Effects OF Mulligan’s Mobilization With Movement On First Rib To Reduce Pain And Improve Cervical Rotation In Mechanical Neck Dysfunction

Mechanical Neck Pain(MNP) is a term used to describe pain that results from stress or strain on the structures of the vertebral column. Factors such as alteration in the anatomical structures, sprain or strain of the muscles or ligaments, and adaptation to a faulty posture can result in First rib dysfunction has been identified as a potential cause for faulty dynamic, static, traumatic or congenital factors, may contribute to the development of elevated first rib dysfunction. Objective: Was to determine the effects of Mulligan’s mobilization with movement on first rib to reduce pain and improve cervical rotation in mechanical neck dysfunction. Material and methods: This study Quasi-experimental trial was done at PT CARE MM Alam road Lahore. The study was completed within the time duration of six months (July-Dec 2019) after the approval of synopsis. A total of 26 cases (13 in each group) were divided into 2 groups. Group A and Group B were treated with conventional exercise program and with Mulligan’s mobilization with movement on first rib and conventional exercise program only respectively. Bubble inclinometer and NPRS tools were used to measure cervical rotation and Pain respectively. Data analysis was done by SPSS 21. Results: The mean change in NPRS was statistically higher in group-B (5.46 ± 0.78) as compared to group-A (2.62 ± 0.87), p-value < 0.001. The mean change in cervical rotation (ROM) was statistically higher in group-B (17.46 ± 5.19) as compared to group-A (31.23 ± 4), p-value < 0.001. Conclusion: It is concluded that Mulligan’s mobilization with movement on first rib and conventional exercise program had statistically significant change in reduction of pain and had higher improvement in cervical rotation (ROM) right and left. Hence, by combining conventional treatment and Mulligan’s mobilization , maximum clinical benefits to reduce pain and improve cervical rotation can be attained in mechanical neck dysfunction

Active Cervical Range of Motion in Babies with Positional Plagiocephaly: Analytical Cross-Sectional Study

Positional plagiocephaly (PP) is a general term describing cranial distortion from pre- or postnatal forces on the infant head. Abnormal intrauterine forces, multiple births, primiparous mothers, obstetric interventions, prematurity, male sex, excessive time lying in the supine position, and mobility restrictions of the cervical spine have been considered as the main predisposing factors. The objective was to investigate the association between the severity of PP and the active cervical rotation and to analyze the influence of predisposing factors in babies with PP. An analytical cross-sectional study was performed on 74 babies with moderate PP. Clinical and demographic data, cranial vault asymmetry, and active cervical rotation range of motion (ROM) were measured. Associations were analyzed with generalized linear models. The mean age was 16.8 ± 5.0 weeks, and 56.8% were male. A restriction in the ROM of active cervical rotation, especially to the left side, was observed. Our models showed that cranial asymmetry was related with left active cervical rotation ROM (p = 0.034) and with being transported in a pushchair (p < 0.001). Conclusions: An increased severity of PP was related with being transported in a baby pushchair and with a reduced active cervical rotation ROM toward the most restricted side.

Screening on Collect Students: Postural Risk Factors of Spinal Musculoskeletal Problems and Scoliosis

Background: Overuse of electronic products and decrease in levels of physical activity may lead to an increased incidence of spinal health problems in college students. This study aims to 1) identify the incidence of spinal health problems in college students, 2) to explore the key postural factors in development of spinal musculoskeletal dysfunction and scoliosis, and 3) to clarify new strategies for early identification and prevention of scoliosis. Methods: A cross-sectional screening by static posture assessment, selective functional movement assessment (SFMA) and Adam's Forward Bend Test, was conducted to 306 college students from October to December 2019. Descriptive analysis, Spearman correlation analysis and binomial logistic regression analysis were performed on the collected data.Results: Static postural assessment was completed among 306 college students, 53% of students’ external auditory meatus and acromioclavicular joint were not in the same gravitational line, 45% had forward-head posture, 42% had uneven shoulders. When performing SFMA, we found spinal musculoskeletal dysfunctions, including abnormalities of multi-segment spine flexion (32%), cervical rotation to right (18%), cervical rotation to left (16%), etc. In Adam's Forward Bend Test, 10.78% had a positive result, which suggested structural or functional scoliosis. Correlation analysis showed that the top three postural factors related to spinal musculoskeletal dysfunctions included uneven shoulders, forward-head, position of thorax and pelvis rotated. And top three postural factors related to scoliosis were spinous processes line deviating from midline, winged scapula and head rotation off midline. Logistic regression analysis displayed that there are two high risk factors for scoliosis, including external auditory meatus and acromioclavicular joint not in the same vertical line (OR = 6.314), and deviation of spinous processes line (OR = 12.743). Conclusions: Poor posture, spinal musculoskeletal dysfunction and scoliosis affect a significant proportion of college students. While their spinal musculoskeletal dysfunction and scoliosis are closely related to poor posture.

Immediate effect of a motor control exercise target to the neck muscles on upper cervical range of motion and motor control in patients with temporomandibular disorder

ObjectiveTo evaluate whether a single specific motor control training session for the neck flexor and deep extensor muscles improves upper cervical range of motion and neck motor control in patients with temporomandibular disorder (TMD) and compare them to a group without TMD. MethodsThis is a before and after, controlled study. The TMD group included women aged between 18-45 years old, complaining of pain in the orofacial region in the last 6 months and diagnosed with masticatory myofascial pain according to Research Diagnostic Criteria (RDC/MD). The control group included match-controls without TMD. The participants were evaluated to global and upper (Flexion Rotation Test - FRT) neck range of motion (ROM) and to neck motor control (Cranio-Cervical Flexion Test - CCFT). They were treated with a protocol of specific motor control exercises targeted to flexor and extensor neck muscles for 30 minutes. One day after the protocol the patients were reevaluated. ResultsA total of 23 volunteers were evaluated. The TMD group showed immediate improvement in left cervical rotation (p=0.043) and right FRT (p=0.036), while the control group did not show any improvement. There was no difference between the groups before and after treatment in relation to cervical movements. Regarding cervical motor control in both groups, the highest prevalence was of results between 24 and 26 mmHg after treatment, different from before the intervention (20 and 22 mmHg) in both groups.ConclusionA single session of specific neck motor control training only improved the left cervical rotation and upper right rotation in the TMD group, but not in the control group. There is no difference at the end of treatment between the groups. Volunteers with TMD showed improvement in the pattern of motor control of the neck when compared to volunteers without TMD.

Mechanical Parameters and Trajectory of Two Chinese Cervical Manipulations Compared by a Motion Capture System

Objective: To compare the mechanical parameters and trajectory while operating the oblique pulling manipulation and the cervical rotation–traction manipulation.Methods: An experimental research measuring kinematics parameter and recording motion trajectories of two cervical manipulations were carried out. A total of 48 healthy volunteers participated in this study, who were randomly divided into two groups of 24 representing each of the two manipulations. A clinician performed two manipulations in two groups separately. A motion capture system was used to monitor and analyze kinematics parameters during the operation.Results: The two cervical manipulations have similar thrust time, displacement, mean velocity, max velocity, and max acceleration. There were no significant differences in active and passive amplitudes between the two cervical rotation manipulations. The thrust amplitudes of the oblique pulling manipulation and the cervical rotation–traction manipulation were 5.735 ± 3.041° and 2.142 ± 1.742°, respectively. The thrust amplitudes of the oblique pulling manipulation was significantly greater than that of the cervical rotation–traction manipulation (P &lt; 0.001).Conclusion: Compared with the oblique pulling manipulation, the cervical rotation–traction manipulation has a less thrust amplitudes.

Application of David Spine Concept Equipment in Rehabilitation of Patients with the Cervical Spine Spondiloarthrosis

Aim. To substantiate the application of the methodology for the rehabilitation of patients with spondyloarthrosis of the cervical spine, which consists of 8 trainings on the David 140 Cervical Extension, Lateral Flexion Device and 160 Cervical Rotation Device. Material and methods. The study involved 24 patients. Completed cases – 21. During the training, the range of motion in the cervical spine and the strength characteristics of the extensor muscles, lateral flexors and the cervical spine rotators were assessed. Results. All studied patients noted a positive effect after undergoing a rehabilitation course on the David 140 and 160 devices. The effectiveness of the developed training methodology was assessed using functional motor tests. Conclusion. The results obtained allow to conclude that David devices training for 8 days has a positive effect in rehabilitation measures to improve the quality of patients’ life. It is worthwhile continuing to explore the eight-day training program and assess the frequency and timing of regression. It is very important to evaluate the preservation of the achieved positive effect both during further training of patients at the outpatient stage or independent regular exercises, and without training in the post-rehabilitation period when returning to the patient’s usual lifestyle.

Kinematic cervical rotation performance in patients with acute non-specific neck pain during the DidRen test improves after manual mobilizations regardless of the painful spinal level

Background: Evaluation of kinematic axial cervical rotation performance is of major importance in the context of studying sensorimotor control of the neck. However, studies are missing on acute neck pain, on the influence of the level of provocation of spinal pain, and on the potential benefits of manual therapy mobilizations. Methods: A non-randomized prospective trial with intervention assessed the influence of acute non-specific neck pain on kinematic parameters during a fast axial head rotation task standardized with the DidRen laser test device. First, we compared kinematic parameters between patients and healthy controls. Second, we assessed whether upper or lower spinal pain location influenced these kinematic parameters. Finally, we examined the short-term effect of passive cervical mobilizations in patients on these kinematic variables. Results: We observed that patients were significantly slower (total time) to perform the DidRen laser test (4.5 s; p<0.006) and to reach the end of rotation from peak acceleration (0.02 s; p<0.016). The time between peaks acceleration and deceleration (-0.03 s; p<0.003), the time to peak deceleration (0.004 s; p<0.003), to peak acceleration (0.04 s; p<0.001) and to peak speed (0.01 s; p<0.001), the average speed (7.2 °s-1; p<0.001), peak speed (21.7 °s-1; p<0.010), acceleration (143.5 °s-2; p<0.013) and deceleration (-193.1 °s-2; p<0.006) were significantly slower for patients compared to controls. No significant effect of spinal pain location was observed on kinematic variables. After the intervention, patients were faster for average speed (2.9 °s-1; p<0.02), peak speed (8.7 °s-1; p<0.011), peak deceleration (69.7 °s-2; p<0.007). Patients took less time to reach peak speed (0.01 s; p<0.033) and peak acceleration (0.01 s; p<0.028). They took also less time (-0.01 s; p<0.003) between peak acceleration and deceleration and to stabilize the laser into the target (0.12 s; p<0.026) and to perform the DidRen laser test (4 s; p<0.001). Conclusion: The DidRen laser test allowed to demonstrate significant differences in kinematic axial cervical rotation in patients suffering from acute non-specific neck pain compared to pain-free controls. No significant effect of spinal pain location was observed on kinematic variables. Pain reduction significantly improved the patients’ kinematic parameters.

Psychological and Physical Risk Factors for Pressure Pain Hypersensitivity of the Upper Trapezius in Food Service Workers With Nonspecific Neck/shoulder Myofascial Pain

Objectives: It is unclear which factors increase the risk of developing pressure pain hypersensitivity, a type of neurophysiological hyperexcitability. The present study investigated the relative contributions of physical and psychological factors to pressure pain hypersensitivity of the upper trapezius for each sex.Methods: In total, 154 individuals with neck/shoulder myofascial pain participated, among 372 food service workers. Participants completed a questionnaire (age, sex, Beck Depression Inventory, and Borg Rating of Perceived Exertion scale) and then were photographed to measure posture. Pressure pain sensitivity, two range of motions (cervical lateral-bending and rotation), and four muscle strengths (serratus anterior, lower trapezius, biceps, and glenohumeral external rotator) were measured by a pressure algometer, iPhone application, and handheld dynamometer. For each sex, forward multivariate logistic regression was used to test our a priori hypothesis among selected variables that a combination of psychosocial and physical factors contributed to the risk for pressure pain hypersensitivity.Results: In multivariate analyses, lower trapezius strength (odds ratio = 0.94, 95% confidence interval = 0.91–0.97, p = 0.001) was the only significant risk factor for pressure pain hypersensitivity in men. Dominant painful ipsilateral cervical rotation range of motion (odds ratio = 0.96, 95% confidence interval = 0.92–0.99, p = 0.037) was the only risk factor for pressure pain hypersensitivity in women.Discussion: Lower trapezius strength and dominant painful ipsilateral cervical rotation range of motion could serve as guidelines for preventing and managing pressure pain hypersensitivity of the upper trapezius in food service workers with nonspecific neck/shoulder myofascial pain.Trial registration: Research Information Service (CRIS) under the code KCT0002810 (granted on 20/04/2018) and the registration timing was retrospective.

Repeated loss of consciousness as the first symptom of recurrence of head and neck malignancy: a case report

Background Head and neck malignancies rarely cause reflex syncope. Three mechanistic patterns of reflex syncope are known in such patients: carotid sinus syndrome, glossopharyngeal neuralgia syndrome, and parapharyngeal space lesions syncope syndrome. There are few reports describing parapharyngeal space lesions syncope syndrome. Case summary A 61-year-old man with a history of head and neck cancer underwent left lingual resection and left anterior cervical lymph node dissection followed by chemoradiotherapy. Two months later, he experienced his first syncope and was admitted to our hospital for further investigation. During the first few days in the hospital, he experienced loss of consciousness. Carotid artery massage and cervical rotation-extension examinations revealed no abnormalities, and glossopharyngeal neuralgia was not observed. Cervical computed tomography showed recurrence of tongue cancer infiltrating the para-nasopharyngeal space. Consequently, the patient had sinus pause during the loss of consciousness; hence, we suspected parapharyngeal space lesions syncope syndrome. Pacemaker implantation was considered but could not be performed as the patient passed away because of the original malignancy. Discussion Parapharyngeal space tumours are often characterized by the absence of subjective symptoms, although symptoms such as neck swelling and discomfort in the throat have been reported. Parapharyngeal space lesions syncope syndrome is caused by tumour invasion into the parapharyngeal space, and there is no known trigger for syncope. Our case is unique because the patient’s first symptom of recurrence of tongue cancer infiltrating the para-nasopharyngeal space was repeated loss of consciousness.