Tina Souvlis

Neck movement and muscle activity characteristics in female office workers with neck pain.

Study Design. Cross-sectional study. Objective. To explore aspects of cervical musculoskeletal function in female office workers with neck pain. Summary of Background Data. Evidence of physical characteristics that differentiate computer workers with and without neck pain is sparse. Patients with chronic neck pain demonstrate reduced motion and altered patterns of muscle control in the cervical flexor and upper trapezius (UT) muscles during specific tasks. Understanding cervical musculoskeletal function in office workers will better direct intervention and prevention strategies. Methods. Measures included neck range of motion; superficial neck flexor muscle activity during a clinical test, the craniocerivcal flexion test; and a motor task, a unilateral muscle coordination task, to assess the activity of both the anterior and posterior neck muscles. Office workers with and without neck pain were formed into 3 groups based on their scores on the Neck Disability Index. Nonworking women without neck pain formed the control group. Surface electromyographic activity was recorded bilaterally from the sternocleidomastoid, anterior scalene (AS), cervical extensor (CE) and UT muscles. Results. Workers with neck pain had reduced rotation range and increased activity of the superficial cervical flexors during the craniocervical flexion test. During the coordination task, workers with pain demonstrated greater activity in the CE muscles bilaterally. On completion of the task, the UT and dominant CE and AS muscles demonstrated an inability to relax in workers with pain. In general, there was a linear relationship between the workers’ self-reported levels of pain and disability and the movement and muscle changes. Conclusion. These results are consistent with those found in other cervical musculoskeletal disorders and may represent an altered muscle recruitment strategy to stabilize the head and neck. An exercise program including motor reeducation may assist in the management of neck pain in office workers.

Psychologic factors are related to some sensory pain thresholds but not nociceptive flexion reflex threshold in chronic whiplash

ObjectivesSensory hypersensitivity, central hyperexcitability [lowered nociceptive flexion reflex (NFR) thresholds], and psychologic distress are features of chronic whiplash. However, relationships between these substrates are not clear. This study tested the hypothesis that psychologic distress and catastrophization are correlated with sensory hypersensitivity and NFR responses in chronic whiplash. MethodsPressure and thermal pain thresholds (mean values across 3 body sites), NFR threshold, and pain at threshold Visual Analog Scale were measured in 30 participants with chronic whiplash and 30 asymptomatic controls. Pain and disability levels Neck Disability Index, psychologic distress (GHQ-28), and catastrophization (PCS) were also measured in the whiplash group. ResultsWhiplash injured participants demonstrated lowered pain thresholds to pressure and cold (P<0.05); lowered NFR thresholds (P=0.003), and demonstrated above threshold levels of psychologic distress (GHQ-28) and levels of catastrophization comparable with other musculoskeletal conditions. There were no group differences for heat pain thresholds or pain at NFR threshold. In the whiplash group, PCS scores correlated moderately with cold pain threshold (r=0.51, P=0.01). In contrast, there were no significant correlations between GHQ-28 scores and pain threshold measures or between psychologic factors and NFR responses in whiplash participants. There were no significant correlations between psychologic factors and pain thresholds or NFR responses in controls. DiscussionWe have demonstrated that psychologic factors have some association with sensory hypersensitivity (cold pain threshold measures) in chronic whiplash but do not seem to influence spinal cord excitability. This suggests that psychologic disorders are important, but not the only, determinants of central hypersensitivity in whiplash patients.

The nature of anterior knee pain following injection of hypertonic saline into the infrapatellar fat pad

The infrapatellar fat pad has been implicated as a possible source of anterior knee pain. This study examined the nature, distribution and time‐course of experimentally induced pain in the infrapatellar fat pad. Hypertonic saline (5%) was injected into the medial fat pad of 11 healthy individuals with no history of knee pain. Severity of pain was assessed at rest and during activity using an 11 point numerical rating scale (NRS) at regular intervals over 15–30 min following injection. Participants described the size of the pain region from a series of different sized circles while the area and type of pain was established from a body chart and the McGill pain questionnaire. The effect of pain on temperature‐pain threshold and sensory thresholds of the anterior knee was assessed. Participants generally reported a deep aching pain that peaked in severity around 3 min and gradually declined over 15 min. Pain levels were not altered by clinical manoeuvres designed to impinge the fat pad. The size of the pain region was related to pain intensity. Pain was most commonly felt in the region of the fat pad medial to the patella, although some individuals reported proximal referred pain as far as the groin region. Thermal and sensory thresholds were not altered at a region close to the injection site during the experimental pain. These results suggest that nociceptive stimulation of the infrapatellar fat pad may cause anterior knee pain that is not necessarily confined locally particularly if pain is severe. This has implications for the investigation of pathological structures in patients presenting clinically with anterior knee pain and provides an experimental model of anterior knee pain.

Exploration of the Extent of Somato-Sensory Impairment in Patients with Unilateral Lateral Epicondylalgia

UNLABELLED There is evidence suggesting an important role of nociceptive sensitization in lateral epicondylalgia (LE). Our aim was to explore somato-sensory changes in patients with unilateral LE to better understand this musculoskeletal condition. Twelve patients (6 female) with LE with a mean (SD) age 47 (10) years, and 16 controls (7 female), aged 41 (9) years were tested. The following somato-sensory parameters were assessed: pressure-pain threshold (PPT), heat- and cold-pain thresholds, thermal, cold- and vibration-detection thresholds. All these tests were bilaterally assessed over the lateral epicondyle (affected/unaffected in patients; dominant/nondominant in controls) and at the dorsal-lateral surface of the wrist in all patients and controls. The results showed that patients with unilateral LE not only exhibited substantial reductions in PPT on the affected side compared to the unaffected side (mean difference and 95% confidence intervals: 219 kPa [136.8 to 301.1 kPa] but also when compared to controls (581.1 kPa [340.5 to 821.7 kPa]), showing bilateral pressure-pain hyperalgesia. These differences represented an effect size (ie, standardized mean difference) of 1.23 and .94, respectively. In the same cohort, there were no such deficits in cold and heat pain, cold- and warm-detection thresholds, and vibration-detection thresholds, either between affected and unaffected sides in patients with LE or between patients and controls. Effect sizes for the sensory-detection tests were small, which were generally less than the pain tests. Our data imply that LE is largely characterized by peripheral and central mechanical pain hyperalgesia. PERSPECTIVE This article reveals the presence of bilateral pressure-pain hypersensitivity in patients with unilateral LE. On the contrary, thermal and vibration tests were not significantly different from controls.

Reliability and Size of the Measurement Error when Determining the Cross-Sectional Area of the Tibial Nerve at the Tarsal Tunnel with Ultrasonography

An in depth analysis of the reliability of ultrasonography to measure the cross-sectional area of the tibial nerve or any other peripheral nerve is not available in the literature. This study determined the reliability and size of the measurement error of high-resolution ultrasound to measure the size of the tibial nerve at the tarsal tunnel. The cross-sectional area of the tibial nerve was measured by two experienced sonographers at 1 cm proximal to the medial malleolus. Measurements were made in 10 healthy participants without plantar heel pain. Intra and intertester reliability were determined by calculation of intraclass correlation coefficients (ICC), measurement error magnitude and smallest detectable difference (SDD). A direct (tracing) and indirect (ellipsoid formula) method were evaluated. Results demonstrated that the intra and intertester reliability were excellent (ICC, all > or =0.86). The measurement error and SDD were very small, especially when measurements from three scans were averaged (measurement error: 0.4-0.9 mm2; SDD: 1.1-2.5 mm2). The findings of this study support the view that high-resolution ultrasound is reliable to measure the cross-sectional area of a peripheral nerve. As a result of the small measurement error, a side-to-side difference as small as approximately 1.8 mm2 can be interpreted meaningfully in an individual patient. This difference is much smaller than the swelling reported in the literature for patients with tibial neuropathy.

Biomechanical evaluation of two clinical tests for plantar heel pain : The dorsiflexion-eversion test for tarsal tunnel syndrome and the windlass test for plantar fasciitis

Background: Plantar heel pain may result from several conditions such as tarsal tunnel syndrome (TTS) and plantar fasciitis. The dorsiflexion-eversion test is used to diagnose TTS, whereas the windlass test is used for plantar fasciitis. Given the similarity between both tests, the purpose of this study was to evaluate whether these tests are able to selectively load the structures which they aim to examine. Methods: Both tests were evaluated in six cadavers by measuring strain in the plantar fascia, tibial nerve, lateral plantar nerve (LPN), and medial plantar nerve (MPN) using miniature displacement transducers. Longitudinal excursion of the nerves was measured with a digital caliper. Results: With the dorsiflexion-eversion test, dorsiflexion and eversion of the ankle in combination with extension of the metatarsophalangeal (MTP) joints significantly increased strain in the tibial nerve (+1.1%), LPN (+2.2%), and MPN (+3.3%) but also in the plantar fascia (+1.2%) (all: p = 0.016). Both components (dorsiflexion-eversion and MTP extension) resulted in significant increases. With the windlass test, extension of all MTP joints significantly increased strain in the plantar fascia (+0.4%, p = 0.016), but also in the tibial nerve (+0.4%, p = 0.016), LPN (+0.8%, p = 0.032) and MPN (+2.0%, p = 0.016). Excursion of the nerves was always in the distal direction but only reached significance for the tibial nerve (6.9 mm, p = 0.016) and LPN (2.2 mm, p = 0.032) during the dorsiflexion-eversion test. Conclusions: Both tests mechanically challenge various structures that have been associated with plantar heel pain. This questions the usefulness of the tests in the differential diagnosis of plantar heel pain.

Interaction of psychosocial risk factors explain increased neck problems among female office workers

Abstract This study investigated the relationship between psychosocial risk factors and (1) neck symptoms and (2) neck pain and disability as measured by the neck disability index (NDI). Female office workers employed in local private and public organizations were invited to participate, with 333 completing a questionnaire. Data were collected on various risk factors including age, negative affectivity, history of previous neck trauma, physical work environment, and task demands. Sixty‐one percent of the sample reported neck symptoms lasting greater than 8 days in the last 12 months. The mean NDI of the sample was 15.5 out of 100, indicating mild neck pain and disability. In a hierarchical multivariate logistic regression, low supervisor support was the only psychosocial risk factor identified with the presence of neck symptoms. Similarly, low supervisor support was the only factor associated with the score on the NDI. These associations remained after adjustment for potential confounders of age, negative affectivity, and physical risk factors. The interaction of job demands, decision authority, and supervisor support was significantly associated with the NDI in the final model and this association increased when those with previous trauma were excluded. Interestingly, and somewhat contrary to initial expectations, as job demands increased, high decision authority had an increasing effect on the NDI when supervisor support was low.

STROKE, COMPLEX REGIONAL PAIN SYNDROME AND PHANTOM LIMB PAIN: CAN COMMONALITIES DIRECT FUTURE MANAGEMENT?

Despite being different conditions, complex regional pain syndrome type 1, phantom limb pain and stroke share some potentially important similarities. This report examines experimental and clinical findings from each patient population. It identifies common aspects of symptomatic presentation, sensory phenomena and patterns of cortical reorganization. Based on these common findings, we argue that established principles of stroke rehabilitation are also applicable to rehabilitation of complex regional pain syndrome type 1 and phantom limb pain. In addition, we contend that promising treatment approaches for complex regional pain syndrome type 1 and phantom limb pain may be helpful in stroke rehabilitation. Examples of emerging supportive evidence for these hypotheses are provided and discussed.

Contribution of individual, workplace, psychosocial and physiological factors to neck pain in female office workers

This study investigated the relative contribution of individual, workplace, psychosocial and physiological features associated with neck pain in female office workers towards developing appropriate intervention programs. Workers without disability (Neck Disability Index (NDI) score≤8, n=33); workers with neck pain and disability (NDI≥9/100, n=52) and 22 controls (women who did not work and without neck pain) participated in this study. Two logistic regression models were constructed to test the association between various measures in (1) workers with and without disability, and (2) workers without disability and controls. Measures included those found to be significantly associated with higher NDI in our previous studies: psychosocial domains; individual factors; task demands; quantitative sensory measures and measures of motor function. In the final model, higher score on negative affectivity scale (OR=4.47), greater activity in the neck flexors during cranio‐cervical flexion (OR=1.44), cold hyperalgesia (OR=1.27) and longer duration of symptoms (OR=1.19) remained significantly associated with neck pain in workers. Workers without disability and controls could only be differentiated by greater muscle activity in the cervical flexors and extensors during a typing task. No psychosocial domains remained in either regression model. These results suggest that impairments in the sensory and motor system should be considered in any assessment of the office worker with neck pain and may have stronger influences on the presenting symptoms than workplace and psychosocial features.

Characterisation of chronic lateral epicondylalgia using the McGill pain questionnaire, visual analog scales, and quantitative sensory tests

Abstract Aims: To characterise chronic lateral epicondylalgia using the McGill Pain Questionnaire, Visual Analog Scales for pain and function, and Quantitative Sensory Tests; and to examine the relationship between these tests in a population with chronic lateral epicondylalgia. Method: Fifty-six patients (29 female, 27 male) diagnosed with unilateral lateral epicondylalgia of 18.7 months (mean) duration (range 1-300), with a mean age of 50.7 years (range 27-73) participated in this study. Each participant underwent assessment with the McGill Pain Questionnaire (MPQ), Visual Analog Scales (VAS) for pain and function, and Quantitative Sensory Tests (QST) including thermal and pressure pain thresholds, pain free grip strength, and neuromeningeal tissue testing via the upper limb tension test 2b (ULTT 2b). Results: Moderate correlation (r = .338 - .514, p = .000 - .013) was found between all indices of the MPQ and VAS for pain experienced in the previous 24 hours and week. Thermal pain threshold was found to...