Neurology

Joint Position Sense Error in People With Neck Pain

By Frank M. Painter|January 25, 2019|Neurology|

Joint Position Sense Error in People With Neck Pain: A Systematic Review

SOURCE: Man Ther. 2015 (Dec); 20 (6): 736–744

J. de Vries, B.K. Ischebeck, L.P. Voogt, J.N. van der Geest, M. Janssen, M.A. Frens, G.J. Kleinrensink

Department of Neuroscience,
Erasmus MC, P.O. Box 2040,
3000 CA Rotterdam,
The Netherlands

BACKGROUND: Several studies in recent decades have examined the relationship between proprioceptive deficits and neck pain. However, there is no uniform conclusion on the relationship between the two. Clinically, proprioception is evaluated using the Joint Position Sense Error (JPSE), which reflects a person’s ability to accurately return his head to a predefined target after a cervical movement.

OBJECTIVES: We focused to differentiate between JPSE in people with neck pain compared to healthy controls.

STUDY DESIGN: Systematic review according to the PRISMA guidelines.

METHOD: Our data sources were Embase, Medline OvidSP, Web of Science, Cochrane Central, CINAHL and Pubmed Publisher. To be included, studies had to compare JPSE of the neck (O) in people with neck pain (P) with JPSE of the neck in healthy controls (C).

RESULTS/FINDINGS: Fourteen studies were included. Four studies reported that participants with traumatic neck pain had a significantly higher JPSE than healthy controls. Of the eight studies involving people with non-traumatic neck pain, four reported significant differences between the groups. The JPSE did not vary between neck-pain groups.

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A Hypothesis of Chronic Back Pain

By Frank M. Painter|July 8, 2018|Neurology, Subluxation|

A Hypothesis of Chronic Back Pain: Ligament Subfailure Injuries Lead to Muscle Control Dysfunction

The Chiro.Org Blog

SOURCE: European Spine Journal 2006 (May); 15 (5): 668–676

Manohar M. Panjabi

Biomechanics Research Laboratory,
Department of Orthopaedics and Rehabilitation,
Yale University School of Medicine,
New Haven, CT 06520-8071, USA.

Clinical reports and research studies have documented the behavior of chronic low back and neck pain patients. A few hypotheses have attempted to explain these varied clinical and research findings. A new hypothesis, based upon the concept that subfailure injuries of ligaments (spinal ligaments, disc annulus and facet capsules) may cause chronic back pain due to muscle control dysfunction, is presented. The hypothesis has the following sequential steps. Single trauma or cumulative microtrauma causes subfailure injuries of the ligaments and embedded mechanoreceptors. The injured mechanoreceptors generate corrupted transducer signals, which lead to corrupted muscle response pattern produced by the neuromuscular control unit.

Muscle coordination and individual muscle force characteristics, i.e. onset, magnitude, and shut-off, are disrupted. This results in abnormal stresses and strains in the ligaments, mechanoreceptors and muscles, and excessive loading of the facet joints. Due to inherently poor healing of spinal ligaments, accelerated degeneration of disc and facet joints may occur. The abnormal conditions may persist, and, over time, may lead to chronic back pain via inflammation of neural tissues. The hypothesis explains many of the clinical observations and research findings about the back pain patients. The hypothesis may help in a better understanding of chronic low back and neck pain patients, and in improved clinical management.

From the Full-Text Article:

Introduction

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Subclinical Neck Pain and the Effects of Cervical Manipulation on Elbow Joint Position Sense

By Frank M. Painter|March 10, 2017|Chiropractic Care, Neurology|

Subclinical Neck Pain and the Effects of Cervical Manipulation on Elbow Joint Position Sense

The Chiro.Org Blog

SOURCE: J Manipulative Physiol Ther. 2011 (Feb); 34 (2): 88–97

Heidi Haavik, PhD, BSc (Chiro),
Bernadette Murphy, PhD, DC

New Zealand College of Chiropractic,
Auckland, New Zealand.
heidi.haavik@nzchiro.co.nz

OBJECTIVE: The objectives of this study were to investigate whether elbow joint position sense (JPS) accuracy differs between participants with a history of subclinical neck pain (SCNP) and those with no neck complaints and to determine whether adjusting dysfunctional cervical segments in the SCNP group improves their JPS accuracy.

METHOD: Twenty-five SCNP participants and 18 control participants took part in this pre-post experimental study. Elbow JPS was measured using an electrogoniometer (MLTS700, ADInstruments, New Zealand). Participants reproduced a previously presented angle of the elbow joint with their neck in 4 positions: neutral, flexion, rotation, and combined flexion/rotation. The experimental intervention was high-velocity, low-amplitude cervical adjustments, and the control intervention was a 5-minute rest period. Group JPS data were compared, and it was assessed pre and post interventions using 3 parameters: absolute, constant, and variable errors.

RESULTS: At baseline, the control group was significantly better at reproducing the elbow target angle. The SCNP group’s absolute error significantly improved after the cervical adjustments when the participants’ heads were in the neutral and left-rotation positions. They displayed a significant overall decrease in variable error after the cervical adjustments. The control group participants’ JPS accuracy was worse after the control intervention, with a significant overall effect in absolute and variable errors. No other significant effects were detected.

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Effects of 12 Weeks of Chiropractic Care on Central Integration of Dual Somatosensory Input in Chronic Pain Patients

By Frank M. Painter|March 3, 2017|Neurology, Spinal Manipulation|

Effects of 12 Weeks of Chiropractic Care on Central Integration of Dual Somatosensory Input in Chronic Pain Patients: A Preliminary Study

The Chiro.Org Blog

SOURCE: J Manipulative Physiol Ther. 2017 (Feb 10) [Epub]

Heidi Haavik, PhD, BSc (Chiro), Imran Khan Niazi, PhD,
Kelly Holt, PhD, BSc (Chiro), Bernadette Murphy, PhD, DC

Centre for Chiropractic,
New Zealand College of Chiropractic,
Mount Wellington,
Auckland, New Zealand.

OBJECTIVE: The purpose of this preliminary study was to assess whether the dual somatosensory evoked potential (SEP) technique is sensitive enough to measure changes in cortical intrinsic inhibitory interactions in patients with chronic neck or upper extremity pain and, if so, whether changes are associated with changes in pain scores.

METHODS: The dual peripheral nerve stimulation SEP ratio technique was used for 6 subjects with a history of chronic neck or upper limb pain. SEPs were recorded after left or right median and ulnar nerve stimulation at the wrist. SEP ratios were calculated for the N9, N13, P14-18, N20-P25, and P22-N30 peak complexes from SEP amplitudes obtained from simultaneous median and ulnar stimulation divided by the arithmetic sum of SEPs obtained from individual stimulation of the median and ulnar nerves. Outcome measures of SEP ratios and subjects’ visual analog scale rating of pains were recorded at baseline, after a 2-week usual care control period, and after 12 weeks of multimodal chiropractic care (chiropractic spinal manipulation and 1 or more of the following: exercises, peripheral joint adjustments/manipulation, soft tissue therapy, and pain education).

RESULTS: A significant decrease in the median and ulnar to median plus ulnar ratio and the median and ulnar amplitude for the cortical P22-N30 SEP component was observed after 12 weeks of chiropractic care, with no changes after the control period. There was a significant decrease in visual analog scale scores (both for current pain and for pain last week).

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Manipulation of Dysfunctional Spinal Joints Affects Sensorimotor Integration in the Prefrontal Cortex

By Frank M. Painter|January 11, 2017|Chiropractic Care, Neurology|

Manipulation of Dysfunctional Spinal Joints Affects Sensorimotor Integration in the Prefrontal Cortex: A Brain Source Localization Study

The Chiro.Org Blog

SOURCE: Neural Plast. 2016 (Mar 7); 2016: 3704964 ~ FULL TEXT

Dina Lelic, Imran Khan Niazi, Kelly Holt, Mads Jochumsen, Kim Dremstrup, Paul Yielder, Bernadette Murphy, Asbjørn Mohr Drewes, and Heidi Haavik

Mech-Sense,
Department of Gastroenterology and Hepatology,
Aalborg University Hospital,
9000 Aalborg, Denmark

Objectives. Studies have shown decreases in N30 somatosensory evoked potential (SEP) peak amplitudes following spinal manipulation (SM) of dysfunctional segments in subclinical pain (SCP) populations. This study sought to verify these findings and to investigate underlying brain sources that may be responsible for such changes.

Methods. Nineteen subclinical pain volunteers attended two experimental sessions, SM and control in random order. SEPs from 62-channel EEG cap were recorded following median nerve stimulation (1000 stimuli at 2.3 Hz) before and after either intervention. Peak-to-peak amplitude and latency analysis was completed for different SEPs peak. Dipolar models of underlying brain sources were built by using the brain electrical source analysis. Two-way repeated measures ANOVA was used to assessed differences in N30 amplitudes, dipole locations, and dipole strengths.

Results. SM decreased the N30 amplitude by 16.9 ± 31.3% (P = 0.02), while no differences were seen following the control intervention (P = 0.4). Brain source modeling revealed a 4-source model but only the prefrontal source showed reduced activity by 20.2 ± 12.2% (P = 0.03) following SM.

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Impact of Spinal Manipulation on Cortical Drive to Upper and Lower Limb Muscles

By Frank M. Painter|January 5, 2017|Neurology|

Impact of Spinal Manipulation on Cortical Drive to Upper and Lower Limb Muscles

The Chiro.Org Blog

SOURCE: Brain Sci. 2016 (Dec 23); 7 (1). pii: E2 ~ FULL TEXT

Heidi Haavik, Imran Khan Niazi, Mads Jochumsen,
Diane Sherwin, Stanley Flavel, and Kemal S. Türker

Centre for Chiropractic Research,
New Zealand College of Chiropractic,
Auckland 1060, New Zealand.

This study investigates whether spinal manipulation leads to changes in motor control by measuring the recruitment pattern of motor units in both an upper and lower limb muscle and to see whether such changes may at least in part occur at the cortical level by recording movement related cortical potential (MRCP) amplitudes.

In experiment one, transcranial magnetic stimulation input-output (TMS I/O) curves for an upper limb muscle (abductor pollicus brevis; APB) were recorded, along with F waves before and after either spinal manipulation or a control intervention for the same subjects on two different days. During two separate days, lower limb TMS I/O curves and MRCPs were recorded from tibialis anterior muscle (TA) pre and post spinal manipulation. Dependent measures were compared with repeated measures analysis of variance, with p set at 0.05.

Spinal manipulation resulted in a 54.5% ± 93.1% increase in maximum motor evoked potential (MEPmax) for APB and a 44.6% ± 69.6% increase in MEPmax for TA. For the MRCP data following spinal manipulation there were significant difference for amplitude of early bereitschafts-potential (EBP), late bereitschafts potential (LBP) and also for peak negativity (PN).

The results of this study show that spinal manipulation leads to changes in cortical excitability, as measured by significantly larger MEPmax for TMS induced input-output curves for both an upper and lower limb muscle, and with larger amplitudes of MRCP component post manipulation. No changes in spinal measures (i.e., F wave amplitudes or persistence) were observed, and no changes were shown following the control condition. These results are consistent with previous findings that have suggested increases in strength following spinal manipulation were due to descending cortical drive and could not be explained by changes at the level of the spinal cord.

Spinal manipulation may therefore be indicated for the patients who have lost tonus of their muscle and/or are recovering from muscle degrading dysfunctions such as stroke or orthopaedic operations and/or may also be of interest to sports performers.

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