Association Between Severity of Temporomandibular Disorders and the Frequency of Headache Attacks in Women With Migraine: A Cross-Sectional Study

Objective

The aim of this study was to investigate the magnitude of association of the severity of temporomandibular disorders (TMDs) in women with episodic and chronic migraine.

Head Posture and Neck Pain of Chronic Nontraumatic Origin: A Comparison Between Patients and Pain-Free Persons

Silva AG, Punt TD, Sharples P, Vilas-Boas JP, Johnson MI. Head posture and neck pain of chronic nontraumatic origin: a comparison between patients and pain-free persons.

Objective

To compare standing head posture measurements between patients with nontraumatic neck pain (NP) and pain-free individuals.

Design

Single-blind (assessor) cross-sectional study.

Setting

Hospital and general community.

Participants

Consecutive patients (n=40) with chronic nontraumatic NP and age- and sex-matched pain-free participants (n=40).

Interventions

Not applicable.

Main Outcome Measures

Three angular measurements: the angle between C7, the tragus of the ear, and the horizontal; the angle between the tragus of the ear, the eye, and the horizontal; and the angle between the inferior margins of the right and the left ear and the horizontal were calculated through the digitization of video images.

Results

NP patients were found to have a significantly smaller angle between C7, the tragus, and the horizontal, resulting in a more forward head posture than pain-free participants (NP, mean ± SD, 45.4°±6.8°; pain-free, mean ± SD, 48.6°±7.1°; P<.05; confidence interval [CI] for the difference between groups, 0.9°-6.3°). Dividing the population according to age into younger (≤50y) and older (>50y) revealed an interaction, with a statistically significant difference in head posture for younger participants with NP compared with younger pain-free participants (NP, mean ± SD, 46.1°±6.7°; pain-free, mean ± SD, 51.8°±5.9°; P<.01; CI for the difference between groups, 1.8°-9.7°) but no difference for the older group (NP, mean ± SD, 44.8°±7.1°; pain-free, mean ± SD, 45.1°±6.7°; P>.05; CI for the difference between groups, -4.9°-4.2°). No other differences were found between patients and pain-free participants.

Conclusions

Younger patients with chronic nontraumatic NP were shown to have a more forward head posture in standing than matched pain-free participants. However, the difference, although statistically significant, was perhaps too small to be clinically meaningful.     

Muscle Activation During Pilates Exercises in Participants With Chronic Nonspecific Low Back Pain: A Cross-Sectional Case-Control Study

Objective

To determine the amplitude of the electromyographic activity of trunk muscles during Pilates exercises in women with and without chronic low back pain (LBP).

Reliability of a Method to Measure Neck Surface Electromyography,Kinematics, and Pain Occurrence in Participants With Neck Pain

Objective

To investigate the reliability of a novel method to measure neck surface electromyography (SEMG), kinematics, and pain during active movements in participants with neck pain.

Effect of a Posture-Cueing Shirt on Sitting Posture During a Functional Task in Healthy Participants: A Randomized Cross-Over Study

ObjectivesThe purpose of this study was to investigate the effect of a posture-cueing shirt on sitting posture during a functional task.MethodsThirty healthy male participants were seated at a standardized workstation while completing 3 laptop writing tasks of 15-minute duration wearing either a posture-cueing shirt, a compression shirt, or no shirt. Posture was assessed based on photos taken at minutes 1 and 15 into the writing task from which the head and shoulder angles were measured and extracted for analysis. After each task, participants rated any potential pain they felt during the task on an 11-point numeric rating scale (NRS).ResultsThe results showed that none of the shirts significantly affected the head or shoulder angles at any time point. Participants reported lower pain levels after using the posture-cueing shirt (NRS 0 [0-1]) compared with no shirt (NRS 1 [0-2]; P = .012). No significant difference in pain levels was observed between shirts.ConclusionAlthough posture did not change in any conditions for these healthy male participants, the posture-cueing shirt resulted in a lower pain intensity compared with no shirt but not with a compression shirt. Although a significant difference was found for pain intensity favoring the posture-cueing shirt, this difference was negligible, and thus its value to reduce pain or improve posture in healthy participants remains in question.     

Craniocervical Orientation Affects Muscle Activation When Exercising the Cervical Extensors in Healthy Subjects

Elliott JM, O'Leary SP, Cagnie B, Durbridge G, Danneels L, Jull G. Craniocervical orientation affects muscle activation when exercising the cervical extensors in healthy subjects.

Objective

To evaluate the activity of neck extensor muscles during different extension exercises with muscle functional magnetic resonance imaging (mfMRI).

Design

Cross-sectional.

Setting

University laboratory.

Participants

Healthy subjects (N=11; 7 men, mean age ± SD, 34±5.6y; 4 women, mean age ± SD, 23.3±5.2y; group mean age ± SD, 30.1±7.5y).

Intervention

Not applicable.

Main Outcome Measures

mfMRI measures of T2 relaxation were made for the multifidus (Mul), the semispinalis cervicis (SCe), the semispinalis capitis (SCa), and the splenius capitis (SpC) at C2-3, C5-6, and C7-T1 in response to 2 head/neck orientations: craniocervical neutral (CCN) and craniocervical extension (CCE). Subjects performed three 1-minute repetitions of each condition at 20% maximum voluntary contraction.

Results

Significant shifts were observed in all muscle groups at the C5-6 and C7-T1 levels after both conditions (P=.04) except the SpC muscle at C5-6 with CCN (P=.17). T2 shifts in the SCa were significantly greater in response to CCE than CCN at C2-3 (P=.03) and C5-6 (P=.02). Similarly, CCE resulted in larger shifts than CCN in the Mul/SCe at C7-T1 (P=.003). No segmental differences were observed between exercises for SpC (P=.25).

Conclusions

The results of this study provide some preliminary insight into the impact of craniocervical orientation on the differential response of the deep and superficial cervical extensor muscles during the performance of cervical extensor exercises.     

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.     

Effects of Walking With a Shopping Trolley on Spinal Posture and Loading in Subjects With Neurogenic Claudication

Comer CM, White D, Conaghan PG, Bird HA, Redmond AC. Effects of walking with a shopping trolley on spinal posture and loading in subjects with neurogenic claudication.

Objectives

To explore possible mechanisms underpinning symptom relief and improved walking tolerance in patients with neurogenic claudication (NC) when pushing a shopping trolley by evaluating the effects of a shopping trolley on spinal posture and loading patterns.

Design

An exploratory study of kinematic and kinetic changes in walking with and without pushing a shopping trolley in persons with NC symptoms and a comparison with asymptomatic control subjects.

Setting

A primary care-based musculoskeletal service.

Participants

Participants (n=8) with NC symptoms who have anecdotally reported symptomatic improvement when walking with a shopping trolley and a control group of asymptomatic persons (n=8).

Interventions

Shopping trolley.

Main Outcome Measures

Changes in lumbar spinal sagittal posture and ground reaction force.

Results

Subjects with NC and asymptomatic controls walked with significantly more flexed spinal posture (increase in flexion, 3.40°; z=3.516; P<.001) and reduced mean ground reaction forces (−6.9% of body weight; z=−3.46; P=.001) when walking with a shopping trolley. However, at the midstance point of the gait cycle, controls showed minimal reliance on the trolley, whereas, people with NC showed continued offloading.

Conclusions

Both posture and loading are affected by pushing a shopping trolley; however, patients with NC were found to offload the spine throughout the stance phase of gait, whereas asymptomatic controls did not.     

Neck Muscle Stiffness in Participants With and Without Chronic Neck Pain: A Shear-Wave Elastography Study

Objectives

The purpose of the present study was to investigate differences in neck muscle stiffness between patients with chronic neck pain and asymptomatic control group.

Effect of Massage on Clinical and Physiological Variables During Muscle Fatigue Task in Participants With Chronic Low Back Pain: A Crossover Study

ObjectiveThe purpose of this study was to determine if a reduction of short-term physiological and clinical effects of muscle fatigue can be seen after a session of massage in nonspecific chronic low back pain (cLBP) individuals and to study the possible association between physiological and clinical changes induced by massage.MethodsThirty-six cLBP individuals participated in 2 experimental sessions. In one session, the Sorenson protocol was preceded by a 30-minute massage, but in the other session, only the Sorenson test was performed by participants. Lumbar paraspinal muscle activity was recorded using surface electromyography, and maximal voluntary contraction force was measured using a load cell. Participants rated their lumbar pain intensity before and after massage and after the Sorensen protocol. A 2-way repeated-measures analysis of variance was conducted to test the effect of massage on both variables for both conditions. Pearson correlation analyses were conducted to determine the linear association between physiological and clinical responses to massage.ResultsResults showed that pain perception was significantly reduced after massage (P = .004) but did not seem to influence pain score increases occurring after the Sorensen protocol. Individuals with a high score of low back pain–related disability showed lower back muscle endurance time (r = -.35). Massage yielded no significant effect on fatigue-related physiological variables.ConclusionThe perception of pain in cLBP individuals was reduced after massage. Although massage yielded some positives clinical effects, they were not explained by a reduction in physiological effect of muscle fatigue.     

Activation of Rectus Capitis Posterior Major Muscles During Voluntary Retraction of the Head in Asymptomatic Subjects

Objective

The purpose of this study was to assess levels of electromyographic activity measured from rectus capitis posterior major (RCPM) muscles of asymptomatic subjects as their heads moved from a self-defined neutral position to a retracted position.

Methods

A 2 × 2 within-subjects factorial research design was used. Disposable, intramuscular electrodes were used to collect electromyographic data from asymptomatic subjects between the ages of 20 and 40 years old. Data analysis was performed using mixed effects β regression models.

Results

Activation of RCPM muscles was found to significantly increase (P < .0001) as the head moved from a self-defined neutral position to a retracted position. Rectus capitis posterior major muscle activation levels, measured as a function of head position, have not been previously reported.

Conclusions

The findings from this study showed that RCPM muscle activation significantly increases during voluntary retraction of the head.     

Effects of a Resistance and Stretching Training Program on Forward Head and Protracted Shoulder Posture in Adolescents

Objective

The purpose of this study was to evaluate the effects of a 16-week resistance and stretching training program applied in physical education (PE) classes on forward head posture and protracted shoulder posture in Portuguese adolescents.

Comparison Between Neck Pain Disability and Cervical Range of Motion in Patients With Episodic and Chronic Migraine: A Cross-Sectional Study

ObjectiveThe purpose of this study was to evaluate neck pain–related disability and cervical range of motion (CROM) in patients with episodic migraine (EM) and chronic migraine (CM) and to examine the correlation of both outcomes.MethodsThis cross-sectional study consisted of 91 patients with EM and 34 with CM. Cervical range of motion was measured with the CROM device, and pain during the cervical movement was recorded. Self-reported disability related to neck pain was assessed with the Neck Disability Index.ResultsPatients with CM showed higher Neck Disability Index scores and more moderate and severe disability (P = .01). Severe disability as a result of neck pain was associated with 7.6-fold risk of developing CM (P = .003). No significant differences in CROM were identified between groups. Moderate negative correlations between CROM and disability were found for 4 motions within the CM group (− 0.60 < r < − 0.39) and with 3 in the EM group (− 0.48 < − 0.45). Disability was positively and moderately correlated to pain evoked during CROM in both groups (0.34 < r < 0.51).ConclusionThis study found that neck pain was highly prevalent in patients with migraine. Neck pain–related disability increased with increased frequency of the migraine attacks and was associated with the risk of migraine chronicity. The correlation between CROM and neck pain disability was more evident in patients with CM and in patients with pain during cervical movement.     

Relationship Between Proprioception and Endurance Functionality of the Cervical Flexor Muscles in Chronic Neck Pain and Asymptomatic Participants

Objective

The purpose of this study was to compare the relationship between flexion endurance capacity and joint position error in participants with or without chronic neck pain (CNP).

Postural Balance During Quiet Standing in Patients With Total Hip Arthroplasty With Large Diameter Femoral Head and Surface Replacement Arthroplasty

Nantel J, Termoz N, Ganapathi M, Vendittoli P-A, Lavigne M, Prince F. Postural balance during quiet standing in patients with total hip arthroplasty with large diameter femoral head and surface replacement arthroplasty.

Objective

To compare postural balance between patients who have had either a large diameter head total hip arthroplasty or surface replacement arthroplasty.

Design

Observational study.

Setting

Outpatient biomechanical laboratory.

Participants

Two groups of 14 patients with surface replacement or large diameter head total hip arthroplasties recruited from a larger randomized study and 14 control subjects.

Interventions

Not applicable.

Main Outcome Measures

Postural balance during quiet standing in dual and one-leg stance (operated leg), hip abductor muscle strength, clinical outcomes, and radiographic analyses were compared between groups.

Results

Compared to the control group, patients in both groups showed smaller center of pressure displacement amplitude in the medial-lateral direction in dual stance. Patients with large diameter head total hip arthroplasty showed lower hip abductor muscle strength compared to control subjects. There was statistical difference between the 2 patient groups in biomechanical reconstruction of the hip. Despite these differences, there was no significant difference in the ability to complete the one-leg stance task between the 3 groups.

Conclusions

The muscular strength in the operated limb could be mainly responsible for the lower center of pressure displacement amplitude compared to control subjects. However, the ability to complete the one-leg stance demonstrates that patients do not fear to load the hip prosthesis when needed. The large diameter femoral head may be a major mechanical factor contributing to these results.     

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.     

Influence of Forward Head Posture on Myotonometric Measurements of Superficial Neck Muscle Tone,Elasticity, and Stiffness in Asymptomatic Individuals With Sedentary Jobs

ObjectiveThe objective of the study was to assess the influence of forward head posture on the mechanical parameters and pressure pain threshold of superficial neck muscles in clinically nonsymptomatic individuals with sedentary jobs.MethodsTwenty-five office workers with forward head posture and 25 office workers with normal head posture were matched for sex, age, body mass index, and the nature and duration of their work and were compared at a single point. The study participants were divided into study groups on the basis of photometric craniovertebral angle measurements. The upper trapezius, sternocleidomastoid, and splenius capitis mechanical properties were assessed in the sitting position. Primary outcome measures were muscle stiffness (N/m), muscle tone (Hz), and muscle elasticity. The secondary variable was perceived pain threshold.ResultsNo significant differences between the groups were found for biomechanical properties and perceived pain threshold in the studied muscles.ConclusionForward head posture has no impact on muscle stiffness, tone, and elasticity, nor does it increase the pressure sensitivity of superficial neck muscles in healthy, mildly symptomatic office workers. It is most likely that not incorrect posture of the cervical spine, but probably other factors combined with forward head posture, like comorbid acute and chronic cervical pain and musculoskeletal disorders or prolonged sitting, contribute to changes in active myofascial tone and tensegrity as well as increased pressure sensitivity of neck muscles.     

Intrarater and Inter-rater Reliability of Maximal Voluntary Neck Muscle Strength Assessment Using a Handheld Dynamometer in Women With Headache and Healthy Women

Objective

This study aimed to determine the inter-rater and intrarater reliability, agreement, and minimal detectable change (MDC) of the neck muscle strength test using a handheld dynamometer in healthy women and women with headaches.