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Youssef H, Ragaa Abdelraouf O. Posterior neck weighting an innovative and novel head orthosis for forward head posture correction: Randomized controlled trial. J Orthop 2024; 55:80-85. [PMID: 38665990 PMCID: PMC11039330 DOI: 10.1016/j.jor.2024.03.033] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/14/2024] [Revised: 03/24/2024] [Accepted: 03/26/2024] [Indexed: 04/28/2024] Open
Abstract
Background Muscle activity of the anterior and posterior elements of the cervical spine, both together actively contribute to the balance of the head position over the neck. Increasing muscular tension of the one cervical muscle group could induce poor motor control of cervical spine joints, this might contribute to the anterior position of the head with neck, known as forward head posture (FHP). We propose posterior neck weighting as an innovative orthosis to correct head posture within FHP participants and improve co-related mechanical neck pain. Methods Sixty-one participants with FHP; were randomly assigned to one of two groups posterior cervical weighing orthosis (PCWO) or deep cervical flexion (DCF) exercise. Each participant has been assessed for change in Craniovertebral Angle (CVA) as an indicator for FHP severity, and neck disability index (NDI). Results Wilcoxon Signed Rank Test showed a statistically significant change difference regarding the degree of CVA improvements, and the score of NDI of pre-and post-intervention of the PCWO group (p < 0.0001), (p < 0.0001), and of the DCF group (p < 0.0001), (p = 0.0039), respectively. Mann-Whitney Test, showed a statistically significant difference between groups for CVA improvement (p < 0.0001), and NDI (p = 0.045). No correlation between CVA and NDI scores within the PCWO group (r = 0.129, p = 0.473), and within the DCF exercise group (r = 0.073, p = 0.71). Conclusion PCWO is a novel and innovative neck orthosis that is considered a promising intervention to correct FHP and improve correlated neck disability.
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Affiliation(s)
- Hussein Youssef
- Hasselt University, Faculty of Rehabilitation Sciences, REVAL Rehabilitation Research Center, Hasselt, Belgium
- Neuroscience, Graduate School of Health Sciences, Koç University, Turkey
- Neuroscience and Biotechnology, Faculty of Science, Alexandria University, Egypt
- Physical Therapy and Rehabilitation, Marmara University, Turkey
- Department of Biomechanics, Faculty of Physical Therapy, Cairo University, Egypt
| | - Osama Ragaa Abdelraouf
- Department of Biomechanics, Faculty of Physical Therapy, Cairo University, Egypt
- Physical Therapy Program, Batterjee Medical College, Jeddah, Saudi Arabia
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Mallio CA, Russo F, Vadalà G, Papalia R, Pileri M, Mancuso V, Bernetti C, Volpecina M, Di Gennaro G, Beomonte Zobel B, Denaro V. The importance of psoas muscle on low back pain: a single-center study on lumbar spine MRI. NORTH AMERICAN SPINE SOCIETY JOURNAL 2024; 18:100326. [PMID: 38947493 PMCID: PMC11214412 DOI: 10.1016/j.xnsj.2024.100326] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 01/04/2024] [Revised: 04/25/2024] [Accepted: 04/25/2024] [Indexed: 07/02/2024]
Abstract
Background Low back pain (LBP) is the most frequent indication to magnetic resonance imaging (MRI) examinations of the lumbosacral spine. The individual role of soft tissues, including muscles, on LBP is not fully understood and the contribution of each MRI-derived parameter of soft tissues status on the intensity of LBP has not been investigated in detail. Methods The study design was observational retrospective, single center carried out at a University Hospital. Images were acquired using a using a 1.5 Tesla scanner. Patients completed a symptom questionnaire and rated their pain intensity using the Visual Analogue Scale (VAS). The VAS scores were categorized as mild, moderate, and severe using cutoff values of 3.8 and 5.7, based on the literature. Biometric data, including weight and height, were also recorded to calculate the body mass index (BMI). The ratios between intramuscular fat infiltration and net muscle area were also calculated. Patient sample included 94 patients with LBP underwent MRI of the lumbosacral spine. Results The stepwise analysis revealed that increasing psoas net area was associated with lower VAS levels (odds ratio [OR]: 0.94: 95% confidence interval [CI]: 0.90-0.98; p=.005), and an increase of one square centimeter of total psoas area resulted in a greater probability of reporting a mild (+1.21%; 95% CI: 0.37, 2.05%) or a moderate VAS (+0.40%; 95% CI: -0.02, 0.82%), Furthermore, a more severe VAS was associated with a higher BMI (OR: 1.13; 95% CI: 1.00-1.27). Conclusion Our study demonstrates a relationship between LBP and MRI parameters of paravertebral and psoas muscles status. The psoas muscle is extremely important for spine stabilization and is linked to clinical symptoms of patients affected by LBP. These findings could contribute to future studies and improve treatment options in patients with LBP, possibly reducing the impact on disability, quality of life and socioeconomical burden.
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Affiliation(s)
- Carlo A. Mallio
- Fondazione Policlinico Universitario Campus Bio-Medico, Via Alvaro del Portillo, 200, 00128 Roma, Italy
- Research Unit of Radiology, Department of Medicine and Surgery, Università Campus Bio-Medico di Roma, Via Alvaro del Portillo, 21, 00128 Roma, Italy
| | - Fabrizio Russo
- Fondazione Policlinico Universitario Campus Bio-Medico, Via Alvaro del Portillo, 200, 00128 Roma, Italy
- Research Unit of Orthopaedic and Trauma Surgery, Department of Medicine and Surgery, Università Campus Bio-Medico di Roma, Via Alvaro del Portillo, 21, 00128 Roma, Italy
| | - Gianluca Vadalà
- Fondazione Policlinico Universitario Campus Bio-Medico, Via Alvaro del Portillo, 200, 00128 Roma, Italy
- Research Unit of Orthopaedic and Trauma Surgery, Department of Medicine and Surgery, Università Campus Bio-Medico di Roma, Via Alvaro del Portillo, 21, 00128 Roma, Italy
| | - Rocco Papalia
- Fondazione Policlinico Universitario Campus Bio-Medico, Via Alvaro del Portillo, 200, 00128 Roma, Italy
- Research Unit of Orthopaedic and Trauma Surgery, Department of Medicine and Surgery, Università Campus Bio-Medico di Roma, Via Alvaro del Portillo, 21, 00128 Roma, Italy
| | - Matteo Pileri
- Fondazione Policlinico Universitario Campus Bio-Medico, Via Alvaro del Portillo, 200, 00128 Roma, Italy
- Research Unit of Radiology, Department of Medicine and Surgery, Università Campus Bio-Medico di Roma, Via Alvaro del Portillo, 21, 00128 Roma, Italy
| | - Valeria Mancuso
- Fondazione Policlinico Universitario Campus Bio-Medico, Via Alvaro del Portillo, 200, 00128 Roma, Italy
- Research Unit of Radiology, Department of Medicine and Surgery, Università Campus Bio-Medico di Roma, Via Alvaro del Portillo, 21, 00128 Roma, Italy
| | - Caterina Bernetti
- Fondazione Policlinico Universitario Campus Bio-Medico, Via Alvaro del Portillo, 200, 00128 Roma, Italy
- Research Unit of Radiology, Department of Medicine and Surgery, Università Campus Bio-Medico di Roma, Via Alvaro del Portillo, 21, 00128 Roma, Italy
| | - Manuel Volpecina
- Fondazione Policlinico Universitario Campus Bio-Medico, Via Alvaro del Portillo, 200, 00128 Roma, Italy
- Research Unit of Radiology, Department of Medicine and Surgery, Università Campus Bio-Medico di Roma, Via Alvaro del Portillo, 21, 00128 Roma, Italy
| | - Gianfranco Di Gennaro
- Department of Health Sciences, Chair of Medical Statistics, University of Catanzaro Magna Græcia, Viale Europa, 88100 Catanzaro, Italy
| | - Bruno Beomonte Zobel
- Fondazione Policlinico Universitario Campus Bio-Medico, Via Alvaro del Portillo, 200, 00128 Roma, Italy
- Research Unit of Radiology, Department of Medicine and Surgery, Università Campus Bio-Medico di Roma, Via Alvaro del Portillo, 21, 00128 Roma, Italy
| | - Vincenzo Denaro
- Fondazione Policlinico Universitario Campus Bio-Medico, Via Alvaro del Portillo, 200, 00128 Roma, Italy
- Research Unit of Orthopaedic and Trauma Surgery, Department of Medicine and Surgery, Università Campus Bio-Medico di Roma, Via Alvaro del Portillo, 21, 00128 Roma, Italy
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Lund N, Dahlqvist Leinhard O, Elliott JM, Peterson G, Borga M, Zsigmond P, Karlsson A, Peolsson A. Fatty infiltrate and neck muscle volume in individuals with chronic whiplash associated disorders compared to healthy controls - a cross sectional case-control study. BMC Musculoskelet Disord 2023; 24:181. [PMID: 36906537 PMCID: PMC10007742 DOI: 10.1186/s12891-023-06289-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/22/2022] [Accepted: 03/02/2023] [Indexed: 03/13/2023] Open
Abstract
BACKGROUND The underlying pathophysiological mechanisms of chronic Whiplash Associated Disorders (WAD) are not fully understood. More knowledge of morphology is needed to better understand the disorder, improve diagnostics and treatments. The aim was to investigate dorsal neck muscle volume (MV) and muscle fat infiltration (MFI) in relation to self-reported neck disability among 30 participants with chronic WAD grade II-III compared to 30 matched healthy controls. METHODS MV and MFI at spinal segments C4 through C7 in both sexes with mild- to moderate chronic WAD (n = 20), severe chronic WAD (n = 10), and age- and sex matched healthy controls (n = 30) was compared. Muscles: trapezius, splenius, semispinalis capitis and semispinalis cervicis were segmented by a blinded assessor and analyzed. RESULTS Higher MFI was found in right trapezius (p = 0.007, Cohen's d = 0.9) among participants with severe chronic WAD compared to healthy controls. No other significant difference was found for MFI (p = 0.22-0.95) or MV (p = 0.20-0.76). CONCLUSIONS There are quantifiable changes in muscle composition of right trapezius on the side of dominant pain and/or symptoms, among participants with severe chronic WAD. No other statistically significant differences were shown for MFI or MV. These findings add knowledge of the association between MFI, muscle size and self-reported neck disability in chronic WAD. TRIAL REGISTRATION NA. This is a cross-sectional case-control embedded in a cohort study.
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Affiliation(s)
- Nils Lund
- Department of Health, Medicine and Caring Sciences, Unit of Physiotherapy, Linköping University, Linköping, Sweden.
- Center for Medical Image Science and Visualization (CMIV), Linköping University, Linköping, Sweden.
| | - Olof Dahlqvist Leinhard
- Center for Medical Image Science and Visualization (CMIV), Linköping University, Linköping, Sweden
- AMRA Medical AB, Linköping, Sweden
- Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden
| | - James M Elliott
- Faculty of Medicine and Health, School of Health Sciences, Northern Sydney Local Health District, The Kolling Institute, University of Sydney, St Leonards, NSW, Australia
- Feinberg School of Medicine, Department of Physical Therapy and Human Movement Sciences, Northwestern University, Chicago, IL, USA
| | - Gunnel Peterson
- Department of Health, Medicine and Caring Sciences, Unit of Physiotherapy, Linköping University, Linköping, Sweden
- Centre for Clinical Research Sörmland, Uppsala University, Uppsala, Sweden
| | - Magnus Borga
- Center for Medical Image Science and Visualization (CMIV), Linköping University, Linköping, Sweden
- AMRA Medical AB, Linköping, Sweden
- Department of Biomedical Engineering, Linköping University, Linköping, Sweden
| | - Peter Zsigmond
- Department of Neurosurgery and Clinical and Experimental Medicine, Linköping University, Linköping, Sweden
| | - Anette Karlsson
- Center for Medical Image Science and Visualization (CMIV), Linköping University, Linköping, Sweden
| | - Anneli Peolsson
- Department of Health, Medicine and Caring Sciences, Unit of Physiotherapy, Linköping University, Linköping, Sweden
- Center for Medical Image Science and Visualization (CMIV), Linköping University, Linköping, Sweden
- Occupational and Environmental Medicine Center, Department of Health, Medicine and Caring Sciences, Unit of Clinical Medicine, Linköping University, Linköping, Sweden
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Varol U, Navarro-Santana MJ, Gómez-Sánchez S, Plaza-Manzano G, Sánchez-Jiménez E, Valera-Calero JA. Inter-Examiner Disagreement for Assessing Cervical Multifidus Ultrasound Metrics Is Associated with Body Composition Features. SENSORS (BASEL, SWITZERLAND) 2023; 23:s23031213. [PMID: 36772252 PMCID: PMC9921918 DOI: 10.3390/s23031213] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/15/2022] [Revised: 01/06/2023] [Accepted: 01/18/2023] [Indexed: 05/28/2023]
Abstract
Ultrasound imaging (US) is a biosensing technique that is widely used in several healthcare disciplines (including physiotherapy) for assessing multiple muscle metrics, such as muscle morphology and quality. Since all biosensors need to be tested in order to demonstrate their reliability, accuracy, sensitivity, and specificity, identifying factors that affect their diagnostic accuracy is essential. Since previous studies analyzed the impact of sociodemographic but not body composition characteristics in US errors, this study aimed to assess whether body composition metrics are associated with ultrasound measurement errors. B-mode images of the lumbar multifidus muscle at the L5 level were acquired and analyzed in 47 healthy volunteers by two examiners (one experienced and one novice). The cross-sectional area, muscle perimeter, and mean echo intensity were calculated bilaterally. A correlation analysis and a multivariate linear regression model were used for assessing the inter-examiner differences with respect to body composition metrics. The results demonstrated good-to-excellent reliability estimates for the cross-sectional area, muscle perimeter, aspect ratio, roundness, circularity, and mean brightness metrics (all ICC > 0.85). However, solidity showed unacceptable reliability (ICC < 0.7). Age, height, total lean mass, trunk lean mass, and water volume were associated with inter-examiner disagreement on mean echo intensity. Cross-sectional area, perimeter, and roundness measurement errors were associated with lean mass and water volume.
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Affiliation(s)
- Umut Varol
- Escuela Internacional de Doctorado, Universidad Rey Juan Carlos, 29222 Alcorcón, Spain
| | | | - Sonia Gómez-Sánchez
- Faculty of Health, Universidad Católica de Ávila, C/Canteros, s/n, 05005 Ávila, Spain
| | - Gustavo Plaza-Manzano
- Department of Radiology, Rehabilitation and Physiotherapy, Universidad Complutense de Madrid, 28040 Madrid, Spain
- Grupo InPhysio, Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdISSC), 28040 Madrid, Spain
| | - Elena Sánchez-Jiménez
- Faculty of Health, Universidad Católica de Ávila, C/Canteros, s/n, 05005 Ávila, Spain
| | - Juan Antonio Valera-Calero
- Department of Radiology, Rehabilitation and Physiotherapy, Universidad Complutense de Madrid, 28040 Madrid, Spain
- Grupo InPhysio, Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdISSC), 28040 Madrid, Spain
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Umezawa H, Daimon K, Fujiwara H, Nishiwaki Y, Michikawa T, Okada E, Nojiri K, Watanabe M, Katoh H, Shimizu K, Ishihama H, Fujita N, Tsuji T, Nakamura M, Matsumoto M, Watanabe K. Changes in cross-sectional areas of posterior extensor muscles in thoracic spine: a 10-year longitudinal MRI study. Sci Rep 2022; 12:14717. [PMID: 36042273 PMCID: PMC9427759 DOI: 10.1038/s41598-022-19000-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2021] [Accepted: 08/23/2022] [Indexed: 11/09/2022] Open
Abstract
Age-related changes in the posterior extensor muscles of the cervical and lumbar spine have been reported in some studies; however, longitudinal changes in the thoracic spine of healthy subjects are rarely reported. Therefore, this study aimed to evaluate changes in the cross-sectional areas (CSAs) of posterior extensor muscles in the thoracic spine over 10 years and identify related factors. The subjects of this study were 85 volunteers (mean age: 44.7 ± 11.5) and the average follow-up period was about 10 years. The CSAs of the transversospinalis muscles, erector spinae muscles, and total CSAs of the extensor muscles from T1/2 to T11/12 were measured on magnetic resonance imaging. The extent of muscle fat infiltration was assessed by the signal intensity (luminance) of the extensor muscles' total cross-section compared to a section of pure muscle. We applied a Poisson regression model, which is included in the generalized linear model, and first examined the univariate (crude) association between each relevant factor (age, sex, body mass index, lifestyle, back pain, neck pain, neck stiffness, and intervertebral disc degeneration) and CSA changes. Then, we constructed a multivariate model, which included age, sex, and related factors in the univariate analysis. The mean CSAs of the transversospinalis muscles, erector spinae muscles, and total CSAs of the extensor muscles significantly increased over 10 years. Exercise habit was associated with increased CSAs of the erector spinae muscles and the total area of the extensor muscles. The cross-section mean luminance significantly increased from baseline, indicating a significant increase of fat infiltration in the posterior extensor muscles. Progression of disc degeneration was inversely associated with increased fat infiltration in the total extensor muscles.
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Affiliation(s)
- Hitoshi Umezawa
- Department of Orthopedic Surgery, Keio University School of Medicine, 35 Shinanomachi, Shinjuku-ku, Tokyo, Japan
| | - Kenshi Daimon
- Department of Orthopedic Surgery, Keio University School of Medicine, 35 Shinanomachi, Shinjuku-ku, Tokyo, Japan
| | - Hirokazu Fujiwara
- Department of Diagnostic Radiology, Keio University School of Medicine, 35 Shinanomachi, Shinjuku-ku, Tokyo, Japan
| | - Yuji Nishiwaki
- Department of Environmental and Occupational Health, School of Medicine, Toho University, 5-21-16 Omorinishi, Ota-ku, Tokyo, Japan
| | - Takehiro Michikawa
- Department of Environmental and Occupational Health, School of Medicine, Toho University, 5-21-16 Omorinishi, Ota-ku, Tokyo, Japan
| | - Eijiro Okada
- Department of Orthopedic Surgery, Keio University School of Medicine, 35 Shinanomachi, Shinjuku-ku, Tokyo, Japan
| | - Kenya Nojiri
- Department of Orthopedic Surgery, Isehara Kyodo Hospital, 345 Tanaka, Isehara-shi, Kanagawa, Japan
| | - Masahiko Watanabe
- Department of Orthopedic Surgery, Tokai University School of Medicine, 143 Shimokasuya, Isehara-shi, Kanagawa, Japan
| | - Hiroyuki Katoh
- Department of Orthopedic Surgery, Tokai University School of Medicine, 143 Shimokasuya, Isehara-shi, Kanagawa, Japan
| | - Kentaro Shimizu
- Department of Orthopedic Surgery, Spine Center, Sanokosei General Hospital, 1728 Horigomecho, Sano-shi, Tochigi, Japan
| | - Hiroko Ishihama
- Department of Orthopedic Surgery, Spine Center, Sanokosei General Hospital, 1728 Horigomecho, Sano-shi, Tochigi, Japan
| | - Nobuyuki Fujita
- Fujita Health University Orthopedic Surgery, 1-98 Kutsukakecho, Toyoake-shi, Aichi, Japan
| | - Takashi Tsuji
- National Hospital Organization Tokyo Medical Center, 2-5-1 Higashigaoka, Meguro-ku, Tokyo, Japan
| | - Masaya Nakamura
- Department of Orthopedic Surgery, Keio University School of Medicine, 35 Shinanomachi, Shinjuku-ku, Tokyo, Japan
| | - Morio Matsumoto
- Department of Orthopedic Surgery, Keio University School of Medicine, 35 Shinanomachi, Shinjuku-ku, Tokyo, Japan
| | - Kota Watanabe
- Department of Orthopedic Surgery, Keio University School of Medicine, 35 Shinanomachi, Shinjuku-ku, Tokyo, Japan.
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The Relationship Between the Myovertebral Structures and Idiopathic Cerebrospinal Fluid Leaks in Whiplash Injuries. Med Hypotheses 2022. [DOI: 10.1016/j.mehy.2022.110902] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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Valera-Calero JA, Fernández-de-Las-Peñas C, Cleland JA, Varol U, Ortega-Santiago R, Arias-Buría JL. Ultrasound assessment of deep cervical extensors morphology and quality in populations with whiplash associated disorders: An intra- and inter-examiner reliability study. Musculoskelet Sci Pract 2022; 59:102538. [PMID: 35272960 DOI: 10.1016/j.msksp.2022.102538] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/17/2021] [Revised: 02/12/2022] [Accepted: 02/21/2022] [Indexed: 11/16/2022]
Abstract
BACKGROUND Ultrasound imaging (US) has shown to be a reliable and valid tool for assessing muscle morphology and quality. However, most studies have focused on asymptomatic populations. OBJECTIVE To investigate intra- and inter-rater reliability estimates of muscle morphology and quality of cervical multifidus (CM) and short rotators (SR) in patients with whiplash associated disorders (WAD). DESIGN An intra- and inter-examiner reliability study. METHODS US images were acquired in a blinded fashion in 34 patients (35% males) by two experienced and two novice examiners. Cross-sectional area (CSA), perimeter, mean echo-intensity (EI) and the percentage of fatty infiltration were assessed twice, one-week apart, in a randomized order. Reliability estimates (i.e., intra-class correlation coefficients -ICC-, standard error of measurement -SEM-, minimal detectable change, mean of measurements, absolute and percent errors) were calculated. RESULTS Intra-examiner reliability for experienced assessors ranged from good to excellent for CM and SR (ICC3,1 = 0.888-0.975 and 0.810-0.964 respectively) and from moderate-to-good for novices (ICC3,1 = 0.708-0.790 and 0.655-0.796 respectively). The agreement between the experienced examiners was moderate to good (ICC3,2 = 0.737-0.899 and 0.728-0.899 CM and SR respectively); between novice and experienced examiners was moderate to good (ICC3,2 = 0.617-0.873 and 0.657-0.766 CM and SR respectively); and between novice examiners was moderate-to-good for CM (ICC3,2 = 0.610-0.777) and moderate for SR (ICC3,2 = 0.600-0.730). CONCLUSION CM and SR intra-examiner reliability was good-to-excellent for novice and experienced examiners. However, inter-examiner reliability was clinically acceptable just for experienced examiners at the C4/C5 level in WAD populations.
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Affiliation(s)
- Juan Antonio Valera-Calero
- Department of Physiotherapy, Faculty of Health, Universidad Camilo José Cela, Villanueva de la Cañada, Madrid, Spain; VALTRADOFI Research Group, Department of Physiotherapy, Faculty of Health, Universidad Camilo José Cela, Villanueva de la Cañada, Madrid, Spain.
| | - César Fernández-de-Las-Peñas
- Department of Physical Therapy, Occupational Therapy, Rehabilitation and Physical Medicine, Universidad Rey Juan Carlos, Alcorcón, Spain; Cátedra Institucional en Docencia, Clínica e Investigación en Fisioterapia: Terapia Manual, Punción Seca y Ejercicio Terapéutico, Universidad Rey Juan Carlos, Alcorcón, Madrid, Spain
| | - Joshua A Cleland
- Doctor of Physical Therapy Program, Department of Public Health and Community Medicine, Tufts University School of Medicine, Boston, Mass, USA
| | - Umut Varol
- VALTRADOFI Research Group, Department of Physiotherapy, Faculty of Health, Universidad Camilo José Cela, Villanueva de la Cañada, Madrid, Spain
| | - Ricardo Ortega-Santiago
- Department of Physical Therapy, Occupational Therapy, Rehabilitation and Physical Medicine, Universidad Rey Juan Carlos, Alcorcón, Spain; Cátedra Institucional en Docencia, Clínica e Investigación en Fisioterapia: Terapia Manual, Punción Seca y Ejercicio Terapéutico, Universidad Rey Juan Carlos, Alcorcón, Madrid, Spain
| | - José Luis Arias-Buría
- Department of Physical Therapy, Occupational Therapy, Rehabilitation and Physical Medicine, Universidad Rey Juan Carlos, Alcorcón, Spain; Cátedra Institucional en Docencia, Clínica e Investigación en Fisioterapia: Terapia Manual, Punción Seca y Ejercicio Terapéutico, Universidad Rey Juan Carlos, Alcorcón, Madrid, Spain
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8
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Erdoğanoğlu Y, Bayraklı B. Short-Term Changes in Chronic Neck Pain After the Use of Elastic Adhesive Tape. J Chiropr Med 2022; 20:70-76. [PMID: 34987323 DOI: 10.1016/j.jcm.2021.04.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2019] [Revised: 04/21/2020] [Accepted: 04/05/2021] [Indexed: 11/30/2022] Open
Abstract
Objectives The aim of the study was to examine the short-term changes of elastic adhesive tape application on pain intensity and the range of motion (ROM), cervical region proprioception sense, and cervical flexor endurance of patients with chronic neck pain. Methods Thirty-four patients (male: 26, female: 8) between ages 20 and 55 with chronic neck pain having the complaints for at least 6 months were included in the study. Demographic information, pain intensity, cervical ROM, cervical flexor endurance, and cervical proprioception sense of the patients were evaluated. Results were examined 2 times. The first evaluation was conducted prior to elastic adhesive tape application and the second one was conducted 24 hours after the procedure. Results The mean age of the patients was 39.56 ± 17.09 years, average height was 165.65 ± 9.83 cm, average weight was 71.44 ± 15.79 kg, and average body mass index was 26.24 ± 6.62. A statistically significant difference was found between the measurement results of pain intensity, ROM of the joint in flexion, extension, right and left rotation, and cervical flexor endurance before and 24 hours after the application of elastic adhesive tape (P < .05). When the proprioception sense was examined, there was a significant difference between the results before elastic adhesive tape application and 24 hours after the same application in deviation angles except for right rotation (P < .05). Conclusion The results of this study revealed short-term changes following the use of elastic adhesive tape on cervical flexor endurance, pain, and cervical proprioception sense for patients with chronic pain.
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Affiliation(s)
- Yıldız Erdoğanoğlu
- Department of Physical Treatment and Rehabilitation, Faculty of Health Sciences, Antalya Bilim University, Antalya, Turkey
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Abstract
OBJECTIVE The purpose of this study was to pilot safety and tolerability of a 1-week aerobic exercise program during the post-acute phase of concussion (14-25 days post-injury) by examining adherence, symptom response, and key functional outcomes (e.g., cognition, mood, sleep, postural stability, and neurocognitive performance) in young adults. METHOD A randomized, non-blinded pilot clinical trial was performed to compare the effects of aerobic versus non-aerobic exercise (placebo) in concussion patients. The study enrolled three groups: 1) patients with concussion/mild traumatic brain injury (mTBI) randomized to an aerobic exercise intervention performed daily for 1-week, 2) patients with concussion/mTBI randomized to a non-aerobic (stretching and calisthenics) exercise program performed daily for 1-week, and 3) non-injured, no intervention reference group. RESULTS Mixed-model analysis of variance results indicated a significant decrease in symptom severity scores from pre- to post-intervention (mean difference = -7.44, 95% CI [-12.37, -2.20]) for both concussion groups. However, the pre- to post-change was not different between groups. Secondary outcomes all showed improvements by post-intervention, but no differences in trajectory between the groups. By three months post-injury, all outcomes in the concussion groups were within ranges of the non-injured reference group. CONCLUSIONS Results from this study indicate that the feasibility and tolerability of administering aerobic exercise via stationary cycling in the post-acute time frame following post-concussion (14-25 days) period are tentatively favorable. Aerobic exercise does not appear to negatively impact recovery trajectories of neurobehavioral outcomes; however, tolerability may be poorer for patients with high symptom burden.
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Wong AYL, Harada G, Lee R, Gandhi SD, Dziedzic A, Espinoza-Orias A, Parnianpour M, Louie PK, Basques B, An HS, Samartzis D. Preoperative paraspinal neck muscle characteristics predict early onset adjacent segment degeneration in anterior cervical fusion patients: A machine-learning modeling analysis. J Orthop Res 2021; 39:1732-1744. [PMID: 32816312 DOI: 10.1002/jor.24829] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/13/2020] [Revised: 07/27/2020] [Accepted: 08/05/2020] [Indexed: 02/04/2023]
Abstract
Early onset adjacent segment degeneration (ASD) can be found within six months after anterior cervical discectomy and fusion (ACDF). Deficits in deep paraspinal neck muscles may be related to early onset ASD. This study aimed to determine whether the morphometry of preoperative deep neck muscles (multifidus and semispinalis cervicis) predicted early onset ASD in patients with ACDF. Thirty-two cases of early onset ASD after a two-level ACDF and 30 matched non-ASD cases were identified from a large-scale cohort. The preoperative total cross-sectional area (CSA) of bilateral deep neck muscles and the lean muscle CSAs from C3 to C7 levels were measured manually on T2-weighted magnetic resonance imaging. Paraspinal muscle CSA asymmetry at each level was calculated. A support vector machine (SVM) algorithm was used to identify demographic, radiographic, and/or muscle parameters that predicted proximal/distal ASD development. No significant between-group differences in demographic or preoperative radiographic data were noted (mean age: 52.4 ± 10.9 years). ACDFs comprised C3 to C5 (n = 9), C4 to C6 (n = 20), and C5 to C7 (n = 32) cases. Eighteen, eight, and six patients had proximal, distal, or both ASD, respectively. The SVM model achieved high accuracy (96.7%) and an area under the curve (AUC = 0.97) for predicting early onset ASD. Asymmetry of fat at C5 (coefficient: 0.06), and standardized measures of C7 lean (coefficient: 0.05) and total CSA measures (coefficient: 0.05) were the strongest predictors of early onset ASD. This is the first study to show that preoperative deep neck muscle CSA, composition, and asymmetry at C5 to C7 independently predicted postoperative early onset ASD in patients with ACDF. Paraspinal muscle assessments are recommended to identify high-risk patients for personalized intervention.
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Affiliation(s)
- Arnold Y L Wong
- Department of Orthopaedic Surgery, Rush University Medical Centre, Chicago, Illinois.,Department of Orthopaedic Surgery, International Spine Research and Innovation Initiative, Rush University Medical Centre, Chicago, Illinois.,Department of Rehabilitation Sciences, The Hong Kong Polytechnic University, Hong Kong SAR, China
| | - Garrett Harada
- Department of Orthopaedic Surgery, Rush University Medical Centre, Chicago, Illinois.,Department of Orthopaedic Surgery, International Spine Research and Innovation Initiative, Rush University Medical Centre, Chicago, Illinois
| | - Remy Lee
- Department of Orthopaedic Surgery, Rush University Medical Centre, Chicago, Illinois.,Department of Orthopaedic Surgery, International Spine Research and Innovation Initiative, Rush University Medical Centre, Chicago, Illinois
| | - Sapan D Gandhi
- Department of Orthopaedic Surgery, Rush University Medical Centre, Chicago, Illinois.,Department of Orthopaedic Surgery, International Spine Research and Innovation Initiative, Rush University Medical Centre, Chicago, Illinois
| | - Adam Dziedzic
- Department of Computer Science, University of Chicago, Chicago, Illinois
| | - Alejandro Espinoza-Orias
- Department of Orthopaedic Surgery, Rush University Medical Centre, Chicago, Illinois.,Department of Orthopaedic Surgery, International Spine Research and Innovation Initiative, Rush University Medical Centre, Chicago, Illinois
| | - Mohamad Parnianpour
- Department of Mechanical Engineering, Sharif University of Technology, Tehran, Iran
| | - Philip K Louie
- Department of Orthopaedic Surgery, Rush University Medical Centre, Chicago, Illinois.,Department of Orthopaedic Surgery, International Spine Research and Innovation Initiative, Rush University Medical Centre, Chicago, Illinois
| | - Bryce Basques
- Department of Orthopaedic Surgery, Rush University Medical Centre, Chicago, Illinois.,Department of Orthopaedic Surgery, International Spine Research and Innovation Initiative, Rush University Medical Centre, Chicago, Illinois
| | - Howard S An
- Department of Orthopaedic Surgery, Rush University Medical Centre, Chicago, Illinois.,Department of Orthopaedic Surgery, International Spine Research and Innovation Initiative, Rush University Medical Centre, Chicago, Illinois
| | - Dino Samartzis
- Department of Orthopaedic Surgery, Rush University Medical Centre, Chicago, Illinois.,Department of Orthopaedic Surgery, International Spine Research and Innovation Initiative, Rush University Medical Centre, Chicago, Illinois
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11
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Echo-intensity, fatty infiltration, and morphology ultrasound imaging assessment in healthy and whiplash associated disorders populations: an observational study. EUROPEAN SPINE JOURNAL : OFFICIAL PUBLICATION OF THE EUROPEAN SPINE SOCIETY, THE EUROPEAN SPINAL DEFORMITY SOCIETY, AND THE EUROPEAN SECTION OF THE CERVICAL SPINE RESEARCH SOCIETY 2021; 30:3059-3067. [PMID: 34218342 DOI: 10.1007/s00586-021-06915-z] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/30/2021] [Revised: 05/24/2021] [Accepted: 06/26/2021] [Indexed: 12/16/2022]
Abstract
BACKGROUND Although changes in muscle morphology and quality in deep neck flexors seem to be clear in patients with whiplash-associated disorders (WAD), evidence for deep neck extensors is heterogeneous. In addition, most studies have used magnetic resonance imaging or computer tomography, which is not available for regular practice. OBJECTIVES To assess differences in deep neck extensors morphology and quality between patients with WAD and controls with ultrasound imaging (US) and to assess the association of imaging findings with clinical features. METHODS One hundred and sixty brightness-mode images at C4/C5 level were acquired in 41 patients with WAD and 39 pain-free controls. Muscle morphology and quality characteristics of the cervical multifidus (CM) and short rotators (SR), clinical pain features and pressure pain thresholds (PPT) were assessed in a blinded design. RESULTS Between-groups differences in both CM and SR were observed for fatty infiltration percentage (mean: 4.9%; P < 0.001; mean: 3.5%; P < 0.05, respectively) and mean EI (mean: 4.1; P < 0.001; mean: 3.2; P < 0.05, respectively): patients exhibited higher fatty infiltration than controls. The intensity of neck pain was negatively associated with multifidus CSA and perimeter (P < 0.001); symptoms duration was negatively associated with CM morphology (P < 0.001), CM mean EI (P < 0.05) and SR morphology (P < 0.05); pain-related disability was associated with CM morphology (P < 0.001) and SR mean EI (P < 0.05); and PPTs was associated with CM mean EI (P < 0.01) and FI (p < 0.05) and SR morphology (P < 0.001). No significant effect of gender was found in any analysis. CONCLUSION US assessment of deep cervical extensors revealed greater fatty infiltration, but no differences in muscle morphology, between WAD patients and pain-free controls.
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12
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Van Looveren E, Cagnie B, Coppieters I, Meeus M, De Pauw R. Changes in Muscle Morphology in Female Chronic Neck Pain Patients Using Magnetic Resonance Imaging. Spine (Phila Pa 1976) 2021; 46:638-648. [PMID: 33290364 DOI: 10.1097/brs.0000000000003856] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
STUDY DESIGN Population-based cross-sectional study. OBJECTIVE The aim of this study was to gain a better understanding of changes in muscle morphology in patients with chronic idiopathic neck pain (CINP) and chronic whiplash-associated disorder (CWAD). SUMMARY OF BACKGROUND DATA Worldwide, neck pain (NP) is a common health problem with high socioeconomic burden. A high percentage of these patients evolves toward chronic symptoms. Efficacy of treatments for these complaints remains variable. In current literature, changes in muscle morphology (muscle fat infiltration and cross-sectional area) have been reported in patients with NP, both CWAD and CINP. However, no strong conclusions could be made. METHODS In this study, magnetic resonance imaging was used to obtain data on muscle morphology from 14 cervical flexor and extensor muscles in 117 female subjects with NP (CWAD = 37; CINP = 45) and healthy controls (HC = 35). RESULTS The CWAD group had a significantly larger muscle fat infiltration in some extensor (semispinalis and splenius capitis, trapezius, obliquus capitis inferior) and flexor (sternocleidomastoid) muscles compared to the CINP and/or HC group. A significantly larger (muscle) cross-sectional area was found in some extensor (levator scapulae, semispinalis capitis, trapezius) and flexor (longus colli, longus capitis, sternocleidomastoid) muscles in the HC group compared to the CINP and/or CWAD group. No clear associations were found between group differences and factors as pain duration, kinesiophobia, and disability. CONCLUSION The results in this study suggest changes in muscle morphology in both NP cohorts. These results show some similarities with earlier findings in this research domain. Further studies based on controlled longitudinal designs are needed to facilitate data compilation, to draw stronger conclusions, and to integrate them into the treatment of patients with chronic NP.Level of Evidence: 4.
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Affiliation(s)
- Eveline Van Looveren
- Department of Rehabilitation Sciences and Physiotherapy, Ghent University, Ghent, Belgium
- Department of Physiotherapy, Human Physiology and Anatomy, Vrije Universiteit Brussel, Brussels, Belgium
- Pain in Motion International Research Group
| | - Barbara Cagnie
- Department of Rehabilitation Sciences and Physiotherapy, Ghent University, Ghent, Belgium
| | - Iris Coppieters
- Department of Rehabilitation Sciences and Physiotherapy, Ghent University, Ghent, Belgium
- Department of Physiotherapy, Human Physiology and Anatomy, Vrije Universiteit Brussel, Brussels, Belgium
- Pain in Motion International Research Group
- Chronic Pain Rehabilitation, Department of Physical Medicine and Physiotherapy, University Hospital Brussels, Brussels, Belgium
| | - Mira Meeus
- Department of Rehabilitation Sciences and Physiotherapy, Ghent University, Ghent, Belgium
- Pain in Motion International Research Group
- Department of Rehabilitation Sciences and Physiotherapy (MOVANT), Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp, Belgium
| | - Robby De Pauw
- Department of Rehabilitation Sciences and Physiotherapy, Ghent University, Ghent, Belgium
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13
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Stone D, Ward EC, Bogaardt H, Heard R, Martin-Harris B, Smith AC, Elliott JM. Self-reported Dysphagia and Pharyngeal Volume Following Whiplash Injury. Dysphagia 2021; 36:1019-1030. [PMID: 33386482 DOI: 10.1007/s00455-020-10233-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2020] [Accepted: 12/11/2020] [Indexed: 11/25/2022]
Abstract
Difficulty swallowing has been reported following whiplash injury; however, the reasons remain poorly understood. A possible factor may be the observed changes in pharyngeal volume. The current exploratory study was designed to examine the prevalence of self-reported dysphagia after whiplash and the relationship with recovery status and change in pharyngeal volume. Data were available from a longitudinal study of adults with whiplash. Data included magnetic resonance imaging (MRI) of the cervical spine, the Dysphagia Handicap Index (DHI), and Neck Disability Index (NDI) collected over four timepoints (< 1 week, 2 weeks, 3 months, and 12 months post-injury). Initial cross-sectional analysis examined 60 patients with DHI data from at least one timepoint. A second, longitudinal analysis was conducted on 31 participants with MRI, NDI, and DHI data at both early (< 1-2 weeks) and late (3-12 months) timepoints. The pharynx was contoured on axial T2-weighted MRI slices using OsiriX image processing software and pharyngeal volume (mm3) was quantified. In the 60-patient cohort, prevalence of self-reported dysphagia (DHI ≥ 3) was observed in 50% of participants at least once in 12 months (M = 4.9, SD 8.16, range 0-40). In the longitudinal cohort (n = 31), mean total DHI significantly (p = 0.006) increased between early and late stages. There was no relationship (p = 1.0) between dysphagia and recovery status, per the NDI% score. Pharyngeal volume remained stable and there was no relationship between dysphagia and pharyngeal volume change (p = 1.0). This exploratory study supports the need for further work to understand the nature of dysphagia, extent of functional compromise, and the underlying pathophysiology post-whiplash.
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Affiliation(s)
- D Stone
- Faculty of Medicine and Health, School of Health Sciences, The University of Sydney, Sydney, NSW, Australia.
- Speech Pathology Department, Royal North Shore Hospital, Northern Sydney Local Health District, St Leonards, NSW, Australia.
- Neuromuscular Imaging Research Laboratory, Kolling Institute at the Northern Sydney Local Health District, Sydney, Australia.
| | - E C Ward
- School of Health and Rehabilitation Sciences, The University of Queensland and Centre for Functioning and Health Research (CFAHR) Metro South Hospital and Health Services, Brisbane, QLD, Australia
| | - H Bogaardt
- Faculty of Medicine and Health, School of Health Sciences, The University of Sydney, Sydney, NSW, Australia
| | - R Heard
- Faculty of Medicine and Health, School of Health Sciences, The University of Sydney, Sydney, NSW, Australia
| | - B Martin-Harris
- Roxelyn and Richard Pepper Department of Communication Sciences and Disorders, School of Communication, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | - A C Smith
- Department of Physical Medicine and Rehabilitation, Physical Therapy Program, University of Colorado, Aurora, CO, USA
| | - J M Elliott
- Faculty of Medicine and Health, School of Health Sciences, The University of Sydney, Sydney, NSW, Australia
- Neuromuscular Imaging Research Laboratory, Kolling Institute at the Northern Sydney Local Health District, Sydney, Australia
- Department of Physical Therapy and Human Movement Sciences, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
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14
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Talebi RZ, Rezasoltani A, Khalkhalizavieh M, Manshadi FD, Baghban AA. Evaluation of cervical spine muscles thickness in patients with cervical vertigo and healthy controls through ultrasonography. J Phys Ther Sci 2020; 32:439-443. [PMID: 32753783 PMCID: PMC7344283 DOI: 10.1589/jpts.32.439] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2020] [Accepted: 04/14/2020] [Indexed: 11/30/2022] Open
Abstract
[Purpose] Cervical vertigo as a common complaint is associated with some
musculoskeletal disorders. However, to date, ultrasonographical parameters of cervical
muscles in patients with cervical vertigo have not been investigated. This study was
conducted to investigate size of cervical muscles in patients with cervical vertigo
compared to healthy controls. [Participants and Methods] Thicknesses of cervical flexor
and extensor muscles were evaluated through ultrasonography and results were compared
between the patients and healthy controls by Independent Samples t-test or Mann-Whitney U
nonparametric test. [Results] Results showed that, thickness of Longus Colli muscle was
significantly different between the patients and healthy controls. [Conclusion] According
to findings of the study, size of Longus Colli muscle is likely to be associated with
etiology of cervical vertigo.
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Affiliation(s)
- Ronak Zargar Talebi
- Department of Physical Therapy, School of Rehabilitation, Shahid Beheshti University of Medical Sciences: Tehran 161679, Iran
| | - Asghar Rezasoltani
- Department of Physical Therapy, School of Rehabilitation, Shahid Beheshti University of Medical Sciences: Tehran 161679, Iran
| | - Minoo Khalkhalizavieh
- Department of Physical Therapy, School of Rehabilitation, Shahid Beheshti University of Medical Sciences: Tehran 161679, Iran
| | - Farideh Dehghan Manshadi
- Department of Physical Therapy, School of Rehabilitation, Shahid Beheshti University of Medical Sciences: Tehran 161679, Iran
| | - Alireza Akbarzadeh Baghban
- Department of Physical Therapy, School of Rehabilitation, Shahid Beheshti University of Medical Sciences: Tehran 161679, Iran
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15
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Ghamkhar L, Amiri Arimi S, Kahlaee AH. Interactive Association Between Mechanical and Sensorimotor Aspects of Cervical Extensor Muscles: Implications for Chronic Neck Pain. J Appl Biomech 2020; 36:190-197. [PMID: 32357313 DOI: 10.1123/jab.2019-0395] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2019] [Revised: 02/02/2020] [Accepted: 03/03/2020] [Indexed: 11/18/2022]
Abstract
While proprioceptive functioning of the cervical extensor muscles has been proposed to be associated with chronic neck pain (NP), the mechanism by which such impairment might contribute to NP is not clear. The aim of this cross-sectional study was to investigate the relevance of proprioception, extensor muscles size, and endurance to chronic NP. A total of 60 participants with (n = 30) or without (n = 30) chronic NP participated in this cross-sectional study. Joint repositioning error (JRE), ultrasonographic parameters of the cervical extensors, and clinical extensor endurance were assessed. Multivariate analysis of variance and logistic regression tests were used to compare the groups and test the predictive value of the dependent variables for chronic NP, respectively. Patients showed comparable JRE scores but smaller multifidus size and lower extensor endurance (Cohen d = 0.66 for both). JRE in the transverse plane (β = 1.20), multifidus muscle size (β = 0.02), and endurance (β = 0.99) were significant predictors for chronic NP odds ratio. The results found multifidus size as the most relevant factor to NP by showing both between-groups difference and considerable odds ratio. As JRE in transverse plane was not different between the groups and extensor endurance demonstrated minimal odds ratio, these 2 factors may be considered as less relevant to NP comparing multifidus muscle size.
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Affiliation(s)
- Leila Ghamkhar
- Rofeideh Rehabilitation Hospital
- University of Social Welfare and Rehabilitation Sciences
| | | | - Amir H Kahlaee
- Rofeideh Rehabilitation Hospital
- University of Social Welfare and Rehabilitation Sciences
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16
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Stone DB, Ward EC, Knijnik SR, Bogaardt H, Elliott JM. Whiplash-Associated Dysphagia and Dysphonia: A Scoping Review. Dysphagia 2020; 36:303-315. [PMID: 32445061 DOI: 10.1007/s00455-020-10137-8] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2019] [Accepted: 05/15/2020] [Indexed: 01/23/2023]
Abstract
Swallowing and voice complaints after a whiplash injury have been observed and reported in several studies; however, variability in study design complicates current understanding of whether dysphagia and dysphonia should be recognised as potential adverse outcomes. A scoping review was conducted across six databases from 1950 to March 2019. A total of 18 studies were included for review. Data regarding study purpose, design, outcome measures, participant characteristics and outcomes reported were extracted. Level of evidence (LOE) was assessed by the American Speech-Language Language Association (ASHA)'s LOE system. All studies were exploratory, with 68% rated as poor (< 3) on quality ratings. Nearly half (n = 6) were single case reports. Only three studies investigated some type of swallow-related outcome specifically within the study aim/s. Incidence of swallow-related problems ranged from 2 to 29%, with unspecified complaints of "swallowing difficulty", "dysphagia" and fatigue and pain whilst chewing reported. Neither swallowing biomechanics nor the underlying pathophysiology of swallow or voice complaints was investigated in any study. Four case studies presented post-whiplash voice complaints; two of which described loss of pitch range. Others described hoarseness, loss of control and weak phonation. Most studies only mentioned swallow- or voice-related deficits when reporting a wider set of post-injury symptomatology and six did not describe the outcome measure used to identify the swallow and voice-related problems reported. The existing literature is limited and of low quality, contributing to an unclear picture of the true incidence and underlying mechanisms of whiplash-related dysphagia and dysphonia.
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Affiliation(s)
- D B Stone
- Faculty of Medicine and Health, School of Health Sciences, The University of Sydney, Sydney, NSW, Australia. .,Speech Pathology Department, Royal North Shore Hospital, Northern Sydney Local Health District, St Leonards, NSW, 2065, Australia. .,Neuromuscular Imaging Research Laboratory, Kolling Institute at the Northern Sydney Local Health District, Sydney, Australia.
| | - E C Ward
- School of Health and Rehabilitation Sciences, The University of Queensland and Centre for Functioning and Health Research (CFAHR) Metro South Hospital and Health Services, Brisbane, QLD, Australia
| | - S R Knijnik
- Faculty of Medicine and Health, School of Health Sciences, The University of Sydney, Sydney, NSW, Australia.,The Federal University of Health Sciences of Porto Alegre, Porto Alegre, Brazil.,The Pontifical Catholic University of Rio Grande do Sul, Porto Alegre, Brazil
| | - H Bogaardt
- Faculty of Medicine and Health, School of Health Sciences, The University of Sydney, Sydney, NSW, Australia
| | - J M Elliott
- Faculty of Medicine and Health, School of Health Sciences, The University of Sydney, Sydney, NSW, Australia.,Neuromuscular Imaging Research Laboratory, Kolling Institute at the Northern Sydney Local Health District, Sydney, Australia.,Department of Physical Therapy and Human Movement Sciences, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
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17
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Dallaway A, Kite C, Griffen C, Duncan M, Tallis J, Renshaw D, Hattersley J. Age-related degeneration of the lumbar paravertebral muscles: Systematic review and three-level meta-regression. Exp Gerontol 2020; 133:110856. [PMID: 32006635 DOI: 10.1016/j.exger.2020.110856] [Citation(s) in RCA: 25] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2019] [Revised: 01/24/2020] [Accepted: 01/28/2020] [Indexed: 02/08/2023]
Abstract
BACKGROUND Morphological changes of the lumbar spine muscles are not well characterised with ageing. To further the understanding of age-related degeneration of the lumbar spine musculature, normative morphological changes that occur within the paravertebral muscles must first be established. METHODS A systematic review and meta-regressions were conducted adhering to PRISMA guidelines. Searches for published and unpublished data were completed in June 2019. RESULTS Searches returned 4781 articles. 34 articles were included in the quantitative analysis. Three-level meta-analyses showed age-related atrophy (r = -0.26; 95% CI: -0.33, -0.17) and fat infiltration (r = 0.39; 95% CI: 0.28, 0.50) in the lumbar paravertebral muscles. Degenerative changes were muscle-specific and men (r = -0.32; 95% CI: -0.61, 0.01) exhibited significantly greater muscle atrophy than women (r = -0.24; 95% CI: -0.47, 0.03). Imaging modality, specifically ultrasound, also influenced age-related muscle atrophy. Measurements taken across all lumbar levels revealed the greatest fat infiltration with ageing (r = 0.58, 95% CI: 0.35, 0.74). Moderators explained a large proportion of between-study variance in true effects for muscle atrophy (72.6%) and fat infiltration (79.8%) models. CONCLUSIONS Lumbar paravertebral muscles undergo age-related degeneration in healthy adults with muscle, lumbar level and sex-specific responses. Future studies should use high-resolution imaging modalities to quantify muscle atrophy and fat infiltration.
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Affiliation(s)
- A Dallaway
- Centre for Sport, Exercise and Life Sciences, Faculty of Health and Life Sciences, Science and Health Building, Whitefriars Street, Coventry University, Coventry CV1 2DS, United Kingdom; Human Metabolic Research Unit, University Hospitals Coventry and Warwickshire, Clifford Bridge Rd, Coventry CV2 2DX, United Kingdom.
| | - C Kite
- School of Life and Health Sciences, Cell and Tissue Biomedical Research Group, Aston University, Aston Triangle, Birmingham B4 7ET, United Kingdom; Centre for Active Living, University Centre Shrewsbury, University of Chester, Guildhall, Frankwell Quay, Shrewsbury SY3 8HQ, United Kingdom
| | - C Griffen
- Centre for Sport, Exercise and Life Sciences, Faculty of Health and Life Sciences, Science and Health Building, Whitefriars Street, Coventry University, Coventry CV1 2DS, United Kingdom; Human Metabolic Research Unit, University Hospitals Coventry and Warwickshire, Clifford Bridge Rd, Coventry CV2 2DX, United Kingdom
| | - M Duncan
- Centre for Sport, Exercise and Life Sciences, Faculty of Health and Life Sciences, Science and Health Building, Whitefriars Street, Coventry University, Coventry CV1 2DS, United Kingdom; School of Life Sciences, Faculty of Health and Life Sciences, Science and Health Building, Whitefriars Street, Coventry University, Coventry CV1 2DS, United Kingdom
| | - J Tallis
- Centre for Sport, Exercise and Life Sciences, Faculty of Health and Life Sciences, Science and Health Building, Whitefriars Street, Coventry University, Coventry CV1 2DS, United Kingdom; School of Life Sciences, Faculty of Health and Life Sciences, Science and Health Building, Whitefriars Street, Coventry University, Coventry CV1 2DS, United Kingdom
| | - D Renshaw
- Centre for Sport, Exercise and Life Sciences, Faculty of Health and Life Sciences, Science and Health Building, Whitefriars Street, Coventry University, Coventry CV1 2DS, United Kingdom
| | - J Hattersley
- Centre for Sport, Exercise and Life Sciences, Faculty of Health and Life Sciences, Science and Health Building, Whitefriars Street, Coventry University, Coventry CV1 2DS, United Kingdom; Human Metabolic Research Unit, University Hospitals Coventry and Warwickshire, Clifford Bridge Rd, Coventry CV2 2DX, United Kingdom
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18
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Nagai T, Schilaty ND, Krause DA, Crowley EM, Hewett TE. Sex Differences in Ultrasound-Based Muscle Size and Mechanical Properties of the Cervical-Flexor and -Extensor Muscles. J Athl Train 2020; 55:282-288. [PMID: 31967864 DOI: 10.4085/1062-6050-482-18] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
CONTEXT Neck pain (NP), neck injuries, and concussions are more prevalent in female athletes than in their male counterparts. Females exhibit less neck girth, strength, and stiffness against a perturbation. As part of the clinical examination for individuals with NP, ultrasound (US)-based imaging of the cervical muscles has become common. Muscle size or thickness and stiffness can be measured with US-based B-mode and shear-wave elastography (SWE), respectively. Information on reliability, normative values, and sex differences based on US-based muscle size or thickness and stiffness in young and athletic individuals is limited. OBJECTIVE To evaluate sex differences in US-based muscle size or thickness and biomechanical properties of the cervical-flexor and -extensor muscles. DESIGN Cross-sectional study. SETTING Laboratory. PATIENTS OR OTHER PARTICIPANTS A total of 13 women (age = 23.7 ± 1.9 years, height = 167.1 ± 6.1 cm, mass = 63.8 ± 5.6 kg) and 11 men (age = 25.6 ± 4.9 years, height = 178.7 ± 8.3 cm, mass = 78.9 ± 12.0 kg). MAIN OUTCOME MEASURE(S) The same examiner collected all measures, using US B-mode to scan the cross-sectional area and thickness of the longus colli (LC), sternocleidomastoid (SCM), cervical-extensor muscles, and upper trapezius (UT) muscle. The US SWE-mode was used to measure the stiffness of the SCM and UT. Independent t tests or Mann-Whitney U tests were calculated to determine sex differences. The intraclass correlation coefficient (ICC) measured intrarater test-retest reliability. RESULTS Men had thicker SCMs than women (P = .01). No sex differences were present for longus colli cross-sectional area, cervical-extensor muscle thickness, or UT thickness (P > .05). In addition, no sex differences were evident for SCM (P = .302) or UT (P = .703) SWE stiffness. Reliability was good to excellent (ICC = 0.715-0.890) except for SCM SWE stiffness (ICC = 0.554). CONCLUSIONS The only sex difference was in SCM thickness. However, smaller SCMs in women did not result in less SCM SWE stiffness. We provided normative values for US-based imaging of the cervical-flexor and -extensor muscles in young and athletic men and women.
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Affiliation(s)
- Takashi Nagai
- Biomechanics Laboratories, Department of Orthopedic Surgery, and Sports Medicine Center, Mayo Clinic, Rochester, MN
| | - Nathan D Schilaty
- Biomechanics Laboratories, Department of Orthopedic Surgery, and Sports Medicine Center, Mayo Clinic, Rochester, MN.,Department of Physiology & Biomedical Engineering, Mayo Clinic, Rochester, MN
| | - David A Krause
- Department of Physical Medicine & Rehabilitation, Mayo Clinic, Rochester, MN
| | - Eric M Crowley
- Biomechanics Laboratories, Department of Orthopedic Surgery, and Sports Medicine Center, Mayo Clinic, Rochester, MN
| | - Timothy E Hewett
- Biomechanics Laboratories, Department of Orthopedic Surgery, and Sports Medicine Center, Mayo Clinic, Rochester, MN.,Department of Physiology & Biomedical Engineering, Mayo Clinic, Rochester, MN.,Department of Physical Medicine & Rehabilitation, Mayo Clinic, Rochester, MN
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19
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Snodgrass SJ, de Zoete RMJ, Croker C, Yerrapothu M, Elliott JM. Reliability of cervical muscle volume quantification using magnetic resonance imaging. Musculoskelet Sci Pract 2019; 44:102056. [PMID: 31563630 DOI: 10.1016/j.msksp.2019.102056] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/17/2019] [Revised: 06/06/2019] [Accepted: 09/04/2019] [Indexed: 12/11/2022]
Abstract
BACKGROUND Magnetic resonance imaging (MRI) is used to quantify the size and structure of the architecturally complex cervical spine musculature of individuals with traumatic and idiopathic neck pain. However, to our knowledge, no scan-rescan reliability data is available on neck muscle volumes. OBJECTIVES This study investigates the intra- and inter-rater reliability and scan-rescan reliability in cervical muscle volume investigations. DESIGN Clinical Measurement, Reliability study. METHODS MRI scans were performed and repeated (within 1 h) for five asymptomatic individuals. Two raters manually traced levator scapulae, multifidus including semispinalis cervicis, semispinalis capitis, splenius capitis including splenius cervicis, and sternocleidomastoid using Analyze software (v12.0). Reliability was determined using intra-class correlation coefficients, Lin's concordance coefficient and Bland-Altman plots, with interpretation of reliability coefficients using the criteria from Fleiss. RESULTS Intra-rater reliability of muscle quantification was excellent (ICCs ranging from 0.78 to 0.96). Inter-rater reliability was excellent for sternocleidomastoid(ICC 0.92, 95% CI 0.80, 0.97) and splenius capitis (ICC 0.77, 0.51, 0.90), and ranged from fair to good for levator scapulae (0.63, 0.18, 0.85), multifidus (0.73, 0.44, 0.88), and semispinalis capitis (0.50, 0.08, 0.77). The scan-rescan reliability was excellent for all muscles (ICCs ranging from 0.94 to 0.98). CONCLUSION Threats to reliability appear to be more related to manual quantification of muscles on images rather than protocols related to re-positioning a participant in the scanner and repeating the same protocol. The current findings suggest that the proposed methods can be used in establishing normative data for cervical muscle volume and comparing individuals with and without neck pain.
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Affiliation(s)
- Suzanne J Snodgrass
- Faculty of Health and Medicine, The University of Newcastle, Australia; Centre for Brain and Mental Health Research, The University of Newcastle, Australia.
| | - Rutger M J de Zoete
- Faculty of Health and Medicine, The University of Newcastle, Australia; Centre for Brain and Mental Health Research, The University of Newcastle, Australia; Recover Injury Research Centre, NHMRC Centre of Research Excellence in Recovery Following Road Traffic Injuries, The University of Queensland, Herston, Australia.
| | - Christopher Croker
- Faculty of Health and Medicine, The University of Newcastle, Australia; Centre for Brain and Mental Health Research, The University of Newcastle, Australia.
| | - Meghana Yerrapothu
- Neuromuscular Imaging Research Laboratory, Northwestern University, Feinberg School of Medicine, Department of Physical Therapy and Human Movement Sciences, Chicago, USA.
| | - James M Elliott
- Neuromuscular Imaging Research Laboratory, Northwestern University, Feinberg School of Medicine, Department of Physical Therapy and Human Movement Sciences, Chicago, USA; Northern Sydney Local Health District, The Kolling Institute, and Faculty of Health Sciences, The University of Sydney, Australia.
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Suvarnnato T, Puntumetakul R, Uthaikhup S, Boucaut R. Effect of specific deep cervical muscle exercises on functional disability, pain intensity, craniovertebral angle, and neck-muscle strength in chronic mechanical neck pain: a randomized controlled trial. J Pain Res 2019; 12:915-925. [PMID: 30881101 PMCID: PMC6411318 DOI: 10.2147/jpr.s190125] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023] Open
Abstract
Background Exercise is known to be an important component of treatment programs for individuals with neck pain. The study aimed to compare the effects of semispinalis cervicis (extensor) training, deep cervical flexor (flexor) training, and usual care (control) on functional disability, pain intensity, craniovertebral (CV) angle, and neck-muscle strength in chronic mechanical neck pain. Methods A total of 54 individuals with chronic mechanical neck pain were randomly allocated to three groups: extensor training, flexor training, or control. A Thai version of the Neck Disability Index, numeric pain scale (NPS), CV angle, and neck-muscle strength were measured at baseline, immediately after 6 weeks of training, and at 1- and 3 -month follow-up. Results Neck Disability Index scores improved significantly more in the exercise groups than in the control group after 6 weeks training and at 1- and 3-month follow-up in both the exten-sor (P=0.001) and flexor groups (P=0.003, P=0.001, P=0.004, respectively). NPS scores also improved significantly more in the exercise groups than in the control group after 6 weeks’ training in both the extensor (P<0.0001) and flexor groups (P=0.029. In both exercise groups, the CV angle improved significantly compared with the control group at 6 weeks and 3 months (extensor group, P=0.008 and P=0.01, respectively; flexor group, P=0.002 and 0.009, respectively). At 1 month, the CV angle had improved significantly in the flexor group (P=0.006). Muscle strength in both exercise groups had improved significantly more than in the control group at 6 weeks and 1- and 3-month follow-up (extensor group, P=0.04, P=0.02, P=0.002, respectively; flexor group, P=0.002, P=0.001, and 0.001, respectively). The semispinalis group gained extensor strength and the deep cervical flexor group gained flexor strength. Conclusion The results suggest that 6 weeks of training in both exercise groups can improve neck disability, pain intensity, CV angle, and neck-muscle strength in chronic mechanical neck pain. Trial registration NCT02656030
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Affiliation(s)
- Thavatchai Suvarnnato
- School of Physical Therapy, Faculty of Associated Medical Sciences, Khon Kaen University, Khon Kaen, Thailand,
| | - Rungthip Puntumetakul
- School of Physical Therapy, Faculty of Associated Medical Sciences, Khon Kaen University, Khon Kaen, Thailand,
| | - Sureeporn Uthaikhup
- School of Physical Therapy, Faculty of Associated Medical Sciences, Chiang Mai University, Chiang Mai, Thailand
| | - Rose Boucaut
- School of Health Sciences (Physiotherapy), University of South Australia, Adelaide, SA, Australia
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Farrell SF, Smith AD, Hancock MJ, Webb AL, Sterling M. Cervical spine findings on MRI in people with neck pain compared with pain‐free controls: A systematic review and meta‐analysis. J Magn Reson Imaging 2019; 49:1638-1654. [DOI: 10.1002/jmri.26567] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2018] [Revised: 09/16/2018] [Accepted: 09/18/2018] [Indexed: 12/13/2022] Open
Affiliation(s)
- Scott F. Farrell
- RECOVER Injury Research Centre, NHMRC Centre for Research Excellence in Recovery Following Road Traffic Injuries University of Queensland Brisbane Australia
- Menzies Health Institute Queensland Griffith University Gold Coast Australia
| | - Ashley D. Smith
- School of Allied Health Sciences Griffith University Gold Coast Australia
| | - Mark J. Hancock
- Discipline of Physiotherapy, Faculty of Medicine and Health Sciences Macquarie University Sydney Australia
| | - Alexandra L. Webb
- Medical School, College of Health and Medicine Australian National University Canberra Australia
| | - Michele Sterling
- RECOVER Injury Research Centre, NHMRC Centre for Research Excellence in Recovery Following Road Traffic Injuries University of Queensland Brisbane Australia
- Menzies Health Institute Queensland Griffith University Gold Coast Australia
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Suman AA, Aktar MN, Asikuzzaman M, Webb AL, Perriman DM, Pickering MR. Segmentation and reconstruction of cervical muscles using knowledge-based grouping adaptation and new step-wise registration with discrete cosines. COMPUTER METHODS IN BIOMECHANICS AND BIOMEDICAL ENGINEERING: IMAGING & VISUALIZATION 2019. [DOI: 10.1080/21681163.2017.1356751] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Affiliation(s)
- Abdulla Al Suman
- School of Engineering and Information Technology, The University of New South Wales, Canberra, Australia
| | - Mst. Nargis Aktar
- School of Engineering and Information Technology, The University of New South Wales, Canberra, Australia
| | - Md. Asikuzzaman
- School of Engineering and Information Technology, The University of New South Wales, Canberra, Australia
| | | | - Diana M. Perriman
- Medical School, Australian National University, Canberra, Australia
- Trauma and Orthopaedic Research Unit, Canberra Hospital, Canberra, Australia
| | - Mark R. Pickering
- School of Engineering and Information Technology, The University of New South Wales, Canberra, Australia
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Fortin M, Wilk N, Dobrescu O, Martel P, Santaguida C, Weber MH. Relationship between cervical muscle morphology evaluated by MRI, cervical muscle strength and functional outcomes in patients with degenerative cervical myelopathy. Musculoskelet Sci Pract 2018; 38:1-7. [PMID: 30059855 DOI: 10.1016/j.msksp.2018.07.003] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/02/2018] [Revised: 06/11/2018] [Accepted: 07/14/2018] [Indexed: 10/28/2022]
Abstract
BACKGROUND Cervical muscle alterations have been reported in patients with chronic neck pain, but the assessment of muscle morphology and strength has been overlooked in patients with degenerative cervical myelopathy (DCM). OBJECTIVES This study aimed to investigate the relationship between cervical muscle degenerative changes observed on MRI, muscle strength and symptoms severity in patients diagnosed with DCM. DESIGN Observational study. METHODS Cervical muscle measurements of total cross-sectional area (CSA), functional CSA (fat free area, FCSA) and ratio of FCSA/CSA (e.g. fatty infiltration) were obtained from T2-weighted axial MR images from C2-C3 to C6-C7 in 20 patients. Muscle strength was assessed manually using a microFET2 dynamometer. The association between cervical muscle morphology parameters, muscle strength, symptoms severity and functional status was investigated. RESULTS Greater mean CSA and FCSA was associated with greater overall muscle strength. The mean FCSA explained 37%, 76%, 39%, 20% and 65% of the total variance in flexion, extension, right-side bending, left-side bending and overall muscle strength, respectively. The mean ratio of FCSA/CSA was not significantly associated with cervical muscle strength in any direction. However, greater FCSA/CSA ratio (e.g. less fatty infiltration) was associated with lower disability score (p = 0.02, R2 = 0.20). CONCLUSIONS Cervical muscle lean muscle mass was positively associated with cervical muscle strength in patients with DCM. Moreover, greater fatty infiltration in the cervical extensor muscles was associated with lower functional score. Such findings suggest that clinicians should pay greater attention to cervical muscle morphology and function in patients with DCM.
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Affiliation(s)
- Maryse Fortin
- McGill University Health Centre, Montreal General Hospital Site, Department of Orthopedic Surgery, Montreal, Quebec, Canada; PERFORM Centre, Concordia University, Montreal, Quebec, Canada.
| | - Nikola Wilk
- McGill University, Faculty of Medicine, Montreal, Quebec, Canada
| | | | - Philippe Martel
- McGill University Health Centre, Montreal General Hospital Site, Department of Orthopedic Surgery, Montreal, Quebec, Canada
| | - Carlo Santaguida
- McGill University, Faculty of Medicine, Department of Neurology and Neurosurgery, Montreal, Quebec, Canada
| | - Michael H Weber
- McGill University Health Centre, Montreal General Hospital Site, Department of Orthopedic Surgery, Montreal, Quebec, Canada
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Application of MR-derived cross-sectional guideline of cervical spine muscles to validate neck surface electromyography placement. J Electromyogr Kinesiol 2018; 43:127-139. [PMID: 30273920 DOI: 10.1016/j.jelekin.2018.09.011] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2018] [Revised: 09/10/2018] [Accepted: 09/24/2018] [Indexed: 02/03/2023] Open
Abstract
The importance of surface-EMG placement for development and interpretation of EMG-assisted biomechanical models is well established. Since MR has become a reliable noninvasive cervical spine musculoskeletal diagnostic tool, this investigation attempted to illustrate the anatomical relationships of individual cervical spine muscles with their paired surface-EMG electrodes. The secondary purpose of this investigation was to provide an MR cross-sectional pictorial and descriptive guideline of the cervical spine musculature. MR scans were performed on a healthy adult male subject from skull to manubrium of the sternum. Prior to scanning, MR safe markers were placed over neck muscles following surface EMG placement recommendations. Twenty-three neck muscles were traced manually in each of 267 scan slices. 3-D models of the neck musculoskeletal structure were constructed to aid with understanding the complex anatomy of the region as well as to identify correct EMG electrode locations and to identify muscles' curved lines-of-action. 3D models of the MR-safe markers were constructed relative to the target muscles. Based on the findings of this study, muscle palpation and bony landmarks can be used to effectively identify appropriate surface EMG electrode locations to record upper trapezius, middle trapezius, semispinalis capitis, splenius capitis, levator scapulae, scalenus, sternocleidomastoid and hyoid muscles activities.
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Quantitative Magnetic Resonance Imaging Analysis of the Cervical Spine Extensor Muscles: Intrarater and Interrater Reliability of a Novice and an Experienced Rater. Asian Spine J 2018; 12:94-102. [PMID: 29503688 PMCID: PMC5821939 DOI: 10.4184/asj.2018.12.1.94] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/09/2017] [Revised: 06/16/2017] [Accepted: 07/10/2017] [Indexed: 12/26/2022] Open
Abstract
Study Design Reliability study. Purpose To examine the reliability of novice and experienced raters for measurements of the size and composition of the cervical extensor muscles using a thresholding technique. Overview of Literature Although some authors have reported on the dependability of magnetic resonance imaging (MRI) measurements of the cervical muscles, there remains some variability regarding intrarater and interrater reliabilities, and few studies have examined the associated measurement error. Whether the rater's experience noticeably influences the reliability and precision of such measurements has also not been examined. Methods A sample of 10 patients with cervical pathologies was selected. Muscle cross-sectional area (CSA), functional cross-sectional area (FCSA), and signal intensity of the cervical extensor muscles were acquired from axial T2-weighted MRIs by a novice and an experienced rater. All measurements were obtained twice, at least 5 days apart, while the raters were blinded to all earlier measurements. Results Interrater reliability estimates (intraclass correlation coefficients) varied between 0.84 and 0.99 for the novice rater and between 0.94 and 0.99 for the experienced rater, indicating excellent reliability. The standard error of measurement for the novice rater was, however, noticeably higher for all cervical muscle measurements. Most of the interrater estimates showed excellent agreement with the exception of CSA measurement of the semispinalis cervicis at C4-C7 and FCSA measurement of the multifidus and semispinalis cervicis at C4-C7, which showed poor interrater reliability. Conclusions The proposed method of investigating cervical muscle measurements was highly reliable; however, novice raters should receive adequate training before using this method for diagnostic, research, and clinical purposes.
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Owers DS, Perriman DM, Smith PN, Neeman T, Webb AL. Evidence for cervical muscle morphometric changes on magnetic resonance images after whiplash: A systematic review and meta-analysis. Injury 2018; 49:165-176. [PMID: 29269107 DOI: 10.1016/j.injury.2017.12.001] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/25/2017] [Revised: 11/29/2017] [Accepted: 12/03/2017] [Indexed: 02/02/2023]
Abstract
INTRODUCTION Morphometric changes to cervical musculature in whiplash associated disorder have been reported in several studies with varying results. However, the evidence is not clear because only a limited number of cohorts have been studied and one cohort has been reported in multiple publications. The aim of this study was to assess the evidence for cervical muscle morphometric changes on magnetic resonance (MR) images after whiplash using a systematic review with meta-analysis. MATERIALS AND METHODS PubMed, MEDLINE and Cochrane Library were searched without language restriction using combinations of the MeSH terms "muscles", "whiplash injuries", and "magnetic resonance imaging". Studies of acute and chronic whiplash were included if they compared whiplash and control cervical spine muscle morphometry measurements from MR images. The search identified 380 studies. After screening, eight studies describing five cohorts (one acute, three chronic, one both acute and chronic) met the inclusion criteria. Participant characteristics and outcome measures were extracted using a standard extraction format. Quality of eligible studies was assessed using the Newcastle-Ottawa Scale. Muscle cross-sectional area (CSA) and fat infiltrate (MFI) for acute and chronic whiplash cohorts were compared using mean difference and 95% confidence intervals. Meta-analysis models were created when data from more than two eligible cohorts was available, using inverse-variance random-effects models (RevMan5 version 5.3.5). RESULTS Quality assessment was uniformly good but only two studies blinded the assessor. Analysis of the acute cohorts revealed no consensus with respect to CSA. MFI was not measured in the acute cohorts. Analysis of the chronic cohorts revealed CSA is probably increased in some muscles after whiplash but there is insufficient evidence to confirm whether MFI is also increased. Because the available data were limited, meta-analyses of only multifidus were performed. In chronic whiplash multifidus CSA was significantly increased at C5 (Z = 3.51, p < 0.01) and C6 (Z = 2.66, p < 0.01); and MFI was significantly increased at C7 only (Z = 2.52, p < 0.01) but the heterogeneity was unacceptably high (I2 = 83%). CONCLUSIONS The strength of the evidence for cervical muscle morphometric changes on MR images after whiplash is inconsistent for CSA and MFI. Future study designs should be standardised with quantification of three-dimensional muscle morphometry.
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Affiliation(s)
- Daniel S Owers
- Australian Capital Territory Health, Canberra Hospital, Woden, ACT, 2605, Australia
| | - Diana M Perriman
- Australian Capital Territory Health, Canberra Hospital, Woden, ACT, 2605, Australia; Trauma and Orthopaedic Research Unit, Canberra Hospital, Woden, ACT, 2605, Australia; Medical School, College of Health and Medicine, Australian National University, Canberra, ACT, 2601, Australia
| | - Paul N Smith
- Australian Capital Territory Health, Canberra Hospital, Woden, ACT, 2605, Australia; Trauma and Orthopaedic Research Unit, Canberra Hospital, Woden, ACT, 2605, Australia; Medical School, College of Health and Medicine, Australian National University, Canberra, ACT, 2601, Australia
| | - Teresa Neeman
- Statistical Consulting Unit, Australian National University, Canberra, ACT, 2601, Australia
| | - Alexandra L Webb
- Medical School, College of Health and Medicine, Australian National University, Canberra, ACT, 2601, Australia.
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Thakar S, Kurudi Siddappa A, Aryan S, Mohan D, Sai Kiran NA, Hegde AS. Does the mesodermal derangement in Chiari Type I malformation extend to the cervical spine? Evidence from an analytical morphometric study on cervical paraspinal muscles. J Neurosurg Spine 2017; 27:421-427. [DOI: 10.3171/2016.12.spine16914] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECTIVEThe 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.METHODSIn 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.RESULTSCompared 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).CONCLUSIONSPatients 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.
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Rivard J, Unsleber C, Schomacher J, Erlenwein J, Petzke F, Falla D. Activation of the semispinalis cervicis and splenius capitis with cervical pulley exercises. Musculoskelet Sci Pract 2017; 30:56-63. [PMID: 28570930 DOI: 10.1016/j.msksp.2017.05.007] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/10/2016] [Revised: 05/11/2017] [Accepted: 05/16/2017] [Indexed: 11/17/2022]
Abstract
STUDY DESIGN Quasi-Experimental. OBJECTIVE To assess the activation of semispinalis cervicis (d-SSC) and splenius capitis (s-SC) muscles, and the activation between the two during neck pulley and free weight exercises. BACKGROUND Altered activation of cervical extensors may occur with neck pain, suggesting that exercises should be designed to target these muscles. METHODS d-SSC and s-SC activity was recorded unilaterally with intramuscular electromyography from healthy volunteers during cervical isometric exercises: 1) extension with a pulley rope angled from incline to vertical, 2) extension with right, left and central forehead hanging weight, and 3) rotation with pulley rope angled from incline to decline. RESULTS Extension against a vertical force led to greater activation of d-SSC (P < 0.001) and s-SC (P < 0.001) compared to the inclined, declined and horizontal pulley. With each of these conditions, amplitude of muscle activity was higher for the d-SSC compared to the s-SC muscle (P < 0.0001). Extension with free weight hanging on right, left or central forehead, showed no differences across conditions, although in each condition, the d-SSC amplitude was higher than the s-SC. For cervical rotation, the declined pulley led to the greatest activation of both muscles (P < 0.05). Higher levels of activity were observed for the s-SC compared to the d-SSC (P < 0.01) for all rotation conditions. CONCLUSION A vertical resistance during an extension exercise or a declined resistance during cervical rotation, increased neck extensor activation. The results from this preliminary study provide guidance for future work on the exploration and development of low-load exercise design for patients with neck pain disorders.
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Affiliation(s)
- Jim Rivard
- The Ola Grimsby Institute, Seattle, WA, USA; MTI Physical Therapy, Bellevue, WA, USA.
| | - Cindy Unsleber
- The Ola Grimsby Institute, Seattle, WA, USA; MTI Physical Therapy, Bellevue, WA, USA
| | | | - Joachim Erlenwein
- Pain Clinic, Center for Anesthesiology, Emergency and Intensive Care Medicine, University Hospital Göttingen, Göttingen, Germany
| | - Frank Petzke
- Pain Clinic, Center for Anesthesiology, Emergency and Intensive Care Medicine, University Hospital Göttingen, Göttingen, Germany
| | - Deborah Falla
- Pain Clinic, Center for Anesthesiology, Emergency and Intensive Care Medicine, University Hospital Göttingen, Göttingen, Germany; Centre of Precision Rehabilitation for Spinal Pain (CPR Spine), School of Sport, Exercise and Rehabilitation Sciences, College of Life and Environmental Sciences, University of Birmingham, Birmingham, UK
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Abstract
The Orthopaedic Section of the American Physical Therapy Association (APTA) has an ongoing effort to create evidence-based practice guidelines for orthopaedic physical therapy management of patients with musculoskeletal impairments described in the World Health Organization's International Classification of Functioning, Disability, and Health (ICF). The purpose of these revised clinical practice guidelines is to review recent peer-reviewed literature and make recommendations related to neck pain. J Orthop Sports Phys Ther. 2017;47(7):A1-A83. doi:10.2519/jospt.2017.0302.
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Olivencia O, Shamash K, Kreymer B, Kolber MJ. Post-Rehabilitation Considerations for Clients With a Cervical Disc Herniation. Strength Cond J 2017. [DOI: 10.1519/ssc.0000000000000237] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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Øverås CK, Myhrvold BL, Røsok G, Magnesen E. Musculoskeletal diagnostic ultrasound imaging for thickness measurement of four principal muscles of the cervical spine -a reliability and agreement study. Chiropr Man Therap 2017; 25:2. [PMID: 28070269 PMCID: PMC5215195 DOI: 10.1186/s12998-016-0132-9] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2016] [Accepted: 12/06/2016] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND The reliability of musculoskeletal diagnostic ultrasound imaging (MSK-DUSI) for the evaluation of neck musculature has been sparsely documented in the research literature. Until now, research has featured a limited number of subjects and only few studies have tested for both inter- and intra-reliability using appropriate methodology. METHODS Four examiners conducted an inter- and intra-rater reliability and agreement study. Fifty females with and without neck pain (NP) between the ages of 20-70 were recruited from October 2014 to April 2015. The muscles that were evaluated were the longus colli (Lcol), the rectus capitis posterior major (Rcpm), the deep cervical extensors (Dce) and the semispinalis capitis (Sscap). Each of the examiners captured ultrasound images of their allocated muscle and measured the thickness of that muscle twice, on separate occasions, for the first part of the intra-rater reliability study. For the second part, a second image of the same muscle was taken on the same subject and measured by the same examiner. The four examiners then met to measure on each other's images, to test inter-rater reliability. Their results were compared pair-wise using Interclass Correlation Coefficients (ICC) and Bland-Altman plots. Linear regression analysis was performed to evaluate for possible bias. RESULTS Inter-rater reliability was found to be good for Lcol and Sscap muscles and moderate towards poor for the deeper Rcpm and Dce muscles. Intra-rater reliability was good for all the muscles, with the exception of the Dce, which was found to be moderate in the second part of the study. The B&A plots showed good agreement, few outliers, and no bias. However, the agreement intervals indicated a measurement error within the variance of the method that may not have been acceptable for these small muscles if the aim is to evaluate change in thickness. CONCLUSIONS This study found that MSK-DUSI had variable reliability in assessing the thickness of the Lcol, Rcpm, Dce, and Sscap muscles. No bias was demonstrated, but agreement intervals were wide.
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Affiliation(s)
- Cecilie Krage Øverås
- MSc Chiropractic, MSc Ultrasound (Musculoskeletal), NEMUS Trondheim, Fjordgata 80, 7010 Trondheim, Norway
| | - Birgitte Lawaetz Myhrvold
- MSc Health Sciences, Clinical Biomechanics, MSc Ultrasound (Musculoskeletal), NEMUS Ullevål, Sognsveien 75B, 0855 Oslo, Norway
| | - Gro Røsok
- DC, MSc Ultrasound (Musculoskeletal), Kiropraktorhuset Elverum, Storgata 7b, 2408 Elverum, Norway
| | - Eli Magnesen
- DC, MSc Ultrasound (Musculoskeletal), Kiropraktorklinikken Holmestrand, Havnegaten 23, 3080 Holmestrand, Norway
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Chronic neck pain patients with traumatic or non-traumatic onset: Differences in characteristics. A cross-sectional study. Scand J Pain 2016; 14:1-8. [PMID: 28850421 DOI: 10.1016/j.sjpain.2016.08.008] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2016] [Revised: 08/23/2016] [Accepted: 08/27/2016] [Indexed: 11/20/2022]
Abstract
BACKGROUND AND AIMS Patients with chronic neck pain can present with disability, low quality of life, psychological factors and clinical symptoms. It is unclear whether patients with a traumatic onset differ from those with a non-traumatic onset, by having more complex and severe symptoms. The purpose of this study was to investigate the clinical presentation of chronic neck pain patients with and without traumatic onset by examining cervical mobility, sensorimotor function, cervical muscle performance and pressure pain threshold in addition to the following self-reported characteristics: quality of life, neck pain and function, kinesiophobia, depression, and pain bothersomeness. METHODS This cross-sectional study included 200 participants with chronic neck pain: 120 with traumatic onset and 80 with non-traumatic onset. Participants were recruited from physiotherapy clinics in primary and secondary health care. For participants to be included, they were required to be at least 18 years of age, have had neck pain for at least 6 months, and experienced neck-related activity limitation as determined by a score of at least 10 on the Neck Disability Index. We conducted the following clinical tests of cervical range of motion, gaze stability, eye movement, cranio-cervical flexion, cervical extensors, and pressure pain threshold. The participants completed the following questionnaires: physical and mental component summary of the Short Form Health Survey, EuroQol-5D, Neck Disability Index, Patient-Specific Functional Scale, Pain Bothersomeness, Beck Depression Inventory-II, and TAMPA scale of kinesiophobia. The level of significance for all analyses was defined as p<0.01. Differences between groups for the continuous data were determined using either a Student's t-test or Mann Whitney U test. RESULTS In both groups, the majority of the participants were female (approximately 75%). Age, educational level, working situation and sleeping patterns were similar in both groups. The traumatic group had symptoms for a shorter duration (88 vs. 138 months p=0.001). Participants in the traumatic group showed worse results on all measures compared with those in the non-traumatic group, significantly on neck muscle function (cervical extension mobility p=0.005, cranio-cervical flexion test p=0.007, cervical extensor test p=0.006) and cervical pressure pain threshold bilateral (p=0.002/0.004), as well on self-reported function (Neck Disability Index p=0.001 and Patient-Specific Functional Scale p=0.007), mental quality of life (mental component summary of the Short Form Health Survey p=0.004 and EuroQol-5D p=0.001) and depression (Beck Depression Inventory-II p=0.001). CONCLUSIONS This study showed significant differences between chronic neck pain patients when differentiated into groups based on their onset of pain. However, no specific clinical test or self-reported characteristic could differentiate between the groups at an individual patient level. IMPLICATIONS Pressure pain threshold tests, cervical muscle performance tests and patient-reported characteristics about self-perceived function and psychological factors may assist in profiling chronic neck pain patients. The need for more intensive management of those with a traumatic onset compared with those with a non-traumatic onset should be examined further.
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Elliott JM, Dayanidhi S, Hazle C, Hoggarth MA, McPherson J, Sparks CL, Weber KA. Advancements in Imaging Technology: Do They (or Will They) Equate to Advancements in Our Knowledge of Recovery in Whiplash? J Orthop Sports Phys Ther 2016; 46:862-873. [PMID: 27690836 PMCID: PMC7274526 DOI: 10.2519/jospt.2016.6735] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Synopsis It is generally accepted that up to 50% of those with a whiplash injury following a motor vehicle collision will fail to fully recover. Twenty-five percent of these patients will demonstrate a markedly complex clinical picture that includes severe pain-related disability, sensory and motor disturbances, and psychological distress. A number of psychosocial factors have shown prognostic value for recovery following whiplash from a motor vehicle collision. To date, no management approach (eg, physical therapies, education, psychological interventions, or interdisciplinary strategies) for acute whiplash has positively influenced recovery rates. For many of the probable pathoanatomical lesions (eg, fracture, ligamentous rupture, disc injury), there remains a lack of available clinical tests for identifying their presence. Fractures, particularly at the craniovertebral and cervicothoracic junctions, may be radiographically occult. While high-resolution computed tomography scans can detect fractures, there remains a lack of prevalence data for fractures in this population. Conventional magnetic resonance imaging has not consistently revealed lesions in patients with acute or chronic whiplash, a "failure" that may be due to limitations in the resolution of available devices and the use of standard sequences. The technological evolution of imaging techniques and sequences eventually might provide greater resolution to reveal currently elusive anatomical lesions (or, perhaps more importantly, temporal changes in physiological responses to assumed lesions) in those patients at risk of poor recovery. Preliminary findings from 2 prospective cohort studies in 2 different countries suggest that this is so, as evidenced by changes to the structure of skeletal muscles in those who do not fully recover. In this clinical commentary, we will briefly introduce the available imaging decision rules and the current knowledge underlying the pathomechanics and pathophysiology of whiplash. We will then acknowledge known prognostic factors underlying functional recovery. Last, we will highlight emerging evidence regarding the pathobiology of muscle degeneration/regeneration, as well as advancements in neuroimaging and musculoskeletal imaging techniques (eg, functional magnetic resonance imaging, magnetization transfer imaging, spectroscopy, diffusion-weighted imaging) that may be used as noninvasive and objective complements to known prognostic factors associated with whiplash recovery, in particular, poor functional recovery. J Orthop Sports Phys Ther 2016;46(10):861-872. doi:10.2519/jospt.2016.6735.
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Valentin S, Yeates TD, Licka T, Elliott J. In vivo MRI features of spinal muscles in the ovine model. J Orthop Translat 2016; 6:1-9. [PMID: 29392107 PMCID: PMC5790160 DOI: 10.1016/j.jot.2015.09.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
Abstract
Background Muscle fatty infiltration (MFI) has been identified in patients with spinal pain using magnetic resonance imaging (MRI). Even though sheep are a commonly used animal model for the human spine, comparative sheep MFI data from MRI is not available. Determining MFI in sheep spinal muscles using acquisition protocols commonly used in man will identify the applicability of this approach in future sheep model studies, such that the effects of spinal interventions on muscle can be assessed prior to their use in a human (clinical) population. Objective To quantify ovine lumbar spine MFI using three-dimensional two-point Dixon and T1-weighted sequences. Methods T1-weighted and Dixon lumbar spine axial sequences were collected in 14 healthy Austrian mountain sheep using a 1.5-T MRI. At each vertebrae, the region of interest of psoas major and minor (PS), multifidus (M), and longissimus (L) were identified. To determine MFI from the T1-weighted images, the mean pixel intensity (MPI) was calculated as a percentage of subcutaneous or intermuscular fat. For the Dixon images, fat sequence MPI was calculated as a percentage of the summed fat and water sequence MPIs. Spinal degeneration was graded and correlated to MFI. Dixon MFI was compared to T1-weighted MFI obtained from subcutaneous and intermuscular fat. Results For every muscle, T1-weighted MFI calculated using subcutaneous fat scored significantly lower than Dixon MFI and T1-weighted MFI calculated using intermuscular fat (p < 0.001). There were no significant MFI differences between T1-weighted images calculated using intermuscular fat and Dixon images for M and L (p > 0.05), although significant differences were found for PS. Conclusion In sheep, Dixon sequences provide an acceptable comparison to T1-weighted sequences for lumbar extensor MFI based on intermuscular fat. However, compared to the human literature, ovine lumbar musculature contains greater MFI, making interspecies comparisons more complex.
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Affiliation(s)
- Stephanie Valentin
- Movement Science Group Vienna, Equine Clinic, University of Veterinary Medicine Vienna, Vienna, Austria
| | - Tobey DeMott Yeates
- Department of Physical Therapy and Human Movement Sciences, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | - Theresia Licka
- Movement Science Group Vienna, Equine Clinic, University of Veterinary Medicine Vienna, Vienna, Austria.,Large Animal Hospital, Royal (Dick) School of Veterinary Studies, University of Edinburgh, Roslin, Scotland, UK
| | - James Elliott
- Department of Physical Therapy and Human Movement Sciences, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA.,School of Health and Rehabilitation Sciences, The University of Queensland, Queensland, Australia
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Au J, Perriman DM, Pickering MR, Buirski G, Smith PN, Webb AL. Magnetic resonance imaging atlas of the cervical spine musculature. Clin Anat 2016; 29:643-59. [PMID: 27106787 DOI: 10.1002/ca.22731] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2015] [Revised: 03/12/2016] [Accepted: 04/20/2016] [Indexed: 11/10/2022]
Abstract
The anatomy of the cervical spine musculature visible on magnetic resonance (MR) images is poorly described in the literature. However, the correct identification of individual muscles is clinically important because certain conditions of the cervical spine, for example whiplash associated disorders, idiopathic neck pain, cervical nerve root avulsion and cervical spondylotic myelopathy, are associated with different morphological changes in specific muscles visible on MR images. Knowledge of the precise structure of different cervical spine muscles is crucial when comparisons with the contralateral side or with normal are required for accurate description of imaging pathology, management and assessment of treatment efficacy. However, learning the intricate arrangement of 27 muscles is challenging. A multi-level cross-sectional depiction combined with three-dimensional reconstructions could facilitate the understanding of this anatomically complex area. This paper presents a comprehensive series of labeled axial MR images from one individual and serves as a reference atlas of the cervical spine musculature to guide clinicians, researchers, and anatomists in the accurate identification of these muscles on MR imaging. Clin. Anat. 29:643-659, 2016. © 2016 Wiley Periodicals, Inc.
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Affiliation(s)
- John Au
- Trauma and Orthopaedic Research Unit, the Canberra Hospital, Canberra, Australia.,Medical School, College of Medicine, Biology and Environment, Australian National University, Canberra, Australia
| | - Diana M Perriman
- Trauma and Orthopaedic Research Unit, the Canberra Hospital, Canberra, Australia.,Medical School, College of Medicine, Biology and Environment, Australian National University, Canberra, Australia
| | - Mark R Pickering
- School of Engineering and Information Technology, Australian Defence Force Academy, University of New South Wales, Canberra, Australia
| | - Graham Buirski
- Medical School, College of Medicine, Biology and Environment, Australian National University, Canberra, Australia.,MusculoSkeletal Imaging, Sidra Medical and Research Center, Doha, Qatar
| | - Paul N Smith
- Trauma and Orthopaedic Research Unit, the Canberra Hospital, Canberra, Australia.,Medical School, College of Medicine, Biology and Environment, Australian National University, Canberra, Australia
| | - Alexandra L Webb
- Medical School, College of Medicine, Biology and Environment, Australian National University, Canberra, Australia
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Peterson G, Nilsson D, Peterson S, Dedering Å, Trygg J, Wallman T, Peolsson A. Changes in Dorsal Neck Muscle Function in Individuals with Chronic Whiplash-Associated Disorders: A Real-Time Ultrasound Case-Control Study. ULTRASOUND IN MEDICINE & BIOLOGY 2016; 42:1090-1102. [PMID: 26921149 DOI: 10.1016/j.ultrasmedbio.2015.12.022] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/26/2015] [Revised: 12/16/2015] [Accepted: 12/21/2015] [Indexed: 06/05/2023]
Abstract
Impaired neck muscle function leads to disability in individuals with chronic whiplash-associated disorder (WAD), but diagnostic tools are lacking. In this study, deformations and deformation rates were investigated in five dorsal neck muscles during 10 arm elevations by ultrasonography with speckle tracking analyses. Forty individuals with chronic WAD (28 women and 12 men, mean age = 37 y) and 40 healthy controls matched for age and sex were included. The WAD group had higher deformation rates in the multifidus muscle during the first (p < 0.04) and 10th (only women, p < 0.01) arm elevations compared with the control group. Linear relationships between the neck muscles for deformation rate (controls: R(2) = 0.24-0.82, WAD: R(2) = 0.05-0.74) and deformation of the deepest muscles (controls: R(2) = 0.61-0.32, WAD: R(2) = 0.15-0.01) were stronger for women in the control group versus women with WAD, indicating there is altered interplay between dorsal neck muscles in chronic WAD.
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Affiliation(s)
- Gunnel Peterson
- Centre for Clinical Research Sörmland, Uppsala University, Eskilstuna, Sweden; Division of Physiotherapy, Department of Medical and Health Sciences, Linköping University, Linköping, Sweden.
| | - David Nilsson
- Computational Life Science Cluster (CLiC), Department of Chemistry, Umeå University, Sweden
| | - Simon Peterson
- Division of Physiotherapy, Department of Medical and Health Sciences, Linköping University, Linköping, Sweden
| | - Åsa Dedering
- Division of Physiotherapy, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Stockholm, Sweden; Department of Physical Therapy, Karolinska University Hospital, Sweden
| | - Johan Trygg
- Computational Life Science Cluster (CLiC), Department of Chemistry, Umeå University, Sweden
| | - Thorne Wallman
- Centre for Clinical Research Sörmland, Uppsala University, Eskilstuna, Sweden; Public Health & Caring Sciences, Family Medicine & Preventive Medicine Section, Uppsala University, Uppsala, Sweden
| | - Anneli Peolsson
- Division of Physiotherapy, Department of Medical and Health Sciences, Linköping University, Linköping, Sweden
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De Pauw R, Coppieters I, Kregel J, De Meulemeester K, Danneels L, Cagnie B. Does muscle morphology change in chronic neck pain patients? – A systematic review. ACTA ACUST UNITED AC 2016; 22:42-9. [DOI: 10.1016/j.math.2015.11.006] [Citation(s) in RCA: 48] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2015] [Revised: 11/23/2015] [Accepted: 11/29/2015] [Indexed: 10/22/2022]
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An interactive segmentation tool for quantifying fat in lumbar muscles using axial lumbar-spine MRI. Ing Rech Biomed 2016. [DOI: 10.1016/j.irbm.2015.10.004] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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A Comparison of the Effects of Stabilization Exercises Plus Manual Therapy to Those of Stabilization Exercises Alone in Patients With Nonspecific Mechanical Neck Pain: A Randomized Clinical Trial. J Orthop Sports Phys Ther 2016; 46:44-55. [PMID: 26755405 DOI: 10.2519/jospt.2016.5979] [Citation(s) in RCA: 46] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
STUDY DESIGN Randomized clinical trial. BACKGROUND Little is known about the efficacy of providing manual therapy in addition to cervical and scapulothoracic stabilization exercises in people with mechanical neck pain (MNP). Objectives To compare the effects of stabilization exercises plus manual therapy to those of stabilization exercises alone on disability, pain, range of motion (ROM), and quality of life in patients with MNP. METHODS One hundred two patients with MNP (18-65 years of age) were recruited and randomly allocated into 2 groups: stabilization exercise without (n = 51) and with (n = 51) manual therapy. The program was carried out 3 days per week for 4 weeks. The Neck Disability Index, visual analog pain scale, digital algometry of pressure pain threshold, goniometric measurements, and Medical Outcomes Study 36-Item Short-Form Health Survey were used to assess participants at baseline and after 4 weeks. RESULTS Improvements in Neck Disability Index score, night pain, rotation ROM, and the Medical Outcomes Study 36-Item Short-Form Health Survey score were greater in the group that received stabilization exercise with manual therapy compared to the group that only received stabilization exercise. Between-group differences (95% confidence interval) were 2.2 (0.1, 4.3) points for the Neck Disability Index, 1.1 (0.0, 2.3) cm for pain at night measured on the visual analog scale, -4.3° (-8.1°, -0.5°) and -5.0° (-8.2°, -1.7°) for right and left rotation ROM, respectively, and -2.9 (-5.4, -0.4) points and -3.1 (-6.2, 0.0) points for the Medical Outcomes Study 36-Item Short-Form Health Survey physical and mental components, respectively. Changes in resting and activity pain, pressure pain threshold, and cervical extension or lateral flexion ROM did not differ significantly between the groups. Pressure pain threshold increased only in those who received stabilization exercise with manual therapy (P<.05). CONCLUSION The results of this study suggest that stabilization exercises with manual therapy may be superior to stabilization exercises alone for improving disability, pain intensity at night, cervical rotation motion, and quality of life in patients with MNP. LEVEL OF EVIDENCE Therapy, level 1b.
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Sions JM, Smith AC, Hicks GE, Elliott JM. Trunk Muscle Size and Composition Assessment in Older Adults with Chronic Low Back Pain: An Intra-Examiner and Inter-Examiner Reliability Study. PAIN MEDICINE 2015; 17:1436-46. [PMID: 26814258 DOI: 10.1093/pm/pnv023] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/20/2014] [Accepted: 09/05/2015] [Indexed: 11/13/2022]
Abstract
OBJECTIVE To evaluate intra- and inter-examiner reliability for the assessment of relative cross-sectional area, muscle-to-fat infiltration indices, and relative muscle cross-sectional area, i.e., total cross-sectional area minus intramuscular fat, from T1-weighted magnetic resonance images obtained in older adults with chronic low back pain. DESIGN Reliability study. SUBJECTS n = 13 (69.3 ± 8.2 years old) METHODS After lumbar magnetic resonance imaging, two examiners produced relative cross-sectional area measurements of multifidi, erector spinae, psoas, and quadratus lumborum by tracing regions of interest just inside fascial borders. Pixel-intensity summaries were used to determine muscle-to-fat infiltration indices; relative muscle cross-sectional area was calculated. Intraclass correlation coefficients were used to estimate intra- and inter-examiner reliability; standard error of measurement was calculated. RESULTS Intra-examiner intraclass correlation coefficient point estimates for relative cross-sectional area, muscle-to-fat infiltration indices, and relative muscle cross-sectional area were excellent for multifidi and erector spinae across levels L2-L5 (ICC = 0.77-0.99). At L3, intra-examiner reliability was excellent for relative cross-sectional area, muscle-to-fat infiltration indices, and relative muscle cross-sectional area for both psoas and quadratus lumborum (ICC = 0.81-0.99). Inter-examiner intraclass correlation coefficients ranged from poor to excellent for relative cross-sectional area, muscle-to-fat infiltration indices, and relative muscle cross-sectional area. CONCLUSIONS Assessment of relative cross-sectional area, muscle-to-fat infiltration indices, and relative muscle cross-sectional area in older adults with chronic low back pain can be reliably determined by one examiner from T1-weighted images. Such assessments provide valuable information, as muscle-to-fat infiltration indices and relative muscle cross-sectional area indicate that a substantial amount of relative cross-sectional area may be magnetic resonance-visible intramuscular fat in older adults with chronic low back pain.
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Affiliation(s)
- Jaclyn Megan Sions
- *Department of Physical Therapy, University of Delaware, Newark, Delaware, USA;
| | - Andrew Craig Smith
- Department of Physical Therapy and Human Movement Sciences, Feinberg School of Medicine, Northwestern University, Chicago, Illinois, USA
| | - Gregory Evan Hicks
- *Department of Physical Therapy, University of Delaware, Newark, Delaware, USA
| | - James Matthew Elliott
- Department of Physical Therapy and Human Movement Sciences, Feinberg School of Medicine, Northwestern University, Chicago, Illinois, USA
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Taouk CM, Desa VG, Leaver AM. Clinical and radiological assessment of the cervical extensor muscles in people with neck pain. A narrative review. PHYSICAL THERAPY REVIEWS 2015. [DOI: 10.1080/10833196.2015.1125586] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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O’Leary S, Jull G, Van Wyk L, Pedler A, Elliott J. Morphological changes in the cervical muscles of women with chronic whiplash can be modified with exercise-A pilot study. Muscle Nerve 2015; 52:772-9. [PMID: 25702919 PMCID: PMC4545448 DOI: 10.1002/mus.24612] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2014] [Revised: 02/02/2015] [Accepted: 02/10/2015] [Indexed: 12/24/2022]
Abstract
INTRODUCTION In this preliminary study we determined whether MRI markers of cervical muscle degeneration [elevated muscle fatty infiltration (MFI), cross-sectional area (CSA), and reduced relative muscle CSA (rmCSA)] could be modified with exercise in patients with chronic whiplash. METHODS Five women with chronic whiplash undertook 10 weeks of neck exercise. MRI measures of the cervical multifidus (posterior) and longus capitus/colli (anterior) muscles, neck muscle strength, and self-reported neck disability were recorded at baseline and at completion of the exercise program. RESULTS Overall significant increases in CSA and rmCSA were observed for both muscles, but significant reductions in MFI were only evident in the cervical multifidus muscle. These changes coincided with increased muscle strength and reduced neck disability. CONCLUSIONS MRI markers of muscle morphology in individuals with chronic whiplash appear to be modifiable with exercise.
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Affiliation(s)
- Shaun O’Leary
- Centre for Clinical Research Excellence in Spinal Pain, Injury and Health, Division of Physiotherapy, The University of Queensland, Brisbane, QLD 4072, Australia
- Physiotherapy Department, Royal Brisbane and Womens Hospital, Herston, Brisbane, QLD 4029, Australia
| | - Gwendolen Jull
- Centre for Clinical Research Excellence in Spinal Pain, Injury and Health, Division of Physiotherapy, The University of Queensland, Brisbane, QLD 4072, Australia
| | - Luke Van Wyk
- Centre for Clinical Research Excellence in Spinal Pain, Injury and Health, Division of Physiotherapy, The University of Queensland, Brisbane, QLD 4072, Australia
| | - Ashley Pedler
- Centre for National Research on Disability and Rehabilitation Medicine, The University of Queensland, Herston, QLD 4029, Australia
| | - James Elliott
- Northwestern University, Feinberg School of Medicine, Department of Physical Therapy and Human Movement Sciences, Chicago, Illinois, USA & Honorary Senior Fellow, School of Health and Rehabilitation Sciences, University of Queensland, Brisbane, QLD 4072, Australia
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Rahnama L, Rezasoltani A, Khalkhali-Zavieh M, Rahnama B, Noori-Kochi F. Reliability of new software in measuring cervical multifidus diameters and shoulder muscle strength in a synchronized way; an ultrasonographic study. Braz J Phys Ther 2015; 19:279-85. [PMID: 26443975 PMCID: PMC4620976 DOI: 10.1590/bjpt-rbf.2014.0097] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
OBJECTIVES: This study was conducted with the purpose of evaluating the inter-session
reliability of new software to measure the diameters of the cervical multifidus
muscle (CMM), both at rest and during isometric contractions of the shoulder
abductors in subjects with neck pain and in healthy individuals. METHOD: In the present study, the reliability of measuring the diameters of the CMM with
the Sonosynch software was evaluated by using 24 participants, including 12
subjects with chronic neck pain and 12 healthy individuals. The anterior-posterior
diameter (APD) and the lateral diameter (LD) of the CMM were measured in a resting
state and then repeated during isometric contraction of the shoulder abductors.
Measurements were taken on separate occasions 3 to 7 days apart in order to
determine inter-session reliability. Intraclass correlation coefficient (ICC),
standard error of measurement (SEM), and smallest detectable difference (SDD) were
used to evaluate the relative and absolute reliability, respectively. RESULTS: The Sonosynch software has shown to be highly reliable in measuring the diameters
of the CMM both in healthy subjects and in those with neck pain. The ICCs 95% CI
for APD ranged from 0.84 to 0.94 in subjects with neck pain and from 0.86 to 0.94
in healthy subjects. For LD, the ICC 95% CI ranged from 0.64 to 0.95 in subjects
with neck pain and from 0.82 to 0.92 in healthy subjects. CONCLUSIONS: Ultrasonographic measurement of the diameters of the CMM using Sonosynch has
proved to be reliable especially for APD in healthy subjects as well as subjects
with neck pain.
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Affiliation(s)
- Leila Rahnama
- Department of Physical Therapy, University of Social Welfare and Rehabilitation Sciences, Tehran, IR
| | - Asghar Rezasoltani
- Physiotherapy Research Center, Faculty of Rehabilitation Sciences, Shahid Beheshti University of Medical Sciences, Tehran, IR
| | - Minoo Khalkhali-Zavieh
- Department of Physical Therapy, Faculty of Rehabilitation Sciences, Shahid Beheshti University of Medical Sciences, Tehran, IR
| | - Behnam Rahnama
- Department of Computer Science, Engineering, Shiraz University, Shiraz, IR
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Smith AC, Parrish TB, Hoggarth MA, McPherson JG, Tysseling VM, Wasielewski M, Kim HE, Hornby TG, Elliott JM. Potential associations between chronic whiplash and incomplete spinal cord injury. Spinal Cord Ser Cases 2015; 1. [PMID: 27630770 DOI: 10.1038/scsandc.2015.24] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022] Open
Abstract
STUDY DESIGN This research utilized a cross-sectional design with control group inclusion. OBJECTIVES Preliminary evidence suggests that a portion of the patient population with chronic whiplash may have sustained spinal cord damage. Our hypothesis is that in some cases of chronic whiplash-associated disorders (WAD), observed muscle weakness in the legs will be associated with local signs of a partial spinal cord injury of the cervical spine. SETTING University based laboratory in Chicago, IL, USA. METHODS Five participants with chronic WAD were compared with five gender/age/height/weight/body mass index (BMI) control participants. For a secondary investigation, the chronic WAD group was compared with five unmatched participants with motor incomplete spinal cord injury (iSCI). Spinal cord motor tract integrity was assessed using magnetization transfer imaging. Muscle fat infiltration (MFI) was quantified using fat/water separation magnetic resonance imaging. Central volitional muscle activation of the plantarflexors was assessed using a burst superimposition technique. RESULTS We found reduced spinal cord motor tract integrity, increased MFI of the neck and lower extremity muscles and significantly impaired voluntary plantarflexor muscle activation in five participants with chronic WAD. The lower extremity structural changes and volitional weakness in chronic WAD were comparable to participants with iSCI. CONCLUSION The results support the position that a subset of the chronic whiplash population may have sustained partial damage to the spinal cord. SPONSORSHIP NIH R01HD079076-01A1, NIH T32 HD057845 and the Foundation for Physical Therapy Promotion of Doctoral Studies program.
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Affiliation(s)
- Andrew C Smith
- Northwestern University Interdepartmental Neuroscience Program, Chicago, IL USA; Northwestern University Department of Physical Therapy and Human Movement Sciences, Chicago, IL USA
| | - Todd B Parrish
- Northwestern University Department of Radiology, Chicago, IL USA
| | - Mark A Hoggarth
- Northwestern University Department of Physical Therapy and Human Movement Sciences, Chicago, IL USA
| | - Jacob G McPherson
- Florida International University Department of Biomedical Engineering, Miami, FL USA
| | - Vicki M Tysseling
- Northwestern University Department of Physical Therapy and Human Movement Sciences, Chicago, IL USA
| | - Marie Wasielewski
- Northwestern University Department of Physical Therapy and Human Movement Sciences, Chicago, IL USA
| | - Hyosub E Kim
- Rehabilitation Institute of Chicago, Chicago, IL USA
| | | | - James M Elliott
- Northwestern University Department of Physical Therapy and Human Movement Sciences, Chicago, IL USA
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Schomacher J, Erlenwein J, Dieterich A, Petzke F, Falla D. Can neck exercises enhance the activation of the semispinalis cervicis relative to the splenius capitis at specific spinal levels? ACTA ACUST UNITED AC 2015; 20:694-702. [PMID: 25935795 DOI: 10.1016/j.math.2015.04.010] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2014] [Revised: 03/31/2015] [Accepted: 04/08/2015] [Indexed: 01/06/2023]
Abstract
The deep cervical extensor, semispinalis cervicis, displays changes in behaviour and structure in people with chronic neck pain yet there is limited knowledge on how activation of this muscle can be emphasized during training. Using intramuscular electromyography (EMG), this study investigated the activity of the deep semispinalis cervicis and the superficial splenius capitis muscle at two spinal levels (C2 and C5) in ten healthy volunteers during a series of neck exercises: 1. Traction and compression, 2. Resistance applied in either flexion or extension at the occiput, at the level of the vertebral arch of C1 and of C4, and 3. Maintaining the neck in neutral while inclined on the elbows, with and without resistance at C4. The ratio between semispinalis cervicis and the splenius capitis EMG amplitude was quantified as an indication of whether the exercise could emphasize the activation of the semispinalis cervicis muscle relative to the splenius capitis. Manual resistance applied in extension over the vertebral arch emphasized the activation of the semispinalis cervicis relative to the splenius capitis at the spinal level directly caudal to the site of resistance (ratio: 2.0 ± 1.1 measured at C5 with resistance at C4 and 2.1 ± 1.2 measured at C2 with resistance at C1). This study confirmed the possibility of emphasizing the activation of the semispinalis cervicis relative to the splenius capitis which may be relevant for targeted exercise interventions for this deep extensor muscle. Further studies are required to investigate the clinical efficacy of these exercises for people with neck pain.
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Affiliation(s)
| | - Joachim Erlenwein
- Pain Clinic, Center for Anesthesiology, Emergency and Intensive Care Medicine, University Hospital Göttingen, Göttingen, Germany
| | - Angela Dieterich
- Pain Clinic, Center for Anesthesiology, Emergency and Intensive Care Medicine, University Hospital Göttingen, Göttingen, Germany
| | - Frank Petzke
- Pain Clinic, Center for Anesthesiology, Emergency and Intensive Care Medicine, University Hospital Göttingen, Göttingen, Germany
| | - Deborah Falla
- Pain Clinic, Center for Anesthesiology, Emergency and Intensive Care Medicine, University Hospital Göttingen, Göttingen, Germany; Department of Neurorehabilitation Engineering, Bernstein Focus Neurotechnology (BFNT) Göttingen, Bernstein Center for Computational Neuroscience, University Medical Center Göttingen, Georg-August University, Göttingen, Germany.
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Magnetic Resonance Imaging Analysis of Deep Cervical Flexors in Patients with Ossification of the Posterior Longitudinal Ligament and Clinical Implication. Am J Phys Med Rehabil 2015; 94:967-74. [PMID: 25802957 DOI: 10.1097/phm.0000000000000288] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
OBJECTIVE The purpose of this study was to analyze the cross-sectional area (CSA) of deep cervical flexors as measured by magnetic resonance imaging in ossification of the posterior longitudinal ligament (OPLL) patients with neck pain and, by implication, how this may relate to recruitment of the deep cervical flexors and sternocleidomastoid. DESIGN A retrospective case-control study was conducted. All 72 subjects were imaged using plain radiography, computed tomography, and magnetic resonance imaging. RESULTS There was a more limited cervical range of motion in the OPLL group than that in the control group. Cervical lordosis, T1 slope, and thoracic inlet angle values were significantly lower in the OPLL group than in the control group. Bilateral CSAs of the longus colli muscle and longus capitis muscle of the OPLL group were smaller than those of the control group. In addition, bilateral CSAs of the sternocleidomastoid of the OPLL subjects were greater than those of healthy subjects. CONCLUSIONS The authors found that the OPLL patients with chronic neck pain had lesser lordotic cervical alignment, smaller deep cervical flexor CSAs, and larger sternocleidomastoid CSAs than the control group did. The authors' theory is that the sternocleidomastoids in these OPLL patients have compensatorily hypertrophied in response to presumably atrophied deep cervical flexors.
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Valentin S, Yeates TD, Licka T, Elliott J. Inter-rater reliability of trunk muscle morphometric analysis. J Back Musculoskelet Rehabil 2015; 28:181-90. [PMID: 25628042 PMCID: PMC5614442 DOI: 10.3233/bmr-140552] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
BACKGROUND Inter-rater reliability of generalised lumbar extensor muscle CSA has been identified, however, more detailed reliability metrics of individual trunk muscles are lacking. OBJECTIVE To report muscle volume and muscle fatty infiltrate (MFI) inter-rater reliability of individual trunk muscles between two novice assessors. METHODS Lumbar axial MRI scans from 10 healthy male participants were analysed. The muscles erector spinae (ES), multifidus (M), rectus abdominis (RA), and psoas (PS) were manually traced, region of interest quantified and muscle volume and MFI determined by both assessors. Agreement between the assessors was determined using intraclass correlation coefficients (3,1), Bland-Altman plots and Lin's concordance coefficient. RESULTS Good to excellent agreement was found for volume (ICC 0.77-0.96) and MFI (0.84-0.96) for all muscles on first evaluation, except for M volume, which required a second evaluation. Best agreement for muscle volume and MFI was found for ES (ICC 0.96). CONCLUSIONS First evaluation of muscle volume and MFI yields high to excellent inter-rater agreement, except for M, where further training and/or experience is required to achieve acceptable reliability outcomes. This may have clinical implications due to the relevance of M atrophy reported in patients with low back pain.
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Affiliation(s)
- Stephanie Valentin
- Movement Science Group Vienna, Equine Clinic, University of Veterinary Medicine Vienna, Vienna, Austria
| | - Tobey DeMott Yeates
- Department of Physical Therapy and Human Movement Sciences, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | - Theresia Licka
- Movement Science Group Vienna, Equine Clinic, University of Veterinary Medicine Vienna, Vienna, Austria,Large Animal Hospital, Royal (Dick) School of Veterinary Studies, University of Edinburgh, Roslin, Scotland,United Kingdom
| | - James Elliott
- Department of Physical Therapy and Human Movement Sciences, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA,School of Health and Rehabilitation Sciences, The University of Queensland, Australia
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Fortin M, Gibbons LE, Videman T, Battié MC. Do variations in paraspinal muscle morphology and composition predict low back pain in men? Scand J Med Sci Sports 2014; 25:880-7. [PMID: 25134643 DOI: 10.1111/sms.12301] [Citation(s) in RCA: 52] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/01/2014] [Indexed: 11/27/2022]
Abstract
This longitudinal study aimed to clarify the longstanding controversy over whether variations in paraspinal muscle morphology (e.g., size, composition and asymmetry) are predictors of low back pain (LBP). A sample of 99 Finnish men were included in this population-based longitudinal study. Data were collected through a structured interview, physical examination and magnetic resonance imaging (MRI). Baseline measurements of the lumbar multifidus and erector spinae muscles were obtained from T2-weighted axial images at L3-L4 and L5-S1, and interview data were obtained at baseline, 1- and 15-year follow-ups. Few of the paraspinal muscle parameters investigated were predictors of change in LBP frequency, intensity or sciatica at 1- and 15-year follow-ups in the population-based sample, and findings were not consistent across muscles and spinal levels. However, greater multifidus and erector spinae fatty infiltration at L5-S1 was associated with a higher risk of having continued, frequent, persistent LBP at 1-year follow-up. None of the relationships observed was confounded by body mass index or the amount of physical activity at work or leisure. This longitudinal study provided evidence that variations in paraspinal muscle morphology on MRI have a limited, if not uncertain, role in the short- and long-term predictions of LBP in men.
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Affiliation(s)
- M Fortin
- Faculty of Rehabilitation Medicine, University of Alberta, Edmonton, Alberta, Canada
| | - L E Gibbons
- Department of Medicine, University of Washington, Seattle, Washington, USA
| | - T Videman
- Faculty of Rehabilitation Medicine, University of Alberta, Edmonton, Alberta, Canada
| | - M C Battié
- Faculty of Rehabilitation Medicine, University of Alberta, Edmonton, Alberta, Canada
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Thakar S, Mohan D, Furtado SV, Sai Kiran NA, Dadlani R, Aryan S, Rao AS, Hegde AS. Paraspinal muscle morphometry in cervical spondylotic myelopathy and its implications in clinicoradiological outcomes following central corpectomy. J Neurosurg Spine 2014; 21:223-30. [DOI: 10.3171/2014.4.spine13627] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Object
The objective of this study was to assess the cross-sectional areas (CSAs) of the superficial, deep flexor (DF), and deep extensor (DE) paraspinal muscles in patients with cervical spondylotic myelopathy (CSM), and to evaluate their correlations with functional status and sagittal spinal alignment changes following central corpectomy with fusion and plating.
Methods
In this retrospective study of 67 patients who underwent central corpectomy with fusion and plating for CSM, the CSAs of the paraspinal muscles were calculated on the preoperative T2-weighted axial MR images and computed as ratios with respect to the corresponding vertebral body areas (VBAs) and as flexor/extensor CSA ratios. These ratios were then compared with those in the normative population and analyzed with respect to various clinicoradiological factors, including pain status, Nurick grade, and segmental angle change at follow-up (SACF).
Results
The mean CSA values for all muscle groups and the DF/DE ratio were significantly lower in the study cohort compared with an age- and sex-matched normative study group (p < 0.001). Among various independent variables tested in a multivariate regression analysis, increasing age and female sex significantly predicted a lower total extensor CSA/VBA ratio (p < 0.001), while a longer duration of symptoms significantly predicted a greater total flexor/total extensor CSA ratio (p = 0.02). In patients undergoing single-level corpectomy, graft subsidence had a positive correlation with SACF in all patients (p < 0.05), irrespective of the preoperative segmental angle and curvature, while in patients undergoing 2-level corpectomy, graft subsidence demonstrated such a correlation only in the subgroup with lordotic curvatures (p = 0.02). Among the muscle area ratios, the DF/DE ratio demonstrated a negative correlation with SACF in the subgroup with preoperative straight or kyphotic segmental angles (p = 0.04 in the single corpectomy group, p = 0.01 in the 2-level corpectomy group). There was no correlation of any of the muscle ratios with change in Nurick grade.
Conclusions
Patients with CSM demonstrate significant atrophy in all the flexor and extensor paraspinal muscles, and also suffer a reduction in the protective effect of a strong DF/DE CSA ratio. Worsening of this ratio significantly correlates with greater segmental kyphotic change in some patients. A physiological mechanism based on DF dysfunction is discussed to elucidate these findings that have implications in preventive physiotherapy and rehabilitation of patients with CSM. Considering that the influence of a muscle ratio was significant only in patients with hypolordosis, a subgroup that is known to have facetal ligament laxity, it may also be postulated that ligamentous support supersedes the influence of paraspinal muscles on postoperative sagittal alignment in CSM.
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Age and side-related morphometric MRI evaluation of trunk muscles in people without back pain. ACTA ACUST UNITED AC 2014; 20:90-5. [PMID: 25085813 DOI: 10.1016/j.math.2014.07.007] [Citation(s) in RCA: 58] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2014] [Revised: 07/04/2014] [Accepted: 07/07/2014] [Indexed: 12/16/2022]
Abstract
This study evaluated lumbar spine muscle volume and Muscle Fatty Infiltrate (MFI) across two age groups of healthy adults. Twenty-four participants (young group - YG: age 18-25, n = 12; mature group - MG: age 45-60, n = 12) without low back pain underwent T1-weighted axial MRI. Muscle volume and MFI were obtained from the left and right lumbar erector spinae (ES), multifidus (M), rectus abdominis (RA) and psoas (PS) muscles. For MFI, mean pixel intensity (MPI) of muscles was reported as a percentage of subcutaneous fat MPI. Within-group comparison of left and right side muscle volume was not significantly different in the YG. In the MG, right RA and ES were significantly smaller than left (RA p = 0.049; ES p = 0.03). In both groups, left PS, M and ES MFI was significantly smaller compared to the right side and left RA MFI was significantly greater compared to right side (all p ≤ 0.001). For M volume, 81.7-84.6% of variance was explained by age, height and Body Mass Index (BMI). For ES volume, 81.6-82.8% of variance was explained by height and BMI. Age explained 18.1%-36.0% of variance in M and ES right MFI. Therefore, age and BMI are relevant factors for extensor muscle volume, but not for flexor muscle volume. Also, age significantly influences MFI for right-sided extensors only. The age effect is apparently independent of full subjective back functionality. For future spinal muscle research, the side-and muscle-specific effect of age on muscle morphology should be considered.
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