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

Abstract

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...

Morphology and composition of the ventral neck muscles in individuals with chronic whiplash related disorders compared to matched healthy controls: a cross-sectional case–control study

“…Thirty-one people (17 women and 14 men, with a mean age of 40 years (SD 12.6)) with chronic WAD (≥ 6 month duration) with a mean symptom duration of 20 months (SD 9) who were right-handed and with right-sided dominant symptoms (right-side only pain or bilateral neck pain worse on the right side) and signs of WAD grade 2 (clinical musculoskeletal findings emanating from the neck) and 3 (as grade 2 but with additional neurological findings) [ 33 ], were consecutively recruited at baseline from an ongoing randomised controlled study [ 16 , 34 , 35 ] after oral and written informed consent (Table 1 ). Right-handed patients with dominant right-sided problems were chosen so that handedness would not imply a bias in the analysis.…”

“…Inclusion criteria for the WAD group were persistent neck problems ≥ 6 months but ≤ 3 years after a whiplash injury [ 33 ]; age 18–63 years; neck pain > 20 mm on a Visual Analogue Scale; and > 20% on the NDI [ 16 , 34 , 35 ].…”

“…Exclusion criteria were neck pain that caused a > 1 month absence from work in the year prior to the WAD trauma, known or suspected serious physical pathology, surgery on the cervical spine, signs of traumatic brain injury at the time of whiplash injury, diseases or other injuries that might prevent full participation in the study, generalised or more dominant pain elsewhere in the body and insufficient knowledge of the Swedish language (inability to answer the questionnaires and to understand instructions) [ 16 , 34 , 35 ]. Additional exclusion criteria in the present study were contraindications for MRI such as shunt, pacemaker, metal in the body, claustrophobia, body mass index (BMI) > 35 (due to the space within the magnet) and pregnancy [ 10 , 26 , 28 ].…”

Neurological outcomes after surgery and postoperative rehabilitation for cervical radiculopathy due to disc disease: a 2-year-follow-up of a randomized clinical trial

“…Evidence-based rehabilitation programmes have been suggested to improve patients' physical function and health after a prolonged period of pain and reduced physical activity preceding cervical spine surgery. Neck-speci c exercises are the single most evidence-based treatment in other types of neck pain disorders [7][8][9] , and are reported to improve neurological function in individuals with moderate/severe chronic whiplash associated disorders (WAD) 8,9 . Neck-speci c exercises have been shown to be tolerated postoperatively by patients with CR without any harm [10][11][12] , but have not been investigated to any signi cant extent.…”

Entrenamiento centrado en la musculatura cervical profunda en prevención del dolor de cuello

“…De manera que encontramos intervenciones en este sentido (De Campos et al, 2018;Lin et al, 2018;Villanueva et al, 2020). Sin embargo, cuando se centra en la musculatura cervical (Ludvigsson et al, 2020), se ve que las intervenciones suelen enfocarse sobre la musculatura superficial cervical (Alpayci & Ilter, 2017;De Campos et al, 2018;Murray et al, 2015), olvidando la musculatura profunda. Pues el estudio sobre esta última es escaso, mucho menor, especialmente cuando nos referimos al campo de la actividad física y el deporte.…”