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BACKGROUND Ankle sprain is a common problem among active people and athletes. About 80 % of the people and 73 % of the athletes, who once had an ankle sprain, have experienced a recurrence of ankle sprain during their work or sport. Chronic ankle instability is described as a repeated ankle sprain, ankle giving way, pain and swelling and functional decline. Due to impaired muscle strength and impaired neuromuscular and postural control, it seems that the morphological criteria of peri-ankle muscles have changed. The study aimed to identify the morphological and muscle performance components of peroneus longus (PL) muscle in subjects with injured and intact sides of the chronic ankle sprain. Furthermore, the difference in ultrasonographic characteristics of PL muscle between genders, and the effect of the dominant limb on PL muscle ultrasonographic characteristics were investigated. METHODS The thickness, width and cross-sectional area (CSA) as morphological components and muscle performance components like fiber length, and pennation angle of PL muscle of the injured were calculated and compared to the intact side of the control in 25 subjects with unilateral chronic ankle instability via ultrasonography. RESULTS The findings of this study indicated a significant difference in the morphological component of PL muscle between both sides with no statistically significant difference in the muscle performance component of PL muscle. CONCLUSIONS Awareness of these changes in the injured side muscle morphology may lead to better clinical decision-making to design the best treatment plan by the physiotherapist. KEY WORDS Ankle Sprain, Chronic Ankle Instability, Ankle Muscle Ultrasonography

The aim of this study was to determine the asymmetry of cervical multifidus (MF) and longus colli (LC) muscles in patients with unilateral chronic radicular neck pain (CRNP) and healthy subjects using ultrasonography.Ninety five individuals (50 patients with unilateral CRNP and 45 healthy subjects) participated in this study. The size of the cervical MF and LC muscles; anterior posterior dimension (APD) and lateral dimension (LD); were bilaterally measured in a relaxed state using ultrasonography.Patients with CRNP showed greater asymmetry in the cervical MF and LC muscles size than the healthy subjects. The mean percentages differences between sides for MF and LC muscles size was higher in patients than that of healthy subjects (for both APD and LD; P0.05). The ratio of smaller to larger dimensions of the cervical MF and LC muscles for patients were significantly less than that of healthy controls (for both APD and LD; P0.05).The results indicated that cervical MF and LC muscles showed higher asymmetry between sides and lesser ratio of smaller size to larger size in patients with CRNP as compared with healthy subjects. Current results confirmed the presence of MF and LC muscles atrophy in subjects with CRNP.

Background The cervical flexion-relaxation ratio (FRR) is known as a quantitative measure of the ability of the cervical extensor muscles to relax during the full flexion of the cervical spine. In this sense, the variations in the cervical FRR indicate some changes in the neuromuscular pattern of extensor muscles, and consequently, their functions. Compared with patients suffering from non-specific neck pain, the changes occurring in the pattern of the neck muscles' functions in cases with cervical spinal stenosis are not yet well understood. Therefore, this study aimed to compare cervical FRR in patients with cervical lateral spinal stenosis and asymptomatic controls. Methods In total, 25 patients with cervical lateral spinal stenosis (aged 44.7±10.4) and 25 asymptomatic individuals (aged 44.3±10.8) were included in this study. These participants performed full-neck flexion, and at the same time, the electrical activity of the cervical erector spinae (CES) muscles was recorded bilaterally. Cervical FRR was further calculated by analyzing the electromyographic (EMG) data recorded for each muscle. Results The mean cervical FRR was significantly lower (P0.05). Conclusion According to the study results, it was concluded that the neuromuscular pattern of the cervical muscles could change asymmetrically and the CE angle could decline in individuals with cervical lateral spinal stenosis. Therefore, such patients will be more susceptible to biomechanical changes and persistent pain if the cervical muscles are not considered in their treatment.

Introduction Neck pain is a very common musculoskeletal complaint in industrialized countries. Theoretically, chronic neck pain is thought to possibly change biomechanics and muscle activation patterns of the shoulder complex, causing its pain and dysfunction in the long term. Purpose The present cross-sectional study was conducted to compare shoulder complex muscle activation characteristics in patients with chronic non-specific neck pain, compared to healthy participants. Method Twenty patients with chronic neck pain and twenty healthy participants were recruited for the present study. Surface Electromyographic (sEMG) activity was recorded from four selected muscles (anterior and middle deltoid, upper and lower trapezius) during shoulder elevation with a predetermined load (25–30% of an individual's maximum voluntary exertion). Result Results revealed only two significant increased onset delays in the anterior and middle deltoid,and a peak delay in the upper trapezius in chronic neck pain patients. Furthermore, increased onset delay for other muscles and decreased peak normalized amplitude (MVE%) for all muscles were found in chronic neck pain patients; however, these findings were not statistically significant. Conclusion There were relationships between chronic non-specific neck pain and the shoulder muscle activation characteristic; hence, the alteration may be considered a predisposing factor for the shoulder dysfunction in future studies.

Background Cervical radiculopathy is a musculoskeletal disorder with an increasing prevalence in office workers. In recent years, ultrasonography (US) has been reported to be a valid, inexpensive, and noninvasive technique for the objective evaluation of muscle morphology. However, measuring deep cervical paraspinal muscle dimensions using US in patients with cervical radiculopathy has not been described. Objective To evaluate intra-session and intersession reliabilities of US to measure dimensions of deep cervical muscles at rest in patients with chronic cervical radiculopathy and healthy controls. Design Reliability study. Setting Outpatients who presented for treatment at an outpatient university physiotherapy clinic. Participants Fifteen patients with cervical radiculopathy and 15 healthy controls. Interventions US measurements. Outcome Cervical multifidus and longus colli muscle dimensions at separate occasions. Methods Two measurements separated by a 1-hour interval were taken on the same day and the third measurement was taken 5 days later. The intraclass correlation coefficient, standard error of measurement, and minimal detectable change were used to evaluate relative and absolute reliabilities. Results US was a highly reliable method for measuring the multifidus and longus colli muscle dimensions in patients and healthy subjects. The highest reliability scores were found for the anteroposterior dimension measurement of the multifidus muscle (intraclass correlation coefficient=0.92) and the lateral dimension measurement of the longus colli muscle (intraclass correlation coefficient=0.97) in healthy subjects. Conclusions The results indicated that US is a highly reliable method of measuring deep cervical muscle dimensions in patients with cervical radiculopathy and healthy controls when measured by the same investigator.

Objective To compare the long-term effect of adding real or sham dry needling with conventional physiotherapy in cervicogenic headache. Design A randomized controlled trial. Setting Physiotherapy Clinic, Rouhani Hospital of Babol University of Medical Sciences, Iran Subjects Sixty-nine patients with cervicogenic headache. Methods Patients were randomly assigned into a control group (n = 23) receiving conventional physical therapy; a dry needling group (n = 23) receiving conventional physical therapy and dry needling on the cervical muscles; placebo needling group (n = 23) receiving conventional physical therapy and superficial dry needling at a point away from the trigger point. The primary outcome was the headache intensity and frequency. Neck disability, deep cervical flexor performance, and range of motion were secondary outcomes. Outcomes were assessed immediately after treatment and 1, 3, and 6 months later. Results Sixty-five patients were finally included in the analysis. Headache intensity and neck disability decreased significantly more in the dry needling compared to sham and control groups after treatment and during all follow-ups. The frequency of headaches also reduced more in the dry needling than in control and sham groups, but it did not reach statistical significance. Higher cervical range of motion and enhancement of deep cervical flexors performance was also observed in the dry needling compared to sham and control groups. Conclusion Dry needling has a positive effect on pain and disability reduction, cervical range of motion, and deep cervical flexor muscles performance in patients with cervicogenic headache and active trigger points, although the clinical relevance of the results was small. Trial registration The trial design was registered in the Iranian Registry of Clinical Trials (www.irct.ir, IRCT20180721040539N1) before the first patient was enrolled.

Background Ankle sprain is a common problem among active people and athletes. It causes reduces their activity of daily living and quality of life. Because of the impaired muscle strength and neuromuscular and postural control, it seems that the morphological criteria of peri-ankle muscles are changed. Objective This study aimed to develop a reliable method for measuring tibialis anterior (TA) and peroneus longus (PL) muscles in the injured and intact side of lower limbs in people with unilateral chronic ankle instability (CAI). Study design Cross-sectional study. Method This study was intra-tester reliability by ultrasound imaging to measure ultrasonography characteristics contains thickness, width, fiber length, pennation angle, and cross-sectional area (CSA) of TA, and PL in both limbs of 25 subjects at three separate times. Intra-class correlation coefficients (ICC), limits of agreement (LOA), standard error of measurement (SEM), and minimal detectable change (MDC) were calculated to analyzed relative and absolute intra-tester reliability, respectively. Results The present study showed good to excellent relative reliability for both injured and intact sides (ICC 0.88-0.98), less proportional measurement error (β coefficient of LOA≈ 0), and suitable absolute reliability. Conclusion Musculoskeletal ultrasonography is a reliable method for the measurement of peri-ankle muscle morphology such as thickness, width, CSA, fiber length, and pennation angle.

Neck pain (NP) is a common occupational health problem associated with a number of professions. Many studies indicate that NP is common among teachers, yet no published study was found to address the prevalence and risk factors of NP in Iranian school teachers. The purpose of the current study was to assess the prevalence and risk factors for NP among school teachers in Iran. A cross-sectional study was conducted on 586 randomly selected primary and high schools teachers from 22 schools in Tehran, Iran. Point, last month, last 6 months, annual, and lifetime prevalence rates of NP were 24%, 29%, 33%, 37%, and 43%, respectively. There was a significant association and increased prevalence of NP with a number of risk factors such as; being female, age, general health, length of employment, regular exercise and job satisfaction (P < 0.05 in all instances). Therefore, some individual and occupational factors may make conditions relevant for the development of NP among teachers.

Neck pain is one of the major public health problems, which has a great impact on people's lives. The purpose of this study was to systematically review published studies conducted on the effect of different exercise programs on activity, size, endurance, and strength of deep cervical flexor (DCF) muscles in patients with chronic neck pain. The PubMed, Science Direct, OVID, Google scholar, Cochrane Library, and Physiotherapy Evidence Databases were searched to determine relevant articles published from 1990 to March 2016. The articles were qualitatively assessed based on the Physiotherapy Evidence Databases scale for randomized controlled trials studies. Nine articles were identified and evaluated in the final analysis. Four studies had moderate quality, and five studies had good quality. From those nine studies, eight studies gave support to the effectiveness of specific low-load exercise training on DCF muscles parameters, while one study reported no significant difference between this exercise and other cervical exercise programs. The results of reviewed studies are in favor of specific low-load craniocervical flexion exercise, which seems to be a highly effective exercise regimen compared to other types of exercises in improving DCF muscles impairments in patients with chronic neck pain.

BACKGROUND: Neck pain is an important cause of disability. In spite of its high prevalence rate, treatment of the disorder is a challenging topic. Stabilization exercise has been the topic of many studies. OBJECTIVE: To compare the effects of stabilization and routine exercises on chronic neck pain. METHODS: Forty patients were randomly assigned into either stabilization or routine exercise groups and undertook a 10-week training program. Electromyographic (EMG) activity was recorded from Sternocleidomastoid (SCM), Anterior Scalene (AS) and Splenius Capitis (SC) muscles bilaterally. Endurance time of deep flexor muscles was measured by chronometer. Pain and disability were measured using Visual Analogue Scale (VAS) and neck disability index (NDI) questionnaire, respectively before and after training period. RESULTS: Findings revealed significant decreased pain and disability in both groups after intervention (P < 0/001). Flexor muscles endurance of stabilization group was significantly increased compared with that of routine (P < 0/001). Also EMG activity of SCM, AS and SC muscles were significantly decreased in stabilization group compared with routine (P

Background Dentists have to remain in a fixed position during dental practices for the accuracy required, therefore they are susceptible to musculoskeletal disorders (MSDs). Objectives Considering the infrequency of ergonomics studies in general dental practitioners (GDPs), especially in cervical region, this study aimed to reviews MSDs in the neck region among GDPs. Methods An analytic cross-sectional study was carried out among the GDPs in 2011. A total of 60 dentists (40 males and 20 females) were examined through a combination of questionnaires (concerning their demographic information) such as the Nordic standardized musculoskeletal disorder questionnaire (NMQ) and Body Discomfort Assessment questionnaire (BDA). Each dentist's working posture was assessed using Rapid Upper Limb Assessment (RULA) and deep cervical flexor muscle endurance through a Craniocervical Flexion test (CCFT). Descriptive statistical indexes and Chi-square test were used for statistical analysis, while considering p Results The mean dental practice experience was 16.9 ± 5.6 years with average 41.2 ± 13.4 working hours per week. About 45% of dentists took regular exercises weekly. Some 83.3% of these dentists expressed to be suffering from the cervical pain, whereas, 56.7% complained about back pains and 41% shoulder problems. Female dentists were found more at risk of neckache, discomfort and pain in shoulder and hand than males. Greater pain frequency in knee was found in more experienced and older age dentists (P= 0.07). Results from the CCF test showed that the deep cervical flexor muscles endurance increased with regular exercise and decreased with aging. Conclusion Many dentists experience the MSDs, especially in cervical region, as a consequence of occupational stresses. Therefore, detecting occupational risk factors, standards of work position, regular exercise and following ergonomic policy are intensely recommended.

BACKGROUND AND OBJECTIVES Cervicogenic headache (CGH) originated from impaired cervical musculoskeletal structures. Dysfunction of deep neck flexor muscles has been reported in CGH subjects. The purpose of this study was to assess relationship between the size of these muscles and headache laterality in CGH subjects. MATERIAL AND METHOD A cross sectional single blind study designed to investigate 37 CGH subjects compared with 37 healthy controls. Longus colli (LC) muscle Cross Sectional Area (CSA) in both sides was measured in supine position utilizing diagnostic ultrasonography. RESULTS The mean CSA of LC muscle in healthy subjects was 0.74 ± 0.06 cm2 and in patients suffering from CGH was 0.74 ± 0.06 cm2 in left and 0.75 ± 0.06 cm

Summary In this study, the reliability of the longus colli muscle (LCM) size was assessed in a relaxed state by a real time ultrasonography (US) device in a group of healthy subjects and a group of patients with chronic neck pain. Fifteen healthy subjects (19–41years old) and 10 patients with chronic neck pain (27–44years old) were recruited for the purpose of this study. LCM size was measured at the level of thyroid cartilage. Two images were taken on the same day with an hour interval to assess the within day reliability and the third image was taken 1week later to determine between days reliability. Cross sectional area (CSA), anterior posterior dimension (APD), and lateral dimension (LD) were measured each time. The shape ratio was calculated as LD/APD. Intraclass correlation coefficients (ICC) and standard error of measurement (SEM) were computed for data analysis. The ICC of left and right CSA for within day and between days reliability in healthy subjects were (0.90, 0.93) and (0.85, 0.82), respectively. The ICC of left and right CSA for within day and between days reliability in patients with neck pain were (0.86, 0.82) and (0.76, 0.81), respectively. The results indicated that US could be used as a reliable tool to measure the LCM dimensions in healthy subjects and patients with chronic neck pain.

Objective This article presents a review of the literature concerning size measurement of cervical muscles using real-time ultrasound imaging (RUSI) in patients with neck pain and in healthy populations. Methods A literature search from 1996 to December 2009 making use of Science Direct and PubMed databases was conducted. Medical Subject Headings and other terms were as follows: ultrasonography , cervical , muscle , neck , size , pain , validity , reliability , neck pain , and healthy subjects . We included studies using RUSI for assessing cervical paraspinal muscles both in healthy subjects and in patients with neck pain. We assessed muscles investigated and the reliability and validity of the method used. Results The literature search yielded 16 studies. Twelve (75%) studies assessed the posterior muscles, whereas in the remaining 4 (25%), the anterior muscles were studied. Three studies quantified the size of the muscles during contraction; 3 assessed the relationship between cross-sectional area, linear dimensions, and anthropometric variables; 1 evaluated the training-induced changes in muscle size; 1 assessed the differences in muscle shape and cross-sectional area of cervical multifidus between patients with chronic neck pain and controls; 8 studies looked at the reliability of using RUSI in patients with neck pain or healthy subjects; and 3 studies evaluated the validity of RUSI compared with magnetic resonance imaging. Conclusions This literature review has shown that there are not sufficient studies for assessing neck muscles with RUSI. It seems that using constant landmarks, knowledge of anatomy and function of target muscle, and a proper definition of muscle borders can help to take a clear image. Standardized position of the subject, correct placement of the transducer, and using multiple RUSI for statistical analyses may improve results.

The purpose of this study was to investigate the differences in pressure and thermal pain hypersensitivity between patients with acute and chronic neck pain and healthy subjects.Five patients with acute neck pain, 7 patients with chronic neck pain, and 6 matched controls participated. Pressure pain thresholds (PPTs) were assessed over the supraorbital, infraorbital, mental, median, ulnar, and radial nerves; the C5-C6 zygapophyseal joint; the second metacarpal; and the tibialis anterior muscle by an assessor blinded to the subjects' condition. Head pain threshold and cold pain threshold (CPT) were measured over the cervical region and over the tibialis anterior muscle.The analysis of variance found significant differences between groups, but not between sides, for PPT over the supraorbital, mental, median, ulnar and radial nerves; the C5-C6 joint; the second metacarpal; and the tibialis anterior muscle: patients with chronic neck pain showed bilateral lower PPTs as compared with controls (P.01). Patients with acute neck pain also showed lower PPT (P.01) over the median and ulnar nerves. No significant differences between groups or sides for head pain threshold over the cervical area or the tibialis anterior muscle were found. Significant differences between groups, but not between sides, for CPT over the neck and the tibialis anterior muscles were found: CPT was also reduced in patients with chronic, but not acute, neck pain (P.01).We found widespread decreased PPT in patients with chronic, but not acute, mechanical neck pain as compared with controls. Patients with chronic neck pain also showed cold pain hypersensitivity as compared with patients with acute neck pain and controls. These results support the existence of different sensitization mechanisms between patients with acute and chronic mechanical insidious neck pain.

Objective The effect of different exercise programs on cervical flexor muscles dimensions in patients with chronic neck pain is yet to be demonstrated. The purpose of this study was to assess the effect of two exercise programs; craniocervical flexion (CCF) and cervical flexion (CF), on flexor muscles dimensions in patients with chronic neck pain. Methods Following ethical approval, 60 patients were randomly assigned into either a CCF group or a CF group. Patients in the CCF group were given CCF exercises and those in the CF group received CF exercises. All patients received interventions for a period of ten weeks. Pain intensity and functional disability were assessed using numerical pain rate scale and neck disability index, respectively. Dimensions of longus colli (LC) and sternoclidomastoid (SCM) muscles were measured using ultrasonography (US). All measurements were taken before and after interventions. Results Following intervention, the CCF group demonstrated a significant increase in LC muscle dimensions including cross sectional area, width and thickness compared with the CF group. A statistically significant increase was found on SCM thickness in the CF group. Following intervention, SCM thickness measurement in the CCF group showed no significant changes. Statistically significant decrease on pain intensity and disability were also found in both groups. Conclusion Present findings demonstrated that craniocervical flexion program which specifically recruiting deep cervical flexor muscles increased LC muscle dimension significantly and CF program as an endurance training program increased SCM thickness.

Javanshir K, Rezasoltani A, Mohseni-Bandpei MA, Amiri M, Ortega-Santiago R, Fernandez-de-las-Penas C: Ultrasound assessment of bilateral longus colli muscles in subjects with chronic bilateral neck pain. Am J Phys Med Rehabil 2011;90:293Y301. Objective: The aim of this study was to investigate bilateral differences in the cross-sectional area (CSA) and shape ratio of the longus colli muscle between subjects with mechanical neck pain and healthy controls. Design: A case-control cohort study was conducted. Bilateral ultrasound images of the longus colli muscle at the thyroid (C5YC6) level were conducted in 20 patients with mechanical bilateral chronic neck pain and 20 controls by an assessor blinded to the subjects' condition. CSA, anterior-posterior dimension (APD), lateral dimension (LD), and shape ratio (LD/APD) were measured. Results: The intraclass correlation coefficients (3,1) were above 0.86 for within-day and above 0.81 for between-day intraexaminer reliability. Patients with mechanical neck pain showed bilateral smaller CSA (P G 0.001) and APD (P = 0.004) as compared with controls. Muscle shape and LD were not different between groups (P = 0.092 and P = 0.963, respectively). Women exhibited smaller bilateral CSA as compared with men (P G 0.01). CSA was negatively associated with self-reported disability, whereas APD was negatively associated with intensity of neck pain: the greater the self-reported disability or the pain intensity, the smaller the bilateral CSA or APD of the longus colli muscle. Conclusions: The longus colli muscle exhibited smaller bilateral CSA and APD, but not LD and shape ratio, in subjects with bilateral chronic neck pain as compared with healthy controls. Reduced CSA was negatively associated with self- reported disability and APD was negatively associated with the intensity of pain.

BACKGROUND AND OBJECTIVE: The deep cervical flexor muscles have a major role in neck stabilization and evidence suggests that these muscles especially longus colli muscle (LCM) becomes dysfunctional in patients suffering from cervicogenic headache. Therefore, measurement of these muscles in healthy subjects and patients may be of great value to understand the stabilization function of the muscles and also to follow the effect of interventions. The aim of this study was to compare the reliability of longus colli muscle size measurement in healthy subjects and patients with cervicogenic headache using ultrasonography.METHODS: This methodological research was performed on 34 subjects including 13 patients with cervicogenic headache (20-35 years old) with headache over 3 month period and 21 healthy subjects (18-25 years old). Neck LCM size was measured in supine position in two sides at the level of thyroid cartilage ultrasonography. Two images of LCM cross section area (CSA) were taken on the same day with an hour interval to assess the within-day reliability and the third image was taken two days later to determine between-days reliability. Then data were compared using statistical analysis.FINDINGS: The mean of the cross section area of the muscle in subjects with cervicogenic headache was 0.77 cm2 in two sides and in healthy subjects were 0.74 cm2 in left side and 0.75 cm2 in right side. Within day and between days reliability in healthy subjects was varied ranging from 0.83 to 0.92. In patient group it was ranged between 0.90-0.98.CONCLUSION: The results indicated that ultrasonography could be a reliable tool to measure the cross section area of LCM in healthy subjects and patients with cervicogenic headache. Therefore, this non invasive method can be used to follow up the effect of exercise therapy interventions.