Relationship of Forward Head Posture and Cervical Backward Bending to Neck Pain

Abstract

The purpose of this study was to investigate the relationship of forward head posture and cervical backward bending to neck pain. The subjects were fifty-four volunteer office workers, who spent at least four hours of their work day at a computer terminal (17 males and 37 females). Since all subjects reported having pain, the subjects who reported pain in four areas or more were considered the case group and those who reported pain in three areas or less were considered the control group. Measurements of forward head posture and cervical backward bending in both the natural sitting position and the erect sitting position were recorded by the Cervical Range of Motion Instrument (CROM). The results showed that compared to the control group, the case group subjects had more pain over the past thirty days, visited medical professionals more frequently during the past twelve months, and when describing a typical day reported greater pain. Additionally, members of the case group had greater forward head posture and less cervical backward bending in the natural sitting position and the erect sitting position. The results of this study support the belief that a relationship of forward head posture and cervical backward bending to neck pain exists.     

The Acute Effects of Manual and Instrument-Assisted Cervical Spine Manipulation on Pressure Pain Threshold,Pressure Pain Perception,and Muscle-Related Variables in Asymptomatic Subjects: A Randomized Controlled Trial

ObjectiveThe purpose of this study was to compare the immediate effects in asymptomatic participants of manual and instrument-assisted cervical manipulation on pressure pain thresholds, pressure pain perception, and muscle mechanical properties (tone, stiffness, and elasticity) over muscles anatomically related and unrelated to the manipulated level.MethodsFifty-nine asymptomatic participants (34 women and 25 men; age [mean ± standard deviation] = 21.1 ± 1.6 years) were randomly assigned to 4 groups in a double-blind, randomized, placebo-controlled trial. Two groups received cervical (C3/C4) manipulation, 1 manual and the other instrument-assisted; the third group received a sham manipulation; and the fourth group served as the control. Bilateral pressure pain threshold, pressure pain perception, muscle tone, stiffness, and elasticity in the upper trapezius and biceps brachii were evaluated before and immediately after the interventions.ResultsAt baseline, there were no differences among the groups on any variable. After the interventions, a significant increase in pressure pain threshold was observed with both manual and instrument-assisted manipulation at local and distal sites (P < .05), whereas no changes were observed in either the control or the placebo group. The perception of pain pressure did not change significantly in any group. The interventions did not promote any statistically significant differences in muscle tone, elasticity, or stiffness at any site (local or distal).ConclusionCervical (C3/C4) manual and instrument-assisted manipulations produced an increase in pressure pain threshold bilaterally and over muscles related and unrelated to the vertebral segment, but had no effect on muscle tone, elasticity, or stiffness.     

Influence of Body Posture and Apnea Severity on the Tone and Elasticity of Upper Airway Muscles in Awake Patients With Obstructive Sleep Apnea: A Cross-Sectional Study

ObjectiveThe purpose of this study was to compare the effect of body posture and apnea severity on the tone, stiffness, and elasticity of upper airway muscles in awake patients with obstructive sleep apnea syndrome (OSAS).MethodsEighty adult patients with OSAS from the Sleep Laboratory of the Bitlis State Hospital between April and December 2021 were included in the study. The tone, stiffness, and elasticity of the genioglossus and accessory muscles (sternocleidomastoid, masseter) were measured while the patients were awake, sitting upright, and in supine posture. According to polysomnography results and the Apnea-Hypopnea Index, patients were classified as mild, moderate, or severe OSAS.ResultsThere were 56 male (70%) and 24 female (30%) patients (age 45.0 ± 11.0 years). Tone of genioglossus, masseter, and sternocleidomastoid muscles were higher in supine than in sitting posture (all P < .05). There was no difference in elasticity scores of the bilateral genioglossus muscle in sitting and supine posture (P > .05). The elasticity scores of the sternocleidomastoid and masseter muscles were higher in sitting (all P < .05). An interaction effect of postural change and apnea severity was observed on stiffness scores of the genioglossus muscle (P < .05).ConclusionResults showed that the genioglossus muscle and accessory muscles take on the inspiratory load that develops with postural strain, regardless of the severity of apnea, in awake patients with OSAS. For participants measured in this study, accessory muscles supported respiration by increasing their elasticity.     

Effect of neck exercise on sitting posture in patients with chronic neck pain

BACKGROUND AND PURPOSE: Poor sitting posture has been implicated in the development and perpetuation of neck pain symptoms. This study had 2 purposes: (1) to compare change in cervical and thoracic posture during a distracting task between subjects with chronic neck pain and control subjects and (2) to compare the effects of 2 different neck exercise regimens on the ability of people with neck pain to maintain an upright cervical and thoracic posture during this task. SUBJECTS: Fifty-eight subjects with chronic, nonsevere neck pain and 10 control subjects participated in the study. METHOD: Change in cervical and thoracic posture from an upright posture was measured every 2 minutes during a 10-minute computer task. Following baseline measurements, the subjects with neck pain were randomized into one of two 6-week exercise intervention groups: a group that received training of the craniocervical flexor muscles or a group that received endurance-strength training of the cervical flexor muscles. The primary outcomes following intervention were changes in the angle of cervical and thoracic posture during the computer task. RESULTS: Subjects with neck pain demonstrated a change in cervical angle across the duration of the task (mean=4.4 degrees ; 95% confidence interval [CI]=3.3-5.4), consistent with a more forward head posture. No significant difference was observed for the change in cervical angle across the duration of the task for the control group subjects (mean=2.2 degrees ; 95% CI=1.0-3.4). Following intervention, the craniocervical flexor training group demonstrated a significant reduction in the change of cervical angle across the duration of the computer task. DISCUSSION AND CONCLUSION: This study showed that people with chronic neck pain demonstrate a reduced ability to maintain an upright posture when distracted. Following intervention with an exercise program targeted at training the craniocervical flexor muscles, subjects with neck pain demonstrated an improved ability to maintain a neutral cervical posture during prolonged sitting.     

Back posture and low back muscle activity in female computer workers: A field study

BackgroundFew studies have investigated sitting posture and low back muscle activity in occupational settings. This study aims to determine back posture and its influence on low back muscle activity in computer workers, and to investigate whether the work situation is associated with exacerbation of low back pain.MethodsTwenty-one female computer workers participated. Surface electromyographic activity was recorded from lumbar multifidus, longissimus, and iliocostalis throughout the workday. Simultaneous inclinometer recordings from pelvis, upper trunk, and left thigh were used to determine back posture and identify periods with sitting, standing, and walking. Low back pain intensity was recorded by visual analogue scale every hour throughout the work and leisure periods.FindingsAll subjects adopted a markedly flexed back posture while seated at work. Surface electromyographic activity was very low for all muscles during sitting (group median <1.4% of root-mean-square-detected response at maximal voluntary contraction). Back posture moderately influenced electromyographic activity, accounting for 19% (sitting) to 38% (standing) of intra-individual variation in muscle activity. Subjects reporting aggravating low back pain (n = 10) during the workday were not distinguished by duration of sitting, sitting posture, or low back muscle activity. Low back pain was markedly reduced from the last hour of work to the first hour of leisure, accompanied by an increase in low back muscle activity.InterpretationLow back muscle activity was very low during seated posture, presumably due to the flexion–relaxation phenomenon. Sustained stretch of passive lumbar structures in combination with essentially silent muscles may exacerbate low back pain in sedentary workers.     

Effects of Corrective Exercises on Posture,Pain, and Muscle Activation of Patients With Chronic Neck Pain Exposed to Anterior-Posterior Perturbation

ObjectivesThis study aimed to evaluate the effects of corrective exercises on posture, pain, and muscle activation of patients with chronic neck pain exposed to anterior-posterior perturbation.MethodsA total of 32 women (37.76 ± 3.83 years) with chronic, nonspecific neck pain were randomized into corrective exercise and control groups. The experimental group underwent a corrective exercise program for 8 weeks, 30 min/d, 3 days per week. The control group received active self-exercise instructions. Neck pain, forward head and protracted shoulder posture, and timing of superficial neck muscle activation were evaluated using the visual analog scale, photogrammetry, and electromyogram, respectively, before and then 48 hours after the 8-week program for both the experimental and control groups. All measurements at pretest and posttest were taken by a blinded assessor.ResultsSignificant alterations were observed in cervical angle (P = .003, effect size = 0.329), shoulder angle (P = .008, effect size = 0.457), neck pain and disability (P = .009, effect size = 0.645), movement control (P = .038, effect size = 0.353), activation onset of the upper trapezius (P = .015, effect size = 0.746), the sternocleidomastoid (P = .018, effect size = 0.879) and cervical erector spinae (P = .031, effect size = 0.765), and the root mean square of the upper trapezius (P = .033, effect size = 0.742), the sternocleidomastoid (P = .041, effect size = 0.587), and the cervical erector spinae (P = .024, effect size = 0.832) in the intervention group from pre- to posttest (P < .05).ConclusionPositive and significant alterations have been observed in the forward head and protracted shoulder posture, the timing of superficial neck muscle activation, neck pain, and disability in female patients with chronic neck pain exposed to anterior-posterior perturbation after performing an 8-week corrective exercise program.     

Reliability, validity, and responsiveness of myotonometric measurement of muscle tone, elasticity, and stiffness in patients with stroke

Chuang L-L, Wu C-Y, Lin K-C. Reliability, validity, and responsiveness of myotonometric measurement of muscle tone, elasticity, and stiffness in patients with stroke.ObjectiveTo assess the metric properties of a myotonometer.DesignMetric study.SettingThree medical centers.ParticipantsStroke patients (N=67).InterventionUpper-extremity rehabilitation programs.Main Outcome MeasuresThe tone, elasticity, and stiffness of relaxed extensor digitorum, flexor carpi radialis, and flexor carpi ulnaris were measured using the myotonometer. Fifty-eight patients completed the myotonometer measures twice at pretreatment. The myotonometric measurement and the criteria measures, including hand strength (grip, lateral pinch, and palmar pinch strength) and Action Research Arm Test (ARAT) were administered at pretreatment and posttreatment.ResultsThe myotonometer showed high test-retest reliability for muscle properties in 3 muscles. Significant correlations existed between the tone and stiffness of the 3 muscles and palmar pinch strength, between those of the flexor carpi muscles and lateral pinch strength, and between those of the flexor carpi radialis and the ARAT at posttreatment. The posttreatment elasticity of the 2 flexor carpi muscles was significantly correlated with grip strength. The pretreatment elasticity of the flexor carpi ulnaris was significantly correlated with posttreatment grip strength, and the pretreatment muscle tone and stiffness of the flexor carpi radialis were significantly correlated with palmar pinch strength and the ARAT. The responsiveness of the extensor digitorum was higher than that of the flexor carpi radialis and ulnaris. Muscle stiffness was more responsive than tone and elasticity in 3 muscles.ConclusionsMyotonometry can be a reliable, valid, and responsive outcome measure for assessing muscle properties after stroke rehabilitation.     

Different ways to balance the spine in sitting: Muscle activity in specific postures differs between individuals with and without a history of back pain in sitting

BackgroundPrevious research explored muscle activity in four distinct sitting postures with fine-wire electromyography, and found that lumbar multifidus muscle activity increased incrementally between sitting with flat thoracolumbar and lumbar regions, long thoracolumbar lordosis, or short lordosis confined to the lumbar region. This study used similar methods to explore whether people with a history of low back pain provoked by prolonged sitting used different patterns of trunk muscle activity in specific postures.MethodsFine-wire electromyography electrodes were inserted into the right lumbar multifidus (deep and superficial), iliocostalis (lateral and medial), longissimus thoracis and transversus abdominis muscles. Superficial abdominal muscle activity was recorded with surface or fine-wire electrodes. Electromyography amplitude was compared between postures for the back pain group and observations were contrasted with the changes previously reported for pain-free controls. For comparison between groups normalised and non-normalised electromyography amplitudes were compared.FindingsIndividuals with a history of back pain demonstrated greater activity of the longissimus thoracis muscle in the long lordosis compared with the flat posture [mean difference (95% CI): 46.6 (17.5–75.7)%, normalised to sitting posture peak activity], but pain-free participants did not [mean difference: 7.7 (minus 12–27.6)%]. Pain-free participants modulated lumbar multifidus activity with changes in lumbar curve, but people with a history of pain in prolonged sitting did not change multifidus activity between the long and short lordotic postures.InterpretationIn clinical ergonomic interventions that modify spinal curves and sagittal balance in sitting, the muscle activity used in those postures may differ between people with and without a history of back pain.     

Association of low back pain with muscle stiffness and muscle mass of the lumbar back muscles,and sagittal spinal alignment in young and middle-aged medical workers

BackgroundMuscle stiffness of the lumbar back muscles in low back pain (LBP) patients has not been clearly elucidated because quantitative assessment of the stiffness of individual muscles was conventionally difficult. This study aimed to examine the association of LBP with muscle stiffness assessed using ultrasonic shear wave elastography (SWE) and muscle mass of the lumbar back muscle, and spinal alignment in young and middle-aged medical workers.MethodsThe study comprised 23 asymptomatic medical workers [control (CTR) group] and 9 medical workers with LBP (LBP group). Muscle stiffness and mass of the lumbar back muscles (lumbar erector spinae, multifidus, and quadratus lumborum) in the prone position were measured using ultrasonic SWE. Sagittal spinal alignment in the standing and prone positions was measured using a Spinal Mouse. The association with LBP was investigated by multiple logistic regression analysis with a forward selection method. The analysis was conducted using the shear elastic modulus and muscle thickness of the lumbar back muscles, and spinal alignment, age, body height, body weight, and sex as independent variables.FindingsMultiple logistic regression analysis showed that muscle stiffness of the lumbar multifidus muscle and body height were significant and independent determinants of LBP, but that muscle mass and spinal alignment were not. Muscle stiffness of the lumbar multifidus muscle in the LBP group was significantly higher than that in the CTR group.InterpretationThe results of this study suggest that LBP is associated with muscle stiffness of the lumbar multifidus muscle in young and middle-aged medical workers.     

Effects of sling-based manual therapy on cervicothoracic junction in patients with neck pain and forward head posture: A randomized clinical trial

ObjectiveThe purpose of this study was to investigate the effect of 4 weeks of sling-based manual therapy on the cervicothoracic junction (CTJ) area in patients with neck pain and forward head posture.DesignSingle-blind randomized controlled trial.SettingOutpatient, Chonbuk National University hospital, Republic of Korea.SubjectsA total of 22 participants with neck pain (Numeric Pain Rating Scale >3) and forward head posture (craniovertebral angle <51) were randomly assigned to a CTJ group or a control group (n = 11 each).InterventionIn the control group, joint mobilization and motor control training was applied for the upper cervical spine (C0–C1). The CTJ group applied the same intervention to the upper cervical spine and cervicothoracic junction (C7-T3).Main measuresNumeric pain rating scale and neck disability index, craniovertebral angle, active range of motion, and muscle activity were evaluated before and after 4 weeks of intervention.ResultThe CTJ group participants showed significant improvement in the craniovertebral angle and cervical extension range after the intervention than the control group (P = 0.025, P = 0.001). While both groups presented significant differences after the intervention regarding Numeric pain rating scale, neck disability index, and muscle activity (sternocleidomastoid and anterior scalene muscle), there were no statistically significant differences between the groups (P > 0.05).ConclusionOur results suggest that the CTJ and the upper cervical region in patients with neck pain and forward head posture represent an area which if approached by manual therapy, improves cervical mobility and posture.     

The influence of different sitting postures on head/neck posture and muscle activity

To date the influence that specific sitting posture has on the head/neck posture and cervico-thoracic muscle activity has been insufficiently investigated. Therefore the aim of this study was to investigate whether three different thoraco-lumbar sitting postures affect head/neck posture and cervico-thoracic muscle activity.Twenty (10 men, 10 women) asymptomatic subjects were placed in 3 standardized thoraco-lumbar sitting postures (lumbo-pelvic, thoracic upright and slump) to investigate their influence on cervico-thoracic muscle activity and head/neck posture.There were significant differences in lumbar and thoracic curvatures in the 3 different sitting postures (P < 0.002). Slump sitting was associated with greater head/neck flexion, anterior translation of the head (P < 0.001) and increased muscle activity of cervical erector spinae (CES) compared to thoracic and lumbo-pelvic sitting (P = 0.001). Thoracic upright sitting showed increased muscle activity of thoracic erector spinae (TES) compared to slump and lumbo-pelvic postures (P = 0.015). Upper trapezius (UT) demonstrated no significant difference in muscle activation in the 3 sitting postures (P < 0.991). This study demonstrates that different sitting postures affect head/neck posture and cervico-thoracic muscle activity. It highlights the potential importance of thoraco-lumbar spine postural adjustment when training head/neck posture.     

The ratio of change in muscle thickness between superficial and deep cervical flexor muscles during the craniocervical flexion test and a suggestion regarding clinical treatment of patients with musculoskeletal neck pain

[Purpose] The purpose of this study was to identify the imbalance of muscle recruitment in cervical flexor muscles during the craniocervical flexion test by using ultrasonography and to propose the optimal level of pressure in clinical craniocervical flexion exercise for people with neck pain. [Subjects and Methods] A total of 18 students (9 males and 9 females) with neck pain at D University in Gyeongsangbuk-do, South Korea, participated in this study. The change in muscle thickness in superficial and deep cervical flexor muscles during the craniocervical flexion test was measured using ultrasonography. The ratio of muscle thickness changes between superficial and deep muscles during the test were obtained to interpret the imbalance of muscle recruitment in cervical flexor muscles. [Results] The muscle thickness ratio of the sternocleidomastoid muscle/deep cervical flexor muscles according to the incremental pressure showed significant differences between 22 mmHg and 24 mmHg, between 24 mmHg and 28 mmHg, between 24 mmHg and 30 mmHg, and between 26 mmHg and 28 mmHg. [Conclusion] Ultrasonography can be applied for examination of cervical flexor muscles in clinical environment, and practical suggestion for intervention exercise of craniocervical flexors can be expected on the pressure level between 24 mmHg and 26 mmHg enabling the smallest activation of the sternocleidomastoid muscle.Key words: Cervical flexor muscle, Ultrasonography, Muscle imbalance     

Does posture of the cervical spine influence dorsal neck muscle activity when lifting?

Previous studies have shown that postural orientations of the neck, such as flexed or forward head postures, are associated with heightened activity of the dorsal neck muscles. While these studies describe the impact of variations in neck posture alone, there is scant literature regarding the effect of neck posture on muscle activity when combined with upper limb activities such as lifting. The purpose of this study was to evaluate the effect of three different neck postures on the activity of the different layers of the dorsal neck muscles during a lifting task. Ultrasound measurements of dorsal neck muscle deformation were compared over two time points (rest, during lift) during a lifting task performed in three different neck postural conditions (neutral, flexed and forward head posture) in 21 healthy subjects. Data were analysed by post-process speckle tracking analysis. Results demonstrated significantly greater muscle deformation induced by flexed and forward head postures, compared to the neutral posture, for all dorsal neck muscles at rest (p < 0.05). Significant condition by time interactions associated with the lift was observed for four out of the five dorsal muscles (p < 0.02). These findings demonstrate that posture of the cervical spine influenced the level of muscle deformation not only at rest, but also when lifting. The findings of the study suggest that neck posture should be considered during the evaluation or design of lifting activities as it may contribute to excessive demands on dorsal neck muscles with potential detrimental consequences.     

Reduction of cervical and respiratory muscle strength in patients with chronic nonspecific neck pain and having moderate to severe disability

Purpose: To investigate whether patients with chronic nonspecific neck pain and having moderate to severe disability have a greater cervical motor function impairment and respiratory disturbances compared with patients with chronic nonspecific neck pain having mild disability and asymptomatic subjects; and the association between these outcomes in patients with chronic nonspecific neck pain and healthy controls.

Methods: Cross-sectional study, 44 patients with chronic nonspecific neck pain and 31 healthy subjects participated. The neck disability index was used to divide the patients into 2 groups: 1) mild disability group (scores between 5 and 14 points); and 2) moderate to severe disability group (scores?>14 points). Cervical motor function was measured by cervical range of motion, forward head posture, neck flexor, and extensor muscle strength. Respiratory function and maximum respiratory pressures were also measured.

Results: Statistically differences were found between the patients with chronic nonspecific neck pain having a moderate to severe disability and the asymptomatic subjects for cervical and respiratory muscle strength. Comparisons between chronic nonspecific neck pain and the asymptomatic groups showed differences for all the variables, except for forward head posture. The regression model determined that strength of cervical flexion explained 36.4 and 45.6% of the variance of maximum inspiratory pressures and maximum expiratory pressures, respectively.

Conclusions: Only the chronic nonspecific neck pain group with moderate to severe disability showed differences compared with the healthy subjects. Neck muscle strength could be a good predictor of respiratory muscle function.

• Implications for rehabilitation

• Neck pain severity could be closely associated with decreased respiratory pressure in patients with chronic nonspecific neck pain.

• These findings suggest a new therapeutic approach for patients with moderate to severe disability, such as respiratory muscle training.

• The regression models show that a simple measurement of neck muscle strength could provide a reasonably accurate prediction for the respiratory function of these patients. Hence, this could provide an easy tool to assess respiratory function to physiotherapists without the need for sophisticated instrumentation.

     

颈肩痛患者颈肩部肌肉的表面肌电图特征

背景：颈肩痛是由颈肩部软组织（主要是肌肉）的慢性劳损所引起的常见临床症状.表面肌电图是一种新型、无创的肌肉活动检查手段,能测量肌肉的活动和功能.目的：评价颈肩疼痛患者颈肩部肌肉功能,为表面肌电图的应用和颈肩疼痛患者合理防治与康复提供理论依据.方法：应用表面肌电图对32例单侧颈肩疼痛的办公室工作人员在站立下,进行低头、头后伸、双手上举时颈竖脊肌、斜方肌上支的表面肌电测试.在测试前,对患者的颈肩疼痛进行目测类比评分.然后根据收集的数据,比较受试者颈肩部疼痛侧与非疼痛侧测试肌肉的肌电活动.结果与结论：测试前,受试者颈肩疼痛目测类比评分（平均分）为5.03分;受试者在低头、头后伸、双手上举过程中,其疼痛侧的颈竖脊肌、斜方肌上支的肌电原始信号较非疼痛侧的颈竖脊肌、斜方肌上支的肌电原始信号弱;疼痛侧颈竖脊肌、斜方肌上支肌电的平均振幅值与非疼痛侧相比差异有显著性意义（P＜0.05）;疼痛侧颈竖脊肌、斜方肌上支肌电的平均频率斜率值与非疼痛侧相比差异无显著性意义（P＞0.05）.提示颈肩疼痛患者疼痛侧的颈肩肌肉的活动能力下降,长期坐位作业的办公室人员要定时进行颈肩部肌肉锻炼.     

Postural neck pain: an investigation of habitual sitting posture, perception of 'good' posture and cervicothoracic kinaesthesia

Impairments of cervico-cephalic kinaesthesia and habitual forward head posture have been considered important in the aetiology of postural neck pain, yet these factors have not been specifically examined in a homogeneous clinical population. The objective of this study was to compare the habitual sitting posture (HSP), perception of good posture and postural repositioning error (PRE) of the cervico-thoracic (CT) spine in individuals with postural neck pain, with a matched group of asymptomatic subjects. Twenty-one subjects with postural neck pain and 22 asymptomatic control subjects were recruited into the study. An optical motion analysis system was used to measure the HSP and perceived ‘good’ sitting posture. PRE was measured over six trials where the subject attempted to replicate their self-selected ‘good’ posture. There was no difference between the groups in the HSP but significant differences were identified in the perception of ‘good’ posture. Posture repositioning error was higher for the head posture variables than for CT and shoulder girdle variables in both groups. However, there was no significant difference in posture repositioning error between groups for any of the posture measures. The findings suggest that individuals with postural neck pain may have a different perception of ‘good’ posture, but no significant difference in HSP or kinaesthetic sensibility compared with matched asymptomatic subjects.     

Comparing Trigger Point Dry Needling and Manual Pressure Technique for the Management of Myofascial Neck/Shoulder Pain: A Randomized Clinical Trial

Objective

The aim of this study was to investigate short-term and long-term treatment effects of dry needling (DN) and manual pressure (MP) technique with the primary goal of determining if DN has better effects on disability, pain, and muscle characteristics in treating myofascial neck/shoulder pain in women.

Myofascial trigger points, neck mobility, and forward head posture in episodic tension-type headache

OBJECTIVE: To assess the differences in the presence of trigger points (TrPs) in head and neck muscles, forward head posture (FHP) and neck mobility between episodic tension-type headache (ETTH) subjects and healthy controls. In addition, we assess the relationship between these muscle TrPs, FHP, neck mobility, and several clinical variables concerning the intensity and the temporal profile of headache. BACKGROUND: TTH is a headache in which musculoskeletal disorders of the craniocervical region might play an important role in its pathogenesis. Design.-A blinded, controlled pilot study. METHODS: Fifteen ETTH subjects and 15 matched controls without headache were studied. TrPs in both upper trapezius, both sternocleidomastoids, and both temporalis muscles were identified according to Simons and Gerwin diagnostic criteria (tenderness in a hypersensible spot within a palpable taut band, local twitch response elicited by snapping palpation, and elicited referred pain with palpation). Side-view pictures of each subject were taken in both sitting and standing positions, in order to assess FHP by measuring the craniovertebral angle. A cervical goniometer was employed to measure neck mobility. All measures were taken by a blinded assessor. A headache diary was kept for 4 weeks in order to assess headache intensity, frequency, and duration. RESULTS: The mean number of TrPs for each ETTH subject was 3.7 (SD: 1.3), of which 1.9 (SD: 0.9) were active, and 1.8 (SD: 0.9) were latent. Control subjects only had latent TrPs (mean: 1.5; SD: 1). TrP occurrence between the 2 groups was significantly different for active TrPs (P < .001), but not for latent TrPs (P > .05). Differences in the distribution of TrPs were significant for the right upper trapezius muscles (P= .04), the left sternocleidomastoid (P= .03), and both temporalis muscles (P < .001). Within the ETTH group, headache intensity, frequency, and duration outcomes did not differ depending on TrP activity, whether the TrP was active or latent. The craniovertebral angle was smaller, ie, there was a greater FHP, in ETTH patients than in healthy controls for both sitting and standing positions (P < .05). ETTH subjects with active TrPs in the analyzed muscles had a greater FHP than those with latent TrPs in both sitting and standing positions, though differences were only significant for certain muscles. Finally, ETTH patients also showed lesser neck mobility than healthy controls in the total range of motion as well as in half-cycles (except for cervical extension), although neck mobility did not seem to influence headache parameters. CONCLUSIONS: Active TrPs in the upper trapezius, sternocleidomastoid, and temporalis muscles were more common in ETTH subjects than in healthy controls, although TrP activity was not related to any clinical variable concerning the intensity and the temporal profile of headache. ETTH patients showed greater FHP and lesser neck mobility than healthy controls, although both disorders were not correlated with headache parameters.     

Preliminary study of neck muscle size and strength measurements in females with chronic non-specific neck pain and healthy control subjects

Neck muscle weakness and atrophy are two common causes of pain and disability among office workers. The aim of this study was to compare the strength of the neck extensor and flexor muscles and the size of the semispinalis capitis muscle (SECM) in patients with chronic non-specific neck pain (CNNP) and healthy subjects. Twenty female office workers (10 patients with CNNP and 10 healthy subjects) participated in this study. The strength of the neck extensor and flexor muscles was measured by an isometric device and the SECM size was measured by ultrasonography. Neck muscle strength, size of the SECM and the ratios of neck strength to body weight, neck extensor strength to SECM size, SECM size to body weight and neck flexor to extensor strength were all significantly lower in patients compared to controls (P < 0.05). In conclusion, neck strength, the size of the SECM and the ratio of neck muscle strength to SECM size appear to be useful parameters in appraising patients with CNNP.     

Analysis of Head Posture and Activation of the Cervical Neck Extensors During a Low-Load Task in Women With Chronic Migraine and Healthy Participants

Objective

The purpose of this study was to investigate the correlation between head and neck posture and superficial neck flexor and extensor activity during performance of the craniocervical flexion test (CCFT) in women with migraine and healthy controls.