Neck Range Of Motion Research Articles

Full-Endoscopic Anterior Odontoid Screw Fixation: A Novel Surgical Technique.

ObjectiveFirst, to propose a novel minimally invasive technique of full‐endoscopic anterior odontoid fixation (FEAOF) that aims to reduce the risk of retropharyngeal approach (both open and percutaneous techniques) to anterior odontoid screw fixation. Second, to describe steps of the procedure and, lastly, to report the initial outcomes in patients treated with this novel technique.MethodsFour non‐consecutive patients who were diagnosed with a displaced odontoid fracture (Anderson‐D'Alonzo classification type II and Grauer subclassification type A or B) from 2019 to 2020 underwent surgical fixation by our novel technique for anterior odontoid screw fixation. A detailed technical approach of FEAOF for the surgical treatment of type II odontoid fractures was described, and the patients' outcomes based on postoperative radiographic results including computed tomography (CT), clinical outcome parameters including visual analogue scale (VAS) for neck pain both preoperatively and at postoperative follow‐up, and range of neck motion at the final follow‐up were reported.ResultsThe mean age was 33.5 years (24–41), three patients were male. The mean operative time was 93.75 min, and the mean blood loss was 7.5 ml. An immediate post‐operative thin‐sliced CT showed that all patients achieved satisfactory reduction and proper screw position. No screw malposition or penetration was found. At a 6‐month follow‐up, a thin‐sliced CT demonstrated solid bony union in every case. The mean VAS for neck pain was reduced from 6.5 to 0.6 at the 6‐months follow‐up. At the final follow‐up, all patients showed improvement in ranges of motion without any complications; however, one patient was lost to follow‐up.ConclusionsFEAOF is a feasible and effective option for treating type II odontoid fractures. The procedure is less invasive than other techniques and provides clear direct visualization of the involved structures.

Cervical Sprain With Residual C1-C2 Laxity as Source of Fibromyalgia and Multiple Sclerosis Symptoms?

Research Objectives To evaluate the upper cervical segmental mobility in patients with a remote history of trauma presenting with persistent fibromyalgia symptoms with evidence of persistent cervical sprain pain. Design Chart review. Setting Outpatient clinic. Participants Patients with history diagnosed with fibromyalgia and demonstrating (1) frequent headache on awakening, (2) pain/increased symptoms with neck range of motion, (3) pain with resistance to neck motion, (4) relief during cervical traction, (5) and typical fibromyalgia symptoms. Interventions CT of the cervical spine including rotation views. Main Outcome Measures Skeletal mobility per CT scan including Cranium, C1, and C2 rotation in degrees Results Analysis reveals that only one of the individuals had < 30 degrees rotation of C1 on C2, versus 14 of 20 having > 35 degrees and 7 of 20 having > 40 degrees rotation of C1 on C2 suggesting ligamentous laxity. Of note, none of the individuals had > 5 degrees rotation of cranium on C1, suggesting greater stability when compared to C1-C2. Conclusions In addition to upper spinal cord, the vertebral-basilar arteries supply the cerebellum, medulla oblongata, midbrain, pons, thalamus, and other areas in the posterior cranium. Symptoms of ischemia involving these areas include dizziness, gait disturbance, limb weakness, dysarthria, headache, nausea, cranial nerve, visual and other sensory dysfunctions. This sampling of persistent neck pain patients demonstrates significant rotational mobility that may involve the vertebral arteries at C1 and C2 in particular, contributing to symptoms similar to those with documented ischemia in the vertebrobasilar distribution. Alternatively, direct compression at cervical spinal cord-medullary junction from C1-2 laxity is illustrated in sagittal view MRI image. Here is seen anterior cranial migration relative to spinal canal compressing the spinal cord at its medullary junction. It is noteworthy that 4 individuals in this small sample developed plaque in the vertebrobasilar distribution and subsequently confirmed to have multiple sclerosis. Whether or not there is a relationship between ligamentous laxity in the upper cervical spine and development of fibromyalgia and/ or multiple sclerosis remains to be demonstrated. Author(s) Disclosures None to declare. To evaluate the upper cervical segmental mobility in patients with a remote history of trauma presenting with persistent fibromyalgia symptoms with evidence of persistent cervical sprain pain. Chart review. Outpatient clinic. Patients with history diagnosed with fibromyalgia and demonstrating (1) frequent headache on awakening, (2) pain/increased symptoms with neck range of motion, (3) pain with resistance to neck motion, (4) relief during cervical traction, (5) and typical fibromyalgia symptoms. CT of the cervical spine including rotation views. Skeletal mobility per CT scan including Cranium, C1, and C2 rotation in degrees Analysis reveals that only one of the individuals had < 30 degrees rotation of C1 on C2, versus 14 of 20 having > 35 degrees and 7 of 20 having > 40 degrees rotation of C1 on C2 suggesting ligamentous laxity. Of note, none of the individuals had > 5 degrees rotation of cranium on C1, suggesting greater stability when compared to C1-C2. In addition to upper spinal cord, the vertebral-basilar arteries supply the cerebellum, medulla oblongata, midbrain, pons, thalamus, and other areas in the posterior cranium. Symptoms of ischemia involving these areas include dizziness, gait disturbance, limb weakness, dysarthria, headache, nausea, cranial nerve, visual and other sensory dysfunctions.

온라인 수업 시 자가 스트레칭 운동이 경부 가동범위와 근활성도에 미치는 영향

The purpose of this study was to analyze the effect of self-stretching exercise on neck range of motion and muscle activity during online classes. The conclusion is as follows. First, there was no significant difference in neck range of motion and muscle activity pre and post online class in the test group. Second, there were significant differences in neck range of motion and muscle activity before and after online classes in the control group. Third, there was no significant difference in neck range of motion and muscle activity before online classes between the test group and the control group. Fourth, there was a significant difference in neck range of motion after online class between the test group and the control group, but there was no significant difference in neck muscle activity. As a result of this study, it can be seen that the self-stretching exercise performed by the experimental group was effective. And in the case of the control group, if the online class time is prolonged, it may cause musculoskeletal disorders, so it is judged that it is necessary to find various intervention methods to solve this problem.

Measurement properties of smartphone applications for the measurement of neck range of motion: a systematic review and meta analyses

BackgroundSmartphone applications offer an accessible and practical option to measure neck range of motion (ROM) and are becoming more commonly used in clinical practice. We assessed the validity, reliability, and responsiveness of smartphone applications (apps) to measure neck ROM in people with and without neck pain.MethodsA comprehensive electronic search strategy of the main electronic databases was conducted from inception until June 2021. The identified studies investigated apps which measured neck ROM, and evaluated their validity, reliability, or responsiveness, in adult participants with neck pain or asymptomatic individuals. Two independent reviewers determined eligibility and risk of bias following COSMIN guidelines. The quality of evidence was assessed according to the GRADE approach.ResultsEleven studies, with a total of 376 participants were included. Three types of apps were identified: clinometer apps, compass apps, and other apps of ‘adequate’ to ‘doubtful’ risk of bias. A meta-analysis revealed ‘good’ to ‘excellent’ intra-rater and inter-rater reliability across the three types of apps. The overall validity was rated from ‘moderate’ to ‘very high’ across all apps. The level of evidence was rated as ‘low’ to ‘very low’.ConclusionSmartphone applications showed sufficient intra-rater reliability, inter-rater reliability, and validity to measure neck ROM in people with and without neck pain. However, the quality of evidence and the confidence in the findings are low. High-quality research with large sample sizes is needed to further provide evidence to support the measurement properties of smartphone applications for the assessment of neck ROM. Study registrationFollowing indications of Prisma-P guidelines, this protocol was registered in PROSPERO on 1/05/2021 with the number CRD42021239501.

Development of a Rehabilitation Instrument of Neurological Training for Cervical Spine

Objective: To develop a kind self active resistance movement training equipment for cervical spine, so as to restore the dynamic balance of the front and back muscle strength of the cervical spine in order to correct the abnormal physiological radian of the cervical spine, thereby relieving the clinical symptoms. Methods: The air spring with adjustable strength was used to provide the power of resistance active movement, and the neurological training cervical audio-visual synthesis training software was used to automatically guide patients to perform resistance active movement training of the cervical spine. Thirty two patients with cervical spondylosis were enrolled for treatment, and SPSS26 was used to statistically analyze the VAS, Lovett muscle strength, head and neck range of motion and C2-3 vertebral body curvature before and after the treatment. Result: There were significant differences in posterior cervical muscle strength (Lovett), dizziness, shoulder and neck pain (VAS) and C2-3 vertebral curvature before and after training in 32 patients (p˂0.001). Conclusion: The application of neurological training cervical vertebra self rehabilitation training instrument can effectively relieve clinical symptoms, restore head and neck range of motion, improve nape muscle strength, restore the dynamic balance of front and rear cervical muscle strength, and also can correct the abnormal physiological radian of the cervical vertebra.

Neck Motion Restriction Negatively Affects Turning Stability in Community-Dwelling Older Adults with and without a History of Falls

Background: Many older adults fall while turning. During the turning maneuver, rotation of the head precedes the rest of the body, creating a spatial frame of reference. Limitations of the neck rotation, may interfere with the turning mechanism, affect stability, and lead to recurrent falls. However, the association between the range of the neck rotation and turning stability was not explored yet. Purpose: To compare the impact of restricting the neck rotation by a brace, on the turning stability of adults with and without a history of falls. Methods: An observational, cross-sectional study consisting of 59 adults (average age 76 ± 6.9). A group (N = 29) with at least 2 falls (FL) in the last year and a group (N = 30) without a history of falls in the last year (NFL). All participants performed three tests: Timed up and Go (TUG), 180° Turn Test (180 TT) and 360° Turn Test (360 TT) with and without a neck brace. Results: All the scores of the FL were lower than those of the NFL (p Application of the brace worsened the performance of the 180 TT and the 360 TT of both groups (p Conclusions: Restricting of the neck mobility worsened the turning stability of both groups but without interaction. The study reinforces the need of considering the neck range of motion when addressing adult stability. A decrease in the range of right neck rotation was identified as a risk factor for loss of balance.

Manual Therapy Approach to the Extraocular Muscles in Migraine Treatment: A Preliminary Study.

The oculomotor system plays an important role in the development of migraines. This is an observational study that aims to investigate the rehabilitative efficacy of muscle energy therapy (MET) in reducing migraine symptoms. MET was based on post-isometric relaxation and reciprocal inhibition, targeting the extraocular muscles. Patients diagnosed with chronic migraines and positive results in the Smooth Pursuit Eye Movement Test were enrolled in the study. The effects of treatment were assessed using the following questionnaires: Migraine Disability Assessment (MIDAS), Neck Disability Index (NDI), Pittsburg Sleep Quality Index (PSQI), Dizziness Handicap Inventory (DHI), and the neck range of motion (ROM). Additionally, rheological parameters of neck muscles were assessed. We reported beneficial effects of MET on the amelioration of the frequency of headaches, neck pain and dizziness-related disabilities and disordered sleep. However, benefits concerning the neck motion and rheological properties of oculomotor structures were unconvincing. In conclusion, the study showed advantageous effects of manual oculomotor therapy consisting of reductions in migraine-related painful symptomatology. The results diminish the role of ocular muscle mechanical properties in the genesis of migraine, shifting attention to the modulatory role of the neuromuscular ocular component, likely involving trigeminal innervation, which can be subject to migraine manual therapy.

Are Measures of Physical Function of the Neck Region Associated With Poor Prognosis Following a Whiplash Trauma?: A Systematic Review.

The objective of this study was to synthesize the current evidence regarding the predictive ability of measures of physical function (PF) of the neck region and perceived PF on prognosis following a whiplash injury. Electronic databases were searched by 2 independent reviewers up to July 2020, including MEDLINE, EMBASE, CINAHL, PsycINFO, Scopus, and Web of Science as well as gray literature. Eligible studies were selected by 2 reviewers who then extracted and assessed the quality of evidence. Observational cohort studies were included if they involved participants with acute whiplash-associated disorders (WAD), followed for at least 3 months postinjury, and included objective measures of neck PF or self-reported measures of PF as prognostic factors. Data could not be pooled and therefore were synthesized qualitatively. Fourteen studies (13 cohorts) were included in this review. Low to very low quality of evidence indicated that initial higher pain-related disability and higher WAD grade were associated with poor outcome, while there was inconclusive evidence that neck range of motion, joint position error, activity of the superficial neck muscles, muscle strength/endurance, and perceived functional capacity are not predictive of outcome. The predictive ability of more contemporary measures of neck PF such as the smoothness of neck movement, variability of neck motion, and coactivation of neck muscles have not been assessed. Although initial higher pain-related disability and higher WAD grade are associated with poor outcome, there is little evidence available investigating the role of neck PF on prognosis following a whiplash injury.

A rare case\xa0as different cause of retropharyngeal and spinal epidural abscess: spondylodiscitis

BackgroundRetropharyngeal abscess (RPA) is a life-threatening, dangerous condition and uncommon in adults. The coexistence of RPA, cervical spinal epidural abscess (CSEA), and spondylodiscitis is extremely rare.Case presentationWe present a case with a retropharyngeal and epidural abscess caused by spondylodiscitis. A 61-year-old man was referred to our clinic with the complaints of sore throat, limitation in neck range of motion, numbness, and weakness in the left arm and the left ear for one month. The airway was not obstructed. Neurological deficits were detected in his left arm. Cervical computed tomography revealed a 50 × 30 × 15 mm retropharyngeal abscess. Cervical magnetic resonance imaging showed abscess, C5–6 spondylodiscitis and epidural abscess, and myelopathic signal changes in the C3–7 spinal cord. The abscess was drained, and C5–6 discectomy was performed. The patient was discharged with cervical collar and antibiotics.ConclusionsMultidisciplinary approach that consists of otolaryngologist, neurosurgeon, and infectious disease specialist is needed to avoid complications and any delay.

Comparing Between the Effects of Dry Needling and Shock Wave in the Treatment of Trapezius Myofascial Pain

Introduction: Musculoskeletal disorders are important causes of pain. Trigger points are one of the common reasons for myofascial pain. This study aimed to compare a single session of dry needling versus a single session of shock wave therapy on the level of pain and Range of Motion (ROM) in the people with Myofascial Pain Syndrome (MPS) of the upper trapezius muscle. Materials and Methods: Sixteen men with active trigger points of upper trapezius muscle were voluntarily attended in this study. They were randomly assigned into two groups. The patients were under a single session treatment of either dry needling or shock wave therapy. Level of pain (by Visual Analog Scale [VAS]) and active ROM of neck lateral flexion (by goniometer) were evaluated once before the treatment and immediately after the intervention. Results: The VAS scores and the neck ROMs were substantially improved at both groups of study immediately after the treatment (P&lt;0.012). However, there were no significant differences between the two groups of interventions in terms of the VAS and ROM scores (P&gt;0.05). Conclusion: Both dry needling and shock wave therapy can improve neck pain and ROM in patients with active trigger points in the upper trapezius muscle.

Immediate effect of a motor control exercise target to the neck muscles on upper cervical range of motion and motor control in patients with temporomandibular disorder

ObjectiveTo evaluate whether a single specific motor control training session for the neck flexor and deep extensor muscles improves upper cervical range of motion and neck motor control in patients with temporomandibular disorder (TMD) and compare them to a group without TMD. MethodsThis is a before and after, controlled study. The TMD group included women aged between 18-45 years old, complaining of pain in the orofacial region in the last 6 months and diagnosed with masticatory myofascial pain according to Research Diagnostic Criteria (RDC/MD). The control group included match-controls without TMD. The participants were evaluated to global and upper (Flexion Rotation Test - FRT) neck range of motion (ROM) and to neck motor control (Cranio-Cervical Flexion Test - CCFT). They were treated with a protocol of specific motor control exercises targeted to flexor and extensor neck muscles for 30 minutes. One day after the protocol the patients were reevaluated. ResultsA total of 23 volunteers were evaluated. The TMD group showed immediate improvement in left cervical rotation (p=0.043) and right FRT (p=0.036), while the control group did not show any improvement. There was no difference between the groups before and after treatment in relation to cervical movements. Regarding cervical motor control in both groups, the highest prevalence was of results between 24 and 26 mmHg after treatment, different from before the intervention (20 and 22 mmHg) in both groups.ConclusionA single session of specific neck motor control training only improved the left cervical rotation and upper right rotation in the TMD group, but not in the control group. There is no difference at the end of treatment between the groups. Volunteers with TMD showed improvement in the pattern of motor control of the neck when compared to volunteers without TMD.

Exercise Effects on Neck Function Among F-15E Aircrew

BACKGROUND: Neck pain (NP) is common among high performance aircrew, yet evidence remains insufficient to guide examination, treatment, and prevention. The purpose of this randomized pilot study was to collect baseline data for neck function for F-15E aircrew and determine efficacy and feasibility of two separate exercise protocols in measuring short-term outcomes of subjective and objective neck function in order to inform future study design. METHODS: Randomized to either progressive (PRO) or general (GEN) exercise groups were 41 F-15E aircrew. Data collection occurred at baseline, 3 wk, and 3 mo. RESULTS: At baseline, 39% of the subjects reported current NP, 79.5% reported a history of NP attributed to flying, 12.8% reported being removed from flying duties due to NP, and 10% reported receiving medical care for NP. PRO and GEN group randomization showed similar baseline assessment data. Blinding was successful and exercise logs showed 31.6% compliance with prescribed exercise regimens. There were small but statistically significant increases in neck range of motion in both groups over the course of the study. Aircrew with current NP had significantly higher F-15E flight hours. DISCUSSION: This study supports the high prevalence of NP in aircrew, yet low frequency of seeking care for NP. Future studies to assess NP prevention and treatment in aircrew require an integrated approach that includes operational exercise policy and long-term data collection in flying units with dedicated resources for assessment and analysis. Lee MS, Briggs R, Scheirer V, Kearby G, Young BA. Exercise effects on neck function among F-15E aircrew. Aerosp Med Hum Perform. 2021; 92(10):815824.

Effect of Sling with Cervical Spine Lateral Mobilization on the Range of Motion and Muscle Stiffness of Cervical Region in Healthy Subjects

Background: Cervical spine mobilization is an effective intervention method to increase cervical range of motion (ROM). However, whether using a sling with cervical spine mobilization can provide a similar positive effect in improving ROM and muscle stiffness as conventional cervical spine mobilization has not yet been proven. Objectives: To investigated the effects of sling with cervical spine lateral mobilization on improving neck ROM and muscle stiffness in healthy subjects. Design: A two-group pre-posttest design. Methods: A total of 20 healthy subjects were allocated to a sling with cervical spine mobilization (SWCM) group (n=10) and a cervical spine mobilization (CM) group (n=10). The mobilization exercise at grade Ⅳ+ amplitude was applied to the left-side and right-side C3-C4 and C4-C5 of each group for three sets. The mobilization exercise was performed for 30 seconds (frequency of two vibrations per second), with a 30-second resting time. The active cervical ROM, muscle tone, and muscle stiffness of the cervical region of each group was measured and compared before and after the intervention. Results: The active cervical ROM of both groups significantly improved after the intervention (p<.05). However, no significant differences in the cervical active ROM, cervical muscle tone, and muscle stiffness were observed between two groups. Conclusion: The application of sling with cervical spine lateral mobilization is an intervention method that can be effectively used to improve the physiological movement of the neck, as well as cervical muscle tone and stiffness.

Effect of a Supervised Stretching Program on Neck, Shoulder, and Trunk Range of Motion in Older Women.

Upper body and neck range of motion (ROM) are important for safe walking and driving. The purpose of this study was to determine whether stretching would improve neck, trunk, and shoulder ROM. Forty-eight community-dwelling women (75 ± 3 years of age) were randomly allocated to intervention (upper body stretching, n = 15) and control conditions (lower body power training, n = 33). All participants exercised in supervised 45-minute sessions twice weekly for 12 weeks. Testing of upper body ROM included a cervical ROM, device-based measurement and field tests of the neck, trunk, and shoulder ranges. Shoulder ROM was the only movement that improved in the intervention group beyond levels seen in control participants (33% increase, p < 0.01). Neck and trunk ROM did not change in response to a specific stretching program. Older adults with ROM limitations may need to explore other exercise options or focus on compensatory strategies for safe community mobility.

청소년의 스마트폰 사용 중 간헐적 경부 스트레칭 운동이 근골격계 건강위험요인에 미치는 영향

The purpose of this study was to analyze how intermittent stretching exercise affects musculoskeletal health risk factors(neck range of motion, muscle activity, pressure pain) when using the smartphone in adolescents. The results of this study are as follows. First, there was no significant difference in musculoskeletal health risk factors pre and post smartphone use in the experimental group. Second, there were significant differences in musculoskeletal health risk factors pre and post smartphone use of the control group. Third, there was no significant difference in musculoskeletal health risk factors before the use of smartphone in the experimental group and the control group. Fourth, the musculoskeletal health risk factors before the use of smartphone in the experimental group and the control group showed a significant difference in muscle activity of the levator scapula, and no significant difference in other factors. From the above results, it was found that when adolescents use their smartphones for 60 minutes without stretching exercises in a chair sitting position, it was found that the musculoskeletal system (neck range of motion, muscle activity, pressure pain) was negatively affected, but 15 minutes It was found that the negative effects on the musculoskeletal system were significantly reduced when simple neck stretching exercises were performed in units.

Immediate effects of positional release therapy and manual trigger point release on neck pain and range of motion in computer users with upper trapezitis.

Background/Objective:The intent of the current study was to compare the immediate effects of positional release therapy (PRT) and manual trigger point release (MTpR) on neck range of motion and pain in upper trapezitis.Materials and Methods:Sixty participants with upper trapezius myofascial trigger points (MTrPs)’ participated in this study. Subjects were randomly classified into two groups (30 in each group): the subjects in Group A received PRT in a shortened position while those in Group B received MTpR in the neutral position for the upper trapezius muscle. They received four therapy sessions every day for four days. The pain intensity and range of motion were measured using the Numerical Pain Rating Scale (NPRS) and cervical range of motion (CROM), respectively, before treatment sessions and repeated immediately after the first and fourth treatment sessions in each group till the last day of their interventions.Results:Paired and unpaired t-Test was used for the data analysis. Pre- and postinterventional effects measured on each day and between groups, revealed that CROM and NPRS values were significantly improved in (MTpR) group (CROM, and NPRS P < 0.05).Conclusion:Both groups (PRT and MTpR) showed an increase in range of motion on CROM and a decrease in pain intensity on the NPRS during four sessions of therapy, but MTpR showed to be more effectual in these participants.

Focus on the Scapular Region in the Rehabilitation of Chronic Neck Pain Is Effective in Improving the Symptoms: A Randomized Controlled Trial.

Chronic neck pain is a common human health problem. Changes in scapular posture and alteration of muscle activation patterns of scapulothoracic muscles are cited as potential risk factors for neck pain. The purpose of this study was to compare the effects of neck exercise training (NET) with and without scapular stabilization training (SST) on pain intensity, the scapula downward rotation index (SDRI), forward head angle (FHA) and neck range of motion (ROM) in patients with chronic neck pain and scapular dyskinesia. A total of sixty-six subjects with chronic neck pain and scapular dyskinesia were randomly divided into three groups: neck exercise training, n = 24, combined training (NET + SST), n = 24 and a control group, n = 24. Pain intensity, SDRI, FHA and ROM were measured by the numerical rating scale, caliper, photogrammetry and IMU sensor, respectively. When the combined intervention group consisting of NET and SST was compared with NET alone at six weeks, there was a statistically significant difference in pain intensity, SDRI, FHA and cervical ROM for flexion and extension (p ≤ 0.05). Adding scapular exercises to neck exercises had a more significant effect in decreasing pain intensity, SDRI, FHA and increased cervical ROM than neck exercises alone in patients with chronic neck pain. These findings indicate that focus on the scapular posture in the rehabilitation of chronic neck pain effectively improves the symptoms.

Comparative effectiveness of routine physical therapy with and without instrument assisted soft tissue mobilization in patients with neck pain due to upper crossed syndrome.

To determine the effectiveness of routine physical therapy with and without instrument-assisted soft tissue mobilisation on pain intensity and range of motion in patients with neck pain due to upper crossed syndrome. The randomised controlled trial was conducted from January to March 2020, and comprised diagnosed male patients aged 18-40 years of upper crossed syndrome complaining of neck pain visiting the Agile Physical Therapy and Rehabilitation Complex and the National Orthopaedic Hospital, Bahawalpur, Pakistan. The subjects were randomised into control group A which received routine physical therapy and experimental group B which received instrument-assisted soft tissue mobilization along with routine physical therapy. The inclinometer was used to measure range of motion and the numeric pain rating scale for pain measurement. Data was analysed using SPSS 22. Of the 60 subjects, there were 30(50%) in group A with a mean age of 31.50±6.388 years and 30(50%) in group B with a mean age of 32.60±5.55 years. Pain rating at baseline in group B compared to group A show significant difference (p=0.01). Neck range of motion, including flexion, neck right bending, and neck left bending showed significant differences between the groups (p<0.05). The results for neck extension showed that both techniques were equally effective (p>0.05). Instrument-assisted soft tissue mobilisation with combination of stretching exercises was found to be more effective in the management of neck pain in upper crossed syndrome compared to routine physical therapy. IRCT20190912044754N1.

Improvement of head and neck range of motion induced by chronic pallidal deep brain stimulation for cervical dystonia.

Deep brain stimulation (DBS) of the globus pallidus internus (GPi) has become an accepted treatment for severe cervical dystonia (CD). Assessment of therapeutic efficacy of DBS mostly focused on head position at rest but hardly on limitations of head and neck mobility, which represent a functionally important impairment in CD. We aimed to determine prospectively head and neck range of motion (ROM) preoperatively and during chronic bilateral GPi DBS in a series of 11 patients with idiopathic CD or segmental dystonia with prominent CD using a computerized motion analysis. Maximum horizontal rotation of the head in the transverse plane and lateral inclination in the frontal plane were measured preoperatively and at a median of 7months of chronic GPi DBS, using an ultrasound-based three-dimensional measuring system combined with surface electromyography of cervical muscles. Horizontal rotation of the head increased from 78.8° ± 31.5° (mean ± SD) preoperatively to 100.7° ± 24.7° with GPi DBS (p < 0.01), thereby improvement of head rotation to the anti-dystonic side (+ 14,2° ± 12,2°) was greater than to the pro-dystonic side (+ 7,8° ± 9,2°; p < 0.05). Movement-related agonistic-antagonistic EMG modulation during head rotation was enhanced with GPi DBS in both sternocleidomastoid (modulation index (MI) 35.8% ± 26.7% preoperatively vs. 67.3% ± 16.9% with GPi DBS, p < 0.01), and splenius capitis muscles (MI 1.9% ± 24.5% preoperatively vs. 44.8% ± 11.6% with GPi DBS, p < 0.01). Chronic bilateral GPi DBS significantly improves head ROM in CD, likely due to enhanced agonist-antagonist EMG activity with reduced co-contraction. Computerized motion analysis provides an objective measurement to assess the improvement of head and neck mobility in CD.

Acupuncture-like versus conventional transcutaneous electrical nerve stimulation in the management of active myofascial trigger points: A randomized controlled trial

PurposeMyofascial pain syndrome (MPS) is one of the most common causes of chronic musculoskeletal pain. The transcutaneous electrical nerve stimulation (TENS) is a non-expensive, safe, feasible modality, used recently for the treatment of MPS with promising but limited results. The purpose of this study was to determine the efficacy of acupuncture-like TENS (AL-TENS) vs conventional TENS (C-TENS) in the treatment of active myofascial trigger points. MethodsThis randomized controlled trial study was carried out with 60 consecutive patients with active trapezius trigger points referred to Physical Medicine and Rehabilitation Clinic. Participants randomly assigned to receive AL-TENS, C-TENS or sham TENS (S-TENS). The Visual Analogue Scale (VAS), Pressure Pain Thresholds (PPTs), and neck range of motion (ROM) were measured at baseline, after the first treatment sessions, after the final treatment session, and 3 months after the end of the last treatment session. Patients function was evaluated by Disabilities of the Arm, Shoulder, and Hand (DASH) at baseline, after the final treatment sessions, and 3 months after the end of intervention. ResultsThe interaction effect of time and group was significantly different when evaluating VAS (df = 4.65, F = 2.50, p = 0.038) and DASH (df = 2.63, F = 7.25, p < 0.001) in favor of active groups, as well as neck total lateral bending in favor of AL-TENS group compared other two groups (df = 4.16, F = 5.23, p = 0.001). Both VAS and DASH improved significantly at all follow-ups in AL-TENS and C-TENS groups. Of note, significant immediate improvement in all outcomes was observed only with AL-TENS. ConclusionsAccording to the present study, both AL-TENS and C-TENS were superior to placebo in pain reduction and functional improvement. Although both TENS techniques have similar efficiency on pain reduction, functional and pain perception improvement, the AL-TENS was the superior approach when evaluating neck lateral bending ROM.