Effect of intensive inpatient physical therapy on whole-body indefinite symptoms in patients with whiplash-associated disorders

Cervical muscle stiffness and parasympathetic nervous system improvements for treatment-resistant depression

BACKGROUND

Although treatment-resistant depression (TRD) is a major public health problem that increases mortality due to suicides, a considerable percentage of patients do not respond adequately to variable treatments. Patients with TRD sometimes have comorbid cervical stiffness. This observational study aims to examine the association of local modulation of cervical muscles with TRD and to learn the involvement of the parasympathetic nervous system in the underlying mechanism.

METHODS

A total of 1103 hospitalized patients with TRD who were resistant to outpatient care were enrolled between May 2006 and October 2021. All patients underwent local modulation of the cervical muscles by physical therapy during hospitalization. The presence or absence of TRD and whole-body disorders, such as headache, dazzling, cervical stiffness, and cardiovascular and gastrointestinal disorders, was determined by the patient's subjectivity using the self-rated medical interview sheet at admission and discharge. Pupil light reflex parameters were also measured at admission and discharge using a binocular infrared pupilometer.

RESULTS

The improvement rate of TRD during hospitalization was 72.1%, and did not differ significantly by sex, age, and hospitalization period. The improvement of TRD showed a strong association with those of cervical stiffness and dazzling, a pupil light reflex disorder (p < 0.001: odds ratios = 12.76 and 6.39, respectively), but not with those of headache or cardiovascular and gastrointestinal disorders (p > 0.05). In the TRD-improved patients, the pupil light reflex parameters representative of the parasympathetic nervous system function ameliorated: pupil diameter decreased, while constriction rate and velocity increased during hospitalization. In contrast, little amelioration of the parameters was seen in the TRD-unimproved patients.

CONCLUSIONS

Cervical muscle stiffness may be associated with TRD, possibly through dysfunction of the parasympathetic nervous system.

TRIAL REGISTRATION

ID: UMIN000040590. First registration date: 30/05/2020.

Possible involvement of the autonomic nervous system in cervical muscles of patients with myalgic encephalomyelitis / chronic fatigue syndrome (ME/CFS)

BACKGROUND

Patients with myalgic encephalomyelitis / chronic fatigue syndrome (ME/CFS) sometimes present with stiffness of the cervical muscles. To investigate the pathophysiology of ME/CFS, this observational study compared patients with versus without recovery from ME/CFS through local modulation of the cervical muscles.

METHODS

Over a period of 11 years, a total of 1226 inpatients with ME/CFS who did not respond to outpatient care were enrolled in this study. All patients received daily cervical muscle physical therapy during hospitalization. Self-rated records documenting the presence or absence of ME/CFS, as well as the representative eight symptoms that frequently accompany it at admission and discharge, were compared. Pupil diameter was also measured to examine autonomic nervous system function involvement.

RESULTS

The recovery rate of ME/CFS after local therapy was 55.5%, and did not differ significantly by sex, age strata, and hospitalization period. The recovery rates of the eight symptoms were variable (36.6-86.9%); however, those of ME/CFS in the symptom subpopulations were similar (52.3-55.8%). The recovery rates of all symptoms showed strong associations with that of ME/CFS (p < 0.001). The pupil diameter was more constricted in the ME/CFS-recovered patients than in the ME/CFS-unrecovered patients in the total population and the subpopulations stratified by sex, age, and hospitalization period.

CONCLUSIONS

There was a strong association between the recovery of ME/CFS and other related whole-body symptoms. The recovery of ME/CFS may be partly linked to amelioration of the autonomic nervous system in the cervical muscles.

TRIAL REGISTRATION

UMIN000036634 . Registered 1 May 2019 - Retrospectively registered.

Can measuring passive neck muscle stiffness in whiplash injury patients help detect false whiplash claims?

BACKGROUND

Whiplash injury of the cervical spine is the most common injury after a car accident and in 25% of patients it progresses into chronic neck pain.

AIM OF THE STUDY

To investigate the difference in neck muscle stiffness using shear wave ultrasound elastography between subjects who suffered an uncomplicated whiplash injury and a control group. Possible recognition of patients who insist on physical therapy in order to support their false whiplash injury claims.

METHODS

This study included 75 whiplash injury patients and 75 control subjects. Trapezius, splenius capitis and sternocleidomastoid muscles were examined by ultrasound shear wave elastography.

RESULTS

Increased muscle stiffness was noticed in trapezius muscle bilaterally in the whiplash group when compared to the control group (p < 0.001; right 57.47 ± 13.82 kPa vs. 87.84 ± 23.23 kPa; left 54.4 ± 12.68 kPa vs. 87.21 ± 26.47 kPa). Muscle stiffness in splenius capitis and sternocleidomastoid muscles was not suitable for analysis because of asymmetrical data distribution. Patients with less than 76 kPa of muscle stiffness in trapezius muscle are unlikely to belong in whiplash injury group (sensitivity 90% for right and 97% for left trapezius muscle, specificity 72% and 73%, respectively).

CONCLUSION

Patients measuring below 76 kPa of muscle stiffness in the trapezius muscle might have no whiplash injury. Further follow-up of the patients measuring higher than cut-off value might be beneficial for detecting patients with prolonged neck muscle spasm that can lead to chronic cervical pain syndrome.

Cervical muscle diseases are associated with indefinite and various symptoms in the whole body

PURPOSE

Patients with various and indefinite symptoms in the whole body occasionally have coincident with stiffness or tenderness of the cervical muscles. This prospective case series examined the effect of local modulation of the cervical muscles in patients with cervical disorders reporting indefinite whole-body symptoms.

METHODS

A total of 1863 hospitalized patients with cervical disorders accompanying three or more indefinite whole-body symptoms, who were resistant to outpatient care, were enrolled in this study for 12 years. All patients underwent daily physical therapies to the cervical muscles during hospitalization. Self-rated records on the medical interview sheets documenting 30 representative symptoms including cervical/shoulder pain or stiffness and 28 representative indefinite whole-body symptoms at admission and discharge were compared across the population.

RESULTS

The number of symptoms decreased significantly with the local modulation of the cervical muscles during hospitalization. All of the 28 indefinite whole-body symptoms at admission showed recovery rates greater than 50% at discharge. The mean number of symptoms decreased significantly from 17.8 at admission to 7.4 at discharge (p < 0.0001). The percentages of patients reporting 10 or more symptoms were 91.1% and 29.3% at admission and discharge, respectively. Moreover, 8.2% of patients reported no residual symptoms at discharge.

CONCLUSION

Cervical muscle lesions may contribute to indefinite whole-body symptoms, possibly through dysfunction of the parasympathetic nervous system in the muscles. Local modulation of cervical muscles could lead to a breakthrough in the management of patients with indefinite whole-body symptoms.

TRIAL REGISTRATION ID

UMIN000035445. These slides can be retrieved under Electronic Supplementary Material.