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Chronic Neck Pain Assessment using Multi-Frequency Bioimpedance

Authors:

Abstract

Scope: Chronic neck pain (CNP) is a disabling condition where the cause is often unknown, making treatment difficult. Muscle involvement is suspected in most cases, and assessment of muscle condition and changes following treatment may be possible with multi-frequency bioimpedance (mfBIA). Our aim was to test mfBIA as an assessment method of possible involvement of the neck, back and other related muscles in two CNP patients, prior to and following physiotherapy treatment with AtlasBalans. Methods: mfBIA measurements were carried out pre-treatment on m. sternocleidomastoideus, m. trapezius, upper back, lower back, m. vastus lateralis, and m. gastrocnemius. Centre frequency (fc), extracellular Resistance (Re) and intracellular Resistance (Ri), Impedance (Z), Resistance (R) and Reactance (Xc) were measured, and Phase Angle (PA) and Membrane Capacitance (Mc) were calculated, using ImpediMed Inc software. AtlasBalans treatment was carried out on m. sternocleidomastoideus and m. trapezius with following mfBIA measurement of these. Relationship between Z, R, fc, Ri and Mc was studied pre and post-treatment. Results: The Z and R data suggested no great degree of inflammation or overuse of the measured muscles. The fc data indicate muscle involvement with elevated resting tension and imbalance between the left and right sides. Ri and Mc confirm the interpretation of imbalance, indicating an elevated metabolic activity in some muscles. Conclusion: mfBIA seems a promising method to follow muscle involvement in chronic neck pain patients. AtlasBalans treatment did not show any clear indication as being an efficient form of treatment to relieve muscle tension in CNP patients.
Research Article Open Access
Fener et al., Physiother Rehabil 2016, 1:2
DOI: 10.4172/2573-0312.1000113
Physiother Rehabil
ISSN: 2573-0312, an open access journal Volume 1 • Issue 2 • 1000113
Journal of
Physiotherapy & Physical Rehabilitation
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ISSN: 2573-0312
*Corresponding author: Fener DK, Bartels EM, Elbrond VS, Harrison AP (2016)
Chronic Neck Pain Assessment using Multi-Frequency Bioimpedance. Physiother
Rehabil 1: 113. doi:10.4172/2573-0312.1000113
Received: May 04, 2016; Accepted: June 09, 2016; Published: June 16, 2016
Citation: Fener DK, Bartels EM, Elbrond VS, Harrison AP (2016) Chronic Neck
Pain Assessment using Multi-Frequency Bioimpedance. Physiother Rehabil 1:
113. doi: 10.4172/2573-0312.1000113
Copyright: © 2016 Fener DK, et al. This is an open-access article distributed under
the terms of the Creative Commons Attribution License, which permits unrestricted
use, distribution, and reproduction in any medium, provided the original author and
source are credited.
Keywords: Bioimpedance; Neck pain; Symptom assessment; erapy
Abbrevations: CN: Chronic Neck Pain; mfBIA: Multi-frequency
Bio impedance; fc: Centre Frequency; Re Extracellular Resistance; Ri:
Intracellular Resistance; Z: Impedance; R: Resistance; Xc: Reactance
Introduction
Chronic neck pain (CNP), where a period of neck pain develops
into what can be dened as a chronic condition, is common [1-3]. To be
chronic, the pain has to persist for a 3 month period aer onset.
CNP creates disability and aects the suerer’s quality of life [4-6].
It also has severe economic consequences for those individuals aected,
as well as for society in general [7,8].
e prevalence of CNP is found to be between 1.7 and 11.5% for
activity-limiting neck pain existing for a period of 12 months aer
onset. Furthermore, even for those individuals in the group capable of
participating in their normal daily activities, a mild chronic pain may
still persist [3].
e fact that there is oen no objective measure to indicate the
cause of the experienced CNP, adds to the stress to which CNP patients
are exposed when prognosis of disease development and choice of
treatment are considered.
Multi-frequency bioimpedance (mfBIA) is able to give an immediate
description of the condition of a muscle [9], and has recently been
shown to provide details regarding muscle resting tension and cellular
activity, as well as training level and recovery rate following muscle
injury [9,10]. Since there are indications that CNP can be improved
with physical therapy and manipulation [11-16], muscle involvement is
very likely in most cases.
Our aim was to test whether mfBIA as a method of assessing the
possible involvement of the neck, back and other related muscles
(myofascial trains [17]), when presented with a CNP patient, allows
the user to follow a suspected involvement of a particular muscle aer
physical therapy treatment following application with the AtlasBalans
method (AtlasBalans AB, Stockholm, Sweden).
Our hypothesis was that CNP, caused in part by muscle changes,
e.g. excessive and constant compensatory muscle tension arising from a
minor or major injury to the neck or other related region/s of the body,
can be monitored in real-time using mfBIA.
Materials and Methods
Participants
Two cases of CNP were studied.
1. A 53 year old woman, weight 70 kg, height 1.65 m, who following
a fall from a horse 3 years previous to the measurement had
experienced continuous neck pain aecting her daily routine and
work ability.
2. A 41 year old woman, weight 68 kg, height 1.78 m, who had been
involved in a bicycle accident and had, subsequently, experienced
chronic neck pain that aected her daily routine with particular
focus on transportation.
Chronic Neck Pain Assessment using Multi-Frequency Bioimpedance
Dilay Kesgin Fener1*, Else Marie Bartels1, Vibeke Sodring Elbrønd2 and Adrian Paul Harrison2
1The Parker Institute, Copenhagen University Hospital, Bispebjerg and Frederiksberg, Denmark
2 IKVH Faculty of Health & Medical Sciences, Copenhagen University, Denmark
Summary
Scope: Chronic neck pain (CNP) is a disabling condition where the cause is often unknown, making treatment
difcult. Muscle involvement is suspected in most cases, and assessment of muscle condition and changes following
treatment may be possible with multi-frequency bioimpedance (mfBIA). Our aim was to test mfBIA as an assessment
method of possible involvement of the neck, back and other related muscles in two CNP patients, prior to and
following physiotherapy treatment with AtlasBalans.
Methods: mfBIA measurements were carried out pre-treatment on m. sternocleidomastoideus, m. trapezius,
upper back, lower back, m. vastus lateralis, and m. gastrocnemius. Centre frequency (fc), extracellular Resistance
(Re) and intracellular Resistance (Ri), Impedance (Z), Resistance (R) and Reactance (Xc) were measured, and
Phase Angle (PA) and Membrane Capacitance (Mc) were calculated, using ImpediMed Inc software. AtlasBalans
treatment was carried out on m. sternocleidomastoideus and m. trapezius with following mfBIA measurement of
these. Relationship between Z, R, fc, Ri and Mc was studied pre and post-treatment.
Results: The Z and R data suggested no great degree of inammation or overuse of the measured muscles. The
fc data indicate muscle involvement with elevated resting tension and imbalance between the left and right sides. Ri
and Mc conrm the interpretation of imbalance, indicating an elevated metabolic activity in some muscles.
Conclusion: mfBIA seems a promising method to follow muscle involvement in chronic neck pain patients.
AtlasBalans treatment did not show any clear indication as being an efcient form of treatment to relieve muscle
tension in CNP patients.
Citation: Fener DK, Bartels EM, Elbrond VS, Harrison AP (2016) Chronic Neck Pain Assessment using Multi-Frequency Bioimpedance. Physiother
Rehabil 1: 113. doi: 10.4172/2573-0312.1000113
Page 2 of 6
Physiother Rehabil
ISSN: 2573-0312, an open access journal Volume 1 • Issue 2 • 1000113
Since the measurements were non-invasive, the technique is
commonly used in the clinic and is readily available to laymen, and the
treatment was pre-agreed between the physiotherapist and the patients,
no ethics committee approval was deemed necessary. e participants
gave their informed written consent to participate in the study, which
was carried out according to the Helsinki Declaration (http://www.
wma.net/en/30publications/10policies/b3/).
Design
mfBIA measurements were carried out on the following muscles:
m. sternocleidomastoideus, m. trapezius, upper back, lower back, m.
vastus lateralis, and m. gastrocnemius, using an ImpediMed Inc tetra
bipolar bioimpedance spectroscopy unit (Imp SFB7; Pinkenba, Qld,
Australia). With this setup, 256 frequencies between 4 and 1000 kHz
with a constant current were applied. For each individual measurement,
a repeated analysis was made 6 times with a 1 second interval between
each analysis. Ag/AgCl electrodes provided by ImpediMed (Single
Tab Electrodes 292-STE) were used according to the manufacturer’s
guidelines. e electrode position adopted involved placement of the
current electrodes on the outside with the voltage-sensing electrodes
on the inside, and 10 mm between the current and the voltage-sensing
electrodes. e electrodes were placed at each end of the specic
muscles measured, just prior to the tendon attachment.
e mfBIA parameters, centre frequency (fc), extracellular
Resistance (Re) and intracellular Resistance (Ri) were measured
directly from the full multi-frequency Cole-Cole plot. e following
parameters, Impedance (Z), Resistance (R) and Reactance (Xc) were
measured at the generally accepted frequency for human subjects of 50
kHz, whilst Phase Angle (PA) was calculated as the arctan Xc/R, and the
Membrane Capacitance (Mc) was determined as 1/2πfc (Re+Ri).
Treatment
AtlasBalans (AtlasBalans AB, Stockholm, Sweden) provides a
deep tissue massage, which is applied through a hand-held, battery-
driven device with an interchangeable head that enables more specic
or more general treatment according to choice of head. A routine
sequence was adopted for each of the regions selected for treatment,
m. sternocleidomastoideus and m. trapezius, and treatment was only
applied to the muscles identied as being aected e.g. high level of
resting tension (fc) or high Ri and low Mc values. e device was angled
in such a way as to reach and follow specic myofascial structures.
Data analysis
e mfBIA data was handled using the ImpediMed Inc soware. At
the time of measurement the Cole-Cole plot was assessed for normal
distribution to assure reliable data. Furthermore, the other available
plots (R and Xc) were also examined to ensure use of acceptable
recordings.
Results
Pre-treatment results
mfBIA results pre-treatment (Table 1).
Centre Frequency fc
e fc is the frequency that gives the maximum Xc value on the
Cole-Cole plot. With a higher level of resting tension, the resulting
greater density of the muscle will require a higher energy, i.e. a higher
frequency, to pass through the tissue. fc therefore provides important
information regarding the relative density of muscle tissue e.g. the level
of resting tension in a muscle.
Case 1: e fc was substantially higher for several of the right side
muscles including m. sternocleidomastoideus, m. longissimus thoracis,
and m. vastus lateralis, with a tendency for m. longissimus cervicis.
In contrast, the low back region showed a higher fc value for the le
side, and m. trapezius and m. gastrocnemius had almost the same
values right versus le side i.e. they were balanced. is subject showed
therefore some imbalance between the le and right sides of the neck
and back muscles, with a tensing up of the right hand side.
Case 2: e fc value was found to be higher for the right side m.
longissimus cervicis and thoracis and m. vastus lateralis, while the fc
values for m. sternocleidomastoideus, and m. trapezius were higher on
the le side. e low back region and m. gastrocnemius were almost
balanced right versus le. e pattern here suggests that the two
sides of the neck/back region were pulling in dierent directions le
versus right sides, which would be expected to result in some degree of
torsion in this region, although the aspect of compensation cannot be
completely ignored.
Both cases quite clearly showed muscle involvement in their pain
condition.
Impedance Z and Resistance R
A combined assessment of the Z and R values for a muscle can help
determine a swelling/oedema or a dehydrated state as well as provide
details regarding muscle mass. When looking at the dierent muscles
assessed here, the values Z and R were almost identical in both subjects,
both for the right and le sides of the muscles, which indicates that
there is no signs of oedema or swelling or dehydration. ese data
suggest that there is no great degree of inammation or overuse of the
muscles measured.
Membrane Capacitance Mc
e membrane capacitance (Mc) indicates the status of the
membrane potential, and hence muscle bre health, as well as the
transport status over the membrane.
Case 1: ere was a slight to almost no dierence for the right versus
le side when looking at m. sternocleidomastoideus, m. longissimus
cervicis and m. gastrocnemius, while the Mc was higher for the le
side for m. trapezius, m. longissimus thoracis and m. vastus lateralis,
indicating higher metabolic activity in these muscles on the le hand
side. A very large le-right dierence was seen for the low back region
muscles where Mc was measured to be almost twice the value for the
right side versus the le side. e interesting observation here is that
where there is a substantially higher fc between the le and right sides, a
lower Mc is found compared to a muscle with a normal resting tension,
indicating that the more tense a muscle is the more metabolically active
it presents, most likely a form of compensation?
Case 2: Mc was likewise found to be lower for those muscles
measured as having a higher fc.
Intracellular Resistance Ri and extracellular resistance Re
Ri has been shown to be correlated with VO2-max at rest [18], and
may therefore be taken as an index of a muscle’s anabolic status [18]. Re
may, on the other hand, be used as a measure of dehydration in cases
where impaired perfusion is not expected [9].
Case 1: Ri was found to dier between the le and right sides in
Citation: Fener DK, Bartels EM, Elbrond VS, Harrison AP (2016) Chronic Neck Pain Assessment using Multi-Frequency Bioimpedance. Physiother
Rehabil 1: 113. doi: 10.4172/2573-0312.1000113
Page 3 of 6
Physiother Rehabil
ISSN: 2573-0312, an open access journal Volume 1 • Issue 2 • 1000113
all measured muscles to a varying degree. In general, when a large
dierence was found, a low Mc value was found to correlate to a high
Ri value, indicating that the anabolic state of the muscle on the side
with the high Ri diers from its counter-part (low Ri), being in a
metabolically more active state.
Case 2: e largest le versus right side dierence was seen for Ri
in m. vastus lateralis (right more oxygen-consumed than le side). Re
values did not show any important dierences.
Post-treatment results
mfBIA results following AtlasBalans treatment of m.
sternocleidomastoideus and trapezius (Table 2).
Two muscles were selected for AtlasBalans treatment, m.
sternocleidomastoideus and m. trapezius. Measurements were taken
directly following treatment.
Eect of treatment
e fc values in Case 1 showed a decrease of 13.6 kHz for the right
side, and 6 kHz for the le side m. sternocleidomastoideus. ere was
also a decrease in fc of 20.4 and 12.4 kHz form. trapezius, le and right
respectively, indicating an eect on all four muscles towards a less tense
state.
e Ri and Mc values both increased, supporting the evidence
that the treatment had led to a more relaxed, less metabolically active
muscle directly aer treatment.
In Case 2 the fc values showed a direct but insignicant decrease
of 2.9 kHz and 0.6 kHz aer treatment, for the le and right sides,
respectively, for m. sternocleidomastoideus. e measurements for m.
trapezius showed a decrease in fc of 12.1 kHz for the le side and an
increase of 5 kHz for the right side.
When comparing changes in the Ri and Mc values, some decrease
was seen, but this was not as convincing as for Case 1, and the eect of
treatment was therefore not as clear cut as that of Case 1.
Discussion
In groups of neck-pain patients, it is dicult to determine why
some individuals develop chronic pain and some do not. A recent
Cochrane review reports that “Neck pain is multifactorial in its etiology
and factors contributing to its development include age, gender, a
history of neck pain, the occurrence of other musculoskeletal problems,
poor posture, repetitive strain, poor self-rated health, and social and
psychological factors” [19]. Indeed, this very broad description of the
underlying causes may in itself provide some of the answers as to the
very dierent outcomes between patients in this group.
Several types of interventions for chronic neck patients exist, but the
eect of these is not always well documented due to a varying quality
of studies concerning these therapies [13]. e Cochrane Collaboration
has provided systematic reviews of some of these interventions, such
as exercise [15], massage for mechanical neck disorders [20], patient
education for neck pain [21], electrotherapy for neck pain [22],
mechanical traction for neck pain with or without radiculopathy [23],
and conservative treatment for whiplash [24]. e overall conclusion of
the reviews is that the evidence for positive eects of treatment is low,
Case 1 m.
sternocleidomastoid m. trapezius m. longissimus
cervicis
m. longissimus
thoracis
m. vastus
lateralis m. gastrocnemius low
back
Left Right Left Right Left Right Left Right Left Right Left Right Left Right
Z Ω 82.4 76.9 99.7 111. 3 98.9 98.1 86.8 105.9 165.2 153.5 107.3 101.6 110.6 94.8
R Ω 81.6 76.3 99.0 110.8 98.4 97.4 86.1 105.3 164.8 153.2 106.2 100.4 110.4 94.5
Xc Ω 11.1 9.9 11.6 10.7 10.7 11.4 10.7 11.4 11.9 9.3 15.8 15.9 6.6 7.1
Phase
Angle ° 7.7 7.4 6.7 5.5 6.2 6.7 7.1 6.2 4.1 3.5 8.5 9.0 3.4 4.3
fc kHz 69.1 77.8 69.2 68.2 71.7 74.6 65.8 83.7 38.1 58.1 50.8 49.1 39.2 32.0
Re Ω 101.0 91.2 116.8 128.2 113.2 112.1 104.0 120.3 189.4 167.4 129.1 124.4 126.9 115.3
Mc nF 10.0 9.0 7.0 5.7 6.2 6.2 9.0 5.1 5.1 2.9 8.5 9.7 7.8 14.0
Ri Ω 128.8 136.3 211.7 284.1 246.9 232.7 165.7 253.3 627.3 788.4 240.8 209.8 395.9 241.0
Case 2 m.
sternocleidomastoid m. trapezius m. longissimus
cervicis
m. longissimus
thoracis
m. vastus
lateralis m. gastrocnemius low
back
Left Right Left Right Left Right Left Right Left Right Left Right Left Right
Z Ω 92.1 87.9 100.4 91.6 91.4 104.2 95.5 101.9 159.1 172.9 136.0 129.8 61.0 65.3
R Ω 90.9 87.2 100.1 91.3 90.6 103.5 94.8 101.3 158.5 172.4 134.2 128.1 60.6 65.0
Xc Ω 15.1 10.8 8.4 7.0 12.5 12.0 11.6 11.2 14.1 13.7 22.3 20.8 6.3 6.3
Phase
Angle ° 9.4 7.1 4.8 4.4 7.9 6.6 7.0 6.3 5.1 4.5 9.4 9.2 5.9 5.5
fc kHz 81.4 73.8 92.8 84.0 81.0 89.7 67.8 74.6 45.5 60.9 42.3 44.0 54.2 52.5
Re Ω 111.1 105.6 114.3 103.4 105.5 119.3 114.0 119.4 183.8 191.3 171.7 162.2 70.8 75.9
Mc nF 8.3 8.4 4.9 5.3 6.9 5.3 8.0 6.4 5.0 3.0 8.7 8.7 12.3 11.8
Ri Ω 125.4 151.5 236.7 253.8 179.2 213.7 181.2 212.9 514.8 679.3 259.4 252.9 167.1 181.4
Table 1: Pre-treatment mfBIA results.
Citation: Fener DK, Bartels EM, Elbrond VS, Harrison AP (2016) Chronic Neck Pain Assessment using Multi-Frequency Bioimpedance. Physiother
Rehabil 1: 113. doi: 10.4172/2573-0312.1000113
Page 4 of 6
Physiother Rehabil
ISSN: 2573-0312, an open access journal Volume 1 • Issue 2 • 1000113
Case 1 m. sternocleidomastoid m. trapezius Case 2 m. sternocleidomastoid m. trapezius
LH RH LH RH LH RH LH RH
Z Ω 82.4 76.9 99.7 111.3 Z Ω 92.1 87.9 100.4 91.6
R Ω 81.6 76.3 99.0 110.8 R Ω 90.9 87.2 100.1 91.3
Xc Ω 11.1 9.9 11.6 10.7 Xc Ω 15.1 10.8 8.4 7.0
Phase Angle ° 7.7 7.4 6.7 5.5 Phase Angle ° 9.4 7.1 4.8 4.4
fc kHz 69.1 77.8 69.2 68.2 fc kHz 81.4 73.8 92.8 84.0
Re Ω 101.0 91.2 116.8 128.2 Re Ω 111 .1 105.6 114.3 103.4
Mc nF 10.0 9.0 7.0 5.7 Mc nF 8.3 8.4 4.9 5.3
Ri Ω 128.8 136.3 211.7 284.1 Ri Ω 125.4 151.5 236.7 253.8
After treatment LH RH LH RH After treatment LH RH LH RH
Z Ω 70.1 81.1 105.6 114.2 Z Ω 94.6 87.6 109.9 105.0
R Ω 68.8 80.0 105.1 113.5 R Ω 93.4 86.8 109.0 104.3
Xc Ω 13.3 13.5 11.0 12.4 Xc Ω 15.1 13.4 13.5 12.0
Phase Angle ° 10.9 9.6 6.0 6.2 Phase Angle ° 9.2 8.8 7.1 6.6
fc kHz 55.5 71.8 48.8 55.8 fc kHz 78.5 73.2 80.7 89.0
Re Ω 90.1 100.4 130.5 139.0 Re Ω1 114.9 111. 7 126.3 120.1
Mc nF 15.7 10.6 9.7 7.9 Mc nF 8.4 10.0 5.5 5.3
Ri Ω 92.8 108.7 205.4 222.5 Ri Ω 127.4 104.8 231.8 216.9
Table 2: mfBIA results following AtlasBalans treatment of m. sternocleidomastoideus and trapezius.
and that no denite statements on the ecacy and clinical usefulness of
these treatments can be made.
A major cause behind this conclusion may very well be the lack
of use of objective measurements to identify the involved muscles in
chronic neck patients, where muscle involvement is oen the case. In
this study, and in earlier studies by Bartels et al. [9] and Nescolarde et al.
[10], mfBIA has been demonstrated as a method to identify asymmetry
of muscle pairs, as well as metabolic state and degree of tension of
muscles which were suspected to be involved in the neck condition.
Applying mfBIA could therefore help providing a clear diagnosis of the
cause behind the neck pain. It would then further be possible to focus
the right treatment towards the involved tissue, and thereby change
from a more general approach towards patient-focused treatment.
e two cases in this study were randomly selected with the
diagnosis of ‘chronic neck pain’ for a period of more than 6 months,
and the planned treatment, in common. e aspect of the mechanism/
accident connected with the development of chronic neck pain was
dierent in the two cases.
e literature presents a large number of potential (specic)
causes of neck pain [3,25-30]. ese vary from trauma (especially
motor vehicle accidents) to infections, tumours, congenital disorders
and inammation. In the vast majority of cases, however, no specic
underlying pathology can be established and the complaints are labelled
as “non-specic neck pain” [26]. With this in mind, it would be of great
value if more measurable common pathologies could indicate a set of
treatment options, which could have a positive eect on the condition.
With the diagnosis and treatment of chronic neck pain being so
dicult, especially when labelled as “non-specic”, our hope was that
mfBIA could be a more objective measure of the particular patient’s
condition. A reliable diagnostic method could perhaps even counteract
the nding of Borghouts et al. who showed that once “non-specic neck
pain” has become chronic, only 44% of the patients seek help from their
general practitioner on a yearly basis [31].
Measurement with mfBIA in chronic neck pain patients
mfBIA is a known and tested method [9,32,33], oen used in sports
clinics, but it has as far as we know not yet been implemented in the
diagnosis of chronic neck pain. It is possible with mfBIA to measure
asymmetrical muscle tension, as well as ascertain whether there is
oedema/dehydration or suspicion of inammation in those muscles
measured [9,32,34]. With mfBIA it is therefore possible to identify
muscles which could be part of the underlying cause behind chronic
neck pain and thereby focus the treatment on the involved muscles
before the condition becomes chronic, a process that involves pain
hypersensitization [35-38]. is latter component may in parallel be
assessed with the Pain Detect Questionnaire [39,40].
Muscles do not operate as completely independent units, but are
interconnected via the myofascial system [19]. e mfBIA assessment
must therefore, as with this case study, include measurements of
myofascial linked muscles for example neck, back, hip and leg muscles,
since myofascial damage may also be an underlying cause. In the two
cases reported in this paper, le-right asymmetry in some of these
linked muscles was found, although the patients complained about neck
pain. is is important knowledge for the clinicians and therapist who,
based on mfBIA measurements, nally have the possibility of directing
forms of treatment towards those parts of the body where problems
have been identied.
Treatment of chronic neck pain
A common choice of treatment for patients with non-specic
chronic neck pain is physiotherapy. General practitioners did, according
Citation: Fener DK, Bartels EM, Elbrond VS, Harrison AP (2016) Chronic Neck Pain Assessment using Multi-Frequency Bioimpedance. Physiother
Rehabil 1: 113. doi: 10.4172/2573-0312.1000113
Page 5 of 6
Physiother Rehabil
ISSN: 2573-0312, an open access journal Volume 1 • Issue 2 • 1000113
to a study by Borghouts and colleagues, refer 51% of their patients with
chronic neck pain for physiotherapy treatment [31].
In a Cochrane review looking at whether massage had positive
eects in patients with mechanical neck disorders, very low level of
evidence that certain massage techniques may have been more eective
than control or placebo treatment in improving function and tenderness
was found [41]. However, others report that massage and manipulation
of aected muscles can have a positive eect on myofascial pain [42].
In a study of 6 horses with movement problems, measurements
involving mfBIA revealed increased myofascial tonus and stiness
in certain regions. e identied regions and specic muscles were
subsequently treated using a form of AtlasBalans, AtlasOrange 1, and
measured 1, 24 and 48 hours post treatment, once again using mfBIA.
e eect of AtlasBalans treatment was in these cases found to be
relatively rapid and eective according to the bioimpedance results [43].
e AtlasBalans treatment did seem to create a positive change in
one of our patients, to such an extent in fact that the patient sought to
continue the treatment, while it is dicult to say how successful the
treatment was for the other patient. Perhaps of greater importance,
though, is the fact that mfBIA is an easily applicable and non-invasive
method to look at possible involvement of interlinked muscles in
chronic neck pain, thereby providing a more overall view of the patient’s
condition when considering treatment choices.
Conclusions
mfBIA was proven to be an easily applicable non-invasive method
for objective measurement of muscle involvement in patients with
chronic neck pain.
AtlasBalans treatment did not show any clear indication as being
an ecient form of treatment in terms of relieving muscle tension in
these patients.
We conclude that mfBIA measurement of potentially involved
muscles in patients with chronic neck pain, prior to treatment,
can help to direct treatment towards those muscles believed to be
involved in this condition. is may reduce the risk of developing pain
hypersensitization and address at least part of the underlying causes for
the presented condition.
Acknowledgement
The study was supported by the OAK Foundation (to EMB), OAK Grant:
OCAY-13-309.
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