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Peolsson A, Bahat HS, German D, Peterson G. Results of neck-specific exercise for altered postural sway in individuals with chronic whiplash-associated disorders: a longitudinal case-control study. Sci Rep 2024; 14:15235. [PMID: 38956135 PMCID: PMC11220100 DOI: 10.1038/s41598-024-66176-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2023] [Accepted: 06/27/2024] [Indexed: 07/04/2024] Open
Abstract
Postural sway has not been investigated before or after a neck exercise intervention in individuals with chronic whiplash-associated disorders (WAD). The aim of the study was to investigate postural sway in individuals with chronic WAD grades 2 and 3: (a) compared with healthy matched controls at baseline; (b) after three months of neck-specific exercise and (c) to investigate the correlation between postural sway with self-reported dizziness during motion and balance problems/unsteadiness. This is a longitudinal prospective experimental case-control intervention study. Individuals with WAD (n = 30) and age- and gender-matched healthy volunteers (n = 30) participated. Postural sway was assessed using an iPhone application. Measurements were carried out at baseline, and for those with WAD a second measurement was performed at the three-month follow-up when neck-specific exercise intervention ended. The WAD group performed significantly worse than the healthy group in both pathway and ellipse area double stance eyes closed at baseline (main outcome), but not at the three-month follow-up. The WAD group significantly improved after rehabilitation in both pathway double stance eyes closed and pathway single stance eyes open. The correlation between postural sway and self-rated dizziness during motion and balance problems was low to moderate. One may conclude that postural sway was improved after a neck-specific exercise programme. The study results strengthen earlier findings that individuals with WAD have worse balance outcome when they have to rely on neck proprioception (eyes closed). The study results may be important for the development of improved rehabilitation methods for WAD.
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Affiliation(s)
- Anneli Peolsson
- Department of Health, Medicine and Caring Sciences, Unit of Physiotherapy, Linköping University, Linköping, Sweden.
- Occupational and Environmental Medicine Centre, Department of Health, Medicine and Caring Sciences, Unit of Clinical Medicine, Linköping University, Linköping, Sweden.
| | | | - Dmitry German
- Department of Physical Therapy, University of Haifa, Haifa, Israel
| | - Gunnel Peterson
- Department of Health, Medicine and Caring Sciences, Unit of Physiotherapy, Linköping University, Linköping, Sweden
- Centre for Clinical Research Sörmland, Uppsala University, Eskilstuna, Sweden
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2
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Ragnarsdottir H, Peterson G, Gislason MK, Oddsdottir GL, Peolsson A. The effect of a neck-specific exercise program on cervical kinesthesia for patients with chronic whiplash-associated disorders: a case-control study. BMC Musculoskelet Disord 2024; 25:346. [PMID: 38693515 PMCID: PMC11064421 DOI: 10.1186/s12891-024-07427-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/05/2023] [Accepted: 04/09/2024] [Indexed: 05/03/2024] Open
Abstract
INTRODUCTION Cervical kinesthesia is an important part of movement control and of great importance for daily function. Previous research on kinesthesia in whiplash-associated disorders (WAD) has focused on grades I-II. More research is needed on WAD grade III. The aim of this study was to investigate cervical kinesthesia in individuals with WAD grades II-III before and after a neck-specific exercise intervention and compare them to healthy controls. METHODS A prospective, case-control study with a treatment arm (n = 30) and a healthy control arm (n = 30) was conducted in Sweden. The WAD group received a neck-specific exercise program for 12 weeks. The primary outcome to evaluate kinesthesia was neck movement control (the Fly test). Secondary outcomes were neck disability, dizziness and neck pain intensity before and after the Fly test. Outcomes were measured at baseline and post-treatment. The control arm underwent measurements at baseline except for the dizziness questionnaire. A linear mixed model was used to evaluate difference between groups (WAD and control) and over time, with difficulty level in the Fly test and gender as factors. RESULTS Between-group analysis showed statistically significant differences in three out of five kinesthetic metrics (p = 0.002 to 0.008), but not for the WAD-group follow-up versus healthy control baseline measurements. Results showed significant improvements for the WAD-group over time for three out of five kinaesthesia metrics (p < 0.001 to 0.008) and for neck disability (p < 0.001) and pain (p = 0.005), but not for dizziness (p = 0.70). CONCLUSIONS The exercise program shows promising results in improving kinesthesia and reducing neck pain and disability in the chronic WAD phase. Future research might benefit from focusing on adding kinesthetic exercises to the exercise protocol and evaluating its beneficial effects on dizziness or further improvement in kinesthesia. IMPACT STATEMENT Kinesthesia can be improved in chronic WAD patients without the use of specific kinesthetic exercises. TRIAL REGISTRATION ClinicalTrials.gov (NCT03664934), first registration approved 11/09/2018.
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Affiliation(s)
- Harpa Ragnarsdottir
- Research Centre of Movement Science, Department of Physiotherapy, University of Iceland, Stapi v/Hringbraut 31, Reykjavik, 101, IS, Iceland
- Elja Physiotherapy, Hafnafjordur, Iceland
| | - Gunnel Peterson
- Department of Health, Medicine and Caring Sciences, Unit of Physiotherapy, Linköping University, Linköping, Sweden
- Centre for Clinical Research Sörmland, Uppsala University, Eskilstuna, Sweden
| | - Magnus K Gislason
- Institute of Biomedical and Neural Engineering, Reykjavik University, Reykjavik, Iceland
| | - Gudny L Oddsdottir
- Research Centre of Movement Science, Department of Physiotherapy, University of Iceland, Stapi v/Hringbraut 31, Reykjavik, 101, IS, Iceland
| | - Anneli Peolsson
- Department of Health, Medicine and Caring Sciences, Unit of Physiotherapy, Linköping University, Linköping, Sweden.
- Occupational and Environmental Medicine Center, Department of Health, Medicine and Caring Sciences, Clinical Medicine, Linköping University, Linköping, Sweden.
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Peterson G, Peolsson A. Efficacy of Neck-Specific Exercise With Internet Support Versus Neck-Specific Exercise at a Physiotherapy Clinic in Chronic Whiplash-Associated Disorders: Multicenter Randomized Controlled Noninferiority Trial. J Med Internet Res 2023; 25:e43888. [PMID: 37338972 PMCID: PMC10337460 DOI: 10.2196/43888] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2022] [Revised: 02/24/2023] [Accepted: 05/27/2023] [Indexed: 06/21/2023] Open
Abstract
BACKGROUND Neck-specific exercises (NSE) supervised by a physiotherapist twice a week for 12 weeks have shown good results in chronic whiplash-associated disorders (WADs), but the effect of exercise delivered via the internet is unknown. OBJECTIVE This study examined whether NSE with internet support (NSEIT) and 4 physiotherapy sessions for 12 weeks were noninferior to the same exercises supervised by a physiotherapist twice a week for 12 weeks (NSE). METHODS In this multicenter randomized controlled noninferiority trial with masked assessors, we recruited adults aged 18-63 years with chronic WAD grade II (ie, neck pain and clinical musculoskeletal signs) or III (ie, grade II plus neurological signs). Outcomes were measured at baseline and at 3- and 15-month follow-ups. The primary outcome was change in neck-related disability, measured with the Neck Disability Index (NDI; 0%-100%), with higher percentages indicating greater disability. Secondary outcomes were neck and arm pain intensity (Visual Analog Scale [VAS]), physical function (Whiplash Disability Questionnaire [WDQ] and Patient-Specific Functional Scale [PSFS]), health-related quality of life (EQ-5D-3L and EQ VAS), and self-rated recovery (Global Rating Scale [GRS]). The analyses were conducted on an intention-to-treat basis and with the per-protocol approach as sensitivity analyses. RESULTS Between April 6, 2017, and September 15, 2020, 140 participants were randomly assigned to the NSEIT group (n=70) or the NSE group (n=70); 63 (90%) and 64 (91%), respectively, were followed up at 3 months, and 56 (80%) and 58 (83%), respectively, at 15 months. NSEIT demonstrated noninferiority to NSE in the primary outcome NDI, as the 1-sided 95% CI of the mean difference in change did not cross the specified noninferiority margin (7 percentage units). There were no significant between-group differences in change in NDI at the 3- or 15-month follow-up, with a mean difference of 1.4 (95% CI -2.5 to 5.3) and 0.9 (95% CI -3.6 to 5.3), respectively. In both groups, the NDI significantly decreased over time (NSEIT: mean change -10.1, 95% CI -13.7 to -6.5, effect size=1.33; NSE: mean change -9.3, 95% CI -12.8 to -5.7, effect size=1.19 at 15 months; P<.001). NSEIT was noninferior to NSE for most of the secondary outcomes except for neck pain intensity and EQ VAS, but post hoc analyses showed no differences between the groups. Similar results were seen in the per-protocol population. No serious adverse events were reported. CONCLUSIONS NSEIT was noninferior to NSE in chronic WAD and required less physiotherapist time. NSEIT could be used as a treatment for patients with chronic WAD grades II and III. TRIAL REGISTRATION ClinicalTrials.gov NCT03022812; https://clinicaltrials.gov/ct2/show/NCT03022812.
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Affiliation(s)
- Gunnel Peterson
- Centre for Clinical Research Sörmland, Uppsala University, Eskilstuna, Sweden
- Department of Health, Medicine and Caring Sciences, Unit of Physiotherapy, Linköping University, Linköping, Sweden
| | - Anneli Peolsson
- Department of Health, Medicine and Caring Sciences, Unit of Physiotherapy, Linköping University, Linköping, Sweden
- Department of Health, Medicine and Caring Sciences, Occupational and Environmental Medicine Center, Unit of Clinical Medicine, Linköping University, Linköping, Sweden
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Wang DM, Li C, Hatchard N, Chang Chien GC, Alm J. Lower trapezius muscle function in people with and without shoulder and neck pain: a systematic review. J Osteopath Med 2023; 123:73-89. [PMID: 36100364 DOI: 10.1515/jom-2022-0056] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2022] [Accepted: 08/04/2022] [Indexed: 01/27/2023]
Abstract
CONTEXT Shoulder and neck pain are leading causes of disability worldwide. Rotator cuff pathology has strong associations with such pain and is extensively targeted by healthcare practitioners. A dysfunctional lower trapezius muscle has also been shown to contribute to neck and shoulder pain, yet it is often overlooked. OBJECTIVES This systematic review analyzes those with a history of, or who are currently managing, shoulder or neck pain to indicate differences in measures of lower trapezius function when compared to subjects without that pain. METHODS Studies with no age restrictions were included in the study. Studies could determine lower trapezius muscle function with any quantifiable measurement tool or clinical assessment. If the study included a control group (no pain) and a comparator group (pain), and if lower trapezius muscle function was assessed in both, the study was typically included. The significance of the lower trapezius muscle function change was summarized in these pain patients. From a final total of 18 studies identified, level of muscle activity, muscle activation, time to onset, muscle strength, and muscle thickness were reported. RESULTS The 18 included articles involved 485 participants with shoulder and/or neck pain and 455 without. Half of the shoulder pain studies (6/12), and all of the neck pain studies (6/6), demonstrated that the lower trapezius had a noticeable impact. The lower trapezius muscle in participants with shoulder and neck pain tended to show decreased muscle strength, and decreased time to onset/latency. CONCLUSIONS The findings from this systematic review should be taken into consideration when assessing and treating patients with shoulder and neck pain. Future studies that define the type and duration of shoulder and neck pain, as well as prospectively assessing lower trapezius muscle function in those with and without that pain, are needed.
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Affiliation(s)
- Daniel M Wang
- Kansas City University, 1750 Independence Avenue, Kansas City, MO 64106-1453, USA
| | - Crystal Li
- University of Maryland School of Medicine, Baltimore, MD, USA
| | - Nicole Hatchard
- Philadelphia College of Osteopathic Medicine, Philadelphia, PA, USA
| | - George C Chang Chien
- Pain Management, Ventura County Medical Center, Ventura, CA, USA.,Center for Regenerative Medicine, Southern California University of Health Sciences, Whittier, CA, USA
| | - John Alm
- Department of Rehabilitation Medicine, The University of Kansas Medical Center, Kansas City, KS, USA
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Peolsson A, Karlsson A, Peterson G, Borén H, Zsigmond P, Elliott JM, Leinhard OD. Morphology and composition of the ventral neck muscles in individuals with chronic whiplash related disorders compared to matched healthy controls: a cross-sectional case-control study. BMC Musculoskelet Disord 2022; 23:867. [PMID: 36114530 PMCID: PMC9482301 DOI: 10.1186/s12891-022-05811-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/27/2022] [Accepted: 09/06/2022] [Indexed: 01/15/2023] Open
Abstract
BACKGROUND OBJECTIVE: Studies of cross-sectional area (CSA) (morphology) and muscle fat infiltration (MFI) (composition) in ventral neck muscles is scarce in patients with chronic whiplash associated disorders (WAD), especially for men and those with severe WAD compared with matched healthy controls. The aim was to compare CSA and MFI of sternocleidomastoid (SCM), longus capitis (LCA) and longus colli (LCO) in patients with chronic right-sided dominant moderate (Neck Disability Index: NDI < 40) or severe WAD (NDI ≥ 40), compared to age- and sex-matched healthy controls. METHODS Cross-sectional case-control study with blinded investigators. Thirty-one patients with chronic WAD (17 women and 14 men, mean age 40 years) (SD 12.6, range 20-62)) and 31 age- and sex-matched healthy controls underwent magnetic resonance imaging of ventral neck muscles segmental level C4. RESULTS Unique to the severe group was a larger magnitude of MFI in right SCM (p = 0.02) compared with healthy controls. There was no significant difference between the groups with regards to the other muscles and measures. CONCLUSIONS Individuals with severe right-sided dominant WAD have a higher MFI in the right SCM compared to healthy controls. No other differences were found between the groups. The present study indicates that there are changes in the composition of muscles on the side of greatest pain.
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Affiliation(s)
- Anneli Peolsson
- grid.5640.70000 0001 2162 9922Occupational and Environmental Medicine Center, Department of Health, Medicine and Caring Sciences, Unit of Clinical Medicine, Linköping University, Linköping, Sweden ,grid.5640.70000 0001 2162 9922Department of Health, Medicine & Caring Sciences, Unit of Physiotherapy, Linköping University, Linköping, Sweden ,grid.5640.70000 0001 2162 9922Center for Medical Image Science and Visualization (CMIV), Linköping University, Linköping, Sweden
| | - Anette Karlsson
- grid.5640.70000 0001 2162 9922Center for Medical Image Science and Visualization (CMIV), Linköping University, Linköping, Sweden
| | - Gunnel Peterson
- grid.5640.70000 0001 2162 9922Department of Health, Medicine & Caring Sciences, Unit of Physiotherapy, Linköping University, Linköping, Sweden ,grid.8993.b0000 0004 1936 9457Centre for Clinical Research Sörmland, Uppsala University, Eskilstuna, Sweden
| | - Hanna Borén
- grid.5640.70000 0001 2162 9922Department of Health, Medicine & Caring Sciences, Unit of Physiotherapy, Linköping University, Linköping, Sweden
| | - Peter Zsigmond
- grid.5640.70000 0001 2162 9922Department of Neurosurgery and Department of Biomedical and Clinical Sciences, Linköping University, Linköping, Sweden
| | - James M. Elliott
- grid.1013.30000 0004 1936 834XThe University of Sydney and the Northern Sydney Local Health District, The Kolling Institute, St. Leonards, NSW Sydney, Australia
| | - Olof Dahlqvist Leinhard
- grid.5640.70000 0001 2162 9922Department of Health, Medicine & Caring Sciences, Linköping University, Linköping, Sweden
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Treleaven J, Peterson G, Ludvigsson ML, Peolsson A. Cervical musculoskeletal, physical and psychological factors associated with ongoing dizziness in patients with whiplash associated disorder, 12 months after undertaking a neck specific or general exercise intervention. BMC Musculoskelet Disord 2022; 23:683. [PMID: 35850745 PMCID: PMC9290277 DOI: 10.1186/s12891-022-05642-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/29/2022] [Accepted: 07/05/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Exercise in the management of persistent whiplash often doesn't specifically address dizziness. This study aimed to determine cervical musculoskeletal and sensorimotor measures, quality of life and psychological factors associated with the presence of dizziness in individuals with persistent whiplash 12 months post exercise intervention commencement. METHODS A retrospective cross sectional review of questionnaires on dizziness, physical and psychological disability, quality of life and physical measures prospectively collected from 172 individuals during a randomised controlled trial. Associations between dizziness at 12 months post intervention and possible predictors was analysed with simple and multiple logistic regression models. RESULTS Sixty-three % reported dizziness with a mean University of California Los Angeles dizziness score of 9 (SD 5) and dizziness intensity during activity of 26 mm (SD 24). They had poorer performance on sharpened Rhomberg, Neck muscle endurance (NME), and range of motion, elevated scores on pain, Neck disability index (NDI) and psychological and quality of life measures compared to those without dizziness. Less improvement in NDI and NME flexion from baseline to 12 months post exercise commencement, along with some baseline covariates were related to persistent dizziness and explained 50% of the variance. CONCLUSION Dizziness following exercise at 12 months post follow-up was associated with lack of improvement in NDI and NME flexion suggesting a cervicogenic role. Alternatively, the presence of dizziness may inhibit exercise response. Additional causes or contributing factors of dizziness should be investigated in those with persistent whiplash to improve quality of life.
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Affiliation(s)
- Julia Treleaven
- The Division of Physiotherapy, CCRE-Spine, School of Health and Rehabilitation Sciences, The University of Queensland, Brisbane, Australia.
| | - Gunnel Peterson
- Department of Health, Medicine and Caring Sciences, Unit of Physiotherapy, Linköping University, Linköping, Sweden.,Centre for Clinical Research Sörmland, Uppsala University, Uppsala, Sweden
| | - Maria Landén Ludvigsson
- Department of Health, Medicine and Caring Sciences, Unit of Physiotherapy, Linköping University, Linköping, Sweden.,Rehab Väst, County Council of Östergötland, Department of Rehabilitation and Department of Health, Medicine and Caring Sciences, Linköping University, Motala, Sweden
| | - Anneli Peolsson
- Department of Health, Medicine and Caring Sciences, Unit of Physiotherapy, Linköping University, Linköping, Sweden.,Occupational and Environmental Medicine Centre, Department of Health, Medicine and Caring Sciences, Unit of Clinical Medicine, Linköping University, Linköping, Sweden
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7
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Peterson G, Carlfjord S, Nilsing Strid E, Ask S, Jönsson M, Peolsson A. Evaluation of implementation and effectiveness of neck-specific exercise for persistent disability and pain after whiplash injury: study protocol for a randomized controlled study using a hybrid 2 design. BMC Musculoskelet Disord 2022; 23:516. [PMID: 35637458 PMCID: PMC9153087 DOI: 10.1186/s12891-022-05470-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/01/2022] [Accepted: 05/24/2022] [Indexed: 11/23/2022] Open
Abstract
Background Persistent pain and disability in whiplash-associated disorders (WAD) grades II and III are common. In two randomized controlled trials (RCTs) of neck-specific exercises (NSE), we have seen promising results in chronic WAD, with a sustained clinically important reduction in pain and disability. NSE can also be delivered through internet support (NSEIT) and a few visits to a physiotherapist, saving time and cost for both patients and providers. NSE have been shown to have positive effects in other neck pain disorders and we will evaluate the diffusion of the exercises to other patients. The aims of the proposed study are to evaluate an implementation strategy for NSEIT and NSE in primary health care and to evaluate the effectiveness of NSEIT and NSE in clinical practice. Methods The proposed study is a prospective cluster-randomized mixed-design study with hybrid 2 trial design. Reg. physiotherapists working in twenty physiotherapy clinics will be included. The primary implementation outcome is proportion of patients with neck pain receiving neck-specific exercise. Secondary outcomes are; physiotherapists attitudes to implementation of evidence-based practice, their self-efficacy and confidence in performing NSEIT/NSE, number of patients visits, and use of additional or other exercises or treatment. To further evaluate the implementation strategy, two qualitative studies will be performed with a sample of the physiotherapists. The primary outcome in the patient effectiveness evaluation is self-reported neck disability according to the Neck Disability Index (NDI). Secondary outcomes are pain intensity in the neck, arm, and head; dizziness; work- and health-related issues; and patient’s improvement or deterioration over time. All measurements will be conducted at baseline and at 3 and 12 months. Physiotherapists´ self-efficacy and confidence in diagnosing and treating patients with neck pain will also be evaluated directly after their instruction in NSEIT/NSE. Discussion This trial will evaluate the implementation strategy in terms of adoption of and adherence to NSEIT and NSE in clinical primary health care, and measure diffusion of the method to other patients. In parallel, the effectiveness of the method will be evaluated. The results may guide physiotherapists and health care providers to sustainable and effective implementation of effective exercise programs. Trial registration The randomized trial is registered on ClinicalTrials.gov, NCT05198258, initial release date January 20, 2022.
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8
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Chrcanovic B, Larsson J, Malmström EM, Westergren H, Häggman-Henrikson B. Exercise therapy for whiplash-associated disorders: a systematic review and meta-analysis. Scand J Pain 2022; 22:232-261. [PMID: 34561976 DOI: 10.1515/sjpain-2021-0064] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2021] [Accepted: 09/02/2021] [Indexed: 11/15/2022]
Abstract
OBJECTIVES Acute as well as chronic pain syndromes are common after whiplash trauma and exercise therapy is proposed as one possible intervention strategy. The aim of the present systematic review was to evaluate the effect of exercise therapy in patients with Whiplash-Associated Disorders for the improvement of neck pain and neck disability, compared with other therapeutic interventions, placebo interventions, no treatment, or waiting list. CONTENT The review was registered in Prospero (CRD42017060356) and conducted in accordance with the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines. A literature search in PubMed, Scopus and Cochrane from inception until January 13, 2020 was combined with a hand search to identify eligible randomized controlled studies. Abstract screening, full text assessment and risk of bias assessment (Cochrane RoB 2.0) were conducted by two independent reviewers. SUMMARY The search identified 4,103 articles. After removal of duplicates, screening of 2,921 abstracts and full text assessment of 100 articles, 27 articles that reported data for 2,127 patients were included. The included articles evaluated the effect of exercise therapy on neck pain, neck disability or other outcome measures and indicated some positive effects from exercise, but many studies lacked control groups not receiving active treatment. Studies on exercise that could be included in the random-effect meta-analysis showed significant short-term effects on neck pain and medium-term effects on neck disability. OUTLOOK Despite a large number of articles published in the area of exercise therapy and Whiplash-Associated Disorders, the current evidence base is weak. The results from the present review with meta-analysis suggests that exercise therapy may provide additional effect for improvement of neck pain and disability in patients with Whiplash-Associated Disorders.
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Affiliation(s)
| | - Johan Larsson
- Department of Neurosurgery and Pain Rehabilitation, Skåne University Hospital, Lund, Sweden
| | - Eva-Maj Malmström
- Department of Neurosurgery and Pain Rehabilitation, Skåne University Hospital, Lund, Sweden
- Department of Otorhinolaryngology, Clinical Sciences, Lund University, Lund, Sweden
| | - Hans Westergren
- Department of Neurosurgery and Pain Rehabilitation, Skåne University Hospital, Lund, Sweden
- Health Sciences, Lund University, Lund, Sweden
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Smith AC, Albin SR, Abbott R, Crawford RJ, Hoggarth MA, Wasielewski M, Elliott JM. Confirming the geography of fatty infiltration in the deep cervical extensor muscles in whiplash recovery. Sci Rep 2020; 10:11471. [PMID: 32651447 PMCID: PMC7351986 DOI: 10.1038/s41598-020-68452-x] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2019] [Accepted: 06/22/2020] [Indexed: 02/08/2023] Open
Abstract
Previous preliminary work mapped the distribution of neck muscle fat infiltration (MFI) in the deep cervical extensor muscles (multifidus and semispinalis cervicis) in a small cohort of participants with chronic whiplash associated disorders (WAD), recovered, and healthy controls. While MFI was reported to be concentrated in the medial portion of the muscles in all participants, the magnitude was significantly greater in those with chronic WAD. This study aims to confirm these results in a prospective fashion with a larger cohort and compare the findings across a population of patients with varying levels of WAD-related disability one-year following the motor vehicle collision. Sixty-one participants enrolled in a longitudinal study: Recovered (n = 25), Mild (n = 26) and Severe WAD (n = 10) were studied using Fat/Water magnetic resonance imaging, 12-months post injury. Bilateral measures of MFI in four quartiles (Q1–Q4; medial to lateral) at cervical levels C4 through C7 were included. A linear mixed model was performed, controlling for covariates (age, sex, body mass index), examining interaction effects, and comparing MFI distribution between groups. The recovered group had significantly less MFI in Q1 compared to the two symptomatic groups. Group differences were not found in the more lateral quartiles. Results at 12 months are consistent with the preliminary study, indicating that MFI is spatially concentrated in the medial portions of the deep cervical extensors regardless of WAD recovery, but the magnitude of MFI in the medial portions of the muscles is significantly larger in those with severe chronic WAD.
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Affiliation(s)
- Andrew C Smith
- School of Physical Therapy, Regis University, Denver, CO, USA
| | | | - Rebecca Abbott
- Physical Therapy and Human Movement Sciences, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA.,Department of Mechanical Engineering, Northwestern University, Evanston, IL, USA
| | | | - Mark A Hoggarth
- Physical Therapy and Human Movement Sciences, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA.,Department of Biomedical Engineering, Northwestern University, Evanston, IL, USA
| | - Marie Wasielewski
- Physical Therapy and Human Movement Sciences, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | - James M Elliott
- Physical Therapy and Human Movement Sciences, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA. .,Faculty of Medicine and Health, The Northern Sydney Local Health District, The Kolling Institute, The University of Sydney, St. Leonards, NSW, 2065, Australia.
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10
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Peolsson A, Karlsson A, Ghafouri B, Ebbers T, Engström M, Jönsson M, Wåhlén K, Romu T, Borga M, Kristjansson E, Bahat HS, German D, Zsigmond P, Peterson G. Pathophysiology behind prolonged whiplash associated disorders: study protocol for an experimental study. BMC Musculoskelet Disord 2019; 20:51. [PMID: 30711003 PMCID: PMC6359872 DOI: 10.1186/s12891-019-2433-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/06/2018] [Accepted: 01/28/2019] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND There is insufficient knowledge of pathophysiological parameters to understand the mechanism behind prolonged whiplash associated disorders (WAD), and it is not known whether or not changes can be restored by rehabilitation. The aims of the projects are to investigate imaging and molecular biomarkers, cervical kinaesthesia, postural sway and the association with pain, disability and other outcomes in individuals with longstanding WAD, before and after a neck-specific exercise intervention. Another aim is to compare individuals with WAD with healthy controls. METHODS Participants are a sub-group (n = 30) of individuals recruited from an ongoing randomized controlled study (RCT). Measurements in this experimental prospective study will be carried out at baseline (before intervention) and at a three month follow-up (end of physiotherapy intervention), and will include muscle structure and inflammation using magnetic resonance imaging (MRI), brain structure and function related to pain using functional MRI (fMRI), muscle function using ultrasonography, biomarkers using samples of blood and saliva, cervical kinaesthesia using the "butterfly test" and static balance test using an iPhone app. Association with other measures (self-reported and clinical measures) obtained in the RCT (e.g. background data, pain, disability, satisfaction with care, work ability, quality of life) may be investigated. Healthy volunteers matched for age and gender will be recruited as controls (n = 30). DISCUSSION The study results may contribute to the development of improved diagnostics and improved rehabilitation methods for WAD. TRIAL REGISTRATION Clinicaltrial.gov Protocol ID: NCT03664934, initial release 09/11/2018.
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Affiliation(s)
- Anneli Peolsson
- Department of Medical and Health Sciences, Physiotherapy, Linköping University, Linköping, Sweden. .,Center for Medical Image Science and Visualization (CMIV), Linköping University, Linköping, Sweden.
| | - Anette Karlsson
- Center for Medical Image Science and Visualization (CMIV), Linköping University, Linköping, Sweden.,Department of Biomedical Engineering, Linköping University, Linköping, Sweden
| | - Bijar Ghafouri
- Pain and Rehabilitation Center, and Department of Medical and Health Sciences, Rehabilitation Medicine, Linköping University, Linköping, Sweden
| | - Tino Ebbers
- Center for Medical Image Science and Visualization (CMIV), Linköping University, Linköping, Sweden.,Department of Medical and Health Sciences, Division of Cardiovascular Medicine, Linköping University, Linköping, Sweden
| | - Maria Engström
- Center for Medical Image Science and Visualization (CMIV), Linköping University, Linköping, Sweden.,Department of Medical and Health Sciences, Radiological Sciences, Linköping University, Linköping, Sweden
| | - Margaretha Jönsson
- Department of Medical and Health Sciences, Physiotherapy, Linköping University, Linköping, Sweden.,Herrgärdets Vårdcentral, Region Västmanland, Västerås, Sweden
| | - Karin Wåhlén
- Pain and Rehabilitation Center, and Department of Medical and Health Sciences, Rehabilitation Medicine, Linköping University, Linköping, Sweden
| | - Thobias Romu
- Center for Medical Image Science and Visualization (CMIV), Linköping University, Linköping, Sweden.,Department of Biomedical Engineering, Linköping University, Linköping, Sweden
| | - Magnus Borga
- Center for Medical Image Science and Visualization (CMIV), Linköping University, Linköping, Sweden.,Department of Biomedical Engineering, Linköping University, Linköping, Sweden
| | | | | | - Dmitry German
- Department of Physical Therapy, University of Haifa, Haifa, Israel
| | - Peter Zsigmond
- Department of Neurosurgery and Clinical and Experimental Medicine, Linköping University, Linköping, Sweden
| | - Gunnel Peterson
- Department of Medical and Health Sciences, Physiotherapy, Linköping University, Linköping, Sweden.,Centre for Clinical Research Sörmland, Uppsala University, Eskilstuna, Sweden
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