Background and objectives

Numerous approaches are recommended for the management of non-specific neck pain (NS-NP). However, the extent to which approaches are used is unclear. This survey investigated current UK physiotherapists' measurement and management of patients with NS-NP.

Background: The purpose of this study was to investigate the relationship between neck pain and upper limb disability.

Methodology: This was a secondary analysis of neck pain patients participating in an RCT comparing usual physiotherapy with graded exercise treatment, to investigate the correlation between baseline neck pain and baseline upper limb disability. 151 neck pain patients from High Wycombe, Nottingham, Grimsby and Hull participated in the study. The measure used to assess baseline neck pain/disability was the Northwick Park Neck Pain Questionnaire (NPQ). The measure of baseline upper limb disability was the Disabilities of Arm, Shoulder, Hand (DASH). A range of variables were also measured at baseline as potential confounding variables. These included pain self efficacy, anxiety, depression, fear avoidance beliefs, coping strategies, age, gender, current smoking status, material and social deprivation and activity level. The measures were validated self administered questionnaires.

Results: Pair wise analysis revealed a strong positive correlation between NPQ score and DASH score (Pearsons’ r=0.799, p< 0.001 (2 tailed), n=142). Stepwise linear regression indicated that increased severity of upper limb disability was predicted by two baseline variables: higher NPQ scores (B=0.743) and lower pain self efficacy scores (B= – 0.489) {Adjusted R2=0.708; n=100, p< 0.001}. After adjusting for potential confounding variables there remains a strong positive association between NPQ score and DASH score.

Conclusions: Patients presenting with high levels of neck pain may also have high levels of upper limb disability. Upper limb disability may need to be assessed and addressed as part of the neck management process.

Purpose: Previous research has reported that increasing the posterior tibial slope through an opening wedge osteotomy results in an anterior shift in the position of the tibia relative to the femur. However, the effect of this on anterior cruciate ligament (ACL) strain remains insufficiently understood. The purpose of this study was to examine the relationship between tibial slope and tibial translation, as well as between tibial slope and ACL strain. It was hypothesized that increasing the posterior tibial slope would result in an increase in anterior tibial translation thereby increasing strain in the ACL.

Methods: Five cadaveric knees were subjected to a randomized experimental design study. One knee was excluded due to failure of a strain gauge during experimentation, resulting in data for four knees. The femoral and tibial portions of the knee were potted with PMMA and fixed using fixation pins. An anterior-based osteotomy was performed with no osteotomy plate present. A strain gauge was then placed in the anteromedial bundle of the ACL. Each knee was mounted at a flexion angle of 15° and loaded with various combinations of A-P loads (18N, 108N, 209N) and axial loads (216N, 418N), according to the study design. Osteotomies of 5mm and 10mm were then performed and measurements of strain and tibial translation were taken after each according to the study design. Tibial slopes were determined through lateral fluoroscopic imaging.

Results: As posterior tibial slope increased, anterior tibial translation increased as anticipated. However, contrary to expectations, as posterior slope increased, ACL strain decreased. One explanation for this result could be that by performing the osteotomy, the insertions sites of the ACL were being moved closer together resulting in increased ACL laxity. At higher slope angles, translation levels off, suggesting constraint of some tissue besides the ACL.

Conclusions: Although increasing the tibial slope through opening wedge osteotomy leads to an anterior tibial translation, there is no increase in strain on the ACL. Further studies are needed to examine the effect of opening wedge osteotomy on other soft tissue restraints of the knee.