Can neck exercises enhance the activation of the semispinalis cervicis relative to the splenius capitis at specific spinal levels?

Greater muscle volume and muscle fat infiltrate in the deep cervical spine extensor muscles (multifidus with semispinalis cervicis) in individuals with chronic idiopathic neck pain compared to age and sex-matched asymptomatic controls: a cross-sectional study

Muscle size and composition (muscle volume and muscle fat infiltrate [MFI]) may provide insight into possible mechanisms underpinning chronic idiopathic neck pain, a common condition with no definitive underlying pathology. In individuals with chronic idiopathic neck pain > 3 months and age- and sex-matched asymptomatic controls, muscle volumes of levator scapulae, multifidus including semispinalis cervicis (MFSS), semispinalis capitis, splenius capitis including splenius cervicis (SCSC), sternocleidomastoid and longus colli from C3 through T1 were quantified from magnetic resonance imaging. Between-group differences were determined using linear mixed models, accounting for side (left or right), muscle, spinal level, sex, age, and body mass index (BMI). Individuals with pain had greater muscle volume (mean difference 76.8mm³; 95% CI 26.6-127.0; p = .003) and MFI (2.3%; 0.2-4.5; p = .034) of the MFSS compared to matched controls with no differences in relative volume, accounting for factors associated with the outcomes: muscle, spinal level, side (left had smaller volume, relative volume and MFI than right), sex (females had less volume and relative volume than males), age (older age associated with less relative volume and greater MFI), and BMI (higher BMI associated with greater muscle volume and MFI). Greater MFI in individuals with chronic idiopathic neck pain suggests a possible underlying mechanism contributing to neck pain. Perspective: These findings suggest MFI in the MFSS may be radiologic sign, potentially identifying patients with a less favourable prognosis. Future studies are needed to confirm this finding and determine if MFI is a contributor to the development or persistence of neck pain, or consequence of neck pain.

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

BACKGROUND

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

OBJECTIVES

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

METHODS

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

RESULTS

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

CONCLUSIONS

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

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

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

Neck-specific strengthening exercise compared with sham ultrasound when added to home-stretching exercise in patients with migraine: study protocol of a two-armed, parallel-groups randomized controlled trial

BACKGROUND

Migraine is a highly disabling condition and pharmacological treatment is the gold standard. However, several patients have also positive responses to the application of different manual techniques and therapeutic exercises in terms of reducing the intensity and frequency of migraine attacks. Nevertheless, the effects of a neck-specific exercise program have not yet been evaluated in these patients.

OBJECTIVE

To determine the effectiveness of a neck-specific exercise program in reducing the intensity and frequency of migraine attacks as compared to a sham ultrasound group.

METHODS

A two-armed, parallel-groups randomized controlled trial with 3 months of follow-up will be conducted. 42 individuals, both genders, aged between 18 and 55 years old with a medical diagnosis of migraine will be included. The intervention group will perform a protocol consisting of exercises for strengthening the muscles of the cervical spine. Participants within the sham ultrasound group will receive detuned ultrasound therapy in the upper trapezius muscle. Both groups will receive a weekly session for 8 weeks. The efficacy of each intervention will be measured by the frequency and intensity of migraine at a 3-months follow-up.

TRIAL REGISTRATION

This study was registered under access code RBT-8gfv5j in the Registro Brasileiro de Ensaios Clínicos (ReBEC) in November 28, 2016.

CONCLUSION

This study will aim to determine the efficacy of a neck-specific exercise program in reducing the frequency and intensity of migraine attacks. If the results show that a neck-specific exercise program is effective in reducing the frequency and intensity of migraine attacks, therapists will have a low cost and easily applicable tool to treat migraine.

Sex Differences in Ultrasound-Based Muscle Size and Mechanical Properties of the Cervical-Flexor and -Extensor Muscles

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.

Electromyographic Evaluation of Specific Elastic Band Exercises Targeting Neck and Shoulder Muscle Activation

Background: Specific strength training at a high intensity is effective in reducing work related neck/shoulder pain. However, it remains to be documented as to which exercises most specifically target neck and shoulder muscles at high activation level while using simple equipment as e.g., elastic bands. We hypothezised that selected exercises would specifically target the respective muscles, as follows: (1) shrugs and reverse flyes: the upper trapezius muscle, (2) cervical extension and lateral flexion: the upper neck extensor muscle, and (3) cervical flexion and rotation: the sternocleidomastoideus muscle. Methods: Eleven healthy males (25.9 ± 1.4 years, BMI 24.3 ± 1.4) with no neck/shoulder pain (VAS = 0) performed the six exercises with elastic bands at 12RM (repetition maximum) and 20RM in a randomized order. Electromyography was bilaterally recorded from the three muscles and it was normalized to maximal voluntary activation (%MVE). Exercises that evoke more than 60%MVE were considered as high intensity activation. Results: High muscle activation level was attained during 12RM in the upper trapezius muscle during shrugs (100.3 ± 29.8%MVE) and reverse flyes (91.6 ± 32.8%MVE) and in the upper neck extensor muscle during cervical extension (67.6 ± 29.8%MVE) and shrugs (61.9 ± 16.8%MVE). In the sternocleidomastoideus muscle, the highest activity was recorded during cervical flexion (51.7 ± 16.4%MVE) but it did not exceed 60%MVE. The overall activity was ~10% higher during 12RM when compared to 20RM. Conclusion: The simple exercises shrugs and reverse flyes resulted in high intensity activation of both the upper trapezius and neck extensors, while no exercises activated sternocleidomastoideus at high intensity.

The effects of deep neck muscle-specific training versus general exercises on deep neck muscle thickness, pain and disability in patients with chronic non-specific neck pain: protocol for a randomized clinical trial (RCT)

BACKGROUND

Altered thickness, cross-sectional area and activity of deep neck muscles have frequently been reported in patients with chronic non-specific neck pain (CNNP). It is claimed that these muscles do not recover spontaneously. These muscles provide a considerable amount of cervical stability. Therefore, various therapeutic exercises have been recommended to recover from resulting complications. However, most exercise protocols do not target deep neck muscles directly. Thus, this might be a reason for long-lasting complications. Accordingly, the purpose of the present study is to discuss a randomized controlled trial (RCT) protocol in which we aim to investigate and compare the effects of neck-specific exercise programmes versus general exercise programmes in patients with CNNP.

METHODS

A 2*2 factorial RCT with before-after design. Sixty-four participants with CNNP will be recruited into the study. They will be randomly divided into two groups, including specific neck exercise and general exercise. Each exercise programme will be carried out three times a week and will last for 8 weeks. Primarily, dorsal and ventral neck muscle thickness, pain and disability and secondarily, muscle strength, quality of life, sleep quality, fear avoidance and neck range of motion will be assessed at the baseline and immediately at the end of the exercise protocol.

DISCUSSION

The results of this study will inform clinicians on which type of exercise is more beneficial for patients with CNNP.

TRIAL REGISTRATION

IRCT2017091620787N2, Sep 16 2017.

Mechanical Properties of Muscles around the Shoulder in Breast Cancer Patients: Intra-rater and Inter-rater Reliability of the MyotonPRO

BACKGROUND

Patients with breast cancer typically experience changes in the properties of muscles around the shoulder. However, there is no appropriate evaluation tool for these changes.

OBJECTIVE

The primary objective was to investigate the inter-rater and intra-rater reliability of muscle-related parameters measured by the MyotonPRO, a myotonometer device. The secondary objective was to investigate differences in properties of muscle around the shoulder between the mastectomy side and the other side.

DESIGN

Cross-sectional reliability study.

SETTING

Outpatient clinic in a tertiary care university-affiliated hospital.

PARTICIPANTS

Twenty-two patients with breast cancer who underwent mastectomy.

METHODS

Muscle tone, stiffness, and elasticity of the pectoralis major (PM), sternocleidomastoid (SCM), and upper trapezius (UT) were measured using the MyotonPRO. Rater 1 performed two sets of measurements with a time interval of 30 minutes to determine intra-rater reliability. Rater 2 performed measurements during the interval between the two sets of rater 1. Reliability was assessed using intraclass correlation coefficients (ICCs) and Bland-Altman analysis. A paired t-test was used to compare muscle properties between the affected and unaffected sides.

MAIN OUTCOME MEASUREMENTS

Frequency (tone, Hz), stiffness (N/m), and decrement (elasticity).

RESULTS

Intra-rater reliability was excellent (ICC > 0.75, 0.85-0.98) for all parameters of the PM, SCM, and UT in the affected and unaffected upper limbs of patients with breast cancer. Inter-rater reliability was fair to excellent for all parameters except unaffected PM elasticity (ICC = 0.34). There were significant differences in all parameters of the PM between the affected and unaffected sides. There were no significant differences in the parameters of the SCM and UT between the two sides.

CONCLUSIONS

Our findings indicate that the MyotonPRO device is a feasible tool to quantify PM, UT, and SCM muscle properties (stiffness, tone, and elasticity) in patients with breast cancer.

LEVEL OF EVIDENCE

III.

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

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

Effects of lumbar lordosis assistive support on craniovertebral angle and mechanical properties of the upper trapezius muscle in subjects with forward head posture

[Purpose] The aim of this study was to investigate the effect of lumbar lordosis assistive support (LLAS) on craniovertebral angle (CVA) and mechanical properties of the upper trapezius (UT) muscle in subjects with forward head posture (FHP). [Subjects and Methods] This study recruited 20 subjects with FHP. CVA and muscle tone, viscoelasticity, and stiffness of the UT were measured using Myoton in all subjects in a sitting position with LLAS and in a neutral sitting position. The order of measurements was randomized and the mean values were calculated twice. [Results] The sitting position with LLAS showed a significantly greater improvement than the neutral sitting position with regard to CVA and muscle tone, viscoelasticity, and stiffness of the UT. [Conclusion] We suggest that the sitting position using LLAS induces the maintenance of normal neck posture and a reduction in the muscle tone of the UT in the subjects with FHP.

Activation of the semispinalis cervicis and splenius capitis with cervical pulley exercises

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.