ORCID Profile
0000-0003-1689-6190
Current Organisations
University of Queensland
,
University of Birmingham
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Publisher: Elsevier BV
Date: 08-2023
Publisher: Springer International Publishing
Date: 13-10-2016
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 04-11-2019
DOI: 10.1249/MSS.0000000000002196
Abstract: Motor unit conduction velocity (MUCV) represents the propagation velocity of action potentials along the muscle fibers innervated by in idual motor neurons and indirectly reflects the electrophysiological properties of the sarcolemma. In this study, we investigated the effect of a 4-wk strength training intervention on the peripheral properties (MUCV and motor unit action potential litude, RMS MU ) of populations of longitudinally tracked motor units (MU). The adjustments exhibited by 12 in iduals who participated in the training (INT) were compared with 12 controls (CON). Strength training involved ballistic (4 × 10) and sustained (3 × 10) isometric ankle dorsiflexions. Measurement sessions involved the recordings of maximal voluntary isometric force and submaximal isometric r contractions, whereas high-density surface EMG was recorded from the tibialis anterior. High-density surface EMG signals were decomposed into in idual MU discharge timings, and MU was tracked across the intervention. Maximal voluntary isometric force (+14.1%, P = 0.003) and average MUCV (+3.0%, P = 0.028) increased in the INT group, whereas normalized MU recruitment threshold (RT) decreased (−14.9%, P = 0.001). The slope (rate of change) of the regression between MUCV and MU RT increased only in the INT group (+32.6%, P = 0.028), indicating a progressive greater increase in MUCV for higher-threshold MU. The intercept (initial value) of MUCV did not change after the intervention ( P = 0.568). The association between RMS MU and MU RT was not altered by the training. The increase in the rate of change in MUCV as a function of MU RT, but not the initial value of MUCV, suggests that short-term strength training elicits specific adaptations in the electrophysiological properties of the muscle fiber membrane in high-threshold MU.
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 08-2019
DOI: 10.1097/AJP.0000000000000728
Abstract: The present study’s objective was to understand the causal mechanisms underpinning the recovery of in iduals with whiplash-associated disorders (WAD). We applied Bayesian Networks (BN) to answer 2 study aims: (1) to identify the causal mechanism(s) of recovery underpinning neck-specific exercise (NSE), and (2) quantify if the cyclical pathway of the fear-avoidance model (FAM) is supported by the present data. We analyzed a prospective cohort data set of 216 in iduals with chronic WAD. Fifteen variables were used to build a BN model: treatment group (NSE with or without a behavioral approach, or general physical activity), muscle endurance, range of motion, hand strength, neck proprioception, pain catastrophizing, fear, anxiety, depression, self-efficacy, perceived work ability, disability, pain intensity, sex, and follow-up time. The BN model showed that neck pain reduction rate was greater after NSE compared with physical activity prescription (β=0.59 points per month [ P .001]) only in the presence of 2 mediators: global neck muscle endurance and perceived work ability. We also found the following pathway of variables that constituted the FAM: anxiety, followed by depressive symptoms, fear, catastrophizing, self-efficacy, and consequently pain. We uncovered 2 mediators that explained the mechanisms of effect behind NSE, and proposed an alternative FAM pathway. The present study is the first to apply BN modelling to understand the causal mechanisms of recovery in WAD. In doing so, it is anticipated that such analytical methods could increase the precision of treatment of in iduals with chronic WAD.
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 07-2005
DOI: 10.1016/J.PAIN.2005.03.038
Abstract: The purpose of this study was to compare average muscle fiber conduction velocity (CV) and its changes over time in the upper trapezius muscle during a repetitive upper limb task in people with chronic neck pain and in healthy controls. Surface EMG signals were detected bilaterally from the upper trapezius muscle of 19 patients and nine healthy controls using linear adhesive arrays of four electrodes. Subjects were asked to tap their hands in a cyclic manner between targets positioned mid-thigh and 120 degrees of shoulder flexion, to the beat of a metronome set at 88 beats/min for up to 5 min. Muscle fiber CV and instantaneous mean power spectral frequency were estimated for each cycle at the time instant corresponding to 90 degrees of shoulder flexion. Average muscle fiber CV of the upper trapezius muscle was higher in people with chronic neck pain (mean+/-SE, 4.8+/-0.1m/s) than in control subjects (4.4+/-0.1 m/s P<0.05). Furthermore, the exercise-induced decrease in CV over time was enhanced in the patient group (P<0.05). It was concluded that membrane muscle fiber properties of the upper trapezius and their changes over time during dynamic contraction of the upper limb are different in a s le of people with chronic neck pain with respect to controls. This may be associated with the histological and morphological changes, which have previously been identified in people with pain over the trapezius muscle.
Publisher: BMJ
Date: 12-2021
DOI: 10.1136/BMJOPEN-2021-053911
Abstract: Content validity is the most important measurement property for any patient-reported outcome measure (PROM). It being the extent that the PROM measures important concepts that are relevant to the population of interest. Adolescent with idiopathic scoliosis (AIS) is the most common spinal deformity in paediatric populations, with the Scoliosis Research Society questionnaire-22 revised (SRS-22r) a commonly used PROMof quality of life. In the absence of existing evidence, a content validity study for SRS-22r is needed to confirm its suitability for AIS. Thus, this study aims to investigate the content validity of SRS-22r for AIS. A secondary aim is to explore healthcare professional (HCP) perspectives of the barriers and facilitators to using outcome measures in AIS. Qualitative study reported according to COnsolidated criteria for Reporting Qualitative Studies. A purposive s le of AIS (n=10–15, Cobb angle °, aged 10–18 years) will be recruited for online semi-structured interviews. A convenience s le (n=10–12) of HCP with clinical and/or research experience in AIS will be recruited for a focus group discussion. Topic guides and age-relevant documents are informed by existing evidence and developed using a framework of concept elicitation and cognitive debriefing. Audio-recordings will be transcribed verbatim, coded, analysed and synthesised using interpretive phenomenology analysis. Themes that generated from the analysis will be used as codes that will then be mapped to the SRS-22r contents. The Health Research Authority and Health and Care Research Wales approval have been granted (IRAS 289888). Study findings will be disseminated through publications in peer-reviewed journals and conference presentations.
Publisher: Georg Thieme Verlag KG
Date: 26-02-2013
Publisher: Elsevier BV
Date: 08-2015
DOI: 10.1016/J.MATH.2015.01.007
Abstract: Apart from the cranio-cervical flexion test and the deep neck flexor endurance test, evidence related to reliability of cervical movement control dysfunction tests is lacking. This study investigated the inter- and intra-tester reliability of a battery of cervical movement control dysfunction tests and the effect of clinician experience on reliability in 15 patients with chronic neck pain and 17 non-neck pain controls. In addition, it explored whether impaired performance on this battery of tests was more frequently observed in the neck pain group. Inter and intra-tester reliability study. Participants were videotaped while performing a battery of nine active cervical movement control dysfunction tests. Two physiotherapists, with different levels of experience, independently rated all tests on two occasions two weeks apart. They were masked to participants' neck pain or non-neck pain status. Inter-tester reliability for the complete battery of tests was substantial (κ = 0.69 95% CI: 0.62, 0.76). Intra-rater reliability values for the expert (κ = 0.86 95% CI: 0.79, 0.92) and novice (κ = 0.76 95% confidence intervals (CI): 0.68, 0.84) were overall comparable suggesting that novices can achieve good accuracy with the battery of tests if trained. The frequency of impaired performances in cervical movement control dysfunction tests was low and comparable between groups. Only two tests achieved a greater number of impaired ratings in the patient group. Although reliable, further research in larger neck pain populations is required to explore this battery of tests, in order to establish their diagnostic accuracy for identifying clinically relevant cervical movement control dysfunction.
Publisher: Springer Science and Business Media LLC
Date: 04-07-2022
DOI: 10.1038/S41598-022-14696-8
Abstract: Although neck pain is known to be a complex and multifactorial condition characterised by the interplay between physical and psychological domains, a comprehensive investigation examining the interactions across multiple features is still lacking. In this study, we aimed to unravel the structure of associations between physical measures of neuromuscular function and fear of movement in people with a history of neck pain. One hundred participants (mean age 33.3 ± 9.4) were assessed for this cross-sectional study, and the neuromuscular and kinematic features investigated were the range of motion, velocity of neck movement, smoothness of neck movement, neck proprioception (measured as the joint reposition error), and neck flexion and extension strength. The T a Scale for Kinesiophobia was used to assess fear of movement. A network analysis was conducted to estimate the associations across features, as well as the role of each feature in the network. The estimated network revealed that fear of movement and neuromuscular/kinematic features were conditionally dependent. Higher fear of movement was associated with a lower range of motion, velocity, smoothness of neck movement, neck muscle strength, and proprioception (partial correlations between − 0.05 and − 0.12). Strong interactions were also found between kinematics features, with partial correlations of 0.39 and 0.58 between the range of motion and velocity, and between velocity and smoothness, respectively. The velocity of neck movement was the most important feature in the network since it showed the highest strength value. Using a novel approach to analysis, this study revealed that fear of movement can be associated with a spectrum of neuromuscular/kinematic adaptations in people with a history of neck pain.
Publisher: BMJ
Date: 11-2019
DOI: 10.1136/BMJOPEN-2019-032113
Abstract: Temporomandibular disorders (TMDs) are principally characterised by pain in the craniomandibular area and probable limitations of jaw opening. Manual therapy, like other recommended conservative treatments included in clinical guidelines, is commonly used to treat patients with TMD to reduce pain and improve function. However, outcomes may be variable. The aim of this study is to identify predictors associated with pain reduction in patients with TMD following manual therapy by analysing a combination of patient-reported outcome measures and clinical tests. Such knowledge will support a more personalised management approach by facilitating clinical decision-making. An observational prospective design will recruit a cohort of 100 adults with a diagnosis of TMD (according to Axis I of the Diagnostic Criteria for TMD) at a Dental Hospital in Italy. Patients will be treated with four weekly sessions of manual therapy applied to craniomandibular structures. An array of predictors has been chosen based on previous research on prognostic factors for TMD and altered pain modulation in musculoskeletal disorders. Candidate predictors including demographic variables, general health variables, psychosocial features, TMD characteristics and clinical tests of the temporomandibular joint and masticatory muscles will be collected at baseline. Definition of good outcome is a clinically significant reduction of pain intensity over the last week (≥30% reduction Visual Analogue Scale) immediately following the four week intervention. Exploratory factor analysis will be applied to analyse factor loading of candidate predictors for good outcome at four weeks. Subsequently, a logistic multivariable regression model will be performed to calculate low and high risk of good outcome. Ethical approval has been obtained from the ‘Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico’ and University of Birmingham Ethics Committee. The results will be submitted for publication in a peer-reviewed journal and presented at conferences. NCT03990662 Pre-results.
Publisher: Wiley
Date: 29-05-2015
DOI: 10.1002/EJP.729
Abstract: Some studies support the prescription of exercise for people with whiplash-associated disorders (WAD) however, the response is highly variable. Further research is necessary to identify factors which predict response. This is a secondary analysis of a randomized, multicentre controlled clinical trial of 202 volunteers with chronic WAD (grades 2 and 3). They received either neck-specific exercise with, or without a behavioural approach, or prescription of physical activity for 12 weeks. Treatment response, defined as a clinical important reduction in pain or disability, was registered after 3 and 12 months, and factors associated with treatment response were explored using logistic regression. Participation in the neck-specific exercise group was the only significant factor associated with both neck pain and neck disability reduction both at 3 and 12 months. Patients in this group had up to 5.3 times higher odds of disability reduction and 3.9 times higher odds of pain reduction compared to those in the physical activity group. Different baseline features were identified as predictors of response depending on the time point examined and the outcome measure selected (pain vs. disability). Factors associated with treatment response after exercise interventions differ in the short and long term and differ depending on whether neck pain or disability is considered as the primary outcome. Participation in a neck-specific exercise intervention, in contrast to general physical activity, was the only factor that consistently indicated higher odds of treatment success. These results support the prescription of neck-specific exercise for in iduals with chronic WAD.
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 15-12-2011
Publisher: BMJ
Date: 04-2018
Publisher: MDPI AG
Date: 28-12-2021
DOI: 10.3390/JCM11010154
Abstract: The aim of this cross-sectional study was to explore the spatial extent of pain and its association with clinical symptoms, psychological features, and pain sensitization in people with frozen shoulder (FS). Forty-eight in iduals with FS completed pain drawings (PDs) and reported their clinical symptoms including pain intensity (Visual Analogue Scale) and shoulder disability (Shoulder Pain and Disability Index). Moreover, pain sensitization measurements (pressure pain thresholds, temporal summation, conditioned pain modulation, and Central Sensitization Inventory (CSI)) were assessed. Psychological features were assessed by Pain Catastrophizing Scale (PCS) and Pain Vigilance and Awareness Questionnaire. Pain frequency maps were generated, Margolis rating scale was used for pain location, and Spearman correlation coefficients were computed. The mean (SD) pain extent was 12.5% (6.7%) and the most common painful area was the anterolateral shoulder region (100%). Women presented a more widespread pain distribution compared with men. Significant positive associations were obtained between pain extent and current pain intensity (rs = 0.421, p 0.01), PCS (rs = 0.307, p 0.05) and CSI (rs = 0.358, p 0.05). The anterolateral region of the shoulder was the most common painful area in people with FS. Women with FS presented more extended areas of pain and a more widespread distribution of pain was correlated with higher levels of pain, pain catastrophizing and pain sensitization.
Publisher: Public Library of Science (PLoS)
Date: 04-2021
DOI: 10.1371/JOURNAL.PONE.0249220
Abstract: A plethora of evidence supports the existence of neuromuscular changes in people with chronic spinal pain (neck and low back pain), yet it is unclear whether neuromuscular adaptations persist for people with recurrent spinal pain when in a period of remission. This systematic review aimed to synthesise the evidence on neuromuscular adaptations in people with recurrent spinal pain during a period of remission. Electronic databases, grey literature, and key journals were searched from inception up to the 4 th of September 2020. Eligibility criteria included observational studies investigating muscle activity, spine kinematics, muscle properties, sensorimotor control, and neuromuscular performance in adults (≥ 18 years) with recurrent spinal pain during a period of remission. Screening, data extraction, and quality assessment (Newcastle-Ottawa Scale) were conducted independently by two reviewers. Data synthesis was conducted per outcome domain. A meta-analysis with a random-effects model was performed where possible. The overall strength of evidence was rated using the Grading of Recommendations, Assessment, Development and Evaluation guidelines (GRADE). From 8292 records, 27 and five studies were included in a qualitative and quantitative synthesis, respectively. Very low level of evidence supports muscle activity changes in people with recurrent low back pain, especially greater co-contraction, redistribution of muscle activity, and delayed postural control of deeper trunk muscles. Reduced range of motion of the lumbar spine was also found. Meaningful conclusions regarding other outcome domains or people with recurrent neck pain could not be drawn. In conclusion, people with recurrent low back pain during a period of remission show muscle activity and spine kinematics adaptations. Future research should investigate the long-term impact of these changes, as well as adaptations in people with recurrent neck pain.
Publisher: Elsevier BV
Date: 02-2023
Publisher: Wiley
Date: 13-11-2022
DOI: 10.1002/EJP.2048
Abstract: Traumatic injuries are amongst the leading causes of death and disability in the world across all age groups. This systematic review aimed to (1) describe the role of post‐traumatic stress symptoms (PTSS) on the development of chronic pain and/or pain‐related disability following musculoskeletal trauma and (2) report pain and or pain‐related disability by injury severity/type. Electronic databases were searched, from inception to 31 November 2021 and updated on 10 May 2022, to identify studies in which: participants were adults aged ≥16 years sustaining any traumatic event that resulted in one or more musculoskeletal injuries an outcome measure of PTSS was used within 3 months of a traumatic event the presence of pain and/or pain‐related disability was recorded at a follow‐up of 3 months or more. Two reviewers independently screened papers and assessed the quality of included studies. Eight studies were included. Owing to between‐study heterogeneity, the results were synthesized using a narrative approach. Five studies investigated the relationship between PTSS and pain. Participants with PTSS were more likely to develop persistent pain for at least 12 months post‐injury. Six studies assessed the relationship between PTSS and pain‐related disability. The results suggest that patients with PTSS had significantly higher disability levels for at least 12 months post‐injury. Findings from this comprehensive systematic review support a clear relationship between PTSS post‐injury and future pain/disability, with the potential importance of certain PTSS clusters (hyper‐arousal and numbing). The findings of this systematic review indicate an association between PTSS reported within 3 months of a traumatic musculoskeletal injury and the development of longer‐term pain and disability. The PTSS clusters of ‘hyper‐arousal’ and ‘numbing’ appear to be of particular importance in this relationship. CRD42021285243.
Publisher: Springer Science and Business Media LLC
Date: 10-2002
DOI: 10.1007/S00421-002-0661-X
Abstract: In this study we examined the repeatability and reliability of the surface electromyographic (sEMG) signal mean frequency (MNF), average rectified value (ARV) and conduction velocity (CV) measured for the sternocleidomastoid (SCM) and the anterior scalene (AS) muscles in nine healthy volunteers during 15-s isometric cervical flexion contractions at 50% of the maximal voluntary contraction level over 3 non-consecutive days. Repeatability and reliability estimates were obtained for the initial values and rates of change of each sEMG variable by using both the Intraclass Correlation Coefficient (ICC) and the normalised standard error of the mean (nSEM). Results from SCM indicated good levels of repeatability for the initial value and slope of ARV (ICC>65%). For the AS, high levels of repeatability were identified for the initial value of MNF (ICC>70%) and the slope of ARV (ICC>75%). Values of nSEM in the range 2.8-7.2% were obtained for the initial values of MNF and CV for both SCM and AS, indicating clinically acceptable measurement precision. The low value obtained for the nSEM of the initial value of MNF for the AS, in combination with the high ICC, indicates that of all of the variables examined, this variable could offer the best normative index to distinguish between subjects with and without neck pain, and represents the sEMG variable of choice for future evaluation purposes.
Publisher: American Physiological Society
Date: 15-04-2014
Abstract: Muscle pain induces a complex reorganization of the motor strategy which cannot be fully explained by current theories. We tested the hypothesis that the neural control of muscles during reaching in the presence of nociceptive input is determined by a reorganization of muscle synergies with respect to control conditions. Muscle pain was induced by injection of hypertonic saline into the anterior deltoid muscle of eight men. Electromyographic (EMG) signals were recorded from 12 upper limb muscles as subjects performed a reaching task before (baseline) and after the injection of hypertonic (pain) saline, and after the pain sensation vanished. The EMG envelopes were factorized in muscle synergies, and activation signals extracted for each condition. Nociceptive stimulation resulted in a complex muscle reorganization without changes in the kinematic output. The anterior deltoid muscle activity decreased in all subjects while the changes in other muscles were subject specific. Three synergies sufficed to describe the EMG patterns in each condition, suggesting that reaching movements remain modular in the presence of experimental pain. Muscle reorganization in all subjects was accompanied by a change in the activation signals compatible with a change in the central drive to muscles. One, two or three synergies were shared between the baseline and painful conditions, depending on the subject. These results indicate that nociceptive stimulation may induce a reorganization of modular control in reaching. We speculate that such reorganization may be due to the recruitment of synergies specific to the painful condition.
Publisher: Wiley
Date: 10-04-2012
DOI: 10.1111/J.1365-2842.2012.02309.X
Abstract: The effects of muscle pain and fatigue on the control of jaw elevator muscles are not well known. Furthermore, the myoelectric manifestations of fatigue and recovery from fatigue in the masticatory muscles are not reported in literature. The main aims of this study were (i) to evaluate the possible use of surface electromyography (sEMG) as an objective measure of fatigue of the jaw elevator muscles, (ii) to compare the myoelectric manifestations of fatigue in the temporalis anterior and masseter muscles bilaterally, (iii) to assess recovery of the investigated muscles after an endurance test and (iv) to compare fatigue and recovery of the jaw elevator muscles in healthy subjects and patients with muscle-related temporomandibular disorders (TMD). The study was performed on twenty healthy volunteers and eighteen patients with muscle-related TMD. An intra-oral compressive-force sensor was used to measure the voluntary contraction forces close to the intercuspal position and to provide visual feedback of submaximal forces to the subject. Surface EMG signals were recorded with linear electrode arrays during isometric contractions at 20%, 40%, 60% and 80% of the maximum voluntary contraction force, during an endurance test and during the recovery phase. The results showed that (i) the slope of the mean power spectral frequency (MNF) and the initial average rectified value (ARV) could be used to monitor fatigue of the jaw elevators, (ii) the temporalis anterior and masseter muscle show the same myoelectric manifestations of fatigue and recovery and (iii) the initial values of MNF and ARV were lower in patients with muscle-related TMD. The assessment of myoelectric manifestations of fatigue in the masticatory muscles may assist in the clinical assessment of TMDs.
Publisher: Elsevier BV
Date: 08-2021
Publisher: Elsevier BV
Date: 08-2004
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 15-08-2008
DOI: 10.1016/J.PAIN.2008.04.004
Abstract: This study examined gender differences in the effect of experimental muscle pain on changes in the relative activation of regions of the upper trapezius muscle during a sustained contraction. Surface electromyographic (EMG) signals were recorded from multiple locations over the upper trapezius muscle with a 10 x 5 grid of electrodes from nine women and nine men during 90 degrees shoulder abduction sustained for 60s. Measurements were performed before and after the injection of 0.4 ml hypertonic (painful) and isotonic (control) saline into the cranial region of the upper trapezius muscle. The EMG root mean square (RMS) was computed for each location of the grid to form a map of the EMG litude distribution. The peak pain intensity following the injection of hypertonic saline was greater for women (numerical rating scale 0-10: women 6.0+/-2.1, men 4.2+/-0.9 P<0.01). For both genders, upper trapezius RMS averaged across the grid decreased following the injection of hypertonic saline (P<0.0001). Moreover, there was a relatively larger pain-induced decrease in RMS in the cranial region compared to the caudal region of the muscle for both genders. During the non-painful sustained contractions, the EMG RMS progressively increased more in the cranial than the caudal region, for both men and women, due to fatigue. This mechanism was maintained in men but not in women during the painful condition. The results demonstrate that muscle pain alters the normal adaptation of upper trapezius muscle activity to fatigue in women but not in men.
Publisher: BMJ
Date: 02-2021
DOI: 10.1136/BMJOPEN-2020-042729
Abstract: Chronic spinal pain (CSP) is the most common musculoskeletal disorder and is a leading cause of disability as per the Global Burden of Diseases. Previous reviews of microscopic changes in the spinal extensor muscles of people with CSP have focused on the lumbar region only and the results have been inconclusive. Therefore, in this protocol, we aim to assess microscopic changes in the extensor muscles of all spinal regions, investigating regionally specific changes in muscle fibre types of the spinal extensor muscles in patients with non-specific CSP. This protocol was designed using Preferred Reporting Items for Systematic Review and Meta-Analysis Protocols (PRISMA-P) guidelines. Searches will use the following databases: MEDLINE, Embase, PubMed, CINAHL Plus and Web of Science along with relevant grey literature searches. Two reviewers will conduct the searches, perform data extraction, apply inclusion criteria and conduct risk of bias assessment using Newcastle-Ottawa Scale. Data will be synthesised and analysed independently. If there is sufficient homogeneity, then meta-analysis will be conducted by the reviewers jointly. If not, meta-synthesis or narrative reporting will be performed. The quality of the evidence will be assessed using Grading of Recommendations, Assessment, Development and Evaluation (GRADE) guidelines. The results of this study will be submitted for publication to a peer-reviewed journal and will be presented at conferences. Ethical approval for this systematic review was not required due to no patient data being collated. CRD42020198087.
Publisher: Springer Science and Business Media LLC
Date: 19-10-2006
DOI: 10.1007/S00221-006-0746-6
Abstract: The aim of the study was to examine the effect of experimental unilateral upper trapezius muscle pain on the relative activation of trapezius muscle sub isions bilaterally during repetitive movement of the upper limb. Surface EMG signals were detected from nine healthy subjects from the upper, middle and lower isions of trapezius during a repetitive bilateral shoulder flexion task. Measurements were performed before and after injection of 0.5 ml hypertonic (pain condition) and isotonic (control) saline into the upper ision of the right trapezius muscle in two experimental sessions. On the painful side, upper trapezius showed decreased EMG litude (average rectified value, ARV) and lower trapezius increased ARV throughout the entire task following the injection of hypertonic saline (40.0 +/- 22.2 vs. 26.0 +/- 17.4 microV, and 12.5 +/- 7.6 vs. 25.6 +/- 14.8 microV, respectively, at the beginning of the contraction). On the side contralateral to pain, greater estimates of ARV were identified for the upper ision of trapezius as the task progressed (37.4 +/- 20.2 vs. 52.7 +/- 28.4 microV, at the end of the contraction). Muscle fiber conduction velocity did not change with pain in all three isions of the right trapezius muscle. The results suggest that local elicitation of nociceptive afferents in the upper ision of the trapezius induces reorganization in the coordinated activity of the three sub isions of the trapezius in repetitive dynamic tasks.
Publisher: Oxford University Press (OUP)
Date: 10-2003
Abstract: Background and Purpose. This study evaluated an electromyographic technique for the measurement of muscle activity of the deep cervical flexor (DCF) muscles. Electromyographic signals were detected from the DCF, sternocleidomastoid (SCM), and anterior scalene (AS) muscles during performance of the craniocervical flexion (CCF) test, which involves performing 5 stages of increasing craniocervical flexion range of motion—the anatomical action of the DCF muscles. Subjects. Ten volunteers without known pathology or impairment participated in this study. Methods. Root-mean-square (RMS) values were calculated for the DCF, SCM, and AS muscles during performance of the CCF test. Myoelectric signals were recorded from the DCF muscles using bipolar electrodes placed over the posterior oropharyngeal wall. Reliability estimates of normalized RMS values were obtained by evaluating intraclass correlation coefficients and the normalized standard error of the mean (SEM). Results. A linear relationship was evident between the litude of DCF muscle activity and the incremental stages of the CCF test (F=239.04, df=36, P& .0001). Normalized SEMs in the range 6.7% to 10.3% were obtained for the normalized RMS values for the DCF muscles, providing evidence of reliability for these variables. Discussion and Conclusion. This approach for obtaining a direct measure of the DCF muscles, which differs from those previously used, may be useful for the examination of these muscles in future electromyographic applications.
Publisher: MDPI AG
Date: 22-01-2022
DOI: 10.3390/JCM11030555
Abstract: This study investigates whether baseline pain extent, extracted from an electronic pain drawing, is an independent predictive factor of pain and disability measured 1 year and 2 years later in people with chronic WAD. Participants completed questionnaires assessing neck pain intensity, disability via the Neck Disability Index (NDI), psychological features, and work ability. Participants also completed electronic pain drawings from which their pain extent was extracted. A two-step modelling approach was undertaken to identify the crude and adjusted association between pain extent and NDI measured at 1-year and 2-year follow-ups. A total of 205 participants were included in the analysis. The univariate analysis showed that pain extent was significantly associated with the NDI score at the 1-year (p = 0.006, 95% CI: 0.159–0.909) and 2-year (p = 0.029, 0.057–0.914) follow-ups. These associations were not maintained when we introduced perceived disability, psychological health, and work ability into the model after 1 year (p = 0.56, 95%CI: −0.28–0.499) and 2 years (p = 0.401, −0.226–0.544). Pain extent, as an independent factor, was significantly associated with perceived pain and disability in patients with chronic WAD for up to 2 years. This association was masked by neck disability, psychological health, and work ability.
Publisher: Medical Journals Sweden AB
Date: 2016
Abstract: To compare short- and long-term changes in neck muscle endurance, electromyography measures of neck muscle activation and fatigue and ratings of fatigue and pain after neck-specific training or physical activity in people with cervical radiculopathy. Randomized clinical trial. Seventy-five patients with cervical radiculopathy. Patients underwent neck-specific training in combination with a cognitive behavioural approach or prescribed physical activity over a period of 14 weeks. Immediately after the intervention and 12 months later, surface electromyography was recorded from neck flexor and extensor muscles during neck endurance tests. Time to task failure, litude and median frequency of the electromyography signal, and subjective fatigue and pain ratings were analysed in 50 patients who completed at least one follow-up. A significant increase in neck flexor endurance time was observed for both groups at 14 weeks compared with baseline and this was maintained at the 12-month follow-up (p < 0.005). No change was identified for the slope of the median frequency. For the neck-specific training group, splenius capitis was less active during neck flexion at both follow-ups (p < 0.01), indicating reduced muscle co-activation. Both specific and general exercise increased neck flexor endurance, but neck-specific training only reduced co-activation of antagonist muscles during sustained neck flexion.
Publisher: Elsevier BV
Date: 11-2014
DOI: 10.1016/J.JMPT.2014.08.007
Abstract: The purpose of this study was to investigate the effect of active vs passive scapular correction on pain and pressure pain threshold at the most symptomatic cervical segment in patients with chronic neck pain. Twenty-three volunteers with chronic, idiopathic neck pain were recruited (age, 38.9 ± 14.4 years sex [man/woman], 3/20 Neck Disability Index, 28.1% ± 9.9%). Subjects were randomly allocated to 2 groups: active scapular correction or passive scapular correction. Pressure pain threshold and pain intensity rated on a numerical rating scale during a posteroanterior glide over the most symptomatic cervical segment were measured before and immediately after the active or passive scapular intervention. Only the active scapular correction produced a reduction in pain (pre, 6.3 ± 1.2 post, 3.7 ± 2.4 P < .05) and increase in pressure pain threshold (pre, 8.7 ± 4.2 kg/cm(2) post, 10.1 ± 3.8 kg/cm(2) P < .05) at the most painful cervical segment. An active scapular correction exercise resulted in an immediate reduction of pain and pressure pain sensitivity in patients with chronic neck pain and scapular dysfunction.
Publisher: BMJ
Date: 02-2020
DOI: 10.1136/BMJOPEN-2019-029855
Abstract: The aim of this Delphi survey was to establish an international consensus on the most useful outcome measures for research on the effectiveness of non-pharmacological interventions for migraine. This is important, since guidelines for pharmacological trials recommend measuring the frequency of headaches with 50% reduction considered a clinically meaningful effect. It is unclear whether the same recommendations apply to complementary (or adjunct) non-pharmacological approaches, whether the same cut-off levels need to be considered for effectiveness when used as an adjunct or stand-alone intervention, and what is meaningful to patients. University-initiated international survey. The expert panel was chosen based on publications on non-pharmacological interventions in migraine populations and from personal contacts. 35 eligible researchers were contacted, 12 agreed to participate and 10 completed all 3 rounds of the survey. To further explore how migraine patients viewed potential outcome measures, four migraine patients were interviewed and presented with the same measurement tools as the researchers. The initial Delphi round was based on a systematic search of the literature for outcome measures used in non-pharmacological interventions for headache. Suggested outcome measures were rated by each expert, blinded towards the other members of the panel, for its usefulness on a 5-point Likert scale ranging from definitely not useful to extremely useful. Results were combined using median values and IQRs. Tools rated overall as definitely or probably not useful were excluded from subsequent rounds. Experts further suggested additional outcome measures that were presented to the panel in subsequent rounds. Additionally, experts were asked to rank the most useful tools and provide information on feasible cut-off levels for effectiveness for the three highest ranked tools. Results suggest the use of the Migraine Disability Assessment (MIDAS), Headache Impact Test (HIT-6) and headache frequency as primary outcome measures. Patient experts suggested the inclusion of a measure of quality of life and evaluation of associated symptoms and fear of attacks. Recommendations are for the use of the MIDAS, the HIT-6 and headache frequency, in combination with an outcome measure for quality of life. Associated symptoms and fear of attacks should also be considered as secondary outcomes, if relevant for the in idual target population. The cut-off level for effectiveness should be lower for non-pharmacological interventions, especially when used as an adjunct to medication. German Register of Clinical Trials (DRKS00011777)
Publisher: American Physiological Society
Date: 08-2015
Abstract: It has been observed that muscle pain influences force variability and low-frequency ( Hz) oscillations in the neural drive to muscle. In this study, we aimed to investigate the effect of experimental muscle pain on the neural control of muscle force at higher frequency bands, associated with afferent feedback (alpha band, 5–13 Hz) and with descending cortical input (beta band, 15–30 Hz). Single-motor unit activity was recorded, in two separate experimental sessions, from the abductor digiti minimi (ADM) and tibialis anterior (TA) muscles with intramuscular wire electrodes, during isometric abductions of the fifth finger at 10% of maximal force [maximum voluntary contraction (MVC)] and ankle dorsiflexions at 25% MVC. The contractions were repeated under three conditions: no pain (baseline) and after intramuscular injection of isotonic (0.9%, control) and hypertonic (5.8%, painful) saline. The results showed an increase of the relative power of both the force signal and the neural drive at the tremor frequency band (alpha, 5–13 Hz) between the baseline and hypertonic (painful) conditions for both muscles ( P 0.05) but no effect on the beta band. Additionally, the strength of motor unit coherence was lower ( P 0.05) in the hypertonic condition in the alpha band for both muscles and in the beta band for the ADM. These results indicate that experimental muscle pain increases the litude of the tremor oscillations because of an increased variability of the neural control (common synaptic input) in the tremor band. Moreover, the concomitant decrease in coherence suggests an increase in independent input in the tremor band due to pain.
Publisher: Elsevier BV
Date: 06-2007
DOI: 10.1016/J.JELEKIN.2006.03.005
Abstract: The purpose of this study was to explore changes in spatial muscle activation within the three isions of the trapezius muscle during a dynamic, cyclic task of the upper limb. Surface EMG signals were detected from thirteen healthy subjects from the upper, middle and lower isions of the trapezius muscle at multiple electrode sites in the cephalad-caudal direction during a repetitive shoulder flexion task. Initial values and rate of change of average rectified value (ARV) and of instantaneous mean power spectral frequency (iMNF) were estimated at 45 degrees , 90 degrees and 120 degrees of shoulder flexion throughout the 5-min task. The location of the electrodes had a significant effect on initial EMG ARV for both the upper and middle ision of the trapezius muscle (P<0.05). Both the rate of change and normalized rate of change of ARV were greatest for the most cranial muscle fibers of the upper ision (P<0.05). Initial values and rates of change of iMNF were also affected by electrode location for the upper and lower isions of the trapezius muscle (P<0.05). These results demonstrate that muscle activity and its changes over time depend on position within the three isions of the trapezius muscle during a dynamic, cyclic task of the upper limb. This suggests non-uniform muscle fiber distribution and/or recruitment. The results also highlight the importance of multiple recording sites when investigating trapezius muscle function in dynamic tasks.
Publisher: Springer Science and Business Media LLC
Date: 16-01-2023
DOI: 10.1186/S13643-022-02162-5
Abstract: Measurement of neck muscle strength is common during the assessment of people with chronic neck pain (CNP). This systematic review evaluates the measurement properties (reliability, validity, and responsiveness) of neck muscle strength measures in people with CNP. This systematic review followed a PROSPERO registered protocol (CRD42021233290). Electronic databases MEDLINE (OVID interface), CINAHL, SPORTDiscuss via (EBSCO interface), EMBASE (OVID interface), and Web of Science were searched from inception to 21 June 2021. Screening, data extraction, and quality assessment (Consensus-based Standards for the selection of Health Measurement Instruments (COSMIN) checklist) were conducted independently by two reviewers. The overall strength of evidence was evaluated using the modified Grading of Recommendations Assessment, Development and Evaluation. From 794 records, nine articles were included in this review which concerned six different neck strength outcome measures. All studies evaluated reliability and one evaluated construct validity. The reliability of neck strength measures ranged from good to excellent. However, the risk of bias was rated as doubtful/inadequate for all except one study and the overall certainty of evidence was rated low/very low for all measures except for the measurement error of a handheld dynamometer. A multitude of measures are used to evaluate neck muscle strength in people with CNP, but their measurement properties have not been fully established. Further methodologically rigorous research is required to increase the overall quality of evidence.
Publisher: American Physiological Society
Date: 11-2022
DOI: 10.1152/JAPPLPHYSIOL.00758.2021
Abstract: By employing ultrasound-transparent high-density EMG electrodes, we show that modulations in tibialis anterior muscle motor unit discharge rate were related to both changes in fascicle length and resultant torque. These relationships permitted the quantification of the relative delays between fluctuations in neural drive, muscle contraction, and transfer of torque via the tendon during sustained isometric dorsiflexion contractions, providing information on the conversion of neural activity into muscle force during a contraction.
Publisher: Elsevier BV
Date: 08-2004
Publisher: BMJ
Date: 10-2019
DOI: 10.1136/BMJOPEN-2019-029850
Abstract: Chronic, non-specific low back pain is a major global cause of disability. One factor which might potentially contribute to ongoing pain is maladaptive variation in the level of activity in the lumbar musculature. Several studies have investigated this activity using surface electromyography, in varied muscles and during a number of functional activities. Due to differences in the applied methodology, the results have been difficult to compare, and previous reviews have been limited in scope. In this protocol, we aim to perform a comprehensive review of the effect of chronic low back pain on lumbar muscle activity. This protocol was informed by the Preferred Reporting Items for Systematic Review and Meta-analysis Protocols (PRISMA-P) and results will be reported in line with the PRISMA. Searches will be conducted on the Web of Science, PubMed, MEDLINE, EMBASE, ZETOC and CINAHL databases, along with a comprehensive review of grey literature and key journals. One reviewer will conduct the searches, but two independent reviewers will screen potential studies and assess the risk of bias within studies which meet the inclusion criteria. The Newcastle-Ottawa risk of bias tool, and the Grading of Recommendations, Assessment, Development and Evaluation (GRADE) guidelines will be used to assess the quality of the data. Meta-analysis will be conducted where appropriate on groups of studies with homogenous methodology. Where studies are too heterogeneous to allow for meta-analysis, meta-synthesis will instead be completed, comparing results in terms of net increases or decreases of activity. This review aims to identify common adaptations of muscle activity in people with low back pain and it is expected that the results will influence future research directions and future rehabilitation approaches. The results will be submitted for publication in a peer-reviewed journal and presented at conferences. CRD42019125156
Publisher: BMJ
Date: 03-2021
DOI: 10.1136/BMJOPEN-2020-043021
Abstract: Cervical radiculopathy (CR) is a clinical condition whereby motor, reflex and/or sensory changes such as radicular pain, paraesthaesia or numbness can exist. Conservative management is a preferred first treatment option as the risk–benefit ratio for surgery is less favourable. Systematic reviews and treatment guidelines gather evidence on the effectiveness of non-surgical management of patients with CR from randomised controlled trials, which do not consider the natural course of recovery to modify the management strategy accordingly. The aim of this study is to establish consensus on effective non-surgical treatment modalities for patients in different stages (acute, subacute and chronic) of CR, using the Delphi method approach. Through an iterative multistage process, experts within the field will rate their agreement with a list of proposed treatment modalities and suggest any missing treatment modalities during each round. Agreement will be measured using a five-point Likert scale. Descriptive statistics will be used to measure agreement (median, IQR and percentage of agreement). Consensus criteria will be defined a priori for each round. Data analysis at the end of round three will produce a consensus list of effective treatment modalities for the management of patients with CR in different stages of recovery. Ethical approval has been granted from the University of Birmingham ethics committee under ERN_20-1121. The study findings will be submitted to a peer-reviewed journal and to relevant conferences for dissemination of the study results.
Publisher: Springer Science and Business Media LLC
Date: 13-02-2018
Publisher: Public Library of Science (PLoS)
Date: 08-11-2018
Publisher: BMJ
Date: 10-2020
DOI: 10.1136/BMJOPEN-2019-035736
Abstract: Not all factors that predict persistent pain and disability following whiplash injury are known. In particular, few physical factors, such as changes in movement and muscle behaviour, have been investigated. The aim of this study is to identify predictive factors that are associated with the development of persistent pain and disability following a whiplash injury by combining contemporary measures of physical function together with established psychological and pain-related predictive factors. A prospective observational study will recruit 150 consecutive eligible patients experiencing whiplash-related symptoms, admitted to a private physiotherapy clinic in Spain within 15 days of their whiplash injury. Poor outcome will be measured using the Neck Disability Index (NDI), defined as an NDI score of 30% or greater at 6 months post injury. Candidate predictors, including demographic characteristics, injury characteristics, pain characteristics, self-reported psychosocial factors and physical factors, will be collected at baseline (within 15 days of inception). Regression analyses will be performed to identify factors that are associated with persistent neck pain and disability over the study period. The project has been approved by the Ethics Committee of the province of Malaga, Spain (#30052019). The results of this study will be published in peer-reviewed journals.
Publisher: Springer Science and Business Media LLC
Date: 25-03-2021
DOI: 10.1038/S41598-021-86344-6
Abstract: The inter-session Intraclass Correlation Coefficient (ICC) is a commonly investigated and clinically important metric of reliability for pressure pain threshold (PPT) measurement. However, current investigations do not account for inter-repetition variability when calculating inter-session ICC, even though a PPT measurement taken at different sessions must also imply different repetitions. The primary aim was to evaluate and report a novel metric of reliability in PPT measurement: the inter-session-repetition ICC. One rater recorded ten repetitions of PPT measurement over the lumbar region bilaterally at two sessions in twenty healthy adults using a pressure algometer. Variance components were computed using linear mixed-models and used to construct ICCs most notably inter-session ICC and inter-session-repetition ICC. At 70.1% of the total variance, the source of greatest variability was between subjects ( $${\\sigma }_{subj}^{2}$$ σ subj 2 = 222.28 N 2 ), whereas the source of least variability (1.5% total variance) was between sessions ( $${\\sigma }_{sess}^{2}$$ σ sess 2 = 4.83 N 2 ). Derived inter-session and inter-session-repetition ICCs were 0.88 (95%CI: 0.77 to 0.94) and 0.73 (95%CI: 0.53 to 0.84) respectively. Inter-session-repetition ICC provides a more conservative estimate of reliability than inter-session ICC, with the magnitude of difference being clinically meaningful. Quantifying in idual sources of variability enables ICC construction to be reflective of in idual testing protocols.
Publisher: Public Library of Science (PLoS)
Date: 21-06-2021
DOI: 10.1371/JOURNAL.PONE.0252657
Abstract: Neuromuscular impairments are frequently observed in patients with chronic neck pain (CNP). This study uniquely investigates whether changes in neck muscle synergies detected during gait are sensitive enough to differentiate between people with and without CNP. Surface electromyography (EMG) was recorded from the sternocleidomastoid, splenius capitis, and upper trapezius muscles bilaterally from 20 asymptomatic in iduals and 20 people with CNP as they performed rectilinear and curvilinear gait. Intermuscular coherence was computed to generate the functional inter-muscle connectivity network, the topology of which is quantified based on a set of graph measures. Besides the functional network, spectrotemporal analysis of each EMG was used to form the feature set. With the use of Neighbourhood Component Analysis (NCA), we identified the most significant features and muscles for the classification/differentiation task conducted using K-Nearest Neighbourhood (K-NN), Support Vector Machine (SVM), and Linear Discriminant Analysis (LDA) algorithms. The NCA algorithm selected features from muscle network topology as one of the most relevant feature sets, which further emphasize the presence of major differences in muscle network topology between people with and without CNP. Curvilinear gait achieved the best classification performance through NCA-SVM based on only 16 features (accuracy: 85.00%, specificity: 81.81%, and sensitivity: 88.88%). Intermuscular muscle networks can be considered as a new sensitive tool for the classification of people with CNP. These findings further our understanding of how fundamental muscle networks are altered in people with CNP.
Publisher: Wiley
Date: 24-02-2021
DOI: 10.1002/EJP.1741
Publisher: Elsevier BV
Date: 02-2014
DOI: 10.1016/J.MATH.2013.05.011
Abstract: This study compared the immediate effects of an assisted plus active cranio-cervical flexion exercise (exercise group) versus a passive mobilisation plus assisted cranio-cervical flexion (mobilisation group) on performance of the cranio-cervical flexion test (CCFT), cervical range of motion (ROM) and pain in patients with chronic neck pain. Eighteen volunteers with chronic idiopathic neck pain participated in the study and were randomised to one of the two intervention groups. Current level of pain, cervical ROM and pain perceived during movement, pressure pain threshold (PPT) and surface electromyography (EMG) during performance of the CCFT were measured before and immediately after the intervention. A significant reduction in resting pain and PPT measured over cervical sites was observed immediately following both interventions, although a greater change was observed for the exercise group. No change in cervical ROM was observed after either intervention. Reduced sternocleidomastoid and anterior scalene EMG litude were observed during stages of the CCFT but only for the participants in the active exercise group. Although both active and passive interventions offered pain relief, only the exercise group improved on a task of motor function highlighting the importance of specific active treatment for improved motor control of the cervical spine.
Publisher: Springer Science and Business Media LLC
Date: 15-03-2014
DOI: 10.1007/S00221-014-3891-3
Abstract: The aim of this study was to assess the activation of the sternocleidomastoid (SCM) and splenius capitis (SC) muscles in response to unanticipated, full body perturbations in in iduals with chronic neck pain (NP) and age-matched healthy controls (HC). In iduals with NP had a history of NP for 8.9 ± 7.8 years, rated the intensity of NP as 4.2 ± 2.0 (score out of 10), and scored 15.3 ± 6.5 on the Neck Disability Index. Participants stood on a moveable platform during which 32 randomized postural perturbations (eight repetitions of four perturbation types: 8 cm forward slide (FS), 8 cm backward slides, 10° forward tilt, and 10° backward tilt) with varying inter-perturbation time intervals were performed over a period of 5 min. Bilateral surface electromyography (EMG) from the SCM and SC was recorded, and the onset time and the average rectified value of the EMG signal was determined for epochs of 100 ms starting 100 ms prior to and 500 ms after the perturbation onset. In iduals with NP, as compared to HC, demonstrated delayed onset times and reduced EMG litude of the SCM and SC muscles in response to all postural perturbations. Such findings were most pronounced following the FS postural perturbation (healthy vs. NP for SCM 83.3 ± 8.0 vs. 86.3 ± 4.4 and SC 75.6 ± 3.5 vs. 89.3 ± 4.2), which was also associated with the greatest change (expressed in % relative to baseline) in EMG litude (healthy vs. NP for SCM 206.6 ± 50.4 vs. 115.9 ± 15.7 and SC 83.4 ± 19.2 vs. 69.2 ± 10.9) across all postural perturbations types. In iduals with NP display altered neural control of the neck musculature in response to rapid, unanticipated full body postural perturbations. Although the relative timing of neck musculature activity in in iduals with NP appears to be intact, simultaneous co-activation of the neck musculature emerges for unanticipated anterior-posterior postural perturbations.
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 05-2011
Publisher: Wiley
Date: 18-11-2020
DOI: 10.1111/PAPR.12851
Abstract: Central sensitization may be present in some patients with hip osteoarthritis (OA), often reflected as widespread pain. We examine the association between pain extent with signs of central sensitization and other clinical and psychological features in patients with hip OA. Thirty patients with hip OA were recruited for this cross-sectional observational study. Participants completed pain drawings on a digital tablet, which displayed frontal and dorsal views of the body. The pain extent (%) for each participant was determined by combining the frontal and dorsal pixels shaded and iding by the total pixels of the body chart area. Participants completed patient-reported outcome measures to assess for signs and symptoms of central sensitization and psychosocial factors. Quantitative sensory testing including pain pressure thresholds (PPTs) and thermal pressure thresholds was performed at points anatomically local and distant from the hip. Women had significantly greater pain extent (6.71%) than men (2.65%) (z = -2.76, P < 0.01). Across all participants, increased pain extent was significantly associated with higher scores on the Widespread Pain Index (r Greater pain extent was associated with several measures of signs and symptoms of central sensitization in patients with hip OA. These results support the utility of the pain drawing for identifying signs of central sensitization in patients with hip OA.
Publisher: Springer Science and Business Media LLC
Date: 07-09-2022
DOI: 10.1038/S41598-022-19516-7
Abstract: We quantified the relationship between spatial oscillations in surface electromyographic (sEMG) activity and trunk-extension torque in in iduals with and without chronic low back pain (CLBP), during two submaximal isometric lumbar extension tasks at 20% and 50% of their maximal voluntary torque. High-density sEMG (HDsEMG) signals were recorded from the lumbar erector spinae (ES) with a 64-electrode grid, and torque signals were recorded with an isokinetic dynamometer. Coherence and cross-correlation analyses were applied between the filtered interference HDsEMG and torque signals for each submaximal contraction. Principal component analysis was used to reduce dimensionality of HDsEMG data and improve the HDsEMG-based torque estimation. sEMG-torque coherence was quantified in the δ(0–5 Hz) frequency bandwidth. Regional differences in sEMG-torque coherence were also evaluated by creating topographical coherence maps. sEMG-torque coherence in the δ band and sEMG-torque cross-correlation increased with the increase in torque in the controls but not in the CLBP group ( p = 0.018, p = 0.030 respectively). As torque increased, the CLBP group increased sEMG-torque coherence in more cranial ES regions, while the opposite was observed for the controls ( p = 0.043). In iduals with CLBP show reductions in sEMG-torque relationships possibly due to the use of compensatory strategies and regional adjustments of ES-sEMG oscillatory activity.
Publisher: MDPI AG
Date: 07-12-2021
DOI: 10.3390/S21248175
Abstract: It remains unknown whether variation of scores on the Medical Research Council (MRC) scale for muscle strength is associated with operator-independent techniques: dynamometry and surface electromyography (sEMG). This study aimed to evaluate whether the scores of the MRC strength scale are associated with instrumented measures of torque and muscle activity in post-stroke survivors with severe hemiparesis both before and after an intervention. Patients affected by a first ischemic or hemorrhagic stroke within 6 months before enrollment and with complete paresis were included in the study. The pre- and post-treatment assessments included the MRC strength scale, sEMG, and dynamometry assessment of the triceps brachii (TB) and biceps brachii (BB) as measures of maximal elbow extension and flexion torque, respectively. Proprioceptive-based training was used as a treatment model, which consisted of multidirectional exercises with verbal feedback. Each treatment session lasted 1 h/day, 5 days a week for a total 15 sessions. Nineteen in iduals with stroke participated in the study. A significant correlation between outcome measures for the BB (MRC and sEMG
Publisher: American Physiological Society
Date: 2012
DOI: 10.1152/JAPPLPHYSIOL.00802.2011
Abstract: This study examined the effects of 3 wk of either endurance or strength training on plasticity of the neural mechanisms involved in the soleus H reflex and V wave. Twenty-five sedentary healthy subjects were randomized into an endurance group ( n = 13) or strength group ( n = 12). Evoked V-wave, H-reflex, and M-wave recruitment curves, maximal voluntary contraction (MVC), and time-to-task-failure (isometric contraction at 40% MVC) of the plantar flexors were recorded before and after training. Following strength training, MVC of the plantar flexors increased by 14.4 ± 5.2% in the strength group ( P 0.001), whereas time-to-task-failure was prolonged in the endurance group (22.7 ± 17.1% P 0.05). The V wave-to-maximal M wave (V/M max ) ratio increased significantly (55.1 ± 28.3% P 0.001) following strength training, but the maximal H wave-to-maximal M wave (H max /M max ) ratio remained unchanged. Conversely, in the endurance group the V/M max ratio was not altered, whereas the H max /M max ratio increased by 30.8 ± 21.7% ( P 0.05). The endurance training group also displayed a reduction in the H-reflex excitability threshold while the H-reflex litude on the ascending limb of the recruitment curve increased. Strength training only elicited a significant decrease in H-reflex excitability threshold, while H-reflex litudes over the ascending limb remained unchanged. These observations indicate that the H-reflex pathway is strongly involved in the enhanced endurance resistance that occurs following endurance training. On the contrary, the improvements in MVC following strength training are likely attributed to increased descending drive and/or modulation in afferents other than Ia afferents.
Publisher: Elsevier BV
Date: 12-2008
DOI: 10.1016/J.JELEKIN.2007.05.007
Abstract: This study investigated whether pain-induced changes in cervical muscle activation affect myoelectric manifestations of cervical muscle fatigue. Surface EMG signals were detected from the sternocleidomastoid and splenius capitis muscles bilaterally from 14 healthy subjects during 20-s cervical flexion contractions at 25% of the maximal force. Measurements were performed before and after the injection of 0.5 ml of hypertonic (painful) or isotonic (control) saline into either the sternocleidomastoid or splenius capitis in two experimental sessions. EMG average rectified value and mean power spectral frequency were estimated throughout the sustained contraction. Sternocleidomastoid or splenius capitis muscle pain resulted in lower sternocleidomastoid EMG average rectified value on the side of pain (P < 0.01). However, changes over time of sternocleidomastoid EMG average rectified value and mean frequency (myoelectric manifestations of fatigue) during sustained flexion were not changed during muscle pain. These results demonstrate that pain-induced modifications of cervical muscle activity do not change myoelectric manifestations of fatigue. This finding has implications for interpreting the mechanisms underlying greater cervical muscle fatigue in people with neck pain disorders.
Publisher: American Physiological Society
Date: 2022
DOI: 10.1152/JAPPLPHYSIOL.00218.2021
Abstract: Although maximal force increases following short-term isometric strength training, the rate of force development (RFD) may remain relatively unaffected. The underlying neural and muscular mechanisms during rapid contractions after strength training are largely unknown. Since strength training increases the neural drive to muscles, it may be hypothesized that there are distinct neural or muscular adaptations determining the change in RFD independently of an increase in maximal force. Therefore, we examined motor unit population data acquired from surface electromyography during the rapid generation of force before and after 4 wk of strength training. We observed that strength training did not change the RFD because it did not influence the number of motor units recruited per second or their initial discharge rate during rapid contractions. Although strength training did not change motoneuron behavior in the force increase phase of rapid contractions, it increased the discharge rate of motoneurons (by ∼4 spikes/s) when reaching the plateau phase (∼150 ms) of the rapid contractions, determining an increase in maximal force production. Computer simulations with a motor unit model that included neural and muscular properties, closely matched the experimental observations and demonstrated that the lack of change in RFD following training is primarily mediated by an unchanged maximal recruitment speed of motoneurons. These results demonstrate that maximal force and contraction speed are determined by different adaptations in motoneuron behavior following strength training and indicate that increases in the recruitment speed of motoneurons are required to evoke training-induced increases in RFD.
Publisher: Elsevier BV
Date: 12-2008
DOI: 10.1016/J.JELEKIN.2007.05.008
Abstract: The purpose of this study was to determine whether surface electromyography (EMG) assessment of myoelectric manifestations of muscle fatigue is capable of detecting differences between the vastus lateralis and medialis muscles which are consistent with the results of previous biopsy studies. Surface EMG signals were recorded from the vastus medialis longus (VML), vastus medialis obliquus (VMO) and vastus lateralis (VL) muscles during isometric knee extension contractions at 60% and 80% of the maximum voluntary contraction (MVC) for 10s and 60s, respectively. Initial values and rate of change of mean frequency (MNF), average rectified value (ARV) and conduction velocity (CV) of the EMG signal were calculated. Comparisons between the two force levels revealed that the initial values of MNF for the VL muscle were greater at 80% MVC compared to 60% MVC (P<0.01). Comparisons between the vasti muscles demonstrated lower initial values of CV for VMO compared to VL at 60% MVC (P<0.01) and lower than VML and VL at 80% MVC (P<0.01). In addition, initial values of MNF were higher for VL with respect to both VML and VMO at 80% MVC (P<0.01) and initial estimates of ARV were higher for VMO compared to VML at both force levels (P<0.01 at 60% MVC and P<0.05 at 80% MVC). For the sustained contraction at 80% MVC, VL demonstrated a greater decrease in CV over time compared to VMO (P<0.05). These findings suggest that surface EMG signals and their time course during sustained isometric contractions may be useful to non-invasively describe functional differences between the vasti muscles.
Publisher: Cold Spring Harbor Laboratory
Date: 28-04-2021
DOI: 10.1101/2021.04.27.441619
Abstract: The integration of electromyography (EMG) and ultrasound imaging has provided important information about the mechanisms of muscle activation and contraction. Unfortunately, EMG does not allow an accurate assessment of the interplay between the neural drive received by muscles, changes in fascicle length (FL) and the force/torque produced. We aimed to assess the relationship between modulations in tibialis anterior (TA) motor unit (MU) firing rate, FL and dorsiflexion torque (DT) using ultrasound-transparent high-density EMG electrodes. EMG and ultrasound images were recorded simultaneously from TA, using a 32-electrode silicon matrix, while performing isometric dorsiflexion, at erse ankle joint positions (0° and 30° plantar flexion) and torques (20% and 40% of maximum). EMG signals were decomposed into in idual MUs and changes in FL were assessed with a fascicle-tracking algorithm. MU firings were converted into a cumulative spike train (CST) that was cross-correlated with DT (CST-DT) and FL (CST-FL). High cross-correlations were found for CST-FL, 0.60 (range: 0.31-0.85) and CST-DT 0.71 (range: 0.31-0.88). Cross-correlation lags revealed that the delay between CST-FL (~75ms) was significantly smaller than CST-DT (~150ms, p .001). These delays affected the interpretation of MU recruitment/de-recruitment thresholds, with FL showing similar lengths for both recruitment and de-recruitment. This study is the first to demonstrate that changes in TA FL are closely related to both modulations in MU firing frequency and DT. These relationships allow assessment of the interplay between neural drive, muscle contraction and resultant torque, thereby providing a better understanding of the mechanisms responsible for the generation of muscle force. By employing ultrasound-transparent high-density surface EMG electrodes, we show that modulations in tibialis anterior motor unit discharge rate were closely related to both changes in its fascicle length and resultant torque. These relationships allowed quantifying delays between neural drive and muscle shortening as well as muscle shortening and torque during submaximal isometric contractions, providing an accurate estimation of the time required to generate muscle force and subsequent production of torque via the tendon.
Publisher: Wiley
Date: 08-07-2022
DOI: 10.1111/PAPR.13147
Abstract: Pain drawings are commonly used in the clinical assessment of people with cervical radiculopathy. This study aimed to assess (1) the agreement of clinical interpretation of pain drawings and MRI findings in identifying the affected level of cervical radiculopathy, (2) the agreement of these predictions based on the pain drawing among four clinicians from two different professions (i.e., physiotherapy and surgery) and (3) the topographical pain distribution of people presenting with cervical radiculopathy (C4–C7). Ninety‐eight pain drawings were obtained from a baseline assessment of participants in a randomized clinical trial, in which single‐level cervical radiculopathy was determined using MRI. Four experienced clinicians independently rated each pain drawing, attributing the pain distribution to a single nerve root (C4–C7). A post hoc analysis was performed to assess agreement. Percentage agreement and kappa values were used to assess the level of agreement. Topographic pain frequency maps were created for each cervical radiculopathy level as determined by MRI. The radiculopathy level determined from the pain drawings showed poor overall agreement with MRI (mean = 35.7%, K = −0.007 to 0.139). The inter‐clinician agreement ranged from fair to moderate ( K = 0.212–0.446). Topographic frequency maps revealed that pain distributions were widespread and overlapped markedly between patients presenting with different levels cervical radiculopathy. This study revealed a lack of agreement between the segmental level affected determined from the patient's pain drawing and the affected level as identified on MRI. The large overlap of pain and non‐dermatomal distribution of pain reported by patients likely contributed to this result.
Publisher: Elsevier BV
Date: 08-2023
Publisher: Public Library of Science (PLoS)
Date: 05-11-2018
Publisher: BMJ
Date: 07-2023
DOI: 10.1136/BMJOPEN-2022-069327
Abstract: Clinical guidelines recommend conservative treatment for the management of temporomandibular disorders (TMD), and manual therapy directed to temporomandibular structures is commonly applied to reduce pain and improve function. In a recent prospective study, we developed a clinical prediction tool based on an array of predictors to identify people with TMD who are likely to experience significant pain relief and functional improvements following a programme of manual therapies (MTP) applied to temporomandibular structures. The purpose of this study is to externally validate in a different s le (temporal validation) the prediction model obtained in the initial study. This observational prospective study will recruit a cohort of 120 adults with TMD from a Dental Hospital in Italy. The intervention will be an MTP consisting of four sessions (once per week) of manual therapy applied to temporomandibular structures. Candidate predictors included in the predictive model will be pain intensity during mouth opening, treatment expectations, number of pain locations, central sensitisation, TMD pain duration and maximal mouth opening. Outcome measures (i.e., pain intensity, functional improvement) will be collected before starting the MTP, after the last session and after 1 month (2 months from baseline). A reduction of pain intensity by at least 30% will be considered a good outcome. External validity of the prediction model will be evaluated after the last session by measuring its calibration, discrimination and overall fit. Additionally, the performance of the model will be evaluated considering the clinical outcomes collected 1 month after the last MTP session. Ethical approval was obtained from the Ethics Committee of the Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Italy. The results will be submitted for publication in a peer-reviewed journal, and the prediction model will be implemented in a web-based calculator to facilitate its use by clinicians. NCT03990662 .
Publisher: Elsevier BV
Date: 11-2007
DOI: 10.1016/J.JPAIN.2007.05.014
Abstract: This study compared the effect of 2 specific cervical flexor muscle exercise protocols on immediate pain relief in the cervical spine of people with chronic neck pain. In addition, the study evaluated whether these exercise protocols elicited any systemic effects by studying sympathetic nervous system (SNS) function and pain at a location distant from the cervical spine. Participants were randomly allocated into either a cranio-cervical flexion (CCF) coordination exercise group (n = 24) or a cervical flexion (CF) endurance exercise group (n = 24). Measures of pain and SNS function were recorded immediately before and after a single session of the exercise interventions. Pain measures included visual analogue scale (VAS) ratings of neck pain at rest and during active cervical motion and pressure pain threshold (PPT) and thermal pain threshold (TPT) recordings over the cervical spine and at a remote site on the leg. Measures of SNS function consisted of blood flow, skin conductance, skin temperature, heart rate, and blood pressure. Immediately after 1 session of exercise, there was a reasonably sized increase of 21% (P < .001, d = 0.88) and 7.3% (P = .03, d = 0.47) in PPT locally at the neck for the CCF exercise and the CF exercise, respectively. There were no changes in local neck TPT with either exercise. Pressure pain threshold and TPT at the leg and SNS did not change after exercise. Only the CCF exercise demonstrated a small improvement in VAS ratings during active movement (change on 10-cm VAS: CCF, 0.42 cm (P = .04). This study shows that specific CCF therapeutic exercise is likely to provide immediate change in mechanical hyperalgesia local to the neck with translation into perceived pain relief on movement in patients with chronic neck pain. This study showed an immediate local mechanical hypoalgesic response to specific exercise of the cervical spine. Understanding the pain-relieving effects of exercise will assist the clinician in prescribing the most appropriate exercise protocols for patients with chronic neck pain.
Publisher: Elsevier BV
Date: 12-2022
DOI: 10.1016/J.JELEKIN.2022.102703
Abstract: To establish intra- and inter-session reliability of high-density surface electromyography (HDEMG)-derived parameters from the thoracic erector spinae (ES) during static and dynamic goal-directed voluntary movements of the trunk, and during functional reaching tasks. Twenty participants performed: 1) static trunk extension, 2) dynamic trunk forward and lateral flexion, and 3) multidirectional functional reaching tasks on two occasions separated by 7.5 ± 1.2 days. Muscle activity was recorded bilaterally from the thoracic ES. Root mean square (RMS), coordinates of the barycentre, mean frequency (MNF), and entropy were derived from the HDEMG signals. Reliability was determined with intraclass correlation coefficient (ICC), coefficient of variation, and standard error of measurement. Good-to-excellent intra-session reliability was found for all parameters and tasks (ICC: 0.79-0.99), whereas inter-session reliability varied across tasks. Static tasks demonstrated higher reliability in most parameters compared to functional and dynamic tasks. Absolute RMS and MNF showed the highest overall reliability across tasks (ICC: 0.66-0.98), while reliability of the barycentre was influenced by the direction of the movements. RMS and MNF derived from HDEMG show consistent inter-session reliability in goal-directed voluntary movements of the trunk and reaching tasks, whereas the measures of the barycentre and entropy demonstrate task-dependent reliability.
Publisher: BMJ
Date: 2021
DOI: 10.1136/BMJOPEN-2020-042525
Abstract: Performing contractions with minimum force fluctuations is essential for everyday life as reduced force steadiness impacts on the precision of voluntary movements and functional ability. Several studies have investigated the effect of experimental or clinical musculoskeletal pain on force steadiness but with conflicting findings. The aim of this systematic review is to summarise the current literature to determine whether pain, whether it be clinical or experimental, influences force steadiness. This protocol for a systematic review was informed and reported in line with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Protocols and the Cochrane Handbook for Systematic Reviews of Interventions. Key databases will be searched from inception to 31 August 2020, including MEDLINE, EMBASE, PubMed, CINAHL Plus, ZETOC and Web of Science. Grey literature and key journals will be also reviewed. Risk of bias will be assessed with the Newcastle-Ottawa tool, and the quality of the cumulative evidence assessed with the Grading of Recommendations, Assessment, Development and Evaluation guidelines. If homogeneity exists between groups of studies, meta-analysis will be conducted. Otherwise, a narrative synthesis approach and a vote-counting method will be used, while the results will be presented as net increases or decreases of force steadiness. The findings will be presented at conferences and the review will be also submitted for publication in a refereed journal. No ethical approval was required. CRD42020196479
Publisher: BMJ
Date: 12-2021
DOI: 10.1136/BMJOPEN-2021-058386
Abstract: Post-traumatic stress symptoms (PTSS), pain and disability frequently co-occur following traumatic injuries. Although the coexistence of these symptoms is common, the relation between these symptoms and the impact on longer-term outcome remains poorly understood. This systematic review aims to determine the role of PTSS on the development of chronic pain and/or pain-related disability following musculoskeletal trauma. This protocol is developed and reported following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses-Protocol. The review will include studies that recruited in iduals aged ≥16 years sustaining any traumatic event that resulted in one or more musculoskeletal injuries and where a recognised measure for the presence of PTSS symptoms, pain and disability using either validated questionnaires or symptom checklists was employed. The following citation databases MEDLINE, PsycINFO, EMBASE, CINAHL, ZETOC, Web of Science, PubMed and Google Scholar, as well as reference lists from key journals and grey literature, will be searched from inception to 31 November 2021. Two independent reviewers will search, screen studies, extract data and assess risk of bias. The relationship of PTSS, pain and pain-related disability by injury type and severity will be estimated with 95% CI. If possible, study results will be pooled into a meta-analysis. However, if heterogeneity between studies is high, data analyses will be presented descriptively. The overall quality of evidence will be assessed using the Grading of Recommendations, Assessment, Development and Evaluation guidelines. Ethical approval will not be required for this systematic review since only data from existing studies will be used. This review is expected to provide a better understanding of the factors associated with PTSS, pain and pain-related disability following musculoskeletal trauma, and help with the development of targeted therapeutic interventions. Results of this review will be disseminated in peer-reviewed publications and via national and international conferences. CRD42021285243.
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 11-2017
DOI: 10.1097/AJP.0000000000000513
Abstract: An association exists between repetitive movements and the development or perpetuation of neck-shoulder muscle pain. The mechanisms underlying this association remain unclear. This observational study investigated the effect of upper trapezius muscle pain on the distribution of upper trapezius activity during repetitive lifting. It was hypothesized that nociception would change the distribution of activity resulting in activation of muscle regions which would not normally be active during the task. Healthy men repeatedly lifted a box with a cycle time of 3 seconds for 50 cycles, at baseline, following injection of isotonic and hypertonic saline into the upper trapezius muscle and 15 minutes after the last injection. High-density surface electromyography (EMG) was recorded from the upper trapezius using a grid of 64 electrodes. The EMG litude was computed for each location to form a map of the EMG litude distribution. During the painful condition, the overall EMG litude was lower compared with all other conditions ( P .05) and in addition, the center of upper trapezius activity was shifted toward the caudal region of the muscle ( P .01), a region not normally active during the task. The described alterations of muscle activity likely play an important role in the perpetuation of pain during repetitive activity. Novel mapping of the spatial distribution of upper trapezius muscle activity showed that nociception induced a redistribution of activity during repetitive lifting. This knowledge provides new insights into the mechanisms underlying the perpetuation of pain with repetitive activity.
Publisher: BMJ
Date: 05-2018
Publisher: Public Library of Science (PLoS)
Date: 18-09-2015
Publisher: Elsevier BV
Date: 06-2023
Publisher: Elsevier BV
Date: 07-2010
DOI: 10.1016/J.JNEUMETH.2010.05.003
Abstract: This study proposes a method for estimating force loss during fatiguing maximal isokinetic knee extension contractions using a set of features from surface EMG signals recorded from multiple locations over the quadriceps muscle. Nine healthy participants performed fatiguing tests which consisted of 50 and 75 isokinetic leg extensions at a speed of 30 degrees /s and 80 degrees /s in two experimental sessions on different days. The set of data recorded from one of the experimental sessions (at both velocities) was used to train a multi-layer perceptron neural network to associate force loss (direct measure of fatigue) to EMG features. The data from the other session (obtained from the tests at both velocities) were used for testing the neural network performance. The proposed method was compared with a previous approach for the assessment of fatigue (Mapping Index, MI) using a signal to noise metrics computed on the estimated trend of fatigue. The signal to noise ratio obtained with the proposed approach was greater (8.83+/-1.07) than that obtained with the MI (5.67+/-1.17) (P<0.05) when the subjects were analyzed in idually and when the network was trained over the entire subject group (8.07 vs. 4.42). In conclusion, the proposed approach allows estimation of force loss during maximal dynamic knee extensions from surface EMG signals with greater accuracy than previous methods.
Publisher: Georg Thieme Verlag KG
Date: 17-05-2006
Publisher: Springer Science and Business Media LLC
Date: 12-2017
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 29-01-2021
DOI: 10.1097/J.PAIN.0000000000002213
Abstract: To better understand the mechanisms underpinning work-related neck pain, this cross-sectional and single-blinded study compared somatosensory profiles among sonographers with varied neck disability levels. Based on K-mean cluster analysis of scores on the neck disability index (NDI), participants were classified into no (NDI ≤ 8%, n = 31, reference group), mild (NDI = 10%-20%, n = 43), or moderate/severe (NDI ≥ 22%, n = 18) disability groups. Data were collected on bodily pain distribution and severity and psychological measures including depression, anxiety, pain-catastrophizing, and fear-avoidance beliefs using validated scales. Participants attended 1 session of quantitative sensory testing performed according to a standardized protocol, including local and remote thermal and mechanical pain thresholds, temporal summation of pain (TSP), conditioned pain modulation, and an exercise-induced analgesia paradigm. Compared with participants with no and mild disability, those with moderate/severe disability showed more widespread pain, cold and mechanical hyperalgesia at a remote nonpainful site, and significantly higher TSP. Participants with mild disability demonstrated significantly higher TSP than those with no disability. These group differences were attenuated after adjusting for depression or anxiety, indicating these psychological factors may mediate the somatosensory changes associated with neck disability. Group differences were not found for conditioned pain modulation or exercise-induced analgesia. These findings suggest that heightened pain facilitation, rather than impaired pain inhibition may underpin nociplastic pain in participants with moderate/severe disability, and it may be associated with depression and anxiety. Clinicians should be aware that in iduals with work-related neck pain presenting with moderate/severe disability display distinct somatosensory features and tailor management strategies accordingly.
Publisher: IEEE
Date: 07-2020
Publisher: Elsevier BV
Date: 08-2014
DOI: 10.1016/J.CLINPH.2013.11.037
Abstract: To apply a novel method to assess the characteristics of spinal movement in subjects with low back pain (LBP) in a functional task. 17 subjects suffering from chronic non-specific LBP (average pain intensity: 1.8±1.6), and 17 age and gender matched controls performed a repetitive lifting task. Spinal movement was recorded using a novel sensor strip with 12 angle sensors recording the spinal dynamics in evenly spaced (25mm) locations along the spine. Recurrence quantification analysis was applied to different components of the angles to assess the structure of its variability. Mechanically, the LBP and control group performed the task similarly. Reported pain increased in the LBP group, yet task-related angular movement was not different. However, the percentage of determinism for the accessory angular movement (movement variability not directly related to task execution) was significantly higher for the LBP group, indicating a more deterministic (less random) structure of the muscle activation pattern variability. The structure of the variability of spinal movement differs in subjects with chronic non-specific LBP. The determinism of accessory spinal movement may be a useful measure for evaluation of movement impairment in LBP and for monitoring rehabilitation effects.
Publisher: Elsevier BV
Date: 12-2021
DOI: 10.1016/J.MSKSP.2021.102447
Abstract: Cortical representation of the painful body region may be disrupted in several chronic pain conditions. The two-point discrimination test (TPDT) and the Left/Right Judgement Task (LRJT) have been used to identify changes in the cortical body schema in several chronic pain conditions. However, it is unclear if these changes are present for all chronic pain mechanisms. To investigate the integrity of the body schema of the painful shoulder in patients with chronic unilateral nociceptive shoulder pain. The s le consisted of 52 in iduals with chronic unilateral nociceptive shoulder pain. The TPDT was measured over the anterosuperior and lateral regions of both shoulders using a staircase method. Participants also performed judgment tests of shoulder and foot laterality. The comparison of the TPDT and LRJT was performed using the linear regression model with mixed effects. There was no difference in TPDT in the anterosuperior and lateral regions when comparing the symptomatic and asymptomatic shoulders. There was no difference in the LRJT accuracy and response time between the symptomatic and asymptomatic shoulders. No differences were observed when comparing LRJT variables from symptomatic shoulder and foot. Therefore, results do not provide clear evidence of altered body schema in chronic nociceptive unilateral shoulder pain. This suggest that alterations in body representations may depend on the primary pain mechanism.
Publisher: Elsevier BV
Date: 2021
Publisher: Public Library of Science (PLoS)
Date: 05-05-2013
DOI: 10.1371/JOURNAL.PONE.0285538
Abstract: Scoliosis Research Society-22 revised (SRS-22r) is the common questionnaire used to evaluate health related quality of life (HRQOL) for young people with adolescent idiopathic scoliosis (AIS). The aim of this study is to evaluate its content validity for this population. In-depth semi-structured interviews were conducted with a purposive s le of young people with AIS (Cobb angle ≥25˚, aged 10–18 years). Concept elicitation was used to evaluate the influence of AIS on participants’ HRQOL. Participant information sheets and consent/assent forms were age relevant. Topic guide was informed by the SRS-22r and existing evidence. Interviews were audio and video recorded, transcribed verbatim, coded, and analysed using thematic analysis. Derived themes/codes were compared with SRS-22r contents (domains/items). Eleven participants (mean age 14.9 years [SD = 1.8] 8 female) were recruited. The mean curve size was 47.5° [SD = 18°] and participants had been managed via different approaches. Four main themes emerged with associated subthemes: 1) Physical effects related to physical symptoms (back hurt, stiffness) and body asymmetry (uneven shoulders), 2) Activity-related effects showed impact on mobility (sitting for long periods), self-care (dressing), and school activities (focus during lessons), 3) Psychological effects revealed emotional (feel worried), mental (sleep quality), and body image effects (hide back from others), 4) Social effects (participation in school and leisure activities), and school, friends and mental health support. A weak association was found between items of the SRS-22r and the identified codes. The SRS-22r does not adequately capture important concepts that relate to HRQOL of adolescents with AIS. These findings support revision of the SRS-22r, or the development of a new patient reported outcome measure to evaluate HRQOL of adolescents with AIS.
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 10-2015
Publisher: Oxford University Press (OUP)
Date: 08-2016
DOI: 10.2522/PTJ.20150492
Abstract: Expanded distribution of pain is considered a sign of central sensitization (CS). The relationship between recording of symptoms and CS in people with knee osteoarthritis (OA) has been poorly investigated. The aim of this study was to examine whether the area of pain assessed using pain drawings relates to CS and clinical symptoms in people with knee OA. This was a cross-sectional study. Fifty-three people with knee OA scheduled to undergo primary total knee arthroplasty were studied. All participants completed pain drawings using a novel digital device, completed self-administration questionnaires, and were assessed by quantitative sensory testing. Pain frequency maps were generated separately for women and men. Spearman correlation coefficients were computed to reveal possible correlations between the area of pain and quantitative sensory testing and clinical symptoms. Pain frequency maps revealed enlarged areas of pain, especially in women. Enlarged areas of pain were associated with higher knee pain severity (rs=.325, P& .05) and stiffness (rs=.341, P& .05), lower pressure pain thresholds at the knee (rs=−.306, P& .05) and epicondyle (rs=−.308, P& .05), and higher scores with the Central Sensitization Inventory (rs=.456, P& .01). No significant associations were observed between the area of pain and the remaining clinical symptoms and measures of CS. Firm conclusions about the predictive role of pain drawings cannot be drawn. Further evaluation of the reliability and validity of pain area extracted from pain drawings in people with knee OA is needed. Expanded distribution of pain was correlated with some measures of CS in in iduals with knee OA. Pain drawings may constitute an easy way for the early identification of CS in people with knee OA, but further research is needed.
Publisher: Wiley
Date: 18-08-2011
DOI: 10.1111/J.1365-2842.2011.02246.X
Abstract: This study tested the hypothesis that painful injections of glutamate into the human masseter muscle differentially affect the distribution of the electromyographic (EMG) activity in the masseter muscle at rest and during tooth clenching. Surface EMG signals were recorded bilaterally from the superficial masseter of nine healthy men with a grid of 32 electrodes, before and after intramuscular injection of glutamate or isotonic saline, during rest and isometric contractions at 20%, 40%, 60% and 80% of the maximal voluntary bite force. Intramuscular injection of glutamate evoked moderate pain (0-10 visual analogue scale: 6·4 ± 1·4), with sensory-discriminative characteristics of the perceived pain, evaluated with the use of the McGill Pain Questionnaire (MPQ), similar to those previously reported for patients with temporomandibular disorders. There was no effect of the glutamate injection on EMG litude during rest, whereas during tooth clenching, the spatial distribution of the masseter EMG activity on both sides was more uniform in the painful condition compared to the control condition. Moreover, the overall EMG litude decreased on both sides during the more forceful tooth clenching following glutamate injection. In conclusion, a unilateral painful stimulation was associated with a bilateral inhibition of the masseter muscles during tooth clenching which resulted in a more uniform distribution of EMG activity.
Publisher: Public Library of Science (PLoS)
Date: 13-09-2022
DOI: 10.1371/JOURNAL.PONE.0274403
Abstract: Motor learning underpins successful motor skill acquisition. Although it is well known that pain changes the way we move, it’s impact on motor learning is less clear. The aim of this systematic review was to synthesize evidence on the impact of experimental and clinical pain on task performance and activity-dependent plasticity measures across learning and explore these findings in relation to different pain and motor learning paradigms. Five databases were searched: Web of Science, Scopus, MEDLINE, Embase and CINAHL. Two reviewers independently screened the studies, extracted data, and assessed risk of bias using the Cochrane ROB2 and ROBIN-I. The overall strength of evidence was rated using the GRADE guidelines. Due to the heterogeneity of study methodologies a narrative synthesis was employed. Twenty studies were included in the review: fifteen experimental pain and five clinical pain studies, covering multiple motor paradigms. GRADE scores for all outcome measures suggested limited confidence in the reported effect for experimental pain and clinical pain, on motor learning. There was no impact of pain on any of the task performance measures following acquisition except for ‘accuracy’ during a tongue protrusion visuomotor task and ‘timing of errors’ during a motor adaptation locomotion task. Task performance measures at retention, and activity dependent measures at both acquisition and retention showed conflicting results. This review delivers a detailed synthesis of research studies exploring the impact of pain on motor learning. This is despite the challenges provided by the heterogeneity of motor learning paradigms, outcome measures and pain paradigms employed in these studies. The results highlight important questions for further research with the goal of strengthening the confidence of findings in this area.
Publisher: Elsevier BV
Date: 06-2012
DOI: 10.1016/J.JELEKIN.2011.11.010
Abstract: Due to the variations in morphological and architectural characteristics of fibers within a skeletal muscle, regions of a muscle may be differently affected by eccentric exercise. Although eccentric exercise may be beneficial for increasing muscle mass and can be beneficial for the treatment of tendinopathies, the non-uniform effect of eccentric exercise results in regional muscle damage and as a consequence, non-uniform changes in muscle activation. This regional muscle weakness can contribute to muscle strength imbalances and may potentially alter the load distribution on joint structures, increasing the risk of injury. In this brief review, the non-uniform effects of eccentric exercise are reviewed and their implications for training and sport are considered.
Publisher: Wiley
Date: 17-10-2008
DOI: 10.1111/J.1748-1716.2007.01776.X
Abstract: To compare the discharge patterns of motor unit populations from different locations within the upper trapezius muscle during brief submaximal constant-force contractions. Intramuscular and surface electromyographic (EMG) signals were collected from three sites of the right upper trapezius muscle distributed along the cranial-caudal direction in 11 volunteers during 10 s shoulder abduction at 25% of the maximum voluntary force. A total of 38 motor units were identified at the cranial location, 36 from the middle location and 17 from the caudal location. Initial discharge rate was greatest at the caudal location (P < 0.05 mean +/- SD, cranial: 16.7 +/- 3.6 pps, middle: 16.9 +/- 4.0 pps, caudal: 19.2 +/- 3.3 pps). Discharge rate decreased during the contraction for the most caudal location only (P < 0.05). Initial estimates of surface EMG root mean square values were highest at the most caudal location (P < 0.05 cranial: 32.3 +/- 20.9 microV, middle: 41.3 +/- 21.0 microV, caudal: 51.6 +/- 23.6 microV). This study demonstrates non-uniformity of motor unit discharge within the upper trapezius muscle during a brief submaximal constant-force contraction. Location-dependent modulation of discharge rate may reflect spatial dependency in the control of motor units necessary for the development and maintenance of force output.
Publisher: Elsevier BV
Date: 02-2020
DOI: 10.1016/J.CLINBIOMECH.2019.11.019
Abstract: Previous findings reported that people with chronic neck pain walk with reduced range trunk rotation, especially when walking in more challenging conditions. Quantification of the quality of neck and trunk movement during gait could provide further insight into biomechanical changes that occur in people with neck pain. This study uniquely compared the variability of trunk and neck rotation during single-task and dual-task gait in people with chronic neck pain and asymptomatic in iduals. An observational case-control study was conducted on 20 asymptomatic in iduals and 24 people with chronic neck pain of idiopathic or traumatic origin. Participants performed rectilinear walking whilst keeping the head in a neutral position (single-task) and whilst rotating the head at a natural speed (dual-task). Trunk and head rotation angles were averaged across gait cycles for the task trials. The data were normalised in time, and the average variability of angular distribution along the normalised cycle was extracted. The T a Scale for Kinesiophobia was used to assess fear of movement. During single-task gait, there were no group differences for the variability of trunk (p = 0.862) or neck (p = 0.427) rotation. For dual-task gait, there was no difference between groups for the variability of neck rotation (p = 0.636), however, the participants with neck pain displayed reduced variability of trunk rotation (p = 0.021). The neck pain group also walked at a significantly slower speed during dual-task gait (p = 0.043) compared to asymptomatic in iduals and the speed of their gait was associated with the extent of fear of movement. The strategy observed in participants with chronic neck pain likely reflects adaptive behaviour when faced with more challenging conditions for postural control.
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 2018
DOI: 10.1097/AJP.0000000000000511
Abstract: This study aimed to first compare the effects of a preoperative treatment combining pain neuroscience education (PNE) with knee joint mobilization versus biomedical education with knee joint mobilization on central sensitization (CS) in patients with knee osteoarthritis, both before and after surgery. Second, we wanted to compare the effects of both interventions on knee pain, disability, and psychosocial variables. Forty-four patients with knee osteoarthritis were allocated to receive 4 sessions of either PNE combined with knee joint mobilization or biomedical education with knee joint mobilization before surgery. All participants completed self-administered questionnaires and quantitative sensory testing was performed at baseline, after treatment and at a 1 month follow-up (all before surgery), and at 3 months after surgery. Significant and clinically relevant differences before and after surgery were found after treatments for both knee pain and disability, and some measures of CS (ie, widespread hyperalgesia, CS inventory), with no significant between-group differences. Other indicators of CS (ie, conditioned pain modulation, temporal summation) did not change over time following either treatment, and in some occasions the observed changes were not in the expected direction. Patients receiving PNE with knee joint mobilization achieved greater improvements in psychosocial variables (pain catastrophizing, kinesiophobia) both before and after surgery. Preoperative PNE combined with knee joint mobilization did not produce any additional benefits over time for knee pain and disability, and CS measures compared with biomedical education with knee joint mobilization. Superior effects in the PNE with knee joint mobilization group were only observed for psychosocial variables related to pain catastrophizing and kinesiophobia.
Publisher: IOP Publishing
Date: 16-10-2018
Abstract: The causes for the disabling condition of phantom limb pain (PLP), affecting 85% of utees, are so far unknown, with few effective treatments available. Sensory feedback based strategies to normalize the motor commands to control the phantom limb offer important targets for new effective treatments as the correlation between phantom limb motor control and sensory feedback from the motor intention has been identified as a possible mechanism for PLP development. Ten upper-limb utees, suffering from chronic PLP, underwent 16 days of intensive training on phantom-limb movement control. Visual and tactile feedback, driven by muscular activity at the stump, was provided with the aim of reducing PLP intensity. A 32.1% reduction of PLP intensity was obtained at the follow-up (6 weeks after the end of the training, with an initial 21.6% reduction immediately at the end of the training) reaching clinical effectiveness for chronic pain reduction. Multimodal sensory-motor training on phantom-limb movements with visual and tactile feedback is a new method for PLP reduction. The study results revealed a substantial reduction in phantom limb pain intensity, obtained with a new training protocol focused on improving phantom limb motor output using visual and tactile feedback from the stump muscular activity executed to move the phantom limb.
Publisher: Wiley
Date: 21-01-2019
DOI: 10.1111/JOA.12935
Publisher: Elsevier BV
Date: 12-2021
Publisher: BMJ
Date: 07-2023
DOI: 10.1136/BMJOPEN-2023-074494
Abstract: Neck-specific exercises (NSEs) are commonly used for the treatment of chronic non-specific neck pain (CNSNP). However, it remains unclear whether baseline features can predict the response to neck-specific exercise (NSE) in people with CNSNP. This systematic review aims to assess whether baseline features such as age, gender, muscle activity, fatigability, endurance and fear of movement can predict pain and disability reduction following a NSE intervention. This systematic review and meta-analysis will be reported in line with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) Protocols guidelines checklist. The Web of Science, PubMed, Scopus, MEDLINE, Embase and CINAHL databases key journals and grey literature will be searched up until June 2023, including medical subject heading terms and keywords combinations. Included studies will investigate an association between the baseline features and pain and disability outcomes following NSE in people with CNSNP. Two independent reviewers will oversee the searching, screening, data extraction and assessment of risk of bias. The risk of bias will be assessed using the Risk Of Bias In Non-randomised Studies of Interventions (ROBINS-I) and Risk-Of-Bias tool for randomised trials 2 (ROB 2). The quality of evidence will be assessed using the Grading of Recommendations Assessment, Development and Evaluation approach (GRADE). Using standardised forms, details regarding study characteristics, baseline features (predictive factors), intervention, primary outcome and effect size (OR and 95% CI of each predictive factor and p value) will be extracted from included studies. Meta-analyses will be considered, if the studies are sufficiently homogeneous and if three or more studies investigate the same or comparable factors that predict the same response (pain intensity or disability). In the event that less than three studies investigated the same factors, a narrative synthesis will be conducted. Ethical approval will not be required as this review will be based on published studies. The results of this study will be submitted to a peer-reviewed journal and presented at conferences. CRD42023408332.
Publisher: MDPI AG
Date: 06-04-2022
DOI: 10.3390/JCM11072042
Abstract: The aim of this study was to examine for the presence of differences in neuromuscular and psychological function in in iduals with recurrent neck pain (RNP) or chronic neck pain (CNP) following a whiplash trauma compared to healthy controls. A secondary aim was to examine whether neuromuscular characteristics together with psychological features in people with RNP were predictive of future painful episodes. Multiple features were assessed including neck disability, kinesiophobia, quality of life, cervical kinematics, proprioception, activity of superficial neck flexor muscles, maximum neck flexion and extension strength, and perceived exertion during submaximal contractions. Overall, those with RNP (n = 22) and CNP (n = 8) presented with higher neck disability, greater kinesiophobia, lower quality of life, slower and irregular neck movements, and less neck strength compared to controls (n = 15). Prediction analysis in the RNP group revealed that a higher number of previous pain episodes within the last 12 months along with lower neck flexion strength were predictors of higher neck disability at a 6-month follow-up. This preliminary study shows that participants with RNP presented with some degree of altered neuromuscular features and poorer psychological function with respect to healthy controls and these features were similar to those with CNP. Neck flexor weakness was predictive of future neck disability.
Publisher: MDPI AG
Date: 12-09-2023
Publisher: Elsevier BV
Date: 07-2022
DOI: 10.1016/J.SPINEE.2022.01.023
Abstract: Chronic spinal pain is one the most common musculoskeletal disorders. Previous studies have observed microscopic structural changes in the spinal extensor muscles in people with chronic spinal pain. This systematic review synthesizes and analyzes all the existing evidence of muscle microscopic changes in people with chronic spinal pain. To assess the microscopy of spinal extensor muscles including the fiber type composition, the area occupied by fiber types, fiber size/cross sectional area (CSA), and narrow diameter (ND) in people with and without chronic spinal pain. Further, to compare these outcome measures across different regions of the spine in people with chronic neck, thoracic and low back pain. Systematic review with meta-analysis. MEDLINE (Ovid Interface), Embase, PubMed, CINAHL Plus, and Web of Science were searched from inception to October 2020. Key journals, conference proceedings, grey literature and hand searching of reference lists from eligible studies were also searched. Two independent reviewers were involved in the selection process. Only studies examining the muscle microscopy of the spinal extensor muscles (erector spinae [ES] and/or multifidus [MF]) between people with and without chronic spinal pain were selected. The risk of bias from the studies was assessed using modified Newcastle Ottawa Scale and the level of evidence was established using the GRADE approach. Data were synthesized based on homogeneity on the methodology and outcome measures of the studies for ES and MF muscles and only four studies were eligible for analysis. All the five studies included were related to chronic low back pain (CLBP). Meta-analysis (inverse variance method for random effect to calculate mean difference and 95% CI) was performed for the ES fiber type composition by numbers for both type I and type II fibers (I For the ES muscle, there was no difference in fiber type composition and fiber CSA between people with and without CLBP and no conclusions could be drawn for ND for the ES. For the MF, no conclusions could be drawn for any of the muscle microscopy outcome measures. Overall, the quality of evidence is very low and there is very low evidence that there are no differences in microscopic muscle features between people with and without CLBP.
Publisher: Journal of Orthopaedic & Sports Physical Therapy (JOSPT)
Date: 05-2009
Abstract: There is irrefutable evidence of an association between mechanical neck pain (MNP) and dysfunction of the muscles of the cervical spine. A myriad of impairments have been demonstrated that include changes in the physical structure (cross-sectional area, fatty infiltration, fiber type), as well as changes in behavior (timing and activation level), of the cervical muscles. Such changes suggest an impaired capacity of the cervical muscles to generate, sustain, and maintain precision of the required levels of torque needed for optimal function. In the context of physical support, these changes potentially have deleterious consequences for the cervical region, which relies heavily on its muscles for mechanical stability. While interventions focused on the retraining of cervical muscle function have shown favorable responses in alleviating MNP, the development of best practice strategies for the assessment and management of cervical muscle dysfunction is still a work in progress. One obstacle in researching the efficacy of cervical muscle training is that, as yet, we do not possess the capacity to optimally measure and classify those patients most likely to respond to different methods of training that would enrich clinical practice. While gains in this area are emerging, the ability of a clinician to best identify the need and implement the most appropriate method of training cervical muscle function is still largely dependent on a comprehensive examination of the patient that considers all aspects of the patient's disorder and functional requirements. Level 5.
Publisher: Elsevier BV
Date: 06-2016
DOI: 10.1016/J.MATH.2016.02.010
Abstract: A wide range of physical tests have been published for use in the assessment of musculoskeletal dysfunction in patients with headache. Which tests are used depends on a physiotherapist's clinical and scientific background as there is little guidance on the most clinically useful tests. To identify which physical examination tests international experts in physiotherapy consider the most clinically useful for the assessment of patients with headache. Delphi survey with pre-specified procedures based on a systematic search of the literature for physical examination tests proposed for the assessment of musculoskeletal dysfunction in patients with headache. Seventeen experts completed all three rounds of the survey. Fifteen tests were included in round one with eleven additional tests suggested by the experts. Finally eleven physical examination tests were considered clinically useful: manual joint palpation, the cranio-cervical flexion test, the cervical flexion-rotation test, active range of cervical movement, head forward position, trigger point palpation, muscle tests of the shoulder girdle, passive physiological intervertebral movements, reproduction and resolution of headache symptoms, screening of the thoracic spine, and combined movement tests. Eleven tests are suggested as a minimum standard for the physical examination of musculoskeletal dysfunctions in patients with headache.
Publisher: BMJ
Date: 03-2019
DOI: 10.1136/BMJOPEN-2018-023204
Abstract: Pain following musculoskeletal trauma is common with poor outcomes and disability well documented. Pain is complex in nature and can include the four primary mechanisms of pain: nociceptive, neuropathic, inflammatory and central sensitisation (CS). CS can be measured in multiple ways however, no systematic review has evaluated the measurement properties of such measures in the musculoskeletal trauma population. This systematic review aims to evaluate the measurement properties of current measures of CS in this population. This protocol is informed and reported in line with the Preferred Reporting Items for Systematic Reviews and Meta-Analysis-P. MEDLINE, EMBASE, CINAHL, ZETOC, Web of Science, PubMed and Google Scholar as well as key journals and grey literature will be searched in two stages to (1) identify what measures are being used to assess CS in this population and (2) evaluate the measurement properties of the identified measures. Two independent reviewers will conduct the search, extract the data, assess risk of bias for included studies and assess overall quality. The Consensus-based Standards for the selection of Health Measurement Instruments Risk of Bias Checklist and a modified Grading of Recommendations, Assessment, Development and Evaluation guidelines will be used. Meta-analysis will be conducted if deemed appropriate. Alternatively, a narrative synthesis will be conducted and summarised per measurement property per outcome measure. This review will aid clinicians in using the most appropriate tool for assessing central sensitisation in this population and is the first step towards a more standardised approach in pain assessment. The results of this study will be submitted to a peer reviewed journal and presented at conferences. CRD42018091531.
Publisher: Elsevier BV
Date: 10-2022
DOI: 10.1016/J.MSKSP.2022.102596
Abstract: Establishing a set of uniform classification criteria (CC) for cervical radiculopathy (CR) is required to aid future recruitment of homogenous populations to clinical trials. To establish expert informed consensus on CC for CR. A pre-defined four round e-Delphi study in accordance with the guidance on Conducting and Reporting Delphi Studies. In iduals with a background in physiotherapy who had authored two or more peer-reviewed publications on CR were invited to participate. The initial round asked opinions on CC for CR. Content analysis was performed on round one output and a list of discrete items were generated forming the round two survey. In rounds two to four, participants were asked to rate the level of importance of each item on a six-point Likert scale. Data were analysed descriptively using median, interquartile range and percentage agreement. Items reaching pre-defined consensus criteria were carried forward to the next round. Items remaining after the fourth round constituted expert consensus on CC for CR. Twelve participants participated with one drop out. The final round identified one inclusion CC and 12 exclusion CC. The inclusion CC that remained achieved 82% agreement and was a cluster criterion consisting of radicular pain with arm pain worse than neck pain paraesthesia or numbness and/or weakness and/or altered reflex MRI confirmed nerve root compression compatible with clinical findings. The CC identified can be used to inform eligibility criteria for future CR trials although caution should be practiced as consensus on measurement tools requires further investigation.
Publisher: BMJ
Date: 10-2003
Abstract: To identify whether subjects with glenohumeral translational instability present with a strength deficit in their internal rotator musculature, and therefore to determine if general strengthening exercises are warranted for the management of this condition. Eighteen male baseball players were allocated to two groups on the basis of expert clinical evaluation of the presence (n=8) or absence (n=10) of shoulder translational instability. A strain gauge was used to calculate the force generated during maximal isometric internal rotation contractions in neutral shoulder rotation and 30 degrees of internal rotation. The Mann-Whitney test identified no significant difference in force production during the maximum contractions in neutral rotation between the two subject groups. In the position of 30 degrees shoulder internal rotation, subjects with glenohumeral translational instability produced significantly greater force than the control group (p<0.05). High load strength testing cannot be used as a diagnostic tool to identify people with glenohumeral instability. Similarly, heavy resistance strengthening exercises for the internal rotator musculature are not warranted during rehabilitation.
Publisher: Public Library of Science (PLoS)
Date: 14-06-2023
DOI: 10.1371/JOURNAL.PONE.0287029
Abstract: Variability in spine kinematics is a common motor adaptation to pain, which has been measured in various ways. However, it remains unclear whether low back pain (LBP) is typically characterised by increased, decreased or unchanged kinematic variability. Therefore, the aim of this review was to synthesise the evidence on whether the amount and structure of spine kinematic variability is altered in people with chronic non-specific LBP (CNSLBP). Electronic databases, grey literature, and key journals were searched from inception up to August 2022, following a published and registered protocol. Eligible studies must investigated kinematic variability in CNSLBP people (adults ≥18 years) while preforming repetitive functional tasks. Two reviewers conducted screening, data extraction, and quality assessment independently. Data synthesis was conducted per task type and in idual results were presented quantitatively to provide a narrative synthesis. The overall strength of evidence was rated using the Grading of Recommendations, Assessment, Development and Evaluation guidelines. Fourteen observational studies were included in this review. To facilitate the interpretation of the results, the included studies were grouped into four categories according to the task preformed (i.e., repeated flexion and extension, lifting, gait, and sit to stand to sit task). The overall quality of evidence was rated as a very low, primarily due to the inclusion criteria that limited the review to observational studies. In addition, the use of heterogeneous metrics for analysis and varying effect sizes contributed to the downgrade of evidence to a very low level. In iduals with chronic non-specific LBP exhibited altered motor adaptability, as evidenced by differences in kinematic movement variability during the performance of various repetitive functional tasks. However, the direction of the changes in movement variability was not consistent across studies.
Publisher: Elsevier BV
Date: 05-2003
DOI: 10.1016/S1356-689X(03)00008-0
Abstract: The purpose of this study was to quantify the sagittal angular displacement of the head (cranio-cervical flexion) for the five incremental stages of the cranio-cervical flexion test (CCFT). Range of cranio-cervical flexion during the CCFT was measured using a digital imaging method in 20 healthy volunteer subjects. The intra-and inter-rater reliability of the digital imaging technique for the assessment of this movement were also examined. The results of this study demonstrated a linear relationship between the incremental pressure targets of the CCFT and the percentages of full range cranio-cervical flexion range of motion (ROM) measured in the supine lying position of the test using a digital imaging technique. A mean of 22.9% full range cranio-cervical flexion was used to reach the first pressure target of the CCFT followed by linear increments up to 76.6% for the last stage of the test. An increasing amount of cranio-cervical flexion ROM was used to achieve the five successive stages of the CCFT reflecting an increasing contractile demand on the deep cervical flexor muscles. Excellent inter-rater (ICC=0.994) and intra-rater reliability (ICC=0.988-0.998) were demonstrated for the angular measurements using this digital imaging technique.
Publisher: Wiley
Date: 21-01-2021
DOI: 10.1111/SMS.13912
Publisher: Public Library of Science (PLoS)
Date: 23-03-2018
Publisher: Elsevier BV
Date: 11-2021
DOI: 10.1016/J.BJPT.2021.07.005
Abstract: Impairments of sensorimotor control relating to head and eye movement control and postural stability are often present in people with neck pain. The upper cervical spine and particularly the obliquus capitis inferior (OCI) play an important proprioceptive role and its impairment may alter cervical sensorimotor control. Dry needling (DN) is a valid technique to target the OCI. To investigate if a single DN session of the OCI muscle improves head and eye movement control-related outcomes, postural stability, and cervical mobility in people with neck pain. Forty people with neck pain were randomly assigned to receive a single session of DN or sham needling of the OCI. Cervical joint position error (JPE), cervical movement sense, standing balance and oculomotor control were examined at baseline, immediately post-intervention, and at one-week follow-up. Active cervical rotation range of motion and the flexion rotation test were used to examine the global and upper cervical rotation mobility, respectively. Linear mixed-models revealed that the DN group showed a decrease of JPE immediately post-intervention compared to the sham group (mean difference [MD]= -0.93° 95% confidence interval [CI]: -1.85, -0.02) which was maintained at one-week follow-up (MD= -1.64° 95%CI: -2.85, -0.43). No effects on standing balance or cervical movement sense were observed in both groups. Upper cervical mobility showed an increase immediately after DN compared to the sham group (MD= 5.14° 95%CI: 0.77, 9.75) which remained stable at one-week follow-up (MD= 6.98° 95%CI: 1.31, 12.40). Both group showed an immediate increase in global cervical mobility (MD= -0.14° 95%CI: -5.29, 4.89). The results from the current study suggest that a single session of DN of the OCI reduces JPE deficits and increases upper cervical mobility in patients with neck pain. Future trials should examine if the addition of this technique to sensorimotor control training add further benefits in the management of neck pain.
Publisher: Wiley
Date: 11-10-2018
DOI: 10.1002/EJP.1318
Abstract: Actigraphy is a quantitative method for the investigation of human physical activity and is normally based on accelerometric and/or kinematic data. A multichannel actigraphy system, able to record both acceleration and spine angles, was employed in this study to measure the quality of movement in 17 in iduals with chronic low back pain (LBP) and 18 healthy in iduals during unrestricted daily activities. An indication of movement complexity was computed by means of non-negative matrix factorization throughout the 24 hr period and in the 60 min of highest activity. Movement complexity differed only when the 60 min of highest activity was taken into account, with the LBP group showing reduced complexity (e.g., for dimensionality = 8, over 90% of the comparisons showed a significant reduction in the LBP group). The results are compatible with the hypothesis that pain induces a reduction in the available kinematic trajectories and degrees of freedom during natural movements, which becomes more evident when more demanding tasks are performed. A reduced movement complexity suggests a persistent alteration of the descending neural pathways and/or a disrupted somatosensory information processing, which could be possibly contrasted by administering highly variable motor tasks. People with chronic pain move differently. Movement quality is difficult to evaluate during daily activities, yet it may prove more informative than quantitative measurements. We proposed a new approach for computing movement complexity and found out that patients' movements get more stereotyped when higher spinal acceleration is required.
Publisher: BMJ
Date: 11-2019
DOI: 10.1136/BMJOPEN-2019-031587
Abstract: Differential diagnosis of migraine and cervicogenic headache (CGH) can be challenging given the large overlap of symptoms, commonly leading to misdiagnosis and ineffective treatment. In order to strengthen the differential diagnosis of headache, previous studies have evaluated the utility of physical tests to examine for musculoskeletal impairment, mainly in the cervical spine, which could be provoking or triggering headache. However, no systematic review has attempted to evaluate whether physical tests can differentiate CGH from migraine or both conditions from asymptomatic subjects. A systematic review protocol has been designed and is reported in line with Preferred Reporting Items for Systematic Reviews and Meta-Analyses Protocols (PRISMA-P). A sensitive topic-based search strategy is planned which will include databases, hand searching of key journals and consultation of relevant leading authors in this field. Terms and keywords will be selected after discussion and agreement. Two independent reviewers will perform the search and select studies according to inclusion and exclusion criteria, including any cohort or observational studies evaluating the topic of this review a third reviewer will confirm accuracy. A narrative synthesis will be developed for all included studies and, if possible, a meta-analysis will be conducted. The overall quality of the evidence will be assessed using the Quality Assessment of Diagnostic Accuracy Studies (QUADAS-2) checklist for diagnostic accuracy studies and the Downs and Black scale for those studies where the QUADAS-2 checklist cannot be applied. Ethical approval is not required since no patient information will be collected. The results will provide a deeper understanding about the possibility of using physical tests to differentiate cervicogenic headache from migraine and from asymptomatic subjects, which has direct relevance for clinicians managing people with headache. The results will be published in a peer-reviewed journal and presented at scientific conferences. CRD42019135269.
Publisher: Springer Science and Business Media LLC
Date: 16-03-2018
Publisher: Wiley
Date: 27-10-2020
DOI: 10.1002/EJP.1670
Publisher: Elsevier BV
Date: 02-2007
DOI: 10.1016/J.JELEKIN.2005.10.006
Abstract: The deep cervical flexor (DCF) muscles are considered to be of substantial clinical importance in the management of neck pain. While conventional cervical flexion (CF) dynamometry methods have been used frequently to assess the capacity of the cervical flexor muscles, it has been suggested that cranio-cervical flexion (CCF) methods may provide a more specific test of DCF muscle performance. This study compared the activation of the deep and superficial cervical flexor muscles between tests of isometric cranio-cervical flexion (CCF) and conventional cervical flexion (CF) dynamometry. Normalised root-mean-square values were recorded for the deep cervical flexor (DCF), sternocleidomastoid (SCM), anterior scalene (AS), and sternohyoid (SH) muscles during isometric CCF and CF tests at maximal voluntary contraction (MVC), 50% MVC, and 20% MVC in ten healthy volunteers. The results demonstrated significantly greater electromyography (EMG) litude for the SCM (P<.001-.002) and AS (P<.001-.001) muscles in the CF test conditions (MVC, 20%MVC, and 50%MVC) compared to CCF test conditions. Moreover, the SH muscle demonstrated significantly greater EMG litude during CF compared to CCF but only in the 50% MVC and 20% MVC conditions (P=.007 and .02 respectively). These results demonstrate that dynamometry tests of CF result in greater activity of the superficial cervical flexor muscles compared to tests of CCF. As a result, CCF dynamometry may provide a more specific method to assess and retrain DCF muscle performance, compared to conventional CF in which superficial muscle activity may mask impaired performance of the DCF muscles.
Publisher: Informa UK Limited
Date: 07-10-2022
DOI: 10.1080/09638288.2022.2130448
Abstract: Conservative management of lumbar radiculopathy (LR) is the first treatment option. To date, systematic reviews and clinical practice guidelines have not considered the most appropriate timing of management. This study aimed to establish consensus on effective conservative treatment modalities across different stages (i.e., acute, sub-acute, or chronic) of LR. Through an iterative multistage Delphi process, experts rated agreement with proposed treatment modalities across stages of LR and could suggest additional treatment modalities. The agreement was measured using a 5-point Likert scale. Descriptive statistics were used to measure agreement (median, interquartile ranges, and percentage of agreement). Consensus criteria were defined a priori for each round. Fourteen panelists produced a consensus list of effective treatment modalities across stages of LR. Acute stage management should focus on providing patients with information about the condition including pain education, in idualized physical activity, and directional preference exercises, supported with NSAIDs. In the sub-acute stage, strength training and neurodynamic mobilization could be added and transforaminal/epidural injections considered. In the chronic stage, spinal manipulative therapy, specific exercise, and function-specific physical training should be combined with in idualized vocational, ergonomic and postural advice. Experts agree effectiveness of interventions differs through the evolution of LR.IMPLICATIONS FOR REHABILITATIONTo date clinical guideline for conservative management of lumbar radiculopathy do not consider the evolution of the condition.Acute stage management of lumbar radiculopathy should focus on providing information about the condition and support in idualized physical activity with pain medication.Sub-acute management should add neurodynamic mobilization to strength training, while transforaminal and/or epidural injections could be considered.Chronic stage management should consider spinal manipulative therapy and focus on restoring personalized functional capacity.
Publisher: Springer Science and Business Media LLC
Date: 13-08-2022
DOI: 10.1186/S12891-022-05684-0
Abstract: Astronauts have a higher risk of cervical intervertebral disc herniation. Several mechanisms have been attributed as causative factors for this increased risk. However, most of the previous studies have examined potential causal factors for lumbar intervertebral disc herniation only. Hence, we aim to conduct a study to identify the various changes in the cervical spine that lead to an increased risk of cervical disc herniation after spaceflight. A cohort study with astronauts will be conducted. The data collection will involve four main components: a) Magnetic resonance imaging (MRI) b) cervical 3D kinematics c) an Integrated Protocol consisting of maximal and submaximal voluntary contractions of the neck muscles, endurance testing of the neck muscles, neck muscle fatigue testing and questionnaires and d) dual energy X-ray absorptiometry (DXA) examination. Measurements will be conducted at several time points before and after astronauts visit the International Space Station. The main outcomes of interest are adaptations in the cervical discs, muscles and bones. Astronauts are at higher risk of cervical disc herniation, but contributing factors remain unclear. The results of this study will inform future preventive measures for astronauts and will also contribute to the understanding of intervertebral disc herniation risk in the cervical spine for people on Earth. In addition, we anticipate deeper insight into the aetiology of neck pain with this research project. German Clinical Trials Register, DRKS00026777. Registered on 08 October 2021.
Publisher: Springer Science and Business Media LLC
Date: 20-10-2020
DOI: 10.1038/S41598-020-74707-4
Abstract: Having an abundance of motor solutions during movement may be advantageous for the health of musculoskeletal tissues, given greater load distribution between tissues. The aim of the present study was to understand whether motor abundance differs between people with and without low back pain (LBP) during a low-load lifting task. Motion capture with electromyography (EMG) assessment of 15 muscles was performed on 48 participants [healthy control (con) = 16, remission LBP (rLBP) = 16, current LBP (cLBP) = 16], during lifting. Non-negative matrix factorization and uncontrolled manifold analysis were performed to decompose inter-repetition variability in the temporal activity of muscle modes into goal equivalent (GEV) and non-goal equivalent (NGEV) variabilities in the control of the pelvis and trunk linear displacements. Motor abundance occurs when the ratio of GEV to NGEV exceeds zero. There were significant group differences in the temporal activity of muscle modes, such that both cLBP and rLBP in iduals demonstrated greater activity of muscle modes that reflected lumbopelvic coactivation during the lifting phase compared to controls. For motor abundance, there were no significant differences between groups. In iduals with LBP, including those in remission, had similar overall motor abundance, but use different activation profiles of muscle modes than asymptomatic people during lifting.
Publisher: Public Library of Science (PLoS)
Date: 29-05-2020
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 26-02-2021
Publisher: Elsevier BV
Date: 05-2019
DOI: 10.1016/J.CELL.2019.03.018
Abstract: Innate immune responses are intricately linked with intracellular metabolism of myeloid cells. Toll-like receptor (TLR) stimulation shifts intracellular metabolism toward glycolysis, while anti-inflammatory signals depend on enhanced mitochondrial respiration. How exogenous metabolic signals affect the immune response is unknown. We demonstrate that TLR-dependent responses of dendritic cells (DCs) are exacerbated by a high-fatty-acid (FA) metabolic environment. FAs suppress the TLR-induced hexokinase activity and perturb tricarboxylic acid cycle metabolism. These metabolic changes enhance mitochondrial reactive oxygen species (mtROS) production and, in turn, the unfolded protein response (UPR), leading to a distinct transcriptomic signature with IL-23 as hallmark. Interestingly, chemical or genetic suppression of glycolysis was sufficient to induce this specific immune response. Conversely, reducing mtROS production or DC-specific deficiency in XBP1 attenuated IL-23 expression and skin inflammation in an IL-23-dependent model of psoriasis. Thus, fine-tuning of innate immunity depends on optimization of metabolic demands and minimization of mtROS-induced UPR.
Publisher: Elsevier BV
Date: 05-2010
DOI: 10.1016/J.CLINPH.2009.12.029
Abstract: To compare the behavior of sternocleidomastoid motor units of patients with chronic neck pain and healthy controls. Nine women (age, 40.4+/-3.5 yr) with chronic neck pain and nine age- and gender-matched healthy controls participated. Surface and intramuscular EMG were recorded from the sternocleidomastoid muscle bilaterally as subjects performed isometric contractions of 10-s duration in the horizontal plane at a force of 15 N in eight directions (0-360 degrees 45 degrees intervals) and isometric contractions at 15 and 30 N force with continuous change in force direction in the range 0-360 degrees . Motor unit behavior was monitored during the 10-s contractions and the subsequent resting periods. The mean motor unit discharge rate depended on the direction of force in the control subjects (P<0.05) but not in the patients. Moreover, in three of the nine patients, but in none of the controls, single motor unit activity continued for 8.1+/-6.1s upon completion of the contraction. The surface EMG litude during the circular contraction at 15N was greater for the patients (43.5+/-54.2 microV) compared to controls (16.9+/-14.9 microV P<0.05). The modulation in discharge rate of in idual motor units with force direction is reduced in the sternocleidomastoid muscle in patients with neck pain, with some patients showing prolonged motor unit activity when they were instructed to rest. These observations suggest that chronic neck pain affects the change in neural drive to muscles with force direction.
Publisher: BMJ
Date: 02-2020
DOI: 10.1136/BMJSEM-2019-000726
Abstract: This study evaluates the intra-rater and inter-rater reliability of the MyotonPRO and its construct validity for the assessment of Achilles tendon stiffness. Reliability and construct validity study. Forty healthy participants were assessed using the MyotonPRO by two raters on two different occasions. Tendon was evaluated in three different positions (relaxed, 0° plantarflexion and standing) and during different isometric contractions (range 0–3 kg). Reliability was calculated using intraclass correlation coefficient (ICC and 95% CI) standard error of measurement and minimal detectable change. Construct validity was evaluated between the different positions and the different contraction intensities using Friedman test. Intra-rater reliability was very high ICC 2,k 0.87–0.98. The reliability of the 0.5 kg contraction was moderate with an ICC 2,k of 0.59. Inter-rater reliability ranged from high to very high with an ICC 2,k of 0.76–0.86. The reliability of the 0.5 kg, 1 kg contraction and the standing position was moderate with an ICC 2,k of 0.55, 0.54 and 0.56 respectively. Inter-session reliability ranged from high to very high with an ICC 2,k of 0.70–0.89. The reliability of the 0.5 kg contraction was moderate with an ICC 2,k of 0.54. Construct validity was demonstrated between different contraction levels and different positions. MyotonPRO is a reliable tool for the evaluation of Achilles tendon stiffness during different contraction levels and in different positions. Construct validity was supported by changes of tendon stiffness during the explored conditions. MyotonPRO can be implemented, as a ready to use device, in the evaluation of tendon tissue mechanical properties.
Publisher: Elsevier BV
Date: 10-2016
DOI: 10.1016/J.JELEKIN.2016.07.006
Abstract: Lumbar multifidus is a complex muscle with multi-fascicular morphology shown to be differentially controlled in healthy in iduals during sagittal-plane motion. The normal behaviour of multifidus muscle regions during walking has only received modest attention in the literature. This study aimed to determine activation patterns for deep and superficial multifidus in young adults during walking at different speeds and inclination. This observational cohort study evaluated ten healthy volunteers in their twenties (three women, seven men) as they walked on a treadmill in eight conditions at 2km/h and 4km/h, each at 0, 1, 5, and 10% inclination. Intramuscular EMG was recorded from the deep and superficial multifidus unilaterally at L5. Activity was characterized by: litude of the peak of activation, position of peak within the gait cycle (0-100%), and duration relative to the full gait cycle. Across all conditions superficial multifidus showed higher normalised EMG litude (p<0.01) superficial multifidus peak litude was 232±115% higher when walking at 4km/h/10%, versus only 172±77% higher for deeper region (p<0.01). The percentage of the gait cycle where peak EMG litude was detected did not differ between regions (49±13%). Deep multifidus duration of activation was longer when walking at the faster vs slower speed at all inclinations (p<0.01), which was not evident for superficial multifidus (p<0.05). Thus, a significantly longer activation of deep multifidus was observed compared to superficial multifidus when walking at 4km/h (p<0.05). Differential activation within lumbar multifidus was shown in young adults during walking. The prolonged, more tonic activation of deep relative to superficial regions of multifidus during gait supports a postural function of deeper fibres.
Publisher: Springer Science and Business Media LLC
Date: 23-05-2007
DOI: 10.1007/S00221-007-0974-4
Abstract: This study compared fatigue and the spatial distribution of upper trapezius electromyographic (EMG) litude during a 6-min constant force shoulder elevation task at 20% of the maximal voluntary contraction force (MVC) (constant force) and during the same task interrupted by brief (2 s) periodic increases in force to 25% MVC every 30 s (variable force). Surface EMG signals were recorded with a 13 x 5 grid of electrodes from the upper trapezius muscle of nine healthy subjects. The centroid (center of activity) of the EMG root mean square map was computed to assess changes over time in the spatial distribution of EMG litude. MVC force decreased by (mean +/- SD) 9.0 +/- 3.9% after the constant force task (P < 0.05) but was unchanged following the variable force contraction. The centroid of EMG litude shifted in the cranial direction across the duration of the variable force contraction (P < 0.05) but not during the constant force contraction (shift of 2.9 +/- 2.3 mm and 1.4 +/- 1.1 mm, respectively). The results demonstrate that periodic increases in force during a sustained contraction enhance the modifications in spatial distribution of upper trapezius EMG litude and reduce fatigue compared to a constant force contraction performed at a lower average load. The change in spatial distribution of EMG litude over time during a sustained contraction may reflect a mechanism to counteract fatigue during prolonged muscle activity.
Publisher: Public Library of Science (PLoS)
Date: 08-03-2016
Publisher: Springer Science and Business Media LLC
Date: 14-05-2021
DOI: 10.1186/S12891-021-04251-3
Abstract: Chronic low back pain (CLBP) prevalence has steadily increased over the last two decades. Manual therapy (MT) is recommended within a multimodal management approach to improve pain and disability although evidence investigating the patients’ experience of MT is scarce. To explore expectations and perceptions of MT techniques in people with CLBP. A qualitative study embedded sequential to an experimental trial using semi-structured interviews (SSI) explored participants’ experiences of thrust, non-thrust and sham technique. Purposive s ling enabled variance in age and CLBP duration. An evidence informed topic guide was used. Data were analysed using thematic analysis (TA). Respondent validation and peer debriefing enhanced trustworthiness. The Consolidating Criteria for Reporting Qualitative Studies (COREQ) reported methodological rigour. Ten participants (50% male) with a mean age of 29.1 years (Standard Deviation (SD): 7.9, range: 19–43), a mean pain intensity of 4.5 on a Numeric Rating Scale (NRS) 0–10 (SD: 1.5, range: 2–7), a mean Oswestry Disability Score (ODI) of 9 (SD: 4.6, range: 2–17) and a mean T a Scale of Kinesiophobia (TSK) score of 38.6 (SD: 4.8, range: 30–45) participated. Four themes were identified: understanding of pain forming expectations perception of care re-evaluation of body awareness and management. Understanding of CLBP is formed by an in iduals’ pain perception and exchange with social environment. This, combined with communication with physiotherapist influenced expectations regarding the MT technique. Expectations for MT were formed by an in idual’s social environment and previous experience. A treatment technique is perceived as positive if its characteristics are aligned with the in idual’s understanding of pain and if care is delivered in an informative and reassuring manner.
Publisher: Elsevier BV
Date: 12-2018
DOI: 10.1016/J.JELEKIN.2018.07.007
Abstract: Isometric bite force control, via measures of force accuracy, force steadiness and force proprioception, was assessed in patients with myogenic temporomandibular disorders (TMDs) compared to healthy controls. Twelve people with myogenic TMDs and twelve age- and gender-matched asymptomatic controls performed maximal voluntary contractions (MVC) of unilateral jaw clenching followed by submaximal isometric contractions, with and without visual feedback of force, at 10, 30 50% and 70% MVC. Force performance was assessed with indices of accuracy (mean distance, MD) and precision (standard deviation, SD) and reported as a percentage of the MVC. A mixed-effect model was used to evaluate differences in MVC, MD and SD. The MVC was lower in the TMD group when clenching either ipsilateral or contralateral to the side of greatest pain (p < 0.05). No difference in MD was observed between groups. The SD depended on the interaction between group and painful side (p = 0.04) with the TMD group displaying higher SD when executing the task with the most painful side when compared to the ipsilateral or contralateral sides of the control group. The reduced maximal bite force and force steadiness observed in people with myogenic pain may interfere with masticatory function and should be considered when planning therapeutic interventions for TMDs.
Publisher: Springer Science and Business Media LLC
Date: 17-02-2021
DOI: 10.1186/S13244-021-00974-Y
Abstract: Changes in mechanical loading as well as pathology can modify the Achilles tendon mechanical properties and therefore detection of these changes is relevant for the diagnosis and management of Achilles tendinopathy. The aim of this study was to evaluate strain and shear wave sonoelastography for their ability to detect changes in the Achilles tendon mechanical properties during a series of isometric contractions. Longitudinal sonoelastography images of the Achilles tendon were acquired from 20 healthy participants using four different ultrasound devices two implementing strain sonoelastography technology (SE1, SE2) and two, shear wave elastography technology (SWE1, SWE2). SE1 measured a decreasing strain ratio (tendon become harder) during the different contraction levels from 1.51 (0.92) to 0.33 (0.16) whereas SE2 mesaured a decreasing strain ratio from 1.08 (0.76) to 0.50 (0.32). SWE1 measured decreasing tendon stiffness during contractions of increasing intensity from 33.40 (19.61) to 16.19 (2.68) whereas SWE2 revealed increasing tendon stiffness between the first two contraction levels from 428.65 (131.5) kPa to 487.9 (121.5) kPa followed by decreasing stiffness for the higher contraction levels from 459.35 (113.48) kPa to 293.5 (91.18) kPa. Strain elastography used with a reference material was able to detect elasticity changes between the different contraction levels whereas shear wave elastography was less able to detect changes in Achilles tendon stiffness when under load. Inconsistent results between the two technologies should be further investigated.
Publisher: Public Library of Science (PLoS)
Date: 08-04-2021
DOI: 10.1371/JOURNAL.PONE.0249659
Abstract: To synthesise and analyse the current evidence regarding changes in joint position sense (JPS) and standing balance in people with whiplash-associated disorder (WAD) taking the presence or absence of dizziness into account. PubMed, CINAHL Plus, Web of Science, Embase, MEDLINE and APA PsycINFO were searched by two independent reviewers from inception until August 2020 and reference lists of all included studies were also reviewed. Only cross-sectional studies that measured JPS and/or standing balance between people with WAD vs. healthy controls (HC) or people with WAD complaining of dizziness (WAD D ) vs. those not complaining of dizziness (WAD ND ) were selected. Relevant data were extracted using specific checklists and quality assessment was performed using Downs and Black Scale (modified version). Twenty-six studies were included. For JPS, data were synthesized for absolute error in the primary plane of movement for separate movement directions. For standing balance, data were synthesized for traditional time- and frequency domain sway parameters considering the conditions of eyes open (EO) and eyes closed (EC) separately. For meta-analysis, reduced JPS was observed in people with WAD compared to HC when the head was repositioned to a neutral head position (NHP) from rotation (standardised mean difference [SMD] = 0.43 [95%: 0.24–0.62]) and extension (0.33 [95%CI: 0.08–0.58]) or when the head was moved toward 50° rotation from a NHP (0.50 [0.05–0.96]). Similarly, people with WAD D had reduced JPS compared to people with WAD ND when the head was repositioned to a NHP from rotation (0.52 [0.22–0.82]). Larger sway velocity and litude was found in people with WAD compared to HC for both EO (0.62 [0.37–0.88] and 0.78 [0.56–0.99], respectively) and EC (0.69 [0.46–0.91] and 0.80 [0.58–1.02]) conditions. The observed changes of JPS and standing balance confirms deficits in sensorimotor control in people with WAD and especially in those with dizziness.
Publisher: MDPI AG
Date: 22-01-2021
Abstract: This study deals with how pain characteristics in conjunction with other factors affect quality of life (QoL) in a vulnerable primary care population. We recruited vulnerable older people (75+, n = 825) living in south-eastern Sweden. A postal questionnaire included pain aspects, QoL (EQ-5D-3L, RAND-36 physical functioning, attitudes toward own aging, and life satisfaction), functional status, social networks, and basic demographic information. Pain extent and localization was obtained by digitalization of pain drawings reported on standard body charts. Most respondents were experiencing pain longer than 3 months (88.8%). Pain frequency varied mostly between occasionally (33.8%) and every day (34.8%). A minority reported high pain intensity (13.6%). The lower back and lower legs were the most frequently reported pain locations ( %). Multiple linear regression model revealed three characteristics of pain (intensity, frequency, and extent) remained inversely associated with the EQ-5D-3L index score (R2 = 0.57). In idually, each of these pain characteristics showed a negative impact on the other three dimensions of QoL (R2 = 0.23–0.59). Different features of pain had impact on different dimensions of QoL in this aging population. A global pain assessment is useful to facilitate in idual treatment and rehabilitation strategies in primary care.
Publisher: Elsevier BV
Date: 10-2015
DOI: 10.1016/J.MATH.2015.04.010
Abstract: The deep cervical extensor, semispinalis cervicis, displays changes in behaviour and structure in people with chronic neck pain yet there is limited knowledge on how activation of this muscle can be emphasized during training. Using intramuscular electromyography (EMG), this study investigated the activity of the deep semispinalis cervicis and the superficial splenius capitis muscle at two spinal levels (C2 and C5) in ten healthy volunteers during a series of neck exercises: 1. Traction and compression, 2. Resistance applied in either flexion or extension at the occiput, at the level of the vertebral arch of C1 and of C4, and 3. Maintaining the neck in neutral while inclined on the elbows, with and without resistance at C4. The ratio between semispinalis cervicis and the splenius capitis EMG litude was quantified as an indication of whether the exercise could emphasize the activation of the semispinalis cervicis muscle relative to the splenius capitis. Manual resistance applied in extension over the vertebral arch emphasized the activation of the semispinalis cervicis relative to the splenius capitis at the spinal level directly caudal to the site of resistance (ratio: 2.0 ± 1.1 measured at C5 with resistance at C4 and 2.1 ± 1.2 measured at C2 with resistance at C1). This study confirmed the possibility of emphasizing the activation of the semispinalis cervicis relative to the splenius capitis which may be relevant for targeted exercise interventions for this deep extensor muscle. Further studies are required to investigate the clinical efficacy of these exercises for people with neck pain.
Publisher: Wiley
Date: 25-06-2021
DOI: 10.1002/EJP.1789
Abstract: Numerous studies have examined the influence of pain on spinal reflex excitability, motor unit behaviour and corticospinal excitability. Nevertheless, there are inconsistencies in the conclusions made. This systematic review sought to understand the effect of pain on spinal and supraspinal projections to motoneurons and motor unit properties by examining the influence of clinical or experimental pain on the following three domains: H‐reflex, corticospinal excitability and motor unit properties. MeSH terms and preselected keywords relating to the H‐reflex, motor evoked potentials and motor unit decomposition in chronic and experimental pain were used to perform a systematic literature search using Cumulative Index of Nursing and Allied Health Literature (CINAHL), Excerpta Medica dataBASE (EMBASE), Web of Science, Medline, Google Scholar and Scopus databases. Two independent reviewers screened papers for inclusion and assessed the methodological quality using a modified Downs and Black risk of bias tool a narrative synthesis and three meta‐analyses were performed. Sixty‐one studies were included, and 17 different outcome variables were assessed across the three domains. Both experimental and clinical pain have no major influence on measures of the H‐reflex, whereas experimental and clinical pain appeared to have differing effects on corticospinal excitability. Experimental pain consistently reduced motor unit discharge rate, a finding which was not consistent with data obtained from patients. The results indicate that when in tonic pain, induced via experimental pain models, inhibitory effects on motoneuron behaviour were evident. However, in chronic clinical pain populations, more varied responses were evident likely reflecting in idual adaptations to chronic symptoms. This is a comprehensive systematic review and meta‐analysis which synthesizes evidence on the influence of pain on spinal and supraspinal projections to motoneurons and motor unit properties considering measures of the H‐reflex, corticospinal excitability and motor unit behaviour. The H‐reflex is largely not influenced by the presence of either clinical or experimental pain. Whilst inhibitory effects on corticospinal excitability and motor unit behaviour were evident under experimental pain conditions, more variable responses were observed for people with painful musculoskeletal disorders.
Publisher: Elsevier BV
Date: 03-2017
DOI: 10.1016/J.PHYSIO.2015.10.016
Abstract: To investigate the activity of the thoracic erector spinae muscles and perceived pain intensity immediately after central postero-anterior (PA) mobilisation of the thoracic spine. Randomised, placebo-controlled, experimental design. Thirty-four participants with non-specific thoracic pain were randomised to the experimental group [grade III central PA mobilisation performed for 3minutes at the level of the seventh thoracic vertebra (T7)] or the placebo group (less than grade I central PA mobilisation performed for 3minutes at T7). Before and immediately after PA mobilisation, surface electromyography (EMG) was recorded from the thoracic erector spinae muscles as the participants performed 10° spine extension from a prone position for 10seconds. Each participant rated their pain intensity as an investigator performed grade III central PA over the most symptomatic thoracic segment, and the pressure pain threshold (PPT) was evaluated bilaterally over the erector spinae muscles. The EMG litude of thoracic erector spinae activity was reduced significantly after the intervention in the experimental group (P<0.05), but not in the placebo group. The difference between the groups was significant {pre-post change: placebo -14 [standard deviation (SD) 50]mV, experimental 28 (SD 48)mV mean difference -42mV 95% confidence interval of the difference -76 to 7 P<0.05} albeit small (Grissom=0.44). However, both groups showed a significant reduction in pain immediately after the intervention, and both groups showed a similar pre-post change in PPT. These preliminary findings indicate that grade III central mobilisation over the most symptomatic thoracic segment reduces thoracic erector spinae activity during extension of the trunk in people with non-specific thoracic spine pain. ISRCTN47601528.
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 10-2013
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 12-2016
DOI: 10.1097/AJP.0000000000000373
Abstract: To apply topographical mapping of the electromyography (EMG) litude recorded from the upper trapezius muscle to evaluate the distribution of activity and the location of peak activity during a shoulder elevation task in participants with and without myofascial pain and myofascial trigger points (MTrP) and compare this location with the site of the MTrP. Thirteen participants with myofascial pain and MTrP in the upper trapezius muscle and 12 asymptomatic in iduals participated. High-density surface EMG was recorded from the upper trapezius muscle using a matrix of 64 surface electrodes aligned with an anatomic landmark system (ALS). Each participant performed a shoulder elevation task consisting of a series of 30 s r ed contractions to 15% or 60% of their maximal voluntary contraction (MVC) force. Topographical maps of the EMG average rectified value were computed and the peak EMG litude during the r ed contractions was identified and its location determined with respect to the ALS. The location of the MTrP was also determined relative to the ALS and Spearman correlation coefficients were used to examine the relationship between MTrP and peak EMG litude location. The location of the peak EMG litude was significantly ( P .05) different between groups (participants with pain/MTrP: −0.32±1.2 cm at 15% MVC and −0.35±0.9 cm at 60% MVC relative to the ALS asymptomatic participants: 1.0±1.3 cm at 15% MVC and 1.3±1.1 cm relative to the ALS). However, no correlation was observed between the position of the MTrP and peak EMG litude during the r ed contractions at either force level (15%: r s =0.039, P =0.9 60%: r s =−0.087, P =0.778). People with myofascial pain and MTrP displayed a caudal shift of the distribution of upper trapezius muscle activity compared with asymptomatic in iduals during a submaximal shoulder elevation task. For the first time, we show that the location of peak muscle activity is not associated with the location of the MTrP.
Publisher: MDPI AG
Date: 19-03-2022
DOI: 10.3390/JCM11061702
Abstract: Background: Deep bite, a frequent malocclusion with a high relapse rate, is associated with craniofacial features that need to be considered in the course of orthodontic treatment. Methods: This study included 81 patients with deep bite malocclusion (11.4 ± 1.1 [yr.mo] M = 32 and F = 49), and 14 age- and gender-matched controls (9.11 ± 1 [yr.mo] M = 5 and F = 9). The patients with deep bite malocclusion were treated with functional therapy. The chewing cycles and masticatory muscle EMG activity were recorded concomitantly before treatment in both groups (n = 95). Following correction of the malocclusion, a second recording took place (n = 25). Results: The kinematic variables showed the same dependency on bolus hardness in those with deep bite and in the controls. The masticatory muscle EMG activity was increased in those with deep bite, but decreased as a result of functional treatment. The chewing patterns showed a tendency towards a reduced lateral component, which significantly increased after treatment, indicating that functional therapy impacts the neuromuscular coordination of mastication, as well as dental positioning. Conclusions: Deep bite is a complex malocclusion, involving alterations in chewing and masticatory muscle activity. Orthognathodontic treatment should not only consider and correct the teeth position, but should also address muscular hyperactivity.
Publisher: American Physiological Society
Date: 02-2012
Abstract: We investigated the influence of nociceptive stimulation on the accuracy of task execution and motor unit spike trains during low-force isometric contractions. Muscle pain was induced by infusion of hypertonic saline into the abductor digiti minimi muscle of 11 healthy men. Intramuscular EMG signals were recorded from the same muscle during four isometric contractions of 60-s duration at 10% of the maximal force [maximal voluntary contraction (MVC)] performed before injection (baseline), after injection of isotonic (control) or hypertonic saline (pain), and 15 min after pain was no longer reported. Each contraction was preceded by three 3-s r contractions from 0% to 10% MVC. The low-frequency oscillations of motor unit spike trains were analyzed by the first principal component of the low-pass filtered spike trains [first common component (FCC)], which represents the effective neural drive to the muscle. Pain decreased the accuracy of task performance [coefficient of variation (CoV) for force: baseline, 2.8 ± 1.8%, pain, 3.9 ± 1.8% P 0.05] and reduced motor unit discharge rates [11.6 ± 2.3 pulses per second (pps) vs. 10.7 ± 1.7 pps P 0.05]. Motor unit recruitment thresholds (2.2 ± 1.2% MVC vs. 2.4 ± 1.6% MVC), interspike interval variability (18.4 ± 4.9% vs. 19.1 ± 5.4%), strength of motor unit short-term synchronization [common input strength (CIS) 1.02 ± 0.44 vs. 0.83 ± 0.22], and strength of common drive (0.47 ± 0.08 vs. 0.47 ± 0.06) did not change across conditions. The FCC signal was correlated with force ( R = 0.45 ± 0.06), and the CoV for FCC increased in the painful condition (5.69 ± 1.29% vs. 7.83 ± 2.61% P 0.05). These results indicate that nociceptive stimulation increased the low-frequency variability in synaptic input to motoneurons.
Publisher: BMJ
Date: 04-2020
DOI: 10.1136/BMJOPEN-2019-034286
Abstract: Physical functioning (PF) is the ability to carry out the physical activity of daily living. It is an important outcome that provides a meaningful evaluation of in iduals’ life. PF can be assessed using patient-reported outcome measures, performance-based outcome measures or body structure and function measure. Measures need to be valid, reliable and responsive to change to evaluate the effects of an intervention. Adolescent idiopathic scoliosis (AIS) is the most common deformity among the paediatric population and impacts on in iduals’ lives. This systematic review will appraise evidence on the measurement properties of PF tools in in iduals with AIS. A protocol for systematic review and meta-analysis informed by Cochrane guidelines is reported in line with Preferred Reporting Items for Systematic Reviews and Meta-Analysis-P. MEDLINE, PsycINFO, EMBASE, CINAHL, SPORTdiscus, Web of Science and PubMed will be searched in two stages, from inception until December 2019. Search 1 will inventory all studies that assessed PF in participants with AIS, without any limitations. The search terms will be scoliosis, adolescent and PF-related terms. Search 2 will include studies which investigated instrument measurement properties in the same population for measures identified in search one. Two reviewers will independently perform study selection, data extraction, risk of bias and overall quality assessment. The COnsensus-based Standards for the selection of health Measurement INstruments (COSMIN) risk of bias and a modified Grading of Recommendations, Assessment, Development and Evaluation (GRADE) guidelines will be used. A meta-analysis will be conducted if possible, or the evidence will be synthesised and summarised per measurement property per outcome measure per measurement type. This review will provide recommendations for practice and future research, considering psychometric properties of outcome measures of PF in AIS. The results of this study will be disseminated through a peer-reviewed publication and conference presentation. CRD42019142335.
Publisher: Elsevier BV
Date: 2009
Publisher: Ordine TSRM PSTRP di Napoli, Avellino, Benevento
Date: 05-11-2021
Abstract: Musculoskeletal diseases and disorders from biomechanical overload are very common among workers. In Italy in 2019, occupational diseases of the osteomuscular system and connective tissue accounted for 66% of the total number of diseases reported to INAIL. Many factors can contribute to the establishment of a condition of biomechanical overload and therefore to the onset of work-related musculoskeletal disorders (WMSDs). Among these, work-related low-back disorders (WLBDs), caused mainly by handling heavy loads, are very common. In recent years, several methods have been developed to assess the risk of biomechanical overload, included in several international standards (ISO-11228, ISO-11226, ISO/TR 12295 and 12296) aimed at identifying high-risk work activities and assessing the effectiveness of ergonomic interventions. Among the best known, with regard to the manual lifting of heavy loads, there is the Revised NIOSH Lifting Equation that, while presenting many advantages (cost-effectiveness, non-invasiveness, speed of application ...) at the same time also has limitations concerning mainly the high subjectivity (subject of scientific debate) and the impossibility of these methods to assess all work tasks. From these premises, it is clear the usefulness of being able to use new quantitative risk assessment methodologies, objectifiable and repeatable, which provide for the possibility of assessing the risk from biomechanical overload even in modern working scenarios where the use of exoskeletons by workers and the sharing of working space with cobots is becoming increasingly widespread. In fact, the methods currently used are incomplete and ineffective in assessing the real impact that these technologies have on the health and safety of workers in Industry 4.0. Recent studies (some of which we were involved in) have introduced the possibilities offered by optoelectronic systems, inertial sensors (IMUs) and surface electromyography (sEMG), to integrate the most widely used observational methodologies. These modern technologies, evaluating how a subject moves his joints and uses his muscles during the execution of a work task, can integrate the observational methods, quantify the elements that characterize the risk minimizing the evaluation errors caused by in idual subjectivity and allow to carry out the assessment of biomechanical risk even in those areas where the currently most widespread methodologies are not able to give exhaustive answers. In particular, the innovative methodologies based on IMUs and sEMG, allow the instrumental quantitative assessment of biomechanical risk directly in the field thanks to the fact that the sensors are miniaturized, wearable, easily transportable and based on "wireless" transmission of data acquired on the worker who performs the task. These aspects facilitate data recording, allowing accurate signal acquisition even in unfavorable environments and in work situations where the worker interacts with a cobot or uses an exoskeleton. Previous studies have involved studies of non-fatiguing lifts, where the movement and relative risk of single repetitions of lifting were studied. Currently, we wonder what happens when the work activity becomes fatiguing and whether it is still possible to use these methods to classify risk. In addition, another unexplored question concerns the presence of workers who continue to perform work activity during the first phase of onset of musculoskeletal disorders: can the risk to which these workers are exposed be considered the same as that involving workers without pain? To answer these questions, we conducted an experimental c aign at the University of Birmingham in collaboration with Roma Tre University and INAIL in which subjects with and without back disorders performed fatiguing lifts of 15 minutes in three risk levels determined by three different lifting frequencies. We studied trunk muscle activity in terms of muscle coactivation of the trunk flexor and extensor muscles. The results show how coactivation can classify risk during manual load lifting activities by distinguishing not only the level of risk but also the presence or absence of back disorders. These results suggest that the use of electromyographic features to assess the biomechanical risk associated with work activities can also be used in the presence of fatiguing lifting also to distinguish the risk in case of subjects with back pain. This methodology could be used to monitor fatigue and extend the possibilities offered by currently available instrumental-based approaches.
Publisher: Elsevier BV
Date: 2002
DOI: 10.1016/S1388-2457(01)00708-8
Abstract: Advances in surface electromyography (sEMG) techniques provide a clear indication that refinement of electrode location relative to innervation zones (IZ) is required in order to optimise the accuracy, relevance and repeatability of the sEMG signals. The aim of this study was to identify the IZ for the sternocleidomastoid and anterior scalene muscles to provide guidelines for electrode positioning for future clinical and research applications. Eleven volunteer subjects participated in this study. Myoelectric signals were detected from the sternal and clavicular heads of the sternocleidomastoid and the anterior scalene muscles bilaterally using a linear array of 8 electrodes during isometric cervical flexion contractions. The signals were reviewed and the IZ(s) were identified, marked on the subjects' skin and measurements were obtained relative to selected anatomical landmarks. The position of the IZ lay consistently around the mid-point or in the superior portion of the muscles studied. Results suggest that electrodes should be positioned over the lower portion of the muscle and not the mid-point, which has been commonly used in previous studies. Recommendations for sensor placement on these muscles should assist investigators and clinicians to ensure improved validity in future sEMG applications.
Publisher: Elsevier BV
Date: 04-2021
Publisher: Elsevier BV
Date: 06-2021
Publisher: Springer Science and Business Media LLC
Date: 02-12-2017
DOI: 10.1007/S00421-016-3509-5
Abstract: The neck extensor muscles contribute to spinal support and posture while performing head and neck motion. Muscle stiffness relates to passive elasticity (support) and active tensioning (posture and movement) of muscle. It was hypothesized that support and motion requirements are reflected in the distribution of stiffness between superficial and deep neck extensor muscles. In ten healthy participants, shear modulus (stiffness) of five neck extensor muscles was determined in prone at rest and during isometric head lift at three intensities using shear wave elastography. Shear modulus differed between muscles (P < 0.001), and was larger for the deeper muscles: (median (interquartile range)) trapezius 7.7 kPa (4.4), splenius capitis 6.5 kPa (2.5), semispinalis capitis 8.9 kPa (2.8), semispinalis cervicis 9.5 kPa (2.5), multifidus 14.9 kPa (1.4). Shear modulus differed between the resting condition and head lift (P < 0.001) but not between levels of head lift intensity. Shear wave elastography revealed highest passive and active stiffness of the deep neck extensor muscles most close to the spine. The highest active increase of stiffness during the head lift was found in the semispinalis cervicis muscle. The non-invasive, clinically applicable estimates of muscle stiffness have potential for the assessment of muscular changes associated with neck pain/injury.
Publisher: BMJ
Date: 09-2022
DOI: 10.1136/BMJOPEN-2022-061679
Abstract: A disturbance in exercise-induced hypoalgesia (EIH) has been observed in patients with chronic whiplash-associated disorders (WAD). Yet, no studies have examined whether EIH occurs in people with acute/subacute WAD. This study will determine whether EIH occurs immediately after and 24 hours after aerobic exercise (AE) and neck-specific exercise (NSE) in people with acute/subacute WAD. A randomised controlled trial has been designed and is reported in line with the Standard Protocol Items: Recommendations for Interventional Trials. EIH will be assessed immediately after and 24 hours after AE, NSE and a control intervention (randomly allocated). As dependent variables of the study, we will measure pressure pain thresholds measured over the region of the spinous process of C2 and C5, the muscle belly of the tibialis anterior and over the three main peripheral nerve trunks, Neck Pain Intensity, Neck-Disability Index, Pain Catastrophizing Scale, T a Scale Kinesiophobia-11, self-reported Leeds Assessment of Neuropathic Symptoms and Signs Scale. Ethical approval has been granted by the Ethics Committee from University Rey Juan Carlos (Madrid, Spain reference number 0707202116721). The results of this study will be disseminated through presentations at scientific conferences and publication in scientific journals. RBR-9tqr2jt, ensaiosclinicos.gov.br/observador/submissao/sumario/11551 .
Publisher: Springer Science and Business Media LLC
Date: 26-05-2017
Publisher: BMJ
Date: 05-2022
DOI: 10.1136/BMJOPEN-2021-060264
Abstract: Low back pain and neck pain are leading causes of disability. Although several studies have examined the effect of exercise on fear of movement in people with spine-related pain, the overall evidence supporting the beneficial effect of different forms of exercise on fear of movement remains unknown. This systematic review will determine the strength of evidence for the effect of exercise hysical activity on fear of movement in people with non-specific spine-related pain. This review protocol was developed following the Preferred Reporting Items for Systematic Reviews and Meta-Analysis Protocols. The review will include randomised controlled trials and non-randomised studies that recruited adults (≥18 years) with chronic non-specific spine-related pain and where a validated measure of fear of movement/kinesiophobia such as the T a Scale of Kinesiophobia (TSK) and the Fear Avoidance Behaviour Questionnaire (FABQ) or any other validated measures to ascertain fear of movement/kinesiophobia was employed. Bibliographic databases include MEDLINE, PsycINFO, EMBASE, CINAHL, ZETOC, Web of Science, PubMed and Google Scholar as well as key journals/grey literature will be searched from inception to 31 January 2022. Only articles published in English will be considered eligible. Two independent reviewers will search, screen studies, extract data and assess risk of bias. Preintervention and postintervention mean and SD with 95% CI of the outcome data (TSK or FABQ) will be extracted or estimated where possible. If possible, study results will be pooled into a meta-analysis. A narrative synthesis of the results will be presented if heterogeneity is high. The overall quality of evidence and risk of bias will be assessed using the Grading of Recommendations Assessment, Development and Evaluation and Risk Of Bias in Non-randomised Studies of Interventions guidelines. This systematic review does not require ethical approval as existing data will be used. The results will be disseminated through a peer-reviewed journal and via national and international conferences. CRD42021295755.
Publisher: Elsevier BV
Date: 10-2013
DOI: 10.1016/J.MATH.2013.05.009
Abstract: The deep cervical extensors are anatomically able to control segmental movements of the cervical spine in concert with the deep cervical flexors. Several investigations have confirmed changes in cervical flexor muscle control in patients with neck pain and as a result, effective evidence-based therapeutic exercises have been developed to address such dysfunctions. However, knowledge on how the deep extensor muscles behave in patients with neck pain disorders is scare. Structural changes such as higher concentration of fat within the muscle, variable cross-sectional area and higher proportions of type II fibres have been observed in the deep cervical extensors of patients with neck pain compared to healthy controls. These findings suggest that the behaviour of the deep extensors may be altered in patients with neck pain. Consistent with this hypothesis, a recent series of studies confirm that patients display reduced activation of the deep cervical extensors as well as less defined activation patterns. This article provides an overview of the various different structural and functional changes in the deep neck extensor muscles documented in patients with neck pain. Relevant recommendations for the management of muscle dysfunction in patients with neck pain are presented.
Publisher: Elsevier BV
Date: 03-2021
Publisher: American Physiological Society
Date: 02-2007
DOI: 10.1152/JAPPLPHYSIOL.00602.2006
Abstract: This study examined the effect of experimental neck muscle pain on the EMG-force relationship of cervical agonist and antagonist muscles. Surface EMG signals were detected from the sternomastoid, splenius capitis, and upper trapezius muscles bilaterally from 14 healthy subjects during cervical flexion and extension contractions of linearly increasing force from 0 to 60% of the maximum voluntary contraction (MVC). Measurements were performed before and after injection of 0.5 ml hypertonic and isotonic saline into either the sternomastoid or splenius capitis in two experimental sessions. EMG average rectified value (ARV) of the sternomastoid, splenius capitis, and upper trapezius muscles and the muscle fiber conduction velocity (CV) of the sternomastoid muscle were estimated at 5% MVC force increments. During cervical flexion with injection of hypertonic saline in sternomastoid, ARV of sternomastoid was lower on the side of pain in the force range 25–60% MVC ( P 0.05) and was associated with a bilateral reduction of splenius capitis and upper trapezius ARV ( P 0.01). During cervical extension, injection of hypertonic saline in splenius capitis resulted in lower estimates of splenius capitis ARV on the painful side from 45 to 60% MVC ( P 0.05), which was associated with a bilateral increase in upper trapezius ARV estimates from 50 to 60% MVC ( P 0.001). However, no significant change was identified for estimates of sternomastoid ARV. Experimentally induced neck muscle pain resulted in task-dependent changes in cervical agonist/antagonist activity without modifications in muscle fiber CV.
Publisher: Wiley
Date: 21-02-2020
DOI: 10.1002/EJP.1537
Abstract: Rehabilitation approaches should be based on an understanding of the mechanisms underpinning functional recovery. Yet, the mediators that drive an improvement in post-surgical pain-related disability in in iduals with cervical radiculopathy (CR) are unknown. The aim of the present study is to use Bayesian networks (BN) to learn the probabilistic relationships between physical and psychological factors, and pain-related disability in CR. We analysed a prospective cohort dataset of 201 post-surgical in iduals with CR. In all, 15 variables were used to build a BN model: age, sex, neck muscle endurance, neck range of motion, neck proprioception, hand grip strength, self-efficacy, catastrophizing, depression, somatic perception, arm pain intensity, neck pain intensity and disability. A one point increase in a change of self-efficacy at 6 months was associated with a 0.09 point decrease in a change in disability at 12 months (t = -64.09, p < .001). Two pathways led to a change in disability: a direct path leading from a change in self-efficacy at 6 months to disability, and an indirect path which was mediated by neck and arm pain intensity changes at 6 and 12 months. This is the first study to apply BN modelling to understand the mechanisms of recovery in post-surgical in iduals with CR. Improvements in pain-related disability was directly and indirectly driven by changes in self-efficacy levels. The present study provides potentially modifiable mediators that could be the target of future intervention trials. BN models could increase the precision of treatment and outcome assessment of in iduals with CR. Using Bayesian Network modelling, we found that changes in self-efficacy levels at 6-month post-surgery directly and indirectly influenced the change in disability in in iduals with CR. A mechanistic understanding of recovery provides potentially modifiable mediators that could be the target of future intervention trials.
Publisher: Elsevier BV
Date: 10-2010
DOI: 10.1016/J.MATH.2010.05.008
Abstract: The extent of cortical neuroplastic changes has been shown to be a key neurophysiological feature that correlates with the level of functional recovery. Therefore, rehabilitation efforts that attempt to maximize cortical reorganization provide the greatest potential for rehabilitation success. This paper reviews the evidence of cortical neuroplastic changes that have been shown to occur in association with experimental or chronic pain disorders. Further, the promising role of novel motor-skill training is discussed in order to best direct the clinician to optimize rehabilitation strategies for patients with musculoskeletal pain disorders.
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 02-2017
DOI: 10.1097/AJP.0000000000000381
Abstract: To characterize the distribution of masseter muscle activity and force control during bilateral jaw clenching tasks in people with chronic nonspecific neck pain, without an associated temporomandibular disorder. Twelve volunteers with nonspecific neck pain and 12 age-matched and sex-matched healthy in iduals participated. Submaximal symmetrical and asymmetrical bilateral jaw clenching was performed with and without visual feedback of force. Force performance was assessed with indices of accuracy (mean distance, offset error) and precision (standard deviation, coefficient of variation of force). High-density, 2-dimensional, surface electromyography (EMG) was recorded to characterize bilateral masseter muscle activity. The EMG root mean square was computed for each location of the electrode grid to form a map of the EMG litude distribution, and the location of the center of activity was measured. The patient group showed a different distribution of masseter muscle activity compared with pain-free in iduals during both symmetrical and asymmetrical bilateral jaw clenching. The position of the center of activity was positioned more cranial ( P .001 right masseter only) and more anteriorly in the patient group ( P .0001). In addition, the patients with chronic neck pain displayed higher levels of masseter muscle activation compared with the control participants regardless of the specific task performed ( P .0001). People with chronic neck pain display increased activation and altered distribution of masseter muscle activity during a jaw-clenching coordination task. These results provide a greater appreciation of how secondary orofacial pain or temporomandibular disorders may develop in people with neck pain.
Publisher: BMJ
Date: 02-2020
DOI: 10.1136/BMJOPEN-2019-033547
Abstract: Neuropathic low back-related leg pain (LBLP) can be a challenge to healthcare providers to diagnose and treat. Accurate diagnosis of neuropathic pain is fundamental to ensure appropriate intervention is given. However, to date there is no gold standard to diagnose neuropathic LBLP. A Delphi study will therefore be conducted to obtain an expert-derived consensus list of clinical indicators to identify a neuropathic component to LBLP. Included participants will be considered experts within the field as measured against a predefined eligibility criterion. Through an iterative multistage process, participants will rate their agreement with a list of clinical indicators and suggest any missing clinical indicators during each round. Agreement will be measured using a 5-point Likert scale. Descriptive statistics will be used to measure agreement median, IQR and percentage of agreement. A priori consensus criteria will be defined for each round. Data analysis at the end of round three will enable a list of clinical indicators to be derived. Ethical approval was gained from the University of Birmingham (ERN_19-1142). On completion of the study, findings will be disseminated in a peer-reviewed journal and presented at relevant conferences.
Publisher: Oxford University Press (OUP)
Date: 25-02-2022
DOI: 10.1093/PM/PNAC038
Abstract: Several factors such as neck pain intensity, disability, anxiety, depression, female sex, or a previous history of headache are associated with post-whiplash headache. However, the possible role of psychosocial factors contributing to the presence of headache or worsening of headache after a whiplash trauma remains unclear. To address this gap in knowledge, there is the need to assess psychosocial factors concerning headache shortly after a whiplash injury. To evaluate psychological features, pain and disability in people with acute whiplash associated disorders (WAD) and compare these features between those with and without headache. Case-control study. A secondary care traumatology center. Forty-seven people with acute WAD were recruited 28 with headache, and 19 without. All participants completed self-reported questionnaires including Visual Analogue Scale (VAS) for neck pain intensity, the Neck Disability Index (NDI), Pain Catastrophizing Scale (PCS), T a Scale Kinesiophobia-11 (TSK-11), and State-Trait Anxiety Inventory. Neck pain intensity (P & .001), neck disability (P & 0.001), pain catastrophizing (P & .001), kinesiophobia (P & .001), and anxiety state (P = .007) and trait (P = .05) were higher in those with headache when compared to those without. In addition, high levels of neck pain (P = .025), moderate levels of neck disability (P & .001), moderate levels of pain catastrophizing (P = .015), and moderate (P = .002) and severe (P = .016) levels of kinesiophobia were related to the presence of headache. The level of neck pain intensity and disability, kinesiophobia, catastrophizing, and anxiety were all greater in people with acute WAD who presented with a headache compared to those without headache.
Publisher: Wiley
Date: 12-2003
DOI: 10.1111/J.1747-4477.2003.TB00540.X
Abstract: There have been recent advances in the rehabilitation of the muscles that control the head and neck. These advances are based on evidence of specific neck muscle dysfunction in in iduals with persistent head and neck pain. Traditional rehabilitation strategies have focused predominantly on muscle strength and endurance under high loads. New evidence suggests that in people with neck pain there are underlying neuromuscular problems that may require more immediate attention and may not be adequately addressed by simple strength and high-load endurance retraining. Evidence of altered coordination between the deep and superficial neck muscles, greater neck muscle fatigue under sustained low loads, and deficits in kinaesthetic sense have been identified in symptomatic in iduals. There is evidence to indicate that addressing these muscle control problems, with specific gentle exercise strategies, results in a reduction in neck pain and associated symptoms.
Publisher: Elsevier BV
Date: 08-2017
DOI: 10.1016/J.MSKSP.2017.05.007
Abstract: Quasi-Experimental. To assess the activation of semispinalis cervicis (d-SSC) and splenius capitis (s-SC) muscles, and the activation between the two during neck pulley and free weight exercises. Altered activation of cervical extensors may occur with neck pain, suggesting that exercises should be designed to target these muscles. d-SSC and s-SC activity was recorded unilaterally with intramuscular electromyography from healthy volunteers during cervical isometric exercises: 1) extension with a pulley rope angled from incline to vertical, 2) extension with right, left and central forehead hanging weight, and 3) rotation with pulley rope angled from incline to decline. Extension against a vertical force led to greater activation of d-SSC (P < 0.001) and s-SC (P < 0.001) compared to the inclined, declined and horizontal pulley. With each of these conditions, litude of muscle activity was higher for the d-SSC compared to the s-SC muscle (P < 0.0001). Extension with free weight hanging on right, left or central forehead, showed no differences across conditions, although in each condition, the d-SSC litude was higher than the s-SC. For cervical rotation, the declined pulley led to the greatest activation of both muscles (P < 0.05). Higher levels of activity were observed for the s-SC compared to the d-SSC (P < 0.01) for all rotation conditions. A vertical resistance during an extension exercise or a declined resistance during cervical rotation, increased neck extensor activation. The results from this preliminary study provide guidance for future work on the exploration and development of low-load exercise design for patients with neck pain disorders.
Publisher: Oxford University Press (OUP)
Date: 18-02-2022
DOI: 10.1093/PM/PNAC034
Abstract: To compare the effects of dry needling or manual pressure release on an active trigger point in the upper trapezius on craniocervical flexion test performance, pressure pain thresholds, and cervical range of motion in chronic neck pain. A parallel randomized clinical trial. Physical therapy service. In iduals with chronic neck pain. Subjects were randomized to receive dry needling (n = 25) or manual trigger point pressure release (n = 25) on upper trapezius active trigger points. Surface electromyography from the upper trapezius, splenius capitis, sternocleidomastoid, and scalene muscles during performance of the craniocervical flexion test was assessed before and immediately after the intervention as the primary outcome. Neck pain intensity, range of motion, and pressure pain thresholds were the secondary outcomes. A decrease in sternocleidomastoid activity at all stages of the craniocervical flexion test (time effect, P & 0.001) was found in both groups after the interventions, with no significant between-group difference. Pressure pain thresholds measured over the cervical spine and second metacarpal increased after dry needling when compared with manual trigger point pressure release (P & 0.05). Pain intensity decreased immediately after both treatments with moderate to large effect sizes, whereas cervical range of motion increased for both groups but with small effect sizes. A single session of dry needling or manual pressure release over upper trapezius active trigger points promotes limited effects on muscle performance during the craniocervical flexion test, pressure pain thresholds, and cervical range of motion in patients with chronic neck pain.
Publisher: American Physiological Society
Date: 02-2009
Abstract: We analyzed in idual motor units of the sternohyoid muscle with the aim of characterizing their minimum and maximum discharge rates and their variability in discharge during voluntary contractions. Surface EMG signals were recorded with an array of eight electrodes from the sternohyoid muscle of seven healthy men (age: 30.2 ± 3.5 yr). The multichannel surface EMG signals were displayed as feedback for the subjects who identified and modulated the activity of one target motor unit in 30-s contractions during which the discharge rate was increased from minimum to maximum (r contraction), sustained at maximum level (sustained), or increased in brief bursts (burst). During the r contractions, the minimum average discharge rate over epochs of 1 s was 11.6 ± 1.5 pulses per second (pps) and the maximum 57.0 ± 5.7 pps ( P 0.001). During the sustained contractions, the motor unit discharge rate decreased from 65.5 ± 8.4 pps at the beginning to 52.9 ± 7.6 pps at the end of the contraction ( P 0.05). The coefficient of variation for the interspike interval during the sustained contractions was 40.2 ± 9.8% and a large percentage of discharges had instantaneous rates pps (52.2 ± 12.5%) and pps (8.0 ± 1.2%), with peak values pps. During the burst contractions, the instantaneous discharge rate reached average maximum values of 97.6 ± 36.8 pps. The observed discharge rates and their variability are higher than those reported for limb muscles, which may be due to large synaptic input and noise received by these motor neurons.
Publisher: Elsevier BV
Date: 04-2008
DOI: 10.1016/J.JELEKIN.2006.11.001
Abstract: The purpose of this brief review is to present evidence from experimental and clinical neck pain studies of pain-induced neuromuscular adaptations. It has been shown that clinical neck pain is associated with a substantial reorganization in the control strategies of cervical muscles during static and dynamic tasks. Experimental neck pain models allow local elicitation of nociceptive afferents, mimicking the sensory aspects of clinical pain, without major changes in muscle properties. These models may help understand the physiological mechanisms underlying the observations from clinical neck pain studies. The knowledge obtained from the interpretation of clinical findings with experimental pain models has relevance for the development of therapeutic interventions for the rehabilitation of patients with neck pain disorders.
Publisher: Wiley
Date: 19-01-2010
DOI: 10.1111/J.1600-0838.2008.00866.X
Abstract: An increase to above-baseline levels of electromyography (EMG) mean power spectral frequency (MPF) has been observed previously during muscle recovery following fatiguing contractions and has been explained by membrane hyperpolarization due to increased activation of the Na+-K+ pump. It is hypothesized that this membrane mechanism is impaired by muscle fiber damage following eccentric exercise. Thus, the aim of the study was to investigate surface EMG signal characteristics during recovery from fatigue after eccentric exercise. Ten healthy subjects performed sustained isometric knee extensions at 40% of the maximal torque (MVC) until task failure before, immediately after and 24 and 48 h after eccentric exercise. Bipolar surface EMG signals were recorded from six locations over the quadriceps during the sustained isometric contraction and during 3-s long contractions at 40% MVC separated by 1-min intervals for 15 min (recovery). Before the eccentric exercise, MPF of EMG signals increased to values above baseline during recovery from the fatiguing isometric contraction (P<0.001), whereas immediately after and 24 and 48 h after the eccentric task, MPF was lower than baseline during the entire recovery period (P<0.01). In conclusion, delayed-onset muscle soreness abolished the supranormal increase in EMG MPF following recovery from fatigue.
Publisher: Public Library of Science (PLoS)
Date: 02-02-2021
DOI: 10.1371/JOURNAL.PONE.0245999
Abstract: This study aimed to understand the impact of COVID-19 distress on psychological status, features of central sensitization and facial pain severity in people with temporomandibular disorders (TMDs). In this prospective cohort study, 45 adults (19 chronic, 26 acute/subacute TMD) were recruited prior to the COVID-19 outbreak. Baseline assessment took place before the outbreak while a follow-up was performed immediately after the lockdown period. Multiple variables were investigated including age, gender, perceived life quality, sleep quality, anxiety and depression, coping strategies, central sensitization, pain intensity, pain-related disability and oral behaviour. COVID Stress Scales (CSS) were applied at follow-up to measure the extent of COVID-related distress. CSS were significantly higher in those with chronic TMDs compared to those with acute/subacute TMDs (p .05). In people with chronic TMD, the variation in anxiety and depression from baseline to follow-up was significantly correlated with scores on the CSS (r = 0.72 p = 0.002). Variations of the central sensitization inventory (r = 0.57 p = 0.020) and graded chronic pain scale (r = 0.59 p = 0.017) were significantly correlated with scores on the CSS. These initial findings indicate that people with chronic TMD were more susceptible to COVID-19 distress with deterioration of psychological status, worsening features of central sensitization and increased chronic facial pain severity. These findings reinforce the role of stress as a possible lifier of central sensitization, anxiety, depression, chronic pain and pain-related disability in people with TMDs. Trial Registration : ClinicalTrials.gov ID: NCT03990662 .
Publisher: Springer Science and Business Media LLC
Date: 04-11-2019
DOI: 10.1038/S41598-019-52434-9
Abstract: Recent research using high-density electromyography (HDEMG) has provided a more precise understanding of the behaviour of the paraspinal muscles in people with low back pain (LBP) but so far, HDEMG has not been used to investigate the flexion relaxation phenomenon (FRP). To evaluate this, HDEMG signals were detected with grids of electrodes (13 × 5) placed bilaterally over the lumbar paraspinal muscles in in iduals with and without LBP as they performed repetitions of full trunk flexion. The root mean square of the HDEMG signals was computed to generate the average normalized litude and the spatial FRP onset was determined and expressed as percentage of trunk flexion. Smoothing spline analysis of variance models and the contrast cycle difference approach using the Bayesian interpretation were used to determine statistical inference. All pain-free controls and 64.3% of the in iduals with LBP exhibited the FRP. In iduals with LBP and the FRP exhibited a delay of its onset compared to pain-free controls (significant mean difference of 13.3% of trunk flexion). They also showed reduced normalized litude compared to those without the FRP, but still greater than pain-free controls (significant mean difference of 27.4% and 11.6% respectively). This study provides novel insights into changes in lumbar muscle behavior in in iduals with LBP.
Publisher: Wiley
Date: 19-09-2023
DOI: 10.1002/EJP.2184
Publisher: Elsevier BV
Date: 02-2011
Publisher: Elsevier BV
Date: 10-2020
Publisher: Elsevier BV
Date: 09-2016
DOI: 10.1016/J.MATH.2016.05.336
Abstract: The craniocervical flexion test assesses the deep cervical flexor muscles (longus capitis, longus colli). Ideally, electromyography (EMG) studies measure activity in both deep and superficial (sternocleidomastoid, anterior scalene) flexors during the test, but most studies confine recordings to superficial muscle activity as the technique to record the deep muscles is invasive. Higher activity of the superficial flexors has been interpreted as an indicator of reduced deep flexor activity in people with neck pain but how close the inverse relationship is during this test is unknown. EMG was recorded from the sternocleidomastoid, anterior scalene and deep cervical flexor muscles to quantify their relationship during the craniocervical flexion test, from 32 women (age: 38.0 ± 11.6 yrs) with a history of chronic non-specific neck pain. The range of craniocervical flexion at each of the five test stages was also measured. A moderate negative correlation was identified (r = -0.45 P < 0.01) between the average normalized EMG litude of the deep cervical flexors and sternocleidomastoid across all stages of the craniocervical flexion test. There was a moderate although weaker and non-significant negative correlation between deep cervical flexors and anterior scalene activity (r = -0.34 P = 0.053). The results affirm the interpretation that higher levels of activity of the superficial flexor muscles are an indicator of reduced deep cervical flexor activity in the craniocervical flexion test. Further studies of neuromuscular and movement strategies used by people with neck pain to compensate for poorer activation of the deep cervical flexors will inform best clinical assessment.
Publisher: Elsevier BV
Date: 11-2013
DOI: 10.1016/J.JMPT.2013.08.004
Abstract: The purpose of this study was to assess the effects of a low-load training program for the deep cervical flexors (DCFs) on pain, disability, and pressure pain threshold (PPT) over cervical myofascial trigger points (MTrPs) in patients with chronic neck pain. Thirty patients with chronic idiopathic neck pain participated in a 6-week program of specific training for the DCF, which consisted of active craniocervical flexion performed twice per day (10-20 minutes) for the duration of the trial. Perceived pain and disability (Neck Disability Index, 0-50) and PPT over MTrPs of the upper trapezius, levator scapulae, and splenius capitis muscles were measured at the beginning and end of the training period. After completion of training, there was a significant reduction in Neck Disability Index values (before, 18.2 ± 12.1 after, 13.5 ± 10.6 P < .01). However, no significant changes in PPT were observed over the MTrPs. Patients performing DCF training for 6 weeks demonstrated reductions in pain and disability but did not show changes in pressure pain sensitivity over MTrPs in the splenius capitis, levator scapulae, or upper trapezius muscles.
Publisher: Elsevier BV
Date: 12-2020
Publisher: Elsevier BV
Date: 11-2012
DOI: 10.1016/J.APMR.2012.04.014
Abstract: To assess a range of physical and psychological factors and determine which factors contribute the most to reduced strength in patients with neck pain. Regression. Laboratory. Women with chronic neck pain (n=34) and healthy controls (n=14). Not applicable. Neck flexion, extension, and lateral flexion maximum voluntary contractions (MVC) were measured in patients and healthy controls. Additional parameters were collected for the patient group including: (1) questionnaires measuring general health (Medical Outcomes Study 36-Item Short-Form Health Survey), pain intensity, disability (Neck Disability Index [NDI] Patient Specific Functional Scale), and fear of movement (Fear-Avoidance Beliefs Questionnaire [FABQ]), (2) pressure pain thresholds, (3) cross-sectional area of selected neck muscles, and (4) surface electromyography from selected neck muscles during a multidirectional isometric task. Univariate and multivariate regression analyses were applied with the average MVC (average of flexion, extension, and lateral flexion MVC) as the dependent variable. The average MVC was significantly lower in patients (mean ± SD, 130.0±6.0N) compared with controls (166.9±11.7N P<.01). Univariate regression of the average MVC with the FABQ, NDI, or pain experienced during the MVC gave R(2) values of 13.4%, 13.8%, and 21.1%, respectively. Collectively, the FABQ and pain experienced during the MVCs resulted in an R(2) of 26.6% and the FABQ, contraction pain, and NDI, an R(2) of 28.2%. The average maximum voluntary force produced in neck flexion, extension, and lateral flexion is inversely and moderately correlated with the pain experienced during maximal contraction, fear of movement, and aspects of neck disability in patients with chronic neck pain.
Publisher: Wiley
Date: 03-2007
DOI: 10.1002/JOR.20220
Abstract: This study compared the effects of conventional proprioceptive training and craniocervical flexion (C-CF) training on cervical joint position error (JPE) in people with persistent neck pain. The aim was to evaluate whether proprioceptive training was superior in improving proprioceptive acuity compared to another form of exercise, which has been shown to be effective in reducing neck pain. This may help to differentiate the mechanisms of effect of such interventions. Sixty-four female subjects with persistent neck pain and deficits in JPE were randomized into two exercise groups: proprioceptive training or C-CF training. Exercise regimes were conducted over a 6-week period, and all patients received personal instruction by an experienced physiotherapist once per week. A significant pre- to postintervention decrease in JPE, neck pain intensity, and perceived disability was identified for both the proprioceptive training group (p < 0.001) and the C-CF training group (p < 0.05). Patients who participated in the proprioceptive training demonstrated a greater reduction in JPE from right rotation compared to the C-CF training group (p < 0.05). No other significant differences were observed between the two groups. The results demonstrated that both proprioceptive training and C-CF training have a demonstrable benefit on impaired cervical JPE in people with neck pain, with marginally more benefit gained from proprioceptive training. The results suggest that improved proprioceptive acuity following intervention with either exercise protocol may occur through an improved quality of cervical afferent input or by addressing input through direct training of relocation sense.
Publisher: BMJ
Date: 05-2018
Publisher: Elsevier BV
Date: 07-2012
DOI: 10.1016/J.CLINPH.2011.11.033
Abstract: The deep cervical extensors show structural changes in patients with neck pain however their activation has never been investigated in patients. This study is the first to present neurophysiological data from the deep semispinalis cervicis muscle in patients. Ten women with chronic neck pain and 10 healthy controls participated. Activity of the semispinalis cervicis was measured as subjects performed isometric contractions at 15 and 30 N force with continuous change in force direction in the range 0-360°. Tuning curves of the EMG litude (average rectified value, ARV) were computed and the mean point of the ARV curves defined a directional vector, which determined the directional specificity of the muscle activity. Patients displayed reduced directional specificity of the semispinalis cervicis (P < 0.05). Furthermore, the EMG litude during the circular contraction was lower for the patients (86.3 ± 38.0 and 104.4 ± 47.0 μV for 15 and 30N, respectively) compared to controls (226.4 ± 128.5 and 315.8 ± 205.5 μV P<0.05). The activity of the semispinalis cervicis muscle is reduced and less defined in patients with neck pain confirming a disturbance in the neural control of this muscle. This finding suggests that exercises that target the deep semispinalis cervicis muscle may be relevant to include in the management of patients with neck pain.
Publisher: Elsevier BV
Date: 06-2012
DOI: 10.1016/J.JELEKIN.2012.01.014
Abstract: Muscle fatigue is associated with reduced power output and work capacity of the skeletal muscle. Fatigue-induced impairments in muscle function are believed to be a potential cause of increased injury rates during the latter stages of athletic competition and often occur during unexpected perturbations. However the effect of fatigue on functionally relevant, full body destabilizing perturbations has not been investigated. This study examines the effect of muscle fatigue on the activation of the quadriceps and hamstrings to fast, full body perturbations evoked by a moveable platform. Surface electromyographic (EMG) signals were recorded from the knee extensor (vastus medialis, rectus femoris, and vastus lateralis) and flexor muscles (biceps femoris and semitendinosus) of the right leg in nine healthy men during full body perturbations performed at baseline and immediately following high intensity exercise performed on a bicycle ergometer. In each condition, participants stood on a moveable platform during which 16 randomized postural perturbations (eight repetitions of two perturbation types: 8 cm forward slides, 8 cm backward slides) with varying inter-perturbation time intervals were performed over a period of 2-3 min. Maximal voluntary knee extension force was measured before and after the high intensity exercise protocol to confirm the presence of fatigue. Immediately after exercise, the maximal force decreased by 63% and 66% for knee extensors and flexors, respectively (P<0.0001). During the post-exercise postural perturbations, the EMG average rectified value (ARV) was significantly lower than the baseline condition for both the knee extensors (average across all muscles baseline: 19.7±25.4μV, post exercise: 16.2±19.4 μV) and flexors (baseline: 24.3±20.9 μV, post exercise: 13.8±11.0 μV) (both P<0.05). Moreover the EMG onset was significantly delayed for both the knee extensors (baseline: 132.7±32.9 ms, post exercise: 170.8±22.9 ms) and flexors (baseline: 139.1±38.8 ms, post exercise: 179.3±50.9 ms) (both P<0.05). A significant correlation (R(2)=0.53 P<0.05) was identified between the percent reduction of knee extension MVC and the percent change in onset time of the knee extensors post exercise. This study shows that muscle fatigue induces a reduction and delay in the activation of both the quadriceps and hamstring muscles in response to rapid destabilizing perturbations potentially reducing the stability around the knee.
Publisher: Elsevier BV
Date: 10-2011
DOI: 10.1016/J.MATH.2011.02.008
Abstract: Changes in motor behavior are a known feature of chronic mechanical neck pain disorders. This study examined the strength of the association between reported levels of pain and disability from 84 in iduals (63 women, 21 men) with chronic mechanical neck pain and levels of electromyographic activity recorded from superficial cervical flexor (sternocleidomastoid SCM and anterior scalene AS) muscles during progressive stages of the cranio-cervical flexion muscle test. A significant positive association was observed between superficial muscle activity and pain intensity (P 0.5) or perceived disability (P > 0.21). The strongest relationship between pain intensity and superficial muscle activity occurred at the final increment of the cranio-cervical flexion test (inner-range test position) for both the SCM and AS muscles (R(2) = 0.16). Although a positive and significant relationship between pain intensity and superficial muscle activity was shown, the relationship was only modest (16% explained variance), indicating that multiple factors contribute to the altered motor function observed in in iduals with chronic mechanical neck pain.
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 11-2018
DOI: 10.1249/MSS.0000000000001705
Abstract: Moderate-intensity continuous training (MICT) and high-intensity interval training (HIIT) are associated with different adjustments in motor output. Changes in motor unit (MU) peripheral properties may contribute to these adjustments, but this is yet to be elucidated. This study evaluated early changes in MU conduction velocity (MUCV) and MU action potential litude after 2 wk of either HIIT or MICT. Sixteen men were assigned to either an MICT group or HIIT group ( n = 8 each), and participated in six training sessions over 14 d. HIIT: 8 to 12 × 60-s intervals at 100% peak power output. Moderate-intensity continuous training: 90 to 120 min continuous cycling at ~65% V˙O 2peak . Preintervention and postintervention, participants performed maximal voluntary contractions (MVC) and submaximal (10%, 30%, 50%, and 70% of MVC) isometric knee extensions while high-density EMG was recorded from the vastus medialis (VM) and vastus lateralis (VL) muscles. The high-density EMG was decomposed into in idual MU by convolutive blind-source separation and tracked preintervention and postintervention. Both training interventions induced changes in MUCV, but these changes depended on the type of training ( P 0.001). The HIIT group showed higher values of MUCV after training at all torque levels ( P 0.05), MICT only displayed changes in MUCV at low torque levels (10%–30% MVC, P 0.002). There were no changes in MU action potential litude for either group ( P = 0.2). Two weeks of HIIT or MICT elicit differential changes in MUCV, likely due to the contrasting load and volume used in such training regimes. This new knowledge on the neuromuscular adaptations to training has implications for exercise prescription.
Publisher: Wiley
Date: 21-10-2021
DOI: 10.1113/JP282014
Abstract: The persistence of quadriceps weakness represents a major concern following anterior cruciate ligament reconstruction (ACLR). The underlying adaptations occurring in the activity of spinal motoneurons are still unexplored. This study examined the discharge patterns of large populations of motor units (MUs) in the vastus lateralis (VL) and vastus medialis muscles following ACLR. Nine ACLR in iduals and 10 controls performed unilateral trapezoidal contractions of the knee extensor muscles at 35%, 50% and 70% of the maximal voluntary isometric force (MVIF). High‐density surface electromyography (HDsEMG) was used to record the myoelectrical activity of the vasti muscles in both limbs. HDsEMG signals were decomposed with a convolutive blind source separation method and MU properties were extracted and compared between sides and groups. The ACLR group showed a lower MVIF on the reconstructed side compared to the contralateral side (28.1% P 0.001). This force deficit was accompanied by reduced MU discharge rates (∼21% P 0.05), lower absolute MU recruitment and derecruitment thresholds (∼22% and ∼22.5%, respectively P 0.05) and lower input–output gain of motoneurons (27.3% P = 0.009). Deficits in MU discharge rates of the VL and in absolute recruitment and derecruitment thresholds of both vasti MUs were associated with deficits in MVIF ( P 0.05). A strong between‐side correlation was found for MU discharge rates of the VL of ACLR in iduals ( P 0.01). There were no significant between‐group differences ( P 0.05). These results indicate that mid‐ to long‐term strength deficits following ACLR may be attributable to a reduced neural drive to vasti muscles, with potential changes in excitatory and inhibitory synaptic inputs. image Impaired expression and control of knee extension forces is common after anterior cruciate ligament reconstruction and is related to high risk of a second injury. To provide novel insights into the neural basis of this impairment, the discharge patterns of motor units in the vastus lateralis and vastus medialis were investigated during voluntary force contractions. There was lower knee extensor strength on the reconstructed side with respect to the contralateral side, which was explained by deficits in motor unit discharge rate and an altered motoneuronal input–output gain. Insufficient excitatory inputs to motoneurons and increased inhibitory afferent signals potentially contributed to these alterations. These results further our understanding of the neural underpinnings of quadriceps weakness following anterior cruciate ligament reconstruction and can help to develop effective rehabilitation protocols to regain muscle strength and reduce the risk of a second injury.
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 03-2017
DOI: 10.1097/AJP.0000000000000390
Abstract: Previous studies have demonstrated the presence of active trigger points (TrPs) in women with migraine reproducing their headache attacks. No study has investigated whether these TrPs can alter cervical muscle function in migraine. Our objective was to analyze differences in the activation of superficial neck flexor and extensor muscles in women with migraine considering the presence of active TrPs in the splenius capitis (SC), the upper trapezius (UT), and the sternocleidomastoid (SCM) muscles. Surface electromyography (EMG) was recorded from the superficial flexors (SCM and anterior scalene) and the extensor (SC, UT) muscles bilaterally as participants performed a staged task of cranio-cervical flexion (CCF 5 contractions representing a progressive increase in CCF range of motion) in 70 women with migraine. They were stratified according to the presence or the absence of active TrPs in the SCM, the SC, or the UT musculature. A comparison of EMG normalized root mean square (RMS) values was conducted with a 2×5 analysis of covariance with the task level as the within-subject variable, group stratified by active TrPs as the between-subjects variable and the presence of neck pain as a covariable. All patients exhibited active TrPs in their cervical muscles, which reproduced their migraine. Women with migraine exhibiting active TrPs in the SCM ( P .01), the UT ( P .05), or the SC ( P .05) muscles had lower normalized RMS values of their superficial neck flexors than those without active TrPs in the same muscles. In addition, in iduals exhibiting active TrPs in the SC and the UT (both, P .05) muscles had higher normalized RMS values in the SC muscle than those without active TrPs in the same muscles. The presence of active TrPs in the cervical musculature determines an altered activation of superficial neck and extensor muscles during low-load, isometric CCF contractions in women with migraine.
Publisher: Wiley
Date: 28-02-2017
DOI: 10.1113/JP273662
Publisher: Wiley
Date: 06-01-2015
DOI: 10.1002/EJP.636
Abstract: Pain drawings (PDs) are an important component of the assessment of a patient with pain. The aim of this work is to present the test-retest reliability of a novel method of quantifying the extent and location of pain. Additionally, the association between PD variables and clinical features in patients with chronic neck pain (CNP) and chronic low back pain (CLBP) was explored. Fifty-one patients with CLBP and 56 patients with CNP participated. Each patient shaded two consecutive PDs using a digital tablet. Software was developed to quantify the pain extent, to analyse the pain overlap between PDs and to produce pain frequency maps. Correlations were obtained between pain extent and clinical features including the level of pain intensity, disability, and psychological distress and cognitive function. The intraclass correlation coefficients for pain extent in CLBP and CNP were very high: 0.97 (95% CI: 0.95-0.98) and 0.92 (95% CI: 0.87-0.98), respectively. The Bland Altman showed a mean difference close to zero: 5.4% pixels in CNP group and 3% pixels in the CLBP group. Significant correlations were observed between pain extent and pain intensity in CLBP and CNP and pain extent and disability in CNP. There was no relation between pain extent and the level of distress or cognitive function. A novel method for the acquisition of PD was presented. Test-retest reliability of reporting pain extent and pain location was supported in people with CNP and CLBP. Future research is needed to establish psychometric properties of PD.
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 10-2004
DOI: 10.1097/01.BRS.0000141170.89317.0E
Abstract: Cross-sectional study. The present study compared activity of deep and superficial cervical flexor muscles and craniocervical flexion range of motion during a test of craniocervical flexion between 10 patients with chronic neck pain and 10 controls. In iduals with chronic neck pain exhibit reduced performance on a test of craniocervical flexion, and training of this maneuver is effective in management of neck complaints. Although this test is hypothesized to reflect dysfunction of the deep cervical flexor muscles, this has not been tested. Deep cervical flexor electromyographic activity was recorded with custom electrodes inserted via the nose and fixed by suction to the posterior mucosa of the oropharynx. Surface electrodes were placed over the superficial neck muscles (sternocleidomastoid and anterior scalene). Root mean square electromyographic litude and craniocervical flexion range of motion was measured during five incremental levels of craniocervical flexion in supine. There was a strong linear relation between the electromyographic litude of the deep cervical flexor muscles and the incremental stages of the craniocervical flexion test for control and in iduals with neck pain (P = 0.002). However, the litude of deep cervical flexor electromyographic activity was less for the group with neck pain than controls, and this difference was significant for the higher increments of the task (P < 0.05). Although not significant, there was a strong trend for greater sternocleidomastoid and anterior scalene electromyographic activity for the group with neck pain. These data confirm that reduced performance of the craniocervical flexion test is associated with dysfunction of the deep cervical flexor muscles and support the validity of this test for patients with neck pain.
Publisher: Wiley
Date: 06-05-2016
DOI: 10.1002/EJP.873
Abstract: Completion of a pain drawing is a familiar task in those presenting with whiplash-associated disorders (WAD). Some people report pain almost over their entire body. Yet the reasons for larger pain extent have not been fully explored. A novel method was applied to quantify pain extent from the pain drawings of 205 in iduals with chronic WAD. Pain extent was evaluated in relation to sex, age, educational level, insurance status and financial status. Multiple linear regression analysis was used to verify whether pain extent was associated with other health indicators including perceived pain and disability, health-related quality of life, pain catastrophizing, anxiety, depression and self-efficacy. Pain extent was influenced by sex (χ(2) :10.392, p < 0.001) with larger pain extent in women compared to men (7.88 ± 7.66% vs. 5.40 ± 6.44%). People with unsettled insurance claims (χ(2) : 7.500, p < 0.05) and those with a worse financial situation (χ(2) :12.223, p < 0.01) also had larger pain extent. Multiple linear regression models revealed that, when accounting for age, sex, education, insurance status, financial status and neck pain intensity, pain extent remained associated with perceived disability (p < 0.01), depression (p < 0.05) and self-efficacy (p < 0.001). By utilizing a novel method for pain extent quantification, this study shows that widespread pain is associated with a number of factors including perceived disability, depression and self-efficacy in in iduals with chronic WAD. Widespread pain should alert the clinician to consider more specific psychological screening, particularly for depression and self-efficacy, in patients with WAD. WHAT DOES THIS STUDY ADD?: Women with chronic WAD, those with unsettled insurance claims and those with poorer financial status perceive more widespread pain. When controlling for these factors, larger pain areas remain associated with perceived pain and disability, depression and self-efficacy. The pain drawing is useful to support psychological screening in people with chronic WAD.
Publisher: Journal of Orthopaedic & Sports Physical Therapy (JOSPT)
Date: 08-2015
Abstract: Study Design A prospective cohort study nested in a randomized controlled trial. Objectives To determine and compare responsiveness and minimal clinically important change of the modified Constant score (CS) and the Oxford Shoulder Score (OSS). Background The OSS and the CS are commonly used to assess shoulder outcomes. However, few studies have evaluated the measurement properties of the OSS and CS in terms of responsiveness and minimal clinically important change. Methods The study included 126 patients who reported having difficulty returning to usual activities 8 to 12 weeks after arthroscopic decompression surgery for subacromial impingement syndrome. The assessment at baseline and at 3 months included the OSS, the CS, and the European Quality of Life-5 Dimensions-3 Level (EQ-5D-3L) index. Responsiveness was assessed as follows: by correlation analysis between the change scores of the OSS, CS, and EQ-5D-3L index, and the Patient Global Impression of Change (PGIC) scale by receiver-operating-characteristic (ROC) curve analysis using the PGIC scale as an external anchor and by effect-size statistics. Results At 3 months, a follow-up assessment of 112 patients (89%) was conducted. The change scores of the CS and the OSS were more strongly correlated with the external anchor (PGIC scale) than the change score of the EQ-5D-3L index. The areas under the ROC curves exceeded 0.80 for both shoulder scores, with no significant differences between them, and comparable effect-size estimates were observed for the CS and the OSS. Minimal clinically important change ROC values were 6 points for the OSS and 11 points for the CS, with upper 95% cutoff limits of 12 and 22 points, respectively. Conclusion The CS and the OSS were both suitable for assessing improvement after decompression surgery.
Publisher: Springer Science and Business Media LLC
Date: 10-02-2021
DOI: 10.1186/S12891-021-04035-9
Abstract: Annually in the UK, 40,000–90,000 people are involved in a traumatic incident. Severity of injury and how well people recover from their injuries varies, with physiotherapy playing a key role in the rehabilitation process. Recovery is evaluated using multiple outcome measures for perceived levels of pain severity and quality of life. It is unclear however, what constitutes a successful recovery from injury throughout the course of recovery from the patient perspective, and whether this aligns with physiotherapists’ perspectives. A qualitative study using two approaches: Interpretive Phenomenological Analysis (IPA) using semi-structured interviews and thematic analysis following the Kreuger framework for focus groups. A purposive s le of 20 patients who have experienced musculoskeletal trauma within the past 4 weeks and 12 physiotherapists who manage this patient population will be recruited from a single trauma centre in the UK. Semi-structured interviews with patients at 4 weeks, 6 and 12 months following injury, and 2 focus groups with physiotherapists will be undertaken at one time point. Views and perceptions on the definition of recovery and what constitutes a successful recovery will be explored using both methods, with a focus on the lived experience and patient journey following musculoskeletal trauma, and how this changes through the process of recovery. Data from both the semi-structured interviews and focus groups will be analysed separately and then integrated and synthesised into key themes ensuring similarities and differences are identified. Strategies to ensure trustworthiness e.g., reflexivity will be employed. Recovery following musculoskeletal trauma is complex and understanding of the concept of successful recovery and how this changes over time following an injury is largely unknown. It is imperative to understand the patient perspective and whether these perceptions align with current views of physiotherapists. A greater understanding of recovery following musculoskeletal trauma has potential to change clinical care, optimise patient centred care and improve efficiency and clinical decision making during rehabilitation. This in turn can contribute to improved clinical effectiveness, patient outcome and patient satisfaction with potential service and economic cost savings. This study has ethical approval (IRAS 287781/REC 20/PR/0712).
Publisher: Springer Science and Business Media LLC
Date: 15-08-2008
DOI: 10.1007/S00221-008-1530-6
Abstract: The aim of the study was to investigate the adaptations of motor unit discharge rate and additional motor unit recruitment in different regions of the upper trapezius muscle during sustained contraction. Intramuscular EMG signals were recorded from three locations (cranial, middle, and caudal) within the upper trapezius of eleven healthy men during 60-s static shoulder abduction at 25% of the maximal force. Surface EMG signals were recorded concurrently with a 10 x 5 electrode grid. Fifty-one (cranial location), 39 (middle), and 19 (caudal) motor units were identified from the intramuscular EMG signals. Motor unit discharge rates at the beginning of the contraction were greater in the caudal than in the other two locations (cranial: 16.5 +/- 3.4 pps n = 28, middle: 16.2 +/- 3.4 pps n = 32, caudal: 19.6 +/- 3.1 pps n = 13 P < 0.05). Because the decrease in discharge rate over time was larger for the caudal location, at the end of the contraction the discharge rates were comparable at all locations (cranial: 15.7 +/- 3.3 pps n = 28, middle: 14.9 +/- 2.3 pps n = 32, caudal: 15.8 +/- 3.6 pps n = 13). Additional motor unit recruitment was observed in all locations but more frequently in the caudal region (19 motor units recruited after the beginning of the contraction vs. only 4 in each of the other two locations). The mean position of the distribution of surface EMG litude over the grid moved by 1.4 +/- 0.7 mm (P < 0.001) in the cranial direction at the end with respect to the beginning of the contraction. The results showed that the neural drive received by the upper trapezius depends on the muscle region, which may indicate non-uniform descending drive to the motor neuron pool.
Publisher: Public Library of Science (PLoS)
Date: 30-10-2017
Publisher: Oxford University Press (OUP)
Date: 06-04-2017
DOI: 10.1093/PM/PNX047
Abstract: Earlier studies suggest that pain extent, extracted from the patients' pain drawings, can help clinicians to identify people with central sensitization or worse clinical features. Our aim was to investigate possible associations between perceived pain extent and clinical pain features, burden of headache, psychological outcomes, and pressure sensitivity in people with chronic tension-type headache (CTTH). Ninety-nine people (27% men) with CTTH reported their pain on four different body charts representing the head and neck. Pain extent and frequency maps were obtained using customized software. Clinical features of headache, burden related to headache (Headache Disability Inventory [HDI]), anxiety and depression (Hospital Anxiety-Depression Scale [HADS]), and anxiety state/trait (State-Trait Anxiety Inventory [STAI]) levels were assessed. Pressure pain thresholds (PPT) were assessed over the temporalis muscle (trigeminal area), the cervical spine (extratrigeminal area), and the tibialis anterior muscle (distant pain-free area) to determine widespread pressure sensitivity. Associations between pain extent and all outcomes were analyzed. Pain extent showed significant positive associations with age (r = 0.221, P = 0.029) and burden of the headache (emotional: r = 0.213, P = 0.030 physical: r = 0.208, P = 0.039), but no other significant association was found. Pain extent weakly correlated with older age as well as with higher emotional and physical burden of the headache in CTTH. In this population, there was no relationship between pain extent and PPT, indicating that larger pain areas were not associated with signs of central sensitization. Pain drawings can complement other clinical pain features for better characterization of CTTH, but further studies are needed.
Publisher: Cold Spring Harbor Laboratory
Date: 23-07-2023
DOI: 10.1101/2023.07.21.23292992
Abstract: Adolescent idiopathic scoliosis (AIS) is one of the most common paediatric spinal complaints (2-3% of children 16 years). Regular physical activity is recommended and has been associated with significant improvements in quality of life, reduced pain, and improved function in AIS. However, participation rates remain low amongst in iduals with AIS with limited research examining why. This qualitative study aims to identify factors influencing participation in sports, exercise, and physical activities in AIS. A qualitative interpretive hermeneutic phenomenology study will be conducted. This study will use a subtle-realist view to enable a focus on the most common experiences of in iduals with AIS considering factors influencing participation in exercise, sports, and physical activity. This will be a secondary data analysis (SDA) of a single centre qualitative study completed at a tertiary scoliosis centre during 2022. Participant data drawn from semi structured interviews of in iduals years old with a diagnosis of AIS will be included in a six-phase thematic analysis. Rigor will be enhanced through a qualitative checklist, reflexivity, researchers with expertise in the phenomena of interest, and additional researchers from the parent study to critique. Patient and public involvement has been utilised since conceptualisation to improve transparency of reporting. Full ethical approval was given for this SDA and the parent study by the Health Research Authority (IRAS 289888) and Health and Care Research Wales approval (REC reference: 21/WM/0076). Dissemination will be via peer reviewed publication and conference presentation with results being used to inform future research projects. No prior registration has been used for this protocol due to the empirical nature of this secondary data analysis. This project will be conducted with a multidisciplinary research team with expertise in qualitative research, spinal conditions and AIS, and patient and public involvement. This study has ethical strengths in its efficiency of data capture from a single parent study. This is significantly cheaper with standardised procedures, less requirement on children suffering from AIS, and relieves the burden of further participant recruitment. The nature of SDA requires researcher reflexivity and involvement of the primary researcher from parent study to ensure that there is no loss of contextual information or a lack of immersion in the data. The s le will be limited to a single centre study with s ling limited to specialist scoliosis clinics giving opportunity for inferential generaslisation, but lacking opportunity for broad basis generalisations or subgroup analysis. The primary aim of parent study was to assess the content validity of the SRS-22r rather than assessment of factors influencing exercise. However, the interview topic guide was reviewed by the secondary data analyst as well as the wider research team to ensure the capture of appropriate and relevant data for this study.
Publisher: Springer Science and Business Media LLC
Date: 07-11-2007
DOI: 10.1007/S11926-007-0080-4
Abstract: Clinical neck pain is associated with impairment of muscle performance, assessable at a functional level. Functional deficiencies reflect altered mechanisms of muscle control and changed muscle properties. The basic physiologic mechanisms of pain have been extensively investigated, and the functional impairments associated with neck pain are well documented. However, the cause-effect relationships between neck pain and motor control are poorly understood, due to difficulty translating basic physiologic findings into the complex scenario of clinical pain conditions. This article reviews current evidence of disturbances in neural control and muscle properties associated with neck pain and discusses their interrelationships. Although the links among pain, motor control, and muscle properties have been established, their relative significance for the perpetuation and recurrence of neck pain remains largely unexplored. Rehabilitation programs that include interventions for neuromuscular changes seem beneficial for restoring motor function and may prove effective for reducing neck pain recurrence.
Publisher: Wiley
Date: 17-01-2022
DOI: 10.1111/JOOR.13299
Abstract: Within physical therapy, manual therapy is known to be effective for managing temporomandibular disorders (TMDs). However, manual therapy is a broad term including different approaches applied to different body regions. This is the first systematic review that aims to evaluate the effectiveness of manual therapy applied specifically to the craniomandibular structures (Cranio‐Mandibular Manual Therapy [CMMT]) on pain and maximum mouth opening in people with TMD. This systematic review was developed based on a pre‐determined published protocol which was prospectively registered with PROSPERO (CRD42019160213). A search of MEDLINE, Embase, CINAHL, ZETOC, Web of Science, SCOPUS, PEDro, PubMed, Cochrane Library and Best Evidence, EBM reviews–Cochrane Central Register of Controlled Trials, Index to Chiropractic Literature ChiroAccess and Google Scholar databases was conducted from inception until October 2020. Randomised controlled trials comparing the effect of CMMT on pain and maximum mouth opening versus other types of treatment in TMDs were included. Two reviewers independently screened articles for inclusion, extracted data, assessed risk of bias with the revised Cochrane risk of bias tool for randomised trials and evaluated the overall quality of evidence with the Grading of Recommendations, Assessment, Development and Evaluations. A total of 2720 records were screened, of which only 6 (293 participants) satisfied the inclusion criteria. All studies showed some concerns in risk of bias, except for one, which was high risk of bias. The overall quality of evidence was very low for all outcomes because of high heterogeneity and small s le sizes. All studies showed a significant improvement in pain and maximum mouth opening for CMMT from baseline in the mid‐term, but only two showed superiority compared to other interventions. Given the high heterogeneity and small s le sizes of the included studies, a quantitative synthesis was not performed. There is the need for future high methodology research investigating different manual therapy techniques applied to different regions and different populations (e.g., chronic versus acute TMD) to determine what is most effective for pain and maximum mouth opening in patients with TMDs.
Publisher: BMJ
Date: 2021
DOI: 10.1136/BMJOPEN-2020-041499
Abstract: Spinal musculoskeletal conditions, including low back and neck pain, are leading causes of disability globally. The trunk muscles, which comprise muscles in the thoracic and lumbar regions, are essential for functional activities, necessitating mobility, motor control and strength. To investigate the effectiveness of interventions directed at improving trunk muscle strength, it is essential to have valid, reliable and responsive performance-based outcome measures (PBOM). While isokinetic dynamometry is considered the gold-standard PBOM, the associated costs, size/weight and operational complexity of this equipment preclude its use in a clinical setting. There is, therefore, a need to evaluate the measurement properties of alternative accessible measures of trunk strength. This systematic review therefore aims to investigate the measurement properties of PBOM of trunk muscle strength measures appropriate for use in a clinical setting. This protocol has been designed using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Protocols. CINAHL, Web of Science, Pedro, MEDLINE, EMBASE, SPORTDiscuss will be searched systematically from the database start date up to 16 April 2020, along with reference checking and the grey literature searching. Eligibility criteria include studies investigating measurement properties of PROM for trunk muscle strength for use in a clinical setting in adults with and without spinal musculoskeletal complaints. Two independent reviewers will determine the eligibility of the studies through screening process of titles, abstract and the full text. Both reviewers will assess the risk of bias using COnsensus-based Standards for the selection of health status Measurement Instruments risk-of-bias tool and then extract the data from included studies. The overall quality of the included studies will be evaluated using the Grading of Recommendations Assessment, Development and Evaluation approach. A narrative synthesis will be carried out if meta-analysis is not applicable. Findings from this systematic review will aid clinicians and practitioners working in the field for ex le, sport, in using the most appropriate PBOM to measure trunk muscle strength. No research ethics application is needed as there are no patient data in this study. The results of this study will be submitted to a peer reviewed journal and presented at conferences. CRD42020167464.
Publisher: Elsevier BV
Date: 12-2009
DOI: 10.1016/J.MATH.2009.05.004
Abstract: Deep cervical flexor muscle (DCF) activation is impaired with neck pain. This study investigated the effects of low load cranio-cervical flexion (C-CF) and neck flexor strengthening exercises on spatial and temporal characteristics of DCF activation during a neck movement task and a task challenging the neck's postural stability. Forty-six chronic neck pain subjects were randomly assigned to an exercise group and undertook a 6-week training program. Electromyographic (EMG) activity was recorded from the DCF, sternocleidomastoid (SCM) and anterior scalene (AS) muscles pre and post intervention during the cranio-cervical flexion test (CCFT) and during perturbations induced by rapid, unilateral shoulder flexion and extension. C-CF training increased DCF EMG litude and decreased SCM and AS EMG litude across all stages of the CCFT (all P<0.05). No change occurred in DCF EMG litude following strength training. There was no significant between group difference in pre-post intervention change in relative latency of DCF but a greater proportion of the C-CF group shortened the relative latency between the activation of the deltoid and the DCF during rapid arm movement compared to the strength group (P<0.05). Specific low load C-CF exercise changes spatial and temporal characteristics of DCF activation which may partially explain its efficacy in rehabilitation.
Publisher: Springer Science and Business Media LLC
Date: 12-2014
Publisher: Elsevier BV
Date: 10-2016
DOI: 10.1016/J.JELEKIN.2016.06.003
Abstract: The current study aimed to investigate differences in activity of neck flexor and extensor muscles in women with migraine considering the chronicity of their condition. Thirty-one subjects with episodic migraine, 21 with chronic migraine and 31 healthy controls participated. Surface electromyography signals were recorded bilaterally from the sternocleidomastoid, anterior scalene, splenius capitis and upper trapezius muscles as subjects performed 5 stages of cranio-cervical flexion (CCF), representing a progressive increase in range of CCF motion. Comparison of normalized root-mean-square among groups was conducted with 3×5 ANCOVA with task level as the within-subject variable, group as the between-subject variable, and the presence of neck pain and disability as co-variates. The group with chronic migraine exhibited increased activity of their extensor muscles compared to the control and episodic migraine groups (splenius capitis: F=3.149, P=0.045 upper trapezius: F=3.369, P=0.041). No significant between-group differences were found for the superficial neck flexors (sternocleidomastoid: F=1.161, P=0.320 anterior scalene: F=0.135, P=0.874). In conclusion, women with chronic migraine exhibit increased activity of their superficial neck extensor muscles when acting as antagonists during low-load isometric CCF contractions in comparison to non-headache subjects.
Publisher: BMJ
Date: 10-2020
DOI: 10.1136/BMJOPEN-2020-037783
Abstract: Non-specific neck pain (NSNP) is a common musculoskeletal condition resulting in pain, physical limitations and associated functional disability. Current guidelines recommend manipulation and/or mobilisation as part of the multimodal management of NSNP. This study focuses on intervention at the articular level and aims to identify whether joint mobilisation or joint manipulation has a greater effect on function, range of movement or pain outcomes in the management of NSNP. A systematic review protocol has been designed and is reported in line with the Preferred Reporting Items for Systematic Reviews and Meta-Analysis Protocols. A targeted search strategy will enable searching of key databases from inception to 31 March 2020: CINAHL, PEDro, AMED, EMBASE, OVID, MEDLINE, Web of Science, PubMed and Google Scholar. Key journals will be searched using predefined keywords determined from preliminary scoping searches for randomised controlled trials of manipulation and mobilisation modalities for adults with NSNP in the absence of radiculopathy or whiplash, published in English. Grey literature and unpublished studies will also be searched. Studies will be screened by title and abstract and full text. Two independent reviewers will conduct the searches independently, extract data, assess risk of bias (Cochrane Risk of Bias Tool 2) and assess overall strength of evidence (Grading of Recommendations, Assessment, Development and Evaluation). Meta-analysis will be performed where in idual studies measure comparable outcomes including performance-based outcome measures such as range of movement or patient reported outcome measures such as Neck Disability Index and where interventions are comparable in their delivery such as number of oscillations and Maitland grading. Where not possible, data will be presented descriptively. This study does not require ethical approval. Findings will be submitted for publication to relevant peer-reviewed journals and will be presented at profession-specific conferences. CRD42020164457.
Publisher: Elsevier BV
Date: 10-2014
DOI: 10.1016/J.JELEKIN.2014.06.004
Abstract: The aim of the study was to examine whether six weeks of endurance training minimizes the effects of fatigue on postural control during dynamic postural perturbations. Eighteen healthy volunteers were assigned to either a 6-week progressive endurance training program on a cycle ergometer or a control group. At week 0 and 7, dynamic exercise was performed on an ergometer until exhaustion and immediately after, the anterior-posterior centre of pressure (COP) sway was analyzed during full body perturbations. Maximal voluntary contractions (MVC) of the knee flexors and extensors, muscle fiber conduction velocity (MFCV) of the vastus lateralis and medialis during sustained isometric knee extension contractions, and power output were measured. Following the training protocol, maximum knee extensor and flexor force and power output increased significantly for the training group with no changes observed for the control group. Moreover, the reduction of MFCV due to fatigue changed for the training group only (from 8.6% to 3.4%). At baseline, the fatiguing exercise induced an increase in the centre of pressure sway during the perturbations in both groups (>10%). The fatiguing protocol also impaired postural control in the control group when measured at week 7. However, for the training group, sway was not altered after the fatiguing exercise when assessed at week 7. In summary, six weeks of endurance training delayed the onset of muscle fatigue and improved the ability to control balance in response to postural perturbations in the presence of muscle fatigue. Results implicate that endurance training should be included in any injury prevention program.
Publisher: Springer Science and Business Media LLC
Date: 08-02-2017
DOI: 10.1038/SREP42011
Abstract: Delayed onset of muscle activation can be a descriptor of impaired motor control. Activation onset can be estimated from electromyography (EMG)-registered muscle excitation and from ultrasound-registered muscle motion, which enables non-invasive measurements in deep muscles. However, in voluntary activation, EMG- and ultrasound-detected activation onsets may not correspond. To evaluate this, ten healthy men performed isometric elbow flexion at 20% to 70% of their maximal force. Utilising a multi-channel electrode transparent to ultrasound, EMG and M(otion)-mode ultrasound were recorded simultaneously over the biceps brachii muscle. The time intervals between automated and visually estimated activation onsets were correlated with the regional variation of EMG and muscle motion onset, contraction level and speed. Automated and visual onsets indicated variable time intervals between EMG- and motion onset, median (interquartile range) 96 (121) ms and 48 (72) ms, respectively. In 17% (computed analysis) or 23% (visual analysis) of trials, motion onset was detected before local EMG onset. Multi-channel EMG and M-mode ultrasound revealed regional differences in activation onset, which decreased with higher contraction speed (Spearman ρ ≥ 0.45, P 0.001). In voluntary activation the heterogeneous motor unit recruitment together with immediate motion transmission may explain the high variation of the time intervals between local EMG- and ultrasound-detected activation onset.
Publisher: Frontiers Media SA
Date: 20-12-2019
Publisher: Elsevier BV
Date: 08-2018
DOI: 10.1016/J.JELEKIN.2018.06.003
Abstract: High intensity eccentric exercise induces muscle fiber damage and associated delayed-onset muscle soreness (DOMS) resulting in an impaired ability of the muscle to generate voluntary force. This study investigates the extent to which DOMS, induced by high intensity eccentric exercise, can affect the activation and performance of the non-exercised homologous muscle of the contralateral limb. Healthy volunteers performed maximal voluntary contractions of knee extension and sustained isometric knee extension at 50% of maximal force until task failure on both the ipsilateral exercised limb and the contralateral limb. Surface electromyography (EMG) was recorded from the ipsilateral and contralateral knee extensor muscles (vastus medialis, rectus femoris, and vastus lateralis). Maximal isometric knee extension force (13.7% reduction) and time to task failure (38.1% reduction) of the contralateral non-exercised leg decreased immediately after eccentric exercise, and persisted 24 h and 48 h later (p < 0.05). Moreover, the litude of muscle activity recorded from the contralateral knee extensor muscles was significantly lower during the post exercise maximal and submaximal contractions following high intensity eccentric exercise of the opposite limb (p < 0.05). Unilateral high intensity eccentric exercise of the quadriceps can contribute to reduced neuromuscular activity and physical work capacity of the non-exercised homologous muscle in the contralateral limb.
Publisher: Wiley
Date: 23-05-2019
DOI: 10.1111/PAPR.12788
Abstract: To assess the influence of clinical, psychological, and psychophysical variables on long-term clinical outcomes after the application of either physical therapy or surgery in women presenting with carpal tunnel syndrome (CTS). A secondary analysis of a randomized trial investigating the efficacy of manual therapy including desensitization maneuvers of the central nervous system against surgery in 120 women with CTS was performed. Clinical outcomes including pain intensity, function, or symptom severity were assessed at 6 and 12 months post-intervention. Participants completed at baseline several clinical (pain intensity, function, and symptom severity), psychological (depression), and psychophysical (pressure pain thresholds and pain extent) variables, which were included as predictors. Multiple regression analyses were conducted to assess the relationship between baseline variables and clinical outcomes at 6 and 12 months post-intervention. The regression models indicated that higher scores of each clinical outcome (ie, intensity of pain or symptom severity) at baseline predicted better outcomes at 6 and 12 months post-intervention (from 15% to 65% of variance) in both groups. Lower pressure pain thresholds over the carpal tunnel at baseline predicted poorer clinical outcomes at 6 and 12 months post-intervention (from 5% to 20% of variance) in the physical therapy group, whereas higher depressive symptoms at baseline contributed to poorer outcomes at 6 and 12 months post-intervention (from 5% to 15% of the variance) within the surgery group. This study found that baseline localized pressure pain sensitivity and depression were predictive of long-term clinical outcomes in women with CTS following physical therapy or surgery, respectively.
Publisher: Springer Science and Business Media LLC
Date: 10-08-2020
DOI: 10.1186/S12891-020-03436-6
Abstract: Low back-related leg pain (LBLP) is a challenge for healthcare providers to manage. Neuropathic pain (NP) is highly prevalent in presentations of LBLP and an accurate diagnosis of NP in LBLP is essential to ensure appropriate intervention. In the absence of a gold standard, the objective of this systematic review was to evaluate the diagnostic utility of patient history, clinical examination and screening tool data for identifying NP in LBLP. This systematic review is reported in line with PRISMA and followed a pre-defined and published protocol. CINAHL, EMBASE, MEDLINE, Web of Science, Cochrane Library, AMED, Pedro and PubMed databases, key journals and the grey literature were searched from inception to 31 July 2019. Eligible studies included any study design reporting primary diagnostic data on the diagnostic utility of patient history, clinical examination or screening tool data to identify NP in LBLP, in an adult population. Two independent reviewers searched information sources, assessed risk of bias (QUADAS-2) and used GRADE to assess overall quality of evidence. From 762 studies, 11 studies were included. Nine studies out of the 11 were at risk of bias. Moderate level evidence supports a cluster of eight signs (age, duration of disease, paroxysmal pain, pain worse in leg than back, typical dermatomal distribution, worse on coughing/sneezing/straining, finger to floor distance and paresis) for diagnosing lumbosacral nerve root compression, demonstrating moderate/high sensitivity (72%) and specificity (80%) values. Moderate level evidence supports the use of the StEP tool for diagnosing lumbar radicular pain, demonstrating high sensitivity (92%) and specificity (97%) values. Overall low-moderate level evidence supports the diagnostic utility of patient history, clinical examination and screening tool data to identify NP in LBLP. The weak evidence base is largely due to methodological flaws and indirectness regarding applicability of the included studies. The most promising diagnostic tools include a cluster of 8 patient history/clinical examination signs and the StEP tool. Low risk of bias and high level of evidence diagnostic utility studies are needed, in order for stronger recommendations to be made.
Publisher: Elsevier BV
Date: 12-2022
Publisher: Elsevier BV
Date: 08-2021
Publisher: Wiley
Date: 15-03-2016
DOI: 10.1111/PAPR.12429
Abstract: Pain drawings (PD) are frequently used in research to illustrate the pain response to pain provocation tests. However, there is a lack of data on the reliability in defining the extent and location of pain. We investigated the test-retest reliability in reporting an acute painful sensation induced by a pain provocation test using a novel approach for PD acquisition and analysis in healthy volunteers. Forty healthy volunteers participated. Each participant underwent 2 upper limb neurodynamic tests 1 (ULNT1), once to the point of pain onset (PO) and once until the point of submaximal pain (SP). After each ULNT1, participants completed 2 consecutive PD with an interval of 1 minute. Custom software was used to quantify the pain extent and analyze the pain overlap. The test-retest reliability of pain extent was examined using Intraclass Correlation Coefficient (ICC The ICC values for PO and SP were 0.98 (95% CI: 0.96-0.99) and 0.97 (95% CI: 0.95-0.98), respectively. The mean difference and 95% limits of agreement (± 1.96 SD) in the Bland-Altman plots were 14 pixels (-1080 ) for PO, and 145 (-1610 ) for SP. The median JSCs (Q1 Q3) were 0.73 (0.64 .80) for PO and 0.76 (0.65 .79) for SP. Pain drawings is a reliable instrument to investigate pain extent and pain location in healthy in iduals experiencing an acute painful sensation induced by a pain provocation test.
Publisher: Elsevier BV
Date: 08-2022
DOI: 10.1016/J.MSKSP.2022.102561
Abstract: Structural and functional impairments of the cervical extensor muscles have been demonstrated in people with neck pain. A global exercise approach targeting all neck extensor muscles has shown positive effects in this population. However, to date, the efficacy of exercises specifically targeting the deep neck extensors has neither been tested nor compared to global exercises for the neck extensors. To compare the effects on pain and disability of a specific lower deep neck extensors (SLDNE) versus a general neck extensor (GNE) exercise program in women with chronic idiopathic neck pain. Fourty-three women with chronic idiopathic neck pain were randomly allocated to either a six-week SLDNE or a GNE exercise program. As primary outcome, neck disability was measured with the Neck Disability Index (NDI). Secondarily, pain intensity (VAS), cervical ROM, pressure pain thresholds (PPTs), cervical and thoracic posture and self-perceived benefit of treatment (GROC) were also measured. Every outcome was measured at baseline and immediately after treatment, except NDI, which was also measured at 6-months follow-up. The GROC was only assessed post-intervention. Both exercise programs lead to reduced neck disability immediately post-intervention (within-group mean difference [MD] = -6.09 95% Confidence Interval [CI]: 7.75, -4.42 and -4.73 95%CI: 6.57, -2.91 respectively) and at the 6-months follow-up (-4.47 95%CI: 6.41, -2.53 and -4.74 95%CI: 6.50, -2.97), but with no between group differences. Similar results were found for pain intensity post-intervention, with no between group interaction (within-group MD = -20.87 mm 95% CI: 28.55, -13.19 and -18.00 mm 95%CI: (-26.24, -9.76) for SLDNE and GNE groups, respectively). GROC improved after both interventions without any between-group difference. A six-week exercise program specifically targeting the lower deep neck extensors lead to comparable outcomes as a general neck extensor exercise program in women with chronic idiopathic neck pain.
Publisher: BMJ
Date: 09-2022
DOI: 10.1136/BMJOPEN-2022-065590
Abstract: Post-traumatic stress symptoms (PTSS) can be triggered following exposure to a traumatic event, such as violence, disasters, serious accidents and injury. Little is known about which interventions provide the greatest benefit for PTSS. This systematic review aims to estimate the effects of early interventions on PTSS following musculoskeletal trauma. Development of this review protocol was guided by the Preferred Reporting Items for Systematic Reviews and Meta-Analysis Protocols checklist. This review will include randomised controlled trials and non-randomised controlled studies evaluating the effect of early (within 3 months of a traumatic event) non-pharmacological and non-surgical interventions on PTSS in adults (aged ≥18 years). MEDLINE, PsycINFO, Embase, CINAHL, Zetoc, PROSPERO, Web of Science, PubMed and Google Scholar, as well as key journals/grey literature, will be searched from inception to 31 July 2022. Only articles published in English will be considered. Two independent reviewers will search, screen studies, extract data and assess risk of bias using the Cochrane Risk of Bias tool V.2 (RoB 2) and the Risk Of Bias in Non-randomised Studies of Interventions (ROBINS-I), respectively. Mean difference or standardised mean difference (SMD) will be extracted with accompanying 95% CIs and p values where these are reported. Group effect size will be extracted and reported. Symptoms of PTSS will be ascertained using SMDs (continuous) and diagnosis of PTSS using risk ratio (dichotomous). If possible, study results will be pooled into a meta-analysis. A narrative synthesis of the results will be presented if heterogeneity is high. The overall quality of evidence and risk of bias will be assessed using the Grading of Recommendations Assessment, Development and Evaluation, RoB 2 and ROBINS-I guidelines, respectively. Ethical approval is not required for this systematic review since data from published studies will be used. This review is expected to provide a better understanding of the effect of early intervention for PTSS following musculoskeletal trauma. Findings of this review will be disseminated in peer-reviewed publications and through national and international conferences. CRD42022333905
Publisher: BMJ
Date: 19-08-2013
DOI: 10.1136/BJSPORTS-2012-092015
Abstract: Appropriate timing of activity of the vastus medialis obliqus (VMO) and vastus lateralis (VL) muscles is a key factor for proper tracking of the patella in the trochlear groove during knee extension. This study investigates the relative timing of activation of the VMO and VL muscles during unexpected perturbations performed before and after eccentric exercise. Surface electromyography signals were recorded from the VMO and VL muscles of the right leg in 11 healthy men during rapid postural perturbations performed at baseline, immediately after eccentric exercise of the quadriceps, and at 24 and 48 h after exercise. Participants stood on a moveable platform during which eight randomised postural perturbations were performed (4 repetitions of 2 perturbation types: 8 cm forward slides, 8 cm backward slides). Before the eccentric exercise, the onset of VMO activity was significantly earlier than the VL muscle (average for both forward and backward perturbations: VMO 39.0±7.1 ms VL 43.7±7.9 ms). However, the onset of VMO activity was significantly later compared with VL muscle immediately after eccentric exercise and this remained 24 and 48 h after eccentric exercise (average across all postexercise sessions and perturbation directions: VMO 72.3±11.1 ms VL 56.0±8.2 ms p<0.05). The onset of VMO-VL activity in response to rapid destabilising perturbations is altered immediately after eccentric exercise and during eccentric exercise-induced muscle soreness up to 48 h later. These observations may help explain the high prevalence of knee disorders after high intensity eccentric exercise.
Publisher: Wiley
Date: 23-10-2015
DOI: 10.1111/SMS.12578
Abstract: We studied the sensitivity of electromyographic (EMG) variables to load and muscle fatigue during continuous and intermittent incremental cycling. Fifteen men attended three laboratory sessions. Visit 1: lactate threshold, peak power output, and VO
Publisher: American Medical Association (AMA)
Date: 26-08-2022
DOI: 10.1001/JAMANETWORKOPEN.2022.28870
Abstract: Serious traumatic injury is a leading cause of death and disability globally, with most survivors known to develop chronic pain. To describe early variables associated with poor long-term outcome for posttrauma pain and create a clinical screening tool for this purpose. This was a prospective cohort study at a major trauma center hospital in England. Recruitment commenced in December 2018 and ceased in March 2020. Participants were followed up for 12 months. Patients aged 16 years or older who were hospitalized because of acute musculoskeletal trauma within the preceding 14 days were included. Data were analyzed from March to December 2021. Acute musculoskeletal trauma requiring admittance to a major trauma center hospital. A poor outcome was defined as Chronic Pain Grade II or higher and measured at both 6 months (primary time point) and 12 months. A broad range of candidate variables potentially associated with outcomes were used, including surrogates for pain mechanisms, quantitative sensory testing, and psychosocial factors. Univariable models were used to identify the variables most likely to be associated with poor outcome, which were entered into multivariable models. A clinical screening tool (nomogram) was derived from 6-month results. In total, 1590 consecutive patients were assessed for eligibility, of whom 772 were deemed eligible and 124 (80 male [64.5%] mean [SD] age, 48.9 [18.8] years) were recruited. At 6 months, 19 of 82 respondents (23.2%) reported a good outcome, whereas at 12 months 27 of 44 respondents (61.4%) reported a good outcome. At 6 months on univariable analysis, an increase in total posttraumatic stress symptoms (odds ratio [OR], 2.09 95% CI, 1.33-3.28), pain intensity average (OR, 2.87 95% CI, 1.37-6.00), number of fractures (OR, 2.79 95% CI, 1.02-7.64), and pain extent (OR, 4.67 95% CI, 1.57-13.87) were associated with worse outcomes. A multivariable model including those variables had a sensitivity of 0.93, a specificity of 0.54, and C-index of 0.92. A poor long-term pain outcome from musculoskeletal traumatic injuries may be estimated by measures recorded within days of injury. These findings suggest that posttraumatic stress symptoms, pain spatial distribution, perceived average pain intensity, and number of fractures are good candidates for a sensitive multivariable model and derived clinical screening tool.
Publisher: Frontiers Media SA
Date: 11-06-2018
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 07-2004
DOI: 10.1097/01.BRS.0000128759.02487.BF
Abstract: Cross-sectional study. This study compared neck muscle activation patterns during and after a repetitive upper limb task between patients with idiopathic neck pain, whiplash-associated disorders, and controls. Previous studies have identified altered motor control of the upper trapezius during functional tasks in patients with neck pain. Whether the cervical flexor muscles demonstrate altered motor control during functional activities is unknown. Electromyographic activity was recorded from the sternocleidomastoid, anterior scalenes, and upper trapezius muscles. Root mean square electromyographic litude was calculated during and on completion of a functional task. A general trend was evident to suggest greatest electromyograph litude in the sternocleidomastoid, anterior scalenes, and left upper trapezius muscles for the whiplash-associated disorders group, followed by the idiopathic group, with lowest electromyographic litude recorded for the control group. A reverse effect was apparent for the right upper trapezius muscle. The level of perceived disability (Neck Disability Index score) had a significant effect on the electromyographic litude recorded between neck pain patients. Patients with neck pain demonstrated greater activation of accessory neck muscles during a repetitive upper limb task compared to asymptomatic controls. Greater activation of the cervical muscles in patients with neck pain may represent an altered pattern of motor control to compensate for reduced activation of painful muscles. Greater perceived disability among patients with neck pain accounted for the greater electromyographic litude of the superficial cervical muscles during performance of the functional task.
Publisher: Wiley
Date: 29-04-2020
DOI: 10.1113/JP279225
Publisher: Elsevier BV
Date: 10-2015
DOI: 10.1016/J.MATH.2015.06.003
Abstract: To evaluate the effect of training and pain education vs pain education alone, on neck pain, neck muscle activity and postural sway in patients with chronic neck pain. Twenty women with chronic neck pain were randomized to receive pain education and specific training (neck-shoulder exercises, balance and aerobic training) (INV), or pain education alone (CTRL). Effect on neck pain, function and Global Perceived Effect (GPE) were measured. Surface electromyography (EMG) was recorded from neck flexor and extensor muscles during performance of the Cranio-Cervical Flexion Test (CCFT) and three postural control tests (two-legged: eyes open and closed, one-legged: eyes open). Sway parameters were calculated. Fifteen participants (CTRL: eight INV: seven) completed the study. Per protocol analyses showed a larger pain reduction (p = 0.002) for the INV group with tendencies for increased GPE (p = 0.06), reduced sternocleidomastoid activity during the CCFT (p = 0.09), reduced sway length (p = 0.09), and increased neck extensor activity (p = 0.02) during sway compared to the CTRL group. Pain education and specific training reduce neck pain more than pain education alone in patients with chronic neck pain. These results provide encouragement for a larger clinical trial to corroborate these observations.
Publisher: Elsevier BV
Date: 11-2019
DOI: 10.1016/J.JSAMS.2019.07.007
Abstract: Despite the high prevalence of low back pain (LBP) in rowers, there are few studies investigating changes in lumbar muscle activation in rowers with a recent history of LBP. Such knowledge is relevant to understand potential mechanisms contributing to the maintenance and recurrence of LBP in rowers. For the first time, we evaluate the spatial distribution of erector spinae (ES) activity in rowers with and without a recent history of LBP, using a novel application of high-density surface electromyography (HDEMG). Cross-sectional study. Asymptomatic rowers (N=10) and rowers with a recent history of LBP (N=8) performed 7×4-min exercise bouts (rowing ergometer) until volitional exhaustion. HDEMG signals were acquired bilaterally over the lumbar ES and the root mean square (RMS) litude and entropy were analyzed. In addition, the y-axis coordinate of the barycentre (RMS-map) was used to assess changes in ES spatial activation. As the load increased, rowers with LBP showed higher litude (p<0.01) and less complexity (entropy) of the HDEMG signals (p<0.001). In addition, rowers with LBP showed opposite displacements of the barycentre, specifically showing a caudal shift of muscle activity at high intensities (p<0.001). Both the magnitude of activation and distribution of ES activity were altered in rowers with a recent history of LBP. The lower complexity of signals together with the caudal displacements of the barycentre suggest an inefficient recruitment of the ES as the load progressed. Modification of the rowing technique in conjunction with feedback from HDEMG might prove useful in future studies.
Publisher: BMJ
Date: 07-2021
DOI: 10.1136/BMJOPEN-2020-045841
Abstract: Motor skill learning is intrinsic to living. Pain demands attention and may disrupt non-pain-related goals such as learning new motor skills. Although rehabilitation approaches have used motor skill learning for in iduals in pain, there is uncertainty on the impact of pain on learning motor skills. The protocol of this systematic review has been designed and is reported in accordance with criteria set out by the Preferred Reporting Items for Systematic Review and Meta-Analysis Protocols guidelines. Web of Science, Scopus, MEDLINE, Embase and CINAHL databases key journals and grey literature will be searched up until March 2021, using subject-specific searches. Two independent assessors will oversee searching, screening and extracting of data and assessment of risk of bias. Both behavioural and activity-dependent plasticity outcome measures of motor learning will be synthesised and presented. The quality of evidence will be assessed using the Grading of Recommendations Assessment, Development and Evaluation approach. No patient data will be collected, and therefore, ethical approval was not required for this review. The results of this review will provide further understanding into the complex effects of pain and may guide clinicians in their use of motor learning strategies for the rehabilitation of in iduals in pain. The results of this review will be published in a peer-reviewed journal and presented at scientific conferences. CRD42020213240.
Publisher: American Physiological Society
Date: 10-2020
Abstract: Motor unit firing and contractile properties during a submaximal contraction until failure were assessed with a new tracking technique. Two distinct phases in firing behavior were observed, which compensated for changes in twitch area and predicted time to failure. However, the late increase in firing rate was below the rates attained in the absence of fatigue, which points to an inability of the central nervous system to sufficiently increase the neural drive to muscle with fatigue.
Publisher: Public Library of Science (PLoS)
Date: 17-06-2022
DOI: 10.1371/JOURNAL.PONE.0270101
Abstract: The evaluation of muscle strength is frequently used as part of the physical examination process, with decreased trunk muscle strength reported in in iduals with spinal disorders (e.g., low back pain). Access to practicable performance-based outcome measures (PBOM) to monitor patients’ progress in spinal rehabilitation is essential. Knowledge of the psychometric properties of the available practicable PBOM for trunk strength evaluation is therefore needed to inform practitioners and further research. To synthesise evidence on the measurement properties of practicable measures of trunk muscle strength in adults with and without musculoskeletal pain. Following a published and registered protocol [PROSPERO CRD42020167464], databases were searched from the database inception date up to 30 th of June 2021. Citations and grey literature were also searched. Eligibility criteria comprised: 1) studies which examined the psychometric properties of the trunk strength outcome measures, 2) included adults ≥ 18 years, either asymptomatic or with spinal musculoskeletal pain. Non-English language studies were excluded. Two independent reviewers evaluated the quality and synthesized the data from included studies according to the COnsensus-based Standards for the selection of health Measurement Instruments (COSMIN) checklist. The overall quality of evidence was evaluated using a modified Grading of Recommendations Assessment Development and Evaluation (GRADE). From 34 included studies, 15 different PBOMs were identified that have been investigated for reliability and validity, none evaluated responsiveness. In asymptomatic in iduals, high quality evidence supports intra-rater reliability of digital-loading cells and moderate quality evidence supports the criterion validity of the hand-held dynamometer. Very low quality evidence exists for the reliability and validity estimates of testing tools among in iduals with spinal pain. Findings underpin a cautious recommendation for the use of practicable PROMs to evaluate muscle strength in in iduals with spinal pain in clinical practice due to the level of evidence and the heterogeneity of the protocols used. Further high quality research to explore the psychometric properties of the practicable PBOMs with detailed methodology is now needed.
Publisher: Elsevier BV
Date: 08-2020
Publisher: BMJ
Date: 12-2019
DOI: 10.1136/BMJOPEN-2019-033276
Abstract: The course of spinal pain (neck or low back pain) is often described as episodic and intermittent, with more than one-third of people continuing to experience episodic symptoms 1 year after first onset. Although ongoing neuromuscular adaptations could contribute to recurrent episodes of pain, no systematic review has synthesised evidence of ongoing neuromuscular changes in people with recurrent spinal pain during a period of symptom remission. This protocol is developed and reported following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses-P, the Update of the Cochrane Back and Neck Group guidelines and the Methodological Expectations of Cochrane Intervention Reviews. PubMed, Web of Science, MEDLINE, EMBASE, CINAHL, ZETOC, Google Scholar, grey literature sources and key journals will be searched up to September 2019. Observational studies investigating neuromuscular changes in people with recurrent spinal pain during a period of remission will be included. Neuromuscular function will be considered under five outcome domains of muscle activity, spine kinematics, muscle properties, sensorimotor control and neuromuscular performance. Two independent reviewers will search, screen studies, extract data and assess risk of bias (Newcastle-Ottawa Scale). Data will be synthesised per outcome domain. Where clinical and methodological homogeneity across studies exists, a random-effects meta-analysis will be conducted. Otherwise, results will be synthesised narratively. The overall quality of evidence will be assessed using the Grading of Recommendations, Assessment, Development and Evaluation guidelines. Findings of this review may aid the identification of factors that could contribute to spinal pain recurrence and aid the development of interventions for secondary prevention aimed at the restoration of optimal neuromuscular function. The results will be submitted for publication in a peer-reviewed journal and presented at conferences. No ethical approval was required. CRD42019141527.
Publisher: Society for Neuroscience
Date: 02-09-2015
DOI: 10.1523/JNEUROSCI.0240-15.2015
Abstract: Neural control of synergist muscles is not well understood. Presumably, each muscle in a synergistic group receives some unique neural drive and some drive that is also shared in common with other muscles in the group. In this investigation, we sought to characterize the strength, frequency spectrum, and force dependence of the neural drive to the human vastus lateralis and vastus medialis muscles during the production of isometric knee extension forces at 10 and 30% of maximum voluntary effort. High-density surface electromyography recordings were decomposed into motor unit action potentials to examine the neural drive to each muscle. Motor unit coherence analysis was used to characterize the total neural drive to each muscle and the drive shared between muscles. Using a novel approach based on partial coherence analysis, we were also able to study specifically the neural drive unique to each muscle (not shared). The results showed that the majority of neural drive to the vasti muscles was a cross-muscle drive characterized by a force-dependent strength and bandwidth. Muscle-specific neural drive was at low frequencies ( Hz) and relatively weak. Frequencies of neural drive associated with afferent feedback (6–12 Hz) and with descending cortical input (∼20 Hz) were almost entirely shared by the two muscles, whereas low-frequency ( Hz) drive comprised shared (primary) and muscle-specific (secondary) components. This study is the first to directly investigate the extent of shared versus independent control of synergist muscles at the motor neuron level. SIGNIFICANCE STATEMENT Precisely how the nervous system coordinates the activity of synergist muscles is not well understood. One possibility is that muscles of a synergy share a common neural drive. In this study, we directly compared the relative strength of shared versus independent neural drive to synergistically activated thigh muscles in humans. The results of this analysis support the notion that synergistically activated muscles share most of their neural drive. Scientifically, this study addressed an important gap in our current understanding of how neural drive is delivered to synergist muscles. We have also demonstrated the feasibility of a novel approach to the study of muscle synergies based on partial coherence analysis of motor unit activity.
Publisher: Elsevier BV
Date: 12-2023
Publisher: Oxford University Press (OUP)
Date: 04-2007
DOI: 10.2522/PTJ.20060009
Abstract: Poor sitting posture has been implicated in the development and perpetuation of neck pain symptoms. This study had 2 purposes: (1) to compare change in cervical and thoracic posture during a distracting task between subjects with chronic neck pain and control subjects and (2) to compare the effects of 2 different neck exercise regimens on the ability of people with neck pain to maintain an upright cervical and thoracic posture during this task. Fifty-eight subjects with chronic, nonsevere neck pain and 10 control subjects participated in the study. Change in cervical and thoracic posture from an upright posture was measured every 2 minutes during a 10-minute computer task. Following baseline measurements, the subjects with neck pain were randomized into one of two 6-week exercise intervention groups: a group that received training of the craniocervical flexor muscles or a group that received endurance-strength training of the cervical flexor muscles. The primary outcomes following intervention were changes in the angle of cervical and thoracic posture during the computer task. Subjects with neck pain demonstrated a change in cervical angle across the duration of the task (mean=4.4° 95% confidence interval [CI]=3.3–5.4), consistent with a more forward head posture. No significant difference was observed for the change in cervical angle across the duration of the task for the control group subjects (mean=2.2° 95% CI=1.0–3.4). Following intervention, the craniocervical flexor training group demonstrated a significant reduction in the change of cervical angle across the duration of the computer task. This study showed that people with chronic neck pain demonstrate a reduced ability to maintain an upright posture when distracted. Following intervention with an exercise program targeted at training the craniocervical flexor muscles, subjects with neck pain demonstrated an improved ability to maintain a neutral cervical posture during prolonged sitting.
Publisher: BMJ
Date: 17-04-2018
DOI: 10.1136/BJSPORTS-2017-098673
Abstract: (1) To explore the level of association between kinesiophobia and pain, disability and quality of life in people with chronic musculoskeletal pain (CMP) detected via cross-sectional analysis and (2) to analyse the prognostic value of kinesiophobia on pain, disability and quality of life in this population detected via longitudinal analyses. A systematic review of the literature including an appraisal of the risk of bias using the adapted Newcastle Ottawa Scale. A synthesis of the evidence was carried out. An electronic search of PubMed, AMED, CINAHL, PsycINFO, PubPsych and grey literature was undertaken from inception to July 2017. Observational studies exploring the role of kinesiophobia (measured with the T a Scale for Kinesiophobia) on pain, disability and quality of life in people with CMP. Sixty-three articles (mostly cross-sectional) (total s le=10 726) were included. We found strong evidence for an association between a greater degree of kinesiophobia and greater levels of pain intensity and disability and moderate evidence between a greater degree of kinesiophobia and higher levels of pain severity and low quality of life. A greater degree of kinesiophobia predicts the progression of disability overtime, with moderate evidence. A greater degree of kinesiophobia also predicts greater levels of pain severity and low levels of quality of life at 6 months, but with limited evidence. Kinesiophobia does not predict changes in pain intensity. The results of this review encourage clinicians to consider kinesiophobia in their preliminary assessment. More longitudinal studies are needed, as most of the included studies were cross-sectional in nature. CRD42016042641.
Publisher: Wiley
Date: 06-10-2023
DOI: 10.1111/SMS.14509
Publisher: Informa UK Limited
Date: 09-2017
DOI: 10.2147/JPR.S137892
Publisher: Elsevier BV
Date: 08-2023
Publisher: MDPI AG
Date: 12-02-2022
DOI: 10.3390/S22041417
Abstract: Lifting tasks are manual material-handling activities and are commonly associated with work-related low back disorders. Instrument-based assessment tools are used to quantitatively assess the biomechanical risk associated with lifting activities. This study aims at highlighting different motor strategies in people with and without low back pain (LBP) during fatiguing frequency-dependent lifting tasks by using parameters of muscle coactivation. A total of 15 healthy controls (HC) and eight people with LBP performed three lifting tasks with a progressively increasing lifting index (LI), each lasting 15 min. Bilaterally erector spinae longissimus (ESL) activity and rectus abdominis superior (RAS) were recorded using bipolar surface electromyography systems (sEMG), and the time-varying multi-muscle coactivation function (TMCf) was computed. The TMCf can significantly discriminate each pair of LI and it is higher in LBP than HC. Collectively, our findings suggest that it is possible to identify different motor strategies between people with and without LBP. The main finding shows that LBP, to counteract pain, coactivates the trunk muscles more than HC, thereby adopting a strategy that is stiffer and more fatiguing.
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 25-01-2021
DOI: 10.1097/BRS.0000000000003969
Abstract: A systematic review. To summarize evidence on measurement properties of Outcome Measures (OM) used to assess physical functioning in adolescents with idiopathic scoliosis (AIS). The AIS is a common spine deformity in those aged 10 to 18 years old. Associated health problems ( e.g. , back pain) significantly impact the quality of life (QoL). One important domain in QoL is physical functioning, which can be measured with patient-reported outcome measures (PROM), performance-based outcome measures (PBOM), and body structure and function OM. Adequate measurement properties of OM are important for precision in research and practice. A two-staged search strategy was performed on electronic databases up to December 2019. Search one revealed a list of OM was used for physical functioning assessment in AIS. Search two identified studies that evaluated the measurement properties of OM in AIS using the list identified in search one. Two independent reviewers determined study eligibility, risk of bias assessment (COnsensus-based Standards for the selection of health Measurement INstruments [COSMIN] checklist), and performed data extraction. The level of evidence was established using a modified GRADE approach. Search one yielded: 28 PROM, 20 PBOM, and 10 body structure and function OM. Search two revealed: 16 measurement properties studies for PROM, one for PBOM, and three for body structure and function measures. Construct validity, reliability, and responsiveness of most PROM has been established in AIS, but not content validity or internal consistency (moderate evidence). Construct validity was sufficient for the Timed Up and Go test and body structure and function measures (very low to low evidence). Currently, physical functioning is evaluated with a variety of measures in AIS. The majority of measurement properties studies evaluated PROM with a paucity of information on measurement properties of PBOM and body structure and function OM. Based on COSMIN methodology, none of the OM identified in this review can be recommended with confidence in in iduals with AIS. Level of Evidence: 2
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 09-2012
Publisher: Elsevier BV
Date: 07-2019
Publisher: Springer Science and Business Media LLC
Date: 18-11-2012
Publisher: BMJ
Date: 11-2019
DOI: 10.1136/BMJOPEN-2019-033187
Abstract: Neuropathic low back-related leg pain (LBLP) can be a challenge to healthcare providers to diagnose and treat. Accurate diagnosis of neuropathic pain is fundamental to ensure appropriate intervention is given. However, to date there is no gold standard to diagnose neuropathic LBLP. Patient examination guidelines and screening tools have been developed and validated for the purpose of diagnosing neuropathic pain in LBLP however, there has been no systematic review conducted to compare the diagnostic validity of these methods. Therefore, this systematic review will investigate the diagnostic utility of patient history, clinical examination and screening tool data to identify neuropathic pain in LBLP. This protocol is informed and reported in line with the Preferred Reporting Items for Systematic Reviews and Meta-Analysis-Protocols. CINAHL, EMBASE, MEDLINE, Web of Science, Cochrane Library, AMED, Pedro, PubMed, key journals and grey literature will be searched rigorously to find diagnostic accuracy studies investigating patient examination data to identify neuropathic pain in LBLP patients. Two independent reviewers will conduct the search, extract the data and assess risk of bias for included studies using the Quality Assessment of Diagnostic Accuracy Studies 2 tool. The overall quality of included studies will be evaluated using Grading of Recommendations, Assessment, Development and Evaluation guidelines. A meta-analysis will be conducted if deemed appropriate. Otherwise, a narrative synthesis will be conducted. No research ethics is required for this systematic review since patient data will not be collected. This review will help to inform healthcare professionals and researchers on the most effective means in which to diagnose neuropathic pain in LBLP. Results of this review will be submitted for publication in a peer-review journal and conference presentations. CRD42019140861
Publisher: Springer Science and Business Media LLC
Date: 07-2004
DOI: 10.1007/S00221-003-1814-9
Abstract: The objective of this study was to compare onset of deep and superficial cervical flexor muscle activity during rapid, unilateral arm movements between ten patients with chronic neck pain and 12 control subjects. Deep cervical flexor (DCF) electromyographic activity (EMG) was recorded with custom electrodes inserted via the nose and fixed by suction to the posterior mucosa of the oropharynx. Surface electrodes were placed over the sternocleidomastoid (SCM) and anterior scalene (AS) muscles. While standing, subjects flexed and extended the right arm in response to a visual stimulus. For the control group, activation of DCF, SCM and AS muscles occurred less than 50 ms after the onset of deltoid activity, which is consistent with feedforward control of the neck during arm flexion and extension. When subjects with a history of neck pain flexed the arm, the onsets of DCF and contralateral SCM and AS muscles were significantly delayed ( p<0.05). It is concluded that the delay in neck muscle activity associated with movement of the arm in patients with neck pain indicates a significant deficit in the automatic feedforward control of the cervical spine. As the deep cervical muscles are fundamentally important for support of the cervical lordosis and the cervical joints, change in the feedforward response may leave the cervical spine vulnerable to reactive forces from arm movement.
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 04-2012
Publisher: Elsevier BV
Date: 12-2012
DOI: 10.1016/J.MATH.2012.05.012
Abstract: The semispinalis cervicis muscle displays reduced and less defined activation in patients with neck pain which is associated with increased activity of the splenius capitis muscle. Exercises to selectively activate the semispinalis cervicis muscle may be relevant for patients with neck pain however the most appropriate type of exercise has not been determined. The purpose of this study was to investigate whether a specific exercise could selectively activate the semispinalis cervicis muscle relative to the splenius capitis. Ten women with chronic neck pain participated. Intramuscular electrodes were inserted into the semispinalis cervicis and splenius capitis unilaterally on the side of greatest pain. After testing the maximal neck extension force, three isometric exercises were performed in sitting: 1. the investigator placed a hand on the patient's occiput and pushed into flexion asking the patient to resist into extension maximally, 2. the investigator placed the thumb and index finger on the vertebral arch of C2 and pushed into flexion asking the patient to resist maximally, 3. same procedure as for C2 however the resistance was applied at C5. The ratio between the normalized electromyography (EMG) litude of the semispinalis cervicis and splenius capitis was computed. The relative activation of the semispinalis cervicis was greater (P < 0.05) than the splenius capitis with resistance at C2 (2.53 ± 2.43) compared to resistance at the occiput (1.39 ± 1.00) or at C5 (1.16 ± 0.85). The results indicate that localized resistance can achieve relative isolation of the semispinalis cervicis muscle. This exercise approach may be relevant for patients with neck pain.
Publisher: American Physiological Society
Date: 10-2019
DOI: 10.1152/JAPPLPHYSIOL.00310.2019
Abstract: Conflicting results have been reported on whether closed kinetic chain exercises (such as a leg press) may induce more balanced activation of vastus medialis (VM) and lateralis (VL) muscles compared with open kinetic chain exercise (such as pure knee extension). This study aimed to 1) compare between-vasti motor unit activity and 2) analyze the combined motor unit behavior from both muscles between open and closed kinetic chain exercises. Thirteen participants (four women, mean ± SD age: 27 ± 5 yr) performed isometric knee extension and leg press at 10, 30, 50, 70% of the maximum voluntary torque. High density surface EMG signals were recorded from the VM and VL and motor unit firings were automatically identified by convolutive blind source separation. We estimated the total synaptic input received by the two muscles by analyzing the difference in discharge rate from recruitment to target torque for motor units matched by recruitment threshold. When controlling for recruitment threshold and discharge rate at recruitment, the motor unit discharge rates were higher for knee extension compared with the leg press exercise at 50% [estimate = 1.2 pulses per second (pps), standard error (SE) = 0.3 pps,
Publisher: Oxford University Press (OUP)
Date: 17-12-2018
DOI: 10.1093/PM/PNY248
Abstract: Our aims were 1) to investigate whether perceived pain extent, assessed from the pain drawing, relates to clinical, psychological, and psychophysical outcomes in women with carpal tunnel syndrome (CTS) 2) to assess differences in pain extent depending on the presence of median or extramedian symptoms and 3) to investigate differences in pain extent according to severity (minimal, moderate, or severe) or laterality (unilateral or bilateral) of CTS. One hundred forty (N = 140) women with CTS completed pain drawings, which were subsequently digitized, allowing pain extent to be calculated. Clinical features including pain intensity (numerical pain rating scale, 0-10) and disability (Boston Carpal Tunnel Questionnaire), psychological features including depression (Beck Depression Inventory), and psychophysical variables (pressure pain and thermal pain thresholds) were assessed. Spearman rho correlation coefficients were used to reveal the correlations between pain extent and other outcomes. Differences in pain extent according to severity (minimal, moderate, severe) or laterality (unilateral, bilateral) and the presence of extramedian symptoms were also evaluated. No significant associations were identified between pain extent and clinical, psychological, or psychophysical outcomes. Women with extramedian symptoms (88%) exhibited a larger (P < 0.001) pain extent (total: 24.2% ± 13.5%) than women with median symptoms (12% total: 12.2% ± 6.9%). Pain extent was not significantly different depending on the severity or laterality of the symptoms. Pain extent in the upper extremity was not associated with clinical, psychological, or psychophysical variables and was not related to the severity or laterality of the symptoms in women with CTS.
Publisher: Springer Science and Business Media LLC
Date: 30-07-2022
DOI: 10.1186/S12891-022-05700-3
Abstract: To evaluate whether digital pain extent is associated with an array of psychological factors such as optimism, pessimism, expectations of recovery, pain acceptance, and pain self-efficacy beliefs as well as to analyse the association between digital pain extent and pain intensity and pain-related disability in people with chronic musculoskeletal pain. A descriptive cross-sectional study conducted in a primary health care setting was carried out including 186 in iduals with chronic musculoskeletal pain. Patient-reported outcomes were used to assess psychological factors, pain intensity, and pain-related disability. Digital pain extent was obtained from pain drawings shaded using a tablet and analysed using novel customized software. Multiple linear regression models were conducted to evaluate the association between digital pain extent and the aforementioned variables. Digital pain extent was statistically significantly associated with pain intensity. However, digital pain extent was not associated with any psychological measure nor with pain-related disability. The results did not support an association between digital pain extent and psychological measures.
Publisher: Elsevier BV
Date: 12-2006
DOI: 10.1016/J.JELEKIN.2005.10.003
Abstract: A novel surface electromyographic (EMG) technique was recently described for the detection of deep cervical flexor muscle activity. Further investigation of this technique is warranted to ensure EMG activity from neighbouring muscles is not markedly influencing the signals recorded. This study compared deep cervical flexor (DCF) muscle activity with the activity of surrounding neck and jaw muscles during various anatomical movements of the neck and jaw in 10 volunteer subjects. DCF EMG activity was recorded with custom electrodes inserted via the nose and fixed by suction to the posterior mucosa of the oropharynx. Surface electrodes were placed over the sternocleidomastoid, anterior scalene, masseter and suprahyoid muscles. Positioned in supine, subjects performed isometric cranio-cervical flexion, cervical flexion, right and left cervical rotation, jaw clench and resisted jaw opening. Across all movements examined, EMG litude of the DCF muscles was greatest during neck movements that would require activity of the DCF muscles, particularly during cranio-cervical flexion, their primary anatomical action. The actions of jaw clench and resisted jaw opening demonstrated significantly less DCF EMG activity than the cranio-cervical flexion action (p<0.05). Across all other movements, the neighbouring neck and jaw muscles demonstrated greatest EMG litude during their respective primary anatomical actions, which occurred in the absence of increased EMG litude recorded from the DCF muscles. The finding of substantial EMG activity of the DCF muscles only during neck actions that would require their activity, particularly cranio-cervical flexion, and not during actions involving the jaw, provide further assurance that the majority of myoelectric signals detected from the nasopharyngeal electrode are from the DCF muscles.
Publisher: SAGE Publications
Date: 07-2008
DOI: 10.1111/J.1468-2982.2008.01584.X
Abstract: The purpose of the study was to compare the co-activation of cervical agonist and antagonist muscles between people with chronic tension-type headache (CTTH) and healthy controls during brief isometric cervical flexion and extension contractions. Nine women with CTTH and 10 matched controls participated. Surface electromyographic (EMG) signals were detected from the sternocleidomastoid and splenius capitis muscles bilaterally during cervical flexion and extension contractions of linearly increasing force from 0% to 60% of the maximum voluntary contraction (MVC) in 3 s. Sternocleidomastoid and splenius capitis EMG average rectified values (ARV) were estimated at 10% MVC force increments. During cervical extension contraction, sternocleidomastoid (i.e. antagonist muscle) ARV was greater for patients than for controls in the force range 20-60% MVC ( P = 0.029). During cervical flexion, the left splenius capitis (i.e. antagonist muscle) ARV was greater for CTTH patients regardless of the force level ( P = 0.02). Maximum cervical flexion and extension force was lower for the CTTH patients compared with controls ( P = 0.001). In conclusion, women with CTTH demonstrated greater co-activation of antagonist musculature during cervical extension and flexion contractions compared with healthy women. Increased co-activation of antagonist musculature may reflect reorganization of the motor control strategy in CTTH patients, potentially leading to muscle overload and increased nociception.
Publisher: Springer Science and Business Media LLC
Date: 08-10-2020
DOI: 10.1038/S41598-020-73740-7
Abstract: Prognostic models play an important role in the clinical management of cervical radiculopathy (CR). No study has compared the performance of modern machine learning techniques, against more traditional stepwise regression techniques, when developing prognostic models in in iduals with CR. We analysed a prospective cohort dataset of 201 in iduals with CR. Four modelling techniques (stepwise regression, least absolute shrinkage and selection operator [LASSO], boosting, and multivariate adaptive regression splines [MuARS]) were each used to form a prognostic model for each of four outcomes obtained at a 12 month follow-up (disability—neck disability index [NDI]), quality of life (EQ5D), present neck pain intensity, and present arm pain intensity). For all four outcomes, the differences in mean performance between all four models were small (difference of NDI 1 point EQ5D 0.1 point neck and arm pain 2 points). Given that the predictive accuracy of all four modelling methods were clinically similar, the optimal modelling method may be selected based on the parsimony of predictors. Some of the most parsimonious models were achieved using MuARS, a non-linear technique. Modern machine learning methods may be used to probe relationships along different regions of the predictor space.
Publisher: Elsevier BV
Date: 10-2019
DOI: 10.1016/J.JELEKIN.2019.07.008
Abstract: The Consensus for Experimental Design in Electromyography (CEDE) project is an international initiative which aims to guide decision-making in recording, analysis, and interpretation of electromyographic (EMG) data. The quality of the EMG recording, and validity of its interpretation depend on many characteristics of the recording set-up and analysis procedures. Different electrode types (i.e., surface and intramuscular) will influence the recorded signal and its interpretation. This report presents a matrix to consider the best electrode type selection for recording EMG, and the process undertaken to achieve consensus. Four electrode types were considered: (1) conventional surface electrode, (2) surface matrix or array electrode, (3) fine-wire electrode, and (4) needle electrode. General features, pros, and cons of each electrode type are presented first. This information is followed by recommendations for specific types of muscles, the information that can be estimated, the typical representativeness of the recording and the types of contractions for which the electrode is best suited. This matrix is intended to help researchers when selecting and reporting the electrode type in EMG studies.
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 04-2009
Publisher: Elsevier BV
Date: 08-2023
Publisher: Elsevier BV
Date: 09-2008
DOI: 10.1016/J.JMPT.2008.08.003
Abstract: The craniocervical flexion test (CCFT) is a clinical test of the anatomical action of the deep cervical flexor muscles, the longus capitis, and colli. It has evolved over 15 years as both a clinical and research tool and was devised in response to research indicating the importance of the deep cervical flexors in support of the cervical lordosis and motion segments and clinical observations of their impairment with neck pain. The CCFT could be described as a test of neuromotor control. The features assessed are the activation and isometric endurance of the deep cervical flexors as well as their interaction with the superficial cervical flexors during the performance of five progressive stages of increasing craniocervical flexion range of motion. It is a low-load test performed in the supine position with the patient guided to each stage by feedback from a pressure sensor placed behind the neck. While the test in the clinical setting provides only an indirect measure of performance, the construct validity of the CCFT has been verified in a laboratory setting by direct measurement of deep and superficial flexor muscle activity. Research has established that patients with neck pain disorders, compared to controls, have an altered neuromotor control strategy during craniocervical flexion characterized by reduced activity in the deep cervical flexors and increased activity in the superficial flexors usually accompanied by altered movement strategies. Furthermore, they display reduced isometric endurance of the deep cervical flexor muscles. The muscle impairment identified with the CCFT appears to be generic to neck pain disorders of various etiologies. These observations prompted the use of the craniocervical flexion action for retraining the deep cervical flexor muscles within a motor relearning program for neck pain patients, which has shown positive therapeutic benefits when tested in clinical trials.
Publisher: Springer Science and Business Media LLC
Date: 16-03-2023
DOI: 10.1038/S41598-023-31054-4
Abstract: Psychological stress, social isolation, physical inactivity, and reduced access to care during lockdowns throughout a pandemic negatively impact pain and function. In the context of the first COVID-19 lockdown in Spain, we aimed to investigate how different biopsychosocial factors influence chiropractic patients’ pain-related outcomes and vice-versa. A total of 648 chiropractic patients completed online questionnaires including variables from the following categories: demographics, pain outcomes, pain beliefs, impact of the COVID-19 pandemic, stress/anxiety and self-efficacy. Twenty-eight variables were considered in a cross-sectional network analysis to examine bidirectional associations between biopsychosocial factors and pain outcomes. Subgroup analyses were conducted to estimate differences according to gender and symptom duration. The greatest associations were observed between pain duration and pain evolution during lockdown. Participants’ age, pain symptoms’ evolution during lockdown, and generalized anxiety were the variables with the strongest influence over the whole network. Negative emotions evoked by the pandemic were indirectly associated with pain outcomes, possibly via pain catastrophizing. The network structure of patients reporting acute pain showed important differences when compared to patients with chronic pain. These findings will contribute to identify which factors explain the deleterious effects of both the pandemic and the restrictions on patients living with pain.
Publisher: Wiley
Date: 16-04-2021
DOI: 10.1111/JOOR.13168
Abstract: Temporomandibular disorders (TMD) are characterised by complex symptomatology and their assessment can be enhanced using pain drawings (PD). To evaluate the location and extent of pain in people TMD using digital PD, and to explore their association with clinical features. Reliability of pain extent and pain location using PD was also assessed. Forty volunteers with TMD completed two consecutive digital PDs. Clinical features were captured from self‐reported questionnaire. Additionally, secondary hyperalgesia was measured using the pressure pain threshold (PPT). The correlation between pain extent and clinical features was investigated using Spearman rank correlation coefficients. Reliability of pain extent was evaluated using intraclass correlation coefficient (ICC) and Bland‐Altman plots. The Jaccard index was computed to assess the reliability of pain location. Analysis of the PDs indicated that people with TMD commonly experience pain in other body regions including the neck, the shoulder and the low back. Except for PPT and pain catastrophising, all other clinical features were significantly correlated with pain extent. The ICCs of pain extent for all body charts were very high (ICCs 95% CI from 0.73 to 0.96), and Bland‐Altman plots showed mean biases close to zero with narrow limits of agreement. The reliability of pain location was also supported by Jaccard index mean scores above 0.68. People with TMD showed widespread pain, and pain extent was associated with pain intensity, neck and headache‐related disability, depression, anxiety, hyperventilation and central sensitivity. The reliability of measuring pain extent and pain location was confirmed.
Publisher: Elsevier BV
Date: 10-2019
DOI: 10.1016/J.JELEKIN.2019.05.018
Abstract: High-density surface electromyography (HDsEMG) provides a detailed analysis of a muscle's spatial distribution of activity. We applied a Bayesian spatio-temporal statistical method to quantify how acute nociception and task repetition alters the upper trapezius instantaneous spatial distribution of activity during dynamic muscular contractions. Ten male adults performed repeated lifting of a 1 kg box between shelves positioned at hip and shoulder heights with a cycle time of 3 s for 50 cycles under four conditions: baseline, isotonic and hypertonic saline injections (nociception) to the right upper trapezius, and 15 min post injection. Activity of the right upper trapezius was measured using a 64-channel surface electrode grid. Statistical inference was performed using Integrated Nested Laplace Approximations (INLA), and significance was determined by a non-zero crossing of the Bayesian 95% credible intervals (CrI). The maximal decrease in activity after nociception was -38.1 µV [95% CrI -40.9 to -35.3] at 30% of the lift cycle when compared to baseline. The maximal reduction in muscle activity between the early and later phases of lifting in the presence of nociception was by 10.4 µV [95% CrI 8.2-12.6]. A more holistic understanding of muscle behaviour is achieved using spatio-temporal inference than traditional reductionist methods.
Publisher: Elsevier BV
Date: 09-2021
DOI: 10.1016/J.APERGO.2021.103456
Abstract: Workers often develop low back pain due to manually lifting heavy loads. Instrumental-based assessment tools are used to quantitatively assess the biomechanical risk in lifting activities. This study aims to verify the hypothesis that high-density surface electromyography (HDsEMG) allows an optimized discrimination of risk levels associated with different fatiguing lifting conditions compared to traditional bipolar sEMG. 15 participants performed three lifting tasks with a progressively increasing lifting index (LI) each lasting 15 min. Erector spinae (ES) activity was recorded using both bipolar and HDsEMG systems. The litude of both bipolar and HDsEMG can significantly discriminate each pair of LI. HDsEMG data could discriminate across the different LIs starting from the fourth minute of the task while bipolar sEMG could only do so towards the end. The higher discriminative power of HDsEMG data across the lifting tasks makes such methodology a valuable tool to be used to monitor fatigue while lifting and could extend the possibilities offered by currently available instrumental-based tools.
Publisher: Wiley
Date: 15-04-2016
Publisher: Informa UK Limited
Date: 05-10-2020
DOI: 10.1080/09593985.2020.1827468
Abstract: Sensitization mechanisms are thought to play a role in the perception of pain in people with cluster headache. No study has investigated the relation between the spatial extent of pain in cluster headache and measures of sensitization or other clinical features. Our aim was to investigate if the size of the painful area in people with cluster headache relates to widespread pressure sensitivity, headache features, and psychological outcomes. Forty men with episodic cluster headache reported their symptoms on a digital body chart and pain extent was calculated. Pressure pain thresholds were assessed locally over the temporalis muscle and the C5-C6 joint and at a remote site over the tibialis anterior to assess widespread pressure sensitivity. Clinical features of headache attacks, and anxiety/depressive levels were also assessed. Patients were assessed during a period of remission 6 months after their last pain attack and after treatment discontinuation. Thirty-two (80%) and thirty (75%) patients reported their headaches in the orbital and the frontal areas, respectively. No significant associations (rho values ranging from -0.228 to 0.187, Pain extent in the trigemino-cervical area was not related to the degree of pressure pain sensitivity or headache features in men with episodic cluster headache during a period of remission.
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 06-2011
Publisher: Elsevier BV
Date: 06-2022
DOI: 10.1016/J.JELEKIN.2022.102656
Abstract: High-density surface electromyography (HDsEMG) can be used to measure the spatial distribution of electrical muscle activity over the skin. As this distribution is associated with the generation and propagation of muscle fiber action potentials, HDsEMG is processed to extract information on regional muscle activation, muscle fiber characteristics and behaviour of in idual motor units. This matrix, developed by the Consensus for Experimental Design in Electromyography (CEDE) project, summarizes recommendations on the use of HDsEMG in experimental studies. For each application, recommendations are included regarding electrode montage, electrode type and configuration, electrode location and orientation, data analysis, and interpretation. Cautions and reporting standards are also included. The steps of the Delphi process to reach consensus are contained in an appendix. This matrix is intended to help researchers when collecting, reporting, and interpreting HDsEMG data. It is hoped that this document will be used to generate new empirical evidence to improve how HDsEMG is used in research and in clinical applications.
Publisher: Georg Thieme Verlag KG
Date: 21-08-2015
Publisher: Oxford University Press (OUP)
Date: 06-2016
DOI: 10.2522/PTJ.20150652
Abstract: Little is known about the effectiveness of exercise programs after decompression surgery for subacromial impingement syndrome. For patients with difficulty returning to usual activities, special efforts may be needed to improve shoulder function. The purpose of this study was to evaluate the effectiveness at 3 and 12 months of a standardized physical therapy exercise intervention compared with usual care in patients with difficulty returning to usual activities after subacromial decompression surgery. A multicenter randomized controlled trial was conducted. The study was conducted in 6 public departments of orthopedic surgery, 2 departments of occupational medicine, and 2 physical therapy training centers in Central Denmark Region. One hundred twenty-six patients reporting difficulty returning to usual activities at the postoperative clinical follow-up 8 to 12 weeks after subacromial decompression surgery participated. A standardized exercise program consisting of physical therapist–supervised in idual training sessions and home training was used. The primary outcome measure was the Oxford Shoulder Score. Secondary outcome measures were the Constant Score and the Fear-Avoidance Beliefs Questionnaire. At 3 and 12 months, follow-up data were obtained for 92% and 83% of the patients, respectively. Intention-to-treat analyses suggested a between-group difference on the Oxford Shoulder Score favoring the exercise group at 3 months, with an adjusted mean difference of 2.0 (95% confidence interval=−0.5, 4.6), and at 12 months, with an adjusted mean difference of 5.8 (95% confidence interval=2.8, 8.9). Significantly larger improvements for the exercise group were observed for most secondary and supplementary outcome measures. The nature of the exercise intervention did not allow blinding of patients and care providers. The standardized physical therapy exercise intervention resulted in statistically significant and clinically relevant improvement in shoulder pain and function at 12 months compared with usual care.
Publisher: BMJ
Date: 11-2019
DOI: 10.1136/BMJOPEN-2019-033298
Abstract: Mitigating the transition from acute to chronic whiplash-associated disorders (WAD) is fundamental, and this could be achieved through early identification of in iduals at risk. Several physical factors such as angular velocity, smoothness of neck movement and coactivation of neck flexors and extensors, have been observed in patients with WAD, but their predictive ability after a whiplash injury have not been considered in previous reviews. Therefore, the aim of the current protocol is to outline the protocol for a systematic review that synthesises the current evidence of which physical factors can predict ongoing pain and disability following a whiplash trauma. Two independent reviewers will search for studies in several electronic databases including MEDLINE, Embase, CINAHL, PsycINFO, Scopus and Web of Science as well as grey literature. Observational cohort studies will be considered if they involve participants with acute WAD followed for at least 3 months post-injury. Studies will be required to assess the prognostic ability of one or more physical factors that directly involve a body function and/or structure and can be measured objectively. Further, patient-reported outcomes of physical function will be considered. The primary outcome for this review is Neck Disability Index, while all other validated measures will be considered as secondary outcomes. Risk of bias across in idual studies will be assessed using the Quality In Prognostic Studies tool along with the Grades of Recommendation, Assessment, Development and Evaluation method to assess the quality of evidence. A meta-analysis will be conducted depending on homogeneity and the number of available studies. If appropriate, data will be pooled and presented as odds ratios, otherwise, a qualitative synthesis will be conducted. Ethical approval is not required for this systematic review. The result from this review will be published in peer-reviewed journals. CRD42019122559
Publisher: Springer Science and Business Media LLC
Date: 26-03-2011
Publisher: Oxford University Press (OUP)
Date: 11-09-2020
DOI: 10.1093/PM/PNAA282
Abstract: The primary aim was to quantify and compare the location and extent of pain in people with either episodic migraine, chronic migraine, or cervicogenic headache. A secondary aim was to examine the associations between pain extent and headache features, quality of life, and psychological distress for each headache type. A cross-sectional, single-site, observational study. Headache outpatient clinic. From a s le of 390 patients, 114 patients with migraine or cervicogenic headache (48 episodic migraine, 30 chronic migraine, 36 cervicogenic headache) were eligible for the study. Pain location and extent were determined using a novel approach for digital pain drawing acquisition and analysis. Headache features included intensity and history duration. Quality of life was measured using the SF-36 and psychological distress using the Hospital Anxiety and Depression Scale. Overall, pain was most frequently reported in the frontal and temporal regions in patients with either episodic or chronic migraine, whereas pain was most frequent in the suboccipital region in patients with cervicogenic headache. A larger pain extent was moderately correlated with higher headache intensity (rs = 0.53, P = 0.003) and poorer quality of life (rs ranged from –0.36 to –0.40, P & 0.05) in patients with chronic migraine, whereas pain extent was associated with longer headache duration in those with cervicogenic headache (rs = 0.35, P = 0.04). No correlation was found between pain extent and psychological features for any headache type (P & 0.05). Despite some differences, there was a large symptomatic overlap between headache types, highlighting the limitations of using pain location in the differential diagnosis of headache.
Publisher: Elsevier BV
Date: 06-2023
Publisher: Elsevier BV
Date: 12-2022
DOI: 10.1016/J.MSKSP.2022.102633
Abstract: To determine if measures of cervical kinematics are altered in people with acute whiplash associated disorders (WAD) and secondarily, to examine whether kinematic variables are associated with self-reported outcomes. We recruited people with acute WAD within 15 days after a motor vehicle collision and asymptomatic control participants. All participants performed active neck movements at a self-determined velocity. Maximal range of motion (ROM), peak and mean velocity of movement, smoothness of movement, and cervical joint position error were assessed. Moreover, self-reported measures of perceived pain and disability, pain catastrophising, and fear of movement were obtained. Sixty people participated: 18 with acute WAD (mean age [SD] 38.7 [12.0]) and 42 as asymptomatic controls (mean age [SD] 38.4 [10.2]). Participants with acute WAD showed significantly decreased ROM in all movement directions (p < 0.0001). All participants with acute WAD showed a reduction in the mean and peak velocity of movement in all directions (p < 0.0001) and the number of velocity peaks was significantly higher (i.e., reduced smoothness of movement) in those with acute WAD in all directions (p < 0.0001). Repositioning acuity following cervical rotation was not significantly different between groups. Neck pain-related disability showed the largest number of significant associations with kinematic features, while fear of movement was not associated with measures of cervical kinematics. Participants with acute WAD presented with altered cervical kinematics compared to asymptomatic participants. Several measures of cervical kinematics were associated with the level of pain and disability in people with acute WAD but not their fear of movement.
Publisher: Springer Science and Business Media LLC
Date: 10-02-2022
DOI: 10.1186/S12891-022-05066-6
Abstract: Smartphone applications offer an accessible and practical option to measure neck range of motion (ROM) and are becoming more commonly used in clinical practice. We assessed the validity, reliability, and responsiveness of smartphone applications (apps) to measure neck ROM in people with and without neck pain. A comprehensive electronic search strategy of the main electronic databases was conducted from inception until June 2021. The identified studies investigated apps which measured neck ROM, and evaluated their validity, reliability, or responsiveness, in adult participants with neck pain or asymptomatic in iduals. Two independent reviewers determined eligibility and risk of bias following COSMIN guidelines. The quality of evidence was assessed according to the GRADE approach. Eleven studies, with a total of 376 participants were included. Three types of apps were identified: clinometer apps, compass apps, and other apps of ‘adequate’ to ‘doubtful’ risk of bias. A meta-analysis revealed ‘good’ to ‘excellent’ intra-rater and inter-rater reliability across the three types of apps. The overall validity was rated from ‘moderate’ to ‘very high’ across all apps. The level of evidence was rated as ‘low’ to ‘very low’. Smartphone applications showed sufficient intra-rater reliability, inter-rater reliability, and validity to measure neck ROM in people with and without neck pain. However, the quality of evidence and the confidence in the findings are low. High-quality research with large s le sizes is needed to further provide evidence to support the measurement properties of smartphone applications for the assessment of neck ROM. Following indications of Prisma-P guidelines, this protocol was registered in PROSPERO on 1/05/2021 with the number CRD42021239501.
Publisher: Elsevier BV
Date: 07-2022
DOI: 10.1016/J.GAITPOST.2022.05.015
Abstract: Changes in gait characteristics have been reported in people with chronic neck pain (CNP). Can we classify people with and without CNP by training machine learning models with Inertial Measurement Units (IMU)-based gait kinematic data? Eighteen asymptomatic in iduals and 21 participants with CNP were recruited for the study and performed two gait trajectories, (1) linear walking with their head straight (single-task) and (2) linear walking with continuous head-rotation (dual-task). Kinematic data were recorded from three IMU sensors attached to the forehead, upper thoracic spine (T1), and lower thoracic spine (T12). Temporal and spectral features were extracted to generate the dataset for both single- and dual-task gait. To evaluate the most significant features and simultaneously reduce the dataset size, the Neighbourhood Component Analysis (NCA) method was utilized. Three supervised models were applied, including K-Nearest Neighbour, Support Vector Machine, and Linear Discriminant Analysis to test the performance of the most important temporal and spectral features. The performance of all classifiers increased after the implementation of NCA. The best performance was achieved by NCA-Support Vector Machine with an accuracy of 86.85%, specificity of 83.30%, and sensitivity of 92.85% during the dual-task gait using only nine features. The results present a data-driven approach and machine learning-based methods to identify test conditions and features from high-dimensional data obtained during gait for the classification of people with and without CNP.
Publisher: American Physiological Society
Date: 06-2012
Abstract: This study investigated the behavior of motor units in the semispinalis cervicis muscle. Intramuscular EMG recordings were obtained unilaterally at levels C2 and C5 in 15 healthy volunteers (8 men, 7 women) who performed isometric neck extensions at 5%, 10%, and 20% of the maximal force [maximum voluntary contraction (MVC)] for 2 min each and linearly increasing force contractions from 0 to 30% MVC over 3 s. In idual motor unit action potentials were identified. The discharge rate and interspike interval variability of the motor units in the two locations did not differ. However, the recruitment threshold of motor units detected at C2 ( n = 16, mean ± SD: 10.3 ± 6.0% MVC) was greater than that of motor units detected at C5 ( n = 92, 6.9 ± 4.3% MVC) ( P 0.01). A significant level of short-term synchronization was identified in 246 of 307 motor unit pairs when computed within one spinal level but only in 28 of 110 pairs of motor units between the two levels. The common input strength, which quantifies motor unit synchronization, was greater for pairs within one level (0.47 ± 0.32) compared with pairs between levels (0.09 ± 0.07) ( P 0.05). In a second experiment on eight healthy subjects, interference EMG was recorded from the same locations during a linearly increasing force contraction from 0 to 40% MVC and showed significantly greater EMG litude at C5 than at C2. In conclusion, synaptic input is distributed partly independently and nonuniformly to different fascicles of the semispinalis cervicis muscle.
Publisher: Springer Science and Business Media LLC
Date: 21-05-2019
Publisher: MDPI AG
Date: 21-02-2021
Abstract: This study aimed to compare the effects of dry needling (DN) versus placebo DN applied to the peroneus longus (PL) and tibialis anterior (TA) on neuromuscular control and static postural control in basketball players with chronic ankle instability (CAI). A single-blinded randomized controlled trial was conducted. Thirty-two male and female basketball players with CAI were randomly assigned to receive either DN (n = 16) or placebo DN (n = 16). Pre-activation litudes of PL and TA were assessed with surface electromyography (EMG) during a dynamic landing test. Center of pressure (CoP) displacement and sway variability in anterior-posterior (AP) and medio-lateral (ML) directions were measured with a force platform during a single leg balance test (SLBT). Measures were obtained prior to a single DN intervention, immediately after, at 48 h, and 1 month after. The DN group displayed a significant increase in PL and TA pre-activation values, which were maintained 1 month later. Significant reductions in the ML and AP displacements and sway variability of CoP were found for the DN group. These results showed improvements in feedback/feed-forward strategies following DN, including enhanced neuromuscular control and static postural control, with the potential to become a convenient and accessible preventive treatment in CAI subjects.
Publisher: BMJ
Date: 06-2015
Publisher: Elsevier BV
Date: 03-2019
DOI: 10.1016/J.CLINBIOMECH.2019.02.011
Abstract: To determine whether the thickness of the rotator interval tendons is different when comparing both symptomatic and non-symptomatic sides in people with chronic shoulder pain, and to those free of pain. Furthermore, to calculate the level of association between the rotator interval tendon thicknesses and perceived shoulder pain-function. A cross-sectional, observational study. The supraspinatus, subscapularis and biceps brachii tendon thickness of sixty two patients with chronic shoulder pain were determined from standardized ultrasonography measures performed on both shoulders, whereas only the dominant arm was measured for the control subjects. Supraspinatus, subscapularis and biceps brachii tendon thickness was comparable between sides in the symptomatic group and was also comparable between the symptomatic and asymptomatic participants. In addition, the correlation between the tendon thickness and shoulder pain-function was non-significant. Tendon thickness was unaltered in people with chronic shoulder pain. These findings do not rule out the possibility that other changes in the tendon are present such as changes in the elastic properties and cell population and this should be explored in future studies.
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 05-2011
Publisher: BMJ
Date: 05-2021
DOI: 10.1136/BMJOPEN-2020-046064
Abstract: Motor variability is an important feature when performing repetitive movement, and in asymptomatic people functional tasks are typically performed with variable motor patterns. However, in the presence of chronic non-specific low back pain (LBP), people often present with different motor control strategies than those without pain. Movement variability has been assessed using a wide range of variables, including kinetic and kinematic components of motion. This has resulted in a wide range of findings reported in the literature and some contradicting results. Therefore, the aim of this systematic review is to investigate whether the amount and structure of motor variability are altered in people with chronic non-specific LBP, during both repetitive non-functional and functional tasks. This protocol for a systematic review is informed by Cochrane guidelines and reported in line with the Preferred Reporting Items for Systematic Reviews and Meta-Analysis Protocols. MEDLINE, EMBASE, CINAHL, ZETOC, Web of Science, PubMed and Scopus will be searched from their inception to December 2020 along with a comprehensive search of grey literature and key journals. Two independent reviewers will conduct the search, extract the data, assess risk of bias (using the Downs and Black Scale) for the included studies and assess overall quality of evidence based on Grading of Recommendations, Assessment, Development and Evaluation guidelines. Meta-analysis will be conducted if deemed appropriate. Alternatively, a narrative synthesis will be conducted and evidence summarised as an increase, decrease or no change in the motor variability of people with LBP compared with healthy controls. This study raises no ethical issues. Results will be submitted for publication in a peer review journal and presented at conferences. CRD42020211580.
Publisher: Elsevier BV
Date: 12-2022
DOI: 10.1016/J.MSKSP.2022.102634
Abstract: Clinical guidelines recommend conservative treatment for the management of temporomandibular disorders (TMD), and manual therapy (MT) is commonly applied to reduce pain and improve function. To identify predictors of pain reduction and functional improvement following a program of manual therapies (MTP) in patients with TMD and develop a first screening tool that could be used in clinical practice to facilitate decision-making. A cohort of 102 adults with a diagnosis of TMD were treated with four weekly sessions within a MTP applied to craniomandibular structures. Candidate predictors were demographic variables, general health variables, psychosocial features, TMD characteristics and related clinical tests. A reduction of pain intensity by at least 30% after the MTP was considered a good outcome. Logistic regression was adopted to develop the predictive model and its performance was assessed considering the explained variance, calibration, and discrimination. Internal validation of the prediction models was further evaluated in 500 bootstrapped s les. Patients experiencing pain intensity greater than 2/10 during mouth opening, positive expectations of outcome following a MTP, pain localized in the craniocervical region, and a low Central Sensitization Inventory score obtained a good outcome following the MTP. Predictive performance of the identified physical and psychological variables was characterized by high explained variance (R2 = 58%) and discrimination (AUC = 89%) after internal validation. A preliminary screening clinical tool was developed and presented as a nomogram. The high discrimination of the prediction model revealed promising findings, although these need to be externally validated in future research. NCT03990662.
Publisher: Elsevier BV
Date: 12-2009
DOI: 10.1016/J.CLINPH.2009.09.011
Abstract: To verify if non-linear recurrence analysis of the surface EMG is a suitable tool for assessing motor unit short-term synchronization. Surface and intramuscular EMG signals were recorded from the abductor digiti minimi and vastus medialis muscles of 12 and 10 healthy men, respectively, during isometric contractions. In the abductor digiti minimi, EMG signals were additionally recorded after a contraction sustained for 1min at 50% of the maximal force. In both muscles, percent of determinism (%DET) was estimated from the surface EMG and common input strength (CIS) index was computed from motor unit recordings. For both muscles, CIS did not correlate with %DET (abductor digiti minimi: R(2)=0.11, P=0.12 vastus medialis: R(2)=0.04, P=0.56). Although the values of CIS for the vastus medialis were lower than those of the abductor digiti minimi (P<0.001), the %DET values did not differ between the two muscles (71.6+/-5.5% vs 66.9+/-8.7% P=0.12). The variable %DET extracted from the surface EMG is a poor indicator of the degree of motor unit short-term synchronization. The study provides a systematic evaluation of a technique previously proposed for the estimation of a clinically relevant characteristic of motor unit behavior.
Publisher: Wiley
Date: 06-05-2013
DOI: 10.1002/J.1532-2149.2013.00321.X
Abstract: Although exercise can be effective for relief of neck pain, little is known about the effect of exercise on the neural control of neck muscles. A randomized controlled trial was conducted on 46 women with chronic neck pain to investigate the immediate effectiveness of an 8-week exercise programme on pain and directional specificity of neck muscle activity. At baseline, the patients completed questionnaires including the neck disability index (NDI) and performed a circular contraction of their head in the horizontal plane at 15 N force, with continuous change in force direction in the range 0-360°. Electromyography (EMG) was recorded from the sternocleidomastoid (SCM) and splenius capitis (SCap) muscles. Tuning curves of the EMG litude were computed, which depicts muscle activity over a range of force directions. The mean point of the tuning curves defined a directional vector, which determined the specificity of muscle activity. Patients were randomly assigned either to a training or control group. A significant between-group difference in the change in NDI was observed. A reduction in NDI was observed following training (pre: 18.2 ± 7.4 post: 14.1 ± 6.5 p < 0.01) but not for the control group (pre: 17.5 ± 6.3 post: 16.6 ± 7.4). The training group showed higher specificity of muscle activity post-intervention (pre: 18.6 ± 9.8%, post: 24.7 ± 14.3% p < 0.05), whereas no change occurred for the control group (pre: 19.4 ± 11.9%, post: 18.2 ± 10.1%). An exercise programme that aims to enhance motor control of the cervical spine improves the specificity of neck muscle activity and reduces pain and disability in patients with neck pain.
Publisher: Elsevier BV
Date: 05-2007
DOI: 10.1016/J.MATH.2006.06.003
Abstract: Specific strategies to optimally facilitate postural muscles to retrain postural form are advocated in the clinical management of neck pain. The purpose of this study was to compare the activation of selected cervical, thoracic and lumbar muscles during independent and facilitated postural correction in sitting in 10 subjects with chronic neck pain. Deep cervical flexor (DCF) muscle activity was recorded with custom electrodes inserted via the nose and fixed by suction to the posterior mucosa of the oropharynx. Surface electrodes were placed over the thoracic erector spinae and lumbar multifidus muscles. Root-mean-square EMG litude was measured for each muscle across two conditions. In the first condition, subjects were instructed to spontaneously "sit up straight" from a slumped posture without any other guidance from the therapist. In the second condition the therapist provided specific manual and verbal facilitation to assist the patient to correct to an upright pelvic position with a neutral spinal lumbo-pelvic position. Activation of the DCF and lumbar multifidus muscles (P<0.05) were significantly greater when the therapist facilitated postural correction compared to independent sitting correction. Specific postural-correction strategies result in better facilitation of key postural muscles compared to non-specific postural advice. The results of this study highlight the need for clinical skill and precision in postural training of patients with neck pain.
Publisher: Elsevier BV
Date: 09-2006
DOI: 10.1016/J.JNEUMETH.2006.03.006
Abstract: The purpose of the study was to examine the temporal and spatial correlation between estimates of trapezius muscle fiber conduction velocity (CV) and surface EMG instantaneous mean power spectral frequency (iMPF) during dynamic movement of the upper limb. Surface EMG signals were detected from the upper ision of the trapezius muscle in 13 healthy volunteers using linear arrays of eight electrodes at three locations in the cephalad-caudal direction. Subjects were asked to tap with their hands in a cyclic manner between targets positioned mid thigh and 120 degrees of shoulder flexion, to the beat of a metronome set at 88 beats per minute for 5 min. Muscle fiber CV and iMPF were estimated for each cycle at the time instant corresponding to 90 degrees of shoulder flexion. Non-significant correlations were identified between CV and iMPF initial values (R(2)=0.03-0.01), rate of change over time (R(2)=0.10-0.004) and normalized rate of change (R(2)=0.12-0.01) at all three locations on the upper trapezius muscle. These results demonstrate that both spatial and temporal variations in trapezius muscle fiber CV are not predicted by EMG spectral analysis during dynamic movement of the upper limb. This finding suggests that spectral analysis cannot be used to infer changes in the spatial and temporal behavior of muscle fiber CV during dynamic tasks.
Publisher: Elsevier BV
Date: 08-2019
DOI: 10.1016/J.JELEKIN.2019.05.004
Abstract: The purpose of this study was to investigate differences in passive muscular stiffness between the superficial multifidus (SM) and deep multifidus (DM), and to compare their passive and active stiffness in in iduals with low back pain (LBP) and asymptomatic in iduals. Fifteen LBP in iduals and 15 asymptomatic in iduals were recruited. Passive stiffness of the SM and DM was measured bilaterally using shear wave elastography (SWE) with participants lying prone. Active stiffness was measured for the SM during trunk extension, and the contraction ratio was calculated. DM displayed higher passive muscular stiffness than SM in both the asymptomatic and LBP groups (14.41 ± 2.62 and 15.40 ± 2.77 kPa respectively p < 0.001). In iduals with LBP exhibited higher passive muscular stiffness of SM (LBP: 10.15 ± 4.21, asymptomatic: 6.84 ± 1.69 kPa p < 0.005) and a lower contraction ratio (LBP: 1.54 ± 0.47, asymptomatic: 2.65 ± 1.36 kPa p < 0.003) compared to the asymptomatic group. The findings support a differentiation in passive muscular stiffness between SM and DM and provide evidence for an alteration in muscular stiffness at rest in in iduals with LBP. The lower increase of muscular stiffness with contraction observed for those with LBP may reflect a deficit in activation of the multifidus.
Publisher: Elsevier BV
Date: 12-2019
DOI: 10.1016/J.JELEKIN.2019.102361
Abstract: We investigate whether visual feedback on the spatial distribution of upper trapezius muscle activity can prolong time to task failure of sustained shoulder abduction. Surface electromyographic signals were acquired with a 13x5 grid of high-density electromyography (HDEMG) electrodes from the right upper trapezius muscle of 12 healthy volunteers as they performed sustained isometric shoulder abduction at 20% of their maximum voluntary contraction torque (MVC) until volitional exhaustion. Data were collected in two sessions one with HDEMG visual feedback on the spatial distribution of upper trapezius activity and one without feedback. Although the HDEMG litude maps could be voluntarily modified by the participants during the feedback condition (significant shift in the barycenter of activity towards the cranial direction, P = 0.038), this did not influence endurance time (total endurance time with HDEMG feedback: 149.01 ± 77.07 s, no feedback 141.74 ± 60.93 s, P = 0.532). Future studies should assess whether endurance performance can be enhanced by allowing changes in arm position during the task (changing fiber tension-length relationships), by providing a more in idual motor strategy, and/or by manipulating the colours used for the HDEMG maps (lighter colours for higher contraction intensities).
Publisher: Elsevier BV
Date: 05-2021
Publisher: Informa UK Limited
Date: 17-06-2004
Publisher: Wiley
Date: 29-07-2016
DOI: 10.1002/EJP.921
Abstract: Opioids are often used for pain treatment, but the response is often insufficient and dependent on e.g. the pain condition, genetic factors and drug class. Thus, there is an urgent need to identify biomarkers to enable selection of the appropriate drug for the in idual patient, a concept known as personalized medicine. Quantitative sensory testing (QST) and clinical parameters can provide some guidance for response, but better and more objective biomarkers are urgently warranted. Electroencephalography (EEG) may be suitable since it assesses the central nervous system where opioids mediate their effects. Clinical parameters, QST and EEG (during rest and tonic pain) was recorded from patients the day prior to total hip replacement surgery. Postoperative pain treatment was performed using oxycodone and piritramide as patient-controlled analgesia. Patients were stratified into responders and non-responders based on pain ratings 24 h post-surgery. Parameters were analysed using conventional group-wise statistical methods. Furthermore, EEG was analysed by machine learning to predict in idual response. Eighty-one patients were included, of which 51 responded to postoperative opioid treatment (30 non-responders). Conventional statistics showed that more severe pre-existing chronic pain was prevalent among non-responders to opioid treatment (p = 0.04). Preoperative EEG analysis was able to predict responders with an accuracy of 65% (p = 0.009), but only during tonic pain. Chronic pain grade before surgery is associated with the outcome of postoperative pain treatment. Furthermore, EEG shows potential as an objective biomarker and might be used to predict postoperative opioid analgesia. The current clinical study demonstrates the viability of EEG as a biomarker and with results consistent with previous experimental results. The combined method of machine learning and electroencephalography offers promising results for future developments of personalized pain treatment.
Publisher: Elsevier BV
Date: 04-2006
DOI: 10.1016/J.CLINPH.2005.12.025
Abstract: The purpose of this study was to investigate whether an endurance-strength training program is effective in reducing myoelectric manifestations of sternocleidomastoid (SCM) and anterior scalene (AS) muscle fatigue which have been found to be greater in people with chronic neck pain. Fifty-eight female patients with chronic non-severe neck pain were randomized into one of two 6-week exercise intervention groups: an endurance-strength training regime for the cervical flexor muscles or a referent exercise intervention involving low load retraining of the cranio-cervical flexor muscles. The primary outcomes were a change in maximum voluntary contraction (MVC) force and change of the initial value and rate of change of the mean frequency, average rectified value and conduction velocity detected from the SCM and AS muscles during sub-maximal isometric cervical flexion contractions at 50, 25 and 10% MVC. At the 7th week follow-up assessment, the endurance-strength training group revealed a significant increase in MVC force and a reduction in the estimates of the initial value and rate of change of the mean frequency for both the SCM and AS muscles (P<0.05). Both exercise groups reported a reduced average intensity of neck pain and reduced neck disability index score (P<0.05). An endurance-strength exercise regime for the cervical flexor muscles is effective in reducing myoelectric manifestations of superficial cervical flexor muscle fatigue as well as increasing cervical flexion strength in a group of patients with chronic non-severe neck pain. Provision of load to challenge the neck flexor muscles is required to reduce the fatigability of the SCM and AS muscles in people with neck pain. Improvements in cervical muscle strength and reduced fatigability may be responsible for the reported efficacy with this type of exercise program.
Publisher: MDPI AG
Date: 18-08-2020
DOI: 10.3390/DIAGNOSTICS10080604
Abstract: The current scoping review aimed to map current literature investigating the relationship between pain extent extracted from pain drawings with clinical, psychological, and psycho-physiological patient-reported outcome measures in people with pain. Electronic databases were searched for cross-sectional cohort studies that collected pain drawings using digital technology or a pen-on-paper approach and assessed for correlations between pain extent and clinical, psychological or psycho-physical outcomes. Data were extracted by two different reviewers. The methodological quality of studies was assessed using the Newcastle–Ottawa Quality Assessment Scale. Mapping of the results included: 1, description of included studies 2, summary of results and 3, identification of gaps in the existing literature. Eleven cross-sectional cohort studies were included. The pain disorders considered were heterogeneous, ranging from musculoskeletal to neuropathic conditions, and from localized to generalized pain conditions. All studies included pain and/or pain-related disability as clinical outcomes. Psychological outcomes included depression and anxiety, kinesiophobia and catastrophism. Psycho-physical measures included pressure or thermal pain thresholds. Ten studies were considered of high methodological quality. There was heterogeneity in the associations between pain extent and patient-reported outcome measures depending on the pain condition. This scoping review found that pain extent is associated with patient-reported outcome measures more so in patients presenting with musculoskeletal pain, e.g., neck pain or osteoarthritis, rather than for those with neuropathic pain or headache.
Publisher: Springer Science and Business Media LLC
Date: 15-10-2021
DOI: 10.1186/S13643-021-01831-1
Abstract: Numerous studies report changes in neuromuscular control in people with low back pain (LBP). However, the relationship between pain and altered neuromuscular control is challenging to unravel given the heterogeneity that exists in clinical populations. One approach commonly adopted to overcome this issue is the use of experimental pain models, but it is currently unclear if the effects of experimental pain are consistent between studies. Therefore, this planned study will systematically evaluate and summarise the effect of experimentally induced pain in the lumbar region on neuromuscular control at sites both locally and remote to the low back. This protocol has been developed following the Preferred Reporting Items for Systematic Review and Meta-Analysis Protocols (PRISMA-P). MEDLINE, EMBASE, CINAHL, ZETOC, Web of Science, and grey literature will be searched up to August 31, 2021. Screening processes (title/abstract and full-text), data extraction, and risk of bias assessment will be conducted by two independent reviewers. Studies investigating the effects of exogenous pain models delivered to the low back region on neuromuscular control in healthy in iduals will be included. Muscle activity and body kinematics will be the outcomes of interest. The comparisons of interest will be between baseline or control conditions and the experimental pain condition, as well as between the experimental pain and post-pain conditions. Randomised crossover and non-randomised studies of interventions will be included and their risk of bias will be evaluated with the Cochrane Risk-of-Bias tool or with the Risk Of Bias In Non-randomised Studies of Interventions tool, respectively. A random-effect meta-analysis will be conducted for quantitative synthesis when clinical and methodological consistency is ensured. Quality of evidence will be evaluated using the Grading of Recommendations, Assessment, Development and Evaluation guidelines. The current review will provide new insights to understand if and what neuromuscular adaptations are caused by pain experimentally induced in the lumbar region. Our findings will reveal which experimental pain model is able to better reproduce adaptations similar to those identified in people with low back pain, possibly contributing to improving our understanding of motor adaptation to low back pain in the long term. PROSPERO CRD42020220130
Publisher: Quintessence Publishing
Date: 10-2015
DOI: 10.11607/OFPH.1432
Abstract: To assess whether patients with persistent neck pain display evidence of altered masticatory muscle behavior during a jaw-clenching task, despite the absence of orofacial pain or temporomandibular disorders. Ten subjects with persistent, nonspecific neck pain and 10 age- and sex-matched healthy controls participated. Maximal voluntary contractions (MVCs) of unilateral jaw clenching followed by 5-second submaximal contractions at 10%, 30%, 50%, and 70% MVC were recorded by two flexible force transducers positioned between the first molar teeth. Task performance was quantified by mean distance and offset error from the reference target force as error indices, and standard deviation of force was used as an index of force steadiness. Electromyographic (EMG) activity was recorded bilaterally from the masseter muscle with 13 X 5 grids of electrodes and from the anterior temporalis with bipolar electrodes. Normalized EMG root mean square (RMS) was computed for each location of the grid to form a map of the EMG litude distribution, and the average normalized RMS was determined for the bipolar acquisition. Between-group differences were analyzed with the Kruskal Wallis analysis of variance. Task performance was similar in patients and controls. However, patients displayed greater masseter EMG activity bilaterally at higher force levels (P<.05). This study has provided novel evidence of altered motor control of the jaw in people with neck pain despite the absence of orofacial pain or temporomandibular disorders.
Publisher: BMJ
Date: 07-2022
DOI: 10.1136/BMJOPEN-2021-058683
Abstract: There is limited evidence on the neural strategies employed by the central nervous system to control muscle force in the presence of non-insertional Achilles tendinopathy (NIAT). Additionally, the neuromuscular mechanisms by which exercise may help to resolve tendon pain remain unclear. This study aims to first establish changes in the gastrocnemius-soleus motor unit firing properties after applying a training protocol of 6 weeks based on either controlled eccentric or concentric contractions in in iduals with NIAT. Second, we want to determine changes in the level of pain and function and mechanical and structural properties of the Achilles tendon after applying the same training protocol. Additionally, we want to compare these variables at baseline between in iduals with NIAT and asymptomatic controls. A total of 26 in iduals with chronic ( months) NIAT and 13 healthy controls will participate in the study. In iduals with NIAT will be randomised to perform eccentric or concentric training for 6 weeks. Motor unit firing properties of the medial gastrocnemius, lateral gastrocnemius and soleus muscles will be assessed using high-density surface electromyography, as well as Achilles tendon length, cross-sectional area, thickness and stiffness using B-mode ultrasonography and shear wave elastography. Moreover, participants will complete a battery of questionnaires to document their level of pain and function. Ethical approval (ERN-20-0604A) for the study was obtained from the Science, Technology, Engineering and Mathematics Ethical Review Committee of the University of Birmingham. The results of the study will be published in peer-review journals. ISRCTN46462385 .
Publisher: Frontiers Media SA
Date: 12-08-2022
DOI: 10.3389/FPSYG.2022.943479
Abstract: Exercise has been used to manage symptoms of post-traumatic stress disorder (PTSD). The effect of exercise on PTSD outcomes has been previously explored in several studies. However, it still remains unclear what type of exercise hysical activity, intensity and duration is most effective for reducing symptoms of PTSD. A systematic review was conducted to determine which forms of exercise or physical activity have the greatest effect on PTSD outcome scores including an evaluation of exercise frequency and volume. The following electronic databases were systematically searched from January 1980 to June 2021: MEDLINE, PsycINFO, PubMed and Web of Science. Inclusion criteria were studies investigating adults aged 18 or over, reporting the effect of exercise and physical activities on PTSD symptom outcome scores. Two reviewers independently extracted information on study characteristics, exposure and outcomes. In total of 3,217 articles were screened and 23 full text articles further assessed, with 13 RCT's included in the review, covering seven exercise hysical activity interventions. The study protocol was registered prospectively with PROSPERO (CRD42021255131). Thirteen studies from four countries involving a total of 531 patients were selected for inclusion. In idual forms of exercise hysical activity examined showed some effect on reducing PTSD symptoms but combined exercises (resistance training, aerobic, strength and yoga) administered over a 12 week period, three times a week for 30–60 min showed greater effects on PTSD symptoms. The limited evidence suggests that a combined exercise intervention has the best evidence for a having a beneficial effect on PTSD symptoms. www.crd.york.ac.uk rospero/display_record.php?RecordID=255131 .
Publisher: Springer Science and Business Media LLC
Date: 04-02-2017
DOI: 10.1007/S10067-017-3557-1
Abstract: Widespread pain is considered a sign of central sensitization in people with chronic pain. Our aim was to examine whether pain extent, assessed from the pain drawing, relates to measures from quantitative sensory testing in fibromyalgia syndrome (FMS). Thirty women with FMS and no other co-morbid conditions completed pain drawings (dorsal and ventral views) and clinical and related disability questionnaires. Pain extent and pain frequency maps were obtained from the pain drawings using a novel customized software. Pressure pain thresholds were assessed over the 18 tender points considered by the 1990 American College of Rheumatology criteria for FMS diagnosis and over two additional standardized points. Heat and cold pain thresholds were also assessed on the dorsal aspect of the neck, the dorsal aspect of the wrist, and the tibialis anterior. Spearman's correlation coefficients were used to assess the relationship between pain extent and quantitative sensory testing outcomes as well as clinical symptoms. Larger extent of pain was associated with a higher pain intensity (dorsal area: r
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 03-2018
DOI: 10.1097/AJP.0000000000000537
Abstract: People with migraine present with varying pain extent and an expanded distribution of perceived pain may reflect central sensitization. The relationship between pain extent and clinical features, psychological outcomes, related disability, and pressure pain sensitivity in migraine has been poorly investigated. Our aim was to investigate whether the perceived pain extent, assessed from pain drawings, relates to measures of pressure pain sensitivity, clinical, psychological outcomes, and related disability in women with episodic migraine. A total of 72 women with episodic migraine completed pain drawings, which were subsequently digitized allowing pain extent to be calculated utilising novel software. Pressure pain thresholds were assessed bilaterally over the temporalis muscle (trigeminal area), the cervical spine (extratrigeminal area), and tibialis anterior muscle (distant pain-free area). Clinical features of migraine, migraine-related disability (migraine disability assessment questionnaire [MIDAS]), and anxiety and depression (Hospital Anxiety-Depression Scale [HADS]) were also assessed. Spearman ρ correlation coefficients were computed to reveal correlations between pain extent and the remaining outcomes. No significant associations were observed between pain extent and pressure pain thresholds in trigeminal, extratrigeminal or distant pain-free areas, migraine pain features, or psychological variables including anxiety or depression, and migraine-related disability. Pain extent within the trigeminocervical area was not associated with any of the measured clinical outcomes and not related to the degree of pressure pain sensitization in women with episodic migraine. Further research is needed to determine if the presence of expanded pain areas outside of the trigeminal area can play a relevant role in the sensitization processes in migraine.
Publisher: Public Library of Science (PLoS)
Date: 10-08-2022
DOI: 10.1371/JOURNAL.PONE.0266731
Abstract: Lifting tasks, among manual material handling activities, are those mainly associated with low back pain. In recent years, several instrumental-based tools were developed to quantitatively assess the biomechanical risk during lifting activities. In this study, parameters related to balance and extracted from the Centre of Pressure (CoP) data series are studied in fatiguing frequency-dependent lifting activities to: i) explore the possibility of classifying people with LBP and asymptomatic people during the execution of task ii) examine the assessment of the risk levels associated with repetitive lifting activities, iii) enhance current understanding of postural control strategies during lifting tasks. Data were recorded from 14 asymptomatic participants and 7 participants with low back pain. The participants performed lifting tasks in three different lifting conditions (with increasing lifting frequency and risk levels) and kinetic and surface electromyography (sEMG) data were acquired. Kinetic data were used to calculated the CoP and parameters extracted from the latter show a discriminant capacity for the groups and the risk levels. Furthermore, sEMG parameters show a trend compatible with myoelectric manifestations of muscular fatigue. Correlation results between sEMG and CoP velocity parameters revealed a positive correlation between litude sEMG parameters and CoP velocity in both groups and a negative correlation between frequency sEMG parameters and CoP velocity. The current findings suggest that it is possible to quantitatively assess the risk level when monitoring fatiguing lifting tasks by using CoP parameters as well as identify different motor strategies between people with and without LBP.
Publisher: Frontiers Media SA
Date: 28-02-2022
DOI: 10.3389/FPHYS.2022.817631
Abstract: While neural changes are thought to be responsible for early increases in strength following resistance training (RT), the exact changes in motor unit (MU) firing properties remain unclear. This review aims to synthesize the available evidence on the effect of RT on MU firing properties. MEDLINE (OVID interface), EMBASE (OVID interface), Web of Science (all databases), Cochrane Library, EBSCO CINAHL Plus, PubMed, and EBSCO SportDiscus were searched from inception until June 2021. Randomized controlled trials and non-randomized studies of interventions that compared RT to no intervention (control) were included. Two reviewers independently extracted data from each trial, assessed the risk of bias and rated the cumulative quality of evidence. Motor unit discharge rate (MUDR), motor unit recruitment threshold (MURT), motor unit discharge rate variability (MUDRV), MU discharge rate at recruitment vs. recruitment threshold relationship, and MU discharge rate vs. recruitment threshold relationship were assessed. Seven trials including 167 participants met the inclusion criteria. Meta-analysis (four studies) revealed that MUDR did not change significantly ( P = 0.43), but with considerable heterogeneity likely to be present ( I 2 = 91). Low to moderate evidence supports changes in MUDRV, MUDR at recruitment vs. recruitment threshold relationship, and the MUDR vs. recruitment threshold relationship. Overall, this systematic review revealed that there is a lack of high-quality evidence for the effect of RT on MU firing properties. Heterogeneity across studies undermines the quality of the evidence for multiple outcomes and affects the conclusions that can be drawn.
Publisher: Hindawi Limited
Date: 2015
DOI: 10.1155/2015/193741
Abstract: Eccentric exercise is characterized by initial unfavorable effects such as subcellular muscle damage, pain, reduced fiber excitability, and initial muscle weakness. However, stretch combined with overload, as in eccentric contractions, is an effective stimulus for inducing physiological and neural adaptations to training. Eccentric exercise-induced adaptations include muscle hypertrophy, increased cortical activity, and changes in motor unit behavior, all of which contribute to improved muscle function. In this brief review, neuromuscular adaptations to different forms of exercise are reviewed, the positive training effects of eccentric exercise are presented, and the implications for training are considered.
Publisher: Elsevier BV
Date: 02-2015
Publisher: Elsevier BV
Date: 10-2023
Publisher: Springer Science and Business Media LLC
Date: 27-01-2021
Publisher: Elsevier BV
Date: 10-2020
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 05-05-2023
DOI: 10.1097/BRS.0000000000004705
Abstract: Retrospective analysis of longitudinal data. To evaluate clinically relevant change in surgical outcomes for Adolescents with Idiopathic Scoliosis (AIS), comparing those who achieved smallest detectable change (SDC) in pain and function at 1-year post-surgery with those who did not, and to evaluate the influencing factors. The SDC is recommended to evaluate the surgical outcomes of AIS. However, little is known about the use of SDC in AIS and its influencing factors. This was a retrospective analysis of longitudinal data from patients who underwent surgical correction at a tertiary spinal centre from 2009 to 2019. Surgical outcomes were assessed at short-term (6 wk, 6 mo) and long-term (1- and 2-years) post-surgery using the Scoliosis Research Society questionnaire (SRS-22r). The difference between “successful” (≥SDC) and “unsuccessful” ( SDC) groups was assessed using an independent t-test. Univariate and logistic regression analyses enabled the assessment of influencing factors. All SRS-22r domains decreased in the short term, except for self-image and satisfaction. In the long term, self-image increased by 1.21 and function increased by 0.2, and pain decreased by 0.1. In all SRS-22r domains “successful” group had low pre-surgery scores and were statistically different to the “unsuccessful group”. The difference remained statistically significant at 1-year for most SRS-22r domains. Being older and having low pre-surgery SRS-22r scores increased the chances of achieving SDC in function at 1-year. Achieving SDC in the pain domain was significantly associated with age, sex, length of hospital stay, and SRS-22r pre-surgery scores. Notably, the self-image domain showed the largest change compared to other SRS-22r domains. A low pre-surgery score increases the likelihood of clinical benefit from surgery. These findings demonstrate the utility of SDC for assessing the benefits and factors that may underpin surgical benefit in AIS.
Publisher: Elsevier BV
Date: 09-2009
DOI: 10.1016/J.EJCA.2009.05.024
Abstract: The objective of this study was to examine the agreement between health care professionals' (HCPs) and patients' evaluation of health-related quality of life (HRQOL) issues for cancer patients with bone metastases. A total of 413 patients and 152 HCPs were interviewed across five centres worldwide. Mean scores were almost always higher for HCPs than for patients. Patients and HCPs agreed that four issues affect HRQOL of bone metastases patients profoundly: 'long-term (chronic) pain', 'difficulty in carrying out usual daily tasks', 'able to perform self-care' and 'able to perform role functioning'. A substantial difference was found with respect to the perceived importance of psychosocial and somatic issues. Patients emphasised psychosocial issues with a particular focus on 'worry' about loss of mobility, dependence on others and disease progression, HCPs however rated 'symptom' issues as more important, specifically those related to 'pain'. In conclusion, patients and HCPs agreed that pain and physical/role functioning are important to the HRQOL of cancer patients with bone metastases, but patients also emphasized the importance of psychosocial issues to HRQOL. This information has been an important component in the development of a health-related quality of life questionnaire for patients with bone metastases (EORTC QLQ-BM 22).
Publisher: Wiley
Date: 23-06-2020
DOI: 10.1111/SMS.13748
Abstract: The neural factors underlying the persistency of quadriceps weakness after anterior cruciate ligament reconstruction (ACLR) have been only partially explained. This study examined muscle fiber conduction velocity (MFCV) as an indirect parameter of motor unit recruitment strategies in the vastus lateralis (VL) and medialis (VM) muscles of soccer players with ACLR. High‐density surface electromyography (HDsEMG) was acquired from VL and VM in nine soccer players (22.7 ± 2.9 years BMI: 22.08 ± 1.72 kg·m −2 7.7 ± 2.2 months post‐surgery). Voluntary muscle force and the relative myoelectrical activity from the reconstructed and contralateral sides were recorded during linearly increasing isometric knee extension contractions up to 70% of maximal voluntary isometric force (MVIF). The relation of MFCV and force was examined by linear regression analysis at the in idual subject level. The initial (intercept), peak (MFCV 70 ), and rate of change (slope) of MFCV related to force were compared between limbs and muscles. The MVIF was lower in the reconstructed side than in the contralateral side (−%20.5 P .05). MFCV intercept was similar among limbs and muscles ( P .05). MFCV 70 and MFCV slope were lower in the reconstructed side compared to the contralateral for both VL (−28.5% and −10.1%, respectively P .001) and VM (−22.6% and −8.1%, respectively P .001). The slope of MFCV was lower in the VL than VM, but only in the reconstructed side (−12.4% P .001). These results suggest possible impairments in recruitment strategies of high‐threshold motor units (HTMUs) as well as deficits in sarcolemmal excitability, fiber diameter, and discharge rate of knee extensor muscles following ACLR.
Publisher: Wiley
Date: 28-05-2017
DOI: 10.1111/PAPR.12581
Publisher: Elsevier BV
Date: 06-2010
DOI: 10.1016/J.JELEKIN.2009.07.002
Abstract: The study compared the distribution of electromyographic (EMG) signal litude in the upper trapezius muscle in 10 women with fibromyalgia and in 10 healthy women before and after experimentally-induced muscle pain. Surface EMG signals were recorded over the right upper trapezius muscle with a 10 x 5 grid of electrodes during 90 degrees shoulder abduction sustained for 60s. The control subjects repeated the abduction task following injections of isotonic and hypertonic (painful) saline into the upper trapezius muscle. The EMG litude was computed for each electrode pair and provided a topographical map of the distribution of muscle activity. The pain level rated by the patients at the beginning of the sustained contraction was 5.9+/-1.5. The peak pain intensity for the control group following the injection of hypertonic saline was 6.0+/-1.6. During the sustained contractions, the EMG litude increased relatively more in the cranial than caudal region of the upper trapezius muscle for the control subjects (shift in the distribution of EMG litude: 2.3+/-1.3mm P<0.01). The patient group showed lower average EMG litude than the controls during the contraction (P<0.05) and did not show different changes in EMG litude between different regions of the upper trapezius. A similar behavior was observed for the control group following injection of hypertonic saline. The results indicate that muscle pain prevents the adaptation of upper trapezius activity during sustained contractions as observed in non-painful conditions, which may induce overuse of similar muscle compartments with fatigue.
Publisher: Wiley
Date: 12-08-2012
DOI: 10.1111/J.1600-0838.2012.01512.X
Abstract: Contracting the knee flexor muscles immediately before a maximum voluntary contraction (MVC) of knee extension increases the maximal force that the extensor muscles can exert. It is hypothesized that this phenomenon can be impaired by muscle fiber damage following eccentric exercise [delayed onset muscle soreness (DOMS)]. This study investigates the effect of eccentric exercise and DOMS on knee extension MVC immediately following a reciprocal-resisted knee flexion contraction. Electromyography (EMG) was recorded from the knee extensors and flexors of 12 healthy men during knee extension MVCs performed in a reciprocal (maximal knee extension preceded by resisted knee flexion), and nonreciprocal condition (preceded by relaxation of the knee flexors). At baseline, knee extension MVC force was greater during the reciprocal condition (P < 0.001), whereas immediately after, 24 and 48 h after eccentric exercise, the MVC force was not different between conditions. Similarly, at baseline, the EMG litude of the quadriceps during the MVC was larger for the reciprocal condition (P < 0.001). However, immediately after, 24 and 48 h postexercise the EMG litude was similar between conditions. In conclusion, eccentric exercise abolished the facilitation of force production for the knee extensors, which normally occurs when maximum knee extension is preceded by activation of the knee flexors.
Publisher: Elsevier BV
Date: 04-2021
Publisher: Springer Science and Business Media LLC
Date: 28-11-2014
DOI: 10.1007/S00421-014-3059-7
Abstract: Shoulder pain is often a challenging clinical phenomenon because of the potential mismatch between pathology and the perception of pain. Current evidence clearly emphasizes an incomplete understanding of the nature of shoulder pain. Indeed, the effective diagnosis and treatment of shoulder pain should not only rely upon a detailed knowledge of the peripheral pathologies that may be present in the shoulder, but also on current knowledge of pain neurophysiology. To assess and treat shoulder pain, a comprehensive understanding of the way in which pain is processed is essential. This review reflects modern pain neurophysiology to the shoulder and aims to answer the following questions: why does my shoulder hurt? What is the impact of shoulder pain on muscle function? What are the implications for the clinical examination of the shoulder? And finally, what are the clinical implications for therapy? Despite the increasing amount of research in this area, an in-depth understanding of the bidirectional nociception-motor interaction is still far from being achieved. Many questions remain, especially related to the treatment of nociception-motor interactions.
Publisher: Elsevier BV
Date: 03-2003
DOI: 10.1016/S1388-2457(02)00418-2
Abstract: This study compares myoelectric manifestations of fatigue of the sternocleidomastoid (SCM) and anterior scalene (AS) muscles between 10 chronic neck pain subjects and 10 normal matched controls. Surface electromyography (sEMG) signals were recorded from the sternal head of SCM and AS muscles bilaterally during sub-maximal isometric cervical flexion contractions at 25 and 50% of the maximum voluntary contraction (MVC). The mean frequency, average rectified value and conduction velocity of the sEMG signal were calculated to quantify myoelectric manifestations of muscle fatigue. For both the SCM and AS muscles, the Mann-Whitney U test indicated that the initial value and slope of the mean frequency in neck pain patients were greater than in healthy subjects (P < 0.05). This was significant both at 25 and 50% of MVC. These results suggest: (a) a predominance of type-II fibres in the neck pain patients and/or (b) greater fatigability of the superficial cervical flexors in neck pain patients. These results are in agreement with previous muscle biopsy studies in subjects with neck pain, which identified transformation of slow-twitch type-1 fibres to fast-twitch type-IIB fibres, as well as the clinical observation of reduced endurance in the cervical flexors in neck pain patients.
Publisher: American Physiological Society
Date: 08-2016
Abstract: Pain is associated with changes in the neural drive to muscles. For the upper trapezius muscle, surface electromyography (EMG) recordings have indicated that acute noxious stimulation in either the cranial or the caudal region of the muscle leads to a relative decrease in muscle activity in the cranial region. It is, however, not known if this adaption reflects different recruitment thresholds of the upper trapezius motor units in the cranial and caudal region or a nonuniform nociceptive input to the motor units of both regions. This study investigated these potential mechanisms by direct motor unit identification. Motor unit activity was investigated with high-density surface EMG signals recorded from the upper trapezius muscle of 12 healthy volunteers during baseline, control (intramuscular injection of isotonic saline), and painful (hypertonic saline) conditions. The EMG was decomposed into in idual motor unit spike trains. Motor unit discharge rates decreased significantly from control to pain conditions by 4.0 ± 3.6 pulses/s (pps) in the cranial region but not in the caudal region (1.4 ± 2.8 pps not significant). These changes were compatible with variations in the synaptic input to the motoneurons of the two regions. These adjustments were observed, irrespective of the location of noxious stimulation. These results strongly indicate that the nociceptive synaptic input is distributed in a nonuniform way across regions of the upper trapezius muscle.
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 06-2017
Publisher: Journal of Orthopaedic & Sports Physical Therapy (JOSPT)
Date: 03-2018
Abstract: Study Design Longitudinal clinimetric study. Background Pain self-efficacy predicts poor recovery and mediates the relationship between pain and disability in patients with neck pain disorders (NPDs). The Pain Self-Efficacy Questionnaire (PSEQ) is a frequently used instrument to measure pain self-efficacy however, its measurement properties have never been evaluated in a group of patients with NPDs. Objectives This study aimed to assess validity and responsiveness of the PSEQ in patients with NPDs. Methods Patients with NPDs (n = 161) were included. Confirmatory and exploratory factor analysis was used to assess structural validity. Twelve hypotheses on expected correlations with other instruments were formulated a priori to assess construct validity. Responsiveness was evaluated in 146 patients with NPDs who underwent multimodal rehabilitation by testing 12 hypotheses on expected effect sizes, area under the curve, and correlations with change in other instruments. Results Factor analyses showed that the PSEQ is a unidimensional instrument with moderate construct validity and responsiveness (50% to 75% of hypotheses met). Validity was consistent when analyzed separately for patients with whiplash-associated disorders and idiopathic neck pain, and responsiveness was better in patients with idiopathic neck pain. Conclusion The PSEQ is a unidimensional measure of pain self-efficacy in patients with NPDs, as found by previous studies in other populations. Nevertheless, in contrast with previous studies, its construct validity and responsiveness were found to be suboptimal in NPDs, suggesting that the content validity of the PSEQ and of the comparator instruments used in this study should be better assessed. J Orthop Sports Phys Ther 2018 (3):204-216. Epub 19 Dec 2017. doi:10.2519/jospt.2018.7605.
Publisher: Medical Journals Sweden AB
Date: 2016
Abstract: To compare the effects of cranio-cervical flexion vs cervical proprioception training on neuromuscular control, pressure pain sensitivity and perceived pain and disability in patients with chronic neck pain. Twenty-eight volunteers with chronic non-specific neck pain were randomly assigned to 1 of 2 interventions and undertook 6 physiotherapist-supervised sessions over a period of 2 months. Both groups performed daily home exercise. Performance on the cranio-cervical flexion test, pressure pain thresholds and reported levels of pain and disability were measured before and immediately after the first treatment session, 1 month after starting treatment and 2 months after starting treatment (at completion of the intervention). At 2 months, both groups improved their performance on the cranio-cervical flexion test (p 0.05). Both groups showed a reduction in their pain at rest and disability at 2 months, but this was also not different between groups (p > 0.05). Pressure pain sensitivity did not change for either group. Both specific cranio-cervical flexion training and proprioception training had a comparable effect on performance on the cranio-cervical flexion test, a test of the neuromuscular control of the deep cervical flexors. These results indicate that proprioception training may have positive effects on the function of the deep cervical flexors.
Publisher: American Physiological Society
Date: 07-2019
DOI: 10.1152/JAPPLPHYSIOL.00139.2019
Abstract: Correlation between motor unit discharge times, often referred to as motor unit synchronization, is determined by common synaptic input to motor neurons. Although it has been largely speculated that synchronization should influence the rate of force development, the association between the degree of motor unit synchronization and rapid force generation has not been determined. In this study, we examined this association with both simulations and experimental motor unit recordings. The analysis of experimental motor unit discharges from the tibialis anterior muscle of 20 healthy in iduals during rapid isometric contractions revealed that the average motor unit discharge rate was associated with the rate of force development. Moreover, the extent of motor unit synchronization was entirely determined by the average motor unit discharge rate (
Publisher: BMJ
Date: 09-2023
Publisher: Public Library of Science (PLoS)
Date: 12-10-2023
Publisher: Elsevier BV
Date: 04-2011
DOI: 10.1016/J.JELEKIN.2010.11.011
Abstract: This study compares neck force steadiness in women with neck pain and controls and the way this is influenced by short term vibration of the neck. In the first experiment, 9 women with chronic neck pain and 9 controls performed 10-s isometric cervical flexion at 15N. Intramuscular EMG was recorded from the sternocleidomastoid muscle. In the second experiment, 10 women with neck pain and 10 controls performed 10-s isometric cervical flexion at 25% of their maximal force before and after vibration to the neck (bursts of 50Hz with duration 20, 40, 60 and 120s). Surface EMG was acquired from the sternocleidomastoid and splenius capitis. In both experiments, force steadiness was characterized by the coefficient of variation (CoV) and the relative power in three frequency subbands (low: 0-3Hz middle: 4-6Hz high: 8-12Hz) of the force signal. Women with neck pain exhibited decreased force steadiness (Exp 1: patients 3.9±1.3%, controls 2.7±0.9%, P<0.05 Exp 2: patients 3.4±1.2%, controls 1.7±0.6%, P<0.01) which was associated with higher power in the low-frequency band (patients 71.2±9.6%, controls 56.7±9.2%, P<0.01). Following vibration, CoV (2.6±1.1%, P<0.05) and the power in the low-frequency band of the force signal decreased (63.1±13.9%, P<0.05) in the patient group. These effects were not present in controls. Motor unit behavior and surface EMG litude were similar between groups. In conclusion, women with neck pain have reduced force steadiness, likely due to alterations in Ia afferent input. Vibration, which modulates Ia afferent input, increases force steadiness in patients with neck pain.
Publisher: Oxford University Press (OUP)
Date: 22-08-2023
DOI: 10.1093/PTJ/PZAD113
Abstract: The Patient-Specific Functional Scale (PSFS) is a patient-reported outcome measure used to assess functional limitations. Recently, the PSFS 2.0 was proposed this instrument includes an inverse numeric rating scale and an additional list of activities that patients can choose. The aim of this study was to assess the test–retest reliability, measurement error, responsiveness, and minimal important change of the PSFS 2.0 when used by patients with nonspecific neck pain. Patients with nonspecific neck pain completed a numeric rating scale, the PSFS 2.0, and the Neck Disability Index at baseline and again after 12 weeks. The Global Perceived Effect (GPE) was also collected at 12 weeks and used as an anchor. Test–retest measurement was assessed by completion of a second PSFS 2.0 after 1 week. Measurement error was calculated using a Bland–Altman plot. The receiver operating characteristic method with the anchor (GPE) functions as the reference standard was used for calculating the minimal important change. One hundred patients were included, with 5 lost at follow-up. No floor and ceiling effects were reported. In the test–retest analysis, the mean difference was 0.15 (4.70 at first test and 4.50 at second test). The ICC (mixed models) was 0.95, indicating high agreement (95% CI = 0.92–0.97). For measurement error, the upper and lower limits of agreement were 0.95 and − 1.25 points, respectively, with a smallest detectable change of 1.10. The minimal important change was determined to be 2.67 points. The PSFS 2.0 showed satisfactory responsiveness, with an area under the curve of 0.82 (95% CI = 0.70–0.93). There were substantial to high correlations between the change scores of the PSFS 2.0 and the Neck Disability Index and GPE (0.60 and 0.52, respectively P & .001). The PSFS 2.0 is a reliable and responsive patient-reported outcome measure for use by patients with neck pain.
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 05-2014
DOI: 10.1016/J.PAIN.2014.01.027
Abstract: This study investigated change in the distribution of lumbar erector spinae muscle activity and pressure pain sensitivity across the low back in in iduals with low back pain (LBP) and healthy controls. Surface electromyographic (EMG) signals were recorded from multiple locations over the lumbar erector spinae muscle with a 13×5 grid of electrodes from 19 people with chronic nonspecific LBP and 17 control subjects as they performed a repetitive lifting task. The EMG root mean square (RMS) was computed for each location of the grid to form a map of the EMG litude distribution. Pressure pain thresholds (PPT) were recorded before and after the lifting task over a similar area of the back. For the control subjects, the EMG RMS progressively increased more in the caudal region of the lumbar erector spinae during the repetitive task, resulting in a shift in the distribution of muscle activity. In contrast, the distribution of muscle activity remained unaltered in the LBP group despite an overall increase in EMG litude. PPT was lower in the LBP group after completion of the repetitive task compared to baseline (average across all locations: pre: 268.0±165.9 kPa post: 242.0±166.7 kPa), whereas no change in PPT over time was observed for the control group (320.1±162.1 kPa post: 322.0±179.5 kPa). The results demonstrate that LBP alters the normal adaptation of lumbar erector spinae muscle activity to exercise, which occurs in the presence of exercise-induced hyperalgesia. Reduced variability of muscle activity may have important implications for the provocation and recurrence of LBP due to repetitive tasks.
Publisher: Elsevier BV
Date: 10-2023
Publisher: Springer Science and Business Media LLC
Date: 08-03-2021
DOI: 10.1186/S13643-021-01623-7
Abstract: The term temporomandibular disorder (TMD) includes disorders of the temporomandibular joints (TMJ), masticatory muscles and adjacent tissues. Several studies have examined the effectiveness of manual therapy (MT) for TMDs by evaluating changes in pain and maximum mouth opening (MMO). Nevertheless, the effectiveness of MT exclusively applied to the craniomandibular structures (craniomandibular manual therapy (CMMT)) on pain and TMJ range of motion remains unclear. This review aims to evaluate the effectiveness of CMMT on pain and TMJ range of motion in people with TMDs. This protocol is reported in line with the preferred reporting items for systematic reviews and meta-analysis protocols (PRISMA-P). Databases including MEDLINE, Embase, CINAHL, ZETOC, Web of Science, SCOPUS, PEDro, PubMed, Cochrane Library and Best Evidence, EBM reviews–Cochrane Central Register of Controlled Trials, Index to Chiropractic Literature ChiroAccess and Google Scholar will be searched from inception as well as key journals and grey literature. Randomised controlled trials involving adults with TMD that compare the effect of any type of CMMT (e.g. mobilisation) on pain and range of motion with a placebo intervention, controlled care intervention or other types of treatment will be included. Two reviewers will independently screen articles for inclusion, extract data, assess risk of bias (revised Cochrane risk of bias tool) for included studies and evaluate overall quality of evidence (Grading of Recommendations Assessment, Development and Evaluation). A meta-analysis will be conducted if possible. If not, a narrative synthesis will be conducted reporting the effectiveness of CMMT according to disorder type (TMJ disorders, masticatory muscle disorders and mixed disorders). In this review, the effectiveness of MT applied to craniomandibular structures for the treatment of TMD will be evaluated. Results will be submitted for publication in a peer-reviewed journal and presented at conferences. We expect our findings will facilitate treatment planning for manual therapists managing patients with TMD and provide future clinical research implications. PROSPERO CRD42019160213
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 02-2008
DOI: 10.1249/MSS.0B013E31815B0DCB
Abstract: The aim of this human study was to apply novel topographical mapping techniques to investigate sensory and EMG manifestations of delayed-onset muscle soreness (DOMS) in multiple locations of the quadriceps. Bipolar surface EMG signals were recorded from 11 healthy men with 15 pairs of electrodes located at 10, 20, 30, 40, and 50% of the distance from the medial, superior, and lateral border of the patella to the anterior superior iliac spine. Subjects performed sustained isometric knee extensions at 40% of the maximal force (MVC) until task failure before, 24 h, and 48 h after eccentric exercise. Pressure-pain thresholds (PPT) were assessed at the 15 locations where the EMG was recorded. Time to task failure was reduced after the eccentric exercise (mean +/- SD, 56.6 +/- 23 s before the eccentric exercise 34.3 +/- 18.9 s at 24 h after exercise and 34.3 +/- 14.4 s at 48 h after exercise). During the postexercise sustained contractions, EMG average rectified value (ARV) significantly decreased over time (P < 0.001), but it did not change over time before the eccentric exercise. Moreover, the decrease in ARV over time during postexercise contractions was greatest in the distal region of the quadriceps, where the PPT were most reduced (P < 0.05). Novel topographical mapping of both surface EMG and PPT of the quadriceps showed site-dependent effects of eccentric exercise, probably attributable to variations in the morphological and architectural characteristics of the muscle fibers. Greater manifestations of DOMS in the distal region of the quadriceps may indicate a greater susceptibility of this region to further injury after eccentric exercise.
Publisher: Springer Science and Business Media LLC
Date: 16-10-2015
DOI: 10.1038/SREP15289
Abstract: Chronic whiplash-associated disorder (WAD) is common after whiplash injury, with considerable personal, social and economic burden. Despite decades of research, factors responsible for continuing pain and disability are largely unknown and diagnostic tools are lacking. Here, we report a novel model of mechanical ventral neck muscle function recorded from non-invasive, real-time, ultrasound measurements. We calculated the deformation area and deformation rate in 23 in iduals with persistent WAD and compared them to 23 sex- and age-matched controls. Multivariate statistics were used to analyse interactions between ventral neck muscles, revealing different interplay between muscles in in iduals with WAD and healthy controls. Although the cause and effect relation cannot be established from this data, for the first time, we reveal a novel method capable of detecting different neck muscle interplay in people with WAD. This non-invasive method stands to make a major breakthrough in the assessment and diagnosis of people following a whiplash trauma.
Publisher: Elsevier BV
Date: 04-2023
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 04-2017
Publisher: American Physiological Society
Date: 04-2018
DOI: 10.1152/JAPPLPHYSIOL.01115.2017
Abstract: Surface electromyographic (EMG) signal litude is typically used to compare the neural drive to muscles. We experimentally investigated this association by studying the motor unit (MU) behavior and action potentials in the vastus medialis (VM) and vastus lateralis (VL) muscles. Eighteen participants performed isometric knee extensions at four target torques [10, 30, 50, and 70% of the maximum torque (MVC)] while high-density EMG signals were recorded from the VM and VL. The absolute EMG litude was greater for VM than VL ( P 0.001), whereas the EMG litude normalized with respect to MVC was greater for VL than VM ( P 0.04). Because differences in EMG litude can be due to both differences in the neural drive and in the size of the MU action potentials, we indirectly inferred the neural drives received by the two muscles by estimating the synaptic inputs received by the corresponding motor neuron pools. For this purpose, we analyzed the increase in discharge rate from recruitment to target torque for motor units matched by recruitment threshold in the two muscles. This analysis indicated that the two muscles received similar levels of neural drive. Nonetheless, the size of the MU action potentials was greater for VM than VL ( P 0.001), and this difference explained most of the differences in EMG litude between the two muscles (~63% of explained variance). These results indicate that EMG litude, even following normalization, does not reflect the neural drive to synergistic muscles. Moreover, absolute EMG litude is mainly explained by the size of MU action potentials. NEW & NOTEWORTHY Electromyographic (EMG) litude is widely used to compare indirectly the strength of neural drive received by synergistic muscles. However, there are no studies validating this approach with motor unit data. Here, we compared between-muscles differences in surface EMG litude and motor unit behavior. The results clarify the limitations of surface EMG to interpret differences in neural drive between muscles.
Publisher: Elsevier BV
Date: 02-2011
DOI: 10.1016/J.JELEKIN.2010.10.001
Abstract: The study investigates the effects of eccentric exercise of the quadriceps on proprioception of the knee in weight and non-weight bearing tasks. Proprioception of the exercised leg was assessed at 120° and 150° of knee extension in 15 healthy adults (age 25.0 ± 3.6 yrs) before, immediately after, and 24h following eccentric exercise of the quadriceps. Three tests of proprioception were performed: 1. matching the position of the exercised leg (right leg) to the reference leg (left leg) in sitting (non-weight bearing matching task) 2. repositioning the exercised leg after active movement in sitting (non-weight bearing repositioning task) 3. repositioning the exercised leg after active movement in standing (weight bearing task). Maximum knee extension force was reduced by 77.0 ± 12.3 % immediately after the exercise, and by 82.7 ± 16.2% 24h post exercise, with respect to baseline (P<0.001). The absolute error in the non-weight bearing matching task at 120° of knee extension was greater immediately following eccentric exercise (12.3 ± 5.6, P<0.001) and 24h after exercise (8.1 ± 4.5, P<0.05) compared to baseline (5.8 ± 2.7). Similarly, the absolute error in the non-weight bearing repositioning task at 120° was greater both immediately (5.9 ± 3.1°, P<0.01) and 24h post exercise (5.2 ± 3.0°, P<0.05) compared to baseline (4.5 ± 2.6°). Therefore, in both non-weight bearing tasks, the subjects matched the position of their leg after eccentric exercise by adopting a more extended knee position of the exercised limb. Furthermore, the subjects showed higher variability in their performance immediately post exercise (P<0.05, compared to baseline) but not 24h after. In contrast, eccentric exercise did not affect the repositioning errors in the weight bearing task. In conclusion, eccentric exercise of the quadriceps impairs proprioception of the knee both immediately after and 24h post exercise, but only in non-weight bearing tasks.
Publisher: Elsevier BV
Date: 08-2020
Publisher: Wiley
Date: 07-07-2019
DOI: 10.1111/PAPR.12804
Abstract: To investigate whether people with chronic low back pain (LBP) show dysfunctional exercise‐induced hypoalgesia (EIH) in response to repeated contractions of their back muscles during a lifting task. In this cross‐sectional observational study conducted on asymptomatic participants ( n = 18) and participants with chronic LBP ( n = 21), quantitative sensory testing (QST) was applied extensively over the lumbar region and a remote area before and after a repeated task that involved lifting a 5‐kg box for ~7 minutes. QST included pressure pain thresholds (PPTs), thermal detection, pain thresholds, and measures of temporal summation. Topographical maps of the percentage change in PPT detected at 16 locations over the lumbar region were generated to explore regional differences and compared between groups. Mean (standard deviation) PPTs measured from 16 sites over the lower back changed significantly in asymptomatic participants (+29.78 kPa [41.4]) following task completion, indicative of EIH, whereas no significant change was observed for the low back pain (LBP) group (−14.87 kPa [61.2]). No changes were detected at the remote site for either group. No changes were revealed for the thermal tests. Temporal summation data revealed decreasing pain sensitivity as the test progressed, but the test response did not change after the exercise for either group. Unlike asymptomatic in iduals, participants with LBP lacked EIH over the lumbar erector spinae muscles following repeated lifting. Although these results should be considered in relation to the study limitations, particularly the absence of a control group, the findings support impaired EIH in patients with LBP.
Publisher: Springer Science and Business Media LLC
Date: 08-09-2020
DOI: 10.1186/S12891-020-03600-Y
Abstract: Neuropathic pain (NP) is common in patients presenting with low back related leg pain. Accurate diagnosis of NP is fundamental to ensure appropriate intervention. In the absence of a clear gold standard, expert opinion provides a useful methodology to progress research and clinical practice. The aim of this study was to achieve expert consensus on a list of clinical indicators to identify NP in low back related leg pain. A modified Delphi method consisting of three rounds was designed in accordance with the Conducting and Reporting Delphi Studies recommendations. Recruitment involved contacting experts directly and through expressions of interest on social media. Experts were identified using pre-defined eligibility criteria. Priori consensus criteria were defined for each round through descriptive statistics. Following completion of round 3 a list of clinical indicators that achieved consensus were generated. Thirty-eight participants were recruited across 11 countries. Thirty-five participants completed round 1 (92.1%), 32 (84.2%) round 2 and 30 (78.9%) round 3. Round 1 identified consensus (Kendall’s W coefficient of concordance 0.456 p 0.001) for 10 clinical indicators out of the original 14, and 9 additional indicators were added to round 2 following content analysis of qualitative data. Round 2 identified consensus (Kendall’s W coefficient of concordance 0.749 p 0.001) for 10 clinical indicators out of 19, and 1 additional indicator was added to round 3. Round 3 identified consensus for 8 indicators (Kendall’s W coefficient of concordance 0.648 p 0.001). Following completion of the third round, an expert derived consensus list of 8 items was generated. Two indicators pain variously described a burning, electric shock like and/or shooting into leg and pain in association with other neurological symptoms (e.g. pins and needles, numbness, weakness), were found to have complete agreement amongst expert participants. Good agreement was found for the consensus derived list of 8 clinical indicators to identify NP in low back related leg pain. This list of indicators provide some indication of the criteria upon which clinicians can identify a NP component to low back related leg pain further research is needed for stronger recommendations to be made.
Publisher: Springer Science and Business Media LLC
Date: 02-03-2020
DOI: 10.1007/S00586-020-06356-0
Abstract: To evaluate the predictive performance of statistical models which distinguishes different low back pain (LBP) sub-types and healthy controls, using as input predictors the time-varying signals of electromyographic and kinematic variables, collected during low-load lifting. Motion capture with electromyography (EMG) assessment was performed on 49 participants [healthy control (con) = 16, remission LBP (rmLBP) = 16, current LBP (LBP) = 17], whilst performing a low-load lifting task, to extract a total of 40 predictors (kinematic and electromyographic variables). Three statistical models were developed using functional data boosting (FDboost), for binary classification of LBP statuses (model 1: con vs. LBP model 2: con vs. rmLBP model 3: rmLBP vs. LBP). After removing collinear predictors (i.e. a correlation of 0.7 with other predictors) and inclusion of the covariate sex, 31 predictors were included for fitting model 1, 31 predictors for model 2, and 32 predictors for model 3. Seven EMG predictors were selected in model 1 (area under the receiver operator curve [AUC] of 90.4%), nine predictors in model 2 (AUC of 91.2%), and seven predictors in model 3 (AUC of 96.7%). The most influential predictor was the biceps femoris muscle (peak $$\\beta $$ β = 0.047) in model 1, the deltoid muscle (peak $$\\beta $$ β = 0.052) in model 2, and the iliocostalis muscle (peak $$\\beta $$ β = 0.16) in model 3. The ability to transform time-varying physiological differences into clinical differences could be used in future prospective prognostic research to identify the dominant movement impairments that drive the increased risk. These slides can be retrieved under Electronic Supplementary Material.
Publisher: Elsevier BV
Date: 06-2020
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 10-2009
Publisher: Elsevier BV
Date: 12-2015
DOI: 10.1016/J.PHYSIO.2015.01.004
Abstract: This paper describes the development and details of a standardised physiotherapy exercise intervention designed to address pain and disability in patients with difficulty returning to usual activities after arthroscopic decompression surgery for subacromial impingement syndrome. To develop the intervention, the literature was reviewed with respect to the effectiveness of postoperative exercises, components of previous exercise programmes were extracted, and input from clinical physiotherapists in the field was obtained through a series of workshops. The physiotherapy exercise intervention is currently being evaluated within the framework of the Shoulder Intervention Project (ISRCTN55768749).
Publisher: BMJ
Date: 02-2022
DOI: 10.1136/BMJOPEN-2021-050186
Abstract: Achilles tendinopathy (AT) is a debilitating overuse injury characterised by pain, impaired functional performance, morpho-mechanical changes to the Achilles tendon and triceps surae neuromuscular alterations. Loading-based exercise has become the principal non-surgical choice for the treatment of AT however, mechanistic evidence by which loading-based treatment may help to resolve tendon pain remains unclear. This systematic review aims to summarise the evidence of the neuromechanical changes produced by AT and by exercise-induced mechanical loading. This systematic review protocol was informed and reported in accordance with the Preferred Reporting Items for Systematic Review and Meta-Analysis (PRISMA-P) and the Cochrane Handbook for Systematic Reviews of Interventions. Pubmed, MEDLINE, EMBASE, CINAHL Plus, Web of Science and SPORTDiscus electronic databases will be searched from inception to February 2021. Additionally, grey literature and key journals will be reviewed. Risk of bias will be determined independently by two reviewers using the version 2 of the Cochrane risk-of-bias tool for randomised trials (RoB 2) and the risk of bias in non-randomised studies - of interventions (ROBINS-I) tool according to Cochrane recommendations. Quality of the cumulative evidence will be assessed with the Grading of Recommendations, Assessment, Development, and Evaluation (GRADE) guidelines. If homogeneity exists between groups of studies, a random-effects meta-analysis will be conducted. If not, results will be synthesised narratively. Our findings will be disseminated through publication in a peer-reviewed journal and presented at conferences. No ethical approval was required. CRD42021231933.
Publisher: Wiley
Date: 02-2004
Publisher: Elsevier BV
Date: 12-2022
DOI: 10.1016/J.MSKSP.2022.102665
Abstract: Shear wave tensiometry is a recent promising technology which can be used to evaluate tendon loading. Knowing the clinimetric features (e.g., reliability) of this technology is important for use in clinical and research settings. To evaluate the inter-session reliability of a novel shear wave tensiometer for the assessment of Achilles tendon loading. A further aim was to test the construct validity of this device by evaluating its precision in detecting Achilles tendon loading changes induced by a plantar flexor isometric contraction of increasing intensity. Ten healthy participants were recruited. Five measurements were performed at different time points to evaluate inter-session reliability. Shear wave speed along the Achilles tendon was evaluated during different isometric contractions using a shear wave tensiometer composed of an array of four accelerometers fixed on the tendon, ranging from 4 to 8.5 cm from the calcaneal insertion of the tendon. Test-retest, intra- and inter-session reliability were determined using intraclass correlation coefficient (ICC Test-retest reliability was good to excellent (ICC This study confirms the reliability of this novel device. Future studies analyzing participants with Achilles tendinopathy are needed to evaluate the capability of shear wave tensiometry to detect transient changes in loading due to pathology.
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 05-2017
Publisher: Elsevier BV
Date: 06-2009
DOI: 10.1016/J.JELEKIN.2007.10.003
Abstract: The purpose of the study was to explore changes in the spatial distribution of erector spinae electromyography litude during static, sustained contractions and during contractions of increasing load. Surface electromyographic (EMG) signals were detected from nine healthy subjects using a grid of 13 x 5 electrodes placed unilaterally over the lumbar erector spinae musculature. Subjects stood in a 20 degrees forward flexed position and performed: (1) six 20-s long contractions with loads ranging from 2.5 kg to 12.5 kg (2.5 kg increments) and (2) a 6 min sustained contraction with 7.5 kg load. Root mean square (RMS) and mean power spectral frequency (MNF) were computed from the recorded EMG signals. EMG RMS increased (P<0.0001) and MNF remained constant during contractions of increased load. During the sustained contraction, MNF decreased (P<0.0001) and RMS did not change over time. The centroid (center of activity) of the RMS map shifted caudally (P<0.0001) with time during the sustained contraction but did not change with varying load. These results suggest a change in the distribution of erector spinae muscle activity with fatigue and a uniform distribution of muscle activation across loads.
Publisher: Elsevier BV
Date: 07-2016
DOI: 10.1016/J.ARCHORALBIO.2016.03.013
Abstract: To describe the effects of therapy on masseter activity and chewing kinematic in patients with unilateral posterior crossbite (UPC). Fifty children (age: mean ± SD: 9.1 ± 2.3 years) with UPC (34 on the right side, 16 on the left side) and twenty children (age: 9.5 ± 2.6 years) with normal occlusion were selected for the study. The mandibular motion and the muscular activity during chewing soft and hard boli were simultaneously recorded, before and after correction with function generating bite, after a mean treatment time of 7.3 ± 2.4 months plus the retention time of 5-6 months. The percentage of reverse cycles and the percent difference between ipsilateral and contralateral peaks of the masseter electromyography envelopes were computed. Before therapy, the percentage of reverse cycles during chewing on the crossbite side was greater in patients than in controls (P<0.001) and significantly reduced after therapy (P<0.001) towards the reference normal value (soft bolus pre: 57 ± 30%, post:12 ± 17% hard bolus pre: 65 ± 34%, post: 12 ± 13% reference value: soft bolus 4 ± 2%, hard bolus 5 ± 3%). Before therapy the percent difference between electromyography envelope peaks in patients was lower than in controls (P<0.01) and significantly increased after therapy (P<0.05) becoming similar to the reference normal value. The correction induced a normal-like coordination of masseter muscles activity together with a significant reduction of the reverse chewing patterns. The previous altered muscular activation corresponded to the altered kinematics of reverse chewing cycles that might be considered a useful indicator of the severity of the masticatory function involvement.
Publisher: Elsevier BV
Date: 2011
Publisher: American Physiological Society
Date: 10-2021
DOI: 10.1152/JAPPLPHYSIOL.01011.2020
Abstract: Pain induces changes in motor performance, motor unit recruitment, and rate coding behavior that varies across different contraction speeds. Here we show that that pain reduces motor unit discharge rate and prolongs the neuromechanical delay at slow contraction speeds only. This new evidence suggests that there are differential nociceptive inhibitory effects across the motor unit pool, which allows fast submaximal contractions to be exerted despite the presence of pain.
Publisher: Elsevier BV
Date: 12-2008
DOI: 10.1016/J.MATH.2007.07.001
Abstract: Both low-load and high-load training of the cervical muscles have been shown to reduce neck pain and change parameters of muscle function directly related to the exercise performed. The purpose of this study was to investigate whether either training regime changes muscle activation during a functional task which is known to be affected in people with neck pain and is not directly related to either exercise protocol. Fifty-eight female patients with chronic neck pain were randomised into one of two 6-week exercise intervention groups: an endurance-strength training regime for the cervical flexor muscles or low-load training of the cranio-cervical flexor muscles. The primary outcome was a change in electromyographic (EMG) litude of the sternocleidomastoid (SCM) muscle during a functional, repetitive upper limb task. At the 7th week follow-up assessment both intervention groups demonstrated a reduction in their average intensity of pain (P 0.05). The results demonstrate that training the cervical muscles with a prescribed motor task may not automatically result in improved muscle activation during a functional activity, despite a reduction in neck pain.
Publisher: Wiley
Date: 09-04-2008
DOI: 10.1002/MUS.20948
Abstract: Measurements of muscle-fiber conduction velocity during voluntary contractions have been used in the diagnosis of neuromuscular diseases. However, the velocity of propagation of action potentials depends on the interspike interval of activation due to the velocity recovery function (VRF) of muscle fibers. The comparison of muscle-fiber conduction velocity estimates between in iduals may thus be influenced by differences in motor unit discharge rate. This study investigates action potential properties of motor units of the sternocleidomastoid muscle during voluntary modulation of discharge rate with the purpose of assessing the effect of the VRF on motor unit properties in voluntary contractions. Nineteen healthy men trained to control a target motor unit with feedback of surface multichannel electromyographic (EMG) signals. The subjects performed three 30-s contractions of cervical flexion/rotation modulating the discharge rate of the target motor unit from 6.6 +/- 1.6 pps to 28.0 +/- 6.4 pps. Action potential conduction velocity was correlated to instantaneous discharge rate (R = 0.38 +/- 0.21). Action potential conduction velocity, peak-to-peak litude, and duration varied between minimum and maximum discharge rate (P < 0.01 percent change 12.3 +/- 5.0, -11.8 +/- 9.9, and -12.9 +/- 7.3). Thus, the properties of surface motor unit action potentials vary with modulation of discharge rate. This has implications for the use of conduction velocity values measured during voluntary contractions to differentiate patient populations from healthy in iduals and for the development of normative data.
Publisher: Elsevier BV
Date: 06-2021
Publisher: Elsevier BV
Date: 10-2004
DOI: 10.1016/J.NEUCLI.2004.04.004
Abstract: Despite the evidence of greater fatigability of the superficial cervical flexor muscles in neck pain patients, the relationship between duration of neck pain and muscle fatigue has not been investigated. This study examined the relationship between myoelectric manifestations of sternocleidomastoid (SCM) and anterior scalene (AS) muscle fatigue and duration of neck pain in a group of patients with chronic neck pain. Twenty chronic neck pain patients with a history of pain ranging between 1 and 25 years (mean 6.15, S.D. 5.48 years) participated in this study. Myoelectric signals were recorded from the SCM and AS muscles from the side of greatest pain as patients performed sustained sub-maximal isometric cervical flexion contractions at 25% and 50% of the maximum voluntary contraction (MVC). The initial value and slope of the mean frequency (MNF), average rectified value (ARV) and conduction velocity (CV) of the EMG signals were calculated. Correlation analysis was applied to determine whether a relationship existed between the duration of neck pain and estimates of EMG variables. No significant correlation was found between duration of pain and estimates of the MNF, ARV and CV for either SCM or AS contracting at 25% and 50% MVC. The length of history of neck pain does not appear to correlate with the extent of SCM and AS muscle fatigability in patients with chronic neck pain. This finding may be due to an increase of muscle fatigability occurring within the first few years of neck pain, which is not followed by signs of increased fatigue after this time. This was supported by the finding of significant correlations between duration of pain and AS fatigability on a subgroup of patients with pain duration less than 5 years. Future studies are warranted to examine how early signs of cervical muscle fatigability are evident after the onset of neck pain as this will have implications for rehabilitation.
Publisher: Journal of Orthopaedic & Sports Physical Therapy (JOSPT)
Date: 04-2020
Abstract: Utilizing shear wave elastography, we compared the stiffness of the neck extensor muscles and the stiffness in muscle-specific regions between women with chronic nonspecific neck pain and asymptomatic controls. Cross-sectional observational study. We measured the average muscle stiffness over multiple neck extensor muscles and in regions corresponding approximately to the trapezius, splenius capitis, semispinalis capitis, semispinalis cervicis, and multifidus muscles using ultrasound shear wave elastography in 20 women with chronic nonspecific neck pain and 18 asymptomatic women during multiple tasks. The measurements were automatically quality controlled and computer processed over the complete visible neck region or a large muscle-specific region. Pooled over all tasks, neck muscle stiffness was not significantly different between those with neck pain and asymptomatic controls (neck pain median, 11.6 kPa interquartile range, 8.9 kPa and control median, 13.3 kPa interquartile range, 8.6 kPa Shear wave elastography revealed similar muscle stiffness in people with and without chronic neck pain, despite the sensation of increased neck stiffness in those with chronic neck pain. Therapeutic interventions aiming to reduce neck muscle tone are often based on the assumption that perceived neck stiffness corresponds to objective muscle stiffness. The current results question this assumption.
Publisher: Elsevier BV
Date: 2018
DOI: 10.1016/J.SPINEE.2017.08.241
Abstract: In clinical practice, the diagnosis of cervical radiculopathy is based on information from the patient's history, physical examination, and diagnostic imaging. Various physical tests may be performed, but their diagnostic accuracy is unknown. This study aimed to summarize and update the evidence on diagnostic performance of tests carried out during a physical examination for the diagnosis of cervical radiculopathy. A review of the accuracy of diagnostic tests was carried out. The study s le comprised diagnostic studies comparing results of tests performed during a physical examination in diagnosing cervical radiculopathy with a reference standard of imaging or surgical findings. Sensitivity, specificity, likelihood ratios are presented, together with pooled results for sensitivity and specificity. A literature search up to March 2016 was performed in CENTRAL, PubMed (MEDLINE), Embase, CINAHL, Web of Science, and Google Scholar. The methodological quality of studies was assessed using the QUADAS-2. Five diagnostic accuracy studies were identified. Only Spurling's test was evaluated in more than one study, showing high specificity ranging from 0.89 to 1.00 (95% confidence interval [CI]: 0.59-1.00) sensitivity varied from 0.38 to 0.97 (95% CI: 0.21-0.99). No studies were found that assessed the diagnostic accuracy of widely used neurological tests such as key muscle strength, tendon reflexes, and sensory impairments. There is limited evidence for accuracy of physical examination tests for the diagnosis of cervical radiculopathy. When consistent with patient history, clinicians may use a combination of Spurling's, axial traction, and an Arm Squeeze test to increase the likelihood of a cervical radiculopathy, whereas a combined results of four negative neurodynamics tests and an Arm Squeeze test could be used to rule out the disorder.
Publisher: Elsevier BV
Date: 02-2019
DOI: 10.1016/J.CLINBIOMECH.2019.01.004
Abstract: Recent work described parameters of the helical axis in asymptomatic people with potential for investigating kinematic changes in the cervical region. This approach could provide novel information on movement variability in people with neck pain, however this has never been investigated. This study aimed to investigate movement variability during active neck movements performed at different speeds in people with and without chronic neck pain. This observational case-control study examined 18 participants with chronic neck pain of either idiopathic or traumatic origin and 18 gender-matched asymptomatic participants. Cervical kinematics were captured with 3D motion capture as people with and without chronic neck pain performed flexion-extension, bilateral lateral flexion and bilateral rotation at different speeds (natural, slow, and fast). The mean distance and mean angle parameters of the helical axis were extracted to describe 3D motion and quantify movement variability. A smaller mean distance was observed in those with neck pain compared to the asymptomatic participants during flexion-extension (P = 0.019) and rotation movements (P = 0.007). The neck pain group displayed smaller values for the mean angle during rotation movements with different speeds (P = 0.01). These findings indicate less variable movement for those with neck pain relative to the asymptomatic participants. No difference in the mean angle was observed between groups for flexion-extension and lateral flexion. The findings reiterate the importance of data derived from kinematic measures, and its potential for providing clinicians with further insight into the quality of active neck movements in people with chronic neck pain.
Publisher: Elsevier BV
Date: 02-2017
DOI: 10.1016/J.MATH.2016.10.008
Abstract: Convex hull area (CHA) and mean angle (MA) have been proposed to describe the behaviour of the helical axis during joint kinematics. This study investigates the intra- and inter-session reliability of CHA and MA during active movements of the cervical spine. Twenty-seven healthy volunteers (19 women) aged 23 ± 2.8 years participated. Each volunteer was tested on two sessions. All participants were instructed to perform the following active movements of the cervical spine: rotation, flexion/extension and lateral bending, each performed to full range and repeated ten consecutive times. Cervical movements were registered with an electromagnetic tracking system. For each participant, each movement and each session, range of motion (ROM), CHA and MA were extracted. ROM showed high intra- and inter-session reliability during all cervical spine movements using this method. Overall, the intra- and inter-session reliability of the helical axis parameters varied depending on the movement direction and ranged from fair to almost perfect. The intra- and inter-session reliability of CHA and MA were almost perfect during rotation whereas the intra- and inter-session reliability of CHA was substantial during lateral bending and intra- and inter-session reliability of MA ranged from fair to substantial during flexion/extension and lateral bending. This is the first study to evaluate the reliability of helical axis measures during active movements of the cervical spine. The results show that CHA and MA are promising descriptors of cervical kinematics which could be applied in future studies to evaluate neck function in patients with cervical spine disorders.
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 11-10-2022
DOI: 10.1097/J.PAIN.0000000000002819
Abstract: Experimental pain models are frequently used to understand the influence of pain on the control of human movement. In this systematic review, we assessed the effects of experimentally induced pain in the lumbar region of healthy in iduals on trunk muscle activity and spine kinematics. Databases were searched from inception up to January 31, 2022. In total, 26 studies using either hypertonic saline injection (n = 19), heat thermal stimulation (n = 3), nociceptive electrical stimulation (n = 3), or capsaicin (n = 1) were included. The identified adaptations were task dependent, and their heterogeneity was partially explained by the experimental pain model adopted. Meta-analyses revealed an increase of erector spinae activity (standardized mean difference = 0.71, 95% confidence interval [CI] = 0.22-1.19) during full trunk flexion and delayed onset of transversus abdominis to postural perturbation tasks (mean difference = 25.2 ms, 95% CI = 4.09-46.30) in the presence of pain. Low quality of evidence supported an increase in the activity of the superficial lumbar muscles during locomotion and during voluntary trunk movements during painful conditions. By contrast, activity of erector spinae, deep multifidus, and transversus abdominis was reduced during postural perturbation tasks. Reduced range of motion of the lumbar spine in the presence of pain was supported by low quality of evidence. Given the agreement between our findings and the adaptations observed in clinical populations, the use of experimental pain models may help to better understand the mechanisms underlying motor adaptations to low back pain.
Publisher: Elsevier BV
Date: 02-2016
DOI: 10.1016/J.JPAIN.2015.10.013
Abstract: Pre-existing or chronic pain is an established risk factor for severe postoperative pain. In this prospective observational cohort study, we investigated whether a history of chronic pain, beyond the presence of hip-related pain, affected other postoperative factors including early mobilization, function, and psychological distress after hip surgery. Patients who underwent total hip replacement surgery were observed from the preoperative day until the seventh postoperative day. Before surgery, they were characterized by their pain history, pain intensity, function, and psychological characteristics. Postoperatively, pain intensity was evaluated on day 1, 3, 5, and 7 and the analgesic consumption was recorded for each of these days. Measures of function (functional questionnaire, ability to mobilize and to climb stairs, and range of hip motion) and psychological distress were re-evaluated on day 7. A history of chronic pain was associated with slower postoperative mobilization, poorer physical function, and greater psychological distress in addition to increased postoperative pain intensity. The comorbidity of a chronic pain disorder resulted in greater pain intensity after surgery, and also impeded postoperative rehabilitation. Identification of patients with a chronic pain disorder is necessary preoperatively so that appropriate pain management and rehabilitation can be planned to facilitate recovery. Chronic pain, beyond the presence of hip-related pain, is associated with slower postoperative mobilization, poorer physical function, and greater psychological distress after total hip replacement surgery. Identification of patients with chronic pain and establishment of multiprofessional perioperative management might improve postoperative rehabilitation of patients with chronic pain.
Publisher: Elsevier BV
Date: 04-2023
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 12-2013
Publisher: Journal of Orthopaedic & Sports Physical Therapy (JOSPT)
Date: 04-2017
Abstract: Study Design Controlled laboratory study, case-control design. Objective To evaluate spine kinematics and gait characteristics in people with nonspecific chronic neck pain. Background People with chronic neck pain present with a number of sensorimotor and biomechanical alterations, yet little is known about the influence of neck pain on gait and motions of the spine during gait. Methods People with chronic nonspecific neck pain and age- and sex-matched asymptomatic controls walked on a treadmill at 3 different speeds (self-selected, 3 km/h, and 5 km/h), either with their head in a neutral position or rotated 30°. Tridimensional motion capture was employed to quantify body kinematics. Neck and trunk rotations were derived from the difference between the transverse plane component of the head and thorax and thorax and pelvis angles to provide an indication of neck and trunk rotation during gait. Results Overall, the patient group showed shorter stride length compared to the control group (P<.001). Moreover, the patients with neck pain showed smaller trunk rotations (P<.001), regardless of the condition or speed. The difference in the amount of trunk rotation between groups became larger for the conditions of walking with the head rotated. Conclusion People with chronic neck pain walk with reduced trunk rotation, especially when challenged by walking with their head positioned in rotation. Reduced rotation of the trunk during gait may have long-term consequences on spinal health. J Orthop Sports Phys Ther 2017 (4):268-277. Epub 3 Feb 2017. doi:10.2519/jospt.2017.6768.
Publisher: Elsevier BV
Date: 02-2011
DOI: 10.1016/J.MATH.2010.07.006
Abstract: This study investigates the relationship between neck muscle coactivation, neck strength and perceived pain and disability in women with neck pain. Surface electromyography (EMG) was acquired from the sternocleidomastoid (SCM) and splenius capitis (SC) muscles of 13 women with chronic neck pain and 10 controls as they performed 1) maximal voluntary contractions (MVC) in flexion, extension and left and right lateral flexion, 2) r ed contractions from 0% to 50% MVC in flexion and extension and 3) circular contractions in the horizontal plane at 15N and 30N force. Higher values of EMG litude were observed for the SC (antagonist) during r ed neck flexion and for the SCM during r ed extension in the patient group (P<0.05). The patients displayed reduced values of directional specificity in the surface EMG of the SCM and SC for the circular contractions (P<0.05). The EMG litude of SC during cervical flexion was positively correlated with the patients' pain (R² =0.35, P<0.05) and perceived disability (R² 0.53, P<0.01). An inverse correlation was evident between the amount of activation of SC during cervical flexion and strength (R² =0.54, P<0.01). These observations indicate a relationship between alterations in neuromuscular control in patients with neck pain and functional consequences, including impaired motor performance and increased levels of perceived disability.
Publisher: American Physiological Society
Date: 10-2018
DOI: 10.1152/JAPPLPHYSIOL.00025.2018
Abstract: Strength-trained in iduals (ST) develop greater levels of force compared with untrained subjects. These differences are partly of neural origin and can be explained by training-induced changes in the neural drive to the muscles. In the present study we hypothesize a greater rate of torque development (RTD) and faster recruitment of motor units with greater muscle fiber conduction velocity (MFCV) in ST compared with a control cohort. MFCV was assessed during maximal voluntary isometric explosive contractions of the elbow flexors in eight ST and eight control in iduals. MFCV was estimated from high-density surface electromyogram recordings (128 electrodes) in intervals of 50 ms starting from the onset of the electromyogram. RTD and MFCV were computed and normalized to their maximal voluntary torque (MVT) values. The explosive torque of the ST was greater than in the control group in all time intervals analyzed ( P 0.001). The absolute MFCV values were also greater for the ST than for controls at all time intervals ( P 0.001). ST also achieved greater normalized RTD in the first 50 ms of contraction [887.6 (152) vs. 568.5 (148.66)%MVT/s, mean (SD), P 0.001] and normalized MFCV before the rise in force compared with controls. We have shown for the first time that ST can recruit motor units with greater MFCV in a shorter amount of time compared with untrained subjects during maximal voluntary isometric explosive contractions. NEW & NOTEWORTHY Strength-trained in iduals show neuromuscular adaptations. These adaptations have been partly related to changes in the neural drive to the muscles. Here, we show for the first time that during the initial phase of a maximal isometric explosive contraction, strength-trained in iduals achieve higher levels of force and recruit motor units with greater conduction velocities.
Publisher: BMJ
Date: 06-2014
Publisher: Mary Ann Liebert Inc
Date: 11-2018
Abstract: To determine the efficacy of suboccipital inhibitory techniques in people with migraine compared with a control treatment based on myofascial trigger point (MTrP) therapy and stretching. A randomized, double-blind controlled pilot trial was conducted. University research laboratory. Forty-six adults diagnosed with migraine with over 6 months duration. Participants were randomized to receive either combined MTrP therapy and stretching (control group) or the control treatment plus suboccipital soft tissue inhibition (experimental group). Treatment was applied on four occasions over 8 weeks (one every 15 days), with a duration of 30 minutes per session in the experimental group and 20 min in the control group. The impact of headache was assessed with the Headache Impact Test (HIT-6), disability by the migraine disability assessment (MIDAS), and quality of life by the Short Form Health Survey (SF-36). Both groups were assessed at baseline and 1 week immediately after the end of treatment. The amount of change of the HIT-6 score and MIDAS scores were significantly different between groups (p < 0.05), although the SF-36 scores were not. The change in the HIT-6 score and MIDAS scores was greater in the experimental group. Both groups showed a reduction on the HIT-6 score (p < 0.001), MIDAS scores (p < 0.05), and SF-36 physical subscale, whereas the SF-36 mental subscale improved only in the experimental group (p < 0.001). Soft tissue techniques based on MTrP therapy and stretching were helpful for improving certain aspects of migraine, such as the impact and disability caused by the headache, and the frequency and intensity of headache however, when combined with suboccipital soft tissue inhibition, the treatment effect was larger.
Publisher: Public Library of Science (PLoS)
Date: 10-02-2023
DOI: 10.1371/JOURNAL.PONE.0281098
Abstract: Coronavirus disease (Covid-19) is a highly infectious disease caused by the SARS-CoV-2 virus and is associated with a decrease of respiratory, physical, and psychological function, subsequently affecting quality of life. The aim of the present pilot study was to use ultrasound imaging (USI) to evaluate and compare the thickness of the diaphragm and abdominal muscles between in iduals recently diagnosed with moderate Covid-19 infection and healthy in iduals. Methods: A cross-sectional observational pilot study was performed. A total s le of 24 participants were recruited from a private medical center (Madrid, Spain): Covid-19 (n = 12) and healthy controls (n = 12). The external oblique (EO), internal oblique (IO), transversus abdominis (TrA), rectus abdominis (RA), interrecti distance (IRD) and diaphragm thickness were assessed using USI during inspiration, expiration and during contraction. Results: USI measurements of the thickness of EO, IO, TrA, RA, IRD and the diaphragm did not differ significantly between groups during inspiration, expiration or during contraction (all P 0.05). Conclusions: These preliminary results suggest that the morphology of the abdominal muscles and diaphragm is not altered in people with a recent history of moderate Covid-19 infection.
Publisher: Elsevier BV
Date: 04-2008
Publisher: Elsevier BV
Date: 02-2016
DOI: 10.1016/J.JELEKIN.2015.10.016
Abstract: This study evaluates and compares the effects of strength and endurance training on motor unit discharge rate variability and force steadiness of knee extensor muscles. Thirty sedentary healthy men (age, 26.0±3.8yrs) were randomly assigned to strength training, endurance training or a control group. Conventional endurance and strength training was performed 3days per week, over a period of 6weeks. Maximum voluntary contraction (MVC), time to task failure (at 30% MVC), coefficient of variation (CoV) of force and of the discharges rates of motor units from the vastus medialis obliquus and vastus lateralis were determined as subjects performed 20% and 30% MVC knee extension contractions before and after training. CoV of motor unit discharges rates was significantly reduced for both muscles following strength training (P<0.001), but did not change in the endurance (P=0.875) or control group (P=0.995). CoV of force was reduced after the strength training intervention only (P<0.01). Strength training, but not endurance training, reduces motor unit discharge rate variability and enhances force steadiness of the knee extensors. These results provide new insights into the neuromuscular adaptations that occur with different training methods.
Publisher: Springer Science and Business Media LLC
Date: 03-09-2021
DOI: 10.1186/S12891-021-04595-W
Abstract: Migraine and cervicogenic headache (CGH) are common headache disorders, although the large overlap of symptoms between them makes differential diagnosis challenging. To strengthen differential diagnosis, physical testing has been used to examine for the presence of musculoskeletal impairments in both conditions. This review aimed to systematically evaluate differences in physical examination findings between people with migraine, CGH and asymptomatic in iduals. The databases MEDLINE, PubMed, CINAHL, Web of Science, Scopus, EMBASE were searched from inception until January 2020. Risk of bias was assessed with the Downs and Black Scale for non-randomized controlled trials, and with the Quality Assessment of Diagnostic Accuracy Studies tool for diagnostic accuracy studies. When possible, meta-analyses with random effect models was performed. From 19,682 articles, 62 studies were included in this review and 41 were included in the meta-analyses. The results revealed: a) decreased range of motion [°] (ROM) on the flexion-rotation test (FRT) (17.67, 95%CI:13.69,21.65) and reduced neck flexion strength [N] (23.81, 95%CI:8.78,38.85) in CGH compared to migraine b) compared to controls, migraineurs exhibit reduced flexion ROM [°] (− 2.85, 95%CI:-5.12,-0.58), lateral flexion ROM [°] (− 2.17, 95% CI:-3.75,-0.59) and FRT [°] (− 8.96, 95%CI:-13.22,-4.69), reduced cervical lordosis angle [°] (− 0.89, 95%CI:-1.72,-0.07), reduced pressure pain thresholds over the cranio-cervical region [kg/cm 2 ], reduced neck extension strength [N] (− 11.13, 95%CI:-16.66,-5.6) and increased activity [%] of the trapezius (6.18, 95%CI:2.65,9.71) and anterior scalene muscles (2.87, 95%CI:0.81,4.94) during performance of the cranio-cervical flexion test c) compared to controls, CGH patients exhibit decreased neck flexion (− 33.70, 95%CI:-47.23,-20.16) and extension (− 55.78, 95%CI:-77.56,-34.00) strength [N]. The FRT and neck flexion strength could support the differential diagnosis of CGH from migraine. Several physical tests were found to differentiate both headache types from asymptomatic in iduals. Nevertheless, additional high-quality studies are required to corroborate these findings. Following indications of Prisma-P guidelines, this protocol was registered in PROSPERO on 21/05/2019 with the number CRD42019135269 . All amendments performed during the review were registered in PROSPERO, indicating the date and what and why was changed.
Publisher: Elsevier BV
Date: 06-2017
DOI: 10.1016/J.MSKSP.2017.03.001
Abstract: A depressed scapular alignment could lead to prolonged and repetitive stress or compression of the brachial plexus, resulting in sensitization of neural tissue. However, no study has investigated the influence of alignment of the scapulae on sensitization of upper limb neural tissue in otherwise asymptomatic people. In this case-control study, we investigate the influence of a depressed scapular alignment on mechanosensitivity of the upper limb peripheral nervous system as well as pressure pain thresholds (PPT). Asymptomatic in iduals with neutral vertical scapular alignment (n = 25) or depressed scapular alignment (n = 25) participated. We measured the upper limb neurodynamic test (ULNT1), including assessment of symptom response and elbow range of motion (ROM), and PPT measured over upper limb peripheral nerve trunks, the upper trapezius muscle and overlying cervical zygapophyseal joints. Subjects with a depressed scapular reported significantly greater pain intensity (t = 5.7, p < 0.0001) and reduced elbow extension ROM (t = -2.7, p < 0.01) during the ULNT1 compared to those with a normal scapular orientation. Regardless of the location tested, the group presenting with a depressed scapular had significantly lower PPT compared to those with a normal scapular orientation (PPT averaged across all sites: normal orientation: 3.3 ± 0.6 kg/cm Despite being asymptomatic, people with a depressed scapular have greater neck and upper limb neural tissue mechanosensitivity when compared to people with a normal scapular orientation. This study offers insight into the potential development of neck-arm pain due to a depressed scapular position.
Location: Germany
Location: United Kingdom of Great Britain and Northern Ireland
No related grants have been discovered for Deborah Falla.