Manual therapy
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There is currently a lack of information regarding neck muscle activity during specific exercises. The purpose of the present study was to investigate deformation and deformation rate in different layers of dorsal and ventral neck muscles during isometric neck muscle contraction in individuals after anterior cervical decompression and fusion and in healthy controls. This study included 10 individuals (mean age 60 years; SD 7.1) with a verified, long-standing neck disorder and 10 healthy, age- and sex-matched controls. ⋯ Among the healthy controls, the multifidus showed a higher degree of deformation (p = 0.02) than the trapezius. In conclusion, our results showed no significant differences between the two groups in mechanical neck muscle activation. Larger studies with different exercises, preferably with a standardized measure of resistance, are needed to investigate whether patients and controls show differences in deformation and deformation rates in neck muscles.
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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. ⋯ 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.
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The purpose of this study was to establish the reliability of a frame-by-frame cross correlation method of assessing longitudinal sciatic nerve excursion motion using real time ultrasound imaging during a modified passive straight leg raise (SLR) test. Eighteen asymptomatic participants (age range 19-68 years) lay on their sides on a purpose made jig and the sciatic nerve in the posterior thigh was imaged during knee extension at 30° and then 60° of hip flexion (HF). Participants were re-tested ≥48 h later. ⋯ The authors also identify points of good practise to ensure an accurate as possible measurement of nerve excursion using this method. These include breaking down larger movements into sub-components, visually tracking the moving nerve during the tracking procedure, and ensuring the optimal image is captured prior to analysis. The use of ultrasound imaging in lower limb nerve dysfunction will enhance the understanding of how nerves move in vivo during neurodynamic testing, as well as being able to identify possible alteration to nerve movements in patients with neuropathic pain states.
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Comparative Study
Assessment of spinal mobility in ankylosing spondylitis using a video-based motion capture system.
This paper describes the use of a video-based motion capture system to assess spinal mobility in patients with ankylosing spondylitis (AS). The aim of the study is to assess reliability of the system comparing it with conventional metrology in order to define and analyze new measurements that reflect better spinal mobility. A motion capture system (UCOTrack) was used to measure spinal mobility in forty AS patients and twenty healthy subjects with a marker set defining 33 3D measurements, some already being used in conventional metrology. ⋯ Motion capture shows very high reliability with Intraclass Correlation Coefficient values ranging from 0.89 to 0.99, low Standard Error of the Measurement (0.37-1.33 cm and 1.58°-6.54°), correlating very well with the Bath Ankylosing Spondylitis Metrology Index (BASMI) (p < 0.001) and, in some individual measures (cervical flexion, cervical lateral flexion, back inclination, shoulder-hip angle and spinal rotation), with mSASSS (p < 0.01). mSASSS also added significantly to the variance in multivariate linear regression analysis to certain measures (back inclination, cervical flexion and cervical lateral flexion). Quantitative results obtained with motion capture system using the protocol defined show to be highly reliable in patients with AS. This technique could be a useful tool for assessing the outcome of the disease and for monitoring the evolution of spinal mobility in AS patients.
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Comparative Study
Inter-therapist agreement in classifying patients with cervical radiculopathy and patients with non-specific neck-arm pain.
Identification of differences in clinical presentation and underlying pain mechanisms may assist the classification of patients with neck-arm pain which is important for the provision of targeted best evidence based management. The aim of this study was to: (i) assess the inter-examiner agreement in using specific systems to classify patients with cervical radiculopathy and patients with non-specific neck-arm pain associated with heightened nerve mechanosensitivity (NSNAP); (ii) assess the agreement between two clinical examiners and two clinical experts in classifying these patients, and (iii) assess the diagnostic accuracy of the two clinical examiners. Forty patients with unilateral neck-arm pain were examined by two clinicians and classified into (i) cervical radiculopathy, (ii) NSNAP, (iii) other. ⋯ Agreement was 72.5%-80% in classifying patients with NSNAP (kappa between 0.43 and 0.52). Clinical examiners' diagnostic accuracy was high (radiculopathy: sensitivity 79%-84%; specificity 76%-81%; NSNAP: sensitivity 78%-100%; specificity 71%-81%). Compared to expert opinion, clinicians were able to identify patients with cervical radiculopathy and patients with NSNAP in 80% of cases, our data supporting the reliability of these classification systems.