Increased forward head posture and restricted cervical range of motion in patients with carpal tunnel syndrome

A Pilot Study In to the Effects of Cervical Manual Therapy Plus Conventional Physical Therapy on Clinical Outcomes and Electrodiagnostic Findings in People With Carpal Tunnel Syndrome

Background

Carpal tunnel syndrome (CTS) is the most common entrapment neuropathy that has a significant impact on patients' quality of life. Current physical therapy treatment options show limited effects or low-quality evidence, especially in the long term. To date, there has been little research to look at the effects of treating the cervical spine on decreasing symptoms distally to the carpal tunnel. This study aimed to evaluate the effects of cervical manual therapy plus conventional physical therapy on patients with carpal tunnel syndrome.

Methods

This pilot pretest/posttest and six-month follow-up clinical study included 15 adult patients with CTS. For two weeks, each patient received 10 sessions of supervised intervention treatment. The efficacy of the therapies was assessed at baseline (T0), immediately after treatment (T1), and six months after treatment (T2). The visual analog scale (VAS), a symptom severity scale, the functional capacity scale of the Boston Carpal Tunnel Questionnaire (BCTQ), the Disabilities of the Arm, Shoulder and Hand (DASH) questionnaire, median nerve motor distal latency (mMDL), and median sensory nerve conduction velocity (mSNCV) were outcome measures.

Results

There were significant improvements in all measures between the baseline values at T0 and those recorded immediately after the treatment at T1 or six months later at T2 (p<.05).

Conclusion

This pilot study indicates that cervical manual therapy plus conventional physical therapy applied for two weeks improves clinical outcomes and electrodiagnostic findings in people with CTS.

Therapeutic routine with respiratory exercises improves posture, muscle activity, and respiratory pattern of patients with neck pain: a randomized controlled trial

Neck pain and forward head posture (FHP) are typical in prolonged smartphone users and need to be targeted for treatment. We aimed to compare the effect of a routine therapeutic program with and without respiratory exercises on smartphone users with FHP and non-specific chronic neck pain (NSCNP). Sixty patients (aged 24.7 ± 2.1 years) with FHP and NSCNP were randomly assigned to the routine therapeutic program (n = 20), combined respiratory exercises with a routine therapeutic program (n = 20), or control (n = 20) groups. At baseline, there was no difference among groups at all variables. Each programme was implemented three times a week for eight weeks. Primary Outcome was pain measured by visual analogue scale (VAS), and secondary ones were forward head angle, the activity of specific muscles, and respiratory patterns, measured by photogrammetry, electromyography and manual, respectively. All outcomes were measured at baseline and eight weeks post-treatment. We used the repeated measures analysis of variance to examine the interaction between time and group, paired t-test for intragroup comparison, one-way analysis of variance for intergroup comparison, and Tukey post hoc test at a significant level 95% was used. There were significant differences in the combined group compared with the routine therapeutic group (P = 0.03) for diaphragm muscle activation, respiratory balance (P = 0.01), and the number of breaths (P = 0.02). There were significant within-group changes from baseline to post-treatment in the combined group for all outcomes above, but no changes in the therapeutic exercise routine group. Despite respiratory pattern, none of the secondary outcomes proved to be superior in the combination group compared to the routine therapeutic program in smartphone users with FHP and NSCNP. Future studies with longer follow-up assessments could strengthen these results.Trial registration: Current Controlled Trials using the IRCT website with ID number of, IRCT20200212046469N1 "Prospectively registered" at 04/03/2020.

Correlation between craniovertebral angle in the sagittal plane and angles and indices measured in the frontal plane at the moment of inducing forward head posture

BACKGROUND

Forward head posture (FHP) is the most common malposition in the head and neck area. With the growing use of digital devices, the prevalence of FHP may be expected to increase dramatically. Thus far, FHP has been evaluated only in the sagittal plane.

OBJECTIVE

The objective of this study was to measure angles and indices from anatomical landmarks in the frontal plane and determine the possible correlations between these variables and craniovertebral angle (CVA) as an index of FHP in the sagittal plane.

METHODS

Fifty eight healthy individuals (29 men, 29 women) between 18 and 40 years old participated in this cross-sectional study. Participants were evaluated with an 8-camera motion analysis system. After markers were placed on predetermined landmarks, the participants were asked to maintain their head and neck in the neutral position for 5 seconds. Then participants induced FHP by flexing and lowering their head. The correlation between CVA and a set of angles and indices was calculated at the moment of FHP induction.

RESULTS

A moderate correlation was observed between 3-D CVA and the angle formed between the sternum and both tragi for the whole sample and separately in both sexes. A moderate negative correlation was observed between 3-D CVA and height, weight, and BMI in women. A moderate negative correlation was observed between 3-D CVA and height, weight, BMI, and hours on digital devices in men.

CONCLUSIONS

Changes in CVA in the sagittal plane can be predicted from changes in the angle formed between the midpoint of the sternum and the left and right tragi in the frontal plane.

Effect of Deep Cervical Flexor Muscle Training Using Pressure Biofeedback on Pain and Forward Head Posture in School Teachers with Neck Pain: An Observational Study

BACKGROUND

Teaching is one of the professions where incidence and prevalence of neck pain is high. Prolonged use of computers, which has further increased due to online teaching amid pandemic, is known to cause neck pain and alter posture, while people with forward head posture (FHP) are prone to develop neck pain and related disability. Research has shown that impairment of deep cervical flexor (DCF) muscles leads to insufficiency in coordination, activation, overload, and poor support on cervical structures that further lead to development of neck pain and altered neck posture. The objective of this study was to see the effect of DCF muscle training using pressure biofeedback on pain and FHP in school teachers with neck pain.

METHODS

This observational study was conducted at medical center in school premises. Fifty-five school teachers aged between 25 and 40 years with experience of more than 5 years were invited to participate in this study. Subjects were divided in two groups. Both the groups received conventional exercises while in experimental group DCF muscle training using pressure biofeedback was given additionally. Pain and FHP were assessed using NPRS and cranio-vertebral angle using digital photograph technique, respectively, at baseline and end of four weeks of treatment.

RESULTS

Although pain and FHP improved in both the groups, mean improvement in both the measures was more in the group that also received DCF training using pressure biofeedback.

CONCLUSIONS

This study shows that although pain and FHP improved following conventional exercises in school teachers with neck pain, mean improvement was more significant among those who received additional DCF muscle training using pressure biofeedback.

The characteristics, disabilities, and spinal alignment of women with double crush syndrome: a case-control study

AIMS

Double crush syndrome is a clinical condition composed of neurological dysfunction due to compressive pathology at multiple sites along a single peripheral nerve. The aims were to investigate the characteristics and disabilities of women with double crush syndrome, to compare the spinal alignment to healthy women, and to determine the cut-offs for the spinal alignment characteristics.

METHODS

Twenty women with double crush syndrome (age: 49.50 ± 8.64 years) and 21 asymptomatic healthy controls (age: 44.76 ± 7.82 years) were included in the study. The physical characteristics, pain intensity, and symptoms were questioned. Disability with Disability of Arm and Shoulder Questionnaire and Neck Disability Index and spinal alignment with Spinal Mouse^® (Idiag, Fehraltorf, Switzerland) were assessed.

RESULTS

The pain intensity at rest, night, and during activity was 3.70 ± 3.25, 6.01 ± 2.77, and 7.15 ± 2.68 cm, respectively. The most bothersome symptom was numbness (65%). The symptoms were seen in hands and/or fingers (55%), arms (15%), shoulder blade (15%), and neck (15%). The Disability of Arm and Shoulder Questionnaire and Neck Disability Index scores were 58.64 ± 15.41 and 19.55 ± 6.37, respectively. The sagittal thoracic curvature (p: .011) and lumbar curvature (p: .049) increased, and the overall spine mobility (p<.001) decreased in the double crush syndrome patients. The cut-off points were detected as 54.5° (area under the curve: 0.680, p: .049, 40% sensitivity, 99.9% specificity) for the thoracic spinal curvature, and 113.5° (area under the curve: 0.667, p<.000, 65% sensitivity, 99.9% specificity) for the overall spine mobility.

CONCLUSIONS

The double crush syndrome patients had moderate to severe pain and disability, increased thoracic and lumbar curvature, and decreased spine mobility. The cut-off values were found as 54.5° for thoracic curvature and 113.5° for spine mobility.

Improved neck posture and reduced neck muscle activity when using a novel camera based workstation for manual precision inspection tasks

PURPOSE

This study investigates the effects of the usage of a novel camera system compared to a conventional lens system for manual precision tasks. Utilizing the novel camera system aims to improve neck posture, reduce neck muscle tension and thereby minimize the risk of neck pain.

METHODS

Camera and lens systems were compared by assessing the craniovertebral angle (CVA), electromyographic activity of the M.trapezius and perceived exertion. 16 healthy participants (n = 8 female, 24 ± 2 years; n = 8 male, 30 ± 5 years) performed manual precision tasks in a cross-over design using both systems in sitting and standing positions.

RESULTS

Analyses showed that using the camera system improved the CVA in sitting [28.4° (22.8°-33.9°) to 42.5° (38.9°-46.1°); p < 0.01] and decreased the M.trapezius activity in standing [13.1% (7.7%-18.6%) to 8.65% (5.49%-11.81%)]. Additionally, overall and neck specific perceived exertion decreased when using the camera system in standing.

CONCLUSIONS

The camera system may prevent neck pain in workers performing manual precision tasks in sitting and standing postures.

The Utilization of Joint Mobilization As Part of a Comprehensive Program to Manage Carpal Tunnel Syndrome: A Systematic Review

OBJECTIVE

The purpose of this review is to identify the role of joint mobilization for individuals with Carpal tunnel syndrome (CTS).

METHODS

A systematic search of 5 electronic databases (PubMed, CINAHL, Scopus, Cochrane Central Register of Controlled Trials, and SPORTDiscus) was performed to identify eligible full-text randomized clinical trials related to the clinical question. Joint mobilization had to be included in one arm of the randomized clinical trials to be included. Two reviewers independently participated in each step of the screening process. A blinded third reviewer assisted in cases of discrepancy. The PEDro scale was used to assess quality.

RESULTS

Ten articles were included after screening 2068 titles. In each article where joint mobilization was used, positive effects in pain, function, or additional outcomes were noted. In most cases, the intervention group integrating joint mobilization performed better than the comparison group not receiving joint techniques.

CONCLUSION

In the articles reviewed, joint mobilization was associated with positive clinical effects for persons with CTS. No studies used joint mobilization in isolation; therefore, results must be interpreted cautiously. This review indicates that joint mobilization might be a useful adjunctive intervention in the management of CTS.

Neurodynamic evaluation and nerve conduction studies in patients with forward head posture

Forward head posture (FHP) is one of the most frequently seen problems. The aim of this study was to evaluate the neurodynamic tests and peripheral nerve conductions of upper extremity in patients with FHP. The study population included 100 patients with upper extremity and neck problems and 34 healthy individuals as a control group. Craniovertebral angle measurement was used to determine forward head posture. Stretch tests for radial, ulnar and median nerves were performed. Nerve conductions of bilateral median, radial, ulnar and medial antebrachial cutaneous (MAC) nerves were examined in all patients included in the study. The most significant nerve conduction differences in moderate-to-severe FHP patients were a decrease in the sensory nerve action potential (SNAP) and compound muscle action potential (CMAP) amplitudes of median nerves, a decrease in the SNAP amplitude of ulnar nerves, a delay in the F response latency of ulnar nerves and prolongation in the SNAP latency of the MAC nerve. FHP makes patients more prone to peripheral entrapments.

Relationship between Forward Head Posture and Tissue Mechanosensitivity: A Cross-Sectional Study

The relationship between forward head posture (FHP) and neck pain is not clear. FHP could possibly increase the mechanosensitivity of cervical tissues, which could lead to the development of pain depending on the adaptation capability of the central nervous system. The purpose of this study was to analyse the influence of FHP in the mechanosensitivity of articular, muscular, and neural tissues related to the cervical spine. The pressure pain threshold was bilaterally measured in different muscles and nerves and the second cervical vertebrae. The cervical spine’s range of movement was also examined. The measurements were obtained from people with (n = 32) and without (n = 64) FHP. The analyses included a 2-by-2 mixed analysis of variance (ANOVA), pairwise comparisons with Bonferroni correction, and point-biserial correlation coefficients. Subjects with FHP showed a less pressure pain threshold (PPT) in all locations except for the upper trapezius and scalenus medius muscles. They also showed less extension and right-rotation range of motion. There was no association between FHP, neck pain, disability, and headache. Nevertheless, more research is needed to evaluate the relationship between FHP, tissue mechanosensitivity, and neck pain.

Impact of Cervical Sensory Feedback for Forward Head Posture on Headache Severity and Physiological Factors in Patients with Tension-type Headache: A Randomized, Single-Blind, Controlled Trial

BACKGROUND Tension-type headache (TTH) decreases the ability to concentrate and function during daily activities in affected patients. As most patients with TTH exhibit forward head posture (FHP). Various interventions have been proposed to resolve TTH. However, research regarding the efficacy of these interventions remains lacking. The present study aimed to investigate the association between FHP and TTH, and to evaluate the efficacy of various intervention methods on headache symptoms and other clinical variables in patients with TTH induced by FHP. MATERIAL AND METHODS Participants were randomly allocated to 3 groups: biofeedback (BF, n₁=21), manual therapy (MT, n₂=20) and, stretching (ST, n₃=21). Interventions were conducted 3 times per week for 4 weeks. Craniovertebral angle (CVA), electroencephalographic findings for attention, stress, and pressure-pain threshold (PPT), headache on activities of daily living (Henry Ford Headache Disability Inventory, HDI), and quality of life (QoL) assessments were obtained pre-intervention, post-intervention, and at the 2-week follow-up. RESULTS The correlation between CVA and HDI after intervention (R²=0.324, P<0.001), and at 2-week follow-up (R²=0.115, P<0.01) are significant. BF was associated with significant improvements in CVA (F₂,₅₉=3.393, P<0.001, η^2/P=0.130), attention (F₂,₅₉=5.186, P<0.01, η^2/P=0.150), stress [skin temperature (F₂,₅₉=6.005, P<0.001, η^2/P=0.169) and skin conductance (F₂,₅₉=4.900, P<0.01, η^2/P=0.142)], PPT (F₂,₅₉=5.050, P<0.01, η^2/P=0.146), HDI (F₂,₅₉=3.303, P<0.01, η^2/P=0.101), and QoL (F₂,₅₉=3.409, P<0.05, η^2/P=0.104). CONCLUSIONS Our findings indicate that BF was more effective than MT and ST in the treatment of TTH due to FHP. Such findings highlight the need to develop and promote a controlled exercise program to facilitate a return to normal daily activities in patients with TTH due to FHP.

The Relationship Between Forward Head Posture and Neck Pain: a Systematic Review and Meta-Analysis

PURPOSE OF REVIEW

Forward head posture (FHP) is the most common cervical postural fault in the sagittal plane that is found with different severity levels in almost all populations. Despite claims that FHP may be related to neck pain, this relation seems to be controversial. Thus, our purpose is to determine whether FHP differs between asymptomatic subjects and those with neck pain and to investigate if there is a relationship between head posture and neck pain.

RECENT FINDINGS

A total of 15 cross-sectional studies were eligible for inclusion for this systematic review and meta-analysis. Ten studies compared FHP between a group of asymptomatic participants and a group of participants with neck pain and an overall mean difference (MD) of 4.84 (95% CI = 0.14, 9.54), indicating a significant between-group difference, contrary to adolescent (MD = - 1.05; 95% CI = - 4.23, 2.12). Eight studies showed significant negative correlations between FHP and neck pain intensity (r = - 0.55; 95% CI = - 0.69, - 0.36) as well as disability (r = - 0.42; 95% CI = - 0.54, - 0.28) in adults and older adults, while in adolescents, only lifetime prevalence and doctor visits due to neck pain were significant predictors for FHP. This systematic review found that age played an important role as a confounding factor in the relation between FHP and neck pain. Also, the results showed that adults with neck pain show increased FHP when compared to asymptomatic adults and that FHP is significantly correlated with neck pain measures in adults and older adults. No association was found between FHP and most of neck pain measures in adolescents.

Effect of adding interferential current stimulation to exercise on outcomes in primary care patients with chronic neck pain: a randomized controlled trial

OBJECTIVE

To evaluate the effect of adding interferential current stimulation to exercise on pain, disability, psychological status and range of motion in patients with neck pain.

DESIGN

A single-blinded randomized controlled trial.

SETTING

Primary care physiotherapy units.

SUBJECTS

A total of 84 patients diagnosed with non-specific mechanical neck pain. This sample was divided into two groups randomly: experimental (n = 42) versus control group (n = 42).

INTERVENTIONS

Patients in both groups had a supervised therapeutic exercise programme, with the experimental group having additional interferential current stimulation treatment.

MAIN MEASURES

The main measures used were intensity of neck pain according to the Visual Analogue Scale; the degree of disability according to the Neck Disability Index and the CORE Outcome Measure; anxiety and depression levels according to the Goldberg scale; apprehension as measured by the Personal Psychological Apprehension scale; and the range of motion of the cervical spine. The sample was evaluated at baseline and posttreatment (10 sessions/two weeks).

RESULTS

Statistically significant differences between groups at posttreatment were observed for Visual Analogue Scale (2.73 ± 1.24 vs 4.99 ± 1.56), Neck Disability Index scores (10.60 ± 4.77 vs 18.45 ± 9.04), CORE Outcome Measure scores (19.18 ± 9.99 vs 35.12 ± 13.36), Goldberg total score (6.17 ± 4.27 vs 7.90 ± 4.87), Goldberg Anxiety subscale, Personal Psychological Apprehension Scale scores (28.17 ± 9.61 vs 26.29 ± 11.14) and active and passive right rotation.

CONCLUSIONS

Adding interferential current stimulation to exercise resulted in better immediate outcome across a range of measures.

Does improvement towards a normal cervical sagittal configuration aid in the management of cervical myofascial pain syndrome: a 1- year randomized controlled trial

Background

There is a growing interest concerning the understanding of and rehabilitation of the sagittal configuration of the cervical spine as a clinical outcome. However, the literature on the topic specific to conservative treatment outcomes of patients with chronic myofascial cervical pain syndrome (CMCPS) has not adequately addressed the relationship between cervical sagittal alignment and improved pain, disability and range of motion.

Methods

A randomized controlled study with a 1-year follow-up. Here, 120 (76 males) patients with chronic CMCPS and defined cervical sagittal posture abnormalities were randomly assigned to the control or an intervention group. Both groups received the Integrated neuromuscular inhibition technique (INIT); additionally, the intervention group received the denneroll cervical traction device. Alignment outcomes included two measures of sagittal posture: cervical angle (CV), and shoulder angle (SH). Patient relevant outcome measures included: neck pain intensity (NRS), neck disability (NDI), pressure pain thresholds (PPT), cervical range of motion using the CROM. Measures were assessed at three intervals: baseline, 10 weeks, and 1 year after the 10 week follow up.

Results

After 10 weeks of treatment, between group statistical analysis, showed equal improvements for both the intervention and control groups in NRS (p = 0.36) and NDI (p = 0.09). However, at 10 weeks, there were significant differences between groups favoring the intervention group for PPT (p<0.001) and all measures of CROM (p<0.001). Additionally, at 10 weeks the sagittal alignment variables showed significant differences favoring the intervention group for CV p<0.001 and SH (p<0.001) indicating improved CSA. Importantly, at the 1-year follow-up, between group analysis identified a regression back to baseline values for the control group for the non-significant group differences (NRS and NDI) at the 10-week mark. Thus, all variables were significantly different between groups favoring the intervention group at 1-year follow up: NRS (p<0.001), NDI (p<0.001), PPT p<0.001), CROM (p<0.001), CV (p<0.001), SH (p<0.001).

Conclusion

The addition of the denneroll cervical orthotic to a multimodal program positively affected CMCPS outcomes at long term follow up. We speculate the improved sagittal cervical posture alignment outcomes contributed to our findings.

Trial registration

Pan African Clinical Trial Registry Clinical Trial Registry: PACTR201801002968301, registered 11 January 2018 (retrospectively registered).

Two-Year Follow-Up of Impaired Range of Motion in Chronic Fatigue Syndrome

OBJECTIVE

To measure changes in range of motion (ROM) over time in a cohort of 55 adolescents and young adults with chronic fatigue syndrome and to determine whether changes in ROM correlated with changes in health-related quality of life.

STUDY DESIGN

Participants underwent a standardized examination of 11 areas of limb and spine ROM at baseline and at 3- to 6-month intervals for 2 years, resulting in a ROM score that ranged from 0 (normal throughout) to 11 (abnormal ROM in all areas tested). We measured the time until the ROM score was ≤2 (the score in healthy age-matched controls). Change in ROM was measured by subtracting the 24-month from the baseline ROM score and by summing the degrees of change in the 10 tests with continuous outcomes. Health-related quality of life was measured using the Pediatric Quality of Life Inventory 4.0 (PedsQL).

RESULTS

The mean age at enrollment was 16.5 years (range 10-23). Two-year follow-up was available for 53 (96%). The proportion with a ROM score of >2 fell gradually over 2 years, from 78% at entry to 20% at 24 months (P < .001). ROM scores improved from a median of 5 at entry to 2 at 24 months (P < .001). The change in the summed degrees of improvement in ROM correlated positively with improvement in the PedsQL physical function subscale (r = 0.30; P < .03).

CONCLUSIONS

In association with multimodal therapy, young people with chronic fatigue syndrome experienced progressively less impairment in ROM over 2 years, correlating with improvements in the physical function subscale of the PedsQL.

The Effects of Forward Head Posture on Neck Extensor Muscle Thickness: An Ultrasonographic Study

OBJECTIVE

This study aimed to compare neck extensor muscle thickness, thickness changes, and strength between participants with forward head posture (FHP) and controls with normal head posture (NHP).

METHODS

Twenty college students with FHP (mean age 21.30 ± 2.36 years) and 20 students with NHP (mean age 21.85 ± 2.78 years) participated in this case-control study. The thickness of neck extensor muscles was measured at rest and at maximal voluntary isometric contraction (MVIC). In addition, the craniovertebral angle (CVA) was calculated. To compare thickness changes between the 2 groups and among 5 muscles, a 2-way repeated measures analysis of variance was applied. In addition, Pearson's correlation test was performed to investigate the relationship between neck extensor MVIC and CVA.

RESULTS

The FHP group demonstrated lower MVIC compared with the NHP group (P = .03). Semispinalis capitis showed the smallest thickness changes during neck extensor MVIC in FHP compared with the controls (P < .001). However, no significant difference in terms of muscle thickness was observed between the 2 groups at the state of rest (P = .16-.99). A positive association was also found between the MVIC and CVA (P = .02).

CONCLUSIONS

Semispinalis capitis had less thickness changes during MVIC of neck extensors in individuals with FHP compared with those with NHP. This indirectly implies lower activity of this muscle in FHP condition. This study finding may help researchers develop therapeutic exercise protocols to manage FHP.

Myofascial Release Therapy in the Treatment of Occupational Mechanical Neck Pain: A Randomized Parallel Group Study

OBJECTIVE

As myofascial release therapy is currently under development, the objective of this study was to compare the effectiveness of myofascial release therapy with manual therapy for treating occupational mechanical neck pain.

DESIGN

A randomized, single-blind parallel group study was developed. The sample (n = 59) was divided into GI, treated with manual therapy, and GII, treated with myofascial release therapy. Variables studied were intensity of neck pain, cervical disability, quality of life, craniovertebral angle, and ranges of cervical motion.

RESULTS

At five sessions, clinical significance was observed in both groups for all the variables studied, except for flexion in GI. At this time point, an intergroup statistical difference was observed, which showed that GII had better craniovertebral angle (P = 0.014), flexion (P = 0.021), extension (P = 0.003), right side bending (P = 0.001), and right rotation (P = 0.031). A comparative analysis between therapies after intervention showed statistical differences indicating that GII had better craniovertebral angle (P = 0.000), right (P = 0.000) and left (P = 0.009) side bending, right (P = 0.024) and left (P = 0.046) rotations, and quality of life.

CONCLUSIONS

The treatment of occupational mechanical neck pain by myofascial release therapy seems to be more effective than manual therapy for correcting the advanced position of the head, recovering range of motion in side bending and rotation, and improving quality of life.

Comparing the effectiveness of myofascial techniques with massage in persons with upper crossed syndrome (preliminary report)

Introduction: Upper crossed syndrome is a postural syndrome, with myofascial and functional imbalance within the shoulder girdle and the cervical spine. The therapy usually includes myofascial techniques or massage. The aim of this work was to indicate which of these forms of therapy is more effective in terms of myofascial release.

Material and methods: The study group consisted of 18 individuals (12 females and 6 males) with upper crossed syndrome who were randomly assigned to one of the two groups. In group 1 (8 females, 1 male), rehabilitation protocol involved myofascial techniques, while in group 2 (4 females, 5 males), massage was performed. In both groups, the therapy consisted of five 30-minute daily sessions. Prior to the therapy, on the 1st and the 5th day of the therapy immediately after the intervention as well as 14 days after the therapy completion, suprasternale height was measured and the cervical spine mobility was examined.

Results: It was revealed that both forms of the therapy resulted in an increase in the range of motion of the cervical spine, particularly in the case of the right flexion and right rotation. Effects were still present two weeks after the therapy. After 5 days of rehabilitation, both forms of the therapy led to a significant increase in suprasternale height (p<0.05).

Conclusions: Both myofascial techniques and massage result in an increase in the cervical spine and chest mobility in the longitudinal dimension in persons with upper crossed syndrome.

The Effectiveness of Manual Therapy Versus Surgery on Self-reported Function, Cervical Range of Motion, and Pinch Grip Force in Carpal Tunnel Syndrome: A Randomized Clinical Trial

Study Design Randomized parallel-group trial. Background Carpal tunnel syndrome (CTS) is a common pain condition that can be managed surgically or conservatively. Objective To compare the effectiveness of manual therapy versus surgery for improving self-reported function, cervical range of motion, and pinch-tip grip force in women with CTS. Methods In this randomized clinical trial, 100 women with CTS were randomly allocated to either a manual therapy (n = 50) or a surgery (n = 50) group. The primary outcome was self-rated hand function, assessed with the Boston Carpal Tunnel Questionnaire. Secondary outcomes included active cervical range of motion, pinch-tip grip force, and the symptom severity subscale of the Boston Carpal Tunnel Questionnaire. Patients were assessed at baseline and 1, 3, 6, and 12 months after the last treatment by an assessor unaware of group assignment. Analysis was by intention to treat, with mixed analyses of covariance adjusted for baseline scores. Results At 12 months, 94 women completed the follow-up. Analyses showed statistically significant differences in favor of manual therapy at 1 month for self-reported function (mean change, -0.8; 95% confidence interval [CI]: -1.1, -0.5) and pinch-tip grip force on the symptomatic side (thumb-index finger: mean change, 2.0; 95% CI: 1.1, 2.9 and thumb-little finger: mean change, 1.0; 95% CI: 0.5, 1.5). Improvements in self-reported function and pinch grip force were similar between the groups at 3, 6, and 12 months. Both groups reported improvements in symptom severity that were not significantly different at all follow-up periods. No significant changes were observed in pinch-tip grip force on the less symptomatic side and in cervical range of motion in either group. Conclusion Manual therapy and surgery had similar effectiveness for improving self-reported function, symptom severity, and pinch-tip grip force on the symptomatic hand in women with CTS. Neither manual therapy nor surgery resulted in changes in cervical range of motion. Level of Evidence Therapy, level 1b. Prospectively registered September 3, 2014 at www.clinicaltrials.gov (NCT02233660). J Orthop Sports Phys Ther 2017;47(3):151-161. Epub 3 Feb 2017. doi:10.2519/jospt.2017.7090.

Neuromuscular Strain Increases Symptom Intensity in Chronic Fatigue Syndrome

Chronic fatigue syndrome (CFS) is a complex, multisystem disorder that can be disabling. CFS symptoms can be provoked by increased physical or cognitive activity, and by orthostatic stress. In preliminary work, we noted that CFS symptoms also could be provoked by application of longitudinal neural and soft tissue strain to the limbs and spine of affected individuals. In this study we measured the responses to a straight leg raise neuromuscular strain maneuver in individuals with CFS and healthy controls. We randomly assigned 60 individuals with CFS and 20 healthy controls to either a 15 minute period of passive supine straight leg raise (true neuromuscular strain) or a sham straight leg raise. The primary outcome measure was the symptom intensity difference between the scores during and 24 hours after the study maneuver compared to baseline. Fatigue, body pain, lightheadedness, concentration difficulties, and headache scores were measured individually on a 0-10 scale, and summed to create a composite symptom score. Compared to individuals with CFS in the sham strain group, those with CFS in the true strain group reported significantly increased body pain (P = 0.04) and concentration difficulties (P = 0.02) as well as increased composite symptom scores (all P = 0.03) during the maneuver. After 24 hours, the symptom intensity differences were significantly greater for the CFS true strain group for the individual symptom of lightheadedness (P = 0.001) and for the composite symptom score (P = 0.005). During and 24 hours after the exposure to the true strain maneuver, those with CFS had significantly higher individual and composite symptom intensity changes compared to the healthy controls. We conclude that a longitudinal strain applied to the nerves and soft tissues of the lower limb is capable of increasing symptom intensity in individuals with CFS for up to 24 hours. These findings support our preliminary observations that increased mechanical sensitivity may be a contributor to the provocation of symptoms in this disorder.

Correlation between head posture and proprioceptive function in the cervical region

[Purpose] The aim of the present study was to investigate correlation between head posture and proprioceptive function in the cervical region. [Subjects and Methods] Seventy-two subjects (35 males and 37 females) participated in this study. For measurement of head posture, the craniovertebral angle was calculated based on the angle between a horizontal line passing through C7 and a line extending from the tragus of the ear to C7. The joint position sense was evaluated using a dual digital inclinometer (Acumar, Lafayette Instrument, Lafayette, IN, USA), which was used to measure the joint position error for cervical flexion and extension. [Results] A significant negative correlation was observed between the craniovertebral angle and position sense error for flexion and extension. [Conclusion] Forward head posture is correlated with greater repositioning error than a more upright posture, and further research is needed to determine whether correction of forward head posture has any impact on repositioning error.

Neck kinematics and sternocleidomastoid muscle activation during neck rotation in subjects with forward head posture

[Purpose] The present study investigated differences in the kinematics of the neck and activation of the sternocleidomastoid (SCM) muscle during neck rotation between subjects with and without forward head posture (FHP). [Subjects and Methods] Twenty-eight subjects participated in the study (14 with FHP, 14 without FHP). Subjects performed neck rotation in two directions, left and right. The kinematics of rotation-lateral flexion movement patterns were recorded using motion analysis. Activity in the bilateral SCM muscles was measured using surface electromyography. Differences in neck kinematics and activation of SCM between the groups were analyzed by independent t-tests. [Results] Maintaining FHP increased the rotation-lateral flexion ratio significantly in both directions. The FHP group had significantly faster onset time for lateral flexion movement in both directions during neck rotation. Regarding the electromyography of the SCM muscles during neck rotation in both directions, the activity values of subjects with FHP were greater than those of subjects without FHP for the contralateral SCM muscles. [Conclusion] FHP can induce changes in movement in the frontal plane and SCM muscle activation during neck rotation. Thus, clinicians should consider movement in the frontal plane as well as in the sagittal plane when assessing and treating patients with forward head posture.

Deep cervical flexor training with a pressure biofeedback unit is an effective method for maintaining neck mobility and muscular endurance in college students with forward head posture

[Purpose] This study investigated the effects of deep cervical flexor training on maintaining forward head posture, muscular endurance, and cervical mobility. It also examined the effectiveness of deep cervical flexor training with a pressure biofeedback unit. [Subjects and Methods] Twenty college students were recruited and randomly assigned to groups that underwent either deep cervical flexor training with a pressure biofeedback unit (experimental group, n=10) or conventional deep cervical flexor training (control group, n=10). The craniovertebral angle of each subject was measured with a lateral-view picture. Neck mobility was assessed using a cervical range of motion device and muscular endurance was measured using a pressure biofeedback unit. Both groups performed conventional deep cervical flexor exercises three times a week for six weeks. The experimental group underwent a pressure biofeedback unit training was 5 to10 minutes/day, thrice a week. [Results] Cervical range of motion in the experimental group increased significantly between the end of training and the end of the four week detraining period, compared to that in control group. [Conclusion] Deep cervical flexor training with a pressure biofeedback unit is a useful method for maintaining neck mobility and muscular endurance in people with forward head posture.

Relationship between functional movement screen scores, core strength, posture, and body mass index in school children in Moldova

The assessment of functionality should include parameters that consider postural control, limb asymmetries, range of motion limitations, proprioceptive deficits, and pain. An increasingly popular battery of tests, the Functional Movement Screen (FMS), is purported to assess the above named parameters. The purpose of our study was twofold: (a) to report differences in total FMS scores in children, provide preliminary normative reference values of each of the 7 individual FMS scores for both genders and report on asymmetries and (b) to evaluate the relationship between total FMS scores, age, body mass index (BMI), core strength/stability, and postural angles to explore the possibility of using the FMS in the assessment of children's functional fitness. Descriptive data on 77 children aged 8-11 years were collected. The children performed core strength/stability exercises. Photographs were taken from a lateral view for later calculation of postural angles. The children performed the FMS while being videotaped for later review. The average total FMS score (of 21) was 14.9 (+1.9), and BMI was 16.4 (+2.2). Static posture is not related to results of the FMS. Core strength was positively correlated to the total FMS score (r = 0.31; p = 0.006). Over 60% demonstrated at least 1 asymmetry. The individual test scores indicate that none of the test items is too difficult for the children. Based on the screen's correlation to core strength, and the fact that it identifies areas of asymmetry, we suggest to further investigate its possible use in the assessment of children's functional fitness.

Outcomes following the conservative management of patients with non-radicular peripheral neuropathic pain

STUDY DESIGN

Prospective cohort.

INTRODUCTION

There is limited evidence for conservative management of patients with non-radicular peripheral neuropathic pain (PNP).

PURPOSE

To investigate the effectiveness of a comprehensive treatment approach on pain and disability in patients with non-radicular PNP and to determine if improvements are maintained following the discontinuation of therapy.

METHODS

Patients received a multi-modal therapeutic intervention. Outcome measures were the shortened version of the Disabilities of the Arm, Shoulder and Hand questionnaire (QDASH), Numeric Pain Rating Scale (NPRS), and grip strength. Follow-up data were collected 5 ± 2 months post-discharge.

RESULTS

There was a significant improvement in the QDASH and mean pain (p < .001). There was no significant change in grip strength (p > .13). Follow-up data suggest that pain and disability scores are maintained (p < .001).

CONCLUSION

A comprehensive, conservative treatment program has a positive and lasting effect on pain and disability scores in patients with non-radicular PNP.

LEVEL OF EVIDENCE

IIIa.

The effect of forward head posture on muscle activity during neck protraction and retraction

[Purpose] The present study was performed to investigate whether forward head posture (FHP) affects muscle activity. [Subjects and Methods] Twenty subjects attending Y university in Gyeongsangnam-do, Republic of Korea. They were divided into two groups according to craniovertebral angle: a control group (n=10) and a FHP group (n=10). Electromyography electrodes were attached to the upper fibers of the trapezius, middle fibers of the trapezius, the splenii (splenius capitis and splenius cervicis), and the sternocleidomastoid (SCM) muscle to measure muscle activity during the neck protraction and retraction. [Results] EMG activities of the middle trapezius, splenii, and SCM muscle showed significant differences between the control group and the FHP group. However, the EMG activity of the upper trapezius muscle showed no significant difference between the two groups during neck protraction and retraction. [Conclusion] The results suggest that FHP alters the muscle activity in neck protraction and retraction.

Characteristics of cervical position sense in subjects with forward head posture

[Purpose] The purpose of this study was to investigate the effect of forward head posture (FHP) on proprioception by determining the cervical position-reposition error. [Subjects and Methods] A sample population was divided into two groups in accordance with the craniovertebral angle: the FHP group and the control group. We measured the craniovertebral angle, which is defined as the angle between a horizontal line passing through C7 and a line extending from the tragus of the ear to C7. The error value of the cervical position sense after cervical flexion, extension, and rotation was evaluated using the head repositioning accuracy test. [Results] There were significant differences in the error value of the joint position sense (cervical flexion, extension, and rotation) between the FHP and control groups. In addition, there was an inverse correlation between the craniovertebral angle and error value of the joint position sense. [Conclusion] FHP is associated with reduced proprioception. This result implies that the change in the muscle length caused by FHP decreases the joint position sense. Also, proprioception becomes worse as FHP becomes more severe.

Comparison of the short-term outcomes between trigger point dry needling and trigger point manual therapy for the management of chronic mechanical neck pain: a randomized clinical trial

STUDY DESIGN

Randomized clinical study.

OBJECTIVES

To compare the effects of trigger point (TrP) dry needling (DN) and TrP manual therapy (MT) on pain, function, pressure pain sensitivity, and cervical range of motion in subjects with chronic mechanical neck pain.

BACKGROUND

Recent evidence suggests that TrP DN could be effective in the treatment of neck pain. However, no studies have directly compared the outcomes of TrP DN and TrP MT in this population.

METHODS

Ninety-four patients (mean ± SD age, 31 ± 3 years; 66% female) were randomized into a TrP DN group (n = 47) or a TrP MT group (n = 47). Neck pain intensity (11-point numeric pain rating scale), cervical range of motion, and pressure pain thresholds (PPTs) over the spinous process of C7 were measured at baseline, postintervention, and at follow-ups of 1 week and 2 weeks after treatment. The Spanish version of the Northwick Park Neck Pain Questionnaire was used to measure disability/function at baseline and the 2-week follow-up. Mixed-model, repeated-measures analyses of variance (ANOVAs) were used to determine if a time-by-group interaction existed on the effects of the treatment on each outcome variable, with time as the within-subject variable and group as the between-subject variable.

RESULTS

The ANOVA revealed that participants who received TrP DN had outcomes similar to those who received TrP MT in terms of pain, function, and cervical range of motion. The 4-by-2 mixed-model ANOVA also revealed a significant time-by-group interaction (P<.001) for PPT: patients who received TrP DN experienced a greater increase in PPT (decreased pressure sensitivity) than those who received TrP MT at all follow-up periods (between-group differences: posttreatment, 59.0 kPa; 95% confidence interval [CI]: 40.0, 69.2; 1-week follow-up, 69.2 kPa; 95% CI: 49.5, 79.1; 2-week follow-up, 78.9 kPa; 95% CI: 49.5, 89.0).

CONCLUSION

The results of this clinical trial suggest that 2 sessions of TrP DN and TrP MT resulted in similar outcomes in terms of pain, disability, and cervical range of motion. Those in the TrP DN group experienced greater improvements in PPT over the cervical spine. Future trials are needed to examine the effects of TrP DN and TrP MT over long-term follow-up periods.

LEVEL OF EVIDENCE

Therapy, level 1b.

Short-term changes in neck pain, widespread pressure pain sensitivity, and cervical range of motion after the application of trigger point dry needling in patients with acute mechanical neck pain: a randomized clinical trial

STUDY DESIGN

Randomized clinical trial.

OBJECTIVES

To determine the effects of trigger point dry needling (TrPDN) on neck pain, widespread pressure pain sensitivity, and cervical range of motion in patients with acute mechanical neck pain and active trigger points in the upper trapezius muscle.

BACKGROUND

TrPDN seems to be effective for decreasing pain in individuals with upper-quadrant pain syndromes. Potential effects of TrPDN for decreasing pain and sensitization in individuals with acute mechanical neck pain are needed. Methods Seventeen patients (53% female) were randomly assigned to 1 of 2 groups: a single session of TrPDN or no intervention (waiting list). Pressure pain thresholds over the C5-6 zygapophyseal joint, second metacarpal, and tibialis anterior muscle; neck pain intensity; and cervical spine range-of-motion data were collected at baseline (pretreatment) and 10 minutes and 1 week after the intervention by an assessor blinded to the treatment allocation of the patient. Mixed-model analyses of variance were used to examine the effects of treatment on each outcome variable.

RESULTS

Patients treated with 1 session of TrPDN experienced greater decreases in neck pain, greater increases in pressure pain threshold, and higher increases in cervical range of motion than those who did not receive an intervention at both 10 minutes and 1 week after the intervention (P<.01 for all comparisons). Between-group effect sizes were medium to large immediately after the TrPDN session (standardized mean score differences greater than 0.56) and large at the 1-week follow-up (standardized mean score differences greater than 1.34).

CONCLUSION

The results of the current randomized clinical trial suggest that a single session of TrPDN may decrease neck pain intensity and widespread pressure pain sensitivity, and also increase active cervical range of motion, in patients with acute mechanical neck pain. Changes in pain, pressure pain threshold, and cervical range of motion surpassed their respective minimal detectable change values, supporting clinically relevant treatment effects. Level of Evidence Therapy, level 1b-.

Craniocervical posture and trigeminal nerve mechanosensitivity in subjects with a history of orthodontic use: a cross-sectional study

The purpose of the study was to evaluate whether, in asymptomatic subjects, there are differences in: (i) head posture while sitting and standing still and (ii) trigeminal nerve mechanosensitivity, between those who have a history of using orthodontics and those who do not. The sample consisted of 72 subjects (21 +/- 2.14 years): one group who had used orthodontics in the past (n = 37), and another group who had not had previous orthodontic treatment (n = 35). The authors measured the CranioVertebral Angle (CVA) while the subject was sitting and standing still by means of lateral photographs, and the pressure pain threshold (PPT) of the trigeminal nerve. The orthodontics group showed a more upright position of the head when sitting compared to the non-orthodontics group, with the difference being statistically significant (ANOVA test; p < 0.001; F1,70 = 16.705; R2 = 0.19), but not for the standing position (p = 0.538). The values of the PPT in the trigeminal nerve (supraorbital-V1, infraorbital-V2 and mandibular-V3) were lower on both sides (dominant and nondominant) in the non-orthodontics group. The between-group comparison (ANOVA test) showed statistically significant differences for the trigeminal nerve PPT in its different branches (V1 p = 0.001; F1,70 = 13.012; R2 = 0.15) (V2 p = 0.004; F1,70 = 9.103; R2 = 0.11) (V3 p = 0.005; F1,70 = 8.228; R2 = 0.10). Based on these observations, it was concluded that subjects with a history of orthodontic use show a better sitting craniocervical posture and mechano-sensitivity of the trigeminal nerve branches compared to the group that had not used orthodontics in the past.

Reappraising entrapment neuropathies--mechanisms, diagnosis and management

The diagnosis of entrapment neuropathies can be difficult because symptoms and signs often do not follow textbook descriptions and vary significantly between patients with the same diagnosis. Signs and symptoms which spread outside of the innervation territory of the affected nerve or nerve root are common. This Masterclass provides insight into relevant mechanisms that may account for this extraterritorial spread in patients with entrapment neuropathies, with an emphasis on neuroinflammation at the level of the dorsal root ganglia and spinal cord, as well as changes in subcortical and cortical regions. Furthermore, we describe how clinical tests and technical investigations may identify these mechanisms if interpreted in the context of gain or loss of function. The management of neuropathies also remains challenging. Common treatment strategies such as joint mobilisation, neurodynamic exercises, education, and medications are discussed in terms of their potential to influence certain mechanisms at the site of nerve injury or in the central nervous system. The mechanism-oriented approach for this Masterclass seems warranted given the limitations in the current evidence for the diagnosis and management of entrapment neuropathies.

Clinical, physical, and neurophysiological impairments associated with decreased function in women with carpal tunnel syndrome

STUDY DESIGN

Cross-sectional study.

OBJECTIVE

To examine the associations between clinical (pain), physical (cervical range of motion [ROM] and pinch grip force), and neurophysiological (pressure pain thresholds) outcomes and self-reported function and disability in women with carpal tunnel syndrome (CTS).

BACKGROUND

The association of physical and physiological variables with self-rated function and disability in patients with CTS has not been fully determined. A better understanding of the association between potentially modifiable risk factors, such as limited cervical ROM, could assist clinicians in optimizing therapeutic programs for this group of patients.

METHODS

One hundred fifty-four women with CTS were recruited. Demographic information and data on duration of symptoms, pain intensity, depression, cervical ROM, pinch grip force, and pressure pain thresholds over the neck, hand, and leg were collected. Self-reported function and disability were measured with the functional status subscale of the Boston Carpal Tunnel Questionnaire. Correlation and regression analyses were performed to determine associations between variables.

RESULTS

There were significant positive correlations between the functional status subscale score and pain intensity (r = 0.36, P<.001), depression (r = 0.32, P<.001), and duration of symptoms (r = 0.23, P = .005). Significant negative correlations were also observed between the functional status subscale score and pinch grip force of the index finger (r = -0.25, P = .002) and little finger (r = -0.28, P<.001), ROM in cervical flexion (r = -0.22, P = .003) and lateral flexion away from the side of CTS (r = -0.24, P = .002) and toward the side of CTS (r = -0.16, P = .045), and pressure pain threshold over C5-6 (r = -0.34, P<.001), the carpal tunnel (r = -0.35, P<.001), and the tibialis anterior muscle (r = -0.26, P<.001). Stepwise regression analyses revealed that pain intensity, thumb and little finger pinch grip force, severity of depression, and cervical ROM in lateral flexion away from the side of CTS explained 38.2% of the variance in functional status (R2 = 0.411, adjusted R2 = 0.382, F = 15.42, P<.001). CONCLUSION This study found that a number of modifiable factors are associated with self-reported function in women with CTS. Future longitudinal studies will help to determine the clinical implications of these findings.

Short-term effects of spinal thrust joint manipulation in patients with chronic neck pain: a randomized clinical trial

Objective:

To compare the effects of an isolated application of cervical spine thrust joint manipulation vs. the application of cervical, cervico-thoracic junction and thoracic manipulation on neck pain, disability and cervical range of motion in chronic neck pain.

Design:

Randomized clinical trial.

Setting:

Clinical practice.

Participants:

Eighty-two patients (41 females) with chronic mechanical neck pain.

Interventions:

Patients were randomly assigned to a cervical spine manipulation group or a full manipulative group who received mid-cervical, cervico-thoracic and thoracic joint manipulations.

Measurements:

Neck pain intensity (11-point numeric pain rating scale), self-reported disability (Neck Disability Index) and cervical range of motion were collected at baseline and one week after the intervention by an assessor blinded to the allocation of the patients.

Results:

A significant Group * Time interaction for Neck Disability Index ( P = 0.022), but not for neck pain ( P = 0.612), was found: patients in the full manipulative group exhibited greater reduction in disability than those who received the cervical spine manipulation alone, whereas both groups experienced similar decreases in neck pain. Patients in both groups experienced similar increases in cervical range of motion ( P > 0.4). No effect of gender was observed ( P > 0.299).

Conclusions:

In patients with chronic mechanical neck pain, manipulation of the cervical and thoracic spine leads to a greater reduction in disability at one week than after manipulation of the cervical spine alone, whereas changes in pain and range of motion are not affected differently.

Immediate changes in widespread pressure pain sensitivity, neck pain, and cervical range of motion after cervical or thoracic thrust manipulation in patients with bilateral chronic mechanical neck pain: a randomized clinical trial

STUDY DESIGN

Randomized clinical trial.

OBJECTIVES

To compare the effects of cervical versus thoracic thrust manipulation in patients with bilateral chronic mechanical neck pain on pressure pain sensitivity, neck pain, and cervical range of motion (CROM).

BACKGROUND

Evidence suggests that spinal interventions can stimulate descending inhibitory pain pathways. To our knowledge, no study has investigated the neurophysiological effects of thoracic thrust manipulation in individuals with bilateral chronic mechanical neck pain, including widespread changes on pressure sensitivity.

METHODS

Ninety patients (51% female) were randomly assigned to 1 of 3 groups: cervical thrust manipulation on the right, cervical thrust manipulation on the left, or thoracic thrust manipulation. Pressure pain thresholds (PPTs) over the C5-6 zygapophyseal joint, lateral epicondyle, and tibialis anterior muscle, neck pain (11-point numeric pain rating scale), and cervical spine range of motion (CROM) were collected at baseline and 10 minutes after the intervention by an assessor blinded to the treatment allocation of the patients. Mixed-model analyses of covariance were used to examine the effects of the treatment on each outcome variable, with group as the between-subjects variable, time and side as the within-subject variables, and gender as the covariate. The primary analysis was the group-by-time interaction.

RESULTS

No significant interactions were found with the mixed-model analyses of covariance for PPT level (C5-6, P>.210; lateral epicondyle, P>.186; tibialis anterior muscle, P>.268), neck pain intensity (P = .923), or CROM (flexion, P = .700; extension, P = .387; lateral flexion, P>.672; rotation, P>.192) as dependent variables. All groups exhibited similar changes in PPT, neck pain, and CROM (all, P<.001). Gender did not influence the main effects or the interaction effects in the analyses of the outcomes (P>.10).

CONCLUSION

The results of the current randomized clinical trial suggest that cervical and thoracic thrust manipulation induce similar changes in PPT, neck pain intensity, and CROM in individuals with bilateral chronic mechanical neck pain. However, changes in PPT and CROM were small and did not surpass their respective minimal detectable change values. Further, because we did not include a control group, we cannot rule out a placebo effect of the thrust interventions on the outcomes.

LEVEL OF EVIDENCE

Therapy, level 1b.J Orthop Sports Phys Ther 2012;42(9):806-814, Epub 18 June 2012. doi:10.2519/jospt.2012.4151.

Immediate effects of the suboccipital muscle inhibition technique in craniocervical posture and greater occipital nerve mechanosensitivity in subjects with a history of orthodontia use: a randomized trial

OBJECTIVE

The purpose of this study was to measure the immediate differences in craniocervical posture and pressure pain threshold of the greater occipital (GO) nerve in asymptomatic subjects with a history of having used orthodontics, after intervention by a suboccipital muscle inhibition (SMI) technique.

METHODS

This was a randomized, single-blind, clinical study with a sample of 24 subjects (21±1.78 years) that were divided into an experimental group (n=12) who underwent the SMI technique and a sham group (n=12) who underwent a sham (placebo) intervention. The sitting and standing craniovertebral angle and the pressure pain threshold of the GO nerve in both hemispheres were measured.

RESULTS

The between-group comparison of the sample indicated that individuals subjected to the SMI technique showed a statistically significant increase in the craniovertebral angle in both the sitting (P<.001, F1,22=102.09, R2=0.82) and the standing (P<.001, F1,22=21.42, R2=0.56) positions and in the GO nerve pressure pain threshold in the nondominant hemisphere (P=.014, F1,22=7.06, R2=0.24). There were no statistically significant differences observed for the GO nerve mechanosensitivity in the dominant side (P=.202).

CONCLUSION

Suboccipital muscle inhibition technique immediately improved the position of the head with the subject seated and standing, the clinical effect size being large in the former case. It also immediately decreased the mechanosensitivity of the GO nerve in the nondominant hemisphere, although the effect size was small.

The double crush syndrome revisited--a Delphi study to reveal current expert views on mechanisms underlying dual nerve disorders

A high prevalence of dual nerve disorders is frequently reported. How a secondary nerve disorder may develop following a primary nerve disorder remains largely unknown. Although still frequently cited, most explanatory theories were formulated many years ago. Considering recent advances in neuroscience, it is uncertain whether these theories still reflect current expert opinion. A Delphi study was conducted to update views on potential mechanisms underlying dual nerve disorders. In three rounds, seventeen international experts in the field of peripheral nerve disorders were asked to list possible mechanisms and rate their plausibility. Mechanisms with a median plausibility rating of ≥7 out of 10 were considered highly plausible. The experts identified fourteen mechanisms associated with a first nerve disorder that may predispose to the development of another nerve disorder. Of these fourteen mechanisms, nine have not previously been linked to double crush. Four mechanisms were considered highly plausible (impaired axonal transport, ion channel up or downregulation, inflammation in the dorsal root ganglia and neuroma-in-continuity). Eight additional mechanisms were listed which are not triggered by a primary nerve disorder, but may render the nervous system more vulnerable to multiple nerve disorders, such as systemic diseases and neurotoxic medication. Even though many mechanisms were classified as plausible or highly plausible, overall plausibility ratings varied widely. Experts indicated that a wide range of mechanisms has to be considered to better understand dual nerve disorders. Previously listed theories cannot be discarded, but may be insufficient to explain the high prevalence of dual nerve disorders.

Women with carpal tunnel syndrome show restricted cervical range of motion

STUDY DESIGN

A case control, blinded study.

OBJECTIVES

To compare the amount of cervical range of motion in women with minimal, mild/moderate, and severe carpal tunnel syndrome (CTS) to that of healthy control participants. We also assessed the relationships between cervical range of motion and clinical variables related to the intensity and temporal profile of pain within each CTS group.

BACKGROUND

It is plausible that the cervical spine may be involved in individuals with CTS. No study has investigated the relationship between cervical range of motion and symptoms associated with CTS severity.

METHODS

Cervical range of motion was assessed in 71 women with CTS (18 with minimal, 18 with mild/moderate, and 35 with severe signs and symptoms) and in 20 similar, healthy women. Those with CTS were aged 35 to 59 years (mean ± SD, 45 ± 8 years) and those in the healthy group were aged 31 to 60 years (45 ± 8 years). An experienced therapist, blinded to the participants' conditions, used a cervical range-of-motion (CROM) device to assess cervical range of motion. Mixed-model analyses of variance (ANOVAs) were conducted to evaluate the differences in cervical range of motion among the 3 groups of patients with CTS and healthy controls. A corrected P value of less than .025 was used as threshold for significance (Bonferroni correction).

RESULTS

The mixed-model ANOVAs revealed that the individuals with CTS exhibited restricted cervical range of motion compared to healthy controls (P<.001), with no significant differences among the groups with minimal, mild/moderate, or severe CTS (P>.356). A significant negative correlation between pain intensity and cervical spine lateral flexion away from the affected side was identified: the greater the mean pain intensity, the lesser the cervical lateral flexion away from the affected side.

CONCLUSIONS

Women with minimal, mild/moderate, or severe CTS exhibited less cervical range of motion compared to women of a similar age, suggesting that restricted cervical range of motion may be a common feature in individuals with CTS, independent of severity subgroups, as defined by electrodiagnosis. Future research should investigate cervical range of motion as a possible consequence or causative factor of CTS and related symptoms.

Association of disturbances in the thoracic outlet in subjects with carpal tunnel syndrome: a case-control study

INTRODUCTION

A limited amount of research has investigated the potential relationship between carpal tunnel syndrome (CTS) and thoracic outlet dysfunction.

PURPOSE OF THE STUDY

To compare the prevalence of positive clinical tests suggestive of disputed neurogenic thoracic outlet syndrome (TOS) in subjects with CTS (CTS+) with that of subjects without CTS (control).

STUDY DESIGN

Case-control study.

METHODS

Subjects with electrodiagnostically confirmed CTS (CTS+) were recruited consecutively and matched by age (±2 years) and gender with asymptomatic (control) subjects. Subjects underwent clinical testing for neurogenic TOS using two provocative tests: modified Cyriax release test and elevated arm stress test (EAST). Subjects were tested for the presence of an elevated first rib using cervical rotation lateral flexion (CRLF) test.

RESULTS

A total of 32 investigational subjects and 32 matched control subjects was included in each group (mean age: 43.5+5.9 years). A significantly greater number of CTS+ subjects presented with positive provocative testing for TOS (modified Cyriax release test p=0.005; EAST approached significance p=0.027) and for the presence of an elevated first rib (CRLF test p=0.003) as compared with controls. The likelihood of neck pain, shoulder pain, or an elevated first rib was 16 times greater in the CTS+ group as compared with that in the control group.

CONCLUSIONS

A greater number of subjects with CTS presented with proximal dysfunctions suggestive of TOS and history of neck and shoulder pain. Evaluation of proximal structures involved with thoracic outlet dysfunction in persons with CTS has clinical merit.

LEVEL OF EVIDENCE

Level III-b.