Search

Objective: The purpose of this study was to examine associations between the degree of central sensitization (CS) and remote muscle performance in people with chronic low back pain (CLBP)., Methods: The 2011 fibromyalgia (FM) criteria and severity scales (2011 FM survey) were used as a surrogate measure of CS to divide the participants into 2 groups: FM-positive CLBP and FM-negative CLBP. Measures related to central sensitization included the 2011 FM survey and pressure pain threshold of the thumbnail. Measures related to muscle performance included neck flexor muscle strength and endurance and plantar flexor muscle strength. Between-groups and correlation analyses were performed., Results: Sixty people with CLBP were enrolled (30 FM-positive, 30 FM-negative). There was no significant difference between the subgroups in age, sex, or pain duration (P > .05). The FM-positive CLBP group showed poorer neck flexor muscle endurance (P = .01) and plantar flexor muscle strength (P = .002) than the FM-negative CLBP group, whereas neck flexor muscle strength was not different between the groups (P = .175). Scores for FM and values for pressure pain thresholds of the thumbnail were associated with neck flexor muscle strength (respectively, r = -0.320, P = .013, and r = 0.467, P < .001), endurance (r = -0.242, P < .001, and r = 0.335, P = .009), and plantar flexor muscle strength (r = -0.469, P < .001, and r = 0.500, P < .001)., Conclusion: We found associations between the degree of CS and remote muscle strength and endurance, suggesting that poor remote muscle performance is possibly a clinical sign of CS in people with CLBP., (Copyright © 2020. Published by Elsevier Inc.)

Objectives: Neck-specific exercise can reduce neck pain and increase function, but information on how different neck muscle layers are activated during neck exercises is scarce. The aim of this study was to investigate deformation and deformation rate in 5 dorsal neck muscles and the correlation among these muscles during a loaded dynamic exercise used in clinical practice., Methods: Deformation and deformation rate were investigated in 5 dorsal right-sided neck muscles in 20 individuals without neck pain using ultrasonography and speckle-tracking analyses. Repeated-measures analysis of variance was used to measure differences between the muscles, and correlations between neck muscles were analyzed with Kendall's tau., Results: Deformation in left (contralateral) rotation showed significant differences among the muscles (P = .01), with higher deformation of the semispinalis capitis muscle compared with the trapezius muscle (P = .02). There were no significant differences among the 5 neck muscles in right (unilateral) rotation (P = .46). There were significant differences in deformation rate among muscles in both right and left rotation (P < .01). The trapezius muscles have the lowest deformation rate in right rotation (P < .01). In left rotation, the trapezius and multifidus muscles showed lower deformation rates compared with most of the other muscles (P < .03). Almost all muscles were correlated in both deformation and deformation rate., Conclusion: The quadruped standing loaded dynamic neck exercise seemed to activate all the investigated neck muscles, with a tendency for more activation of the semispinalis capitis., (Copyright © 2020. Published by Elsevier Inc.)

Objective: In this cross-sectional descriptive-analytical study, we sought to compare the ultrasonic thickness of the masseter muscle in people with severe forward head posture vs people without forward head posture, and to determine sex differences in muscle thickness., Methods: Thirty-eight volunteers (19 with normal head postures and 19 with severe forward head postures), aged 18 to 35 years, entered the study. The severity of the forward head posture was measured by a plumb line and the craniovertebral angle drawn on the recorded images. Based on the recorded images, the masseter muscle thickness was also measured by a 7.5-MHz linear transducer using an ultrasound device in the seated position with 3 mouth positions (closed, half open, and fully open)., Results: The results showed that the head posture affects masseter thickness significantly (P = .01), with masseter thickness significantly lower in the participants without severe forward head postures compared to those with severe forward head postures in the closed, half-open, and fully open mouth positions (P < .05). Comparing the mean masseter thickness across sexes showed that the masseter muscle is significantly thicker in men compared to women (P = .01)., Conclusion: Head posture and thickness of the masseter muscle are linked, as the masseter muscle was thicker in all 3 positions in the participants with severe forward head postures., (Copyright © 2020. Published by Elsevier Inc.)

Objective: The purpose of this study was to investigate the correlation between head and neck posture and superficial neck flexor and extensor activity during performance of the craniocervical flexion test (CCFT) in women with migraine and healthy controls., Methods: Fifty-two women with episodic migraine, 16 with chronic migraine, and 23 healthy controls participated. Head and neck posture were determined by assessing the craniovertebral (CV) angle and cervical lordosis angle. Surface electromyography signals were recorded bilaterally from sternocleidomastoid, anterior scalene, splenius capitis, and upper trapezius muscles as participants performed the CCFT. Differences in electromyogram activity and posture among groups were compared with analyses of variance. Correlations between posture and electromyogram activity were analyzed with the Pearson correlation coefficient., Results: Both migraine groups had a significant increase in splenius capitis muscle activity, when acting as an antagonist, at the last stage of CCFT (F = 4.687; P = .012) compared with controls. No differences among groups were observed for head and neck posture. No significant correlation was found in the episodic migraine group. Moderate correlations between the CV angle and upper trapezius activity at the majority stages of the CCFT (-0.61 < r < -0.65, all P < .05) were observed within the chronic migraine group: the more extended the head posture, the higher the activity of the upper trapezius muscle. The CV angle also was correlated with upper trapezius muscle activity at the first stage of the CCFT and with splenius capitis muscle activity at the last stages (-0.42 < r < -0.52; P < .05)., Conclusion: An extended (forward) head posture was moderately correlated with an increased in electrical activity of superficial neck extensor muscles, particularly the upper trapezius, when acting as an antagonist, during the performance of the CCFT in women with chronic but not episodic migraine., (Copyright © 2018. Published by Elsevier Inc.)

Objective: The purpose of this study was to assess the correlations between neck muscle strength and pain features, such as neck-related disability, neck pain frequency and intensity, and headache frequency in women with headache., Methods: Seventy women with migraine between 18 and 55 years of age diagnosed according to International Headache Society criteria were assessed. Participants provided clinical information regarding neck pain and headache. The Neck Disability Index was used to assess neck-related disability, and neck muscle strength was assessed via maximum voluntary contraction during flexion, extension, and lateral flexion with a handheld dynamometer. The correlation was verified with Spearman's correlation coefficient (ρ). Multiple linear regression was performed to verify whether the clinical variables could predict the strength of neck muscles. All calculations were performed adopting a level of significance of 0.05., Results: Neck extensor strength was negatively correlated with all clinical variables (ρ range = -.24 to -.32, p < .05); lateral flexor strength was negatively correlated with headache frequency, neck pain intensity, and neck-related disability (ρ range = -.27 to -.39, p < .05); and flexor strength also correlated negatively with neck pain intensity and related disability (ρ r = -.26 to -.29, p < .05). Headache frequency and neck pain intensity were identified as significant predictors of the strength variability in extension (R 2 = 0.16, p < .05) and in lateral flexion (R 2 = 0.18, p < .05)., Conclusions: For the women with migraine in this study, correlations of headache and neck pain with neck muscle strength features were weakly to moderately negative. Headache frequency and neck pain intensity may influence a small proportion of the strength variability in extension and lateral flexion., (Copyright © 2018. Published by Elsevier Inc.)

Objective: The purpose of this study was to compare the thickness of the oblique cervical inferior (OCI) and the error of the head reposition test between the painful and nonpainful sides of patients with cervicogenic headache (CeH) and between the patients and the asymptomatic group., Methods: Thirteen patients (24.5 ± 4.8 years) and 14 asymptomatic participants (23.9 ± 2.7 years) were included. The head reposition test was recorded by a 3-dimensional motion analysis system. The thickness of the OCI was recorded by ultrasonography. The measured outcomes were compared between the painful and nonpainful sides and with the asymptomatic participants., Results: The thickness of the OCI in the rest condition on the painful side (9.92 ± 2.31 mm) was smaller than that of the nonpainful side (10.56 ± 2.24 mm). The constant error of the head-to-target test toward the nonpainful side was smaller in the patients with CeH (-1.6 ± 4.3°) than in the asymptomatic group (3.3 ± 3.7°, P = 0.005)., Conclusion: Asymmetric OCI and cervical proprioception were demonstrated in patients with CeH., (Copyright © 2018. Published by Elsevier Inc.)

Objectives: The purpose of the present study was to investigate differences in neck muscle stiffness between patients with chronic neck pain and asymptomatic control group., Methods: Thirty-five patients with chronic neck pain and 35 age-matched asymptomatic participants enrolled in the study. Shear wave velocity (SWV) of upper trapezius, levator scapulae, splenius capitis, and sternocleidomastoid muscles were obtained using an ACUSON S3000 Ultrasonography Device (Siemens Medical Solutions, Mountain View, California). In patients with chronic neck pain, pain intensity was measured by Numerical Rating Scale and disability level was measured by Neck Disability Index., Results: The SWV of splenius capitis was similar in both groups (P = .985); however, SWV of upper trapezius (P = .001), levator scapulae (P = .038), and sternocleidomastoid (P = .001) of the patients with chronic neck pain were higher compared with the asymptomatic controls groups. Numerical Rating Scale and Neck Disability Index scores did not correlate with the SWV of the selected muscles (P > .05)., Conclusions: Stiffness of upper trapezius, levator scapulae, and sternocleidomastoid muscles in patients with neck pain were higher compared to asymptomatic participants. In addition, severity of pain and disability did not correlate to stiffness of these muscles in patient with chronic neck pain., (Copyright © 2018. Published by Elsevier Inc.)

Objectives: The purpose of this study was to compare pericranial tenderness of females with episodic cervical headache vs matched asymptomatic controls., Methods: Through a single-blind, cross-sectional study, pericranial tenderness was compared between 20 females with episodic cervical headaches (29.4 ± 13.2 years) and 20 age-matched female asymptomatic controls (30.1 ± 13.7 years). Pericranial tenderness was bilaterally measured in a headache-free period with the "total tenderness score" (TTS) in the suboccipital, temporal, frontal, masseter, upper trapezius (UT), levator scapula, and sternocleidomastoid (SCM) muscle insertions. Passive cervical mobility, headache intensity, frequency, and duration were secondary outcomes. Analysis was done with a 95% confidence level (SPSS version 22). The Mann-Whitney U-test was used to compare pericranial, cephalic, cervical, and muscle-specific tenderness between groups. Correlations between passive cervical mobility and headache characteristics and the TTS were estimated with Spearman's ρ., Results: The headache group (1.25 ± 0.89) showed a 2 times higher (P < .05) pericranial TTS compared to the control group (0.62 ± 0.70). Higher (P < .05) scores were observed for the left suboccipital, temporal, masseter, UT, levator scapula, and SCM muscles and the right suboccipital, frontal, UT, and levator scapula muscles. Grouping the tenderness scores into cervical (suboccipital, UT, levator scapula, SCM) and cephalic (frontal, temporal, masseter) regions revealed greater scores (P < .05) in the headache group. In the latter, the TTS was significantly positively correlated with passive cervical extension (ρ = 0.78)., Conclusion: Consistent higher tenderness scores were observed and suggest involvement of sensitization in patients with episodic cervical headaches. A positive correlation was seen between passive cervical extension and sensitivity., (Copyright © 2018. Published by Elsevier Inc.)

Objective: The purpose of this study was to evaluate the effect of combined manual therapy (MT) and diadynamic (DD) currents on myofascial trigger points of the upper trapezius muscle in individuals with a diagnosis of unilateral shoulder impingement syndrome., Methods: A randomized clinical trial was conducted involving 60 individuals with shoulder impingement syndrome who were allocated to the following 3 groups: (1) MT and DD currents (MTDD), (2) MT alone, and (3) DD currents alone. The participants were submitted to 16 treatment sessions over an 8-week period and were evaluated using the Numerical Rating Pain Scale as well as the pain and disability subscales of the Shoulder Pain and Disability Index., Results: Differences in Numerical Rating Pain Scale scores (secondary outcome) between MTDD and MT groups (mean difference 2.25 points, 95% confidence interval 1.07-3.42) and between MTDD and DD groups (mean difference 2.30 points, 95% confidence interval 1.42-3.17) were clinically relevant. No clinical gains were observed in the comparisons between groups of Shoulder Pain and Disability Index scores., Conclusion: The combination of MT and DD currents on myofascial trigger points was more effective at reducing pain intensity but not disability than each therapy performed individually for patients with unilateral shoulder impingement syndrome., (Copyright © 2018. Published by Elsevier Inc.)

Objective: The purpose of this study was to compare the relationship between flexion endurance capacity and joint position error in participants with or without chronic neck pain (CNP)., Methods: Sixty-one CNP and 60 asymptomatic volunteers participated in this cross-sectional, case-control, and correlational analysis study. The measured variables included absolute and constant joint repositioning errors in the sagittal and horizontal directions, clinical flexor endurance test score, pain intensity, and neck disability index., Results: The groups did not statistically differ in flexion endurance (P > .05). The CNP group had a smaller absolute error on the right (P < .01) and left (P = .01) rotation and an overshooting error pattern in the flexion direction (P < .05). But the asymptomatic group did not exhibit any over-/undershooting pattern tendency (P > .05). Although flexion endurance was not correlated with any of the joint repositioning error components in either group, pain and disability scores were significantly correlated with left rotation absolute error (r = -0.34 and ρ = -0.37, respectively)., Conclusion: The clinical cervical flexor endurance test, ignoring the relative contribution of the deep and superficial groups of muscles, may not efficiently characterize CNP patients., (Copyright © 2018. Published by Elsevier Inc.)

Objective: The objective of this study was to collect muscle stiffness data from the 4 rectus capitis (RC) muscles to better understand their role in stabilizing the atlanto-occipital joint. The passive load displacement properties of these muscles have not been previously reported., Methods: Rectus capitis muscles were removed from 3 unembalmed head and neck specimens. Passive length-force (stiffness) data were collected by using a servo-controlled hydraulic test machine. Multivariate analysis of variance with Bonferroni correction was used to assess the significance of the differences among passive stiffness within the elastic region of each muscle and the load and strain at the yield points., Results: Rectus capitis lateralis (RCL) muscles failed at significantly higher levels of load and strain compared with the other 3 pairs of muscles. Passive stiffness of both RCL and RC anterior muscles was significantly higher than the other 2 pairs of muscles., Conclusion: The anatomic location of the RCL muscles, along with their high levels of passive stiffness, would be expected to facilitate the maintenance of atlanto-occipital joint congruence during normal daily activities. The level at which the RC posterior minor muscles failed could put them at risk of a strain injury during a rear end motor vehicle accident. Diagnostic and treatment protocols that apply forces to the upper cervical spine should be tailored to consider the patient's age, gender, and history of previous injuries to avoid overstretching RC muscles., (Copyright © 2016. Published by Elsevier Inc.)

Objective: The aim of this study was to assess the immediate and short-term effects of upper thoracic spine manipulation on pain intensity and myoelectric activity of the sternocleidomastoid muscles in young women with chronic neck pain., Methods: A randomized clinical trial was carried out involving 32 women with chronic neck pain (mean age, 24.8 ± 5.4 years) allocated to an experimental group and a placebo group. Three evaluations were carried out: baseline, immediate postintervention, and short-term postintervention (48-72 hours after intervention). Myoelectric activity of the right and left sternocleidomastoid muscles was assessed at rest and during isometric contractions for cervical flexion and elevation of the shoulder girdle. Neck pain intensity was assessed at rest using a visual analog scale. Comparisons of the data were performed using 2-way repeated-measures analysis of variance with the Bonferroni correction. The level of significance was set at P < .05., Results: A moderate treatment effect on myoelectric activity of the right and left sternocleidomastoid muscles during isometric elevation of the shoulder girdle was found in the experimental group only on the short-term postintervention evaluation (d > 0.40). No statistically significant differences were found for any of the variables analyzed in the intergroup comparisons at the different evaluation times (P > .05)., Conclusion: No statistically significant differences were found in the intragroup or intergroup analyses of the experimental and placebo groups regarding myoelectric activity of the cervical muscles or the intensity of neck pain at rest in the immediate or short-term postintervention evaluations., (Copyright © 2015 National University of Health Sciences. Published by Elsevier Inc. All rights reserved.)

Objective: The purpose of this study was to compare the effects of 3 different exercise approaches on neck muscle endurance (NME), kinesiophobia, exercise compliance, and patient satisfaction in patients with chronic whiplash., Methods: This prospective randomized clinical trial included 216 individuals with chronic whiplash. Participants were randomized to 1 of 3 exercise interventions: neck-specific exercise (NSE), NSE combined with a behavioral approach (NSEB), or prescribed physical activity (PPA). Measures of ventral and dorsal NME (endurance time in seconds), perceived pain after NME testing, kinesiophobia, exercise compliance, and patient satisfaction were recorded at baseline and at the 3- and 6-month follow-ups., Results: Compared with individuals in the prescribed physical activity group, participants in the NSE and NSEB groups exhibited greater gains in dorsal NME (P = .003), greater reductions in pain after NME testing (P = .03), and more satisfaction with treatment (P < .001). Kinesiophobia and exercise compliance did not significantly differ between groups (P > .07)., Conclusion: Among patients with chronic whiplash, a neck-specific exercise intervention (with or without a behavioral approach) appears to improve NME. Participants were more satisfied with intervention including neck-specific exercises than with the prescription of general exercise., (Copyright © 2015 National University of Health Sciences. Published by Elsevier Inc. All rights reserved.)

Objective: The purposes of this study were to examine whether any differences in function and health exist between patients with cervical radiculopathy (CR) due to disk disease scheduled for surgery and patients with chronic whiplash-associated disorders (WADs) and to compare measures of patients' physical function with those obtained from healthy volunteers., Methods: This is a cross-sectional study of patients with CR (n = 198) and patients with chronic WAD (n = 215). Patient data were compared with raw data previously obtained from healthy people. Physical measures included cervical active range of motion, neck muscle endurance, and hand grip strength. Self-rated measures included pain intensity (visual analog scale), neck disability (Neck Disability Index), self-efficacy (Self-Efficacy Scale), and health-related quality of life (EuroQol 5-dimensional self-classifier)., Results: Patient groups exhibited significantly lower performance than the healthy group in all physical measures (P < .0005) except for neck muscle endurance in flexion for women (P > .09). There was a general trend toward worse results in the CR group than the WAD group, with significant differences in neck active range of motion, left hand strength for women, pain intensity, Neck Disability Index, EuroQol 5-dimensional self-classifier, and Self-Efficacy Scale (P < .0001)., Conclusions: Patients had worse values than healthy individuals in almost all physical measures. There was a trend toward worse results for CR than WAD patients., (Copyright © 2014 National University of Health Sciences. Published by Mosby, Inc. All rights reserved.)

Objective: The purpose of this study was to evaluate neck-related physical function in individuals 11 to 14 years after anterior cervical decompression and fusion (ACDF) surgery for degenerative cervical disk disease and to compare the long-term outcome of 2 surgical techniques, including the Cloward procedure and cervical intervertebral fusion cage., Methods: In this cross-sectional study, 51 individuals, 11 years or more after ACDF, underwent testing of cervical active range of motion, hand-grip strength, static and dynamic balance, neck muscle endurance, and completed pain ratings. The participants' values were compared with values of age- and sex-matched healthy individuals to evaluate impairments. Correlations between different test scores and pain were performed. Group differences were analyzed between the 2 surgical techniques., Results: Sixty-five percent and 82% exhibited impairment in ventral and dorsal neck muscle endurance, respectively. Impairment rates of 18% to 39% for cervical active range of motion, 27% to 43% for hand-grip strength, 37% for standing balance, and 35% for dynamic balance were recorded. Twenty-nine percent of the participants had impairment (>30 mm visual analog scale) in pain. There were no significant differences in physical function between the 2 surgical treatment groups (Cloward procedure or cervical intervertebral fusion cage) (P = .10-.92)., Conclusions: In those studied, a large percentage of patients who had anterior cervical decompression and fusion surgery have impairments in neck-related physical function when compared 11 to 14 years after surgery with age- and sex-matched healthy reference individuals. Neck-specific function, but not balance, was statistically correlated to pain. Neck muscle endurance was most affected, and balance impairments were also present in one-third of the individuals. There were no differences in long-term physical function between the 2 surgical techniques., (Copyright © 2014 National University of Health Sciences. Published by Mosby, Inc. All rights reserved.)

Objective: The purpose of this study was to assess the effects of a low-load training program for the deep cervical flexors (DCFs) on pain, disability, and pressure pain threshold (PPT) over cervical myofascial trigger points (MTrPs) in patients with chronic neck pain., Methods: Thirty patients with chronic idiopathic neck pain participated in a 6-week program of specific training for the DCF, which consisted of active craniocervical flexion performed twice per day (10-20 minutes) for the duration of the trial. Perceived pain and disability (Neck Disability Index, 0-50) and PPT over MTrPs of the upper trapezius, levator scapulae, and splenius capitis muscles were measured at the beginning and end of the training period., Results: After completion of training, there was a significant reduction in Neck Disability Index values (before, 18.2 ± 12.1; after, 13.5 ± 10.6; P < .01). However, no significant changes in PPT were observed over the MTrPs., Conclusion: Patients performing DCF training for 6 weeks demonstrated reductions in pain and disability but did not show changes in pressure pain sensitivity over MTrPs in the splenius capitis, levator scapulae, or upper trapezius muscles., (© 2013. Published by National University of Health Sciences All rights reserved.)

Objective: The purpose of this preliminary study was to determine feasibility of a clinical trial to measure the effects of manual therapy on sternocleidomastoid active trigger points (TrPs) in patients with cervicogenic headache (CeH)., Methods: Twenty patients, 7 males and 13 females (mean ± SD age, 39 ± 13 years), with a clinical diagnosis of CeH and active TrPs in the sternocleidomastoid muscle were randomly divided into 2 groups. One group received TrP therapy (manual pressure applied to taut bands and passive stretching), and the other group received simulated TrP therapy (after TrP localization no additional pressure was added, and inclusion of longitudinal stroking but no additional stretching). The primary outcome was headache intensity (numeric pain scale) based on the headaches experienced in the preceding week. Secondary outcomes included neck pain intensity, cervical range of motion (CROM), pressure pain thresholds (PPT) over the upper cervical spine joints and deep cervical flexors motor performance. Outcomes were captured at baseline and 1 week after the treatment., Results: Patients receiving TrP therapy showed greater reduction in headache and neck pain intensity than those receiving the simulation (P < .001). Patients receiving the TrP therapy experienced greater improvements in motor performance of the deep cervical flexors, active CROM, and PPT (all, P < .001) than those receiving the simulation. Between-groups effect sizes were large (all, standardized mean difference, >0.84)., Conclusion: This study provides preliminary evidence that a trial of this nature is feasible. The preliminary findings show that manual therapy targeted to active TrPs in the sternocleidomastoid muscle may be effective for reducing headache and neck pain intensity and increasing motor performance of the deep cervical flexors, PPT, and active CROM in individuals with CeH showing active TrPs in this muscle. Studies including greater sample sizes and examining long-term effects are needed., (Copyright © 2013 National University of Health Sciences. Published by Mosby, Inc. All rights reserved.)

Objective: The purpose of this study was to compare the mechanical activity of the neck muscles during loaded arm lifting tasks in individuals with long-standing disability after anterior cervical decompression and fusion (ACDF) with that of healthy controls., Methods: Ten individuals (mean age, 60 years; SD, 7.1) who underwent ACDF (10-13 years previously) for cervical disc disease and 10 healthy age- and sex-matched controls participated in the study. Ultrasonography was used to investigate the degree of deformation and deformation rate of ventral and dorsal neck muscles at the C4 segmental level during a single (1× arm flexion to 120°) and repeated (10× arm flexion to 90°) loaded arm elevation condition., Results: The ACDF group showed greater deformation and deformation rate of the longus capitis (P=.02) and deformation rate of the sternocleidomastoid (P=.04) during the 120° arm lift. For repeated 90° arm lift, there was a significant group effect with higher deformation rate values observed in the longus capitis (P=.005-.01) and multifidus (P=.03) muscles in the ACDF group. Muscle behavior did not change the repeated arm lifts (no group×time interactions) for either the ventral or the dorsal muscles., Conclusions: For study participants, greater muscle mechanical activity levels were observed in the ventral and multifidus muscles of patients with persistent symptoms after ACDF. These differences may indicate altered motor strategy in this patient group when performing the upper limb task and may need to be considered when prescribing exercise for postsurgical rehabilitation., (Copyright © 2013 National University of Health Sciences. Published by Mosby, Inc. All rights reserved.)

Objective: The purpose of this study was to investigate the presence of active myofascial trigger points (MTrPs) in a greater number of muscles than previous studies and the relation between the presence of MTrPs, the intensity of pain, disability, and sleep quality in mechanical neck pain., Methods: Fifteen patients with mechanical neck pain (80% women) and 12 comparable controls participated. Myofascial trigger points were bilaterally explored in the upper trapezius, splenius capitis, semispinalis capitis, sternocleidomastoid, levator scapulae, and scalene muscles in a blinded design. Myofascial trigger points were considered active if the subject recognized the elicited referred pain as a familiar symptom. Myofascial trigger points were considered latent if the elicited referred pain was not recognized as a symptom. Pain was collected with a numerical pain rate scale (0-10); disability was assessed with Neck Disability Index; and sleep quality, with the Pittsburgh Sleep Quality Index., Results: Patients exhibited a greater disability and worse sleep quality than controls (P < .001). The Pittsburgh Sleep Quality Index score was associated with the worst intensity of pain (r = 0.589; P = .021) and disability (r = 0.552; P = .033). Patients showed a greater (P = .002) number of active MTrPs (mean, 2 ± 2) and similar number (P = .505) of latent MTrPs (1.6 ± 1.4) than controls (latent MTrPs, 1.3 ± 1.4). No significant association between the number of latent or active MTrPs and pain, disability, or sleep quality was found., Conclusions: The referred pain elicited by active MTrPs in the neck and shoulder muscles contributed to symptoms in mechanical neck pain. Patients exhibited higher disability and worse sleep quality than controls. Sleep quality was associated with pain intensity and disability. No association between active MTrPs and the intensity of pain, disability, or sleep quality was found., (Copyright © 2012 National University of Health Sciences. Published by Mosby, Inc. All rights reserved.)

Objective: Muscle functional magnetic resonance imaging (mfMRI) quantifies exercise-induced alterations in soft-aqueous skeletal muscle as a surrogate measure of muscle activity. Because of its excellent spatiotemporal resolution, mfMRI can be used as a noninvasive evaluation of the function of muscles that are challenging to evaluate, such as the serratus anterior (SA) muscle. The purpose of this preliminary study was to investigate the feasibility of evaluating SA muscle function in individuals with neck pain compared with healthy controls using mfMRI., Methods: Muscle functional magnetic resonance imaging scans of the SA muscle were obtained before and immediately after an isometric upper limb exercise in 10 subjects with chronic ipsilateral mechanical neck pain and scapular dysfunction (scan on symptomatic side) and in 10 age- and sex-matched healthy subjects. Scans were recorded at 4 intervertebral levels (T6-7, T7-8, T8-9, and T9-10). Differences in water relaxation values (T2 relaxation) quantified from scans before and after exercise were calculated (T2 shift) as a measure of SA muscle activity at each level and compared between groups., Results: There were significant effects for level (P = .03) and significant group × level interactions (P = .04) but no significant main effect for group (P = .59). Post hoc tests revealed that significant differences in T2 shift values between levels were only evident in the healthy control group., Conclusions: This study demonstrated that despite some inherent challenges associated with imaging the SA muscle, mfMRI appears to have adequate spatiotemporal resolution to effectively evaluate SA muscle activity and function in healthy and clinical populations., (Copyright © 2012 National University of Health Sciences. Published by Mosby, Inc. All rights reserved.)

Objective: The purpose of this study was to measure the immediate differences in craniocervical posture and pressure pain threshold of the greater occipital (GO) nerve in asymptomatic subjects with a history of having used orthodontics, after intervention by a suboccipital muscle inhibition (SMI) technique., Methods: This was a randomized, single-blind, clinical study with a sample of 24 subjects (21±1.78 years) that were divided into an experimental group (n=12) who underwent the SMI technique and a sham group (n=12) who underwent a sham (placebo) intervention. The sitting and standing craniovertebral angle and the pressure pain threshold of the GO nerve in both hemispheres were measured., Results: The between-group comparison of the sample indicated that individuals subjected to the SMI technique showed a statistically significant increase in the craniovertebral angle in both the sitting (P<.001, F1,22=102.09, R2=0.82) and the standing (P<.001, F1,22=21.42, R2=0.56) positions and in the GO nerve pressure pain threshold in the nondominant hemisphere (P=.014, F1,22=7.06, R2=0.24). There were no statistically significant differences observed for the GO nerve mechanosensitivity in the dominant side (P=.202)., Conclusion: Suboccipital muscle inhibition technique immediately improved the position of the head with the subject seated and standing, the clinical effect size being large in the former case. It also immediately decreased the mechanosensitivity of the GO nerve in the nondominant hemisphere, although the effect size was small., (Copyright © 2012 National University of Health Sciences. Published by Mosby, Inc. All rights reserved.)

Objective: The purpose of the study was to analyze the upper trapezius muscle temperature using thermography in women with and without neck pain., Methods: Thirty-six female university students were classified through the Neck Disability Index (NDI) into 2 groups: the neck pain group comprised 18 volunteers diagnosed with mild disability, and the control group, 18 healthy volunteers. All subjects were submitted to evaluation by thermography, which registered the skin surface temperature of the upper bilateral trapezius muscle. Student t test and Mann-Whitney U test were used for the comparison between the groups, and the Spearman correlation coefficient was used for the appropriate correlations between the NDI score and the temperature values. A significance level of 5% was set., Results: No significant difference was found between the groups regarding the temperature values of the upper left (P = .565) and right (P = .917) trapezius muscles, as well as in comparisons of temperature asymmetry (P = .542). In addition, no significant association was found between the study variables (P > .05)., Conclusion: Women with neck pain, diagnosed with mild disability by NDI, did not present with reduction or asymmetry of upper trapezius muscle temperature when compared with a group without neck pain., (Copyright © 2012 National University of Health Sciences. Published by Mosby, Inc. All rights reserved.)

Objective: Thoracic outlet syndrome classically results from constrictions in 1 or more of 3 specific anatomical locations: the interscalene triangle, costoclavicular space, and coracopectoral tunnel. Magnetic resonance and computed tomographic imaging studies suggest that, of the 3 potential locations for constriction, the costoclavicular space is the most susceptible to compression. This study of human cadavers aims to expand on the descriptive anatomy of the interscalene triangle and associated costoclavicular space., Methods: The interscalene angle, interscalene triangle base, and costoclavicular space were measured on 120 sides of embalmed human cadavers. Linear distances and angles were measured using a caliper and protractor, respectively. The data were analyzed by calculating the mean, range, and standard deviation., Results: The range for the interscalene base was 0 to 21.0 mm with a mean of 10.7 mm. For the interscalene angle, the range was 4° to 22° with a mean of 11.3°. Measurements for the costoclavicular space ranged from 6 to 30.9 mm with a mean of 13.5 mm., Conclusions: No significant differences were observed between left and right interscalene triangles or costoclavicular spaces; furthermore, there were no differences between the sexes concerning these 2 locations., (Copyright © 2012 National University of Health Sciences. Published by Mosby, Inc. All rights reserved.)

Objective: The purpose of this study was to analyze changes in the recruitment of the muscles longus colli (Lco) and sternocledomastoid (SCM) as measured by ultrasonography in patients with chronic neck pain before and immediately after a single cervical Maitland's posterior-anterior central mobilization technique., Methods: This was a cross-sectional, case-control research design study. Ultrasonographic images of Lco and SCM were taken in 31 patients with chronic neck pain and matched controls during the 5 phases of the craniocervical flexion test before and after a Maitland's posterior-anterior central mobilization session at the cervical spine. Changes in muscle thickness during the test were calculated to infer muscle recruitment. Separate analysis of variance models for each muscle was built., Results: Both groups showed increases in Lco and SCM recruitment between phases (F = 7.95, P < .001; F = 21.29, P < .001), with patients with chronic neck pain demonstrating lesser increases for Lco changes in thickness compared with controls, mainly at phase 5 (-0.09, P = .004; 95% confidence interval [CI], 0.03-0.15). After the mobilization, Lco recruitment increased more significantly in patients with chronic neck pain, and previous difference between groups in phase 5 was no longer significant (-0.07, P = .07; 95% CI, -0.14 to 0.01). The SCM recruitment decreased in phase 1 for patients with chronic neck pain (P = .01; 95% CI, -0.06 to -0.01)., Conclusion: Cervical mobilization appeared to modulate neck muscles function by increasing deep muscle and reducing superficial muscles recruitment., (Copyright © 2011 National University of Health Sciences. Published by Mosby, Inc. All rights reserved.)

Objective: Evidence suggests that the deep cervical flexors (DCFs) are important for the control of the cervical spine. The craniocervical flexion (CCF) test is a clinical test developed for patients with neck pain disorders based on the action of the DCFs. Because these muscles are deeply situated, it is difficult to reach the DCFs with surface electromyography. Magnetic resonance imaging (MRI) can be used to measure these muscles in cross section. The objective of this study was (1) to determine the reliability of MRI for measuring cross-sectional area (CSA) of the longus colli (Lco) and longus capitis (Lca) and (2) to evaluate the changes in CSA during contraction., Methods: Thirty healthy subjects aged 29 +/- 9.3 years were imaged using MRI. The CSA of the Lco and Lca was evaluated at 4 different levels (C0-C1, C2-C3, C4-C5, and C6-C7) at rest and during CCF., Results: The intraclass correlation coefficients for the CSA of the Lco and Lca showed good to excellent reliability (0.73-0.92), except at the C4-C5 level. There was a significant increase in CSA of both Lco (F = 6.79, P = .015) and Lca (F = 19.20, P

Objective: This study investigates changes in the intrinsic inhibitory and facilitatory interactions within the sensorimotor cortex subsequent to a single session of cervical spine manipulation using single- and paired-pulse transcranial magnetic stimulation protocols., Method: Twelve subjects with a history of reoccurring neck pain participated in this study. Short interval intracortical inhibition, short interval intracortical facilitation (SICF), motor evoked potentials, and cortical silent periods (CSPs) were recorded from the abductor pollicis brevis and the extensor indices proprios muscles of the dominant limb after single- and paired-pulse transcranial magnetic stimulation of the contralateral motor cortex. The experimental measures were recorded before and after spinal manipulation of dysfunctional cervical joints, and on a different day after passive head movement. To assess spinal excitability, F wave persistence and amplitudes were recorded after median nerve stimulation at the wrist., Results: After cervical manipulations, there was an increase in SICF, a decrease in short interval intracortical inhibition, and a shortening of the CSP in abductor pollicis brevis. The opposite effect was observed in extensor indices proprios, with a decrease in SICF and a lengthening of the CSP. No motor evoked potentials or F wave response alterations were observed, and no changes were observed after the control condition., Conclusion: Spinal manipulation of dysfunctional cervical joints may alter specific central corticomotor facilitatory and inhibitory neural processing and cortical motor control of 2 upper limb muscles in a muscle-specific manner. This suggests that spinal manipulation may alter sensorimotor integration. These findings may help elucidate mechanisms responsible for the effective relief of pain and restoration of functional ability documented after spinal manipulation.

Objective: The purpose of this study was to investigate differences in ventral and dorsal neck muscle endurance (NME) among men and women with nonspecific neck pain (NP) or cervical disk disease (who had anterior cervical decompression and fusion [ACDF]) and healthy controls (C). Another purpose was to investigate changes in NME after intervention., Methods: Neck muscle endurance was measured in patients with NP (n = 78) and ACDF (n = 25) before and after the treatment period, and their results were compared to each other and to sex-specific reference values from controls (n = 116) at both the individual and group levels., Results: Patients had significantly decreased (P < .01) NME compared with control subjects, except for ventral NME in female patients with NP before treatment and male patients with ACDF after treatment. Female patients with ACDF had lower ventral NME than female patients with NP (P < .01). Among the patients, 35% to 100% had NME disability, with most of them having a lower rate than the 95% confidence interval of controls. Female patients with NP and male patients with ACDF showed improvement (P < .05) after treatment. Flexion/extension ratio in patients with NP (P = .36), but not in patients with ACDF (P < .0001), returned to normal levels after treatment. There was a significant negative correlation (P < .02) between NME and Neck Disability Index in both patient groups, except for ventral NME in patients with NP before treatment., Conclusion: Many patients had impairment in NME before and after treatment. This suggests that additional exercise of specific training for NME should be incorporated into the rehabilitation program, which may improve treatment outcome.

Objective: The aim of this study is to assess a possible relationship between unilateral hip dysplasia and sternocleidomastoid muscle function during a fatiguing task., Methods: In this patient-control, cross-sectional study, 11 female patients (aged 37-63 years) with unilateral coxoarthrosis subsequent to hip dysplasia and 9 female control subjects matched for age were assessed. Surface electromyography of the right and left sternocleidomastoid muscles was measured in the women performing a standardized endurance test. The median power frequency was calculated at the beginning (T0) and at the end of the task (T1, endurance time). For each subject and muscle, percentage decrements in the median power frequency were computed at T1., Results: Endurance time ranged between 15 and 125 s (control group), and 10 and 200 s (patient group), without a significant difference between the 2 groups (Mann-Whitney test, P > .05). In the patient group, no significant differences in the median power frequency between the ispilateral to coxoarthrosis and contralateral sides were found (Wilcoxon test, P > .05). The percentage decrements of the median power frequency in the control (right and left side pooled) and patient group did not significantly differ either in the ispilateral to coxoarthrosis and contralateral sides (Mann-Whitney test, P > .05)., Conclusions: The lack of significant differences between the sternocleidomastoid muscles of healthy women and those of women with hip dysplasia does not support the presence of a common noxa causing both congenital muscular torticollis and hip joint alterations. Alternatively, the coexistence of the 2 alterations in infancy may disappear during adult life.

Objective: The objective of this study was to determine the effect of a standard 3-point lap-and-shoulder seat belt and car seat on the electromyogram (EMG) response of the cervical muscles to increasing low-velocity impacts in comparison with that of a rigid seat and 5-point restraint., Methods: Seventeen healthy volunteers were subjected to rear, frontal, right and left lateral and bilateral anterolateral, and posterolateral impacts with an acceleration varying from 4.4 to 16.8 m/s(2) while in a car seat with lap-and-shoulder seat belt., Results: For rear-end impacts, whether straight on, right posterolateral, or left posterolateral, all muscles generated 50% or less of the maximal voluntary contraction (MVC) EMG. In straight-on rear impacts, the sternocleidomastoid was symmetrically the most active; however, in posterolateral impacts, the sternocleidomastoid contralateral to impact direction was more active than its counterpart. For a right lateral impact, at the highest acceleration, the left splenius capitis generated 47% of its MVC and the left trapezius did 46% of its MVC. In a left lateral impact, the right splenius capitis generated 48% of its MVC and the right trapezius did 57% of its MVC. In a straight-on frontal impact, the left trapezius generated 35% of its MVC and the right trapezius did 48% of its MVC. In a left anterolateral impact, the right splenius generated 60% of its MVC and the right trapezius did 66% of its MVC. Similarly, in a right anterolateral impact, the contralateral splenius muscle increased its activity to 52% of its MVC and the left trapezius was at 52% of its MVC., Conclusions: Compared with previously reported impact studies with a rigid seat and 5-point harness, the use of a 3-point lap-and-shoulder seat belt with a standard car seat did not appear to adversely affect cervical muscle response. In very-low-velocity and low-velocity impact experiments, seat belt and seat type may not significantly alter cervical EMG and kinematics.

Objective: To determine the electromyogram (EMG) response of the cervical muscles to a right lateral impact whiplash-type perturbation when the head is rotated., Methods: Twenty healthy volunteers were subjected to right lateral impacts of 4.2, 8.1, 10.3, and 12.5 m/s2 and were looking either left or right. Bilateral EMGs of the sternocleidomastoid, trapezius, and splenius capitis muscles were recorded. Triaxial accelerometers recorded the acceleration of the chair, torso at the shoulder level, and head of the participant., Results: In a right lateral impact, muscle responses were of low magnitude with the head rotated to either the left or the right. At the highest acceleration of 12.5 m/s2, all generated less than 39% of their maximal voluntary contraction EMG. The sternocleidomastoid muscle showed a greater EMG response than its counterpart and the muscles contralateral to the direction of impact had higher EMG responses. The time to onset of the EMG for the splenii capitis and trapezii generally decreased with increasing levels of acceleration. As anticipated, an increase in applied acceleration resulted in an increase in accompanying head accelerations (P < .05), and when the head acceleration increased, so too did the force equivalent exertions by the various muscles., Conclusions: Overall, a right lateral impact with head rotation to either right or left appears to reduce the activity and thus the risk of muscle injury, perhaps because of "bracing" by muscles actively producing rotation or because of greater spinal stability from other structures when the head is in the rotated position.

Background: Despite the high prevalence and cost of neck-pain problems, there is currently little data available on the physical characteristics associated with different levels of neck pain., Objective: To investigate associations between categories of response to neck pain/discomfort and (1) the endurance time of neck muscles, neck range of motion (ROM), and neck and head morphology, (2) sensitization or stretch effects arising from repeating end-of-range measurements, and (3) self-report data from neck pain and disability questionnaires., Design: A cross-sectional study design., Methods: Fifty-five Australian volunteers with and without neck pain, who were not taking time off work, were measured for neck muscle endurance, active neck ROM, craniocervical and thoracic posture, neck length, and head circumference and completed questionnaires about any neck pain/discomfort and disability., Results: Twenty-two subjects reported a level of neck pain/discomfort that had required treatment (treated neck pain), a group of 17 subjects reported experiencing low-level neck pain/discomfort on a recurrent basis for which they had not sought treatment (untreated neck pain), whereas 16 subjects had no experience of neck pain or discomfort (no pain). Neck muscle endurance time was significantly lower for both pain groups. The affective dimension of the Short-Form McGill Pain Questionnaire and neck disability questionnaires were scored significantly higher by subjects who had sought treatment than by those in either of the untreated groups. Both pain groups showed a range decrease for most directions of neck motion at second measurement., Conclusions: Neck muscle endurance times, repeated end-ROM testing, the Short-Form McGill Pain Questionnaire, and disability questionnaires may distinguish between groups with untreated, treated, and no neck pain.

Objective: To discuss the management of upper crossed syndrome and cervicogenic headache with chiropractic care, myofascial release, and exercise., Clinical Features: A 56-year-old male writer had been having constant 1-sided headaches radiating into the right eye twice weekly for the past 5 years. Tenderness to palpation was elicited from the occiput to T4 bilaterally. Trigger points were palpated in the pectoralis major, levator scapulae, upper trapezius, and supraspinatus muscles bilaterally. Range of motion in the cervical region was decreased in all ranges and was painful. Visual examination demonstrated severe forward translation of the head, rounded shoulders, and right cervical translation., Intervention and Outcome: The patient was adjusted using high-velocity, short-lever arm manipulation procedures (diversified technique) and was given interferential myofascial release and cryotherapy 3 times weekly for 2 weeks. He progressed to stretching and isometric exercise, McKenzie retraction exercises, and physioball for proprioception, among other therapies. The patient's initial headache lasted 4 days. He had a second headache for 1.5 days during his exercise training. During the next 7 months while returning to the clinic twice monthly for an elective chiropractic maintenance program, his headaches did not recur. He also had improvement on radiograph., Conclusion: The principles of upper crossed syndrome and the use of exercise, chiropractic care, and myofascial release in the treatment of cervicogenic headache are discussed. A review of the literature indicates that analyzing muscle imbalance as well as vertebral subluxation may increase the effectiveness of chiropractic treatment for cervicogenic headache.

Objective: To determine if there was a basis for the treatment of temporomandibular disease (TMD) using the chiropractic protocol developed by Activator Methods, International., Setting: Private, solo practice of an Activator advanced proficiency rated chiropractor with 15 years experience., Design: Prospective case series., Participants: Nine adult volunteers with articular TMD recruited from the practice of the treating clinician. Main outcome measures Change from baseline to follow-up of Visual Analog Scale (VAS) for temporomandibular joint (TMJ) pain and maximum active mouth opening without pain., Interventions: Full spine and TMJ adjusting in accordance with the advanced protocol of Activator Methods, International. Participants were typically seen 3 times per week for 2 weeks and according to individual progress thereafter for 6 more weeks., Results: Eight participants completed outcome assessments. The median VAS decrease was 45 mm (range 21-71); all experienced improvement. The median increase of mouth opening was 9 mm (range 1-15); all showed improvement., Conclusion: The results of this prospective case series indicated that the TMD symptoms of these participants improved following a course of treatment using the Activator Methods, International protocol. Consequently, further investigation of this type of chiropractic treatment for patients with the articular type of TMD is warranted.

Objective: To discuss the management of chronic sleep bruxism in a 6-year old girl. Clinical features The patient had morning headaches and cervical spine pain. Due to abnormal tooth wear, bruxism had been previously diagnosed and was verified by observation during sleep. She also had abnormal postural and palpatory findings, indicating upper cervical joint dysfunction. Intervention and outcome Bilateral rotary cervical stretching/mobilization and a vectored high-velocity, low-amplitude adjustment were performed in the upper cervical spine, using the atlas transverse process as the contact point. There was complete relief of the chronic subjective symptoms concomitant with remission of the objective signs of joint dysfunction., Conclusions: Cervical, particularly upper cervical, spine muscle-joint dysfunction should be considered as a potential etiology in chronic childhood sleep bruxism.

Objective: To compare physical characteristics of the cervical musculature, including maximal isometric strength of the flexors and extensors, relative isometric endurance of the extensors and the active range of motion (ROM) in extension in a group of patients seeking treatment for chronic neck pain and a group of age-matched healthy people., Setting: Department of Medical Orthopedics, National University Hospital, Denmark., Methods: One hundred and nineteen chronic neck-pain patients underwent physical testing for active ROM in extension, maximal isometric torque in extension and flexion and relative isometric endurance in extension before entering a clinical controlled trial studying the treatment of chronic neck pain. Their results were then compared with those of 80 age-matched healthy people., Results: The reliability study demonstrated good within-day and day-to-day reproducibility for active ROM. Active ROM was significantly reduced in female patients, but not in all male age groups. Patients exhibited clinically and statistically significant reductions in maximal isometric torque in both the flexors and extensors of the cervical spine, with the greatest reduction seen in the extensor muscle group. Most patient groups demonstrated a significant reduction in relative isometric endurance of the extensors., Conclusions: In agreement with most low-back comparisons between patients and age-matched healthy people, the greatest relative muscular deficiencies seem to be in the extensor muscle group. Additionally, most patients exhibit a significant decrease in active ROM during extension. The clinical utility of physical measurements has not been firmly established.

Thermographic findings in two patients suffering from myofascial trigger points are presented. These are shown as discrete foci of increased thermal emission, with corresponding areas of diffuse hyperthermia. These thermal findings correlate highly with the classic locations of specific trigger points and their areas of pain referral, respectively, as described in literature. Not only do these cases describe a thermal pattern that varies somewhat from previous reports, but they also illustrate the previously unreported imaging of areas of pain referral from specific trigger points.