People With Chronic Neck Pain Walk With a Stiffer Spine

Cervicocephalic kinaesthesia reveals novel subgroups of motor control impairments in patients with neck pain

Cervical-spine sensorimotor control is associated with chronicity and recurrence of neck pain (NP). Tests used to measure sensorimotor impairments lack consistency in studied parameters. Interpretation is often based on either a handful or numerous parameters, without considering their possible interrelation. Different aspects of motor-control could be studied with different parameters, but this has not yet been addressed. The aim of this study was to determine if different parameters of cervical position (JPE) and movement (Butterfly) sense tests represent distinct components of motor-control strategies in patients with chronic NP. Principal component analysis performed on 135 patients revealed three direction-specific (repositioning from flexion, extension or rotations) and one parameter-specific (variability of repositioning) component for JPE, two difficulty-specific (easy or medium and difficult trajectory) and one movement-specific (undershooting a target) component for Butterfly test. Here we report that these components could be related to central (neck repositioning and control of cervical movement) and peripheral sensorimotor adaptations (variability of repositioning) present in NP. New technologies allow extraction of greater number of parameters of which hand-picking could lead to information loss. This study adds towards better identification of diverse groups of parameters offering potentially clinically relevant information and improved functional diagnostics for patients with NP.

Changes in gait performances during walking with head movements in older adults with chronic neck pain

Background

Chronic neck pain (CNP) can lead to altered gait which is worse when combined with head movement. Gait parameters for indicating speed and symmetry have not been thoroughly investigated in older adults with CNP. This study aimed to compare gait performance in term of speed and symmetry in older adults with and without CNP during walking with head movement.

Methods

Fifty young older adults, consisting of 36 healthy controls without neck pain (OLDs) and 14 older adults with CNP, participated in the study. Participants completed the Neck Disability Index and Activities-specific Balance Confidence Scale. The 10-Meter Walk Test (10MWT) was used to assess gait performance. Participants were instructed to walk at preferred speed under three different head movement patterns: no head movement (NM), horizontal head movement (HM), and vertical head movement (VM). The Inertial Measurement Unit was used to capture gait performance, and its software was used to analyze gait variables; gait speed, Locomotor Rehabilitation Index (LRI), gait asymmetry index, Phase Coordination Index (PCI).

Results

The CNP group reported moderate neck pain with mild disability in activities of daily living, and less balance confidence than the OLD group (p < 0.05). The CNP group showed significantly slower gait speed and lower LRI during walking with both the HM and VM (p < 0.05), which corresponded to lower stride length and cadence. The gait asymmetry index in the CNP group was significantly higher than the OLD group during walking with VM (p < 0.05), whereas the PCI was significantly higher than the OLD group during walking with both HM and VM (p < 0.05).

Conclusion

Chronic neck pain affects both speed and symmetry when walking with head movement. Gait parameters in this study could be implemented to identify changes in speed and symmetry of gait in older adults with CNP who have mild disability and high physical functioning.

Differences of diaphragmatic muscle contraction between female patients with chronic neck pain and asymptomatic controls: A case-control study based on ultrasonography

BACKGROUND

Recent systematic reviews and meta-analyses show that individuals with chronic neck pain (CNP) have altered respiratory muscle strength and abnormal respiratory mechanics. However, no study has investigated the diaphragmatic function in individuals with CNP compared to asymptomatic peers.

OBJECTIVES

This study aimed to compare the respiratory muscle strength and diaphragmatic function between patients with CNP and asymptomatic controls.

DESIGN

Observational, case-control study.

METHODS

A total of 25 women with CNP and 23 asymptomatic controls participated in this case-control study. The visual analog scale and neck disability index were used to assess the pain and disability characteristics of the CNP group. Maximum inspiratory and expiratory pressures (MIP and MEP) were measured to determine respiratory muscle strengths. The diaphragmatic function (muscle thickness in deep inspiration, Tins; and at the end of calm expiration, Texp; muscle thickness change, ΔT; contraction ratio, CR) were evaluated by two-dimensional ultrasonography.

RESULTS

The MIP (p = 0.001, d = 1.11), ΔT (p = 0.033, d = 0.63), and CR (p = 0.012, d = 0.75) of the diaphragm were found significantly reduced in the CNP group compared to asymptomatic controls whilst MEP, Tins, and Texp of the diaphragm were similar between study groups (p > 0.05). The intensity of neck pain was moderately correlated with MIP (r = -0.48), Tins (r = -0.46), and ΔT (r = -0.42) while NDI (r = -0.42) had a moderate correlation with Tins (p < 0.05).

CONCLUSION

The present findings revealed that women with CNP have altered diaphragmatic function. Thus, screening and targeting diaphragm may improve the rehabilitation process in CNP. However, further experimental studies regarding the efficacy of breathing exercise approaches are needed.

Validity of an inertial measurement unit for the assessment of range and quality of movement during head and thoracic spine movements

BACKGROUND

Patients with spinal pain often exhibit movement limitations and altered motor control, which can be challenging to measure accurately in clinical practice. Inertial measurement sensors present a promising new opportunity to develop valid, low-cost, and easy-to-use methods for assessing and monitoring spinal motion in a clinical setting.

AIM

This study aimed to investigate the agreement of an inertial sensor and a 3D camera system for assessing the range of motion (ROM) and quality of movement (QOM) in head and trunk single-plane movements.

METHODS

Thirty-three healthy, pain-free volunteers were included. Each participant performed movements of the head (cervical flexion, extension, and lateral flexion) and trunk (trunk flexion, extension, rotation, and lateral flexion), which were simultaneously recorded by a 3D camera system and an inertial measurement unit (MOTI, Aalborg, Denmark). Agreement and consistency were analyzed for ROM and QOM by determining intraclass correlation coefficients (ICC), mean bias, and with Bland-Altman plots.

RESULTS

The agreement between systems was excellent for all movements (ICC between 0.91 and 1.00) for ROM and good to excellent for the QOM (ICC between 0.84 and 0.95). The mean bias for all movements (0.1-0.8°) was below the minimum acceptable difference between devices. The Bland-Altman plot indicated that MOTI systematically measured a slightly greater ROM and QOM than the 3D camera system for all neck and trunk movements.

CONCLUSION

This study showed that MOTI is a feasible and potentially applicable option to assess ROM and QOM for head and trunk movements in experimental and clinical settings.

The impact of neck pain on gait health: a systematic review and meta-analysis

BACKGROUND

Evidence exists demonstrating the negative impacts of chronic musculoskeletal pain on key measures of gait. Despite neck pain being the second most common musculoskeletal pain condition, there is a paucity of evidence exploring the impacts of neck pain specifically on these outcomes. The aims of this work were to systematically review the current evidence of the associations between chronic neck pain and measures of gait health and to conduct meta-analysis for quantitative assessment of the effect sizes under different walking conditions.

METHODS

Systematic review was conducted following PRISMA guidelines. Databases searched included MEDLINE, Embase, Web of Science, CINAHL, and PEDro. Eligible study designs included observational studies consisting of an exposure group with chronic neck pain and control group without chronic neck pain and primary outcomes relating to gait health. For outcomes amenable to meta-analysis, a random-effects model was used to derive summary estimates of Hedge's g depicted graphically with forest plots. Other gait outcomes were narratively summarized. Risk of bias was also assessed.

RESULTS

The original search yielded 1918 articles; 12 met final eligibility criteria including 10 cross-sectional studies. Outcomes were grouped first by the five domains of gait: pace, rhythm, asymmetry, variability, and postural control; and second by the tested walking conditions. Meta-analyses for gait speed revealed large effect-sizes indicating that individuals with chronic neck pain had slower measures of gait and lower measures of cadence. Gait outcomes that were narratively summarized supported these findings.

CONCLUSION

The quantitative and qualitative findings of this systematic review and meta-analysis suggest a negative impact of CNNP on measures of gait health, particularly gait speed, under various walking conditions. However, broad interpretation of these results should be cautious. Testing gait under dual task conditions may be particularly sensitive to the impact of CNNP, and future work is needed to better understand how pain disrupts this important functionality of the locomotor system. Additionally, consideration should be made to assess measures of variability and investigate these relationships in the older adult population.

SPATIOTEMPORAL GAIT PARAMETERS, PELVIC MOVEMENTS AND PELVIC SYMMETRY DURING SINGLE AND DUAL TASK IN INDIVIDUALS WITH CHRONIC IDIOPATHIC NECK PAIN

Purpose: Neck pain is associated with gait disturbances. The first aim of this study was to examine spatiotemporal gait parameters, pelvic movements and pelvic symmetry during single and dual task conditions in persons with CINP compared to healthy subjects (HS). The second aim was to investigate the relationship between disability and gait in persons with CINP.Methods: Thirty-one individuals with CINP (mean age 22.06±1.38 years, range 18-56 years) and 24 HS (mean age 22.60±1.51 years, range 18-43 years) participated in the study. CINP group completed Neck Disability Index. All participants performed 10-meter walking test in two conditions: (1) walking with head straight at usual speed, (2) walking with head straight at usual speed while carrying a tray. The BTS G-Walk wearable sensor was used to assess spatiotemporal parameters (speed, cadence, step length), pelvic movements (tilt, obliquity, rotation), and pelvic symmetry. Results: During single task gait, the CINP group had significantly lower walking speed, shorter stride length and worse pelvic tilt symmetry (p&lt;0.05), but pelvic movements did not differ significantly according to the HS (p&lt;0.05). During dual task condition, the CINP group had significantly lower cadence, gait speed and stride length, significantly increased pelvic movements and significantly worse pelvic rotation symmetry compared to HS (p&lt;0.05). Conclusion: Patients with CINP had a slower gait, lower stride length, decreased pelvic symmetry and increased pelvic movements compared to HS. Differences in gait and pelvic movements between the two groups were more pronounced during the dual task gait than single task gait. 

Reduction of Thoracic Hyper-Kyphosis Improves Short and Long Term Outcomes in Patients with Chronic Nonspecific Neck Pain: A Randomized Controlled Trial

This study investigates thoracic hyper kyphosis (THK) rehabilitation using the Denneroll™ thoracic traction orthosis (DTTO). Eighty participants, with chronic non-specific neck pain (CNSNP) and THK were randomly assigned to the control or intervention group (IG). Both groups received the multimodal program; IG received the DTTO. Outcomes included formetric thoracic kyphotic angle ICT—ITL, neck pain and disability (NDI), head repositioning accuracy (HRA), smooth pursuit neck torsion test (SPNT) and overall stability index (OSI). Measures were assessed at baseline, after 30 treatment sessions over the course of 10 weeks, and 1-year after cessation of treatment. After 10 weeks, the IG improved more in neck pain intensity (p < 0.0001) and NDI (p < 0.001). No differences were found for SPNT (p = 0.48) and left-sided HRA (p = 0.3). IG improved greater for OSI (p = 0.047) and right sided HRA (p = 0.02). Only the IG improved in THK (p < 0.001). At 1-year follow-up, a regression back to baseline values for the control group was found for pain and disability such that all outcomes favored improvement in the IG receiving the DTTO; all outcomes (p < 0.001). The addition of the DTTO to a multimodal program positively affected CNSNP outcomes at both the short and 1-year follow-up.

A Single-Center Study Comparing the Effects of Thoracic Spine Manipulation vs Mobility Exercises in 26 Office Workers with Chronic Neck Pain: A Randomized Controlled Clinical Study

Background

Neck pain is associated with computer work, poor posture, imbalanced neck muscles, and fatigue, particularly in office workers. This study from a single center aimed to compare the effects of thoracic spine mobility exercise and thoracic spine manipulation to improve cervical spine range of motion in 26 office workers who had chronic neck pain for more than 12 weeks.

Material/Methods

The participants were 26 office workers with neck pain lasting >12 weeks. These participants were randomly assigned to undergo TSME (n=13) or TSM (n=13). Both groups underwent cervical joint mobilization and deep cervical flexor muscle exercises for 25 min a day, twice weekly, for 6 weeks. The TSME group additionally performed TSME 15 min a day, twice a week, for 6 weeks, while the TSM group received TSM 2 times a day, twice a week, for 6 weeks. Cervical and thoracic spine ROM, numeric pain rating scale (NPRS), and neck disability index (NDI) were measured before and after interventions. The ROM of cervical and thoracic spine was measured using a dual inclinometer.

Results

Both groups showed significant changes in cervical spine ROM, thoracic spine ROM, NPRS, and NDI after intervention compared to before intervention (P<0.05). Cervical spine right lateral flexion and right rotation differed significantly between the groups (P<0.05), while thoracic spine ROM, NPRS, and NDI did not.

Conclusions

TSME and TSM have similar effects in improving pain and disability in office workers with non-specific chronic neck pain.

A machine learning approach for the identification of kinematic biomarkers of chronic neck pain during single- and dual-task gait

BACKGROUND

Changes in gait characteristics have been reported in people with chronic neck pain (CNP).

RESEARCH QUESTION

Can we classify people with and without CNP by training machine learning models with Inertial Measurement Units (IMU)-based gait kinematic data?

METHODS

Eighteen asymptomatic individuals and 21 participants with CNP were recruited for the study and performed two gait trajectories, (1) linear walking with their head straight (single-task) and (2) linear walking with continuous head-rotation (dual-task). Kinematic data were recorded from three IMU sensors attached to the forehead, upper thoracic spine (T1), and lower thoracic spine (T12). Temporal and spectral features were extracted to generate the dataset for both single- and dual-task gait. To evaluate the most significant features and simultaneously reduce the dataset size, the Neighbourhood Component Analysis (NCA) method was utilized. Three supervised models were applied, including K-Nearest Neighbour, Support Vector Machine, and Linear Discriminant Analysis to test the performance of the most important temporal and spectral features.

RESULTS

The performance of all classifiers increased after the implementation of NCA. The best performance was achieved by NCA-Support Vector Machine with an accuracy of 86.85%, specificity of 83.30%, and sensitivity of 92.85% during the dual-task gait using only nine features.

SIGNIFICANCE

The results present a data-driven approach and machine learning-based methods to identify test conditions and features from high-dimensional data obtained during gait for the classification of people with and without CNP.

Neck Strength in Coronal and Sagittal Head Movement in Military Pilots and Aircrew With Chronic Neck Pain: A Systematic Review With Meta-Analysis

OBJECTIVE

This systematic review aimed to assess whether there is a difference in neck strength between military pilots and aircrew with and without chronic neck pain.

METHODS

The PubMed, Embase, and Scopus databases were searched. Two independent reviewers selected relevant full articles comparing neck strength between military pilots and aircrew with and without chronic neck pain. Two independent reviewers extracted the data from the full articles selected. A meta-analysis was used to assess standardized mean differences in neck strength based on a random-effects model.

RESULTS

The search returned 3554 results; 5 articles were included in the study. Military pilots and aircrew with chronic neck pain showed no difference in neck strength from military pilots and aircrew without chronic neck pain for flexion and extension, but did show a neck strength reduction for right and left lateral flexion -0.29 (95% confidence interval, -0.52 to -0.06; I² = 3%) and -0.23 (95% confidence interval, -0.45 to 0.00; I² = 0%), respectively.

CONCLUSION

Based on this meta-analysis with a 3a level of evidence, military pilots and aircrew with chronic neck pain have reduced neck strength for coronal head movement, but not sagittal movement compared with military pilots and aircrew without chronic neck pain.

Comparisons of cervical and thoracic spine kinematic joint and body segment angles, timing, and velocity between individuals with and without chronic idiopathic neck pain during functional tasks

BACKGROUND

Few studies comprehensively analyse 3D neck kinematics in individuals with chronic idiopathic neck pain during functional tasks considered challenging. This critical knowledge is needed to assist clinicians to recognise and address how altered movement strategies might contribute to pain.

RESEARCH QUESTION

Are there differences in 3D neck kinematics (angles, timing, velocity) during functional tasks in people with chronic neck pain compared to matched asymptomatic control participants?

METHODS

Participants with chronic idiopathic neck pain (n = 33) and matched asymptomatic controls (n = 30) performed four functional tasks (overhead reach forward, right and left, and putting on a seatbelt) while evaluated using 3D motion capture. Kinematic variables included joint angles, range of motion (ROM,°), velocity (m s^-1) and timing (% of movement phase) for joint angles (head-neck [HN joint], head+neck-upper trunk [HNT], and thoracolumbar) and segments (head, neck, head+neck [HN segment], upper trunk, and trunk. Generalised linear mixed models examined between-group differences.

RESULTS

There were few between-group differences. The neck pain group had less HN segment extension that controls (mean difference [MD] left -2.06°; 95% CI -3.82, -0.29; p = .023; and right reach -2.52°; -4.67, -0.37; P = .022), and had less total sagittal HNT ROM across all tasks (-1.28; 95% CI -2.25, -0.31; p = .010). Approaching significance was the pain group having less thoracolumbar left rotation than controls (MD -2.14, 95% CI -4.41 to 0.13, p = .064). The pain group had higher neck segment peak flexion velocity than controls across all tasks (MD -3.09; 95% CI -5.21 to -0.10; P = .004). Timing of joint angle peaks did not differ between groups.

SIGNIFICANCE

When performing an overhead reach task to the left and right and putting on a seatbelt, people with neck pain maintain a more flexed HN segment, use less sagittal ROM and have higher velocity peaks. These findings can assist clinicians in their assessment of patients by identifying possible underlying contributors to neck pain.

Comparison of kinematic similarity index during gait between adults with and without nonspecific chronic neck pain

BACKGROUND

Individuals with nonspecific chronic neck pain (NP) walk with a stiffer spine. However, there is a lack of understanding on kinematic similarities on the limbs during gait between individuals with and without NP.

RESEARCH QUESTION

Are there differences in gait parameters and the kinematic similarity index (SI) between individuals with and without NP?

METHODS

Eighteen individuals with NP and 17 controls participated in this study. A three-dimensional motion capture system and two force plates were utilized to measure kinematic changes of the upper and lower limbs during gait. The gait parameters included cadence, speed, stride length, and step width. The SI calculations were compared based on the response vectors from the NP group and the prototype response vectors from the control participants. The SI values at 5% intervals of the entire gait cycle were compared between groups.

RESULTS

Although the gait parameters were not significantly different between groups, the SI values of the control group were significantly higher than the NP group during gait (0.98 ± 0.02 vs. 0.95 ± 0.03), especially at the midstance (10-30 %) and swing (80-90 %) phases. Also, the standard deviation of the SI decreased in the control group when compared to the NP group (0.02 ± 0.01 vs. 0.04 ± 0.02).

SIGNIFICANCE

The SI was a useful measure to differentiate similarities between groups in the gait cycle at specific phases. These results indicated that the NP group demonstrated a greater variation of walking patterns during the midstance and swing phases and displayed altered compensatory gait. Clinicians need to consider the similarities of the kinematic changes for the NP group to aid in detection of limb motion differences and the resulting gait dysfunction.

Reducing the Weight of Spinal Pain in Children and Adolescents

Spinal pain in adults is a significant burden, from an individual and societal perspective. According to epidemiologic data, spinal pain is commonly found in children and adolescents, where evidence emerging over the past decade has demonstrated that spinal pain in adults can, in many cases, be traced back to childhood or adolescence. Nevertheless, very little focus has been on how to best manage spinal pain in younger age groups. The purpose of this article is to put the focus on spinal pain in children and adolescents and highlight how and where these problems emerge and how they are commonly dealt with. We will draw on findings from the relevant literature from adults to highlight potential common pathways that can be used in the management of spinal pain in children and adolescents. The overall focus is on how healthcare professionals can best support children and adolescents and their caregivers in making sense of spinal pain (when present) and support them in the self-management of the condition.

Machine learning approaches applied in spinal pain research

The purpose of this narrative review is to provide a critical reflection of how analytical machine learning approaches could provide the platform to harness variability of patient presentation to enhance clinical prediction. The review includes a summary of current knowledge on the physiological adaptations present in people with spinal pain. We discuss how contemporary evidence highlights the importance of not relying on single features when characterizing patients given the variability of physiological adaptations present in people with spinal pain. The advantages and disadvantages of current analytical strategies in contemporary basic science and epidemiological research are reviewed and we consider how analytical machine learning approaches could provide the platform to harness the variability of patient presentations to enhance clinical prediction of pain persistence or recurrence. We propose that machine learning techniques can be leveraged to translate a potentially heterogeneous set of variables into clinically useful information with the potential to enhance patient management.

Spinal postural variability relates to biopsychosocial variables in patients with cervicogenic headache

Patients with cervicogenic headache (CeH) showed lower spinal postural variability (SPV). In a next step, the complex character of such SPV needs to be analysed. Therefore, variables influencing SPV need to be explored. A non-randomized repeated-measure design was applied to analyse relations between biopsychosocial variables and SPV within a CeH-group (n = 18), 29–51 years, and matched control-group (n = 18), 26–52 years. Spinal postural variability, expressed by standard deviations, was deducted from 3D-Vicon motion analysis of habitual spinal postures (degrees). Interactions between SPV and pain processing, lifestyle, psychosocial characteristics were analysed. Pain processing characteristics included symptoms of central sensitization (Central Sensitization Inventory), (extra)-cephalic pressure pain thresholds (kPa/cm²/s). Lifestyle characteristics included sleep quality (Pittsburgh Sleep Quality Index), physical activity, screen-time, sedentary-time (hours a week), position (cm) and inclination (degrees) of the laptop (= desk-setup). Psychosocial characteristics included degree of depression, anxiety and stress (Depression Anxiety Stress Scale-21), impact of headache on quality of life (Headache Impact Test-6). Spinal postural variability related significantly to intrinsic (stress, anxiety, extra-cephalic pressure pain thresholds, sleep-duration) and extrinsic (desk-setup, screen-time) variables in the CeH-group. In the control-group, SPV related significantly to extra-cephalic pressure pain thresholds. Spinal postural variability related to diverse variables in the CeH-group compared to the control-group. More research is needed into a possible causal relationship and its clinical implication.

Comparison and Association of Neck Extensor Muscles’ Endurance and Postural Function in Subjects with and without Chronic Neck Pain – A Cross-Sectional Study

Purpose Neck extensor endurance (NEE) and position sense are vital for maintaining cervical spine function and defects in these processes may be associated with impaired postural control in chronic neck pain (CNP) subjects. The study’s objectives are 1) to compare the cervical extensor endurance capability and postural control of CNP subjects with those of asymptomatic controls; 2) to investigate the association between NEE and postural control.

Materials and Methods Sixty-four participants (38 asymptomatic, 38 with CNP) participated in this cross-sectional study. NEE was assessed using a clinical extensor endurance test. Under open and closed eyes conditions, postural control measures were tested with the Good Balance system. The postural control parameters were AP-velocity (mm/s), ML-velocity (mm/s) and Velocity moment (mm2). NEE capacity and postural control parameters were compared and correlated between asymptomatic and CNP subjects.

Results and Discussion CNP subjects showed lower NEE capacity (p<0.001) and significantly larger AP-velocity (p<0.001), ML-velocity (p<0.001) and Velocity moment (p<0.001) than asymptomatic participants. NEE negatively correlated with AP-velocity (r=−0.51, p=0.001), ML-velocity (r=0.46, p=0.003) and velocity moment (r=0.38, p=0.020) in asymptomatic subjects in eyes open condition and no correlations in subjects with CNP. CNP subjects showed increased postural sway velocities and lowered extensor endurance capacity compared to asymptomatic participants. No correlations existed between NEE and postural control parameters in CNP subjects.

Lower spinal postural variability during laptop-work in subjects with cervicogenic headache compared to healthy controls

Spinal postural variability (SPV) is a prerequisite to prevent musculoskeletal complaints during functional tasks. Our objective was to evaluate SPV in cervicogenic headache (CeH) since CeH is characterized by such complaints. A non-randomized repeated-measure design was applied to compare SPV between 18 participants with reporting CeH aged 29–51 years, and 18 matched controls aged 26–52 years during a 30-min-laptop-task. Habitual spinal postures (degrees) of the cervical, thoracic and lumbar spine were analysed using 3D-Vicon motion analysis. SPV, to express variation in mean habitual spinal posture, was deducted from the postural analysis. Mean SPV of each spinal segment was lower in the CeH-group compared to the control-group. Within the CeH-group, SPV of all except one spinal segment (lower-lumbar) was higher compared to the group’s mean SPV. Within the control-group, SPV was more comparable to the group’s mean SPV. SPV differed between groups. Averaging data resulted in decreased SPV in the CeH-group compared to the control-group during the laptop-task. However, the higher within-group-SPV in the CeH-group compared to the group’s mean SPV accentuated more postural heterogeneity. It should be further determined if addressing individual SPV is a relevant intervention.

Is the pain pressure threshold linked to the transversus abdominis in women with chronic neck pain?: a preliminary report

PURPOSE

The present study aimed to investigate the relationship between the ultrasonography parameters of transversus abdominis and neck pain manifestations in women with chronic neck pain.

MATERIALS AND METHODS

Thirty women (mean age: 38.44 ± 9.56 years, BMI: 25.57 ± 3.32 kg/m²) with chronic neck pain were included in the study. The pain severity, disability scores, and bilateral pain pressure threshold of upper trapezius were assessed. The thickness of transversus abdominis in-rest and abdominal draw-in conditions were evaluated by two-dimensional ultrasonography. Pearson's correlation coefficients and linear regression statistics were determined.

RESULTS

We found a moderate correlation between the thickness of transversus abdominis in abdominal draw-in and the pain pressure threshold of right (r = 0.636, p < 0.001), and left upper trapezius (r = 0.403, p = 0.03). Moreover, there was a moderate correlation between the pain pressure threshold of the right upper trapezius and the thickness of transversus abdominis in-rest (r = 0.498, p = 0.006). No significant correlation was found between pain intensity, disability scores, and ultrasonography parameters of transversus abdominis. There was also a significant total effect of transversus abdominis' thickness on abdominal draw-in manoeuvre on predicting pain pressure threshold of right upper trapezius (B = 0.636, SE = 0.765, p < 0.001) and pain pressure threshold of left upper trapezius (B = 0.403, SE = 0.840, p = 0.03).

CONCLUSIONS

Our results revealed that upper trapezius muscle tenderness may associated with decreased muscle thickness of transversus abdominis. Addressing new exercise methodologies including transversus abdominis training in the management of chronic neck pain may be helpful to improve neck pain symptoms.

Kinematic biomarkers of chronic neck pain measured during gait: A data-driven classification approach

People with chronic neck pain (CNP) often present with altered gait kinematics. This paper investigates, combines, and compares the kinematic features from linear and nonlinear walking trajectories to design supervised machine learning models which differentiate asymptomatic individuals from those with CNP. For this, 126 features were extracted from seven body segments of 20 asymptomatic subjects and 20 individuals with non-specific CNP. Neighbourhood Component Analysis (NCA) was used to identify body segments and the corresponding significant features which have the maximum discriminative power for conducting classification. We assessed the efficacy of NCA combined with K- Nearest Neighbour (K-NN), Support Vector Machine and Linear Discriminant Analysis. By applying NCA, all classifiers increased their performance for both linear and nonlinear walking trajectories. Notably, features selected by NCA which magnify the classification power of the computational model were solely from the head, trunk and pelvis kinematics. Our results revealed that the nonlinear trajectory provides the best classification performance through the NCA-K-NN algorithms with an accuracy of 90%, specificity of 100% and sensitivity of 83.3%. The selected features by NCA are introduced as key biomarkers of gait kinematics for classifying non-specific CNP. This paper provides insight into changes in gait kinematics which are present in people with non-specific CNP which can be exploited for classification purposes. The result highlights the importance of curvilinear gait kinematic features which potentially could be utilized in future research to predict recurrent episodes of neck pain.

Comparison of neck extensor muscle endurance and cervical proprioception between asymptomatic individuals and patients with chronic neck pain

INTRODUCTION

Neck extensor endurance (NEE) and cervical proprioception are vital for maintaining cervical spine function and defects in these processes have been associated with chronic neck pain (CNP). The objectives of the study are 1) To investigate the association between NEE and cervical joint position error (JPE) in subjects with CNP; 2) to compare the cervical extensor endurance and cervical JPE of CNP subjects with those of asymptomatic controls; and 3) to determine the relationship between Pain Catastrophizing Scale (PCS) scores, NEE, and cervical JPE in subjects with CNP.

METHOD

Sixty-four participants (32 asymptomatic, 32 with CNP) participated in this comparative cross-sectional study. Cervical proprioception was assessed by measuring the absolute JPE in the sagittal and transverse directions. NEE was assessed using a clinical extensor endurance test. NEE capacity and JPE were compared and correlated between asymptomatic and CNP subjects. Pain catastrophic behavior was assessed using the Pain Catastrophizing Scale (PCS) in CNP subjects.

RESULTS

CNP subjects showed lower NEE capacity (p < 0.001) and significantly larger JPEs (p < 0.001) than asymptomatic participants. NEE negatively correlated with JPEs in all directions (p < 0.001) in asymptomatic subjects and only neck extension errors showed a correlation in CNP subjects (r = -0.45, p = 0.009). PCS scores were negatively correlated with endurance capacity (r = -0.42, p = 0.017) and positively correlated with JPE (flexion: r = 0.57, p = 0.001).

CONCLUSION

CNP subjects showed impaired proprioception and lower endurance capacity compared to asymptomatic participants. Neck extension errors alone correlated with JPE in CNP subjects. PCS scores negatively correlated with NEE in subjects with CNP.

A Pilot Longitudinal Study of 3-Dimensional Head and Neck Kinematics During Functional Tasks in Individuals With Chronic Idiopathic Neck Pain Either Wait-Listed for or Receiving Chiropractic Spinal Manipulative Therapy With Exercise

OBJECTIVE

The purpose of this study was to determine if there is a relationship between pain and movement kinematics during functional tasks, evaluated over time, in individuals with chronic idiopathic neck pain.

METHODS

Ten participants with chronic idiopathic neck pain performed 2 functional tasks (overhead reach to the right and putting on a seatbelt) while evaluated using 8 Oqus 300+ cameras. Kinematic variables included joint angles and range of motion (ROM) (°), head segment relative to neck segment (head-neck [HN]); and head/neck segment relative to upper thoracic segment (head/neck-trunk), velocity (m/s), and time (% of movement phase). Pain was quantified using a 100-mm visual analog scale. Linear mixed effects regression models were used to analyze associations between pain and kinematic variables adjusting for treatment group.

RESULTS

For overhead reach, higher pain was associated with less HN peak rotation at baseline (β = -0.33; 95% CI -0.52 to -0.14, P = .003) and less HN total rotation ROM at 6 months (β = -0.19; 95% CI -0.38 to -0.003, P = .048). For the seatbelt task, higher pain was associated with less HN peak rotation (β = -0.52; 95% CI -0.74 to -0.30 to -0.74, P < .001) and less HN total rotation ROM at baseline (β = -0.32; 95% CI -0.53 to -0.10, P = .006). No other movement variables demonstrated meaningful relationships with pain for the reach or seatbelt tasks.

CONCLUSION

Higher pain is associated with less HN peak and total rotation during functional reaching tasks requiring head rotation. Recognizing altered functional kinematics in individuals with chronic neck pain may assist patient management.

Kinematic Biomarkers of Chronic Neck Pain During Curvilinear Walking: A Data-driven Differential Diagnosis Approach. ANNUAL INTERNATIONAL CONFERENCE OF THE IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. ANNUAL INTERNATIONAL CONFERENCE 2020;2020:5162-5166. [PMID: 33019148 DOI: 10.1109/embc44109.2020.9176457] [Citation(s) in RCA: 0] [Impact Index Per Article: 0]

Chronic Neck Pain (CNP) can be associated with biomechanical changes. This paper investigates the changes in patterns of walking kinematics along a curvilinear trajectory and uses a specially designed feature space, coupled with a machine learning framework to conduct a data-driven differential diagnosis, between asymptomatic individuals and those with CNP. For this, 126 kinematic features were collected from seven body segments of 40 participants (20 asymptomatic, 20 individuals with CNP). The features space was processed through a Neighbourhood Component Analysis (NCA) algorithm to systematically select the most significant features which have the maximum discriminative power for conducting the differential diagnosis. The selected features were then processed by a K-Nearest Neighbors (K-NN) classifier to conduct the task. Our results show that, through a systematic selection of feature space, we can significantly increase the classification accuracy. In this regard, a 35% increase is reported after applying the NCA. Thus, we have shown that using only 13 features (of which 61% belong to kinematic features and 39% to statistical features) from five body segments (Head, Trunk, Pelvic, Hip and Knee) we can achieve an accuracy, sensitivity and specificity of 82.50%, 80.95% and 84.21% respectively. This promising result highlights the importance of curvilinear kinematic features through the proposed information processing pipeline for conducting differential diagnosis and could be tested in future studies to predict the likelihood of people developing recurrent neck pain.

Variability of neck and trunk movement during single- and dual-task gait in people with chronic neck pain

BACKGROUND

Previous findings reported that people with chronic neck pain walk with reduced range trunk rotation, especially when walking in more challenging conditions. Quantification of the quality of neck and trunk movement during gait could provide further insight into biomechanical changes that occur in people with neck pain. This study uniquely compared the variability of trunk and neck rotation during single-task and dual-task gait in people with chronic neck pain and asymptomatic individuals.

METHODS

An observational case-control study was conducted on 20 asymptomatic individuals and 24 people with chronic neck pain of idiopathic or traumatic origin. Participants performed rectilinear walking whilst keeping the head in a neutral position (single-task) and whilst rotating the head at a natural speed (dual-task). Trunk and head rotation angles were averaged across gait cycles for the task trials. The data were normalised in time, and the average variability of angular distribution along the normalised cycle was extracted. The Tampa Scale for Kinesiophobia was used to assess fear of movement.

FINDINGS

During single-task gait, there were no group differences for the variability of trunk (p = 0.862) or neck (p = 0.427) rotation. For dual-task gait, there was no difference between groups for the variability of neck rotation (p = 0.636), however, the participants with neck pain displayed reduced variability of trunk rotation (p = 0.021). The neck pain group also walked at a significantly slower speed during dual-task gait (p = 0.043) compared to asymptomatic individuals and the speed of their gait was associated with the extent of fear of movement.

INTERPRETATION

The strategy observed in participants with chronic neck pain likely reflects adaptive behaviour when faced with more challenging conditions for postural control.

Classifying neck pain status using scalar and functional biomechanical variables - development of a method using functional data boosting

BACKGROUND

Individuals with neck pain have different movement and muscular activation (collectively termed as biomechanical variables) patterns compared to healthy individuals. Incorporating biomechanical variables as covariates into prognostic models is challenging due to the high dimensionality of the data.

RESEARCH QUESTION

What is the classification performance of neck pain status of a statistical model which uses both scalar and functional biomechanical covariates?

METHODS

Motion capture with electromyography assessment on the sternocleidomastoid, splenius cervicis, erector spinae, was performed on 21 healthy and 26 individuals with neck pain during walking over three gait conditions (rectilinear, curvilinear clockwise (CW) and counterclockwise (CCW)). After removing highly collinear variables, 94 covariates across the three conditions were used to classify neck pain status using functional data boosting (FDboost).

RESULTS

Two functional covariates trunk lateral flexion angle during CCW gait, and trunk flexion angle during CW gait; and a scalar covariate, hip jerk index during CCW gait were selected. The model achieved an estimated AUC of 80.8 %. For hip jerk index, an increase in hip jerk index by one unit increased the log odds of being in the neck pain group by 0.37. A 1° increase in trunk lateral flexion angle throughout gait alone reduced the probability of being in the neck pain group from 0.5 to 0.15. A 1° increase in trunk flexion angle throughout gait alone increased the probability of being in the neck pain group from 0.5 to 0.9.

SIGNIFICANCE

Interpreting the physiological significance of the extracted covariates, with other biomechanical variables, suggests that individuals with neck pain performed curvilinear walking using a stiffer strategy, compared to controls; and this increased the risk of being in the neck pain group. FDboost can produce clinically interpretable models with complex high dimensional data and could be used in future prognostic modelling studies in neck pain research.

The use of posture-correcting shirts for managing musculoskeletal pain is not supported by current evidence - a scoping review of the literature

BACKGROUND AND AIMS

The concept of bad posture being a dominant driver of pain is commonly held belief in the society. This may explain the significant attention supportive clothing such as posture-correcting shirts has recently gained in Scandinavia and the USA. The aim of this scoping review was to present an overview and synthesis of the available evidence for the use of posture-correcting shirts aimed at reducing pain or postural discomfort and optimising function/posture.

METHODS

A systematic search was conducted for literature investigating the effect of posture-correcting shirts on musculoskeletal pain or function. PubMed, Embase, CINAHL, PEDro and the Cochrane Library were searched for relevant literature. Results of the searches were evaluated by two independent reviewers in three separate steps based on title, abstract and full text. For data synthesis, the population, intervention, comparator and outcome were extracted. The quality of the literature was evaluated using the Quality Assessment Tool for Observational Cohort and Cross-Sectional Studies and the risk of bias was assessed using the Risk Of Bias In Non-randomized Studies - of Interventions (ROBINS-I) assessment tool or the RoB 2.0 tool for individually randomized, parallel group trials. The overall confidence in the literature was determined using the Grading of Recommendations Assessment, Development and Evaluation (GRADE).

RESULTS

A total of 136 articles were identified and six of these were included in the review. These studies were heterogeneous with regards to aims, outcomes and methods, presenting contrasting results. The overall findings were that posture-correcting shirts change posture and subjectively have a positive effect on discomfort, energy levels and productivity. The quality of the included literature was poor to fair with only one study being of good quality. The risk of bias was serious or critical for the included studies. Overall, this resulted in very low confidence in available evidence. An important limitation of all studies was that they were conducted in pain-free individuals.

CONCLUSIONS

The contrasting findings and the low quality of current literature, questions the intended effect of posture-correcting shirts and whether the changes it creates are in fact useful for clinical practice. Moreover, the findings are contrasted by the available evidence regarding posture and pain with a particular focus on whether this management strategy may have a detrimental effect on people living with musculoskeletal pain. A major limitation to the existing literature on the effect of posture-correcting shirts is that no studies have investigated their effect in clinical populations.

IMPLICATIONS

Based on the available literature and the major limitation of no studies investigating clinical populations, there is no good quality evidence to support recommendation of posture-correcting shirts as a management strategy for musculoskeletal pain. Promotion of this product may reinforce the inaccurate and unhelpful message that poor posture leads to pain. The efficacy of such garments should be tested in clinical populations and not only in pain-free individuals, to assess whether there is any meaningful benefit of this management approach. Until then, the use of posture-correcting shirts for musculoskeletal pain is not supported by current evidence.

Thoracic Posture and Mobility in Mechanical Neck Pain Population: A Review of the Literature

Neck pain is a common condition with several proposed biomechanical contributing factors. Thoracic spine dysfunction is hypothesized as one of the predisposing factors, which necessitates the need to explore the contribution of thoracic posture and mobility toward neck pain. Accordingly, the present work aimed to review the existing literature investigating the presence of thoracic spine dysfunction in individuals with neck pain. A literature search was conducted in the three electronic databases of PubMed, CINAHL, and Web of Science. Studies published between 1990 and 2017 were considered. After reviewing the abstracts, two authors independently scrutinized the full-text documents for their relevance. The initial search yielded 2,167 articles, of which nine studies involving comparisons of neck pain patients and healthy controls were identified for the review. Increased thoracic kyphosis was positively correlated with the presence of forward head posture but not uniformly associated with neck pain intensity and disability. Thoracic mobility was reduced in the neck pain population, and the role of thoracic kyphosis as a risk factor for pain development could not be confirmed. Thus, an association exists between thoracic kyphosis and postural alteration in the cervical spine. The review favors the inclusion of thoracic spine assessment and treatment in mechanical neck pain patients. Further studies are needed to investigate the cause-effect relationship between thoracic posture and cervical dysfunction.

Paraspinal muscle function and pain sensitivity following exercise-induced delayed-onset muscle soreness

PURPOSE

The aim of this study was to evaluate the effectiveness of an exercise protocol designed to induce delayed-onset muscle soreness (DOMS) in paraspinal muscles and its effects on low back functional capacities.

METHODS

Twenty-four healthy participants were asked to perform four series of 25 trunk flexion-extension in a prone position (45° inclined Roman chair). The protocol was performed using loads corresponding to participant's trunk weight plus 10% of their trunk extension maximal voluntary contraction. Perceived soreness and pain were assessed using an 11-point numerical analogue scale three times a day during 5 day post-DOMS protocol. Pressure-pain thresholds (PPT) in paraspinal muscles (L2 and L4 bilaterally) and the vastus medialis (control site), and trunk extension maximal voluntary contraction were assessed 24-36 h post-protocol and compared to baseline (t tests).

RESULTS

Muscle soreness (3.8/10) and pain (2.1/10) peak scores were observed 24-36 h post-protocol (mean of 28 h). A significant reduction in trunk extension maximal voluntary contraction was observed post-protocol (p = 0.005). Significant reductions in PPT were observed post-protocol for all trunk extensor sites (ps < 0.01), but not for the control site (p = 0.40).

CONCLUSIONS

The exercise protocol efficiently led to low back muscle DOMS, reduced functional capacities, and increased pain sensitivity locally. Such protocol could be used as an efficient and safe experimental low back pain model.

Age-related changes in trunk muscle activity and spinal and lower limb kinematics during gait

The influence of age on spinal muscle activation patterns and its relation to kinematics is poorly understood. We aimed at understanding age-related changes to spine and trunk muscle activity in addition to spinal and lower limb kinematics during treadmill walking under various conditions. An observational study was conducted evaluating asymptomatic young (n = 10; 3F, 7M; 26.3±2.5yrs) and older (n = 9; 3F, 6M; 67.1±4.2yrs) adults’ treadmill walking at 2km/h and 4km/h, each at 0, 1, 5, and 10% inclination. Unilateral (right side) electromyography (EMG) was recorded from deep and superficial multifidus (intramuscular) and erector spinae and abdominal obliques (surface); trunk and leg kinematics were also measured. Muscle activity was characterised by peak amplitude and duration of activity, and the time-point of peak amplitude in the gait cycle (0–100%). Peak activation in older adults was lower for the superficial multifidus (p<0.0001) and higher for the thoracolumbar (p<0.001) and lumbar erector spinae (p<0.01). The duration of activation was longer in older adults for all muscles (p<0.05) except the superficial multifidus, and longer during faster walking for all participants. The time-point of peak amplitude in the gait cycle was earlier in older participants for the external obliques (p<0.05). Walking speed appeared to influence muscle activity more than inclination. Older adults used less spine, trunk and lower limb motion, except at the ankle. Age-related differences within multifidus and between paravertebral and trunk muscles were inconsistent. Walking at 4km/h at 5–10% inclination may specifically target the lumbar paravertebral muscles.

People with low back pain show reduced movement complexity during their most active daily tasks

BACKGROUND

Actigraphy is a quantitative method for the investigation of human physical activity and is normally based on accelerometric and/or kinematic data.

METHODS

A multichannel actigraphy system, able to record both acceleration and spine angles, was employed in this study to measure the quality of movement in 17 individuals with chronic low back pain (LBP) and 18 healthy individuals during unrestricted daily activities. An indication of movement complexity was computed by means of non-negative matrix factorization throughout the 24 hr period and in the 60 min of highest activity.

RESULTS

Movement complexity differed only when the 60 min of highest activity was taken into account, with the LBP group showing reduced complexity (e.g., for dimensionality = 8, over 90% of the comparisons showed a significant reduction in the LBP group).

CONCLUSIONS

The results are compatible with the hypothesis that pain induces a reduction in the available kinematic trajectories and degrees of freedom during natural movements, which becomes more evident when more demanding tasks are performed. A reduced movement complexity suggests a persistent alteration of the descending neural pathways and/or a disrupted somatosensory information processing, which could be possibly contrasted by administering highly variable motor tasks.

SIGNIFICANCE

People with chronic pain move differently. Movement quality is difficult to evaluate during daily activities, yet it may prove more informative than quantitative measurements. We proposed a new approach for computing movement complexity and found out that patients' movements get more stereotyped when higher spinal acceleration is required.

What is the effect of prolonged sitting and physical activity on thoracic spine mobility? An observational study of young adults in a UK university setting

OBJECTIVE

Sedentary behaviour has long been associated with neck and low back pain, although relatively little is known about the thoracic spine. Contributing around 33% of functional neck movement, understanding the effect of sedentary behaviour and physical activity on thoracic spinal mobility may guide clinical practice and inform research of novel interventions.

DESIGN

An assessor-blinded prospective observational study designed and reported in accordance with Strengthening the Reporting of Observational Studies in Epidemiology.

SETTING

UK university (June-September 2016).

PARTICIPANTS

A convenience sample (18-30 years) was recruited and based on self-report behaviours, the participants were assigned to one of three groups: group 1, sitters-sitting >7 hours/day+physical activity<150 min/week; group 2, physically active-moderate exercise >150 min/week+sitting <4 hours/day and group 3, low activity-sitting 2-7 hours/day+physical activity <150 min/week.

OUTCOME MEASURES

Thoracic spine mobility was assessed in the heel-sit position using Acumar digital goniometer; a validated measure. Descriptive and inferential analyses included analysis of variance and analysis of covariance for between group differences and Spearman's rank correlation for post hoc analysis of associations.

RESULTS

The sample (n=92) comprised: sitters n=30, physically active n=32 and low activity n=30. Groups were comparable with respect to age and body mass index.Thoracic spine mobility (mean (SD)) was: group 1 sitters 64.75 (1.20), group 2 physically active 74.96 (1.18) and group 3 low activity 68.44 (1.22). Significant differences were detected between (1) sitters and low activity, (2) sitters and physically active (p<0.001). There was an overall effect size of 0.31. Correlations between thoracic rotation and exercise duration (r=0.67, p<0.001), sitting duration (r=-0.29, p<0.001) and days exercised (r=0.45, p<0.001) were observed.

CONCLUSIONS

Findings evidence reduced thoracic mobility in individuals who spend >7 hours/day sitting and <150 min/week of physical activity. Further research is required to explore possible causal relationships between activity behaviours and spinal musculoskeletal health.