Neck Disorders Research Articles

KSHEERA DHOOMA: A TRADITIONAL PRACTICE WITH MULTIFOLD APPLICATION

Ksheera Dhooma is an effective and popular Ayurvedic procedure in which decoction of herbal medicines and cow’s milk are mixed, heated and the emitted vapours are directed through a rubber tube. The steam coming out of the tube is applied to the whole body or the affected part of the patient’s body. It is used in the treatment of facial paralysis, lock jaw and disorders of head and neck, with Vata Dosha imbalance. Though Ksheera Dhooma is considered as a type of Sweda, it is termed as Dhooma because steam is inhaled with gaping mouth. Ksheera Dhooma has multi-fold benefits like facilitating proper blood circulation of the body and relaxation of the mind, lubrication of the joints, relief from pain, spasms and stiffness of the muscles and joints. This study was performed with an aim to review the procedure of Ksheera Dhooma or Palpuka Swedam, understand the standard operating procedure and its efficacy.

Similar effects of fatigue induced by a repetitive pointing task on local and remote light touch and pain perception in men and women.

Women involved in repetitive, fatiguing, jobs develop more neck and/or shoulder musculoskeletal disorders than men. Sex differences in the pain response to exercise could contribute to the higher prevalence of neck/shoulder musculoskeletal disorders in women. The objective of this study was to assess sex differences in pain sensitivity following a fatiguing upper limb task. Relationships between measures of fatigue and of the sensitivity to nociceptive and to non-nociceptive stimulations were also explored. Thirty healthy adults (15 women) performed a fatiguing repetitive pointing task with their dominant arm. Upper limb electromyography was recorded from the dominant upper trapezius, anterior deltoid and bicep brachii and from the contralateral tibialis anterior. Before and immediately after the repetitive pointing task, pressure pain and light touch sensitivity thresholds were measured over the same muscles. Electromyographic signs of fatigue were observed only in the anterior deltoid and biceps brachii muscles. Pressure pain thresholds over both muscles increased slightly (effect size ≤ 0.34), but no changes occurred over the upper trapezius and the tibialis anterior. Light touch thresholds increased moderately to importantly after the repetitive pointing task over all four muscles (effect sizes = 0.58 to 0.87). No sex differences were observed in any sensory variable. Moreover, no or weak correlations (r = -0.27 to 0.39) were observed between electromyographical signs of fatigue, light touch threshold and pressure pain threshold variables. We observed sex-independent effects of a repetitive upper limb task on the sensitivity to painful and to nonpainful stimuli. Moreover, the hypoalgesia induced by the repetitive pointing task was weak and localized, and did not directly correlate with the induced muscle fatigue. Results suggest that fatigue-related changes in the sensitivity to noxious and innocuous stimuli could not explain women's greater prevalence of neck/shoulder musculoskeletal disorders.

How can Head & Neck disorders be a liability to Indian population: Hindrance & Nuisance or Hesitance & Negligence???

Introduction: Head & Neck disorders still remains a “global burden” in the world map till date. With the increasing trend of cancer in the present day scenario and raising parameters of aetiology with varied clinical occurrence, there has been a major plunge at the way things are perceived by a common man in day to day life. Aims & Objectives: To find out the various causes for Head & Neck disorder at our set up. Also to put together and touch upon aspects like risk factors, symptomatology associated with nature of the disease process in this belt of Malnad region. Methodology: 352 patients with Head & Neck disorders were considered for the study over a period of 1 year who were evaluated clinically and radiologically. After initial evaluation, most of them were referred to higher centre for further management. Results: Nearly 75% of patients presented with malignancy with 5 times predominance in males and around 97% patients belonging to the region from oral cavity up to larynx as they have a common epithelial origin. Conclusion: Head & Neck disorders are never to be neglected as it the “runway” to the crux of the body system. Any sort of limitation or hesitation can cost life and well-being.

The effects of a 6-Week balance training in addition to conventional physiotherapy on pain, postural control, and balance confidence in patients with cervical disc herniation: a randomized controlled trial

Purpose Impaired postural control and fear of falling are common symptoms in patients with neck disorders, but the effects of balance training have not yet been sufficiently investigated. The aim of this study was to determine the effects of balance training on neck pain, postural control, and balance confidence in patients with cervical disc herniation (CDH). Materials and methods Thirty patients (21 females and 9 males) aged 18–55 years were randomly assigned into two groups and followed up for 6 weeks, with a 3-day weekly treatment program. Both groups received hot pack therapy, interferential current, and myofascial relaxation and cervical dynamic isometric exercises. The training group also received additional balance training on a force platform with the visual feedback technique. All patients were evaluated using the visual analogue scale for pain intensity, activity specific balance confidence scale (ABC) for balance confidence, centre of pressure with eyes closed-eyes open (CoP-EO/CoP-EC), and the limits of stability tests (LoS) for postural control with a monoaxial bipodal stabilometric force platform pre- and post-intervention. Results The pain intensity was significantly reduced in both groups (p = 0.01). CoP-EO/CoP-EC and LoS results improved in the training group (p = 0.036, p = 0.020, p = 0.23, respectively), whereas no effects were observed in the control group (p = 0.955, p = 0.307, p = 0.363, respectively). Although ABC scores increased significantly in both groups (p = 0.001, p = 0.009, respectively), the increase in the training group was significantly higher than that of the control group (p = 0.003). Conclusions The results of our study revealed that balance training added to the treatment protocol of CDH may have positive results in the treatment of neck problems. Accordingly, balance training in the treatment of chronic neck problems should also be considered for a comprehensive management of CDH

Ultrasound shear wave elastography measurement of the deep posterior cervical muscles: Reliability and ability to differentiate between muscle contraction states

The deep posterior cervical muscles (DPCM), specifically the semispinalis cervicis and cervical multifidus, are often impaired in patients with neck disorders and have been assessed by several imaging techniques. Prior ultrasound shear wave elastography (SWE) imaging and reliability assessments of the DPCM were performed utilizing similar positioning as assessments for the more superficial cervical extensors. Our objectives were to describe an SWE imaging technique for the DPCM, establish intra-rater reliability of DPCM SWE, and compare DPCM shear modulus during rest and submaximal contraction in both prone and seated positions in individuals without spinal pain. In sixteen participants, the DPCM was located using B‐mode ultrasound, then muscle shear modulus was assessed via SWE at both rest and with contraction against a 2‐kg resistance applied at the C2 spinous process. Within‐day intra‐rater reliability was moderate to good (ICC = 0.70–0.88). The DPCM were stiffer during contraction than at rest in the prone position (p = 0.002), and at rest in sitting versus at rest in prone (p = 0.003). Further research is needed to assess DPCM-specific SWE in symptomatic individuals and compare DPCM shear modulus to electromyography across contraction intensities.

Current Procedural Terminology-based Procedure Categorization Enhances Cost Prediction of Medicare Severity Diagnosis Related Group in Spine Surgery.

Retrospective cohort study. The aim of this study was to analyze how a Current Procedural Terminology (CPT)-based categorization method can predict cost variation in surgical spine procedures. Neck and back disorders affect a majority of the adult population and account for tens of billions of dollars in health care spending each year. In the era of bundled payments and value-based reimbursement, it is imperative for surgeons to identify sources of cost variability across surgical spine procedures. Historically, this has been accomplished using Medicare Severity Diagnosis Related Group (MS-DRG) codes, but they utilize an overly simplistic categorization of surgical procedures. The specificity and familiarity of the CPT coding structure makes it a better option for categorizing differences in surgical decision making and technique. Hospital billing data for patients undergoing a surgical spine procedure requiring an overnight, in-patient stay was retrospectively collected over 4 fiscal years (2012-2016) from a single health care system. Linear regression analysis was performed to assess the correlation between cost variation and: spine-specific MS-DRG codes; a novel CPT-based categorization method; and the combination of MS-DRG codes and CPT-based categorization. There were 5020 surgical procedures were analyzed with respect to 16 different MS-DRG codes and 30 distinct CPT-based surgical categories (CSCs). Linear regression results were: MS-DRG R2 = 0.6545 (P < 0.001); CSC R2 = 0.5709 (P < 0.001); and R2 = 0.744 for the combined MS-DRG and CSC methods (P < 0.05). Median difference between the actual and predicted cost for the combined model was -$261.00, compared with -$727.50 for the CSC model and -$478.70 for the MS-DRG model. Addition of the CPT-based categorization method to MS-DRG coding provides an enhanced method to evaluate the association between predicted and actual cost when using linear regression analysis to assess cost variation in spine surgery.Level of Evidence: 3.

Frequency of Neck and Upper Extremity Musculoskeletal Disorders in Dentists

Background: Musculoskeletal disorders are not only becoming prevalent among health care professionals in our country but are affecting their health and performance adversely. They are caused by poor ergonomics and awkward posture during work activities. The purpose of this study was to determine the frequency of neck and upper limb musculoskeletal disorders in dentists of Lahore, Pakistan.&#x0D; Material and Methods: This cross-sectional study was conducted during October 2017 to March 2018. The data was collected using convenient sampling technique from 162 Dentists including 52 males and 110 females of Children hospital Lahore, Punjab Dental hospital and Fatima Memorial Hospital, Lahore. Data was collected by using Mangalore Questionnaire for identification of musculoskeletal disorders. Descriptive analysis of the data was done using SPSS version 22.0.&#x0D; Results: Of 162 dentists, 115 (71%) suffered from musculoskeletal disorders. Shoulder was the most commonly affected region (30.9%) followed by neck (25.9%), arm (6.2%), wrist (4.3%), elbow (3.1%) and forearm (0.6%). Pain (45.7%) was found to be the most common complaint followed by muscle weakness (20.4%), paraesthesia (3.7%) and swelling (1.2%).&#x0D; Conclusions: It was concluded that majority of the dentists were suffering from musculoskeletal disorders with shoulder as the most affected region and pain as the most frequent complaint.&#x0D; Key words: Dentists, Musculoskeletal disorders, Neck pain, Upper extremity

Neck pain among smartphone users: an imminent public health issue during the pandemic time

Neck pain among smartphone users: an imminent public health issue during the pandemic time

An electromyography-assisted biomechanical cervical spine model: Model development and validation

BackgroundIn spite of the prevalence of occupational neck disorders as a result of work force fluctuating from industry to sedentary office work, most cervical spine computational models are not capable of simulating occupational and daily living activities whereas majority of cervical spine models specialized to simulate crash and impact scenarios. Therefore, estimating spine tissue loads accurately to quantify the risk of neck disorders in occupational environments within those models is not possible due to the lack of muscle models, dynamic simulation and passive spine structures. MethodsIn this effort the structure, logic, and validation process of an electromyography-assisted cervical biomechanical model that is capable of estimating neck loading under three-dimensional complex motions is described. The developed model was designed to simulate complex dynamic motions similar to work place exposure. Curved muscle geometry, personalized muscle force parameters, and separate passive and (electromyography-driven) active muscle force components are implemented in this model. FindingsCalibration algorithms were able to reverse-engineer personalized muscle properties to calculate active and passive muscle forces of each individual. InterpretationThis electromyography-assisted cervical spine model with curved muscle model is capable to accurately predict spinal tissue loads during isometric and dynamic head and neck activities. Personalized active and passive muscle force algorithms will help to more robustly investigate person-specific muscle forces and spinal tissue loads.

The clinical consequences of the COVID-19 lockdown: A report from an Italian referral ENT department.

ObjectivesTo evaluate the clinical effects of health care reorganization because of COVID‐19, in a non‐red zone Italian referral department of Otorhinolaryngology.Materials and MethodsWe retrospectively reviewed the statistics of admissions to the Emergency Department (ED) of the Careggi University Hospital, Florence, from January 1, 2020, to May 17, 2020. Data regarding elective and urgent head and neck disorders were reviewed and the most challenging cases were discussed.ResultsDuring the lockdown period, outpatient otolaryngological consultations and elective procedures decreased by 78% and 75% respectively, while emergency/urgency surgery increased by 128%. The five most emblematic clinical cases were thoroughly analyzed.ConclusionOur analysis shows how the profound rearrangement of clinical and surgical activities, along with the citizens' fear to seek medical care has probably exacerbated the management of many routine head and neck conditions.Level of Evidence4.

Ergonomic and At-work Exercises based Educational Program among Nurses Working in Hospital: a Protocol Design regarding Neck Disorders Prevention

Ergonomic and At-work Exercises based Educational Program among Nurses Working in Hospital: a Protocol Design regarding Neck Disorders Prevention

Effects of manual continuous home cervical traction in cervical spondylosis

Background: Cervical spondylosis is the results of disc degeneration with associated osteophytosis. Cervical traction is widely used to treat neck disorders. Rehabilitation treatment like cervical traction along with other measures at home may play an important role to reduce symptoms of the patients with cervical spondylosis.&#x0D; Objective: A randomised clinical trial was conducted among 125 patients having cervical spondylosis to find out the effects of manual continuous home cervical traction.&#x0D; Methods: The patients were selected on the basis specific selection criteria. They were subdivided into two groups. In Group-A (manual continuous home cervical traction group), 61 patients were treated with exercise, cervical collar, neck support, manual continuous home cervical traction, NSAID, warm moist compression and instruction in posture. In Group-B (conventional treatment receiving group), 64 patients were treated with exercise, cervical collar, neck support, warm moist compression, NSAID and instruction in posture.&#x0D; Results: Among the subjects there were 68 (54.4 %) male and 57 (45.6 %) female. The mean age of the subjects was 45.94 ± 11.65 years. There was marked improvement of symptoms of the patients of Group-A in response to treatment for 6 weeks (p &lt; 0.007). It indicates that manual home cervical traction was found effective to reduce the sign and symptoms of cervical spondylosis. There was improvement after treatment in Group-B also (p &lt; 0.01). It indicates that conventional treatment was also found effective. In comparison, there was no significant difference between two groups (p &lt; 0.36, 95% CI= ‐0.56 to 1.51) found after first week. But there was significant improvement in Group-A than Group-B after six weeks of treatment (p &lt; 0.003, 95% CI= -2.40 to -0.51).&#x0D; Conclusion: It may be concluded that manual continuous home cervical traction is beneficial for the patients with cervical spondylosis.&#x0D; Bangladesh Med Res Counc Bull 2020; 46(2): 128-133

How can Head &amp; Neck disorders be a liability to Indian population: Hindrance &amp; Nuisance or Hesitance &amp; Negligence???

Introduction: Head &amp; Neck disorders still remains a “global burden” in the world map till date. With the increasing trend of cancer in the present day scenario and raising parameters of aetiology with varied clinical occurrence, there has been a major plunge at the way things are perceived by a common man in day to day life. Aims &amp; Objectives: To find out the various causes for Head &amp; Neck disorder at our set up. Also to put together and touch upon aspects like risk factors, symptomatology associated with nature of the disease process in this belt of Malnad region. Methodology: 352 patients with Head &amp; Neck disorders were considered for the study over a period of 1 year who were evaluated clinically and radiologically. After initial evaluation, most of them were referred to higher centre for further management. Results: Nearly 75% of patients presented with malignancy with 5 times predominance in males and around 97% patients belonging to the region from oral cavity up to larynx as they have a common epithelial origin. Conclusion: Head &amp; Neck disorders are never to be neglected as it the “runway” to the crux of the body system. Any sort of limitation or hesitation can cost life and well-being.

Influences of Neck and/or Wrist Pain on Hand Grip Strength of Industrial Quality Proofing Workers.

BackgroundThe aim of this study was to analyze the interaction between neck and/or wrist pain and hand grip strength (HGS) and to investigate factors (age, sex, neck disorders, and carpal tunnel syndrome) influencing the HGS of industrial quality proofing workers (N = 145).MethodsStandardized questionnaires [Neck Disability Index (NDI), Boston Carpal Tunnel Questionnaire] were used to evaluate existing neck and/or wrist pain. HGS measurements were performed in different wrist positions.ResultsSignificant differences between participants with and without neck pain were found in different wrist positions, in neutral wrist position right [without neck pain (n = 48) 46.34 (43.39 – 49.30); with neck pain (n = 97) 38.46 (36.20 – 40.72), F(1,144) = 16.82, p < 0.001, ŋp2 = 0.11] and left [without neck pain 44.06 (41.19 – 46.94); with neck pain 37.36 (35.13 – 39.58), F(1,144) = 12.70, p < 0.001, ŋp2 = 0.08]. A significant difference between participants with and without wrist pain was found for neutral wrist position right [without wrist pain (n = 105) 42.53 (40.37 – 44.70); with wrist pain (n = 40) 37.24 (33.56 – 40.91), F(1,144) = 6.41, p = 0.01, ŋp2 = 0.04]. Regression analysis showed significant results especially for steps two (age and weight, NDI) and three (age and weight, NDI, Boston Carpal Tunnel Questionnaire) for neutral position right (R2 = 0.355, R2 = 0.357, respectively).ConclusionNeck pain has an impact on HGS but should be evaluated in consideration of age and sex.

Work Related Musculoskeletal Disorders in Electrical, Telecommunication and Instrument Mechanics of Armed forces

Background: Modern defence system has a significant role of electrical, electronic and instrument technicians in armed forces. Despite their intensive role, little is known about work-related musculoskeletal disorder in these technicians.&#x0D; Objective: To investigate the prevalence of the work-related musculoskeletal disorder in defence personnel involved in electrical and electronic maintenance and repairs.&#x0D; Methods: A cross-sectional study was carried out for 3 years, in Electrical, telecom and instrument defence technicians (N = 164). Prevalence of work-related musculoskeletal disorder was assessed using the Nordic Musculoskeletal Questionnaire. Effect of age, working hours, work experience, Basal metabolic index and type of job on the prevalence of work-related musculoskeletal disorder was investigated using logistic regression analysis.&#x0D; Results: A total of 119 (72.56%) respondents reported work-related musculoskeletal disorder with 53.04% multiples &amp; 19.51% single work-related musculoskeletal disorder. Simultaneous presence of neck, shoulder and upper back work-related musculoskeletal disorder were observed. Highest rate of work-related musculoskeletal disorder was in neck (44.44%), followed by shoulder (27.16%), ankle/ foot (14.81%), elbow/ forearm (12.96%), low back (11.72%) and wrist/ finger (9.87%). Neck (44%) related work-related musculoskeletal disorder were highest across all job crafts. Work experience (p = 0.012; OR = 0.87; 95% CI – 0.78- 0.97), working hours (p = 0.031; OR= 1.73, 95% CI – 0.58-5.12) smoking (p = 0.00 ; OR = 5.3, 95 % CI = 4.3 – 8.48) and job crafts like electrician (p = 0.434; OR = 1.89, 95% CI = 1.08-3.31) and telecom mechanics (p = 0.026; OR = 1.26, 95% CI =0.74 – 2.15) were significantly associated as risk factors of work-related musculoskeletal disorder.&#x0D; Conclusion: High prevalence of work-related musculoskeletal disorder was observed in electrical, telecommunication &amp; instrument mechanics, with higher multiple work-related musculoskeletal disorder. Working hours, work experience, job craft and smoking were highly associated with a work-related musculoskeletal disorder. We suggest suitable ergonomic intervention and awareness program along with smoking control drive to reduce the risk of work-related musculoskeletal disorder.

Evaluation of biomechanical risk factors for neck and back disorders in traditional bakers during a work-day: Implications for ergonomics intervention

Awkward back and neck postures have been recognized as one common problem in bakery workers. This study aimed to evaluation of the biomechanical risk factors on the back and neck of bakers. Twenty bakers of four types of bread- baking systems were randomly selected. Working postures and movements of the back and neck during work were continuously recorded with inclinometry measurements during three hours. Physical workload in bakers was characterized by awkward postures and the percentage of time spent with the neck flexed more than 20°. Besides, low angular velocity and lack of postural variation during baking shows that bakers’ back is in the static position and bakers have to work with constrained back for a long time. The current findings have important implications for prioritizing ergonomic interventions and any ergonomic interventions should be focused on reducing neck flexion and constrained postures of the back.

Electromyographic activity of the neck muscles: Effects of varying standing height-derived teaching board heights.

Despite the increasing emergence of modern facilities, the ancient practice of writing on a teaching board is still common in the teaching profession. Ergonomic guidelines of this practice are required for the prevention of work-related neck musculoskeletal disorders inherent of teachers. This study investigated the effects of varying teaching board heights on the activities of the neck muscles. Thirty participants (15 males and 15 females) participated in this experimental study. Each performed writing tasks on a teaching board set at five different heights derived from their standing height (SH) [(D 10 = SH minus 10% of SH; Norm H = SH; Sum 10 = SH plus 10% of SH; Sum 20 = SH plus 20% of SH; Sum 25 = SH plus 25% of SH)]. Electromyographic (EMG) activities of both components of the sternocleidomastoid and upper trapezius muscles were measured during each task. Asymmetry ratio of right and left muscle components were determined. Data were analyzed with one-way ANOVA. EMG activities of the four muscles as well as their asymmetry ratios significantly (p< 0.01) increased with increasing board heights. Teaching board-related tasks have increased possibilities of inducing neck disorders when performed beyond Norm H vertical heights.

Neck and shoulder disorders in medical secretaries. Part II. Ergonomical work environment and symptom profile

Seventy-nine medical secretaries with neck and shoulder pain were included in a study aimed at an in-depth description of the ergonomical work environment and the participant's symptom profile, as well as analysing relationships between ergonomical factors and symptoms. Data were collected by daily ratings, questionnaires, and direct observation. The symptom profile showed low mean daily ratings of perceived fatigue and pain, a low medicine consumption, and few stress symptoms. A mean number of 2.1 undesirable work postures was observed. The correlations between perceived fatigue, pain, and well-being with number of shifts from sitting to standing and time spent typing, were generally small. This study suggests that risk factors for neck and shoulder pain are individual and multifactorial.

Neck and shoulder disorders in medical secretaries. Part I. Pain prevalence and risk factors

420 medical secretaries took part in a cross-sectional study at examining the prevalence of musculoskeletal disorders as well as the relationship between neck and shoulder pain and possible risk factors. Sixty-three percent had experienced neck pain sometime during the previous year and while 15% had suffered almost constant pain 32% had experienced neck pain only occasionally. Shoulder pain during the previous year had been experienced by 62%, 17% had suffered almost constant pain while 29% experienced pain only occasionally. Fifty-one percent had experienced low back pain. Age and length of employment were significantly related to neck and shoulder pain. Furthermore, working with office machines 5 hours or more per day was associated with a significantly increased risk for neck pain (OR 1.7), shoulder pain (OR 1.9) and headache (OR 1.8). Finally, a poorly experienced psychosocial work environment was significantly related to headache, neck, shoulder and low back pain. The results of this study suggest that work with office machines as well as the psychosocial work environment are important factors in neck and shoulder pain

Musculoskeletal Consequences in Cyber-Addicted Students - Is It Really A Matter of Health? A ROC Curve Analysis for Prioritizing Risk Factors.

Background: The high prevalence and also multiple consequences of addiction to various online content, including online games and social networks, have become a major challenge. The ability to predict musculoskeletal disorders from this addiction can help reveal in students' health status in the near future. The aim of this study was to determine the prevalence of this addiction and the ability to predict neck pain from this matter in students. Study Design: A cross sectional study. Methods: This study was carried out among 665 students. Data collection was performed through three questionnaires on problematic use of online games, social networking addiction, and Nordic musculoskeletal disorders. Data were compared with Chi-square and independent T-test, and the logistic regression model was then presented at a significant level of 0.05. Finally, the area under the receiver operating characteristic (ROC) curve and Discriminant analysis were conducted to clarify associations. Results: The prevalence of Internet-related content addiction was 32.8%. The results showed that addiction to social networks and online games can increase the risk of neck disorder. Also 0.58 area under ROC curve depicted the ability to predict neck pain from this addiction. Conclusions: In students with internet - related content addiction, neck disorder can be predicted. Given the high prevalence of internet addiction in students, it is essential to take immediate and appropriate interventions to avoid the associated adverse effects such as neck problems.