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J Brachial Plex Peripher Nerve Inj 2009; 04(01): e60-e65
DOI: 10.1186/1749-7221-4-10
Research article
Nystrom et al; licensee BioMed Central Ltd.

Pre- and post-operative gait analysis for evaluation of neck pain in chronic whiplash[*]

Ake Nystrom
1   Department of Orthopaedic Surgery and Rehabilitation, University of Nebraska Medical Center, Omaha NE 68198, USA
2   Division of Plastic and Reconstructive Surgery, University of Nebraska Medical Center, Omaha NE 68198, USA
,
Glen M Ginsburg
1   Department of Orthopaedic Surgery and Rehabilitation, University of Nebraska Medical Center, Omaha NE 68198, USA
3   Munroe-Meyer Motion Analysis Laboratory, University of Nebraska, Lincoln, NE 68588, USA
,
Wayne Stuberg
3   Munroe-Meyer Motion Analysis Laboratory, University of Nebraska, Lincoln, NE 68588, USA
,
Stacey Dejong
3   Munroe-Meyer Motion Analysis Laboratory, University of Nebraska, Lincoln, NE 68588, USA
› Author Affiliations
Subject Editor:
Further Information

Publication History

22 April 2009

17 July 2009

Publication Date:
18 September 2014 (online)

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Abstract

Introduction Chronic neck pain after whiplash is notoriously refractory to conservative treatment, and positive radiological findings to explain the symptoms are scarce. The apparent disproportionality between subjective complaints and objective findings is significant for the planning of treatment, impairment ratings, and judicial questions on causation. However, failure to identify a symptom’s focal origin with routine imaging studies does not invalidate the symptom per se. It is therefore of a general interest both to develop effective therapeutic strategies in chronic whiplash, and to establish techniques for objectively evaluation of treatment outcomes.

Methods Twelve patients with chronic neck pain after whiplash underwent pre- and postoperative computerized 3D gait analysis.

Results Significant improvement was found in all gait parameters, cervical range-of-motion, and self reported pain (VAS).

Conclusion Chronic neck pain is associated with abnormal cervical spine motion and gait patterns. 3D gait analysis is a useful instrument to assess the outcome of treatment for neck pain.

*This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.


 

  • References

  • 1 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 7604354
    CrossrefPubMedGoogle Scholar
  • 2 United Nations Economic and Social Council Proposal to Develop a Global Technical Regulation Concerning Head Restraints TRANS/WP.29/AC.3/13 2005
    PubMed
  • 3 Carette S. Whiplash injury and chronic neck pain. N Engl J Med 1994; 330: 1083-1084 10.1056/NEJM199404143301512 8127339
    CrossrefPubMedGoogle Scholar
  • 4 Rosenfeld M, Seferiadis A, Gunnarsson R. Active intervention in patients with whiplash-associated disorders improves long-term prognosis: a randomized controlled clinical trial. Spine 2003; 28: 2491-2498 10.1097/01.BRS.0000090822.96814.13 14624083
    CrossrefPubMedGoogle Scholar
  • 5 Rauschning W, Jónsson H. Injuries of the cervical spine in automobile accidents: pathoanatomical and clinical aspects. In: Gunzburb R, Szpalski M. Whiplash injuries. Current concepts in prevention, diagnosis, and treatment of the cervical whiplash syndrome. Lippincott-Raven Publishers; Philadelphia, PA: 1998: 33-53
    Google Scholar
  • 6 Yoganandan N, Cusick JF, Pintar FA, Rao RD. Whiplash injury determination with conventional spine imaging and cryomicrotomy. Spine 2001; 26: 2443-2448 10.1097/00007632-200111150-00010 11707708
    CrossrefPubMedGoogle Scholar
  • 7 Antonaci F, Bulgheroni M, Ghirmai S, Lanfranchi S, Dalla Toffola E, 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 12230595
    CrossrefPubMedGoogle Scholar
  • 8 Juan FJ. Use of botulinum toxin-A for musculoskeletal pain in patients with whiplash associated disorders. BMC Musculoskelet Disord 2004; 5: 5 356919 15018625 10.1186/1471-2474-5-5
    CrossrefPubMedGoogle Scholar
  • 9 Tomlinson PJ, Gargan MF, Bannister GC. The fluctuation in recovery following whiplash injury 7.5-year prospective review. Injury 2005; 36: 758-761 10.1016/j.injury.2005.01.006 15910829
    CrossrefPubMedGoogle Scholar
  • 10 Gargan MF, Bannister G, Main C, Hollis S. The behavioural response to whiplash injury. J Bone Joint Surg Br 1997; 79: 517-518 10.1302/0301-620X.79B4.6940 9250726
    CrossrefPubMedGoogle Scholar
  • 11 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 11698884
    CrossrefPubMedGoogle Scholar
  • 12 Freeman MD, Nystrom A, Centeno C. Chronic whiplash and central sensitization; an evaluation of the role of a myofascial trigger points in pain modulation. Brachial Plex Peripher Nerve Inj 2009; 4: 2 10.1186/1749-7221-4-2
    PubMedGoogle Scholar
  • 13 Duffy MF, Stuberg W, DeJong S, Gold KV, Nystrom NA. Case Report: Whiplash-Associated Disorder from a low velocity bumper car collision. History, evaluation, and surgery. Spine 2004; 29: 1881-1884 10.1097/01.brs.0000137064.85554.fa 15534409
    CrossrefPubMedGoogle Scholar
  • 14 Mulavara AP, Verstraete MC, Bloomberg JJ. Modulation of head movement control in humans during treadmill walking. Gait Posture 2002; 16: 271-282 10.1016/S0966-6362(02)00016-4 12443952
    CrossrefPubMedGoogle Scholar
  • 15 Menz HB, Lord SR, Fitzpatrick RC. Acceleration patterns of the head and pelvis when walking on level and irregular surfaces. Gait Posture 2003; 18: 35-46 10.1016/S0966-6362(02)00159-5 12855299
    CrossrefPubMedGoogle Scholar
  • 16 Chen KJ, Keshner EA, Peterson BW, Hain TC. Modeling head tracking of visual targets. J Vestib Res 2002; 12: 25-33 12515889
    PubMedGoogle Scholar
  • 17 Kavanagh JJ, Barrett RS, Morrison S. Upper body accelerations during walking in healthy young and elderly men. Gait Posture 2004; 20: 291-298 10.1016/j.gaitpost.2003.10.004 15531176
    CrossrefPubMedGoogle Scholar
  • 18 Frigo C, Carabalona R, Dalla Mura M, Negrini S. The upper body segmental movements during walking by young females. Clin Biomech (Bristol, Avon) 2003; 18: 419-425 10.1016/S0268-0033(03)00028-7 12763438
    CrossrefPubMedGoogle Scholar
  • 19 Bartonek A, Saraste H, Eriksson M, Knutson L, Cresswell AG. Upper body movement during walking in children with lumbosacral myelomeningocele. Gait Posture 2002; 15: 120-129 10.1016/S0966-6362(01)00147-3 11869905
    CrossrefPubMedGoogle Scholar
  • 20 Hagert CG, Christenson JT. Hyperpressure in the trapezius muscle associated with fibrosis. Acta Orthop Scand 1990; 61: 263-265 2371824
    CrossrefPubMedGoogle Scholar
  • 21 Kadaba MP, Ramakrishnan HK, Wootten ME. Measurement of lower extremity kinematics during level walking. J Orthop Res 1990; 8: 383-390 10.1002/jor.1100080310 2324857
    CrossrefPubMedGoogle Scholar
  • 22 Shrout PE, Fleiss JL. Intraclass Correlations: Uses in Assessing Rater Reliabilty. Psychol Bull 1979; 2: 420-428 10.1037/0033-2909.86.2.420
    PubMedGoogle Scholar
  • 23 Ferrari R, Shorter E. From railway spine to whiplash – the recycling of nervous irritation. Med Sci Monit 2003; 9: HY27-37 14586283
    PubMedGoogle Scholar
  • 24 Ferrari R, Russell AS, Carroll LJ, Cassidy JD. A re-examination of the whiplash associated disorders (WAD) as a systemic illness. Ann Rheum Dis 2005; 64: 1337-1342 1755634 15731286 10.1136/ard.2004.034447
    CrossrefPubMedGoogle Scholar
  • 25 Ferrari R, Kwan O, Russell AS, Pearce JM, Schrader H. best approach to the problem of whiplash? One ticket to Lithuania, please. Clin Exp Rheumatol 1999; 17: 321-326 10410265
    PubMedGoogle Scholar
  • 26 Schaufele MK, Boden SD. Physical function measurements in neck pain. Phys Med Rehabil Clin N Am 2003; 14: 569-588 12948342
    CrossrefPubMedGoogle Scholar
  • 27 Wilk B, Karol LA, Johnston 2nd CE, Colby S, Haideri N. The effect of scoliosis fusion on spinal motion: a comparison of fused and nonfused patients with idiopathic scoliosis. Spine 2006; 31: 309-314 10.1097/01.brs.0000197168.11815.ec 16449904
    CrossrefPubMedGoogle Scholar
  • 28 Engsberg JR, Lenke LG, Uhrich ML, Ross SA, Bridwell KH. Prospective comparison of gait and trunk range of motion in adolescents with idiopathic thoracic scoliosis undergoing anterior or posterior spinal fusion. Spine 2003; 28: 1993-2000 10.1097/01.BRS.0000087209.34602.42 12973147
    CrossrefPubMedGoogle Scholar
  • 29 Berger M, Lechner-Steinleitner S, Hoffmann F, Schönegger J. Akzelerations-Dezelerations-Trauma der Halswirbelsäule. Diagnose schmerzbedingter und simulierter zervikaler Bewegungsstörungen. Schmerz 1998; 12: 400-405 10.1007/s004820050171 12799954
    CrossrefPubMedGoogle Scholar
  • 30 Kristjansson E, Leivseth G, Brinckmann P, Frobin W. Increased sagittal plane segmental motion in the lower cervical spine in women with chronic whiplash-associated disorders, grades I-II: A case-control study using a new measurement protocol. Spine 2003; 28: 2215-2221 10.1097/01.BRS.0000089525.59684.49 14520034
    CrossrefPubMedGoogle Scholar
  • 31 Krakenes J, Kaale BR, Moen G, Nordli H, Gilhus NE, Rorvik J. MRI assessment of the alar ligaments in the late stage of whiplash injury-a study of structural abnormalities and observer agreement. Neuroradiology 2002; 44: 617-624 10.1007/s00234-002-0799-6 12136365
    CrossrefPubMedGoogle Scholar
  • 32 Johansson BH. Whiplash injuries can be visible by functional magnetic resonance imaging. Pain Res Manag 2006; 11: 197-199 2538999 16960637
    PubMedGoogle Scholar
  • 33 Volle E, Montazem A. MRI video diagnosis and surgical therapy of soft tissue trauma to the craniocervical junction. Ear Nose Throat J 2001; 80: 41-4 46–8 11209518
    PubMedGoogle Scholar
  • 34 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: 1642-4 1738789 15489407 10.1136/jnnp.2003.031278
    CrossrefPubMedGoogle Scholar
  • 35 Gimse R, Tjell C, Bjørgen IA, Saunte C. Disturbed eye movements after whiplash due to injuries to the posture control system. J Clin Exp Neuropsychol 1996; 18: 176-186
    PubMedGoogle Scholar
  • 36 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 15031839
    CrossrefPubMedGoogle Scholar
  • 37 Hildingsson C, Wenngren BI, Bring G, Toolanen G. Oculomotor problems after cervical spine injury. Acta Orthop Scand 1989; 60: 513-516 2603649
    CrossrefPubMedGoogle Scholar