2015 Young Investigator Award Winner

Lohman, Chelsea; Gilbert, Kerry K.; Sobczak, Stéphane; Brismée, Jean-Michel; James, C. Roger; Day, Miles; Smith, Michael P.; Taylor, LesLee L; Dugailly, Pierre-Michel; Pendergrass, Timothy T; Sizer, P. S.

doi:10.1097/brs.0000000000000686

Cited by 23 publications

(6 citation statements)

References 13 publications

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“…Deep tendon reflexes (Biceps, Brachioradialis, Triceps) were classified as normal or abnormal (hypo- or hyperreflexia, or areflexia) 37 . Neurodynamic testing, evaluating neural pathology by stressing nervous tissues, was made using the Upper Limb Neural Tension Testing (ULNTT) with median nerve bias 38 . All tests were compared with the uninvolved extremity.…”

Section: Methodsmentioning

confidence: 99%

Neck-specific exercise may reduce radiating pain and signs of neurological deficits in chronic whiplash - Analyses of a randomized clinical trial

Ludvigsson

Peterson

Peolsson

2018

Sci Rep

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Up to 90% of people with neurological deficits following a whiplash injury do not recover and cervical muscle dysfunction is common. The aim of this multicentre, randomized controlled trial was to examine whether two versions of neck-specific exercise or prescription of physical activity (PPA) can improve radiating arm pain and clinical signs that can be associated with neurological deficits in people with chronic whiplash associated disorders (WAD). Participants with chronic WAD, arm symptoms and signs associated with neurological deficits (n = 171) were randomized to: 12 weeks of neck-specific exercise without (NSE) or with a behavioural approach (NSEB), or PPA. Pain/bothersomeness frequency, six measures of arm pain/paraesthesia (VAS scales), and four clinical neurological tests were evaluated after 3 months. The NSE group reported the lowest frequency and lowest levels of arm pain, the highest proportion of participants with at least 50% pain reduction and the highest proportion of normal arm muscle force. The NSEB group reported increased normal tendon reflexes. No improvements were recorded for the PPA group. Neck-specific exercise may improve arm pain and decrease signs of neurological deficits, but the addition of a behavioural approach does not seem to be of additional benefit.

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Section: Methodsmentioning

confidence: 99%

Neck-specific exercise may reduce radiating pain and signs of neurological deficits in chronic whiplash - Analyses of a randomized clinical trial

Ludvigsson

Peterson

Peolsson

2018

Sci Rep

View full text Add to dashboard Cite

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“…Deep tendon reflexes (biceps, brachioradial, triceps) were classified as normal or abnormal (hypo-or hyperreflexia, or areflexia) 35 . The Upper Limb Neural Tension test (ULNT) with median nerve bias (ULNT-A) was used to evaluate neural pathology by stressing nervous tissue 36 . The ULNT test was positive (provocative) when reproducing familiar arm pain and protective muscle tension occurred.…”

Section: Prescription Of Physical Activity (Ppa)mentioning

confidence: 99%

Neck-specific exercise for radiating pain and neurological deficits in chronic whiplash, a 1-year follow-up of a randomised clinical trial

Ludvigsson

Peterson

Peolsson

2020

Sci Rep

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Up to 90% of people with neurological deficits following whiplash injury report chronic symptoms. A recent unique study of neck-specific exercise showed positive results (post-intervention at 12 weeks), regarding arm pain and neurological deficits in people with chronic whiplash associated disorders (WAD). This 1-year follow-up of that randomised controlled study with assessor blinding aimed to examine whether neck-specific exercise with (NSEB) or without (NSE) a behavioural approach has longterm benefits over physical activity prescription (PPA) regarding arm pain and neurological deficits (n = 171). Interventions were: NSE, NSEB, or PPA. Follow-up of arm pain, paraesthesia bothersomeness (questionnaires) and clinical neurological tests were performed after 3, 6 and 12 months and analysed with Linear Mixed Models and General Estimating Equations. The NSE and/or NSEB groups reported significantly less pain and paraesthesia bothersomeness as well as higher odds of normal key muscle arm strength and of normal upper limb neural tension over the year (all p < 0.03), compared with PPA. In conclusion, results suggest that neck-specific exercise with or without a behavioural approach may have persisting long term benefits over PPA regarding arm pain and clinical signs associated with neurological deficits in chronic WAD. Whiplash-associated disorders (WAD) present a significant public health problem with an incidence of at least 300 per 100,000 1. After a whiplash injury resulting in neurological deficits (e.g. abnormal reflexes, reduced muscle strength and/or altered sensibility), the recovery rate is low. After 1 year, up to 90% still report pain and other symptoms 2-4. Individuals with neurological deficits, (WAD grade 3 5), also suffer more than those without 2,6. In clinical practice, antidepressants, analgesics/non-steroidal anti-inflammatory drugs and muscle relaxants are often prescribed despite the lack of evidence to support the use of either for radiating pain 7. Disc protrusions/ prolapses may cause neurological deficits in WAD. Furthermore, prolapses seem to progress over time in WAD 8. A brachial plexus traction injury 9 may be another cause. A recent MRI-study reports that morphological changes in the brachial plexus and median nerve can be found in people with chronic arm and neck pain following a whiplash injury, even without loss of reflexes or key muscle strength 10. Protective shoulder elevation, which may reduce brachial nerve tension 11 and thus also reduce arm pain, is common on the painful side. Altered muscle function 12 and difficulty in relaxing the trapezius muscle, as detected with electromyography/ultrasound, are reported in WAD 13. Dysfunction of predominantly the deep cervical muscles in WAD 14-16 could be another explanation for the increased activity of superficial muscles. Control of intersegmental motion, and thus stability, depends on the deep muscle layers 17. Ligaments may account for only 25% of the cervical stability 18 , and the deep muscles are thus of great importance in maint...

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“…It has to be taken into consideration that the degree of traction and/or compression may alter DTI measurements also in the periphery, for instance in the optic, ulnar, or sciatic nerves. Recently, cervical nerve root displacement and strain during upper limb neural tension testing has been confirmed in cadavers [27,28]. Thus, nerve root entrapment may alter quantitative DTI values not only by direct compression [29] but potentially also by nerve displacement and tension.…”

Section: Discussionmentioning

confidence: 98%