Asghar Rezasoltani

Ultrasonography of longus colli muscle: A reliability study on healthy subjects and patients with chronic neck pain

In this study, the reliability of the longus colli muscle (LCM) size was assessed in a relaxed state by a real time ultrasonography (US) device in a group of healthy subjects and a group of patients with chronic neck pain. Fifteen healthy subjects (19-41 years old) and 10 patients with chronic neck pain (27-44 years old) were recruited for the purpose of this study. LCM size was measured at the level of thyroid cartilage. Two images were taken on the same day with an hour interval to assess the within day reliability and the third image was taken 1 week later to determine between days reliability. Cross sectional area (CSA), anterior posterior dimension (APD), and lateral dimension (LD) were measured each time. The shape ratio was calculated as LD/APD. Intraclass correlation coefficients (ICC) and standard error of measurement (SEM) were computed for data analysis. The ICC of left and right CSA for within day and between days reliability in healthy subjects were (0.90, 0.93) and (0.85, 0.82), respectively. The ICC of left and right CSA for within day and between days reliability in patients with neck pain were (0.86, 0.82) and (0.76, 0.81), respectively. The results indicated that US could be used as a reliable tool to measure the LCM dimensions in healthy subjects and patients with chronic neck pain.

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.

The relationship between the height of the medial longitudinal arch (MLA) and the ankle and knee injuries in professional runners

BACKGROUND Usually the rate of lower extremitys injuries in sports such as running is known to be correlated with the height of foot arches. Foot pressure measurement studies have shown controversial results in this issue, mainly due to the complexity of the foot structure. This study aimed to investigate if any relationship exists between the MLA height and the ankle/knee injuries in professional runners. It was also aimed to find out any association between the foot pressure patterns and the clinical navicular drop test in the subjects. MATERIALS AND METHODS Forty-seven professional runners were participated in this study and using the clinical navicular drop test, they were categorized into normal, low and high arch foot subjects. Using an Emed pedography platform (Novel, Germany), the maximum force, peak pressure and the contact area of their feet were studied in both static (single limb support) and dynamic conditions. RESULTS The results of this study showed no strong correlation between the height of MLA and the rate of the ankle/knee injuries (P=0.58). The correlation between the clinical navicular drop test and the modified arch index (MAI) was between 0.32 in static and 0.57 in dynamic tests. CONCLUSION The results of this study conveyed that having a lower or higher than a normal MLA is not a definite risk factor for sports-related injuries. This might be due to the complexity of the foot structure and its ability to accommodate with new situations routinely occurs in sport. Furthermore, although a high correlation was not found between the clinical navicular drop test and the foot pressure indices, due to the clinical entity of this test, the obtained association is relatively good. A significant correlation was found between the foot pressure distribution in single limb support (static) and the dynamic conditions, which provides an extrapolation of the results of this type static condition tests to the dynamic conditions.

Ultrasonography of the Cervical Muscles: A Critical Review of the Literature

OBJECTIVE This article presents a review of the literature concerning size measurement of cervical muscles using real-time ultrasound imaging (RUSI) in patients with neck pain and in healthy populations. METHODS A literature search from 1996 to December 2009 making use of Science Direct and PubMed databases was conducted. Medical Subject Headings and other terms were as follows: ultrasonography, cervical, muscle, neck, size, pain, validity, reliability, neck pain, and healthy subjects. We included studies using RUSI for assessing cervical paraspinal muscles both in healthy subjects and in patients with neck pain. We assessed muscles investigated and the reliability and validity of the method used. RESULTS The literature search yielded 16 studies. Twelve (75%) studies assessed the posterior muscles, whereas in the remaining 4 (25%), the anterior muscles were studied. Three studies quantified the size of the muscles during contraction; 3 assessed the relationship between cross-sectional area, linear dimensions, and anthropometric variables; 1 evaluated the training-induced changes in muscle size; 1 assessed the differences in muscle shape and cross-sectional area of cervical multifidus between patients with chronic neck pain and controls; 8 studies looked at the reliability of using RUSI in patients with neck pain or healthy subjects; and 3 studies evaluated the validity of RUSI compared with magnetic resonance imaging. CONCLUSIONS This literature review has shown that there are not sufficient studies for assessing neck muscles with RUSI. It seems that using constant landmarks, knowledge of anatomy and function of target muscle, and a proper definition of muscle borders can help to take a clear image. Standardized position of the subject, correct placement of the transducer, and using multiple RUSI for statistical analyses may improve results.

The sign of unilateral neck semispinalis capitis muscle atrophy in patients with chronic non-specific neck pain

BACKGROUND AND OBJECTIVES Neck muscles have a major role in normal stability and mobility of cervical spine in healthy subjects. Weakness and related atrophy of these muscles may be a causative factor in cervical pain among office workers. The aim of this study was to compare the size and asymmetry of the neck semispinalis capitis muscle (SECM) between a group of female office workers with unilateral chronic non-specific neck pain (CNNP) and a group of healthy control subjects. MATERIAL AND METHOD Twenty female office workers (10 patients with unilateral CNNP and 10 healthy subjects) participated in this study. The right and left SECM sizes, anterior posterior dimension (APD) and lateral dimension (LD) were measured by an ultrasonography apparatus. The size of SECM was calculated as APD × LD. RESULTS The SECM size and the ratio of the size to body weight in patients were less than that of controls (P < 0.05, P < 0.001). The size of SECM was also smaller in affected side than unaffected side in patients group (P < 0.05). Between sides asymmetry of SECM size was higher in patients than that of controls (P < 0.001). The mean APD of SECM of patients was less than that of controls (P < 0.01). There was not significant difference in LD between two groups. CONCLUSIONS Neck SECM size and asymmetry measurements and the ratio of SECM size to body weight as well as APD appeared to be useful parameters to detect neck muscle atrophy in patients with CNNP.

Differences in Cervical Multifidus Muscle Thickness During Isometric Contraction of Shoulder Muscles: A Comparison Between Patients With Chronic Neck Pain and Healthy Controls

OBJECTIVE The purposes of this study were to (1) measure the thickness of cervical multifidus muscle (CMM) in different maximal voluntary contraction percentages of isometric contraction of shoulder muscles, (2) evaluate the differences of the CMM thickness in different directions of the shoulder movement, and (3) compare the changes in the CMM thickness of participants with neck pain and also of healthy individuals. METHODS Twenty healthy men (age, 27.45 ± 4.37 years; height, 177 ± 4.66 cm; weight, 72.85 ± 6.46 kg) and 20 men with chronic mechanical neck pain (age, 28.90 ± 5.53 years; height, 176 ± 5.98 cm; weight, 73.15 ± 7.82 kg) participated in the study. Both the right and left CMM thicknesses were measured using an ultrasound device while participants performed isometric contraction of shoulder muscles in 6 movement directions. RESULTS In both groups, an increment of CMM thickness followed as the increase of isometric force (P < .01).The increase of muscle thickness of healthy participants was substantially more than the chronic mechanical neck pain participants (P = .03). Although no significant difference of CMM thickness was seen among the effects of the 6 force directions (P > .05), there was a significant difference of activity noted between the left and right sides (P = .047). CONCLUSION The results of the present study indicate that isometric contraction of shoulder muscles caused an increase in the CMM thickness regardless of force direction. This increase was seen in both groups of healthy participants and patients with neck pain. However, less thickness changes were observed in participants with neck pain, which may be interpreted as reduced CMM activity in such people.

The effect of different exercise programs on cervical flexor muscles dimensions in patients with chronic neck pain

OBJECTIVE The effect of different exercise programs on cervical flexor muscles dimensions in patients with chronic neck pain is yet to be demonstrated. The purpose of this study was to assess the effect of two exercise programs; craniocervical flexion (CCF) and cervical flexion (CF), on flexor muscles dimensions in patients with chronic neck pain. METHODS Following ethical approval, 60 patients were randomly assigned into either a CCF group or a CF group. Patients in the CCF group were given CCF exercises and those in the CF group received CF exercises. All patients received interventions for a period of ten weeks. Pain intensity and functional disability were assessed using numerical pain rate scale and neck disability index, respectively. Dimensions of longus colli (LC) and sternoclidomastoid (SCM) muscles were measured using ultrasonography (US). All measurements were taken before and after interventions. RESULTS Following intervention, the CCF group demonstrated a significant increase in LC muscle dimensions including cross sectional area, width and thickness compared with the CF group. A statistically significant increase was found on SCM thickness in the CF group. Following intervention, SCM thickness measurement in the CCF group showed no significant changes. Statistically significant decrease on pain intensity and disability were also found in both groups. CONCLUSION Present findings demonstrated that craniocervical flexion program which specifically recruiting deep cervical flexor muscles increased LC muscle dimension significantly and CF program as an endurance training program increased SCM thickness.

The effects of isometric contraction of shoulder muscles on cervical multifidus muscle dimensions in healthy office workers.

It is argued that cervical multifidus muscles (CMM) are responsible for providing neck stability. However, whether they are actually activated during the tasks performed by the upper extremities to the neck is still unknown. Therefore, the aim of this study was to examine the effects of isometric contraction of shoulder muscles on the dimensions of CMM. Twenty three healthy males voluntarily participated in this study. Ultrasonography imaging of CMM was conducted at rest and at 25%, 50%, 75%, and 100% of maximal voluntary contraction of shoulder muscles in 6 directions of shoulder movements. Anterior-posterior dimension (APD), lateral dimension (LD), shape ratio and multiplied linear dimension (MLD) of cervical multifidus were measured. The APD of CMM was increased while LD and shape ratio were decreased by shoulder muscles contraction (P < 0.01).

The variation of the strength of neck extensor muscles and semispinalis capitis muscle size with head and neck position.

Semispinalis capitis muscle (SECM) is a massive and long cervico-thoracic muscle which functions as a main head and neck extensor muscle. The aim of this study was to detect the effect of head and neck positions on the strength of neck extensor muscles and size of SECM in healthy subjects. Thirty healthy women students voluntarily participated in this study. An ultrasonography apparatus (Hitachi EUB 525) and a system of tension-meter were used to scan the right SECM at the level of third cervical spine and to measure the strength of neck extensor muscles at three head and neck positions. Neck extensor muscles were stronger in neutral than flexion or than extension positions while the size of SECM was larger in extension than neutral or than flexion position. The force generation capacity of the main neck extensor muscle was lower at two head and neck flexion and extension positions than neutral position.

Comparison of isometric force of the craniocervical flexor and extensor muscles between women with and without forward head posture.

Objective: The stability of the craniocervical (CC) area is provided by CC muscles. Muscle imbalance between forces of these muscles may lead to forward head posture (FHP). FHP is one of the most prevalent abnormal postures in patients with neck pain. The aim of the present study was to compare isometric force of the CC flexor and extensor muscles between women with and without FHP. Method: Isometric force of the CC flexor and extensor muscles was measured by a custom-made device and compared between 70 women with and without FHP (35 in each group). Results: No significant difference was observed between the two groups regarding isometric force of the CC flexor and extensor muscles, but the ratio of the isometric force of the CC muscles (flexor to extensor) revealed significant difference between the two groups, and it was greater in the control group compared with that in the FHP group. Discussion: The ratio of isometric force of the CC muscles (flexor to extensor) may be a good indicator for assessment of patients with FHP. This ratio may also be valuable to follow the results of therapeutic intervention for these patients.