Original articleUltrasonographic analysis of dorsal neck muscles thickness changes induced by isometric contraction of shoulder muscles: A comparison between patients with chronic neck pain and healthy controls
Introduction
Neck pain is considered as a common musculoskeletal problems of office workers which impose socio-economical burden to the society (Alshagga et al., 2013). Neck pain is commonly associated with various sensorimotor deficits (Treleaven, 2008). Weakness of cervical muscles is represented in individuals with chronic neck pain (CNP) (Rezasoltani et al., 2002, Ylinen et al., 2004). Altered muscle activity is also recognized as a common feature in such individuals (Johnston et al., 2008). It is suggested that muscle impairment may be a potential reason for long standing disability, seen in individuals suffering from chronic neck pain (Peolsson et al., 2013). Delayed muscle activity with increased or decreased muscular activation may lead to modification of normal activity pattern (Falla et al., 2004). Therefore, study of faulty movement pattern in individuals with neck pain (Falla et al., 2004, Peolsson et al., 2012) may shed light on this area of research.
Needle and surface EMG are popular techniques for evaluation of the muscle activity (Falla et al., 2003, Falla et al., 2004, Falla et al., 2007). However, the invasive nature of needle EMG (Falla et al., 2007) and the potential cross talk of surface EMG during data collection, reduces their popularity for evaluation of dorsal neck muscles activity (Stokes et al., 2003). Ultrasonography is a non-invasive method for evaluation of real-time activity of muscles and a reliable method for assessment of dorsal neck muscles activity both in healthy individuals and patients with CNP (Kristjansson, 2004, Stokes et al., 2005, Kiesel et al., 2007). Therefore, during the last decade, it has been increasingly used in investigating the neck muscle function (Kristjansson, 2004, Cagnie et al., 2009, Rezasoltani et al., 2010, Rezasoltani et al., 2012, Rahnama et al., 2014).
Dorsal neck muscles play a critical role in establishing the optimal mechanical support during activities of daily living. Upper extremity tasks are major components of daily activities which impose various loads to the cervical spine (Anderson et al., 2005, Peolsson et al., 2013). Performing upper extremity tasks in different directions may have different loading effects on cervical spine (Takasaki et al., 2009). Literature indicates functional impairment of dorsal neck muscles during movements of upper extremities in patients with CNP (Peolsson et al., 2013). Accordingly, altered muscle activity in patients with CNP may contribute to changes in loading to cervical spine, which may lead to pain in cervical area. This may produce more devastating effects particularly when tasks are done forcefully like many activities of daily livings. The reason of such devastating effect is that each of axioscapular and cervical muscles originate from and terminate to different landmarks causing diverse moment arms and actions. The cervical spine is stabilized by aforementioned muscles during weight bearing activities. Therefore, altered pattern of their activities may cause altered amount of loads imposed to cervical spine. Consequently, it may cause pain in cervical area (Takasaki et al., 2009).
Despite the importance of the integrated activity of dorsal neck muscles in health of cervical spine, the extent which muscle activity changes in individuals with CNP while performing upper extremity tasks, is not well understood. Therefore, the aim in current study is to, firstly, evaluate effects of isometric contraction of arm muscles in different force directions on dorsal neck muscles' thickness in patients with CNP and healthy participants and, secondly, to compare the effect of each force direction on dorsal neck muscles' thickness in such individuals. Based on the previous literature (Takasaki et al., 2009, Peolsson et al., 2013), it is hypothesized that: 1) compared to healthy individuals, patients with chronic neck pain show greater changes in dorsal neck muscles' thickness during isometric contractions of shoulder muscles and 2) dorsal neck muscles' thickness changes in each movement direction.
Section snippets
Participants
A convenience sample of seventeen individuals with non-specific CNP and 20 comparable healthy controls in terms of age, height and weight were participated in this study. All participants were right handed males. Patients with CNP had pain with intensity of minimum 3 on Visual Analog Scale (VAS) for at least 3 months prior to the current study. The controls were pain free at the time of the participation while they did not report any history of neck pain. Participants were not included if they
Statistica analysis
Statistical analyses were carried out using SPSS software for Windows, version 16.0. The Shapiro–Wilk test was used for normality evaluation. To evaluate the main and interaction effects of variables, a three way repeated measures of ANOVA with force (0–50% and 0–100%), direction (6 movement directions of the shoulder joint) and muscle (5 dorsal neck muscles) as 3 within factors and group (CNP and controls) as the between factor, was utilized. The level of significance was set at p < 0.05.
Population and baseline characteristics
A total of 400 volunteers completed the announcement questionnaire and showed their interest to participate in the study. Of these 20 healthy participants (age 27 ± 4.37 years, range 19–35; height 1.77 ± 0.04 m, range 1.68–1.85; weight 72.85 ± 6.46 kg, range 58–85; BMI 23.28 ± 1.67 kg/m2) and 17 patients with CNP (age 29 ± 5.50 years, range 19–35; height 1.76 ± 0.06 m, range 1.60–1.86; weight 73.23 ± 8.29 kg, range 55–85; BMI 23.46 ± 1.67 kg/m2; Pain intensity 5.18 ± 1.81) were entered the
Between groups comparison of dorsal neck muscles
This study demonstrated that individuals with chronic neck pain showed different pattern of thickness changes of deep dorsal neck muscles compared with healthy participants. Semispinalis Cervicis muscle in individuals with neck pain undertook greater thickness changes compared with Multifidus muscle while Semispinalis Cervicis muscle demonstrated smaller thickness changes in comparison to Multifidus muscle in healthy participants. Semispinalis cervices muscle is a long thoraco-cervical muscle
Conclusion
The Splenius Capitis muscle showed the greatest change in muscle thickness during isometric contraction of shoulder muscles. Individuals with CNP and healthy individuals differ in terms of thickness changes of deep muscles including Semispinalis Cervicis and Multifidus muscles but similar for superficial muscles. Isometric abduction of shoulder muscles imposed the greatest load on cervical spine, and consequently induced the biggest changes in neck dorsal muscles' thickness.
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