Musculoskeletal Neck Research Articles

Routine Physical Therapy with and without Neural Mobilization in Chronic Musculoskeletal Neck Disorders with Nerve-Related Symptoms: Systematic Review and Meta-Analysis.

No previous study has evaluated the effectiveness of routine physical therapy with and without neural mobilization for patients with chronic musculoskeletal neck disorders and cervical radiculopathy. The objective is to evaluate the effectiveness of routine physical therapy with and without neural mobilization on pain and mobility in patients with chronic musculoskeletal neck disorders and cervical radiculopathy. A systematic review with meta-analysis of randomized clinical trials involving the use of neural mobilization techniques for the treatment of chronic musculoskeletal neck disorders and cervical radiculopathy was conducted. Methodological quality was assessed by the Cochrane Risk of Bias Tool and PEDro scale. Data were pooled and a meta-analysis was performed using a random effects model with Review Manager 5 software. Seven articles were included in our review. Significant differences were found in mobility but not in pain in favor of using routine physical therapy with neural mobilization for the treatment of chronic musculoskeletal neck disorders and cervical radiculopathy. Our results show that routine physical therapy accompanied by neural mobilization is superior for improving mobility in comparison with routine physical therapy alone in patients with musculoskeletal neck disorders and cervical radiculopathy.

Oxygen-Ozone Therapy of Musculoskeletal Neck Pain: A Review.

Minimally invasive oxygen-ozone (O2-O3) therapy utilizing the biochemical effects of O2-O3 mixture is commonly used in the treatment of musculoskeletal pain. The literature dealing with O2-O3 therapy of spinal pain focuses mainly on the lumbosacral region. The aim of this review is to evaluate the efficacy of O2-O3 therapy in musculoskeletal pain in the neck region. The Medline (PubMed), SCOPUS, Web of Science, and Google Scholar databases were searched for clinical studies, using the free text terms: ozone, neck, cervical, spine, pain, disc, hernia, nucleolysis, paravertebral, treatment, and various combinations of them. In total, seven studies (two randomized controlled trials and five observational studies) were found. These studies dealt with the intradiscal or intramuscular paravertebral application of O2-O3 mixture in patients with myofascial pain syndrome, cervical disc hernias, and chronic neck pain. All these studies proved a significant decrease in neck pain (evaluated by Visual Analog Scale or Numerical Rating Scale), and most of them showed improvement in functional status (measured by Oswestry Disability Index or Neck Disability Index). In addition, other pain assessment scales and function and quality of life measures (DN4 questionnaire, pain pressure threshold, cervical lateral flexion range of motion, Japanese Orthopedic Association scale, 12- and 36-Item Short Form Surveys, modified MacNab criteria, and analgesic drug intake reduction) were used. Changes in these measurements also mostly supported the efficacy of O2-O3 treatment. No significant complications of the treatment were reported. The available evidence is sparse, but despite this, the O2-O3 treatment of musculoskeletal neck pain can be considered potentially beneficial and relatively safe.

Лекция: Скелетно-мышечная патология у офисных работников: возможности лечения в амбулаторных условиях

Musculoskeletal neck, shoulder, upper extremity, low back pain is a disorder that is most common in office employees. Furthermore, neck pain and low back pain are the most prevalent. Neck pain and low back pain are in Top-5 of the disorders contributing to disability, ahead of other disorders, such as diabetes mellitus, chronic lung diseases, coronary artery disease. The paper considers pathogenetic features of musculoskeletal disorders developing in office employees, along with treatment options with emphasis on the neurotropic vitamins and their combinations with NSAIDs.

Effects of Scapular Interventions on Pain and Disability in Subjects with Neck Pain: A Systematic Review and Meta-analysis of Randomized Controlled Trials.

Musculoskeletal neck pain is the fourth common cause of disability worldwide. Scapula dysfunction can subsequently lead to neck pain. Previous literature could not establish the effectiveness of scapular stabilization exercises on neck pain due to the different definitions used for exercise in different studies. There is a need for quality evidence examining the effectiveness of scapular interventions on pain and disability in patients with neck pain. PubMed, EMBASE, Scopus, Cochrane, OVID, and PEDro were searched from 1 April 2011 to 31 March 2022. We included randomized controlled trials that focused on scapular interventions and other active strategies in the management of neck pain. The following outcomes were assessed: pain, disability, and quality of life. PEDro scale was used to assess the risk of bias and the data pooled was analyzed using standardized mean difference. The 5 trials included in the review assessed (116 participants) the effects of scapular interventions in patients with chronic nonspecific neck pain. Risk of bias for one study was low and that for the others was moderate. The meta-analysis showed that there was a significant difference between the combined effect of neck and scapula interventions and only neck interventions group (Standardized mean difference -1.51, 95% CI [-2.79, -0.23], z=2.32, p=0.02). On assessing the effect of scapula interventions on disability, the results revealed that there was no significant (p=0.40) impact. Moderate quality evidence was found for the combined effect of scapular and neck interventions in reducing pain in patients with neck pain. However, it was not effective in improving the disability.

Neck stabilization through sensory integration of vestibular and visual motion cues.

To counteract gravity, trunk motion, and other perturbations, the human head-neck system requires continuous muscular stabilization. In this study, we combine a musculoskeletal neck model with models of sensory integration (SI) to unravel the role of vestibular, visual, and muscle sensory cues in head-neck stabilization and relate SI conflicts and postural instability to motion sickness. A 3D multisegment neck model with 258 Hill-type muscle elements was extended with postural stabilization using SI of vestibular (semicircular and otolith) and visual (rotation rate, verticality, and yaw) cues using the multisensory observer model (MSOM) and the subjective vertical conflict model (SVC). Dynamic head-neck stabilization was studied using empirical datasets, including 6D trunk perturbations and a 4 m/s2 slalom drive inducing motion sickness. Recorded head translation and rotation are well matched when using all feedback loops with MSOM or SVC or assuming perfect perception. A basic version of the model, including muscle, but omitting vestibular and visual perception, shows that muscular feedback can stabilize the neck in all conditions. However, this model predicts excessive head rotations in conditions with trunk rotation and in the slalom. Adding feedback of head rotational velocity sensed by the semicircular canals effectively reduces head rotations at mid-frequencies. Realistic head rotations at low frequencies are obtained by adding vestibular and visual feedback of head rotation based on the MSOM or SVC model or assuming perfect perception. The MSOM with full vision well captures all conditions, whereas the MSOM excluding vision well captures all conditions without vision. The SVC provides two estimates of verticality, with a vestibular estimate SVCvest, which is highly effective in controlling head verticality, and an integrated vestibular/visual estimate SVCint which can complement SVCvest in conditions with vision. As expected, in the sickening drive, SI models imprecisely estimate verticality, resulting in sensory conflict and postural instability. The results support the validity of SI models in postural stabilization, where both MSOM and SVC provide credible results. The results in the sickening drive show imprecise sensory integration to enlarge head motion. This uniquely links the sensory conflict theory and the postural instability theory in motion sickness causation.

The Impact of the Addition of a Physical Therapy Assistant to the Treatment Team for Management of Neck Pain: A Retrospective Analysis of Outpatient Physical Therapy Clinics.

Introduction The impact of physical therapy assistants (PTAs) on patient outcomes, mostly in the acute and subacute setting, is well known in the literature. However, no study to date has examined the impact of using PTAs as part of a treatment team in the outpatient setting for common musculoskeletal conditions. The purpose of this study is to determine if physical therapy team composition, either physical therapists (PTs) only or a team consisting of PTs and PTAs, has a significant impact on patient outcomes in adult patients with musculoskeletal neck pain to help investigate an ideal practice pattern for outpatient physical therapy. Methods This is a retrospective cohort study analyzing the impact of physical therapy treatment team composition (PTs only, or team consisting of PTs and PTAs) on pain, active range-of-motion (AROM), and disability outcomes via the Neck Disability Index (NDI) in the conservative treatment of neck pain. All patients were treated with usual physical therapy care. Inclusion criteria involved patients with a diagnosis of neck pain (M48.2), older than 18 years old, a physical therapy evaluation procedure code (97161, 97162, 97163), and at least two visits per bout of physical therapy. Primary outcome measures were pain, bilateral rotation AROM, disability, and number of visits. Results Included patients (n=195) had an average age of 60.8 years ± 16.1 years with an average number of total physical therapy visits of 7.4 visits ± 4.3 visits (range, 2 visits - 22 visits) with 120 patients (61.5%) treated by a PT only (PT-only group) and 75 patients (38.5%) treated by a team consisting of a PT and a PTA (PTA group). The PT-only group had significantly fewer visits than the PTA group (p<0.001). The PT-only group had a pain improvement of 2.1 points ± 2.3 points whereas the PTA group had a pain improvement of 2.2 points ± 2.4 points with no significant difference between the two groups (p=0.573). The PT-only group (n=46 patients) had an average rotation AROM improvement of 20.0 ± 17.4 degrees whereas the PTA group (n=40 patients) had an average rotation AROM improvement of 16.8 degrees ± 23.0 degrees with no significant difference between the level of rotation AROM improvement between the two groups (p=0.408). Furthermore, there was also no significant difference in the amount of NDI improvement seen in both groups (p=0.594). Conclusion There was no significant difference in patient outcomes for pain, AROM, and disability when PTAs were added to the physical therapy treatment team in the conservative management of neck pain in the outpatient setting. However, patients treated with a treatment team consisting of PTAs had significantly more visits, despite no significant change in outcomes. Randomized controlled trials are needed as the reasons for these findings can be many and require further research.

Kinematic Analysis of the Forward Head Posture Associated with Smartphone Use

Background: Frequent use of mobile devices has a known association with musculoskeletal neck pain. This study sought out to localize the region with greatest flexion in the cervical spine and explored the role of symmetry in maintaining the pose during texting. Methods: Three inertial measuring units (IMUs) superficially attached along the cervical spine divided the cervical spine into two measurable segments. Twenty-five subjects participated in the study and performed three tasks when using smartphones: sitting, standing, and walking. Data from each IMU were used to calculate the flexion of cervical divided into two segments: craniocervical junction (C0–C1) and subaxial (C1–C7). Results: The greatest flexion by far occurred at C0–C1. While sitting, standing, and walking, the mean flexion angles were 33.33 ± 13.56°, 27.50 ± 14.05°, and 32.03 ± 10.03° for the C0–C1 joint and −3.30 ± 10.10°, 2.50 ± 9.99°, and −1.05 ± 11.88° for the C2–C7 segment, respectively. There is a noticeable pattern of yaw movement of the head, with a slow rotation toward symmetry and a fast corrective movement toward the smartphone held in one hand. Conclusions: This study identified the region of greatest contribution toward forward flexion along the cervical parameters during various tasks involving smartphone use. With each task, the greatest contributor to head flexion was the C0–C1 joint. There is involuntary rotation of the cervical spine toward symmetry when texting.

MIGRAINE: BASIC PRINCIPLES OF TREATMENT AND PREVENTION

Migraine is a disease manifested by attacks of severe headaches. Often, the pain is one-sided, pulsating, increases with physical exertion and may be accompanied by nausea and hypersensitivity to light, sound and smells. The precursors of migraines last from a few minutes to an hour. During this period, a person's balance, sensitivity, coordination of movements, speech and vision may be disturbed. Migraines usually begin during puberty and weaken after 50 years. Tension migraine is an incorrect term that is sometimes used to refer to tension headaches. Tension headaches are associated with stress or musculoskeletal neck problems. This type of headache is characterized by squeezing or squeezing pain, as from a tight bandage around the head. The pain may start from the neck or spread to it.

Understanding barriers to adherence to home exercise programs in patients with musculoskeletal neck pain

BackgroundHome exercise program (HEP) prescription is commonplace in physical therapy (PT). Adherence to HEPs is generally poor, with non-adherence as high as 70%. Poor adherence may negatively impact outcomes. ObjectivesTo (i) qualitatively assess patients’ thoughts and beliefs regarding HEP performance and (ii) quantitatively define the relationship between adherence to HEPs and functional outcomes and identify variables that impact adherence. DesignMixed-methods. MethodPart 1 involved semi-structured interviews with patients attending PT for neck pain. Responses were assessed using thematic analysis. Part 2 involved a retrospective chart review of patients seen in outpatient PT for neck pain. Between-group (adherent and non-adherent) differences in functional scores were analyzed using a linear mixed model. Sex, age, and functional score data was entered into a regression model to explore their ability to predict adherence. Results25 participants were interviewed. Qualitative analysis revealed the following themes associated with adherence to a HEP: (i) prior PT, (ii) observability of outcomes, (iii) expectations of PT, and (iv) experience of pain. Retrospective data from 187 patients was analyzed. Functional scores at discharge were significantly higher (p = 0.03, mean difference = 12.4) in the adherent group. Age (OR = 0.98; 95% CI = 0.93–1.02), male sex (OR = 1.23; 95% CI = 0.22–6.91), and functional scores at intake (OR = 0.99; 95% CI = 0.92–1.07) were not significant predictors of non-adherence. ConclusionsIndividual patient experiences such as delayed improvement in symptoms and/or experience of pain associated with HEP performance may contribute to poor adherence to HEPs. Adherence to a HEP was associated with superior functional outcomes compared to non-adherence. Age, sex, and functional scores were not predictors of non-adherence.

Use of Thrust Cervical Spinal Manipulative Therapy for Complicated Neck Pain: A Cross-Sectional Survey of Asia-Pacific Chiropractors.

Background Chiropractors often use manual thrust cervical spinal manipulative therapy (thrust-cSMT) to treat musculoskeletal neck conditions. We hypothesized <50% of surveyed Asia-Pacific chiropractors would report using thrust-cSMT given potential contraindications, and secondarily explored predictors of thrust-cSMT use. Materials and methods We designed, validated, achieved sufficient reliability, and disseminated a survey to explore thrust-cSMT use. The survey queried chiropractors' characteristics (e.g., years in practice, education level, time with patients, importance of subluxation), and use of thrust-cSMT for uncomplicated neck pain and vignettes describing vertebral artery disorders, Arnold-Chiari malformation, and anterior cervical discectomy and fusion (ACDF). We performed logistic regression for each vignette with thrust-cSMT as the dependent variable and chiropractor characteristics as covariates. Results There were 241 respondents, having 12.8±10.9 years in practice, representing >15 countries. Less than 50% of chiropractors reported the use of thrust-cSMT for each vignette, including vertebral artery insufficiency (14%) and stenosis (17%), Arnold-Chiari type I (18%) and type II (5%), C5/6 ACDF (39%) and C3-6 ACDF (27%). Regressions identified significant predictors of increased or decreased use of thrust-cSMT including time spent with new patients, focus on subluxation, degree, group practice environment, use of thrust-cSMT on a healthy patient, and hours reading scientific literature (P<.05 for each). Conclusions This study was the first to chiropractors' use of thrust-cSMT for complicated neck pain and found that most Asia-Pacific chiropractors reported avoiding this treatment in the presence of a potential treatment contraindication. The use of thrust-cSMT in complicated neck pain may be related to practice characteristics. However, further research is needed to identify specific reasons why chiropractors use or avoid thrust-cSMT.

Impact of breastfeeding positions on neck pain in postpartum mothers

Background: Breastfeeding mothers often encounters various complaints such as pain and discomfort. It was also seen that a mother has to attain feeding position for a long period of time. Thus, our aim was to find if there is any correlation between musculoskeletal neck pain and breastfeeding position in post-partum mothers.Methods: It was a cross sectional, observational study in which sampling was done by purposive method. 207 postpartum mothers fulfilling inclusion criteria were included and a self-made questionnaire and neck disability index (NDI) were used as outcome measure. Statistical analysis was done using statistical package for the social sciences (SPSS) version 24.Results: Almost all those mothers reported neck pain while breastfeeding in different positions especially in side-lying and cross-cradle in terms of NDI with median value of 11.1 and there were 65.7% mothers who had awareness about ideal breastfeeding position. The interpretation of neck pain showed changes with respect to different positions, when analyzed by Kruskal Wallis test.Conclusions: Though it showed statistical insignificance in correlation due to various reasons such as negligence, habitualisation, lack of awareness, unmet support from family.

Willingness to use nonpharmacologic treatments for musculoskeletal pain in the emergency department: a cross-sectional study.

Pain is an individual experience that should incorporate patient-centered care. This study seeks to incorporate patient perspectives toward expanding nonpharmacologic treatment options for pain from the emergency department (ED). In this cross-sectional study of adult patients in ED with musculoskeletal neck, back, or extremity pain, patient-reported outcomes were collected including willingness to try and prior use of various nonpharmacologic pain treatments, sociodemographics, clinical characteristics, functional outcomes, psychological distress, and nonmusculoskeletal symptoms. Least absolute shrinkage and selection operator regression identified variables associated with (1) willingness to try and (2) having previously tried nonpharmacologic treatments. Responses were analyzed from 206 adults, with a mean age of 45.4 (SD 16.4) years. The majority (90.3%) of patients in ED were willing to try at least one form of nonpharmacologic pain treatment, with 70.4%, 81.6%, and 70.9% willing to try respective subcategories of active (eg, exercise), passive (eg, heat), and psychosocial (eg, prayer) modalities. Only 56.3% of patients had previously tried any, with 35.0%, 52.4%, and 41.3% having tried active, passive, and psychosocial modalities, respectively. Patient-level factors associated with willingness included pain in upper back, more severe pain-related symptoms, and functional impairments. The factor most consistently associated with treatment use was health care provider encouragement to do so. Patients in ED report high willingness to try nonpharmacologic treatments for pain. Higher pain severity and interference may indicate greater willingness, while health care provider encouragement correlated with treatment use. These findings may inform future strategies to increase the introduction of nonpharmacologic treatments from the ED.

Disparities Exist in Physical Therapy Utilization and Time to Utilization Between Black and White Patients With Musculoskeletal Pain.

Black patients are less likely than White patients to receive physical therapy for musculoskeletal pain conditions. Current evidence, however, is limited to self-reported conditions and health services use. The purpose of this study was to use a large electronic health record database to determine whether a race disparity existed in use of physical therapy within 90days of a new musculoskeletal diagnosis. Eligible patients (n = 52,384) were sampled from an Optum deidentified electronic health record database of 5 million adults distributed throughout the United States. In this database, patients were designated as "Black" and "White." Patients were eligible if they had a new diagnosis for musculoskeletal neck, shoulder, back, or knee pain between January 1, 2012, and December 31, 2017. Logistic regression and Cox proportional hazard models were computed before and after adjusting for covariates to estimate the association between race and receipt of physical therapy services within 90days of musculoskeletal pain diagnoses. Patients were on average 47.5 (SD = 14.9) years of age, 12.8% were Black, 87.2% were White, and 52.7% were female. Ten percent of Black patients and 15.5% of White patients received physical therapy services within 90days of musculoskeletal pain diagnoses. After adjusting for covariates, White patients were 57% more likely (odds ratio = 1.57; 95% CI = 1.44-1.71) to receive physical therapy compared with Black patients and had significantly shorter time to physical therapy than Black patients (hazard ratio = 1.53; 95% CI = 1.42-1.66). In a nationally distributed cohort, Black patients were less likely than White patients to utilize physical therapy and had a longer time to utilization of physical therapy for musculoskeletal pain. These findings highlight the need to determine the mechanisms underlying the observed disparities and how these disparities influence health outcomes.

WORK RELATED MUSCULOSKELETAL NECK PAIN: A NEGLECTED OCCUPATIONAL DISEASE AMONG DENTISTS IN PESHAWAR, PAKISTAN

Objective:To determine the frequency and risk factors of work-related neck pain among dentists working in Public sector Hospitals in Peshawar, Pakistan.Materials and Methods: A cross sectional study was conducted in Khyber College of Density, Lady Reading Hospital and Hayatabad Medical Complex, Peshawar, Pakistan from 23rd September 2018 to23rd February 2019. A total of 150 dentists who were working in public sector hospitals and were willing to participate were included in the study by convenience sampling. The Standardized Nordic Questionnaire (SNQ) was used for data collection. Data was analyzed with SPSS, version 23.Results:The total number of participants in our study were 150. Males were 105(70%) and females were 45(30%).The mean age was 31.4200± 6.1 years. Majority(72.7%,n=109) of dentists were reported to have work related musculoskeletal pain while 41(27.3%) dentists had no such complaints. The commonly affected dentists were trainee medical officers(61.3%,n=92).The frequency of neck pain was more common among dentists who examined more than 15 patients per day(49.3%,74%) and worked 6 days per week(64%,n=96).Dentists performing root canal treatment(70.7%,n=106) were more prone to have neck pain than others.Conclusion:The frequency of musculoskeletal neck pain among the dentists was high. The risk factors were prolong working hours, examining more patients and prolong dental procedures.

Physiotherapists’ identification and knowledge of Cervical Artery Dysfunction

Purpose: Neck pain is the fourth leading cause of global disability, with its prevalence exceeding 30%. Consequently, physiotherapists assess a significant number of patients with neck pain. However, some conditions, such as vertebral artery dissection, are known to masquerade as musculoskeletal neck pain and require immediate medical referral. Usual musculoskeletal management of such patients could exacerbate their condition with life-threatening outcomes therefore it is vital that physiotherapists have knowledge of differing characteristics of pain presentations in order to manage each condition safely and effectively.

Effectiveness of Neural Mobilization Techniques in the Management of Musculoskeletal Neck Disorders with Nerve-Related Symptoms: A Systematic Review and Meta-Analysis with a Mapping Report.

The objective was to assess the effectiveness of neural mobilization (NM) techniques in the management of musculoskeletal neck disorders with nerve-related symptoms (MND-NRS). We conducted a systematic review with meta-analysis, using pain intensity, disability, perceived function, cervical range of motion, and mechanosensitivity as the main outcome measures. The systematic review included 22 studies (n = 978). More favorable outcomes were observed for NM on pain intensity compared with control interventions (standardized mean differences (SMDs) -0.92; 95% CI -1.66-0.18), but not compared with other treatments (OTs) (SMD 1.06; 95% CI -0.02 to 2.15). Regarding neck pain intensity, no significant differences were found in favor of NM compared with OTs (SMD 0.37; 95% CI -0.35 to 1.1). However, between-treatment differences were found in favor of OT on arm-pain intensity (SMD 0.57; 95% CI 0.08-1.05). In addition, the grouped MA did not show statistically significant differences between NM and OT outcomes on the cervical range of motion (SMD 0.16; 95% CI -0.06 to 0.38). However, compared with no intervention, NM was associated with significantly improved outcomes in cervical rotation (SMD 0.91; 95% CI 0.61-1.22). Similar results were found regarding disability (SMD -0.08; 95% CI -0.36-0.20, and SMD -1.44; 95% CI -2.28-0.6, respectively). Finally, NM was associated with more favorable outcomes on mechanosensitivity compared with OT (SMD 0.79; 95% CI 0.15-1.42) and greater improvements in function compared with no intervention (SMD 0.89; 95% CI 0.16-1.62). NM appeared to be effective to improve overall pain intensity when embedded in a physiotherapy treatment in the management of MND-NRS. When compared with no intervention, it was effective to improve neck rotation, disability, and function. However, it was not superior to other types of treatments in improving overall pain intensity, neck pain intensity, arm pain intensity, cervical range of motion and disability, except for mechanosensitivity.

Relationship between workplace ergonomics and musculoskeletal pain, range of motion and spinal deformities in employees: A case study, Kermanshah Oil Refinery

Introduction: Today, the health of human resources in organizations is considered an important arm. This study aimed to investigate the relationship between workplace ergonomics and musculoskeletal pain, joint range of motion (ROM), and spinal deformities in Kermanshah oil refinery staff. Materials and Methods: In the present descriptive-analytical study, all official employees of Kermanshah Oil Refinery (n = 300) were invited to participate in the study, in which 160 employees participated as a statistical sample. The independent variable in this study was workplace ergonomics and the dependent variables including musculoskeletal pain joint ROM and spinal abnormalities. Spinal mouse device was used for spinal deformities assessment, ROSA and RULA forms for workplace ergonomics evaluation, babble baseline inclinometer for measuring the range of motion of the neck, shoulder, thigh, knee, and ankle joints, and Visual Analog scale (VAS) to assess musculoskeletal pain. SPSS software (version 25) and Pearson correlation coefficient were used to investigate the relationship between research variables at a significance level of 0.05. Results: The results showed that there was a negative and significant relationship between ergonomics of the workplace with musculoskeletal pain (p&lt;0.05), hip, neck, shoulder, knee, and ankle joints ROM (p&lt;0.05). There was also a positive and significant relationship between workplace ergonomics and spinal abnormalities (lordosis and kyphosis) (p&lt;0.05). Conclusion: The findings of the study showed, improper workplace ergonomics is significantly associated with chronic musculoskeletal pain, hyperkyphosis, and hyperlordosis abnormalities, and abnormal range of motion of the joints.

Risk factors for non-specific neck pain in young adults. A systematic review

BackgroundYoung adulthood is a sensitive period of life where development of musculoskeletal neck pain may be established and impact future health. The objective of this systematic review was to investigate risk factors for non-specific neck pain in young adults.MethodsSystematic searches were conducted in six databases in September 2019. Prospective cohorts and registry studies including participants in whom the risk factor or the outcome (neck pain) was registered in the ages 18–29 years old were included. The Quality in Prognosis Studies tool was used for quality assessment. A modification of the Grading of Recommendations Assessments, Development and Evaluation was used to assess the overall quality of the evidence. Potential risk factors investigated in more than one study were summarised.ResultsSearches yielded 4527 articles, of which six matched the eligibility criteria. Fifty-six potential risk factors were investigated in the six studies, covering a broad range of domains. Five risk factors were investigated in more than one study (female sex, body mass index (BMI), physical activity, duration of computer use and perceived stress). Physical activity and BMI showed no association with neck pain, and inconsistent results were found for female sex, duration of daily computer use and perceived stress. Risk of bias was moderate or high in all studies, and the overall quality of evidence was very low.ConclusionThe studies included many potential risk factors, but none of them showed consistent associations with neck pain. There is a paucity of high-quality studies investigating risk factors for neck pain in young adults.

Measurement Properties of the Craniocervical Flexion Test: A Systematic Review.

Patients with neck pain commonly have altered activity of the neck muscles. The craniocervical flexion test (CCFT) is used to assess the function of the deep neck flexor muscles in patients with musculoskeletal neck disorders. Systematic reviews summarizing the measurement properties of the CCFT are outdated. The objective of this study was to systematically review the measurement properties of the CCFT for assessing the deep neck flexor muscles. The data sources MEDLINE, EMBASE, Physiotherapy Evidence Database, Cochrane Central Register of Controlled Trials, Scopus, and Science Direct were searched in April 2019. Studies of any design that reported at least 1 measurement property of the CCFT for assessing the deep neck flexor muscles were selected. Two reviewers independently extracted data and rated the risk of bias of individual studies using the COnsensus-based Standards for the selection of health Measurement INstruments (COSMIN) risk-of-bias checklist. The overall rating for each measurement property was classified as "positive," "indeterminate," or "negative." The overall rating was accompanied with a level of evidence. Fourteen studies were included in the data synthesis. The ratings were positive, and the level of evidence was moderate for interrater and intrarater reliability and convergent validity. There was conflicting rating and level of evidence for discriminative validity. Measurement error was indeterminate, with an unknown level of evidence. Responsiveness was negative, with a limited level of evidence. A limitation of this study was that only papers published in English were included. The CCFT is a valid and reliable test that can be used in clinical practice as an assessment test. Because of the conflicting and low-quality evidence, caution is advised when using the CCFT as a discriminative test and as an outcome measure. Future better-designed studies are warranted.

Risk factors and complications of Musculoskeletal Neck Pain among children and adolescents.

Objectives: Neck pain is a frequent spinal pain problem and considered an important health issue in the modern world. Neck pain may originate from intervertebrals discs, ligaments, muscles or of the structures involving the neck. The aim of this study was to find out characteristics along with social and psychological implications of musculoskeletal neck pain amongst children aged 8 to 18 years. Study Design: Descriptive study. Setting: Orthopedic Department of Mayo Hospital, Lahore. Period: From March 2017 to February 2018. Material &amp; Methods: A total of 260 children and adolescents of both genders, aged 8 to 18 years and having musculoskeletal neck pain with spasm were enrolled in this study. A structured questionnaire was interviewed from participants or parents/guardians of this study. Results: Out of a total of 260 cases, there were 125 (48.1%) were boys and 135 (51.9%) girls. Most cases, 158 (60.8%) were between the age of 12 to 18 years while mean age amongst study participants was 14.58+2.63 years. Most of the children, 98 (37.7%) were studying in high school. All 260 cases had flawed flexion of back and neck during study and while using mobile phones or similar devices. Pain location involving neck was recorded in all 260 (100%) study participants while shoulder pain was demonstrated by 188 (72.3%). Most common eye symptoms were eye strain, in 64 (24.6%). Most of the cases, 180 (69.2%) were having irritability while poor communication was noted in 164 (63.1%). Conclusion: Musculoskeletal neck pain is frequent amongst children and adolescents. Hunching the head, neck and shoulders on mobile phones and similar devices, as well as improper posture during studying and watching television increase stress on cervical spine area, may be leading to musculoskeletal neck pain.