Diagnosis of Cervical Disorders: Exploring a Mechanistic Approach
Article Outline
Abstract
A current direction in research into cervical disorders is towards investigating the value of a “mechanisms” approach to diagnosis. This commentary reviews some of the research investigating the pathophysiological features of neck pain, in terms of changes in the articular, muscle, sensorimotor and sensory systems. Changes have been found in patterns of cervical muscle activation in cognitive, functional and automatic tasks in neck pain patients. In addition, some patients have been found to have disturbances in features of the postural control system in association with their neck disorders. Altered responses to sensory testing have also been determined, particularly in some patients with whiplash-induced neck pain. The value of this mechanisms approach to diagnosis is in its ability to direct specific treatment strategies to address the precise impairments presenting in the individual neck pain patient. It supports the evidence that indicates that a multimodal approach to management is likely to be most efficacious.
Key words: cervical spine , diagnosis , classification , impairment
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References
- . Neck pain . In: Crombie I editors. Epidemiology of Pain . Seattle: IASP Press; 1999;p. 235–255
- . The Saskatchewan health and back pain survey: the prevalence of neck pain and related disability in Saskatchewan adults . Spine . 1998;23:1689–1698
- The prevalence of neck pain in a university community . Phys Ther . 1994;74:S26
- . The factors associated with neck pain and its related disability in the Saskatchewan population . Spine . 2000;25:1109–1117
- . Outcomes of disabling cervical spine disorders in compensation injuries. A prospective comparison to tertiary rehabilitation response for chronic lumbar spinal disorders . Spine . 1999;24:178–183
- Neck pain: a long-term follow-up of 205 patients . Spine . 1987;12:1–5
- Australian Acute Musculoskeletal Pain Guidelines. Evidence Based Management of Acute Musculoskeletal Pain . Brisbane: Australian Academic Press; 2003;
- Cervical range of motion discriminates between asymptomatic and whiplash subjects . Spine . 2001;26:2090–2094
- . In: Cervical Musculoskeletal Impairment in Frequent Intermittent Headache . Brisbane: School of Health and Rehabilitation Sciences, The University of Queensland; 2004;p. 273
- . Neck mobility in different headache disorders . Headache . 1997;37:6–11
- Pain-provocation tests for C0–4 as a tool in the diagnosis of cervicogenic headache . Cephalalgia . 1999;19:436
- . The accuracy of manual diagnosis for cervical zygapophysial joint pain syndromes . Med J Aust . 1988;148:233–236
- Inter-examiner reliability to detect painful upper cervical joint dysfunction . Aust J Physiother . 1997;43:125–129
- Third occipital nerve headache: a prevalence study . J Neurol Neurosurg Psychiatry . 1994;57:1187–1190
- Musculoskeletal abnormalities in chronic headache: a controlled comparison of headache diagnostic groups . Headache . 1999;39:21–27
- . Validity of five common manual neck pain provoking tests . Scand J Rehabil Med . 1995;27:131–136
- Manual therapy, physical therapy or continued care by a general practitioner for patients with neck pain . Ann Intern Med . 2002;136:713–722
- A randomized controlled trial of exercise and manipulative therapy for cervicogenic headache . Spine . 2002;27:1835–1843
- Early intervention in whiplash associated disorders: a comparison of two treatment protocols . Spine . 2000;25:1782–1787
- Active intervention in patients with whiplash-associated disorders improves long-term prognosis: a randomized controlled clinical trial . Spine . 2003;28:2491–2498
- . Cervical mobilisation: concurrent effects on pain, motor function and sympathetic nervous system activity . Man Ther . 2001;6:72–81
- . The initial effects of a cervical spine manipulative physiotherapy treatment on the pain and dysfunction of lateral epicondylalgia . Pain . 1996;68:69–74
- A Cochrane review of manipulation and mobilization for mechanical neck disorders . Spine . 2004;29:1541–1548
- Development of motor system dysfunction following whiplash injury . Pain . 2003;103:65–73
- Neuromuscular efficiency of the sternocleidomastoid and anterior scalene muscles in patients with chronic neck pain . Dis Rehabil . 2004;26:712–717
- Myoelectric manifestations of sternocleidomastoid and anterior scalene muscle fatigue in chronic neck pain patients . Clin Neurophysiol . 2003;114:488–495
- . Electromyographic analysis of neck muscle fatigue in patients with osteoarthritis of the cervical spine . Spine . 1994;19:502–506
- . Feedforward activity of the cervical flexor muscles during voluntary arm movements is delayed in chronic neck pain . Exp Brain Res . 2004;157:43–48
- . Patients with neck pain demonstrate reduced electromyographic activity of the deep cervical flexor muscles during performance of the craniocervical flexion test . Spine . 2004;29:2108–2114
- . Impairment in the cervical flexors: a comparison of whiplash and insidious onset neck pain patients . Man Ther . 2004;9:89–94
- . Deep cervical neck flexor dysfunction in whiplash . J Musculoskelet Pain . 2000;8:143–154
- . Chronic neck pain patients demonstrate altered patterns of muscle activation during performance of a functional upper limb task . Spine . 2004;29:1436–1440
- Cervical muscle dysfunction in chronic whiplash associated disorder grade 11 (WAD-II) . Spine . 2000;25:1938–1943
- A therapeutic exercise approach for cervical disorders . In: Boyling J , Jull G editor. Grieves' Modern Manual Therapy . 3rd edition. London: Elsevier; 2004; (in press).
- . Chronic neck pain, standing balance, and suboccipital muscle atrophy - a pilot study . J Manipulative Physiol Ther . 1997;20:24–29
- . A study of five cervico-cephalic relocation tests in three subject groups . Clin Rehabil . 2003;17:768–774
- . Dizziness and unsteadiness following whiplash injury - characteristic features and relationship to cervical joint position error . J Rehabil Med . 2003;35:36–43
- Is signal analysis important for measuring standing balance in chronic whiplash? . Gait Posture . 2004; (in press).
- . Smooth pursuit neck torsion test in whiplash associated disorders - relationship to self reports of neck pain and disability, dizziness and anxiety . J Rehabil Med . 2004; (in press).
- Changes in cervicocephalic kinesthesia after a proprioceptive rehabilitation program in patients with neck pain: a randomized controlled study . Arch Phys Med Rehabil . 1994;75:895–899
- . The effect of a rehabilitation program on head repositioning accuracy and reported levels of pain in chronic neck pain subjects . J Whiplash and Related Disorders . 2002;1:99–112
- . Effect of acupuncture, cervical manipulation and NSAID therapy on dizziness and impaired head repositioning of suspected cervical origin: a pilot study . Man Ther . 2000;5:151–157
- Postural and symptomatic improvement after physiotherapy in patients with dizziness of suspected cervical origin . Scand J Rehabil Med . 1996;77:874–882
- . Predictors of responsiveness to physiotherapy management of cervicogenic headache . Cephalalgia . 2004; (in press).
- Pressure pain thresholds in chronic whiplash associated disorder: further evidence of altered central pain processing . J Musculoskelet Pain . 2002;10:69–81
- . A psychophysical investigation of pain processing mechanisms in chronic neck pain . Clin J Pain . 2004; (in press).
- Sensory hypersensitivity occurs soon after whiplash injury and is associated with poor recovery . Pain . 2003;104:509–517
PII: S1013-7025(09)70043-0
doi:10.1016/S1013-7025(09)70043-0
© 2004 Elsevier. Published by Elsevier Inc. All rights reserved.
