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_1991_ conducted a study on The Neck Disability Indexa study of

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_1991_ conducted a study on The Neck Disability Indexa study of Powered By Docstoc
					6.   Brief resume of the intended work:
     6.1 Need for the study:
            India has been in the forefront of the cyber world with IT industries developing into a major
     service provider.1Among these, Bangalore has the highest number of software companies in India,
     hence called the Silicon Valley of India .2
            As the computer is a vital tool in many different occupations, the number of users has
     increased rapidly and so is the time spent in front of the computer. However long periods of working
     at computers can increase the chance of development of an injury. Muscle and joint pain, overuse
     injuries of the upper limbs, low back pain , neck pain, eyestrains and headache can result from
     inappropriate computer use.3 A.K.Sharma , in his study on computer related health problems has
     said that the common sites affected were neck (44%) , low back (30.5%) , wrist/hand ( 19%) and
     shoulders(12.5%). The problem in neck, low back and shoulders was present in large proportions in
     subjects and present for more than 30 days. 1
            One of the most common reasons of neck pain is the faulty posture assumed in front of the
     computer. Computer users have forward-head-posture which causes strain on the neck and back
     which results in mechanical neck pain. Faulty neck and head posture causes stress to vertebrae. Since
     the bones get mal -aligned by the faulty posture, the muscles, joints and ligaments have to strain more
     than the natural need. This happens because the computer user often finds that his/her head drifts
     forward towards the screen. Sitting in the faulty posture for a long time causes fatigue, muscle strain
     and, in course of time, pain in and around neck and upper back region. This causes serious
     consequences if left untreated.
            While sitting with the forward head posture, the head moves ‘forward’ and the muscles in the
     upper back and neck have to work harder to keep the chin from dropping forward onto the chest. The
     head constitutes for 40% of the total body weight and 30% of the total body length. 4 This forces the
     muscles which raise the chin to remain in constant contraction, causing pressure on the sub occipital
     nerves at the base of the skull.5
            Repetitive micro trauma due to this posture (as permissible angle of neck flexion should not
     exceed more than 30 degree by Chaffin 1971) can lead to trigger point formation which causes
     vascular constriction and nerve irritation. This in turn can lead to headaches.6
            Headache is one of the stress symptoms related to computer use. It is also one of the most
     difficult problems to diagnose and treat effectively. Headaches are reported at least once a month by
     76% of women and 57% of men. There are numerous types of headaches that computer users are
     prone to including tension, cluster and migraine headaches. Cervicogenic headache is also seen in this

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population.7Head pain that is referred from the bony structures or soft tissues of the neck are called
‘CERVICOGENIC HEADACHE’. It is often the sequel of a head or neck injury, but may also occur
in the absence of trauma. The prevalence of this headache in general population is estimated to be
0.4% - 2.5% but is as high as 20% in patients with chronic headache.8 It has been reported that in
Western society as many as 16% of individuals experience cervicogenic headache, which can lead to
significant amounts of pain and perceived disability.9
       These headaches can be precipitated by many forms of stress, poor posture, anxiety and
depression. This type of headache is mild to moderate in intensity, and often occurs on either or both
sides of the head. 7
       Cervicogenic headache is diagnosed based on Cervicogenic Headache International Study
Group Diagnostic Criteria.8 Only after the publication of the 1990 headache , classification criteria
did a generally accepted clinical definition of cervicogenic headache emerge.10
       Cervicogenic headaches is a very rare condition which cannot be easily diagnosed and has
specific treatment i.e. mobilization at C1-C2 level or above C4 vertebrae (as this is the dominant
source of pain for these subjects). 11, 12 And physical therapy (PT) practice is an important therapeutic
modality for the rehabilitation of cervicogenic headache. Physical treatment is initiated with gentle
muscle stretching and manual cervical traction. Therapy can be advanced, to strengthening and
aerobic conditioning. For parallel treatment use of anesthetic blockade and neurolytic procedures for
temporary pain relief can enhance the efficacy of physical therapy.8
       Early diagnosis and management can significantly decrease the protracted course of costly
treatment and disability that is often associated with this challenging pain disorder. 8 The success of
physical therapy treatment for cervicogenic headache depends on accurate differential diagnosis of
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cervical musculoskeletal origin to the headache.        Headache along with neck pain can be a disabling
condition disturbing the quality of life of the individual. If it is not treated properly there can be
chances of recurrence
       The prevalence of this form of headache has only been estimated in two highly selected in-
clinic patient populations however the study was done in general population which was randomly
selected between the age group of 20-59 yrs old patients. Here a specific population or condition was
not selected. No data exist regarding the prevalence in representative selected population. 10
Since there are many IT industries in Bangalore, there is an urgent need to understand the dynamics
of this problem and to prevent it from assuming epidemic proportions.
       Thus the need arises to find The Prevalence Of Cervicogenic Headache In IT Professionals
With Neck Pain.


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RESEARCH QUESTION:
Are computer professionals with neck pain prone to cervicogenic headache?
6.2 Review of Literature:
Toby Hall Kathy Briffa, Diana Hopper and Kim Robinson (2010) investigated the reliability of
manual examination procedures and the frequency that each or multiple segments in the upper
cervical spine above the C4 vertebra were the dominant source of pain in subjects with cervicogenic
headache (CGH) 80 subjects were taken out of which 60 had (CGH) and 20 were un symptomatic .
Manual examination above the C4 vertebra showed good reliability. The C1/2 segment was most
commonly symptomatic, with a positive finding at this segment in 63% of cases. The high frequency
of C1/2 involvement in CGH highlights the importance of examination and treatment procedures for
this motion segment .12
Knackstedt H, Bansevicius D, Aaseth K, Grande RB, Lundqvist C , Russell MB. (2010) An age-
and gender-stratified random sample of 30,000 persons aged 30-44 years received a mailed
questionnaire. Those with self-reported chronic headache were interviewed by neurological residents.
The criteria of the Cervicogenic Headache International Study Group and the International
Classification of Headache Disorders, second edition, were applied. The prevalence of CEH was
0.17% in the general population, with a female pre-ponderance. 13
Sjaastad, O. and Bakketeig, L. S. (2008) prevalence of cervicogenic headache was done in Vaga ,
Norway where population at large was taken between 18 to 65-year-old citizens, i.e. 88.6% of this age
group, underwent an interview/clinical examination. The Cervicogenic Headache International Study
Group criteria include: (I) unilaterality of head pain, (II) reduction, range of movement, neck, (III/IV)
ipsilateral shoulder/arm discomfort, (V/VI) mechanical provocation of similar pain, objectively or
subjectively. A prevalence of 4.1% was found. In 41 cases with the highest number of CEH criteria
(‘core ‘cases), there was a male preponderance (F/M: 0.71).14
Jacqueline van Duijn, Arie J. van Duijn, EdD, Wanda Nitsch. (2007) This case report describes
the physical therapy differential diagnosis, management, and outcomes of a patient with cervicogenic
headache. Self-report outcome measures included the Visual Analog Scale for headache pain intensity
and the Neck Disability Index. Management consisted of various thrust and non-thrust manipulations,
soft tissue mobilizations, postural re-education, and exercise to address postural deficits and cervical
and thoracic hypomobility and diminished strength. At discharge, the patient demonstrated clinically
meaningful improvements with regard to pain, disability, and headache.9
A.K.Sharma, S.Khera, J.Khandekar. (2006) did a study on health problems in computer users in
Delhi were 200 IT professionals were taken with varied job profiles like software developers (82),


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call centre (54) and data entry/processing (64). The magnitude of computer related problems were as
high as 93% in this study out of which neck pain (44%) , low back pain(30.5%) ,wrist /hand (19%)
and shoulders(12.5%) the problem with neck ,low back and shoulders in last twelve months were
present in large proportion in subjects for more than thirty days.1
Peter A. Idowu, Rufus A. Adedoyin, Rotimi E. Adagunodo (2005) This paper explains the
repetitive strain injuries that are associated with the use of the computer system. It also outlines the
administrative and ergonomic precautions that should be taken in order to prevent or reduce the
occurrence of RSIs in computer users.7
David M. Biondi, DO (2004) this article gives an overview of cervicogenic headache, its causes,
diagnosis, and treatment. It is a common cause of chronic headache and often misdiagnosed or
undiagnosed as compared to other headaches like migraine or tension headache. Early diagnosis and
management by way of a comprehensive, multidisciplinary pain treatment program can significantly
decrease the protracted course of costly treatment and disability that is often associated with this
challenging pain disorder.8
Hains F, Waalen J, Mior S, (1998) A cross sectional study evaluating the psychometric properties of
the NDI. Internal consistency was measured by a Cronbachs alpha, two factor analyses (exploratory
and confirmatory) were conducted to examine the structure of the NDI and stepwise regression
analysis was used to examine the variables most predictive of VAS scores. Results from 237 neck
pain patients show that the responses given on the eight versions of the NDI are a function of the
content and not of the format in which the items are presented.            The NDI possesses stable
psychometric properties and provides an objective means of assessing the disability of patients
suffering from neck pain. 15
G. Jull (1997) The success of physical therapies in the management of headache relies in the first
instance on an accurate differential diagnosis of a cervical musculoskeletal origin to the headache.
Dysfunction in the upper three cervical joints, poor activation levels and endurance capacity of the
deep and postural supporting muscles of the neck; shoulder girdle region and deficits in kinesthesia
have been identified in the cervical headache patient. Treatment needs to be precise and
comprehensive to address each aspect of this interrelated dysfunction if long-term success of
treatment is to be achieved.11
Nilsson, Niels DC, (1995) prevalence of cervicogenic headache was checked in general population
from 20-59 yrs who fulfilled the International Headache Society criteria for cervicogenic headache.
Of the 45 persons examined, eight fulfilled the diagnostic criteria for cervicogenic headache,
equivalent to a prevalence in the headache group of 17.8% (95% confidence interval = 8%-32%). 10


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     Vernon H, Mior S, (1991) conducted a study on The Neck Disability Index: a study of reliability and
     validity. Test-retest reliability was conducted on an initial sample of 17 consecutive "whiplash"-
     injured patients in an outpatient clinic. Concurrent validity was assessed in two ways. Secondly, in a
     larger subset of 30 subjects, NDI scores were compared to scores on the McGill Pain Questionnaire,
     with similar moderately high correlations. Thus, this study demonstrated that the NDI achieved a high
     degree of reliability and internal consistency.16
     6.3 Objectives of the study:
     To find the prevalence of cervicogenic headache in IT professionals with neck pain.
7.   Materials and Methods:
     7.1 Source of Data :
      IT Companies in and around Bangalore.
     7.2 Method of collection of data:
             Population            : IT professionals with neck pain
             Sample design         : Convenient sampling
             Sample size           : 100 subjects
             Type of Study         : cross sectional (survey) study
             Duration of Study : six months.
     Materials required:
             Pen
             Paper
     INCLUSION CRITERIA:
             Subjects having neck pain with NDI score 41-60%
             Both genders between 30- 40 years of age.
             Working experience of more than one year
             Computer work for more than 5 to 6 hours / day.
     EXCLUSION CRITERIA:
             Subjects with any systemic conditions like rheumatoid arthritis, ankylosing spondyloysis, or
               any primary muscle disease.
             Subjects having other causes of headache like migraine, cluster or tension headaches.
             Subjects with any tumors or surgeries of cervical spine.
             Any infective conditions causing headaches
             Any disc prolapsed or degenerative conditions or any chronic condition causing neck pain like

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         cervical spondylosis or herniated disc prolapsed, sub occipital neuralgia, trigeminal
         neuralgia.
Methodology:
       After taking ethical clearance a list of 100 subjects will be taken from respective organizations.
Demographic data consisting of name of the subject, age, gender, occupation, contact address,
phone number, mail address, will be collected from the subject.
Preliminary assessment will be done to find neck pain severity.
Also the type of job, working hours, frequency and duration of headaches will be assessed.
The subjects who fulfill the inclusion and exclusion criteria will be included in the study and an
informed consent will be taken from them.
   The subjects will be assessed according to NDI and the diagnostic criteria for cervicogenic
   headache by Sjaastad.O.et.al, which includes the following
      unilateral headache triggered by head/neck movements or posture;
      unilateral headache triggered by pressure on the neck;
       unilateral headache spreading to the neck and the homolateral shoulder/arm.
       The subjects who fulfill the diagnostic criteria will be sent to Neuro physician for
       confirmation.
       Information about job risk activities, male or female preponderance and how stress levels
affect them according to their experience will be collected.
Data will be collected in form of percentage and appropriate statistical measures will be done.
Statistics:
    Statistical analysis will be performed by using SPSS software (version17) for windows. Alpha
       value will be set as 0.05.
       Percentage/ Frequency analysis will be used for screening to assess the prevalence of
       cervicogenic headache in IT professionals.
       Chi –square test for bivariable association with age, gender and work experience
Outcome measures:
              Percentage of cervicogenic headache in subjects with neck pain
              Neck disability index.
7.3 Ethical Clearance:
As this study involve human subjects, the ethical clearance has been obtained from the ethical
committee of Padmashree institute of physiotherapy, Nagarbhavi, Bangalore, as per ethical guidelines
research from biomedical research on human subjects, 2000, ICMR, New Delhi.

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8.   List of References:
     1. A.K.Sharma, S.Khera, J.Khandekar. Computer Related Health Problems among Information
          Technology Professionals in Delhi. Indian Journal of Community Medicine 2006 January –
          March 1; Vol.31:36-38.
     2. The Indian Express,[Online] 2011August Available from :URL:http://www.wikipedia.com
     3. Better.Health.Channel,[Online]2011MayAvailable:from:URL:http://www.betterhealth.vic.gov.au/
          bhcv2/bhcarticles.nsf/pages/Computer_related_injuries?open">Computer-related     injuries   -
          Better Health Channel.
     4. P.A Aroye. The head body- weight and body- length relationship of Synodontis Schall. Nigeria
          Bloch and Schneider 2004.
     5.   Health Mad [Online] 2011 feb12 Available from: URL:http:// Computer Posture Causing
          Pains Healthmad.html
     6. Tracey R. Cervicogenic headache causes [Online] 2010 [cited 2010Mar23] Available from: URL:
          http:// Cervicogenic Headache Causes LIVESTRONG.COM 1.html
     7. Peter A. Idowu, Rufus A. Adedoyin, Rotimi E. Adagunodo. Computer-related repetitive strain
          injuries. Journal of the Nigeria Society of Physiotherapy.2005 Jan: 1.
     8. Dav M.Biondi.Do.Cervicogenic Headache: Diagnostic Evaluation and Treatment Strategies. Pain
          management rounds.2004 Vol.1(8):1-5
     9. Jacqueline van Duijin, PT, DPT, OCS, Arie J. Van Duijin, PT, EdD, OCS, and Wanda Nitsch, PT,
          PhD. Orthopedic Manual Physical Therapy Including Thrust Manipulation and Exercise in the
          Management of a Patient with Cervicogenic Headache: A Case Report. Journal of Manual and
          Manipulative Therapy.2007;15(1):10-24.
     10. Nilsson, Niels DC, MD. The prevalence of Cervicogenic headache in a random population
          Sample of 20-59 Year Olds. Spine journal.1995 Sept 20(17).
     11. G. Jull. Management of cervicogenic headache .Manual Therapy.1997 Nov 2(4):182-190.
     12. Toby Hall Kathy Briffa, Diana Hopper and Kim Robinson. Reliability of manual examination and
          frequency of symptomatic cervical motion segment dysfunction in cervicogenic headache.
          Manual Therapy. 2010 Dec 15(6):542-546.
     13. Kanckstedt H, Bansevicius D,Aaseth K, Grande RB, Lundqvist C, Russell MB. Cervicogenic
          headache in the general population: the Akershus study of chronic headache. Cephalalgia. 2010
          Dec; 30(12):1468-76.
     14. Sjaastad, O., Bakketeig, L. S. Prevalence of cervicogenic headache: Vaga study of headache
          epidemiology. The Authors Journal compilation.2008 Mar; 117:173-180.


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15. Hains F, Waalen J, Mior S. Psychometric properties of the neck disability index. J Manipulative
   Physiol Ther. 1998 Feb; 21(2):75-80.
16. Vernon H, Mior S.The Neck Disability Index: a study of reliability and validity. J
   Manipulative Physiol Ther. 1991 Sep; 14(7):409-15.




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