Relationship between cervical muscle morphology evaluated by MRI, cervical muscle strength and functional outcomes in patients with degenerative cervical myelopathy

BACKGROUND

Cervical muscle alterations have been reported in patients with chronic neck pain, but the assessment of muscle morphology and strength has been overlooked in patients with degenerative cervical myelopathy (DCM).

OBJECTIVES

This study aimed to investigate the relationship between cervical muscle degenerative changes observed on MRI, muscle strength and symptoms severity in patients diagnosed with DCM.

DESIGN

Observational study.

METHODS

Cervical muscle measurements of total cross-sectional area (CSA), functional CSA (fat free area, FCSA) and ratio of FCSA/CSA (e.g. fatty infiltration) were obtained from T2-weighted axial MR images from C2-C3 to C6-C7 in 20 patients. Muscle strength was assessed manually using a microFET2 dynamometer. The association between cervical muscle morphology parameters, muscle strength, symptoms severity and functional status was investigated.

RESULTS

Greater mean CSA and FCSA was associated with greater overall muscle strength. The mean FCSA explained 37%, 76%, 39%, 20% and 65% of the total variance in flexion, extension, right-side bending, left-side bending and overall muscle strength, respectively. The mean ratio of FCSA/CSA was not significantly associated with cervical muscle strength in any direction. However, greater FCSA/CSA ratio (e.g. less fatty infiltration) was associated with lower disability score (p = 0.02, R² = 0.20).

CONCLUSIONS

Cervical muscle lean muscle mass was positively associated with cervical muscle strength in patients with DCM. Moreover, greater fatty infiltration in the cervical extensor muscles was associated with lower functional score. Such findings suggest that clinicians should pay greater attention to cervical muscle morphology and function in patients with DCM.

Patient adherence in an individualized rehabilitation programme: A clinical follow-up

Aims: This investigation aims to describe patients with longstanding pain who did not complete their participation and/or participated infrequently in physiotherapy (PT) treatment based on their own activity and responsibility, and in addition to understand the phenomenon of adherence from a behavioural theoretical perspective. Methods: The phenomenon compliance/adherence was studied in relation to health locus of control (HLC) factors and health belief (HB) variables. Outcome measures were based on a questionnaire answered by all patients before the beginning of treatment. Definitions of adherence were completed treatment period and exercise frequency respectively. Patients completing treatment were compared with those who did not. Exercise frequencies of those completing treatment were also studied. Results: Those who did not complete treatment reported higher pain intensity, higher Oswestry score, and worse general health than those completing treatment. Results also showed that those who exercised once a week or less often valued the significance of healthcare treatment less, perceived higher pain intensity, presented a higher Oswestry score, worse general health, more pain locations, lower expectations, were younger and almost solely women, than those who exercised more often. Conclusions: Individuals exercising irregularly were above all women. This fact needs further investigation. Individuals' belief in treatment effects is of significance to adherence. Adherence is a comprehensive concept and depending on how we look at it we find different populations.

The effects of cervical traction, cranial rhythmic impulse, and Mckenzie exercise on headache and cervical muscle stiffness in episodic tension-type headache patients

[Purpose] The purpose of this study was to examine the effects of cervical traction treatment, cranial rhythmic impulse treatment, a manual therapy, and McKenzie exercise, a dynamic strengthening exercise, on patients who have the neck muscle stiffness of the infrequent episodic tension-type (IETTH) headache and frequent episodic tension-type headache(FETTH), as well as to provide the basic materials for clinical interventions. [Subjects] Twenty-seven subjects (males: 15, females: 12) who were diagnosed with IETTH and FETTH after treatment by a neurologist were divided into three groups: (a cervical traction group (CTG, n=9), a cranial rhythmic contractiongroup (CRIG, n=9), and a McKenzie exercise group (MEG, n=9). An intervention was conducted for each group and the differences in their degrees of neck pain and changes in muscle tone were observed. [Results] In the within-group comparison of each group, headache significantly decreased in CTG. According to the results of the analysis of the muscle tone of the upper trapezius, there was a statistically significant difference in MEG on the right side and in CRIG on the left side. According to the results of the analysis of the muscle tone of the sternocleidomastoid muscle, there was a statistically significant difference in MEG on the right side and in CRIG on the left side. [Conclusion] In the comparison of the splenius capitis muscle between the groups, there was a statistically significant difference on the right side. Hence, compared to the other methods, cervical traction is concluded to be more effective at reducing headaches in IETTH and FETTH patients.

Association of neck pain, disability and neck pain during maximal effort with neck muscle strength and range of movement in women with chronic non-specific neck pain

Several studies have reported lower neck muscle strength in patients with chronic neck pain compared to healthy controls. The aim of the present study was to evaluate the association between the severity of neck pain and disability with neck strength and range of movement in women suffering from chronic neck pain. One hundred and seventy-nine female office workers with chronic neck pain were selected to the study. The outcome was assessed by the self-rating questionnaires on neck pain (visual analogue scale, Vernon's disability index, Neck pain and disability index) and by measures of the passive range of movement (ROM) and maximal isometric neck muscle strength. No statistically significant correlation was found between perceived neck pain and the disability indices and the maximal isometric neck strength and ROM measures. However, the pain values reported during the strength tests were inversely correlated with the results of strength tests (r=-0.24 to -0.46), showing that pain was associated with decreased force production. About two-thirds of the patients felt pain during test efforts. Pain may prevent full effort during strength tests and hence the production of maximal force. Thus in patients with chronic neck pain the results do not always describe true maximal strength, but rather the patients' ability to bear strain, which may be considerably influenced by their painful condition. The results of the present study suggest that rehabilitation in cases of chronic neck pain should aim at raising tolerance to mechanical strain.

The assessment of the cervical spine. Part 2: strength and endurance/fatigue

Quantitative documentation of physical deficits such as muscle strength and endurance/fatigue in the cervical spine may provide objective information, not only helping the diagnostic procedures, but also monitoring rehabilitation progress and documenting permanent impairments. The reliable and valid evaluation of muscle strength and endurance both in clinical and research environments are a difficult task since there are many factors that could affect the assessment procedure and the obtained values. The aim of the second part of this critical review is to identify the factors influencing the assessment of strength and endurance/fatigue of the muscles in the cervical spine.

Issues in relation to the repeatability of and correlation between EMG and Borg scale assessments of neck muscle fatigue

INTRODUCTION

The repeatability of subjective and objective assessments of neck muscle fatigue is very important with regard to the clinical applicability of these methods.

METHOD

To establish between-days reliability, 33 healthy volunteers performed a 60% maximum voluntary isometric contraction test from a standing position in all neck movements. Cervical muscle fatigue was assessed on three separate occasions from the spectral (median frequency, MF) and amplitude (root mean square, RMS) analysis of the electromyogram (EMG) signal recorded from the cervical paraspinal group, splenius capitis, levator scapulae and sternocleidomastoid. Subjective assessment of fatigue was rated by employing the Borg scale. Intraclass correlation coefficient ICC((1,1)), standard error of measurement (SEM), smallest detectable difference (SDD) indices and Pearson's correlation co-efficient were calculated for the analysis of the results.

RESULTS

Normalised median frequency (MF) slope had low repeatability and large between-day error (ICC((1,1))=0.28-0.61; SEM=0.33-0.60%/s; SDD=132.7-703.2%) for the protagonist muscles of each movement. Initial median frequency (IMF) had moderate to good reliability and small error (ICC((1,1))=0.64-0.81; SEM=2.8-8.8Hz; SDD=19.9-38.5%). The RMS slope yielded also poor repeatability. The Borg assessment was more reliable than the EMG estimate though variability between sessions was still quite high (SDD=29.2-136.5%). No correlation was found between the EMG and Borg assessment of neck muscle fatigue (r=-0.01-0.39).

CONCLUSION

The protocol used for assessing neck muscle fatigue proved to be reliable only for the IMF but the clinical usefulness of this measure remains questionable. The lack of correlation between objective and subjective estimation of neck muscle fatigue was possibly a consequence of the poor measurement repeatability. Further research is needed to identify the factors responsible for these results on neck area.

Body Chart Pain Location and Side-Specific Physical Impairment in Subclinical Neck Pain

OBJECTIVE

To test computer-using students to examine the relationship between location of neck pain as indicated on pain drawings and physical impairments compared with those subjects not reporting pain.

METHODS

This cross-sectional study enrolled 81 healthy student volunteers at the College of Rehabilitation Science, Daegu University, Korea, aged 18 to 30 years. Outcomes were endurance time of neck muscles and neck range of motion (ROM) sensitization or stretch effects on repeated range tests. Active neck ROM measures were taken twice, 10 minutes apart. Neck muscle endurance time was obtained using a horizontal head-holding test with a 10-minute goal. After all physical measurements were completed, information about any neck pain was collected and 4 groups were formed on the basis of the pain location noted on the body chart.

RESULTS

Sixty-seven subjects experienced recurrent neck pain. Nineteen had right-side pain, another 19 had left-side pain, 29 reported pain on both sides, and 14 did not experience neck pain. Neck muscle endurance time was significantly lower for all pain groups. For extension, left and right rotation movements at the second test, ROM decreased for subjects reporting subclinical pain and increased for those with no pain. Location of the pain to one side was related to the ROM decreased, in that the amount of reduction in the second-test rotation range was significantly greater on the side opposite to the pain.

CONCLUSIONS

The location of neck pain that occurs intermittently, but is not present during range testing, affects the second test when the rotation involves stretching of tissue on the side of pain.

Decreased Muscle Strength and Mobility of the Neck in Patients With Rheumatoid Arthritis and Atlantoaxial Disorders

OBJECTIVE

To compare neck muscle strength and mobility of the cervical spine in rheumatoid arthritis (RA) patients with and without atlantoaxial (AA) disorders (anterior atlantoaxial subluxation [AAS], AA impaction).

DESIGN

Clinical cross-sectional study.

SETTING

Outpatient rheumatology and rehabilitation clinics in a Finnish hospital.

PARTICIPANTS

Patients with RA (N=124; mean age +/- standard deviation, 62+/-12y [corrected]) on a waiting list for orthopedic surgery. Thirty (24%) patients presented with AA disorders (16 with anterior AAS, 8 with AA impaction, 6 with a combination of anterior AAS and AA impaction).

INTERVENTIONS

Not applicable.

MAIN OUTCOME MEASURES

Neck function was measured by isometric neck strength and mobility tests, neck pain by a visual analog scale, erosion of the hands and feet by radiography, and the patients' function by the Health Assessment Questionnaire (HAQ).

RESULTS

Maximal neck muscle strength against flexion, extension, and rotation was lower in patients with AA disorders compared with the other patients in both women (P=.012) and men (P=.017). Mobility was lowest in the AA impaction group in all measured directions (P<.001). Peripheral erosive disease was more frequent in the group with AA disorders. They also had longer disease duration and were more disabled (HAQ) than the other patients.

CONCLUSIONS

Neck muscle strength is significantly decreased in patients with AA disorders. Mobility of the cervical spine is most limited in patients with AA impaction, but can be normal in cases with solitary anterior AAS.

Decreased neck muscle strength is highly associated with pain in cervical dystonia patients treated with botulinum toxin injections

OBJECTIVES

To compare the isometric neck muscle strength of cervical dystonia patients treated with botulinum toxin injections with that of healthy control subjects and to evaluate the association between neck strength, neck pain, and disability in these patients.

DESIGN

Clinical cross-sectional study.

SETTING

Outpatient rehabilitation and neurology clinics in a Finnish hospital.

PARTICIPANTS

Twenty-three patients with cervical dystonia with botulinum toxin-treated neck muscles and 23 healthy control subjects.

INTERVENTIONS

Not applicable. Main outcome measures Isometric neck strength was measured by a special neck strength measurement system. Disability was measured by the Neck Disability Index, and pain and symptoms of cervical dystonia by a visual analog scale.

RESULTS

Isometric neck strength in all directions measured was significantly lower (25%-44%) in the cervical dystonia patients than in the healthy controls. Neck pain levels reported during the strength tests (r range, -.36 to -.70) and neck pain experienced during the preceding week (r range, -.52 to -.63) were inversely associated with isometric strength results. The difference between sides in rotation strength was 35% in the patient group (P<.001), whereas no significant difference between sides was found in the healthy controls. Fifty-one percent of the patients reported moderate or severe disability. Pain, stiffness, and incorrect position of the head were the most prominent symptoms.

CONCLUSIONS

Cervical dystonia patients with botulinum toxin-treated neck muscles showed significantly lower maximal neck strength than healthy controls. The patients also had a statistically significant difference between sides in neck rotation strength. Thus, strength measures may be useful to detect disturbance in the function of the neck muscles.

Intratester and intertester reliability of neck isometric dynamometry

OBJECTIVE

To evaluate the reproducibility of measurement for maximum voluntary isometric contractions of the cervical musculature in different movements.

DESIGN

Repeated test-retest measurements.

SETTING

A department of physiotherapy.

PARTICIPANTS

Thirty-three healthy subjects (17 men, 16 women; age range, 19-63 y) for the intraexaminer study and 10 healthy subjects (4 men, 6 women; age range, 20-37 y) for the interexaminer study.

INTERVENTIONS

Maximum isometric strength in sitting and standing for flexion, extension, lateral flexion, and rotation using a custom isomyometer device. Three tests, performed 5 to 8 days apart, to assess intraexaminer reliability. Two examiners, each performing 1 trial, measuring on the same day to assess interexaminer reliability.

MAIN OUTCOME MEASURES

Intraexaminer and interexaminer reliability of neck muscle strength.

RESULTS

The standing position showed better reproducibility than the sitting position. The intraclass correlation coefficient (ICC1,3) was above .84 for all tests in any movement and position and above .93 when the first test was excluded. The standard error (SE) of measurement (<16.5 N; <.13 N-m for rotation) and smallest detectable difference (SDD) (<20.1%) were also small. For interexaminer reliability, the ICC(2,1) ranged from.88 to.94 and the SE from 10.7 to 20.8 N (<1.15 N-m for rotation); the SDD was less than 29.8% (except right rotation, which was 38.8%).

CONCLUSIONS

A reliable protocol for measuring neck strength has been developed. Standing position and a full practice session produces more reliable measurements.

Decreased isometric neck strength in women with chronic neck pain and the repeatability of neck strength measurements11No commercial party having a direct financial interest in the results of the research supporting this article has or will confer a benefit upon the author(s) or upon any organization with which the author(s) is/are associated

OBJECTIVES

To evaluate neck flexion, extension, and, especially, rotation strength in women with chronic neck pain compared with healthy controls and to evaluate the repeatability of peak isometric neck strength measurements in patients with neck pain.

DESIGN

Cross-sectional.

SETTINGS

Rehabilitation center and physical and rehabilitation medicine department at a Finnish hospital.

PARTICIPANTS

Twenty-one women with chronic neck pain and healthy controls matched for sex, age, anthropometric measures, and occupation.

INTERVENTIONS

Not applicable.

MAIN OUTCOME MEASURES

Peak isometric strength of the cervical muscles was tested in rotation, flexion, and extension.

RESULTS

Significantly lower flexion (29%), extension (29%), and rotation forces (23%) were produced by the chronic neck pain group compared with controls. When the repeated test results were compared pairwise against their mean, considerable variation was observed in the measures on the individual level. Intratester repeatability of the neck muscle strength measurements was good in all the 4 directions tested in the chronic neck pain group (intraclass correlation coefficient range,.74-.94). The coefficient of repeatability was 15N, both in flexion and extension, and 1.8 Nm in rotation. On the group level, improvement up to 10% due to repeated testing was observed.

CONCLUSIONS

The group with neck pain had lower neck muscle strength in all the directions tested than the control group. This factor should be considered when planning rehabilitation programs. Strength tests may be useful in monitoring training progress in clinical settings, but training programs should be planned so that the improvement in results is well above biologic variation, measurement error, and learning effect because of repeated testing.

Cervical range of motion associations with subclinical neck pain

STUDY DESIGN

Cross-sectional study.

OBJECTIVE

To investigate associations between subclinical neck pain/discomfort, and range of motion and physical dimensions of the cervicothoracic spine.

SUMMARY OF BACKGROUND DATA

Despite the high prevalence of neck problems, few studies are available indicating any physical associations with the development of neck pain, or information regarding early signs of pathology from neck pain for subjects not in treatment.

METHODS

Forty healthy volunteers, between 19 and 42 years of age (mean age 28 years), were recruited. The dimensions of the cervicothoracic spine measured were as follows: spinal posture, active cervical range of motion, and segment length of the neck. All measurements were taken twice from each subject by different testers, on the same occasion. Cervical muscle endurance was measured by a modified Biering-Sørensen Test. Finally, subjects were questioned about any recurrent neck pain/discomfort.

RESULTS

Fourteen subjects reported experiencing low-level neck pain/discomfort on a recurrent basis. Neck muscle endurance time (F1,38 = 6.75, P = 0.01) and left rotation end-of-range (F1,38 = 4.56, P = 0.04) were found to be significantly lower for subjects with neck pain. Extension end-of-range showed a group-specific change at retest, increasing for subjects without pain, but decreasing for those with neck pain (F1,38 = 4.67, P = 0.04). This same group had a greater range of retraction than the asymptomatic group (F1,38 = 4.56, P = 0.04). Subjects overall, irrespective of pain classification, demonstrated greater left rotation than right rotation (F1,38 = 4.34, P = 0.04) and also showed reduced side flexion on the left (F1,38 = 5.10, P = 0.03) and right (F1,38 = 5.27, P = 0.03) with repeated measurement.

CONCLUSIONS

Between-groups differences were observed as lower neck muscle endurance time, reduced left rotation, relatively reduced extension at second test, but greater range of retraction, when the subclinical and normal groups were compared. These data suggest that there are early range changes associated with the development of neck pain.

Chiropractic spinal manipulation for neck pain: a systematic review

Chiropractic spinal manipulation (CSM) is often used as a treatment for neck pain. However, its effectiveness is unclear. The aim of this article was to evaluate systematically and critically the effectiveness of CSM for neck pain. Six electronic databases were searched for all relevant randomized clinical trials. Strict inclusion/exclusion criteria had been predefined. Key data were validated and extracted. Methodologic quality was assessed by using the Jadad score. Statistical pooling was anticipated but was deemed not feasible. Four studies met the inclusion/exclusion criteria. Two studies were on single interventions, and 2 included series of CSM treatments, both with a 12-month follow-up. The 2 short-term trials used spinal mobilization as a control intervention. The 2 long-term studies compared CSM with exercise therapy. None of the 4 trials convincingly demonstrated the superiority of CSM over control interventions. In conclusion, the notion that CSM is more effective than conventional exercise treatment in the treatment of neck pain was not supported by rigorous trial data.

Decreased strength and mobility in patients after anterior cervical diskectomy compared with healthy subjects

OBJECTIVE

To evaluate whether patients acquired normal physical function after cervical disk prolapse and surgery compared with healthy matched controls.

DESIGN

Cross-sectional study.

SETTING

Hospital in central Finland.

PARTICIPANTS

Fifty-three patients with cervical diskectomy and 53 healthy matched controls.

INTERVENTIONS

Not applicable.

MAIN OUTCOME MEASURES

Postoperative physical function was studied by measuring muscle strength and range of motion (ROM) values of the neck and grip strength. Disability was assessed by the neck and shoulder pain index and by the Oswestry index, mood by the Short Depression Inventory; and pain on a visual analog scale (VAS).

RESULTS

Most patients recovered well after the operation. Forty-three percent of the patients still experienced moderate or high pain (VAS score, >30mm). Subjective pain and disability were associated with decreased neck movement and strength. Both ROM and cervical muscle strength values were significantly lower (P<.001) in all the measured directions in cervical disk surgery patients compared with healthy controls. ROM was mostly confined in extension (25%). Muscle strength of the neck was mostly confined in both rotation directions (38%). No statistically significant difference in grip strength was found between the groups.

CONCLUSION

The loss of muscle strength and ROM is clearly visible postoperatively and thus the effectiveness of the early identification and rehabilitation of these deficits merits further studies.

Axial neck rotation strength in neutral and prerotated postures

OBJECTIVE

To characterize isometric rotation strength in the neutral and in different prerotated positions of the neck.

DESIGN

This was a descriptive study involving maximal isometric strength measurements of the cervical musculature.

BACKGROUND

The literature contains only a few studies pertaining to strength levels of the neck rotator muscles in the neutral position. None of these studies have dealt in detail with maximal neck strength in selected prerotation positions.

METHOD

Twenty healthy men volunteered as subjects. Maximal axial rotation strength of the neck muscles was measured in a neutral position and bilaterally at 30 degrees and 60 degrees rotation using the isometric neck strength measurement system. Isometric maximum voluntary contractions of the neck muscles in flexion and extension were also tested.

RESULTS

The highest strength values were not reached in the neutral position, but at the largest joint angles, while turning the head in the opposite direction from the prerotated position. Maximal strength increased with increasing angle, and at the 60 degrees prerotation angle it was 44% higher towards the right and 27% higher towards the left compared to the values obtained in the neutral position. The smallest strength values were also produced at the largest prerotation angles, but in the same direction.

CONCLUSIONS

The present results show a clear relationship between the prerotated position of the neck and maximal voluntary strength in rotation.

RELEVANCE

The data suggest that neck strength is highly prerotation angle dependent. Neck strength should be measured at several prerotation positions in addition to the neutral position in order to obtain the true strength values throughout the entire range of motion. Maximal neck rotation strength between subjects is differentiated best at the greatest prerotation angles.

Effectiveness of physical therapy for patients with neck pain: an individualized approach using a clinical decision-making algorithm

OBJECTIVE

The purpose of this study was to determine the effectiveness of an individualized physical therapy intervention in treating neck pain based on a clinical reasoning algorithm. Treatment effectiveness was examined by assessing changes in impairment, physical performance, and disability in response to intervention.

DESIGN

One treatment group of 30 patients with neck pain completed physical therapy treatment. The control group of convenience was formed by a cohort group of 27 subjects who also had neck pain but did not receive treatment for various reasons. There were no significant differences between groups in demographic data and the initial test scores of the outcome measures. A quasi-experimental, nonequivalent, pretest-posttest control group design was used. A physical therapist rendered an eclectic intervention to the treatment group based on a clinical decision-making algorithm. Treatment outcome measures included the following five dependent variables: cervical range of motion, numeric pain rating, timed weighted overhead endurance, the supine capital flexion endurance test, and the Patient Specific Functional Scale. Both the treatment and control groups completed the initial and follow-up examinations, with an average duration of 4 wk between tests.

RESULTS

Five mixed analyses of variance with follow-up tests showed a significant difference for all outcome measures in the treatment group compared with the control group. After an average 4 wk of physical therapy intervention, patients in the treatment group demonstrated statistically significant increases of cervical range of motion, decrease of pain, increases of physical performance measures, and decreases in the level of disability. The control group showed no differences in all five outcome variables between the initial and follow-up test scores.

CONCLUSIONS

This study delineated algorithm-based clinical reasoning strategies for evaluating and treating patients with cervical pain. The algorithm can help clinicians classify patients with cervical pain into clinical patterns and provides pattern-specific guidelines for physical therapy interventions. An organized and specific physical therapy program was effective in improving the status of patients with neck pain.

Perceived pain before and after three exercise programs--a controlled clinical trial of women with work-related trapezius myalgia

The effect of exercise on neck-shoulder pain was studied in 103 women with work-related trapezius myalgia randomized into three exercise groups and a control group. One group trained strength, the second muscular endurance and the third co-ordination. The exercise groups met three times weekly for 10 weeks. Pain assessment was made on three visual analogue scales, indicating pain at present, pain in general and pain at worst. Pain thresholds were measured in the trapezius muscle with a pressure algometer. A pain drawing was completed. The rated pain decreased significantly (P<0.05) on the VAS describing pain at worst in the strength and endurance groups. Pressure sensitivity decreased significantly (P<0.05) in four triggerpoints in the exercise groups. No changes were seen in the extent of painful body area in any group. Comparison of exercisers (n=82) and controls (n=21) showed significantly larger pain reductions on VAS pain at present and VAS pain at worst among exercisers. All three exercise programs showed similar decreases of pain which indicates that the type of exercise is of less importance to achieve pain reduction.

Maximal isometric strength of the cervical musculature in 100 healthy volunteers

STUDY DESIGN

A descriptive study involving maximal isometric strength measurements of the cervical musculature.

OBJECTIVES

To determine the maximal isometric strength of the flexors and extensors and of the cervical musculature in 100 healthy volunteers (50 men and 50 women).

SUMMARY OF BACKGROUND DATA

The literature contains only a few descriptive studies pertaining to strength levels of the cervical musculature. These studies include small subject populations, and measurement methods have demonstrated weak reliability.

METHODS

Testing was carried out using strain-gauge technology on a neck muscle training apparatus.

RESULTS

A reliability study demonstrated acceptable intraday and day-to-day values. Maximal isometric strength was approximately 20% to 25% higher in male subjects than female subjects in both flexion and extension from the third to the sixth decades. In the seventh decade, the women's strength levels surpassed values for men in both flexion and extension. Extension-flexion ratios were approximately 1.7 to 1 in both the men and women participants. The men demonstrated a significant decrease in maximal isometric strength with increasing age in both flexion and extension, whereas the women were able to maintain strength values in the ages tested.

CONCLUSIONS

Men and women demonstrate impressive levels of muscular strength in the flexors and extensors of the cervical spine and can maintain these values until the seventh decade of life. Successful rehabilitation of the cervical musculature will require considerable resistance for sufficient stimulation of the cervical musculature.

Intensive dynamic training for females with chronic neck/shoulder pain. A randomized controlled trial

OBJECTIVES

To compare the clinical effectiveness of an intensive three-month training programme with a less intensive programme on females suffering from chronic neck/shoulder pain.

STUDY DESIGN

A prospective observer-blinded clinical trial including 12-month pretreatment follow-up.

SETTING

Patients were referred to the Departments of Rheumatology and Physical Medicine at Hvidovre Hospital by their general practitioners. Training was undertaken at a satellite clinic for physiotherapy of Hvidovre Hospital.

SUBJECTS

Female patients aged 18-65 years suffering from chronic neck/shoulder pain for a minimum of six months.

INTERVENTION

Patients were examined by a physician in order to exclude serious diseases. They were then randomized to either an intensive neck/shoulder training programme or a programme of lesser intensity but of similar duration.

MAIN OUTCOME MEASURES

Scales measuring pain and activities of daily living (ADL) were used, and strength and endurance measurements of the cervical and shoulder muscles were carried out at baseline and completion of the study. Follow-up measurements were carried out by postal questionnaire at 6 and 12 months after inclusion, and included pain, ADL and treatment satisfaction measurements.

RESULTS

Seventy-seven patients were included in the trial, of whom 27 (69%) completed the intensive programme and 25 (61%) the lighter programme. Forty-one (>80%) completed the follow-up questionnaires. The patients in the two groups did not differ with regard to age, pain, ADL scores and physical measurements prior to training. Patients in both groups that completed the trial demonstrated statistically significant improvements in nearly all of the outcome measurements at completion. ADL scores maintained statistical significance at 12 months in both groups, but pain scores were only significantly improved in the intensive group at 12 months follow-up. There was no statistically significant difference between groups regarding pain or ADL, but overall 50% of all patients showed improvement.

CONCLUSIONS

The type of low-tech dynamic training used in either of our two programmes resulted in both subjective and objective improvements in patients suffering from chronic neck/shoulder pain, but there were no statistically significant differences in outcome between the two approaches. The subjective improvements were maintained throughout the follow-up period.

Does physical activity enhance health?

This paper provides the justification of physical activity promotion for health by critically reviewing the recent US Surgeon General's Report. Evidence is summarized of the effects of physical activity on physiological responses, overall mortality, a number of diseases and disabilities, overall functional capacity, and mental health and quality of life. Cumulating evidence suggests that the effects be applicable to both genders and to a wide age range. The adverse effects of physical activity on health are shown to be small and mostly preventable. It is emphasized that substantial health effects can be gained by moderate daily physical activity which does not require high skill level nor specialized equipment or facilities. It is concluded that the health potential of physical activity is substantial due to the high prevalence of inactive lifestyle in the populations, the great number of health conditions being affected by physical activity, and the feasibility and safety of physical activity as a health measure.

Intensive training, physiotherapy, or manipulation for patients with chronic neck pain. A prospective, single-blinded, randomized clinical trial

STUDY DESIGN

A randomized, prospective clinical study was conducted that included 119 patients with chronic neck pain of greater than 3 months' duration.

OBJECTIVES

To compare the relative effectiveness of intensive training of the cervical musculature, a physiotherapy treatment regimen, and chiropractic treatment on this patient group.

SUMMARY OF BACKGROUND DATA

There are only a few studies involving chronic neck pain patients representative of those seeking care in primary health care centers. Mobilization techniques and intensive training have been shown to be useful, but cervical manipulation has not been assessed. Clinical results involving these commonly used therapies have not been compared.

METHODS

A total of 167 consecutive patients were screened. One hundred nineteen patients were admitted to the study and were randomized according to Taves' minimization principles. Primary outcome measures included self-reported pain, disability, medication use, patients' perceived effect, and physician's global assessment. Patients were assessed at enrollment and at completion of the study. Postal questionnaires were used to carry out 4- and 12-month follow-up assessments. Secondary outcome measures included active range of motion of the cervical spine as well as strength and endurance measurements of the cervical musculature. These measurements were carried out at enrollment and completion of the study.

RESULTS

A total of 88% of the patients completed the study. Of these, 97% completed the 4-month questionnaire and 93% the 12-month questionnaire. Patients from all three groups demonstrated significant improvements regarding self-reported pain and disability on completion of the study. Improvements were maintained throughout the follow-up period. Medication use was also significantly reduced in all groups. There was, however, no significant difference between groups at any assessment period. Physician's and patients' assessments were also positive, and again group scores were essentially equal. Patients who underwent intensive training demonstrated significantly greater endurance levels at the completion of treatment.

CONCLUSIONS

There was no clinical difference between the three treatments. All three treatment interventions demonstrated meaningful improvement in all primary effect parameters. Improvements were maintained at 4- and 12-month follow-up. However, whether this was a result of the treatments or simply a result of time is unknown. Future studies will be necessary to delineate ideal treatment strategies.

Exercise and physical health: musculoskeletal health and functional capabilities

An adequately functioning musculoskeletal system is a key factor for functional capacity, independence, and good quality of life. Impaired functional capacity and degenerative diseases of the musculoskeletal organs are one of the most prevalent and increasing sources of morbidity and suffering. Physical activity positively influences most structural components of the musculoskeletal system that are related to functional capabilities and the risk of degenerative diseases. Physical activity also has the potential to postpone or prevent prevalent musculoskeletal disorders, such as mechanical low back pain, neck and shoulder pain, and osteoporosis and related fractures. Exercise can contribute to the rehabilitation of musculoskeletal disorders and recovery from orthopedic surgery. A substantial part of the age-related decline in functional capabilities is not due to aging per se but to decreased and insufficient physical activity. Physical activity has great potential to favorably influence both the normal and pathological structures, functions, and processes. Musculoskeletal benefits of physical activity can be attained by people of all ages and with various diseases. This potential is substantial because many benefits are gained by activity which is moderate in amount and intensity. Scientific evidence is sufficient to recommend regular lifelong physical activity as part of a healthy lifestyle for everyone in order to enhance musculoskeletal health and functions for individual and population levels. However, several important issues regarding the effects, effectiveness, feasibility, and safety of exercise to improve various aspects of musculoskeletal health and functional capabilities need further research.