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Table of Contents
                            preface Musculoskeletal Disorder
Rehabilitation in Musculoskeletal Disorders
02_Myofascial Trigger Point:
Symptoms, Diagnosis, Intervention
03_Postural Mismatch in
Musculoskeletal Disorders
04_Fractal Analysis Design for
Distinguishing Subject Characteristics
on Motor Control of Neck Pain Patients
05_Upper Limb Work-Related Musculoskeletal
Disorders in the Manufacturing Industry
Document Text Contents
Page 1


Edited by Marie Alricsson

Page 2

Musculoskeletal Disorder
Edited by Marie Alricsson

Published by InTech
Janeza Trdine 9, 51000 Rijeka, Croatia

Copyright © 2012 InTech
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license, which allows users to download, copy and build upon published articles even for
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Publishing Process Manager Jana Sertic
Technical Editor Teodora Smiljanic
Cover Designer InTech Design Team

First published April, 2012
Printed in Croatia

A free online edition of this book is available at
Additional hard copies can be obtained from [email protected]

Musculoskeletal Disorder, Edited by Marie Alricsson
p. cm.
ISBN 978-953-51-0485-8

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Musculoskeletal Disorder 36

The diagnosis BPPV is objectified by demonstrating nystagmus when the patient is positioned
in a Dix-Hallpike position or in the first position of a Brandt-Daroff maneuver, i.e., lying down
on one side [51]. The nystagmus is registered by video-oculography (Interacoustics A/S,
Assens, Denmark) (Figure 3). This technique allows identification of nystagmus occurring
intermittently, as well as after a long latency. Each positioning is done in slow motion, and the
subject is kept for three minutes in each position. The gravity constituted the acceleration.
Otoliths in one SSC give a specific nystagmus pattern. Otoliths in more than one SSC give
various nystagmus patterns depending on which SSC is activated and the amount of debris
present. The resulting nystagmus is expressed as a vector. Divergence from one-SSC pattern is
interpreted as a BPPV with otoliths in more than one SSC.

Fig. 3. The video-oculography documents a BPPV (Interacoustics A/S, Assens, Denmark).
The patient was tested in the Brandt Daroff position for three minutes; no nystagmus was
registered when she was lying down, neither in the Dix-Hallpike position. First in the sitting
position nystagmus occurred. The illustration demonstrates a sequence after one minute in
the sitting position. The intensive nystagmus was ongoing and after three minutes the
patient was allowed to gaze to control the dizziness and nausea.
The patient is a 35 year old woman with a head and neck trauma ten years back and she has
had intermittent symptoms. She has the clinical picture of a long lasting BPPV. Her earlier
given diagnosis was phobic postural vertigo.

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Postural Mismatch in Musculoskeletal Disorders 37

Video-oculography for Smooth Pursuit Neck Torsion (SPNT) test [52,53]. This test is relevant to
perform, if there is a history of neck trauma. The registration is done by binocular video-
oculography (Interacoustics A/S, Assens, Denmark). This equipment is full digital without
any analogue parts. The SPNT test is partly a conventional test of the smooth pursuit eye
movement test and partly a test of the proprioceptives of the neck. We used a moving
sinusoid stimulus with a maximum velocity of 20 degrees per second. This test has to be
performed after at least five minutes of rest without any movement of the head. The test
starts with the subject facing the target (a yellow dot on a screen) without turning the head
in relation to the torso (neutral position). Six cycles were performed. The torso of the subject
was then actively turned away from the screen and kept in a static position at a maximum
angle of 45 degrees – or at some angle which did not increase pain, stress and / or
discomfort in this position – with the head held in a horizontal position facing the screen.
After a short pause, the visual stimulus was again presented. The test was then repeated in
the opposite direction. The ability to follow the target is expressed as a gain, i.e. the
proportion between the movement of the eyes and the movement of the target. The average
gain of each head position in relation to torso and direction of the eye movements were
recorded. The test parameter chosen to represent the SPNT test was called the SPNT (diff) is
defined by the algorithm:

SPNT (diff) =
neutral position (gain R + gain L) right turn (gain R + gain L) + left turn (gain R + gain L)

2 4

Gain R represents the gain of smooth pursuits, tracking a target which moves to the right;
gain L represents the corresponding gain to the left.

A positive SPNT test seems to be an expression of a serious neck dysfunction. In our study
only 30 % of patients who fulfill the Quebec Task Force criteria of a WAD have a positive
SPNT test [54]. If the patient has not rested for five minutes before the start of the test, there
is a risk of a false positive test result. This is due to the effects of BPPV.

7. Treatment
7.1 General principle of treatment

A balance disorder is either due to abnormal afferent signals from the periphery or
abnormal processing in the CNS. If a balance disorder is static, the central postural control
system will compensate and the condition will improve. This is the normal course after a
vestibular neuritis, labyrintitis and lacunar brain stem- or cerebellar infarcts. In the opposite
situation where the activity of the peripheral balance organ varies from time to time, the
central postural control system has limited possibility to compensate. This is a well-known
phenomenon in Ménière ´s disease and in BPPV. When the otoliths are displaced from the
semicircular canals in BPPV, the signals from the labyrinth will be ameliorated. The more
normalized a balance unit can function; the less stabilizing vestibulo-spinal and vestibulo-ocular
reflex activity is needed [3].

A neck with an abnormal movement pattern gives an inappropriate afferent signal activity
from the gamma-muscle spindles to the central postural control system primarily via the
cervico-collic reflex (CCR) [25-27]. Static muscle contraction leads to increased pain [35-38].

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Upper Limb Work-Related Musculoskeletal Disorders in the Manufacturing Industry 81

assessment and ergonomic interventions of larger companies to small-medium firms also
through the use of simple tools for risk identification.

Ergonomic interventions not only concur in the management and control of negative events
for workers health but also in achieving advantages in terms of lower costs and greater
productivity. A complete intervention that uses all available instruments such as risk
assessment, health surveillance, education, task analysis, reorganization and technological
innovation can achieve appreciable results.

9. References
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