Neck Pain

Extensive computer use amongst office workers has lead to an increase in work-related neck pain. Aberrant activity within the three portions of the trapezius muscle and associated changes in scapular posture have been identified as potential contributing factors. This study compared the activity (surface electromyography) of the three portions of the trapezius in healthy controls (n ¼ 20) to a neck pain group with poor scapular posture (n ¼ 18) during the performance of a functional typing task. A scapular postural correction strategy was used to correct scapular orientation in the neck pain group and electromyographic recordings were repeated. During the typing task, the neck pain group generated greater activity in the middle trapezius (MT) (p ¼ 0.02) and less activity in the lower trapezius (LT) (p ¼ 0.03) than the control group. Following correction of the scapula, activity recorded by the neck pain group was similar to the control group for the middle and lower portions (p ¼ 0.09; p ¼ 0.91). These findings indicate that a scapular postural correction exercise may be effective in altering the distribution of activity in the trapezius to better reflect that displayed by healthy individuals.

We analyzed the CT appearances of degenerative change in the atlanto-odontoid joint (AOJ) in patients with rheumatoid arthritis (RA) and evaluated the effect of these changes on atlanto-axial joint (AAJ) rotation by dynamic CT. This revealed that 9 patients (24%) treated with methotrexate had degenerative features in the AOJ. The ratio of AAJ rotation to the total rotation of the cervical spine was significantly higher in normal subjects (54±3%) than in patients (38±12%). The degree of AAJ rotation was significantly lower in the patient group with degenerative features in the AOJ (20.9±8.4°) than in patients without degenerative features (28.5±7.4°). RA patients with a history of longstanding disease and treatment with antirheumatic drugs may develop AO OA. Although secondary OA was described as healing phenomena in the joints of RA patients, it can limit rotation in the AAJ and cause suboccipital neck pain. A regular check-up of the AAJ and AOJ by means of dynamic CT in all RA patients is proposed to avoid possible antirheumatic drug complications.

Ce travail présente une partie des étapes de la validation de l'échelle fonctionnelle de Copenhague pour l'évaluation des cervicalgies. Méthodes.-Réinterprétation, a posteriori, des données d'un essai thérapeutique sur la cervicalgie. Les patients sont recrutés localement et examinés en insu par un médecin indépendant des traitements délivrés. Le recueil de données comprend des mesures de douleurs par échelle visuelle analogique (EVA), le questionnaire de qualité de vie SF 36, le montant des prestations remboursées par la sécurité sociale, l'opinion du patient et du médecin. L'évaluation est réalisée à l'entrée dans l'étude, en fin de traitement, à trois mois et à six mois. Résultats.-La répartition des valeurs de l'échelle est normale. La concordance des valeurs et de leurs variations est bonne avec les autres critères de jugement. L'échelle de Copenhague est moins sensible au changement que l'EVA de la douleur mais plus sensible au changement que les autres critères de jugement. Conclusion.-L'échelle fonctionnelle de Copenhague paraît être un instrument utile pour l'évaluation des cervicalgies. Il faudra encore mesurer sa reproductibilité pour en connaître sa validité. Elle vient donc s'ajouter aux échelles déjà existantes qui ont été traduites ces dernières années et qui sont destinées à la recherche clinique. Nous pensons que sa simplicité d'emploi pour les patients lui donnera également une place dans la pratique clinique.

The aim of the present study was to compare the effect of increased aerobic capacity versus muscle strength rehabilitation of female hospital staff with long-lasting musculoskeletal back pain. Seventy-nine women agreed to participate in the intervention study. After a medical examination, 65 individuals were assigned to one of three balanced groups: Endurance training (aerobic capacity promoting training: ET: n = 22), strength promotion exercise (SP: n = 24) or a control group (CON: n = 19). The active groups met twice a week for 60 minutes of exercise over 15 weeks. Aerobic capacity (VO 2m ax ) and musculoskeletal pain were measured immediately before (T1) and after the intervention period (T2). Aerobic capacity signi cantly increased in the ET group, whereas no change was observed in the SP group, and a signi cant reduction was found in the CON group from T1 to T2. Musculoskeletal pain was signi cantly reduced in both intervention groups, whereas minor changes were observed in the control group. Results from a 7-month follow-up (T3) survey con rmed the bene cial effects of interventions on musculoskeletal pain. In conclusion, improved aerobic capacity appeared not to be a necessary mechanism in musculoskeletal back pain reduction.

Rheumatoid arthritis (RA) is characterized by inflammation of the synovial membrane, which can lead to deformities and functional disability. Unlike the dorsal and lumbar spine, the cervical spine is often affected by RA. The objective of this paper is to assess cervical pain and function in patients with RA and correlate these variables with overall function, quality of life, and radiographic findings on the cervical spine. One hundred individuals aged 18 to 65 years were divided into study group (50 patients with rheumatoid arthritis) and control group (50 healthy individuals, paired for gender and age). Patients with prior surgery, prior trauma or other symptomatic cervical spine condition were excluded. The visual analogue pain scale (VAS), Neck Pain and Disability Scale (NPDS), SF-36, HAQ and X-rays were used for evaluation purposes. Mean disease duration was 11.1 years. The cervical VAS was 2.4 cm and 1.3 cm for the study and control groups, respectively (p=0.074). Statistical differences were found in NPDS scores, mean=26.7 and 6.9, and HAQ scores, mean=1.1 and 0.1, for the study and control groups, respectively (p<0.001). SF-36 scores were statistically worse in the study group, except for the vitality, social aspects and mental health subscales. There was a positive correlation between the NPDS and VAS (r=0.54) and between the NPDS and HAQ (r=0.67). There was a negative correlation between the NPDS and SF-36 functional capacity domain (r=−0.53) and physical limitation domain (r=−0.58). The radiographic findings revealed more prevalent anterior atlanto-axial subluxation (p= 0.030), listhesis in neutral posture (p=0.037), listhesis in extension (p=0.007), degenerative alteration of C4-C5 segment (p=0.023), size of C2 spinal canal (p=0.002) and C3 spinal canal (p=0.029) in the study group. Patients with RA have poorer cervical function than healthy individuals, although there is no difference in cervical pain.

tive analysis of all mechanical trigger factors revealed a significant association of mechanical risk factors as a whole in CAD ! 24 h prior to symptom onset (p = 0.01). Conclusion: Mild mechanical stress, including CMT, plays a role as possible trigger factor in the pathogenesis of CAD. CMT and recent infections alone failed to reach significance during the present investigation, presumably due to the relatively small sample size of the study cohort.

Background: Solid plastic replicas of anatomical structures obtained by stereolithography from computed tomographic images and magnetic resonance imaging are being used as complementary tools for diagnostic purposes and therapy planning for diverse pathologies. Case Descriptions: Case 1-The spine mold of a 62-year-old man with neurologic compromise secondary to degenerative cervical disease was used to study the pathologic features of his spine and to plan and simulate the approach to remove osteophytes before surgery. Also, by examining the replica of his spine, the unconvinced patient was able to understand the nature of his pathology and realize that his neurologic symptoms would disappear only through surgery, as they did. Case 2-A 27-year-old woman had uncontrolled back and leg pain possibly related to anxiety and depression. She had undergone one unsuccessful lumbo-sacral surgery and was now obsessed with the thought that her second surgery, performed by us, likewise had failed, even though her magnetic resonance images proved otherwise. It was not until she held a replica of her repaired spine in her hands that she was able to understand that her pain was unfounded. Once she was able to relax, her chronic pain and anxiety disappeared within a month, using the same antidepressive treatment that formerly had been ineffective. Conclusions: Spine replicas are useful devices for diagnosis, planning, and simulating surgery, and they enable patients to understand the nature of their pathologies and the surgical procedures at hand.

Aim/Objectives/Background Considerable attention has been paid to assessing the risk factors for the development of disability following neck pain (NP) in the general population, but we still lack knowledge regarding disability in NP patients referred to a specialist level of care. This study investigated the associations among the socio-demographic characteristics, work ability, selfreported pain, emotional distress, fear of movement and disability of NP patients referred to a specialised neck and back outpatient clinic. In total, 221 patients participated in this cross-sectional study, which was conducted from December 2007 to December 2009.

Patients with acute whiplash trauma were followed to examine if post-trauma ratings of pre-collision pain and psychological distress were associated with reduced work capability and neck pain at 12 months follow-up. The study included 740 consecutive patients (474 females, 266 males) referred from emergency departments or primary care after car accidents in four counties in Denmark. After the collision patients received a questionnaire on psychological distress, unspecified pain and socio-demographics and 12 months later a follow-up on work capability and neck pain was performed. Risk factors were identified by multiple logistic regression analysis. Factors associated with affected work capacity at the 12-month follow-up were pre-collision unspecified pain condition (OR = 2.4, p = 0.002) and socio-demographic characteristics: female gender, low educational level, unemployment and blue collar worker. Factors associated with considerable neck pain at follow-up were pre-collision unspecified pain (OR = 3.5, p < 0.000), pre-collision high psychological distress (OR = 2.1, p = 0.03) and socio-demographic characteristics: female gender and formal education >4 years. Pre-collision neck pain and severity of accident were not associated with poor outcome. In conclusion unspecified as opposed to specified pain (neck pain) before the collision is associated with poor recovery and high accumulation of pre-collision psychological distress is associated with considerable neck pain at follow-up. However, no conclusions on causality can be drawn. Personal characteristics before the collision are important for recovery and attention to pre-collision characteristics may contribute to the prevention of poor recovery after acute whiplash trauma. Ó

Background: Chronic neck pain is a common condition associated not only with a decrease in neck muscle strength, but also with decrease in health-related quality of life (HRQoL). While neck strength training has been shown to be effective in improving neck muscle strength and reducing neck pain, HRQoL among patients with neck pain has been reported as an outcome in only two short-term exercise intervention studies. Thus, reports on the influence of a longterm neck strength training intervention on HRQoL among patients with chronic neck pain have been lacking. This study reports the effect of one-year neck strength training on HRQoL in females with chronic neck pain.

Objective: To compare the effects of an isolated application of cervical spine thrust joint manipulation vs. the application of cervical, cervico-thoracic junction and thoracic manipulation on neck pain, disability and cervical range of motion in chronic neck pain. Design: Randomized clinical trial. Setting: Clinical practice. Participants: Eighty-two patients (41 females) with chronic mechanical neck pain. Interventions: Patients were randomly assigned to a cervical spine manipulation group or a full manipulative group who received mid-cervical, cervico-thoracic and thoracic joint manipulations. Measurements: Neck pain intensity (11-point numeric pain rating scale), self-reported disability (Neck Disability Index) and cervical range of motion were collected at baseline and one week after the intervention by an assessor blinded to the allocation of the patients. Results: A significant Group * Time interaction for Neck Disability Index (P = 0.022), but not for neck pain (P = 0.612), was found: patients in the full manipulative group exhibited greater reduction in disability than those who received the cervical spine manipulation alone, whereas both groups experienced similar decreases in neck pain. Patients in both groups experienced similar increases in cervical range of motion (P > 0.4). No effect of gender was observed (P > 0.299).

Diffuse idiopathic skeletal hyperostosis is a common but poorly recognised condition that may have important and occasionally life-threatening clinical outcomes. We report the case of a 71-year-old man with giant osteophytes in his cervical spine which caused dysphagia and silent aspiration, leading to pneumonia, septicaemia, aortic wall infection and septic arthritis. Early recognition of the cause of his neck pain may have averted the subsequent clinical course.

PURPOSE: Report the test-retest reliability, construct validity, minimum clinically important difference (MCID), and minimal detectable change (MDC) for the Neck Disability Index (NDI). STUDY DESIGN/SETTING: Cohort study of patients presenting to outpatient physical therapy clinics. PATIENT SAMPLE: Ninety-one subjects with a primary complaint of neck pain, with or without concomitant upper extremity (UE) symptoms, who were participants in a randomized clinical trial. OUTCOME MEASURES: NDI and the 15-point Global Rating of Change (GRC) self-report measures. METHODS: All subjects completed the NDI at baseline and at a 3-week follow-up. Additionally, subjects completed the GRC scale, which was used to dichotomize patients into improved or stable groups. Changes in the NDI were used to assess test-retest reliability, construct validity, MCID, and MDC. RESULTS: Test-retest reliability was moderate for the NDI (intraclass correlation coefficient, 0.64; 95% confidence interval, 0.19-0.84). For the NDI, the MCID was 7.5 points and the MDC was 10.2 points. CONCLUSIONS: The NDI appears to demonstrate adequate responsiveness based on statistical reference criteria when used in a sample that approximates the high percentage of patients with neck pain and concomitant UE referred symptoms. Because the MCID is within the bounds of measurement error, a 10-point change (the MDC) should be used as the MCID. Ó

To determine whether spinal manipulative therapy (SMT) is an independent risk factor for cervical artery dissection. Methods: Using a nested case-control design, the authors reviewed all patients under age 60 with cervical arterial dissection (n ϭ 151) and ischemic stroke or TIA from between 1995 and 2000 at two academic stroke centers. Controls (n ϭ 306) were selected to match cases by sex and within age strata. Cases and controls were solicited by mail, and respondents were interviewed using a structured questionnaire. The medical records of interviewed patients were reviewed by two blinded neurologists to confirm that the patient had stroke or TIA and to determine whether there was evidence of arterial dissection. Results: After interview and blinded chart review, 51 patients with dissection (mean age 41 Ϯ 10 years; 59% female) and 100 control patients (44 Ϯ 9 years; 58% female) were studied. In univariate analysis, patients with dissection were more likely to have had SMT within 30 days (14% vs 3%, p ϭ 0.032), to have had neck or head pain preceding stroke or TIA (76% vs 40%, p Ͻ 0.001), and to be current consumers of alcohol (76% vs 57%, p ϭ 0.021). In multivariate analysis, vertebral artery dissections were independently associated with SMT within 30 days (OR 6.62, 95% CI 1.4 to 30) and pain before stroke/TIA (OR 3.76, 95% CI 1.3 to 11). Conclusions: This case-controlled study of the influence of SMT and cervical arterial dissection shows that SMT is independently associated with vertebral arterial dissection, even after controlling for neck pain. Patients undergoing SMT should be consented for risk of stroke or vascular injury from the procedure. A significant increase in neck pain following spinal manipulative therapy warrants immediate medical evaluation.

Anterior cervical discectomy and fusion (ACDF) is a common surgical intervention for radiculopathy resulting from degenerative cervical spine conditions. Post-surgical cervical collar use is believed to reduce post-operative pain, provide the patient with a sense of security during activities of daily living and even reduce rates of non-fusion. This prospective randomized controlled pilot trial investigates trial design feasibility in relation to prospective physical, functional, and quality of life-related outcomes of patients undergoing ACDF with interbody cage, with (n = 17) and without (n = 16) post-operative cervical collar usage. Results show that the sample provides sufficient statistical power to show that the use of a rigid cervical collar during 6 post-operative weeks is associated with significantly lower levels of neck disability index after 6 weeks and significantly lower levels of prospective neck pain. To investigate causal quality of life or fusion rate outcomes, sample size needs to be increased at least fourfold and optimally sixfold when accounting for data loss in prospective follow-up. The study suggests that post-surgical cervical collar usage may help certain patients cope with initial post-operative pain and disability.

Manipulation and mobilisation of the cervical spine are well established interventions in the management of patients with headache and/or neck pain. However, their benefits are accompanied by potential, yet rare risks in terms of serious adverse events, including neurovascular insult to the brain. A recent international framework for risk assessment and management offers directions in the mitigation of this risk by facilitating sound clinical reasoning. The aim of this article is to critically reflect on and summarize the current knowledge about cervical spine manual therapy and to provide guidance for clinical reasoning for cervical spine manual therapy.

This paper reports data from recent studies on integrative jaw–neck motor control in healthy subjects and disturbed jaw–neck behaviour in whiplash-associated disorders (WAD). The results show that neck function is an integral part of natural jaw behaviour, and that neck injury can impair jaw function and therefore disturb eating behaviour. We also show preliminary results from implementation of a new approach for rehabilitation of jaw–neck dysfunction and pain in WAD.

Background: Cervical sensorimotor control (CSMC) becomes increasingly important in the assessment and treatment of patients with neck pain. This review aims to compare commonly used CSMC measuring methods in terms of required tasks, measuring device and clinimetric properties. Search methods: A systematic review of two databases, followed by methodological quality assessment (CBO guidelines). Results: The methodological quality of 34 included articles was generally good (five to seven out of eight), the inter-rater agreement was excellent (k w = 0.966, p < 0.01). Following tasks were found: head repositioning accuracy to the neutral head position (HRA-to-NHP) and to a target position (HRA-totarget), a virtual reality test, a continuous linear movement technique (CLMT) and an object following non-linear movement technique (NLMT) (The Fly TM ). Test-retest reliability was fair to excellent (ICC 0.35-0.87) for the HRA-to-NHP, very bad to excellent (ICC 0.01-0.90) for the HRA-to-target, fair to good (ICC 0.25-0.77) for the virtual reality test and moderate to excellent (ICC: 0.60-0.86) for The Fly TM . The reliability of the CLMT was not documented. The HRA-to-NHP, The Fly TM and the CLMT can discriminate between patients with neck complaints and controls (discriminant validity). Currently, only The Fly TM can discriminate between different patient populations (post-traumatic and non-traumatic neck pain). The sensitivity, specificity and responsiveness of the methods have to be assessed in future research. Conclusions: The dynamic method The Fly TM appears to be more reliable than the HRA-to-NHP and is able to discriminate between different patient populations. The diagnostic potential is to be confirmed in future research. ß

Background: Clinicians and researchers commonly use responsive outcome measures to interpret changes in a patient’s condition as a result of an intervention. This study was conducted to assess the ability of the Persian version of Neck Disability Index and Functional Rating Index to detect responsiveness in the patients with neck pain. Methods: A diagnostic accuracy study was done in Ahvaz, Iran, 2016. A convenience sample of 57 Persian-speaking patients with non-specific chronic neck pain completed the Neck Disability Index and the Functional Rating Index at the beginning and after physiotherapy intervention. The responsiveness was investigated by the receiver operating characteristics method and the correlation analysis. Statistical analysis was done using SPSS (version 21), with a P&lt;0.05 as the level of significance. Results: The Functional Rating Index showed that the area under the curve was greater than 0.70 (range=0.651-0.942). The optimal cutoff points for the Functional ...

Neck pain is common, disabling, and costly. The effectiveness of patient education strategies is unclear. To assess whether patient education strategies are of benefit for pain, function/disability, global perceived effect, quality of life, or patient satisfaction, in adults with neck pain with or without radiculopathy. Cochrane systematic review. Computerized bibliographic databases were searched from their start to May 31, 2008. Eligible studies were randomized trials investigating the effectiveness of patient education strategies for neck pain. Paired independent reviewers carried out study selection, data abstraction, and methodological quality assessment. Relative risk and standardized mean differences were calculated. Because of differences in intervention type or disorder, no studies were considered appropriate to pool. Of the 10 selected trials, two (20%) were rated as of high quality. Patient education was assessed as follows: 1) eight trials of advice focusing on activatio...

Whiplash associated disorders commonly affect people after a motor vehicle accident, causing a variety of disabling manifestations. Some manual and physical approaches have been proposed to improve myofascial function after traumatic injuries, in order to effectively reduce pain and functional limitation. To evaluate whether the application of the Fascial Manipulation© technique could be more effective than a conventional approach to improve cervical range of motion in patients with subacute whiplash associated disorders. Pilot randomized clinical trial. Eighteen patients with subacute whiplash associated disorders were randomized into two groups. Group A (N.=9) received three, 30-minute sessions, (every five days during a two week period) of neck Fascial Manipulation©. Group B (N.=9) received ten, 30-minute sessions (five days a week for two consecutive weeks) of neck exercises plus mobilization. Patients were evaluated before, immediately after and two weeks post-treatment. cervic...

test; (3) age C55; (4) positive upper limb tension test A; and (5) positive neck distraction test. Having at least three out of five predictors present resulted in a ?LR equal to 4.81 (95% CI = 2.17-11.4), increasing the likelihood of success with cervical traction from 44 to 79.2%. If at least four out of five variables were present, the ?LR was equal to 23.1 (2.5-227.9), increasing the post-test probability of having improvement with cervical traction to 94.8%. This preliminary CPR provides the ability to a priori identify patients with neck pain likely to experience a dramatic response with cervical traction and exercise. Before the rule can be implemented in routine clinical practice, future studies are necessary to validate the rule. The CPR developed in this study may improve clinical decision-making by assisting clinicians in identifying patients with neck pain likely to benefit from cervical traction and exercise.

Chronic nonspecific neck pain is a common problem in rheumatology and may resist conventional treatment. Pathophysiological links exist between the cervical spine and masticatory system. Occlusal disorders may cause neck pain and may respond to dental treatment. The estimated prevalence of occlusal disorders is about 45%, with half the cases being due to functional factors. Minor repeated masticatory dysfunction (MD) with craniocervical asymmetry is the most common clinical picture. The pain is usually located in the suboccipital region and refractory to conventional treatment. The time pattern may be suggestive, with nocturnal arousals or triggering by temporomandibular movements. MD should be strongly suspected in patients with at least two of the following: history of treated or untreated MD, unilateral temporomandibular joint pain and clicking, lateral deviation during mouth opening, and limitation of mouth opening (less than three fingerbreadths). Rheumatologists should consider MD among causes of neck pain, most notably in patients with abnormal craniocervical posture, signs linking the neck pain to mastication, and clinical manifestations of MD. Evidence suggesting that MD may cause neck pain has been published. However, studies are needed to determine whether treatment of MD can relieve neck pain.

Study Design. Ecological study. Objectives. To determine the annual incidence of hospitalized vertebrobasilar artery (VBA) stroke and chiropractic utilization in Saskatchewan and Ontario between 1993 and 2004. To determine whether at an ecological level, the incidence of VBA stroke parallels the incidence of chiropractic utilization. Summary of Background Data. Little is known about the incidence and time trends of VBA stroke diagnoses in the population. Chiropractic manipulation to the neck is believed to be a risk factor for VBA stroke. No study has yet found an association between chiropractic utilization and VBA diagnoses at the population level. Methods. All hospitalizations with discharge diagnoses of VBA stroke were extracted from administrative databases for Saskatchewan and Ontario. We included incident cases that were diagnosed between January 1993 and December 2004 for Saskatchewan and from April 1993 to March 2002 for Ontario. VBA cases that had previously been hospitalized for any stroke or transient ischemic attack (TIA) were excluded. Chiropractic utilization was measured using billing data from Saskatchewan Health and Ontario Health Insurance Plan. Denominators were derived from Statistics Canada's annual population estimates. Results. The incidence rate of VBA stroke was 0.855 per 100,000 person-years for Saskatchewan and 0.750 per 100,000 person-years for Ontario. The annual incidence rate spiked dramatically with a 360% increase for Saskatchewan in 2000. There was a 38% increase for the 2000 incidence rate in Ontario. The rate of chiropractic utilization did not increase significantly during the study period. Conclusion. In Saskatchewan, we observed a dramatic increase in the incidence rate in 2000 and there was a corresponding relatively small increase in chiropractic utilization. In Ontario, there was a small increase in the incidence rate; however, chiropractic utilization decreased. At the ecological level, the increase in VBA stroke does not seem to be associated with an increase in the rate of chiropractic utilization.

Los osteocondromas son tumores óseos benignos de lento crecimiento que se localizan habitualmente en los huesos largos. Aproximadamente el 1-4% de ellos se localizan en la columna vertebral. Los osteocondromas espinales solitarios pueden producir una gran variedad de síntomas, dependiendo de su localización y de su relación con las estructuras adyacentes. Recogemos el caso de una paciente de 74 años que fue ingresada en nuestro centro tras referir debilidad progresiva en el hemicuerpo izquierdo y dolor cervical. La exploración neurológica mostró hemiparesia izquierda leve y tortícolis izquierda. Los estudios de tomografía computarizada y resonancia magnética de la columna cervical demostraron una lesión expansiva afectando la articulación facetaria C3-C4 izquierda. Se realizó una hemilaminectomía C3 y C4, resección completa de la lesión y fijación cervical posterior instrumentada. El estudio anatomopatológico confirmó el diagnóstico de osteocondroma. Tras la intervención quirúrgica, los síntomas de la paciente mejoraron progresivamente sin secuelas neurológicas.

Objective General practitioners refer patients with continued neck pain that do not respond well to conservative care frequently to secondary care for further assessment. Are surgical interventions to the cervical spine effective when compared to conservative care for patients with neck pain? Design Systematic review.

This study to assessed the prevalence of signs and symptoms of temporomandibular disorders (TMD) by means of the frequency distribution of data for 218 dentistry students from a Brazilian public university using the Fonseca&#39;s questionnaire. The group consisted of 96 men and 122 women, with an average age of 20 years. Of the students, 53.21% showed some level of TMD: 35.78% mild TMD 11.93% moderate and 5.5% severe. Women were the most affected group, with 63.11% showing some level of TMD, against 40.62% of men. When considering only severe TMD, women are approximately 9 times more affected than men. Students with any level of TMD showed marked characteristics: 76.72% considered themselves tense people; 71.55% reported to clench or grind their teeth; 65.52% reported clicking of the temporomandibular joint; 64.66% reported frequent headache and 61.21% neck pain. In conclusion, clinical signs and symptoms of TMD can occur in young population and this information is of great importan...

The objective of our prospective inception cohort study was to identify prognostic factors for poor recovery in patients with whiplashassociated disorders grade 1 or 2 who still had neck pain and accompanying complaints 2 weeks after the accident. The study was carried out in a primary health care setting in The Netherlands and included 125 patients. The primary outcome measure was functional recovery defined in terms of neck pain intensity or work disability without medication use. The secondary outcome measures included neck pain intensity, work disability and sick leave. The outcomes were assessed at 4, 12 and 52 weeks after the accident. Prognostic factors were identified by logistic regression analyses. One year after the injury, 64% of the patients were recovered. Factors related to poor recovery were female gender, a low level of education, high initial neck pain, more severe disability, higher levels of somatisation and sleep difficulties. Neck pain intensity and work disability proved to be the most consistent predictors for poor recovery. The accuracy of the predictions of the prognostic models was high, meaning that the models adequately distinguished patients with poor recovery from those regarded as recovered. These findings add to the growing body of evidence, indicating that socio-demographic, physical and psychological factors affect short-and longterm outcome after whiplash injury. Our findings also indicate that care providers can easily identify patients at risk for poor recovery with a visual analogue scale for initial pain intensity and work-related activities. q

Whiplash-associated disorders are common and incur considerable expense in social and economic terms. There are no known effective treatments for those people whose pain and disability persist beyond 3 months. We conducted a randomized, assessorblinded, controlled trial at two centres in Australia. All participants received 3 advice sessions. In addition the experimental group participated in 12 exercise sessions over 6 weeks. Primary outcomes were pain intensity, pain bothersomeness and function measured at 6 weeks and 12 months. Exercise and advice was more effective than advice alone at 6 weeks for all primary outcomes but not at 12 months. The effect of exercise on the 0-10 pain intensity scale was À1.1 (95%CI À1.8 to À0.3, p = 0.005) at 6 weeks and À0.2 (0.6 to À1.0, p = 0.59) at 12 months; on the bothersomeness scale the effect was À1.0 (À1.9 to À0.2, p = 0.003) at 6 weeks and 0.3 (À0.6 to 1.3, p = 0.48) at 12 months. The effect on function was 0.9 (0.3 to 1.6, p = 0.006) at 6 weeks and 0.6 (À0.1 to 1.4, p = 0.10) at 12 months. High levels of baseline pain intensity were associated with greater treatment effects at 6 weeks and high levels of baseline disability were associated with greater treatment effects at 12 months. In the short-term exercise and advice is slightly more effective than advice alone for people with persisting pain and disability following whiplash. Exercise is more effective for subjects with higher baseline pain and disability. Ó

Objective. The prevalence of neck muscle pain has steadily increased and especially pain from the descending part of the trapezius muscle has been associated with monotonous work tasks such as computer work. Physical exercise is generally recommended as treatment, but it is unclear which type of training is most effective. Our objective was to determine the effectiveness of specific strength training of the painful muscle versus general fitness training without direct involvement of the painful muscle (leg bicycling) on work-related neck muscle pain. Methods. We conducted a randomized controlled trial and recruited subjects from 7 workplaces characterized by monotonous jobs (e.g., computer-intensive work). Forty-eight employed women with chronic neck muscle pain (defined as a clinical diagnosis of trapezius myalgia) were randomly assigned to 10 weeks of specific strength training locally for the affected muscle, general fitness training performed as leg bicycling with relaxed shoulders, or a reference intervention without physical activity. The main outcome measure was an acute and prolonged change in intensity of neck muscle pain (100-mm visual analog scale [VAS]). Results. A decrease of 35 mm (ϳ79%; P < 0.001) in the worst VAS pain score over a 10-week period was seen with specific strength training, whereas an acute and transient decrease in pain (5 mm; P < 0.05) was found with general fitness training. Conclusion. Specific strength training had high clinical relevance and led to marked prolonged relief in neck muscle pain. General fitness training showed only a small yet statistically significant acute pain reduction. ISRCTN: 87055459.

To date the influence that specific sitting posture has on the head/neck posture and cervico-thoracic muscle activity has been insufficiently investigated. Therefore the aim of this study was to investigate whether three different thoraco-lumbar sitting postures affect head/neck posture and cervico-thoracic muscle activity.

Although local thermotherapy reduces mental stress and neck stiffness, its physiological mechanisms are still not fully understood. We speculated that local thermotherapy exerts its effect, in addition to its direct peripheral effects, through the central nervous system that is involved in controlling stress responses. In the present study, we investigated the effects of a heat-and steam-generating (HSG) sheet on cerebral hemodynamics and autonomic nervous activity using near-infrared spectroscopy (NIRS) and the electrocardiograms (ECGs). Thirteen healthy young female subjects participated in this study. HSG or simple (control) sheets were repeatedly applied to the neck for 120 s with 180 s intervals of rest between applications. During the experiment, brain hemodynamic responses (changes in Oxy-Hb, Deoxy-Hb, and Total-Hb) and autonomic nervous activity based on heart rate variability (HRV) were monitored. Subjective perception of neck stiffness and fatigue was significantly improved after application of the HSG sheet. NIRS findings indicated that the application of HSG sheets decreased Oxy-Hb concentration in the anterior-dorsal region of the medial prefrontal cortex (adMPFC), while increasing parasympathetic nervous activity and decreasing sympathetic nervous activity. Furthermore, changes in Oxy-Hb in the adMPFC were significantly and negatively correlated with those in parasympathetic nervous activity during application of the HSG sheet. These findings suggest that application of the HSG sheet to the neck region induced mental relaxation and ameliorated neck stiffness by modifying activity of the adMPFC.

OBJECTIVECervical disc arthroplasty (CDA) has been demonstrated to be as safe and effective as anterior cervical discectomy and fusion (ACDF) in the management of 1- and 2-level degenerative disc disease (DDD). However, there has been a lack of data to address the fundamental discrepancy between the two surgeries (CDA vs ACDF), and preservation versus elimination of motion, in the management of cervical myelopathy associated with congenital cervical stenosis (CCS). Although younger patients tend to benefit more from motion preservation, it is uncertain if CCS caused by multilevel DDD can be treated safely with CDA.METHODSConsecutive patients who underwent 3-level anterior cervical discectomy were retrospectively reviewed. Inclusion criteria were age less than 50 years, CCS (Pavlov ratio ≤ 0.82), symptomatic myelopathy correlated with DDD, and stenosis limited to 3 levels of the subaxial cervical (C3–7) spine. Exclusion criteria were ossification of the posterior longitudinal ligamen...

To determine the psychometric properties of the Neck Bournemouth Questionnaire in patients with chronic neck pain, using Rasch analysis. A sample of 161 subjects with chronic neck pain was assessed with the Neck Bournemouth Questionnaire. Before performing Rasch analysis, we examined the structure of the scale with factor analysis. The goodness-of-fit of the data to the model, thresholds ordering, unidimensionality, local independence of the items, differential item functioning, person separation index, and mean person&#39;s location were assessed. Both exploratory and confirmatory factor analyses supported the presence of 2 factors. Only Factor 1 needed a modification (item 7 removal) in order to achieve the fit to the Rasch model (χ2 = 10.65, df 8, p = 0.22). The person separation index was 0.80 and the mean location of persons 0.48 (standard deviation (SD) 1.02). Factor 2 (items 4 and 5) fitted the model without modifications (χ2 = 3.86, df 4, p = 0.42). Its person separation ind...

Segmental neurological modulation, neural hysteresis and biomechanical effects have been proposed as mechanisms underpinning the effects of manual therapy. An increasing number of studies hypothesise activation of the central nervous system resulting in a non-segmental hypoalgesic effect with concurrent activation of other neural pathways as a potential mechanism of action. Whether this model is consistent with the current literature is unknown.

Objectives: This trial was conducted to assess the effectiveness of interactive neurostimulation (INS) therapy on the treatment of pain associated with myofascial trigger points (MTPs) in adults with mechanical neck pain. Design: This was a preliminary, randomized, sham-controlled trial. Setting: The trial was conducted in a tertiary-care institution. Subjects: The participants were 23 adults with pain and MTPs in the neck or shoulder lasting > 2 weeks. Interventions: INS (active or sham) was delivered for 10 minutes in a single session over the MTP area in each patient. Outcome measures: Immediately following the intervention, subjects were tested for pressure pain thresholds (PPTs) and 10-cm visual analogue scale score (VAS) for pain intensity. At the 5 day follow-up, two additional tests were performed: the neck disability index (NDI) and the patient specific functional scale (PSFS) for function. Results: Improvements in function (PSFS) were observed in the treatment group, which were of clinical significance in selected subjects. These effects were statistically greater than those obtained in the sham group but were overall not at a level of clinical significance in this small population. Improvements in pain intensity (VAS) and neck disability (NDI) were observed in both the treatment and sham groups, indicating that INS had no greater benefit using these measures. There was no change in PPTs following either the active or sham treatment. Conclusions: INS is a new and emerging therapy, which may be efficacious for managing musculoskeletal conditions, such as myofascial pain syndrome. This study demonstrated improvements in function in individuals with MTPs following INS therapy, which may be of clinical significance in certain patients with neck or shoulder pain. Further large-scale clinical trials are required to confirm this effect and to determine if INS also reduces pain and neck disability.