Normative data for the balance error scoring system for patients with chronic neck pain.

Chronic neck pain is a common problem with a poorly understood pathophysiology. Often no underlying structural pathology can be found and radiological imaging findings are more related to age than to a patient's symptoms. Besides its common occurrence, chronic idiopathic neck pain is also very disabling with almost 50% of all neck pain patients showing moderate disability at long-term follow-up. Central sensitization (CS) is defined as "an amplification of neural signaling within the central nervous system that elicits pain hypersensitivity," "increased responsiveness of nociceptive neurons in the central nervous system to their normal or subthreshold afferent input," or "an augmentation of responsiveness of central neurons to input from unimodal and polymodal receptors." There is increasing evidence for involvement of CS in many chronic pain conditions. Within the area of chronic idiopathic neck pain, there is consistent evidence for the presence and clinical importance of CS in patients with traumatic neck pain, or whiplash-associated disorders. However, the majority of chronic idiopathic neck pain patients are unrelated to a traumatic injury, and hence are termed chronic idiopathic non-traumatic neck pain. When comparing whiplash with idiopathic non-traumatic neck pain, indications for different underlying mechanisms are found. The goal of this article was to review the existing scientific literature on the role of CS in patients with chronic idiopathic non-traumatic neck pain. Systematic review. All selected studies were case control studies. A systematic search of existing, relevant literature was performed via the electronic databases Medline, Embase, Web of Science, Cinahl, PubMed, and Google Scholar. All titles and abstracts were checked to identify relevant articles. An article was considered eligible if it met following inclusion criteria: (1) participants had to be human adults (> 18 years) diagnosed with idiopathic non-traumatic chronic (present for at least 3 months) neck pain; (2) papers had to report outcomes related to CS; and (3) articles had to be full-text reports or original research (no abstracts, case-reports, reviews, meta-analysis, letters, or editorials). Six articles were found eligible after screening the title, abstract and - when necessary - the full text for in- and exclusion criteria. All selected studies were case-control studies. Overall, results regarding the presence of CS were divergent. While the majority of patients with chronic traumatic neck pain (i.e. whiplash) are characterized by CS, this is not the case for patients with chronic idiopathic neck pain. The available evidence suggests that CS is not a major feature of chronic idiopathic neck pain. Individual cases might have CS pain, but further work should reveal how they can be characterized. Very few studies available. Literature about CS in patients with chronic idiopathic non-traumatic neck pain is rare and results from the available studies provide an inconclusive message. CS is not a characteristic feature of chronic idiopathic and non-traumatic neck pain, but can be present in some individuals of the population. In the future a subgroup with CS might be defined, but based on current knowledge it is not possible to characterize this subgroup. Such information is important in order to provide targeted treatment.

Sensitization in office workers with chronic neck pain in different pain conditions and intensities.

Background: According to Picavet and Schouten (2003) the incidence of neck pain is increasing at a greater rate than other spine problems (Hoving et al. 2004). Furthermore, chronic neck pain is a substantial burden to society with chronic neck pain being the fourth leading cause of disability worldwide (Hoy et al. 2014). Chronic mechanical neck pain (CMNP) has been defined as localised, asymmetrical neck pain with restricted range of motion and dysfunctional musculature (Grieve, 1988). Treatments for those suffering with chronic pain, which are non-surgical, appear to be the most beneficial for patients according to Haldeman et al. (2008). Giles and Müller (1999) have stated that spinal manipulation is the most effective method of treating spinal pain on its own. However, the literature suggests that there is benefit in combining manipulation with an “anti-inflammatory type” drug (Crawford 1988; Oberbaum 1998; Serrentino 2003). Many studies have been successfully conducted on Homoeopathic complexes to treat neck pain (Fisher 1986; Bohmer and Ambrus 1992; Hepburn 2000; Soeken 2004) however no study has yet to been carried out on the combination of Homoeopathic Simillimum (single remedy) and spinal manipulation for CMNP. Objective: The aim of this study was to determine if spinal manipulation and Homoeopathic Simillimum in combination are more relatively effective than spinal manipulation alone in the treatment of chronic mechanical neck pain. Methodology: This study was a randomised, blinded placebo controlled quantitative trial with a comparative clinical trial design. Thirty consenting participants with CMNP who met the inclusion criteria were randomly distributed between two treatment groups. Group A received spinal manipulation as well as Homoeopathic Simillimum and group B received spinal manipulation with placebo medication. Each participant received three treatments over a period of a week; with subjective and objective readings taken at every consultation. The subjective tools included the Numerical Pain Rating Scale and Canadian Memorial College of Chiropractic Neck Disability Index. Objective tools included the Algometer and CROM-II Goniometer. All data captured was analysed using SPSS version 24.0. Inferential and non-parametric analysis of the data were also be performed. Results: The results showed that no statistically significant differences were observed between the two groups in terms of subjective and objective measurements. However, there were statistically significant improvements seen in both groups equally in terms of ANOVA subjective and objective measurements i.e. both groups showed improvement. Conclusion: The results of this study concluded that no statistical or clinically significant changes were noticed between the groups and therefore the Homoeopathic Simillimum added no statistical significant improvements in those who received it over those participants who received placebo in the treatment of chronic mechanical neck pain.

Investigation of Joint Position Sense and Balance in Individuals With Chronic Idiopathic Neck Pain: A Cross-Sectional Study

Abstract- Neck pain is one of the most common musculoskeletal condition on a global scale in India, 67% of population experience neck pain and out of that 20% develop chronic type neck pain. In health care students neck pain is caused due to lower mobility in daily life, sleep disturbance and poor ability to perform activity of daily living due to neck pain. MFR is a manual therapy technique used to improve range of motion, decrease pain and enhance tissue recovery. Aerobic exercise promote anti-inflammatory cytokines. Aim & Objectives: To evaluate the effect of aerobic exercise in terms of pain, endurance and functional activity. To estimate the effect of aerobic exercise and MFR with foam roller in improving pain among health care students in term of functional outcome, reducing pain, muscles relaxation and enhancing Lymphatic drainage and posture correction. Methodology: An observational study conducted among healthcare student with 60 participant. Inclusion criteria- No history of fracture, no neurological, chronic neck pain without medication Age group 18-30 years with both male and female participants, chronic neck pain without administration of medications. Exclusion criteria -underwent any recent therapeutic intervention, any associated psychological illness, neck instability and other degenerative disorder, acute neck pain with/without radiculopathy, vertigo, and headache. Result: There is beneficial effect of using MRF technique with foam roller and aerobic exercise among healthcare students with chronic pain. Conclusion: This study helps us to conclude that aerobic exercise using MFR with foam roller has more positive effect in terms of reducing neck pain and increasing functional function activity. Clinical Relevance: There is reduction in pain and it will improved mobility. Prolong sitting and improper ergonomics can contribute to poor posture. Combination of MFR and aerobic exercise can enhance all over functional performance. Key words: Myofascial Release, NDI, Aerobic Exercise, Foam Roller, Neck Pain

Does muscle morphology change in chronic neck pain patients? – A systematic review

BackgroundSeveral potential causes can impair balance in older people. The neck torsion maneuver may be useful in demonstrating impaired balance caused by the stimulation of cervical proprioceptive input. Whereas evidence suggests impaired standing balance in older people with chronic neck pain, balance impairment during the neck torsion position and its relationship with clinical characteristics have not yet been investigated in this population. The aims of this study were to investigate whether the neck torsion position could significantly influence balance responses in older people with chronic non-specific neck pain and to determine the relationships between the balance responses and characteristics of neck pain.MethodsSixty-eight older people (34 with chronic non-specific neck pain and 34 controls) participated in the study. Balance was tested using a force plate during comfortable stance with eyes open under four conditions: neutral head on a firm surface, neutral head on a soft surface, neck torsion to left and right on a firm surface and neck torsion to left and right on a soft surface. Balance outcomes were anterior-posterior (AP) and medial-lateral (ML) displacements, sway area and velocity. Characteristics of neck pain were intensity, duration and disability.ResultsOverall, the neck pain group exhibited greater AP and ML displacements, sway area and velocity in the neck torsion position on firm and soft surfaces compared to controls (partial eta squared (η²p) = 0.06–0.15, p < 0.05). The neck pain group also had greater AP displacement, sway area and velocity in the neutral position on a soft surface compared to controls (η²p = 0.09–0.16, p < 0.05). For both groups, the neck torsion position displayed overall greater postural sway compared to the neutral position (η²p = 0.16–0.69, p < 0.05). There were no relationships between the postural sway outcomes and characteristics of neck pain (p > 0.05).ConclusionThe neck torsion maneuver, stimulating the receptors resulted in increased postural sway in older people, with a more pronounced effect in those with neck pain. The study provides evidence supporting the use of neck torsion for assessing impaired balance related to abnormal cervical input in older people with chronic non-specific neck pain.

Gua Sha is a traditional East Asian healing technique where the body surface is "press-stroked" with a smooth-edged instrument to raise therapeutic petechiae that last 2-5 days. The technique is traditionally used in the treatment of both acute and chronic neck and back pain. This study aimed to measure the effects of Gua Sha therapy on the pain ratings and pressure pain thresholds of patients with chronic neck pain (CNP) and chronic low back pain (CLBP). A total of 40 patients with either CNP or CLBP (mean age 49.23 ± 10.96 years) were randomized to either a treatment group (TG) or a waiting list control group (WLC). At baseline assessment (T1), all patients rated their pain on a 10 cm visual analog scale (VAS). Patients' pressure pain thresholds (PPT) at a site of maximal pain (pain-maximum) and an adjacent (pain-adjacent) site were also established. The treatment group then received a single Gua Sha treatment. Post-intervention measurements were taken for both groups at T2, seven days after baseline assessment (T1), using the same VAS and PPT measurements in precisely the same locations as at T1. Final analysis were conducted with 21 patients with CNP and 18 patients with CLBP. The study groups were equally distributed with regard to randomization. Patients in both the CNP and the CLBP treatment groups reported pain reduction (p < 0.05) and improved health status from their one Gua Sha treatment, as compared to the waiting list group. Pain sensitivity improved in the TG in CNP, but not in CLBP patients, possibly due to higher pressure sensitivity in the neck area. No adverse events were reported. These results suggest that Gua Sha may be an effective treatment for patients with chronic neck and low back pain. Further study of Gua Sha is warranted.

Background It is unclear whether the prevalence of chronic low back pain is higher in chronic whiplash patients than in the general population. In a population-based study, we evaluated the prevalence of chronic low back pain in individuals with chronic neck pain of traumatic and non-traumatic origin, with special emphasis on whiplash injury.Subjects and methods Additional questions concerning the patient's experience of neck and low back pain were added to the questionnaire of the MONICA health survey. 4,415 subjects aged 25–64 years were randomly selected from a geographically well-defined area in northern Sweden.Results The prevalences of chronic low back pain and chronic neck pain were 16% and 17%, respectively. 51% of subjects had both back and neck pain. Of the patients with neck pain, one quarter had a history of neck injury, which was related to whiplash injury in almost one-half of the cases. The prevalence of chronic low back pain in individuals with chronic non-traumatic neck pain was 53%, and it was 48% in those with chronic neck pain and a history of neck trauma. There was no difference in the prevalence of chronic low back pain between whiplash injury and other types of neck trauma. Confounding factors such as sex, age, marital status, BMI, smoking status and level of education were not significantly different between traumatic and non-traumatic groups.Interpretation Independently of traumatic or non-traumatic origin of the symptoms, the prevalence of chronic low back pain is 3 times higher in individuals with chronic neck pain than in the general population. Causes other than a history of neck trauma, such as chronic muskuloskeletal pain syndromes, may be important in evaluation of these cases. ▪

Background: Chronic neck pain is a common problem in the adult population with a typical 12- month prevalence of 30% to 50%. Cervical disc herniation and radiculitis is one of the common conditions described responsible for chronic neck and upper extremity pain. Cervical epidural injections for managing chronic neck pain with disc herniation are one of the commonly performed non-surgical interventions in the United States. However, the literature supporting cervical interlaminar epidural steroids in managing chronic neck pain is scant. Study Design: A randomized, double-blind, controlled trial. Setting: A private interventional pain management practice and specialty referral center in the United States. Objectives: To evaluate the effectiveness of cervical interlaminar epidural injections of local anesthetic with or without steroids in providing effective and long-lasting relief in the management of chronic neck pain and upper extremity pain in patients with disc herniation and radiculitis, and to evaluate the differences between local anesthetic with or without steroids. Methods: Patients were randomly assigned to one of 2 groups: Group I patients received cervical interlaminar epidural injections of local anesthetic (lidocaine 0.5%, 5 mL); Group II patients received cervical interlaminar epidural injections with 0.5% lidocaine, 4 mL, mixed with 1 mL of nonparticulate betamethasone. Outcomes Assessment: Multiple outcome measures were utilized. They included the Numeric Rating Scale (NRS), the Neck Disability Index (NDI), employment status, and opioid intake. Assessments were done at baseline and 3, 6, and 12 months post-treatment. Significant pain relief was defined as 50% or more; significant improvement in disability score was defined as a reduction of 50% or more. Results: Significant pain relief (≥ 50%) was demonstrated in 77% of patients in both groups. Functional status improvement was demonstrated by a reduction (&gt; 50%) in the NDI scores in 74% of Group I and 71% of Group II at 12 months. The overall average procedures per year were 3.7 ± 1.1 in Group I and 4.0 ± 0.91 in Group II; the average total relief per year was 39.45 ± 11.59 weeks in Group I and 41.06 ± 11.56 weeks in Group II over the 52 week study period in the patients defined as successful. The initial therapy was considered to be successful if a patient obtained consistent relief with 2 initial injections lasting at least 4 weeks. All others were considered failures. Limitations: The study results are limited by the lack of a placebo group and a preliminary report of 70 patients, 35 in each group. Conclusion: Cervical interlaminar epidural injections with local anesthetic with or without steroids might be effective in 77% of patients with chronic function-limiting neck pain and upper extremity pain secondary to cervical disc herniation and radiculitis. Key words: Chronic neck pain, cervical disc herniation, upper extremity pain, cervical epidural injections, epidural steroids, local anesthetics

BackgroundForward head posture (FHP) is a common postural deviation that has been linked to neck pain and dysfunction. The impact of FHP on neck muscle endurance and thickness in individuals with chronic neck pain remains unclear. This study aimed to compare neck muscle endurance and thickness between women with chronic neck pain and FHP versus those with chronic neck pain but normal head/neck posture.MethodsForty women with chronic non-specific neck pain were divided into two groups based on craniovertebral angle assessment, 20 with FHP and 20 with normal posture in each group. Neck pain, disability, neck flexor and extensor muscle endurance, and neck muscle normalized thickness (sternocleidomastoid, upper trapezius (Utrap), longus coli and total neck extensors) measured via ultrasound were compared between the groups.ResultsWomen with FHP demonstrated significantly lower endurance of the extensor muscles, normalized thickness of the Utrap muscle, and significantly higher Neck Pain and Disability Scale (NPDS) and Neck Disability Index (NDI) scores compared to the Non-FHP group (p < 0.05). Craniovertebral angle (CVA) was positively correlated with extensor muscle endurance (p = 0.002, r = 0.481).ConclusionsOur findings indicate that the endurance of neck extensor muscles decreases, and neck pain and disability increase in women with chronic neck pain and FHP. This emphasizes the importance of addressing FHP in patients with chronic neck pain and considering the improvement of neck extensor muscle endurance as part of their treatment. These findings may also serve as indicators of the severity of neck pain and assist in patient monitoring.

Cervical movement kinematic analysis in patients with chronic neck pain: A comparative study with healthy subjects

Utilizing shear wave elastography, we compared the stiffness of the neck extensor muscles and the stiffness in muscle-specific regions between women with chronic nonspecific neck pain and asymptomatic controls. Cross-sectional observational study. We measured the average muscle stiffness over multiple neck extensor muscles and in regions corresponding approximately to the trapezius, splenius capitis, semispinalis capitis, semispinalis cervicis, and multifidus muscles using ultrasound shear wave elastography in 20 women with chronic nonspecific neck pain and 18 asymptomatic women during multiple tasks. The measurements were automatically quality controlled and computer processed over the complete visible neck region or a large muscle-specific region. Pooled over all tasks, neck muscle stiffness was not significantly different between those with neck pain and asymptomatic controls (neck pain median, 11.6 kPa; interquartile range, 8.9 kPa and control median, 13.3 kPa; interquartile range, 8.6 kPa; P = .175). The measure of neck muscle stiffness was not correlated with the intensity of neck pain or perceived disability. Shear wave elastography revealed similar muscle stiffness in people with and without chronic neck pain, despite the sensation of increased neck stiffness in those with chronic neck pain. Therapeutic interventions aiming to reduce neck muscle tone are often based on the assumption that perceived neck stiffness corresponds to objective muscle stiffness. The current results question this assumption. J Orthop Sports Phys Ther 2020;50(4):179-188. Epub 6 Jan 2020. doi:10.2519/jospt.2020.8821.

Introduction: Chronic neck pain is a common complaint among office workers. The aim of the present study was to compare the efficacy of a high-intensity laser and physiotherapy in office workers who were diagnosed with chronic non-specific neck pain. Methods: This study was a single-blind randomized controlled trial, with parallel allocation. Sixty office workers with chronic neck pain, aged between 25 and 55 years, participated in the study. The participants were randomly divided into two groups: photobiomodulation (by a high-level laser) and physiotherapy. Visual analogue scale (VAS), Neck Disability Index (NDI), Neck Pain and Disability Scale (NPDS) and Bournemouth Questionnaire (BQN) were completed on three occasions (before, immediately and 2 weeks after the intervention) to assess and compare the efficacy of the high-intensity laser and physiotherapy in neck pain. Data were analyzed by SPSS 23 software using the chi-square test, Student's t test, multivariate tests, and Fisher's exact test. Results: The mean age of the participants was 37.53±9.52 and 41.16±7.85 years in physiotherapy and laser therapy respectively. The VAS score and NDI scores decreased after both kinds of interventions, and the effect of photobiomodulation was significantly higher than physiotherapy (P < 0.001). Both treatment modalities significantly affect different aspects of chronic neck pain assessed by NDPS and BQN questionnaires and the effect of photobiomodulation was more prominent than physiotherapy. Conclusion: The findings of this study showed that photobiomodulation and physiotherapy can reduce chronic neck pain and its different aspects and the effect of laser therapy was significantly higher than physiotherapy.

Background: Impairment of cervical sensory input in patients with neck pain may disturb postural stability. The purpose of present study was to assess the dynamic postural stability of subjects with chronic neck pain compared to a matched control group. Methods: In this case-control study, 22 chronic non-specific neck pain and 22 healthy individuals participated. Postural stability was measured with Techno-body Prokin tilting platform. Subjects performed balance tests under two conditions: eyes open and closed. The parameters for assessment of postural stability were total stability index (TSI), anteroposterior stability index (APSI), mediolateral stability index (MLSI), and trunk deviation which demonstrated total trunk sway in medio-lateral and antero-posterior. We used a separate 2 (group) by 2 (postural difficulty) mixed-design analysis of variance (ANOVA) for analysis of postural performance. Results: There were significant differences between the chronic neck pain and matched control groups in APSI, MLSI, and TSI, p<0.001 in both eyes opened and closed conditions. The trunk deviation was greater for non-specific neck pain in comparison to healthy subjects, p<0.05 in both conditions of eyes open and closed. Conclusion: The results of this study showed that patients with chronic neck pain have poorer postural control than healthy subjects. The findings suggest that clinicians take into account the importance of dynamic postural stability assessment in patients with chronic non-specific neck pain and consider the application of intervention programs for improvement of the dynamic balance.