Original article
Is There Altered Activity of the Extensor Muscles in Chronic Mechanical Neck Pain? A Functional Magnetic Resonance Imaging Study

https://doi.org/10.1016/j.apmr.2010.12.021Get rights and content

Abstract

O'Leary S, Cagnie B, Reeve A, Jull G, Elliott JM. Is there altered activity of the extensor muscles in chronic mechanical neck pain? A functional magnetic resonance imaging study.

Objective

To compare the pattern of neck extensor muscle use in participants with chronic mechanical neck pain to that of healthy controls during 2 different extension exercises by use of muscle functional magnetic resonance imaging (mfMRI).

Design

Cross-sectional.

Setting

University laboratory.

Participants

Data recorded from subjects with chronic mechanical neck pain (n=12; 10 women, 2 men) were compared with previously recorded data from healthy subjects (n=11; 7 men, 4 women).

Interventions

Not applicable.

Main Outcome Measures

mfMRI measures of shifts in T2 relaxation were made for the multifidus, semispinalis cervicis, semispinalis capitis, and splenius capitis muscles, at C2-3, C5-6, and C7-T1 levels, prior and immediately after 2 different exercises: cervical extension in craniocervical neutral (CCN) and cervical extension in craniocervical extension. T2 shift values (difference between pre- and postexercise T2 relaxation values) for each muscle and exercise condition were used for analysis.

Results

While there were observed differences in differential activation of the extensor muscles in participants with mechanical neck pain compared with controls, these differences were only evident for the CCN exercise condition and were only observed for 3 out of the 7 muscle regions of interest during this exercise.

Conclusions

Results of this study suggest some alteration in the differential activation of the cervical extensors in patients with mechanical neck pain and indicate that further investigation of this muscle group in mechanical neck pain disorders is warranted.

Section snippets

Participants

Twelve volunteers with chronic mechanical neck pain participated in the study including, 10 women (mean age ± SD, 26.9±5.5y) and 2 men (mean age ± SD, 29.5±6.4y). The group mean age ± SD was 27.3±5.4 years and the group mean body mass index (BMI) ± SD was 23.1±5.4kg/m2. Participants were recruited via advertising throughout the local community. Data for the 12 participants with mechanical neck pain were compared with data recorded from 11 healthy participants from our previous study using

Results

Table 1 displays the T2 values at rest and after exercise calculated for all muscles and levels in the chronic mechanical neck pain and healthy control groups. There were no significant differences in group characteristics at baseline (age, P=0.26; BMI, P=0.74) or in T2 values at rest between the control and mechanical neck pain group, except for the SpC muscle at the C7-T1 level (P=0.003). To account for this, the T2 rest values for the SpC muscle at the C7-T1 level were included as a

Discussion

This study suggests some alteration in the differential activation of the cervical extensor muscles in patients with mechanical neck pain in response to a cervical extension exercise compared with healthy controls using mfMRI. The response, however, was dependent on the type of exercise performed. As indicated in figure 2, post hoc tests revealed that differences were only evident for the CCN exercise condition, and were only seen in 3 of the 7 muscle ROIs examined during the CCN exercise. When

Conclusions

In this study, mfMRI recordings of T2 shifts induced in cervical extensor muscles were compared between participants with chronic nontraumatic mechanical neck pain and healthy controls after the performance of exercises for the neck extensor muscles. Compared with the healthy controls, less activity was observed in the Mul/SCe and SpC muscles low in the cervical spine during the CCN exercise condition. This may represent a change in motor strategy of the cervical extensor muscles during the

References (40)

  • M.M. Panjabi et al.

    Critical load of the human cervical spine: an in vitro experimental study

    Clin Biomech (Bristol, Avon)

    (1998)
  • D. Le Pera et al.

    Inhibition of motor system excitability at cortical and spinal level by tonic muscle pain

    Clin Neurophysiol

    (2001)
  • K.B. Nilsen et al.

    Pain induced by low-grade stress in patients with fibromyalgia and chronic shoulder/neck pain, relation to surface electromyography

    Eur J Pain

    (2006)
  • D. Falla et al.

    Muscle fiber conduction velocity of the upper trapezius muscle during dynamic contraction of the upper limb in patients with chronic neck pain

    Pain

    (2005)
  • M. Amiri et al.

    Cervical musculoskeletal impairment in frequent intermittent headachePart 2: subjects with concurrent headache types

    Cephalalgia

    (2007)
  • C. Fernández-de-las-Peñas et al.

    Cross-sectional area of cervical multifidus muscle in females with chronic bilateral neck pain compared to controls

    J Orthop Sports Phys Ther

    (2008)
  • C. Fernández-de-Las-Peñas et al.

    Magnetic resonance imaging study of the morphometry of cervical extensor muscles in chronic tension-type headache

    Cephalalgia

    (2007)
  • G. Jull et al.

    Cervical musculoskeletal impairment in frequent intermittent headachePart 1: subjects with single headaches

    Cephalalgia

    (2007)
  • G. Jull et al.

    Whiplash, headache and neck pain: research based directions for physical therapies

    (2008)
  • Y. Uhlig et al.

    Fiber composition and fiber transformations in neck muscles of patients with dysfunction of the cervical spine

    J Orthop Res

    (1995)
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    No commercial party having a direct financial interest in the results of the research supporting this article has or will confer a benefit on the authors or on any organization with which the authors are associated.

    Published online April 29, 2011 at www.archives-pmr.org.

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