Trapped in the neutral zone: another symptom of whiplash-associated disorder?

Klein, G. N.; Mannion, Anne F.; Panjabi, Manohar M.; Dvořák, Jiří

doi:10.1007/s005860100248

Cited by 55 publications

(37 citation statements)

References 21 publications

(38 reference statements)

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“…15 Unlike RACSI, dysfunction of the active and neural subsystems is more appropriately described as an abnormality of movement rather than hypermobility 22,24 and can present indicators of instability in the absence of passive system (osseoligamentous) pathology. These indicators may include cervical pain, 25 aberrant cervical movements, 26 referred shoulder pain, 26,27 radiculopathy or myelopathy, 28 paraspinal muscle spasms, decreased cervical lordosis, 26 tinnitus, 29 pain during sustained postures, 26 complaints of "catching" or "locking," 16,25,30,31 and altered range of motion. 16,25,30,31 In addition, a history of major trauma or repetitive microtrauma may predate report of symptoms.…”

mentioning

confidence: 99%

Identifiers Suggestive of Clinical Cervical Spine Instability: A Delphi Study of Physical Therapists

et al. 2005

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Background and Purpose Clinical cervical spine instability (CCSI) is controversial and difficult to diagnose. Within the literature, no clinical or diagnostic tests that yield valid and reliable results have been described to differentially diagnose this condition. The purpose of this study was to attempt to obtain consensus on symptoms and physical examination findings that are associated with CCSI. Subjects One hundred seventy-two physical therapists who were Orthopaedic Certified Specialists (OCS) or Fellows of the American Academy of Orthopaedic Manual Physical Therapists (FAAOMPT) participated in the survey. Methods This study was a 3-round Delphi survey designed to obtain consensual symptoms and physical examination findings for CCSI. Results The symptoms that reached the highest consensus among respondents were “intolerance to prolonged static postures,” “fatigue and inability to hold head up,” “better with external support, including hands or collar,” “frequent need for self-manipulation,” “feeling of instability, shaking, or lack of control,” “frequent episodes of acute attacks,” and “sharp pain, possibly with sudden movements.” The physical examination findings related to cervical instability that reached the highest consensus among respondents included “poor coordination/neuromuscular control, including poor recruitment and dissociation of cervical segments with movement,” “abnormal joint play,” “motion that is not smooth throughout range (of motion), including segmental hinging, pivoting, or fulcruming,” and “aberrant movement.” Discussion and Conclusion The Delphi method is useful in situations where clinical judgments are encountered but empirical evidence to provide evidence-based decision making does not exist. Findings of this study may provide beneficial clinical information, specifically when the identifiers are clustered together, because no set of clinical examination and symptom standards for CCSI currently exists. Diagnosis of CCSI is challenging; therefore, appropriate clinical reasoning is required for distinctive physical therapy assessment using pertinent symptoms and physical examination findings.

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confidence: 99%

Identifiers Suggestive of Clinical Cervical Spine Instability: A Delphi Study of Physical Therapists

et al. 2005

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“…There are limited and very variable findings of thoracic muscle dysfunction (activation) in WAD with studies investigating a relatively small number of muscles: sternocleidomastoid [12,49,56]; serratus anterior [45]; middle and lower fibres of trapezius [45,54]. Although it is difficult to derive meaningful conclusions with respect to serratus anterior and trapezius, there is evidence supporting changes in sternocleidomastoid muscle activation with heightened levels of activation during a task of cranio-cervical flexion; this increase in sternocleidomastoid activity however, was not seen during neck rotation [49]. There appears to be a positive relationship between sternocleidomastoid activation and higher levels of pain severity, with participants with CWADII/III and moderate to severe levels of disability demonstrating increased levels of sternocleidomastoid activation of between 27-47% [12,56].…”

Section: Controlmentioning

confidence: 99%

“…There is unequivocal evidence of altered function of muscles following whiplash injury [66], however this evidence is largely limited to cervical muscles, with this review identifying just three muscles with insertions to the thoracic region, sternocleidomastoid [12,49,56]; serratus anterior [45]; middle and lower fibres of trapezius [45,54]. Although it is difficult to derive meaningful conclusions with so few muscles investigated and the quality of the evidence, the observed positive relationship between sternocleidomastoid activation and pain severity, and evidence across all stages post injury [12,49,56] supports the need for further research into altered activation of cervico-thoracic and thoracic muscles, ideally involving functional spinal movements; something that is now feasible with advances in technology, including high density EMG.…”

Section: Summary Of Evidencementioning

confidence: 99%

Thoracic dysfunction in whiplash associated disorders: a systematic review

et al. 2017

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“…On the other hand, the assessment of head and cervical range of motion (ROM) is an important part of the clinical evaluation of patients reporting several disturbances. Indeed, head and neck motion often accompanies the movements of other body districts, such as mouth opening and closing.7,8,10,11) Alterations in head and neck movements have been reported not only in subjects with spine pathologies, 21,22) but also in patients with temporomandibular disorders. 23,24) However, from an assessment of published reliable studies for III.…”

Section: Introductionmentioning

confidence: 99%

A novel system to measure head and trunk posture during daily activities

Kawahara

Hirano

Saito

et al. 2005

J. Jpn. Soc. Stomatognath. Funct.

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Although the posture and jaw function has been speculated to relate to each other, little scientific evidence is presented in humans due to lack of recording method. To clarify that, we designed and tested a standard noninvasive, accurate, and repeatable clinical method to record head and trunk posture for hours in freely behaving humans. The system was evaluated by measuring the following tasks successively conducted by five subjects: 1) reading a sheet of text (vertical and horizontal documents) while sitting on a chair, 2) sitting on a chair (in an upright position and freely), 3) walking slowly (in an upright position and freely) in a room, 4) tilting the head (anterior and posterior directions and right and left directions) and 5) turning the head (right and left) while sitting on a chair.Characteristic features were observed in the volunteers performing the reading and head movement tasks. While reading text of vertically lined letters, head movement was in the antero-posterior direction along with the direction of the letters, however, movement was limited when the volunteers read text of horizontally lined letters. During head tilting and turning, head and trunk movement was in the same direction for pitch but in the opposite direction for roll. In conclusion, this system accurately records head and trunk posture individually in human subjects; it is easily operated for clinical use and small enough to sit on the patient's trunk for hours of recording. A potential problem may be its battery consumption; however, current technology may overcome this.

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Trapped in the neutral zone: another symptom of whiplash-associated disorder?

Cited by 55 publications

References 21 publications

Identifiers Suggestive of Clinical Cervical Spine Instability: A Delphi Study of Physical Therapists

Identifiers Suggestive of Clinical Cervical Spine Instability: A Delphi Study of Physical Therapists

Thoracic dysfunction in whiplash associated disorders: a systematic review

A novel system to measure head and trunk posture during daily activities

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