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References
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Introduction
Acknowledgment
Discussion
Results
Chronic pain occurs in patterns and recurs when nociceptive pain generators
overwhelm an individual’s tolerance and interfere with function. Management
and treatment usually target at symptoms, not base causation. Research targets
are interrupting, confusing or blockading pain signals; they are not
identification and removal of the base generators of those signals.
A basic scientist seeks identification of patterns, pattern analysis. He seeks
calculation of the simplest, lowest common denominator. Usually this involves
multiple fancy, expensive gadgets or drugs with success measured by a “p”
value of <0.05. This is an epidemiologic study with the same scientific goals.
The tools are more basic. The P value sought is < .00001.
Headache syndromes are well documented as the greatest cause of lost and
diminished work capacity in the United State. This holds true across the world
for both absenteeism from work and “presenteeism” (at work with diminished
performance capability). (1)
Headache syndromes are often categorized as migraine or tension. This study
addressed these together as a mixed pattern headache syndrome (HAp). Most
headache sufferers with function loss have mixed headaches. Impairment from
function is what counts. This is regardless of category: tension, migranoid, or
mixed– with or without neuro-vascular-sympathomimetic, visceral…
components. The focus here is on a pattern: recurrence; related functional
impairment; persistence over a year; an identifiable trigger on one main side;
strict adherence to an anatomical area ;and, a consistent timing.
Pattern headache affect work-place ability to function/concentrate. Those with chronic headache conditions are also noted to have associated tempromandibular joint dysfunction, tinnitus, neck muscle spasms, sleep problems, anxiety and depression. The authors noted an unsuspected close pattern of correlation between patterned headache syndromes and face sleep postures = head and neck twisting, specific muscle triggers, and laterality.
This data set focuses on the head and neck. The head and neck may be untwisted, face neutral (Fn); or, it may be torqued right or left, in order to breathe face twisted (Ft). Ft posture hyper-stretches muscles, pinchesnerves and pulls at joints. It also twists the fleshy airway.
1- Burton W, Landy S, Downs K, et al. The impact of migraine and the effect of migraine treatment on workplace productivity in the United States and suggestions for future research. Mayo Clinic Proc. 2009; 84 (5): 436 445.
2- Malik, Z. Pain, Endorphins, and rTMS. PowerPoint. UCSD3- Mount F, Whitmore M, and Stealey S. Evaluation of neutral body posture on shuttle mission STS-57
(spacehab-1). 2003. 1-30.
4- Panettiere, A. Treating Sleep Problems in PTSD and TBI. PowerPoint. Monthly Webinar. 23 Feb 2012.5- Romanello S, Spiri D, Marcuzzi E, et al. Association between childhood migraine and history of infantile
colic. JAMA. 2013; 309 (15): 1607-1612
Humans typically engage in prolonged periods of sleep with very little movement. During these “relaxed” periods, the twisted, curled and or torqued body slowly kink, distorts or compresses sensitive and vital structures. Such traumas form the basis of injury and chronic pain. These may or may not heal in the more active daytime.
The data demonstrates the strong relationship between twisted head and neck postures and headache syndrome (pattern headaches with lost work efficiency and time), cervical pain, and obstructive sleep dysfunctions. Also demonstrated is a very high correlation of laterality with the head direction, specific muscle spasms, and headache trigger sides.
In this unselected group of subjects, most of these findings were not active complaints. They were in the background, yet found when looked for. It gives an insight into causation that rarely identified, yet necessary understand pain syndromes.
Sleep posture can be readily controlled if the individual understands the posture and the effects of the postures. They can then can picture them and provide a nest into which to employ them. The safest, restorative sleep positions are the neutral body postures. In contradistinction, twisted (and curled) postures predispose to a spectrum of injury and pain.
Image 1: NASA Astronaut Neutral Body Posture
1
Face neutral (Fn)=Untwisted -- Neutral Body Position for Sleep
Graphs for Group A – 109
Illustration 3: 107 of the 109 were evaluated for
Positive findings of spasticity and tenderness of ±3/5.
--Negative, no pain or spasm= 3 ;
--Positive R + R>L = 52 ;
--Positive, about equal, R≅ = 2 5; and,
--Positive L + L>R = 27.
Illustration 4: 258 subjects. The
individual breakdown for each side is,
Face Neutral (Fn): 41,
Face twist right (rrlFt) =R+R>L = 148,
Face twist equal (eFt), Equal: 13
Face twist left (llrFt) = L+L>R = 56.
*41 are Face neutral, 2 with pHA
*217 are face twisted, 190 with ppHA.
Headaches are 36/1 Ft/Fn
Numbers are similar for SCM and TMJ.
Laterality is matched with HA side,
SCM spasm side, and Face turn
direction.
Graphs for Group B – 258
Illustration 1: Of 109, 106 were evaluated
for headache..
Pattern headache affect on work-place
ability to function/concentrate.
--Gp-0,
G-2-Mild headache, loss of 6-10 hours per
month of effective function
G-2, “presenteeism” pain is there, & job
duties are impaired 10-30 hours per month
total; they l may lose, 8 h/mo.
G-3, loss of 20 to 60 hours+ per month,
mostly absenteeism
Illustration 2: Laterality in 105 subjects
--No Headache: 4;
--Right side and Right>Left: 59;
--Equal,( right and left seem equal): 21;
--Left side and Left>Right: 23.
Illustration 5:
A total of 258 subjects. This graph is
similar to the one above, it
summarizes the face neutral
individuals from face twisted
This is dedicated to the hundreds of active duty service members whose eager, honest and frank responses to along and detailed active-exam-survey made it possible to catalogue patterns of pain, injury and behaviors.
There is a particular thanks to the scores of those who begged and demanded that the above and the multitude of directly related chronic-pain-patterns be brought to the attention of their command structure and their health providers.
Illustration 8:
Examples of neutral sleep postures:
Illustration 9:
The data present in the 109 and 258 groups illustrates an epidemiologic relationship between just one specific element in sleep posture and headaches, neck muscle pain and sleep dysfunctions. This is a small hip of the iceberg. Sleep time should be about recovery and rest, but for some, twisted sleep postures evoke injury to a number of areas.
Fn
Fn
X
X
According to fifty years of NASA research, at zero gravity, a Neutral Body Posture, during static poses or sleep protects human nerves and muscles from injury.
The current data from two detailed exam-surveys strongly confirms the NASA research. It also documents a strong reproducible pattern of specific neuro-musculo-skeletal pain and other maladies directly associated with specific dominant (static) twisted or hyper-flexed static sleep postures.
Protection of nerves, vasculature, muscle, viscera, and bone from static cumulative compressive injury is maintenance of a neutral posture during sleep (Image 1).
Methodology
The gathered data was recorded into a fully de-identified databases separate from files or records. None of the data was correlated, nor sleep positions calculated, until six months after the final subject exam-study collection. Specific sleep postures of the head and neck are closely related to pattern headaches, headache syndromes with function loss, and specific lateralized muscle muscle trigger areas. The observations recorded demonstrate that the triggers are mechanical associated with neuro-vascular structures. The data patterns multiple positive findings of physical disabilities that correlate with related sleep postures. Such patterns (causes?) are unknown and have not been previously catalogued.
First, Group-A (109:) over a six month period, five applicants per week were selected who complained of or were found with TMJ, bruxism, and jaw tenderness. 109-Subjects; Average age 36; 94-males;15 female.s
Second, Group-B (258), for prevalence: all randomly assigned applicants for screening general physical exam over 6 months. None were specifically being evaluated for headache, sleep dysfunction, or the other myofascial-pain disorders that were documented for absence or presence and intensity. Average age 42; 22-male; 30-female.
Group-B had less detail gathered, but the data was parallel with Group-A.
There were 367 randomly-assigned evaluees for general medical screening in two sequential
groups.
Face (Ft): Head and neck =Twisted to breathe during dominant sleep posture
Examples of Head & Neck/ Face Positions Demonstrated
Fn
Fn
Neuroscience, Anesthesiology and Medicine
University of California San Diego
Al-Timimi, NA & Gillick, JS
Illustration 6:
Cervical pain was muscle-related to the
combined SCM and other cervical muscles
258 subjects, the breakdown for each –
*No spasm–53;
*Spasm/pain-Right= R+R>L= 117
*Spasm/ pain about equal= R≅L =35:
*Spasm/pain-Left=L+L>R= 53
*** 205 subjects are positive for cervical
pain and 53 with none.
***9/41 Fn’s had cervical pain/spasm
***196/217 Ft’s had cervical pain/spasm
This is a 6.3/1 ratio with Ft/Fn
The SCM muscle is usually the local
trigger for tension headache with the
Suboccipital area for migranoid.
If neck sleep position is twisted, the
SCM and posterior cervical muscle
on the most faced side twisted
toward is tender, spastic and the
trigger.
Illustration 7:
In the258 subjects. ;
28/30 females slept twisted,
189/228 males slept
twisted.
Ft-rightFt-left
Ft-left
Ft-right
Positions & Onset
Headaches and Neck Muscles
Combined Conditions
Sleep Problems
Group-A
Group-A
Headaches
Group-A- HApf
affecting work
function - loss
Group-B
Headache
Correlates
Group-B
Prevalence
Group-B
Prevalence
Group-B
Prevalence
Group-A
Group-B
Prevalence
Group-A
Do Specific Common Sleep Postures Independently Evoke
Headaches and Breathing Obstruction?