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PubMed2003

Active neck muscle training in the treatment of chronic neck pain in women: a randomized controlled trial.

CONTEXT: Active physical training is commonly recommended for patients with chronic neck pain; however, its efficacy has not been demonstrated in randomized studies. OBJECTIVE: To evaluate the efficacy of intensive isometric neck strength training and lighter endurance training of neck muscles on pain and disability in women with chronic, nonspecific neck pain. DESIGN: Examiner-blinded randomized controlled trial conducted between February 2000 and March 2002. SETTING: Participants were recruited from occupational health care systems in southern and eastern Finland. PATIENTS: A total of 180 female office workers between the ages of 25 and 53 years with chronic, nonspecific neck pain. INTERVENTIONS: Patients were randomly assigned to either 2 training groups or to a control group, with 60 patients in each group. The endurance training group performed dynamic neck exercises, which included lifting the head up from the supine and prone positions. The strength training group performed high-intensity isometric neck strengthening and stabilization exercises with an elastic band. Both training groups performed dynamic exercises for the shoulders and upper extremities with dumbbells. All groups were advised to do aerobic and stretching exercises regularly 3 times a week. MAIN OUTCOME MEASURES: Neck pain and disability were assessed by a visual analog scale, the neck and shoulder pain and disability index, and the Vernon neck disability index. Intermediate outcome measures included mood assessed by a short depression inventory and by maximal isometric neck strength and range of motion measures. RESULTS: At the 12-month follow-up visit, both neck pain and disability had decreased in both training groups compared with the control group (P<.001). Maximal isometric neck strength had improved flexion by 110%, rotation by 76%, and extension by 69% in the strength training group. The respective improvements in the endurance training group were 28%, 29%, and 16% and in the control group were 10%, 10%, and 7%. Range of motion had also improved statistically significantly in both training groups compared with the control group in rotation, but only the strength training group had statistically significant improvements in lateral flexion and in flexion and extension. CONCLUSIONS: Both strength and endurance training for 12 months were effective methods for decreasing pain and disability in women with chronic, nonspecific neck pain. Stretching and fitness training are commonly advised for patients with chronic neck pain, but stretching and aerobic exercising alone proved to be a much less effective form of training than strength training.

Adult↗
PubMed2005

Effect of long-term neck muscle training on pressure pain threshold: a randomized controlled trial.

Muscle tenderness has been measured in several studies to evaluate effectiveness of treatment methods, but only short-term results have been reported so far. The aim of the present study was to evaluate the long-term effects of two different muscle training methods on the pressure pain threshold of neck muscles in women with neck pain. Altogether 180 woman with chronic, non-specific neck pain were randomized into three groups: neck muscle endurance training, neck muscle strength training and control groups. The main outcome measures included pressure pain threshold measurement at six muscle sites and on the sternum. Neck pain was assessed by a visual analogue scale (VAS). At the 12-month follow-up statistically significantly higher pressure pain threshold values were obtained in both training groups at all muscle sites compared to the baseline, while no significant change occurred in the controls. Significantly higher changes in pressure pain threshold were detected at all six sites in the strength training group and at four out of six sites in the endurance training group compared to the control group. This is the first study to show an increase in pressure pain thresholds as a result of long-term muscle training. A decrease in neck pain was associated with reduced pressure pain sensitivity in neck muscles, showing that the pressure pain threshold may be a useful outcome measure of the effectiveness of neck muscle rehabilitation.

Adult↗
PubMed1988

Compartmentalization of motor units in the cat neck muscle, biventer cervicis.

1. The neck muscle biventer cervicis is supplied by five separate nerve bundles that originate from segments C2-C5 and enter the muscle at different rostrocaudal levels. We have used the glycogen-depletion method to investigate the distribution of muscle fibers supplied by each nerve bundle and also the extent of motor-unit territories supplied by single motoneurons in the C3 segment. 2. Prolonged intermittent stimulation of each nerve bundle produced glycogen depletion in a compartment of muscle fibers that ran only a fraction of the whole-muscle length. The depleted compartment was separated by tendinous inscriptions from adjacent, serially arranged compartments that were supplied by different nerve bundles. Thus the muscle was divided into five in-series compartments, arranged in the same rostrocaudal sequence as the nerves by which they were supplied. 3. Six fast, glycolytic (FG) and five fast, oxidative-glycolytic (FOG) motor units were depleted by repetitive intracellular stimulation of their antidromically identified motoneurons in the C3 segment. The fibers of each motor unit were confined to a striplike subvolume whose cross-sectional area was only 20-40% of that for the whole compartment in which it was located. Single motor units contained an average of 408 extrafusal fibers (range: 262-582 fibers), and these were distributed with an average density of 20 fibers/mm2 in cross sections through their motor domains. No significant differences were found between the numbers or densities of fibers in FG and FOG motor units. 4. The specialized in-series organization of compartments has functional implications because the forces generated by one compartment of motor units must be transmitted through other in-series compartments of muscle fibers rather than directly onto skeletal attachments. The confined distribution of muscle fibers belonging to a single motor unit suggests that an additional level of organization may exist within individual compartments. The implications of these features for the physiological behavior and neural control of biventer cervicis are discussed.

Animals↗
PubMed2006

ATP induces sustained facilitation of craniofacial nociception through P2X receptors on neck muscle nociceptors in mice.

Noxious input from neck muscles probably plays a key role in tension-type headache pathophysiology. ATP selectively excites group III and IV muscle afferents in vitro. Accordingly, ATP infusion into trapezius muscle induces strong pain and local tenderness in healthy man. The present study addresses the impact of ATP on neck muscle nociception in anaesthetized mice. Craniofacial nociceptive processing was tested by the jaw-opening reflex via noxious electrical tongue stimulation. Within 2 h after injection of 100 nmol/l or 1 micromol/l ATP into semispinal neck muscles, reflex integrals significantly increased by 114% or 328%, respectively. Preceding intramuscular administration of the P2X receptor antagonist PPADS (3-100 nmol/l) suppressed the ATP effect. Subsequent application of PPADS (100 nmol/l) caused a total recovery of facilitated reflex to baseline values. ATP induces sustained facilitation of craniofacial nociception by prolonged excitation of P2X receptors in neck muscles.

Adenosine Triphosphate↗
PubMed2005

Effect of gaze direction on neck muscle activity during cervical rotation.

Control of the neck muscles is coordinated with the sensory organs of vision, hearing and balance. For instance, activity of splenius capitis (SC) is modified with gaze shift. This interaction between eye movement and neck muscle activity is likely to influence the control of neck movement. The aim of this study was to investigate the effect of eye position on neck muscle activity during cervical rotation. In eleven subjects we recorded electromyographic activity (EMG) of muscles that rotate the neck to the right [right obliquus capitis inferior (OI), multifides (MF), and SC, and left sternocleidomastoid (SCM)] with intramuscular or surface electrodes. In sitting, subjects rotated the neck in each direction to specific points in range that were held statically with gaze either fixed to a guide (at three different positions) that moved with the head to maintain a constant intra-orbit eye position or to a panel in front of the subject. Although right SC and left SCM EMG increased with rotation to the right, contrary to anatomical texts, OI EMG increased with both directions and MF EMG did not change from the activity recorded at rest. During neck rotation SCM and MF EMG was less when the eyes were maintained with a constant intra-orbit position that was opposite to the direction of rotation compared to trials in which the eyes were maintained in the same direction as the head movement. The inter-relationship between eye position and neck muscle activity may affect the control of neck posture and movement.

Adult↗
PubMed2005

Responses of muscle spindles in feline dorsal neck muscles to electrical stimulation of the cervical sympathetic nerve.

Previous studies performed in jaw muscles of rabbits and rats have demonstrated that sympathetic outflow may affect the activity of muscle spindle afferents (MSAs). The resulting impairment of MSA information has been suggested to be involved in the genesis and spread of chronic muscle pain. The present study was designed to investigate sympathetic influences on muscle spindles in feline trapezius and splenius muscles (TrSp), as these muscles are commonly affected by chronic pain in humans. Experiments were carried out in cats anesthetized with alpha-chloralose. The effect of electrical stimulation (10 Hz for 90 s or 3 Hz for 5 min) of the peripheral stump of the cervical sympathetic nerve (CSN) was investigated on the discharge of TrSp MSAs (units classified as Ia-like and II-like) and on their responses to sinusoidal stretching of these muscles. In some of the experiments, the local microcirculation of the muscles was monitored by laser Doppler flowmetry. In total, 46 MSAs were recorded. Stimulation of the CSN at 10 Hz powerfully depressed the mean discharge rate of the majority of the tested MSAs (73%) and also affected the sensitivity of MSAs to sinusoidal changes of muscle length, which were evaluated in terms of amplitude and phase of the sinusoidal fitting of unitary activity. The amplitude was significantly reduced in Ia-like units and variably affected in II-like units, while in general the phase was affected little and not changed significantly in either group. The discharge of a smaller percentage of tested units was also modulated by 3-Hz CSN stimulation. Blockade of the neuromuscular junctions by pancuronium did not induce any changes in MSA responses to CSN stimulation, showing that these responses were not secondary to changes in extrafusal or fusimotor activity. Further data showed that the sympathetically induced modulation of MSA discharge was not secondary to the concomitant reduction of muscle blood flow induced by the stimulation. Hence, changes in sympathetic outflow can modulate the afferent signals from muscle spindles through an action exerted directly on the spindles, independent of changes in blood flow. It is suggested that such an action may be one of the mechanisms mediating the onset of chronic muscle pain in these muscles in humans.

Adrenergic alpha-Antagonists↗
PubMed2004

Association of neck pain, disability and neck pain during maximal effort with neck muscle strength and range of movement in women with chronic non-specific neck pain.

Several studies have reported lower neck muscle strength in patients with chronic neck pain compared to healthy controls. The aim of the present study was to evaluate the association between the severity of neck pain and disability with neck strength and range of movement in women suffering from chronic neck pain. One hundred and seventy-nine female office workers with chronic neck pain were selected to the study. The outcome was assessed by the self-rating questionnaires on neck pain (visual analogue scale, Vernon's disability index, Neck pain and disability index) and by measures of the passive range of movement (ROM) and maximal isometric neck muscle strength. No statistically significant correlation was found between perceived neck pain and the disability indices and the maximal isometric neck strength and ROM measures. However, the pain values reported during the strength tests were inversely correlated with the results of strength tests (r=-0.24 to -0.46), showing that pain was associated with decreased force production. About two-thirds of the patients felt pain during test efforts. Pain may prevent full effort during strength tests and hence the production of maximal force. Thus in patients with chronic neck pain the results do not always describe true maximal strength, but rather the patients' ability to bear strain, which may be considerably influenced by their painful condition. The results of the present study suggest that rehabilitation in cases of chronic neck pain should aim at raising tolerance to mechanical strain.

Adult↗
PubMed2003

Acceleration effects on neck muscle strength: pilots vs. non-pilots.

BACKGROUND: Conditioning of neck muscles, if any, due to repeated exposures to +Gz forces has received little research attention. OBJECTIVE: This study was conducted to evaluate and compare the neck muscle strength of test volunteers representative of the general populations of fighter aircraft pilots and non-pilots. METHODS: The tests were performed using a special attachment device on a computerized dynamometer. Ten pilots and ten non-pilots volunteered as test subjects. Each individual's maximal isometric neck muscle strength was evaluated in the extension, flexion, and left and right lateral bending directions in a single day. Peak values from the measurements were used for data analysis. Overall neck strength was calculated as the mean values for the four directions in each group. RESULTS: The overall muscular strength of the necks of pilots did not differ significantly from that of non-pilots, nor did exposure to +Gz forces lead to specific changes in isometric muscle strength across any of the four principal directions. Neck muscle strength in the four measured directions pooled across the two subgroups were statistically significant. The widespread practice of adopting protective head-positioning strategies to minimize neck strains, coupled with results from this research study, suggest that the neck muscles are subjected to reduced in-flight strengthening workouts during exposures to +Gz forces. CONCLUSIONS: To maximize in-flight performance and minimize +Gz-induced neck injuries, fighter pilots should be encouraged to perform on-land neck muscle strengthening exercise and in-flight head-positioning techniques. More research is needed to fine-tune this countermeasure strategy against cervical spine injury.

Adult↗
PubMed2006

Neck muscle fatigue and postural control in patients with whiplash injury.

OBJECTIVES: To examine if patients with whiplash injury show identifiable increases in neck muscle fatigability and associated increase in postural body sway after contractions of dorsal neck muscles, and if physiotherapy treatment reduces these effects. METHODS: Sway was measured during stance in 13 patients before and after 5 min of isometric dorsal neck muscle contractions and after recovery, pre- and post-physiotherapy, using a force platform. Amplitude and median frequency of neck muscle EMG were calculated during the contracting period. After each stance trial, patients gave a subjective score of sway. RESULTS: Pre-treatment, seven patients showed EMG signs of fatigue (increases in amplitude, decreases in median frequency) and increases in sway (eyes closed) after contractions. The other patients showed neither fatigue nor increased sway. Post-treatment, no signs of fatigue or imbalance were recorded in all patients, for the same levels of muscle contraction. CONCLUSIONS: As in normal human subjects, increases in sway are associated with signs of neck muscle fatigue in some whiplash injury patients. Physiotherapy decreases the susceptibility to fatigue of neck muscles and is an effective choice of treatment of subjective instability and sway. SIGNIFICANCE: This study demonstrates a pathophysiological link between neck muscle fatigue and impaired postural control, and also that physiotherapy can relieve symptoms and signs of impaired neck muscle function by reducing muscle fatigability.

Adult↗
PubMed1997

Postural responses to vibration of neck muscles in patients with idiopathic torticollis.

Vibration of the dorsal muscles of the neck, simulating lengthening, in standing man causes a visible forwards tilt of the body shown on posturography as a tonic sagittal sway deviation. According to the theory that posture is organized with respect to a 'body schema' this deviation is a result of an interpretation of the concurrent neck afferent and vestibular signals. Considering the hypothesis that neck afferent signals may be misinterpreted in patients with spasmodic torticollis (ST) causing abnormal postural responses, we recorded body sway induced by unilateral dorsal neck muscle vibration in 22 idiopathic ST patients (19 treated with botulinum toxin) during upright stance with eyes closed. Comparison groups were 19 normal subjects and 11 patients with bilateral loss of vestibular function (labyrinthine defective, LD) in whom neck afference should be intact. Both treated and untreated ST and LD patients had absent or diminished sway deviations. When sway deviation did occur, it was sagitally oriented as with normal subjects and unrelated to ST head turns. In most ST and LD patients, neck vibration induced neck extension, an effect which is observed in normal subjects only if the torso is retrained. The results suggest that neck proprioceptive input retains local postural functions in ST, however, it is relatively ignored in the context of the whole body postural control and spatial orientation. The mild disorders of vestibular function reported in torticollis patients may be due to an inability to calibrate vestibular signals by reference to corroborative signals from neck proprioception.

Achilles Tendon↗
PubMed1980

Postural effects of neck muscle vibration in man.

Vibration of the dorsal neck muscles in man induces falling reactions, walking and "marche en étoile", probably by muscle afferent activation. It can be used as a reproducible error signal in analyzing the interaction between neck muscle proprioception and vestibular as well as ocular motor systems. These interactions are important for posture and coordinated head-eye movements.

Afferent Pathways↗
PubMed1994

Effect of neck posture on the activation of feline neck muscles during voluntary head turns.

1. To determine whether neck posture affects the usage of neck muscles during a specific motor task, we recorded the electromyographic (EMG) patterns of neck muscles in four cats, which made horizontal, head-turning movements to fixate eccentrically placed targets. In some trials, the cervical column was oriented vertically whereas in other trials, the cervical column was oriented more horizontally. 2. During horizontal head movements, five muscles (obliquus capitis inferior, splenius, levator scapulae, complexus, and biventer cervicis) displayed activation patterns that were consistent from cat to cat and did not change when the cats adopted a different neck posture. Most of these muscles are large, superficial muscles that attach to the skull and span many cervical joints. 3. Posturally dependent patterns of activation were observed in five other neck muscles (semispinalis cervicis, longissimus capitis, levator scapulae ventralis, scalenus anterior, and obliquus capitis superior). Most of these muscles lie deeper and more laterally within the neck musculature and generally span fewer cervical joints than the muscles that displayed invariant patterns of activation. 4. These results suggest that the set of invariantly activated muscles may compose part of a basic motor program that is triggered during head movements in the horizontal plane. This motor program appears to be modified by the selective activation of ancillary muscles, which are recruited in a manner related to the neck posture. The deep positioning of the ancillary muscles may permit them to regulate the mobility of the cervical column and to adjust the net muscular force applied across the neck to the skull. Organizing the motor output in this manner might simplify the task of computing the appropriate patterns of neck-muscle activation.

Animals↗
PubMed2005

Nerve growth factor injection into semispinal neck muscle evokes sustained facilitation of the jaw-opening reflex in anesthetized mice -- possible implications for tension-type headache.

Nociceptive input from neck muscles probably plays a role in the pathophysiology of tension-type headache. In order to elaborate an animal model, the impact of noxious input from neck muscles on orofacial sensorimotor processing was investigated by electrophysiological means in anesthetized mice. Group IV muscle afferents of the semispinal neck muscle were excited by local injection of nerve growth factor (NGF, 0.8 microM, 20 microl). Orofacial sensorimotor processing was monitored by the jaw-opening reflex (JOR) elicited by electric tongue stimulation. After unilateral NGF injection into the right neck muscle (n = 10), JOR integral (+89%) and duration (+9%) increased and latency decreased (-5%) for at least 1 h. Bilateral injection of NGF (n = 10) into neck muscles induced an increase of JOR integral (+111%) and duration (+20%) and a reduction of latency (-9%). This facilitation of the JOR lasted for at least 90 min without any downward drift (n = 5). Electric JOR threshold diminished after NGF injection. After intramuscular injection of isotonic saline into the right semispinal neck muscle (20 microl), the JOR remained unchanged (n = 10). Local NGF injection into neck muscles evoked noxious input to the brainstem that induced a sustained central facilitation of the JOR for more than 1 h. This long-term facilitation of orofacial sensorimotor processing by a singular NGF injection possibly reflects plastic changes of nociceptive synaptic processing that may be involved in the pathophysiology of headache.

Anesthesia↗
PubMed1996

Properties of eye movements induced by activation of neck muscle proprioceptors.

BACKGROUND: We have previously reported that neck muscle vibration can induce visual illusory movements and eye movements under subdued ambient illumination in human subjects with the head and body fixed. The subjects viewed a fixation light with one eye and the other eye was covered. The eye movements were recorded with an infrared system mounted in goggles attached to the head of the subject. METHODS: In order to further examine the properties of these cervico-ocular reactions and reveal any artefacts in the eye movement recordings, we have studied (1) the effect of increasing the ambient light, which made visual illusory movements disappear, (2) the timing between the illusory movement and the eye movement in subdued light, (3) the effect of viewing the target through a pin-hole, which would reveal artefacts due to head movement, and (4) the effect of mounting the eye movement recording system on the head support, which would allow recording to the absolute eye position change. RESULTS: The results of these experiments showed no significant difference from those that were reported previously. Eye movements of about the same amplitude were induced in both eyes under all conditions, and there was no time difference in the occurrence of visual illusory movements and eye movements. CONCLUSION: The results of this study confirm that neck muscle vibration can induce eye position changes. This seems to confirm that the proprioceptive messages originating in the neck muscles are processed together with visual information of eye position in determining gaze direction.

Adult↗
PubMed1986

[A method for puncturing the deep neck muscles in humans].

The authors developed a method to puncture neck muscles by means of computer tomographic control, enabling the introduction of an electrode into the obliquus capitis inferior muscle, to investigate the particular role of neck muscles in posture and head movement.

Electromyography↗