Brian Clausen

Increased neck muscle activity and impaired balance among females with whiplash-related chronic neck pain: a cross-sectional study.

OBJECTIVE To investigate neck muscle activity and postural control in patients with whiplash-associated disorder compared with healthy controls. DESIGN Cross-sectional study with convenience sampling. SUBJECTS Ten females with whiplash-associated disorder (age 37.7 years (21-58), neck pain > 2 years and neck disability index (NDI) > 10) and 10 healthy female controls (age 35.9 years (21-53), NDI < 6). METHODS Surface electromyography measured muscle activity of the anterior scalene, sternocleidomastoid, neck extensors and upper trapezius muscles, expressed as mean relative activity related to maximum voluntary electromyography (%MVE). On a force plate, 3 balance tasks (Romberg stance with open and closed eyes, 1-legged stance) and a perturbation task with sudden unloading, were performed. The total area, areas from slow and fast components, and range of displacements were calculated from decomposed centre of pressure anterior-posterior and medial-lateral signals. RESULTS During balance tasks with closed eyes and one-legged stance, the relative mean activity of all 4 muscles was significantly increased in whiplash-associated disorder compared with healthy controls. Postural sway was also significantly increased. CONCLUSION Increased neck muscle activity and increased postural sway during simple balance tasks indicate disturbed sensory feedback patterns in people with whiplash-associated disorder, which may have negative consequences when performing daily activities.

An 8-Week Neuromuscular Exercise Program for Patients With Mild to Moderate Knee Osteoarthritis: A Case Series Drawn From a Registered Clinical Trial

OBJECTIVE   To describe the feasibility of a neuromuscular exercise (NEMEX) program in patients with mild to moderate knee osteoarthritis (KOA). BACKGROUND   Neuromuscular exercise has been increasingly used in patients with osteoarthritis to achieve sensorimotor control and improved daily function. TREATMENT   A study of the first 23 physically active patients (11 men, 12 women; age range = 48-70 years) who had mild to moderate KOA and were undergoing an 8-week, twice-weekly program, consisting of 11 exercises with 3 to 4 levels of difficulty, as part of an ongoing randomized controlled trial. The level of difficulty was noted for each exercise and session. We recorded exertion, pain, adverse events, and adherence. For the 18 patients who participated in 6 or more sessions, a progression of at least 1 level of difficulty (out of 3-4) was observed in half or more of the exercises. However, few patients progressed to jumping activities. Exertion ranged from light to very heavy. Four patients reported a clinically relevant increase in short-term pain after 1 to 2 of the 16 scheduled sessions. No adverse musculoskeletal events were reported. Notably, 3 patients dropped out due to increased (n = 2) or persisting (n = 1) knee pain. However, their pain ratings did not show worsening symptoms. UNIQUENESS   This NEMEX-KOA program was designed for physically active middle-aged patients with mild to moderate KOA; therefore, it involved exercises and difficulty levels that were more challenging than a previously described NEMEX program for patients eligible for total joint replacement. CONCLUSIONS   In patients with baseline mild to severe pain with activity, the NEMEX-KOA program was feasible. Progression was achieved with few incidents of clinically relevant increases in pain and no adverse events. However, jumping activities were not feasible. These findings hold promise for investigating the efficacy of the NEMEX-KOA program in individuals with mild to moderate KOA.