WEAK ANTERIOR NECK MUSCLES LEAD TO HEADACHES 59 individuals with either
migraine-type headache or common headache were compared with 30 people with no
headaches using electromyography, showing that the cervical spine flexor and
associated muscles showed far less strength in those with both types of headaches,
compared to stronger muscles in the group with no headaches. The obvious
implication in our practice, where we see a high number of cervicogenic and some
other types of headaches is to add neck flexor strengthening. Not only have we found
this to benefit patients in the long run, cervical spine retraction exercises seem to offer
fairly immediate symptomatic relief for a number of patients with cervicogenic
headaches, as they stretch the suboccipital muscles, which are often difficult to isolate
in other flexibility activities. Oksanen A, et al. (2007). Neck flexor muscle fatigue in
adolescents with headache - An electromyographic study European Journal of Pain.
Vol. 11, Iss. 7, pp. 764-772.
---
CERVICAL SPINE COLLARS DON'T HELP MUCH IN THE LONG RUN In study, 450
participants were recruited from emergency rooms and from family physicians' offices
within ten days after a neck injury and randomized to one of three groups:
immobilization in a rigid collar followed by active mobilization, advice to carry on with no
restrictions or placed in an active mobilization program. At 3, 6, and 12 months
postinjury, using pain scales to measure headache and neck pain intensity and work
capability, patients were assessed. At one year, no significant differences were
observed between the 3 intervention groups and fully 48% were reporting continued
pain, with 53% reporting at least some disability, with 14% still out of work. I think that
the second striking conclusion was how many participants were still having
pronounced symptoms after one year. Kongsted A, et al. (2007). Neck Collar,
"Act-as-Usual" or Active Mobilization for Whiplash Injury?: A Randomized Parallel-Group
Trial. Spine. Vol. 32, Iss. 6, pp. 618-626.
---
RISK OF STROKE AND CERVICAL SPINE MANIPULATION? Some articles have appeared in
the popular media that raise concerns about vertebrobasilar artery (VBA) stroke and the
use of spinal manipulation for the cervical region. In the most extensive study to date,
performed at Toronto Western Hospital, records of visits to either chiropractors or
primary care physicians (PCP) from 1993-2002 were examined. There were 818 VBA
strokes hospitalized in a population of more than 100 million person-years. In those
aged younger than 45 years, cases were about three times more likely to see either a
chiropractor or a PCP before their stroke than the controls. There was no increased
association between chiropractic visits and VBA stroke in those older than 45 years.
Positive associations were found between PCP visits and VBA stroke in all age groups.
The conclusions were that: (1) VBA stroke is a very rare event; (2) patients under 45
who visited either a chiropractor or a primary care physician had a slightly increased
stroke risk; (3) the increased risks of VBA stroke associated with chiropractic and PCP
visits is likely due to patients with headache and neck pain from VBA dissection seeking
care before an undetected stroke; (4) there was no evidence of excess risk of VBA
stroke associated chiropractic care, compared to primary care. This study coincides
with previous studies of less strength that indicate that the risk of serious side-effects
from cervical spine manipulation, while not unknown, are exceptionally rare, estimated
to be one case in one to ten million. Cassidy JD, Boyle E, Côté P, He Y, Hogg-Johnson
S, Silver FL, Bondy SJ. (2008). Risk of vertebrobasilar stroke and chiropractic care:
results of a population-based case-control and case-crossover study. Spine. 33(4
Suppl):S176-83.
---
WHIPLASH CAUSES LAXITY IN CERVICAL SPINE CAPSULAR LIGAMENTS Previous clinical
studies have identified the cervical facet joint, including the capsular ligaments, as
sources of pain in whiplash patients. In this study, cadaver specimens were divided
into whiplash-exposed and non-whiplash groups and then the joint capsules were
dissected. In each of the former specimens, there was less tensile strength and more
ligamentous laxity than in the control group. The distribution of injury was at various
spinal levels, with no significant difference. This study, in my opinion, again highlights
some of the issues seen with injured patients and the difficulty of recovery due to
hypermobility of the cervical spine. Both manual methods and exercise are important
for overcoming these injuries. The only surprise in this study, in my view, is that the
injuries were at all levels of the spine. My experience has been that post-trauma
patients later show the most degnerative changes in the lower cervical spine on x-ray
or MRI. Ivancic PC, et al. (2008). Whiplash causes increased laxity of cervical capsular
ligament. Clin Biomech. 23(2):159-65.
---
SOLUTION TO COMPUTER-GENERATED NECK PAIN In 2006, a study in the Journal of the
British Chiropractic Association indicated that those who work at computers have a pain
frequency for the neck and upper back approaching that of over-the road truck drivers.
Many patients, typically computer operators, beauticians, dental assistants, dentists and
surgeons are seen in our office with this as an occupational complaint and the following
study indicates that long-term very successful solutions include certain strengthening
exercises. In particular, the most useful were the shoulder shrug, lateral raise and
upright row, all of which the authors stated can and should be used equally. Anderson,
L. et al. (2008). Muscle Activation During Selected Strength Exercises in Women With
Chronic Neck Muscle Pain. Phys Ther. 18339796
---
THORACIC SPINE TREATMENT STOPS NECK PAIN? Although cervical spine manipulation
is commonly used for a variety of cervical spine complaints, this randomized clinical
trial of patients with acute neck pain indicated that thoracic spine manipulation results
in rapid pain relief. Further investigation is warranted and is recommended by the
authors. Most chiropractors, physical therapists, physiatrists and others involved with
manual therapy would readily confirm what the authors are stating here, in my opinion. I
think that an interesting point to investigate would be to compare the effect that
manipulation of the thoracic spine and the cervical spine would have on range of
motion, which is often a significant issue. Childs JD et al. (2005) Immediate effects of
thoracic manipulation in patients with neck pain: a randomized clinical trial. Man Ther.
10(2):127-35.
---
WHAT WORKS FOR CHRONIC NECK PAIN? 88 randomized controlled trials were
examined to determine if conservative measures would help give long-term relief to
chronic neck pain. The most successful methods in achieving long-term pain reduction
and increased function were cervical spine manipulation, exercise, intramuscular
lidocaine or glucocorticoids, and low-level laser treatment. Many other treatments
were found to have short-term or no effect. A combination of cervical spine
manipulation and exercise received one of the strongest ratings. Gross AR et al.
(2007). Conservative management of mechanical neck disorders: a systematic review. J
Rheumatol. 34(5):1083-102.
---
CHRONIC NECK PAIN AND TRACTION This article is a good follow-up to the one above.
Patients with at least 6 weeks of nonspecific neck pain were selected for the study and
was randomly assigned to one of two groups. The first group received conventional
physical therapy, with the second group also receiving cervical spine intermittent
traction. Using three scoring tools, it was found that neck pain was perceived as
identical at the conclusion of the study. I will add that, anecdotally, I have noticed better
results when cervical spine manipulation and traction are employed together. Borman
P. The efficacy of intermittent cervical traction in patents with
chronic neck pain. J. Clinical Rheumatology. 23 April 2008.
CLICK THE "RESEARCH REVIEW" TABS AT TOP FOR MORE ARTICLE REVIEWS
migraine-type headache or common headache were compared with 30 people with no
headaches using electromyography, showing that the cervical spine flexor and
associated muscles showed far less strength in those with both types of headaches,
compared to stronger muscles in the group with no headaches. The obvious
implication in our practice, where we see a high number of cervicogenic and some
other types of headaches is to add neck flexor strengthening. Not only have we found
this to benefit patients in the long run, cervical spine retraction exercises seem to offer
fairly immediate symptomatic relief for a number of patients with cervicogenic
headaches, as they stretch the suboccipital muscles, which are often difficult to isolate
in other flexibility activities. Oksanen A, et al. (2007). Neck flexor muscle fatigue in
adolescents with headache - An electromyographic study European Journal of Pain.
Vol. 11, Iss. 7, pp. 764-772.
---
CERVICAL SPINE COLLARS DON'T HELP MUCH IN THE LONG RUN In study, 450
participants were recruited from emergency rooms and from family physicians' offices
within ten days after a neck injury and randomized to one of three groups:
immobilization in a rigid collar followed by active mobilization, advice to carry on with no
restrictions or placed in an active mobilization program. At 3, 6, and 12 months
postinjury, using pain scales to measure headache and neck pain intensity and work
capability, patients were assessed. At one year, no significant differences were
observed between the 3 intervention groups and fully 48% were reporting continued
pain, with 53% reporting at least some disability, with 14% still out of work. I think that
the second striking conclusion was how many participants were still having
pronounced symptoms after one year. Kongsted A, et al. (2007). Neck Collar,
"Act-as-Usual" or Active Mobilization for Whiplash Injury?: A Randomized Parallel-Group
Trial. Spine. Vol. 32, Iss. 6, pp. 618-626.
---
RISK OF STROKE AND CERVICAL SPINE MANIPULATION? Some articles have appeared in
the popular media that raise concerns about vertebrobasilar artery (VBA) stroke and the
use of spinal manipulation for the cervical region. In the most extensive study to date,
performed at Toronto Western Hospital, records of visits to either chiropractors or
primary care physicians (PCP) from 1993-2002 were examined. There were 818 VBA
strokes hospitalized in a population of more than 100 million person-years. In those
aged younger than 45 years, cases were about three times more likely to see either a
chiropractor or a PCP before their stroke than the controls. There was no increased
association between chiropractic visits and VBA stroke in those older than 45 years.
Positive associations were found between PCP visits and VBA stroke in all age groups.
The conclusions were that: (1) VBA stroke is a very rare event; (2) patients under 45
who visited either a chiropractor or a primary care physician had a slightly increased
stroke risk; (3) the increased risks of VBA stroke associated with chiropractic and PCP
visits is likely due to patients with headache and neck pain from VBA dissection seeking
care before an undetected stroke; (4) there was no evidence of excess risk of VBA
stroke associated chiropractic care, compared to primary care. This study coincides
with previous studies of less strength that indicate that the risk of serious side-effects
from cervical spine manipulation, while not unknown, are exceptionally rare, estimated
to be one case in one to ten million. Cassidy JD, Boyle E, Côté P, He Y, Hogg-Johnson
S, Silver FL, Bondy SJ. (2008). Risk of vertebrobasilar stroke and chiropractic care:
results of a population-based case-control and case-crossover study. Spine. 33(4
Suppl):S176-83.
---
WHIPLASH CAUSES LAXITY IN CERVICAL SPINE CAPSULAR LIGAMENTS Previous clinical
studies have identified the cervical facet joint, including the capsular ligaments, as
sources of pain in whiplash patients. In this study, cadaver specimens were divided
into whiplash-exposed and non-whiplash groups and then the joint capsules were
dissected. In each of the former specimens, there was less tensile strength and more
ligamentous laxity than in the control group. The distribution of injury was at various
spinal levels, with no significant difference. This study, in my opinion, again highlights
some of the issues seen with injured patients and the difficulty of recovery due to
hypermobility of the cervical spine. Both manual methods and exercise are important
for overcoming these injuries. The only surprise in this study, in my view, is that the
injuries were at all levels of the spine. My experience has been that post-trauma
patients later show the most degnerative changes in the lower cervical spine on x-ray
or MRI. Ivancic PC, et al. (2008). Whiplash causes increased laxity of cervical capsular
ligament. Clin Biomech. 23(2):159-65.
---
SOLUTION TO COMPUTER-GENERATED NECK PAIN In 2006, a study in the Journal of the
British Chiropractic Association indicated that those who work at computers have a pain
frequency for the neck and upper back approaching that of over-the road truck drivers.
Many patients, typically computer operators, beauticians, dental assistants, dentists and
surgeons are seen in our office with this as an occupational complaint and the following
study indicates that long-term very successful solutions include certain strengthening
exercises. In particular, the most useful were the shoulder shrug, lateral raise and
upright row, all of which the authors stated can and should be used equally. Anderson,
L. et al. (2008). Muscle Activation During Selected Strength Exercises in Women With
Chronic Neck Muscle Pain. Phys Ther. 18339796
---
THORACIC SPINE TREATMENT STOPS NECK PAIN? Although cervical spine manipulation
is commonly used for a variety of cervical spine complaints, this randomized clinical
trial of patients with acute neck pain indicated that thoracic spine manipulation results
in rapid pain relief. Further investigation is warranted and is recommended by the
authors. Most chiropractors, physical therapists, physiatrists and others involved with
manual therapy would readily confirm what the authors are stating here, in my opinion. I
think that an interesting point to investigate would be to compare the effect that
manipulation of the thoracic spine and the cervical spine would have on range of
motion, which is often a significant issue. Childs JD et al. (2005) Immediate effects of
thoracic manipulation in patients with neck pain: a randomized clinical trial. Man Ther.
10(2):127-35.
---
WHAT WORKS FOR CHRONIC NECK PAIN? 88 randomized controlled trials were
examined to determine if conservative measures would help give long-term relief to
chronic neck pain. The most successful methods in achieving long-term pain reduction
and increased function were cervical spine manipulation, exercise, intramuscular
lidocaine or glucocorticoids, and low-level laser treatment. Many other treatments
were found to have short-term or no effect. A combination of cervical spine
manipulation and exercise received one of the strongest ratings. Gross AR et al.
(2007). Conservative management of mechanical neck disorders: a systematic review. J
Rheumatol. 34(5):1083-102.
---
CHRONIC NECK PAIN AND TRACTION This article is a good follow-up to the one above.
Patients with at least 6 weeks of nonspecific neck pain were selected for the study and
was randomly assigned to one of two groups. The first group received conventional
physical therapy, with the second group also receiving cervical spine intermittent
traction. Using three scoring tools, it was found that neck pain was perceived as
identical at the conclusion of the study. I will add that, anecdotally, I have noticed better
results when cervical spine manipulation and traction are employed together. Borman
P. The efficacy of intermittent cervical traction in patents with
chronic neck pain. J. Clinical Rheumatology. 23 April 2008.
CLICK THE "RESEARCH REVIEW" TABS AT TOP FOR MORE ARTICLE REVIEWS
Recent research articles primarily about the cervical spine
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