Effect of thoracic manipulation on neck pain in the mobility group: A randomized controlled trial.

Background and aims: Thoracic spine manipulation (TSM) increases the thoracic spine's range of motion (ROM), effectively reducing pain intensity and disability in patients with mechanical neck pain. We aimed to determine the effect of TSM on neck pain intensity and functional impairment in patients classified under the "mobility" category in Childs' classification. Methods: In this randomized controlled trial, patients with mechanical neck pain who met the inclusion criteria were randomly assigned to either the TSM (n = 21) or sham manipulation (n = 20) group. The primary outcomes were pain during neck rotation and subjective improvement assessed using the Numerical Pain Rating Scale (NPRS) and Global Rating of Change (GROC), respectively. The secondary outcomes were NPRS at rest, disability (assessed using the Neck Disability Index [NDI]), and ROM of the cervical and thoracic spine rotation. Outcome measurements were performed at baseline, immediately after treatment, 1 week after treatment, and at the 4-week follow-up. Linear mixed models were used to analyze the NPRS, NDI, and ROM. The GROC was analyzed using a chi-square test for the percentage recording ≥+4; the means of each group were compared using an unpaired t-test. Results: The NPRS with neck rotation, neck and thoracic ROM, and NDI showed significant interactions between the groups. The NPRS with neck rotation was significantly lower in the TSM group than in the sham group at all time points after the treatment (p < 0.001). There was no difference between the groups in the proportion showing moderate (≥+4) improvement according to the GROC; however, there was a significant difference in the mean values (p = 0.013). Conclusion: Incorporating TSM into treatment protocols may improve clinical outcomes in patients with neck pain, potentially leading to better pain management and functional recovery. Therefore, physiotherapists should consider TSM as a viable and effective intervention to improve patient outcomes in neck pain rehabilitation.

A Case of Neck Pain in a Patient with Spontaneous Cerebrospinal Fluid Leak Who Showed Characteristic Findings on Cervical Spine MRI.

We report a case of a patient with neck pain only who was diagnosed with spontaneous cerebrospinal fluid leak (SCFL) based on characteristic findings on cervical spine magnetic resonance imaging (MRI). The patient was a 47-year-old man who had been experiencing neck pain for 3 days. He experienced neck pain when he got up in the morning and could not keep standing. Cervical spine MRI showed significant dilatation of the anterolateral dural canal veins at the C2 level. Under the suspicion of SCFL, additional thoracic spine MRI was performed, which revealed epidural fluid collection in the lower thoracic spine. He underwent bed rest, but his symptoms returned. Epidural blood patch (EBP) was performed. The symptoms improved after EBP, and the venous dilatation disappeared on MRI. Venous dilatation in SCFL is considered an effect of epidural space enlargement due to dural sac shrinkage caused by cerebrospinal fluid loss. Therefore, venous dilatation in the cervical spine is an indirect finding of SCFL. It has been reported that images of epidural fluid collection and dural canal collapse on spinal MRI are useful as direct findings in the diagnosis of SCFL, and these findings are most noticeable at the thoracic level. Because SCFL with neck pain only also exists, dilated images of the epidural vein are valuable for diagnosing SCFL, and neurospine surgeons should be aware of this finding when encountering patients complaining of neck pain.

Reducing Chronic Spine Pain in an Adult Male by Decreasing Lumbar Scoliosis and Increasing Cervical Lordosis Using Chiropractic BioPhysics® Protocols: A 26-Month Follow-Up Case Report.

We present a case report of a patient suffering from chronic low back pain (CLBP) and chronic non-specific neck pain (CNSNP), both of which were caused and complicated by a physically demanding occupation, a history of mixed martial arts, and lumbar scoliosis. Improvements in patient-reported outcomes (PROs) and radiographic findings were observed following conservative spine rehabilitation. The patient, a 34-year-old male, had experienced chronic spine pain, particularly CLBP and CNSNP, for several years. He reported severe pain and increasing disability after a recent neck injury sustained while practicing jiu-jitsu. Radicular pain, along with numbness and tingling, was noted in the right upper extremity, extending to the first three digits, and there were also altered sensations and temperature changes in both feet. He described sharp, pinching mid-back pain and worsening disability due to the persistent pain, which led him to seek manual manipulative chiropractic spine therapy, though he reported little benefit from it. The patient had relied on over-the-counter pain medications for many years without achieving long-term pain and disability relief, and these medications were no longer used following treatment. Chiropractic BioPhysics® (CBP®) spinal structural rehabilitation protocols were used to improve coronal and sagittal balance, as well as paraspinal muscular strength, addressing posture, mobility, and related aspects. These protocols include postural exercises, postural Mirror Image® traction, and postural spinal manipulative therapy. All PROs improved, with a near resolution of all initial symptoms of chronic spine pain. Outcomes measured included disability indices and health-related quality of life (HRQoL) indicators. Radiographic parameter improvements were significant, demonstrating improved coronal and sagittal balance as a result of the treatment. Following 30 in-office treatments, administered three times per week for 10 weeks, initial outcomes were reassessed. The patient then received 13 in-office treatments periodically over one year, and all initial outcomes were repeated. The improvements remained stable over time. A 26-month follow-up found that the improvements were sustained over a very long period without additional treatment after the 13-month examination. Chronic spine pain, specifically CLBP and CNSNP, is a significant source of suffering and contributes substantially to the global burden of disease. Improvement in HRQoLs, PROs, and objective spine parameters are desirable clinical outcomes. Our case report documents objective improvement in lumbar scoliosis and spine pain, which is rare in conservative studies. This successful treatment of chronic pain with long-term follow-up contributes to the growing evidence supporting conservative, non-surgical treatments for CNSNP and CLBP. Successful management of chronic spine pain was observed in a patient undergoing CBP® treatment. The treatment was designed to address abnormal sagittal and coronal postural balance and radiographic abnormalities indicating spinal misalignment and reassess progress in PROs, as well as objective and subjective HRQoL measures, both following treatment and 13 months later. However, larger studies are needed to draw firm conclusions regarding the efficacy of this treatment for chronic pain.

The association between mobile phone usage duration, neck muscle endurance, and neck pain among university students.

The mobile phone is essential in daily life, especially during the pandemic. Prolonged use can cause postural issues, leading to common neck pain. This study aims to determine the correlation between mobile phone use duration, addiction, neck muscle endurance, and neck pain in university students. The study included 62 participants (30 female, 32 male) aged 18-35 years. Inclusion criteria required participants to have experienced neck pain at least twice in the past year and to have no other concomitant issues, as well as to volunteer for the study. Demographic information and daily mobile phone usage time were collected. Neck pain was assessed with the Visual Analogue Scale, smartphone addiction with the Smartphone Addiction Scale, and cervical muscle endurance was evaluated. Correlation analysis reveals a moderate relationship between neck pain severity (NPS) and cervical extensor muscle endurance (CEME), a strong relationship between NPS and cervical flexor muscle endurance (CFME), as well as a strong relationship among daily phone usage time (DPUT), CFME, and NPS, with a moderate relationship between DPUT and CEME. Participants were divided into two groups based on their DPUT, revealing that those who used their phone for four hours or more showed significantly higher levels of pain (p < 0.05) and reduced endurance in cervical flexor muscles. Our study found a strong correlation between neck pain, muscle endurance, and daily phone usage. Participants using their phones for more than four hours daily reported increased neck pain and decreased muscle endurance. We suggest integrating phone usage duration into neck pain assessments, promoting ergonomic practices, and offering detailed usage guidelines for users.

Efficacy of Myofascial Release With Transcutaneous Electrical Nerve Stimulation Conductive Glove for Neck Myofascial Syndrome: A Randomized Clinical Trial Study.

OBJECTIVE: The purpose of this study was to assess the efficacy of a myofascial release (MR) protocol applied with a transcutaneous electrical nerve stimulation (TENS) conductive glove. METHODS: Eighty individuals with neck myofascial syndrome were randomly divided into 4 groups: (1) MR protocol with a TENS conductive glove (MR+TENS), (2) MR protocol without TENS (MR), (3) conventional TENS protocol (TENS), and (4) placebo TENS (control). All participants attended 6 sessions over a period of 3 weeks. The following measures were evaluated at baseline, at the third week, and at the 1-month follow-up: Pain with the visual analog scale (VAS pain), upper trapezius pressure pain threshold (PPT) with pressure algometry, cervical range of motion (ROM) with goniometry, and disability with the neck disability index (NDI). A 2-way ANOVA with repeated measurements was applied. RESULTS: Significant changes between the 3 intervention groups and the control group were noted in the VAS and the NDI scores (P < .05) with the MR+TENS group exhibiting the biggest difference. Additionally, MR significantly increased PPT compared to TENS, and even further when applied with the conductive glove (P < .05). Regarding lateral flexion ROM, MR was equally effective either alone or in combination with the glove compared to TENS (P < .05). In contrast, TENS did not appear to affect neck PPT and ROM (P > .05). Finally, no difference between the groups was detected in cervical rotation ROM (P > .05). CONCLUSION: The MR protocol appears to be more effective in dealing with pain, disability, and lateral flexion ROM than conventional TENS. A TENS conductive glove significantly improves the effects of MR, possibly due to the combined mechanical and electrical stimulation of the muscle.

Immersive and Nonimmersive Virtual Reality-Assisted Active Training in Chronic Musculoskeletal Pain: Systematic Review and Meta-Analysis.

BACKGROUND: Virtual reality (VR) in different immersive conditions has been increasingly used as a nonpharmacological method for managing chronic musculoskeletal pain. OBJECTIVE: We aimed to assess the effectiveness of VR-assisted active training versus conventional exercise or physiotherapy in chronic musculoskeletal pain and to analyze the effects of immersive versus nonimmersive VR on pain outcomes. METHODS: This systematic review of randomized control trials (RCTs) searched PubMed, Scopus, and Web of Science databases from inception to June 9, 2024. RCTs comparing adults with chronic musculoskeletal pain receiving VR-assisted training were included. The primary outcome was pain intensity; secondary outcomes included functional disability and kinesiophobia. Available data were pooled in a meta-analysis. Studies were graded using the Cochrane Risk-of-Bias Tool version 2. RESULTS: In total, 28 RCTs including 1114 participants with some concerns for a high risk of bias were identified, and 25 RCTs were included in the meta-analysis. In low back pain, short-term outcomes measured post intervention showed that nonimmersive VR is effective in reducing pain (standardized mean difference [SMD] -1.79, 95% CI -2.72 to -0.87; P<.001), improving disability (SMD -0.44, 95% CI -0.72 to -0.16; P=.002), and kinesiophobia (SMD -2.94, 95% CI -5.20 to -0.68; P=.01). Intermediate-term outcomes measured at 6 months also showed that nonimmersive VR is effective in reducing pain (SMD -8.15, 95% CI -15.29 to -1.01; P=.03), and kinesiophobia (SMD -4.28, 95% CI -8.12 to -0.44; P=.03) compared to conventional active training. For neck pain, immersive VR reduced pain intensity (SMD -0.55, 95% CI -1.02 to -0.08; P=.02) but not disability and kinesiophobia in the short term. No statistical significances were detected for knee pain or other pain regions at all time points. In addition, 2 (8%) studies had a high risk of bias. CONCLUSIONS: Both nonimmersive and immersive VR-assisted active training is effective in reducing back and neck pain symptoms. Our study findings suggest that VR is effective in alleviating chronic musculoskeletal pain. TRIAL REGISTRATION: PROSPERO CRD42022302912; https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=302912.

Unravelling the mechanisms behind the short-term effects of dry needling: new insights from a mediation analysis with repeatedly measured mediators and outcomes.

OBJECTIVE: to explore the causal pathways underlying the short-term effects of deep dry needling (DDN) in people with chronic neck pain. DESIGN: explanatory longitudinal mediation analysis with repeatedly measured mediators and outcomes. SETTING: primary care setting PARTICIPANTS: 128 patients with chronic neck pain. INTERVENTIONS: Participants were randomized in 2 groups; DDN of the neck muscles combined with stretching (N = 64) and stretching alone (N=64). OUTCOME MEASURES(S): Two outcomes (pain intensity and neck pain-related disability) and 3 candidate mediators (local pain pressure thresholds (PPTs), cervical range of motion (ROM) and neck muscle strength) were included. Pain intensity was also included as a competing mediator in the mediation analysis for disability. Mediators and outcomes were measured at three timepoints; post-intervention and 2- and 4-week follow-up. Age, gender and the baseline values of the outcome and mediators were included as pre-treatment mediator-outcome confounders. RESULTS: reductions in pain intensity strongly mediated the short-term effects of DDN on disability, from post-intervention to 4-week follow-up. In addition, the attenuation of local hypersensitivity (via increasing PPTs) moderately mediated reductions in pain intensity at each timepoint. On the other hand, gains in cervical ROM contributed to reducing neck pain-related disability. Changes in muscle strength did not lead to better outcomes. CONCLUSION: this novel study demonstrated that DDN effect on neck pain-related disability is strongly driven by the analgesic effects of this physical therapy modality. Increasing PPTs and cervical ROM seem to be also part of the mechanisms behind DDN's effect.

Geometric morphometric analysis of the brainstem and cerebellum in Chiari I malformation.

Background: Chiari I malformation (CMI) is characterized by inferior descent of the cerebellar tonsils through the foramen magnum and is associated with headache and neck pain. Many morphometric research efforts have aimed to describe CMI anatomy in the midsagittal plane using classical measurement techniques such as linear dimensions and angles. These methods are less frequently applied to parasagittal features and may fall short in quantifying more intricate anatomy with fewer distinct homologous landmarks. Methods: Landmark-based geometric morphometric techniques were used to asses CMI morphology in five anatomical planes of interest. Results: Significant shape differences between CMI and age/sex-matched controls were found in the midsagittal (Pseudo-F = 5.4841, p = 0.001) and axial planes through the rostral medulla (Pseudo-F = 7.6319, p = 0.001). In addition to tonsillar descent, CMI principal component 1 (PC1) scores in the midsagittal protocol were associated with marked anterior concavity of the brainstem and generalized verticality of the cerebellum with anterior rotation of its anterior lobe. In the axial medulla/cerebellum protocol, CMI PC1 scores were associated with greater anterior-posterior (A-P) dimension with loss of medial-lateral (M-L) dimension. Discussion: These results suggest that CMI is associated with greater curvature of the brainstem and spinal cord, which may perturb normal neural activities and disrupt cerebrospinal fluid movements. Previous reports on the A-P diameter of the posterior fossa in CMI have conflicted; our findings of greater A-P cerebellar dimensionality with concomitant loss of width alludes to the possibility that more caudal aspects of the posterior cranial fossa are more bowl-like (homogenous in axial dimensions) and less trough-like or elongated in the M-L direction.

The prevalence and factors associated with neck and low back pain in patients with stroke: insights from the CHARLS.

BACKGROUND: Although stroke is prevalent among Chinese, individuals with stroke may become more disabling if they have concomitant neck pain (NP) and low back pain (LBP). However, the prevalence and factors associated with post-stroke spinal pain among Chinese remain unknown. The current study used the 2018 cohort data from the China Health and Aged Care Tracking Survey (CHARLS) to determine the prevalence and factors associated with increased post-stroke NP and LBP in China. METHODS: The CHARLS study was conducted on four cohorts of nationally representative samples of individuals aged 45 years and above from 30 provincial-level administrative units in China. We used data from the 2018 cohort of the CHARLS survey to determine the prevalence and factors associated with NP and LBP in the non-stroke and post-stroke populations. Participants aged 45 years or older who reported to have NP, and/or LBP were identified. The study was statistically analyzed using t-test, and ANOVA analysis of variance. A multiple logistic regression model was used to identify factors significantly associated with NP and/or LBP in the non-stroke and post-stroke populations. RESULTS: A total of 19,816 individuals participated in the 2018 survey. The final inclusion of 17,802 subjects who met the criteria included 16,197 non-stroke and 885 stroke participants. The prevalence of NP and LBP in non-stroke population was 17.80% (95% CI: 17.21-18.39) and 37.22% (95% CI: 36.47-37.96), respectively. The prevalence of NP and LBP in the target stroke population was 26.44% (95% CI: 23.53-29.35) and 45.42% (95% CI: 42.14-48.71), respectively, and the difference was statistically significant (p < 0.05). Factors associated with increased post-stroke NP included female, short sleep duration, long lunch break, physical dysfunction, and depression. Factors associated with increased post-stroke LBP included female, comorbidities of two or more chronic diseases, physical dysfunction, and depression. CONCLUSION: The current study highlighted the high prevalence of post-stroke neck pain (26.44%) and LBP (45.42%) in China. While slightly different associated factors were found to be associated with a higher prevalence of post-stroke NP and LBP, female and individuals with more physical dysfunction or depression were more likely to experience post-stroke spinal pain. Clinicians should pay more attention to vulnerable individuals and provide pain management measures.

The influence of breastfeeding factors on the prevalence of back and neck pain: data from an online survey.

BACKGROUND: Sometimes during breastfeeding women adopt positions that may cause problems with musculoskeletal system, resulting in back pain. The aim of this study was to determine the prevalence of lower back, upper back and neck pain in breastfeeding women and how this may be related to the act of breastfeeding. METHODS: An online survey within Poland was conducted among 395 breastfeeding women who were 1 to 48 months postpartum and were divided into two groups; "no back pain" and "back pain present". The measurement tools used included an original questionnaire, the International Physical Activity Questionnaire (IPAQ), a Numerical Pain Rating Scale (0-10), and the Roland-Morris Disability Questionnaire. Pearson's chi-squared tests, Mann-Whitney U tests, Student's t-tests, and Kruskal-Wallis ANOVA tests were used to compare the groups. RESULTS: It was found that 84% of breastfeeding mothers suffered from back pain at least once a month. Pain was experienced at least once a week in the cervical, thoracic and lumbosacral regions in 48%, 36%, and 66% of the women, respectively. A dysfunctional state was present in 27.6% of breastfeeding mothers who suffered from back pain. Mothers experiencing back pain spent significantly more time on single breastfeeding episodes (p < 0.05) and had an increased total time breastfeeding per day (p < 0.01) compared to mothers with no back pain. Neck pain was significantly less intense in mothers preferring to breastfeed in a lying position as compared to mothers preferring a sitting position in a chair or an armchair (p < 0.05). CONCLUSIONS: This survey of Polish breastfeeding mothers revealed a very high prevalence of lower back, upper back and neck pain. The amount of time spent on breastfeeding and the choice of body position for breastfeeding were important factors differentiating the prevalence and intensity of the pain. It is recommended that breastfeeding mothers do not extend the single-feeding time in the adopted position beyond the required time. It is of utmost importance to choose a breastfeeding position in which all parts of the mother's body are supported. To prevent neck pain, lying and semi-lying positions with head support are recommended.

Spontaneous neck hematoma associated with parathyroid adenoma.

We should consider parathyroid extraglandular bleeding for patients with acute neck pain and swelling. Evaluation of serum calcium and parathyroid hormone levels is crucial for a suspected neck hematoma associated with parathyroid adenoma.

Systematic review and meta-analysis of Neck Disability Index and Numeric Pain Rating Scale in patients with migraine and tension-type headache.

BACKGROUND: The present study aimed to assess the burden of neck pain in adults with migraine and tension-type headache (TTH), utilizing the Neck Disability Index (NDI) and Numeric Pain Rating Scale (NPRS). METHODS: A systematic literature search was conducted on PubMed and Embase to identify observational studies assessing NDI and NPRS in populations with migraine or TTH. The screening of articles was independently performed by two investigators (HMA and ZA). Pooled mean estimates were calculated through random-effects meta-analysis. The I2 statistic assessed between-study heterogeneity, and meta-regression further explored heterogeneity factors. RESULTS: Thirty-three clinic-based studies met the inclusion criteria. For participants with migraine, the pooled mean NDI score was 16.2 (95% confidence interval (CI) = 13.2-19.2, I2 = 99%). Additionally, the mean NDI was 5.5 (95% CI = 4.11-6.8, p < 0.001) scores higher in participants with chronic compared to episodic migraine. The pooled mean NDI score for participants with TTH was 13.7 (95% CI = 4.9-22.4, I2 = 99%). In addition, the meta-analysis revealed a mean NPRS score of 5.7 (95% CI = 5.1-6.2, I2 = 95%) across all participants with migraine. CONCLUSIONS: This systematic review and meta-analysis shows a greater degree of neck pain-related disability in migraine compared to TTH. Nevertheless, the generalizability of these findings is constrained by methodological variations identified in the current literature.

Evaluation of Subjective Visual Vertical and Cervical Neuromotor Control in Young Nomophobians: A Cross Sectional Study.

Misperceptions of subjective visual vertical are associated with poor balance, increasing the risk of falls and accidents. The aim of the present study was to evaluate the effect of nomophobia on verticality perception using subjective visual vertical (S.V.V.) test and cervical neuromotor control of the deep neck flexors (DNF) in adults aged 18-29 years old. This cross-sectional study employed convenience sampling and was conducted at a tertiary health institute over an eight-month period.After obtaining the written informed consent, 102 participants were asked to fill the Nomophobia Questionnaire (NMP-Q) and based on the responses participants were stratified into mild (n1 = 34), moderate(n2 = 34), and severe(n3 = 34) nomophobian group. Each nomophobian group underwent testing for verticality perception by using the SVV test and cervical neuromotor control. 102 healthy age and gender matched controls were recruited and underwent testing for verticality perception by using the SVV test and cervical neuromotor control. The mean age of the study participants was 22 ± 3.15 years with 35(33.98%) males and 67(65.04%) females. There was a statistically significant difference between the median scores across the three nomophobian groups with S.V.V. (p = 0.005), activation score (p = 0.012), and endurance score (p = 0.000) of the deep neck flexors in the severe nomophobia group. This study demonstrated that SVV and cervical neuromotor control was predominantly affected in the severe nomophobian group.

Anterior Cervical Decompression and Fusion for Neck Pain in Patients with Cervical Spondylosis: Pooled Results of Three Prospective Cohort Studies.

INTRODUCTION: Currently, there is a lack of large-scale prospective cohort data to explore the response of neck pain to anterior cervical decompression and fusion (ACDF). The aim of this study was to investigate whether patients with neck pain can achieve consistent neck pain relief following ACDF regardless of preoperative neurological symptoms and number of surgical segments. MATERIALS AND METHODS: The study was a pooled analysis of 3 multicenter prospective cohort studies. Patients with cervical radiculopathy and/or myelopathy with significant neck pain (visual analog scale [VAS] ≥ 4) who underwent ACDF were included. Neck pain VAS scores (VAS-neck) were collected at preoperative and postoperative follow-up time points (3 months, 6 months, and 1 year). Subgroup analyses were conducted for patients with radiculopathy, myelopathy, or myeloradiculopathy, as well as for single- versus multi-segment ACDF. RESULTS: A total of 237 patients were confirmed. Patients showed significant improvement in VAS-neck at all follow-up time points compared with baseline (P < 0.001 for each). In the first year after surgery, VAS-neck were reduced by 3.3 points (57.0%) on average, and the rates of achieving minimum clinically important difference and patient acceptable symptom state were 72.2% and 73.8%, respectively. Meanwhile, one year after surgery, there was no significant difference in ΔVAS-neck, recovery rate, minimum clinically important difference, and patient acceptable symptom state attainment rate between the radiculopathy, myelopathy and myeloradiculopathy groups, and the same trend was observed between the single-segment and multi-segment groups. CONCLUSIONS: This study found that ACDF significantly improved neck pain in patients with cervical spondylosis, regardless of preoperative neurological symptoms and number of surgical segments.

Does Pain Explain Trends in Disability? An Analysis of Middle-Aged and Older US Adults, 2002-2018.

OBJECTIVES: This article investigates the role of pain in disability trends in the United States, within the context of recent unfavorable disability trends and the concurrent rise in pain. METHOD: We conducted a two-part analysis using National Health Interview Survey data from 2002 to 2018 for US adults aged 45-84. First, we assessed how changes in the prevalence of five site-specific types of pain (headaches/migraines, joint, low back, neck, and facial/jaw pain) associate with disability trends. Second, we used self-reported causes of disability and examined whether there has been a change in the proportion of individuals who attribute their disability to one of five chronic or acute painful conditions. RESULTS: The five site-specific types of pain, individually and collectively, were significantly associated with increases in disability. If site-specific chronic pain had not increased during the study period, the trend for functional limitations would have been 40% lower, and that for activity limitations would have shown a slight decline instead of an increase. Attributions of functional limitations to painful conditions increased by 23% during the 2002-2018 period, representing an additional 9.82 million Americans experiencing pain-attributable disability. Arthritis/rheumatism, back/neck problems, and other musculoskeletal/connective conditions were the primary sources of pain-related disability. DISCUSSION: Our research provides the first systematic, national examination of how pain is contributing to disability trends in the United States. The findings have implications for disability reduction policies and shed light on the far-reaching consequences of pain for overall population health.

The effect of experimentally induced pain in the cervical, shoulder or orofacial regions on cervical neuromuscular and kinematic features: a systematic review and meta-analysis.

In this systematic review, we synthesize the literature investigating the effect of experimentally induced pain in the cervical, shoulder, or orofacial regions on cervical neuromuscular and kinematic features. Databases were searched up to November 1st, 2023. A total of 29 studies using hypertonic saline injection (n = 27) or glutamate injection (n = 2) as experimental pain models were included. Meta-analyses revealed reduced upper trapezius activation during shoulder flexion/abduction when pain was induced in the upper trapezius (standardized mean difference: -0.90, 95% confidence interval: [-1.29; -0.51]), splenius capitis (-1.03 [-1.44; -0.63]), and supraspinatus (-0.63 [-1.25; -0.01]), but not in the subacromial space (0.22 [-0.16; 0.60]). Furthermore, experimentally induced pain caused a caudal redistribution of activation within the upper trapezius (0.96 [0.58; 1.34]) but did not change the medio-lateral distribution (0.11 [-0.22; 0.42]). None of these adaptations persisted after pain resolution. Low-quality evidence supported the absence of an effect of experimental pain on upper trapezius muscle activation during manual dexterity and cervical flexion/extension tasks, as well as on cervical flexor and extensor muscle activation during cervical and jaw tasks. Inconsistent and limited evidence, attributed to the large heterogeneity of task and outcomes, precluded drawing meaningful conclusions about the effects of experimentally induced pain in the cervical region on cervical kinematics. Overall, cervical muscle activation tended to decrease in response to experimentally induced pain, and the decrease of muscle activation depended on the location of the painful stimulus. These adaptations are only partially representative of muscle activation patterns observed in clinical populations. PERSPECTIVE: This systematic review and meta-analysis revealed a reduced or unchanged muscle activation during experimental pain in the cervical, shoulder or orofacial regions, depending on the task and location of nociceptive stimulation. There was inconsistent evidence on cervical kinematics. These findings enhance our understanding of neuromuscular adaptations to acute experimental pain.

Assessing the Impact of Smartphone Use on Neck Pain and Related Symptoms Among Residents in Jeddah, Saudi Arabia: A Cross-Sectional Study.

BACKGROUND: The widespread adoption of smartphones has transformed global communication but raised health concerns like Text Neck Syndrome - a musculoskeletal condition arising from prolonged device use, causing discomfort in the cervical spine. This study investigates its prevalence and associated factors among smartphone users in Jeddah, Saudi Arabia, focusing on usage patterns, symptoms, and awareness. METHODS: This cross-sectional online survey was conducted from June 1 to June 30, 2024. Data on demographics, smartphone habits, symptoms, and Text Neck Syndrome awareness were collected using a structured questionnaire. Statistical analysis involved descriptive statistics and chi-square tests. RESULTS: The study included 421 participants, predominantly female (279, 66.3%) and Saudi nationals (397, 94.3%). The largest age group was 21-40 years (308, 73.2%), and most were single (251, 59.6%) with a college degree (236, 56.1%). Over 42.0% of participants used smartphones for more than five hours daily, with 39.4% adopting a 30-degree neck posture. The most prevalent symptoms reported were neck pain (272, 64.6%), headaches (203, 48.2%), and shoulder pain (178, 42.3%). Awareness of Text Neck Syndrome was reported by 197 participants (46.8%), but only 60 (14.3%) had been diagnosed. Concerns about long-term complications such as osteoporosis (105, 24.9%) and prolapsed intervertebral disc (120, 28.5%) were expressed. Despite these concerns, 97.9% of participants hesitated to reduce smartphone usage due to reported symptoms. CONCLUSION: This study highlights the significant musculoskeletal impact of smartphone use in Jeddah, underscoring the need for interventions promoting ergonomic practices and increasing awareness about associated risks. Public health strategies should focus on promoting ergonomic practices and educating users about preventive measures.

Optimizing Pain Relief and Range of Motion in Unilateral Cervical Radiculopathy: A Study on Neural Tissue Mobilization and Cervical Stabilization Exercises.

Background This study aimed to analyze the combined effect of neural mobilization along with cervical stabilization exercises on pain and cervical range of motion in unilateral cervical radiculopathy patients. Methodology A total of 30 patients aged 30-45 years with unilateral cervical radiculopathy were randomly divided into the following two groups: experimental (n = 15) and control (n = 15). The experimental group received neural mobilization along with cervical stabilization exercises, while the control group received conventional treatment. Outcome measures included pain intensity measured on a visual analog scale (VAS), functional status of the neck measured by the Neck Disability Index (NDI), and cervical range of motion measured by a goniometer. All measures were taken before treatment, after treatment, and at the one-week follow-up. Results The results showed statistically significant positive improvements in VAS, NDI score, and cervical range of motion in unilateral cervical radiculopathy subjects of the experimental group. Conclusions Neural mobilization combined with cervical stabilization exercises led to significant improvements in pain, functional status, and cervical range of motion in patients with unilateral cervical radiculopathy compared to conventional treatment.

The effectiveness of neck stretching exercises in alleviating neck pain and self-reported disability after thyroidectomy: A systematic review and meta-analysis of clinical trials.

Thyroidectomy can lead to significant challenges such as neck pain, disability, and limited range of motion. Therefore, our objective is to conduct a systematic review and meta-analysis of clinical trials to investigate the clinical effectiveness of neck stretching exercises in alleviating neck pain and self-reported disability immediately after thyroidectomy. We systematically searched PubMed, CENTRAL, Scopus, and Web of Science from inception until July 28th, 2023. We assessed the selected trials for the risk of bias using both the RoB-2 and ROBINS-I tools. Our specific outcomes were the severity of neck pain and self-reported disability after thyroidectomy. The results were synthesized using risk ratio (RR) and standardized mean differences (SMD) with 95% confidence intervals (CI) in a random-effects model using Stata software. Nine clinical trials, comprising five randomized and four non-randomized trials, were included, with a total of 1026 patients. Neck stretching exercises were significantly associated with improved mean pain scores both after 1 week (n = 625 patients, SMD = -2.43, 95% CI [-4.65, -0.22], p = 0.03, I2 = 98%) and 1 month (n = 545 patients, SMD = -4.11, 95% CI [-8.12, -0.11], p = 0.04, I2 = 99%). Similarly, neck stretching exercises were significantly associated with improved mean self-reported disability scores both after 1 week (n = 298 patients, SMD = -0.70, 95% CI [-1.36, -0.04], p = 0.04, I2 = 87%) and 1 month (n = 298 patients, SMD = -0.42, 95% CI [-0.65, -0.19], p = 0.0004, I2 = 0%). The pooled analysis showed heterogeneity (chi-square p < 0.01, I2 > 80%), except for the mean self-reported neck disability score after 1 month, which showed homogeneity (chi-square p > 0.01, I2 = 0%). This systematic review and meta-analysis, involving 1026 patients, revealed the potential benefits of neck stretching exercises in alleviating neck pain and self-reported disability after thyroidectomy. However, further research is required to address methodological limitations, evaluate long-term outcomes, investigate potential moderators (i.e., the duration or intensity of the exercise program), and explore patients' analgesic consumption.

Jaw-neck motor function 2 years after whiplash trauma.

BACKGROUND: There is limited knowledge about the possible long-term effects on jaw motor function after whiplash trauma. OBJECTIVES: The primary aim was to evaluate integrated jaw and head-neck movement amplitudes during jaw function in individuals 2 years after whiplash trauma, compared to controls. The secondary aim was to evaluate changes between the acute stage and a 2-year follow-up in terms of jaw and head-neck movement amplitudes during jaw function. METHODS: This study included 28 cases exposed to a whiplash trauma 2 years earlier (13 women) and 28 controls (13 women) without previous neck trauma. Head and jaw movement amplitudes were recorded during maximal jaw opening-closing movements using an optoelectronic 3D recording system. For a subpopulation of 12 cases and 15 controls, recordings had also been performed in the acute stage after the whiplash trauma. Jaw and head movement amplitudes were analysed using linear regression with group and sex as independent variables. The subpopulation longitudinal analysis was adjusted for movement amplitudes at baseline. RESULTS: Jaw movement amplitudes were significantly associated with group (coefficient: -0.359: 95% CI: -10.70 to -1.93, p = .006) with smaller amplitudes of jaw movements for whiplash cases. Head movement amplitudes were not associated with group (coefficient: -0.051, 95% CI: -4.81 to 3.20, p = .687). In the longitudinal analysis, both jaw and head movement amplitudes showed significant associations between baseline and the 2-year follow-up. CONCLUSION: The present findings indicate that the effects on jaw function in terms of jaw opening capacity in the acute stage after whiplash trauma do not spontaneously recover.