Evidenz muskulärer Beeinträchtigungen bei Patienten mit chronischen Nackenschmerzen

Zusammenfassung

Nackenschmerzen sind ein häufig auftretendes Leiden mit hoher Rückfallrate. Es ist nicht unwahrscheinlich, dass zu geringe muskuläre Stabilisierung der HWS ein beitragender Faktor für rezidivierende Nackenschmerzen sein könnte. In der Literatur finden sich im Zusammenhang mit Nackenschmerzen Hinweise auf komplexe Defizite der motorischen Kontrolle. Möglicherweise stellt die adäquate Rehabilitation dieser Defizite einen Weg dar, um die hohe Rate erneuten Auftretens von Nackenschmerzen gezielt zu senken.

Zweck des vorliegenden Artikels ist es, einen Überblick über die Evidenz für muskuläre Beeinträchtigungen bei Menschen mit chronischen Nackenschmerzen zu geben und zu diskutieren, welche Folgen sich für die Rehabilitation des Muskelsystems ergeben.

Abstract

Neck pain is a common complaint which is associated with a high recurrence rate. It is not improbable that poor muscle support could be a contributing factor for the recurrence of neck pain episodes. The literature indicates complex deficits in motor control related to neck pain. Adequate rehabilitation of these deficits may provide one avenue to target and reduce the high recurrence rate of neck pain episodes.

The purpose of this article is to review the evidence of muscle impairment in people with chronic neck pain and to discuss the implications for rehabilitation of the muscle system.

Schlüsselwörter

Nackenschmerzen - muskuläre Beeinträchtigung - therapeutische Übungen - Rehabilitation

Key words

Neck pain - muscle impairment - therapeutic exercise - rehabilitation

Literatur

• 1 Andary M T, Hallgren R C, Greenman P E. et al . Neurogenic atrophy of suboccipital muscles after a cervical injury: A case study.  Am J Phys Med Rehabil. 1998;  77 545-549
• 2 Bansevicius D, Sjaastad O. Cervicogenic headache: the influence of mental load on pain level and EMG of shoulder-neck and facial muscles.  Headache. 1996;  36 372-378
• 3 Barton P M, Hayes K C. Neck flexor muscle strength, efficiency, and relaxation times in normal subjects and subjects with unilateral neck pain and headache.  Arch Phys Med Rehabil. 1996;  77 680-687
• 4 Behrsin J F, Maguire K. Levator scapulae action during shoulder movement. A possible mechanism of shoulder pain of cervical origin.  Aust J Physiother. 1986;  32 101-106
• 5 Boyd C lark LC, Briggs C A, Galea M P. Comparative histochemical composition of muscle fibres in a pre- and a postvertebral muscle of the cervical spine.  J Anat. 2001;  199 709-716
• 6 Boyd C lark LC, Briggs C A, Galea M P. Muscle spindle distribution, morphology, and density in longus colli and multifidus muscles of the cervical spine.  Spine. 2002;  27 694-701
• 7 Conley M S, Meyer R A, Bloomberg J J. et al . Noninvasive analysis of human neck muscle function.  Spine. 1995;  20 2505-2512
• 8 Falla D, Jull G, Dall’Alba P. et al . An electromyographic analysis of the deep cervical flexor muscles during cranio-cervical flexion.  Phys Ther. 2003;  83 899-906
• 9 Falla D, Rainoldi A, Merletti R. et al . Myoelectric manifestations of sternocleidomastoid and anterior scalene muscle fatigue in chronic neck pain patients.  Clin Neurophysiol. 2003;  114 488-495
• 10 Falla D, Bilenkij G, Jull G. Patients with chronic neck pain demonstrate altered patterns of muscle activation during performance of a functional upper limb task.  Spine. 2004;  29 1436-1440
• 11 Falla D, Jull G, Edwards S. et al . Neuromuscular efficiency of the sternocleidomastoid and anterior scalene muscles in patients with neck pain.  Disabil Rehabil. 2004;  26 712-717
• 12 Falla D, Jull G, Hodges P W. Feedforward activity of the cervical flexor muscles during voluntary arm movements is delayed in chronic neck pain.  Exp Brain Res. 2004;  157 43-48
• 13 Falla D, Jull G, Hodges P W. Neck pain patients demonstrate reduced activation of the deep neck flexor muscles during performance of the cranio-cervical flexion test.  Spine. 2004;  29 2108-2114
• 14 Falla D, Rainoldi A, Merletti R. et al . Spatio-temporal evaluation of neck muscle activation during postural perturbations.  J Electromyogr Kinesiol. 2004;  14 463-474
• 15 Falla D, Farina D. Muscle fiber conduction velocity of the upper trapezius muscle during dynamic contraction of the upper limb in patients with chronic neck pain.  Pain. 2005;  116 138-145
• 16 Falla D, Jull G, Vicenzino B. et al . The effect of different neck exercise regimes on control of posture in sitting in patients with chronic neck pain.  2005 [submitted for publication]; 
• 17 van der Fits I BM, Kilp A WJ, van Eykern L A. et al . Postural adjustments accompanying fast pointing movements in standing, sitting and lying adults.  Exp Brain Res. 1998;  120 202-216
• 18 Fredin Y, Elert J, Britschgi N. et al . A decreased ability to relax between repetitive muscle contractions in patients with chronic symptoms after whiplash trauma of the neck.  Journal of Musculoskeletal Pain. 1997;  5 55-70
• 19 Gogia P P, Sabbahi M A. Electromyographic analysis of neck muscle fatigue in patients with osteoarthritis of the cervical spine.  Spine. 1994;  19 502-506
• 20 Gore D R, Sepic S B, Gardner G M. et al . Neck pain: a long term follow-up of 205 patients.  Spine. 1987;  12 1-5
• 21 Gurfinkel V S, Lipshits M I, Lestienne F G. Anticipatory neck muscle activity associated with rapid arm movements.  Neurosci Lett. 1988;  94 104-108
• 22 Hallgren R C, Greenman P E, Rechtien J J. Atrophy of suboccipital muscles in patients with chronic pain: a pilot study.  J Am Osteopath Assoc. 1994;  94 1032-1038
• 23 Harms-Ringdahl K, Ekholm J, Schuldt K. et al . Load moments and myoelectric activity when the cervical spine is held in full flexion and extension.  Ergonomics. 1986;  29 1539-1552
• 24 Jull G, Barrett C, Magee R. et al . Further clinical clarification of the muscle dysfunction in cervical headache.  Cephalalgia. 1999;  19 179-185
• 25 Jull G A. Deep cervical flexor muscle dysfunction in whiplash.  Journal of Musculoskeletal Pain. 2000;  8 143-154
• 26 Jull G, Trott P, Potter H. et al . A randomized controlled trial of exercise and manipulative therapy for cervicogenic headache.  Spine. 2002;  27 1835-1843
• 27 Jull G, Falla D, Treleaven J. et al .A therapeutic exercise approach for cervical disorders. Boyling JD, Jull G Grieve’s modern manual therapy: The vertebral column. 3rd ed London; Elsevier 2004
• 28 Jull G, Kristjansson E, Dall’Alba P. Impairment in the cervical flexors: a comparison of whiplash and insidious onset neck pain patients.  Man Ther. 2004;  9 89-94
• 29 Jull G, Falla D, Hodges P. et al .Cervical flexor muscle retraining: physiological mechanisms of efficacy. 2nd International Conference on Movement Dysfunction. Edinburgh; 2005
• 30 Kadi F, Waling K, Ahlgren C. et al . Pathological mechanisms implicated in localized female trapezius myalgia.  Pain. 1998;  78 191-196
• 31 Larsson R, Cai H, Zhang Q. et al . Visualization of chronic neck-shoulder pain: Impaired microcirculation in the upper trapezius muscle in chronic cervico-brachial pain.  Occup Med (London). 1998;  48 189-194
• 32 Laursen B, Jensen B R, Garde A H. et al . Effect of mental and physical demands on muscular activity during the use of a computer mouse and a keyboard.  Scand J Work Environ Health. 2002;  28 215-221
• 33 Lindman R, Hagberg M, Angqvist K. et al . Changes in muscle morphology in chronic trapezius myalgia.  Scand J Work Environ Health. 1991;  17 347-355
• 34 Mayoux-Benhamou M A, Revel M, Vallee C. et al . Longus Colli has a postural function on cervical curvature.  Surg Radiol Anat. 1994;  16 367-371
• 35 McPartland J M, Brodeur R R, Hallgren R C. Chronic neck pain, standing balance, and suboccipital muscle atrophy - a pilot study.  J Manipulative Physiol Ther. 1997;  20 24-29
• 36 Moore K L, Dalley A F. Clinically orientated anatomy. 4th ed. Philadelphia; Lippincott Williams and Wilkins 1999
• 37 Nederhand M J, Ijzerman M J, Hermens H J. et al . Cervical muscle dysfunction in the chronic whiplash associated disorder grade II (WAD-II).  Spine. 2000;  25 1938-1943
• 38 Nederhand M J, Hermens H, Ijzerman M J. et al . Cervical muscle dysfunction in the chronic whiplash associated disorder grade 2: the relevance of the trauma.  Spine. 2002;  27 1056-1061
• 39 Panjabi M M, Cholewicki J, Nibu K. et al . Critical load of the human cervical spine: An in vitro experimental study.  Clinical biomechanics. 1998;  13 11-17
• 40 Silverman J L, Rodriquez A A, Agre J C. Quantitative cervical flexor strength in healthy subjects and in subjects with mechanical neck pain.  Arch Phys Med Rehabil. 1991;  72 679-681
• 41 Sterling M, Jull G, Vicenzino B. et al . Development of motor dysfunction following whiplash injury.  Pain. 2003;  103 65-73
• 42 Szeto G P, Straker L M, O’Sullivan P B. A comparison of symptomatic and asymptomatic office workers performing monotonous keyboard work. 1: Neck and shoulder muscle recruitment patterns.  Man Ther. 2005;  10 270-280
• 43 Uhlig Y, Weber B R, Grob D. et al . Fiber composition and fiber transformations in neck muscles of patients with dysfunction of the cervical spine.  J Orthop Res. 1995;  13 240-249
• 44 Vasavada A N, Li S, Delp S L. Influence of muscle morphometry and moment arms on the moment-generating capacity of human neck muscles.  Spine. 1998;  23 412-422
• 45 Vernon H T, Aker P, Aramenko M. et al . Evaluation of neck muscle strength with a modified sphygmomanometer dynamometer: reliability and validity.  J Manipulative Physiol Ther. 1992;  15 343-349
• 46 Watson D H, Trott P H. Cervical headache: an investigation of natural head posture and upper cervical flexor muscle performance.  Cephalalgia. 1993;  13 272-284
• 47 Westgaard R H. Muscle activity as a releasing factor for pain in the shoulder and neck.  Cephalalgia. 1999;  19 251-258