Background: Neck pain is among the most common musculoskeletal disorders worldwide. It poses a major burden on office workers, resulting in discomfort and decreased work productivity. Despite the expected growth of the service sector, the current literature does not offer a convincing approach to address this issue. Thus, the need to develop an effective intervention to reduce neck pain in the context of office work became evident. Given the substantial socio-economic consequences of neck pain (i.e., costs resulting from neck pain-related presenteeism), this emerged as the primary interest of our study.
Purpose: This study aimed to investigate the effect of a 12-week multi-component intervention, combining current best-evidence interventions, on neck pain-related work productivity loss in Swiss office workers.
Methods: Between January 2020 and April 2021, we conducted a stepped-wedge cluster randomized controlled trial titled “Neck Exercises for Productivity” (NEXpro). Office workers aged 18 to 65 years, and without severe neck problems were recruited from two Swiss organizations. The 12-week multi-component intervention included neck exercises, health-promotion information workshops, and workplace ergonomics. The primary outcome of neck pain-related work productivity loss (absenteeism, presenteeism) was measured using the Work Productivity and Activity Impairment Questionnaire and expressed as percentages of working time. Additionally, we reported the weekly monetary value of neck pain-related work productivity loss. Data were collected through an online questionnaire. A generalized linear mixed-effects model was fitted to the data to estimate the change in neck pain-related productivity loss.
Results: This analysis included data from 120 participants with a total of 517 observations (average of 4.3 observations per participant, attrition rate of 22%). At baseline measurement in January 2020, the mean age of participants was 43.7 years (SD 9.8 years), 71.7% of the participants were female (N=86), about 80% (N=95) reported mild to moderate neck pain, and neck pain-related work productivity loss was 12% of working time (absenteeism: 1.2%, presenteeism: 10.8%). We found an effect of our multi-component intervention on neck pain-related work productivity loss, with a marginal predicted mean reduction of 2.8 percentage points (-0.27; 95% CI from -0.54 to -0.001, p=0.049). Weekly saved costs were CHF 27.40 per participant. One adverse event occurred.
Conclusion: This study provides evidence of the effectiveness of a 12-week multi-component intervention in reducing neck pain-related work productivity loss among office workers. Not only employers and the socio-economic system benefit through decreased neck pain-associated costs (i.e., productivity), but also office workers by reduced pain and disability. Further research is necessary to investigate long-term effects.
Implications: In the context of office work, we strongly recommend the implementation of our multi-component intervention to reduce the burden of neck pain. Within Switzerland, the multi-component intervention has already been promoted through various media appearances, including television and radio, and a video is planned for sharing on social media in order to reach patients and healthcare providers (i.e., physical therapists).

Background:
Office workers are specifically vulnerable to headache conditions. Neck pain is reported by almost 80% of patients with headaches. Associations between currently recommended tests to examine cervical musculoskeletal impairments, pressure pain sensitivity and self-reported variables in headache, are unknown.
The aim of this study is to evaluate whether cervical musculoskeletal impairments and pressure pain sensitivity are associated with self-reported headache variables in office workers.
Methods:
This study reports a cross-sectional analysis using baseline data of a randomized controlled trial. Office
workers with headache were included in this analysis. Multivariate associations, controlled for age, sex and neck pain, between cervical musculoskeletal variables (strength, endurance, range of motion, movement control) and pressure pain threshold (PPT) over the neck and self-reported headache variables, such as frequency, intensity, and the Headache-Impact-Test-6, were examined.
Results:
Eighty-eight office workers with a 4-week headache frequency of 4.8 (±5.1) days, a moderate average
headache intensity (4.5 ± 2.1 on the NRS), and “some impact” (mean score: 53.7 ± 7.9) on the headache-impacttest-6, were included. Range of motion and PPT tested over the upper cervical spine were found to be most consistently associated with any headache variable. An adjusted R2 of 0.26 was found to explain headache intensity and the score on the Headache-Impact-Test-6 by several cervical musculoskeletal and PPT variables.
Discussion:
Cervical musculoskeletal impairments can explain, irrespective of coexisting neck pain, only little
variability of the presence of headache in office workers. Neck pain is likely a symptom of the headache condition, and not a separate entity.

Abstract

Background

Head-load bearing is a common phenomenon across sub-Saharan Africa. The Gambia shows an above average rate of female head-load carrying water collectors compared to other sub-Saharan African countries. From a health perspective, questions arise of how long-term head-load bearing affects the carrier’s health.

Objectives

To explore whether reported pain and functional limitations are related to range of motion (ROM) and proprioception of the cervical spine in rural female Gambian head-load bearers.

Methods

Cross sectional study. Women aged 18 to 45 years with a minimum of one year of head-load bearing experience were examined. The relationship between independent variables such as cervical ROM and proprioception, and head-load bearing characteristics towards the outcome variables pain and functional limitation have been examined by backwards linear regression models. Frequencies between functional limitation and regions of pain complaints have been determined.

Results

Thirty-five of 39 eligible women complained about neck pain. The amount of weight carried; together with reduced extension mobility in the upper cervical spine has been found the strongest explanatory variables for pain and functional limitation. Those women suffering from moderate to severe pain and functional limitation carried on average 3.05 and 2.70kg less weight. Functional limitation was associated with lower back pain but not with neck pain.

Conclusions

Although frequently reported in head-load bearing women, neck pain has not been found functionally limiting. Nonetheless, women suffering from at least moderate pain and functional limitation carry less weight compared to women reporting no limitation and no or only mild pain.

Background:
Tinnitus, or ‘ringing in the ears’, is the perception of sound in the absence of acoustic stimulation. It appears in 10-15% of adults and is typically caused by hearing loss or noise trauma. In about 25% of patients with tinnitus, however, tinnitus gets worse when cervical spine or temporomandibular dysfunctions are present, then called somatic tinnitus (ST). Previous studies have proven that musculoskeletal treatment of the cervical spine and temporomandibular area can decrease tinnitus severity and loudness. To maximize this treatment effect, it is essential that only patients with a large somatic influence on their tinnitus are referred for musculoskeletal physiotherapy. Diagnosing these patients correctly, though, remains a challenge.
In 2018, a set of 16 diagnostic criteria for ST was determined based on an international Delphi study with a consensus meeting. The next step in the development of easily applicable diagnostic criteria is now to provide an uncomplicated model based on the existing criteria, which can easily be used in clinical practice.

Objectives:
This study aimed to construct an accurate decision tree, combining several diagnostic criteria, to optimize both sensitivity and specificity of ST diagnosis.

Design:
An online survey was launched on the online forum Tinnitus Talk, managed by Tinnitus Hub in a convenience sample of participants with tinnitus. The survey included 42 questions, both on the presence of diagnostic criteria for ST and on other potentially influencing factors. A decision tree was constructed to classify participants with and without ST using the rpart package in R. Tree depth was optimized during a five-fold cross-validation. Finally, model performance was evaluated on a subset containing 20% of the original dataset.

Results:
Data of 7981 participants were used to construct a decision tree for ST diagnosis. Four criteria were included in the final decision tree: ‘Tinnitus and neck/jaw pain increase/decrease simultaneously’, ‘Tension in suboccipital muscles’, ‘Somatic modulation’, and ‘Bruxism’. The presented model has an accuracy of 82.2%, a sensitivity of 82.5%, and a specificity of 79%. Receiver operator characteristic curves demonstrated an area under the curve of 0.88.

Conclusions:
Based on a 42-item survey, a decision tree was created that was able to detect ST patients with high accuracy (82.2%) using only 4 questions. The RaSST is therefore expected to be easily implementable in clinical practice.

Background: Migraine patients may present with both cervical and balance dysfunctions. The neck plays an important role in balance by providing substantial proprioceptive input, which is integrated in the central nervous system and influences the balance control systems. Whether balance and neck dysfunctions are associated in patients with migraine is still to be explored. Objectives: This study aimed to assess the association between the sensory organization test of balance with neck pain features, cervical strength, endurance, and range of motion in patients with migraine. Methods: Sixty-five patients with migraine underwent the sensory organization test assessed with the Equitest- Neurocom® device. Maximum voluntary isometric contraction, cervical flexion and extension range of motion, and cervical flexor and extensor endurance were assessed. In addition, the features of migraine and neck pain were collected. Patients were dichotomized according to cut-off scores of balance performance and the association between outcomes were explored. Results: Patients with reduced balance performance presented a higher frequency of migraine (p = 0.035), a higher frequency of aura (p = 0.002), greater neck pain intensity (p = 0.013), and decreased endurance of cervical flexors (p = 0.010) and extensors (p < 0.0001). The total balance score was correlated with age (r = - 0.33; p = 0.007), migraine frequency (r = - 0.29; p = 0.021), neck pain intensity (r = - 0.26; p = 0.038), and endurance of the cervical flexors (r = 0.39; p = 0.001) and extensors (r = 0.36; p = 0.001). Migraine frequency, neck pain intensity, and endurance of the cervical flexors can predict 21% of the sensory organization test variability. Conclusion: Neck pain features and endurance of the cervical muscles are related to reduced balance performance in patients with migraine. These results shed light to a better understanding of balance alterations in migraine patients.

Background:
The close relationship between head, neck and facial dysfunction and pain and the effects of treatment during manual therapy are often explained by a neurophysiological model in which the trigeminocervical nucleus (TCN) plays a predominant role. Existing evidence has established a link between the orofacial, cranial and cervical regions mediated by the TCN. However, the prevailing direction of this connection, whether from the cervical region to the orofacial/cranial region or vice versa, remains uncertain.

Objective:
The purpose of this study is to determine the dominant direction of connectivity within the TCN when investigating the relationship between the neck and oro-craniofacial regions.

Methods;
A scoping review was conducted in accordance with the PRISMA-Scoping Review (ScR) guidelines. Six electronic databases were systematically queried, employing a search strategy that combined subject headings and keyword terms for three concepts: TCN, cervical region, and face/jaw/head region. No date, language, study design, or publication type limits were used. No restrictions were imposed on publication date, language, study design, or publication type. The screening and data extraction processes were carried out independently by two reviewers. The investigation included a comprehensive assessment of anatomical, histological, biochemical, electrophysiological, neurophysiological, radiological, and clinical parameters in both humans and mammals. In addition, the study determined the extent of interconnectivity between different regions (i.e., cervical region, head, and face) through the TCN.

Results:
Following the evaluation of 2,284 papers based on title, abstract, and full text, a total of 83 studies were included in the analysis. The predominant direction of connection between the orofacial and cervical regions via the TCN was reported to be from the orofacial region to the cervical region (58 of 83), with the majority of studies (82 of 83) conducted in mammals. About the TCN area investigated, 62.8% (n = 49) of the studies looked at the transition zone interpolaris/caudalis (Vi/Vc), 19.2% (n = 15) looked at the upper cervical spinal cord (C1/C2), followed by the transition zone oralis/interpolaris (Vo/Vi) in 11.5% (n = 9) of them. Twenty-three studies (29.5%) investigated other TCN areas, and four (4.8%) studies did not report the specific area investigated.


Conclusion:
Although the orofacial to cervical direction was dominant in the included studies, it remains uncertain whether this observation reflects researchers' interest or represents the true prevailing direction. Caution should be exercised when extrapolating findings from animal studies to humans.

Implications:
Simultaneously, this discovery aligns with clinical observations and studies on clinical outcomes, indicating that manual therapies and/or neck exercises may have the potential to influence orofacial symptoms, and vice versa. Further investigations are required, encompassing both animal and human clinical studies involving varying kind of stimuli with different intensities applied to the cervical region, head, and face and determine possible interconnections of these areas through the TCN. These studies can offer deeper insights into the assessment and treatment options within the orofacial-cervical complex in the future.

Background:
Guidelines for the assessment of people with whiplash have yet to be systematically produced. To date, individual recommendations exist for constructs to assess people with whiplash (e.g., cervical range of motion (ROM), neurological assessment, muscle performance, and sensorimotor control). However, these are difficult to interpret because they have yet to systematically be appraised to determine the strength of evidence that underpins the recommendation.
The objective was to develop clinical guidelines for the assessment of people with whiplash using a modified GRADE approach to develop recommendations for clinical constructs to be assessed in acute and chronic whiplash conditions.

Methods:
We conducted a systematic review of cross-sectional studies. Studies were eligible if participants were of driving age ≥16 years, had a WAD grade I-III resulting from a motor vehicle accident, and compared an acute or chronic WAD group to other populations (e.g., idiopathic neck pain). Further considerations were if the purpose of the study was to determine differences between people with WAD and comparison groups, to quantify impairment, or results inform treatment.
Assessment constructs were divided into the following categories: physical/musculoskeletal impairment, sensorimotor, pain sensitivity, psychological factors, symptom factors, advanced medical testing, and imaging. The certainty of the evidence was determined using a modified GRADE approach.
A multidisciplinary panel was convened, comprising clinicians, research experts, insurers, legal and government regulators, and consumer representatives. Eighteen panel members voted to provide consensus recommendations. The evidence-to-decision framework was adapted to assist in recommending what factor or assessment methods or tests/techniques clinicians should assess in people with WAD. Clinical feasibility of assessing or performing the test, the strength of association (number of studies finding differences between groups) and undesirable effects (benefits/adverse effects of performing the test) were considered by the panel when developing consensus recommendations.

Results:
From 4287 titles screened, 29 acute and 135 chronic WAD studies were included. For acute WAD, guideline panel consensus recommendations FOR measuring the factors to establish diagnosis (WAD grade) were following Canadian C-spine rule, conducting a neurological assessment and measuring Cervical ROM. Other constructs reaching consensus FOR to assess in acute WAD were pain sensitivity (i.e., thermal hyperalgesia) and additional symptoms (i.e., sleep quality). NEUTRAL recommendations were to assess neck muscle function and performance, sensorimotor assessment (i.e., joint position error), and psychological factors (i.e., fear avoidance). Recommendations were made AGAINST imaging or advanced testing (e.g., inflammatory biomarkers, fat infiltration).
In chronic WAD, more categories achieved a consensus FOR measuring the factor based on stronger evidence. These included ROM, pain sensitivity (i.e., thermal hyperalgesia) and additional symptoms (i.e., sleep quality), psychological factors (e.g., depression), neck muscle function and sensorimotor assessment (i.e., balance).

Conclusion(s):
Clinicians are recommended to undertake assessments to establish the WAD grade, such as the Canadian C-spine rule, neurological assessment and cervical ROM. Other factors can be assessed depending on the individual clinical presentation, risk stratification status and stage of disorder (acute vs chronic). Advanced imaging techniques are not recommended as they are not feasible to implement in clinical settings and do not assist in treatment direction.

Background: Current evidence suggests that specific exercise (SNE) for the deep craniocervical flexors is effective in reducing pain and disability in different cervical disorders including cervicogenic headache. Jull et al. 2008 described a testing and training protocol for the deep craniocervical flexor muscles in which a pressure biofeedback unit is used to guide the instruction for exercise performance and progression. Recent recommendations suggest that while the pressure biofeedback is essential for clinical assessment, it not be used as a training device. Rather it is recommended that emphasis be placed on teaching and practicing correct performance of the craniocervical flexion movement and facilitating the deep cervical flexors with strategies such as eye movement, i.e. looking down during the exercise. To enhance training and its progression further, a device was developed (the Spinertial) which facilitates and guides the performance of the exercise with the facility to add resistance. However, its efficacy to reduce symptoms and improve performance in the craniocervical flexion test (CCFT) is yet to be tested.
Purpose: To compare a guided and progressive resistance exercise performed with the Spinertial to free exercise in a cohort with CH.
Methods: Twenty-four participant with CH were randomly allocated to either the Spinertial group (SG) or to the free-exercise group (EG). Both groups performed twelve sessions of SNE for cervical flexor and extensor muscles over six-weeks. The SG performed the SNE flexor-extensor (SNE-fe) with the Spinertial device and a patient-tailored progression was performed by adding elastic bands. The EG performed the SNE-fe as free exercise without the device with a similar patient-tailored progression but without resistance. The primary outcome was the headache impact test (HIT-6). The secondary outcomes were performance in the CCFT, total upper cervical spine (UCS) range of movement (ROM), flexion rotation test (FRT) analysed as more restricted side (MRS) and less restricted side (LRS), mid-lower cervical spine ROM, self-reported global rating of change (GROC-scale) and satisfaction with the exercise program (PACES). All outcomes were measured at baseline, post-intervention (T1) and after 1-month (T2).
Results: Statistically significant between-groups differences were found favouring the SG for HIT-6 at T1 and T2 (p < 0.001), CCFT, UCS ROM, FRT MRS, FRT LRS, PACES and GROC-scale at T1 and T2 (p < 0.01). No between-groups differences were found for mid-lower cervical ROM in any plane.
Conclusion: Training with the Spinertial device was more effective than free exercise for improving the impact of headache, the endurance of deep neck flexor and UCS ROM in participants with CH. The results warrant further research into physiological effects of training with the Spinertial device.
Implications: The Spinertial device guides and facilitates correct craniocervical flexion and extension movement, and resistance can be added to progress training. Exercising with the Spinertial device improved headache impact, upper cervical range of motion and cervical muscles endurance to a greater extent than did free exercise.