Cervical musculoskeletal impairments in migraine

Background Neck pain is common and disabling amongst individuals with migraine. Cervical musculoskeletal interventions are often sought but there is currently no evidence to support such interventions for this population. Improved understanding of how cervical musculoskeletal impairments present in migraine can elucidate neck pain mechanisms and guide clinicians and researchers in the management of patients with migraine and neck pain. Main body Migraine hypersensitivity is a major consideration when assessing for cervical impairments as it can aggravate migraine and confound findings. Current evidence of cervical impairments in migraine is limited by disregard for the different underlying causes of neck pain and possible influence of hypersensitivity. Findings of cervical musculoskeletal impairments are mixed within and across studies, indicating that different forms of neck pain are present in migraine. Some migraineurs have neck pain that is part of the migraine symptom complex and therefore exhibit little or no cervical musculoskeletal impairment. Others have a cervical source of neck pain and therefore exhibit a pattern of cervical musculoskeletal impairments akin to that of cervical disorders. The presence of cervical musculoskeletal dysfunction may or may not be related to migraine but knowledge of this is currently lacking which impacts decision making on management. Cervical musculoskeletal interventions may be indicated for migraineurs with identified cervical dysfunction but other factors requiring further clarification include determination of i) patient specific outcomes, ii) impact of co-existing migraine referred neck pain, and iii) potential moderating effects of migraine hypersensitivity on treatment efficacy. Conclusions Physiotherapists should seek a combination of cervical impairments through skilful assessment to identify if cervical musculoskeletal dysfunction is present or not in individual patients. The relevance of cervical dysfunction to migraine and influence of co-existing migraine referred neck pain need to be established through detailed evaluation of pain behaviours and further research. Future clinical trials should define expected treatment outcomes and select individuals with cervical musculoskeletal dysfunction when investigating the efficacy of cervical musculoskeletal interventions.

Illness and injury among Norwegian Para athletes over five consecutive Paralympic Summer and Winter Games cycles: prevailing high illness burden on the road from 2012 to 2020

ObjectiveTo describe the illness and injury pattern of Norwegian Para athletes over five consecutive Paralympic Summer and Winter Games cycles and to identify which health problems should be targeted in risk management plans with respect to impairment types.MethodsWe monitored athletes from 12 to 18 months prior to each Game using a weekly online questionnaire (Oslo Sports Trauma Research Center-H2 (OSTRC-H2)). We asked them to report all health problems they had experienced in the preceding 7 days, irrespective of their consequences on their sports participation or performance and whether they had sought medical attention.ResultsBetween 2011 and 2020, 94 candidate athletes were included in this monitoring programme and prepared to represent Norway; of these, 66 (71%) were finally selected for multiple Paralympic Games. The overall response rate to the weekly questionnaires was 87%. At any given time during the five observation cycles, 37% of the athletes (95% CI 36% to 38%) reported having at least one health problem. Athletes with neurological impairments (n=51) lost 10 days per year due to respiratory problems (95% CI 9 to 11) compared with 9 days (8-10) among those with musculoskeletal impairments (n=37). Gastrointestinal problems caused a time loss of on average 4 days per year in athletes with neurological impairments versus 1 day in athletes with musculoskeletal impairments (mean difference 2.7 days, 2.1–3.3). Musculoskeletal injuries generated a high burden for both athlete groups, in particular, to the elbow, shoulder and lumbosacral regions.ConclusionAt any given time, nearly two out of five elite Norwegian Para athletes reported at least one health problem. Respiratory tract and other infections; gastrointestinal problems, injuries to the shoulder, elbow and lumbosacral regions represented the greatest health burden. Our findings can help guide the allocation of clinical resources, which should include a broad network of medical specialists, together with dieticians and physiotherapists, to meet the health challenges in Para athletes.

Number of Synergies Impacts Sensitivity of Gait to Weakness and Contracture

Muscle activity during gait can be described by a small set of synergies, weighted groups of muscles, that are often theorized to reflect underlying neural control. For people with neurologic injuries, like in cerebral palsy or stroke, even fewer (e.g., < 5) synergies are required to explain muscle activity during gait. This reduction in synergies is thought to reflect simplified control strategies and is associated with impairment severity and treatment outcomes. Individuals with neurologic injuries also develop secondary musculoskeletal impairments, like weakness or contracture, that can also impact gait. The combined impacts of simplified control and musculoskeletal impairments on gait remains unclear. In this study, we use a musculoskeletal model constrained to synergies to simulate unimpaired gait. We vary the number of synergies (3-5), while simulating muscle weakness and contracture to examine how altered control impacts sensitivity to muscle weakness and contracture. Our results highlight that reducing the number of synergies increases sensitivity to weakness and contracture. For example, simulations using five-synergy control tolerated 40% and 51% more knee extensor weakness than those using four- and three-synergy control, respectively. Furthermore, the model became increasingly sensitive to contracture and proximal muscle weakness, such as hamstring and hip flexor weakness, when constrained to four- and three-synergy control. However, the models sensitivity to weakness of the plantarflexors and smaller bi-articular muscles was not affected by the number of synergies. These findings provide insight into the interactions between altered control and musculoskeletal impairments, emphasizing the importance of incorporating both in future simulation studies.

EFFECTS OF TRIGGER POINT DRY NEEDLING ON NECK PAIN AND CERVICAL RANGE OF MOTION (ROM) IN PATIENTS WITH CERVICOGENIC HEADACHE: A CASE SERIES

Musculoskeletal headaches are a common complaint with impaired postures. About 15% to 20% of chronic and recurrent headaches are diagnosed as cervicogenic headaches and are related to musculoskeletal impairments (4). Often associated with tension in posterior cervical muscles and pain at the attachment of the cervical extensors, at the cervico-thoracic junction, and/or radiating across the top, side, or back of the scalp

Changes to Biceps and Supraspinatus Tendons in Response to a Progressive Maximal Treadmill-Based Propulsion Aerobic Fitness Test in Manual Wheelchair Users: A Quantitative Musculoskeletal Ultrasound Study

Relevance. To develop personalized cardiorespiratory fitness training programs among manual wheelchair users and assess their impact over time, the completion of a performance-based maximal cardiorespiratory fitness test is required. However, these tests could potentially increase the risk exposure for the development of upper limb secondary musculoskeletal impairments. Hence, finding an equilibrium between the need to measure aerobic fitness and the increased risk of developing secondary musculoskeletal impairments when completing performance-based test is fundamental. Objective. To investigate if the completion of a recently developed treadmill-based wheelchair propulsion maximal progressive workload incremental test alters the integrity of the long head of the biceps and supraspinatus tendons using musculoskeletal ultrasound imaging biomarkers. Method. Fifteen manual wheelchair users completed the incremental test. Ultrasound images of the long head of the biceps and supraspinatus tendons were recorded before, immediately after, and 48 hours after the completion of the test using a standardized protocol. Geometric, composition, and texture-related ultrasound biomarkers characterized tendon integrity. Results. Participants propelled during 10.2 ± 2.9 minutes with the majority ( N = 13 / 15 ) having reached at least the eighth stage of the test ( speed = 0.8 m / s ; slope = 3.6 ° ). All ultrasound biomarkers characterizing tendon integrity, measured in the longitudinal and transversal planes for both tendons, were similar ( p = 0.063 to 1.000) across measurement times. Conclusion. The performance of the motorized treadmill wheelchair propulsion test to assess aerobic fitness produced no changes to ultrasound biomarkers of the biceps or supraspinatus tendons. Hence, there was no ultrasound imaging evidence of a maladaptive response due to overstimulation in these tendons immediately after and 48 hours after the performance of the test.