Physical Factors Associated with Non-Specific Neck Pain: Correlations Among Pain, Disability, Posture, Endurance, and Compensatory Movement.

BACKGROUND This study was conducted to investigate physical risk factors in patients with non-specific neck pain. The correlations among pain intensity, pressure pain threshold, range of motion (ROM), and disability index were analyzed in 50 patients with non-specific neck pain at a hospital in Korea. MATERIAL AND METHODS We enrolled 50 patients diagnosed with non-specific neck pain by a doctor. All subjects were evaluated for pain intensity, pressure threshold, degree of disability, active range of motion (ROM) of the neck, upper cervical rotation ROM, muscular endurance of deep cervical flexor, compensatory movements for neck flexion, forward head posture, shoulder height difference, and rounded shoulder posture. The correlation between each variable was analyzed. RESULTS Pain intensity had a significant correlation between cervical rotation ROM, cervical flexion-rotation ROM, rounded shoulder posture, shoulder height difference, and forward head posture (P<.05). There was a significant correlation between the pressure pain threshold and the cervical extension ROM, cervical flexion-rotation ROM, and rounded shoulder height (P<.05). The disability index had a significant correlation between the cervical rotation ROM, cervical flexion-rotation ROM, rounded shoulder posture, and the compensatory movement of neck flexion (P<.05). CONCLUSIONS Physical risk factors for non-specific neck pain included cervical rotation ROM, upper cervical rotation ROM, rounded shoulder posture, shoulder height difference, and cervical flexion compensatory movements, which can affect pain intensity and pressure pain threshold.

Correlation between degeneration of cervical intervertebral disc and degeneration of paravertebral muscle.

Objective: To investigate the relationship between degeneration of cervical intervertebral disc and degeneration of paravertebral muscles[multifidus (MF), cervical semispinalis (SCer), semispinalis capitis (SCap) and splenius capitis (SPL)]. Methods: 82 patients with chronic neck pain were randomly selected, including 43 males and 39 females, with 50.73 0.7.51 years old. All patients were scanned by 3.0T MRI Philips Ingenia performed conventional MRI sequence scanning and fat measurement sequence mDIXON-Quant scanning of cervical. Fat infiltration (FI) and cross-sectional area (CSA) of cervical paravertebral muscle (MF, SCer, SCap and SPL) at central level of C5-6 disc were measured by Philips 3.0T MRI image post-processing workstation. According to Pfirrmann grading system, there was no grade I in the included cases. The number of grade IIr IV cases were n=16, 40, 19 and 7 respectively. CSA and FI of cervical paravertebral muscles were compared with t test or one-way ANOVA, Spearman correlation analysis was used to evaluate the correlation between age, disc degeneration, and CSA, FI of cervical paravertebral muscles, and multiple linear regression analysis was used to analyze the independent influencing factors of CSA and FI. Results: CSA of cervical paravertebral muscles in male patients was significantly higher than that in female patients (all P<0.001), but there was no significant difference in FI (all P>0.05). Age was weakly correlated with CSA of MF+SCer, moderately correlated with CSA of SCap and SPL (r=-0.256, -0.355 and -0.361, P<0.05), weakly correlated with FI of SCap and SPL (r= 0.182 and 0.264, P<0.001), moderately correlated with FI of MF+SCer (r=0.408, P<0.001). There were significant differences in FI with disc degeneration (P<0.001, P=0.028 and P=0.005). Further correlation analysis showed that disc degeneration was strongly correlated with FI of MF+SCer (r=0.629, P<0.001), and moderately correlated with FI of SCap and SPL (r=0.363, P=0.001; r=0.345, P=0.002). Multiple linear regression analysis showed that sex and age were the influencing factors of CSA of SCap and SPL, sex was the independent influencing factor of CSA of MF+SCer, and disc degeneration was the independent influencing factor of FI. Conclusions: Age is negatively correlated with CSA and positively correlated with FI. Disc degeneration was correlated with FI of paravertebral muscles, especially with FI of MF and SCer. Sex and age were the influencing factors of CSA, while disc degeneration was the independent influencing factor of FI.

Alternate levels versus all levels mini-plate fixation in C3-6 cervical laminoplasty: a retrospective comparative study.

OBJECTIVE: The purpose of this study is to compare radiological and clinical outcomes between alternate levels (C4 and C6) and all levels mini-plate fixation in C3-6 unilateral open-door laminoplasty. METHODS: Ninety-six patients who underwent C3-6 unilateral open-door laminoplasty with alternate levels mini-plate fixation (54 patients in group A) or all levels mini-plate fixation (42 patients in group B) between September 2014 and September 2019 were reviewed in this study. Radiologic and clinical outcomes were assessed. Clinical results included Visual Analogue Scale (VAS) of axial neck pain and Japanese Orthopedic Association (JOA) score. Radiographic results included cervical range of motion (ROM), cervical curvature index (CCI), and the spinal canal expansive parameters including open angle, anteroposterior diameter (APD), and Pavlov`s ratio. RESULTS: There was no significant difference in VAS, JOA score, ROM, and CCI between two groups. There was no significant difference in canal expansion postoperatively between two groups. However, open angle, APD, and Pavlov`s ratio in group A decreased significantly during the follow-up. In group B, APD, Pavlov`s ratio, and open angle were maintained until the final follow-up. There was no hardware failure or lamina reclosure occurred in both groups during the follow-up. The mean cost of group B was higher than that of group A. CONCLUSIONS: Despite the differences in the maintenance of canal expansion, alternate levels mini-plate fixation can achieve similar clinical outcomes as all levels mini-plate fixation in C3-6 unilateral open-door laminoplasty. As evidenced in this study, we believe C3-6 laminoplasty with alternate levels (C4 and C6) mini-plate fixation is an economical, effective, and safe treatment method.

Multimodal therapeutic intervention program associated with photobiomodulation therapy for individuals with chronic nonspecific neck pain: protocol for a clinical trial.

BACKGROUND: Neck pain is a prevalent global musculoskeletal issue, significantly contributing to the loss of years of healthy life due to disability. Chronic nonspecific neck pain (CNNP) involves diverse symptoms impacting mobility and quality of life. While therapeutic exercises demonstrate efficacy, the role of photobiomodulation therapy (PBMT) remains uncertain. This study aims to assess the additional effects of PBMT within a multimodal therapeutic intervention for CNNP. METHODS: A randomized, two-arm, controlled, blind clinical trial follows CONSORT and SPIRIT guidelines. Participants diagnosed with CNNP will receive a stand-alone multimodal therapeutic intervention or the same program with additional PBMT. The primary outcomes will be assessed by the functional disability identified through applying the NDI (Neck Disability Index). Secondary outcomes will be pain intensity during rest and active neck movement, catastrophizing and kinesiophobia, functionality, and disability assessed at baseline, after 8 weeks, and at a 4-week follow-up. Both groups receive pain education before personalized interventions, including resistance exercises, neuromuscular activities, mobility, and body balance. The PBMT group undergoes low-level light therapy. Intention-to-treat analysis, using linear mixed models, employs data presented as mean, standard deviation, and differences with a 95% confidence interval. Non-normally distributed variables transform. Statistical significance is set at 5%. DISCUSSION: This study addresses a critical gap in understanding the combined effects of PBMT and therapeutic exercises for CNNP. The findings aim to guide clinicians, researchers, and CNNP sufferers through rigorous methodology and diverse outcome assessments, offering valuable insights into evidence-based practices for CNNP management. Data confidentiality is maintained throughout, ensuring participant privacy during statistical analysis. TRIAL REGISTRATION: Effects of adding photobiomodulation to a specific therapeutic exercise program for the treatment of individuals with chronic nonspecific neck pain, registration number: NCT05400473, on 2022-05-27.

Psychophysiological responses to a multimodal physiotherapy program in fighter pilots with flight-related neck pain: A pilot trial.

BACKGROUND: The physical and cognitive demands of combat flying may influence the development and persistence of flight-related neck pain (FRNP). The aim of this pilot study was to analyse the effect of a multimodal physiotherapy program which combined supervised exercise with laser-guided feedback and interferential current therapy on psychophysiological variables in fighter pilots with FRNP. METHODS: Thirty-one fighter pilots were randomly assigned to two groups (Intervention Group: n = 14; Control Group: n = 17). The intervention consisted of 8 treatment sessions (twice per week) delivered over 4 weeks. The following primary outcomes were assessed: perceived pain intensity (Numeric Pain Rating Scale-NPRS) and Heart Rate Variability (HRV; time-domain, frequency-domain and non-linear variables). A number of secondary outcomes were also assessed: myoelectric activity of the upper trapezius and sternocleidomastoid, pain catastrophizing (Pain Catastrophizing Scale-PCS) and kinesiophobia (TSK-11). RESULTS: Statistically significant differences (p≤0.05) within and between groups were observed for all outcomes except for frequency domain and non-linear HRV variables. A significant time*group effect (one-way ANOVA) in favour of the intervention group was found for all variables (p<0.001). Effect sizes were large (d≥0.6). CONCLUSIONS: The use of a multimodal physiotherapy program consisting of supervised exercise with laser-guided feedback and interferential current appears to show clinical benefit in fighter pilots with FRNP. TRIAL REGISTRATION: ClinicalTrials.gov: NCT05541848.

An Artificial Intelligence-Based App for Self-Management of Low Back and Neck Pain in Specialist Care: Process Evaluation From a Randomized Clinical Trial.

BACKGROUND: Self-management is endorsed in clinical practice guidelines for the care of musculoskeletal pain. In a randomized clinical trial, we tested the effectiveness of an artificial intelligence-based self-management app (selfBACK) as an adjunct to usual care for patients with low back and neck pain referred to specialist care. OBJECTIVE: This study is a process evaluation aiming to explore patients' engagement and experiences with the selfBACK app and specialist health care practitioners' views on adopting digital self-management tools in their clinical practice. METHODS: App usage analytics in the first 12 weeks were used to explore patients' engagement with the SELFBACK app. Among the 99 patients allocated to the SELFBACK interventions, a purposive sample of 11 patients (aged 27-75 years, 8 female) was selected for semistructured individual interviews based on app usage. Two focus group interviews were conducted with specialist health care practitioners (n=9). Interviews were analyzed using thematic analysis. RESULTS: Nearly one-third of patients never accessed the app, and one-third were low users. Three themes were identified from interviews with patients and health care practitioners: (1) overall impression of the app, where patients discussed the interface and content of the app, reported on usability issues, and described their app usage; (2) perceived value of the app, where patients and health care practitioners described the primary value of the app and its potential to supplement usual care; and (3) suggestions for future use, where patients and health care practitioners addressed aspects they believed would determine acceptance. CONCLUSIONS: Although the app's uptake was relatively low, both patients and health care practitioners had a positive opinion about adopting an app-based self-management intervention for low back and neck pain as an add-on to usual care. Both described that the app could reassure patients by providing trustworthy information, thus empowering them to take actions on their own. Factors influencing app acceptance and engagement, such as content relevance, tailoring, trust, and usability properties, were identified. TRIAL REGISTRATION: ClinicalTrials.gov NCT04463043; https://clinicaltrials.gov/study/NCT04463043.

Angina Pectoris Is Associated with Cervical Disc Disease: A Cross-Sectional, Population-Based Study Using the Medicare Expenditure Panel Survey (MEPS).

Atherosclerotic disease in the vessels that supply the cervical spine may lead to degenerative disease. In angina pectoris (AP), atherosclerotic disease leads to coronary vessel occlusion and resulting symptoms. This study aims to determine the relationship between AP and neck pain. Analysis was focused on respondents who had a history of cervical pain disorders, adjusting for demographic, education, and mental health confounders. A total of 30,461 participated in the survey. Of 1,049 respondents, 21% reported neck pain. Mean age of the respondents was 62.6 ± 16.1 years. Nonwhite race, current everyday smokers, lower family income, hypertension, and diabetes had higher prevalence of neck pain (p < 0.05). On multivariate analysis, AP was associated with increased odds of neck pain (odds ratio [OR] = 1.42 [95% confidence interval (CI) 1.04 to 1.92], p = 0.026). AP was independently associated with 42% increased odds of having neck pain. Further study into the association of cardiovascular disease with degenerative disc disease pain should be performed. (Journal of Surgical Orthopaedic Advances 33(2):093-096, 2024).

Immediate efficacy of acupuncture combined with active exercise as 10 min rapid therapy for pain and movement disorders in patients suffering from acute stiff neck: protocol for a randomised controlled trial.

INTRODUCTION: Stiff neck is a condition mainly characterised by persistent pain and limited neck movement, which can substantially impact patients' daily lives during acute episodes. Accordingly, rapid pain relief and restoration of normal activities are the main needs of patients during doctor visits. This study aims to assess the immediate efficacy of acupuncture combined with active exercises in rapidly relieving pain and improving movement disorders within 10 min in patients with acute stiff neck (ASN). METHODS AND ANALYSIS: This randomised controlled clinical trial is being conducted at a single centre in China. 120 participants diagnosed with ASN will randomly be assigned in a 1:1:1 ratio to one of three groups: the acupuncture combined with active exercise group (group A), sham acupuncture combined with active exercise group (group B) and active exercise only group (group C). Each participant will undergo a single 10 min session. The primary outcome is the effective rate at 10 min of treatment. Secondary outcomes include the effective rate at other time points (0-1, 2, 4, 6 and 8 min), Visual Analogue Scale score and cervical range of motion. The intention-to-treat analysis will include all randomised participants. ETHICS AND DISSEMINATION: Ethics approval was obtained from the Ethics Committee of the Second Affiliated Hospital of Yunnan University of Chinese Medicine (2022-009). Written informed consent will be obtained from all participants before randomisation. The findings of this study will be disseminated through publication in a peer-reviewed journal and presentation at conferences. TRIAL REGISTRATION NUMBER: ChiCTR2200066997.

Neck Kinematics in Patients With Chronic Mechanical Neck Pain: An Observational Study to Explore the Integration of Multiple Influencing Factors Through a Bayesian Model-Based Approach.

The aim of this observational, cross-sectional study is to evaluate potential differences in kinematics, specifically range of motion (ROM) and velocity, during planar cervical movements between patients with non-traumatic chronic neck pain and disability and asymptomatic controls, while accounting for potential influencing variables of age, sex and fear of movement. The influence of pain intensity, neck disability, age, sex or fear of motion on kinematics was analyzed through robust multivariate Bayesian regression models fitted using the brms library in R. Forty-three patients with neck pain (aged 36.70 ± 13.75 years; 10 men and 33 women) and 42 asymptomatic participants (aged 32.74 ± 13.24 years; 25 men and 17 women) completed the study protocol. The presence of neck pain/disability was associated with lower ROM and peak velocity during all planar movements when considering the influence of age, sex or fear of motion, with standardized regression coefficients that had a small effect size (ranged from 0.11 to 0.28) and estimated differences of less than 2.21° in ROM and 25.61°/s in peak velocity. Although patients with chronic mechanical neck pain showed reduced ROM and peak velocity, the small effect sizes and the low estimated differences between groups question the relevance and clinical usefulness of kinematic analysis of planar movements in samples of patients similar to those included in our study. It is probable that there are differences between the groups, but it is insufficient to rely solely on kinematic variables for patient discrimination. This limitation likely arises from the substantial variability in patient kinematics.

Characterizing neck pain during headache among people with migraine: Multicountry results from the Chronic Migraine Epidemiology and Outcomes - International (CaMEO-I) cross-sectional study.

OBJECTIVE: To assess the prevalence and impact of neck pain during headache among respondents with migraine in the multicountry Chronic Migraine Epidemiology and Outcomes - International (CaMEO-I) Study. BACKGROUND: Neck pain among individuals with migraine is highly prevalent and contributes to disability. METHODS: The CaMEO-I was a prospective, cross-sectional, web-based study conducted in Canada, France, Germany, Japan, United Kingdom, and the United States. A demographically representative sample of participants from each country completed a screening survey to evaluate headache characteristics. Respondents with headache were identified as having migraine or non-migraine headache based on modified International Classification of Headache Disorders, third edition, criteria; those with migraine completed a detailed survey with migraine-specific assessments. Results were stratified by the presence or absence of neck pain with headache (NPWH). For these analyses, data were pooled across the six countries. RESULTS: Of 51,969 respondents who reported headache within the past 12 months, 14,492 (27.9%) were classified as having migraine; the remaining 37,477 (72.1%) had non-migraine headache. Overall, 9896/14,492 (68.3%) of respondents with migraine headache reported NPWH, which was significantly higher (p < 0.001) than the proportion of respondents with non-migraine headache who reported NPWH (13,536/37,477 [36.1%]). Among respondents with migraine, moderate-to-severe disability was significantly more prevalent for those with NPWH versus without (47.7% [4718/9896] vs. 28.9%, p < 0.001). Respondents with NPWH versus without also had significantly greater work productivity losses, at a median (interquartile range [IQR]) of 50.0 (20.0, 71.3) vs. 30.0 (0.0, 60.0) (p < 0.001), lower quality of life (Migraine-Specific Quality of Life questionnaire version 2.1, median [IQR] Role Function-Restrictive domain score 60.0 [42.9, 74.3] vs. 68.6 [54.3, 82.9], p < 0.001), higher prevalence of depression and anxiety symptoms (depression, 40.2% [3982/9896] vs. 28.2% [1296/4596], p < 0.001); anxiety, 41.2% [4082/9896] vs. 29.2% [1343/4596], p < 0.001), higher prevalence of cutaneous allodynia during headache (54.0% [5345/9896] vs. 36.6% [1681/4596], p < 0.001), and higher prevalence of poor acute treatment optimization (61.1% [5582/9129] vs. 53.3% [2197/4122], p < 0.001). CONCLUSIONS: Nearly 70% of respondents with migraine reported NPWH. Individuals with migraine with neck pain during their headaches had greater disability, depression, anxiety, and cutaneous allodynia (during headache) than those without neck pain during their headaches. They also had diminished quality of life and work productivity, and poorer response to acute treatment compared with those without neck pain.

Efficacy of wet cupping in the pain management of cervical spondylosis - A randomized, controlled, open -label, parallel-group clinical trial.

BACKGROUND AND OBJECTIVE: Cervical spondylosis is a chronic degenerative process of the cervical spine characterized by pain in neck, degenerative changes in intervertebral disc and osteophyte formation. Cervical spondylosis is translated as Waja' ur Raqaba, a type of joint pain. The present study was aimed to evaluate the effect of wet cupping in the pain management of cervical spondylosis. METHODS: This Open, randomized, controlled, clinical study was conducted on 44 patients. Subjects in the test group (n = 22) received a series of three-staged wet cupping treatment, performed on 0, 7th and 14th day. Subjects in the control group (n = 22) received 12 sittings of Transcutaneous Electrical Nerve Stimulation (TENS): 6 sittings per week for two weeks. The objective findings of treatment were assessed with the help of VAS, Neck Disability Index (NDI) and Cervical range of motion. RESULTS: Intra group comparison in test group from baseline to 21st day were found highly significant (p < 0.001) in terms of VAS, NDI, Flexion, Extension and Left rotation score. While in Right rotation, Left rotation and Left lateral flexion score were found moderately significant (p < 0.01). Statistically significant difference was observed between two groups at 21st day in VAS scale, NDI, and Cervical range of motion score (p < 0.001). INTERPRETATION AND CONCLUSION: Hijama Bish Shart was found better in the management of pain due to cervical spondylosis than TENS. It can be concluded that Hijama Bish Shart may a better option for the pain management of cervical spondylosis. CLINICAL TRIAL REGISTRATION: The trial was registered on clinical trial registry website (www.ctri.nic.in) bearing a CTRI Number, CTRI/2020/03/024,249.

Effects of a novel osteopathic visceral technique for the pancreas on pain and range of motion in a patient with neck pain: Case report.

INTRODUCTION: Neck pain is a leading cause of disability worldwide. Visceral referred pain is a common form of disease-induced pain, with visceral nociception being referred to somatic tissues. OBJECTIVE: The aim of this case report was to evaluate the immediate and long term effects of a novel osteopathic visceral technique (OVT) on pain and cervical range of motion (CROM) in a patient with nonspecific neck pain (NS-NP). METHOD: A case of a 47-year-old female suffering with NS-NP for four months. The patient had sought physiotherapy treatment several times, and occasionally used anti-inflammatory medication to relieve symptoms. The patient presented muscle cervical tenderness and hyperalgesia over the spinous processes of C3-C4 spinal segments with limited CROM. A novel osteopathic visceral manipulation (OVM) technique was applied in the epigastric region targeting the pancreas. Immediately after the treatment, the patient reported reduction in pain evaluated with the numerical evaluation scale (NRS), and a clinically significant increase in pressure pain threshold (PPT) in C3 spinous process. Improvement in CROM was also observed. The post-treatment improvements have been maintained at 1-month of follow-up assessment. CONCLUSION: A single OVT was effective in reducing cervical pain and increasing CROM in a patient with NS-NP caused by a viscerosomatic reflex. The results of this case study provides preliminary evidence that OVM can produce hypoalgesia in somatic tissues with segmentally related innervation. This finding encourages future research to gain a better understanding of the mechanisms of regional inhibitory interdependence involving the viscerosomatic reflexes of OVM.

The effect of mulligan mobilization technique application in addition to conventional physiotherapy on pain and joint range of motion in people with neck pain.

BACKGROUND: To evaluate the effect of the Mulligan mobilization technique on pain intensity and range of motion in individuals with neck pain. METHODS: Forty individuals with mechanical neck pain were enrolled in the study. The patients were randomly divided into 2 groups and a total of 10 sessions of treatment were administered to all 2 groups for 2 weeks, 5 days a week. Mulligan mobilization technique, electrophysical agents, active range of motion, and stretching exercises were carried out in the Mulligan group. In contrast, only electrophysical agents and exercises were applied to the conventional physiotherapy group. Range of motion (ROM) of the neck, Visual Analog Scale (VAS), Neck Pain and Disability Scale (NPDS), and Short-Form 36 Health Survey (SF-36) were used for evaluation. RESULTS: Statistical analyses were done to compare the amounts at the baseline and immediately after treatment. Statistically significant improvements were found in the post-treatment ROM, VAS, NPDS values in both groups (p < 0.05). When the differences were compared, the results of the Mulligan group were significantly better than the conventional physiotherapy group (p < 0.05). There was no significant difference between the groups in terms of SF-36 parameters (p > 0.05). CONCLUSIONS: This study showed that the Mulligan mobilization technique plus conventional physiotherapy is more effective than conventional physiotherapy in increasing joint range of motion, reducing pain, and reducing neck disability. TRIAL REGISTRATON: ClinicalTrials.gov (NCT05074576).

Use of cervical traction for managing neck pain: A cross-sectional survey of physiotherapists in India.

BACKGROUND: Neck pain remains the fourth leading cause of disability and work loss, and a multimodal treatment approach is effective in reducing neck pain and disability. PURPOSE: The purpose of this study is to examine the use of cervical traction for managing neck pain by Physiotherapists in India, including how and when the traction is used, the modes and parameters of traction, any additional interventions given with traction, and the influence of professional demographic characteristics in decision making in traction usage. STUDY DESIGN: A cross-sectional survey. METHODOLOGY: A random sample of approximately 2500 musculoskeletal physiotherapists was surveyed, and the data was presented in a descriptive form. Chi-square analyses were used to identify the association between responders' qualifications and traction usage. RESULTS: From the total physiotherapist approached 18.52% (n = 463) responses were obtained, and 62% (n = 287) respondents reported that they would use traction in their clinical practice. Out of 92.3% of responders indicated using traction for radiculopathy, 78.7% of respondents used traction for patients with neck pain without radiculopathy. It is used as a combination therapy by 58.8% for radiculopathy and 52.2% for stiffness. There was no association between the responder's qualification and traction usage (χ2 = 0.707, p = 0.40). Traction is used in combination with other physiotherapeutic techniques. CONCLUSION: Traction use was consistent with the proposed criteria identifying patients likely to benefit. However, disregarding current guidelines, physiotherapists also use traction for non-radicular neck pain. Various traction delivery modes and parameters were used within a comprehensive plan of care incorporating multiple interventions.

Characteristics of head and neck alignment and function of deep cervical flexor muscles in patients with nonspecific neck pain.

OBJECTIVES: The objectives were to compare forward head posture (FHP) in natural and corrected head postures between patients with nonspecific neck pain (NSNP) and controls and to clarify the relationship between natural and corrected head posture angle differences and deep cervical flexor function. This study aimed to provide useful evidence for postural assessment and treatment in patients with NSNP. METHODS: In this cross-sectional study, 19 patients with NSNP reporting a pain score of 3-7 for at least 3 months and 19 participants with no neck pain within the previous 12 months were recruited. To evaluate FHP, the cranial rotation and vertical angles were measured using lateral head and neck photographs. The craniocervical flexion test was used to evaluate deep cervical flexor activation and endurance. We evaluated the head and neck alignment in natural and corrected head postures and the relationship between the degree of change and deep cervical flexor function. RESULTS: FHP in the natural head posture did not differ between groups. In the corrected head posture, FHP was significantly smaller in the NSNP group than in the control group. In the NSNP group, the cranial rotation and vertical angles were significantly different between the natural and corrected head postures, and the angle difference correlated significantly with deep cervical flexor function. CONCLUSIONS: Patients with NSNP show hypercorrection in the corrected head posture, which may be correlated with deep cervical flexor dysfunction. Further investigation into the causal relationship between hypercorrection, deep neck flexor dysfunction, and neck pain is required.

Unknotting tech neck by breaking the cycle of pain and disability: Comparing the impact of instrument assisted soft tissue mobilization on specific muscles and superficial back arm line.

BACKGROUND: Computer professionals often develop a forward head posture due to prolonged hours of computer use, leading to neck pain. Instrument-assisted soft tissue mobilization (IASTM), an advanced technique for treating myofascial trigger points, has become increasingly popular for addressing these musculoskeletal issues. OBJECTIVES: The study aimed to compare the effectiveness of IASTM mobilization on SBAL (superficial back arm line) and SM(specific muscles-upper trapezius, levator scapulae, and sternocleidomastoid) in managing chronic neck pain among computer professionals. PARTICIPANTS & METHODS: The study involved 62 computer professionals, randomly divided into two groups. Group A received IASTM on SBAL and group B received IASTM on SM for neck pain each receiving three sessions weekly for four weeks. Outcome variables like Neck Disability Index (NDI), NPRS(Neck Pain Rating Scale), Craniovertebral angle (CVA), and range of motion (ROM) for flexion, and side flexion (right & left side) were evaluated at baseline, 2 weeks and 4 weeks. RESULTS: Significant improvement in NPRS were observed in both the SBAL and SM groups after 2 weeks of IASTM, wth the SBAL group demonstrating greater improvement. At 4 weeks, IASTM on SBAL showed significantly higher improvements in NPRS, CVA, NDI, and flexion compared to the SM group. The repeated measures ANOVA indicated a significant main effect of both time and group, along with a significant interaction between time and group for all outcome variables, except for CVA. CONCLUSION: The study indicates that IASTM on SBAL may offer a more effective treatment for chronic neck pain in computer professionals compared to targeting specific muscles.

Advanced subject-specific neck musculoskeletal modeling unveils sex differences in muscle moment arm and cervical spine loading.

Neck pain and injuries are growing healthcare burdens with women having a higher incidence rate and poorer treatment outcomes than males. A better understanding of sex differences in neck biomechanics, foundational for more targeted, effective prevention or treatment strategies, calls for more advanced subject-specific musculoskeletal modeling. Current neck musculoskeletal models are based on generic anatomy, lack subject specificity beyond anthropometric scaling, and are unable to accurately reproduce neck strengths exhibited in vivo without arbitrary muscle force scaling factors or residual torque actuators. In this work, subject-specific neck musculoskeletal models of 23 individuals (11 male, 12 female) were constructed by integrating multi-modality imaging and biomechanical measurements. Each model simulated maximal voluntary neck static exertions in three postures: neck flexion in a neutral posture, flexion in a 40° extended posture, and extension in a 40° flexed posture. Quantitative model validation showed close agreement between model-predicted muscle activation and EMG measurement. The models unveiled that (1) males have greater moment arms in one flexor muscle group and five extensor muscle groups, (2) females exhibited higher cervical spinal compression per unit exertion force in the flexed posture, and (3) the variability of compression force was much greater in females in all three exertions but most notably in the extension with a flexed "dropped head" position. These insights illuminated a plausible pathway from sex differences in neck biomechanics to sex disparities in the risk and prevalence of neck pain.

Improving Function and Quality of Life in Patients with Chronic Neck Pain, Tension-Type Headache, and Forward Head Posture: The Role of Eyeball Exercise and Cervical Stabilization Programs.

BACKGROUND The purpose of this study was to investigate the effects of eyeball exercise and cervical stabilization programs to patients with chronic neck pain, tension-type headache (TTH), and forward head posture (FHP). MATERIAL AND METHODS The design of this study was a randomized controlled trial. A total of 40 participants were randomly divided into 2 groups: the experimental group (n=20) and the control group (n=20). Both groups received cervical manual therapy and biofeedback-guided stabilization exercises (30 min/session, 3 sessions/week, 6 weeks). In addition to the regular treatments, the participants in the experimental group also performed eyeball exercises for 20 minutes per session, 3 sessions per week, for a total of 6 weeks. Changes in neck pain (numeric rating scale, NRS), neck disability index (NDI), quality of life (Short Form-12 Health Survey Questionnaire, SF-12), headache impact test-6 (HIT-6), craniovertebral angle (CVA), cranial rotation angle (CRA), and muscle tone were measured. RESULTS Both groups showed significant improvements in NRS, NDI, SF-12, HIT-6 scores, CVA, CRA, and muscle tone (p<0.05). The experimental group had significant differences in NDI, SF-12, HIT-6 scores, and suboccipital muscle tone compared to the control (p<0.05). CONCLUSIONS Combining the eyeball exercise program with commonly used manual therapy and stabilization exercises for patients with chronic neck pain can help reduce nerve compression and promote muscle relaxation in the eye and neck areas. The method is thus proposed as an effective intervention to enhance function and quality of life in patients with chronic neck pain patients, TTH, and FHP.

Tips for Transient Perivascular Inflammation of the Carotid Artery Syndrome.

BACKGROUND: Idiopathic carotidynia, also known as transient perivascular inflammation of the carotid artery (TIPIC) syndrome, is a rare, self-limited, clinical-radiologic entity. Over the years, the diagnosis of carotidynia has been controversial, but recent pathologic, radiologic, clinical, and laboratory findings support an inflammatory etiology. CASE REPORT: A 61-year-old woman with a history of hypertension, left lower extremity liposarcoma, and right internal jugular port placement 2 weeks prior with initiation of chemotherapy presented to the emergency department with right neck pain and swelling of the lateral neck and lower face for the past 3 days. Computed tomography-neck with IV contrast revealed marked mural thickening of the right common carotid artery, which can be seen with carotidynia (Fay syndrome and TIPIC syndrome) and vasculitis. The patient had elevated inflammatory markers and was treated clinically for carotidynia with ibuprofen, evaluated by vascular surgery, and discharged home. WHY SHOULD AN EMERGENCY PHYSICIAN BE AWARE OF THIS?: The causes of acute neck pain are diverse, ranging from nonemergent to surgically emergent etiologies. As radiologists and emergency physicians, we believe TIPIC syndrome is a rare entity with important clinical impact deserving attention, as it is not typically included in medical training and is usually learned only through years of clinical experience and practice. TIPIC syndrome requires a unique combination of both clinical and radiologic findings to diagnose accurately and appropriately. It is important to be familiar with this diagnosis because treatment is focused on symptomatic relief without the need for invasive procedures. Our goal was to increase awareness of this uncommon diagnosis to improve patient care by preventing unnecessary invasive procedures and aid in timely and accurate diagnosis.