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Objectives To evaluate the occurrence of low back pain (LBP) and LBP that limits work ability, to identify their potential early risks and to quantify occupational physical activity in Swedish Armed Forces (SwAF) marines during their basic 4 month marine training course. Design Prospective observational cohort study with weekly follow-ups. Participants Fifty-three SwAF marines entering the training course. Outcomes Incident of LBP and its related effect on workability and associated early risks. Occupational physical activity, as monitored using accelerometers and self-reports. Results During the training course, 68% of the marines experienced at least one episode of LBP. This yielded a LBP and LBP limiting work ability incidence rate of 13.5 (95% CI 10.4 to 17.8) and 6.3 (95% CI 4.2 to 10.0) episodes per 1000 person-days, respectively. Previous back pain and shorter body height (<= 1.80 m) emerged as independent risks for LBP (HR 2.5, 95% CI 1.4 to 4.3; HR 2.0, 95% CI 1.2 to 3.3, respectively), as well as for LBP that limited work ability (HR 3.6, 95% CI 1.4 to 8.9; HR 4.5, 95% CI 2.0 to 10.0, respectively). Furthermore, managing fewer than four pull-ups emerged as a risk for LBP (HR 1.9, 95% CI 1.2 to 3.0), while physical training of fewer than three sessions per week emerged as a risk for LBP that limited work ability (HR 3.0, 95% CI 1.2 to 7.4). More than 80% of the work time measured was spent performing low levels of ambulation, however, combat equipment (>= 17.5 kg) was carried for more than half of the work time. Conclusions Incidents of LBP are common in SwAF marines' early careers. The link between LBP and previous pain as well as low levels of exercise highlights the need for preventive actions early on in a marine's career. The role of body height on LBP needs further investigation, including its relationship with body-worn equipment, before it can effectively contribute to LBP prevention.

Background: Cervical strength and stability is often addressed in rehabilitation of people with neck pain. These functions may be associated with emergence and retention of neck pain in cases where the neck strength does not meet daily demands. However, clear empiric support for these notions are lacking, partly due to a scarcity of well controlled dynamometry studies with large samples. First, clarification is needed whether neck strength is in fact reduced in people with neck pain and to resolve the diagnostic performance of neck strength tests. Purpose: To compare neck muscle strength of women with non-specific long-term neck pain and healthy controls. Also, to assess the diagnostic performance of neck strength tests by assessing their discriminative ability to discern women with and without neck pain. Methods: The study had a cross-sectional design with data on cervical strength derived from the baseline measurement of a randomized controlled trial (RCT). 80 women with long-term non-specific neck pain (NP) were compared with 40 healthy women (CON). The NP group was a subsample from the RCT selected so that there were no group differences (NP-CON) for body weight and physical activity. Cervical strength assessment included dynamometry of cervico-thoracic extension (CTE) and flexion (CTF) in sitting and cranio-cervical flexion (CCF) in standing, all performed with isometric maximum voluntary contraction (iMVC). Independent samples Mann-Whitney U test and T-test were used to assess group differences for iMVC of the tests. Diagnostic accuracy was further assessed with a receiver operating characteristic (ROC) curve by plotting the true positive rate (sensitivity) as a function of the false positive rate (1 - specificity). The area under the ROC curve (AUC) with 95% confidence interval was used to determine discriminative ability of the tests. The optimal cut-off value to discern NP from CON with corresponding sensitivity and specificity was also determined. Results

Electricians have an increased risk of developing musculoskeletal disorders (MSDs) compared to most other blue collar professions. Many end up with chronic disabilities, forcing them to change careers or to go on sickness pension. Besides negative consequences for the individuals concerned, MSDs also have a detrimental impact on the workforce (reduced number of professionals) and on society (financial costs). It is therefore important to find ways to prevent MSDs and to promote good ergonomic behavior. Electricians’ knowledge and habits regarding MSDs are first formed and shaped in school, during vocational education to become an electrician. In the course of this time the students have periods of internship during which they interact with professionals within the field. Drawing on the ideas of bio-power and governmentality, as introduced and developed by Foucault and developed further by Rose, discourses govern how it is possible to think and act. From this standpoint, then, talk and discourses are not perceived as innocent or ‘mere’ talk but as producing and regulating subjects through their acquisition of specific dispositions, tastes and abilities. Thus, discourses drawn on about electricians and the profession during the students’ internship will govern how it is possible for the students to think and act about themselves and others in relation to both ergonomic behavior and MSDs and, by extension, will have material effects on electricians’ health. This means that, to foster healthy ergonomic behavior one needs to consider how electricians are thought of within the field, i.e. how electricians and the profession are discursively conceived. The purpose of this paper is thus to explore discursive constructions of electricians and the profession as these were expressed in discussions about MSDs among professionals in the field. Two semi-structured focus group interviews and one individual interview with professionals in the field were conducted. The participants

Bakgrund och syfte Många yrkesprogram på gymnasiet utbildar för yrken där vi vet att anställda ofta drabbas av belastningsrelaterad ohälsa. Exempelvis visar data från Arbetsmiljöverket att 9–12% av alla installationselektriker och elmontörer rapporterar besvär orsakade av påfrestande arbetsställningar och att de rapporterar en ettårsprevalens på 6–10% för besvär i nacke, axlar, arm och rygg till följd av arbetet som varit så svåra att det påverkat arbetsförmågan. Forskning har även visat att elever på elteknikprogram löper särskilt hög risk att drabbas av arbetsskada relativt andra utbildningar. Redan under utbildningen bör åtgärder sättas in för att minska dessa risker. En genomgång av litteraturen visar dock att det finns tydliga brister i hur yrkesprogram förbereder eleverna för ett kommande arbetsliv vad gäller arbetsmiljökunskap och att orsakerna till dessa brister troligen finns inom undervisningens innehåll och utformning, lärares kompetens och samverkan med yrkeslivet under utbildningen. Vidare kan elever-nas attityder till arbetsmiljöundervisning utgöra ett hinder. Sammantaget förefaller hin-dren för en bra arbetsmiljöutbildning på yrkesprogram inom gymnasiet vara komplexa och multifaktoriella. Innan åtgärder sätts in för att utveckla undervisningen finns därför stort behov av att kartlägga de komplexa orsakssambanden bakom brister inom utbildningen och utifrån det utforma förbättringsåtgärder. I vår studie avser vi att svara på forskningsfrågan: Hur anser olika intressenter att olika faktorer inom såväl utbildningen som framtida yrkeskontext interagerar och bidrar till uppkomsten av belastningsbesvär hos installationselektriker? Metod och resultat Studien har en fallstudiedesign där fokusgrupper och problemträdsanalys används. Pro-blemträdsanalys är en metod för att kartlägga komplexa orsakssamband och att klargöra grundläggande orsaker. Analysen kan därmed säkra att aktiviteter och insatser inte väljs och påbörjas utan att man först har kartlagt kärnprobl

Students in vocational education to become electricians have an increased risk of developing musculoskeletal disorders (MSDs) once in the workforce compared to most other blue collar professions (Toomingas et al., 2014). This increased risk comes from having to work in awkward body positions, with heavy and sometimes poorly adapted tools and with time constraints. Many end up with chronic disabilities, forcing them to change careers or to go on sickness pension. Besides the significant and damaging consequences for the individual concerned, losing electricians from the workforce is a significant loss for the building industry in which electricians these days are scarce, and for society that not only loses tax-incomes but also possibly need to pay sickness pension for these people during quite a few years. It is therefore important to find ways to prevent MSDs and to promote good ergonomics in the building industry in general and among electricians specifically. Electricians’ knowledge and habits regarding MSDs are first formed and shaped in school, during vocational education to become an electrician. Drawing on the ideas of bio-power and governmentality, as introduced and developed by Foucault (1988, 1990, 2003) and developed by Rose (1999; Rabinow and Rose, 2006), discourses govern how it is possible to think and act. From this standpoint, then, talk and discourses are not perceived as innocent or ‘mere’ talk (Hall, 2001) but as governing the production, regulation and representation of both bodies and subjects through the acquisition of specific dispositions, tastes and abilities (Foucault, 1988; Rose, 1999). Thus, discourses drawn on in school about electricians and the profession govern how it is possible to think and act about oneself and others in relation to both ergonomics and MSD and, by extension, have material effects on electricians’ health. This means that, to foster healthy ergonomics one needs to consider how electricians and the profession are conce

Besvär ifrån kroppens muskler och leder såsom nack- och ryggbesvär är fortfarande ett stort problem inom arbetslivet. Muskuloskeletal diagnos är den vanligaste orsaken till lång sjukfrånvaro inom privat sektor och näst vanligast inom kommuner och landsting. Orsakerna till dessa besvär kan vara relaterade till exponering både under arbete och på fritid, men även till individfaktorer. Vår forskargrupp har en bred ansats för att fylla kunskapsluckor inom detta område och kommer att presentera resultat från flera forskningsprojekt i symposiet Arbete, individ och nacksmärta. Långvarigt sittande har blivit alltmer vanligt förekommande i många yrkesgrupper. Långvarigt sittande och låg fysisk aktivitet har också uppmärksammats som ett betydande hälsoproblem i dagens arbetsliv och även som en möjlig riskfaktor för smärta i nacke-skuldra. Men forskningen om betydelsen av långvarigt sittande för smärta i nacke-skuldra är fortfarande begränsad. Likaså är det oklart om huvudets hållning vid sittandet och nackens funktion, exempelvis nackens rörelsefunktion och styrka, har betydelse för besvärsutveckling. Statiskt arbete med nacken i vridna och böjda positioner misstänks vara en riskfaktor för nack-skuldersmärta i yrken såsom tandläkare, men det är oklart varför vissa exponerade individer drabbas medan andra inte får ont. För de med långvarig smärta krävs ofta rehabiliterande åtgärder, och hur väl dessa åtgärder lyckas kan även det vara beroende av individens fysiska och psykosociala arbetsmiljö. Individens arbetsmiljö påverkar således inte bara risken för om man får besvär utan kan också ha betydelse för hur rehabiliteringen av besvären lyckas. Syftet med detta symposium är att presentera studier från Centrum för belastningsskadeforskning som handlar om nacksmärta i arbetslivet, sammanfatta kunskapsläget inom området och diskutera hur arbetet kan utformas för att bli hållbart och inkluderande. De forskningsexempel som presenteras berör stillasittande och hållning i arbetslivet o, Symposiet omfattade följande presentationer:1. Stillasittande och nackbesvär i yrken med manuellt arbete. David Hallman, Svend Erik Mathiassen, Marina Heiden, Marie Birk Jørgensen, Andreas Holtermann2. Har personer med nacksmärta dålig hållning – kan detta vara av betydelse för besvärsutvecklingen? Thomas Rudolfsson, Martin Björklund, Åsa Svedmark, Mats Djupsjöbacka3. Riskfaktorer bakom nacksmärta i tandläkaryrket. Fredrik Hellström, Tina Rönnlund Borg, Mats Djupsjöbacka, Martin Björklund4. Påverkar arbetsmiljön rehabiliteringsresultatet? En longitudinell uppföljning av kvinnor med nacksmärta. Martin Björklund, Åsa Svedmark, Charlotte Häger, Johan Sommar, Jens Wahlström

Background Cervical range of motion (ROM) is commonly assessed in clinical practice and research. In a previous study we decomposed active cervical sagittal ROM into contributions from lower and upper levels of the cervical spine and found level- and direction-specific impairments in women with chronic non-specific neck pain. The present study aimed to validate these results and investigate if the specific impairments can be explained by the neutral posture (defining zero flexion/extension) or a movement strategy to avoid large gravitationally induced torques on the cervical spine. Methods Kinematics of the head and thorax was assessed in sitting during maximal sagittal cervical flexion/extension (high torque condition) and maximal protraction (low torque condition) in 120 women with chronic non-specific neck pain and 40 controls. We derived the lower and upper cervical angles, and the head centre of mass (HCM), from a 3-segment kinematic model. Neutral head posture was assessed using a standardized procedure. Findings Previous findings of level- and direction-specific impairments in neck pain were confirmed. Neutral head posture was equal between groups and did not explain the direction-specific impairments. The relative magnitude of group difference in HCM migration did not differ between high and low torques conditions, lending no support for our hypothesis that impairments in sagittal ROM are due to torque avoidance behaviour. Interpretation The direction-and level-specific impairments in cervical sagittal ROM can be generalised to the population of women with non-specific neck pain. Further research is necessary to clarify if torque avoidance behaviour can explain the impairments., Orginally published in manuscript form with title: Direction specific impairments in cervical range of motion in women with chronic neck pain: Influence of head posture and gravitationally induced torque.

RATIONALE, AIMS AND OBJECTIVES: The aims of this study is to investigate the prevalence of patients seeking care due to different musculoskeletal disorders (MSDs) at primary health care centres (PHCs), to chart different factors such as symptoms, diagnosis and actions prescribed for patients that visited the PHCs due to MSD and to make comparisons regarding differences due to gender, age and rural or urban PHC. METHODS: Patient records (2000) for patients in working age were randomly selected equally distributed on one rural and one urban PHC. A 3-year period was reviewed retrospectively. For all patient records' background data, cause to the visit and diagnosis were registered. For visits due to MSD, type and location of symptoms and actions to resolve the patients problems were registered. Data was analysed using cross tabulation, multidimensional chi-squared. RESULTS: The prevalence of MSD was high; almost 60% of all patients were seeking care due to MSD. Upper and lower limb problems were most common. Symptoms were most prevalent in the young and middle age groups. The patients got a variety of different diagnoses, and between 13 and 35% of the patients did not receive a MSD diagnose despite having MSD symptoms. There was a great variation in how the cases were handled. CONCLUSIONS: The present study points out some weaknesses regarding diagnostics and management of MSD in primary care.

BACKGROUND: The evidence for the effect of treatments of neck pain is modest. In the absence of causal treatments, a possibility is to tailor the treatment to the individuals' functional limitations and symptoms. The aim was to evaluate treatment effects of a tailored treatment versus a non-tailored treatment. Our hypothesis was that tailored treatment (TT) would have better effect on pain intensity and disability than either non-tailored treatment (NTT) (same treatment components but applied quasi-randomly) or treatment-as-usual (TAU) (no treatment from the study, no restrictions). We further hypothesized that TT and NTT would both have better effect than TAU. METHOD: One hundred twenty working women with subacute and chronic non-specific neck pain were allocated to 11 weeks of either TT, NTT or TAU in a randomized controlled trial with follow-ups at 3, 9 and 15 months. The TT was designed from a decision model based on assessment of function and symptoms with defined cut-off levels for the following categories: reduced cervical mobility, impaired neck-shoulder strength and motor control, impaired eye-head-neck control, trapezius myalgia and cervicogenic headache. Primary outcomes were pain and disability. Secondary outcomes were symptoms, general improvement, work productivity, and pressure pain threshold of m. trapezius. RESULTS: Linear mixed models analysis showed no differences between TT and NTT besides work productivity favoring TT at 9- and 15-months follow-ups. TT and NTT improved significantly more than TAU on pain, disability and symptoms at 3-month follow-up. General improvement also favored TT and NTT over TAU at all follow-ups. CONCLUSION: Tailored treatment according to our proposed decision model was not more effective than non-tailored treatment in women with subacute and chronic neck pain. Both tailored and non-tailored treatments had better short-term effects than treatment-as-usual, supporting active and specific exercise therapy, although therap, Funding text: The project was funded by the Swedish Council for Working Life and Social Research (registration number 2009-1403), AFA Insurance (registration number 090288) and The Centre for Environmental Research (project number 1152383).

Background: It is recognised that back pain (BP) is a debilitating medical problem in the soldier community, which limits operational readiness as well as work ability. As such, identification of risk factors is a necessity for effective preventive actions, but also regarded as important from a safety perspective. The aim of this prospective cohort study was therefore to identify risk factors for back pain and BP limiting work ability in active duty marines within a 6 and 12-month period. Methods: Demographic characteristics, health-related factors and occupational exposure information, as gathered from questionnaires, as well as clinical test of movement control among 137 Swedish marines were regressed with multivariable logistic regressions, and strength of associations was presented as odds ratio (OR) with 95 % confidence intervals (CI). BP within 6 and 12 months were used as primary outcomes, whereas BP limiting work ability within 6 and 12 months served as secondary outcomes. Results: Previous BP and tall body height (≥1.86 m) emerged as risk factors for back pain within 6 months (OR 2.99, 95 % CI 1.22-7.30; OR 2.81, 95 % CI 1.16- 6.84, respectively), and 12 months (OR 6.75, 95 % CI 2.30-19.80; 2.75, 95 % CI 1.21-6.29, respectively). Previous BP was also identified as risk factor for BP limiting work ability within 12 months (OR 6.64, 95 % CI 1.78-24.78), and tall body height emerged as a risk within both six (OR 4.30, 95 % CI 1.31-14.13) and 12 months (OR 4.55, 95 % CI 1.53-13.57) from baseline. Conclusions: Marines with a history of BP are at risk of further BP episodes, which, thus, emphasise the importance of early BP preventive actions. Tall body height also emerged as an important risk which may reflect that personal equipment and work tasks are not adapted for the tallest marines. While this should be considered when introducing new work equipment, further studies are warranted to clarify the underlying mechanism of this association., Forskningsfinansiärer:Swedish Society for Military Medical Officers1st Marine Regiment, Swedish Armed ForcesSwedish Armed Forces PhD Programme

Background. Perceived muscular tension (PMT) has been suggested to predict development of neck/shoulder pain. It has been hypothesized to be an early sign of musculoskeletal disorder and a possible mediator of stress on symptoms. However, the content of the concept of PMT is not clear. This study examined the association between PMT and physical and psychosocial factors and physical activity in a group of healthy students. Methods. This cross-sectional study was conducted on the baseline measurements of an ongoing longitudinal case-control study. A total of 63 healthy university students without complaints of neck/shoulder pain were included (21 males, 42 females, mean age 24 years). PMT was measured by asking the question “Have you, during the past month, experienced muscular tension (for example, wrinkled your forehead, ground your teeth, raised your shoulders)?” with the following response options: never, a few times, a few times per week, or one or several times per day. Self-reports on symptoms in the neck, anxiety, depression, stress, mental health, physical health, sleep and physical activity were collected with questionnaires, as well as by tenderness on palpation of neck muscles and trapezius pressure pain threshold. This produced a total of 15 variables. The relationship between these variables and PMT were analyzed using Spearman’s rank correlation coefficient. Results. Positive correlations were found between PMT and temporomandibular complaints (rho= .34, p < .001), neck crepitus (rho= .33, p < .001), anxiety (rho= .33, p < .001), depression (rho= .31, p < .05), tenderness on palpation (rho= .25, p < .05). There was a negative correlation between PMT and mental health (rho= -.26, p < .05). Frequent experience of PMT had weak to moderate correlations with frequency of symptoms and higher psychosocial strain, but not with stress. This suggests some covariance between PMT and both physical and psychosocial factors.

Aim: To investigate whether total knee arthroplasty (TKA) was associated with stability in single-limb stance and whether reduced stability in single-limb stance was associated with increased postural sway in bilateral quiet standing. Methods: 3D kinematics for center of mass was used to assess postural sway in 23 subjects with TKA and 23 controls. Tests included bilateral quiet standing with and without vision and on a compliant surface, and single-limb stance. Results: 30% of the subjects in the TKA group were unable to maintain single-limb stance for 20. s on any leg. Of the 70% in the TKA group able to stand on one leg, mean sway velocity in the medio-lateral direction was marginally higher for the prosthetic side (p = .02), but no differences were found between the TKA and the control group in single-limb stance. Performance in bilateral quiet standing was similar in TKA-subjects, able as well as unable to stand on one leg, and controls. Reduced quadriceps strength in the contralateral leg, higher BMI, and older age predicted failure to maintain single-limb stance. Conclusion: In subjects able to stand on one leg, performance was considered comparable between the prosthetic and contralateral side and between groups. Inability to stand on one leg did not affect postural sway in bilateral quiet standing. The results suggest that inability to maintain single-limb stance is explained by reduced physical capacity rather than the knee condition in itself. The present study emphasizes the importance of physical activity to improve strength and functional capacity.

Objectives To estimate the prevalence of self-rated musculoskeletal pain and pain limiting work ability in Swedish Armed Forces (SAF) marines, and to study factors potentially associated with pain limiting work ability for the most prevalent pain regions reported. Design Population-based, cross-sectional survey. Participants There were 272 SAF marines from the main marine battalion in Sweden included in the study. Outcomes Self-assessed musculoskeletal pain and pain limiting the marines' work ability within a 6-month period, as obtained from structured questionnaires. The association of individual, health and work-related factors with musculoskeletal pain limiting work ability was systematically regressed with multiple logistic models, estimating OR and 95% CI. Results Musculoskeletal pain and pain limiting work ability were most common in the back, at 46% and 20%, and lower extremities at 51% and 29%, respectively. Physical training ≤1 day/week (OR 5.3, 95% CI 1.7 to 16.8); body height ≤1.80 m (OR 5.0, 95% CI 1.6 to 15.1) and ≥1.86 m (OR 4.4, 95% CI 1.4 to 14.1); computer work 1/4 of the working day (OR 3.2, 95% CI 1.0 to 10.0) and ≥1/2 (OR 3.3, 95% CI 1.1 to 10.1) of the working day were independently associated with back pain limiting work ability. None of the studied variables emerged significantly associated with such pain for the lower extremities. Conclusions Our findings show that musculoskeletal pain and resultant limitations in work ability are common in SAF marines. Low frequency of physical training emerged independently associated with back pain limiting work ability. This suggests that marines performing physical training 1 day per week or less are suitable candidates for further medical evaluation and secondary preventive actions. While also associated, body height and computer work need further exploration as underlying mechanisms for back pain limiting work ability. Further prospective studies are necessary to clarify the direction of causality., Finansierat av:- 1st Marine Regiment, Swedish Armed Forces, the Swedish Armed Forces PhD Programme- Swedish Society for Military Medical Officers

OBJECTIVE: To evaluate the effect of neck coordination exercise on sensorimotor function in women with neck pain compared with best-available treatment and sham treatment. DESIGN: Observer-blinded randomized controlled trial with short-term and 6-month follow-ups. SUBJECTS: Women with chronic non-specific neck pain were randomized to 3 groups: neck coordination exercise with a novel training device; strength training for the neck and shoulders; or massage. Each group had 36 participants. METHODS: The intervention period was 11 weeks with 22 individually supervised sessions. Primary outcomes were postural sway measures and precision of goal-directed arm movements. Secondary outcomes were range of motion for the neck, peak speed of axial rotation, and neck pain. A repeated measures multivariate analysis of variance (MANOVA) was conducted separately on the primary outcomes for the short-term and 6-month evaluations and on the sensorimotor secondary outcomes for the 6-month effect. The 6-month effect on pain was analysed with a repeated measures analysis of variance (ANOVA). RESULTS: No significant treatment effects in favour of neck coordination exercise were found for short-term or 6-month evaluations. CONCLUSION: Neck coordination exercise is no better than strength training and massage in improving sensorimotor function. Further research should investigate the use of cut-offs for sensorimotor dysfunctions prior to proprioceptive or coordinative training.

Aim of the investigation: The evidence for physiotherapy treatments of nonspecific neck pain is modest despite a large increase of intervention studies the last decade. One reason could be different underlying causes for pain in individuals with nonspecific neck pain, and that identification of sub-groups or individual needs is seldom accounted for in studies. In the absence of causal treatment options, a tailored treatment approach based on an explicit clinical decision model guided by assessment of function, clinical signs and symptoms, should be considered. Our aim was to evaluate tailored treatment based on such a decision model, targeting women with nonspecific neck pain. Our main hypothesis was that the tailored treatment (T) would have better short, intermediate and long-term effects on pain intensity and pressure pain threshold for the trapezius muscles than either non-tailored treatment (NT) (same treatment components but applied quasi-randomly) or treatment-as-usual (TAU) (no treatment from the study, no restrictions). We further hypothesized that T or NT has better effect than TAU. For details, cf. Current Controlled Trials registration ISRCTN49348025 and published study protocol. Methods: 120 working women with minimum six weeks duration of neck pain were randomized to the T, NT or TAU groups. All participants had more than “no disability” but less than “complete disability” according to the Neck Disability Index, and reported impaired capacity on the quality or quantity to work the preceding month. Main exclusion criteria were trauma-related neck pain, specific diagnoses and generalized pain or concomitant low back pain. The decision model for tailored treatment was based on tests and symptoms with defined cut-off levels comprising the following main categories: reduced cervical mobility, impaired neck-shoulder strength and motor control, trapezius myalgia, cervicogenic headache and impaired eye-head-neck control (cf. published study protocol). Assessme

There is evidence that patients with psychotic conditions display greater center of pressure (CoP) displacement during quite standing than healthy subjects, but the underlying impairments in the control mechanisms are uncertain. The aim of this study was to identify the nature of possible impairments in the control of posture by modulation of visual and kinesthetic information during quiet standing. Center of pressure (CoP) data and whole-body kinematics of the center of mass (CoM) were recorded during quite standing on a firm surface with eyes open and with eyes closed, and standing with eyes open on a yielding surface. During all three conditions, patients displayed greater migration of CoM and CoP-CoM, a measure related to ankle joint torque, whereas CoP-frequency (MPF) was similar in patients and healthy subjects. Our results suggested that greater postural sway in patients may depend on disproportionally large ankle joint torque without corresponding increase in frequency. Furthermore, interactions between groups and conditions suggested that the patients made less use of visual information for postural control than the healthy subjects.

Reduced cervical range of motion (ROM) is a common finding in people with neck pain. With few exceptions, only the angle between head and thorax has been measured. Our aim was to use an extended model to compare active cervical flexion and extension, separate for upper and lower cervical levels, between people with chronic non-traumatic neck pain and controls. We also investigated associations between ROM measures, symptoms and self-rated functioning. In this cross-sectional study, 102 subjects with neck pain and 33 healthy controls participated. An electromagnetic tracker system was used to measure the kinematics to construct a three-segment model including the thorax, cervical spine and head. Neutral flexion/extension were defined at subjects’ self-selected seated posture. We found that in the neck pain group, extension in the upper cervical levels and predominately flexion for the lower levels were reduced. The ratio between ROM for the upper and lower levels was altered in the neck pain group so that the lower levels contributed to a lesser extent to the total sagittal ROM compared to controls. These findings could not be explained by a greater forward head posture but must have other origins. For the neck pain group, ROM measures were weakly associated to pain and self-rated functioning. Altogether, this implies that using a three-segment model for assessment of ROM can be a valuable improvement for characterisation of patients and treatment evaluation.

BACKGROUND: A major problem with rehabilitation interventions for neck pain is that the condition may have multiple causes, thus a single treatment approach is seldom efficient. The present study protocol outlines a single blinded randomised controlled trial evaluating the effect of tailored treatment for neck-shoulder pain. The treatment is based on a decision model guided by standardized clinical assessment and functional tests with cut-off values. Our main hypothesis is that the tailored treatment has better short, intermediate and long-term effects than either non-tailored treatment or treatment-as-usual (TAU) on pain and function. We sub-sequentially hypothesize that tailored and non-tailored treatment both have better effect than TAU. METHODS: 120 working women with minimum six weeks of nonspecific neck-shoulder pain aged 20-65, are allocated by minimisation with the factors age, duration of pain, pain intensity and disability in to the groups tailored treatment (T), non-tailored treatment (NT) or treatment-as-usual (TAU). Treatment is given to the groups T and NT for 11 weeks (27 sessions evenly distributed). An extensive presentation of the tests and treatment decision model is provided. The main treatment components are manual therapy, cranio-cervical flexion exercise and strength training, EMG-biofeedback training, treatment for cervicogenic headache, neck motor control training. A decision algorithm based on the baseline assessment determines the treatment components given to the each participant of T- and NT-groups. Primary outcome measures are physical functioning (Neck Disability Index) and average pain intensity last week (Numeric Rating Scale). Secondary outcomes are general improvement (Patient Global Impression of Change scale), symptoms (Profile Fitness Mapping neck questionnaire), capacity to work in the last 6 weeks (quality and quantity) and pressure pain threshold of m. trapezius. Primary and secondary outcomes will be reported for each group

Objective: To evaluate the slow and fast components of postural control in quiet stance in subjects with chronic neck pain, associations between postural sway and self-rated characteristics and to study the impact of anthropometrics on postural sway. Design: A single-blinded cross-sectional study including two separate data collections. Subjects: Sample 1: Persons with chronic non-specific neck pain (NS, n=24), whiplash associated disorders (WAD, n=21). Healthy subjects were controls (CON, n=21). Sample 2: Women only, 98 NS and 32 CON subjects. Methods: Subject performed a quiet stance test with eyes closed on a force platform while the center of pressure (CoP) trajectory was measured. Sample 1 was tested on a firm surface for 30 seconds, while sample 2 was tested on both firm and foam surfaces for 190 seconds. The CoP signal was decomposed into the slow and fast components and the magnitude of these signals were calculated. Anthropometrics were included as covariate in the analysis of group differences if correlated with postural sway variables. Group differences in the sway variables were evaluated, as well as association between postural sway and self-ratings of symptoms, functioning and kinesiophobia. Results: Increased magnitude of the slow sway component was found for both neck pain groups. Increasing age was associated with increased magnitude of the fast component. Surface conditions had no effect on group difference. For WAD, associations were found between the magnitude of the slow component and self-rated characteristics related to physical functioning, sensory alterations and psychosocial functioning. For NS, concurrent low back pain was associated with increased postural sway. Conclusion: Postural control can be altered in chronic neck pain. This effect was present only for the slow sway component, which implies aberration in sensory feedback or processing of sensory information. Associations between postural sway and self-rated characteristics in WAD s, Manuscript included in medical doctorial thesis

Godkänd; 2011; 20120317 (ulrroi)

Upprättat; 2010; 20120317 (ulrroi)

The effect of neck/shoulder pain on the performance in a hand laterality motor imagery test was studied. Responses to the Cooper and Shepard (1975, Journal of Experimental Psychology: Human Perception and Performance 104 48–56) hand laterality test were explored in twenty-four individuals with chronic non-specific neck pain and twenty-one subjects with chronic neck pain of traumatic origin (whiplash-associated disorder). Twenty-two controls were also included in the study. Digitalised right- or left-hand stimuli were presented at five different stimulus angles (0°, 45° laterally, 90° laterally, 135° laterally, and 180°). The experimental task was to decide the laterality as fast and accurately as possible. The performance, both reaction time (RT) and accuracy, of the two experimental groups was contrasted with that of the control group. The main results revealed that the subjects afflicted with whiplash injury on the average exhibited a faster response pattern than symptom-free healthy controls. Despite their musculoskeletal deficits and experience of pain these volunteers also exhibited a preserved speed–accuracy tradeoff. Longer duration of time with symptoms of neck pain was, moreover, associated with progressively faster RTs. These results point to perceptual learning and may reflect different stages of adaptation to neck pain.

AIM: Several studies have reported reduced cervical range of motion (ROM) in people with neck pain. Different methodologies have been used, but with a few exception they measure only head-trunk relationship and do not discriminate between upper and lower cervical motion. Recent strategies for treatment of neck pain condition include retraining the function of the deep cervical flexors that act in cranio-cervical movements. Thus objective measures of cervical ROM in flexion-extension that includes determination of cervical level can be valuable for treatment evaluation. The aim of the present study was to compare cervical flexion and extension, separate for upper and lower cervical levels, between people with chronic neck pain and controls. Also, the association between upper and lower cervical ROM and self rated characteristics was studied. METHODS: In a cross-sectional study design, 135 subjects (non-traumatic neck pain: n = 102, controls: n = 33) performed three trials of maximum active cervical flexion and extension. Subjects were seated in a chair with belts crossed over the chest. An electromagnetic tracker system was used to register the kinematics to construct a three-segment model including the trunk, cervical spine and head. The angle for the upper cervical level was defined as the angle between the head and the cervical spine segments. The angle for the lower cervical level was defined as the angle between the cervical spine and the trunk segments. Pressure pain thresholds, pain ratings as well as self ratings of functioning and physical activity were assessed. RESULTS: Total ROM was reduced in the neck pain group for both the lower (controls: mean = 26.5, SD=6.7, neck pain: mean=19.0, SD =6.5 degrees) and the upper cervical levels (controls: mean = 84.7, SD = 7.9, neck pain: mean = 73.0, SD = 11.2 degrees). This reduction was direction specific: in the upper cervical level only extension was reduced and in the lower cervical level the reduction was predom

Nackbesvär är vanligt förekommande och utgör en betydande orsak till ohälsa och inskränkt arbetsförmåga. Vanligen går det inte att klarlägga organisk orsak till långvariga nackbesvär men mycket tyder på att de oftast är ett komplext tillstånd där både biologiska och psykosociala faktorer är av betydelse. Forskning har visat på samband mellan långvariga nackbesvär och störningar i olika sensomotoriska funktioner och att graden av funktionspåverkan ofta är kopplad till graden av upplevda besvär. Undersökning av sensomotorisk funktion kan därför vara en viktig del i bedömningen av denna patientgrupp. Forskning har även visat att det finns evidens för positiva effekter av sensomotorisk träning vid nackbesvär på kort sikt, medan kunskap om långtidseffekter saknas. Vid träning av sensomotorisk funktion är det viktigt att beakta grundläggande kunskap inom motorisk inlärning för att öka möjligheterna till bestående träningseffekter och att dessa överförs till vardagliga situationer.