Neck muscle endurance, self-report, and range of motion data from subjects with treated and untreated neck pain

Effects of Virtual Reality Therapy Combined With Conventional Rehabilitation on Pain, Kinematic Function, and Disability in Patients With Chronic Neck Pain: Randomized Controlled Trial

BACKGROUND

Neck pain is a common condition that leads to neck motor dysfunction and subsequent disability, with a significant global health care burden. As a newly emerging tool, virtual reality (VR) technology has been employed to address pain and reduce disability among patients with neck pain. However, there is still a lack of high-quality studies evaluating the efficacy of VR therapy combined with conventional rehabilitation for patients with chronic neck pain, particularly in terms of kinematic function.

OBJECTIVE

This study aims to investigate the effect of VR therapy combined with conventional rehabilitation on pain, kinematic function, and disability in patients with chronic neck pain.

METHODS

We conducted an assessor-blinded, allocation-concealed randomized controlled trial. Sixty-four participants experiencing chronic neck pain were randomly allocated into the experimental group that underwent VR rehabilitation plus conventional rehabilitation or the control group receiving the same amount of conventional rehabilitation alone for 10 sessions over 4 weeks. Pain intensity, disability, kinematic function (cervical range of motion, proprioception, and mean and peak velocity), degree of satisfaction, and relief of symptoms were evaluated at 3 timepoints (baseline, postintervention, and at 3 months follow-up). A 2*3 mixed repeated measures analysis of variance was utilized for analyzing the difference across indicators, with a significant difference level of .05.

RESULTS

Both groups demonstrated significant improvements in pain, disability, and kinematic functions (P<.05) at postintervention and at 3-month follow-up. The experimental group showed superior therapeutic outcomes compared to the control group in pain reduction (mean difference from the baseline: 5.50 vs 1.81 at posttreatment; 5.21 vs 1.91 at the 3-month follow-up, respectively; P<.001), disability improvement (mean difference from baseline: 3.04 vs 0.50 at posttreatment; 3.20 vs 0.85 at the 3-month follow-up, respectively; P<.001), and enhanced kinematic functions (P<.05). Moreover, participants in the experimental group reported better satisfaction and relief of symptoms than the control group (P<.05), with better initiative for exercising during the follow-up period. However, there was no between-group difference of improvement in proprioception. No adverse events were reported or observed in our research.

CONCLUSIONS

The findings of our study support the efficacy of combining VR therapy with conventional rehabilitation in alleviating pain, enhancing kinematic function, and reducing disability of patients with chronic neck pain. Future research should focus on refining the therapeutic protocols and dosages for VR therapy as well as on optimizing its application in clinical settings for improved convenience and effectiveness.

TRIAL REGISTRATION

Chinese Clinical Trial Registry ChiCTR2000040132; http://www.chictr.org.cn/showproj.aspx?proj=64346.

Feature recognition in multiple CNNs using sEMG images from a prototype comfort test

OBJECTIVE

Deep learning-based CNN networks have recently been investigated to solve the problem of body posture recognition based on surface electromyographic signals (sEMG). Influenced by these studies, to develop a combined approach of sEMG and CNNs in the study of human-product interactions and the impact of body comfort, and to compare the advantages and disadvantages of various CNNs networks.

METHODS

In this study, sEMG measurements were carried out by building a prototype usability experiment, and the data were divided into four categories, with two types of datasets: training and testing. Four CNNs, LeNet-5, VGGNet-11, InceptionNet V4, and DenseNet, were used for the recognition of sEMG images.

RESULTS

DenseNet is another type of convolutional neural network with deep layers, which has a unique advantage over other algorithms. unique advantages over other algorithms. DenseNet has fewer layers and better accuracy than InceptionNet V4, but not only does it bypass enhanced feature reuse, but its network is easier to train and has some regularization effects, while also mitigating the problems of gradient disappearance and model degradation.

CONCLUSION

These findings could lead to a more appropriate CNN model and a useful tool for developing comfort judgments of surface EMG signals, furthering the development of products that come into contact with the human body without the need for routine retraining.

Elastic Taping Application on the Neck: Immediate and Short-Term Impacts on Pain and Mobility of Cervical Spine

The aim of this study was to measure the effects on three-planar active cervical range of motion (ACROM) and self-perceived pain of elastic taping (ET) application in the cervical area. Thirty participants (n: 22-M and 8-F, age 35.4 ± 4.4 years; body height 173.1 ± 8.4 cm; body mass 73.5 ± 12.8 kg) in the study group (SG) and twenty participants (n: 11-M and 9-F, age 32.6 ± 3.9 years; body height 174.9 ± 10.9 cm; body mass 71.2 ± 12.9 kg) in the control group (CG) were recruited. All subjects had neck and cervical pain in baseline condition. Each group performed an ACROM test and measured the perceived pain in the neck based on the Numerical Rating Scale (NRS 0--10, a.u.) at the baseline (T0), after 20' from the ET application (T1), and after three days of wearing the ET application (T2). Between T0 and T1, an ET was applied to the cervical area of the SG participants. Statistical analysis did not show any significant change in CG in any measurement session for ACROM and neck pain parameters. Conversely, the SG showed significant improvements for ACROM rotation to the left (T0 64.8 ± 7.7°-T2 76.0 ± 11.1° p < 0.000) and right (T0 66.0 ± 11.9°-T2 74.2 ± 9.6° p < 0.000), lateral inclination to the left (T0 37.5 ± 6.9°-T2 40.6 ± 10.8° p < 0.000) and right (T0 36.5 ± 7.9°-T2 40.9 ± 5.2° p < 0.000), extension (T0 47.0 ± 12.9°-T2 55.1 ± 12.3° p < 0.001), and flexion (T0 55.0 ± 3.6°-T2 62.9 ± 12.0° p < 0.006). A significant decrease was also measured in SG for pain NRS between T0 and T2 (T0 7.5 ± 1.0°-T1 5.5 ± 1.4-T2 1.4 ± 1.5° p < 0.000). In conclusion, a bilateral and symmetrical ET cervical application is useful to enhance multiplanar ACROM and reduce subjective self-perceived cervical pain when it is needed. Based on the evidence, the use of ET on the neck is recommended for managing neck motion restrictions and pain in adult individuals.

Influence of forward head posture on muscle activation pattern of the trapezius pars descendens muscle in young adults

Forward head posture (FHP) is a serious problem causing head and neck disability, but the characteristics of muscle activity during long-term postural maintenance are unclear. This study aimed to investigate a comparison of electromyography (EMG) activation properties and subjective fatigue between young adults with and without habitual FHP. In this study, we examined the changes in the spatial and temporal distribution patterns of muscle activity using high-density surface EMG (HD-SEMG) in addition to mean frequency, a conventional measure of muscle fatigue. Nineteen male participants were included in the study (FHP group (n = 9; age = 22.3 ± 1.5 years) and normal group (n = 10; age = 22.5 ± 1.4 years)). Participants held three head positions (e.g., forward, backward, and neutral positions) for a total of 30 min each, and the EMG activity of the trapezius pars descendens muscle during posture maintenance was measured by HD-SEMG. The root mean square (RMS), the modified entropy, and the correlation coefficient were calculated. Additionally, the visual analogue scale (VAS) was evaluated to assess subjective fatigue. The RMS, VAS, modified entropy, and correlation coefficients were significantly higher in the FHP group than in the normal group (p < 0.001). With increasing postural maintenance time, the modified entropy and correlation coefficient values significantly decreased, and the mean frequency and VAS values significantly increased (p < 0.001). Furthermore, the forward position had significantly higher RMS, correlation coefficient, modified entropy, and VAS values than in the neutral position (p < 0.001). The HD-SEMG potential distribution patterns in the FHP group showed less heterogeneity and greater muscle activity in the entire muscle and subjective fatigue than those in the normal group. Excess muscle activity even in the neutral/comfortable position in the FHP group could potentially be a mechanism of neuromuscular conditions in this population.

Impact of adding scapular stabilization to postural correctional exercises on symptomatic forward head posture: a randomized controlled trial

BACKGROUND

One of the most overspread postural abnormalities is forward head posture (FHP) and it is described as head projection anteriorly in relation to the trunk which appears mainly in sagittal plane. Scapular stabilization exercise (SSE) is capable of restoring each of thoracic cage and head neutral optimum position by neck and shoulder muscles interactions and through controlling scapular position and movement.

AIM

This study was conducted to investigate the impact of adding scapular stabilization (SSE) to postural correctional exercises (PCE) on symptomatic FHP.

DESIGN

The pre-post single-masking (assessor) randomized experimental trial.

SETTING

Participants with postural dysfunction in form of FHP admitted to outer clinic of the Faculty of Physical Therapy.

POPULATION

Sixty participants (20 to 35 years) with symptomatic FHP and recruited from outer clinic at faculty of physical therapy.

METHODS

Participants were allocated randomly by opaque sealed envelope to two groups who are referred from an orthopedist: Group "A" received SSE and postural correction exercises, whereas Group "B" received only postural correctional exercises; treatments were performed three times/week for 10 weeks. The craniovertebral angle, pressure pain threshold, cervical flexor and extensor muscles endurance, Arabic neck disability index, upper trapezius and sternocleidomastoid muscle root mean square during rest and activity were used to evaluate the patients' pretreatment and post-treatment.

RESULTS

Within group analysis for sixty participants reported statistical significant difference between baseline and post-treatment as P value <0.05 with more refinement in stabilization exercise group.

CONCLUSIONS

Adding SSEs to PCEs is more effective method than PCEs seldom for the management of FHP patients.

CLINICAL REHABILITATION IMPACT

Both scapular stabilization and postural correction exercise increase craniovertebral angle and pressure pain threshold (PPT) and decrease muscle activity and disability. Scapular stabilization alone increase craniovertebral angle and PPT and decrease muscle activity and disability more than postural correction exercise. In addition of statistical significant difference in all variables but there were clinical change in disability only.

Fat Infiltration of Multifidus Muscle Is Correlated with Neck Disability in Patients with Non-Specific Chronic Neck Pain

Background: Chronic non-specific neck pain (CINP) is common, but the etiology remains unclear. This study aimed to examine the relationship between cervical muscle composition (cervical multifidus and longus capitis/longus colli), morphometry, range of movement, muscle function, and disability severity (Neck Disability Index) in patients with CINP. Methods: From September 2020 to July 2021, subjects underwent cervical MRI and clinical tests (cervical range of motion, cranio-cervical flexion test, neck flexor, and extensor muscle endurance). MRI analysis comprised muscle cross-sectional area, volume, and fat infiltration of multifidus and longus colli between C4 and C7 levels. Results: Twenty-five participants were included. Multiple linear regression analysis indicated that NDI was positively correlated with the volume percentage of fat infiltration of the multifidus (B = 0.496), negatively correlated with fat-free muscle volume of the multifidus normalized by subject height (B = −0.230), and accounted for 32% of the variance. There was no relationship between neck disability and longus capitis/longus colli morphology. We also found no relationship between neck disability scores, neck flexor or extensor muscle endurance, or the outcome motor control test of craniocervical flexion (p > 0.05). Conclusions: Neck disability was moderately correlated with the percentage of fat volume in the multifidus muscle and fat-free volume of the multifidus. There was no relationship between NDI scores and muscle function test outcomes or any fat or volume measures pertaining to the longus colli muscle.

Specific versus non-specific exercises for the neck extensor muscles in women with chronic idiopathic neck pain: A randomized controlled trial

BACKGROUND

Structural and functional impairments of the cervical extensor muscles have been demonstrated in people with neck pain. A global exercise approach targeting all neck extensor muscles has shown positive effects in this population. However, to date, the efficacy of exercises specifically targeting the deep neck extensors has neither been tested nor compared to global exercises for the neck extensors.

OBJECTIVES

To compare the effects on pain and disability of a specific lower deep neck extensors (SLDNE) versus a general neck extensor (GNE) exercise program in women with chronic idiopathic neck pain.

METHODS

Fourty-three women with chronic idiopathic neck pain were randomly allocated to either a six-week SLDNE or a GNE exercise program. As primary outcome, neck disability was measured with the Neck Disability Index (NDI). Secondarily, pain intensity (VAS), cervical ROM, pressure pain thresholds (PPTs), cervical and thoracic posture and self-perceived benefit of treatment (GROC) were also measured. Every outcome was measured at baseline and immediately after treatment, except NDI, which was also measured at 6-months follow-up. The GROC was only assessed post-intervention.

RESULTS

Both exercise programs lead to reduced neck disability immediately post-intervention (within-group mean difference [MD] = -6.09; 95% Confidence Interval [CI]: 7.75, -4.42 and -4.73; 95%CI: 6.57, -2.91 respectively) and at the 6-months follow-up (-4.47; 95%CI: 6.41, -2.53 and -4.74; 95%CI: 6.50, -2.97), but with no between group differences. Similar results were found for pain intensity post-intervention, with no between group interaction (within-group MD = -20.87 mm; 95% CI: 28.55, -13.19 and -18.00 mm; 95%CI: (-26.24, -9.76) for SLDNE and GNE groups, respectively). GROC improved after both interventions without any between-group difference.

CONCLUSIONS

A six-week exercise program specifically targeting the lower deep neck extensors lead to comparable outcomes as a general neck extensor exercise program in women with chronic idiopathic neck pain.

Effects of clinical pilates exercises in patients with chronic nonspecific neck pain: a randomized clinical trial

BACKGROUND

Neck pain is a common musculoskeletal problem in adults. Clinical pilates exercises can be beneficial managing the pain and improving the risk factors.

AIMS

The aim of this study was to investigate the effects of clinical pilates exercises on pain and disability, deep neck flexor endurance (DNFE), posture, cervical range of motion (CROM), and proprioception in patients with chronic nonspecific neck pain.

METHODS

Fifty patients with chronic nonspecific neck pain were randomized into two groups. The clinical pilates exercise group (CPEG) received clinical pilates exercises for 6 weeks. The control group (CG) received posture education. Pain and disability, DNFE, forward head angle (FHA) and forward shoulder angle (FSA) degrees, CROM, and joint position error (JPE) were measured before and after 6 weeks.

RESULTS

Clinical pilates exercises improved pain, Neck Disability Index (NDI), DNFE, posture, CROM (except extension), and JPE (p < 0.05). We found significant differences between CPEG and CG in the comparisons for the change of pain, NDI, DNFE, FSA, CROM (except extension), and JPE (except left rotation) (p < 0.05). NDI, FSA, and rotational JPE also improved in CG (p < 0.05). However, these improvements were significantly better in CPEG than CG (p < 0.05) except JPE in left rotation (p = 0.118).

CONCLUSION

In patients with chronic nonspecific neck pain, clinical pilates exercise is a safe and effective method to improve pain and disability, DNFE, posture, ROM, and proprioception.

CLINICAL TRIAL REGISTRATION

NCT03782584 retrospectively registered December 20 2018.

Comparison and correlation of cervical proprioception and muscle endurance in general joint hypermobility participants with and without non-specific neck pain-a cross-sectional study

Background

Cervical proprioception and muscle endurance are essential for maintaining cervical functional joint stability. Proprioception and muscle endurance may be impaired in those with general joint hypermobility (GJH). Examining these aspects is crucial. This study's aims are to (1) compare the cervical joint position error (JPE) and muscle endurance holding capacities in GJH individuals with and without non-specific neck pain (NSNP) (2) to assess the relationship between hypermobility Beighton scores, cervical JPE's, and muscle endurance in GJH individuals with and without NSNP.

Methods

In this cross-sectional comparative study, 33 GJH participants with NSNP (mean age 21.7 ± 1.8 years) and 35 asymptomatic participants GJH (mean age 22.42 ± 1.7 years) participated. Beighton's score of ≥4 of 9 tests was used as criteria to diagnose GJH. Cervical JPEs were estimated in degrees using a cervical range of motion device, and muscle endurance (flexor and extensor) were estimated in seconds using a stopwatch.

Results

GJH participants with NSNP showed significantly larger cervical JPEs (p < 0.001) and decreased muscle endurance holding times (p < 0.001) compared to asymptomatic participants. Beighton hypermobility scores showed a significant moderate positive correlation with cervical JPEs (flexion: r = 0.43, p = 0.013), left rotation: r = 0.47, p = 0.005, right rotation: r = 0.57, p = 0.001) in NSNP individuals. Also, Beighton hypermobility scores showed a moderate negative correlation with muscle endurance in NSNP (flexor muscles: r = -0.40, p = 0.020, extensor muscles: r = -0.41, p = 0.020, and asymptomatic individuals (flexor muscles: -0.34, p = 0.045, extensor muscles: r = -0.45, p = 0.007).

Conclusion

GJH individuals with NSNP showed increased cervical JPEs and reduced muscle endurance compared to asymptomatic. Individuals with GJH with higher Beighton scores demonstrated increased cervical JPEs and reduced neck muscle endurance holding ability. In clinical practice, therapists should be aware of these findings, incorporate proprioceptive and muscle endurance assessments, and formulate rehabilitation strategies for NSNP individuals with GJM.

Evaluation and Treatment of Trigeminal Symptoms of Cervical Origin After a Motor-Vehicle Crash: A Case Report With 9-Month Follow-up

Objective

The purpose of this case report is to describe the management of a patient with trigeminal symptoms of cervical origin after a motor-vehicle crash (MVC).

Clinical Features

After a head-on MVC, a 65-year-old woman presented with complaints of dizziness, headaches, facial tingling, visual disturbance, tinnitus, loss of cervical motion, and pain in the cervical spine.

Intervention and Outcome

The intervention applied was manipulation of the left C1-C2 and right C2-C3, with targeted exercise to strengthen the cervical musculature. After 4 weeks of treatment, the patient reported improvement in functional tasks and reduction in overall pain, headaches, facial tingling, tinnitus, and dizziness. At a 9-month follow-up, the patient had no report of facial tingling, tinnitus, loss of motion, or eye pain.

Conclusion

This patient with trigeminal symptoms of cervical origin after an MVC responded well to manual therapy to the cervical spine as part of a combination of services.

Assessment of computer workstations for compliance with ergonomic guidelines: A field study

BACKGROUND

Computer workstation use is a risk factor for the development of musculoskeletal disorders. Governmental guidelines have been developed as a resource for workstation set-up to minimize this risk. The degree of worksite compliance with guidelines has not been examined.

OBJECTIVE

The purpose of this study was to examine workstations using the VDT Workstation Checklist to determine compliance, and potential modifications.

METHODS

Subjects were recruited from a variety of work settings in Erie, PA. Workstations were assessed with the worker present, using the VDT Workstation Checklist. Adjustments and recommendations were made as appropriate.

RESULTS

Of the 60 workstations examined, 48%did not receive a passing score. All but one were correctable to an acceptable level with minimal low-cost modifications. The recommendation for wrist rests (43%), changes in monitor height (30%) or position (27%) and reposition of the keyboard (13.3%) and mouse (13.3%) were the most frequent modifications. Ten (16.7%) workstations did not require modification.

CONCLUSIONS

Almost half of workstations reviewed were not in compliance with current guidelines, however almost all (98%) could be brought into compliance with simple modifications. Office workers need guidance in setting up workspace and adjusting ergonomic equipment to provide comfortable and safe work settings and minimize musculoskeletal symptoms.

Cervicothoracic spinal alignment and neck flexor muscle endurance in young and older adult females with and without neck and shoulder pain (Katakori in Japanese)

[Purpose] The characteristics of neck and shoulder pain (NSP) in different age populations have not been sufficiently examined. Therefore, the purpose of this study was to compare and verify the cervicothoracic spinal alignment and neck flexor muscle endurance of young and older adult females with and without NSP. [Participants and Methods] We assessed 72 female participants (39 young participants, 33 elderly participants, 43 NSP, 29 non-NSP) aged 18–82 years who were recruited for this study. Cervicothoracic spinal alignment measurements were obtained with forward head alignment (FHA) along with the upper thoracic angle. The neck flexor endurance test was performed. [Results] There were no significant age-by-group interactions for any of the assessment variables. However, the upper thoracic angle and neck flexor muscle endurance showed significant effects in the groups. Age also had significant effects on FHA and upper thoracic angle. [Conclusion] These results suggested that the neck flexor muscle endurance was more appropriate as an evaluation tool for older adult females with NSP. It was also suggested that the cervical flexor muscle endurance and upper thoracic angle were more appropriate as evaluation tools for young adult females with NSP.

Comparison and Association of Neck Extensor Muscles’ Endurance and Postural Function in Subjects with and without Chronic Neck Pain – A Cross-Sectional Study

Purpose Neck extensor endurance (NEE) and position sense are vital for maintaining cervical spine function and defects in these processes may be associated with impaired postural control in chronic neck pain (CNP) subjects. The study’s objectives are 1) to compare the cervical extensor endurance capability and postural control of CNP subjects with those of asymptomatic controls; 2) to investigate the association between NEE and postural control.

Materials and Methods Sixty-four participants (38 asymptomatic, 38 with CNP) participated in this cross-sectional study. NEE was assessed using a clinical extensor endurance test. Under open and closed eyes conditions, postural control measures were tested with the Good Balance system. The postural control parameters were AP-velocity (mm/s), ML-velocity (mm/s) and Velocity moment (mm2). NEE capacity and postural control parameters were compared and correlated between asymptomatic and CNP subjects.

Results and Discussion CNP subjects showed lower NEE capacity (p<0.001) and significantly larger AP-velocity (p<0.001), ML-velocity (p<0.001) and Velocity moment (p<0.001) than asymptomatic participants. NEE negatively correlated with AP-velocity (r=−0.51, p=0.001), ML-velocity (r=0.46, p=0.003) and velocity moment (r=0.38, p=0.020) in asymptomatic subjects in eyes open condition and no correlations in subjects with CNP. CNP subjects showed increased postural sway velocities and lowered extensor endurance capacity compared to asymptomatic participants. No correlations existed between NEE and postural control parameters in CNP subjects.

Cervical Proprioception Impairment in Neck Pain-Pathophysiology, Clinical Evaluation, and Management: A Narrative Review

Neck pain is very common, but most of the causes are unknown, making diagnosis and treatment extremely challenging. Current studies have found that one of the main problems in patients with neck pain is the impairment of cervical proprioception, which subsequently leads to cervical sensorimotor control disturbances. Cervical spine has a very delicate proprioceptive system that plays a crucial role in controlling posture and balance. Cervical proprioceptive impairment in neck pain occurs through a variety of mechanisms. Experimental neck muscle pain induced by injection of hypertonic saline results in inhibition of the activation of painful muscle; chronic neck pain causes structural and functional impairment of cervical muscles; excessive activation of mechanoreceptors in degenerative cervical discs and facet joints produces a large number of erroneous sensory signals. Clinical examinations to assess the link between structural pathology and neck pain have been unsuccessful, opening the way for the development of function-based tests. To date, eight neck sensorimotor control tests have been reported to evaluate patients with chronic neck pain. Although some tests may involve different subsystems (such as oculomotor system and vestibular system), all tests measure sensorimotor control in the neck, and the most commonly used is cervical joint position error (JPE) test. Current studies support the effectiveness of exercises targeting different aspects of sensorimotor function, in particular retraining aimed at improving cervical proprioception and muscle coordination. Based on the available evidence, it is recommended that patients with neck pain should be assessed and managed for cervical proprioceptive impairment and sensorimotor control disturbances.

Comparison of neck extensor muscle endurance and cervical proprioception between asymptomatic individuals and patients with chronic neck pain

INTRODUCTION

Neck extensor endurance (NEE) and cervical proprioception are vital for maintaining cervical spine function and defects in these processes have been associated with chronic neck pain (CNP). The objectives of the study are 1) To investigate the association between NEE and cervical joint position error (JPE) in subjects with CNP; 2) to compare the cervical extensor endurance and cervical JPE of CNP subjects with those of asymptomatic controls; and 3) to determine the relationship between Pain Catastrophizing Scale (PCS) scores, NEE, and cervical JPE in subjects with CNP.

METHOD

Sixty-four participants (32 asymptomatic, 32 with CNP) participated in this comparative cross-sectional study. Cervical proprioception was assessed by measuring the absolute JPE in the sagittal and transverse directions. NEE was assessed using a clinical extensor endurance test. NEE capacity and JPE were compared and correlated between asymptomatic and CNP subjects. Pain catastrophic behavior was assessed using the Pain Catastrophizing Scale (PCS) in CNP subjects.

RESULTS

CNP subjects showed lower NEE capacity (p < 0.001) and significantly larger JPEs (p < 0.001) than asymptomatic participants. NEE negatively correlated with JPEs in all directions (p < 0.001) in asymptomatic subjects and only neck extension errors showed a correlation in CNP subjects (r = -0.45, p = 0.009). PCS scores were negatively correlated with endurance capacity (r = -0.42, p = 0.017) and positively correlated with JPE (flexion: r = 0.57, p = 0.001).

CONCLUSION

CNP subjects showed impaired proprioception and lower endurance capacity compared to asymptomatic participants. Neck extension errors alone correlated with JPE in CNP subjects. PCS scores negatively correlated with NEE in subjects with CNP.

Effects of Virtual Reality versus Exercise on Pain, Functional, Somatosensory and Psychosocial Outcomes in Patients with Non-specific Chronic Neck Pain: A Randomized Clinical Trial

Background: Virtual reality (VR) applied to patients with neck pain is a promising intervention to produce positive effects when used alone or combined with exercise. Therefore, the objective of this manuscript is to compare the effects of VR versus exercise treatment on pain intensity, conditioned pain modulation (CPM), temporal summation (TS) and functional and somatosensory outcomes in patients with non-specific chronic neck pain (NS-CNP). Methods: A single-blinded, randomized clinical trial was carried out. A total sample of 44 patients with NS-CNP was randomized into a VR treatment group or neck exercises group. The intervention consisted of two treatment sessions per week, for four weeks and eight sessions. Four measurement moments (at baseline, immediately, 1 month, and 3 months after intervention) were considered. Pain intensity, CPM, TS, functional and somatosensory outcomes were measured. Results: Statistically significant differences were revealed for time factor (F = 16.40, p < 0.01, η_p² = 0.28) and group*time interaction for kinesiophobia (F = 3.89, p = 0.01, η_p² = 0.08) showing post-hoc differences in favor of the VR group at 3 months (p < 0.05, d = 0.65). Significant effects were shown for time factor (p < 0.05) but not for the group*time interaction (p > 0.05) for pain intensity, rotation range of motion (ROM), Neck Disability Index, pain catastrophizing, fear-avoidance beliefs, left side pressure pain threshold (PPT) and anxiety. Statistically significant differences were not found for time factor (p > 0.05) and neither in group*time interaction (p > 0.05) for CPM, TS, right side PPT, flexo-extension and lateral-flexion ROM. Conclusions: Kinesiophobia was the only outcome that showed differences between VR and exercise at 3 months. Nevertheless, pain intensity, CPM, TS, ROM, neck disability, pain catastrophizing, fear-avoidance beliefs, PPT and anxiety did not show differences between both interventions.

The Relationship Between Forward Head Posture and Neck Pain: a Systematic Review and Meta-Analysis

PURPOSE OF REVIEW

Forward head posture (FHP) is the most common cervical postural fault in the sagittal plane that is found with different severity levels in almost all populations. Despite claims that FHP may be related to neck pain, this relation seems to be controversial. Thus, our purpose is to determine whether FHP differs between asymptomatic subjects and those with neck pain and to investigate if there is a relationship between head posture and neck pain.

RECENT FINDINGS

A total of 15 cross-sectional studies were eligible for inclusion for this systematic review and meta-analysis. Ten studies compared FHP between a group of asymptomatic participants and a group of participants with neck pain and an overall mean difference (MD) of 4.84 (95% CI = 0.14, 9.54), indicating a significant between-group difference, contrary to adolescent (MD = - 1.05; 95% CI = - 4.23, 2.12). Eight studies showed significant negative correlations between FHP and neck pain intensity (r = - 0.55; 95% CI = - 0.69, - 0.36) as well as disability (r = - 0.42; 95% CI = - 0.54, - 0.28) in adults and older adults, while in adolescents, only lifetime prevalence and doctor visits due to neck pain were significant predictors for FHP. This systematic review found that age played an important role as a confounding factor in the relation between FHP and neck pain. Also, the results showed that adults with neck pain show increased FHP when compared to asymptomatic adults and that FHP is significantly correlated with neck pain measures in adults and older adults. No association was found between FHP and most of neck pain measures in adolescents.

Computer vision symptoms in people with and without neck pain

BACKGROUND

Sixty-four to 90% of computer users experience symptoms of computer vision syndrome (CVS). People with CVS symptoms experience neck pain (NP), and people with NP can have visual symptoms.

OBJECTIVES

(1) To examine differences in CVS symptoms in computer users with and without persistent NP. (2) To determine relationships between visual ergonomics, demographics, and CVS in those with and without persistent NP DESIGN: Comparative cross-sectional observational study METHOD: An online survey consisting of multiple questionnaires including the Computer Vision Syndrome Questionnaire (CVS-Q), Visual Symptoms Survey (VSS), and Convergence Insufficiency Symptoms Survey (CISS) was completed by 167 participants.

RESULTS

The persistent NP group had significantly higher CVS-Q, VSS, and CISS scores (p <0.01) compared to controls. No relationships were found between visual ergonomics, demographics, and visual symptoms in both groups.

CONCLUSIONS

People with persitent NP are more likely to present with CVS than controls. Clinicians should consider assessing visual symptoms in people presenting with persisting NP.

Effect of respiratory muscle training session on ankle muscle activity in athletes with chronic low back pain performing overhead squats: a randomized controlled trial

AIM

The current study was conducted to evaluate the effect of a respiratory muscle training session on ankle muscle activity in athletes with chronic low back pain performing overhead squats.

METHODS

The current double-blind, randomized, controlled trial was conducted on 24 patients randomly selected as the training group and 23 patients as the control group. The training group received the respiratory muscle training protocol. The electromyography activity of the tibialis anterior, peroneus longus, gastrocnemius medialis and gastrocnemius lateralis muscles of the dominant leg was recorded in the participants.

RESULTS

The findings showed that a session of respiratory muscle training reduced the activities of some ankle joint muscles when performing overhead squats, including tibialis anterior in the static and dynamic overhead squat tests and peroneus longus in the ascending phase. In the dynamic test, the angle to reach peak activity changed in tibialis anterior in the descending phase and also in tibialis anterior and peroneus longus in the ascending phase.

CONCLUSION

Effects of respiratory muscle training prevented excessive ankle joint muscle activity through stimulating local muscles while performing overhead squats, which had indicated an improved postural control and multisectional proprioception to maintain postural stability and stimulated the local muscles of the core area.

Concurrent validity and reliability of a mobile tracking technology to measure angular and linear movements of the neck

The neck can be moved in six degrees of freedom. Current 3D-optoelectronic motion-capture systems capable of measuring these movements are inappropriate for use in clinical practice because they are stationary, expensive and time-consuming. We therefore developed a less complex 3D-tracking technology based on Steam®VR to measure six degrees of freedom in a clinical setting. The aim of this study was to assess the validity and reliability of this system. The developed prototype consists of two infrared-emitting lighthouses and sensors, mounted on the participant's helmet and trunk belt, to detect the orientation of the head and trunk. The system was evaluated by means of an infrared light-reflecting marker tracking system. Twenty healthy participants, equipped with these sensors and markers, performed thirteen neck movement tasks. Linear and angular movements were measured. These tasks were repeated after six to eight days to assess test-retest reliability. Concurrent validity was assessed by the root mean square error, and reliability with generalizability theory. With an average root mean square error between 1.2 and 2.0° in angular and 0.4-0.5 cm in linear movements, the prototype was shown to precisely track these movements. Reliability of the prototype and the reference system was comparable for all tasks. A high contribution of participant's variability to the observed variance was generally detected, with the exception of joint repositioning error and upper cervical flexion. The reliability was task-specific and did not differ between the systems. The prototype system was shown to be valid, although the reliability of the repositioning and upper cervical flexion tests needs to be reconsidered.

Comparative Strength and Endurance Parameters of the Craniocervical and Cervicothoracic Extensors and Flexors in Females With and Without Idiopathic Neck Pain

Isometric strength and endurance performance of cervical flexor and extensor muscles were compared in women with (n = 30) and without (n = 30) idiopathic neck pain at the craniocervical and cervicothoracic axes. Strength and endurance time (time to task failure in seconds) at 50% maximal voluntary contraction were recorded in 4 directions (craniocervical flexion/extension and cervicothoracic flexion/extension) and 6 strength and endurance ratios were calculated. Participants in both groups were matched for body mass index. The idiopathic neck pain group demonstrated significantly less strength for the cervicothoracic flexors and extensors (1.58-4.7 N·m [12.4%-17.9%] less, P < .04) and significantly less endurance time for the cervicothoracic and craniocervical flexors (10.77-10.9 s [23.3%-27.5%] less, P < .03). The cervicothoracic extension to craniocervical flexion strength ratio was also lower in the idiopathic neck pain group (P = .01); however, no other strength or endurance ratio was significantly different between groups. This exploratory study suggests assessing specific performance parameters accounting for regional muscular differences in the upper and lower neck is potentially informative to understanding impairments in neck pain conditions, particularly as impairments may not be uniform across muscle groups.

Comparing neck extensor muscle function in asymptomatic Canadian adults and adults with tension-type headache: a cross-sectional study

AIM

To further the understanding of the pathophysiological mechanisms underlying tension-type headache (TTH) by comparing the endurance and strength of neck extensor muscles under acute muscle fatigue in participants with TTH and asymptomatic participants.

METHODS

We conducted a cross-sectional analysis of neck extensor muscle performance. Asymptomatic participants and participants with TTH were recruited via social media platforms and from the Université du Québec à Trois-Rivières community and employees. A total of 44 participants with TTH and 40 asymptomatic participants took part in an isometric neck extensor endurance task performed at 60% of their maximum voluntary contraction. Inclusion criteria for the headache group were to be older than 18 years old and to fulfil the International Headache Society classification's criteria for either frequent episodic or chronic TTH. Clinical (self-efficacy, anxiety, neck disability and kinesiophobia) and physical parameters (neck extensors maximum voluntary contraction, endurance time, muscle fatigue) as well as characteristics of headache episodes (intensity, frequency and associated disability) were collected for all participants. Surface electromyography was used to document upper trapezius, splenius capitis and sternocleidomastoids muscle activity and muscle fatigue.

RESULTS

Both groups displayed similar neck extensor muscle endurance capacity with a mean difference of 6.2 s (p>0.05) in favour of the control group (control=68.1±32.3; TTH=61.9±20.1). Similarly, participants in the headache group showed comparable neck extensor muscle strength (95.9±30.4 N) to the control group (111.3±38.7 N). Among participants with TTH, those scoring as severely incapacitated by headaches were the ones with higher neck-related disability (F[1,44]=10.77; p=0.002), the more frequent headache episodes (F[1,44]=6.70; p=0.01) and higher maximum headache intensity (F[1,44]=10.81; p=0.002).

CONCLUSION

A fatigue task consisting of isometric neck extension cannot efficiently differentiate participants with TTH from asymptomatic participants.

Cervical Muscular Endurance Performance in Women With and Without Migraine

BACKGROUND

Despite previous evidence, the association between migraines and cervical muscular performance is unclear.

OBJECTIVE

To compare the differences in neck flexor and extensor muscle endurance between women with and without migraine.

METHODS

In this cross-sectional, controlled laboratory study, 26 women with migraine and 26 age-matched women without migraine or headache were assessed using clinical tests of neck flexor and extensor muscle endurance. Holding times were compared between groups using the Mann-Whitney U test for independent samples.

RESULTS

Patients with migraine exhibited a lower holding time for both neck extensor endurance (P = .001) and neck flexor endurance (P<.001) than did the controls. The median neck flexor holding time was 35.0 seconds for the migraine group and 60.5 seconds for the control group. The migraine group held the neck extensor endurance test position for a median of 166.5 seconds compared to 290.5 seconds held by the control group. Both groups reported a similar level of neck pain during the endurance tests (P>.05); however, only individuals in the migraine group reported pain referred to the head during testing.

CONCLUSION

Women with migraine demonstrated decreased neck flexor and extensor endurance compared to women without migraine, which may indicate an association between migraine and reduced performance of the neck muscles. J Orthop Sports Phys Ther 2019;49(5):330-336. Epub 26 Mar 2019. doi:10.2519/jospt.2019.8816.

Effect of jaw functional status on neck muscle endurance

OBJECTIVE

To investigate the effect of resting jaw and maximum voluntary clenching on neck flexor and extensor muscle endurance.

DESIGN

Neck flexor and extensor endurance was measured in a college health clinic in 85 male college students in two test positions: resting jaw (control) and maximum voluntary clenching.

RESULTS

Mean neck flexor muscle endurance values during resting jaw and maximum voluntary clenching were 70.06 SD 28.24, and 60.03 SD 16.5, seconds respectively. Mean neck extensor muscle endurance values during resting jaw and maximum voluntary clenching were 105.54 SD 29.9, and 98.32 SD 24.54, respectively. Both values were significantly lower while maximum voluntary clenching as compared to resting jaw position (p < 0.05).

CONCLUSION

Modification of jaw position can affect neck muscle endurance. Results of this study further supports sensory-motor relation between jaw and neck region.

Variability of the helical axis during active cervical movements in people with chronic neck pain

BACKGROUND

Recent work described parameters of the helical axis in asymptomatic people with potential for investigating kinematic changes in the cervical region. This approach could provide novel information on movement variability in people with neck pain, however this has never been investigated. This study aimed to investigate movement variability during active neck movements performed at different speeds in people with and without chronic neck pain.

METHODS

This observational case-control study examined 18 participants with chronic neck pain of either idiopathic or traumatic origin and 18 gender-matched asymptomatic participants. Cervical kinematics were captured with 3D motion capture as people with and without chronic neck pain performed flexion-extension, bilateral lateral flexion and bilateral rotation at different speeds (natural, slow, and fast). The mean distance and mean angle parameters of the helical axis were extracted to describe 3D motion and quantify movement variability.

FINDINGS

A smaller mean distance was observed in those with neck pain compared to the asymptomatic participants during flexion-extension (P = 0.019) and rotation movements (P = 0.007). The neck pain group displayed smaller values for the mean angle during rotation movements with different speeds (P = 0.01). These findings indicate less variable movement for those with neck pain relative to the asymptomatic participants. No difference in the mean angle was observed between groups for flexion-extension and lateral flexion.

INTERPRETATION

The findings reiterate the importance of data derived from kinematic measures, and its potential for providing clinicians with further insight into the quality of active neck movements in people with chronic neck pain.

Posture, muscle endurance and ROM in individuals with and without neck pain

Abstract Introduction: Factors such as postural changes, reduced neck muscle endurance and reduced range of motion (ROM) are common characteristics attributed to people with neck pain. Objective: (a) Identify differences in postural, muscular endurance and ROM characteristics between individuals with and without neck pain and (b) relate the presence and intensity of neck pain with the characteristics of static posture, muscular endurance and cervical ROM. Method: A cross-sectional study with 60 subjects equally divided into two groups with respect to the presence of neck pain carrying out the following evaluations: (1) static postural evaluation by digital photogrammetry; (2) the neck flexor endurance test; and (3) evaluation of cervical ROM using a fleximeter. The data were analyzed with independent t-tests, the Mann-Whitney U test, and the Spearman and Tau of Kendall correlation tests (α < 0.05). Results: There were no statistical differences between individuals with and without neck pain regarding the postural, muscle endurance and cervical ROM characteristics. No statistically significant correlations were found between pain and posture, muscle endurance and cervical ROM. Conclusion: Individuals with neck pain do not appear to present differences in their postural, neck flexor muscle endurance or cervical ROM characteristics when compared to individuals without neck pain, and neck pain appears to be unrelated to these variables.

Functional limitations and associated psychological factors in military personnel with chronic nonspecific neck pain with higher levels of kinesiophobia

BACKGROUND

Neck pain is one of the largest health problems in the military sector.

OBJECTIVE

To assess differences in the strength and endurance of the cervical muscles between military personnel with chronic nonspecific neck pain (CNSNP) with higher level of kinesiophobia (CNSNP-K) and individuals with lower levels of kinesiophobia (CNSNP-NK).

METHODS

We used kinesiophobia as a classification method: (1) CNSNP-K and (2) CNSNP-NK. The variables measured were endurance and strength of cervical muscles; range of motion (ROM), disability, pain intensity and psychological factors.

RESULTS

Eighty-three military personnel (26 CNSNP-K; 20 CNSNP-NK and 37 asymptomatic). Statistically significant differences in endurance and ROM were only found between the CNSNP-K group and the control group. In strength and disability differences were revealed between both symptomatic groups and the control group [CNSNP-K vs. control (flex-ext p <  0.001); CNSNP-NK vs. control (flex p = 0.003) and (ext p <  0.001)]. For psychological variables, the CNSNP-K group showed differences compared with the CNSNP-NK (pain catastrophizing, p = 0.007; anxiety and depression, p <  0.001) and with the asymptomatic group (pain catastrophizing, p = 0.008; anxiety and depression, p <  0.001).

CONCLUSIONS

Military personnel with CNSNP-K have functional limitations and associated psychosocial factors compared with asymptomatic subjects, and showed greater associated psychological factors than CNSNP-NK group. Military personnel with CNSNP-NK only showed decreased strength with respect to those who were asymptomatic.

Is forward head posture relevant to cervical muscles performance and neck pain? A case-control study

BACKGROUND

Forward head posture (FHP) and muscular dysfunction are likely contributing factors to chronic neck pain (CNP) but there are inconsistent findings on the relevance of these factors to clinical CNP characteristics.

OBJECTIVE

To compare FHP, cervical muscles size and endurance between CNP and asymptomatic participants and to investigate their association with pain and disability and relative involvement of deep/superficial and flexor/extensor muscles.

METHODS

Thirty-two patients with CNP and 35 asymptomatic participants were included in this case-control study. FHP in standing, extensor and flexor muscles endurance and dimensions were assessed using digital photography, clinical tests and ultrasonographic imaging, respectively. The visual analog scale and neck disability index were also used to evaluate CNP patients' clinical characteristics.

RESULTS

Deep flexor (mean difference=0.06, 95% CI=0.02-0.11) and extensor muscles size (mean difference=0.07, 95% CI=0.01-0.12) were found to be significantly smaller in CNP patients. CNP patients also demonstrated lower levels of flexor (mean difference=14.68, 95% CI=3.65-25.72) and global extensor endurance capacity. FHP was neither different between the groups nor correlated with any of the dependent variables. Neither FHP nor endurance was correlated with pain/disability. Extensor endurance in both groups and flexor endurance in the asymptomatic group showed significant correlations with muscles size.

CONCLUSIONS

FHP was found neither different between groups nor correlated with muscle performance or CNP clinical characteristics. While cervical endurance was found lower in CNP patients, it did not show any association with pain/disability. The muscular size-endurance relationship seems to become more complex in the presence of NP. While deep muscles seem to be differentially affected in the presence of CNP, the alterations do not seem to be uniform in the flexor and extensor groups.

Asymmetry of neck motion and activation of the cervical paraspinal muscles during prone neck extension in subjects with unilateral posterior neck pain

BACKGROUND

Although unilateral posterior neck pain (UPNP) is more prevalent than central neck pain, little is known about how UPNP affects neck motion and the muscle activation pattern during prone neck extension.

OBJECTIVE

To investigate whether deviation in neck motion and asymmetry of activation of the bilateral cervical paraspinal muscles occur during prone neck extension in subjects with UPNP compared to subjects without UPNP.

METHODS

This study recruited 20 subjects with UPNP and 20 age- and sex-matched control subjects without such pain. Neck motion and muscle onset time during prone neck extension were measured using a three-dimensional motion-analysis system and surface electromyography.

RESULTS

The deviation during prone neck extension was greater in the UPNP group than in the controls (p < 0.05). Compared with the controls, cervical extensor muscle activation in the UPNP group was significantly delayed on the painful side during prone neck extension (p < 0.05).

CONCLUSIONS

Subjects with UPNP showed greater asymmetry of neck motion and muscle activation during prone neck extension compared with the controls. This suggests that UPNP has specific effects on neck motion asymmetry and the functions of the cervical extensors, triggering a need for specific evaluation and exercises in the management of patients with UPNP.

Does the mesodermal derangement in Chiari Type I malformation extend to the cervical spine? Evidence from an analytical morphometric study on cervical paraspinal muscles

OBJECTIVE

The mesodermal derangement in Chiari Type I malformation (CMI) has been postulated to encompass the cervical spine. The objectives of this study were to assess the cross-sectional areas (CSAs) of cervical paraspinal muscles (PSMs) in patients with CMI without syringomyelia, compare them with those in non-CMI subjects, and evaluate their correlations with various factors.

METHODS

In this retrospective study, the CSAs of cervical PSMs in 25 patients were calculated on T2-weighted axial MR images and computed as ratios with respect to the corresponding vertebral body areas. These values and the cervical taper ratios were then compared with those of age- and sex-matched non-CMI subjects and analyzed with respect to demographic data and clinicoradiological factors.

RESULTS

Compared with the non-CMI group, the mean CSA values for the rectus capitis minor and all of the subaxial PSMs were lower in the study group, and those of the deep extensors were significantly lower (p = 0.004). The cervical taper ratio was found to be significantly higher in the study cohort (p = 0.0003). A longer duration of symptoms and a steeper cervical taper ratio were independently associated with lower CSA values for the deep extensors (p = 0.04 and p = 0.03, respectively). The presence of neck pain was associated with a lower CSA value for the deep flexors (p = 0.03).

CONCLUSIONS

Patients with CMI demonstrate alterations in their cervical paraspinal musculature even in the absence of coexistent syringomyelia. Their deep extensor muscles undergo significant atrophic changes that worsen with the duration of their symptoms. This could be related to a significantly steeper cervical taper ratio that their cervical cords are exposed to. Neck pain in these patients is related to atrophy of their deep flexor muscles. A steeper cervical taper ratio and alterations in the PSMs could be additional indicators for surgery in patients with CMI without syringomyelia.

Understanding the complete pathophysiology of chronic mild to moderate neck pain: Implications for the inclusion of a comprehensive sensorimotor evaluation

BACKGROUND

Inconsistencies in the literature concerning the effect of neck pain have led to a lack of understanding concerning the complete pathophysiology of neck pain. While the effect of neck pain on motor function as measured by active range of motion and isometric neck strength is well documented the effect of neck pain on sensory measures such as tactical acuity and neck reposition error (NRE) remain poorly understood.

OBJECTIVE

The purpose of this study was to evaluate a combined sensorimotor evaluation to explore the potential benefits of incorporating both sensory and motor task into a physical evaluation of neck pain suffers to gain an added knowledge of the complete pathophysiology of their health status.

METHODS

A cross-sectional study that measured neck joint reposition error, tactical acuity, neck isometric strength and range of motion in 40 volunteer participants (22 pain, 18 control).

RESULTS

A statistically significant increase in NRE in flexion (2.75∘± 1.52∘ vs. 4.53∘± 1.74∘ and in extension (3.78∘± 1.95∘ vs 5.77∘± 2.73∘ in participants suffering from neck pain was observed. Additionally, the dermatome C5 was found to be the most affected. No differences were found in neck strength or neck range of motion between healthy controls and patients with chronic moderate neck pain.

Multidimensional features of pain in patients with chronic neck pain

Abstract Introduction: Chronic neck pain is associated with significant health costs and loss of productivity at work. Objective: to assess pain and disability in individuals with chronic neck pain. Methods: 31 volunteers with chronic neck pain, mean age 29, 65 years, were assessed using the McGill Pain Questionnaire in Brazilian version (Br-MPQ) and Neck Disability Index (NDI). The Br-MPQ analysis was performed based on the numerical values associated with the words selected to describe the experience of pain (Pain Rating Index - PRI), and present pain intensity (PPI). NDI was used to evaluate the influence of neck pain in performance of everyday tasks. Finally, we investigated the association between PPI and NDI. Results: PRI revealed that the most significant dimension was the sensory pain (70%), and the number of chosen words was 10 (2,62) out of 20 words. Mean PPI value was 1,23 (0,76) in five points; 40% of participants described pain intensity as moderate. NDI score was 9,77 (3,34), indicating mild disability. There was a positive association between disability and pain intensity (r = 0,36; p =0,046). Pain intensity and duration of pain were not associated. Conclusions: Findings of this study identified important information related to neck pain experienced by patients when suffering from chronic neck pain, moreover, the association between disability and pain intensity reinforces the importance of complementary investigation of these aspects to optimize function in them.

Is the clinical cervical extensor endurance test capable of differentiating the local and global muscles?

BACKGROUND CONTEXT

Differential alterations have been reported in the local and global cervical muscles in the presence of chronic neck pain (CNP), including the endurance alterations of these muscles. Identifying the involved muscles is crucial to the assessment and rehabilitation of patients with CNP.

PURPOSE

To assess the relationship between clinical endurance test results, pain and disability indices, and ultrasonographic (US) measurements of the neck extensor muscles; to compare the deep and superficial cervical extensor muscle endurance and size of CNP patients with those of asymptomatic subjects and to compare the relationship between local and global extensor endurance with US measures, pain intensity, and disability.

STUDY DESIGN/SETTING

Cross-sectional correlational analysis with a case-control design.

PATIENT SAMPLE

Thirty patients with CNP and 30 asymptomatic subjects participated in this study.

OUTCOME MEASURES

Endurance, thickness, cross-sectional area, and shape ratio of the cervical extensor muscles (splenius capitis [SpCap], semispinalis capitis [SSCap], semispinalis cervicis [SSCer], and multifidus [MF]); pain intensity measured by the visual analog scale (VAS); neck disability index (NDI); correlation between US measures, pain intensity and NDI and extensor endurance; and correlation of US measures with pain intensity and NDI.

METHODS

The deep and superficial cervical extensor muscle endurance and dimensions were measured via a clinical test and by US, respectively. Participants were asked to hold the neutral chin-tuck position while lying prone. The test would be terminated if the head moved into either flexion or extension, which would yield "global" or "local" extensor muscle endurance, respectively.

RESULTS

The CNP patients showed lower global extensor endurance levels than the control participants (p<.05). The US measures of the deep extensor muscles were also smaller in the CNP group (p<.05). There were no significant correlations between extensor endurance test results and US measures in either group except for the SSCap muscle size with local and total endurance (p=.04 for both) of CNP and control participants, respectively. NDI was correlated with SpCap and SSCer muscle thicknesses in a positive and negative manner, respectively (p=.03 for both). There was also a significant correlation between MF size and VAS (p<.05).

CONCLUSIONS

The findings showed higher levels of global muscle fatigability and smaller size of deep neck extensor muscles in CNP patients. Disability and extensor endurance were found to be associated with extensor muscle size. The results challenge the validity of the clinical extensor muscle endurance test in the differentiation of the deep and superficial extensor muscle endurance and the use of US in the assessment of cervical muscle endurance. Further investigations are needed to judge the superficial and deep muscle endurance in CNP patients.

The effects of neck mobilization in patients with chronic neck pain: A randomized controlled trial

OBJECTIVE

To determine the effect of mobilization and routine physiotherapy on pain, disability, neck range of motion (ROM) and neck muscle endurance (NME) in patients having chronic mechanical neck pain (NP).

METHODS

Sixty eight patients with chronic mechanical NP were randomly allocated into two groups by using a computer generated random sequence table with 34 patients in the multi-modal mobilization group and 34 patients in the routine physiotherapy group. Baseline values for pain, disability, NME, and neck ROM were recorded using visual analogue scale (VAS), neck disability index (NDI), neck flexor muscle endurance test and universal goniometer respectively, before the treatment. Each patient received 10 treatment sessions over a period of four weeks and at the end of four weeks all the outcome measures were recorded again.

RESULTS

A paired t-test revealed significant pre to post treatment differences for all outcome measures in both groups (p ≤ 0.001 in all instances). An independent t-test revealed statistically significant differences for pain, disability, NME, and neck ROM in favor of the multi-modal mobilization group with a between group difference of 1.57 cm for VAS (p < 0.001), 11.74 points for NDI (p = 0.001), 18.45 s for NME (p < 0.001) and 6.06-8.24° for neck ROM (p < 0.05).

CONCLUSION

The results suggest that a combination of cervical mobilization with routine physiotherapy is more effective for reducing pain and disability and improving NME and neck ROM in patients with chronic mechanical NP compared to routine physiotherapy alone.

Analysis of the upper cervical spine stiffness during axial rotation: A comparative study among patients with tension-type headache or migraine and asymptomatic subjects

BACKGROUND

Many studies reported the implication of the cervical musculoskeletal system in patients with tension type headache and migraine. The objective of this study is to investigate the upper cervical spine stiffness features in axial rotation among headache patients in comparison with a healthy population.

METHODS

48 subjects including 30 migraine patients with/without aura and 18 patients with tension-type headache, aged between 18 and 60years (mean 36, SD 11years) have been evaluated. Stiffness measurements were carried out for passive axial rotation using a torque meter device. The flexion-rotation test was used to emphasize assessment of the upper cervical spine.

FINDINGS

Neither the stiffness nor the neutral zone varies between different populations studied. Passive range of motion in axial rotation is unilaterally reduced in symptomatic subjects (p=0.001). Considering the elastic zone, right and left motion magnitude was significantly lower for clinical groups compared to the control group.

INTERPRETATION

Stiffness seems not to be altered among tension type headache and migraine patients. However, patients seem prone to display a larger right-left asymmetry of axial rotation and a reduction in the motion range tolerance, emphasizing the likely link between the cervical discomfort and these pathologies. Any difference is observed in the elastic behavior of the upper cervical spine between the two primary headache populations. However, further investigations are needed to confirm these previous results taking various specific clinical characteristics into consideration.

Direction-Specific Impairments in Cervical Range of Motion in Women with Chronic Neck Pain: Influence of Head Posture and Gravitationally Induced Torque

BACKGROUND

Cervical range of motion (ROM) is commonly assessed in clinical practice and research. In a previous study we decomposed active cervical sagittal ROM into contributions from lower and upper levels of the cervical spine and found level- and direction-specific impairments in women with chronic non-specific neck pain. The present study aimed to validate these results and investigate if the specific impairments can be explained by the neutral posture (defining zero flexion/extension) or a movement strategy to avoid large gravitationally induced torques on the cervical spine.

METHODS

Kinematics of the head and thorax was assessed in sitting during maximal sagittal cervical flexion/extension (high torque condition) and maximal protraction (low torque condition) in 120 women with chronic non-specific neck pain and 40 controls. We derived the lower and upper cervical angles, and the head centre of mass (HCM), from a 3-segment kinematic model. Neutral head posture was assessed using a standardized procedure.

FINDINGS

Previous findings of level- and direction-specific impairments in neck pain were confirmed. Neutral head posture was equal between groups and did not explain the direction-specific impairments. The relative magnitude of group difference in HCM migration did not differ between high and low torques conditions, lending no support for our hypothesis that impairments in sagittal ROM are due to torque avoidance behaviour.

INTERPRETATION

The direction- and level-specific impairments in cervical sagittal ROM can be generalised to the population of women with non-specific neck pain. Further research is necessary to clarify if torque avoidance behaviour can explain the impairments.

Neck Posture Clusters and Their Association With Biopsychosocial Factors and Neck Pain in Australian Adolescents

BACKGROUND

There is conflicting evidence on the association between sagittal neck posture and neck pain.

OBJECTIVE

The purposes of this study were: (1) to determine the existence of clusters of neck posture in a cohort of 17-year-olds and (2) to establish whether identified subgroups were associated with biopsychosocial factors and neck pain.

DESIGN

This was a cross-sectional study.

METHODS

The adolescents (N=1,108) underwent 2-dimensional photographic postural assessment in a sitting position. One distance and 4 angular measurements of the head, neck, and thorax were calculated from photo-reflective markers placed on bony landmarks. Subgroups of sagittal sitting neck posture were determined by cluster analysis. Height and weight were measured, and lifestyle and psychological factors, neck pain, and headache were assessed by questionnaire. The associations among posture subgroups, neck pain, and other factors were evaluated using logistic regression.

RESULTS

Four distinct clusters of sitting neck posture were identified: upright, intermediate, slumped thorax/forward head, and erect thorax/forward head. Significant associations between cluster and sex, weight, and height were found. Participants classified as having slumped thorax/forward head posture were at higher odds of mild, moderate, or severe depression. Participants classified as having upright posture exercised more frequently. There was no significant difference in the odds of neck pain or headache across the clusters.

LIMITATIONS

The results are specific to 17-year-olds and may not be applicable to adults.

CONCLUSION

Meaningful sagittal sitting neck posture clusters were identified in 17-year-olds who demonstrated some differences with biopsychosocial profiling. The finding of no association between cluster membership and neck pain and headaches challenges widely held beliefs about the role of posture in adolescent neck pain.

Neck Flexor and Extensor Muscle Endurance in Subclinical Neck Pain: Intrarater Reliability, Standard Error of Measurement, Minimal Detectable Change, and Comparison With Asymptomatic Participants in a University Student Population

OBJECTIVE

The aims of this study were to assess intrarater reliability and to calculate the standard error of measurement (SEM) and minimal detectable change (MDC) for deep neck flexor and neck extensor muscle endurance tests, and compare the results between individuals with and without subclinical neck pain.

METHODS

Participants were students of the University of Aveiro reporting subclinical neck pain and asymptomatic participants matched for sex and age to the neck pain group. Data on endurance capacity of the deep neck flexors and neck extensors were collected by a blinded assessor using the deep neck flexor endurance test and the extensor endurance test, respectively. Intraclass correlation coefficients (ICCs), SEM, and MDC were calculated for measurements taken within a session by the same assessor. Differences between groups for endurance capacity were investigated using a Mann-Whitney U test.

RESULTS

The deep neck flexor endurance test (ICC = 0.71; SEM = 6.91 seconds; MDC = 19.15 seconds) and neck extensor endurance test (ICC = 0.73; SEM = 9.84 minutes; MDC = 2.34 minutes) are reliable. No significant differences were found between participants with and without neck pain for both tests of muscle endurance (P > .05).

CONCLUSION

The endurance capacity of the deep neck flexors and neck extensors can be reliably measured in participants with subclinical neck pain. However, the wide SEM and MDC might limit the sensitivity of these tests.

Anterior Cervical Discectomy and Fusion: Practice Patterns Among Greek Spinal Surgeons

Background

A web-based survey was conducted among Greek spinal surgeons to outline the current practice trends in regard to the surgical management of patients undergoing anterior cervical discectomy and fusion (ACDF) for degenerative cervical spine pathology. Various practice patterns exist in the surgical management of patients undergoing anterior cervical discectomy for degenerative pathology. No consensus exists regarding the type of the employed graft, the necessity of implanting a plate, the prescription of an external orthotic device, and the length of the leave of absence in these patients.

Methods

A specially designed questionnaire was used for evaluating the criteria for surgical intervention, the frequency of fusion employment, the type of the graft, the frequency of plate implantation, the employment of an external spinal orthosis (ESO), the length of the leave of absence, and the prescription of postoperative physical therapy. Physicians’ demographic factors were assessed including residency and spinal fellowship training, as well as type and length in practice.

Results

Eighty responses were received. Neurosurgeons represented 70%, and orthopedic surgeons represented 30%. The majority of the participants (91.3%) considered fusion necessary. Allograft was the preferred type of graft. Neurosurgeons used a plate in 42.9% of cases, whereas orthopedic surgeons in 100%. An ESO was recommended for 87.5% of patients without plates, and in 83.3% of patients with plates. The average duration of ESO usage was 4 weeks. Physical therapy was routinely prescribed postoperatively by 75% of the neurosurgeons, and by 83.3% of the orthopedic surgeons. The majority of the participants recommended 4 weeks leave of absence.

Conclusions

The vast majority of participants considered ACDF a better treatment option than an ACD, and preferred an allograft. The majority of them employed a plate, prescribed an ESO postoperatively, and recommended physical therapy to their patients.

A comparison of the effects of Mulligan's mobilization and Kinesio taping on pain, range of motion, muscle strength, and neck disability in patients with cervical spondylosis: A randomized controlled study

BACKGROUND

Cervical Spondylosis (CS) is a degenerative and painful pathology, which needs conservative treatment to relieve symptoms.

OBJECTIVE

The aim was to investigate the effects of Mulligan's mobilization (MM) and Kinesio taping (KT) on pain, range of motion (ROM), muscle strength, and function in CS.

METHODS

Forty-five subjects were randomly placed into three groups: Group 1: control group (conventional rehabilitation-CR); Group 2: MM and CR; Group 3: KT and CR. Assessments including neck pain, cervical ROM, muscle strength and Neck Disability index (NDI) were conducted at baseline, after three-week treatment, and at one-month follow up. Results were analyzed using ANCOVA.

RESULTS

In all groups, pain and NDI scores reduced, cervical ROM and muscle strength increased with time (p< 0.001). Greater improvements in neck extension, left and right rotation were obtained in the KT and MM groups when compared to the control group (p< 0.05). In the KT group, improvement in right lateral flexion ROM was greater than the control and deep cervical flexor muscle strength was greater than the MM and the control groups (p< 0.05).

CONCLUSION

KT and MM contributed to CR for increasing cervical ROM and deep cervical flexor muscle strength in patients with CS.

Chronic Neck Pain and Cervico-Craniofacial Pain Patients Express Similar Levels of Neck Pain-Related Disability, Pain Catastrophizing, and Cervical Range of Motion

Background. Neck pain (NP) is strongly associated with cervico-craniofacial pain (CCFP). The primary aim of the present study was to compare the neck pain-related disability, pain catastrophizing, and cervical and mandibular ROM between patients with chronic mechanical NP and patients with CCFP, as well as asymptomatic subjects. Methods. A total of 64 participants formed three groups. All participants underwent a clinical examination evaluating the cervical range of motion and maximum mouth opening, neck disability index (NDI), and psychological factor of Pain Catastrophizing Scale (PCS). Results. There were no statistically significant differences between patients with NP and CCFP for NDI and PCS (P > 0.05). One- way ANOVA revealed significant differences for all ROM measurements. The post hoc analysis showed no statistically significant differences in cervical extension and rotation between the two patient groups (P > 0.05). The Pearson correlation analysis shows a moderate positive association between NDI and the PCS for the group of patients with NP and CCFP. Conclusion. The CCFP and NP patient groups have similar neck disability levels and limitation in cervical ROM in extension and rotation. Both groups had positively correlated the NDI with the PCS.

Local Muscle Fatigue and 3D Kinematics of the Cervical Spine in Healthy Subjects

The authors aimed to further explore the effects of local muscle fatigue on cervical 3D kinematics and the interrelationship between these kinematic characteristics and local muscle endurance capacity in the unimpaired cervical spine. Twenty healthy subjects (38 ± 10 years; 5 women) performed 2 × 10 maximal cervical flexion-extension movements. Isometric muscle endurance tests (prone/supine lying) were applied between sets to induce local muscle fatigue quantified by Borg scale rates of perceived exertion (RPE) and slope in mean power frequency (MPF; surface electromyography; m. sternocleidomastoideus, m. splenius capitis). Cervical motion characteristics (maximal range of motion [ROM], coefficient of variation of the 10 repetitive movements, mean angular velocity, conjunct movements in transversal and frontal plane) were calculated from raw 3D ultrasonic movement data. Average isometric strength testing duration for flexion and extension correlated to the cervical ROM (r = .49/r = .48; p < .05). However, Student's t test demonstrated no significant alterations in any kinematic parameter following local muscle fatigue (p > .05). Although subjects' cervical muscle endurance capacity and motor output seems to be conjugated, no impact of local cervical muscle fatigue on motor function was shown. These findings underline the importance of complementary measures to address muscular performance and kinematic characteristics in outcome assessment and functional rehabilitation of the cervical spine.

Effects of spinal manipulation in patients with mechanical neck pain

Objective: To analyse changes in the range of motion (ROM) and pain after spinal manipulation of the cervical spine and thoracic spine in subjects with mechanical neck pain. Methods : Spinal manipulations were performed in the cervical and thoracic spine with the Gonstead and Diversified DTV techniques. To assess cervical ROM an inclinometer was used. Cervical pain was assessed by Visual Analogue Scale (VAS). The participation of 73 patients was obtained. Ages ranged from 18 to 63 years, with an average of 42.27 years. The subjects of this study were characterized by having mechanical neck pain and restricted cervical ROM. Results: We observed a reduction in the intensity of pain perceived by patients and increased cervical ROM. There were significant differences between pre-treatment values (first visit) and the fifth and tenth visits (p&lt;0.01), and between the fifth and tenth visits (p&lt;0.01) in all parameters except in the cervical extension of 70&#186;. Conclusions: The results of this study suggest that spinal manipulation of the cervical and thoracic regions with the Gonstead and Diversified DTV techniques could subjectively reduce pain and produce considerable increase in cervical ROM in adults with mechanical neck pain.

The current perception threshold test differentiates categories of mechanical neck disorder

STUDY DESIGN

Cross-sectional discriminative analysis.

OBJECTIVE

To determine whether current perception threshold (CPT) can differentiate between categories of patients with mechanical neck disorders (MNDs).

BACKGROUND

Neck pain is the third most common musculoskeletal disorder and affects a third of all adults each year. It can present as neck pain without musculoskeletal signs, neck pain with musculoskeletal signs but no neurological signs, or neck pain with neurological signs. CPT testing can assess altered sensory perception that may reflect neurological changes.

METHODS

Patients with MNDs (n = 106) were classified into 3 groups, based on a standardized musculoskeletal examination process performed by an experienced physiotherapist who was blinded to CPT scores. The 3 groups were defined as neck pain without musculoskeletal signs (MND I) (n = 60), neck pain with musculoskeletal signs (MND II) (n = 29), and neck pain with neurological signs (MND III) (n = 17). A rapid protocol of CPT testing was performed at 3 frequencies (5, 250, and 2000 Hz), using 3 dermatomal locations on the hand. A 1-way analysis of variance with post hoc comparison and effect sizes was calculated to compare the mean CPT scores between the groups. A binary logistic-regression model was used to predict probability of higher CPT in MND III and to create a receiver-operating-characteristic curve.

RESULTS

Mean CPT differed significantly across the 3 MND groups (MND I, 9.7; MND II, 10.6; and MND III, 11.8; P<.001; η(2) = 0.6). Post hoc comparisons indicated differences between MND I and MND II (P = .05) and between MND II and MND III (P = .01) that had large effect sizes (MND I versus II, d = 1 and MND II versus III, d = 2.2). CPT testing was able to distinguish between MND II and III when a threshold value of greater than 11 was used to indicate MND III. The predicted probability of abnormal CPT in MND III had an estimated 73% sensitivity and 81% specificity; the odds ratio was 11.5 (P = .001) for the differentiation capacity of CPT between MND II and III, with a cutoff of 11. The area under the receiver-operating-characteristic curve was 0.84 (95% confidence interval: 0.72, 0.96; P<.001).

CONCLUSION

CPT testing has moderate discriminatory accuracy, specificity, and sensitivity for classification of MND categories into neck pain with or without neurological signs. J Orthop Sports Phys Ther 2014;44(7):532-540. Epub 10 May 2014. doi:10.2519/jospt.2014.4691.