A study of isokinetic trunk and knee muscle strength in patients with chronic sciatica.

OBJECTIVE: To evaluate trunk and knee muscle strength in patients with chronic sciatica. PATIENTS AND METHOD: Twenty-eight patients with right-side chronic sciatica (group 1, G1) and 40 healthy controls (group 2, G2) were evaluated using an isokinetic dynamometer (Cybex Norm II). Quadriceps and hamstring muscle strength were evaluated at concentric velocities of 60 and 120 degrees /s and the trunk muscles were evaluated at concentric velocities of 60 and 90 degrees /s. RESULTS: G1 comprised 15 women and 13 men (mean +/- SD age: 34.787+/-6.06; weight: 65.85+/-5.33kg; height: 165+/-6.92cm). G2 comprised 20 women and 20 men (mean +/- SD age: 35.92+/-6.66; weight: 67.07+/-6.12kg; height: 165.82+/-7.65cm. There were no significant inter-group differences concerning these parameters. In G1, the peak torque values for the trunk extensors were 123.71+/-32.45 and 108.85+/-32.07 Newton metres (Nm) at angular velocities of 60 and 90 degrees /s, respectively. In G2, the values were 192.73+/-64.24 and 168.65+/-53.96Nm, respectively. In G1, the peak torque values for the trunk flexors were 134.32+/-30.77 and 124.39+/-32.59Nm at angular velocities of 60 and 90 degrees /s, respectively. In G2, they were 177.44+/-44.1 and 157.81+/-39.01 Nm, respectively. The difference between G1 and G2 was statistically significant. The peak torque for the right quadriceps in G1 was 100.03+/-24.45 and 78.71+/-22.92Nm at angular velocities of 60 and 120 degrees /s, respectively. In G2, these values were 160.5+/-36.34 and 131.05+/-33.42Nm. The peak torque for the hamstrings in G1 was 56.42+/-13.02 and 50+/-13.55Nm at angular velocities of 60 and 120 degrees /s, respectively. In G2, these values were 97.77+/-33.32 and 84.72+/-31.41Nm. Again the difference between G1 and G2 was statistically significant. We also noted a statistically significant difference between G1 and G2 in terms of the peak quadriceps and hamstring torque values on the left side. In G1, the quadriceps and hamstrings were significantly weaker on the sciatica side than on the unaffected side. CONCLUSION: The present study demonstrated trunk and knee muscle weakness in patients with chronic sciatica, when compared with healthy subjects. This weakness was predominant on the sciatica side. Consequently, the management of these patients should include a knee muscle reinforcement programme.

Chronic neck pain and vertigo: Is a true balance disorder present?

OBJECTIVE: We sought to establish whether chronic neck pain patients suffering from vertigo and instability have true balance disorders. PATIENTS AND METHODS: Ninety-two patients having suffered from chronic neck pain for at least 3 months were enrolled in the present study. Patients with a history of neck trauma or ear, nose and throat, ophthalmological or neurological abnormalities were excluded. The patients were evaluated in a clinical examination (neck mobility) and a test of dynamic and static balance on the Satel((R)) platform in which mediolateral (Long X) and anterior-posterior deviations (Long Y) were monitored. Our patients were divided into three groups: a group of 32 patients with neck pain and vertigo (G1), a group of 30 patients with chronic neck pain but no vertigo (G2) and a group of 30 healthy controls. RESULTS: All groups were comparable in terms of age, gender, weight and shoe size. Osteoarthritis was found in 75% and 70% of the subjects in G1 and G2, respectively. Neck-related headache was more frequent in G1 than in G2 (65.5% versus 40%, respectively; p=0.043). Restricted neck movement was more frequent in G1 and concerned flexion (p<0.001), extension (p<0.001), rotation (p<0.001), right inclination (p<0.001) and left inclination (p<0.001). Balance abnormalities were found more frequently in G1 than in G2 or G3. Static and dynamic posturographic assessments (under "eyes open" and "eyes shut" conditions) revealed abnormalities in statokinetic parameters (Long X and Long Y) in G1. CONCLUSION: Our study evidenced abnormal static and dynamic balance parameters in chronic neck pain patients with vertigo. These disorders can be explained by impaired cervical proprioception and neck movement limitations. Headache was more frequent in these patients.