A comparison of nocturnal upper trapezius muscle activity between chronic neck pain patients with sleep disturbance and healthy participants.

BACKGROUND: Sleep disturbances frequently occur in patients with chronic neck pain. In these patients, upper trapezius muscle dysfunction is observed during sleep. This study aimed to evaluate the trapezius muscle activity during sleep among patients with chronic neck pain and sleep disturbances for comparison with healthy subjects.  STUDY DESIGN: Cross-sectional study. METHODS: Patients with chronic neck pain and healthy subjects participated in the study. Two overnight polysomnography recordings were conducted for each subject. Surface electromyography was utilized to record the nocturnal activity of the right and left upper trapezius muscles throughout the night. The nocturnal upper trapezius activity recording was divided into the following parts: wakefulness, rapid eye movement sleep (REM), and non-rapid eye movement sleep (NREM). The nocturnal activity during NREM sleep was further divided into three parts (stage I NREM sleep, stage II NREM, and stage III NREM. Normalization of EMG signals was performed. The normalized value of nocturnal activity was derived for analysis. RESULTS: Among 15 patients with chronic neck pain and 15 healthy subjects, statistically significant differences were observed in the nocturnal activity of the upper trapezius. Compared to healthy subjects, the nocturnal activity of the upper trapezius was significantly higher during wakefulness, REM sleep, and NREM II and III sleep in patients with chronic neck pain and sleep disturbances. CONCLUSION: There was higher nocturnal upper trapezius activity in patients with chronic neck pain compared to healthy controls. The findings suggest a possible pathophysiological mechanism that may relate to chronic neck pain. TRIAL REGISTRATION: CTRI/2019/09/021028.

A polysomnographic study of sleep disruptions in individuals with chronic neck pain.

Various lines of evidence suggest that a bidirectional relationship exists between poor sleep quality and chronic pain, with each condition tending to promote and exacerbate the other. This has led to the hypothesis that the two conditions may be linked by common underlying mechanisms. It has thus been suggested that inadequate sleep and chronic pain may share neurophysiological and molecular pathways that are similar or overlapping. Some studies based on self-report measures have tended to support the inference that chronic neck pain may promote sleep disturbance, but this association has not, until now, been investigated with quantitative measures. The present study is the first to evaluate the sleep quality of patients with chronic neck pain through the use of polysomnography. The study sought to identify the sleep characteristics of patients with chronic neck pain and then to determine whether these characteristics were associated with the severity of their neck pain. Laboratory testing with polysomnography was carried out on 32 males who had complaints of chronic neck pain and on 12 healthy participants who served as controls. Compared to the control subjects, patients with chronic neck pain were found to have significantly shorter times spent in sleep (p = 0.015), longer latencies to sleep onset (p = 0.015) and rapid eye movement (REM) sleep (p < 0.05), longer durations spent in Stage 1 (p < 0.05), and shorter durations spent in both Stage 2 (p = 0.001) and REM sleep (p = 0.00). The severity of discomfort was related negatively to the amount of time spent in REM sleep. The present study's quantitative measures corroborate the view that patients with chronic neck pain have poor sleep quality. These findings confirm long-held clinical observations that the sleep quality of patients with chronic neck pain is compromised, and that, in this clinical group, poor sleep is at least a correlate of and may be an amplifier of perceived pain.

Effect of Increased Lumbar Lordosis on Lumbar Multifidus and Longissimus Thoracis Activation During Quadruped Exercise in Patients With Chronic Low Back Pain: An EMG Study.

The objective was to investigate the electromyographic activity of the lumbar multifidus (MF) muscle and longissimus thoracis muscle, along with their activity ratio (MF longissimus thoracis ratio), during quadruped stabilization exercise performed with neutral posture and with increased lumbar lordosis in patients with chronic low back pain (CLBP). A total of 23 patients with CLBP (12 females and 11 males) were recruited based on inclusion and exclusion criterion. Each patient performed 4 exercises in random order, with surface electromyography electrodes and an electrogoniometer attached. A cross-sectional study design was used to measure the amplitude of muscle activation (as a percentage of maximum voluntary contraction) in each patient across the 2 muscles (MF and longissimus thoracis) during quadruped stabilization exercise with neutral posture and with increased lumbar lordosis. A 2-way analysis of variance was conducted, which demonstrated a statistically significant increase in the recruitment of MF with increased lumbar lordosis in patients with CLBP during quadruped exercise. An increase of 9.7% and 16.9% maximum voluntary contraction in MF electromyographic activity was observed in lumbar lordosis posture during the quadruped leg raise and quadruped leg-arm raise exercise, respectively (P < .01), when compared to the neutral posture. The increased recruitment of MF with lumbar lordosis in the quadruped position has strong implications in the assessment and management of patients with CLBP.

Sleep quality and its association with anxiety, stress, sleep-related beliefs and attitudes and postural control in young adults: a cross-sectional study.

OBJECTIVES: Adequate sleep is essential for young adults, as this age group primarily consists of students, job seekers, and working people constantly managing a hectic lifestyle. Poor quality of sleep, which is essential for physical and mental well-being in the short and long term, can result in impaired overall health. However, there exists a gap in the literature regarding the factors affecting sleep among young adults. Hence, the objective of this study was to find the prevalence of sleep-related parameters (sleep health, hygiene, and sleep-related beliefs and attitudes) and potential risk factors for sleep quality and to investigate the association between sleep and postural control in young adults. METHODS: This prospective, cross-sectional, analytical study included 181 young adults, 113 (62.43 %) females, and 68 (37.57 %) males, with a mean age of 23.82 ± 2.88 years. Sleep quality, health, beliefs, hygiene, stress, anxiety, and depression were assessed using questionnaires. Postural control was assessed using center of pressure (COP) indices. RESULTS: The overall prevalence of poor sleep quality was 79.01 % among young adults. Multiple linear regression showed that predictors explained 44 % of sleep quality variance (adjusted R square=0.44, f (12,168) = 20.91, p<0.05). Poor sleep-related beliefs and attitudes (95 % CI [0.037, 0.679], p=0.029), higher perceived stress (95 % CI [0.005, 0.219], p=0.039), higher anxiety severity (95 % CI [0.108, 0.526], p=0.003), and poor COP stability index A/P (95 % CI [4.986, 11.248], p=0.00) were found to be significant predictors of poor sleep quality. CONCLUSIONS: High anxiety and stress, and poor dysfunctional beliefs and attitudes about sleep are predictors of poor sleep quality in young adults. These factors may significantly affect sleep quality and the experience of restful sleep among young adults. Also, poor sleep quality is associated with reduced postural control (decreased stability in the A/P direction). These findings are crucial for improving young adults' overall health and well-being, as poor sleep is highly prevalent among this age group.

Exploring the role of respiratory intervention as an effective adjunct tool in the management of chronic low back pain: A scoping systematic review.

BACKGROUND: Individuals with chronic low back pain (CLBP) are usually prescribed manual therapy and exercise programs. Respiratory exercise interventions are also recommended by some researchers for CLBP. However, the evidence for the relative effectiveness of these treatments is limited, and the question of which sort of intervention is most suited remains unanswered. OBJECTIVE: This systematic review aims to evaluate the effectiveness of respiratory interventions in CLBP. METHODS: A systematic search was performed using databases: PubMed, Web of Science, PEDro, Cochrane Library, and Science Direct. The review was registered in PROSPERO (CRD42021233739). RESULTS: Seven studies met the inclusion criteria. Out of these, one was of poor, three were of fair, and three were of good qualities. A total of 293 subjects were included in seven studies, the mean age of subjects ranged from 21 to 53 years. The largest effect size was reported for pain (d = 1.5) and maximum inspiratory pressure (d = 1.38). No detrimental effects were reported for any of the intervention programs. CONCLUSIONS: Since most of the research has been done on pain and MIP, and both of these parameters have revealed significant changes with large effect size, therefore it can be concluded that respiratory interventions improve pain and MIP in CLBP. Owing to the limited number of studies available, a definitive outcome could not be documented for other parameters. Thus, further research is needed to provide a more robust piece of evidence and understanding.

Predictors of persistent pain in patients with acute neck pain treated with physical therapy: A prospective study with 2 years follow up.

BACKGROUND: Clinicians specialising in musculoskeletal medicine have observed that patients with neck pain often seek repeat consultations because of recurring neck pain. Despite this pattern, there is a lack of research exploring the persistence nature of neck pain. Understanding potential predictors of persistent neck pain could help clinicians develop effective treatment approaches to prevent the chronicity of these conditions. OBJECTIVE: The current study investigated the potential predictors of persistent neck pain over a 2-year period among patients with acute neck pain treated with physical therapy. METHODS: A longitudinal study design was employed. Data were collected at baseline and at 2-year follow-up from 152 acute neck pain patients aged (29.2 ± 6.7). Patients were recruited from physiotherapy clinics. Logistic regression was used for analysis. At 2-year follow-up, participants were reassessed for their pain intensity (Dependent variable) and categorised as recovered or reporting persistent neck pain. Baseline acute neck pain intensity, sleep quality, disability, depression, anxiety, and sleepiness were used as potential predictors. RESULTS: Among 152 participants, 51 (33.6%) patients with acute neck pain reported persistent neck pain at 2-year follow-up. 43% of the variation in the dependent variable was explained by the model. Despite the strong correlations between persistent pain at follow-up with all potential predictors, only sleep quality 95% CI (1.1,1.6), and anxiety 95% CI (1.1,1.4) were the significant predictors of persistent neck pain. CONCLUSION: Our results suggest that poor sleep quality and anxiety may serve as potential predictors of persistent neck pain. The findings highlight the importance of a comprehensive approach to managing neck pain that addresses both physical and psychological factors. By targeting these co-morbidities, healthcare providers may be able to improve outcomes and prevent the progression of the case.

Effect of Adding Diaphragmatic Breathing Exercises to Core Stabilization Exercises on Pain, Muscle Activity, Disability, and Sleep Quality in Patients With Chronic Low Back Pain: A Randomized Control Trial.

Objective: The purpose of this study was to test the effect of adding diaphragmatic breathing exercises (DBEs) to core stabilization exercises (CSEs) for patients with chronic low back pain (CLPB). Methods: Twenty-two patients with CLPB were randomly allocated to the experimental (DBE + CSE) or control group (CSE only). They were given 12 treatment sessions 3 times a week for 4 weeks. Patients were evaluated before and after the 12 sessions. Surface electromyography of transverse abdominis, Oswestry Disability Index, Fear Avoidance Belief Questionnaire, Pittsburgh Sleep Quality Index, Numeric Pain Rating Scale, and chest expansion were used as outcome measures for pain, muscle activity, disability, and sleep quality. Results: The outcome measure scores showed statistical significance of (P = .01) in time effect on muscle activity, sleep quality, disability score, pain score, fear-avoidance belief of patients and chest expansion; and group effect on Fear Avoidance Belief Questionnaire and physical activity parameter (P = .05). An interaction effect (time x group) on muscle activity for right transverse abdominus during tuck in (P = .01) and chest expansion (P = .01) was also found; however, no significant difference was found related to other parameters. Conclusion: The combination of DBE and CSE interventions compared to CSE alone showed improvement in the measured parameters for patients with CLBP. Incorporating DBE with CSE also improved muscle activation and chest expansion.

Establishing Responsiveness and Minimal Clinically Important Difference of Quebec Back Pain Disability Scale (Hindi Version) in Chronic Low Back Pain Patients Undergoing Multimodal Physical Therapy.

Increasing emphasis is placed on physical functional measures to examine treatments for chronic low back pain (CLBP). The Quebec Back Pain Disability Scale (Hindi version) (QBPDS-H) has never been evaluated for responsiveness. The objectives of this study were to (1) examine the internal and external responsiveness of the Quebec Back Pain Disability Scale (Hindi version) (QBPDS-H) and (2) find out the minimal clinically important difference (MCID) and minimal detectable change (MDC) in the functional ability of patients with chronic low back pain (CLBP) undergoing multimodal physical therapy treatment. In this prospective cohort study, QBPDS-H responses were recorded at the baseline and after eight weeks from 156 CLBP patients undergoing multimodal physiotherapy treatment. To differentiate between the clinically unimproved (n = 65, age: 44.16 ± 11.8 years) and clinically improved (n = 91, age: 43.28 ± 10.7 years) scores of patients from the initial assessment to the last follow-up, the Hindi version of the Patient's Global Impression of Change (H-PGIC) scale was utilized. Internal responsiveness was large (E.S. (pooled S.D.) (n = 91): 0.98 (95% CI = 1.14-0.85) and Standardized Response Mean (S.R.M.) (n = 91): 2.57 (95% CI = 3.05-2.17)). In addition, the correlation coefficient and receiver operative characteristics (R.O.C.) curve were used to assess the QBPDS-H external responsiveness. MCID and MDC were detected by the R.O.C. curve and standard error of measurements (S.E.M.), respectively. The H-PGIC scale showed moderate responsiveness (ρ = 0.514 and area under the curve (A.U.C.) = 0.658; 95% CI, 0.596-0.874), while the MDC achieved 13.68 points, and the MCID was found have 6 points (A.U.C. = 0.82; 95% CI: 0.74-0.88, sensitivity = 90%, specificity = 61%). This study shows that QBPDS-H has moderate levels of responsiveness in CLBP patients receiving multimodal physical therapy treatment, so it can be used to measure the changes in disability scores. MCID and MDC changes were also reported with QBPDS-H.

Effects of scapular stabilization and upper limb proprioception as an adjunct to cervical stabilization in chronic neck pain patients: A randomized controlled trial.

BACKGROUND: Chronic neck pain is a prevalent health condition and a leading cause of disability worldwide. Prompt therapeutic measures are required to overcome this condition. OBJECTIVES: To evaluate the efficacy of incorporation of scapular stabilization and upper limb proprioceptive exercises to cervical stabilization exercises in patients with chronic neck pain (CNP). DESIGN: A single-blinded randomized controlled design. METHODS: A sample of convenience was deployed to recruit twenty-eight patients having CNP (18-45 years) and was randomized into two groups: group A (cervical stabilization exercises group) and group B (scapular stabilization and upper limb proprioceptive exercises group + cervical stabilization exercises). Pain intensity, disability, sleep quality, quality of life, scapular muscles strength and proprioception were assessed at 4 weeks follow up to determine the efficacy of the intervention. RESULTS: A mixed model ANOVA was used. A statistically significant (p < 0.05) group by time interaction for pain intensity (p = 0.000), scapular muscles strength of all muscles (p = 0.000) was observed. Significant group interaction for absolute error (p = 0.00), for pain (p = 0.001), disability (p = 0.04) and scapular muscle's strength (p = 0.000) was also demonstrated. CONCLUSION: The results indicated that scapular stabilization and upper limb proprioceptive exercises when combined with cervical stabilization exercises are more beneficial in alleviating pain and disability and improving scapular muscle strength and proprioception in patients with CNP.

Effects of surface variability in whole-body vibration platform on knee osteoarthritis: A scoping review.

INTRODUCTION: Whole body vibration (WBV) has received much attention in recent years but there is a lack of consensus as far as its effects are concerned. It is usually applied on the stable surface but its effects on the unstable surface are also being explored. However, only a few studies have described the efficacy of using the unstable surface on WBV platform in knee osteoarthritis (KOA) and this lack of information generates uncertainties regarding the efficacy of stable and unstable WBV training in KOA. OBJECTIVE: To identify the efficacy of stable and unstable surface WBV training in KOA. METHODS: Comprehensive searches, combining "whole body vibration", "knee osteoarthritis", and "unstable surface" were conducted on PubMed, Web of Science, Science Direct, Cochrane library, and Google Scholar. Randomized control trials focusing on outcomes of muscle activity, strength, proprioception, balance, and pain using unstable and stable platform WBV in KOA were included. Data were charted and narrative synthesis was applied. RESULTS: 17 studies were included. There is no consensus on the effects of stable surface WBV in KOA. Only limited studies used unstable platform WBVT in KOA. Majority of studies in KOA either using stable or unstable surface WBV failed to provide the exact mechanism of WBV. CONCLUSIONS: Stable surface WBV improve strength, balance, sEMG activity, proprioception, and provide a mild degree of instability while higher degree of instability would be given when WBV is performed on an unstable surface and may positively stress the neuromuscular system to a greater extent than the stable WBV by various mechanisms.

Is poor sleep quality associated with a deterioration in postural control?

OBJECTIVE: The primary aim was to investigate whether any association exists between poor sleep quality and deterioration in postural control among university student population. MATERIALS AND METHODS: A case-control study was conducted in which sleep quality of 119 university students from different departments of Jamia Millia Islamia University, New Delhi, India was assessed using Pittsburgh sleep quality index (PSQI) following which the participants postural control, or dynamic balance was measured using the Y balance test (YBT). The participants were divided into two groups (A and B) based on their PSQI cut off scores. The YBT data was then evaluated for the dynamic balance assessment of the participants. RESULTS: The mean age of the participants was 22.23±2.29 out of which 86 were female and 33 were male. The mean BMI of the participants was 21.58±3.66. Group A included 63 participants who had "good" sleep quality (global PSQI score < 5) whereas group B included 56 participants who had "poor" sleep quality (global PSQI score ≥ 5). Group comparisons based on t-test revealed a significant difference (p<0.05) between means of the two groups, with the mean balance of group A being greater than that of group B. Also, chi-square testing showed no significant association between the BMI and dynamic balance scores for the participants (p<0.10). CONCLUSION: The findings of the study conclude that poor sleep quality is associated with a deterioration of postural control in university students. The study also revealed that there was no association between BMI and dynamic balance in this population.