Chronic Idiopathic Neck Pain Research Articles

Diagnostic Accuracy of Ultrasound Imaging and Shear Wave Elastography to Discriminate Patients with Chronic Neck Pain from Asymptomatic Individuals

Objectives: The aim of this study was to determine and compare the capability of several B-mode ultrasound (US) and shear wave elastography (SWE) metrics to differentiate subjects with chronic non-specific neck pain from asymptomatic subjects. Methods: A diagnostic accuracy study recruiting a sample of patients with chronic neck pain and asymptomatic controls was conducted. Data collection included sociodemographic information (i.e., gender, age, height, weight and body mass index), clinical information (pain intensity assessed using the Visual Analogue Scale and pain-related disability using the Neck Disability Index) and B-mode ultrasound and shear wave elastography features of the cervical multifidus muscle (cross-sectional area, perimeter, mean echo intensity, fat infiltration, shear wave speed and Young’s modulus). After analyzing between-group differences for left/right sides, cases and controls, and males and females, the area under the receiver operating characteristic (ROC) curve, the optimal cut-off point, the sensitivity, the specificity, the positive likelihood ratio (LR) and negative LR for each metric were calculated. A total of 316 individuals were recruited in this study (n = 174 cases with neck pain and n = 142 asymptomatic controls). Results: No significant differences (p > 0.05) were found between cases and controls for most variables, except for fatty infiltration, which was significantly higher in chronic neck pain cases (p < 0.001). Gender differences were significant across all US and SWE metrics (all, p < 0.001 except p = 0.015 for fatty infiltrates). A slight asymmetry was observed between the left and right sides for area (p = 0.038). No significant interactions between group, gender and side (all metrics, p > 0.008) were identified. Fatty infiltration was the most effective discriminator, with a ROC value of 0.723, indicating acceptable discrimination. The optimal cut-off point for fatty infiltration was 25.77, with a moderate balance between sensitivity (59.8%) and specificity (20.5%). However, its positive likelihood ratio (LR) of 0.75 suggests limited usefulness in confirming the condition. Conclusions: Fatty infiltration was significantly higher in individuals with chronic idiopathic neck pain compared to those without symptoms, while other muscle metrics were similar between both groups. However, since fat infiltration had moderate diagnostic accuracy and the other metrics showed poor discriminatory power, US cannot be used solely to discriminate patients with idiopathic neck pain.

Reduced Cervical Muscle Fat Infiltrate Is Associated with Self-Reported Recovery from Chronic Idiopathic Neck Pain Over Six Months: A Magnetic Resonance Imaging Longitudinal Cohort Study.

Background: It is unclear why neck pain persists or resolves, making assessment and management decisions challenging. Muscle composition, particularly muscle fat infiltrate (MFI), is related to neck pain, but it is unknown whether MFI changes with recovery following targeted interventions. Methods: We compared muscle composition quantified from fat-water magnetic resonance images from the C3 to T1 vertebrae in individuals with and without chronic idiopathic neck pain at two times 6 months apart. Those with neck pain received six weeks of intervention (physiotherapy or chiropractic) after their baseline MRI; at 6 months, they were classified as recovered (≥3 on the 11-point Global Rating of Change scale) or not recovered. Results: At 6 months, both asymptomatic and recovered individuals had decreased MFI compared to baseline (asymptomatic estimated marginal mean difference -1.6% 95%; CI -1.9, -1.4; recovered -1.6; -1.8, -1.4; p < 0.001) whereas those classified as not recovered had increased MFI compared to baseline (0.4; 0.1, 0.7; p = 0.014), independent of age, sex and body mass index. Conclusions: It appears MFI decreases with recovery from neck pain but increases when neck pain persists. The relationship between cervical MFI and neck pain suggests MFI may inform diagnosis, theragnosis and prognosis in individuals with neck pain. Future development of a clinical test for MFI may assist in identifying patients who will benefit from targeted muscle intervention, improving outcomes.

Immediate effects of dry needling on pain sensitivity and pain modulation in patients with chronic idiopathic neck pain: a single-blinded randomized clinical trial

BackgroundDry needling is frequently used for the treatment of neck pain but knowledge about its neurophysiological central effects is scarce. ObjectivesTo compare the immediate effects of a single session of dry needling (DN) and sham needling (SN) on local and distant pressure pain thresholds and conditioned pain modulation in patients with chronic idiopathic neck pain. MethodParticipants with chronic idiopathic neck pain were randomly allocated to a DN or SN group. The primary outcome measure was the pressure pain threshold (PPT) at one peripheral location: quadriceps muscle (Q). Secondary outcome measures were local PPTs at the treated (most painful) (tUT) and non-treated upper trapezius muscle (ntUT), absolute and relative conditioned pain modulation (CPM) effects and pain during hot water immersion. Patients were assessed at baseline and immediately post intervention. Linear mixed models were used to examine interaction effects as well as between- and within-group differences. ResultsFifty-four participants were included for statistical analysis. Linear mixed model analyses showed no significant “group X time” interaction effects for any of the outcome measures. The relative CPM effect at the Q was significantly higher post-intervention, compared to baseline within the DN group (mean difference= 13.52%; 95% CI: 0.46, 26.59). ConclusionThe present study shows no superior effect of DN, compared to SN, in the immediate effect on local and distant PPTs and CPM in patients with chronic idiopathic neck pain.

Effect of Neck Rehabilitation Exercise and Breathing Exercise on Visual Complaints in Individuals with Idiopathic Chronic Neck Pain

Background: Neck pain is one of the most common musculoskeletal disorders and a leading cause of disability. Chronic neck pain causes hyperalgesia in soft tissues around the neck, and in severe cases, it leads to restriction of daily life activities. The excessive stress caused by the chronic pain leads to cervico-ocular gain, leading to a mismatch of reflexes that determine the gaze and vision. Chronic neck pain also alters the cervicothoracic kinematic change and length-tension changes in neck muscles and leads to decreased thoracic cage mobility. This leads to respiratory insufficiency in patients with chronic neck pain, which is similar to the changes that occur in cases of a neuromuscular disorder. Objective: The objective of this study was to find the effect of neck rehabilitation exercises and breathing exercises on visual complaints in individuals with idiopathic chronic neck pain. Materials and Methods: Thirty individuals with idiopathic chronic neck pain of both sexes ranging from 20 to 35 years were included according to the selection criteria and divided into two groups. Group A (n = 15) received the intervention for neck pain, whereas Group B (n = 15) did not receive any interventions. Outcome Measures: Neck disability Index, Visual Complain Index and NPRS are used as outcome measures. Results: Statistical analysis was done using SBM SPSS software version 20, which showed that there was a significant improvement in NDI in the experimental group (P &lt; 0.05). Conclusion: This study concludes that there is a significant effect of neck rehabilitation exercises and breathing exercises on visual complaints in individuals with idiopathic chronic neck pain.

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

Purpose: Neck pain is associated with gait disturbances. The first aim of this study was to examine spatiotemporal gait parameters, pelvic movements and pelvic symmetry during single and dual task conditions in persons with Chronic Idiopathic Neck Pain (CINP) compared to healthy subjects (HS). The second aim was to investigate the relationship between disability and gait in persons with CINP.&#x0D; Methods: Thirty-one individuals with CINP (mean age 22.06±1.38 years, range 18-56 years) and 24 HS (mean age 22.60±1.51 years, range 18-43 years) participated in the study. CINP group completed Neck Disability Index. All participants performed 10-meter walking test in two conditions: (1) walking with head straight at usual speed, (2) walking with head straight at usual speed while carrying a tray. The BTS G-Walk wearable sensor was used to assess spatiotemporal parameters (speed, cadence, step length), pelvic movements (tilt, obliquity, rotation), and pelvic symmetry.&#x0D; Results: During single task gait, the CINP group had significantly lower walking speed, shorter stride length and worse pelvic tilt symmetry (p

Greater muscle volume and muscle fat infiltrate in the deep cervical spine extensor muscles (multifidus with semispinalis cervicis) in individuals with chronic idiopathic neck pain compared to age and sex-matched asymptomatic controls: a cross-sectional study

Muscle size and composition (muscle volume and muscle fat infiltrate [MFI]) may provide insight into possible mechanisms underpinning chronic idiopathic neck pain, a common condition with no definitive underlying pathology. In individuals with chronic idiopathic neck pain > 3 months and age- and sex-matched asymptomatic controls, muscle volumes of levator scapulae, multifidus including semispinalis cervicis (MFSS), semispinalis capitis, splenius capitis including splenius cervicis (SCSC), sternocleidomastoid and longus colli from C3 through T1 were quantified from magnetic resonance imaging. Between-group differences were determined using linear mixed models, accounting for side (left or right), muscle, spinal level, sex, age, and body mass index (BMI). Individuals with pain had greater muscle volume (mean difference 76.8mm3; 95% CI 26.6–127.0; p = .003) and MFI (2.3%; 0.2–4.5; p = .034) of the MFSS compared to matched controls with no differences in relative volume, accounting for factors associated with the outcomes: muscle, spinal level, side (left had smaller volume, relative volume and MFI than right), sex (females had less volume and relative volume than males), age (older age associated with less relative volume and greater MFI), and BMI (higher BMI associated with greater muscle volume and MFI). Greater MFI in individuals with chronic idiopathic neck pain suggests a possible underlying mechanism contributing to neck pain. Perspective: These findings suggest MFI in the MFSS may be radiologic sign, potentially identifying patients with a less favourable prognosis. Future studies are needed to confirm this finding and determine if MFI is a contributor to the development or persistence of neck pain, or consequence of neck pain.

Identifying Demographic, Clinical, Muscular and Histological Factors Associated with Ultrasound Cervical Multifidus Measurement Errors in a Chronic Neck Pain Population.

Ultrasound imaging (US) is a widely used imaging tool in physiotherapy for assessing muscle morphology and quality, among other purposes, such as ensuring the patients' safety during invasive procedures or providing visual feedback during motor control exercises. Identifying factors associated with measurement errors is essential to target avoid bias in high-risk of bias populations. Therefore, this study aimed to assess whether demographic, clinical, muscular and histological factors are associated with ultrasound measurement errors in patients with idiopathic chronic neck pain. B-mode images were acquired and analyzed in 126 patients with chronic neck pain by two experienced examiners. Cross-sectional area, muscle perimeter, mean echo intensity and percentage of fatty infiltration were analyzed. The interexaminer agreement was assessed by calculating the absolute error, intraclass correlation coefficient (ICC), standard error of measurement (SEM) and minimal detectable changes (MDC). A Pearson's correlation matrix including all variables was calculated to conduct a multivariate linear stepwise regression model for estimating the explained variance for each measurement error. Results demonstrated excellent reliability (ICC = 0.965) for assessing the cross-sectional area, and good reliability for assessing the muscle perimeter, mean echo intensity and intramuscular infiltrates estimation (ICC = 0.898, 0.882 and 0.758, respectively). Although clinical variables were not associated with measurement errors (p &gt; 0.05), multiple correlations were found between demographic and cervical multifidus characteristics with measurement errors.

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.

The influence of idiopathic chronic neck pain on upper trapezius and sternocleidomastoid muscle activity and elasticity during functional reaching: A cross-sectional study

It remains unclear whether idiopathic chronic neck pain is associated with changes in muscle stiffness alongside alterations in neuromuscular control. Therefore, the purpose of this study was to determine the influence of idiopathic chronic neck pain on the muscle stiffness and muscle activity of the upper trapezius and sternocleidomastoid muscles during the maintenance of unilateral and bilateral functional reaching tasks. Surface electromyography (EMG) and ultrasound shear wave elastography were collected from the sternocleidomastoid and upper trapezius muscles in 18 individuals with idiopathic chronic neck pain and 18 matched healthy controls. Participants completed three functional reaching tasks; 1) unilateral forward reach, 2) bilateral forward reach, and 3) unilateral upward reach, and held at the top of each reaching movement for data to be collected bilaterally. A univariate ANOVA was utilized for each outcome measure (mean EMG amplitude and shear wave velocity) and each reaching task. Individuals with idiopathic chronic neck pain exhibited significantly lower upper trapezius activation during bilateral reaches without corresponding changes to stiffness during similar trials. Similarly, this cohort exhibited decreased sternocleidomastoid stiffness during forward reaching, without corresponding activation changes. Lastly, women demonstrated consistently higher sternocleidomastoid activation and stiffness when compared to men. These findings indicate individuals with idiopathic chronic neck pain may adapt their movement strategies, possibly for pain avoidance. The demonstrated changes in muscle stiffness independent of changes in muscle activity highlight the importance of evaluating both muscle stiffness and activation in individuals with idiopathic chronic neck pain prior to designing rehabilitation programs.

Specific versus non-specific exercises for the neck extensor muscles in women with chronic idiopathic neck pain: A randomized controlled trial

BackgroundStructural and functional impairments of the cervical extensor muscles have been demonstrated in people with neck pain. A global exercise approach targeting all neck extensor muscles has shown positive effects in this population. However, to date, the efficacy of exercises specifically targeting the deep neck extensors has neither been tested nor compared to global exercises for the neck extensors. ObjectivesTo compare the effects on pain and disability of a specific lower deep neck extensors (SLDNE) versus a general neck extensor (GNE) exercise program in women with chronic idiopathic neck pain. MethodsFourty-three women with chronic idiopathic neck pain were randomly allocated to either a six-week SLDNE or a GNE exercise program. As primary outcome, neck disability was measured with the Neck Disability Index (NDI). Secondarily, pain intensity (VAS), cervical ROM, pressure pain thresholds (PPTs), cervical and thoracic posture and self-perceived benefit of treatment (GROC) were also measured. Every outcome was measured at baseline and immediately after treatment, except NDI, which was also measured at 6-months follow-up. The GROC was only assessed post-intervention. ResultsBoth exercise programs lead to reduced neck disability immediately post-intervention (within-group mean difference [MD] = −6.09; 95% Confidence Interval [CI]: 7.75, −4.42 and −4.73; 95%CI: 6.57, −2.91 respectively) and at the 6-months follow-up (−4.47; 95%CI: 6.41, −2.53 and −4.74; 95%CI: 6.50, −2.97), but with no between group differences. Similar results were found for pain intensity post-intervention, with no between group interaction (within-group MD = −20.87 mm; 95% CI: 28.55, −13.19 and −18.00 mm; 95%CI: (−26.24, −9.76) for SLDNE and GNE groups, respectively). GROC improved after both interventions without any between-group difference. ConclusionsA six-week exercise program specifically targeting the lower deep neck extensors lead to comparable outcomes as a general neck extensor exercise program in women with chronic idiopathic neck pain.

Differences in upper body posture between individuals with and without chronic idiopathic neck pain during computerised device use: A 3D motion analysis study

BackgroundComputer use is associated with poor postures and increased risk of developing neck pain. Evaluating differences in working posture of individuals with and without chronic neck pain may assist the development of strategies to lessen or prevent pain. ObjectiveTo identify if upper body kinematics differs between individuals with and without chronic idiopathic neck pain during four conditions (tablet, laptop, and desktop computer sitting and standing). MethodsThree-dimensional (3D) motion capture measured upper body kinematics in 44 individuals with chronic idiopathic neck pain > 90 days (Cases n = 22) and without pain (Control n = 22), during a typing task under four conditions: tablet, laptop, desktop computer (sitting and standing). Differences between groups were evaluated using generalised linear mixed models. ResultsAcross all conditions and compared to controls, cases had significantly less flexion between their head-neck and upper trunk segments (between group mean difference 7.15°, 2.1, 12.2, p = .006), greater upper trunk flexion relative to the laboratory (−6.15°, −10.9, −1.3, p = .012), greater shoulder flexion bilaterally (left 12.35°, 6.7, 17.9, p < .001; right 13.49°, 7.9, 19.1, p < .001) and less right elbow flexion (−6.87°, −12.1, −1.7, p = .010). Approaching significance, the case group had less left elbow flexion (between group mean difference −5.36°, −10.9, 0.1, p = .056) and a smaller mean craniocervical angle for the seated desktop condition (group x condition interaction −6.37°; 95% CI −12.7, −0.1, p = .052). SignificanceIndividuals with neck pain consistently used different upper body postures compared to individuals without pain when working on computerised devices under varying workstation conditions. This finding suggests that people with neck pain work in potentially aggravating postures that may be associated with their pain.

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

ObjectiveThe aim of this study was to determine the relationship between joint position sense and static and dynamic balance in female patients with chronic neck pain compared with healthy controls. MethodsThe study sample comprised 25 female patients with chronic neck pain and 25 healthy (asymptomatic) female controls. Pain severity with the visual analog scale, joint position sense with the laser pointer method, static balance with the Single-Leg Balance Test, and dynamic balance with the Y Balance Test were assessed. ResultsThe deviation in cervical joint position sense was greater in extension (P < .001), right rotation (P < .001), and left lateral rotation (P < .05) in the patients with chronic neck pain compared with the healthy controls. The results of the patients with chronic neck pain were worse than the healthy controls in the Single-Leg Balance Test with both eyes open (P < .05) and eyes closed (P < .05). The patients with chronic neck pain had worse dynamic balance only in the anterior direction reach of the left leg (P < .05). ConclusionCervical joint position sense and static balance were worse in female patients with chronic idiopathic neck pain when compared with asymptomatic controls. Dynamic balance in all other directions except for the anterior direction was not negatively affected in individuals with chronic idiopathic neck pain.

The Influence of Idiopathic Chronic Neck Pain on Sternocleidomastoid and Upper Trapezius Muscle Activity and Elasticity

The Influence of Idiopathic Chronic Neck Pain on Sternocleidomastoid and Upper Trapezius Muscle Activity and Elasticity

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

BackgroundFew studies comprehensively analyse 3D neck kinematics in individuals with chronic idiopathic neck pain during functional tasks considered challenging. This critical knowledge is needed to assist clinicians to recognise and address how altered movement strategies might contribute to pain. Research questionAre there differences in 3D neck kinematics (angles, timing, velocity) during functional tasks in people with chronic neck pain compared to matched asymptomatic control participants? MethodsParticipants with chronic idiopathic neck pain (n = 33) and matched asymptomatic controls (n = 30) performed four functional tasks (overhead reach forward, right and left, and putting on a seatbelt) while evaluated using 3D motion capture. Kinematic variables included joint angles, range of motion (ROM,°), velocity (m s−1) and timing (% of movement phase) for joint angles (head-neck [HN joint], head+neck-upper trunk [HNT], and thoracolumbar) and segments (head, neck, head+neck [HN segment], upper trunk, and trunk. Generalised linear mixed models examined between-group differences. ResultsThere were few between-group differences. The neck pain group had less HN segment extension that controls (mean difference [MD] left −2.06°; 95% CI −3.82, −0.29; p = .023; and right reach −2.52°; −4.67, −0.37; P = .022), and had less total sagittal HNT ROM across all tasks (−1.28; 95% CI −2.25, −0.31; p = .010). Approaching significance was the pain group having less thoracolumbar left rotation than controls (MD −2.14, 95% CI −4.41 to 0.13, p = .064). The pain group had higher neck segment peak flexion velocity than controls across all tasks (MD −3.09; 95% CI −5.21 to −0.10; P = .004). Timing of joint angle peaks did not differ between groups. SignificanceWhen performing an overhead reach task to the left and right and putting on a seatbelt, people with neck pain maintain a more flexed HN segment, use less sagittal ROM and have higher velocity peaks. These findings can assist clinicians in their assessment of patients by identifying possible underlying contributors to neck pain.

The Impact of Chronic Neck Pain on Respiratory Functions among Female University Students

Objective: Students with chronic neck pain have several issues that could constitute susceptibility to respiratory dysfunction. So, this current study was conducted to investigate the impact of chronic neck pain on respiratory function among female university students.Material and Methods: In this cross-sectional study, 60, female University students voluntarily participated, and were divided into two groups: 30 students with chronic idiopathic neck pain (age=21.9±2.2 years, height=160.7±6.5 cm, weight=71.9±8.5 kg, body mass index (BMI)=28±3.6 kg/cm2 ), and 30 healthy students as the control group (age=21.5±2.1 years, height=163.5±6.8 cm, weight=69.5±11 kg, BMI=26.2±5 kg/cm2 ). Both groups were investigated using a Spirometer (One-FlowTM Forced Vital Capacity (FVC) Kit, USA, Granbury). Descriptive statistics and Multivariate analysis of the variance test were both used to compare both groups.Results: Students with chronic neck pain were found to have statistically significant reductions in Peak Expiratory Flow and the Forced Expiratory Volume in one second (FEV1)/FVC ratio (p-values=0.043 and 0.000, respectively). However, FVC (p-value=0.372) and FEV1 (p-value=0.840) revealed no statistically significant differences between both groups.Conclusion: Respiratory dysfunction, with chronic neck pain mainly manifests as respiratory weakness and hypocapnia. Studying the hypothesis of neck pain, and its possibility of causing respiratory dysfunction in these subjects gives rise to important clinical implications concerning the assessment and treatment of patients with chronic neck pain.

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.

Comparative study regarding the impact of dry needling therapy in the treatment of chronic cervical idiopathic pain

Regarding the number of years lived with a disability, neck pain is an important condition worldwide and at least one episode affects an individ during a lifetime.The aim of this study was to investigate the effectiveness of dry needling in addition to routine care in patients with idiopathic chronic neck pain. The study was performed on a sample on 20 females, aged 32-45 years, with this condition. Chosen patiens were grouped into two groups. In Group 1 the patientsbenefited from a protocol which included specific rehabilitation exercises focused on neck, upper limbs, mobility, strength and stretching exercices. The Group 2 included patients who benefited from a rehabilitation program which included exercises and dry needling therapy performed on the shoulder area, trapezius muscle, splenius, elevator scapulae, paravertebral muscles. The treatment lasted 8 weeks, with a frequency of dry needling of1 session/week.To monitor the evolution of the research subjects, were used The Visual Analog Pain Scale (VAS) and Neck Disability Index (NDI).NDI values showed improvements in both groups from 34.8 to 25.4 in Group 2 and from 35.6 to 30.0 in Group 1. So, NDI values showed a better functional status in both groups after 8 weeks of treatment.The mean results of VAS and NDI at the final evaluations showed a higher efficacy of the conservative treatment associated with dry needling, with a major statistical significance (p &lt;0.05) in the case of mean VAS values at the final evaluation(Group 1: VAS 2 = 4.25; Group 2: VAS 2 = 2.60).

Changes in Muscle Morphology in Female Chronic Neck Pain Patients Using Magnetic Resonance Imaging.

Population-based cross-sectional study. The aim of this study was to gain a better understanding of changes in muscle morphology in patients with chronic idiopathic neck pain (CINP) and chronic whiplash-associated disorder (CWAD). Worldwide, neck pain (NP) is a common health problem with high socioeconomic burden. A high percentage of these patients evolves toward chronic symptoms. Efficacy of treatments for these complaints remains variable. In current literature, changes in muscle morphology (muscle fat infiltration and cross-sectional area) have been reported in patients with NP, both CWAD and CINP. However, no strong conclusions could be made. In this study, magnetic resonance imaging was used to obtain data on muscle morphology from 14 cervical flexor and extensor muscles in 117 female subjects with NP (CWAD = 37; CINP = 45) and healthy controls (HC = 35). The CWAD group had a significantly larger muscle fat infiltration in some extensor (semispinalis and splenius capitis, trapezius, obliquus capitis inferior) and flexor (sternocleidomastoid) muscles compared to the CINP and/or HC group. A significantly larger (muscle) cross-sectional area was found in some extensor (levator scapulae, semispinalis capitis, trapezius) and flexor (longus colli, longus capitis, sternocleidomastoid) muscles in the HC group compared to the CINP and/or CWAD group. No clear associations were found between group differences and factors as pain duration, kinesiophobia, and disability. The results in this study suggest changes in muscle morphology in both NP cohorts. These results show some similarities with earlier findings in this research domain. Further studies based on controlled longitudinal designs are needed to facilitate data compilation, to draw stronger conclusions, and to integrate them into the treatment of patients with chronic NP.Level of Evidence: 4.

Prescription of exercises for the treatment of chronic pain along the continuum of nociplastic pain: A systematic review with meta‐analysis

To compare different exercise prescriptions for patients with chronic pain along the continuum of nociplastic pain: fibromyalgia, chronic whiplash-associated disorders (CWAD), and chronic idiopathic neck pain (CINP). Randomized controlled trials comparing different exercise parameters were included. The search was performed in the databases Cochrane Central Register of Controlled Trials, MEDLINE, EMBASE, CINAHL and PEDro. Data on the parameters for the physical exercise programs for pain management were extracted for analysis. Fifty studies with 3,562 participants were included. For fibromyalgia, both aerobic strengthening exercises were similar and better than stretching exercises alone. Exercises could be performed in 50- to 60-min supervised sessions, 2 to 3 times a week, for 13weeks or more. For CWAD, body awareness exercises were similar to combined exercises, and there was no difference in adding sling exercises to a strengthening exercise program. The exercises could be performed in 90-min supervised sessions, twice a week, for 10 to 16weeks. For CINP, motor control exercises and nonspecific muscle strengthening had a similar effect. Exercises could be performed in 30- to 60-min supervised sessions, 2 to 3 times a week, for 7 to 12weeks. The choice of parameters regarding exercises should emphasize global exercises in nociplastic pain conditions (such as fibromyalgia and CWAD) and specific exercises in non-nociplastic pain conditions (such as CINP) and be based on patient's preference and therapist's skills. CRD42019123271. The pain mechanism must be considered to optimize exercise prescription in patients with different chronic pain profiles. The main message of this article is that low to moderate intensity global exercises performed for a long period of treatment should be performed in patients with nociplastic pain predominance. Additionally, focused and intense exercises for a short period of treatment can be prescribed for patients with nociceptive pain predominance.

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

ObjectiveThe purpose of this study was to determine if there is a relationship between pain and movement kinematics during functional tasks, evaluated over time, in individuals with chronic idiopathic neck pain. MethodsTen participants with chronic idiopathic neck pain performed 2 functional tasks (overhead reach to the right and putting on a seatbelt) while evaluated using 8 Oqus 300+ cameras. Kinematic variables included joint angles and range of motion (ROM) (°), head segment relative to neck segment (head-neck [HN]); and head/neck segment relative to upper thoracic segment (head/neck-trunk), velocity (m/s), and time (% of movement phase). Pain was quantified using a 100-mm visual analog scale. Linear mixed effects regression models were used to analyze associations between pain and kinematic variables adjusting for treatment group. ResultsFor overhead reach, higher pain was associated with less HN peak rotation at baseline (β = –0.33; 95% CI −0.52 to –0.14, P = .003) and less HN total rotation ROM at 6 months (β = –0.19; 95% CI –0.38 to –0.003, P = .048). For the seatbelt task, higher pain was associated with less HN peak rotation (β = –0.52; 95% CI −0.74 to –0.30 to –0.74, P < .001) and less HN total rotation ROM at baseline (β = –0.32; 95% CI –0.53 to –0.10, P = .006). No other movement variables demonstrated meaningful relationships with pain for the reach or seatbelt tasks. ConclusionHigher pain is associated with less HN peak and total rotation during functional reaching tasks requiring head rotation. Recognizing altered functional kinematics in individuals with chronic neck pain may assist patient management.