The effect of 3 different exercise approaches on neck muscle endurance, kinesiophobia, exercise compliance, and patient satisfaction in chronic whiplash.

OBJECTIVE: The purpose of this study was to compare the effects of 3 different exercise approaches on neck muscle endurance (NME), kinesiophobia, exercise compliance, and patient satisfaction in patients with chronic whiplash. METHODS: This prospective randomized clinical trial included 216 individuals with chronic whiplash. Participants were randomized to 1 of 3 exercise interventions: neck-specific exercise (NSE), NSE combined with a behavioral approach (NSEB), or prescribed physical activity (PPA). Measures of ventral and dorsal NME (endurance time in seconds), perceived pain after NME testing, kinesiophobia, exercise compliance, and patient satisfaction were recorded at baseline and at the 3- and 6-month follow-ups. RESULTS: Compared with individuals in the prescribed physical activity group, participants in the NSE and NSEB groups exhibited greater gains in dorsal NME (P = .003), greater reductions in pain after NME testing (P = .03), and more satisfaction with treatment (P < .001). Kinesiophobia and exercise compliance did not significantly differ between groups (P > .07). CONCLUSION: Among patients with chronic whiplash, a neck-specific exercise intervention (with or without a behavioral approach) appears to improve NME. Participants were more satisfied with intervention including neck-specific exercises than with the prescription of general exercise.

Evaluation of physical function in individuals 11 to 14 years after anterior cervical decompression and fusion surgery--a comparison between patients and healthy reference samples and between 2 surgical techniques.

OBJECTIVE: The purpose of this study was to evaluate neck-related physical function in individuals 11 to 14 years after anterior cervical decompression and fusion (ACDF) surgery for degenerative cervical disk disease and to compare the long-term outcome of 2 surgical techniques, including the Cloward procedure and cervical intervertebral fusion cage. METHODS: In this cross-sectional study, 51 individuals, 11 years or more after ACDF, underwent testing of cervical active range of motion, hand-grip strength, static and dynamic balance, neck muscle endurance, and completed pain ratings. The participants' values were compared with values of age- and sex-matched healthy individuals to evaluate impairments. Correlations between different test scores and pain were performed. Group differences were analyzed between the 2 surgical techniques. RESULTS: Sixty-five percent and 82% exhibited impairment in ventral and dorsal neck muscle endurance, respectively. Impairment rates of 18% to 39% for cervical active range of motion, 27% to 43% for hand-grip strength, 37% for standing balance, and 35% for dynamic balance were recorded. Twenty-nine percent of the participants had impairment (>30 mm visual analog scale) in pain. There were no significant differences in physical function between the 2 surgical treatment groups (Cloward procedure or cervical intervertebral fusion cage) (P = .10-.92). CONCLUSIONS: In those studied, a large percentage of patients who had anterior cervical decompression and fusion surgery have impairments in neck-related physical function when compared 11 to 14 years after surgery with age- and sex-matched healthy reference individuals. Neck-specific function, but not balance, was statistically correlated to pain. Neck muscle endurance was most affected, and balance impairments were also present in one-third of the individuals. There were no differences in long-term physical function between the 2 surgical techniques.

Cervical muscle activity during loaded arm lifts in patients 10 years postsurgery for cervical disc disease.

OBJECTIVE: The purpose of this study was to compare the mechanical activity of the neck muscles during loaded arm lifting tasks in individuals with long-standing disability after anterior cervical decompression and fusion (ACDF) with that of healthy controls. METHODS: Ten individuals (mean age, 60 years; SD, 7.1) who underwent ACDF (10-13 years previously) for cervical disc disease and 10 healthy age- and sex-matched controls participated in the study. Ultrasonography was used to investigate the degree of deformation and deformation rate of ventral and dorsal neck muscles at the C4 segmental level during a single (1× arm flexion to 120°) and repeated (10× arm flexion to 90°) loaded arm elevation condition. RESULTS: The ACDF group showed greater deformation and deformation rate of the longus capitis (P=.02) and deformation rate of the sternocleidomastoid (P=.04) during the 120° arm lift. For repeated 90° arm lift, there was a significant group effect with higher deformation rate values observed in the longus capitis (P=.005-.01) and multifidus (P=.03) muscles in the ACDF group. Muscle behavior did not change the repeated arm lifts (no group×time interactions) for either the ventral or the dorsal muscles. CONCLUSIONS: For study participants, greater muscle mechanical activity levels were observed in the ventral and multifidus muscles of patients with persistent symptoms after ACDF. These differences may indicate altered motor strategy in this patient group when performing the upper limb task and may need to be considered when prescribing exercise for postsurgical rehabilitation.