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Background Context: The development of muscle fat infiltration (MFI) in the neck muscles is associated with poor functional recovery following whiplash injury. Custom software and time-consuming manual segmentation of magnetic resonance imaging (MRI) is required for quantitative analysis and presents as a barrier for clinical translation.Purpose: The purpose of this work was to establish a qualitative MRI measure for MFI and evaluate its ability to differentiate between individuals with severe whiplash-associated disorder (WAD), mild or moderate WAD, and healthy controls.Study Design/setting: This is a cross-sectional study.Patient Sample: Thirty-one subjects with WAD and 31 age- and sex-matched controls were recruited from an ongoing randomized controlled trial.Outcome Measures: The cervical multifidus was visually identified and segmented into eighths in the axial fat/water images (C4-C7). Muscle fat infiltration was assessed on a visual scale: 0 for no or marginal MFI, 1 for light MFI, and 2 for distinct MFI. The participants with WAD were divided in two groups: mild or moderate and severe based on Neck Disability Index % scores.Methods: The mean regional MFI was compared between the healthy controls and each of the WAD groups using the Mann-Whitney U test. Receiver operator characteristic (ROC) analyses were carried out to evaluate the validity of the qualitative method.Results: Twenty (65%) patients had mild or moderate disability and 11 (35%) were considered severe. Inter- and intra-rater reliability was excellent when grading was averaged by level or when frequency of grade II was considered. Statistically significant differences (p<.05) in regional MFI were particularly notable between the severe WAD group and healthy controls. The ROC curve, based on detection of distinct MFI, showed an area-under-the curve of 0.768 (95% confidence interval 0.59-0.94) for discrimination of WAD participants.Conclusions: These preliminary results suggest a qualitative MRI measure for MFI is reliable and valid, and may prove useful toward the classification of WAD in radiology practice. [ABSTRACT FROM AUTHOR]

Background Many patients with cervical disc disease require leave from work, due to long-lasting, complex symptoms, including chronic pain and reduced levels of physical and psychological function. Surgery on a few segmental levels might be expected to resolve disc-specific pain and reduce neurological deficits, but not the non-specific neck pain and the frequent illness. No study has investigated whether post-surgery physiotherapy might improve the outcome of surgery. The main purpose of this study was to evaluate whether a well-structured rehabilitation programme might add benefit to the customary post-surgical treatment for cervical disc disease, with respect to function, disability, work capability, and cost effectiveness. Methods/ Design This study was designed as a prospective, randomised, controlled, multi-centre study. An independent, blinded investigator will compare two alternatives of rehabilitation. We will include 200 patients of working age, with cervical disc disease confirmed by clinical findings and symptoms of cervical nerve root compression. After providing informed consent, study participants will be randomised to one of two alternative physiotherapy regimes; (A) customary treatment (information and advice on a specialist clinic); or (B) customary treatment plus active physiotherapy. Physiotherapy will follow a standardised, structured programme of neck-specific exercises combined with a behavioural approach. All patients will be evaluated both clinically and subjectively (with questionnaires) before surgery and at 6 weeks, 3 months, 6 months, 12 months, and 24 months after surgery. The main outcome variable will be neck-specific disability. Cost-effectiveness will also be calculated. Discussion We anticipate that the results of this study will provide evidence to support physiotherapeutic rehabilitation applied after surgery for cervical radiculopathy due to cervical disc disease. [ABSTRACT FROM AUTHOR]

Background Up to 50% of chronic whiplash associated disorders (WAD) patients experience considerable pain and disability and remain on sick-leave. No evidence supports the use of physiotherapy treatment of chronic WAD, although exercise is recommended. Previous randomised controlled studies did not evaluate the value of adding a behavioural therapy intervention to neck-specific exercises, nor did they compare these treatments to prescription of general physical activity. Few exercise studies focus on patients with chronic WAD, and few have looked at patients' ability to return to work and the cost-effectiveness of treatments. Thus, there is a great need to develop successful evidence-based rehabilitation models. The study aim is to investigate whether neck-specific exercise with or without a behavioural approach (facilitated by a single caregiver per patient) improves functioning compared to prescription of general physical activity for individuals with chronic WAD. Methods/design The study is a prospective, randomised, controlled, multi-centre study with a 2-year followup that includes 216 patients with chronic WAD (>6 months and <3 years). The patients (aged 18 to 63) must be classified as WAD grade 2 or 3. Eligibility will be determined with a questionnaire, telephone interview and clinical examination. The participants will be randomised into one of three treatments: (A) neck-specific exercise followed by prescription of physical activity; (B) neck-specific exercise with a behavioural approach followed by prescription of physical activity; or (C) prescription of physical activity alone without neckspecific exercises. Treatments will be performed for 3 months. We will examine physical and psychological function, pain intensity, health care consumption, the ability to resume work and economic health benefits. An independent, blinded investigator will perform the measurements at baseline and 3, 6, 12 and 24 months after inclusion. The main study outcome will be improvement in neck-specific disability as measured with the Neck Disability Index. All treatments will be recorded in treatment diaries and medical records. Discussion The study findings will help improve the treatment of patients with chronic WAD. [ABSTRACT FROM AUTHOR]

The aims of the study were to compare the relative electromyographic (EMG) activity of the extensor muscles at three different locations of the spine (cervical, thoracic and lumbar) during three different dorsal neck muscle endurance test procedures, in order to determine the procedure in which the dorsal neck muscles are maximally activated in asymptomatic individuals. The reliability for one of these test procedures was evaluated using an endurance test expressed in seconds in both healthy volunteers and patients with neck discomfort. Surface EMG activity of the spinal extensor muscles was acquired in three different locations during three different test procedures: the "extended neck lift", and "straight neck lift" with light and heavy loads in 12 healthy volunteers. The "extended neck lift" was assessed for intra-rater reliability in 30 healthy volunteers and 10 patients with neck disorders and for inter-rater reliability in another 30 healthy volunteers and nine patients with neck disorders. EMG activation of the spinal extensor muscles was generally low. Only during the "extended neck lift" was there a slight tendency that cervical extensors were more activated compared with thoracic extensors. The reliability was good (ICC 0.80-0.94); however, the maximal intra-individual differences and the measurement error were large. The different test procedures used are comparable but there was a slight tendency for "the extended neck lift" to be a more selective measurement for the cervical extensors. The "extended neck lift" is reliable and could be appropriate for evaluating groups of patients. [ABSTRACT FROM AUTHOR]

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. [ABSTRACT FROM AUTHOR]

Objective: This study evaluates age- and sex-specific reference values for neck muscle endurance (NME). Methods: In this cross-sectional study, 116 randomly selected, healthy volunteers (ages 25-64 years) stratified according to age and gender participated. Dorsal and ventral NME was measured in seconds until exhaustion in a laying-down position. A weight of 4 kg for men or 2 kg for women was used in the dorsal procedure. The ventral procedure was performed without external load. Background and physical activity data were obtained and used in the analysis of NME performance. Results: Mean values for dorsal and ventral NME were about 7 and 2.5 minutes for men and 8.5 arid 0.5 minutes for women, respectively. Tue cutoff values for subnormal dorsal and ventral NME were 157 and 56 seconds for men and 173 and 23 seconds for women, respectively. Women's NME was 122% of men's NME in the dorsal (P = .17) and 24% of men's NME in the ventral (P <.0001) procedure. There were no significant differences among age groups. In multiple regression analysis, physical activity explained 4% of variability in the performance of the dorsal NME; and sex explained 37% of the variability in the performance of ventral NME. Conclusion: Tile reference values and tile cutoff points obtained could be used in clinical practice to identify patients with a subnormal NME. Sex is an important consideration when using both the test procedure and the reference values. [ABSTRACT FROM AUTHOR]

Few prospective studies on outcome have been conducted with respect to disability after anterior cervical decompression and fusion (ACDF), and the need for further rehabilitation after surgery is unknown. Thirty-four patients with cervical disc disease verified by magnetic resonance imaging were included before ACDF with a cervical carbon fibre intervertebral fusion cage. Measurements took place the day before, 6 months and 1 year after surgery, and consisted of both objective and subjective measurements. The results showed a significant improvement from surgery in neck muscle endurance in flexion, neck strength in lateral flexion, some of the pain variables, numbness, neck specific disability, change in general health and symptom satisfaction at the 1-year follow-up. Except for worsening in general health, there were no significant differences between the 6-month and the 1-year follow-up. Despite improvement in several of the variables, about one-third of the patients had deficits in the objective measurements and about two-thirds had deficits in the subjective variables. Only five patients were without neck problems according to average pain, the Neck Disability Index and general health. This suggests that there is still a great need for improvement both of the surgical procedure and the rehabilitation afterwards. [ABSTRACT FROM AUTHOR]

Impaired neck muscle function leads to disability in individuals with chronic whiplash-associated disorder (WAD), but diagnostic tools are lacking. In this study, deformations and deformation rates were investigated in five dorsal neck muscles during 10 arm elevations by ultrasonography with speckle tracking analyses. Forty individuals with chronic WAD (28 women and 12 men, mean age = 37 y) and 40 healthy controls matched for age and sex were included. The WAD group had higher deformation rates in the multifidus muscle during the first (p < 0.04) and 10th (only women, p < 0.01) arm elevations compared with the control group. Linear relationships between the neck muscles for deformation rate (controls: R(2) = 0.24-0.82, WAD: R(2) = 0.05-0.74) and deformation of the deepest muscles (controls: R(2) = 0.61-0.32, WAD: R(2) = 0.15-0.01) were stronger for women in the control group versus women with WAD, indicating there is altered interplay between dorsal neck muscles in chronic WAD. [ABSTRACT FROM AUTHOR]