Chronic Neck Pain Group Research Articles

Cervical Multifidus Stiffness Assessment in Individuals with and without Unilateral Chronic Neck Pain: An Inter-Examiner Reliability Study.

This study aimed to evaluate the inter-examiner reliability of shear wave elastography (SWE) for measuring cervical multifidus (CM) muscle stiffness in asymptomatic controls and patients with chronic neck pain. A longitudinal observational study was conducted to assess the diagnostic accuracy of a procedure. SWE images, following a detailed procedure previously tested, were acquired by two examiners (one novice and one experienced) to calculate the shear wave speed (SWS) and Young's modulus. The painful side was examined for the experimental cases while the side examined in the control group was selected randomly. Data analyses calculated the intra-class correlation coefficients (ICCs), absolute errors between examiners, standard errors of measurement, and minimal detectable changes. A total of 125 participants were analyzed (n = 54 controls and n = 71 cases). The Young's modulus and SWS measurements obtained by both examiners were comparable within the asymptomatic group (both, p > 0.05) and the chronic neck pain group (both, p > 0.05). Nonetheless, a notable distinction was observed in the absolute error between examiners for shear wave speed measurements among patients with neck pain, where a significant difference was registered (p = 0.045), pointing to a sensitivity in measurement consistency affected by the presence of chronic neck pain. ICCs demonstrated moderate-to-good reliability across both groups, with ICC values for asymptomatic individuals reported as >0.8. Among the chronic neck pain patients, ICC values were slightly lower (>0.780). The study revealed moderate-to-good consistency, highlighting the practicality and generalizability of SWE.

Ultrasonographic measurement indicated patients with chronic neck pain had reduced diaphragm thickness and mobility along with declined respiratory functions

Chronic neck pain (CNP) is a prevalent musculoskeletal condition including notable impairments in respiratory function. The diaphragm, serving dual roles in respiration and spinal stability, is intricately linked to the cervical spine through fascial, neurophysiological, and biomechanical connections. However, to date, none has investigated the diaphragm function in patients with CNP. To investigate the diaphragm function, respiratory muscle strength, and pulmonary function in patients with CNP. In addition, their associations were also examined. A case-control study. A total of 54 participants were recruited including 25 patients with CNP (CNP group) and 29 healthy adults (CON group). Pulmonary function including forced vital capacity (FVC) and forced expiratory volume in 1s (FEV1), and respiratory muscle strength represented by maximal inspiratory (MIP) and maximal expiratory pressure (MEP), as well as diaphragm function including ultrasonographic measures of mobility and thickness changes during maximal inspiration and expiration were assessed in all participants. Additionally, the intensity of pain and disability were evaluated using a Visual Analog Scale and Neck Disability Index only in patients with CNP. Significant reductions of the FVC, FEV1, MIP, and MEP were found in the CNP group compared to the CON group (p<0.05). The diaphragm mobility and thickness changes were also significantly decreased in the CNP group than the CON group with medium effect sizes (p<0.05). Only diaphragm thickness change was positively correlated with FVC, FEV1, and MEP in patients with CNP. Furthermore, MEP showed the strongest contribution to diaphragm thickness change based on the regression analysis. Impaired diaphragm function, respiratory muscle strength, and pulmonary function were observed in patients with CNP. Patients with smaller diaphragm thickness change had poorer pulmonary function and reduced maximal expiratory muscle strength. Diaphragm assessment and intervention may be considered in CNP management.

The Comparison of Fatigue and Trunk and Neck Postures during Working in Tailors with and Without Nonspecific Chronic Neck Pain

Objectives: Work-induced musculoskeletal pain disorders are among the most common problems among workers. This study aimed to compare fatigue and trunk and neck postures during work in tailors with and without nonspecific chronic neck pain.&#x0D; Methods: In this cross-sectional study, 30 sewing machine operators participated voluntarily and were divided in two groups of people with (15 persons) and without (15 persons) chronic nonspecific neck pain. The craniovertebral, cranial, and shoulder angles were calculated three intervals (at the start of work, after 2 hours of continuous work, after 4 hours of continuous work) using the photogrammetric method. Borg scale was used to examine work-induced fatigue. A one-way repeated measure analysis of variance at the significance level of 0.05 was used for data analysis.&#x0D; Results: There were significant differences in craniovertebral, cranial, and shoulder angle changes (P &lt; 0.001) between the two groups while working. Postural trunk and neck changes were more evident in the nonspecific chronic neck pain group. However, there were no significant differences in terms of fatigue levels between the two groups (P = 0.639).&#x0D; Conclusion: The upper trunk related posture among workers with nonspecific chronic neck pain may be more negatively affected during work. So it is suggested that maintaining proper posture should be more emphasized among these workers.

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

BackgroundRecent 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. ObjectivesThis study aimed to compare the respiratory muscle strength and diaphragmatic function between patients with CNP and asymptomatic controls. DesignObservational, case-control study. MethodsA 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. ResultsThe 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). ConclusionThe 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.

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

BackgroundEvidence 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.MethodsSystematic 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.ResultsThe 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.ConclusionThe 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.

Cross-cultural adaptation, reliability and validity tests of the Chinese version of the Profile Fitness Mapping neck questionnaire

ObjectiveTo translate and culturally adapt the Profile Fitness Mapping neck questionnaire (ProFitMap-neck) into the Chinese version and evaluate its psychometric properties.MethodsThe procedure of translation and cross-cultural adaptation was performed according to the recommended guidelines. A total of 220 patients with chronic neck pain (CNP) and 100 individuals without neck pain participated in the study. Internal consistency, test-retest reliability, content validity and construct validity were investigated.ResultsThe Chinese version of ProFitMap-neck (CHN-ProFitMap-neck) showed adequate internal consistency (Cronbach’s α = 0.88–0.95). A good test-retest reliability was proven by the intraclass correlation coefficient (ICC3A,1 = 0.78–0.86). Floor-ceiling effects were absent. Exploratory factor analysis revealed 6 factors for the symptom scale and 4 factors for the function scale. The CHN-ProFitMap-neck showed a moderate to high negative correlation with NDI (r = 0.46–0.60, P < 0.01), a small to moderate negative correlation with VAS (r = 0.29–0.36, P < 0.01), and a small to high positive correlation with SF-36 (r = 0.21–0.52, P < 0.01). No significant correlation between the CHN-ProFitMap-neck function scale and VAS (P > 0.05) or the mental health domain of the SF-36 was found (P > 0.05). The CHN-ProFitMap-neck scores were significantly lower in the CNP group than in the non-CNP group (P < 0.01).ConclusionsThe CHN-ProFitMap-neck had acceptable psychometric properties and could be used as a reliable and valid instrument in the assessment of patients with chronic neck pain in mainland China.

Cognitive and motor performances in dual tasks in older adults with chronic neck pain: A randomized controlled clinical trial

Aim: There is limited information on dual-task performance in older individuals with chronic neck pain. This study aims to investigate cognitive and motor performances during dual tasks in older adults with chronic neck pain. Methods: Thirty-five older adults with chronic neck pain and 35 older adults without neck pain were included in the study. The timed up and go test evaluated individuals’ single-task performance. To assess the dual-task performances of the groups, the individuals were given motor and cognitive (forward and backward digit span) tasks simultaneously with the timed up and go test. During cognitive dual-task, the cognitive performances of individuals were evaluated and the duration of their timed up and go test was recorded. Results: There was no difference between the groups in terms of single-task timed up and go test (p &gt;0.05). There was also no difference between the groups in terms of cognitive-forward and cognitive-backward (p &gt;0.05). However, cognitive performance of the chronic neck pain group during dual-task was worse than that of the control group (p &lt;0.05). Additionally, the motor dual-task of older adults in the chronic neck pain group was worse than the control group (p &lt;0.05). Conclusion: Older adults with chronic neck pain struggle more in motor dual-task situations than asymptomatic older adults. Therefore, gait assessment with a motor dual task should be performed for older adults with chronic neck pain. In addition, during cognitive dual-task conditions, the cognitive performance of older adults should be evaluated in addition to their gait performance. Keywords: Aged; Gait; Neck Pain; Postural Balance; Task Performance and Analysis.

Can the balance evaluation systems test be used to identify system-specific postural control impairments in older adults with chronic neck pain?

Older adults with chronic neck pain (CNP) demonstrate impaired postural control. The Balance Evaluation Systems Test (BESTest) is used to assess systems underlying postural control impairments, but its use in CNP has not been reported. This study assessed whether the BESTest can identify postural control impairments in CNP as well as the level of BESTest item difficulty by Rasch analysis. This cross-sectional study recruited thirty young adults (YOUNG) aged 20-40 years and eighty older adults aged 60 years or older [without neck pain (OLD) = 60, with chronic neck pain (CNP) = 20]. Questionnaires were administered to collect demographic data, intensity of neck pain (VAS), patient's self-rated neck pain and disability (NDI), and balance confidence in daily activities (ABC). The BESTest was used to assess postural control. The CNP group showed the lowest ABC scores. Compared to the YOUNG group, the BESTest score was significantly lower in the OLD group, while the CNP group showed the lowest score, suggesting that balance control deteriorated from the normal aging process and further declined in the CNP group, especially in biomechanical constraints, transitions-anticipatory postural adjustment, and reactive postural response (p < 0.05). Using scores from these three sections, the BESTest was accurate at the cutoff score of 48.5 out of 51 for differentiating the older adults whose daily life are affected by neck problems (using the NDI as a reference) with a high AUC (0.79), sensitivity (72%), and specificity (69%). The Rasch analysis revealed that the Timed Up and Go with dual task test was the most difficult BESTest item for all groups, whereas 14 items showed more difficulty for the CNP group. The BESTest can be used to identify postural control impairments in CNP patients, even those with moderate pain and mild disability with a high level of physical functioning. The combined score of biomechanical constraints, transitions-anticipatory postural adjustment, and reactive postural response domains was suggested for the detection of older adults whose daily lives are affected by neck problems. This will also help clinicians consider the management of neck pain to prevent falls in CNP.

Sensorimotor integration, cervical sensorimotor control, and cost of cognitive-motor dual tasking: Are there differences in patients with chronic whiplash-associated disorders and chronic idiopathic neck pain compared to healthy controls?

The current investigation aimed to compare the sensorimotor integration, sensorimotor control, and cost of cognitive-motor dual task during walking, in persons with chronic WAD as compared to matched chronic idiopathic neck pain and normal healthy controls. A cross-sectional, case control design comparing 30 participants in each of two study groups (chronic WAD and chronic idiopathic neck pain) to a matched control group was conducted. Measurements included: (1) the cranio-vertebral angle (CVA), (2) left and right rotation head repositioning accuracy (HRA), (3) frontal N30 amplitudes to assess sensorimotor integration, (4) dual cognitive gait cost (DCGC). A statistically significant difference for the CVA was found between groups: WAD 36.8° ± 3.4, chronic pain 44.5° ± 1.5, and controls 47.1° ± 4; p < 0.05. MANOVA revealed significant group differences for the N30 amplitude (p < 0.05), where the WAD group had the greatest amplitude. Statistically significant differences among the three groups were found for HRA left and right where the WAD group had the greatest error, (p < 0.05). Post hoc tests revealed that the WAD group had the highest dual-task cost during walking, (p < 0.05). Significant linear correlations between the CVA and N30 amplitude, HRA, and DCGC were identified in all 3 groups, (p < 0.05). Compared to both a matched control group and chronic neck pain group, whiplash-injured persons have greater forward head posture, greater error in sensorimotor control, and an altered ability to perform a motor task with a simultaneous cognitive task.

Pulmonary Functions in Patients With Chronic Neck Pain: A Case-Control Study

ObjectiveThe purpose of the study was to investigate pulmonary functions of patients with chronic neck pain and compare them with those of asymptomatic controls. MethodsThis case-control study was conducted with 25 patients with chronic neck pain (age, 26.84 ± 7.89 years) and 27 age-matched asymptomatic controls (age, 25.96 ± 7.13 years). Pulmonary function tests were performed using spirometry (Quark PFT, COSMED, Rome, Italy). Forced vital capacity (FVC), forced expiratory volume in the first second (FEV1), forced expiratory flow at 25% to 75% vital capacity, peak expiratory flow, maximum voluntary ventilation, and the FEV1/FVC ratio were measured and are expressed as (%) predicted value for patients with chronic neck pain and asymptomatic controls. ResultsThe chronic neck pain group had lower FEV1 (P = .015), FVC (P = .029), forced expiratory flow at 25% to 75% vital capacity (P = .040), and maximum voluntary ventilation (P = .042) compared with asymptomatic controls; however, FEV1/FVC (P = .470) and peak expiratory flow (P = .183) were similar in both groups. ConclusionThese results demonstrated that dynamic lung volumes were lower in patients with chronic neck pain compared with asymptomatic controls.

Kinestetičke i vizuelne slike kod mladih odraslih osoba sa hroničnim bolom u vratu

Background:Young adults complain of neck pain almost every year. In recent years the ability of motor imagery (kinesthetic and visual imagery) in many musculoskeletal system problems other than neck pain in young adults has been investigated in the literature. The Cross-Sectional study aimed to question motor imagery ability in young adults with chronic neck pain. Methods: Two groups were included in the study: the chronic neck pain group (n = 83) and the control group (n = 91). Motor imagery ability of both groups was evaluated with Movement Imagery Questionnaire-3. Additionally, in the chronic neck pain group, pain was evaluated with the Short Form-McGill Pain Questionnaire, disability was evaluated with the Neck Disability Index, and kinesiophobia was evaluated with Tampa Scale for Kinesiophobia. Conclusions: Internal visual imagery and kinesthetic imagery were significantly different between chronic neck pain and control groups. There was a negative linear relationship between disability and internal visual imagery, external visual imagery, and kinesthetic imagery. Motor imagery ability is reduced in young adults with chronic neck pain. In addition, as the severity of disability increases, the motor imagery ability decreases. Therefore, it is considered appropriate to include a motor imagery training program when treating chronic neck pain in the future.

Croatian version of the neck disability index can distinguish between acute, chronic and no neck pain : Results of avalidation study.

Longitudinal study to test the validity and reliability of the Croatian version of the neck disability index (NDI-CRO) for use in patients. Three groups were given NDI-CRO on two occasions, 48 h apart: acute whiplash neck injury group (n = 30), hospital physiotherapists-professional chronic neck pain group (n = 56) and control group (n = 65). To test validity, correlation between NDI-CRO and the pain VAS and PHQ‑9 questionnaire for depression was analyzed. Reliability testing was done using the test-retest experiment and item-total score correlation. Test-retest showed excellent correlation in all groups: whiplash 0.86, control 0.95 and physiotherapist 0.89 (Spearmanr). Item-total score in the 3 analyzed groups showed positive correlation in all 10 categories, varying from 0.43-0.85. The NDI-CRO score showed significant difference between groups (median whiplash 38%, physiotherapist 12% and control 6%, p < 0.05). Validity testing showed positive correlation between NDI and pain VAS (control r = 0.63, physiotherapist r = 0.68 and whiplash r = 0.83, p < 0.05) and PHQ‑9 (control r = 0.49, physiotherapist r = 0.71 and whiplash r = 0.69, p < 0.05). No correlation was found between NDI-CRO and age, gender or radiographic findings. In the whiplash injury group 75% of patients showed moderate to severe disability. The majority of physiotherapists showed mild to moderate disability due to neck pain while 40% showed no disability. In the control group two out of three people reported no disability. The NDI-CRO is avalid index for measuring the degree of neck disability in people with acute and chronic neck pain and in control group. It is strongly correlated with pain VAS and PHQ‑9 index.

The study of respiratory muscles activation during respiratory muscle strength effort in adult females with chronic neck pain.

[Purpose] This study aimed to compare maximal inspiratory pressure (MIP), maximal expiratory pressure (MEP) values and muscle activity during MIP and MEP between chronic neck pain and healthy participants. [Participants and Methods] Twenty chronic neck pain and 20 non-symptomatic females participated in this study. Maximal airway pressure (MIP and MEP) and surface electromyography (sEMG) for both sides of the upper trapezius, anterior scalene, pectoralis major and 6th intercostal muscles were recorded simultaneously. [Results] Significant differences of MIP and MEP values were found between the groups. The muscle activities of both sides of upper trapezius and 6th intercostal muscles during MEP were significantly higher in the chronic neck pain group than the healthy group except both sides of anterior scalene and pectoralis major muscles. During MIP, the activities of upper trapezius, 6th intercostal muscles and anterior scalene were significantly different between the two studied groups. Higher activity of left pectoralis major was found in the chronic neck pain group. [Conclusion] Decreasing values of MEP and MIP as well as muscles activities elevation in chronic neck pain participants were clearly demonstrated. Besides the musculoskeletal treatment, we suggest breathing exercise training to be considered in treatment programs.

Cervical flexion relaxation phenomenon in patients with and without non-specific chronic neck pain.

The cervical flexion relaxation phenomenon (FRP) is a myoelectric silence of neck extensor muscles which occurs after a certain degree of flexion. Impaired flexion relaxation can impose the vertebral structures to excessive loading resulting from the persistence of muscular contraction. This study aimed to investigate the incidence or absence of FRP in cervical erector spinae (CES) and upper trapezius muscles in patients with chronic neck pain (CNP). Twenty-five patients with CNP and 25 healthy volunteers were recruited. They accomplished cervical flexion and extension from a neutral position in four phases in the sitting position. The surface electromyography activity of both CES and upper trapezius muscles was recorded in each phase. Cervical flexion and extension movements were simultaneously measured using an electrogoniometer. FRP in CES was observed in 84% and 36% of healthy subjects and CNP patients, respectively. Flexion relaxation ratio (FRR) in CES was lower in CNP patients than in healthy subjects (mean diff = 1.33; 95% CI: 0.75-1.91) (P< 0.001). Only in CNP patients, FRR in right erector spinea was significantly higher than that in the left erector spinea (P= 0.04). FRP incidence in CNP patients was less than in healthy subjects. Moreover, this phenomenon begins later in CNP patients than in healthy subjects indicating prolonged activity of CES muscles during flexion in the CNP group. The difference between FRR in the right and left sides of erector spinea muscles can result in CNP.

Real-World Evidence in Prescription Medication Use Among U.S. Adults with Neck Pain.

IntroductionNeck pain is a common condition that leads to serious pain, disability, and increased healthcare costs worldwide. Pharmacotherapy is one of the most common strategies to reduce neck pain in patients. The aim of this study was to analyze the real-world pattern of drugs prescribed for patients with neck pain in the USA.MethodsData on individuals who reported current neck pain in the 2009−2010 US National Health and Nutrition Examination Survey (NHANES) and with a history of persistent pain for at least 6 weeks or 3 months were extracted from the NHANES database. Those included in the study were divided into three groups based on the duration of pain: the without neck pain group (Group A); subacute group (Group B) with a history of 6 weeks of neck pain; and the chronic neck pain group (Group C) with a history of 3 months of neck pain. The use and duration of medication prescribed for Group A, B, and C patients were compared.ResultsThe analysis revealed that opioid use was significantly more prevalent in the subacute and chronic neck pain group than in the without neck pain group (Group A) (adjusted odds ratio [aOR] 4.20, 95% confidence interval [CI] 2.07–8.52 and aOR 7.00, 95% CI 4.32–11.33, respectively). The factors strongly associated with higher opioid use included older age, low education level, and low family income. In the chronic neck group, opioids, followed in decreasing order of frequency by acetaminophen and nonsteroidal anti-infammatory drugs, were the most common analgesics used in combination with other analgesics.ConclusionOur analysis of the data shows that the long-term excessive use of opioids and the underutilization of other analgesics are two major issues in the treatment of neck pain in the USA. Possible improvements include improved education of patients by healthcare professionals on the use of opioids and more consideration given to non-pharmacotherapy options. Our results reveal the potential problem in pharmacotherapy choices for neck pain treatment and may help improve the current clinical practice in the USA and other countries.

Differences of Spinal Curvature, Thoracic Mobility, and Respiratory Strength Between Chronic Neck Pain Patients and People Without Cervical Pain.

ObjectiveTo investigate the differences of spinal curvature, thoracic sagittal mobility, and respiratory strength between patients with chronic neck pain (CNP) and people without cervical pain, and to determine the correlation between respiratory strength and thoracic mobility in CNP patients.MethodsA total of 78 participants were finally included in this study, of whom 30 had no cervical pain and 48 had CNP. The Neck Disability Index (NDI), cervical lordotic curvature, thoracic kyphotic curvature, thoracic sagittal range of motion (ROM), maximal inspiratory pressure (MIP), and maximal expiratory pressure (MEP) were measured and analyzed.ResultsIn males, thoracic sagittal ROMMEP-MIP and MEP showed a significant difference between the no cervical pain group and the CNP group. In females, thoracic kyphotic curvature, thoracic sagittal ROMMEP-MIP, MIP, and MEP were significantly different between the no cervical pain group and the CNP group. Thoracic kyphotic curvature was significantly correlated with MEP and MIP in all population groups, and significantly correlated with NDI in the female group. Thoracic sagittal ROMMEP-MIP had a significant linear relationship with NDI, MEP, and MIP in all population groups.ConclusionThe thoracic mobility during forced respiration was reduced in patients with CNP and was correlated with respiratory strength. Changes in the biomechanics of the cervicothoracic spine and rib cage due to CNP may contribute to impairment of respiratory strength.

Fatigue changes neck muscle control and deteriorates postural stability during arm movement perturbations in patients with chronic neck pain

BACKGROUND CONTEXTMultisensory afferent inputs to the cervical spine affect the generation of neck muscle control. Chronic neck pain (CNP) and muscle fatigue are factors that disturb somatosensory function. Whether they affect postural control under self-initiated perturbation in daily activities is still unclear. PURPOSETo investigate the effect of CNP and neck flexor muscle fatigue on muscle control strategy and postural control in young patients performing voluntary shoulder flexion movements. STUDY DESIGNCross-sectional case-control study. PATIENT SAMPLETwenty-five patients with CNP and 25 age-matched asymptomatic controls. OUTCOME MEASURESThe postural sway, muscle onset time, and activation level of the erector spinae, rectus abdominal, semispinalis capitis (SSC), and sternocleidomastoid (SCM) muscles were recorded and analyzed using two-way ANOVA to evaluate the interaction of CNP and muscle fatigue on standing balance and muscle control upon self-initiated perturbations. METHODSAll participants were instructed to perform shoulder flexion movements in the standing position before and after a neck flexor muscle fatigue exercise under either the eyes-open or eyes-closed condition. RESULTSThe CNP group exhibited significantly larger body sway, greater neck muscle activation (SCM and SSC), and longer onset time of neck flexor muscle (SCM) compared with the control group. The CNP group also demonstrated a trend of greater postural sway and shorter muscle onset under the eyes-closed condition than those under the eyes-open condition. After muscle fatigue, the CNP group further exhibited (1) greater body sway during the eyes-open condition but decreased body sway during the eyes-closed condition, (2) higher activation of the neck flexor (SCM) and lower activation of the trunk extensor (erector spinae), and (3) early onset of the neck muscles (SCM and SSC). CONCLUSIONSCNP causes poor postural control and altered neck muscle control patterns. The addition of neck flexor muscle fatigue further decreases balance stability and provokes a protective neck muscle control strategy during the shoulder flexion movement. Those findings facilitate the understanding of the strategies adopted by patients and suggest that neck endurance training programs may be beneficial to improve whole postural control in patients with CNP.

Observing neck movements evokes an excitatory response in the sympathetic nervous system associated with fear of movement in patients with chronic neck pain

The objective of this study was to evaluate the response of the sympathetic-excitatory nervous system in patients with chronic neck pain compared with a control group of asymptomatic subjects who underwent an intervention of watching activities involving movements in the neck region. Thirty participants were divided into two groups: patients with chronic neck pain (n = 15) and the control group (n = 15). The patients’ neck disability, fear of movement and catastrophism were assessed with a self-report. The recorded variables related to the autonomic nervous system were skin conductance and skin temperature. The ANOVA test revealed significant differences in the increase in skin conductance in the chronic neck pain group after observing the activities (both in the photographs and video) at the end of the observation and 5 minutes after the intervention (p < .01; d > 0.80). There were no significant differences in skin temperature. Ultimately, the correlation analysis revealed a moderate positive correlation between kinesiophobia and skin conductance at 30 seconds (r = 0.53) and at 60 seconds (r = 0.52) of observing the activities in the video for the chronic neck pain group. Based on the results of the present study, we suggest that observing activities involving neck movements causes an activation of the sympathetic-excitatory nervous system in patients with chronic neck pain. These changes could be related to a fear of movement when faced with visual exposure to neck movements that could be interpreted as ‘harmful’ or ‘dangerous’.

Neck Muscle Stiffness in Participants With and Without Chronic Neck Pain: A Shear-Wave Elastography Study

ObjectivesThe purpose of the present study was to investigate differences in neck muscle stiffness between patients with chronic neck pain and asymptomatic control group. MethodsThirty-five patients with chronic neck pain and 35 age-matched asymptomatic participants enrolled in the study. Shear wave velocity (SWV) of upper trapezius, levator scapulae, splenius capitis, and sternocleidomastoid muscles were obtained using an ACUSON S3000 Ultrasonography Device (Siemens Medical Solutions, Mountain View, California). In patients with chronic neck pain, pain intensity was measured by Numerical Rating Scale and disability level was measured by Neck Disability Index. ResultsThe SWV of splenius capitis was similar in both groups (P = .985); however, SWV of upper trapezius (P = .001), levator scapulae (P = .038), and sternocleidomastoid (P = .001) of the patients with chronic neck pain were higher compared with the asymptomatic controls groups. Numerical Rating Scale and Neck Disability Index scores did not correlate with the SWV of the selected muscles (P > .05). ConclusionsStiffness of upper trapezius, levator scapulae, and sternocleidomastoid muscles in patients with neck pain were higher compared to asymptomatic participants. In addition, severity of pain and disability did not correlate to stiffness of these muscles in patient with chronic neck pain.

The short-term effects of TENS plus therapeutic ultrasound combinations in chronic neck pain

IntroductionTo investigate the effects of TENS plus therapeutic ultrasound combinations on symptom relief, physical functionality, perceived stress levels, daytime sleepiness and neck mobility in patients with chronic neck pain (CNP). MethodsA total of 64 patients were divided into two groups as the TENS plus ultrasound group (n = 39) and the control CNP group (n = 25). The therapy comprised TENS and therapeutic ultrasound applications for 10 sessions. The control subjects were discouraged from using analgesics but were allowed to use paracetamol daily, if necessary. The Neck Disability Index (NDI), Epworth Sleepiness Scale (ESS), Perceived Stress Scale (PSS), visual analog scale (VAS) and tragus-wall/chin-manubrium distances were recorded at the baseline and after therapy. ResultsSignificant improvements were detected in the TENS plus ultrasound group compared to the control CNP subjects in respect of VAS, PSS and NDI scores after the TENS plus therapeutic ultrasound therapies (all p < 0.05). DiscussionThe combination of therapeutic ultrasound plus TENS can be an effective modality for relieving pain/stress levels and improving functionality in the short-term of CNP.