Neck pain causes respiratory dysfunction

doi:10.1016/j.mehy.2007.07.050

Medical Hypotheses

Volume 70, Issue 5, 2008, Pages 1009-1013

https://doi.org/10.1016/j.mehy.2007.07.050 Get rights and content

Summary

This paper describes a presumptive mechanism for the development of changes in respiratory function due to chronic neck pain. The patient with neck pain presents a number of factors that could constitute a predisposition of leading to a respiratory dysfunction: (a) the decreased strength of deep neck flexors and extensors, (b) the hyperactivity and increased fatigability of superficial neck flexors, (c) the limitation of range of motion, (d) the decrease in proprioception and disturbances in neuromuscular control, (e) the existence of pain and (f) the psychosocial influence of dysfunction. The possible connection of neck pain and respiratory function could have a great impact on various clinical aspects notably patient assessment, rehabilitation and pharmacological prescription.

Section snippets

Background

Although not life-threatening, spinal pain constitutes a significant epidemiological and economic problem, which appears to be growing despite improvements in diagnosis and therapy [1]. Neck pain and headaches of cervical origin are complaints affecting an increasing number of the general population. It is clear that they are very common and have a considerable impact on the health and quality of life of individuals and on society as a whole [2].

Literature presents a reduction of neck muscle

The hypothesis

The patient with neck pain presents a number of factors that could constitute a predisposition of leading to a respiratory dysfunction (Fig. 1). These factors are (a) the decreased strength of deep neck flexors and extensors, (b) the hyperactivity and increased fatigability of superficial neck flexors (especially SCM and AS), (c) the limitation of range of motion, (d) the decrease in proprioception and neuromuscular disturbances, (e) the existence of pain and (f) the psychosocial influence of

Evaluation of hypothesis

The impact of neck pain on respiratory function could be expressed by means of a number of different components. According to the hypothesis, rib cage mechanisms, strength and neuromuscular coordination of respiratory muscles and spirometric values are expected to have been influenced in a varied proportion. The current hypothesis is supported by a pilot study that examined the existence of a correlation between faulty breathing and musculoskeletal pain patterns [45]. Abdominal and chest

Relevance to clinical practice

The presumptive connection of neck pain and respiratory function could have a great impact on various clinical aspects notably patient assessment, rehabilitation and consumption of pharmacological agents. In terms of assessment, all the different components of respiratory function should be included, aiming to gather a representative wholesome perspective of patients’ problems. Besides, rehabilitation should embody respiratory implements, not merely dealing with the musculoskeletal dysfunction.

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Cited by (68)

Effect of diaphragmatic breathing, respiratory muscle stretch gymnastics and conventional physiotherapy on chest expansion, pulmonary function and pain in patients with mechanical neck pain: A single group pre pretest-posttest quasi-experimental pilot study
2023, Journal of Bodywork and Movement Therapies
There is evidence that mechanical neck pain results in respiratory dysfunction. Physiotherapy management for mechanical neck pain is well documented but the evidence regarding inclusion of breathing strategies to improve pulmonary functions in mechanical neck pain patients is scarce.
To investigate the combined effect of diaphragmatic breathing, respiratory muscles stretch gymnastics (RMSG) and conventional physiotherapy on chest expansion, pulmonary function and pain in patient with mechanical neck pain.
Thirteen patients with mechanical neck pain (18–35years) with neck pain history of ≥ three months and NPRS (numeric pain rating scale) score ≥3 were recruited for this single group pre pretest-posttest quasi experimental pilot study. Informed consent was taken from all participants. After initial screening and assessment, diaphragmatic breathing, RSMG (5 patterns) and conventional physiotherapy (hot pack and TENS for 10 min) were given for one week. Chest expansion, spirometry (FEV_1, FVC, FEV₁/FVC, PEFR), NDI (neck disability index) and NPRS were assessed on baseline and after one week following the intervention.
The normality of data was tested by using Shapiro-wilk test and the data was found to be normally distributed. Paired t-test was used to compare the baseline and post intervention values. Diaphragmatic breathing, RMSG and conventional physiotherapy had significant effect on chest expansion, FEV₁, NPRS and NDI in patients with mechanical neck pain.
The rehabilitation strategies should emphasize breathing exercises to improve the lung function and pain scores in addition to conventional physiotherapy in rehabilitation of mechanical neck pain patients.
Pulmonary Functions in Patients With Chronic Neck Pain: A Case-Control Study
2022, Journal of Manipulative and Physiological Therapeutics
Citation Excerpt :
Moreover, the impairment of proprioception in patients with chronic neck pain may alter neuro-motor patterns.9-12 Alterations in neuro-motor patterns, changes in rib cage mechanics, and/or changes in the force-length curve of the respiratory muscles may lead to the development of respiratory dysfunctions or abnormalities in patients with chronic neck pain.9,11-13 There are limited studies aiming to clarify the effects of chronic neck pain on pulmonary function, and there appears to be no consensus among the results of these studies.11,13,15,16
The purpose of the study was to investigate pulmonary functions of patients with chronic neck pain and compare them with those of asymptomatic controls.
This case-control study was conducted with 25 patients with chronic neck pain (age, 26.84 ± 7.89 years) and 27 age-matched asymptomatic controls (age, 25.96 ± 7.13 years). Pulmonary function tests were performed using spirometry (Quark PFT, COSMED, Rome, Italy). Forced vital capacity (FVC), forced expiratory volume in the first second (FEV₁), forced expiratory flow at 25% to 75% vital capacity, peak expiratory flow, maximum voluntary ventilation, and the FEV₁/FVC ratio were measured and are expressed as (%) predicted value for patients with chronic neck pain and asymptomatic controls.
The chronic neck pain group had lower FEV₁ (P = .015), FVC (P = .029), forced expiratory flow at 25% to 75% vital capacity (P = .040), and maximum voluntary ventilation (P = .042) compared with asymptomatic controls; however, FEV₁/FVC (P = .470) and peak expiratory flow (P = .183) were similar in both groups.
These results demonstrated that dynamic lung volumes were lower in patients with chronic neck pain compared with asymptomatic controls.
The correlation between scapulocostal syndrome and masticatory myofascial pain on selected pain and functional parameters- an observational study
2022, Journal of Bodywork and Movement Therapies
Although scapulocostal syndrome (SCS) and masticatory myofascial pain (MMP) occur in different regions, the concept of myofascial linkage and neurophysiology may be proven per the connection of the two disorders. Therefore, this study aimed to investigate the correlation between SCS and MMP on selected pain and functional parameters.
75 participants with SCS participated in the protocol. The diagnosis of SCS was considered by the presence of muscle referred pain in the medial scapular muscles. All participants were measured for pain intensity, pressure pain threshold (PPT), and craniovertebral angle (CV-angle) for pain and functional parameters related to SCS. They were measured for pain intensity, PPT, and mouth distance for the pain and functional parameters related to MMP. The diagnosis of MMP was considered by the presence of muscle tenderness of the masticatory muscle and the decreasing of mouth opening distance. The correlation between SCS and MMP was determined using Pearson's correlation coefficient and Spearman's correlation.
Participants exhibiting SCS were diagnosed for MMP at 74.67%. The results showed positive correlations in pain intensity and PPT between SCS and MMP (r = 0.367, r = 0.478, p < 0.01), PPT of SCS, and mouth distance amid both pain-free and maximum mouth opening conditions, respectively (r = 0.290, r = 0.282, p < 0.05).
In conclusion, SCS and MMP present an association with each other in terms of both selected pain, and functional parameters. Thus, a treatment program for SCS patients should be concerned with the masticatory muscles even if they did not report any pain at the jaw area.
Effectiveness of standard cervical physiotherapy plus diaphragm manual therapy on pain in patients with chronic neck pain: A randomized controlled trial
2021, Journal of Bodywork and Movement Therapies
Citation Excerpt :
Kapreli hypothesized a number of factors presented by patients with CNP that could contribute to the development of respiratory dysfunctions. These factors are decreased strength of deep neck flexors and extensors, hyperactivity and increased fatigability of superficial neck flexors (especially sternocleidomastoid and anterior scalene), limitation of range of motion, decrease in proprioception and neuromuscular disturbances, presence of pain and psychosocial dysfunction (Kapreli et al., 2008, 2009). Dimitriadis summarized the current evidence regarding respiratory function in patients with CNP; studies in this review report that this kind of patient can present with dysfunction of the respiratory system even if it cannot be classified as pathological (Dimitriadis et al., 2016).
Literature concerning the effect of diaphragm treatment to reduce neck pain symptoms is scarce. Aim of this trial was to investigate the effects of diaphragm manual therapy associated with standard physiotherapy treatment on pain in patients with Chronic Neck Pain (CNP).
In a private practice clinic, subjects with CNP were randomly assigned to receive three 30-min treatment sessions of standard cervical physiotherapy and Diaphragm Manual Therapy (DMT) or Sham Diaphragm Technique (SDT). Participants and assessors were blinded to the assignment. Primary outcome was pain, secondary outcomes were cervical active range of motion, pain pressure threshold, disability and quality of life measured at baseline, before and after each session, at 3 and 6-months. Adverse events were monitored. A non-parametric multivariate approach (combined permutation test) was applied to assess the effect of the treatment on all the outcomes. An intention to treat analysis was performed.
Forty patients were randomly allocated to DMT and SDT groups. Combined permutation test showed a significant higher improvement in DMT group compared to SDT group (p-value = 0.0002). The between-group comparisons on single outcomes showed a statistically significant improvement only for pain pressure threshold on upper trapezius (adjusted p-value = 0.029). No adverse events related to the intervention were registered.
In patients with CNP, addition of diaphragm manual techniques to standard cervical treatment seems to give a better global outcome, but this improvement is of unclear clinical relevance; the primary outcome seems not to have a role. Further studies are needed to confirm and clarify these results.
Release Date: July 18, 2017 Registered in ClinicalTrial.gov database ID: NCT03223285A.
A multidimensional strategy to managing dysfunctional breathing and exercise-induced laryngeal obstruction in adolescent athletes
2024, BMC Sports Science, Medicine and Rehabilitation
Comparison of breathing pattern and diaphragmatic motion in patients with unilateral cervical radiculopathy and asymptomatic group
2023, BMC Pulmonary Medicine

View all citing articles on Scopus

View full text

Neck pain causes respiratory dysfunction

Summary

Section snippets

Background

The hypothesis

Evaluation of hypothesis

Relevance to clinical practice

Clin Neurophysiol

Neurophysiol Clin

Clin Biomech

Pain

Pain

Clin Biomech (Bristol, Avon)

Man Ther

Med Hypotheses

Arch Phys Med Rehabil

Arch Phys Med Rehabil

Pain

J Bodywork Mov Ther

The back pain revolution

Quality of life and cost of care of back pain patients in Finnish general practice

Spine

Cervical headache: an investigation of natural head posture and upper cervical flexor muscle performance

Cephalalgia

Further clinical clarification of the muscle dysfunction in cervical headache

Cephalalgia

The influence of the cervical spine on chronic headache in women: a pilot study

J Man Manip Ther

A physiotherapy test package for assessing back and neck dysfunction-discriminative ability for patients versus healthy control subjects

Physiother Res Int

Cervical electromyogram profile differences between patients of neck pain and control

Spine

Physical impairments in cervicogenic headache: traumatic vs. nontraumatic onset

Cephalalgia

Deep cervical flexor muscle dysfunction in whiplash

J Musculoskeletal Pain

Patients with chronic neck pain demonstrate altered patterns of muscle activation during performance of a functional upper limb task

Spine

Neuromuscular efficiency of the sternocleidomastoid and anterior scalene muscles in patients with chronic neck pain

Disabil Rehabil