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Wu SK, Kuo LC, Lan HCH, Tsai SW, Su FC. Segmental Percentage Contributions of Cervical Spine During Different Motion Ranges of Flexion and Extension. ACTA ACUST UNITED AC 2010; 23:278-84. [DOI: 10.1097/bsd.0b013e3181a98d26] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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202
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Relating a manual medicine diagnostic test of cervical motion function to specific three-dimensional kinematic variables. INT J OSTEOPATH MED 2010. [DOI: 10.1016/j.ijosm.2010.01.005] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
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Abstract
Chronic pain can be a frustrating condition for patient and clinician. The integrative medicine approach to pain can offer hope, adding safe complementary and alternative medical (CAM) therapies to mitigate pain and suffering. Such CAM therapies include nutrition, supplements and herbs, manual medicine, acupuncture, yoga, and mind-body approaches. The evidence is heterogeneous regarding these approaches, but some evidence suggests efficacy and confirms safety. The integrative medicine approach can be beneficial in a patient with chronic pain.
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Butler HL, Lariviere C, Hubley-Kozey CL, Sullivan MJL. Directed attention alters the temporal activation patterns of back extensors during trunk flexion-extension in individuals with chronic low back pain. 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 2010; 19:1508-16. [PMID: 20473625 DOI: 10.1007/s00586-010-1403-0] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/29/2009] [Revised: 02/08/2010] [Accepted: 04/04/2010] [Indexed: 12/25/2022]
Abstract
In chronic low back pain patients (CLBP), neuromuscular and pain intensity have been identified as contributing factors in the disability of the individual. However, it is unclear whether pain intensity influences neuromuscular activation and if directed attention mediates this relationship. Thus, the purpose of this study was to determine the effect of directed attention in individuals with different pain intensities on back extensor activation profiles. Fifty-four CLBP patients were separated into either high- or low-pain groups. Surface electromyograms were recorded from back muscles while the subjects performed a trunk flexion motion for four different attention conditions. Pattern recognition and repeated measures ANOVAs were used to examine the effect of sex, attention and pain intensity on temporal muscle activation patterns. The results showed that there was a significant sex x attention x pain interaction. The largest changes in muscle timing were observed in the low-pain group when their attention was focused on their pain, but the pattern of muscle activation differed between sexes. For males, a rapid decline in activation at mid-extension occurred, whereas females showed delayed activation at the beginning of extension. Overall, this study demonstrated that directed attention on pain had an effect on trunk muscle temporal recruitment, and that this relationship differed between sexes and pain groups. This suggests that sex-specific mechanisms may alter the neuromuscular control of the spine in CLBP patients for different pain levels.
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Affiliation(s)
- Heather L Butler
- Department of Psychology, McGill University, 1205 Dr Penfield, Montreal, QC, Canada.
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A Double-Blind, Controlled, Randomized Trial to Evaluate the Efficacy of Botulinum Toxin for the Treatment of Lumbar Myofascial Pain in Humans. Reg Anesth Pain Med 2010; 35:255-60. [DOI: 10.1097/aap.0b013e3181d23241] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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206
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Hoskins W, Pollard H. The effect of a sports chiropractic manual therapy intervention on the prevention of back pain, hamstring and lower limb injuries in semi-elite Australian Rules footballers: a randomized controlled trial. BMC Musculoskelet Disord 2010; 11:64. [PMID: 20374662 PMCID: PMC2858097 DOI: 10.1186/1471-2474-11-64] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/27/2009] [Accepted: 04/08/2010] [Indexed: 01/02/2023] Open
Abstract
Background Hamstring injuries are the most common injury in Australian Rules football. It was the aims to investigate whether a sports chiropractic manual therapy intervention protocol provided in addition to the current best practice management could prevent the occurrence of and weeks missed due to hamstring and other lower-limb injuries at the semi-elite level of Australian football. Methods Sixty male subjects were assessed for eligibility with 59 meeting entry requirements and randomly allocated to an intervention (n = 29) or control group (n = 30), being matched for age and hamstring injury history. Twenty-eight intervention and 29 control group participants completed the trial. Both groups received the current best practice medical and sports science management, which acted as the control. Additionally, the intervention group received a sports chiropractic intervention. Treatment for the intervention group was individually determined and could involve manipulation/mobilization and/or soft tissue therapies to the spine and extremity. Minimum scheduling was: 1 treatment per week for 6 weeks, 1 treatment per fortnight for 3 months, 1 treatment per month for the remainder of the season (3 months). The main outcome measure was an injury surveillance with a missed match injury definition. Results After 24 matches there was no statistical significant difference between the groups for the incidence of hamstring injury (OR:0.116, 95% CI:0.013-1.019, p = 0.051) and primary non-contact knee injury (OR:0.116, 95% CI:0.013-1.019, p = 0.051). The difference for primary lower-limb muscle strains was significant (OR:0.097, 95%CI:0.011-0.839, p = 0.025). There was no significant difference for weeks missed due to hamstring injury (4 v14, χ2:1.12, p = 0.29) and lower-limb muscle strains (4 v 21, χ2:2.66, p = 0.10). A significant difference in weeks missed due to non-contact knee injury was noted (1 v 24, χ2:6.70, p = 0.01). Conclusions This study demonstrated a trend towards lower limb injury prevention with a significant reduction in primary lower limb muscle strains and weeks missed due to non-contact knee injuries through the addition of a sports chiropractic intervention to the current best practice management. Trial registration The study was registered with the Australian and New Zealand Clinical Trials Registry (ACTRN12608000533392).
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Affiliation(s)
- Wayne Hoskins
- Macquarie Injury Management Group, Department of Chiropractic, Faculty of Science, Macquarie University, NSW 2109, Australia.
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Decrease in postural sway and trunk stiffness during cognitive dual-task in nonspecific chronic low back pain patients, performance compared to healthy control subjects. Spine (Phila Pa 1976) 2010; 35:583-9. [PMID: 20147880 DOI: 10.1097/brs.0b013e3181b4fe4d] [Citation(s) in RCA: 39] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
STUDY DESIGN A 2-group experimental design. OBJECTIVE To investigate the effect of a cognitive dual-task on postural sway of pelvis and trunk during unstable sitting in nonspecific chronic patients with low back pain (CLBP) compared to healthy control subjects. SUMMARY OF BACKGROUND DATA Higher cognitive systems as well as sensory processes contribute to postural control. An increase in postural sway due to a cognitive dual task could mean more need of cognitive systems to control balance. METHODS A total of 21 CLBP patients and 21 control subjects were included based on detailed clinical criteria. Every subject was submitted to 2 postural control tests in an unstable sitting position (easy test position: 2 feet on the ground and difficult test position: 1 foot lifted). Both tests were performed with and without cognitive dual-task. A 3-dimensional motion analysis system was used measure angular displacement of trunk and pelvis in the 3 cardinal planes. RESULTS In the most difficult balance position, postural sway increases in the control group when the cognitive dual-task is added, for 50% of the variables the increase is significant (P between 0.02 and 0.05). On the contrary, postural sway decreases, not significantly, in the CLBP group when the dual-task is added. These findings are the same for trunk as for pelvis deviations. The Pearson correlation coefficient between trunk and pelvis movement from the CLBP group are lower for all 3 movement directions in the dual-task condition (r between 0.441 and 0.988) compared to the single task condition (r between 0.982 and 0.995). CONCLUSION In nonspecific CLBP patients, a cognitive dual-task reduces both postural sway and trunk stiffness due to the distracting effect of the dual-task. This effect is only visible when the balance task is difficult.
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Larivière C, Forget R, Vadeboncoeur R, Bilodeau M, Mecheri H. The effect of sex and chronic low back pain on back muscle reflex responses. Eur J Appl Physiol 2010; 109:577-90. [PMID: 20174929 DOI: 10.1007/s00421-010-1389-7] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/31/2010] [Indexed: 11/28/2022]
Abstract
Different back muscle reflex assessment protocols have shown abnormally longer reflex latency responses of back muscles in chronic low back pain (CLBP). However, many confounding variables are difficult to control, such as the load magnitude and the preactivation of trunk muscles. The aims of this study were to evaluate, in 30 subjects with CLBP and 30 healthy controls, the activation levels of back muscles during pre-loading and their reflex responses to sudden loading. After subjected to six practice perturbations, 20 sudden and unexpected forward perturbations of the trunk were applied in 30 CLBP subjects (14 women) and 31 controls (17 women), while attempting to minimize the confounding effect of preactivation level and perturbation amplitude. Reflex latency and amplitudes were computed from the surface EMG signals of four back muscles (bilaterally at L5, L3, L1, T10 vertebral levels). EMG was also collected from abdominal muscles. Subjects with CLBP significantly increased the preactivation of back muscles (abdominal preactivation the same) relative to controls while no sex effect was observed. While adjusting statistically for these differences, reflex amplitude was significantly higher in subjects with CLBP and men, compared to healthy controls and women, respectively. Interestingly, contrary to most of the literature available, no between-group effects were detected for reflex latency, which could potentially be explained by an appropriate control of confounding variables, but this remains to be clarified in future research.
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Affiliation(s)
- Christian Larivière
- Institut de recherche Robert-Sauvé en santé et en sécurité du travail (IRSST), 505, boul. De Maisonneuve Ouest, Montreal, QC, H3A 3C2, Canada.
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210
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Heydari A, Nargol AVF, Jones APC, Humphrey AR, Greenough CG. EMG analysis of lumbar paraspinal muscles as a predictor of the risk of low-back pain. 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 2010; 19:1145-52. [PMID: 20127260 DOI: 10.1007/s00586-010-1277-1] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/16/2008] [Revised: 07/20/2009] [Accepted: 01/10/2010] [Indexed: 11/28/2022]
Abstract
Studies of EMG power spectra have established associations between low-back pain (LBP) and median frequency (MF). This 2-year prospective study investigates the association of LBP with EMG variables over time. 120 health care workers underwent paraspinal EMG measurements and assessment of back pain disability. The EMG recordings were performed under isometric trunk extension at 2/3 maximum voluntary contraction and acquired from erector spinae muscles at the level of L4/L5. 108 (90%) subjects were reviewed at a minimum 2-year follow up. 16 out of 93 subjects with no history of chronic low-back pain became worse as measured by time off work, disability, reported pain and self-assessment rating. The value of the EMG variable half-width at inception demonstrated significant association with changes in subject's outcome measure and their own assessment of their LBP at follow up (p < 0.05). Based on self-assessment data, subjects with no history of chronic LBP with half-width of greater than 56 Hz were at threefold greater risk of developing back pain compared with the remainder of the population (p = 0.045). The value of the initial median frequency (IMF) and MF slope at inception were also associated with the subjects' own assessment of LBP at follow up. Subjects with an IMF greater than 49 Hz were at 5.8-fold greater risk of developing back pain compared with the remainder of the population (p = 0.014). EMG variables recorded from lumbar paraspinal muscles can identify a sub group of subjects at increased risk of developing low-back pain in the future.
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Affiliation(s)
- Abbas Heydari
- The Teesside Spine Centre, The James Cook University Hospital, Marton Road, Middlesbrough, TS4 3BW, UK.
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211
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Dumas GA, Leger A, Plamondon A, Charpentier KM, Pinti A, McGrath M. Fatigability of back extensor muscles and low back pain during pregnancy. Clin Biomech (Bristol, Avon) 2010; 25:1-5. [PMID: 19857916 DOI: 10.1016/j.clinbiomech.2009.09.011] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/14/2008] [Revised: 09/30/2009] [Accepted: 09/30/2009] [Indexed: 02/07/2023]
Abstract
BACKGROUND Back pain is the most frequently reported musculo-skeletal problem during pregnancy. High muscle fatigability has been associated with back pain in the general population. During pregnancy, the gradual increase in loads may have a training effect, increasing strength and endurance of back muscles. This adaptation however may be too slow, or insufficient to be significant in light of other changes during pregnancy. METHODS Thirty-two pregnant women performed a fatigue test which consisted of maintaining a fixed load of 70 Nm for 60 s while the surface EMG of the longissimus lumborum and multifidus muscles were recorded bilaterally at 14, 24 and 34 weeks of pregnancy. The measure of fatigability was the highest absolute slope of the median frequency of the power spectrum of the EMG of the four muscles. Occurrence and severity of back pain were reported on questionnaires at 14, 19, 24, 29 and 34 weeks. Binomial logistic regressions between back pain occurrence and the median frequency slopes were calculated. FINDINGS None of the five logistic analyses demonstrated an improvement of the one-predictor model over the constant-only model, which indicates that the degree of fatigability of back extensor muscles did not predict the occurrence of back pain in our sample. INTERPRETATION Fatigability of back extensor muscles was not found to be a predictor of back pain during pregnancy. This result should be taken with caution due to the small number of participants and broad definition of back pain used, and should be confirmed by studies with a larger number of participants.
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Affiliation(s)
- Geneviève A Dumas
- Department of Mechanical and Materials Engineering, Queen's University, Kingston, Ontario, Canada.
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Ivancic PC, Sha D. Comparison of the whiplash injury criteria. ACCIDENT; ANALYSIS AND PREVENTION 2010; 42:56-63. [PMID: 19887145 DOI: 10.1016/j.aap.2009.07.001] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/08/2009] [Revised: 06/16/2009] [Accepted: 07/06/2009] [Indexed: 05/28/2023]
Abstract
Whiplash injury criteria are based upon the hypothesis that neck injuries are caused by excessive loads, displacements, or head/T1 relative acceleration and velocity. The objectives of this study were to evaluate and compare the whiplash injury criteria (IV-NIC, NIC, Nkm, Nij, and NDC) during simulated rear impacts of a new Human Model of the Neck (HUMON) with and without an active head restraint (AHR). HUMON consisted of a neck specimen mounted to the torso of BioRID II and carrying an anthropometric head stabilized with muscle force replication. HUMON was seated and secured in a Kia Sedona seat with AHR on a sled. Rear impacts (7.1 and 11.1g) were simulated with the AHR in five different positions followed by an impact with no HR. Statistical differences (P < 0.05) were determined in the peak NIC and NDC due to the AHR, as compared to no HR, and in the peak IV-NIC relative to physiologic limits. Linear regression analyses identified correlation between IV-NIC and NIC, Nkm, Nij, and NDC (R(2) > or = 0.35 and P < 0.001). The AHR caused significant decreases in peak NIC and NDC as compared to no HR. The IV-NIC identified significantly increased motion above the physiologic limit at the middle and lower cervical spine with and without the AHR. Correlation was observed between IV-NIC and NIC, Nkm, Nij, and NDC. Extrapolation using the present correlations and the IV-NIC injury thresholds suggests neck injuries may occur at peak NIC of 14.4m(2)/s(2), Nkm of 0.33, or Nij of 0.09. Nonphysiologic spinal rotation at one or more spinal levels may occur even if head/T1 motions are small.
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Affiliation(s)
- Paul C Ivancic
- Biomechanics Research Laboratory, Department of Orthopaedics and Rehabilitation, Yale University School of Medicine, 333 Cedar Street, P.O. Box 208071, New Haven, CT 06520-8071, USA.
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Changes in paraspinal muscles and their association with low back pain and spinal degeneration: CT study. EUROPEAN SPINE JOURNAL : OFFICIAL PUBLICATION OF THE EUROPEAN SPINE SOCIETY, THE EUROPEAN SPINAL DEFORMITY SOCIETY, AND THE EUROPEAN SECTION OF THE CERVICAL SPINE RESEARCH SOCIETY 2009; 19:1136-44. [PMID: 20033739 DOI: 10.1007/s00586-009-1257-5] [Citation(s) in RCA: 153] [Impact Index Per Article: 10.2] [Reference Citation Analysis] [Abstract] [Subscribe] [Scholar Register] [Received: 05/26/2009] [Revised: 10/17/2009] [Accepted: 12/10/2009] [Indexed: 01/01/2023]
Abstract
The objectives of the study were to evaluate the association between lumbar paraspinal muscle density, evaluated on computed tomography (CT) and age, sex and BMI; and to evaluate the association of those changes with low back pain (LBP) and spinal degeneration features in a community-based sample. This study was an ancillary project to the Framingham Study. A sample of 3,529 participants aged 40-80 years had a CT scan performed to assess aortic calcification. 187 individuals were randomly enrolled in this study. LBP in the last 12 months was evaluated using self-report questionnaire. Density (in Hounsfield units) of multifidus and erector spinae was evaluated on CT. The prevalence of intervertebral disc narrowing, facet joint osteoarthritis (FJOA), spondylolysis, spondylolisthesis and spinal stenosis were also evaluated. We used linear regression models to examine the association of paraspinal muscles density with age, sex, BMI, LBP, and spinal degeneration features. The results show that in our study, men have higher density of paraspinal muscles than women, younger individuals have higher density than older ones and individuals with lower weight have higher muscle density than overweight. No differences between individuals with and without LBP were found. Significant association was found between L4 multifidus/erector spinae density and FJOA at L4-L5; between multifidus at L4 and spondylolisthesis at L4-5; and between erector spinae at L4 and L5 with disc narrowing at L4-5 and L5-S1, respectively. We conclude that the paraspinal muscle density decreases with age, and increases BMI. It is associated with at some levels FJOA, spondylolisthesis and disc narrowing at the same level, but not associated with occurrence of LBP.
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214
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Lumbar segmental mobility according to the grade of the disc, the facet joint, the muscle, and the ligament pathology by using kinetic magnetic resonance imaging. Spine (Phila Pa 1976) 2009; 34:2537-44. [PMID: 19841613 DOI: 10.1097/brs.0b013e3181b353ea] [Citation(s) in RCA: 67] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
STUDY DESIGN The kinematic study of human lumbar spinal movements. OBJECTIVE To investigate how disc degeneration and the degeneration of facet joint, ligaments, and paraspinal muscles are associated with lumbar segmental mobility. SUMMARY OF BACKGROUND DATA Previous studies revealed relationship between spinal motion and osteoarthritic changes of facet joint as well as disc degeneration; however, little is known about the association of disc, facet joint, ligament, and muscle degeneration with lumbar segmental motion characteristics. METHODS The 1580 lumbar motion segments from 316 patients (200 male, 116 female) underwent Kinetic magnetic resonance imaging, which were used to assess disc degeneration (grade I-V) and facet joint degeneration (grade 1-4), interspinous ligament (ISL) degeneration (grade 1-4), ligamentum flavum hypertrophy (LFH), and fatty degeneration of muscles. Segmental translational and angular motion in the flexion, extension, and neutral postures were digitally automatically measured by MR analyzer. RESULTS Grade II (46.77%) disc, grade 1 (48.35%) facet joint degeneration, and grade 1 (64.1%) ISL were most common. LFH was most common in L4-L5 (49/330, 14.8%). In younger age (<35), grade I disc and grade 1 facet joint were predominant compared with the older age (35< or = and <45) in which grade III, IV, and V disc and grade 2 facet joint were predominant (P < 0.05). Translational motion increased significantly in high grade of disc and facet joint (except grade V disc and grade 4 facet joint) and with LFH in L1-L5 (P < 0.05). Angular motion significantly decreased in grade V disc, grade 4 ISL, and without LFH in L1-L5 (P < 0.05). According to muscle fatty degeneration, translational and angular motions were not significantly changed. CONCLUSION Our results support that facet joint degeneration is followed by disc degeneration according to age. Increased translational movements of the lumbar segments occurred in severe disc degeneration accompanied by facet joint degeneration or the presence of LFH even if the movements were stabilized in the advanced status. Therefore, the current status of the intervertebral discs, facet joints, and ligamentum flavum should be taken into consideration when evaluating stability within the lumbar spine.
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Murphy DR, Hurwitz EL, McGovern EE. Outcome of Pregnancy-Related Lumbopelvic Pain Treated According to a Diagnosis-Based Decision Rule: A Prospective Observational Cohort Study. J Manipulative Physiol Ther 2009; 32:616-24. [DOI: 10.1016/j.jmpt.2009.09.002] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2008] [Revised: 02/20/2009] [Accepted: 04/06/2009] [Indexed: 11/25/2022]
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Functional cervical MRI within the scope of whiplash injuries: presentation of a new motion device for the cervical spine. Surg Radiol Anat 2009; 32:181-8. [DOI: 10.1007/s00276-009-0557-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2009] [Accepted: 08/31/2009] [Indexed: 11/26/2022]
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217
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Offering proper feedback to control for out-of-plane lumbar moments influences the activity of trunk muscles during unidirectional isometric trunk exertions. J Biomech 2009; 42:1498-1505. [DOI: 10.1016/j.jbiomech.2009.03.045] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2008] [Revised: 03/16/2009] [Accepted: 03/24/2009] [Indexed: 11/18/2022]
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218
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Effectiveness of the physical therapy Godelive Denys-Struyf method for nonspecific low back pain: primary care randomized control trial. Spine (Phila Pa 1976) 2009; 34:1529-38. [PMID: 19564761 DOI: 10.1097/brs.0b013e3181aa2771] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
STUDY DESIGN A simple blind, random controlled clinical trial. OBJECTIVE To assess the effectiveness of physiotherapy treatment based on the muscular and articular chains Godelive Denys-Struyf (GDS) method for nonspecific low back pain (LBP) in primary care. SUMMARY OF BACKGROUND DATA Despite a systematic review by the European COST ACTION B13 "Low back pain: guidelines for its management," there are still many unresolved questions regarding the effectiveness of the different physical therapy treatments used for LBP. SETTING 21 physicians and physiotherapists in 7 Primary Care Centers and 6 researches in the Complutense University of Madrid (Spain). PARTICIPANTS 137 patients diagnosed with nonspecific LBP. METHODS The control group underwent 15 sessions of conventional physiotherapy in Primary Care Centers, and the experimental group received 15 GDS treatment sessions. Pain was evaluated by Visual Analogical Scale (VAS), functional disability by Oswestry questionnaire, and quality of life by the physical and mental components of SF-36 questionnaire. Outcome measures were assessed before treatment (A1), at the end of treatment (A2), and at 3 months (A3), and 6 months (A4) of follow-up. RESULTS Repeated measures analysis of variance revealed that at the end of treatment and 3 months later, subjects in both groups showed less pain, reduced functional disability, and an improved quality of life, though improvements were greater in the GDS group.Six months after treatment, patients in the GDS group continued to show reduced pain (VAS(A4-A1) = -3.54, 95% CI: -4.18 to -2.90) while VAS scores in the control group returned to initial values (VAS(A4-A1) = 0.15, 95% CI: -0.36 to 0.67). CONCLUSION Treatment of nonspecific LBP using the GDS method provides greater improvements in the midterm (6 months) in terms of the pain, functional ability, and quality of life perceived by patients than the conventional treatment based administered in primary care.
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219
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Silfies SP, Mehta R, Smith SS, Karduna AR. Differences in Feedforward Trunk Muscle Activity in Subgroups of Patients With Mechanical Low Back Pain. Arch Phys Med Rehabil 2009; 90:1159-69. [PMID: 19501348 DOI: 10.1016/j.apmr.2008.10.033] [Citation(s) in RCA: 86] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2008] [Revised: 09/28/2008] [Accepted: 10/01/2008] [Indexed: 01/22/2023]
Affiliation(s)
- Sheri P Silfies
- Rehabilitation Sciences Research Laboratory, Drexel University, Philadelphia, PA 19102-1192, USA.
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220
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Tidstrand J, Horneij E. Inter-rater reliability of three standardized functional tests in patients with low back pain. BMC Musculoskelet Disord 2009; 10:58. [PMID: 19490644 PMCID: PMC2696417 DOI: 10.1186/1471-2474-10-58] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/14/2008] [Accepted: 06/02/2009] [Indexed: 11/10/2022] Open
Abstract
Background Of all patients with low back pain, 85% are diagnosed as "non-specific lumbar pain". Lumbar instability has been described as one specific diagnosis which several authors have described as delayed muscular responses, impaired postural control as well as impaired muscular coordination among these patients. This has mostly been measured and evaluated in a laboratory setting. There are few standardized and evaluated functional tests, examining functional muscular coordination which are also applicable in the non-laboratory setting. In ordinary clinical work, tests of functional muscular coordination should be easy to apply. The aim of this present study was to therefore standardize and examine the inter-rater reliability of three functional tests of muscular functional coordination of the lumbar spine in patients with low back pain. Methods Nineteen consecutive individuals, ten men and nine women were included. (Mean age 42 years, SD ± 12 yrs). Two independent examiners assessed three tests: "single limb stance", "sitting on a Bobath ball with one leg lifted" and "unilateral pelvic lift" on the same occasion. The standardization procedure took altered positions of the spine or pelvis and compensatory movements of the free extremities into account. The inter-rater reliability was analyzed by Cohen's kappa coefficient (κ) and by percentage agreement. Results The inter-rater reliability for the right and the left leg respectively was: for the single limb stance very good (κ: 0.88–1.0), for sitting on a Bobath ball good (κ: 0.79) and very good (κ: 0.88) and for the unilateral pelvic lift: good (κ: 0.61) and moderate (κ: 0.47). Conclusion The present study showed good to very good inter-rater reliability for two standardized tests, that is, the single-limb stance and sitting on a Bobath-ball with one leg lifted. Inter-rater reliability for the unilateral pelvic lift test was moderate to good. Validation of the tests in their ability to evaluate lumbar stability is required.
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Affiliation(s)
- Johan Tidstrand
- Department of Health Sciences, Division of Physiotherapy, Lund University, Lund, Sweden.
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221
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Bazrgari B, Shirazi-Adl A, Parnianpour M. Transient analysis of trunk response in sudden release loading using kinematics-driven finite element model. Clin Biomech (Bristol, Avon) 2009; 24:341-7. [PMID: 19285367 DOI: 10.1016/j.clinbiomech.2009.02.002] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/27/2008] [Revised: 01/13/2009] [Accepted: 02/10/2009] [Indexed: 02/07/2023]
Abstract
BACKGROUND Sudden trunk perturbations occur in various occupational and sport activities. Despite numerous measurement studies, no comprehensive modeling simulations have yet been attempted to investigate trunk biodynamics under sudden loading/unloading. METHODS Dynamic kinematics-driven approach was used to evaluate the temporal variation of trunk muscle forces, internal loads and stability before and after a sudden release of a posterior horizontal load. Measured post-disturbance trunk kinematics, as input, and muscle electromyography (EMG) activities, for qualitative validation, were considered. FINDINGS Computed agonist and antagonist muscle forces before and after release agreed well with reported EMG activities and demonstrated basic response characteristics such as activation latency and reflex activation. The trunk was found quite stable before release and in early post-release period. Larger applied load substantially increased trunk kinematics, muscle forces and spinal loads. INTERPRETATION Excessive spinal loads due to large muscle forces in sudden loading conditions is a risk factor as the central nervous system attempts to reflexively control the sudden disturbances, a situation that further deteriorates under larger perturbations and longer latency periods. Predictions indicate the potential of the kinematics-driven model in ergonomics as well as training and rehabilitation programs.
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Affiliation(s)
- B Bazrgari
- Department of Mechanical Engineering, Ecole Polytechnique, P.O. Box 6079, Station "Centre-ville", Montreal, Quebec H3C3A7, Canada
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222
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Siegmund GP, Winkelstein BA, Ivancic PC, Svensson MY, Vasavada A. The anatomy and biomechanics of acute and chronic whiplash injury. TRAFFIC INJURY PREVENTION 2009; 10:101-112. [PMID: 19333822 DOI: 10.1080/15389580802593269] [Citation(s) in RCA: 58] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
Abstract
Whiplash injury is the most common motor vehicle injury, yet it is also one of the most poorly understood. Here we examine the evidence supporting an organic basis for acute and chronic whiplash injuries and review the anatomical sites within the neck that are potentially injured during these collisions. For each proposed anatomical site--facet joints, spinal ligaments, intervertebral discs, vertebral arteries, dorsal root ganglia, and neck muscles--we present the clinical evidence supporting that injury site, its relevant anatomy, the mechanism of and tolerance to injury, and the future research needed to determine whether that site is responsible for some whiplash injuries. This article serves as a snapshot of the current state of whiplash biomechanics research and provides a roadmap for future research to better understand and ultimately prevent whiplash injuries.
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Affiliation(s)
- Gunter P Siegmund
- MEA Forensic Engineers & Scientists, 11-11151 Horseshoe Way, Richmond, BC, Canada.
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223
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Azar NR, Kallakuri S, Chen C, Lu Y, Cavanaugh JM. Strain and load thresholds for cervical muscle recruitment in response to quasi-static tensile stretch of the caprine C5-C6 facet joint capsule. J Electromyogr Kinesiol 2009; 19:e387-94. [PMID: 19223204 DOI: 10.1016/j.jelekin.2009.01.002] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2008] [Revised: 12/27/2008] [Accepted: 01/08/2009] [Indexed: 10/21/2022] Open
Abstract
The aim of this study was to investigate the response of cervical muscles to physiologic tensile stretch of cervical facet joint capsule (FJC) at a quasi-static displacement rate of 0.5mm/s. In vivo caprine left C5-C6 FJC preparations were subjected to an incremental tensile displacement paradigm. EMG activity was recorded during FJC stretch from the right trapezius (TR) and multifidus (MF) muscle groups at the C5 and C6 levels and bilaterally from the sternomastoid (SM) and longus colli (LC) muscle groups at the C5-C6 level. Onset of muscular activity was later analyzed using visual and computer-based methods. Capsule load and strain at the time of onset were recorded and compared between the muscle groups. Results indicated capsule load was a better indicator of the tensile stretch thresholds for muscular recruitment than capsule strain. MF responded at significantly smaller capsule loads than TR and LC, while TR and LC activation loads were not significantly different. SM did not respond to physiologic FJC stretch. Muscle group recruitment order reflected the muscles' fiber type compositions and functional roles in the spine. This study provides the first evidence that the cervical ligamento-muscular reflex pathways are activated via tensile FJC stretch and extend to superficial and deep musculature on the anterior and posterior aspects of the neck, ipsilateral and contralateral to the side of FJC stretch.
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Affiliation(s)
- Nadia R Azar
- Bioengineering Center, Wayne State University, Detroit, MI, USA.
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224
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Wagner H, Puta C, Anders C, Petrovitch A, Schilling N, Scholle H. Chronischer unspezifischer Rückenschmerz. MANUELLE MEDIZIN 2009. [DOI: 10.1007/s00337-009-0663-4] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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225
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Shum GL, Crosbie J, Lee RY. Energy Transfer Across the Lumbosacral and Lower-Extremity Joints in Patients With Low Back Pain During Sit-to-Stand. Arch Phys Med Rehabil 2009; 90:127-35. [DOI: 10.1016/j.apmr.2008.06.028] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2008] [Revised: 06/10/2008] [Accepted: 06/30/2008] [Indexed: 10/21/2022]
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Phillips FM, Tzermiadianos MN, Voronov LI, Havey RM, Carandang G, Renner SM, Rosler DM, Ochoa JA, Patwardhan AG. Effect of the Total Facet Arthroplasty System after complete laminectomy-facetectomy on the biomechanics of implanted and adjacent segments. Spine J 2009; 9:96-102. [PMID: 18440280 DOI: 10.1016/j.spinee.2008.01.010] [Citation(s) in RCA: 39] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/16/2007] [Revised: 12/11/2007] [Accepted: 01/22/2008] [Indexed: 02/03/2023]
Abstract
BACKGROUND CONTEXT Lumbar fusion is traditionally used to restore stability after wide surgical decompression for spinal stenosis. The Total Facet Arthroplasty System (TFAS) is a motion-restoring implant suggested as an alternative to rigid fixation after complete facetectomy. PURPOSE To investigate the effect of TFAS on the kinematics of the implanted and adjacent lumbar segments. STUDY DESIGN Biomechanical in vitro study. METHODS Nine human lumbar spines (L1 to sacrum) were tested in flexion-extension (+8 to -6Nm), lateral bending (+/-6Nm), and axial rotation (+/-5Nm). Flexion-extension was tested under 400 N follower preload. Specimens were tested intact, after complete L3 laminectomy with L3-L4 facetectomy, after L3-L4 pedicle screw fixation, and after L3-L4 TFAS implantation. Range of motion (ROM) was assessed in all tested directions. Neutral zone and stiffness in flexion and extension were calculated to assess quality of motion. RESULTS Complete laminectomy-facetectomy increased L3-L4 ROM compared with intact in flexion-extension (8.7+/-2.0 degrees to 12.2+/-3.2 degrees, p<.05) lateral bending (9.0+/-2.5 degrees to 12.6+/-3.2 degrees, p=.09), and axial rotation (3.8+/-2.7 degrees to 7.8+/-4.5 degrees p<.05). Pedicle screw fixation decreased ROM compared with intact, resulting in 1.7+/-0.5 degrees flexion-extension (p<.05), 3.3+/-1.4 degrees lateral bending (p<.05), and 1.8+/-0.6 degrees axial rotation (p=.09). TFAS restored intact ROM (p>.05) resulting in 7.9+/-2.1 degrees flexion-extension, 10.1+/-3.0 degrees lateral bending, and 4.7+/-1.6 degrees axial rotation. Fusion significantly increased the normalized ROM at all remaining lumbar segments, whereas TFAS implantation resulted in near-normal distribution of normalized ROM at the implanted and remaining lumbar segments. Flexion and extension stiffness in the high-flexibility zone decreased after facetectomy (p<.05) and increased after simulated fusion (p<.05). TFAS restored quality of motion parameters (load-displacement curves) to intact (p>.05). The quality of motion parameters for the whole lumbar spine mimicked L3-L4 segmental results. CONCLUSIONS TFAS restored range and quality of motion at the operated segment to intact values and restored near-normal motion at the adjacent segments.
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Schmitt WH, Cuthbert SC. Common errors and clinical guidelines for manual muscle testing: "the arm test" and other inaccurate procedures. CHIROPRACTIC & OSTEOPATHY 2008; 16:16. [PMID: 19099575 PMCID: PMC2628341 DOI: 10.1186/1746-1340-16-16] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/02/2008] [Accepted: 12/19/2008] [Indexed: 11/10/2022]
Abstract
BACKGROUND The manual muscle test (MMT) has been offered as a chiropractic assessment tool that may help diagnose neuromusculoskeletal dysfunction. We contend that due to the number of manipulative practitioners using this test as part of the assessment of patients, clinical guidelines for the MMT are required to heighten the accuracy in the use of this tool. OBJECTIVE To present essential operational definitions of the MMT for chiropractors and other clinicians that should improve the reliability of the MMT as a diagnostic test. Controversy about the usefulness and reliability of the MMT for chiropractic diagnosis is ongoing, and clinical guidelines about the MMT are needed to resolve confusion regarding the MMT as used in clinical practice as well as the evaluation of experimental evidence concerning its use. DISCUSSION We expect that the resistance to accept the MMT as a reliable and valid diagnostic tool will continue within some portions of the manipulative professions if clinical guidelines for the use of MMT methods are not established and accepted. Unreliable assessments of this method of diagnosis will continue when non-standard MMT research papers are considered representative of the methods used by properly trained clinicians. CONCLUSION Practitioners who employ the MMT should use these clinical guidelines for improving their use of the MMT in their assessments of muscle dysfunction in patients with musculoskeletal pain.
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Affiliation(s)
- Walter H Schmitt
- Chiropractic Health Center, 255 West Abriendo Avenue, Pueblo, CO 81004, USA
| | - Scott C Cuthbert
- Chiropractic Health Center, 255 West Abriendo Avenue, Pueblo, CO 81004, USA
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Larivière C, Arsenault AB. On the use of EMG-ratios to assess the coordination of back muscles. Clin Biomech (Bristol, Avon) 2008; 23:1209-19. [PMID: 18926609 DOI: 10.1016/j.clinbiomech.2008.09.001] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/04/2008] [Revised: 09/02/2008] [Accepted: 09/03/2008] [Indexed: 02/07/2023]
Abstract
BACKGROUND Electromyographic (EMG) amplitude ratios (EMG-ratios) have been proposed to assess back muscle coordination in chronic low back pain patients to avoid the normalization of EMG using maximal contractions. The aim of this study was to test the relevance of this type of EMG analysis. METHODS Healthy subjects (44 men and 13 women) and patients with chronic low back pain (57 men) performed three 7s static ramp extension contractions ranging from 0% to 100% of the maximal voluntary contraction while standing in a static dynamometer. A subgroup of 20 healthy men also performed 5s step contractions at 10%, 20%, 40%, 60% and 80% of the maximal voluntary contraction. Finally, to assess reliability, another subgroup (n=20 healthy and 20 men with chronic low back pain) performed the protocol three times, on different days. Surface EMG signals were collected from four pairs of back muscles and subcutaneous tissue thickness was measured at the corresponding electrode sites. EMG amplitude values were computed at each 5% force level from 10% to 80% of the maximal voluntary contraction. Then, EMG-ratios were computed between different electrode sites and averaged bilaterally. FINDINGS All EMG-ratios were affected by the force level and the contraction type (ramp vs step contractions). Statistically significant Pearson's correlations (r=-0.38 to -0.57) were obtained between some EMG-ratios and their corresponding subcutaneous tissue thickness ratios. The reliability of the EMG-ratio variables ranged from moderate to excellent (intra-class correlation coefficients between 0.50 and 0.91). Comparisons between 12 men and 13 women and between 24 healthy men and 57 men with chronic low back pain showed that EMG-ratios were sensitive to sex but not to pain status. Multivariate analyses applied on the EMG-ratios identified clusters of subjects but none of the main clinical variables were able to clearly characterize these clusters. INTERPRETATION Overall, even though additional research is warranted to further substantiate some important psychometric characteristics of the EMG-ratios as well as their biomechanical and clinical significance, these results support their use for assessing the coordination patterns of back muscles, provided that confounding variables such as the force level, the contraction type, and subcutaneous tissue thickness are accounted for.
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Affiliation(s)
- Christian Larivière
- Occupational Health and Safety Research Institute Robert-Sauvé, Montreal, Quebec, Canada
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Power spectra characteristics associated with static reflexive activation of the multifidus muscle in feline models. Eur J Appl Physiol 2008; 104:873-83. [DOI: 10.1007/s00421-008-0844-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/22/2008] [Indexed: 11/27/2022]
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230
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Woodhouse A, Vasseljen O. Altered motor control patterns in whiplash and chronic neck pain. BMC Musculoskelet Disord 2008; 9:90. [PMID: 18570647 PMCID: PMC2446396 DOI: 10.1186/1471-2474-9-90] [Citation(s) in RCA: 135] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/14/2008] [Accepted: 06/20/2008] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Persistent whiplash associated disorders (WAD) have been associated with alterations in kinesthetic sense and motor control. The evidence is however inconclusive, particularly for differences between WAD patients and patients with chronic non-traumatic neck pain. The aim of this study was to investigate motor control deficits in WAD compared to chronic non-traumatic neck pain and healthy controls in relation to cervical range of motion (ROM), conjunct motion, joint position error and ROM-variability. METHODS Participants (n = 173) were recruited to three groups: 59 patients with persistent WAD, 57 patients with chronic non-traumatic neck pain and 57 asymptomatic volunteers. A 3D motion tracking system (Fastrak) was used to record maximal range of motion in the three cardinal planes of the cervical spine (sagittal, frontal and horizontal), and concurrent motion in the two associated cardinal planes relative to each primary plane were used to express conjunct motion. Joint position error was registered as the difference in head positions before and after cervical rotations. RESULTS Reduced conjunct motion was found for WAD and chronic neck pain patients compared to asymptomatic subjects. This was most evident during cervical rotation. Reduced conjunct motion was not explained by current pain or by range of motion in the primary plane. Total conjunct motion during primary rotation was 13.9 degrees (95% CI; 12.2-15.6) for the WAD group, 17.9 degrees (95% CI; 16.1-19.6) for the chronic neck pain group and 25.9 degrees (95% CI; 23.7-28.1) for the asymptomatic group. As expected, maximal cervical range of motion was significantly reduced among the WAD patients compared to both control groups. No group differences were found in maximal ROM-variability or joint position error. CONCLUSION Altered movement patterns in the cervical spine were found for both pain groups, indicating changes in motor control strategies. The changes were not related to a history of neck trauma, nor to current pain, but more likely due to long-lasting pain. No group differences were found for kinaesthetic sense.
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Affiliation(s)
- Astrid Woodhouse
- Department of Public Health and General Practice, Faculty of Medicine, Norwegian University of Science and Technology (NTNU), N-7489 Trondheim, Norway.
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231
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Mulholland RC. The myth of lumbar instability: the importance of abnormal loading as a cause of low back pain. 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 2008; 17:619-25. [PMID: 18301932 PMCID: PMC2367421 DOI: 10.1007/s00586-008-0612-2] [Citation(s) in RCA: 58] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/15/2007] [Accepted: 01/22/2008] [Indexed: 11/26/2022]
Abstract
Spinal fusion became what has been termed the "gold standard" for the treatment of mechanical low back pain, yet there was no scientific basis for this. Operations of fusion for low back pain were initially done at the beginning of the last century for back pain thought to be related to congenital abnormalities or for past spinal infection. The recognition of the disc as a cause of sciatica, commonly associated with back pain, and the recognition that a degenerate disc led to abnormal movement suggested the concept that this abnormal movement was the cause of pain, and this abnormal movement came to be called "instability". Much biomechanical expertise confirmed the fact that degenerate discs led to abnormal movement, there were many hypothesis as to why this caused pain. However clinical results of fusion for back pain were unpredictable. The failure of pedicle screws and cage fusion to improve the clinical results of fusion despite near 100% fusion success, and the introduction of "flexible stabilization" and artificial discs, which demonstrated that despite the often unpredictable movement permitted by of these devices, clinical success was similar to fusion, directed attention to the other role of the disc, that of load transfer, which these devices also affected. Abnormal load transfer was already known to be critical in other joints in the body and had led to the use of osteotomy to realign joints. The relevance of load transfer to the future design of spinal implants used in the treatment of low back pain is discussed, and some finite element studies are reported demonstrating the likely effect of abnormal loading beneath an incompletely incorporated plate of an artificial disc, perhaps explaining in part the somewhat disappointing clinical results to date of the implantation of artificial discs.
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Ivancic PC, Ito S, Tominaga Y, Rubin W, Coe MP, Ndu AB, Carlson EJ, Panjabi MM. Whiplash causes increased laxity of cervical capsular ligament. Clin Biomech (Bristol, Avon) 2008; 23:159-65. [PMID: 17959284 PMCID: PMC2701103 DOI: 10.1016/j.clinbiomech.2007.09.003] [Citation(s) in RCA: 30] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/07/2007] [Revised: 09/07/2007] [Accepted: 09/10/2007] [Indexed: 02/07/2023]
Abstract
BACKGROUND Previous clinical studies have identified the cervical facet joint, including the capsular ligaments, as sources of pain in whiplash patients. The goal of this study was to determine whether whiplash caused increased capsular ligament laxity by applying quasi-static loading to whiplash-exposed and control capsular ligaments. METHODS A total of 66 capsular ligament specimens (C2/3 to C7/T1) were prepared from 12 cervical spines (6 whiplash-exposed and 6 control). The whiplash-exposed spines had been previously rear impacted at a maximum peak T1 horizontal acceleration of 8 g. Capsular ligaments were elongated at 1mm/s in increments of 0.05 mm until a tensile force of 5 N was achieved and subsequently returned to neutral position. Four pre-conditioning cycles were performed and data from the load phase of the fifth cycle were used for subsequent analyses. Ligament elongation was computed at tensile forces of 0, 0.25, 0.5, 0.75, 1.0, 2.5, and 5.0 N. Two factor, non-repeated measures ANOVA (P<0.05) was performed to determine significant differences in the average ligament elongation at tensile forces of 0 and 5 N between the whiplash-exposed and control groups and between spinal levels. FINDINGS Average elongation of the whiplash-exposed capsular ligaments was significantly greater than that of the control ligaments at tensile forces of 0 and 5 N. No significant differences between spinal levels were observed. INTERPRETATION Capsular ligament injuries, in the form of increased laxity, may be one component perpetuating chronic pain and clinical instability in whiplash patients.
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Affiliation(s)
- Paul C. Ivancic
- Biomechanics Research Laboratory, Department of Orthopaedics and Rehabilitation, Yale University School of Medicine, New Haven, Connecticut, USA, Address for Correspondence: Paul C. Ivancic, Ph.D., Associate Research Scientist, Biomechanics Research Laboratory, Department of Orthopaedics and Rehabilitation, Yale University School of Medicine, 333 Cedar St., P.O. Box 208071, New Haven CT 06520-8071, USA. Phone: (203) 785-4052, Fax: (203) 785-7069, e-mail:
| | - Shigeki Ito
- Department of Orthopaedic Surgery, St. Marianna University School of Medicine, Kanagawa, Japan
| | - Yasuhiro Tominaga
- Department of Orthopaedic Surgery, St. Marianna University School of Medicine, Kanagawa, Japan
| | - Wolfgang Rubin
- Biomechanics Research Laboratory, Department of Orthopaedics and Rehabilitation, Yale University School of Medicine, New Haven, Connecticut, USA
| | - Marcus P. Coe
- Department of Orthopaedic Surgery, Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire, USA
| | - Anthony B. Ndu
- Biomechanics Research Laboratory, Department of Orthopaedics and Rehabilitation, Yale University School of Medicine, New Haven, Connecticut, USA
| | - Erik J. Carlson
- Biomechanics Research Laboratory, Department of Orthopaedics and Rehabilitation, Yale University School of Medicine, New Haven, Connecticut, USA
| | - Manohar M. Panjabi
- Biomechanics Research Laboratory, Department of Orthopaedics and Rehabilitation, Yale University School of Medicine, New Haven, Connecticut, USA
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Zeinali-Davarani S, Hemami H, Barin K, Shirazi-Adl A, Parnianpour M. Dynamic Stability of Spine Using Stability-Based Optimization and Muscle Spindle Reflex. IEEE Trans Neural Syst Rehabil Eng 2008; 16:106-18. [PMID: 18303812 DOI: 10.1109/tnsre.2007.906963] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
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França FJR, Burke TN, Claret DC, Marques AP. Estabilização segmentar da coluna lombar nas lombalgias: uma revisão bibliográfica e um programa de exercícios. FISIOTERAPIA E PESQUISA 2008. [DOI: 10.1590/s1809-29502008000200015] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
No tratamento de lombalgias, exercícios tradicionais de fortalecimento dos músculos abdominais e extensores do tronco têm sido alvo de críticas por submeter a coluna vertebral a altas cargas de trabalho, aumentando o risco de nova lesão. Estudos recentes comprovam a eficácia da estabilização segmentar como tratamento para a lombalgia, sendo menos lesiva por ser realizada em posição neutra. Pesquisas sugerem que, sem a ativação correta dos estabilizadores profundos do tronco, as recidivas do quadro álgico são notadas com muita freqüência. Este estudo procedeu à revisão da literatura sobre o tratamento das lombalgias mediante estabilização da coluna e propõe exercícios para seu tratamento baseados na estabilização segmentar lombar. Na base PubMed, por meio dos descritores estabilização lombar, multífido lombar, transverso do abdome e os equivalentes em inglês, foram selecionados 47 artigos e livros publicados entre 1984 e 2006. A literatura estabelece um elo entre lombalgia e escasso controle dos músculos profundos do tronco, em especial o multífido lombar e o transverso do abdome; estudos também indicam os músculos quadrado lombar e diafragma como estabilizadores lombares. Propõem-se assim exercícios de contrações isométricas sincronizadas, sutis e específicas, que atuam diretamente no alívio da dor por meio do aumento da estabilidade do segmento vertebral.
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Harringe ML, Nordgren JS, Arvidsson I, Werner S. Low back pain in young female gymnasts and the effect of specific segmental muscle control exercises of the lumbar spine: a prospective controlled intervention study. Knee Surg Sports Traumatol Arthrosc 2007; 15:1264-71. [PMID: 17594077 DOI: 10.1007/s00167-007-0289-9] [Citation(s) in RCA: 33] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/16/2006] [Accepted: 01/09/2007] [Indexed: 10/23/2022]
Abstract
Prospective controlled intervention study. To evaluate a specific segmental muscle training program of the lumbar spine in order to prevent and reduce low back pain in young female teamgym gymnasts. Teamgym is a team sport comprising three events: trampette, tumbling and floor programme. In a recent study, it was found that teamgym gymnasts practice and compete despite suffering from back pain. Specific muscle control exercises of the lumbar spine have shown good results in reducing pain intensity and functional disability levels in patients with low back pain. To our knowledge, this type of training has not been studied in an adolescent athletic population before. Fifty-one gymnasts, with and without LBP, 11-16 years old, from three top-level gymnastics team participated in the study comprising 12 weeks. Every day the gymnasts answered a questionnaire regarding low back pain. After baseline (4 weeks) the intervention group performed a specific segmental muscle training program. Twenty-four gymnasts (47%) reported low back pain during baseline. Nine gymnasts failed to answer the questionnaire every day and the following results are based on 42 gymnasts (intervention group, n = 30, and control group, n=12). Gymnasts in the intervention group reported significantly less number of days with low back pain at completion compared to baseline (P=0.02). Gymnasts in the control group showed no difference in terms of days with low back pain or intensity of low back pain between baseline and completion. Eight gymnasts (out of 15) with LBP in the intervention group became pain free. Specific segmental muscle control exercises of the lumbar spine may be of value in preventing and reducing low back pain in young teamgym gymnasts.
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Affiliation(s)
- M L Harringe
- Department of Molecular Medicine and Surgery, Section of Orthopaedics and Sports Medicine, Karolinska Institutet, Forskningscentrum M3:00, 171 76, Stockholm, Sweden.
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Skillgate E, Vingård E, Alfredsson L. Naprapathic manual therapy or evidence-based care for back and neck pain: a randomized, controlled trial. Clin J Pain 2007; 23:431-9. [PMID: 17515742 DOI: 10.1097/ajp.0b013e31805593d8] [Citation(s) in RCA: 52] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
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.
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Affiliation(s)
- Eva Skillgate
- Institute of Environmental Medicine, Karolinska Institutet, SE-171 77 Stockholm, Sweden.
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Lee HY, Wang JD, Yao G, Wang SF. Association between cervicocephalic kinesthetic sensibility and frequency of subclinical neck pain. ACTA ACUST UNITED AC 2007; 13:419-25. [PMID: 17544825 DOI: 10.1016/j.math.2007.04.001] [Citation(s) in RCA: 68] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2006] [Revised: 03/12/2007] [Accepted: 04/16/2007] [Indexed: 11/30/2022]
Abstract
Although impaired neck proprioception has been demonstrated in patients with chronic neck pain, previous studies have not consistently shown any association between pain intensity and proprioceptive performance. We therefore investigated whether temporal aspects of pain are associated with cervicocephalic kinesthetic sensibility. One hundred and twenty-seven adults with or without subclinical neck pain undertook two tasks, repositioning their heads to the neutral head position (head-to-NHP) and target position (head-to-target) in sagittal and transverse plane. Absolute error was calculated from position data recorded by an ultrasound-based motion analysis system. Pain frequency, duration, and intensity were evaluated using a questionnaire. A mixed effects model was constructed to test the effect on reposition error by different pain factors, with age, gender and maximal cervical range of motion as covariates. A higher pain frequency was associated with greater reposition errors for all movement directions in the head-to-NHP task. No consistent effect was observed for pain intensity or duration. In the case of the head-to-target task, no consistent effect was observed for any of the three pain factors. The findings reveal that pain frequency, not the intensity or duration of pain, is associated with neck proprioception in individuals with subclinical neck pain.
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Affiliation(s)
- Hsin-Yi Lee
- Institute of Occupational Medicine and Industrial Hygiene, College of Public Health, National Taiwan University, Taipei, Taiwan, ROC
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238
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Gombatto SP, Collins DR, Sahrmann SA, Engsberg JR, Van Dillen LR. Patterns of lumbar region movement during trunk lateral bending in 2 subgroups of people with low back pain. Phys Ther 2007; 87:441-54. [PMID: 17374634 DOI: 10.2522/ptj.20050370] [Citation(s) in RCA: 56] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND AND PURPOSE The movement system impairment (MSI) system is one proposed system for classifying low back pain (LBP) problems. Prior clinical data and observations for the MSI system suggest that different LBP subgroups demonstrate different patterns of movement during clinical tests, such as trunk lateral bending (TLB). The purpose of this study, therefore, was to examine the validity of the observation that lumbar region (LR) movement patterns during TLB are different between 2 subgroups of people with LBP: lumbar rotation with extension (Rotation With Extension) and lumbar rotation (Rotation). SUBJECTS Participants were 44 people (28 men and 16 women; age [X+/-SD], 28.5+/-8.4 years) with chronic or recurrent LBP. METHODS Each participant's LBP problem was classified with the MSI system. Kinematic variables were measured, and LBP symptoms were recorded during the TLB test. RESULTS People in the 2 LBP subgroups demonstrated different patterns of LR movement during TLB. People in the Rotation With Extension subgroup displayed an asymmetric (right versus left) pattern of LR movement across the TLB movement, whereas people in the Rotation subgroup displayed a symmetric pattern of LR movement. Equal proportions of people in the 2 subgroups reported an increase in symptoms with the TLB test. DISCUSSION AND CONCLUSION The patterns of LR movement across the TLB movement were different in 2 subgroups of people with LBP. The difference in the LR movement patterns between subgroups may be an important factor to consider in specifying the details of the interventions for these 2 LBP problems.
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Affiliation(s)
- Sara P Gombatto
- Washington University School of Medicine, Campus Box #8502, 4444 Forest Park Blvd, St Louis, MO 63110, USA.
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239
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Shum GLK, Crosbie J, Lee RYW. Three-dimensional kinetics of the lumbar spine and hips in low back pain patients during sit-to-stand and stand-to-sit. Spine (Phila Pa 1976) 2007; 32:E211-9. [PMID: 17414896 DOI: 10.1097/01.brs.0000259204.05598.10] [Citation(s) in RCA: 81] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
STUDY DESIGN Experimental, biomechanical study to determine the kinetics of the lumbar spine and hips during sit-to-stand and stand-to-sit. OBJECTIVE To investigate the effects of back pain, with and without limitation in straight leg raise, on the joint moment and power of the lumbar and hips during sit-to-stand and stand-to-sit. SUMMARY OF BACKGROUND DATA Movements of the lumbar spine and hips, and their coordination have been reported to be affected by the presence of low back pain (LBP), especially in those with a positive straight leg raise. However, the literature has no information concerning moment and power characteristics of the lumbar spine and hips during sit-to-stand and stand-to-sit in such patients. METHODS Twenty asymptomatic subjects, 20 LBP patients, and 20 patients with LBP and a positive straight leg raise sign were requested to perform the sit-to-stand and stand-to-sit activities. Electromagnetic sensors were attached to the body segments to measure their kinematics while 2 nonconductive force plates gathered ground reaction force data. Biomechanical models were used to determine the muscle moments and power at the lumbosacral (L5/S1) joint and hips. RESULTS Muscle moments acting at the lumbar spine and hip in the sagittal plane were found to decrease in subjects with LBP, but there were significant increases in moments in other planes of motion. The power patterns of the spine and hips were also significantly altered, particularly in subjects with a positive straight leg raise sign. CONCLUSIONS Back pain subjects exhibit compensatory movements and altered load sharing strategies during the sit-to-stand and stand-to-sit activities. Exercise therapy should take account of these changes so that the normal kinematic and kinetic characteristics of the spine and hips can be restored.
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Affiliation(s)
- Gary L K Shum
- School of Physiotherapy, the University of Sydney, Sydney, Australia
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240
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Schleip R, Vleeming A, Lehmann-Horn F, Klingler W. Letter to the Editor concerning "A hypothesis of chronic back pain: ligament subfailure injuries lead to muscle control dysfunction" (M. Panjabi). 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 2007; 16:1733-5; author reply 1736. [PMID: 17342512 PMCID: PMC2078289 DOI: 10.1007/s00586-006-0298-2] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/18/2006] [Accepted: 12/17/2006] [Indexed: 12/28/2022]
Affiliation(s)
- Robert Schleip
- Department of Applied Physiology, Ulm University, Albert-Einstein-Allee 11, 89081 Ulm, Germany
| | | | - Frank Lehmann-Horn
- Department of Applied Physiology, Ulm University, Albert-Einstein-Allee 11, 89081 Ulm, Germany
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241
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Cuthbert SC, Goodheart GJ. On the reliability and validity of manual muscle testing: a literature review. CHIROPRACTIC & OSTEOPATHY 2007; 15:4. [PMID: 17341308 PMCID: PMC1847521 DOI: 10.1186/1746-1340-15-4] [Citation(s) in RCA: 221] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 02/14/2007] [Accepted: 03/06/2007] [Indexed: 11/10/2022]
Abstract
INTRODUCTION A body of basic science and clinical research has been generated on the manual muscle test (MMT) since its first peer-reviewed publication in 1915. The aim of this report is to provide an historical overview, literature review, description, synthesis and critique of the reliability and validity of MMT in the evaluation of the musculoskeletal and nervous systems. METHODS Online resources were searched including Pubmed and CINAHL (each from inception to June 2006). The search terms manual muscle testing or manual muscle test were used. Relevant peer-reviewed studies, commentaries, and reviews were selected. The two reviewers assessed data quality independently, with selection standards based on predefined methodologic criteria. Studies of MMT were categorized by research content type: inter- and intraexaminer reliability studies, and construct, content, concurrent and predictive validity studies. Each study was reviewed in terms of its quality and contribution to knowledge regarding MMT, and its findings presented. RESULTS More than 100 studies related to MMT and the applied kinesiology chiropractic technique (AK) that employs MMT in its methodology were reviewed, including studies on the clinical efficacy of MMT in the diagnosis of patients with symptomatology. With regard to analysis there is evidence for good reliability and validity in the use of MMT for patients with neuromusculoskeletal dysfunction. The observational cohort studies demonstrated good external and internal validity, and the 12 randomized controlled trials (RCTs) that were reviewed show that MMT findings were not dependent upon examiner bias. CONCLUSION The MMT employed by chiropractors, physical therapists, and neurologists was shown to be a clinically useful tool, but its ultimate scientific validation and application requires testing that employs sophisticated research models in the areas of neurophysiology, biomechanics, RCTs, and statistical analysis.
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Affiliation(s)
- Scott C Cuthbert
- Chiropractic Health Center, 255 West Abriendo Avenue, Pueblo, CO 81004, USA
| | - George J Goodheart
- Goodheart Zatkin Hack and Associates, 20567 Mack Avenue, Grosse Pointe Woods, MI 48236-1655, USA
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242
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Panjabi MM, Timm JP. Development of Stabilimax NZ From Biomechanical Principles. SAS JOURNAL 2007. [DOI: 10.1016/s1935-9810(07)70040-3] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Panjabi MM, Timm JP. Development of Stabilimax NZ From Biomechanical Principles. SAS JOURNAL 2007; 1:2-7. [PMID: 25802572 PMCID: PMC4365568 DOI: 10.1016/sasj-2006-0006-co] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/03/2007] [Accepted: 02/26/2007] [Indexed: 11/27/2022]
Abstract
BACKGROUND Traditionally, spinal degeneration and injury have been associated with abnormal intervertebral motion; thus, treatment for lowback pain has centered on prevention of motion through spinal fusion. Although the rate of successful spinal fusions is improving, complications such as adjacent-level syndrome emphasize the need to develop alternatives for treating spinal degeneration. In an effort to improve the clinical outcomes associated with such treatment, we hypothesized that spinal stabilization and a consequent reduction in symptoms is achievable without the harsh restrictions to spinal motion imposed by fusion. This idea was based on the principle of the neutral zone and the neutral zone hypothesis of back pain. DEVELOPMENT Performance requirements for a novel device were determined through a series of biomechanical experiments. From these data, the Stabilimax NZ was developed to provide stabilization to a degenerated or surgically destabilized spine while maintaining the maximum possible total range of motion. Applied Spine Technologies Inc has tested 70 bilateral assemblies of the final design of the Stabilimax NZ, and all exceeded the biomechanical, static, fatigue, wear, and histological requirements necessary to initiate clinical investigation. DISCUSSION The Stabilimax NZ device has been systematically designed and tested under protocols developed by Applied Spine Technologies in conjunction with Panjabi, Patwardhan, and Goel. The device decreased the neutral zone in destabilized spines while maintaining substantial range of motion. CLINICAL RELEVANCE Development testing has been submitted to the US Food and Drug Administration and permission obtained to initiate an investigational device exemption trial to clinically investigate the efficacy of the Stabilimax NZ device.
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Affiliation(s)
- Manohar M. Panjabi
- The Department of Orthopaedics and Rehabilitation, Yale University School of Medicine, New Haven, Conn
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244
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Yue JJ, Timm JP, Panjabi MM, Jaramillo-de la Torre J. Clinical application of the Panjabi neutral zone hypothesis: the Stabilimax NZ posterior lumbar dynamic stabilization system. Neurosurg Focus 2007; 22:E12. [PMID: 17608333 DOI: 10.3171/foc.2007.22.1.12] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
The neutral zone (NZ) is a region of intervertebral motion around the neutral posture where little resistance is offered by the passive spinal column. The NZ appears to be a clinically important measure of spinal stability function. Its size may increase with injury to the spinal column, which in turn may result in spinal instability or low-back pain. Dynamic stabilization systems are designed to support and stabilize the spine while maintaining range of motion (ROM). The Stabilimax NZ device has been designed to reduce the NZ after spinal injury to treat pain while preserving ROM.
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Affiliation(s)
- James J Yue
- Department of Orthopaedics and Rehabilitation, Yale University School of Medicine, New Haven, Connecticut 06520, USA.
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245
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Abstract
In summary, the past several years have shown an increase in the quality of trials examining the clinical efficacy of various CAM modalities for pain conditions. There is still need to raise the quality of the studies from a scientific and methodological point of view in many areas of CAM research by randomization, appropriate sample size, blinding, and developing more sophisticated sham procedures. However, much work still has to be done to find ways to preserve the clinical authenticity of CAM treatment methods when brought into the light of a research protocol. Recent attempts have been made to find a method of maintaining the standardization and reproducibility of research protocols while allowing the kind of flexible treatment that would normally be applied in a clinical setting. Other questions that should be answered with future studies include understanding how treatment length influences outcome, if maintenance treatments are needed for chronic conditions, and cost and risk comparisons with standard pharmacological treatment. Providing this kind of detail will assist both with reproducibility as well as help us gain a better understanding about whether certain treatment paradigms are superior to others for specific clinical conditions. Finally, physicians who have an interest in pursuing CAM research should educate themselves both about the methodological issues inherent with the particular area of interest as well as about ways to maintain the authenticity of the CAM treatment protocols so that the literature is not populated with more poorly designed studies. With the emerging interest in integrative medicine, there is a growing interest in collaboration and a greater number of physicians are interested in obtaining training in CAM modalities to help bridge this gap between CAM and conventional clinicians. For example, the American Academy of Medical Acupuncturists (AAMA) has been formed to help as both an educational and research forum for physician acupuncturists and the American Holistic Medical Association provides educational exposure in a broad range of Integrative and CAM modalities. The future of medicine will likely be Integrative and the more health care providers can educate themselves about this area of medicine, the better they will be able to provide the highest quality of care to their patients.
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Affiliation(s)
- Gira Patel
- Osher Integrative Care Center, Harvard Medical School, Osher Institute, Division for Research and Education in Complementary and Integrative Medical Therapies, Kiiko Matsumoto International, 1647 Washington Street, Newton, MA 02465, USA
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246
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Tominaga Y, Ndu AB, Coe MP, Valenson AJ, Ivancic PC, Ito S, Rubin W, Panjabi MM. Neck ligament strength is decreased following whiplash trauma. BMC Musculoskelet Disord 2006; 7:103. [PMID: 17184536 PMCID: PMC1764743 DOI: 10.1186/1471-2474-7-103] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/17/2006] [Accepted: 12/21/2006] [Indexed: 11/21/2022] Open
Abstract
Background Previous clinical studies have documented successful neck pain relief in whiplash patients using nerve block and radiofrequency ablation of facet joint afferents, including capsular ligament nerves. No previous study has documented injuries to the neck ligaments as determined by altered dynamic mechanical properties due to whiplash. The goal of the present study was to determine the dynamic mechanical properties of whiplash-exposed human cervical spine ligaments. Additionally, the present data were compared to previously reported control data. The ligaments included the anterior and posterior longitudinal, capsular, and interspinous and supraspinous ligaments, middle-third disc, and ligamentum flavum. Methods A total of 98 bone-ligament-bone specimens (C2–C3 to C7-T1) were prepared from six cervical spines following 3.5, 5, 6.5, and 8 g rear impacts and pre- and post-impact flexibility testing. The specimens were elongated to failure at a peak rate of 725 (SD 95) mm/s. Failure force, elongation, and energy absorbed, as well as stiffness were determined. The mechanical properties were statistically compared among ligaments, and to the control data (significance level: P < 0.05; trend: P < 0.1). The average physiological ligament elongation was determined using a mathematical model. Results For all whiplash-exposed ligaments, the average failure elongation exceeded the average physiological elongation. The highest average failure force of 204.6 N was observed in the ligamentum flavum, significantly greater than in middle-third disc and interspinous and supraspinous ligaments. The highest average failure elongation of 4.9 mm was observed in the interspinous and supraspinous ligaments, significantly greater than in the anterior longitudinal ligament, middle-third disc, and ligamentum flavum. The average energy absorbed ranged from 0.04 J by the middle-third disc to 0.44 J by the capsular ligament. The ligamentum flavum was the stiffest ligament, while the interspinous and supraspinous ligaments were most flexible. The whiplash-exposed ligaments had significantly lower (P = 0.036) failure force, 149.4 vs. 186.0 N, and a trend (P = 0.078) towards less energy absorption capacity, 308.6 vs. 397.0 J, as compared to the control data. Conclusion The present decreases in neck ligament strength due to whiplash provide support for the ligament-injury hypothesis of whiplash syndrome.
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Affiliation(s)
- Yasuhiro Tominaga
- Department of Orthopaedic Surgery, St. Marianna University School of Medicine, Kanagawa, Japan
| | - Anthony B Ndu
- Biomechanics Research Laboratory, Department of Orthopaedics and Rehabilitation, Yale University School of Medicine, New Haven, Connecticut, USA
| | - Marcus P Coe
- Department of Orthopaedic Surgery, Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire, USA
| | - Arnold J Valenson
- Department of Orthopedic Surgery, Rush University Medical Center, Chicago, Illinois, USA
| | - Paul C Ivancic
- Biomechanics Research Laboratory, Department of Orthopaedics and Rehabilitation, Yale University School of Medicine, New Haven, Connecticut, USA
| | - Shigeki Ito
- Department of Orthopaedic Surgery, St. Marianna University School of Medicine, Kanagawa, Japan
| | - Wolfgang Rubin
- Biomechanics Research Laboratory, Department of Orthopaedics and Rehabilitation, Yale University School of Medicine, New Haven, Connecticut, USA
| | - Manohar M Panjabi
- Biomechanics Research Laboratory, Department of Orthopaedics and Rehabilitation, Yale University School of Medicine, New Haven, Connecticut, USA
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