Skip to main content
Key Specialties
Cardiology Diabetology Endocrinology Gastroenterology Geriatrics and Gerontology Gynecology and Obstetrics Hematology Infectious Disease Internal Medicine Nephrology Neurology Oncology Pediatrics Respiratory Medicine Rheumatology Surgery
Congress Coverage
2024 ACC Congress 2023 ESMO Congress 2023 EASD Congress 2023 ERS Congress 2023 ESC Congress
Clinical Collections
Advances in Alzheimer’s

At a glance: The ONWARDS insulin icodec trials

A round-up of the ONWARDS phase 3 clinical trials evaluating the novel weekly insulin icodec in people with diabetes.
ADVANCED SEARCH
Log in
Top
BMC Musculoskeletal Disorders
Published in: BMC Musculoskeletal Disorders 1/2008

Open Access 01-12-2008 | Research article

Altered motor control patterns in whiplash and chronic neck pain

Authors: Astrid Woodhouse, Ottar Vasseljen

Published in: BMC Musculoskeletal Disorders | Issue 1/2008

Login to get access

Abstract

Background

Persistent whiplash associated disorders (WAD) have been associated with alterations in kinesthetic sense and motor control. The evidence is however inconclusive, particularly for differences between WAD patients and patients with chronic non-traumatic neck pain. The aim of this study was to investigate motor control deficits in WAD compared to chronic non-traumatic neck pain and healthy controls in relation to cervical range of motion (ROM), conjunct motion, joint position error and ROM-variability.

Methods

Participants (n = 173) were recruited to three groups: 59 patients with persistent WAD, 57 patients with chronic non-traumatic neck pain and 57 asymptomatic volunteers. A 3D motion tracking system (Fastrak) was used to record maximal range of motion in the three cardinal planes of the cervical spine (sagittal, frontal and horizontal), and concurrent motion in the two associated cardinal planes relative to each primary plane were used to express conjunct motion. Joint position error was registered as the difference in head positions before and after cervical rotations.

Results

Reduced conjunct motion was found for WAD and chronic neck pain patients compared to asymptomatic subjects. This was most evident during cervical rotation. Reduced conjunct motion was not explained by current pain or by range of motion in the primary plane. Total conjunct motion during primary rotation was 13.9° (95% CI; 12.2–15.6) for the WAD group, 17.9° (95% CI; 16.1–19.6) for the chronic neck pain group and 25.9° (95% CI; 23.7–28.1) for the asymptomatic group. As expected, maximal cervical range of motion was significantly reduced among the WAD patients compared to both control groups. No group differences were found in maximal ROM-variability or joint position error.

Conclusion

Altered movement patterns in the cervical spine were found for both pain groups, indicating changes in motor control strategies. The changes were not related to a history of neck trauma, nor to current pain, but more likely due to long-lasting pain. No group differences were found for kinaesthetic sense.
Appendix
Available only for authorised users
Literature
1.
Rodriquez AA, Barr KP, Burns SP: Whiplash: Pathophysiology, diagnosis, treatment, and prognosis. Muscle Nerve. 2004, 29: 768-781. 10.1002/mus.20060.CrossRefPubMed
2.
Borchgrevink GE, Smevik O, Haave I, Haraldseth O, Nordby A, Lereim I: MRI of cerebrum and cervical columna within two days after whiplash neck sprain injury. Injury . 1997, 28 (5-6): 331-5. 10.1016/S0022-3999(96)00352-2.CrossRefPubMed
3.
Sturzenegger M, Radanov BP, Winter P, Simko M, Farra AD, Di SG: MRI-based brain volumetry in chronic whiplash patients: no evidence for traumatic brain injury. Acta Neurol Scand. 2008, 117: 49-54.PubMed
4.
Curatolo M, Petersen-Felix S, Arendt-Nielsen L, Giani C, Zbinden AM, Radanov BP: Central hypersensitivity in chronic pain after whiplash injury. Clin J Pain. 2001, 17: 306-315. 10.1097/00002508-200112000-00004.CrossRefPubMed
5.
Kasch H, Qerama E, Bach FW, Jensen TS: Reduced cold pressor pain tolerance in non-recovered whiplash patients: a 1-year prospective study. Eur J Pain. 2005, 9: 561-569. 10.1016/j.ejpain.2004.11.011.CrossRefPubMed
6.
Koelbaek JM, Graven-Nielsen T, Schou OA, Arendt-Nielsen L: Generalised muscular hyperalgesia in chronic whiplash syndrome. Pain. 1999, 83: 229-234. 10.1016/S0304-3959(99)00106-2.CrossRef
7.
Sterling M, Jull G, Vicenzino B, Kenardy J: Sensory hypersensitivity occurs soon after whiplash injury and is associated with poor recovery. Pain. 2003, 104: 509-517. 10.1016/S0304-3959(03)00078-2.CrossRefPubMed
8.
Scott D, Jull G, Sterling M: Widespread sensory hypersensitivity is a feature of chronic whiplash-associated disorder but not chronic idiopathic neck pain. Clin J Pain. 2005, 21: 175-181. 10.1097/00002508-200503000-00009.CrossRefPubMed
9.
Treleaven J, Jull G, Sterling M: Dizziness and unsteadiness following whiplash injury: characteristic features and relationship with cervical joint position error. J Rehabil Med. 2003, 35: 36-43. 10.1080/16501970306109.CrossRefPubMed
10.
Sterling M, Jull G, Vicenzino B, Kenardy J: Characterization of acute whiplash-associated disorders. Spine. 2004, 29: 182-188. 10.1097/01.BRS.0000105535.12598.AE.CrossRefPubMed
11.
Kristjansson E, Dall'Alba P, Jull G: A study of five cervicocephalic relocation tests in three different subject groups. Clin Rehabil. 2003, 17: 768-774. 10.1191/0269215503cr676oa.CrossRefPubMed
12.
Grip H, Sundelin G, Gerdle B, Karlsson JS: Variations in the axis of motion during head repositioning--a comparison of subjects with whiplash-associated disorders or non-specific neck pain and healthy controls. Clin Biomech (Bristol , Avon ). 2007, 22: 865-873. 10.1016/j.clinbiomech.2007.05.008.CrossRef
13.
Armstrong BS, McNair PJ, Williams M: Head and neck position sense in whiplash patients and healthy individuals and the effect of the cranio-cervical flexion action. Clinical Biomechanics. 2005, 20: 675-684. 10.1016/j.clinbiomech.2005.03.009.CrossRefPubMed
14.
Heikkila H, Astrom PG: Cervicocephalic kinesthetic sensibility in patients with whiplash injury. Scand J Rehabil Med. 1996, 28: 133-138.PubMed
15.
Rix GD, Bagust J: Cervicocephalic kinesthetic sensibility in patients with chronic, nontraumatic cervical spine pain. Arch Phys Med Rehabil. 2001, 82: 911-919. 10.1053/apmr.2001.23300.CrossRefPubMed
16.
Edmondston SJ, Chan HY, Ngai GC, Warren ML, Williams JM, Glennon S, Netto K: Postural neck pain: an investigation of habitual sitting posture, perception of 'good' posture and cervicothoracic kinaesthesia. Man Ther. 2007, 12: 363-371. 10.1016/j.math.2006.07.007.CrossRefPubMed
17.
Treleaven J, Jull G, Lowchoy N: Smooth pursuit neck torsion test in whiplash-associated disorders: relationship to self-reports of neck pain and disability, dizziness and anxiety. J Rehabil Med. 2005, 37: 219-223. 10.1080/16501970510027989.CrossRefPubMed
18.
Kongsted A, Jorgensen LV, Bendix T, Korsholm L, Leboeuf-Yde C: Are smooth pursuit eye movements altered in chronic whiplash-associated disorders? A cross-sectional study. Clin Rehabil. 2007, 21: 1038-1049. 10.1177/0269215507075519.CrossRefPubMed
19.
Prushansky T, Dvir Z, Pevzner E, Gordon CR: Electro-oculographic measures in patients with chronic whiplash and healthy subjects: a comparative study. J Neurol Neurosurg Psychiatry. 2004, 75: 1642-1644. 10.1136/jnnp.2003.031278.CrossRefPubMedPubMedCentral
20.
Sjostrom H, Allum JH, Carpenter MG, Adkin AL, Honegger F, Ettlin T: Trunk sway measures of postural stability during clinical balance tests in patients with chronic whiplash injury symptoms. Spine. 2003, 28: 1725-1734. 10.1097/00007632-200308010-00018.PubMed
21.
Kogler A, Lindfors J, Odkvist LM, Ledin T: Postural stability using different neck positions in normal subjects and patients with neck trauma. Acta Otolaryngol. 2000, 120: 151-155.PubMed
22.
Madeleine P, Prietzel H, Svarrer H, Arendt-Nielsen L: Quantitative posturography in altered sensory conditions: a way to assess balance instability in patients with chronic whiplash injury. Arch Phys Med Rehabil. 2004, 85: 432-438. 10.1016/j.apmr.2003.03.003.CrossRefPubMed
23.
Michaelson P, Michaelson M, Jaric S, Latash ML, Sjolander P, Djupsjobacka M: Vertical posture and head stability in patients with chronic neck pain. J Rehabil Med. 2003, 35: 229-235. 10.1080/16501970306093.CrossRefPubMed
24.
Dehner C, Heym B, Maier D, Sander S, Arand M, Elbel M, Hartwig E, Kramer M: Postural control deficit in acute QTF grade II whiplash injuries. Gait Posture. 2008, 28: 113-119. 10.1016/j.gaitpost.2007.10.007.CrossRefPubMed
25.
Rubin AM, Woolley SM, Dailey VM, Goebel JA: Postural stability following mild head or whiplash injuries. Am J Otol. 1995, 16: 216-221. 10.1016/0196-0709(95)90108-6.CrossRefPubMed
26.
Biguer B, Donaldson IM, Hein A, Jeannerod M: Neck muscle vibration modifies the representation of visual motion and direction in man. Brain. 1988, 111 ( Pt 6): 1405-1424. 10.1093/brain/111.6.1405.CrossRef
27.
Knox J, Cordo P, Skoss R, Durrant S, Hodges P: Illusory changes in head position induced by neck muscle vibration can alter the perception of elbow position. Behav Neurosci. 2006, 120: 1211-1217. 10.1037/0735-7044.120.6.1211.CrossRefPubMed
28.
Keshner EA, Dhaher Y: Characterizing head motion in three planes during combined visual and base of support disturbances in healthy and visually sensitive subjects. Gait Posture. 2008, 28: 127-134. 10.1016/j.gaitpost.2007.11.003.CrossRefPubMed
29.
Antonaci F, Bulgheroni M, Ghirmai S, Lanfranchi S, Dalla TE, Sandrini G, Nappi G: 3D kinematic analysis and clinical evaluation of neck movements in patients with whiplash injury. Cephalalgia. 2002, 22: 533-542. 10.1046/j.1468-2982.2002.00405.x.CrossRefPubMed
30.
Dall'Alba PT, Sterling MM, Treleaven JM, Edwards SL, Jull GA: Cervical range of motion discriminates between asymptomatic persons and those with whiplash. Spine. 2001, 26: 2090-2094. 10.1097/00007632-200110010-00009.CrossRefPubMed
31.
Sjolander P, Michaelson P, Jaric S, Djupsjobacka M: Sensorimotor disturbances in chronic neck pain-Range of motion, peak velocity, smoothness of movement, and repositioning acuity. Man Ther. 2008, 13: 122-131. 10.1016/j.math.2006.10.002.CrossRefPubMed
32.
Kristjansson E, Hardardottir L, Asmundardottir M, Gudmundsson K: A new clinical test for cervicocephalic kinesthetic sensibility: "the fly". Arch Phys Med Rehabil. 2004, 85: 490-495. 10.1016/S0003-9993(03)00619-1.CrossRefPubMed
33.
Lamoth CJ, Meijer OG, Daffertshofer A, Wuisman PI, Beek PJ: Effects of chronic low back pain on trunk coordination and back muscle activity during walking: changes in motor control. Eur Spine J. 2006, 15: 23-40. 10.1007/s00586-004-0825-y.CrossRefPubMed
34.
Moseley GL, Hodges PW: Reduced variability of postural strategy prevents normalization of motor changes induced by back pain: a risk factor for chronic trouble?. Behav Neurosci. 2006, 120: 474-476. 10.1037/0735-7044.120.2.474.CrossRefPubMed
35.
Spitzer WO, Skovron ML, Salmi LR, Cassidy JD, Duranceau J, Suissa S, Zeiss E: Scientific monograph of the Quebec Task Force on Whiplash-Associated Disorders: redefining "whiplash" and its management. Spine. 1995, 20: 1S-73S.CrossRefPubMed
36.
Jordan K, Dziedzic K, Jones PW, Ong BN, Dawes PT: The reliability of the three-dimensional FASTRAK measurement system in measuring cervical spine and shoulder range of motion in healthy subjects. Rheumatology (Oxford). 2000, 39: 382-388. 10.1093/rheumatology/39.4.382.CrossRef
37.
Sterling M, Jull G, Carlsson Y, Crommert L: Are cervical physical outcome measures influenced by the presence of symptomatology?. Physiother Res Int. 2002, 7: 113-121. 10.1002/pri.248.CrossRefPubMed
38.
Amiri M, Jull G, Bullock-Saxton J: Measuring range of active cervical rotation in a position of full head flexion using the 3D Fastrak measurement system: an intra-tester reliability study. Man Ther. 2003, 8: 176-179. 10.1016/S1356-689X(03)00009-2.CrossRefPubMed
39.
Stavdahl O, Bondhus AK, Pettersen KY, Malvig KE: Optimal statistical operators for 3-dimensional rotational data: geometric interpretations and application to prosthesis kinematics. Robotica. 2005, United Kingdom, Cambridge University Press, 23: 283-292. 10.1017/S0263574704001304.
40.
Flor H: Cortical reorganisation and chronic pain: implications for rehabilitation. J Rehabil Med. 2003, 66-72. 10.1080/16501960310010179.
41.
Treleaven J: Sensorimotor disturbances in neck disorders affecting postural stability, head and eye movement control. Man Ther. 2008, 13: 2-11. 10.1016/j.math.2007.06.003.CrossRefPubMed
42.
Trott PH, Pearcy MJ, Ruston SA, Fulton I, Brien C: Three-dimensional analysis of active cervical motion: the effect of age and gender. Clin Biomech (Bristol , Avon ). 1996, 11: 201-206. 10.1016/0268-0033(95)00072-0.CrossRef
43.
Feipel V, Rondelet B, Le PJ, Rooze M: Normal global motion of the cervical spine: an electrogoniometric study. Clin Biomech (Bristol , Avon ). 1999, 14: 462-470. 10.1016/S0268-0033(98)90098-5.CrossRef
44.
Ferrario VF, Sforza C, Serrao G, Grassi G, Mossi E: Active range of motion of the head and cervical spine: a three-dimensional investigation in healthy young adults. J Orthop Res. 2002, 20: 122-129. 10.1016/S0736-0266(01)00079-1.CrossRefPubMed
45.
Sforza C, Grassi G, Fragnito N, Turci M, Ferrario V: Three-dimensional analysis of active head and cervical spine range of motion: effect of age in healthy male subjects. Clin Biomech (Bristol , Avon ). 2002, 17: 611-614. 10.1016/S0268-0033(02)00071-2.CrossRef
46.
Feipel V, Rondelet B, LePallec JP, DeWitte O, Rooze M: The use of disharmonic motion curves in problems of the cervical spine. Int Orthop. 1999, 23: 205-209. 10.1007/s002640050351.CrossRefPubMedPubMedCentral
47.
Yoganandan N, Kumaresan S, Pintar FA: Biomechanics of the cervical spine Part 2. Cervical spine soft tissue responses and biomechanical modeling. Clin Biomech (Bristol , Avon ). 2001, 16: 1-27. 10.1016/S0268-0033(00)00074-7.CrossRef
48.
Panjabi MM: A hypothesis of chronic back pain: ligament subfailure injuries lead to muscle control dysfunction. Eur Spine J. 2006, 15: 668-676. 10.1007/s00586-005-0925-3.CrossRefPubMed
49.
Revel M, Andre-Deshays C, Minguet M: Cervicocephalic kinesthetic sensibility in patients with cervical pain. Arch Phys Med Rehabil. 1991, 72: 288-291.PubMed
50.
Taylor HH, Murphy B: Altered sensorimotor integration with cervical spine manipulation. J Manipulative Physiol Ther. 2008, 31: 115-126. 10.1016/j.jmpt.2007.12.011.CrossRefPubMed
51.
Juottonen K, Gockel M, Silen T, Hurri H, Hari R, Forss N: Altered central sensorimotor processing in patients with complex regional pain syndrome. Pain. 2002, 98: 315-323. 10.1016/S0304-3959(02)00119-7.CrossRefPubMed
52.
Loudon JK, Ruhl M, Field E: Ability to reproduce head position after whiplash injury. Spine. 1997, 22: 865-868. 10.1097/00007632-199704150-00008.CrossRefPubMed
53.
Feipel V, Salvia P, Klein H, Rooze M: Head repositioning accuracy in patients with whiplash-associated disorders. Spine. 2006, 31: E51-E58. 10.1097/01.brs.0000194786.63690.54.CrossRefPubMed
54.
Sterling M, Jull G, Vicenzino B, Kenardy J, Darnell R: Development of motor system dysfunction following whiplash injury. Pain. 2003, 103: 65-73. 10.1016/S0304-3959(02)00420-7.CrossRefPubMed
55.
Dvir Z, Gal-Eshel N, Shamir B, Prushansky T, Pevzner E, Peretz C: Cervical motion in patients with chronic disorders of the cervical spine: a reproducibility study. Spine. 2006, 31: E394-E399. 10.1097/01.brs.0000219951.79922.df.CrossRefPubMed
56.
Prushansky T, Pevzner E, Gordon C, Dvir Z: Performance of cervical motion in chronic whiplash patients and healthy subjects: the case of atypical patients. Spine. 2006, 31: 37-43. 10.1097/01.brs.0000193557.47355.2f.CrossRefPubMed
57.
Dvir Z, Gal-Eshel N, Shamir B, Pevzner E, Peretz C, Knoller N: Simulated pain and cervical motion in patients with chronic disorders of the cervical spine. Pain Res Manag. 2004, 9: 131-136.CrossRefPubMed
58.
Dvir Z, Prushansky T, Peretz C: Maximal versus feigned active cervical motion in healthy patients: the coefficient of variation as an indicator for sincerity of effort. Spine. 2001, 26: 1680-1688. 10.1097/00007632-200108010-00010.CrossRefPubMed
Metadata
Title
Altered motor control patterns in whiplash and chronic neck pain
Authors
Astrid Woodhouse
Ottar Vasseljen
Publication date
01-12-2008
Publisher
BioMed Central
Published in
BMC Musculoskeletal Disorders / Issue 1/2008
Electronic ISSN: 1471-2474
DOI
https://doi.org/10.1186/1471-2474-9-90

Other articles of this Issue 1/2008

BMC Musculoskeletal Disorders 1/2008 Go to the issue

Research article

Analgesic effect of percutaneously absorbed non-steroidal anti-inflammatory drugs: an experimental study in a rat acute inflammation model

Research article

Characterization of a rat osteotomy model with impaired healing

Research article

Rotational knee laxity: Reliability of a simple measurement device in vivo

Research article

The discordance between clinical and radiographic knee osteoarthritis: A systematic search and summary of the literature

Research article

Experiencing and controlling time in everyday life with chronic widespread pain: a qualitative study

Study protocol

Motor control or graded activity exercises for chronic low back pain? A randomised controlled trial