M.Tech. (Homoeopathy) / Neck pain is a common condition usually experienced due to mechanical or degenerative problems (Colledge et al., 2010). The onset of neck pain may be acute and associated with asymmetrical restriction of neck movements and a history of awkward posture or sudden onset. Acute neck pain is an aching pain in the cervical paraspinal muscles and ligaments. It is associated with muscle spasm, stiffness and tightness in the upper back and shoulders that lasts up to six weeks. Headaches may be present (Bickley & Szilagyi, 2009). Causes of neck pain can be mechanical, inflammatory, metabolic, neoplastic, due to referred pain or other underlying aetiologies (Colledge et al., 2010). The most common treatments for neck pain are nonsteroidal anti-inflammatory drugs, physiotherapy, chiropractic adjustment or therapeutic massage (Taylor, 2010). The NeuroTrac® MultiTENS device provides a non-invasive, drug-free method of controlling acute pain by transmitting mild electrical impulses via surface electrodes through the skin (Verity Medical Ltd., 2013). There have been many studies done on Transcutaneous Electrical Nerve Stimulation (TENS) devices, but little on its immediate effect on acute neck pain. The aim of this study was to determine the immediate effect of the NeuroTrac® MultiTENS device on acute neck pain, using the Neck Pain Disability Index, Visual Analogue Scale and the Cervical Range of Motion (CROM). This study was an unblinded, single-group experimental design (Brink, 2010). The study took place at the University of Johannesburg Campus Clinic. Recruitment took place by means of advertisements (Appendix H) placed at the University of Johannesburg campuses. Inclusion criteria consisted of males and females between the ages of eighteen to fifty years. Participants had to be suffering from aching pain in the cervical paraspinal muscles and ligaments with associated muscle spasm, stiffness and tightness in the upper back and shoulders that was present for more than one day and no longer than one week, with decreased range of motion on CROMs (Appendix G) and a minimum score of 10 on the Neck Pain Disability Index (Appendix D). Exclusion criteria consisted of participants suffering from severe headaches with meningeal signs associated nausea, blurred vision, photophobia and phonophobia or fever; a history of thrombus formation or transient ischaemic attack (Longmore et al., 2010); if they had a pacemaker or if they have had any head and neck surgery; if they suffered from cardiac arrhythmia or myocardial infarction; pregnancy or suspected pregnancy; if they had a general skin sensitivity or known allergy to adhesives or if they have had a recent chiropractic adjustment. A total of forty participants were selected. The participants acted as their own baseline control. The researcher was only required to see participants once for one forty minute session to determine the immediate vi effect of the NeuroTrac® MultiTENS device on acute neck pain. Participants were asked to fill in an Information (Appendix A) and Consent Form (Appendix B). Participants came in for an initial consult where a history was taken on the type of neck pain experienced and the cause of the pain experienced. Vital signs were recorded on a case taking form (Appendix C). Thereafter participants were asked to fill in the Vernon and Mior Neck Pain Disability Index (Appendix D) relating to the neck pain they experienced and to complete a Visual Analogue Scale to rate their neck pain (Appendix F). The CROM goniometer device was placed on the participant’s head to measure all cervical spine ranges of motion, to the limit of pain (Appendix G). All forty participants received treatment at a frequency of 90Hz with a 200μS pulse width with the electronic pads placed on the shoulders. NeuroTrac® MultiTENS device treatment was administered for forty minutes to the participants in a seated position. The treatment was administered by the researcher. Once the treatment ended, participants were asked to fill in an amended questionnaire (Appendix E) that assessed if they noticed a change in the neck pain they were experiencing, to complete the Visual Analogue Scale (Appendix F) and their vital signs were again recorded on a case taking form (Appendix C). The CROM goniometer device was again placed on the participant’s head to measure all cervical spine ranges of motion to assess if there was a change in the readings recorded (Appendix G). The data obtained was statistically analysed by the researcher with the aid of a statistician at Statkon. The Shapiro-Wilk test and the Wilcoxon Signed-Rank test (non-parametric test) were used (Van Staden, 2014) ...

Objetivo: verificar a razão extensores/flexores dos músculos cervicais no âmbito de força muscular e atividade eletromiográfica durante a mensuração da força na contração isométrica voluntária máxima (CIVM) e teste de flexão craniocervical (TFCC) em pacientes com migrânea e em indivíduos sem cefaleia. Além de verificar o desempenho muscular, avaliado pelo TFCC, em ambos os grupos. Materiais e métodos: foram incluídas 52 mulheres com diagnóstico de migrânea segundo a Classificação Internacional de Cefaleias e 52 mulheres sem histórico de cefaleia ou dor cervical com idade entre 18 e 55 anos. No grupo migrânea os questionários Neck Disability Index, Migraine Disability Assessment e 12-item Allodynia Symptom Checklist foram aplicados. Em ambos os grupos a força dos músculos flexores e extensores cervicais foi avaliada utilizando-se um dinamômetro manual (Lafayette Instrument Company®, Lafayette, IN, USA). A CIVM foi mantida por 3 segundos e foram realizadas 3 repetições. Além do teste de força, o TFCC também foi realizado para os dois grupos utilizando-se o dispositivo de pressão Stabilizer Pressure Biofeedback® (Chatanooga, Hixson, TN, USA). O dispositivo, incialmente, foi inflado a 20 mmHg e a participante deveria aumentar 2 mmHg a cada estágio, totalizando cinco estágios (30 mmHg), e manter a pressão por 10 segundos. Em ambos os testes, para os dois grupos, a atividade eletromiográfica dos músculos cervicais foi avaliada por meio de sensores de superfície sem fio (TrignoTM Wireless System, Delsys Inc. Boston, MA). Resultados: observamos que o grupo migrânea apresenta uma redução na força dos músculos flexores em comparação ao grupo controle e consequentemente, uma maior razão de força dos músculos extensores/flexores além de uma reduzida razão eletromiográfica dos músculos extensores/flexores durante a CIVM em flexão. Nossos resultados demonstraram ainda uma pior performance no TFCC no grupo migrânea e consequente aumento da razão eletromiográfica dos músculos extensores/flexores cervicais no último estágio do teste. Conclusão: de acordo com os nossos resultados podemos concluir que mulheres com migrânea apresentam um notável desequilíbrio dos músculos flexores e extensores cervicais em comparação a controles não apenas na produção de força, mas também na atividade muscular. / Objective: To verify the extensor/flexor ratio of neck muscle strength and electromyographic activity at maximal voluntary isometric contraction (MVIC) and at the craniocervical flexion test (CCFT) of patients with migraine and of individuals with no history of headache. In addition, we aimed to assess the performance of both groups at the CCFT. Materials and methods: Fifty-two women with a diagnosis of migraine according to the International Classification of Headache Disorders and 52 women without history of migraine or cervical pain with ages between 18 and 55 years were included. The Neck Disability Index, Migraine Disability Assessment and 12-item Allodynia Symptom Checklist questionnaires were applied to the migraine group. In both groups, cervical muscle strength was assessed during a MVIC using a hand-held dynamometer (Lafayette Instrument Company®, Lafayette, IN, USA). The MVCI was maintained for 3 seconds and 3 repetitions were performed. The CCFT was also performed by the two groups using the Stabilizer Pressure Biofeedback® (Chatanooga, Hixson, TN, USA). The device was initially inflated to 20 mmHg and the participant had to increase 2 mmHg at each stage, achieving five stages (30 mmHg), and maintaining the pressure for 10 seconds. In both tests, the electromyographic activity of the cervical muscles was evaluated using wireless surface sensors (TrignoTM Wireless System, Delsys Inc. Boston, MA). Results: migraine group has a reduction in flexor muscle strength compared to the control group and consequently a greater muscle strength ratio of extensor/flexor and a reduced electromyographic ratio of the extensor/flexor muscles during MVIC in flexion. Our results also demonstrated a worse performance in the CCFT in the migraine group and consequent increase in the electromyographic ratio of the extensor/flexor neck muscles in the last stage of the test. Conclusion: women with migraine present a remarkable imbalance of the flexor and extensors cervical muscles compared to controls not only in the production of strength but also in muscle activity.

Objetivo: verificar a razão extensores/flexores dos músculos cervicais no âmbito de força muscular e atividade eletromiográfica durante a mensuração da força na contração isométrica voluntária máxima (CIVM) e teste de flexão craniocervical (TFCC) em pacientes com migrânea e em indivíduos sem cefaleia. Além de verificar o desempenho muscular, avaliado pelo TFCC, em ambos os grupos. Materiais e métodos: foram incluídas 52 mulheres com diagnóstico de migrânea segundo a Classificação Internacional de Cefaleias e 52 mulheres sem histórico de cefaleia ou dor cervical com idade entre 18 e 55 anos. No grupo migrânea os questionários Neck Disability Index, Migraine Disability Assessment e 12-item Allodynia Symptom Checklist foram aplicados. Em ambos os grupos a força dos músculos flexores e extensores cervicais foi avaliada utilizando-se um dinamômetro manual (Lafayette Instrument Company®, Lafayette, IN, USA). A CIVM foi mantida por 3 segundos e foram realizadas 3 repetições. Além do teste de força, o TFCC também foi realizado para os dois grupos utilizando-se o dispositivo de pressão Stabilizer Pressure Biofeedback® (Chatanooga, Hixson, TN, USA). O dispositivo, incialmente, foi inflado a 20 mmHg e a participante deveria aumentar 2 mmHg a cada estágio, totalizando cinco estágios (30 mmHg), e manter a pressão por 10 segundos. Em ambos os testes, para os dois grupos, a atividade eletromiográfica dos músculos cervicais foi avaliada por meio de sensores de superfície sem fio (TrignoTM Wireless System, Delsys Inc. Boston, MA). Resultados: observamos que o grupo migrânea apresenta uma redução na força dos músculos flexores em comparação ao grupo controle e consequentemente, uma maior razão de força dos músculos extensores/flexores além de uma reduzida razão eletromiográfica dos músculos extensores/flexores durante a CIVM em flexão. Nossos resultados demonstraram ainda uma pior performance no TFCC no grupo migrânea e consequente aumento da razão eletromiográfica dos músculos extensores/flexores cervicais no último estágio do teste. Conclusão: de acordo com os nossos resultados podemos concluir que mulheres com migrânea apresentam um notável desequilíbrio dos músculos flexores e extensores cervicais em comparação a controles não apenas na produção de força, mas também na atividade muscular. / Objective: To verify the extensor/flexor ratio of neck muscle strength and electromyographic activity at maximal voluntary isometric contraction (MVIC) and at the craniocervical flexion test (CCFT) of patients with migraine and of individuals with no history of headache. In addition, we aimed to assess the performance of both groups at the CCFT. Materials and methods: Fifty-two women with a diagnosis of migraine according to the International Classification of Headache Disorders and 52 women without history of migraine or cervical pain with ages between 18 and 55 years were included. The Neck Disability Index, Migraine Disability Assessment and 12-item Allodynia Symptom Checklist questionnaires were applied to the migraine group. In both groups, cervical muscle strength was assessed during a MVIC using a hand-held dynamometer (Lafayette Instrument Company®, Lafayette, IN, USA). The MVCI was maintained for 3 seconds and 3 repetitions were performed. The CCFT was also performed by the two groups using the Stabilizer Pressure Biofeedback® (Chatanooga, Hixson, TN, USA). The device was initially inflated to 20 mmHg and the participant had to increase 2 mmHg at each stage, achieving five stages (30 mmHg), and maintaining the pressure for 10 seconds. In both tests, the electromyographic activity of the cervical muscles was evaluated using wireless surface sensors (TrignoTM Wireless System, Delsys Inc. Boston, MA). Results: migraine group has a reduction in flexor muscle strength compared to the control group and consequently a greater muscle strength ratio of extensor/flexor and a reduced electromyographic ratio of the extensor/flexor muscles during MVIC in flexion. Our results also demonstrated a worse performance in the CCFT in the migraine group and consequent increase in the electromyographic ratio of the extensor/flexor neck muscles in the last stage of the test. Conclusion: women with migraine present a remarkable imbalance of the flexor and extensors cervical muscles compared to controls not only in the production of strength but also in muscle activity.

A dissertation presented to the Faculty of Health Sciences at the Durban University of Technology in partial compliance with the requirements for the Master’s Degree in Technology: Chiropractic, 2009 / Introduction: The aetiology of Temporomandibular Joint Dysfunction (TMJD) is not fully understood and the treatment of TMJD is controversial. Most treatment plans are based on postulated aetiology. Treatment plans currently range from pharmacological to surgical and occasionally physical therapy is also used for any myofascial component. Myofacial Trigger Points (MFTP’s) in the head and neck region have similar pain referral patterns as TMJD and there is overlap in aetiology and epidemiology. If correlation can be proved to exist between the severities of TMJD and MFTP’s then the treatment of MFTP’s can potentially decrease the severity of TMJD and then the more radical treatments can be avoided. Objectives: To determine whether TMJD was present and establish severity. To locate any MFTP’s in the Sternocleidomastiod (SCM), Temporalis, Masseter, Posterior Cervical (PC), Lateral and Medial Pterygoid muscles and determine their severity. Methods: A random sample of 25 participants were evaluated. A p value <0.05 was considered as statistically significant. Quantitative variables were summarized using median, inter-quartile range and range due to skewness of distribution, while categorical variables were described using frequency distributions and bar charts. Spearman’s nonparametric correlation analysis, and curve estimation were used to determine the existence of a relationship between TMJ severity and MFTP severity. A scatterplot was used to graphically assess the relationship. Conclusion: The results suggested that the participants were actually chronic neck pain suffers that developed TMJD over the long term as a result of chronic neck pain changing the kinematic biomechanics or as a result of a completely different and independent event as suggested by Foreman and Croft (1995).

Dissertation submitted in partial compliance with the requirements for a Masters Degree in Technology: Chiropractic, Durban University of Technology, 2010. / The aim of this study was to determine the prevalence of and risk factors for neck pain in the white population in the greater Durban area. The rational for this study was that there have been few epidemiological studies done on neck pain and even less when concerning different population groups. Discrepancies between population groups have been found in various pain related studies. The present epidemiological study eliminated any possible variables between population groups by studying only the white population in a specific geographical area (Durban). Therefore, physicians treating people with neck pain should use the risk factors that were established in this and other studies and integrate them in their treatment protocol. The study was conducted at three shopping centres around Durban that were randomly selected. Each shopping centre was grouped by the socio-economic status of the surrounding suburbs. There were 900 participants surveyed at three shopping centres by means of a questionnaire. The data were then statistically analysed using SPSS version 15. It was found that the overall prevalence of neck pain was 45%. The participants in this study that had neck pain were more likely to be females that were married or previously married, had a job that caused their heads to turn or to work with their arms above their heads. Lifestyle factors included one or a combination of the following: lead a stressful lifestyle, were emotional, had perceived bad posture, had previously experienced neck or head trauma, slept in awkward positions, watched television, required glasses and did not play squash.

Submitted in partial compliance with the requirements for the Master’s Degree in Technology: Chiropractic Durban University of Technology, 2013. / Background : Chronic non-specific neck pain is a common condition that negatively affects cervical muscle functioning and activities of daily living. Combined exercise and mobilisation are currently recommended as the most effective treatment for this condition. Mobilisation, such as mobilisation of the cervical spine, provides short-term pain relief and affects neural activity, while the craniocervical flexion exercise provides immediate pain relief and activates the deep cervical flexors. The short-term effect of mobilisation and the craniocervical flexion exercise have not been compared. Objectives : This study aimed to compare mobilisation and craniocervical flexion exercise in terms of subjective and objective outcome measures at a short-term follow-up consultation for the treatment of chronic non-specific neck pain. The null-hypothesis was that the mobilisation group would not respond differently to the craniocervical flexion exercise group. Method : A group of thirty females between the ages of 20 and 35 complaining of non-specific neck pain for more than three months were randomly allocated into either the mobilisation or craniocervical flexion exercise groups. During the first two consultations, a mobilisation was administered to the mobilisation group. Whereas the craniocervical flexion exercise and a posture correcting exercise were taught to the participants of the craniocervical flexion exercise group. The Numerical Pain Rating Scale, Neck Disability Index, Neck Bournemouth Questionnaire, cervical range of motion and algometer readings were taken at each of the three consultations. The Patient Global Impression of Change Scale was administered at the last consultation one week after the first consultation. Results : Both the mobilisation and craniocervical flexion exercise groups showed significant improvements in all of the subjective outcomes. The Neck Disability Index score of the craniocervical flexion exercise group was the only subjective outcome that did not decrease enough to be considered clinically significant. The PGIC score of the mobilisation group was slightly higher than that of the craniocervical flexion exercise group. There was no statistically significant improvement in the objective outcomes of either group. All ranges of motion decreased in both groups, while pain pressure threshold improved in both groups. There was no significant difference between the results of the subjective and objective outcomes of the mobilisation and craniocervical flexion exercise groups. Conclusions and recommendations : The two interventions were found to have a similar effect in the treatment of chronic non-specific neck pain in terms of subjective and objective outcome measures. Participants of both groups indicated on the subjective scales that their conditions improved, even though objective outcomes showed no significant change. In future studies, a larger sample size should be used and the sample should be stratified for ethnicity to increase validity of the results.

Diss. (sammanfattning) Umeå : Univ., 2007. / Härtill 4 uppsatser.

Thesis (DScPT)--University of Alabama at Birmingham, 2007. / Title from first page of PDF file (viewed on June 29, 2009). Includes bibliographical references (p. 28-33).

Diss. (sammanfattning) Stockholm : Karolinska institutet, 2010.

Orientador: Wilkens Aurélio Buarque e Silva / Dissertação (mestrado) - Universidade Estadual de Campinas, Faculdade de Odontologia de Piracicaba / Made available in DSpace on 2018-08-19T17:19:18Z (GMT). No. of bitstreams: 1 Fernandes_JoaoPaulodosSantos_M.pdf: 1949531 bytes, checksum: 8b69749dcdca84f0eaba7a2ac05299a1 (MD5) Previous issue date: 2012 / Resumo: O objetivo neste trabalho foi analisar a influência da dimensão vertical de oclusão na postura da coluna cervical e da cabeça por meio de aferições de medidas angulares craniocervicais. Foram selecionados 17 voluntários desdentados totais, com sinais clínicos de diminuição de dimensão vertical de oclusão, portadores de sinais e sintomas de disfunção temporomandibular e usuários de próteses totais, inscritos no cadastro de pacientes do CETASE (Centro de Estudos e Tratamento das Alterações Funcionais do Sistema Estomatognático) da Faculdade de Odontologia de Piracicaba. Os voluntários utilizaram o aparelho de cobertura oclusal plana para o restabelecimento da dimensão vertical de oclusão e do tônus muscular, por um período de 120 dias. Telerradiografias em norma lateral foram realizadas antes (com as próteses totais antigas) e após o período de 120 dias. Foram traçadas as linhas Sela-Násio (SN), a Linha Odontoídea (OD), a Linha CVT (Tangente da Vértebra Cervical), e o Plano mandibular (LM). Cinco medidas angulares craniocervicais foram realizadas: SN/OD; SN/LM; SN/CVT; LM/OD e OD/CVT e duas medidas lineares foram feitas: S-OD e S-CVT. Os dados obtidos foram submetidos à análise estatística pelos testes t de Student e teste de Wilcoxon pareado com nível de significância de p<0,05. As médias iniciais e finais dos ângulos SN/LM e LM/OD apresentaram diferenças estatisticamente significantes, alterando a postura da mandíbula em relação à coluna cervical e à base do crânio e as médias iniciais e finais dos ângulos SN/OD, SN/CVT e OD/CVT não apresentaram diferenças estatisticamente significantes, mostrando o movimento de extensão da cabeça após o tratamento instituído. Os resultados demonstraram que existe relação entre DVO, postura da cabeça e da coluna cervical e que a terapêutica com aparelhos oclusais interferiu melhorando o posicionamento da cabeça e da coluna cervical / Abstract: The aim of this study was to analyze since the influence of the vertical dimension of occlusion in the posture of the cervical spine and head through measurements of craniocervical angles. Seventeen volunteers edentulous were selected, with clinical signs of reduced vertical dimension of occlusion, with signs and symptoms of temporomandibular disorders and denture wearers. The volunteers used occlusal plane appliance coverage for the reestablishment of vertical dimension of occlusion and muscle tone, for a period of 120 days. Lateral cephalometric radiographs were taken before (with the old dentures), and after 120 days. In the radiographs were traced sella-nasion line (SN), Odontoid Line (OD), the CVT line (Cervical Vertebra Tangent), and mandibular plane (ML). Five craniocervical angle measurements were performed: SN/OD, SN/ML, SN/CVT, ML/OD and OD/CVT and two linear measurements were made: S-OD and S-CVT. The data were statistically analyzed by Student's t test and Wilcoxon test with a significance level of p <0.05. The average initial and final angles of the SN/LM and LM/OD showed statistically significant differences by changing the posture of the mandible in relation to the cervical spine and skull base and the mean initial and final angles of the SN/OD, SN/CVT and OD/CVT did not show statistically significant differences, showing the extension movement of the head after the treatment. Our studies demonstrated that a relationship exists between VDO, head posture and cervical spine and that therapy with occlusal devices interfered improving the positioning of the head and cervical spine / Mestrado / Protese Dental / Mestre em Clínica Odontológica