McPartland J M, Brodeur R R, Hallgren R C
Department of Biomechanics, Michigan State University, East Lansing, USA.
J Manipulative Physiol Ther. 1997 Jan;20(1):24-9.
To study the relationship between chronic neck pain, standing balance and suboccipital muscle atrophy. We hypothesize that patients with chronic neck pain have more somatic dysfunction in the cervical spine than control subjects without neck pain. We also hypothesize that patients with chronic neck pain and somatic dysfunction exhibit more atrophy of suboccipital muscles. Lastly, because suboccipital muscles have a high density of proprioceptors, we hypothesize that chronic pain patients exhibit a loss in standing balance.
Randomized, controlled, partially blind study examining chronic neck pain patients and control subjects for differences in degree of upper cervical somatic dysfunction, standing balance and suboccipital muscle atrophy.
Subjects were recruited from a clinical practice at Michigan State University; controls were recruited from the faculty, staff and students.
Seven chronic neck pain patients and seven asymptomatic control subjects.
Palpation was used to diagnose somatic dysfunction in the upper cervical spine. Balance parameters were calculated using a force platform; muscle atrophy was judged with magnetic resonance images.
Chronic neck pain patients had almost twice as many somatic dysfunctions as controls (p = .028). Force platform results showed a decrease in standing balance in patients compared with control subjects (p = .004). MRI showed that chronic neck pain subjects had marked atrophy of the rectus capitis posterior major and minor muscles, including fatty infiltration.
This study suggests that there is a relationship between chronic pain, somatic dysfunction, muscle atrophy and standing balance. We hypothesize a cycle initiated by chronic somatic dysfunction, which may result in muscle atrophy, which can be further expected to reduce proprioceptive output from atrophied muscles. The lack of proprioceptive inhibition of nociceptors at the dorsal horn of the spinal cord would result in chronic pain and a loss of standing balance.
研究慢性颈部疼痛、站立平衡与枕下肌萎缩之间的关系。我们假设，与无颈部疼痛的对照组相比，慢性颈部疼痛患者的颈椎存在更多的躯体功能障碍。我们还假设，患有慢性颈部疼痛和躯体功能障碍的患者枕下肌萎缩更为明显。最后，由于枕下肌本体感受器密度较高，我们假设慢性疼痛患者存在站立平衡能力下降。
随机、对照、部分盲法研究，比较慢性颈部疼痛患者和对照组在上颈椎躯体功能障碍程度、站立平衡和枕下肌萎缩方面的差异。
研究对象招募自密歇根州立大学的临床实践；对照组招募自教职员工和学生。
7名慢性颈部疼痛患者和7名无症状对照者。
通过触诊诊断上颈椎的躯体功能障碍。使用测力平台计算平衡参数；通过磁共振成像判断肌肉萎缩情况。
慢性颈部疼痛患者的躯体功能障碍数量几乎是对照组的两倍（p = 0.028）。测力平台结果显示，与对照组相比，患者的站立平衡能力下降（p = 0.004）。磁共振成像显示，慢性颈部疼痛受试者的头后大直肌和头后小直肌明显萎缩，包括脂肪浸润。
本研究表明，慢性疼痛、躯体功能障碍、肌肉萎缩和站立平衡之间存在关联。我们推测，由慢性躯体功能障碍引发的一个循环，可能导致肌肉萎缩，进而预期会进一步减少萎缩肌肉的本体感觉输出。脊髓背角伤害性感受器缺乏本体感觉抑制会导致慢性疼痛和站立平衡能力丧失。
