Zacharias Dimitriadis

Respiratory weakness in patients with chronic neck pain

Respiratory muscle strength is one parameter that is currently proposed to be affected in patients with chronic neck pain. This study was aimed at examining whether patients with chronic neck pain have reduced respiratory strength and with which neck pain problems their respiratory strength is associated. In this controlled cross-sectional study, 45 patients with chronic neck pain and 45 healthy well-matched controls were recruited. Respiratory muscle strength was assessed through maximal mouth pressures. The subjects were additionally assessed for their pain intensity and disability, neck muscle strength, endurance of deep neck flexors, neck range of movement, forward head posture and psychological states. Paired t-tests showed that patients with chronic neck pain have reduced Maximal Inspiratory (MIP) (r = 0.35) and Maximal Expiratory Pressures (MEP) (r = 0.39) (P < 0.05). Neck muscle strength (r > 0.5), kinesiophobia (r < -0.3) and catastrophizing (r < -0.3) were significantly associated with maximal mouth pressures (P < 0.05), whereas MEP was additionally negatively correlated with neck pain and disability (r < -0.3, P < 0.05). Neck muscle strength was the only predictor that remained as significant into the prediction models of MIP and MEP. It can be concluded that patients with chronic neck pain present weakness of their respiratory muscles. This weakness seems to be a result of the impaired global and local muscle system of neck pain patients, and psychological states also appear to have an additional contribution. Clinicians are advised to consider the respiratory system of patients with chronic neck pain during their usual assessment and appropriately address their treatment.

Hypocapnia in patients with chronic neck pain: Association with pain, muscle function, and psychologic states

ObjectiveThe aim of this study was to investigate whether patients with chronic neck pain have changes in their transcutaneous partial pressure of arterial carbon dioxide (PtcCO2) and whether other physical and psychologic parameters are associated. DesignIn this cross-sectional study, 45 patients with chronic idiopathic neck pain and 45 healthy sex-, age-, height-, and weight-matched controls were voluntarily recruited. The participants’ neck muscle strength, endurance of the deep neck flexors, neck range of movement, forward head posture, psychologic states (anxiety, depression, kinesiophobia, and catastrophizing), disability, and pain were assessed. PtcCO2 was assessed using transcutaneous blood gas monitoring. ResultsThe patients with chronic neck pain presented significantly reduced PtcCO2 (P < 0.01). In the patients, PtcCO2 was significantly correlated with strength of the neck muscles, endurance of the deep neck flexors, kinesiophobia, catastrophizing, and pain intensity (P < 0.05). Pain intensity, endurance of the deep neck flexors, and kinesiophobia remained as significant predictors into the regression model of PtcCO2. ConclusionsPatients with chronic neck pain present with reduced PtcCO2, which can reach the limits of hypocapnia. This disturbance seems to be associated with physical and psychologic manifestations of neck pain. These findings can have a great impact on various clinical aspects, notably, patient assessment, rehabilitation, and drug prescription.

Reliability of the chin tuck neck flexion test for assessing endurance of short neck flexors in healthy individuals

Abstract Objectives: The aim of the study was to examine of the intra-rater reliability of the chin tuck neck flexion (CTNF) test for assessing the endurance of neck flexors. Materials and methods: The study was performed at the Cardiorespiratory laboratory of the Physiotherapy Department, School of Health and Caring Professions, TEI Lamia, Greece. Twenty healthy volunteers (males/females: 9/11, age: 22.2 ± 1.7 y ears) with no known musculoskeletal, cardiovascular, pulmonary, neurological, or psychiatric disorder were recruited. The participants were positioned in a supine position and were asked to raise their head 2.5 cm above the plinth and to maintain this position for as long as possible without losing craniocervical or cervical flexion. This test was repeated three times with 5-min intervals between the trials. Results: The results showed that this test could discriminate between neck flexor endurance in men and women. However, although the test seems to be highly reliable (ICC: 0.81–0.88), it presents unsatisfactory standard error of measurement (SEM: 10.7–14.7 s) and smallest detectable differences (SDD: 80.5–110.9%). Furthermore, subgroup analysis showed the test seems to be more reliable for women (ICC: 0.93–0.94) than for men (ICC: 0.68–0.8), but the SEM and SDD values for them remain unsatisfactory (SEM: 4.4–5.3 s, SDD: 57.5–63.99%). Conclusions: Due to high reproducibility and discriminant validity, clinicians and researchers might want to consider using the CTNF test for the assessment of neck flexor endurance. However, they should seek alternative measurement tools when they want to avoid a large measurement error.

Validity of Visual Analog Scales for Assessing Psychological States in Patients with Chronic Neck Pain

Abstract Objectives: Examination of visual analog scale’s [VAS] validity for assessing psychological states in patients with chronic neck pain. Methods: Forty-five patients with chronic neck pain completed the Hospital Anxiety and Depression Scale, Tampa Scale for Kinesiophobia, and Pain Catastrophizing Scale. Anxiety, depression, kinesiophobia, and catastrophizing were additionally assessed by using a VAS for each. Results: Only the anxiety VAS could correlate high enough with its corresponding questionnaire. This correlation was higher than any other of its correlations with the other psychological instruments. Conclusions: The VAS seems to be a valid scale for assessing anxiety in patients with chronic neck pain.

DOES MOTIVATION AFFECT THE PERFORMANCE IN CLINICAL TESTS OF ENDURANCE OF DEEP NECK FLEXORS

The aim of the study was to investigate the association between the performance in two clinical tests for the endurance of deep neck flexors [Craniocervical Flexion Test (CCFT) and Chin Tuck Neck Flexion Test (CTNFT)] and the motivation of participants to continue and complete physical activities. Twenty-one healthy volunteers participated (men/women 13/8, age 21.1±1.37 years). Participants were asked to complete the Assessment Scale for Completion of Usual Physical Activities (ASCUPA), the Short Scale of Physical Activity Motives (SSPAM), a visual analog scale for the recording of their motivation to complete a physical activity (VAS motivation) and then they performed the CCFT and CTNFT. The CCFT did not present any significant correlation with either VAS motivation or ASCUPA. The CTNFT was not significantly associated with VAS motivation, but it was significantly correlated with ASCUPA (rs=0.58, p<0.01). Furthermore, the CTNFT was significantly correlated with the total number of motives for physical a...

Respiratory dysfunction in patients with chronic neck pain: What is the current evidence?

Respiratory function of patients with neck pain has not been given much consideration in usual clinical practice. The problem has however been highlighted occasionally by renown clinical scientists and recently there is a growing interest in the investigation of respiratory function in this clinical population. The aim of this review is to critically present the emerging evidence and discuss the similarities and differences observed. Although the evidence for some respiratory parameters is conflicting, it seems to be generally agreed that others such as maximal voluntary ventilation, strength of respiratory muscles, chest mechanics and partial pressure of arterial carbon dioxide are affected in patients with chronic neck pain. The effect size of the respiratory dysfunction regarding these respiratory parameters can be approximately described as moderate. These findings not only suggest a more thoughtful drug prescription, but they may lead to consideration of incorporation of respiratory assessment and treatment into routine physiotherapy practice. Indeed preliminary studies exploring the incorporation of such a treatment into usual practice have provided very promising results not only in relation to respiratory function, but also for other parameters of clinical interest. There remains however imminent need for randomized controlled trials to confirm the evidence base for such an approach.