Objective: To evaluate the effects of neck-specific sensorimotor training using a virtual reality device compared with 2 standard rehabilitation programmes: with, and without general sensorimotor training, in patients with non-traumatic chronic neck pain. Design: Pilot randomized control study. Patients and methods: A total of 51 participants were randomly assigned to 1 of 3 groups: 1: control group; 2: sensorimotor group; 3: virtual reality group. All 3 groups received the clinic's standard rehabilitation programme. Group 2 also received "general sensorimotor training" in the form of group therapy, for a total of 120 min. Group 3 received additional virtual reality-based "neck-specific sensorimotor training" for a total of 120 min. Participants' neck pain, headaches, active cervical range of motion, and Neck Disability Index were determined before and after 3 weeks of intervention. Results: Compared with the control group, the virtual reality group showed significant (p <0.05) advantages in relief of headaches, and active cervical range of motion in flexion and extension. Compared with the sensorimotor group, the virtual reality group showed significant improvements in cervical extension. Conclusion: Virtual reality-based sensorimotor training may increase the effects of a standard rehabilitation programme for patients with non-traumatic chronic neck pain, especially active cervical range of motion in extension.

Das Beschleunigungstrauma der Halswirbelsaule nach Unfallen ist kontrovers diskutiert. Sind die oft chronischen Schmerzverlaufe posttraumatisch allein biomedizinisch zu erklaren oder spielen psychosoziale Faktoren eine dominante Rolle? Christoph Dehner und Michael Kramer geben einen Uberblick zu Verletzungsmechanismen, Diagnostik und Therapieoptionen einer umstrittenen Verletzung.

OBJECTIVE:Although much research has been performed to investigate the cervical spine kinematics during rear-end collisions, our understanding about the exact role of the musculature is limited. The question of the influence of muscle activity on cervical spine kinematics has been discussed.METHODS:A rear-end collision with a speed change (ΔV) of 6.3 km/h was simulated in a sled test with 8 female subjects to investigate the influence of the ventral and dorsal cervical spine musculature on cervical spine kinematics. A high-speed camera and accelerometers recorded the motion and acceleration data. The activity of the sternocleidomastoid muscles was recorded with surface electrodes. To avoid cross talk, an intramuscular recording of the semispinalis capitis muscles was performed with fine-wire electrodes.RESULTS:The analysis of the motion and acceleration parameters allowed the definition of 4 phases. The headrest contact began after a median of 84 ms and the sternocleidomastoid muscle force could be detected after a median of 81 ms, with 0 defining the time of the trigger signal. The maximal force of the sternocleidomastoid muscle and the maximal headrest effect began prior to the maximal ventral angular head acceleration and prior to the maximal ventral horizontal head acceleration relative to T1. The start of the semispinalis capitis muscle force was observed after a median of 159 ms and increased until a flexion of 20 to 25° was reached.CONCLUSIONS:The headrest effect and the sternocleidomastoid muscle force firstly supported the deceleration of the head relative to T1 toward dorsal, which was followed by an accelerating effect toward ventral. The semispinalis capitis muscle force exerted a late decelerating effect on head flexion and ventral translation movement.

Ein Schock: Nach 30 unfallfreien Jahren musste Frau Schindel vor einem Jahr einen Auffahrunfall verkraften. Seitdem leidet die Sekretärin unter den Symptomen des Schleudertraumas. Sie fühlt sich wie „ausgebremst“. Zwei Physiotherapeuten, ein Arzt, ein medizinischer Gutachter und ein Psychotherapeut erklären, wie sie bei ihrem Fall vorgehen würden.

OBJECTIVES:To investigate training effects of two different resistance and proprioceptive exercising concepts of neck muscles.MATERIAL AND METHOD:Twenty-six healthy women participated in a randomized pilot trial. The test persons were randomized to two different neck-training programs (resistance training (RT) and proprioceptive resistance training (PRT)). They performed a standardized training program for the duration of ten weeks two times weekly. The neck strength, the cross-sectional area of three neck muscle groups (1. sternocleidomastoid muscles; 2. multifidus and semispinalis cervicis muscles; 3. semispinalis capitis and splenius muscles) and the proprioceptive capability evaluated by the dynamic joint repositioning error (DJRE) of the head were assessed pre- and post-intervention.RESULTS:Strength gain did not differ significantly between the two resistance training groups (PRT group: 8.2% to 29.3%; RT group: 1.4% to 19.8%). Change of hypertrophy of all neck muscle groups was significantly (p< 0.001 to p=0.013) greater in the PRT group (18.9% to 32.3%) than in the RT group (1.5% to 12.9%). The DJRE deteriorated with 35% in the RT group and did not change in PRT group (-2.0%).CONCLUSION:In combination with resistance training, proprioceptive training led to a significantly higher muscle hypertrophy and didn't effect a significant deterioration of the proprioceptive capability compared to isolated resistance training.

The description of cervical spine motion and the risk to sustain a cervical spine injury in traffic accidents is mainly based on rear-end collisions. The knowledge about frontal collisions is comparable low. Therefore the objective of this exploratory study was, to describe the in-vivo cervical spine motion and acceleration during simulated frontal sled collisions and to identify sequences of motion in which the risk of injury is increased. A frontal collision with a speed change of 10.2km/h was simulated in a sled test with ten volunteers. Cervical spine kinematics was assessed by the simultaneous analysis of the angular head motion and acceleration as well as the simultaneous analysis of the relative motion and acceleration between the head and the first thoracic vertebral body. The motion sequence was divided into five phases. The combination of peak values of the angular head acceleration to ventral and the relative horizontal head acceleration to dorsal between the time period of 90ms and 110ms (early flexion phase) included – potential injury generating – shear forces. Although a hyperflexion (late rebound phase) as injury pattern didn’t occur, dorsal soft tissue injuries due to eccentric muscle-sprain could not be ruled out completely. In conclusion the study showed under simulated test conditions that during the early flexion phase and the late rebound phase, acceleration and movement pattern occur that could lead to cervical spine injuries.

Objective: The question of muscle activity influence on the cervical spine kinematics during rear-end and frontal crash events has been discussed. Less data are available concerning frontal collisions. Therefore, the objective of this study was to investigate the influence of the ventral and dorsal neck muscles on the cervical spine kinematics during simulated frontal sled collisions.Methods: A frontal collision with a velocity change (delta V) of 10.2km/h was simulated in a sled test with 10 healthy subjects (7 female; 3 male). A high-speed camera and accelerometers recorded the motion and acceleration data. The activity of the sternocleidomastoid muscles was recorded with surface electrodes. To avoid cross-talk, an intramuscular recording of the semispinalis capitis muscles was performed with fine-wire electrodes.Results: The sequence of both muscle activities was reproducible in all subjects. The maximal force of the sternocleidomastoid muscle was observed after a median of 152ms, with 0 defining the time of the trigger signal. With earlier onset of muscle force, maximal dorsal horizontal acceleration of the head (r = -0.600) was reached later and the ventral translation (r = -0.733) and flexion movement (r = -0.755) set in earlier. The maximal force of the semispinalis capitis muscle was observed after a median of 160ms. If the duration of muscle force was longer, the maximal head flexion (r = 0.685) and the maximal ventral head translation (r = 0.738) were reached later.Conclusions: The sternocleidomastoid muscle force is mainly associated with the horizontal head acceleration and influences the onset of the flexion and translation motion. To summarize, these temporal correlations allow the conclusion that the semispinalis capitis muscle force is mainly associated with the angular head acceleration and influences the duration of the flexion and translation motion.

Up to now no therapy study has used the classification system of the Quebec Task Force (QTF) to differentiate between patients with (QTF II°) and without functional disorders (QTF I°). This differentiation seems meaningful, as this difference may be relevant for the correct treatment planning. In this context the effect of the therapy recommendation "act as usual" has been evaluated in a homogeneous patient collective with whiplash injuries QTF I°. 470 patients with acute whiplash injuries had been catched in this study and classified according to the QTF. 359 patients (76.4%) with QTF I° injuries could be identified. Out of that 162 patients were enrolled to the study and received the therapy recommendation "act as usual" and the adapted pain treatment with non-steroidal anti-inflammatory drugs (NSAID). After six months the outcome was evaluated by phone. After injury the median pain score assessed by a visual analogue scale (VAS) was 5.4 (min = 3.3; max = 8.5). After six months 5 of the 162 patients complained intermittent pain symptoms (VAS values < 2). This is consistent with a chronification rate of 3.1%. After injury, the median pain disability index (PDI) was 3.9 (min = 1.9; max = 7.7). After six months 3 of the 162 patients stated persisting disability during sporting and physical activities (VAS values < 1). The therapy recommendation "act as usual" in combination with an adapted pain treatment is sufficient. Usually patients with whiplash injuries QTF I° do not need physical therapy. An escalation of therapy measures should be reserved to patients with complicated healing processes.

Traumatic rupture of the descending aorta is an acute life-threatening event. The most common cause is deceleration trauma resulting in a sudden stretching of the aortic isthmus as for example in car and motorcycle accidents and falls from a great height. Exemplified by a case report of a multiply injured 57-year-old male the diagnostic pathways, therapy and postoperative complications are presented.

In a majority of cases, whiplash injuries are a domain of conservative therapy. Nevertheless it remains unclear whether physical therapy is of medical or economic benefit in patients with whiplash injuries.

The predictive value of trauma impact for the severity of whiplash injuries has mainly been investigated in sled- and crash-test studies. However, very little data exist for real-life accidents. Therefore, the predictive value of the trauma impact as assessed by the change in velocity of the car due to the collision (ΔV) for the resulting cervical spine injuries were investigated in 57 cases after real-life car accidents.

Krischak GD, Krasteva A, Schneider F, Gulkin D, Gebhard F, Kramer M. Physiotherapy after volar plating of wrist fractures is effective using a home exercise program. Arch Phys Med Rehabil 2009;90:537-44.Objective: To determine the effect of 2 different postoperative therapy approaches after operative stabilization of the wrist fractures: treatment by a physical therapist with 12 sessions and an unassisted home exercise program.Design: Randomized controlled cohort study.Setting: Hospital-based care, primary center of orthopedic surgery.Participants: Volunteers (N=48) with fractures of the distal radius after internal fixation with locking plates. There were 46 patients available for follow-up after exclusion of 2 participants due to physiotherapy sessions in excess of the study protocol.Interventions: Not applicable.Main Outcome Measures: Evaluation of grip strength using a Jamar dynamometer, range of motion (ROM), and Patient Related Wrist Evaluation (PRWE).Results: After a 6-week period of postoperative treatment, the patients (n=23) performing an independent home exercise program using a training diary showed a significantly greater improvement of the functionality of the wrist. Grip strength reached 54% (P=.003), and ROM in extension and flexion 79% (P<.001) of the uninjured side. Ulnar and radial abduction was also higher in this group. In contrast, patients who were treated by a physical therapist achieved grip strength equal to 32%, and ROM in extension and flexion of 52% of the uninjured side. Patients who were performing the home training after operation recorded an improved wrist function with a nearly 50% lower value (P<.001) in the PRWE score.Conclusions: In the postoperative rehabilitation of wrist fractures, instructions in a home exercise program are an effective alternative to prescribed physical therapy treatment.

CONTEXT Chronic low back pain (LBP) has been reported with a high incidence in elite rowers. It results in less effective training, long interruptions in training, and a drop in performance. OBJECTIVE The authors hypothesized that exercise-induced LBP in rowers is caused by a chronic functional compartment syndrome (CFCS) of the multifidus muscle. DESIGN Controlled clinical trial. SETTING The rowers were tested in their training camp. The control group was tested at a university hospital. PARTICIPANTS 14 volunteer elite rowers complaining of LBP and 16 healthy volunteer amateur athletes. MAIN OUTCOME MEASUREMENTS Intramuscular pressure (IMP), tissue oxygenation pressure (pO2), and median frequency (MF) shift in the electromyographic power density spectrum during isometric fatiguing extension at 60% of maximum voluntary contraction. RESULTS At the beginning (controls 186.6 mm Hg vs rowers 60.2 mm Hg, P = .002) and the end (controls 224.1 mm HG vs rowers 77.1 mm Hg, P < .001) of the endurance exercise the median IMP was significantly higher in the healthy controls. Nearly identical resting pO2 was measured in both groups (controls 37.6 mm Hg vs rowers 37.3 mm Hg, P = .740). Rowers showed higher median MF shift (rowers -11.5 Hz vs controls -8.5 Hz, P = .079) during contraction. CONCLUSIONS These observations cannot sufficiently be explained by the CFCS model and suggest that factors other than IMP have an additional effect on pain generation during exercise in elite rowers.

Background: Low back pain is a problem that not only affects the general population but is also an underestimated problem in athletes involved in endurance sports. Rowing in particular has been associated with a high incidence of exercise-associated low back pain. Research question: The present study hypothesises that a device-assisted training programme leads to an improvement of the microcirculation and muscle performance of the multifidus muscle, which contributes to the reduction of exercise-associated low back pain.Type of study: Before-and-after trialMethods: Thirteen young elite oarsmen (five males, eight females; age range: 14.6-15.3 years) with exercise-associated low back pain performed a device-assisted training programme for isometric exercise of the low back 2-3 times per week for a duration of three months. To measure the training effect on the microcirculation and muscle performance of the multifidus muscle, simultaneous measurements of intramuscular pressure, tissue oxygen saturation, and median frequency shift in the surface electromyography were performed before and after the training period. The pain course was evaluated using a visual analogue scale.Results: The device-assisted training programme resulted in a median increase in maximum trunk torque (19N) and isometric exercise duration (44sec) coupled with a decrease in the frequency, duration and intensity of pain in 12 of 13 oarsmen. During the isometric endurance test, the increase in intramuscular pressure (17.0mmHg vs. 8.9mmHg) and the drop in tissue oxygen saturation (-6.6mmHg vs. 0.1mmHg) were significantly greater before training than after training. The median frequency shift in the surface electromyography remained unchanged.Conclusions: As the device-assisted training programme led to a reduction of exercise-associated low back pain and in addition resulted in an improvement of the microcirculation and muscle performance of the multifidus muscle, the hypothesis of this study seems to be confirmed. Therefore the findings of the present study strongly indicate that muscle training focusing on the multifidus muscle should be taken into consideration in the planning of back training programmes for oarsmen.

The aim of this study was to investigate whether the final displacement of conservatively treated distal radius fractures can be predicted after primary reduction. We analysed the radiographic documents of 311 patients with a conservatively treated distal radius fracture at the time of injury, after reduction and after bony consolidation. We measured the dorsal angulation (DA), the radial angle (RA) and the radial shortening (RS) at each time point. The parameters were analysed separately for metaphyseally “stable” (A2, C1) and “unstable” (A3, C2, C3) fractures, according to the AO classification system. Spearman’s rank correlations and regression functions were determined for the analysis. The highest correlations were found for the DA between the time points ‘reduction’ and ‘complete healing’ ( r = 0.75) and for the RA between the time points ‘reduction’ and ‘complete healing’ ( r = 0.80). The DA and the RA after complete healing can be predicted from the regression functions.

The aim of this study was to investigate the cervicocephalic kinaesthesia of healthy subjects for gender and age effects and its reliability in a new virtual reality test procedure. 57 healthy subjects (30 male, 27 females; 18-64 years) were immersed into a virtual 3D scene via a headmounted display, which generated specific head movements. The joint repositioning error was determined in a static and dynamic test at the times T0, T1 (T0+10 minutes) and T2 (T0+24 hours). The intrasession reliability (T0-T1) and the intersession reliability (T0-T2) were analysed. In both tests no gender- or age-specific effects were found. In the overall group the means of the static test were 6.2 degrees -6.9 degrees and of the dynamic test were 4.5 degrees -4.9 degrees . The intratest difference in the static test was -0.16 degrees and the intertest difference was 0.47 degrees . The intratest difference in the dynamic test was 0.42 degrees and the intertest difference was 0.37 degrees . The static and dynamic test was reproducible in healthy subjects, with minor deviations, irrespective of gender and age. The smaller interindividual differences in the dynamic test could be beneficial in the comparison of healthy individuals and individuals with cervical spine disorders.

Study design: Experimental in vivo study. Objective: The objective was to investigate the balance control in patients with acute QTF grade 11 whiplash injuries of the cervical spine.Summary of background data: Tetra-ataxiametric posturography in chronic pain patients after whiplash injuries of the cervical spine has revealed an impaired regulation of balance. However, so far it is unclear if this is caused by the accident or other factors that are associated with the pain chronification process.Methods: 40 patients with acute QTF grade 11 whiplash injuries and 40 healthy matched controls were examined on a posturography platform. The stability index ST(Sigma) and the Fourier analysis FA(Sigma) (0.10-1.00 Hz) were established for eight standing positions and sum scores were calculated. The pain index was established using a visual analog scale ranging from 0 to 100. A follow-up examination was conducted for the patients after 2 months.Results: The patients with acute whiplash injuries of the cervical spine achieved significantly poorer results for both ST(Sigma) and FA(Sigma) than the healthy controls. There were no differences between the eight standing positions for both ST(Sigma) and FA(Sigma). After 2 months, 17 patients had no change in the pain development, 21 patients showed an improvement in pain intensity and 2 patients had deteriorated. The subgroup of patients with improvement in pain intensity showed a significant improvement in balance control concerning the FA(Sigma) compared to patients with unchanged pain intensity.Conclusion: Patients with acute whiplash injuries have a reduced balance control as compared to matched controls. This study gives an indication that post-traumatic neck pain is associated with impairments of postural control. (C) 2007 Elsevier B.V. All rights reserved.

The objective of this study was to investigate the influence of anthropometric data on the kinematics of the cervical spine and the risk factors for sustaining a neck injury during rear-end collisions occurring in a sled test. A rear-end collision with a velocity change (DeltaV) of 6.3 km/h was simulated in a sled test with eight healthy female subjects. The study analysed the association of anthropometric data with the initial distance between the head and the head restraint, defined kinematic characteristics, the neck injury criterion (NIC) and the neck injury criterion minor (NICmin). The head circumference is negatively associated (r=-0.598) with the initial distance between the head and the head restraint, the maximal head extension (r=-0.687) and the maximal dorsal angular head acceleration (r=-0.633). The body weight (r=0.800), body height (r=0.949) and thorax circumference (r=0.632) are positively associated with the maximal ventral head translation. The neck length correlates positively with the NIC (r=0.826) and negatively with the NICmin (r=-0.797). Anthropometric factors influence the kinematics of the cervical spine and the risk of injury. A high risk of injury may be assumed for individuals with a small head circumference, long neck, tall body height and high body weight.

PURPOSE:Radius fractures are frequent in adults, and the long-term results of conservative treatment remain disappointing. This study examines predictors for the clinical outcome in the initial radiograph. This will help to identify patients who will benefit from surgical treatment.MATERIALS AND METHODS:A cohort study including a standardized telephone interview (Cooney score) was used to identify all conservatively treated patients with a distal radius fracture over a five-year period. The additional selection criteria were: over 15 years old, initial X-ray available, patient reachable by phone for the follow-up interview. The following measurements were taken from the initial radiograph: radius-base angle, radial shortening, radiopalmar angle and intraarticular displacement. Correlations and a simple test to predict negative outcome were computed.RESULTS:Of the initially identified 2211 patients with distal radius fracture, 179 also fulfilled the other criteria. The patients were 56.2 years old on average (standard deviation SD = +/- 22.45 years) and 72 % were female. 60 % of the fractures were on the right side. The average follow-up was 4.3 years (SD +/- 1.66). The Cooney score results averaged 85 points (with 100 being the optimal and maximum score), indicating good or very good functional results in the long term follow-up for 61 % of patients. However, 31 % received a rating of fair or poor and therefore had an unfavorable outcome. With respect to the correlations, age and shortening of the radius (but not gender) had a significant influence on the functional result. Using an age of 75 years or above and a radial shortening of at least 4 mm to predict an unfavorable outcome, the sensitivity is only 16 %, but the positive predictive value is 73 % and the specificity is 96 %.CONCLUSION:In the analysis of the initial radiographs after distal radius fracture, age and radial shortening primarily correlate with functional results after four years after conservative treatment. Using the values age > or = 75 and radial shortening > or = 4 mm, it is possible to predict an unfavorable functional outcome with a positive predictive value of 73 %. This could aid in the indication of operative treatment.

OBJECTIVE:To investigate the effects of 2-day and 10-day immobilization of the cervical spine on pain, range of motion (ROM), and disability of patients with Quebec Task Force (QTF) grade II whiplash injuries.DESIGN:Randomized controlled trial.SETTING:University hospital emergency department.PARTICIPANTS:Seventy patients with acute QTF grade II whiplash injuries.INTERVENTIONS:At the intake examination within 24 hours after the whiplash trauma, the patients were randomized to 2 therapy groups (2-d or 10-d immobilization with a soft cervical collar). All patients received pain drugs (nonsteroidal anti-inflammatory drugs) and after 7 days, all patients started a standardized physiotherapy program 2 to 3 times a week.MAIN OUTCOME MEASURES:Patients' pain and disability scores were assessed using visual analog scales and ROM was assessed using a goniometer. All parameters were measured within 24 hours after injury and after 2 and 6 months.RESULTS:After 2 months, the different periods of immobilization (2d or 10d) were associated with comparable improvements in pain symptoms (median, 4.60 vs 4.65), ROM (median, 100.0 degrees vs 117.5 degrees ), and disability score (median, 4.90 vs 5.15). No statistically significant differences could be identified between the 2 treatment groups. After 6 months, persistent pain was reported by 4 patients in each group (12.5%).CONCLUSIONS:In patients with QTF grade II whiplash injuries, there is no short- or long-term difference between 2-day and 10-day immobilization with a cervical collar in terms of pain, ROM, or disability.