has negative influence on outcome in low back pain patients. Tender point examination is a standardized examination method to estimate diffuse tenderness. To assess diffuse tenderness by means of a standardized tender point examination and to analyse for associations between the number of tender points and spinal structural changes as well as psycho-social factors.

Patients sick-listed 3-16 weeks due to low back pain with or without sciatica completed a questionnaire and went through a clinical low back examination and tender point examination. Of 326 patients 111 had verified nerve root affection and 215 had non-specific low back pain with or without radiating pain. Disc height reductions were estimated on lateral X-rays.

Multivariate logistic regression analysis showed that more than 8 tender points were strongly negatively associated with disc degeneration, and verified nerve root affection and were positively associated with number of years since first episode of low back pain. Furthermore, more than 8 tender points were positively associated with widespread pain, female sex and bodily distress. With all patients included, bodily distress and the number of tender points were positively associated with the intensity of low back pain, but disc degeneration was only positively associated with low back pain in patients with less than 6 tender points.

The pain in patients with diffuse tenderness was rarely related to disc degeneration or nerve root affection, rather it may be caused by disturbed pain regulation.

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 23, 2010

Effectiveness of manual therapy for chronic tension-type headache: A pragmatic, randomised, clinical trial

Filed under: Headaches — Administrator @ 2:52 pm

Effectiveness of manual therapy for chronic tension-type headache: A pragmatic, randomised, clinical trial

From: Cephalalgia. 2010 Jul 20. [Epub ahead of print]

The 1-year prevalence of chronic tension-type headache is about 2–5% in the general population. In half of the chronic tension-type headache cases, headache related impairment in work performance is reported. In addition to considerable impact on daily functioning and work participation, chronic tension-type headache is a risk factor for overuse of analgesic medication. Only about 20% of the chronic tension-type headache patients seek medical care for their headache. This low consultation rate may be explained by insufficient information on the effectiveness of treatments or by previous negative health care experiences.

In primary care treatment for patients with chronic tension-type headache is often provided by the general practitioner. The Dutch national general practice guideline for the management of headache describes diagnostic and therapeutic algorithms, consisting mainly of reassurance, lifestyle advice and medication. The effectiveness of this guideline for patients with chronic tension-type headache has not been investigated.

The pathogenesis of chronic tension-type headache remains unclear. Pathophysiological theories considering central and peripheral pain mechanisms are described and have been discussed in the literature. In recent research a correlation between chronic tension-type headache and impairment of the cranio-cervical musculoskeletal function (forward head position, trigger points trapezius muscle, neck mobility) has been demonstrated. In combination with results obtained in previous studies the present data support the hypothesis that improvement of the cranio-cervical musculoskeletal function by a manual therapy intervention (postural correction, mobilisation cervical spine, and training of cervical muscles) may be an important factor to modify central or peripheral pain mechanism in chronic tension-type headache.

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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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July 17, 2010

Prognosis of Patients With Nonspecific Neck Pain: Development and External Validation of a Prediction Rule for Persistence of Complaints

Filed under: Neck Pain — Administrator @ 1:34 pm

Prognosis of Patients With Nonspecific Neck Pain: Development and External Validation of a Prediction Rule for Persistence of Complaints.

From: Spine (Phila Pa 1976). 2010 Jul 12.

Neck pain is one of the most common musculoskeletal disorders, with an estimated 1-year prevalence of 31.4% to 35.6% of adults in the general population. The course of neck pain is characterized by exacerbations and remissions and only a small part of the patients experience complete resolution of their symptoms within 1 year.

A substantial proportion of the neck pain patients will thus develop chronic neck pain. The definition of chronicity differs between studies, in terms of either 3 or 6 months duration of complaints. Nevertheless, the estimates of their 1-year prevalence in the general population are similar: 8.7% to 17.8% for the 3-months definition, and 8% to 13.8% for the 6-months definition.

An important question is whether we can identify patients at risk of persistent complaints at the first consultation with the physician, based on their personal characteristics? This information could be helpful for a physician to gain insight into the prognosis of an individual patient with neck pain, and would aid in informing patients more accurately about their expected prognosis. Furthermore, this would aid researchers in selecting patients at high risk in studies on prevention of chronic neck pain.

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July 15, 2010

A systematic review of chiropractic management of adults with Whiplash-Associated Disorders: recommendations for advancing evidence-based practice and research

Filed under: Chiropractic,Whiplash — Administrator @ 3:02 pm

A systematic review of chiropractic management of adults with Whiplash-Associated Disorders: recommendations for advancing evidence-based practice and research

From: Work. 2010;35(3):369-94

The literature relevant to the treatment of Whiplash Associated Disorders is extensive and heterogeneous. A Participatory Action Research approach was used to engage a chiropractic community of practice and stakeholders in a systematic review to address a general question: ‘Does chiropractic management of whiplash associated disorders clients have an effect on improving health status?’ A systematic review of the empirical studies relevant to whiplash associated disorders interventions was conducted followed by a review of the evidence.

The initial search identified 1,155 articles. Ninety-two of the articles were retrieved, and 27 articles consistent with specific criteria of whiplash associated disorders intervention were analyzed in-depth. The best evidence supporting the chiropractic management of clients with whiplash associated disorders is reported. Further review identified ways to overcome gaps needed to inform clinical practice and culminated in the development of a proposed care model: the whiplash associated disorders-plus model.

There is a baseline of evidence that suggests chiropractic care improves cervical range of motion and pain in the management of whiplash associated disorders. However, the level of this evidence relevant to clinical practice remains low or draws on clinical consensus at this time. The whiplash associated disorders-plus model has implications for use by chiropractors and interdisciplinary professionals in the assessment and management of acute, subacute and chronic pain due to whiplash associated disorders. Furthermore, the whiplash associated disorders-plus model can be used in the future study of interventions and outcomes to advance evidence-based care in the management of whiplash associated disorders.

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