Shannon Petersen

Lower Trapezius Muscle Strength in Individuals With Unilateral Neck Pain

STUDY DESIGN Descriptive and within-subject comparative study. OBJECTIVES To examine lower trapezius muscle strength in individuals with unilateral neck pain. BACKGROUND Previous research has established the presence of reduced cervical flexor, extensor, and rotator muscle strength in individuals with neck pain. Some authors have suggested that individuals with neck pain have limited strength of the lower trapezius muscle, yet no research has investigated this claim. METHODS Twenty-five individuals with unilateral neck pain participated in this study. Participants completed the Northwick Park Neck Pain Questionnaire (NPQ) as a measure of disability. Side of neck pain, duration of neck pain, and hand dominance were recorded. Lower trapezius muscle strength was assessed bilaterally in each participant, using a handheld dynamometer. RESULTS A significant difference in lower trapezius strength was found between sides (P<.001), with participants demonstrating an average of 3.9 N less force on the side of neck pain. The tested levels of association between NPQ score and percent strength deficit (r = -0.31, P = .13), and between symptom duration and percent strength deficit (r = -0.25, P = .22), were not statistically significant. No significant association was found between hand dominance and side of stronger lower trapezius (P = .59). CONCLUSION The results of this study demonstrate that individuals with unilateral neck pain exhibit significantly less lower trapezius strength on the side of neck pain compared to the contralateral side. This study suggests a possible association between lower trapezius muscle weakness and neck pain.

Is there preliminary value to a within- and/or between-session change for determining short-term outcomes of manual therapy on mechanical neck pain?

Abstract Objectives: The primary purpose of this study was to determine whether occurrences of within- and between-session changes were significantly associated with functional outcomes, pain, and self-report of recovery in patients at discharge who were treated with manual therapy for mechanical neck pain. A secondary purpose was to determine the extent of change needed for the within- and between-session change in association to function. Methods: This secondary data analysis examined 56 patients who demonstrated a positive response to manual therapy during the initial assessment within a randomized controlled trial (RCT) that examined manual therapy techniques and a home exercise program (HEP). Within- and between-session findings were defined as ‘changes in pain report during the initial session (within)’ and ‘changes in pain from baseline to 48-hours post initial assessment (between)’. Outcomes were analyzed for associations with the global rating of change (GRoC), self-report activity scale (SRAS), and a 50% reduction of the neck disability index (NDI) by discharge at 96 hours. Results: Findings indicate that within-session pain changes of 36·7% are strongly associated with a 50% change in NDI at 96 hours. Between-session changes in pain were associated with 50% change in NDI and a ≧3-point change in GRoC at 96 hours. Conclusion: Both within- and between-session measures may be useful to predict success levels at 96 hours for NDI; however, between-session changes are more useful to predict success in GRoC. Measures used during clinical examination may help guide clinicians in identification of candidates best suited for the treatment.

Upper extremity neurodynamic tests: Range of motion asymmetry may not indicate impairment

Upper extremity (UE) neurodynamic tests are used to examine neural tissue in patients with neuro-musculoskeletal disorders. Although comparisons between involved and uninvolved limbs are made clinically, minimal data exist reflecting the normal variation between sides. The purpose of this study was to determine if within-subject differences exist between limbs in the UE component of neurodynamic tests of the median, radial, and ulnar nerves. Sixty-one healthy subjects were examined. Difference between limbs for the median nerve-biased test was significant (right = 16.4° ± 11.4°, left = 20.1° ± 13.7°; p = 0.045). There was no significant difference between limbs for the radial or ulnar nerve-biased tests. Correlation between limbs was poor for all tests (median r2 = 0.14; radial r2 = 0.20; ulnar r2 = 0.13). Lower-bound scores were calculated to determine the amount of difference needed to consider asymmetry beyond measurement error; the scores for each neurodynamic test were as follows: median 27°, radial 20°, and ulnar 21°. The results of this study show that between-limb values have low correlation and that it may be normal for an individual to have range of motion differences between limbs with neurodynamic tests.

Quality improvement in neurology Primary headache quality measures

Headache and migraine are common, debilitating, and costly. Headaches are among the most prevalent neurologic disorders. In US studies, somewhere between 12% and 23% of adults over the age of 18 have had a migraine headache in the past 3 months.1 In fact, the WHO ranks migraine headache in the top 20 of the worlds most disabling medical illnesses.2 Frequent headache or migraine can significantly and negatively impact an individuals quality of life, family interactions, and ability to work.3,4 Hawkins et al.5 found that nationally, migraine-associated expenditures include outpatient care costs of

A Prescriptively Selected Nonthrust Manipulation Versus a Therapist-Selected Nonthrust Manipulation for Treatment of Individuals With Low Back Pain: A Randomized Clinical Trial

5.21 billion; prescription costs of

Scapulothoracic muscle strength in individuals with neck pain

4.61 billion; inpatient care costs of

The flexion-rotation test performed actively and passively: a comparison of range of motion in patients with cervicogenic headache.

0.73 billion; and emergency department care costs of

Reliability of the radial and ulnar nerve biased upper extremity neural tissue provocation tests

0.52 billion. At work, people with migraine have higher levels of lost productivity and reduced performance, and more absences from work.6

Application of a classification system and description of a combined manual therapy intervention: a case with low back related leg pain

STUDY DESIGN Randomized controlled trial. BACKGROUND Several studies that have investigated the effects of a therapist-selected versus a randomly assigned segmental approach have looked at immediate effects only for pain-related outcomes. OBJECTIVES To examine differences in outcomes following a therapist-selected nonthrust manipulation versus a prescriptively selected nonthrust manipulation in subjects with low back pain. METHODS Subjects with mechanically producible low back pain were randomly treated with nonthrust manipulation in a therapist-selected approach or a prescriptively selected approach. All subjects received a standardized home exercise program. Outcome measures included pain, disability, global rating of change, and patient acceptable symptom state. Analyses of covariance, chi-square tests, and Mann-Whitney U tests were used to determine differences between groups. RESULTS Sixty-three subjects were tracked for 6 months, during which subjects in both groups significantly improved. There were no differences between groups in pain, disability, or patient acceptable symptom state scores at 6 months. There was a significant difference in global rating of change scores favoring the therapist-selected manipulation group at 6 months. CONCLUSION This study measured long-term differences between a prescriptively selected nonthrust manipulation and a therapist-selected approach to nonthrust manipulation. In pain, disability, and patient acceptable symptom state there were no differences in outcomes, findings similar to studies of immediate effects. After 6 months, perceived well-being was significantly higher for those in the therapist-selected treatment group. The study was registered at ClinicalTrials.gov (NCT01940744). LEVEL OF EVIDENCE Therapy, level 1b.

Scapulothoracic Muscle Strength Changes Following a Single Session of Manual Therapy and an Exercise Programme in Subjects with Neck Pain

BACKGROUND People with neck pain often present with weakness in the scapulothoracic muscles. Few studies have examined lower trapezius (LT), middle trapezius (MT) and serratus anterior (SA) muscle strength in individuals with neck pain, nor compared strength to asymptomatic individuals. OBJECTIVES The aim of this study was to examine LT, MT and SA muscle strength in individuals with chronic neck pain. METHODS Descriptive cross sectional design. Twenty two individuals with chronic neck pain and 17 asymptomatic individuals were included. Participants were asked to complete a screening questionnaire, Neck Disability Index, and underwent manual muscle testing for the LT, MT, and SA muscles bilaterally. Data analyses included paired and comparative independent t-tests. RESULTS For individuals with neck pain, significant within subject differences in strength between sides for the LT (P< 0.01) and MT (P< 0.01) were present. In contrast, no within subject difference between sides for the asymptomatic group was found for any muscle. Individuals with neck pain were significantly weaker than asymptomatic individuals for the LT (p= 0.02), MT (p= 0.03), and SA (p= 0.01) on their side of neck pain, but not on their non-painful side. CONCLUSIONS Significant within subject differences were found between sides for the LT and MT while significant between group differences were identified for all three muscles tested.