Effect of strength training in addition to general exercise in the rehabilitation of patients with non-specific neck pain. A randomized clinical trial.

BACKGROUND: The optimal type of exercise protocol in the physical rehabilitation of non-specific neck pain has not yet been established. Furthermore, the role of fear-avoidance belief in the maintenance of pain and disability has been highlighted. Research indicates that exercise may be a means to reduce fear-avoidance belief, but evidence is scarce. AIM: To compare the effect of two different exercise programs on pain, strength and fear-avoidance belief. DESIGN: Randomized clinical trial. SETTING: A specialized outpatient hospital clinic in Denmark. POPULATION: Twenty-three men and 60 women on sick leave due to non-specific neck pain. METHODS: Participants were randomized to either general physical activity (GPA group) or GPA and additional strength training of the neck and shoulder (SST group). The primary outcome was pain intensity. Secondary outcomes were muscle strength of the neck and shoulder and fear-avoidance belief. RESULTS: Pain was significantly reduced within groups with a median of -1 (IQR: -3 to 0, P<0.001) in the SST group and -1 (IQR: -4 to 1, P=0.046) in the GPA group. The difference between groups was not significant. Changes in strength did not differ between groups. Both groups experienced significant increases in neck flexion strength of 14.7 N (IQR: -1 to 28.4, P=0. 001) in the SST group and 6.9 N (IQR: -4.9 to18.6, P=0.014) in the GPA group. Furthermore, the SST group achieved an increase of 18.6 N (IQR: -2.6 to 69.7, P=0.005) in neck extension. Fear-avoidance beliefs improved with 6 (IQR: 3 to 12, P<0.001) in the SST group, while the GPA group improved with 3 (IQR: 0 to 8, P=0.004). This between-group difference was significant (P=0.046). CONCLUSION AND REHABILITATION IMPACT: This study indicates that in rehabilitation of subjects severely disabled by non-specific neck pain, there is no additional improvement on pain or muscle strength when neck exercises are given as a home-based program with a minimum of supervision. However, strength training of the painful muscles seems to be effective in decreasing fear-avoidance beliefs.

[Gender differences of post-traumatic headache and other post-commotio symptoms. A follow-up study after a period of 9-12 months]. / Kønsforskelle ved posttraumatisk hovedpine og andre postkommotionelle symptomer. Et 9-12-måneders followup-studie.

BACKGROUND AND AIM: Symptoms following head injury are common. The aim of the present study was to estimate the association between age, sex, unconsciousness in connection with the trauma, type of accident, headache before the trauma, fractures, and post-traumatic headache, or other symptoms. MATERIALS AND METHODS: The patients studied were aged 18-60 years and had been under observation at the University Hospital of Aarhus in the period August 1986 to August 1987, because of concussion or suspected concussion. The records were examined, and the patients were interviewed by telephone 9-12 months after the trauma. RESULTS: Out of 233 patients, 168 were interviewed (72%). Of these, 57% had symptoms and 26% had received treatment. Two per cent were still on sick leave. Sixty-four patients (38%) complained of post-traumatic headache, whereas 31% had symptoms without post-traumatic headache, most often difficulties with memory or concentration. In a logistic regression model we estimated the adjusted odds ratio of having post-traumatic headache in women compared with men to 2.6 (1.2-5.8), whereas the corresponding OR for other symptoms was 1.0 (0.4-2.7). CONCLUSION: We found that women had an increased risk of post-traumatic headache, but not other post-traumatic symptoms, in comparison with men.

[Increased p-homocysteine--a risk factor for thrombosis]. / Forhøjet p-homocystein--en risikofaktor for trombose.

In the healthy population P-homocysteine increases with age and the level is higher in men aged 30-60 years as compared to women of the same age group. Most often, elevated P-homocysteine is caused by genetic defects, vitamin deficiency (folic acid, B6- and B12-vitamin) or renal failure. Based on retrospective as well as prospective studies, it can be concluded that elevated P-homocysteine is a risk factor for arterial as well as venous thrombosis. Severely elevated P-homocysteine is capable of causing premature arteriosclerosis, whereas slightly elevated levels may also be involved. A slightly positive correlation has been found between P-homocysteine on one hand, and smoking, blood pressure and cholesterol on the other, whereas physical activity is slightly negatively correlated to P-homocysteine. Altered function of endothelial cells and coagulation has been demonstrated in relation to elevated P-homocysteine, but the pathogenetic mechanisms have not been fully elucidated. Usually, an elevated P-homocysteine is normalised by folic acid supplementation, although additional treatment with vitamin B6 may be required. Presumably, the risk of thrombosis is thereby reduced, but future controlled studies may reveal whether this holds true.

Detection of a novel deletion in the cystathionine beta-synthase (CBS) gene using an improved genomic DNA based method.

We elucidated the intron-exon boundaries of the 15 coding exons of the human cystathionine beta-synthase (CBS) gene in order to establish an improved method based on PCR and direct sequencing for detection of CBS mutations. Using this method we identified the pathogenic mutations in two Danish siblings with CBS deficiency. Patients were compound heterozygotes: we detected the 833T-->C mutation and a novel 22 bp deletion of exon 4 (493-514del) that introduces a frameshift and a stop codon immediately after the deletion. The deletion resulted in no detectable mRNA from this allele, as assessed by sequencing of cDNA. The established method represents an improvement of the existing method based on sequencing of cDNA because it permits the detection of mutations within the entire coding region of the CBS gene from a peripheral blood sample, including splice mutations and mutations resulting in the lack or a reduced amount of transcript.

The influence of sex and pre-traumatic headache on the incidence and severity of headache after head injury.

Pre- and post-traumatic headache of 168 individuals aged 18-60 years was registered 9-12 months after a head trauma. Headache before the trauma was reported by 39.9%, women being in the majority. After the trauma 64.3% were suffering from headache. Post-traumatic headache was reported by 64 patients (38.1%), of whom 22 patients experienced an increase of already existing headache and 42 patients complained of new headache. Patients suffering from headache before the trauma were not more at risk of having post-traumatic headache than patients who did not suffer from headache before the trauma. Patients who experienced an increase of already-existing pre-traumatic headache used more analgesics than patients first suffering from headache after the trauma. Post-traumatic headache was reported by more women than men (p less than 0.02), the corresponding relative risk being 1.6. Both the use of analgesics and the frequency of headache showed a significant increase for patients with post-traumatic headache when compared with a "control group" of 41 patients with unchanged headache and when compared with all patients with headache before the trauma. There was no significant difference in the location of pain between the groups analysed.

Functional radiographic examination of the cervical spine in patients with post-traumatic headache.

The segmental extension-flexion motion of the cervical spine and the overall C1-C7 motion were measured on functional X-rays in 19 patients with post-traumatic headache and 19 age- and sex-matched controls. The extension-flexion C1-C7 motion was reduced in patients with post-traumatic headache due to reduced motion in three segments: C2-C3, C5-C6 (p less than 0.05), and C6-C7 (p less than 0.01). In both groups a negative correlation between the C1-C7 motion and age was found, but the regression coefficients were different. Only in the control group could a negative correlation between segmental motion and age be demonstrated. In the patients with post-traumatic headache a statistically significant negative correlation between the log (pain index) and the age-corrected C1-C7 motion was found (p less than 0.04). On the segmental level a negative correlation between the log (pain index) and the age-corrected C1-C2 and C5-C6 motion could be demonstrated (p less than 0.05). Regarding C6-C7 there was a tendency to negative correlation. Furthermore, a negative correlation between the frequency of associated symptoms (dizziness, visual disturbances and ear symptoms) and the age-corrected C5-C6 motion was found. Consequently the decrement of motion primarily affected C2-C3, C5-C6, and C6-C7, whereas the analysis of correlation with pain index indicated C1-C2 and C5-C6 (C6-C7) as the most important segments involved.

An open study comparing manual therapy with the use of cold packs in the treatment of post-traumatic headache.

One year after head trauma, 23 patients with post-traumatic headache entered a prospective clinical controlled trial to find out if specific manual therapy on the neck could reduce the headache. The study was completed by 19 patients (83%). Ten patients were treated twice with manual therapy and nine patients were treated twice with cold packs on the neck. The pain index was calculated blindly. Two weeks after the last treatment the mean pain index was significantly reduced to 43% in the group treated with manual therapy compared with the pretreatment level. At follow-up five weeks later, the pain index was still lower in this group compared with the group treated with cold packs, but this difference was not statistically significant. The pain index for all 19 patients was significantly correlated to the use of analgesics as well as to the frequency of associated symptoms (number of days per week with dizziness, visual disturbances and ear symptoms). It is concluded that the type of manual therapy used in this study seems to have a specific effect in reducing post-traumatic headache. The result supports the hypothesis of a cervical mechanism causing post-traumatic headache and suggests that post-traumatic dizziness, visual disturbances and ear symptoms could be part of a cervical syndrome.