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The slow and fast components of postural sway in chronic neck pain
Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Physiotherapy. (Centrum för belastningsskadeforskning)
Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Physiotherapy. (Centrum för belastningsskadeforskning, Högskolan i Gävle)ORCID iD: 0000-0001-7543-4397
Högskolan i Gävle. (Centrum för belastningsskadeforskning)
2011 (English)In: Manual Therapy, ISSN 1356-689X, E-ISSN 1532-2769, Vol. 16, no 3, 273-278 p.Article in journal (Refereed) Published
Abstract [en]

Objective: To evaluate the slow and fast components of postural control in quiet stance in subjects with chronic neck pain, associations between postural sway and self-rated characteristics and to study the impact of anthropometrics on postural sway.

Design: A single-blinded cross-sectional study including two separate data collections.

Subjects: Sample 1: Persons with chronic non-specific neck pain (NS, n=24), whiplash associated disorders (WAD, n=21). Healthy subjects were controls (CON, n=21). Sample 2: Women only, 98 NS and 32 CON subjects.

Methods: Subject performed a quiet stance test with eyes closed on a force platform while the center of pressure (CoP) trajectory was measured. Sample 1 was tested on a firm surface for 30 seconds, while sample 2 was tested on both firm and foam surfaces for 190 seconds. The CoP signal was decomposed into the slow and fast components and the magnitude of these signals were calculated. Anthropometrics were included as covariate in the analysis of group differences if correlated with postural sway variables. Group differences in the sway variables were evaluated, as well as association between postural sway and self-ratings of symptoms, functioning and kinesiophobia.

Results: Increased magnitude of the slow sway component was found for both neck pain groups. Increasing age was associated with increased magnitude of the fast component. Surface conditions had no effect on group difference. For WAD, associations were found between the magnitude of the slow component and self-rated characteristics related to physical functioning, sensory alterations and psychosocial functioning. For NS, concurrent low back pain was associated with increased postural sway.

Conclusion: Postural control can be altered in chronic neck pain. This effect was present only for the slow sway component, which implies aberration in sensory feedback or processing of sensory information. Associations between postural sway and self-rated characteristics in WAD support the clinical validity of postural control assessment in this group. Increased postural sway found in NS with concurrent low back pain suggests an important role of generalised spinal pain on postural control alterations.

Place, publisher, year, edition, pages
2011. Vol. 16, no 3, 273-278 p.
Keyword [en]
Neck pain, Whiplash injuries, Low back pain, Musculoskeletal disorders, Postural control
National Category
Physiotherapy
Research subject
Rehabilitation Medicine
Identifiers
URN: urn:nbn:se:umu:diva-22672DOI: 10.1016/j.math.2010.11.008PubMedID: 21185768OAI: oai:DiVA.org:umu-22672DiVA: diva2:217579
Note

Manuscript included in medical doctorial thesis

Available from: 2009-05-14 Created: 2009-05-14 Last updated: 2017-12-13Bibliographically approved
In thesis
1. Sensorimotor function in chronic neck pain: objective assessments and a novel method for neck coordination exercise
Open this publication in new window or tab >>Sensorimotor function in chronic neck pain: objective assessments and a novel method for neck coordination exercise
2009 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

Chronic neck pain is a widespread problem that causes individual suffering as well as large costs for the society. The knowledge about the pathophysiology is poor and therefore specific diagnosis and causal treatment are rare. Important knowledge for characterization of the disorders has been gained from research on sensorimotor functions in people with neck pain. Moreover, rehabilitation regimes including sensorimotor exercises indicate promising results.

The main objectives of this thesis were to extend the knowledge on sensorimotor dysfunctions in chronic neck pain, and to develop a new exercise method for improving sensorimotor functions of the neck. The studies focused on aspects of postural control and movements of the arm and neck. These are vital functions for many activities of daily living. People with chronic (>3 months) neck pain were compared to healthy controls (CON). Neck pain related to trauma was referred to as whiplash associated disorders (WAD), while neck pain without association to trauma was referred to as non-specific (NS).

Arm-functioning was assessed in a pointing task. WAD and NS had reduced pointing precision compared to CON. The reduced precision was associated with self-rated difficulties performing neck movements, physical functioning, and in WAD, also pain and balance disturbances.

Postural control was assessed in quiet standing on a force platform without vision. The center of pressure signal was decomposed into it’s slow and fast components. WAD and NS were compared to CON. The results revealed an effect of age on the magnitude of the fast sway component, but no effect of group. The magnitude of the slow component was elevated in both WAD and NS. This increase was associated with self-rated balance disturbance, arm-functioning, difficulties to run and sensory alterations in WAD, while in NS, the increase in the slow sway component was associated with concurrent low back pain.

Neck movements were assessed in a cervical axial rotation test with maximal speed. In total 8 variables representing basic kinematics, including variables reflecting movement smoothness and conjunct motions were calculated. NS were compared to CON. Linear discriminant modelling indicated Peak Speed and conjunct motions as significant classification variables that together had a sensitivity of 76.3% and specificity of 77.6%. Retest reliability was good for Peak Speed but poor for the measure of conjunct motions. Peak Speed was slower in NS compared to CON, and even slower in a sub-group of NS with concurrent low back pain. Reduced Peak Speed was associated with self-rated difficulties performing neck movements, car driving, running, sleeping disturbances and pain.

The clinical applicability of a novel method for neck coordination exercise was assessed in a pilot study on persons with NS. The results supported the applicability and indicated positive effects of the exercise: reduced postural sway in quiet standing and increased smoothness in cervical rotations. Indications on improvement in self-rated disability and fear of movement were seen at six months follow up.

In conclusion, sensorimotor functions can be altered in chronic neck pain, particularly in neck disorders with concurrent low back pain and WAD. The discriminative ability and clinical validity displayed in pointing precision, postural sway and cervical axial rotation speed imply that such tests can be valuable tools in the assessment of chronic neck pain patients, and for selecting and evaluating treatment interventions. Indications of improvements seen in the pilot-study support a future RCT.

Place, publisher, year, edition, pages
Umeå: Institutionen för samhällsmedicin och rehabilitering, 2009. 88 p.
Series
Umeå University medical dissertations, ISSN 0346-6612 ; 1273
Keyword
Neck pain, Whiplash, Sensorimotor, Motor Control, Motor Learning, Neck Coordination Exercise, Postural Control, Cervical kinematics, Reliability.
National Category
Public Health, Global Health, Social Medicine and Epidemiology
Research subject
Rehabilitation Medicine
Identifiers
urn:nbn:se:umu:diva-22674 (URN)978-91-7264-809-8 (ISBN)
Distributor:
Sjukgymnastik, 901 87, Umeå
Public defence
2009-06-12, Aulan Vårdvetarhuset, Inst för samhällsmedicin och rehabilitering, Vårdvetarhuset, Umeå universitet, 901 87 Umeå, Umeå, 13:00 (English)
Opponent
Supervisors
Available from: 2009-05-20 Created: 2009-05-14 Last updated: 2015-11-13Bibliographically approved

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