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Neck muscle function in individuals with persistent pain and disability after whiplash injury
Linköping University, Department of Medical and Health Sciences, Division of Physiotherapy. Linköping University, Faculty of Medicine and Health Sciences.ORCID iD: 0000-0003-2492-0306
2016 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

Background: Neck pain and disability are common after whiplash injury. One year after the accident up to 50 % still have symptoms called whiplash associated disorders (WAD). Despite decades of research the cause of persistent pain and disability are largely unknown and effective treatment and diagnostic tools are lacking. Altered neck muscle function may cause pain and disability, and real-time non-invasive methods that investigate both superficial and deep neck muscle function need to be evaluated.

Aim: The general aim of the work presented in this thesis was to investigate mechanical neck muscle function and evaluate effects of three different exercise interventions related to neck muscle function in individuals with persistent pain and disability after whiplash injury.

Method: The thesis comprised two studies, reported in four papers. Study A was a prospective randomized controlled trail with 216 participants. The effects of three exercise interventions; neck-specific exercises, neck-specific exercises with behavioral approach and prescription of physical activity were evaluated. Neck muscle endurance, perceived pain following testing, kinesiophobia and satisfaction with treatment were compared between the three groups (paper I). Study B was an experimental case-control study with participants consecutively recruited from the randomized controlled trial. Deformation and deformation rates in the neck muscles were investigated with real-time ultrasound imaging during ten repetitive arm elevations (paper II-IV). To investigate ventral neck muscles, 26 individuals with WAD were compared with 26 healthy controls (paper II). The dorsal neck muscles were investigated in paper III, including 40 individuals with WAD and 40 controls. In total 46 individuals, 23 with WAD and 23 healthy controls were included in paper IV to develop ventral neck muscle interaction models.

Results: Paper I: Participants in the two neck-specific exercise groups (with and without behavioral approach) showed increased dorsal neck muscle endurance (p = 0.003), decreased pain intensity following testing (p = 0.04) and were more satisfied with treatment (p < 0.001) than participants in the prescribed physical activity group. Kinesiophobia did not significantly differ between groups (p > 0.12).

Paper II: Deformation and deformation rate showed linear positive relationship between ventral muscle pairs in healthy controls, especially between superficial and deep neck muscles. This relationship was weaker or absent in the WAD group.

Paper III: The WAD group had higher deformation rates in the deepest dorsal neck muscles during the first and tenth (only women) arm elevations compared to the control group (p < 0.04). Women in the WAD group showed a weaker linear relationship between the two deepest dorsal neck muscles compared to women in the control group.

Paper IV: The results revealed two different ventral neck muscle models in individuals with WAD and healthy controls (R2Y = 0.72, Q2Y = 0.59). The models were capable to detect different neck muscle interplay in people with WAD.

Conclusion: Neck-specific exercise intervention with or without a behavioral approach appears to improve neck muscle endurance in individuals with persistent WAD. Decreased pain after the neck muscle endurance test also suggests improved tolerance of load in these two groups. Altered mechanical neck muscle function was revealed in individuals with WAD indicating decreased muscular support for maintain a stable cervical spine during repetitive arm elevations. The results show great promise for improved diagnosis of neck muscle function in WAD.

Place, publisher, year, edition, pages
Linköping: Linköping University Electronic Press, 2016. , 87 p.
Series
Linköping Studies in Science and Technology. Dissertations, ISSN 0345-7524 ; 1523
National Category
Physiotherapy Sport and Fitness Sciences Clinical Science Applied Psychology Other Medical Sciences not elsewhere specified
Identifiers
URN: urn:nbn:se:liu:diva-132420DOI: 10.3384/diss.diva-132420ISBN: 9789176857472 (Print)OAI: oai:DiVA.org:liu-132420DiVA: diva2:1045564
Public defence
2016-11-25, Berzeliussalen, Campus US, Linköping, 09:00 (Swedish)
Opponent
Supervisors
Note

The corrections in the errata list has been carried out in the electronic version.

Available from: 2016-11-10 Created: 2016-11-10 Last updated: 2016-11-10Bibliographically approved
List of papers
1. THE EFFECT OF 3 DIFFERENT EXERCISE APPROACHES ON NECK MUSCLE ENDURANCE, KINESIOPHOBIA, EXERCISE COMPLIANCE, AND PATIENT SATISFACTION IN CHRONIC WHIPLASH
Open this publication in new window or tab >>THE EFFECT OF 3 DIFFERENT EXERCISE APPROACHES ON NECK MUSCLE ENDURANCE, KINESIOPHOBIA, EXERCISE COMPLIANCE, AND PATIENT SATISFACTION IN CHRONIC WHIPLASH
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2015 (English)In: Journal of Manipulative and Physiological Therapeutics, ISSN 0161-4754, E-ISSN 1532-6586, Vol. 38, no 7, 465-746.e4 p.Article in journal (Refereed) Published
Abstract [en]

Objective: The purpose of this study was to compare the effects of 3 different exercise approaches on neck muscle endurance (NME), kinesiophobia, exercise compliance, and patient satisfaction in patients with chronic whiplash. Methods: This prospective randomized clinical trial included 216 individuals with chronic whiplash. Participants were randomized to 1 of 3 exercise interventions: neck-specific exercise (NSE), NSE combined with a behavioral approach (NSEB), or prescribed physical activity (PPA). Measures of ventral and dorsal NME (endurance time in seconds), perceived pain after NME testing, kinesiophobia, exercise compliance, and patient satisfaction were recorded at baseline and at the 3- and 6-month follow-ups. Results: Compared with individuals in the prescribed physical activity group, participants in the NSE and NSEB groups exhibited greater gains in dorsal NME (P = .003), greater reductions in pain after NME testing (P = .03), and more satisfaction with treatment (P less than .001). Kinesiophobia and exercise compliance did not significantly differ between groups (P greater than .07). Conclusion: Among patients with chronic whiplash, a neck-specific exercise intervention (with or without a behavioral approach) appears to improve NME. Participants were more satisfied with intervention including neck-specific exercises than with the prescription of general exercise.

Place, publisher, year, edition, pages
MOSBY-ELSEVIER, 2015
Keyword
Exercise Therapy; Neck Pain; Whiplash Injuries; Rehabilitation
National Category
Physiotherapy Medical and Health Sciences Health Sciences
Identifiers
urn:nbn:se:liu:diva-122438 (URN)10.1016/j.jmpt.2015.06.011 (DOI)000362450700003 ()26387858 (PubMedID)
Note

Funding Agencies|Swedish government; Swedish Social Insurance Agency through the REHSAM Foundation [RS2010/009]; Centre for Clinical Research Sormland at Uppsala University Sweden; Medical Research Council of Southeast Sweden; Center for Clinical Research of Ostergotland; Uppsala-Orebro Regional Research Council Sweden; Health Practitioner Research Fellowship from Queensland Health; University of Queensland (NHMRC CCRE Spinal Pain, Injury, and Health); Swedish Research Council; Wennergren Foundation

Available from: 2015-11-03 Created: 2015-11-02 Last updated: 2016-11-10
2. Altered ventral neck muscle deformation for individuals with whiplash associated disorder compared to healthy controls: A case-control ultrasound study
Open this publication in new window or tab >>Altered ventral neck muscle deformation for individuals with whiplash associated disorder compared to healthy controls: A case-control ultrasound study
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2015 (English)In: Manual Therapy, ISSN 1356-689X, E-ISSN 1532-2769, Vol. 20, no 2, 319-327 p.Article in journal (Refereed) Published
Abstract [en]

Previous studies have shown altered neck muscle function in individuals with chronic whiplash associated disorder (WAD). However, we lack real-time investigations with non-invasive methods that can distinguish between the different ventral neck muscle layers. This study investigated deformations and deformation rates in the sternocleidomastoid (SCM), longus capitis (Lcap), and longus colli (Lco) muscles with real-time ultrasonography. Twenty-six individuals with WAD were compared with 26 controls, matched for age and sex. Ultrasound imaging of the SCM, Lcap, and Lco were recorded during 10 repetitive arm elevations. The first and tenth arm elevations were post-process analyzed with speckle tracking. There were few significant differences in the deformations or deformation rates in the SCM, Lcap, and Lco between the WAD and control group. In controls, deformations and deformation rates showed linear positive relationships between SCM/Lcap, SCM/Lco, and Lcap/Lco which increased from the first arm elevation (R(2) = 0.14-0.70); to the tenth arm elevation (R(2) = 0.51-0.71). The WAD group showed similar or weaker linear relationship (R(2) < 0.19) during the tenth compared to the first (R(2) < 0.44) arm elevation except for deformations in Lcap/Lco (R(2) = 0.13-0.57). This result indicated that deformations and deformation rates in one muscle were correlated by similar deformations and deformation rates in other neck muscles in the control group, but this interplay between muscles was not found in the WAD group.

National Category
Physiotherapy
Identifiers
urn:nbn:se:liu:diva-115920 (URN)10.1016/j.math.2014.10.006 (DOI)000352769200013 ()25454684 (PubMedID)
Available from: 2015-03-24 Created: 2015-03-24 Last updated: 2016-11-10
3. CHANGES IN DORSAL NECK MUSCLE FUNCTION IN INDIVIDUALS WITH CHRONIC WHIPLASH-ASSOCIATED DISORDERS: A REAL-TIME ULTRASOUND CASE-CONTROL STUDY
Open this publication in new window or tab >>CHANGES IN DORSAL NECK MUSCLE FUNCTION IN INDIVIDUALS WITH CHRONIC WHIPLASH-ASSOCIATED DISORDERS: A REAL-TIME ULTRASOUND CASE-CONTROL STUDY
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2016 (English)In: Ultrasound in Medicine and Biology, ISSN 0301-5629, E-ISSN 1879-291X, Vol. 42, no 5, 1090-1102 p.Article in journal (Refereed) Published
Abstract [en]

Impaired neck muscle function leads to disability in individuals with chronic whiplash-associated disorder (WAD), but diagnostic tools are lacking. In this study, deformations and deformation rates were investigated in five dorsal neck muscles during 10 arm elevations by ultrasonography with speckle tracking analyses. Forty individuals with chronic WAD (28 women and 12 men, mean age = 37 y) and 40 healthy controls matched for age and sex were included. The WAD group had higher deformation rates in the multifidus muscle during the first (p &lt; 0.04) and 10th (only women, p &lt; 0.01) arm elevations compared with the control group. Linear relationships between the neck muscles for deformation rate (controls: R-2 = 0.24-0.82, WAD: R-2 = 0.05-0.74) and deformation of the deepest muscles (controls: R-2 = 0.61-0.32, WAD: R-2 = 0.15-0.01) were stronger for women in the control group versus women with WAD, indicating there is altered interplay between dorsal neck muscles in chronic WAD. (C) 2016 World Federation for Ultrasound in Medicine & Biology.

Place, publisher, year, edition, pages
ELSEVIER SCIENCE INC, 2016
Keyword
Whiplash injury; Ultrasonography; Neck muscles; Spine
National Category
Health Sciences
Identifiers
urn:nbn:se:liu:diva-127550 (URN)10.1016/j.ultrasmedbio.2015.12.022 (DOI)000373385300008 ()26921149 (PubMedID)
Note

Funding Agencies|Swedish government; Swedish Social Insurance Agency through the REHSAM Foundation [RS2010/009]; Swedish Research Council; Centre for Clinical Research Sormland at Uppsala University Sweden; Uppsala-Orebro Regional Research Council Sweden

Available from: 2016-05-04 Created: 2016-05-03 Last updated: 2016-11-10
4. Novel insights into the interplay between ventral neck muscles in individuals with whiplash-associated disorders
Open this publication in new window or tab >>Novel insights into the interplay between ventral neck muscles in individuals with whiplash-associated disorders
Show others...
2015 (English)In: Scientific Reports, ISSN 2045-2322, E-ISSN 2045-2322, Vol. 5, no 15289Article in journal (Refereed) Published
Abstract [en]

Chronic whiplash-associated disorder (WAD) is common after whiplash injury, with considerable personal, social, and economic burden. Despite decades of research, factors responsible for continuing pain and disability are largely unknown, and diagnostic tools are lacking. Here, we report a novel model of mechanical ventral neck muscle function recorded from non-invasive, real-time, ultrasound measurements. We calculated the deformation area and deformation rate in 23 individuals with persistent WAD and compared them to 23 sex-and age-matched controls. Multivariate statistics were used to analyse interactions between ventral neck muscles, revealing different interplay between muscles in individuals with WAD and healthy controls. Although the cause and effect relation cannot be established from this data, for the first time, we reveal a novel method capable of detecting different neck muscle interplay in people with WAD. This non-invasive method stands to make a major breakthrough in the assessment and diagnosis of people following a whiplash trauma.

Place, publisher, year, edition, pages
NATURE PUBLISHING GROUP, 2015
National Category
Physiotherapy
Identifiers
urn:nbn:se:liu:diva-122524 (URN)10.1038/srep15289 (DOI)000362884300001 ()26472599 (PubMedID)
Note

Funding Agencies|Swedish government; Swedish Social Insurance Agency through the REHSAM foundation; Swedish Research Council; Centre for Clinical Research Sormland at Uppsala University Sweden; Uppsala-Orebro Regional Research Council Sweden

Available from: 2015-11-09 Created: 2015-11-06 Last updated: 2016-11-10

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