Non-traumatic Chronic Neck Pain Research Articles

Neck Kinematics in Patients With Chronic Mechanical Neck Pain: An Observational Study to Explore the Integration of Multiple Influencing Factors Through a Bayesian Model-Based Approach.

The aim of this observational, cross-sectional study is to evaluate potential differences in kinematics, specifically range of motion (ROM) and velocity, during planar cervical movements between patients with non-traumatic chronic neck pain and disability and asymptomatic controls, while accounting for potential influencing variables of age, sex and fear of movement. The influence of pain intensity, neck disability, age, sex or fear of motion on kinematics was analyzed through robust multivariate Bayesian regression models fitted using the brms library in R. Forty-three patients with neck pain (aged 36.70 ± 13.75 years; 10 men and 33 women) and 42 asymptomatic participants (aged 32.74 ± 13.24 years; 25 men and 17 women) completed the study protocol. The presence of neck pain/disability was associated with lower ROM and peak velocity during all planar movements when considering the influence of age, sex or fear of motion, with standardized regression coefficients that had a small effect size (ranged from 0.11 to 0.28) and estimated differences of less than 2.21° in ROM and 25.61°/s in peak velocity. Although patients with chronic mechanical neck pain showed reduced ROM and peak velocity, the small effect sizes and the low estimated differences between groups question the relevance and clinical usefulness of kinematic analysis of planar movements in samples of patients similar to those included in our study. It is probable that there are differences between the groups, but it is insufficient to rely solely on kinematic variables for patient discrimination. This limitation likely arises from the substantial variability in patient kinematics.

Effectiveness of psychological interventions delivered by physiotherapists in the management of neck pain: a systematic review with meta-analysis.

Physiotherapists are increasingly using psychological treatments for musculoskeletal conditions. We assessed the effects of physiotherapist-delivered psychological interventions on pain, disability, and quality of life in neck pain. We evaluated quality of intervention reporting. We searched databases for randomized controlled trials (RCTs) comprising individuals with acute or chronic whiplash-associated disorder (WAD) or nontraumatic neck pain (NTNP), comparing physiotherapist-delivered psychological interventions to standard care or no treatment. Data were extracted regarding study characteristics and outcomes. Standardised mean difference (SMD) was calculated by random-effects meta-analysis. We evaluated certainty of evidence using Grades of Recommendation, Assessment, Development, and Evaluation (GRADE) and intervention reporting using TIDieR. Fourteen RCTs (18 articles-4 detail additional outcome/follow-up data) were included comprising 2028 patients, examining acute WAD (n = 4), subacute/mixed NTNP (n = 3), chronic WAD (n = 2), and chronic NTNP (n = 5). Treatment effects on pain favoured psychological interventions in chronic NTNP at short-term (SMD -0.40 [95% CI -0.73, -0.07]), medium-term (SMD -0.29 [95% CI -0.57, 0.00]), and long-term (SMD -0.32 [95% CI -0.60, -0.05]) follow-up. For disability, effects favoured psychological interventions in acute WAD at short-term follow-up (SMD -0.39 [95% CI -0.72, -0.07]) and chronic NTNP at short-term (SMD -0.53 [95% CI -0.91, -0.15]), medium-term (SMD -0.49 [95% CI -0.77, -0.21]), and long-term (SMD -0.60 [95% CI -0.94, -0.26]) follow-up. GRADE ratings were typically moderate, and intervention reporting often lacked provision of trial materials and procedural descriptions. Psychological interventions delivered by physiotherapists were more effective than standard physiotherapy for chronic NTNP (small-to-medium effects) and, in the short term, acute WAD.

Kinematic analysis of sensorimotor control during the craniocervical flexion movement in patients with neck pain and asymptomatic individuals: a cross-sectional study

BackgroundPatients with craniocervical pain have shown reduced performance in the craniocervical flexion test (CCFT). However, there is limited evidence of other possible kinematic alterations not assessed in the context of the CCFT. Previous studies on other functional or planar movements have reported alterations in sensorimotor control (e.g., range of motion [ROM], velocity, or smoothness) in subjects with neck pain. The objective of this study was to explore the association between sensorimotor control variables associated with craniocervical flexion movement and different characteristics related to pain, age, disability, and fear of movement in individuals with non-traumatic chronic neck pain and asymptomatic controls.MethodsThis was an observational, cross-sectional study in patients with non-traumatic neck pain and asymptomatic participants. Regression models were used to assess whether descriptive characteristics of the sample, including: (a) age, (b) intensity of pain, (c) neck disability, (d) chronicity of pain, and (e) fear of movement could explain sensorimotor control variables such as ROM, velocity, jerk, head repositioning accuracy, and conjunct motion. All these variables were recorded by means of light inertial measurement unit sensors during the performance of three maximal repetitions of full range craniocervical flexion in the supine position.ResultsA total of 211 individuals were screened and 192 participants finished the protocol and were included in the analyses. Participants had an average age of 34.55 ± 13.93 years and included 124 patients with non-traumatic neck pain and 68 asymptomatic subjects. Kinesiophobia partially explained lower craniocervical flexion ROM (p = .01) and lower peak velocity in flexion (P < .001). Age partially explained increased craniocervical extension ROM (P < .001) and lower peak velocity in flexion (P = .03). Chronicity partially explained increased lateral flexion conjunct motion (P = .008). All models showed low values of explained variance (< 32%) and low absolute values of regression coefficients.ConclusionsThis study did not find a clear relationship between population characteristics and sensorimotor control variables associated with the craniocervical flexion movement. Kinesiophobia might have some association with reduced ROM in craniocervical flexion, but further research in this field is needed in large samples of patients with higher levels of kinesiophobia pain or disability.

Comparison between Two Low Doses of Amitriptyline in the Management of Chronic Neck Pain: A Randomized, Double-Blind, Comparative Study.

Chronic neck pain (CNP) is a major concern for pain therapists. Many drugs including antidepressants such as amitriptyline have been used in the management of CNP. This study compared the efficacy and safety of 2 different doses of amitriptyline (5 mg and 10 mg at bedtime) in patients with CNP. A total of 80 patients of both sexes with idiopathic CNP, ranging in age from 18 to 75 years, were divided into 2 groups that received 5 or 10 mg oral amitriptyline at bedtime for 120 days. The primary outcome measure was neck pain disability index (NPDI). Neck pain intensity, Athens Insomnia Scale score, Hospital Anxiety and Depression Scale (HADS), side effects of the drug, and patient satisfaction were secondary outcome measures. NPDI decreased by 71.9% ± 13.4% in the 10 mg group compared to 47.3% ± 17.3% in the 5 mg group, representing a statistically significant difference (95% confidence interval: 27.3–12.6). Additionally, the 10 mg group showed greater mean reductions in pain score and HADS scores (both the anxiety and depression subscales), as well as improvement in sleep disturbance compared to the 5 mg group. A higher dose (10 mg) of amitriptyline at bedtime significantly reduced neck pain intensity, sleep disturbance, and anxiety and depression compared to a lower dose (5 mg) in patients with idiopathic and nontraumatic CNP after 120 days of treatment, with no significant difference between groups in the rate of side effects.

Effects of virtual reality-based neck-specific sensorimotor training in patients with chronic neck pain: A randomized controlled pilot trial.

ObjectiveTo evaluate the effects of neck-specific sensorimotor training using a virtual reality device compared with 2 standard rehabilitation programmes: with, and without general sensorimotor training, in patients with non-traumatic chronic neck pain.DesignPilot randomized control study.Patients and methodsA total of 51 participants were randomly assigned to 1 of 3 groups: 1: control group; 2: sensorimotor group; 3: virtual reality group. All 3 groups received the clinic’s standard rehabilitation programme. Group 2 also received “general sensorimotor training” in the form of group therapy, for a total of 120 min. Group 3 received additional virtual reality-based “neck-specific sensorimotor training” for a total of 120 min. Participants’ neck pain, headaches, active cervical range of motion, and Neck Disability Index were determined before and after 3 weeks of intervention.ResultsCompared with the control group, the virtual reality group showed significant (p < 0.05) advantages in relief of headaches, and active cervical range of motion in flexion and extension. Compared with the sensorimotor group, the virtual reality group showed significant improvements in cervical extension.ConclusionVirtual reality-based sensorimotor training may increase the effects of a standard rehabilitation programme for patients with non-traumatic chronic neck pain, especially active cervical range of motion in extension.LAY ABSTRACTThe aim of this study was to evaluate the effectiveness of neck-specific coordination training using a virtual reality device, in comparison with general coordination training and a standard exercise programme as part of inpatient rehabilitation for patients with chronic neck pain. Pain, disability and mobility of the neck were determined before and after 3 weeks of training intervention in 51 patients. The virtual reality training group exhibited greater effects in relief of headaches, and bending the neck forwards and backwards compared with the standard exercise group, and an increased ability to bend the neck backwards compared with the coordination training group. The results suggest that neck-specific coordination training using a virtual reality device increases the benefits of standard inpatient rehabilitation in patients with chronic neck pain, particularly in bending the neck backwards.

Frequency of cervical radiculopathy among patients with chronic cervical pain in Lahore, Pakistan.

To determine the frequency of cervical radiculopathy in cases of non-traumatic chronic neck pain. The descriptive cross-sectional study was conducted from September 2015 to February 2016 at the Department of Physiotherapy, Azra Naheed Medical College, Superior University, Lahore and comprised patients of either gender aged 20-50 years with chronic neck pain lasting more than 6 months. Data was collected using a 14-point self-administered questionnaire. Spurling test was applied to find out the occurrence of radiculopathy in chronic neck pain and the intensity of pain was rated using visual analogue scale. Data was analysed using SPSS 21. Of the 196 patients, 135(68.9%) were females and 61(31.1%) were males. The largest age group was 20-30 years with 75(38.3%) patients. Also, 46(23.5%) patients had no neck pain, 144(73.5%) had moderate pain and 6(3.1%) had unbearable pain. Radiculopathy was negative in 84(42.9%) patients and positive in 112(57.1%). Cervical radiculopathy was found to be associated with chronic neck pain.

Differences in white matter structure and cortical thickness between patients with traumatic and idiopathic chronic neck pain: Associations with cognition and pain modulation?

Brain alterations are hypothesized to be present in patients with chronic whiplash-associated disorders (CWAD). The aim of this case-control study was to examine alterations in cortical thickness and white matter (WM) structure, and the presence of brain microhemorrhages in a patient group encountering chronic neck pain of traumatic origin (i.e., CWAD) when compared with a patient group characterized by nontraumatic chronic neck pain [i.e., chronic idiopathic neck pain (CINP)], and healthy controls. Furthermore, we aimed to investigate associations between brain structure on one hand and cognitive performance and central sensitization (CS) on the other hand. T1-weighted, diffusion-weighted and T2*-weighted magnetic resonance images of the brain were acquired in 105 women (31 controls, 37 CINP, 37 CWAD) to investigate regional cortical thickness, WM structure, and microhemorrhages, respectively. Next, cognitive performance, and CS encompassing distant hyperalgesia and conditioned pain modulation (CPM) efficacy were examined. Cortical thinning in the left precuneus was revealed in CWAD compared with CINP patients. Also, decreased fractional anisotropy, together with increased values of mean diffusivity and radial diffusivity could be observed in the left cingulum hippocampus and tapetum in CWAD compared with CINP, and in the left tapetum in CWAD patients compared with controls. Moreover, the extent of WM structural deficits in the left tapetum coincided with decreased CPM efficacy in the CWAD group. This yields evidence for associations between decreased endogenous pain inhibition, and the degree of regional WM deficits in CWAD. Our results emphasize the role of structural brain alterations in women with CWAD compared with CINP.

Decreased Regional Grey Matter Volume in Women with Chronic Whiplash-Associated Disorders: Relationships with Cognitive Deficits and Disturbed Pain Processing

Background: Patients with chronic whiplash-associated disorders (CWAD) are characterized by pain of traumatic origin, cognitive deficits, and central sensitization (CS). Previous neuroimaging studies revealed altered grey matter volume (GMV) in mild traumatic brain injury patients and chronic pain conditions also characterized by CS. It can therefore be hypothesized that GMV alterations also play a role in the persistent complaints of CWAD. However, brain alterations remain poorly investigated in these patients. Objectives: This study examined regional GMV alterations in patients with CWAD compared to patients with non-traumatic chronic idiopathic neck pain (CINP), who normally do not show CS at a group level, and healthy controls. Additionally, in both patient groups, relationships between regional GMV and measures of cognition as well as pain processing were assessed. Study Design: A cross-sectional case-control study. Setting: This study was performed at the Department of Rehabilitation Sciences and Physiotherapy of Ghent University in cooperation with the Ghent Institute for Functional and Metabolic Imaging. Methods: Ninety-three women (28 healthy controls, 34 CINP patients, and 31 CWAD patients) were enrolled. First, T1-weighted magnetic resonance images (MRIs) were acquired to examine GMV alterations in the brain regions involved in processing cognition and pain. Next, cognitive performance, pain cognitions, and CS symptoms were assessed. Finally, hyperalgesia and conditioned pain modulation efficacy were examined. Results: Regional GMV of the right lateral orbitofrontal cortex, left supramarginal cortex, and left posterior cingulate cortex was decreased in CWAD patients compared to healthy controls (P = 0.023; P = 0.012; P = 0.047, respectively). Additionally, GMV of the right superior parietal cortex and left posterior cingulate cortex was decreased in CWAD patients compared to CINP patients (P = 0.008; P = 0.035, respectively). Decreased regional GMV correlated with worse cognitive performance, higher maladapted pain cognitions, CS symptoms, and hyperalgesia in CWAD patients (rs = -0.515 to -0.657; P &lt; 0.01). In CINP patients, decreased regional GMV correlated only with worse cognitive performance (rs = -0.499 to -0.619; P &lt; 0.01), and no GMV differences compared with the controls could be revealed. Limitations: No conclusions about the causality of the observed relationships can be drawn. Conclusions: These results provide the first evidence for reduced GMV in cortical regions involved in processing cognition and pain in patients with CWAD. Accordingly, it is recommended that therapy approaches for CWAD patients should address the brain and take into account neuroplasticity of the central nervous system (CNS). Key words: Whiplash injuries, neck pain, magnetic resonance imaging, grey matter, cognitive dysfunction, pain catastrophizing, central sensitization

Eye stabilization reflexes in traumatic and non-traumatic chronic neck pain patients

BackgroundMany chronic neck pain patients experience problems with vision. These problems are possibly induced by deviations of the eye stabilization reflexes. It is not known whether these eye reflex alterations occur both in traumatic and non-traumatic neck pain patients. ObjectiveTo investigate if the cervico-ocular reflex (COR) and the vestibulo-ocular reflex (VOR) are changed in tertiary care patients with prolonged, chronic neck pain with various origin of complaints. DesignCross sectional study. MethodsNinety-one chronic neck pain patients were subdivided into three groups by origin of complaints, and compared with healthy controls. COR and VOR gains were measured with an infrared eye tracking device with the subject sitting on a rotating chair in a darkened room and with the head fixed. ResultsNeck pain patients had a higher COR gain (median 0.41, IQR 0.289) compared with healthy controls (median 0.231, IQR 0.179). The mean COR gain did not differ between the three patient groups (Whiplash Associated Disorders 0.444 (SD 0.221); traumatic 0.397 (SD0.205); non-traumatic 0.468 (SD0.236)). There was no difference in VOR gain between the groups. ConclusionChronic neck pain patients, who already received primary care, still have an elevated cervico-ocular reflex. The origin of complaints did not seem to be associated with this deviant oculomotor behavior.

Altered grey matter morphology of pain processing regions in traumatic and non-traumatic chronic neck pain patients: Relations with clinical pain measures?

Altered grey matter morphology of pain processing regions in traumatic and non-traumatic chronic neck pain patients: Relations with clinical pain measures?

Differences between traumatic and non-traumatic chronic neck pain patients: The role of central pain modulation, cognitive functioning and psychosocial characteristics

Differences between traumatic and non-traumatic chronic neck pain patients: The role of central pain modulation, cognitive functioning and psychosocial characteristics

Age Moderates the Relationships between Family Functioning and Neck Pain/Disability.

This cross-sectional clinical study was designed to explore the relationships between family functioning, coping styles, and neck pain and neck disability. It was hypothesized that better family functioning and more effective coping styles would be associated with less pain and pain-related disability. It also was hypothesized that these relationships would be stronger in older people because they have fewer resources, more limited coping styles, and may depend more on their family for support. In this study, 88 women with chronic non-traumatic neck pain completed the Family Assessment Measure (FAM), Coping Inventory for Stressful Situations (CISS), Neck Disability Index (NDI), and a Visual-Analogue Scale (VAS) measuring the subjective intensity of neck pain. Zero-order and partial correlations and hierarchical stepwise regression were performed. CISS was not correlated with the NDI orVAS. Good family functioning was correlated with lower NDI and VAS scores. Age was found to moderate the relationship between the FAM and both NDI and VAS. This relationship was significant and positive in older patients, but non-significant in younger patients. It was concluded that better family functioning is associated with lower neck disability and pain intensity, especially in the case of older women suffering from non-traumatic neck pain.

Effect of verbal persuasion on self-efficacy for pain-related diagnostic sensory testing in individuals with chronic neck pain and healthy controls - a randomized, controlled trial.

The aim of this study was to investigate the differences in cold pain threshold (CTh), pressure pain threshold (PPT), cold pain tolerance (CPTo) tests, and the level of self-efficacy when self-efficacy for diagnostic sensory testing was manipulated by verbal persuasion before a testing situation in persons with neck pain and in healthy controls. A randomized experimental design was used. Twenty-one healthy volunteers and 22 individuals with either traumatic or nontraumatic chronic neck pain were recruited to participate in the study. The intervention consisted of two experimental verbal persuasion conditions: Increase self-efficacy and Decrease self-efficacy. The PPT was measured using a pressure algometer, the CTh was measured using a thermo test system, and CPTo was measured by submerging the participant’s hand in ice water up to the elbow joint. On three occasions, the participants reported their self-efficacy level in performing the sensory tests. In the chronic neck pain group, there were no differences in pain threshold or tolerance. There was a difference in the self-efficacy level after verbal persuasion between the experimental conditions. In the healthy control group, the CThs increased following the condition that aimed to increase self-efficacy. No other differences were observed in the healthy controls. A short verbal persuasion in the form of manipulative instructions seems to have a marginal effect on the individual’s self-efficacy levels in the chronic neck pain group and a slight influence on the results of sensory testing in healthy controls.

Central pain modulation and cognitive functioning in patients with traumatic and non-traumatic chronic neck pain

Central pain modulation and cognitive functioning in patients with traumatic and non-traumatic chronic neck pain

Lack of Evidence for Central Sensitization in Idiopathic, Non-Traumatic Neck Pain: A Systematic Review

Background: 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. Objective: 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. Study Design: Systematic review. Setting: All selected studies were case control studies. Methods: 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 (&gt; 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). Results: 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. Limitations: Very few studies available. Conclusions: 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. Key words: Central sensitization, hypersensitivity, chronic pain, neck pain, idiopathic, nontraumatic, pressure pain thresholds, review

A Modern Neuroscience Approach to Chronic Spinal Pain: Combining Pain Neuroscience Education With Cognition-Targeted Motor Control Training

Chronic spinal pain (CSP) is a severely disabling disorder, including nontraumatic chronic low back and neck pain, failed back surgery, and chronic whiplash-associated disorders. Much of the current therapy is focused on input mechanisms (treating peripheral elements such as muscles and joints) and output mechanisms (addressing motor control), while there is less attention to processing (central) mechanisms. In addition to the compelling evidence for impaired motor control of spinal muscles in patients with CSP, there is increasing evidence that central mechanisms (ie, hyperexcitability of the central nervous system and brain abnormalities) play a role in CSP. Hence, treatments for CSP should address not only peripheral dysfunctions but also the brain. Therefore, a modern neuroscience approach, comprising therapeutic pain neuroscience education followed by cognition-targeted motor control training, is proposed. This perspective article explains why and how such an approach to CSP can be applied in physical therapist practice.

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.

Range of motion in the upper and lower cervical spine in people with chronic neck pain

Reduced cervical range of motion (ROM) is a common finding in people with neck pain. With few exceptions, only the angle between head and thorax has been measured. Our aim was to use an extended model to compare active cervical flexion and extension, separate for upper and lower cervical levels, between people with chronic non-traumatic neck pain and controls. We also investigated associations between ROM measures, symptoms and self-rated functioning. In this cross-sectional study, 102 subjects with neck pain and 33 healthy controls participated. An electromagnetic tracker system was used to measure the kinematics to construct a three-segment model including the thorax, cervical spine and head. Neutral flexion/extension were defined at subjects’ self-selected seated posture. We found that in the neck pain group, extension in the upper cervical levels and predominately flexion for the lower levels were reduced. The ratio between ROM for the upper and lower levels was altered in the neck pain group so that the lower levels contributed to a lesser extent to the total sagittal ROM compared to controls. These findings could not be explained by a greater forward head posture but must have other origins. For the neck pain group, ROM measures were weakly associated to pain and self-rated functioning. Altogether, this implies that using a three-segment model for assessment of ROM can be a valuable improvement for characterisation of patients and treatment evaluation.

Association of manual muscle tests and mechanical neck pain: Results from a prospective pilot study

To determine whether there was a statistical difference for manual muscle test (MMT) findings for cervical muscles in subjects with and without mechanical neck pain (MNP), and to use confidence intervals to evaluate the sensitivity and specificity of the MMT in this group of subjects. Manual muscle strength tests were conducted on two groups of patients who reported to two outpatient chiropractic clinics. In group 1, 148 patients were evaluated for MMT data (50 males and 98 females, average age 37), 127 with "whiplash"-type injuries (average duration 16 weeks) and 21 with non-traumatic chronic neck pain (average duration 36 weeks). In group 2, 100 patients were evaluated for comparative MMT data (39 males and 61 females, average age 38) with no current MNP or remarkable history of MNP. Standardized MMT assessments of the strength of the sternocleidomastoid, anterior scalene, upper trapezius, and cervical extensor muscles bilaterally were performed on all subjects in groups 1 and 2. In group 1, 139 of 148 patients reporting neck pain also showed positive results in at least one of four MMT tests (sternocleidomastoid, anterior scalene, upper trapezius, and cervical extensors). In group 2, 30 of the 100 patients without MNP showed positive results in one or more of the four MMT tests. Confidence intervals were calculated and showed that, in terms of MMT findings, there was a significant difference between the two groups of patients. A symptomatic group of patients with MNP demonstrated significantly increased MMT findings in the form of reduced strength levels compared to a control group. This evidence suggests that the MMT is potentially a sensitive and specific test for evaluating cervical spine muscular impairments in patients with MNP.

Clinical Characteristics, Pain, and Disability in Relation to Alar Ligament MRI Findings

Cross-sectional study. To evaluate the association between degree of signal changes in the alar ligaments on MRI with respect to pain and disability. Conflicting evidence exists whether areas of high-signal intensity in the alar ligaments on MRI are associated with pain and disability. A cross-sectional designed study of 173 subjects including a group with persistent whiplash associated disorder (WAD) Grade II after a car accident (n = 59), a group with chronic nontraumatic neck pain (n = 57) and a group without neck pain or previous neck trauma (n = 57). To assess pain and disability, all participants filled in the Brief Pain Inventory (BPI-intensity and BPI-interference), the European Quality of Life (EQ-5D and EQ VAS) and the Hospital Anxiety and Depression Rating Scale (HADS). High-resolution proton-weighted MR images in three planes were evaluated by two experienced neuroradiologists who were blinded to patient history and group allocation. The alar ligaments were evaluated according to a 4-point grading scale; 0 = low-signal intensity throughout the entire cross-section area, 1 = high-signal intensity in one third or less, 2 = high-signal intensity in one third to two thirds, and 3 = high-signal intensity in two thirds or more of the cross-section area. With respect to BPI and HADS, the scores were highest in the WAD group, intermediate in the chronic nontraumatic neck pain group, and lowest among controls. EuroQol scores were lowest in the WAD group, intermediate in the chronic nontraumatic neck pain group, and highest among controls (P < 0.001). There was, however, no significant correlation between the alar ligament changes and measures for pain and disability. The previously reported assumption that changes in the alar ligaments detected on MRI are associated with pain and disability is not supported by this study. The diagnostic value and the clinical relevance of MR-detectable areas of high intensity in the alar ligaments remain questionable.