Barbara Cagnie

Prevalence and Risk Factors of Neck Pain in Military Office Workers

An extensive cross-sectional questionnaire was used to estimate the prevalence of neck pain and to identify risk factors (short term to long term) in the occurrence of neck pain in military office workers. Two standardized scales (Neck Disability Index and Tampa Scale for Kinesiophobia) allowed assessment of the impact of neck pain on the persons life and the pain-related fear avoidance. A total of 629 completed questionnaires were evaluated which revealed the following: lifetime prevalence (78%), week prevalence (53%), point prevalence (59%), year prevalence (65%) (once-only, 19%; regular, 51%; long term, 15%; never, 7%). The results of this study provided support for the role of physical and psychosocial job characteristics in the etiology of neck pain in military office workers.

Use of Muscle Functional Magnetic Resonance Imaging to Compare Cervical Flexor Activity Between Patients With Whiplash-Associated Disorders and People Who Are Healthy

Background Chronic whiplash-associated disorders (WAD) have been shown to be associated with motor dysfunction. Increased electromyographic (EMG) activity in neck and shoulder girdle muscles has been demonstrated during different tasks in participants with persistent WAD. Muscle functional magnetic resonance imaging (mfMRI) is an innovative technique to evaluate muscle activity and differential recruitment of deep and superficial muscles following exercise. Objective The purpose of this study was to compare the recruitment pattern of deep and superficial neck flexors between patients with WAD and controls using mfMRI. Design A cross-sectional design was used. Method The study was conducted in a physical and rehabilitation medicine department. The participants were 19 controls who were healthy (10 men, 9 women; mean [±SD] age=22.2±0.6 years) and 16 patients with WAD (5 men, 11 women; mean [±SD] age=32.9±12.7 years). The T2 values were calculated for the longus colli (Lco), longus capitis (Lca), and sternocleidomastoid (SCM) muscles at rest and following cranio-cervical flexion (CCF). Results In the overall statistical model for T2 shift, there was a significant main effect for muscle (F=3.906, P=.033) but not for group (F=2.855, P=.101). The muscle × group interaction effect was significant (F=3.618, P=.041). Although not significant, there was a strong trend for lesser Lco (P=.061) and Lca (P=.060) activity for the WAD group compared with the control group. Although the SCM showed higher T2 shifts, this difference was not significant (P=.291). Limitations Although mfMRI is an innovative and useful technique for the evaluation of deep cervical muscles, consideration is required, as this method encompasses a postexercise evaluation and is limited to resistance types of exercises. Conclusions Muscle functional magnetic resonance imaging demonstrated a difference in muscle recruitment between the Lco, Lca, and SCM during CCF in the control group, but failed to demonstrate a changed activity pattern in the WAD group compared with the control group. The mild symptoms in the WAD group and the wide variability in T2 values may explain the lack of significance.

Extrinsic risk factors for compromised blood flow in the vertebral artery: anatomical observations of the transverse foramina from C3 to C7

The vertebral artery (VA) is often involved in the occurrence of complications after spinal manipulative therapy. Due to osteophytes compressing the VA anteriorly from the uncinate process or posteriorly from the facet complex, the VAs are susceptible to trauma in the transverse foramina. Such altered anatomical configurations are of major clinical significance, as spinal manipulations may result in dissection of the VA with serious consequences for the blood supply to the vertebrobasilar region. The purpose of this study is to describe numerous structural features of the third to seventh cervical vertebrae in order to contribute to the understanding of pathological conditions related to the VA. The minimal and maximal diameter of 111 transverse foramina in dry cervical vertebrae were studied. The presence of osteophytes and their influence on the VA were evaluated at the vertebral body and at the superior and inferior articular facets. The diameter of the transverse foramina increased from C3 to C6, while the transverse foramina of C7 had the smallest diameter. At all levels the mean dimensions of the left foramina were greater than those of the right side. Osteophytes from the uncinate process of C5 and C6 vertebrae were found in over 60% of dry vertebrae. Osteophytes from the zygapophyseal joints were more frequent at C3 and C4 vertebrae. About half of the osteophytes of the uncinate and of the superior articular process partially covered the transverse foramina. This was less common with those of the inferior articular facets. Osteophytes covering the transverse foramen force the VAs to meander around these obstructions, causing narrowing through external compression and are potential sites of trauma to the VAs potentially even leading to dissection. We strongly advocate that screening protocols for vertebrobasilar insufficiency (VBI) be used prior to any manipulation of the cervical spine and should include not only extension and rotation but any starting position from which the planned manipulation will be performed.

8 Trapeziusmyalgie bij beeldschermwerkers: pathofysiologie en implicaties voor preventie en behandeling

» Trapeziusmyalgie bij beeldschermwerkers is een vaak voorkomend probleem, dat wordt gekenmerkt door pijn en vermoeidheid ter hoogte van de schouder- en nekregio. In dit artikel wordt, vertrekkend vanuit de klinische symptomen, dieper ingegaan op de histologische en biochemische bevindingen en de onderliggende mechanismen die deze klachten kunnen verklaren. De meest plausibele pathofysiologische mechanismen zijn 1) de cinderellahypothese, 2) Ca2+-accumulatie en 3) verminderde doorbloeding. Kennis van de onderliggende mechanismen heeft belangrijke implicaties voor preventie en behandeling van deze courante aandoening.

In response to Dr. Thiel

We agree with Dr. Thiel that dissection is the most common complication after cervical spine manipulation. A direct relationship between spondylosis and dissection can indeed not be supported by the literature. However, we think it is important to make a distinction between the rather devastating VBI (vertebro basilar insufficiency) as a consequence of dissection, and transient VBI, which may be a consequence of temporary occlusion of the vertebral artery. The latter is supported by the work of Sheehan et al. who found 26 cases, which he termed ‘‘spondylotic vertebral artery compression’’ [1]. Dizziness, vertigo, blurred vision, ataxia, drop attacks and headache were the most important symptoms commonly provoked or precipitated by hyperextension and rotation of the neck. In different cases, congenital absence or hypoplasia of the opposite vessel was present. Additionally, repeated traumatic injury of the vertebral artery by spondylotic exostoses may predispose the vessel to the formation of atherosclerotic plaques, and it is obvious that if the two conditions occur together, the liability to ischemic episodes is increased. We totally agree with the reviewer that premanipulative testing procedures have come under scrutiny in recent years, due to their high rate of false-positives and false-negatives. The occurrence of injury following cervical manipulation in individuals without known pathology and the possibility of cumulative subclinical damage to the vertebral arteries are factors that need to be considered when using cervical manipulation. These factors complicate the assessment of sensitivity and specificity of premanipulative screening protocols. We had to make this more clear in the Discussion section, but, with this response, we hope to prevent a clinician from a false sense of safety. A rationale for the prevention of complications from spinal manipulation should be based on a larger entity, i.e. knowledge of patient’s history and contraindications, thorough skilled manipulative training, premanipulative testing, appropriate medical imaging and avoidance of certain techniques in patients thought to be at risk. We propose to use a clinical decision algorithm, adapted from Magarey et al. as a guide to clinical reasoning in patient’s examination and management [2]. Subtle clues obtained during the clinical reasoning process should alert the aware clinician of a potential vascular problem, which will contribute to the decision with regard to management and potential spinal manipulative therapy. However, future studies need to determine whether unambiguous, sensitive and specific premanipulative screening protocols can be developed. We hope this answer satisfies the responder and further opens the door to continuing research and dialogue.