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2.
Biomed Res Int ; 2021: 7190808, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-33521131

RESUMO

Background: Neck pain (NP) is a common work-related disorder, with high prevalence in the profession of teaching. The daily duties of a school teacher involve head-down postures while reading and writing, which expose them to the risk of developing NP. Deep cervical flexor (DCF) muscles have been reported to have lower endurance in patients with cervical impairment, which has additionally been associated with disability. There is limited evidence regarding the efficacy of training of DCF muscles in occupational NP. The objective of this study was to investigate the effects of DCF muscle training on pain, muscle endurance, and functional disability using pressure biofeedback in school teachers with NP. Methods: Sixty-five teachers (age, 25-45 years) with more than 5 years of teaching experience participated in this study. They were randomly divided into two groups: the experimental (E) and control (C) groups. In the E group, the subjects underwent DCF muscle training using pressure biofeedback in addition to conventional exercises for neck pain, while those in the C group underwent conventional exercises only. Pain, muscle endurance, and disability were measured at day 0 (before the treatment) and days 14 and 42 after the treatment. Endurance of DCF muscles was measured by the craniocervical flexion test using pressure biofeedback, pain intensity was measured using the numeric pain rating scale, and functional disability was assessed using the neck disability index questionnaire. This study was performed in accordance with CONSORT guidelines. Results: On day 0, there were no significant differences in the age, pain, muscle endurance, and disability levels between the groups. After initiating the intervention, although there were improvements in both groups, there was a statistically significant improvement in muscle endurance, pain, and disability in subjects who received additional training with pressure biofeedback. Conclusions: Besides increasing muscle endurance, specific training of DCF muscles in addition to conventional exercises can improve neck pain and functional disability. These results should be further correlated clinically. A dedicated time for exercises at school could help prevent the development of NP in teachers. This trial is registered with ClinicalTrials.gov NCT03537300 May 24, 2018 (retrospectively registered).


Assuntos
Terapia por Exercício/métodos , Músculos do Pescoço/fisiopatologia , Cervicalgia/fisiopatologia , Doenças Profissionais/fisiopatologia , Professores Escolares , Adulto , Biorretroalimentação Psicológica , Dor Crônica/terapia , Pessoas com Deficiência , Exercício Físico , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Manejo da Dor/métodos , Medição da Dor/métodos , Postura
3.
PLoS One ; 15(12): e0244137, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-33370389

RESUMO

BACKGROUND: The clinical presentation of neck-arm pain is heterogeneous with varying underlying pain types (nociceptive/neuropathic/mixed) and pain mechanisms (peripheral/central sensitization). A mechanism-based clinical framework for spinally referred pain has been proposed, which classifies into (1) somatic pain, (2) neural mechanosensitivity, (3) radicular pain, (4) radiculopathy and mixed pain presentations. This study aims to (i) investigate the application of the clinical framework in patients with neck-arm pain, (ii) determine their somatosensory, clinical and psychosocial profile and (iii) observe their clinical course over time. METHOD: We describe a study protocol. Patients with unilateral neck-arm pain (n = 180) will undergo a clinical examination, after which they will be classified into subgroups according to the proposed clinical framework. Standardized quantitative sensory testing (QST) measurements will be taken in their main pain area and contralateral side. Participants will have to complete questionnaires to assess function (Neck Disability Index), psychosocial factors (Tampa Scale of Kinesiophobia, Pain Catastrophizing Scale, Depression, anxiety and stress scale), neuropathic pain (Douleur Neuropathique 4 Questions, PainDETECT Questionnaire) and central sensitization features (Central Sensitization Inventory). Follow-ups at three, six and 12 months include the baseline questionnaires. The differences of QST data and questionnaire outcomes between and within groups will be analyzed using (M)AN(C)OVA and/or regression models. Repeated measurement analysis of variance or a linear mixed model will be used to calculate the differences between three, six, and 12 months outcomes. Multiple regression models will be used to analyze potential predictors for the clinical course. CONCLUSION: The rationale for this study is to assess the usability and utility of the proposed clinical framework as well as to identify possible differing somatosensory and psychosocial phenotypes between the subgroups. This could increase our knowledge of the underlying pain mechanisms. The longitudinal analysis may help to assess possible predictors for pain persistency.


Assuntos
Dor Musculoesquelética/fisiopatologia , Cervicalgia/fisiopatologia , Neuralgia/fisiopatologia , Dor Nociceptiva/fisiopatologia , Inquéritos e Questionários , Adulto , Estudos Transversais , Feminino , Humanos , Estudos Longitudinais , Masculino , Pessoa de Meia-Idade , Medição da Dor , Estudos Prospectivos
5.
Bone Joint J ; 102-B(8): 981-996, 2020 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-32731832

RESUMO

AIMS: Whether to perform hybrid surgery (HS) in contrast to anterior cervical discectomy and fusion (ACDF) when treating patients with multilevel cervical disc degeneration remains a controversial subject. To resolve this we have undertaken a meta-analysis comparing the outcomes from HS with ACDF in this condition. METHODS: Seven databases were searched for studies of HS and ACDF from inception of the study to 1 September 2019. Both random-effects and fixed-effects models were used to evaluate the overall effect of the C2-C7 range of motion (ROM), ROM of superior/inferior adjacent levels, adjacent segment degeneration (ASD), heterotopic ossification (HO), complications, neck disability index (NDI) score, visual analogue scale (VAS) score, Japanese Orthopaedic Association (JOA) score, Odom's criteria, blood loss, and operating and hospitalization time. To obtain more credible results contour-enhanced funnel plots, Egger's and Begg's tests, meta-regression, and sensitivity analyses were performed. RESULTS: In total, 17 studies involving 861 patients were included in the analysis. HS was found to be superior to ACDF in maintaining C2-C7 ROM and ROM of superior/inferior adjacent levels, but HS did not reduce the incidence of associated level ASD. Also, HS did not cause a higher rate of HO than ACDF. The frequency of complications was similar between the two techniques. HS failed to achieve more favourable outcomes than ACDF using the NDI, VAS, JOA, and Odom's scores. HS did not show any more advantages in operating or hospitalization time but did show reduction in blood loss. CONCLUSION: Although HS maintained cervical kinetics, it failed to reduce the incidence of ASD. This finding differs from previous reports. Moreover, patients did not show more benefits from HS with respect to symptom improvement, prevention of complications, and clinical outcomes. Cite this article: Bone Joint J 2020;102-B(8):981-996.


Assuntos
Vértebras Cervicais/cirurgia , Discotomia/métodos , Degeneração do Disco Intervertebral/cirurgia , Amplitude de Movimento Articular/fisiologia , Fusão Vertebral/métodos , Substituição Total de Disco/métodos , Adulto , Idoso , Bases de Dados Factuais , Avaliação da Deficiência , Feminino , Humanos , Degeneração do Disco Intervertebral/diagnóstico por imagem , Japão , Masculino , Pessoa de Meia-Idade , Cervicalgia/etiologia , Cervicalgia/fisiopatologia , Cervicalgia/cirurgia , Medição da Dor , Prognóstico , Estudos Retrospectivos , Índice de Gravidade de Doença , Espondilose/diagnóstico por imagem , Espondilose/cirurgia , Resultado do Tratamento
6.
PLoS One ; 15(8): e0237860, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32834008

RESUMO

In a previous study we have shown that patients with long standing non-specific neck-pain display more rigid neck movement behavior than controls in response to unpredictable perturbations. In the present study we investigated head/neck motor control in patients with neck-pain during a course of physiotherapy intervention and the associations with pain, neck disability and kinesiophobia. In this longitudinal observational study, 72 patients with non-specific neck-pain were exposed to unpredictable horizontal rotations by means of an actuated chair in three conditions; with a visual reference, and without vision with and without a cognitive task before first consultation with physiotherapist, after 2 weeks and 2 months of intervention. The neck movements were analyzed in the frequency domain to cover voluntarily and reflex controlled responses. Questionnaires encompassed Neck Disability Index, Tampa Scale of Kinesiophobia, and the Numerical Rating Scale for current pain. The results showed that the response pattern for the amplitudes of movement between head and trunk across frequencies did not change over time, whereas some changes in timing were found for some frequencies. Pain, neck disability, and kinesiophobia improved after intervention, but were not significantly associated with neck movement responses to perturbations across time or condition. Although physiotherapy intervention improved self-reported function, the rigid responses to unpredictable perturbations remained unchanged. This indicates altered function in reflex mediated control mechanisms, i.e., the vestibulocollic and the cervicocollic reflex systems that control the head in space and on the trunk. Future research should further investigate pain related changes in reflex systems and whether alterations in these systems are modifiable.


Assuntos
Cervicalgia/fisiopatologia , Cervicalgia/terapia , Pescoço/fisiopatologia , Adolescente , Adulto , Idoso , Cognição , Feminino , Cabeça/fisiopatologia , Humanos , Masculino , Pessoa de Meia-Idade , Atividade Motora , Resultado do Tratamento , Visão Ocular , Adulto Jovem
8.
Muscle Nerve ; 62(4): 462-473, 2020 10.
Artigo em Inglês | MEDLINE | ID: mdl-32557709

RESUMO

Persons with back, neck, and limb symptoms constitute a major referral population to specialists in electrodiagnostic (EDX) medicine. The evaluation of these patients involves consideration of both the common and less common disorders. The EDX examination with needle electromyography (EMG) is the most important means of testing for radiculopathy. This test has modest sensitivity but high specificity and well complements imaging of the spine. Needle EMG in combination with nerve conduction testing is valuable in excluding entrapment neuropathies and polyneuropathy-conditions that frequently mimic radicular symptoms. In this first of a two-part review, the optimal EDX evaluation of persons with suspected radiculopathy is presented. In part two, the implications of EDX findings for diagnosis and clinical management of persons with radiculopathy are reviewed.


Assuntos
Técnicas de Diagnóstico Neurológico , Eletromiografia/métodos , Condução Nervosa , Radiculopatia/diagnóstico , Variação Anatômica , Vértebras Cervicais , Eletrodiagnóstico/métodos , Potencial Evocado Motor , Humanos , Dor Lombar/etiologia , Dor Lombar/fisiopatologia , Vértebras Lombares , Debilidade Muscular/etiologia , Debilidade Muscular/fisiopatologia , Cervicalgia/etiologia , Cervicalgia/fisiopatologia , Agulhas , Exame Neurológico , Exame Físico , Radiculopatia/complicações , Radiculopatia/fisiopatologia , Reflexo Anormal , Sacro , Ciática/etiologia , Ciática/fisiopatologia , Raízes Nervosas Espinhais
9.
J Occup Health ; 62(1): e12108, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-32515885

RESUMO

OBJECTIVES: The problem of spinal pain among nurses and lack of compliance with workplace ergonomy is increasing. The study aimed to assess the pressure pain threshold (PPT) at the cervical and lumbar spine in nursing staff. METHODS: The sample of this prospective and observational study consisted of 30 female nurses with a mean age of 38.6 ± 11.1 years. The standardized Oswestry (ODI) and the Neck Disability Index (NDI) were used, as well as the Authors' Designed Questionnaire (ADQ) was used to assess compliance with ergonomic principles. The PPT analysis using a computerized pressure algometer (CPA) was performed to examine the level of PPT. RESULTS: A mild disability was found in 56% of nurses (NDI and ODI). A value of <4 kg/cm2 (CPA), indicating musculoskeletal overload was observed in 57% of subjects. Also, 60% of nurses work with a lying patient; 73.4% grabs the patient's armpits while transferring in bed; 16.7% never adjusts the height of the bed, and only 13.4% choose specialist footwear for work. There is a correlation between PPT values for trapezius and erector spinae muscles on the same side of the body in nurses with mild and moderate disability (P < .05). CONCLUSIONS: Pain complaints are associated with lower PPT of trapezius and erector spinae muscles and asymmetry of muscle tension. Also, it was noted that the lack of implementation of ergonomic principles by nursing staff affects their degree of disability.


Assuntos
Dor Lombar/fisiopatologia , Cervicalgia/fisiopatologia , Enfermeiras e Enfermeiros , Limiar da Dor , Adulto , Estudos Transversais , Avaliação da Deficiência , Feminino , Humanos , Pessoa de Meia-Idade , Pressão , Estudos Prospectivos
11.
Phys Ther ; 100(2): 268-282, 2020 02 07.
Artigo em Inglês | MEDLINE | ID: mdl-32031655

RESUMO

BACKGROUND: Cervical sensorimotor control (CSMC) outcomes have been suggested to be important in the assessment of individuals with neck pain, despite the lack of consistent supporting evidence that CSMC skills are related to neck pain. OBJECTIVE: The aim of this study was to investigate whether CSMC changes over time in individuals with chronic idiopathic neck pain and whether neck pain characteristics are associated with CSMC. DESIGN: A longitudinal observational study was performed. METHODS: A total 50 participants with chronic idiopathic neck pain and 50 matched participants who were healthy (controls) completed 7 CSMC tests (including 14 test conditions): joint position error, postural balance, subjective visual vertical, head tilt response, The Fly, smooth pursuit neck torsion, and head steadiness. Neck pain characteristics included pain intensity (visual analog scale), pain duration, and neck disability (Neck Disability Index). Linear mixed models were used to investigate whether any factors were associated with changes in CSMC. RESULTS: Neck pain intensity was associated with 1 of 14 CSMC test conditions (balance with torsion and eyes open), and neck disability was associated with balance with eyes open and high-load head steadiness. Other factors, including sex, age, body mass index, physical activity levels, and neck pain duration, showed no association with CSMC. LIMITATIONS: Although all other tests involved computerized data collection, the joint position error test was administered manually, introducing the risk of researcher bias. CONCLUSIONS: The few associations between test conditions and neck pain characteristics were at best weak; hence, these are likely to be chance findings. These results suggest that CSMC may not be associated with improvement/worsening of chronic idiopathic neck pain, spawning debate on the clinical usefulness of CSMC tests.


Assuntos
Dor Crônica/fisiopatologia , Cervicalgia/fisiopatologia , Equilíbrio Postural/fisiologia , Propriocepção/fisiologia , Adulto , Estudos de Casos e Controles , Análise de Dados , Retroalimentação Sensorial/fisiologia , Feminino , Humanos , Estudos Longitudinais , Masculino , Pessoa de Meia-Idade , Medição da Dor , Tamanho da Amostra , Fatores de Tempo
12.
J Orthop Sports Phys Ther ; 50(4): 179-188, 2020 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-31905095

RESUMO

OBJECTIVE: Utilizing shear wave elastography, we compared the stiffness of the neck extensor muscles and the stiffness in muscle-specific regions between women with chronic nonspecific neck pain and asymptomatic controls. DESIGN: Cross-sectional observational study. METHODS: We measured the average muscle stiffness over multiple neck extensor muscles and in regions corresponding approximately to the trapezius, splenius capitis, semispinalis capitis, semispinalis cervicis, and multifidus muscles using ultrasound shear wave elastography in 20 women with chronic nonspecific neck pain and 18 asymptomatic women during multiple tasks. The measurements were automatically quality controlled and computer processed over the complete visible neck region or a large muscle-specific region. RESULTS: Pooled over all tasks, neck muscle stiffness was not significantly different between those with neck pain and asymptomatic controls (neck pain median, 11.6 kPa; interquartile range, 8.9 kPa and control median, 13.3 kPa; interquartile range, 8.6 kPa; P = .175). The measure of neck muscle stiffness was not correlated with the intensity of neck pain or perceived disability. CONCLUSION: Shear wave elastography revealed similar muscle stiffness in people with and without chronic neck pain, despite the sensation of increased neck stiffness in those with chronic neck pain. Therapeutic interventions aiming to reduce neck muscle tone are often based on the assumption that perceived neck stiffness corresponds to objective muscle stiffness. The current results question this assumption. J Orthop Sports Phys Ther 2020;50(4):179-188. Epub 6 Jan 2020. doi:10.2519/jospt.2020.8821.


Assuntos
Dor Crônica/diagnóstico por imagem , Técnicas de Imagem por Elasticidade , Tono Muscular , Músculos do Pescoço/diagnóstico por imagem , Cervicalgia/diagnóstico por imagem , Dor Crônica/fisiopatologia , Dor Crônica/terapia , Estudos Transversais , Feminino , Humanos , Pessoa de Meia-Idade , Músculos do Pescoço/fisiopatologia , Cervicalgia/fisiopatologia , Cervicalgia/terapia , Modalidades de Fisioterapia
14.
J Athl Train ; 55(3): 282-288, 2020 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-31967864

RESUMO

CONTEXT: Neck pain (NP), neck injuries, and concussions are more prevalent in female athletes than in their male counterparts. Females exhibit less neck girth, strength, and stiffness against a perturbation. As part of the clinical examination for individuals with NP, ultrasound (US)-based imaging of the cervical muscles has become common. Muscle size or thickness and stiffness can be measured with US-based B-mode and shear-wave elastography (SWE), respectively. Information on reliability, normative values, and sex differences based on US-based muscle size or thickness and stiffness in young and athletic individuals is limited. OBJECTIVE: To evaluate sex differences in US-based muscle size or thickness and biomechanical properties of the cervical-flexor and -extensor muscles. DESIGN: Cross-sectional study. SETTING: Laboratory. PATIENTS OR OTHER PARTICIPANTS: A total of 13 women (age = 23.7 ± 1.9 years, height = 167.1 ± 6.1 cm, mass = 63.8 ± 5.6 kg) and 11 men (age = 25.6 ± 4.9 years, height = 178.7 ± 8.3 cm, mass = 78.9 ± 12.0 kg). MAIN OUTCOME MEASURE(S): The same examiner collected all measures, using US B-mode to scan the cross-sectional area and thickness of the longus colli (LC), sternocleidomastoid (SCM), cervical-extensor muscles, and upper trapezius (UT) muscle. The US SWE-mode was used to measure the stiffness of the SCM and UT. Independent t tests or Mann-Whitney U tests were calculated to determine sex differences. The intraclass correlation coefficient (ICC) measured intrarater test-retest reliability. RESULTS: Men had thicker SCMs than women (P = .01). No sex differences were present for longus colli cross-sectional area, cervical-extensor muscle thickness, or UT thickness (P > .05). In addition, no sex differences were evident for SCM (P = .302) or UT (P = .703) SWE stiffness. Reliability was good to excellent (ICC = 0.715-0.890) except for SCM SWE stiffness (ICC = 0.554). CONCLUSIONS: The only sex difference was in SCM thickness. However, smaller SCMs in women did not result in less SCM SWE stiffness. We provided normative values for US-based imaging of the cervical-flexor and -extensor muscles in young and athletic men and women.


Assuntos
Músculos do Pescoço/anatomia & histologia , Músculos do Pescoço/fisiologia , Caracteres Sexuais , Adulto , Traumatismos em Atletas/fisiopatologia , Fenômenos Biomecânicos , Feminino , Humanos , Masculino , Força Muscular/fisiologia , Músculos do Pescoço/diagnóstico por imagem , Cervicalgia/fisiopatologia , Reprodutibilidade dos Testes , Músculos Superficiais do Dorso/anatomia & histologia , Músculos Superficiais do Dorso/diagnóstico por imagem , Músculos Superficiais do Dorso/fisiologia , Ultrassonografia , Adulto Jovem
15.
J Clin Neurosci ; 73: 57-61, 2020 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-31987630

RESUMO

The pathophysiology of dropped head syndrome (DHS) remains unknown, and its treatment algorithm and indication are not standardized. Here, we established a novel rehabilitation program, short and intensive rehabilitation program for DHS (SHAiR program), consisting of cervical paraspinal muscles exercise, range of motion exercise, cervical and thoracic mobilization, deep cervical flexor muscle exercise, hip lift exercise, anterior pelvic tilt exercise, and walking exercise. The aim of this study was to evaluate the clinical effectiveness of this program. We reviewed clinical outcomes for five consecutive patients with DHS who underwent the SHAiR program (SHAiR group). The outcomes were compared with those of other five patients with DHS who received exercise instruction (control group). Demographic data, the duration from onset of DHS, the apex of sagittal kyphosis on the lateral radiographs, and clinical outcomes including the ability to maintain normal horizontal gaze, chin brow vertical angle, and numerical rating scale (NRS) were evaluated at the initial visit and final follow-up at 7.5 months. There was no significant difference between the two groups in terms of demographic and radiographic data. The ability of horizontal gaze and NRS of cervical pain improved rapidly for all five patients in the SHAiR group as compared to no improvement for all patients in the control group. Rehabilitation for DHS was considered effective not only for localized rehabilitation such as exercise for training cervical extensor muscle function but also exercises for thoracolumbar posture improvement and the psoas muscle.


Assuntos
Terapia por Exercício/métodos , Cifose/reabilitação , Doenças Musculares/reabilitação , Músculos do Pescoço , Adulto , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Cifose/diagnóstico , Cifose/fisiopatologia , Masculino , Pessoa de Meia-Idade , Debilidade Muscular/diagnóstico , Debilidade Muscular/fisiopatologia , Debilidade Muscular/reabilitação , Doenças Musculares/diagnóstico , Doenças Musculares/fisiopatologia , Músculos do Pescoço/fisiopatologia , Cervicalgia/diagnóstico , Cervicalgia/fisiopatologia , Cervicalgia/reabilitação , Músculos Paraespinais/fisiopatologia , Postura/fisiologia , Amplitude de Movimento Articular/fisiologia , Síndrome , Fatores de Tempo , Adulto Jovem
16.
J Orthop Sports Phys Ther ; 50(1): 33-43, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31892290

RESUMO

OBJECTIVE: Cervical sensorimotor outcomes have been suggested to be important in the assessment of individuals with neck pain. However, the large variety of sensorimotor control tests used in varying populations makes it difficult to draw conclusions about their clinical value. We aimed to compare cervical sensorimotor control outcomes between individuals with chronic idiopathic neck pain and asymptomatic individuals using a battery of recommended tests, and to investigate the correlation between cervical sensorimotor control outcomes and pain intensity and neck disability. DESIGN: Case-control study. METHODS: Fifty participants with chronic idiopathic neck pain and 50 age- and sex-matched asymptomatic controls completed 7 cervical sensorimotor control tests: joint position error (including joint position error torsion), postural balance, subjective visual vertical, head-tilt response, "the Fly," smooth pursuit neck torsion, and head steadiness. Between-group differences were investigated with the Mann-Whitney U test. Correlations between tests and levels of neck pain and disability were investigated using the Spearman rho. RESULTS: There were no differences in cervical sensorimotor outcomes between participants with chronic idiopathic neck pain and asymptomatic controls for any test (P = .203-.981). For each test, "poor performers" consisted of both individuals with and without neck pain. Correlations were weak between tests and levels of neck pain (r = 0.010-0.294) and neck disability (r = 0.007-0.316). CONCLUSION: These findings suggest that sensorimotor control disturbances in individuals with chronic idiopathic neck pain may not be present, spawning debate on the clinical usefulness of these tests. J Orthop Sports Phys Ther 2020;50(1):33-43. Epub 23 Aug 2019. doi:10.2519/jospt.2020.8846.


Assuntos
Dor Crônica/diagnóstico , Cervicalgia/diagnóstico , Exame Neurológico , Adulto , Estudos de Casos e Controles , Dor Crônica/etiologia , Dor Crônica/fisiopatologia , Estudos Transversais , Feminino , Cabeça/fisiologia , Humanos , Masculino , Pessoa de Meia-Idade , Cervicalgia/etiologia , Cervicalgia/fisiopatologia , Equilíbrio Postural/fisiologia , Propriocepção/fisiologia
17.
J Stroke Cerebrovasc Dis ; 29(3): 104601, 2020 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-31917091

RESUMO

Herein, we described 2 patients with posterior spinal artery syndrome (PSAS) caused by vertebral artery dissection. The patients complained of sudden neck pain or walking instability. Neurological examination revealed sensory loss, muscle weakness, and sensory ataxia. Angiography showed double lumen sign or intimal flap in the vertebral artery. T2-weighted imaging and diffusion-weighted imaging of MRI showed a hyperintense lesion in the dorsal side of the cervical spinal cord at different times after onset. Both patients had good outcome after antiplatelet therapy and physiotherapy. A review of previously reported PSAS cases was also conducted in order to improve the understanding and awareness of this rare myelopathy.


Assuntos
Doenças Vasculares da Medula Espinal/etiologia , Dissecação da Artéria Vertebral/complicações , Adulto , Feminino , Marcha , Transtornos Neurológicos da Marcha/etiologia , Transtornos Neurológicos da Marcha/fisiopatologia , Transtornos Neurológicos da Marcha/terapia , Humanos , Masculino , Cervicalgia/etiologia , Cervicalgia/fisiopatologia , Cervicalgia/terapia , Modalidades de Fisioterapia , Inibidores da Agregação de Plaquetas/uso terapêutico , Recuperação de Função Fisiológica , Doenças Vasculares da Medula Espinal/diagnóstico por imagem , Doenças Vasculares da Medula Espinal/fisiopatologia , Doenças Vasculares da Medula Espinal/terapia , Resultado do Tratamento , Dissecação da Artéria Vertebral/diagnóstico por imagem , Dissecação da Artéria Vertebral/fisiopatologia , Dissecação da Artéria Vertebral/terapia
18.
Clin Biomech (Bristol, Avon) ; 71: 125-132, 2020 01.
Artigo em Inglês | MEDLINE | ID: mdl-31726402

RESUMO

BACKGROUND: Impaired sensorimotor ability has been demonstrated in recurrent neck pain patients. It is however not clear if cervical joint motion and pressure pain sensitivity in recurrent neck pain patients are different from asymptomatic controls. METHODS: Cervical flexion and extension motions were examined by video-fluoroscopy and pressure pain thresholds were assessed bilaterally over C2/C3, C5/C6 facet joints and right tibialis anterior in eighteen recurrent neck pain patients and eighteen healthy subjects. Individual joint motion was analyzed by dividing fluoroscopic videos into 10 epochs. The motion opposite to the primary direction (anti-directional motion) and motion along with the primary direction (pro-directional motion) of each joint were extracted across epochs. Total joint motion was the sum of anti-directional and pro-directional motions. Joint motion variability was represented by the variance of joint motions across epochs. FINDINGS: Compared to controls, recurrent neck pain patients showed: 1) decreased anti-directional motion at C2/C3 and C3/C4 (P < 0.05) and increased anti-directional motion at C5/C6 and C6/C7 (P < 0.05) during extension motion. 2) Increased overall anti-direction motion during flexion motion (P < 0.05). 3) Lower joint motion variability at C3/C4 during extension motion (P < 0.05). INTERPRETATION: Recurrent neck pain patients showed a redistribution of anti-directional motion between the middle cervical spine and the lower cervical spine during cervical extension and increased overall anti-directional motion during cervical flexion compared with healthy controls. The anti-directional motion was more sensitive to neck pain compared to other cervical joint motion parameters in the present study.


Assuntos
Vértebras Cervicais/fisiopatologia , Cervicalgia/fisiopatologia , Amplitude de Movimento Articular , Adulto , Fenômenos Biomecânicos , Feminino , Fluoroscopia , Humanos , Hiperalgesia/diagnóstico por imagem , Masculino , Pessoa de Meia-Idade , Movimento , Pescoço/fisiopatologia , Pressão , Recidiva , Gravação em Vídeo , Adulto Jovem
19.
Gait Posture ; 76: 146-150, 2020 02.
Artigo em Inglês | MEDLINE | ID: mdl-31855805

RESUMO

BACKGROUND: Individuals with neck pain have different movement and muscular activation (collectively termed as biomechanical variables) patterns compared to healthy individuals. Incorporating biomechanical variables as covariates into prognostic models is challenging due to the high dimensionality of the data. RESEARCH QUESTION: What is the classification performance of neck pain status of a statistical model which uses both scalar and functional biomechanical covariates? METHODS: Motion capture with electromyography assessment on the sternocleidomastoid, splenius cervicis, erector spinae, was performed on 21 healthy and 26 individuals with neck pain during walking over three gait conditions (rectilinear, curvilinear clockwise (CW) and counterclockwise (CCW)). After removing highly collinear variables, 94 covariates across the three conditions were used to classify neck pain status using functional data boosting (FDboost). RESULTS: Two functional covariates trunk lateral flexion angle during CCW gait, and trunk flexion angle during CW gait; and a scalar covariate, hip jerk index during CCW gait were selected. The model achieved an estimated AUC of 80.8 %. For hip jerk index, an increase in hip jerk index by one unit increased the log odds of being in the neck pain group by 0.37. A 1° increase in trunk lateral flexion angle throughout gait alone reduced the probability of being in the neck pain group from 0.5 to 0.15. A 1° increase in trunk flexion angle throughout gait alone increased the probability of being in the neck pain group from 0.5 to 0.9. SIGNIFICANCE: Interpreting the physiological significance of the extracted covariates, with other biomechanical variables, suggests that individuals with neck pain performed curvilinear walking using a stiffer strategy, compared to controls; and this increased the risk of being in the neck pain group. FDboost can produce clinically interpretable models with complex high dimensional data and could be used in future prognostic modelling studies in neck pain research.


Assuntos
Marcha/fisiologia , Movimento/fisiologia , Músculos do Pescoço/fisiopatologia , Cervicalgia/classificação , Medição da Dor/métodos , Caminhada/fisiologia , Adulto , Fenômenos Biomecânicos , Eletromiografia , Feminino , Humanos , Masculino , Cervicalgia/diagnóstico , Cervicalgia/fisiopatologia
20.
J Back Musculoskelet Rehabil ; 33(1): 21-28, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-31594202

RESUMO

BACKGROUND: Heating the skin and muscles is a commonly accepted method of pain relief and a modality to increase relaxation in muscles and increase tissue blood flow. OBJECTIVE: The purpose of the present study was to examine the effect of local heat applied to trigger points and to determine if there was pain relief in the neck and plantar fascia. METHODS: Forty adults were divided into 2 different groups according to their pain; twenty subjects had plantar foot pain and the other 20 had nonspecific neck pain. The 20 subjects in each group were randomly subdivided into a heat and a sham group. Sensitivity to pressure was measured with an algometer. A stopwatch was given to the subject and started when either the heat patch or placebo was applied. Heat cells were applied at trigger points on the pain area. RESULTS: Subjective pain significantly decreased in both sham and heat group patients with neck pain (p< 0.05), however, the change was greater in the heat group and there was a significant difference between the heat and sham groups (p= 0.002, d= 0.81). For the plantar pain group, a significant decrease in subjective pain was found in the heat group but not in the sham group. Pressure pain threshold significantly decreased in the heat group patients both with neck and plantar pain but for the sham group there was an increase in the pressure after sham treatment. Pain relief during the intervention was also significantly different between the heat and sham group in both patients with neck and plantar pain. CONCLUSION: The effect of local heat on trigger points of the body on pain relief was significantly better in the heat groups than in the sham groups. This finding is significant because using heat on trigger points could be an alternative to dry needling performed by healthcare professionals. This modality can be alternative for home use and avoids opioids.


Assuntos
Fasciíte Plantar/terapia , Temperatura Alta/uso terapêutico , Cervicalgia/terapia , Manejo da Dor/métodos , Pontos-Gatilho/fisiopatologia , Adulto , Fáscia/fisiopatologia , Fasciíte Plantar/fisiopatologia , Feminino , Pé/fisiopatologia , Humanos , Masculino , Pessoa de Meia-Idade , Músculo Esquelético/fisiopatologia , Cervicalgia/fisiopatologia , Limiar da Dor/fisiologia , Resultado do Tratamento , Adulto Jovem
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