SYNOPSIS: Neck pain is a common and episodic condition that is treated using a spectrum of interventions known to be moderately effective but is associated with a significant incidence of chronic pain. Recently, there has been increased focus on defining biological aspects of neck pain. Studies have indicated that neurophysiological, biomechanical, and motor control abnormalities are present and may be useful either in prognosis or classification. We review some of these findings in the context of our own work defining biological markers that may form the basis for clinical tests that can be used for prognosis, classification, or outcome evaluation in patients with neck pain. We have identified abnormalities in neurophysiology using quantitative sensory testing (vibration, touch, and current perception) and response to cold provocation that are related to neck disability. We have identified altered muscle biochemistry by measuring circulating muscle proteins in a lumbar surgery model and are now applying those methods to whiplash injury. We have incorporated capnography into treatment to address central physiological changes present in some patients by monitoring and training CO₂ levels. We have developed an innovative new test, the Neck Walk Index, that captures abnormal control of head movement during slow gait as a means of differentiating patients with neck pain from either unaffected controls or individuals with other pathologies. We have used time-varying 3-dimensional joint orientation kinematics to assess deficits in motor control during an upper extremity reach task, the results showing that poor coordination and control of the shoulder girdle leads to shoulder guarding and inconsistencies in elbow joint movement. Despite some promising early results, future research is needed to determine how these measures help clinicians to diagnose, evaluate, and forecast future outcome for patients who present with neck pain. LEVEL OF EVIDENCE: Diagnosis, level 5.

Note: Appendices A and B are online-only and are included in this downloadable PDF.

J Orthop Sports Phys Ther 2009;39(5):388-399. doi:10.2519/jospt.2009.3126

KEY WORDS: biochemistry, capnography, cold intolerance, muscle, neck, pain, sensory evaluation

A comparison of function of individuals 1 year after total knee arthroplasty (TKA) with healthy control subjects (controls) meaningfully describes outcome in these patients. Perception of function measured by 2 questionnaires, the Lower Extremity Activity Profile (LEAP) and the Western Ontario McMaster Osteoarthritis Index (WOMAC), and walking and stair performance was compared between 29 patients, 1 year after TKA, and 40 controls. There was significantly greater perceived difficulty with function in patients with TKA than in controls. In TKA men, LEAP and WOMAC scores correlated respectively with self-paced walk speed (r = -.71 and -.55) and stair performance time (r = 0.70 and 0.68). In TKA women, LEAP difficulty score correlated with self-paced walk speed (r = -.41) and stair performance time (r = 0.71). By 1 year, TKA subjects regained 80% of the function of controls. Perception of function after TKA can be measured by either questionnaire in men; however the LEAP is the preferable questionnaire with women.

J Orthop Sports Phys Ther. 1998;27(4):255-262.

Key Words: outcome assessment, knee replacement arthroplasty, case control study, physical function, pain