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Experimentally induced neck pain causes a decrease in thoracic but not lumbar spine stability.
Pinto, BL, Beaudette, SM, Graham, RB, Brown, SHM
Journal of biomechanics. 2019;:78-83
Abstract
Maintenance of spine stability is considered to be a critical component of spine health. Ross et al. (2015) used a topical capsaicin/heat pain sensitization model to experimentally induce lower back pain, and demonstrated that the experimental pain experience caused a decrease in the muscular contribution to lumbar spine rotational stiffness (related to mechanical stability) as well as lower back local dynamic stability (LDS). It has yet to be established if pain elsewhere in the body, specifically in other regions of the spine, can similarly affect the stability of the lower back. The purpose of this investigation was therefore to quantify thoracic and lumbar spine LDS as well as the muscular contribution to lumbar spine rotational stiffness after an experimental neck pain protocol. Results demonstrated that LDS of the thoracic spine decreased in response to the capsaicin/heat induced neck pain. Limited adaptation was required at the lumbar spine as demonstrated by the lack of statistically significant changes in lower back LDS or rotational stiffness.
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A soft massage tool is advantageous for compressing deep soft tissue with low muscle tension: Therapeutic evidence for self-myofascial release.
Kim, Y, Hong, Y, Park, HS
Complementary therapies in medicine. 2019;:312-318
Abstract
OBJECTIVES This study aimed to compare the amount of deep tissue pressure and muscle relaxation between a soft inflatable rubber ball (SIRB) and a hard massage ball (HMB). DESIGN Crossover experimental design study. INTERVENTIONS Thirty participants with neck pain (age: 65.9 ± 3.4, Neck Disability Index score: 34.0% ± 15.2) pillowed a SIRB or an HMB beneath the suboccipital region in the supine position. For the baseline condition, participants pillowed a foam block without a ball. MAIN OUTCOME MEASURES To quantify the amount of deep-tissue pressure by a ball, compressed soft tissue thickness was measured with lateral cervical radiographs. To assess muscle relaxation, the amount of muscle tension was determined using electromyography of the sternocleidomastoid and upper trapezius muscles. To monitor the cervical lordosis in each condition, the extension angles of the cervical vertebrae were quantified using the relative rotation angles. RESULTS The compressed soft tissue thickness in the SIRB condition was significantly lower than that in the HMB condition. The normalised muscle activities exhibited that right sternocleidomastoid muscle activity in the HMB condition was significantly higher than that in the baseline and SIRB conditions. In the SIRB and HMB conditions, Numeric Rating Scale for pain was 0.2 ± 0.5 and 5.2 ± 1.4, respectively. CONCLUSIONS Our findings demonstrate that a SIRB is more advantageous than an HMB for pressing the soft tissue deeply. This finding would be related to reduced muscle tension and discomfort in the SIRB condition when compared with the HMB condition.
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Lifestyle Advice and Self-Care Integral to Acupuncture Treatment for Patients with Chronic Neck Pain: Secondary Analysis of Outcomes Within a Randomized Controlled Trial.
MacPherson, H, Elliot, B, Hopton, A, Lansdown, H, Birch, S, Hewitt, C
Journal of alternative and complementary medicine (New York, N.Y.). 2017;(3):180-187
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Abstract
BACKGROUND Lifestyle advice is widely considered as an integral component of acupuncture treatment. However, it is unclear whether lifestyle advice and related self-care are important for sustaining benefit over the longer term. In a novel secondary analysis of trial data, this paper explores the nature and impact of acupuncture-related diagnosis, and associated lifestyle advice and self-care, in patients with chronic neck pain. DESIGN In a three-arm, randomized, controlled multicenter trial with 12 months of follow-up, a total of 517 patients with chronic neck pain were randomized in equal proportions to acupuncture, Alexander technique, or usual care alone. METHODS For each acupuncture patient, practitioners reported treatment components that included an acupuncture-related diagnosis and provision of associated lifestyle advice. Patients reported at baseline, 3, 6, and 12 months on variables related to treatment, which included aspects of self-care, self-efficacy, and lifestyle advice acted upon, as well as pain and disability scores. Congruence between practitioner advice and patient take-up was assessed using chi-squared test. Impact of lifestyle advice and self-efficacy on outcome was evaluated using regression models. RESULTS Among patients randomized to acupuncture, the most common diagnostic framework involved the Zang-Fu syndromes for 139/160 (87%) patients. Lifestyle advice was provided by practitioners to 134/160 (84%) of patients, most commonly related to exercise, relaxation, diet, rest, and work. Significant congruence with patient take-up was found for diet, rest, and work. Moreover, patients in the acupuncture group improved their ability to use what they had learnt and increased their self-efficacy. In turn, these characteristics were associated with significant reductions in pain and disability scores at 12 months. CONCLUSION Acupuncture-related lifestyle advice helped patients improve the way they live and care for themselves and enhanced self-efficacy and ability to use what they had learnt. These changes were associated with reductions in pain and disability at 12 months.
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The Treatment of Neck Pain-Associated Disorders and Whiplash-Associated Disorders: A Clinical Practice Guideline.
Bussières, AE, Stewart, G, Al-Zoubi, F, Decina, P, Descarreaux, M, Hayden, J, Hendrickson, B, Hincapié, C, Pagé, I, Passmore, S, et al
Journal of manipulative and physiological therapeutics. 2016;(8):523-564.e27
Abstract
OBJECTIVE The objective was to develop a clinical practice guideline on the management of neck pain-associated disorders (NADs) and whiplash-associated disorders (WADs). This guideline replaces 2 prior chiropractic guidelines on NADs and WADs. METHODS Pertinent systematic reviews on 6 topic areas (education, multimodal care, exercise, work disability, manual therapy, passive modalities) were assessed using A Measurement Tool to Assess Systematic Reviews (AMSTAR) and data extracted from admissible randomized controlled trials. We incorporated risk of bias scores in the Grading of Recommendations Assessment, Development, and Evaluation. Evidence profiles were used to summarize judgments of the evidence quality, detail relative and absolute effects, and link recommendations to the supporting evidence. The guideline panel considered the balance of desirable and undesirable consequences. Consensus was achieved using a modified Delphi. The guideline was peer reviewed by a 10-member multidisciplinary (medical and chiropractic) external committee. RESULTS For recent-onset (0-3 months) neck pain, we suggest offering multimodal care; manipulation or mobilization; range-of-motion home exercise, or multimodal manual therapy (for grades I-II NAD); supervised graded strengthening exercise (grade III NAD); and multimodal care (grade III WAD). For persistent (>3 months) neck pain, we suggest offering multimodal care or stress self-management; manipulation with soft tissue therapy; high-dose massage; supervised group exercise; supervised yoga; supervised strengthening exercises or home exercises (grades I-II NAD); multimodal care or practitioner's advice (grades I-III NAD); and supervised exercise with advice or advice alone (grades I-II WAD). For workers with persistent neck and shoulder pain, evidence supports mixed supervised and unsupervised high-intensity strength training or advice alone (grades I-III NAD). CONCLUSIONS A multimodal approach including manual therapy, self-management advice, and exercise is an effective treatment strategy for both recent-onset and persistent neck pain.
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Crowned Dens Syndrome: Report of Three Cases and a Review of the Literature.
Oka, A, Okazaki, K, Takeno, A, Kumanomido, S, Kusunoki, R, Sato, S, Ishihara, S, Kinoshita, Y, Nishina, M
The Journal of emergency medicine. 2015;(1):e9-e13
Abstract
BACKGROUND Patients with crowned dens syndrome (CDS), which is pseudogout of the atlantoaxial junction induced by "crown-like" calcifications around the dens, present with symptoms of severe neck pain, rigidity, and high fever. CDS patients are often misdiagnosed as having meningitis or polymyalgia rheumatica, leading to potentially unnecessary invasive procedures for diagnosis and treatment. CASE REPORT We report 3 patients with CDS who had characteristic findings on computed tomography (CT), all of whom quickly recovered with nonsteroidal antiinflammatory drug (NSAID) administration. In addition, we reviewed 72 published cases, including our patients. CDS typically occurs in elderly people (mean age 71.4 years). Common symptoms include neck pain (100%), neck rigidity (98%), and fever (80.4%), and most show elevated inflammatory markers (88.3%) on serum laboratory tests. Neck pain on rotation is a characteristic and helpful symptom in the diagnosis. The most useful modality is CT (97.1%), showing linear calcium deposits around the dens, mostly in the transverse ligament of atlas (TLA). CT number is especially helpful to distinguish a normal TLA (35-110 HU) from a calcified one (202-258 HU) in our cases. The most effective treatment is NSAID administration (85%), which usually leads to marked resolution of symptoms within days or weeks. WHY SHOULD AN EMERGENCY PHYSICIAN BE AWARE OF THIS?: Due to acute and severe symptoms, CDS patients often present to an emergency department. To avoid unnecessary invasive procedures for diagnosis and treatment, CDS should be considered in the differential diagnosis of febrile neck pain.
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Lasting effects of workplace strength training for neck/shoulder/arm pain among laboratory technicians: natural experiment with 3-year follow-up.
Mortensen, P, Larsen, AI, Zebis, MK, Pedersen, MT, Sjøgaard, G, Andersen, LL
BioMed research international. 2014;:845851
Abstract
OBJECTIVES This study investigated long-term effects and implementation processes of workplace strength training for musculoskeletal disorders. METHODS 333 and 140 laboratory technicians from private and public sector companies, respectively, replied to a 3-year follow-up questionnaire subsequent to a 1-year randomized controlled trial (RCT) with high-intensity strength training for prevention and treatment of neck, shoulder, and arm pain. Being a natural experiment, the two participating companies implemented and modified the initial training program in different ways during the subsequent 2 years after the RCT. RESULTS At 3-year follow-up the pain reduction in neck, shoulder, elbow, and wrist achieved during the first year was largely maintained at both companies. However, the private sector company was rated significantly better than the public sector company in (1) training adherence, (2) training culture, that is, relatively more employees trained at the workplace and with colleagues, (3) self-reported health changes, and (4) prevention of neck and wrist pain development among initially pain-free employees. CONCLUSIONS This natural experiment shows that strength training can be implemented successfully at different companies during working hours on a long-term basis with lasting effects on pain in neck, shoulder, and arm.
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Acute experimentally induced neck pain does not affect fatigability of the peripheral biceps brachii muscle.
Hung, LY, Maracle, E, Srbely, JZ, Brown, SH
Motor control. 2014;(4):395-404
Abstract
Evidence has shown that upper limb muscles peripheral to the cervical spine, such as the biceps brachii, can demonstrate functional deficits in the presence of chronic neck pain. However, few studies have examined how neck pain can affect the fatigability of upper limb muscles; therefore we were motivated to investigate the effects of acutely induced neuropathic neck pain on the fatigability of the biceps brachii muscle during isometric contraction to exhaustion. Topical capsaicin was used to induce neck pain in 11 healthy male participants. Surface EMG signals were recorded from the biceps brachii during an isometric elbow flexion fatigue task in which participants held a weight equivalent to 30% of their MVC until exhaustion. Two experimental sessions, one placebo and one capsaicin, were conducted separated by two days. EMG mean power frequency and average normalized activation values were calculated over the course of the fatigue task. In the presence of pain, there was no statistically significant effect on EMG parameters during fatigue of the biceps brachii. These results demonstrate that acutely induced neuropathic neck pain does not affect the fatigability, under the tested conditions, of the biceps brachii.
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α-Lipoic acid and superoxide dismutase in the management of chronic neck pain: a prospective randomized study.
Letizia Mauro, G, Cataldo, P, Barbera, G, Sanfilippo, A
Drugs in R&D. 2014;(1):1-7
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Abstract
BACKGROUND AND OBJECTIVE Since oxidative stress plays a pathogenetic role in chronic neck pain (CNP), we investigated whether a combination of α-lipoic acid (ALA) and superoxide dismutase (SOD) might improve pain control and the efficacy of physiotherapy ("multimodal therapy") in patients with CNP. SETTING This study was conducted in the Rehabilitation Unit of the Department of Surgical and Oncological Sciences at the University Policlinic in Palermo, Italy. DESIGN AND PATIENTS This was a prospective, randomized, open study in outpatients. INTERVENTION Patients randomly received either physiotherapy alone (group 2; n = 45) or a combination of ALA 600 mg and SOD 140 IU daily in addition to physiotherapy (group 1; n = 51), for 60 days. Pain was assessed by a visual analogue scale (VAS) and a modified Neck Pain Questionnaire (mNPQ). Treatment compliance and safety were also evaluated. RESULTS Both groups experienced a significant reduction in the VAS and mNPQ scores after 1 month; however, while no further improvement was observed in group 2 at 60 days, group 1 showed a further VAS reduction (p < 0.001). In addition, in the mNPQ at 60 days, more patients in group 1 than in group 2 reported that their neck pain was improved (p < 0.01), and they showed greater compliance with prescribed physiotherapy (p = 0.048). No drug reaction was observed. CONCLUSION Use of ALA/SOD in combination with physiotherapy may be a useful approach to CNP, being antioxidants that act on nerve inflammation and disease progression. CLINICAL REHABILITATION IMPACT These preliminary observations suggest that some interesting goals (better pain control and physical wellbeing) can be achieved by multimodal therapy in CNP patients.
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The association between physical activity and neck and low back pain: a systematic review.
Sitthipornvorakul, E, Janwantanakul, P, Purepong, N, Pensri, P, van der Beek, AJ
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. 2011;(5):677-89
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The effect of physical activity on neck and low back pain is still controversial. No systematic review has been conducted on the association between daily physical activity and neck and low back pain. The objective of this study was to evaluate the association between physical activity and the incidence/prevalence of neck and low back pain. Publications were systematically searched from 1980 to June 2009 in several databases. The following key words were used: neck pain, back pain, physical activity, leisure time activity, daily activity, everyday activity, lifestyle activity, sedentary, and physical inactivity. A hand search of relevant journals was also carried out. Relevant studies were retrieved and assessed for methodological quality by two independent reviewers. The strength of the evidence was based on methodological quality and consistency of the results. Seventeen studies were included in this review, of which 13 were rated as high-quality studies. Of high-quality studies, there was limited evidence for no association between physical activity and neck pain in workers and strong evidence for no association in school children. Conflicting evidence was found for the association between physical activity and low back pain in both general population and school children. Literature with respect to the effect of physical activity on neck and low back pain was too heterogeneous and more research is needed before any final conclusion can be reached.
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Naprapathic manual therapy or evidence-based care for back and neck pain: a randomized, controlled trial.
Skillgate, E, Vingård, E, Alfredsson, L
The Clinical journal of pain. 2007;(5):431-9
Abstract
OBJECTIVES To compare naprapathic manual therapy with evidence-based care for back or neck pain regarding pain, disability, and perceived recovery. Naprapathy that is common in the Nordic countries and in some states in the United States is characterized by manual manipulations with a focus on soft and connective tissues, aiming to decrease pain and disability in the musculoskeletal system. METHODS Four hundred and nine patients with pain and disability in the back or neck lasting for at least 2 weeks, recruited at 2 large public companies in Sweden in 2005, were included in this randomized controlled trial. The 2 interventions were naprapathy, including spinal manipulation/mobilization, massage, and stretching (Index Group) and support and advice to stay active and how to cope with pain, according to the best scientific evidence available, provided by a physician (Control Group). Pain, disability, and perceived recovery were measured by questionnaires at baseline and after 3, 7, and 12 weeks. RESULTS At 7-week and 12-week follow-ups, statistically significant differences between the groups were found in all outcomes favoring the Index Group. At 12-week follow-up, a higher proportion in the naprapathy group had improved regarding pain [risk difference (RD)=27%, 95% confidence interval (CI): 17-37], disability (RD=18%, 95% CI: 7-28), and perceived recovery (RD=44%, 95% CI: 35-53). Separate analysis of neck pain and back pain patients showed similar results. DISCUSSION This trial suggests that combined manual therapy, like naprapathy, might be an alternative to consider for back and neck pain patients.