Cervical Spine Muscles Research Articles

A subject-specific biomechanical control model for the prediction of cervical spine muscle forces

BackgroundThe aim of the present study is to propose a subject-specific biomechanical control model for the estimation of active cervical spine muscle forces. MethodsThe proprioception-based regulation model developed by Pomero et al. (2004) for the lumbar spine was adapted to the cervical spine. The model assumption is that the control strategy drives muscular activation to maintain the spinal joint load below the physiological threshold, thus avoiding excessive intervertebral displacements. Model evaluation was based on the comparison with the results of two reference studies. The effect of the uncertainty on the main model input parameters on the predicted force pattern was assessed. The feasibility of building this subject-specific model was illustrated with a case study of one subject. FindingsThe model muscle force predictions, although independent from EMG recordings, were consistent with the available literature, with mean differences of 20%. Spinal loads generally remained below the physiological thresholds. Moreover, the model behavior was found robust against the uncertainty on the muscle orientation, with a maximum coefficient of variation (CV) of 10%. InterpretationAfter full validation, this model should offer a relevant and efficient tool for the biomechanical and clinical study of the cervical spine, which might improve the understanding of cervical spine disorders.

Prognostic indicators for decrease in tinnitus severity after cervical physical therapy in patients with cervicogenic somatic tinnitus

BackgroundTinnitus can be related to many different aetiologies such as hearing loss or a noise trauma, but it can also be related to the somatosensory system of the cervical spine, called cervicogenic somatic tinnitus(CST). Recently, a positive effect of multi-modal cervical physical therapy on tinnitus severity in patients with CST was demonstrated. To date however, the outcome of the intervention cannot be predicted. ObjectiveTo identify prognostic indicators for decrease in tinnitus severity after cervical physical therapy in patients with CST. PatientsPatients with moderate to severe subjective tinnitus (Tinnitus Functional Index(TFI):25–90points) and neck complaints (Neck Bournemouth Questionnaire(NBQ) > 14points). InterventionAll patients received multimodal cervical physical therapy for 6 weeks (12 sessions). This physical therapy contained a combination of manual mobilizations and exercises of the cervical spine. MeasurementsTFI and NBQ-scores were documented at baseline, after treatment and after a 6-weeks follow-up period. Impairments in cervical spine mobility and muscle function were identified at baseline and after 6-weeks follow-up. ResultsPatients with co-varying (increasing or decreasing simultaneously) tinnitus and neck complaints had significantly lower TFI-scores after treatment (p = 0.001) and follow-up (p = 0.03). The presence of this co-variation and a combination of low pitched tinnitus and increasing tinnitus during inadequate cervical spine postures are prognostic indicators for a decrease in TFI-scores after cervical physical therapy (adjusted R2 = 0.357). ConclusionPatients who experience a decrease in tinnitus annoyance from cervical physical therapy are those with co-varying tinnitus and neck complaints and those with a combination of low-pitched tinnitus and increasing tinnitus during inadequate cervical spine postures.

MRI cross sectional atlas of normal canine cervical musculoskeletal structure

Although magnetic resonance imaging (MRI) has been increasingly used as a diagnostic tool for cervical spine injuries in canines, a comprehensive normal MRI anatomy of the canine cervical spine muscles is lacking. Therefore, the purpose of this study was to build a magnetic resonance imaging atlas of the normal cross sectional anatomy of the muscles of the canine cervical spine. MRI scans were performed on a canine cadaver using a combination of T1 and T2-weighted images in the transverse, sagittal and dorsal planes acquired at a slice thickness of 1mm. Muscle contours were traced manually in each slice, using local osseous structures as reference points for muscle identification. Twenty-two muscles were traced in 401 slices in the cervical region. A three dimensional surface model of all the contoured muscles was created to illustrate the complex geometrical arrangement of canine neck muscles. The cross-sectional area of the muscles was measured at the mid-level of each vertebra. The accuracy of the location of the mapped muscles was verified by comparing the sagittal view of the 3D model of muscles with still photographs obtained from anatomic canine cadaver dissection. We believe that this information will provide a unique and valuable resource for veterinary researchers, clinicians and surgeons who wish to evaluate MRI images of the cervical spine. It will also serve as the foundation for ongoing work to develop a computational model of the canine cervical spine in which anatomical information is combined with electromyographic, kinematic and kinetic data.

Evaluation of Paraspinal Fat Pad as an Indicator of Posterior Ligamentous Complex Injury in Cervical Spine Trauma.

Purpose To determine if the obliteration of a cervical space, the paraspinal fat pad (PFP), can be used as an indicator at computed tomography (CT) of an injury of cervical spine posterior ligamentous complex (PLC). Materials and Methods This retrospective study was approved by the institutional board review; written informed consent was obtained from healthy subjects and was waived for patients. First, PFP appearance was evaluated in an anatomic specimen and in 10 healthy subjects on spine CT scans by three radiologists (readers 1, 2, and 3) working in consensus. Then, in 85 patients with suspicion of cervical spine trauma following high-velocity trauma, readers 2 and 3 reviewed in consensus the cervical spine CT (reference for fracture and luxation) and 1.5-T magnetic resonance images (T1, T2, and short inversion time inversion-recovery sequences; reference for ligament and disk injuries and contusion or occult fracture) for traumatic injuries. CT appearance of PFP was independently analyzed by readers 1 and 2, and interobserver agreement (weighted kappa) was calculated. Relationships between PFP changes and injuries and descriptive analysis were calculated by using logistic regression and Fisher test, respectively. Results The PFP could be identified as a well-circumscribed fatty area between cervical spine and posterior muscles. Interobserver agreement was 0.76. An abnormal PFP was associated with PLC (P < .001) and arch (P = .006) injuries but not with body (P = .056), longitudinal ligaments (P = .412), or disk (P = .665) injuries. Sensitivity, specificity, positive predictive value, and negative predictive value for PLC injuries were 55% (11 of 20), 97% (38 of 39), 92% (11 of 12), and 81% (38 of 47), respectively. Conclusion PFP changes on CT scans are significantly associated with injuries of PLC in patients with spine cervical trauma. © RSNA, 2016 Online supplemental material is available for this article.

Magnetic resonance imaging atlas of the cervical spine musculature.

The anatomy of the cervical spine musculature visible on magnetic resonance (MR) images is poorly described in the literature. However, the correct identification of individual muscles is clinically important because certain conditions of the cervical spine, for example whiplash associated disorders, idiopathic neck pain, cervical nerve root avulsion and cervical spondylotic myelopathy, are associated with different morphological changes in specific muscles visible on MR images. Knowledge of the precise structure of different cervical spine muscles is crucial when comparisons with the contralateral side or with normal are required for accurate description of imaging pathology, management and assessment of treatment efficacy. However, learning the intricate arrangement of 27 muscles is challenging. A multi-level cross-sectional depiction combined with three-dimensional reconstructions could facilitate the understanding of this anatomically complex area. This paper presents a comprehensive series of labeled axial MR images from one individual and serves as a reference atlas of the cervical spine musculature to guide clinicians, researchers, and anatomists in the accurate identification of these muscles on MR imaging. Clin. Anat. 29:643-659, 2016. © 2016 Wiley Periodicals, Inc.

Effect of tight clothes on cervical and thoracic spine muscles during shoulder abduction.

[Purpose] The purpose of this study was investigated the effect of tight clothes on cervical and thoracic spine muscles activities during shoulder abduction. [Subjects and Methods] The subjects of this study were 10 healthy males. The subjects performed two shoulder abduction trials for each of two jacket-wearing conditions. The right upper, middle, and lower trapezius and serratus anterior muscles activities were measured using a surface electromyography system during right shoulder abduction. [Results] The upper and middle trapezius muscle activities during shoulder abduction were significantly increased under the tight-jacket conditions compared with the general-jacket conditions. The lower trapezius and serratus anterior muscle activities were significantly decreased under the tight-jacket conditions compared with the general-jacket conditions. [Conclusion] The results of this study suggest that normal scapular movements did not occur sufficiently when wearing a tight jacket.

Improvement in balance, pallesthesia, gait and tandem walk after chiropractic spinal manipulative therapy and functional neurological rehabilitation.

Event Abstract Back to Event Improvement in balance, pallesthesia, gait and tandem walk after chiropractic spinal manipulative therapy and functional neurological rehabilitation. Paula Rhodes1* and Xavier Barreto-Alderondo1 1 Life University, Center for Health and Optimum Performance Outpatient Clinic, United States Background: A 66-year-old Caucasian male and former paint contractor presented on September 11, 2015 with complaints of poor balance, an unsteady “shuffling” gait and fatigue of his leg muscles which he had first noticed in approximately January of 2015. He had stopped his dance lessons in April 2015 due to these complaints, but had started them again in September 2015. His wife had died two years before, and dance was an important social event in which he wanted to be able to fully participate. Methods: A detailed chiropractic and functional neurological examination was performed, which revealed that ambulation was slow and deliberate, as were his speech, gestures and general affect. He was unable to perform tandem walk. Hypertonicity of his cervical spine musculature was noted. His gait lacked any right or left arm swing, and he dragged his right foot when he walked. Pallesthesia (vibration sense) was absent on his left foot up to five inches above the left medial malleolus. Heel–to-shin testing was poor on the left. A treatment plan involving peripheral somatosensory stimulation, active and passive movement exercises, specific ocular exercises including gaze stabilization, sensorimotor therapies and chiropractic spinal manipulative therapy (SMT) was applied. He was compliant in performing home exercises including walking outside for exercise. Results: Improvement in some findings occurred in approximately four months, and in other findings in approximately 10 months as additional therapies were applied. Pallesthesia was restored completely to the left foot. His gait produced arm swing, and his right foot no longer dragged though he still did not lift it as high as the left. He was able to perform tandem walk for at least 8 steps before losing his balance. He reported that his dance instructor noticed improvement in his ability to be stable and to dance. His emotional state went from being depressed and fearful of the future, to being hopeful, proactively involved in his therapies and enjoying social engagement. Conclusion: Improvement in a 66-year-old male’s balance, pallesthesia, ambulation, and tandem walk as a result of chiropractic functional neurological therapy suggests that chiropractic and brain-based therapies may have a place in the treatment of these symptoms in the aging population. Acknowledgements Beatrice Tapia, DC, DACNB Susan Esposito, DC, DACNB Linda Mullin, DC Keywords: pallesthesia, Vibration sense, shuffling gait, tandem walk, Arm swing Conference: International Symposium on Clinical Neuroscience: Clinical Neuroscience for Optimization of Human Function, Orlando, United States, 7 Oct - 9 Oct, 2016. Presentation Type: Poster Presentation Topic: Abstracts ISCN 2016 Citation: Rhodes P and Barreto-Alderondo X (2016). Improvement in balance, pallesthesia, gait and tandem walk after chiropractic spinal manipulative therapy and functional neurological rehabilitation.. Front. Neurol. Conference Abstract: International Symposium on Clinical Neuroscience: Clinical Neuroscience for Optimization of Human Function. doi: 10.3389/conf.fneur.2016.59.00066 Copyright: The abstracts in this collection have not been subject to any Frontiers peer review or checks, and are not endorsed by Frontiers. They are made available through the Frontiers publishing platform as a service to conference organizers and presenters. The copyright in the individual abstracts is owned by the author of each abstract or his/her employer unless otherwise stated. Each abstract, as well as the collection of abstracts, are published under a Creative Commons CC-BY 4.0 (attribution) licence (https://creativecommons.org/licenses/by/4.0/) and may thus be reproduced, translated, adapted and be the subject of derivative works provided the authors and Frontiers are attributed. For Frontiers’ terms and conditions please see https://www.frontiersin.org/legal/terms-and-conditions. Received: 01 Sep 2016; Published Online: 07 Sep 2016. * Correspondence: Dr. Paula Rhodes, Life University, Center for Health and Optimum Performance Outpatient Clinic, Marietta, GA, 30060, United States, paular412@gmail.com Login Required This action requires you to be registered with Frontiers and logged in. 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Validation of the device for evaluation of muscular strength in the cervical spine region

Abstract Background: In the physiotherapeutic practice, the need for measurements of e.g. range of motion or strength of the cervical spine muscles results from a variety of degenerative processes in the area of the head, cervical spine and shoulder girdle. In Poland, we designed a measurement stand based on the equipment described in foreign literature. Validation of the measurement stand was performed in order to determine the usefulness of this stand for measurements of maximal strength and muscle torques for the isometric contraction of the cervical spine muscles. Material/Methods: A group of 13 women was examined to validate the device. The criteria for inclusion into the study group were adult age, no back pain and head pain syndromes. Validation of the equipment consisted in the calculation of the intraclass correlation coefficient (ICC). Three measurements were performed for each movement in three planes: initial measurement (I), second measurement after 15 minutes (II) and the third measurement after a week (III). The ICC coefficient was calculated based on the methodology discussed in the study by Shrout and Fleiss (1979). Results: The results of the measurements reached the "excellent" level of the ICC coefficient between the first and the second test. In the case of the first and the third tests, the ICC coefficient reached the "good" level for the movements in the sagittal and transverse planes and the "excellent" level for the movements in the frontal plane. Conclusions: The measurement system used in the measurement stand designed by the authors of the present study can be successfully used for comparative studies of several groups or repeated examinations of the same study group after application of a specific therapeutic procedure.The stand cannot be used for evaluation whether the results obtained are consistent with the standards for specific populations or for comparison with the results obtained from other devices.

Non-rigid registration of cervical spine MRI volumes.

Whiplash is the colloquial term for neck injuries caused by sudden extension of the cervical spine. Patients with chronic whiplash associated disorder (WAD) can experience neck pain for many years after the original injury. Researchers have found some evidence to suggest that chronic whiplash is related to the amount of intra-muscular fat in the cervical spine muscles. Hence, an important step towards developing a treatment for chronic WAD is a technique to accurately and efficiently measure the amount of intra-muscular fat in the muscles of the cervical spine. Our proposed technique for making this measurement is to automatically segment the cervical spine muscles using a fused volume created from multi-modal MRI volumes of the cervical spine. Multiple modes are required to enhance the boundaries between the different muscles to assist the following automatic segmentation process. However, before these multiple modes can be fused it is first necessary to accurately register these volumes. Hence, in this paper, we have proposed a new non-rigid multi-modal registration algorithm using the sum of conditional variance (SCV) with partial volume interpolation (PVI) similarity measure and Gauss-Newton (GN) optimization for the accurate registration of multi-modal cervical spine MRI volumes. The performance of the proposed approach is compared with the existing SCV based registration algorithm and the sum of the conditional squared deviation from the mode (SCSDM) method. The experimental results demonstrate that the proposed approach provides superior performance than the best existing approaches.

Altered pain sensitivity in elderly women with chronic neck pain.

BackgroundAge-related changes occur in both the peripheral and central nervous system, yet little is known about the influence of chronic pain on pain sensitivity in older persons. The aim of this study was to investigate pain sensitivity in elders with chronic neck pain compared to healthy elders.MethodsThirty elderly women with chronic neck pain and 30 controls were recruited. Measures of pain sensitivity included pressure pain thresholds, heat/cold pain thresholds and suprathreshold heat pain responses. The pain measures were assessed over the cervical spine and at a remote site, the tibialis anterior muscle.ResultsElders with chronic neck pain had lower pressure pain threshold over the articular pillar of C5-C6 and decreased cold pain thresholds over the cervical spine and tibialis anterior muscle when compared with controls (p < 0.05). There were no between group differences in heat pain thresholds and suprathreshold heat pain responses (p > 0.05).ConclusionThe presence of pain hypersensitivity in elderly women with chronic neck pain appears to be dependent on types of painful stimuli. This may reflect changes in the peripheral and central nervous system with age.

칼텐본 경추 관절가동술 후 적용된 능동적 중재가 두부 전방자세 환자의 경추 정렬과 근활성도에 미치는 영향

칼텐본 경추 관절가동술 후 적용된 능동적 중재가 두부 전방자세 환자의 경추 정렬과 근활성도에 미치는 영향

The use of botulinum toxin in the treatment of the consequences of bruxism on cervical spine musculature

Hypertonia and hyperactivity of masticatory muscles are involved in pain and contractions of the cervical spine musculature, but their pathophysiology remains nonetheless unknown and its treatment far to be codified. In this study, 8 patients, showing disabling posterior neck muscle contractures linked with bruxism were prospectively treated and followed for an average 15 months period, after having received Injections of botulinum toxin A essentially in masticatory muscles. Injections were made every 3 months, varying from 10 to 100 U Botox* by muscles, without administrating more than 300 U Botox* in the same patient. The angle of cervical lordosis were calculated on lateral sitting radiographs in neutral position, good results being considered to be achieved in the case of a 2 point diminution of VAS score as well as at least a 5° positive gain in the curve. 7 patients out of 8 showed a real improvement in their symptoms after an average of 3 injections, showing a decrease of 4.5 points on the VAS score and an average increment of 15° in cervical lordosis. Although the follow-up period of patients was relatively short and the sample quite small, the general impression, confirmed by the patients' experience, seems to suggest a potential place for the use of botulinum toxin amongst the array of treatments which can be offered in certain selected cases which associate bruxism and posterior cervical contractions.

Effect of Active Head Restraint on Cervical Vertebrae Injuries Lessening

A three-dimensional multi-body model of the 50th percentile male human and discretized neck was built to evaluate the effect of active head restraint on cervical vertebrae injuries lessening in vehicle rear impact. The discretized neck includes of cervical spine vertebrae, intervertebral discs, ligaments, and muscles. The BioRID-II adult male dummy restrained using safety belt was seated on a sled, whose longitudinal velocity measured from rear impact FEM simulation was applied to simulate the relative motion of the head and neck. According to the interspinous ligament loads and the ligamenta flava loads of the cervical spine, an active head restraint and an impact absorber were designed to lessening the neck injuries in vehicle rear end collisions.

Quantification of cervical spine muscle fat: a comparison between T1-weighted and multi-echo gradient echo imaging using a variable projection algorithm (VARPRO)

BackgroundPrevious data using T1-weighted MRI demonstrated neck muscle fat infiltration (MFI) in patients with poor functional recovery following whiplash. Such findings do not occur in those with milder symptoms of whiplash, chronic non-traumatic neck pain or healthy controls, suggesting traumatic factors play a role. Muscle degeneration could potentially represent a quantifiable marker of poor recovery, but the temporal constraints of running a T1-weighted sequence and performing the subsequent analysis for muscle fat may be a barrier for clinical translation. The purpose of this preliminary study was to evaluate, quantify and compare MFI for the cervical multifidus muscles with T1-weighted imaging and a more rapid quantitative 3D multi-echo gradient echo (GRE) Dixon based method in healthy subjects.Methods5 asymptomatic participants with no history of neck pain underwent cervical spine MRI with a Siemens 3 Tesla system. The muscle and fat signal intensities on axial spin-echo T1-weighted images were quantitatively classified for the cervical multifidii from C3-C7, bilaterally. Additional axial GRE Dixon based data for fat and water quantification were used for comparison via paired t-tests. Inter-tester reliability for fat and water measures with GRE images were examined using 1) Pearson’s Intra-class correlation coefficient 2) Bland-Altman Plots and 3) Lin’s-Concordance Coefficient. P < 0.05 was used to indicate significance.ResultsTotal mean (SD) MFI (C3-C7) for the multifidii obtained with T1-weighted imaging and GRE were 18.4% (3.3) (range 14-22%) and 18.8% (2.9) (range 15-22%), respectively. The Pearson correlation coefficients for inter-tester reliability on the GRE sequences for the C3-C7 multifidii ranged from .83 - .99, indicating high levels of agreement with segmental MFI measures. Bland-Altman Plots revealed all data points were within 2 SDs and concordance was established between 2-blinded raters, suggesting good agreement between two raters measuring fat and water with GRE imaging.ConclusionsResults of this preliminary study demonstrate reliability between 2 raters of varying experience for MRI analysis of MFI with 3D GRE MRI. The quantification of MFI for healthy cervical musculature is comparable to T1-weighted images. Inclusion of larger samples of symptomatic data and histological comparison with the reference standard biopsy is warranted.

Pulmonary Function of Patients with Chronic Neck Pain: A Spirometry Study

Chronic neck pain is one of the most common musculoskeletal pain conditions experienced by many people during their lives. Although patients with neck pain are managed predominantly as musculoskeletal patients, there are indications that they also have poor pulmonary function. The aim of this study was to examine whether patients with chronic neck pain have spirometric abnormalities and whether neck pain problems and psychological states are associated with these abnormalities. Forty-five participants with chronic neck pain and 45 well-matched healthy controls were recruited. Spirometry was used to assess participants' pulmonary function. Neck muscle strength, endurance of deep neck flexors, cervical range of motion, forward head posture, psychological states, disability, and pain intensity were also evaluated. The results showed that patients with chronic neck pain yielded significantly reduced vital capacity, FVC, expiratory reserve volume, and maximum voluntary ventilation (P < .05), but peak expiratory flow, FEV1, and FEV1/FVC ratio were not affected (P > .05). Strength of neck muscles, pain intensity, and kinesiophobia were found to be significantly correlated (r > 0.3, P < .05) with respiratory function. Patients with chronic neck pain do not have optimal pulmonary function. Cervical spine muscle dysfunction in parallel with pain intensity and kinesiophobia are factors that are associated mainly with this respiratory dysfunction.

Muscle Activity Influence on the Kinematics of the Cervical Spine in Rear-End Sled Tests in Female Volunteers

Objective: Although much research has been performed to investigate the cervical spine kinematics during rear-end collisions, our understanding about the exact role of the musculature is limited. The question of the influence of muscle activity on cervical spine kinematics has been discussed. Methods: A rear-end collision with a speed change (ΔV) of 6.3 km/h was simulated in a sled test with 8 female subjects to investigate the influence of the ventral and dorsal cervical spine musculature on cervical spine kinematics. A high-speed camera and accelerometers recorded the motion and acceleration data. The activity of the sternocleidomastoid muscles was recorded with surface electrodes. To avoid cross talk, an intramuscular recording of the semispinalis capitis muscles was performed with fine-wire electrodes. Results: The analysis of the motion and acceleration parameters allowed the definition of 4 phases. The headrest contact began after a median of 84 ms and the sternocleidomastoid muscle force could be detected after a median of 81 ms, with 0 defining the time of the trigger signal. The maximal force of the sternocleidomastoid muscle and the maximal headrest effect began prior to the maximal ventral angular head acceleration and prior to the maximal ventral horizontal head acceleration relative to T1. The start of the semispinalis capitis muscle force was observed after a median of 159 ms and increased until a flexion of 20 to 25° was reached. Conclusions: The headrest effect and the sternocleidomastoid muscle force firstly supported the deceleration of the head relative to T1 toward dorsal, which was followed by an accelerating effect toward ventral. The semispinalis capitis muscle force exerted a late decelerating effect on head flexion and ventral translation movement.

Cervical muscle area measurements in whiplash patients: Acute, 3, and 6 months of follow‐up

To investigate the role of the cervical spine muscles in whiplash injury. We hypothesized that (i) cervical muscle hypotrophy would be evident after a 6-month follow-up and, (ii) cervical muscle hypotrophy would correlate with symptom persistence probably related to pain or inactivity. Ninety symptomatic patients (48 females) were recruited from our emergency department and examined within 48 h, and at 3, and 6 months after a motor vehicle accident. MRI cross-sectional muscle area (CSA) measurements were performed bilaterally of the cervical extensor and sternocleidomastoid muscles using transverse STIR (Short Tau inversion Recovery) sequences at the C2 (deep and total dorsal cervical extensor muscles), C4 (sternocleidomastoid muscles) and C5 (deep and total dorsal cervical extensor muscles) levels. Two blinded raters independently performed the measurements at each time point. First, CSA changes over time were analyzed and, second, CSAs were correlated with clinical outcomes (EuroQuol, Whiplash Disability Score, neck pain intensity [VAS], cervical spine mobility). There was a high agreement of CSA measurements between the two raters. Women consistently had smaller CSAs than men. There were no significant changes of CSAs over time at any of the three levels. There were no consistent significant correlations of CSA values with the clinical scores at all time points except with the body mass index. Our results do not support a major role of cervical muscle volume in the genesis of symptoms after whiplash injury.

The Influence of Patient Attitude Toward Massage on Pressure Pain Sensitivity and Immune System after Application of Myofascial Release in Breast Cancer Survivors: A Randomized, Controlled Crossover Study

ObjectiveThe purpose of this study was to evaluate the influence of patient's attitudes toward massage on pressure pain sensitivity and the immune effects of myofascial release in breast cancer survivors (BCS). MethodsTwenty BCS participated. They presented to the laboratory at the same time of the day on 2 occasions separated by 2 weeks. At each session, they received either a myofascial release technique or control (special attention) intervention. Salivary flow rate, cortisol and immunoglobulin A (IgA) concentrations, and α-amylase activity were obtained before and immediately after intervention from saliva samples. Pressure pain thresholds (PPT) over the cervical spine and temporalis muscle were assessed bilaterally. The attitude toward massage (ATOM) scale was collected before the first session in all BCS. ResultsThe analysis of covariance revealed a significant intervention × time interaction for salivary flow rate (P = .010), but not α-amylase (P = .111), IgA (P = .655), and cortisol (P = .363) in favor of the experimental group: BCS exhibited an increase of salivary flow rate after myofascial release intervention. When the ATOM scale was included in the analysis, significant influence on IgA (P = .001) was found: BCS with positive attitude had a significant increase in IgA (P > .05). The analysis of covariance did not find a significant intervention × time interaction for PPT over the cervical spine or temporalis muscle, with no effect of ATOM scales for PPT (P > .05). ConclusionThe current study suggests that myofascial release may lead to an immediate increase in salivary flow rate in BCS with cancer-related fatigue. We also found that the effect of myofascial release on immune function was modulated by a positive patient's attitude toward massage.

Evaluation of the loading of neck and shoulder musculature in overhead pushing and pulling exertions

Despite substantial epidemiological evidence relating overhead exertions with work-related musculoskeletal disorders (WMSD) of the neck, effects of such exertions on the loading of neck or cervical spine musculature are not well understood. In this study, the effects of overhead pushing and pulling exertions on the loading of the cervical spine were evaluated using electromyography (EMG) and subjective discomfort ratings. Additionally, the role of gender as well as individual strength on the loading of neck musculature during such exertions was evaluated. Twenty-four healthy individuals (12 men and 12 women) participated in this study. Each participant performed overhead pushing and pulling exertions, exerting 25%, 50%, and 75% of their respective maximum strengths. Overhead pushing exertions were found to be significantly more strenuous to the neck musculature than were the pulling exertions. Gender had no significant effect on the activities of the neck muscles. Participants with high strength, however, were able to exert more force at comparatively low muscle activation levels. Subjective discomfort ratings were strongly correlated with the EMG data. At various workplaces, avoiding overhead exertions is rather impossible due to material, interface, and site constraints. Based on the results of this study, however, during such exertions, an interchange between directions of force application could prevent sustained loading of the neck muscles, fatigue, and consequently the probability of neck WMSD incidents. © 2011 Wiley Periodicals, Inc.

Musculoskeletal Modeling of the Suboccipital Spine

In vitro and modeling study of upper cervical spine (UCS) three-dimensional (3D) kinematics and muscle moment arm (MA) during axial rotation (AR) and flexion extension (FE). To create musculoskeletal models with movement simulation including helical axis (HA) and muscle features. Integration of various kinematics and muscle data into specific-specimen 3D anatomical models with graphical representation of HA and muscle orientation and MA is not reported for the UCS musculoskeletal system. Kinematics, anatomical, and computed tomographic imaging data were sampled in 10 anatomical specimens. Using technical markers and anatomical landmarks digitizing, spatial position of segments was computed for five discrete positions of AR and FE using a 3D digitizer. To obtain musculoskeletal model simulation, a registration method was used to combine collected data. Processing was performed using orientation vector and HA computation and suboccipital muscle features (i.e., length and MA) relative to motion angle. Range of motion and coupling were in agreement with previous in vitro studies. HA (i.e., location and orientation) showed low variation at the occipitoaxial and atlantoaxial levels for FE and AR, respectively. The main orientation of the HA was vertical at C1-C2 during AR and horizontal at C0-C1 during FE. For muscles MA, absolute peak value (ranging from 20 to 40 mm) occurred at different poses depending on the analyzed muscle and motion. Poor magnitude was found for obliquus capitis inferior and rectus capitis posterior minor in FE and AR, respectively. On the basis of previous methods, we developed a protocol to create UCS musculoskeletal modeling with motion simulation including HA and suboccipital muscles representation. In this study, simultaneous segmental movement displaying with HA and muscles features was shown to be feasible.