[Acupuncture combined with tuina therapy for stiff neck with levator scapula injury type: a randomized controlled trial].

OBJECTIVE: To observe the clinical efficacy of acupuncture combined with tuina therapy for stiff neck with levator scapula injury type. METHODS: A total of 162 patients with stiff neck of levator scapula injury type were randomly divided into an acupuncture combined with tuina group (combined group, 52 patients), a tuina group (55 patients), and an acupuncture group (55 patients). The patients in the acupuncture group received acupuncture on the affected side's Houxi (SI 3), inserting the needle 10 to 20 mm towards Laogong (PC 8) with strong or moderate stimulation, and patients were instructed to move their neck, shoulders, and upper limbs during the process, with the needle retained for 2 to 3 min. The patients in the tuina group received strong stimulation pressing on tender points to release the starting and ending points of the trapezius muscle with modified techniques. The combined group first received tuina therapy, followed immediately by acupuncture treatment at the Houxi (SI 3). Treatments were administered every other day for a total of three sessions. Before treatment and on 1, 3, and 7 days after treatment, the simple McGill pain questionnaire (SF-MPQ) scores [including the pain rating index (PRI), visual analogue scale (VAS), and present pain intensity (PPI) scores] of the head, neck and shoulder, cervical spine mobility scores were observed, and the clinical efficacy and safety of each group were evaluated. RESULTS: On the 1, 3, and 7 days after treatment, the SF-MPQ, PRI, VAS, and PPI scores of the head, neck, and shoulder in all groups were significantly reduced (P<0.01). On the 1 and 3 days after treatment, the above scores in the combined group were lower than those in the tuina group and the acupuncture group (P<0.05, P<0.01). On the 7 days after treatment, the above scores in the combined group were lower than those in the acupuncture group (P<0.01). On the 3 days after treatment, the SF-MPQ, PRI, and VAS scores in the tuina group were lower than those in the acupuncture group (P<0.01). On the 7 days after treatment, the SF-MPQ, PRI, VAS, and PPI scores in the tuina group were lower than those in the acupuncture group (P<0.01, P<0.05). On the 1, 3, and 7 days after treatment, the cervical spine mobility scores in each group were decreased compared to those before treatment (P<0.01). On the 3 days after treatment, the cervical spine mobility score in the combined group was lower than that in the acupuncture group and the tuina group (P<0.01). On the 1, 3, and 7 days after treatment, the cured rate in the combined group was higher than that in the tuina group and the acupuncture group (P<0.01). During the treatment period, no serious adverse reactions occurred in any group. CONCLUSION: Acupuncture combined with tuina therapy could effectively improve stiff neck with levator scapula injury type, alleviate patient pain, restore cervical spine mobility, and clinically outperform both tuina and acupuncture therapy alone.

Torticollis as a presenting symptom of pediatric CNS tumors: A systematic review.

To assess the frequency of torticollis as a presenting symptom of pediatric CNS tumors and its impact on pre-diagnostic symptom intervals (PSIs) and patient outcomes. We performed a systematic review of studies reporting torticollis in children with various CNS tumors. We searched PubMed for studies published from January 1972 to March 2021 in English. Case reports were included in the analysis if the following criteria were met (1) torticollis was the presenting symptom secondary to a CNS tumor (2) children <18 years of age, (3) underwent imaging intervention and (4) outcome data provided. Of 1,365 relevant articles, 45 were eligible for analysis according to our inclusion criteria representing 95 patients. Two independent investigators extracted the data, and a third investigator arbitrated discrepancies. We found that 38.9% of CNS tumors exhibited torticollis as the only presenting symptom. PSI lengths ranged from 0 to 4 years (median, 5 months) for low-grade tumors, and patient age and PSI length were inversely associated. Of patients with low-grade tumors, 23.8% received physiotherapy, in contrast with 0% of patients with high-grade tumors. PSI length also increased for patients who received rehabilitation, and 39.3% and 7.1% of patients with high-grade and low-grade tumors, respectively, died of their disease. Patients with low-grade tumors and torticollis as a primary presenting symptom were more likely to have a prolonged PSI. Therefore, CNS tumors should be considered in the differential diagnosis of acquired torticollis in children.

Initial development of a patient-reported outcome measure of disability due to Katakori via evaluating patient comprehensibility and comprehensiveness.

[Purpose] "Katakori" refers to a nonspecific symptom, including discomfort or dull pain, that is experienced around the occiput and that extends through the cervical spine to the acromion and scapular area. This study aimed to develop a patient-reported outcome measure of disability due to Katakori, namely the Katakori Disability Index, via evaluating patient comprehensibility and comprehensiveness. [Participants and Methods] We conducted a semi-structured interview among participants who had experienced Katakori consistently during the past month to examine patient comprehensibility and comprehensiveness; we particularly used the thinking-aloud method and cognitive debriefing to evaluate comprehensibility. [Results] We initially tested a provisional version of the Katakori Disability Index with 24 items using two 11-point numeric rating scales in a subset of 10 participants. Considering the issues identified concerning comprehensibility and comprehensiveness, we created a second draft of the Katakori Disability Index with two 6-point Likert scales, modified items, and four additional items. The second draft was tested in another subset of 10 participants. We eventually developed a 31-item Katakori Disability Index with modified instructions and items, two additional items, and a post-survey checklist; all these features addressed the concerns identified and suggestions obtained in the second round of interviews. [Conclusion] We developed a 31-item Katakori Disability Index with content validity.

Lifestyle and subjective musculoskeletal symptoms in young male Japanese workers: A 16-year retrospective cohort study.

This longitudinal study was conducted from 2002 to 2018 and aimed to investigate predictive lifestyle factors for the occurrence of subjective musculoskeletal symptoms. The participants came from several employers in Japan. Setting 2002 as the baseline, we performed logistic regression analyses using lifestyle questionnaire items as explanatory variables and Stiff neck/shoulders (SN/S) and Lower back pain (LBP) as objective variables (n = 16,748). Workers who responded positively to good lifestyle items with an odds ratio < 1.0 and those who did not were classified in the Good (GL) and Poor lifestyle groups (PL), respectively. The survival period between the groups was compared using the log-rank test and Cox hazard regression analysis with propensity score matching (n = 3,593). Based on the Cox hazard regression analysis results, the risk of SN/S was about 2.54 (95% confidence interval [CI]: 1.80-3.59) times higher for PL than for GL (p < 0.001). Similarly, after propensity score matching, the risk was about 2.33 (95% CI: 1.07-5.10) times higher for PL than for GL (p < 0.05). Further, LBP risk was about 2.45 (95% CI: 1.67-3.58) times higher for PL than for GL (p < 0.001). Similarly, after propensity score matching, the risk was about 3.50 (95% CI: 1.60-7.68) times higher for PL than for GL (p < 0.01). This study highlighted that workers with four good lifestyle factors (life satisfaction, hours of sleep, exercise habits, and physical fitness) presented reduced risk of subjective musculoskeletal symptom occurrence. To prevent musculoskeletal symptoms, physicians and occupational health staff should advise on workers' individual lifestyle.

Clinical observation on Yi Jin Jing (Sinew-transforming Qigong Exercises) plus tuina on the neck for stiff neck / 针灸推拿医学（英文版）

Objective: To observe the effect of Yi Jin Jing (Sinew-transforming Qigong Exercises) plus tuina on the neck for stiff neck. Methods: A total of 60 patients with stiff neck who met the screening criteria were selected and randomly divided into two groups, with 30 cases in each group. Patients in the control group received tuina on the neck, 30 min every time, once a day, while patients in the observation group practiced Yi Jin Jing (Sinew-transforming Qigong Exercises) plus the same tuina therapy as the control group, and Yi Jin Jing (Sinew-transforming Qigong Exercises) was conducted for more than 30 min every time, once a day. Visual analog scale (VAS) scores were observed before treatment, and after 1 time, 3 times and 5 times of treatment to evaluate the degree of neck pain. Results: During the treatment, each group had 2 dropouts. After treatment, the total effective rate was 92.9％ in the observation group versus 82.1％ in the control group, showing a statistical significance (P<0.05). The VAS scores in the observation group at the three time points were significantly lower than those in the control group (all P<0.05). Conclusion: Yi Jin Jing (Sinew-transforming Qigong Exercises) plus tuina on the neck can effectively relieve neck pain and improve cervical range of motion in patients with stiff neck, and can achieve a better effect than tuina alone.

Proprioceptive neuromuscular facilitation versus acupuncture in treatment of naval soldiers with stiff neck: A comparison of effectiveness / 第二军医大学学报

Objective To explore the clinical efficacy of proprioceptive neuromuscular facilitation (PNF) and acupuncture in the treatment of naval soldiers with stiff neck. Methods Fifty naval soldiers with neck stiffness were divided into PNF group and acupuncture group (received PNF or acupuncture treatment, respectively), each group with 25 cases. The Visual Analogue Scale (VAS) score of patients in the two groups was compared immediately and at 3 months after treatment, the degree of range of motion was compared immediately after treatment, and the recurrence rate was compared at 5 months after treatment. Results The VAS scores of patients in the two groups immediately after treatment were significantly lower than those before treatment (1.9 ± 0.5 vs 7.6 ± 1.6, 2 7 ± 0.7 vs 8.0 ± 1. 4; both P0.05). Conclusion Acupuncture has a better immediate effect than PNF in treating patients with stiff neck, but PNF is simple to operate and may reduce the recurrence rate of stiff neck, indicating that PNF can be used as an alternative in the treatment of stiff neck.

Observations on the Efficacy of Mallet Needle plus Acupuncture in Treating Stiff Neck / 上海针灸杂志

Objective To investigate the clinical efficacy of mallet needle plus acupuncture in treating stiff neck. Method Eighty patients with stiff neck were randomly allocated to treatment and control groups, 40 cases each. The treatment group received mallet needle therapy plus acupuncture and the control group, acupuncture alone, for three consecutive days. In the two groups, the Pain Rating Index (PRI) score and the Visual Analogue Scale (VAS) score were recorded before and after treatment and the clinical therapeutic effects were evaluated after treatment. Result The PRI score and the VAS score decreased in both groups after treatment compared with before (P<0.05) and decreased more in the treatment group than in the control group at the end of treatment (P<0.05). The total efficacy rate was 95.0% in the treatment group and 87.5% in the control group; there was a statistically significant difference between the two groups (P<0.05). Conclusion Mallet needle therapy plus acupuncture is more effective than acupuncture alone in treating stiff neck.

Acupuncture at Houxi (SI 3) acupoint for acute neck pain caused by stiff neck: study protocol for a pilot randomised controlled trial.

INTRODUCTION: The use of acupuncture has been suggested for the treatment of acute neck pain caused by stiff neck in China. However, current evidence is insufficient to draw any conclusions about its efficacy. Therefore this pilot study was designed to evaluate the feasibility and efficacy of acupuncture at the Houxi (SI3) acupoint for treatment of acute neck pain. METHODS/ANALYSIS: This pilot study will be a two-parallel-group, assessor-blinded, randomised controlled trial. Thirty-six stiff neck participants with acute neck pain will be recruited and randomly divided into two groups in a 1:1 ratio. Participants in the control group will receive massage on the local neck region (5 min each session, three times a day for 3 days). In addition to massage, patients in the treatment group will receive acupuncture (one session a day for 3 days). Measures will be taken at 0, 3 and 15 days. The primary outcome is the Northwick Park Neck Pain Questionnaire (NPQ). The secondary outcome is the Short Form of the McGill Pain Questionnaire (SF-MPQ). ETHICS/DISSEMINATION: The protocol for this pilot randomised clinical trial has undergone ethics scrutiny and been approved by the ethics review boards of the First Affiliated Hospital of Heilongjiang University of Traditional Chinese Medicine (Permission number: HZYLL201303502). The findings of this study will provide important clinical evidence on the feasibility and efficacy of acupuncture treatment for stiff neck patients with acute neck pain. In addition, it will explore the feasibility of further acupuncture research. TRIAL REGISTRATION NUMBER: ChiCTR-TRC-13003911.

Clinical Study of Tuina for Stiff Neck / 针灸推拿医学（英文版）

Objective: To observe the clinical effect of Tuina for stiffneck. Methods: All of 216 cases with stiff neck were randomly allocated into a tuina group (110 cases) and a control group (106 cases). The patients in the tuina group were treated with Three Parts, Four Points,Five Manipulation tuina therapy, while those in the control group were treated with pucturing Wailaogong (Ex-UE 8), Houxi (SI 3), Jianjing (GB 21) and Ashi points in the affected side,Once a day, and 3 times constitute one treatment course. The effect was observed after 2-course treatments. Result: The effective rate in the tuina group and the control group was 93.64% and 83.02%, respectively, and there was statistical difference between the two groups (P < 0.05).Conclusion: The tuina therapy of Three Parts, Four Points, Five Manipulations is better than simple acupuncture therapy in treating stiff neck.