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Hides JA, Franettovich Smith MM, Mendis MD, Smith NA, Cooper AJ, Treleaven J, Leung F, Gardner AJ, McCrory P, Low Choy NL. A prospective investigation of changes in the sensorimotor system following sports concussion. An exploratory study. Musculoskelet Sci Pract 2017; 29:7-19. [PMID: 28259770 DOI: 10.1016/j.msksp.2017.02.003] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/02/2016] [Revised: 02/10/2017] [Accepted: 02/16/2017] [Indexed: 11/29/2022]
Abstract
BACKGROUND Sports concussion is a risk for players involved in high impact, collision sports. Post-concussion, the majority of symptoms subside within 7-10 days, but can persist in 10-20% of athletes. Understanding the effects of sports concussion on sensorimotor systems could inform physiotherapy treatment. OBJECTIVE To explore changes in sensorimotor function in the acute phase following sports concussion. DESIGN Prospective cohort study. METHODS Fifty-four players from elite rugby union and league teams were assessed at the start of the playing season. Players who sustained a concussion were assessed three to five days later. Measures included assessments of balance (sway velocity), vestibular system function (vestibular ocular reflex gain; right-left asymmetry), cervical proprioception (joint position error) and trunk muscle size and function. RESULTS During the playing season, 14 post-concussion assessments were performed within 3-5 days of injury. Significantly decreased sway velocity and increased size/contraction of trunk muscles, were identified. Whilst not significant overall, large inter-individual variation of test results for cervical proprioception and the vestibular system was observed. LIMITATIONS The number of players who sustained a concussion was not large, but numbers were comparable with other studies in this field. There was missing baseline data for vestibular and cervical proprioception testing for some players. CONCLUSIONS Preliminary findings post-concussion suggest an altered balance strategy and trunk muscle control with splinting/over-holding requiring consideration as part of the development of appropriate physiotherapy management strategies.
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Affiliation(s)
- Julie A Hides
- Centre for Musculoskeletal Research, Mary MacKillop Institute for Health Research, Australian Catholic University, Brisbane, QLD, 4102, Australia.
| | - Melinda M Franettovich Smith
- Centre for Musculoskeletal Research, Mary MacKillop Institute for Health Research, Australian Catholic University, Brisbane, QLD, 4102, Australia
| | - M Dilani Mendis
- Centre for Musculoskeletal Research, Mary MacKillop Institute for Health Research, Australian Catholic University, Brisbane, QLD, 4102, Australia; Physiotherapy Department, Mater Health Services, South Brisbane, 4101, Australia
| | - Nigel A Smith
- Centre for Musculoskeletal Research, Mary MacKillop Institute for Health Research, Australian Catholic University, Brisbane, QLD, 4102, Australia
| | - Andrew J Cooper
- Centre for Musculoskeletal Research, Mary MacKillop Institute for Health Research, Australian Catholic University, Brisbane, QLD, 4102, Australia
| | - Julia Treleaven
- Division of Physiotherapy, School of Health and Rehabilitation Sciences, The University of Queensland, 4072, Australia
| | - Felix Leung
- Centre for Musculoskeletal Research, Mary MacKillop Institute for Health Research, Australian Catholic University, Brisbane, QLD, 4102, Australia
| | - Andrew J Gardner
- Priority Research Centre for Stroke and Brain Injury, School of Medicine and Public Health, University of Newcastle, Callaghan, NSW, 2310, Australia; Hunter New England Local Health District Sports Concussion Program, John Hunter Hospital, New Lambton Heights, NSW, 2305, Australia
| | - Paul McCrory
- The Florey Institute of Neuroscience and Mental Health, Heidelberg, Victoria, Australia
| | - Nancy L Low Choy
- School of Physiotherapy, Australian Catholic University, Brisbane, QLD, 4014, Australia
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Bittar R, Alves NGP, Bertoldo C, Brugnera C, Oiticica J. Efficacy of Carbon Microcoils in Relieving Cervicogenic Dizziness. Int Arch Otorhinolaryngol 2016; 21:4-7. [PMID: 28050200 PMCID: PMC5205517 DOI: 10.1055/s-0036-1592418] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2016] [Accepted: 08/14/2016] [Indexed: 11/25/2022] Open
Abstract
Introduction Cervical pain contributes to postural deviations and imbalance. Nanotechnology may be used for the treatment of neck pain by fixing to the skin small rounds silicone patches containing double spiral carbon nanotubes arranged in the form of a coil (Helical), which would then relieve dizziness caused by muscular contraction. Objective The objective of this study is to Evaluate pain and dizziness scores before and after Helical patches effect on cervicogenic dizziness treatment. Methods The selected patients should have neck pain arising from muscle contraction with loss of balance or instability lasting more than 90 days and normal electrooculography. Treatment consisted of placing 10 Helical patches distributed as follows: two in the upper cervical area, two in the lower cervical area (near the 5th and 6th vertebrae), two in the upper trapezius muscle area (between neck and shoulder), and four in the tender point area (as reported by the patient). Using a Visual Analogue Scale (VAS), we matched pain and dizziness scores from Day 1 to those from Day 15 and Day 30 using Mann-Whitney test. Results There was a significant difference between pain score reported on Day 1 and Day 15 (Z = 2.43, U = 5, p = 0.01). We also found significant differences between dizziness scores reported on days 1 and 15 (Z = 2.62, U = 3.5, p = 0.01) and days 1 and 30 (Z = 2.36, U = 5.5, p = 0.01). Conclusion The Helical patches seem to be an effective treatment for cervicogenic dizziness.
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Affiliation(s)
- Roseli Bittar
- Department of Otorhinolaryngology, Universidade de São Paulo, São Paulo, SP, Brazil
| | | | - César Bertoldo
- Department of Otorhinolaryngology, Universidade de São Paulo, São Paulo, SP, Brazil
| | - Cibele Brugnera
- Department of Otorhinolaryngology, Universidade de São Paulo, São Paulo, SP, Brazil
| | - Jeanne Oiticica
- Department of Otorhinolaryngology, Universidade de São Paulo, São Paulo, SP, Brazil
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Pain education combined with neck- and aerobic training is more effective at relieving chronic neck pain than pain education alone – A preliminary randomized controlled trial. ACTA ACUST UNITED AC 2015; 20:686-93. [DOI: 10.1016/j.math.2015.06.003] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2014] [Revised: 06/04/2015] [Accepted: 06/12/2015] [Indexed: 11/20/2022]
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Iglebekk W, Tjell C, Borenstein P. Treatment of chronic canalithiasis can be beneficial for patients with vertigo/dizziness and chronic musculoskeletal pain, including whiplash related pain. Scand J Pain 2015; 8:1-7. [PMID: 29911614 DOI: 10.1016/j.sjpain.2015.02.002] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2014] [Accepted: 02/03/2015] [Indexed: 10/23/2022]
Abstract
Background and aim Chronic musculoskeletal pain, e.g. whiplash associated disorders (WAD), fibromyalgia and myalgia, causes significant burden on both the individual and on society as a whole. In a previous study, the authors concluded that there is a likely connection between chronic benign paroxysmal positional vertigo (BPPV)/canalithiasis and headache, neck pain, generalized pain, fatigue, cognitive dysfunctions as well as tinnitus. The balance dysfunction in BPPV/canalithiasis is dynamic and not static. This leads to a perpetual postural mismatch. The vicious cycle of a disturbed equilibrium control system may be the driving force behind the vicious cycle of pain. The aim of this study is to investigate if otolith-repositioning manoeuvres in patients with chronic BPPV/canalithiasis can be beneficial. Methods During a period of about two years a prospective observational study on patients with chronic musculoskeletal pain referred for physiotherapy was performed. Those with a Dizziness Handicap Inventory (DHI) inquiry score above 20 underwent further investigations to diagnose chronic BPPV/canalithiasis. Diagnostic criteria: (A) The diagnosis of BPPV/canalithiasis was confirmed with the following: (1) specific history of vertigo or dizziness provoked by acceleration/deceleration, AND (2) nystagmus and symptoms during at least one of the test positions; (B) the disorder had persisted for at least one year. Specific otolith repositioning manoeuvre for each semi-circular canal (SCC) was performed. Symptom questionnaire ("yes" or "no" answers during a personal interview) and a follow-up questionnaire were used. Results The responders of the follow-up questionnaire constituted the study group. Thirty-nine patients responded (i.e. 87%) (31 females, 8 males) with a median age of 44 years (17-65). The median duration of the disease was5 years. Seventy-nine percent had ahistory ofhead or neck trauma. The DHI median score was 48 points (score >60 indicates a risk of fall). The video-oculography confirmed BPPV/canalithiasis in more than one semi-circular canal in all patients. In the present study the frequency of affected anterior semi-circular canal (SSC) was at a minimum of 26% and could be as high as 65%. Ninety-five percent suffered from headache, 92% from neck pain, 54% had generalized pain, and 56% had temporo-mandibular joint region pain. Fatigue (97%), aggravation by physical exertion (87%), decreased ability to concentrate (85%) aswellas visual disturbances (85%) were the most frequently reported symptoms, and 49% suffered from tinnitus. The median number of otolith repositioning manoeuvres done was six (2-29). Median time span between finishing otolith repositioning manoeuvres and answering the questionnaire was 7 months. Effects of treatment and conclusion The present study has shown that repositioning of otoliths in the SCCs in nearly all patients with chronic BPPV/canalithiasis ameliorated pain and other symptoms. The correlation between vertigo/dizziness and the majority of symptoms was significant. Therefore, there is strong evidence to suggest that there is a connection between chronic BPPV/canalithiasis and chronic pain as well as the above-mentioned symptoms. Implications Patients with unexplained pain conditions should be evaluated withthe Dizziness Handicap Inventory-questionnaire, which can identify treatable balance disorders.
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Sarig Bahat H, Takasaki H, Chen X, Bet-Or Y, Treleaven J. Cervical kinematic training with and without interactive VR training for chronic neck pain – a randomized clinical trial. ACTA ACUST UNITED AC 2015; 20:68-78. [DOI: 10.1016/j.math.2014.06.008] [Citation(s) in RCA: 61] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2013] [Revised: 06/24/2014] [Accepted: 06/27/2014] [Indexed: 10/25/2022]
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See KS, Treleaven J. Identifying upper limb disability in patients with persistent whiplash. ACTA ACUST UNITED AC 2014; 20:487-93. [PMID: 25554214 DOI: 10.1016/j.math.2014.12.001] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2014] [Revised: 11/26/2014] [Accepted: 12/10/2014] [Indexed: 11/19/2022]
Abstract
BACKGROUND Patients with persistent whiplash associated disorders (WAD) report upper limb (UL) symptoms and functional difficulties but there is limited information regarding the nature of these complaints. Impairments in motor performance may relate to functional deficits. OBJECTIVE To identify symptoms and the degree and nature of UL functional difficulties. DESIGN Cross sectional study. METHODS Twenty-four age matched subjects with persistent WAD and healthy controls were surveyed using the Disabilities of the Arm, Shoulder and Hand (DASH), Neck Disability Index (NDI) and Patient Specific Functional Scale (PSFS). A series of case studies on six subjects with persistent WAD and thirteen age and gender matched controls also had their motor performance assessed using a specialised UL testing battery, including reaction time, movement speed, accuracy, co-ordination and tapping speed. RESULTS The results suggest that UL symptoms and functional deficits are prevalent in persistent WAD. All individual item scores on the DASH, except one, were significantly higher in the WAD group and the DASH moderately correlated to pain, NDI and PSFS. Four-choice reaction time was the only motor performance measure that was significantly impaired in the WAD compared to control group and this correlated to pain levels. CONCLUSIONS The findings suggest the DASH is a suitable measure for subjects with persistent WAD and could be administered when high NDI scores are present or the patient specifically reports difficulty with UL activities. Further investigation regarding UL motor performance in subjects with persistent WAD is warranted to determine relationships between symptoms and reported functional deficits.
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Affiliation(s)
- Kirsten Sue See
- CCRE Spine, Division of Physiotherapy, School of Health and Rehabilitation Sciences, The University of Queensland, Brisbane 4072, Australia
| | - Julia Treleaven
- CCRE Spine, Division of Physiotherapy, School of Health and Rehabilitation Sciences, The University of Queensland, Brisbane 4072, Australia.
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Fisher AR, Bacon CJ, Mannion JVH. The effect of cervical spine manipulation on postural sway in patients with nonspecific neck pain. J Manipulative Physiol Ther 2014; 38:65-73. [PMID: 25467613 DOI: 10.1016/j.jmpt.2014.10.014] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2013] [Revised: 08/25/2014] [Accepted: 09/01/2014] [Indexed: 11/25/2022]
Abstract
OBJECTIVE This crossover study aimed to determine whether a single high-velocity, low-amplitude manipulation of the cervical spine would affect postural sway in adults with nonspecific neck pain. METHODS Ten participants received, in random order, 7 days apart, a high-velocity, low-amplitude manipulation applied to a dysfunctional spinal segment and a passive head-movement control. Four parameters of postural sway were measured before, immediately after, and at 5 and 10 minutes after each procedure. RESULTS Results showed no differences between interventions in change in any of the parameters. When changes before and immediately after each procedure were analyzed separately, only the control showed a significant change in the length of center of pressure path (an increase from median, 118 mm; interquartlie range, 93-137 mm to an increase to 132 mm; 112-147; P = .02). CONCLUSION This study failed to show evidence that single manipulation of the cervical spine influenced postural sway. Given the ability of the postural control system to reweight the hierarchy of sensory information to compensate for inadequacies in any 1 component, it is possible that any improvements in the mechanisms controlling postural sway elicited by the manipulative intervention may have been concealed.
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Affiliation(s)
- Alison R Fisher
- Osteopath, Department of Osteopathy, Unitec Institute of Technology, Auckland, New Zealand
| | - Catherine J Bacon
- Research Supervisor, Department of Osteopathy, Unitec Institute of Technology, Auckland, New Zealand; Postdoctoral Research Fellow, Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand.
| | - Jamie V H Mannion
- Lecturer, Department of Osteopathy, Unitec Institute of Technology, Auckland, New Zealand
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L’Heureux-Lebeau B, Godbout A, Berbiche D, Saliba I. Evaluation of Paraclinical Tests in the Diagnosis of Cervicogenic Dizziness. Otol Neurotol 2014; 35:1858-65. [DOI: 10.1097/mao.0000000000000506] [Citation(s) in RCA: 52] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Treleaven J, Takasaki H. High variability of the subjective visual vertical test of vertical perception, in some people with neck pain - Should this be a standard measure of cervical proprioception? ACTA ACUST UNITED AC 2014; 20:183-8. [PMID: 25241660 DOI: 10.1016/j.math.2014.08.005] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2014] [Revised: 08/06/2014] [Accepted: 08/26/2014] [Indexed: 11/19/2022]
Abstract
BACKGROUND Subjective visual vertical (SVV) assesses visual dependence for spacial orientation, via vertical perception testing. Using the computerized rod-and-frame test (CRFT), SVV is thought to be an important measure of cervical proprioception and might be greater in those with whiplash associated disorder (WAD), but to date research findings are inconsistent. OBJECTIVE The aim of this study was to investigate the most sensitive SVV error measurement to detect group differences between no neck pain control, idiopathic neck pain (INP) and WAD subjects. DESIGN Cross sectional study. METHODS Neck Disability Index (NDI), Dizziness Handicap Inventory short form (DHIsf) and the average constant error (CE), absolute error (AE), root mean square error (RMSE), and variable error (VE) of the SVV were obtained from 142 subjects (48 asymptomatic, 36 INP, 42 WAD). RESULTS The INP group had significantly (p < 0.03) greater VE and RMSE when compared to both the control and WAD groups. There were no differences seen between the WAD and controls. CONCLUSION The results demonstrated that people with INP (not WAD), had an altered strategy for maintaining the perception of vertical by increasing variability of performance. This may be due to the complexity of the task. Further, the SVV performance was not related to reported pain or dizziness handicap. These findings are inconsistent with other measures of cervical proprioception in neck pain and more research is required before the SVV can be considered an important measure and utilized clinically.
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Affiliation(s)
- Julia Treleaven
- CCRE Spine, Division of Physiotherapy, School of Health and Rehabilitation Sciences, The University of Queensland, Brisbane 4072, Australia.
| | - Hiroshi Takasaki
- CCRE Spine, Division of Physiotherapy, School of Health and Rehabilitation Sciences, The University of Queensland, Brisbane 4072, Australia
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Reid SA, Callister R, Katekar MG, Rivett DA. Effects of Cervical Spine Manual Therapy on Range of Motion, Head Repositioning, and Balance in Participants With Cervicogenic Dizziness: A Randomized Controlled Trial. Arch Phys Med Rehabil 2014; 95:1603-12. [DOI: 10.1016/j.apmr.2014.04.009] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2014] [Accepted: 04/04/2014] [Indexed: 10/25/2022]
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Worsfold C. When range of motion is not enough: Towards an evidence-based approach to medico-legal reporting in whiplash injury. J Forensic Leg Med 2014; 25:95-9. [DOI: 10.1016/j.jflm.2014.04.013] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2013] [Revised: 03/05/2014] [Accepted: 04/15/2014] [Indexed: 10/25/2022]
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Gosselin G, Fagan MJ. Effects of cervical muscle fatigue on the perception of the subjective vertical and horizontal. SPRINGERPLUS 2014; 3:78. [PMID: 24600540 PMCID: PMC3940717 DOI: 10.1186/2193-1801-3-78] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/15/2013] [Accepted: 01/14/2014] [Indexed: 11/12/2022]
Abstract
Introduction Cervical functional capacity outcome measures that are simple and reliable are urgently needed in order permit accurate assessment/reassessment during treatments and rehabilitation. Induced neck muscle fatigue has been shown to alter functional capacities such as balance and kinaesthetic sense in the standing posture. The Rod and Frame Test has also shown promise as a method of assessing the effects of chronic neck pain and injury, but currently only in the sitting position. The objectives of this project were therefore 1) to validate the computerised rod and frame test in the standing posture, and 2) to measure the effects that different cervical muscle fatigue protocol would have on the assessment of the subjective visual vertical and horizontal. Method The validation of the standing computerised rod and frame test in the standing posture was obtained by comparing results (n = 74) between the sitting and standing positions with the Spearman’s correlation coefficient. In addition, agreement between the two methods was analysed with the Bland-Altman method. Participants (n = 56) resisted with their neck muscles approximately 35% maximum isometric voluntary contraction force for 15 minutes on a purpose built apparatus in eight different directions. Wilcoxon signed rank tests analysed changes in horizontal and vertical rod and frame test between the neutral and all different directions of contraction. The changes of recorded unsigned vertical and horizontal errors for the combined frame condition in all situations of isometric contraction were analysed with two respective one-way repeated measures analysis of variance (ANOVA). Discussion The Spearman’s rho and Bland-Altman plots show that the Rod and Frame Test works equally well in sitting and standing positions. After muscle contraction, there were significant increases in error in all participants for both horizontal and vertical rod and frame tests, except after flexion. These errors were predominantly present after fatigue of muscles in the coronal plane of contraction. Proprioception alone cannot explain the difference in the rod and frame results between different muscle groups. It is suggested that an evolutionary advantage of developing improved subjective verticality awareness in the same direction as the main visual field could explain these findings.
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Affiliation(s)
- Guy Gosselin
- School of Engineering, University of Hull, Cottingham Road, Kingston-upon-Hull, HU6 7RX UK
| | - Michael J Fagan
- School of Engineering, University of Hull, Cottingham Road, Kingston-upon-Hull, HU6 7RX UK
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Freppel S, Bisdorff A, Colnat-Coulbois S, Ceyte H, Cian C, Gauchard G, Auque J, Perrin P. Visuo-proprioceptive interactions in degenerative cervical spine diseases requiring surgery. Neuroscience 2013; 255:226-32. [DOI: 10.1016/j.neuroscience.2013.09.060] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2013] [Revised: 09/25/2013] [Accepted: 09/26/2013] [Indexed: 12/21/2022]
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Uthaikhup S, Sunkarat S, Khamsaen K, Meeyan K, Treleaven J. The effects of head movement and walking speed on gait parameters in patients with chronic neck pain. MANUAL THERAPY 2013; 19:137-41. [PMID: 24144513 DOI: 10.1016/j.math.2013.09.004] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/03/2012] [Revised: 08/31/2013] [Accepted: 09/16/2013] [Indexed: 10/26/2022]
Abstract
It has been documented that neck pain can influence sensorimotor function. However, little is known about the effects of head movement and walking speed on gait characteristics in patients with neck pain. The aim of this study was to determine gait characteristics of patients with neck pain during walking with different head movements and gait speeds as compared to a control group without neck pain. Twenty women aged between 18 and 59 years with chronic neck pain (>3 months) and 20 healthy controls of similar age, weight and height were recruited into the study. Participants with neck pain completed the Neck Disability Index and Visual Analogue Pain Scale. The experiment consisted of two walking sessions. The first session included walking with head straight, head up-down, and head turns from side to side. The second session included walking at comfortable and maximum speeds. Each trial was performed twice. Gait parameters measured using GAITRite walkway system were step length, stride length, step time, stride time, step width, cadence and gait speed. Patients with chronic neck pain demonstrated a narrower step width, a shorter step length and a slower gait speed during walking with the head movements and at maximum speed compared to the control group (all p < 0.05). Maximum gait speed was moderately correlated with pain intensity and disability (p < 0.01). The results suggest that patients with chronic neck pain have gait disturbances. This supports the notion that assessment of gait should be addressed in patients with persistent neck pain.
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Affiliation(s)
- Sureeporn Uthaikhup
- Department of Physical Therapy, Faculty of Associated Medical Sciences, Chiang Mai University, Thailand; Back, Neck and Other Joint Pain Research Group, Khon Kaen University, Thailand.
| | - Somporn Sunkarat
- Department of Physical Therapy, Faculty of Associated Medical Sciences, Chiang Mai University, Thailand
| | - Khanamporn Khamsaen
- Department of Physical Therapy, Faculty of Associated Medical Sciences, Chiang Mai University, Thailand
| | - Kitti Meeyan
- Department of Physical Therapy, Faculty of Associated Medical Sciences, Chiang Mai University, Thailand
| | - Julia Treleaven
- Division of Physiotherapy, NHMRC Centre for Clinical Research Excellence in Spinal Pain, Injury and Health (CCRE Spine), School of Health and Rehabilitation Sciences, The University of Queensland, Australia
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The influence of cervical spine flexion-rotation range-of-motion asymmetry on postural stability in older adults. Spine (Phila Pa 1976) 2013; 38:1648-55. [PMID: 23778365 DOI: 10.1097/brs.0b013e31829f23a0] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
STUDY DESIGN Cross-sectional design. OBJECTIVE The purpose of this study was to isolate the contribution of cervical spine range-of-motion (ROM) asymmetry to postural control in a group of older adults with neck pain. SUMMARY OF BACKGROUND DATA Previous research has suggested that the upper cervical spine plays an important role in postural stability. However, it remains unclear whether the upper cervical spine rotation ROM asymmetry is associated with postural stability. METHODS Using the cervical range-of-motion device to assess upper cervical spine ROM via the cervical flexion-rotation test, we classified 54 older adults with neck pain (30 females; mean [standard deviation] age, 66 [5] yr) into the (1) symmetrical group (SYM; n = 20; ≤5° side-to-side difference) or (2) asymmetrical group (ASYM; n = 34; >5° difference). Standing postural control was characterized by the center-of-pressure (CoP) movements measured using a Balance Board. Other measures included habitual, fast-paced gait speed and neck pain. Both groups were compared on the various measures using Welch t tests. RESULTS Although the ASYM group had 26% greater anteroposterior postural sway than the SYM (P < 0.01), both groups did not differ on postural sway velocity, gait speed, and neck pain intensity. Analyzing the frequency content of the postural sway using wavelet analysis (a modern, nonlinear signal processing method) shed further light: the standing postural sway in the ASYM group was skewed toward lower frequency movement (ultralow [< 0.10Hz] frequency content, anteroposterior: 6.7% in ASYM, 4.7% in SYM, P = 0.01; medial-lateral: 4.2% in ASYM, 3.4% in SYM, P = 0.045). CONCLUSION The ASYM group seemed to have compensated for their altered somatosensory input to achieve similar functional levels as the SYM group. Given what is known about the association between ultralow frequency postural sway and visual input, we speculated that the postural strategy adopted by the ASYM group was adaptive and that this group may be relying on the visual system to achieve these compensations.
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Jöud A, Stjerna J, Malmström EM, Westergren H, Petersson IF, Englund M. Healthcare consultation and sick leave before and after neck injury: a cohort study with matched population-based references. BMJ Open 2013; 3:e003172. [PMID: 23996819 PMCID: PMC3758980 DOI: 10.1136/bmjopen-2013-003172] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVES Recent studies based on self-assessed data on exposure and outcome suggest a negative association between poor health before neck injury and recovery. Our aim was to study actual healthcare consultation and work disability before and after neck injury (whiplash). DESIGN Cohort study with matched references studied prospectively and retrospectively via regional and national held registers. SETTING Population-based study in Region Skåne, Sweden (population=1.21 million) including all levels of healthcare. PARTICIPANTS 1443 participants aged ≥18 (54% women) with acute neck injury, Whiplash, (International Classification of Diseases-10-SE code S13.4*) in 2007 or 2008 and no such diagnosis since 1998. Each patient with a neck injury was assigned four randomly selected population references matched for age, sex and area of residence (97% of the patients and 94% of the references were followed during the whole study period). PRIMARY AND SECONDARY OUTCOME MEASURES We studied changes in healthcare consultations 3 years before to 3 years after diagnosis as well as sick leave episodes. Analyses were also stratified by preinjury frequency of consultation. RESULTS Before the injury, the mean number of total consultations over 36 months among the neck injured (n=1443) and references (n=5772) was 9.3 vs 7.2 (p<0.0001) and postneck injury 12.7 vs 7.8 (p<0.0001). In the group of high-frequent consulters, there were more women compared with frequent and low-frequent consulters (70.6% vs 32.8%; p<0.0001). Among low-frequent and frequent consulters preinjury (n=967, 67% of the cohort), 16% became high-frequent consulters attributable to the injury. The number of days of sick leave preinjury was correlated with the number of preinjury and postinjury consultations (r=0.47 (99% CI 0.38 to 0.49), r=0.32 (99% CI 0.25 to 0.37)). CONCLUSIONS People with a neck injury constitute a heterogeneous group. The preinjury level of healthcare consultation is associated with the postinjury level of consultation.
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Affiliation(s)
- Anna Jöud
- Department of Orthopedics, Clinical Sciences Lund, Lund University, Lund, Sweden
- Epi-centre Skåne, Skåne University Hospital, Lund, Sweden
| | - Johanna Stjerna
- Department of Rehabilitation, Skåne University Hospital, Lund, Sweden
| | - Eva-Maj Malmström
- Department of Rehabilitation, Skåne University Hospital, Lund, Sweden
- Department of Otorhinolaryngology, Clinical Sciences Lund, Lund University, Lund, Sweden
| | - Hans Westergren
- Department of Rehabilitation, Skåne University Hospital, Lund, Sweden
- Department of Health Sciences, Lund University, Lund, Sweden
| | - Ingemar F Petersson
- Department of Orthopedics, Clinical Sciences Lund, Lund University, Lund, Sweden
- Epi-centre Skåne, Skåne University Hospital, Lund, Sweden
| | - Martin Englund
- Department of Orthopedics, Clinical Sciences Lund, Lund University, Lund, Sweden
- Epi-centre Skåne, Skåne University Hospital, Lund, Sweden
- Clinical Epidemiology Research and Training Unit, Boston University School of Medicine, Boston, Massachusetts, USA
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Pedler A, Motlagh H, Sterling M. Laterality judgments are not impaired in patients with chronic whiplash associated disorders. ACTA ACUST UNITED AC 2013; 18:72-6. [DOI: 10.1016/j.math.2012.07.006] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2012] [Revised: 07/16/2012] [Accepted: 07/23/2012] [Indexed: 10/27/2022]
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Uthaikhup S, Jull G, Sungkarat S, Treleaven J. The influence of neck pain on sensorimotor function in the elderly. Arch Gerontol Geriatr 2012; 55:667-72. [DOI: 10.1016/j.archger.2012.01.013] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2011] [Revised: 01/27/2012] [Accepted: 01/27/2012] [Indexed: 10/28/2022]
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Silva AG, Cruz AL. Standing balance in patients with whiplash-associated neck pain and idiopathic neck pain when compared with asymptomatic participants: A systematic review. Physiother Theory Pract 2012; 29:1-18. [PMID: 22515180 DOI: 10.3109/09593985.2012.677111] [Citation(s) in RCA: 45] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Neck proprioception is one of the information sources that helps regulate postural balance. However, it is believed to be impaired as patients with both idiopathic neck pain (INP) and whiplash-associated disorders (WAD) have been shown to have a more unstable balance than healthy controls. This systematic review aims to determine if there are significant differences in balance between patients with INP and healthy controls and between patients with WAD and healthy controls. Studies were sought from PubMed, Cinahl, Physiotherapy Evidence Database, Web of Science, Academic Search Complete, Science Direct, and Scielo. Two reviewers independently screened titles and abstracts, assessed full reports for potentially eligible studies, and extracted information on participants' characteristics, pain characteristics, study methods, study results, and study quality. Twelve studies were included in this systematic review. Of these, six compared INP and healthy controls and eight compared WAD and healthy controls. All but one study (11/12) found a statistically significant difference for at least one measurement between patients with INP and WAD and healthy controls. The results of this systematic review suggest that both patients with INP and patients with WAD have poorer balance than healthy controls.
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Affiliation(s)
- Anabela G Silva
- Adjunct Professor, School of Health Sciences, University of Aveiro, 3810-193 Aveiro, Portugal.
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Talebian S, Otadi K, Ansari NN, Hadian MR, Shadmehr A, Jalaie S. Postural Control in Women with Myofascial Neck Pain. JOURNAL OF MUSCULOSKELETAL PAIN 2011. [DOI: 10.3109/10582452.2011.635847] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
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Dizziness, unsteadiness, visual disturbances, and postural control: implications for the transition to chronic symptoms after a whiplash trauma. Spine (Phila Pa 1976) 2011; 36:S211-7. [PMID: 22020615 DOI: 10.1097/brs.0b013e3182387f78] [Citation(s) in RCA: 54] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
STUDY DESIGN Synthesis and application of research. OBJECTIVE To provide a framework to consider the role of signs and symptoms of postural control disturbance in the transition to chronicity after a whiplash trauma. SUMMARY OF BACKGROUND DATA Dizziness is one of the most frequent complaints in those with persistent pain after a whiplash trauma and is often associated with postural control disturbances. METHODS Focus paper to review the causes, management, onset, and relationships of such signs and symptoms after a whiplash trauma to explore the role they may have in the transition to chronicity. RESULTS Contemporary literature suggests these signs and symptoms are often, but not always, aligned with those with significant neck pain and disability and have been related to a poorer prognosis. There are obvious links between the cervical proprioceptors and the musculoskeletal system, but links to the autonomic nervous, vestibular, and visual systems and influence on pain modulation are important. Postural control may have potential to alter other systems and affect pain and should be considered as one of the processes that might influence the transition to chronicity after a whiplash trauma. Future research should monitor the effect that addressing abnormal cervical afferent input has on not just dizziness and postural control but other symptoms such as altered pain processing and psychological distress. CONCLUSION The causes of transition into chronicity after a whiplash trauma are present early and appear to be multifactorial. Pain sensitivity and psychosocial distress have recently been considered but postural deficits and the symptom of dizziness also appear to have a role.It is recommended that future research address these issues to further the understanding of the transition to chronicity after a whiplash trauma.
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72
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Do whiplash patients differ from other patients with non-specific neck pain regarding pain, function or prognosis? ACTA ACUST UNITED AC 2011; 16:456-62. [DOI: 10.1016/j.math.2011.02.009] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2010] [Revised: 02/08/2011] [Accepted: 02/11/2011] [Indexed: 11/21/2022]
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73
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Treleaven J, Clamaron-Cheers C, Jull G. Does the region of pain influence the presence of sensorimotor disturbances in neck pain disorders? ACTA ACUST UNITED AC 2011; 16:636-40. [PMID: 21890397 DOI: 10.1016/j.math.2011.07.008] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2010] [Revised: 07/18/2011] [Accepted: 07/25/2011] [Indexed: 11/16/2022]
Abstract
Impairments in sensorimotor control have been demonstrated in neck pain disorders. However, there are more anatomical and neurophysiological connections between the sensorimotor control system and the upper cervical region and thus potential for greater disturbances in those with upper region pain. This study investigated whether sensorimotor impairment was greater in those suffering pain from the upper rather than lower cervical spine region, taking the onset of pain into account. Sixty-four subjects with persistent neck pain were divided into 4 groups -upper and lower region non-traumatic and upper and lower region traumatic. Cervical Joint Position Error (JPE), smooth pursuit neck torsion (SPNT) and standing balance tests were compared between groups. The lower non-traumatic group demonstrated significantly less (p < 0.03) deficit in SPNT compared to all other groups as well as less total energy of sway on the eyes open balance tests (p < 0.05) compared to both traumatic neck pain groups. The upper traumatic group demonstrated significantly greater JPE following rotation to the right (p < 0.04) when compared to both lower groups. Less sensorimotor dysfunction appears to occur in those with lower compared to upper cervical region pain, although this depends on whether trauma is involved in the onset of pain.
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Affiliation(s)
- Julia Treleaven
- NHMRC Centre of Clinical Research Excellence-Spine, Division of Physiotherapy, School of Health and Rehabilitation Sciences, The University of Queensland, Brisbane 4072, Australia.
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Jørgensen MB, Skotte JH, Holtermann A, Sjøgaard G, Petersen NC, Søgaard K. Neck pain and postural balance among workers with high postural demands - a cross-sectional study. BMC Musculoskelet Disord 2011; 12:176. [PMID: 21806796 PMCID: PMC3161921 DOI: 10.1186/1471-2474-12-176] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/04/2010] [Accepted: 08/01/2011] [Indexed: 11/25/2022] Open
Abstract
Background Neck pain is related to impaired postural balance among patients and is highly prevalent among workers with high postural demands, for example, cleaners. We therefore hypothesised, that cleaners with neck pain suffer from postural dysfunction. This cross-sectional study tested if cleaners with neck pain have an impaired postural balance compared with cleaners without neck pain. Methods Postural balance of 194 cleaners with (n = 85) and without (N = 109) neck pain was studied using three different tests. Success or failure to maintain the standing position for 30 s in unilateral stance was recorded. Participants were asked to stand on a force platform for 30 s in the Romberg position with eyes open and closed. The centre of pressure of the sway was calculated, and separated into a slow (rambling) and fast (trembling) component. Subsequently, the 95% confidence ellipse area (CEA) was calculated. Furthermore a perturbation test was performed. Results More cleaners with neck pain (81%) failed the unilateral stance compared with cleaners without neck pain (61%) (p < 0.01). However, the risk of failure in unilateral stance was statistically elevated in cleaners with concurrent neck/low back pain compared to cleaners without neck/low back pain (p < 0.01), whereas pain at only neck or only low back did not increase the risk. Impaired postural balance, measured as CEA (p < 0.01), rambling (p < 0.05) and trembling (p < 0.05) was observed among cleaners with neck pain in comparison with cleaners without neck pain in the Romberg position with eyes closed, but not with eyes open. Conclusions Postural balance is impaired among cleaners with neck pain and the current study suggests a particular role of the slow component of postural sway. Furthermore, the unilateral stance test is a simple test to illustrate functional impairment among cleaners with concurrent neck and low back pain. Trial registration ISRCTN96241850
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Affiliation(s)
- Marie B Jørgensen
- National Research Centre for the Working Environment, Copenhagen, Denmark.
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75
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Stokell R, Yu A, Williams K, Treleaven J. Dynamic and functional balance tasks in subjects with persistent whiplash: A pilot trial. ACTA ACUST UNITED AC 2011; 16:394-8. [DOI: 10.1016/j.math.2011.01.012] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2010] [Revised: 01/24/2011] [Accepted: 01/31/2011] [Indexed: 11/16/2022]
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Röijezon U, Björklund M, Djupsjöbacka M. The slow and fast components of postural sway in chronic neck pain. ACTA ACUST UNITED AC 2011; 16:273-8. [PMID: 21185768 DOI: 10.1016/j.math.2010.11.008] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2010] [Revised: 10/26/2010] [Accepted: 11/20/2010] [Indexed: 10/18/2022]
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Ruhe A, Fejer R, Walker B. Altered postural sway in patients suffering from non-specific neck pain and whiplash associated disorder - A systematic review of the literature. Chiropr Man Therap 2011; 19:13. [PMID: 21609469 PMCID: PMC3121601 DOI: 10.1186/2045-709x-19-13] [Citation(s) in RCA: 56] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2010] [Accepted: 05/24/2011] [Indexed: 12/12/2022] Open
Abstract
Study design Systematic literature review. Objectives To assess differences in center of pressure (COP) measures in patients suffering from non-specific neck pain (NSNP) or whiplash-associated disorder (WAD) compared to healthy controls and any relationship between changes in postural sway and the presence of pain, its intensity, previous pain duration and the perceived level of disability. Summary of Background data Over the past 20 years, the center of pressure (COP) has been commonly used as an index of postural stability in standing. While several studies investigated COP excursions in neck pain and WAD patients and compared these to healthy individuals, no comprehensive analysis of the reported differences in postural sway pattern exists. Search methods Six online databases were systematically searched followed by a manual search of the retrieved papers. Selection Criteria Papers comparing COP measures derived from bipedal static task conditions on a force plate of people with NSNP and WAD to those of healthy controls. Data collection and analysis Two reviewers independently screened titles and abstracts for relevance. Screening for final inclusion, data extraction and quality assessment were carried out with a third reviewer to reconcile differences. Results Ten papers met the inclusion criteria. Heterogeneity in study designs prevented pooling of the data and no direct comparison of data across the studies was possible. Instead, a qualitative data analysis was conducted. There was broad consensus that patients with either type of neck pain have increased COP excursions compared to healthy individuals, a difference that was more pronounced in people with WAD. An increased sway in antero-posterior direction was observed in both groups. Conclusions Patients with neck pain (due to either NSNP or WAD) exhibit greater postural instability than healthy controls, signified by greater COP excursions irrespective of the COP parameter chosen. Further, the decreased postural stability in people with neck pain appears to be associated with the presence of pain and correlates with the extent of proprioceptive impairment, but appears unrelated to pain duration.
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Affiliation(s)
- Alexander Ruhe
- Murdoch University, Praxis fuer Chiropraktik Wolfsburg, Porschestrasse 1, 38440 Wolfsburg, Germany.
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Yu LJ, Stokell R, Treleaven J. The effect of neck torsion on postural stability in subjects with persistent whiplash. ACTA ACUST UNITED AC 2011; 16:339-43. [PMID: 21256074 DOI: 10.1016/j.math.2010.12.006] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2010] [Revised: 11/22/2010] [Accepted: 12/13/2010] [Indexed: 01/16/2023]
Abstract
Dysfunction of cervical receptors in neck disorders has been shown to lead to disturbances in postural stability. The neck torsion manoeuvre used in the smooth pursuit neck torsion (SPNT) test is thought to be a specific measure of neck afferent dysfunction on eye movement in those with neck pain. This study aimed to determine whether neck torsion could change balance responses in those with persistent whiplash-associated disorders (WADs). Twenty subjects with persistent WAD and 20 healthy controls aged between 18 and 50 years stood on a computerised force plate with eyes closed in comfortable stance under 5 conditions: neutral head, head turned to left and right and neck torsion to left and right. Root mean square (rms) amplitude of sway was measured in the anterior-posterior (AP) and medial-lateral (ML) directions. The whiplash group had significantly greater rms amplitude in the AP direction following neck torsion compared to the control group (p < 0.03). The results show that the neck torsion manoeuvre may lead to greater postural deficits in individuals with persistent WAD and provides further evidence of neck torsion to identify abnormal cervical afferent input, as an underlying cause of balance disturbances in WAD. Further research is warranted.
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Affiliation(s)
- Li-Ju Yu
- Division of Physiotherapy, School of Health and Rehabilitation Sciences, The University of Queensland, Brisbane 4072, Australia
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Rushton A, Wright C, Heneghan N, Eveleigh G, Calvert M, Freemantle N. Physiotherapy rehabilitation for whiplash associated disorder II: a systematic review and meta-analysis of randomised controlled trials. BMJ Open 2011; 1:e000265. [PMID: 22102642 PMCID: PMC3221298 DOI: 10.1136/bmjopen-2011-000265] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
Objective To evaluate effectiveness of physiotherapy management in patients experiencing whiplash associated disorder II, on clinically relevant outcomes in the short and longer term. Design Systematic review and meta-analysis. Two reviewers independently searched information sources, assessed studies for inclusion, evaluated risk of bias and extracted data. A third reviewer mediated disagreement. Assessment of risk of bias was tabulated across included trials. Quantitative synthesis was conducted on comparable outcomes across trials with similar interventions. Meta-analyses compared effect sizes, with random effects as primary analyses. Data sources Predefined terms were employed to search electronic databases. Additional studies were identified from key journals, reference lists, authors and experts. Eligibility criteria for selecting studies Randomised controlled trials (RCTs) published in English before 31 December 2010 evaluating physiotherapy management of patients (>16 years), experiencing whiplash associated disorder II. Any physiotherapy intervention was included, when compared with other types of management, placebo/sham, or no intervention. Measurements reported on ≥1 outcome from the domains within the international classification of function, disability and health, were included. Results 21 RCTs (2126 participants, 9 countries) were included. Interventions were categorised as active physiotherapy or a specific physiotherapy intervention. 20/21 trials were evaluated as high risk of bias and one as unclear. 1395 participants were incorporated in the meta-analyses on 12 trials. In evaluating short term outcome in the acute/sub-acute stage, there was some evidence that active physiotherapy intervention reduces pain and improves range of movement, and that a specific physiotherapy intervention may reduce pain. However, moderate/considerable heterogeneity suggested that treatments may differ in nature or effect in different trial patients. Differences between participants, interventions and trial designs limited potential meta-analyses. Conclusions Inconclusive evidence exists for the effectiveness of physiotherapy management for whiplash associated disorder II. There is potential benefit for improving range of movement and pain short term through active physiotherapy, and for improving pain through a specific physiotherapy intervention.
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Affiliation(s)
- Alison Rushton
- School of Health and Population Sciences, College of Medicine and Dentistry, University of Birmingham, Edgbaston, Birmingham, UK
| | - Chris Wright
- School of Health and Population Sciences, College of Medicine and Dentistry, University of Birmingham, Edgbaston, Birmingham, UK
| | - Nicola Heneghan
- School of Health and Population Sciences, College of Medicine and Dentistry, University of Birmingham, Edgbaston, Birmingham, UK
| | - Gillian Eveleigh
- School of Health and Population Sciences, College of Medicine and Dentistry, University of Birmingham, Edgbaston, Birmingham, UK
| | - Melanie Calvert
- School of Health and Population Sciences, College of Medicine and Dentistry, University of Birmingham, Edgbaston, Birmingham, UK
| | - Nick Freemantle
- Department of Primary Care and Population Health, UCL Medical School (Royal Free Campus), London, UK
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Reis FJJD, Mafra B, Mazza D, Marcato G, Ribeiro M, Absalão T. Avaliação dos distúrbios do controle sensório-motor em pessoas com dor cervical mecânica: uma revisão. FISIOTERAPIA EM MOVIMENTO 2010. [DOI: 10.1590/s0103-51502010000400012] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
INTRODUÇÃO: A dor cervical mecânica é problema comum na população em geral e engloba a dor cervical aguda, as lesões em chicote, as disfunções cervicais e a dor cervical-ombro. A limitação da amplitude de movimento, a sensação de aumento da tensão muscular, a cefaleia, a braquialgia, a vertigem e outros sinais e sintomas são manifestações comuns e podem ser agravados por movimentos ou pela manutenção de posturas da coluna cervical. Estudos recentes mostram comprometimento no controle sensório-motor em pessoas com dor cervical manifestando-se por alterações da cinestesia cervical com dificuldade no reconhecimento da posição da cabeça, do movimento dos olhos e do equilíbrio. OBJETIVOS: Descrever, com base na revisão da literatura, as manifestações e os métodos de avaliação dos distúrbios sensório-motores relacionados à dor cervical mecânica. MÉTODOS: Para a revisão foram utilizadas as bases de dados de literatura científica indexada no período de 1965 a 2009. Considerou-se para a inclusão os artigos que abordassem a dor cervical mecânica e os distúrbios da propriocepção cervical, da coordenação dos movimentos dos olhos e do equilíbrio. Não houve restrição quanto à língua de publicação. O processo de seleção foi realizado por dois examinadores independentes, considerando a evidência científica em ordem decrescente, havendo preferência para as meta-análises e os estudos randomizados controlados. RESULTADOS: Dos 119 artigos encontrados, 69 preenchiam os critérios de inclusão. DISCUSSÃO: A presença de alterações dos músculos e das articulações cervicais, o processo de envelhecimento e a presença de dor cervical são descritos como fatores que alteram o sistema somatossensorial cervical e devem ser considerados também como perpetuantes. CONCLUSÃO: As alterações dos sistemas visual, do equilíbrio e proprioceptivo não podem ser desprezadas e devem ser consideradas durante a avaliação fisioterapêutica dos distúrbios cervicais, visto que existe uma integração entre os sistemas.
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Abstract
STUDY DESIGN Prospective longitudinal study. OBJECTIVE To identify prognosis factors that allow us to identify patients with risk of developing chronic symptoms and disabilities after a whiplash injury. SUMMARY OF BACKGROUND DATA The prognosis factors for poor recovery in acute whiplash are not conclusive. METHODS We included 557 patients who suffered whiplash injury after road traffic accident and visited the Department of Physical Medicine and Rehabilitation of Mataró Hospital (Spain) for medical evaluation and rehabilitation treatment. The variables were collected following a protocol designed for the study, and all patients were assessed through the Visual Analogue Scale (VAS) for the intensity of neck pain, the Goldberg Depression and Anxiety Scale and the Northwick Park Neck Pain Questionnaire (NPH) for cervical column functionality at initial evaluation and 6 months later. RESULTS Factors related with VAS 6 months after the whiplash injury were women, age, number of days of cervical column immobilization, previous neck pain, self-employed workers, housewives, pensioners, students, presence of headache or dizziness, and VAS, Goldberg Depression and Anxiety scale, and NPH scores at initial evaluation. In multivaried analysis, it had been found that the variables that had influence on VAS 6 months after the whiplash injury were statistically significant for age, presence of dizziness, self-employed workers, and VAS and NPH scores at initial evaluation. CONCLUSION Our findings indicate that factors that allow us to identify patients at risk for poor recovery are age, dizziness, and initial evaluation of neck pain with VAS and cervical column functionality with NPH.
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Woodhouse A, Stavdahl Ø, Vasseljen O. Irregular head movement patterns in whiplash patients during a trajectory task. Exp Brain Res 2009; 201:261-70. [DOI: 10.1007/s00221-009-2033-9] [Citation(s) in RCA: 37] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2009] [Accepted: 09/23/2009] [Indexed: 01/21/2023]
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83
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The clinical presentation of chronic whiplash and the relationship to findings of MRI fatty infiltrates in the cervical extensor musculature: a preliminary investigation. 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 2009; 18:1371-8. [PMID: 19672633 DOI: 10.1007/s00586-009-1130-6] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/01/2009] [Revised: 06/08/2009] [Accepted: 07/30/2009] [Indexed: 10/20/2022]
Abstract
The objective was to determine whether any measurable changes in sensory responses, kinesthetic sense, cervical motion, and psychological features were related to established fatty infiltration values in the cervical extensor musculature in subjects with persistent whiplash. It is unknown if fatty infiltrate is related to any signs or symptoms. Data on motor function, Quantitative Sensory Testing, psychological and general well-being, and pain and disability were collected from 79 female subjects with chronic whiplash. Total fat values were created for all subjects by averaging the muscle fat indices by muscle, level, and side from our MRI dataset of all the cervical extensor muscles. Results of this study indicate the presence of altered physical, kinesthetic, sensory, and psychological features in this cohort of patients with chronic whiplash. Combined factors of sensory, physical, kinesthetic, and psychological features all contributed to a small extent in explaining the varying levels of fatty infiltrate, with cold pain thresholds having the most influence (r (2) = 0.28; P = 0.02). Identifying and relating quantifiable muscular alterations to clinical measures in the chronic state, underpin some clinical hypotheses for possible pathophysiological processes in this group with a chronic and recalcitrant whiplash disorder. Future research investigations aimed at accurate identification, sub-classification, prediction, and management of patients with acute and chronic whiplash is warranted and underway.
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84
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Strimpakos N. The assessment of the cervical spine. Part 1: Range of motion and proprioception. J Bodyw Mov Ther 2009; 15:114-24. [PMID: 21147427 DOI: 10.1016/j.jbmt.2009.06.003] [Citation(s) in RCA: 53] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2009] [Revised: 05/29/2009] [Accepted: 06/05/2009] [Indexed: 02/02/2023]
Abstract
Neck pain and headache of cervical origin are complaints affecting an increasing number of the general population. Mechanical factors such as sustained neck postures or movements and long-term "abnormal" physiologic loads on the neck are believed to affect the cervical structures and compromise neck function. A comprehensive assessment of neck function requires evaluation of its physical parameters such as range of motion, proprioception, strength and endurance/fatigue. The complicated structure of the cervical spine however, makes it difficult for any clinician to obtain reliable and valid results. The aim of the first part of this systematic critical review is to identify the factors influencing the assessment of range of motion and proprioception of the cervical spine.
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Affiliation(s)
- Nikolaos Strimpakos
- Department of Physiotherapy, TEI Lamias, 3rd Km Old National Road Lamia-Athens, Lamia 35100, Greece.
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85
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Palmgren PJ, Andreasson D, Eriksson M, Hägglund A. Cervicocephalic kinesthetic sensibility and postural balance in patients with nontraumatic chronic neck pain--a pilot study. CHIROPRACTIC & OSTEOPATHY 2009; 17:6. [PMID: 19566929 PMCID: PMC2715410 DOI: 10.1186/1746-1340-17-6] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/15/2008] [Accepted: 06/30/2009] [Indexed: 11/17/2022]
Abstract
Background Although cervical pain is widespread, most victims are only mildly and occasionally affected. A minority, however, suffer chronic pain and/or functional impairments. Although there is abundant literature regarding nontraumatic neck pain, little focuses on diagnostic criteria. During the last decade, research on neck pain has been designed to evaluate underlying pathophysiological mechanisms, without noteworthy success. Independent researchers have investigated postural balance and cervicocephalic kinesthetic sensibility among patients with chronic neck pain, and have (in most cases) concluded the source of the problem is a reduced ability in the neck's proprioceptive system. Here, we investigated cervicocephalic kinesthetic sensibility and postural balance among patients with nontraumatic chronic neck pain. Methods Ours was a two-group, observational pilot study of patients with complaints of continuous neck pain during the 3 months prior to recruitment. Thirteen patients with chronic neck pain of nontraumatic origin were recruited from an institutional outpatient clinic. Sixteen healthy persons were recruited as a control group. Cervicocephalic kinesthetic sensibility was assessed by exploring head repositioning accuracy and postural balance was measured with computerized static posturography. Results Parameters of cervicocephalic kinesthetic sensibility were not reduced. However, in one of six test movements (flexion), global repositioning errors were significantly larger in the experimental group than in the control group (p < .05). Measurements did not demonstrate any general impaired postural balance, and varied substantially among participants in both groups. Conclusion In patients with nontraumatic chronic neck pain, we found statistically significant global repositioning errors in only one of six test movements. In this cohort, we found no evidence of impaired postural balance. Head repositioning accuracy and computerized static posturography are imperfect measures of functional proprioceptive impairments. Validity of (and procedures for using) these instruments demand further investigation. Trial registration Current Controlled Trials ISRCTN96873990
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Affiliation(s)
- Per J Palmgren
- Department of Research, Scandinavian College of Chiropractic, Solna, Sweden.
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86
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Sensorimotor function and dizziness in neck pain: implications for assessment and management. J Orthop Sports Phys Ther 2009; 39:364-77. [PMID: 19411769 DOI: 10.2519/jospt.2009.2834] [Citation(s) in RCA: 200] [Impact Index Per Article: 13.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
SYNOPSIS The term sensorimotor describes all the afferent, efferent, and central integration and processing components involved in maintaining stability in the postural control system through intrinsic motor-control properties. The scope of this paper is to highlight the sensorimotor deficits that can arise from altered cervical afferent input. From a clinical orthopaedic perspective, the peripheral mechanoreceptors are the most important in functional joint stability; but in the cervical region they are also important for postural stability, as well as head and eye movement control. Consequently, conventional musculoskeletal intervention approaches may be sufficient only for patients with neck pain and minimal sensorimotor proprioceptive disturbances. Clinical experience and research indicates that significant sensorimotor cervical proprioceptive disturbances might be an important factor in the maintenance, recurrence, or progression of various symptoms in some patients with neck pain. In these cases, more specific and novel treatment methods are needed which progressively address neck position and movement sense, as well as cervicogenic oculomotor disturbances, postural stability, and cervicogenic dizziness. In this commentary we review the most relevant theoretical and practical knowledge on this matter and implications for clinical assessment and management, and we propose future directions for research. LEVEL OF EVIDENCE Level 5.
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Röijezon U, Björklund M, Bergenheim M, Djupsjöbacka M. A novel method for neck coordination exercise--a pilot study on persons with chronic non-specific neck pain. J Neuroeng Rehabil 2008; 5:36. [PMID: 19105826 PMCID: PMC2625342 DOI: 10.1186/1743-0003-5-36] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2008] [Accepted: 12/23/2008] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Chronic neck pain is a common problem and is often associated with changes in sensorimotor functions, such as reduced proprioceptive acuity of the neck, altered coordination of the cervical muscles, and increased postural sway. In line with these findings there are studies supporting the efficacy of exercises targeting different aspects of sensorimotor function, for example training aimed at improving proprioception and muscle coordination. To further develop this type of exercises we have designed a novel device and method for neck coordination training. The aim of the study was to investigate the clinical applicability of the method and to obtain indications of preliminary effects on sensorimotor functions, symptoms and self-rated characteristics in non-specific chronic neck pain METHODS The study was designed as an uncontrolled clinical trial including fourteen subjects with chronic non-specific neck pain. A new device was designed to allow for an open skills task with adjustable difficulty. With visual feedback, subjects had to control the movement of a metal ball on a flat surface with a rim strapped on the subjects' head. Eight training sessions were performed over a four week period. Skill acquisition was measured throughout the intervention period. After intervention subjects were interviewed about their experience of the exercise and pain and sensorimotor functions, including the fast and slow components of postural sway and jerkiness-, range-, position sense-, movement time- and velocity of cervical rotation, were measured. At six-month follow up, self-rated pain, health and functioning was collected. RESULTS The subjects improved their skill to perform the exercise and were overall positive to the method. No residual negative side-effects due to the exercise were reported. After intervention the fast component of postural sway (p = 0.019) and jerkiness of cervical rotation (p = 0.032) were reduced. The follow up showed decreased disability (one out of three indices) and fear of movement, and increased general health (three out of eight dimensions). CONCLUSION The results support the clinical applicability of the method. The improvements in sensorimotor functions may suggest transfer from the exercise to other, non-task specific motor functions and justifies a future randomized controlled trial.
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Affiliation(s)
- Ulrik Röijezon
- Centre for Musculoskeletal Research, University of Gävle, Gävle, Sweden.
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Lafond D, Champagne A, Cadieux R, Descarreaux M. Rehabilitation program for traumatic chronic cervical pain associated with unsteadiness: a single case study. CHIROPRACTIC & OSTEOPATHY 2008; 16:15. [PMID: 19014706 PMCID: PMC2600629 DOI: 10.1186/1746-1340-16-15] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/25/2008] [Accepted: 11/17/2008] [Indexed: 11/13/2022]
Abstract
BACKGROUND Neck problems are often recurring or chronic. After pain, unsteadiness and balance problems are among the most frequent symptoms reported by chronic neck pain (CNP) patients. Altered sensorimotor control of the cervical spine and sensorimotor integration problems affecting postural control have been observed in CNP patients. Very few data are available regarding the post-intervention effects of rehabilitation programs on postural control in CNP. CASE PRESENTATION This is a case study of a traumatic CNP patient (a 45-year old female) with postural unsteadiness who participated in an 8-week rehabilitation program combining therapeutic exercises with spinal manipulative therapy. Pre-intervention data revealed that the postural control system was challenged when postural control sensory inputs were altered, particularly during the head-extended-backward condition. Post-intervention centre of pressure measurements indicated a drastic reduction in postural sway during trials with changes in neck orientation. CONCLUSION This case report indicates that an 8-week rehabilitation program combining therapeutic exercises with spinal manipulative therapy may have had an effect on improvement of postural control in a trauma CNP patient with unsteadiness. These results warrant further studies to investigate the relationships between pain amelioration, sensorimotor control of the cervical spine, muscle fitness and postural steadiness.
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Affiliation(s)
- Danik Lafond
- Département des sciences de l'activité physique, Université du Québec à Trois-Rivières, Trois-Rivières, Quebec, Canada
| | - Annick Champagne
- Département des sciences de l'activité physique, Université du Québec à Trois-Rivières, Trois-Rivières, Quebec, Canada
| | - Rosalie Cadieux
- Département des sciences de l'activité physique, Université du Québec à Trois-Rivières, Trois-Rivières, Quebec, Canada
| | - Martin Descarreaux
- Département de chiropratique, Université du Québec à Trois-Rivières, Trois-Rivières, Quebec, Canada
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Sterling M, Kenardy J. Physical and psychological aspects of whiplash: Important considerations for primary care assessment. ACTA ACUST UNITED AC 2008; 13:93-102. [DOI: 10.1016/j.math.2007.11.003] [Citation(s) in RCA: 37] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2007] [Accepted: 11/16/2007] [Indexed: 01/22/2023]
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