Active Cervical Range Of Motion Research Articles

Clinical relevance of occipital condyle fractures.

Context:No consensus about classification, treatment, and clinical relevance of occipital condyle fractures (OCFs) exists.Aims:The aim of the study was to determine radiological, clinical, and functional outcome of OCFs and thereby determine its clinical relevance.Settings and Design:This was a retrospective analysis of a prospective follow-up study.Materials and Methods:From May 2005 to May 2008, all OCFs were included from a Level-1 trauma center. Patient files were reviewed for patient and fracture characteristics. Fracture classification was done according to the Anderson criteria. Clinical outcome was assessed by completing two questionnaires, radiological outcome by computed tomography imaging, and functional outcome by measuring active cervical range of motion using a Cybex EDI-320.Statistical Analysis Used:A Fisher's exact Test was used in categorical variables and a one-sample t-test for comparing means of active cervical range of motion in occipital fracture patients with normal values. An independent samples t-test was carried out to compare the means of groups with and without accompanying cervical fractures for each motion.Results:Thirty-nine patients were included (4 type I, 16 type II, and 19 type III). Twenty-seven patients completed follow-up, of whom 26 were treated conservatively. Fracture healing was established in 25 of 28 fractures at a median follow-up of 19 months. Eleven patients had none to minimal pain or disability at follow-up, 12 had mild, and two had moderate pain or disability on questionnaires. No statistically significant difference in active cervical range of motion was identified comparing means stratified for accompanying cervical fractures.Conclusions:Conservatively treated patients with an OCF generally show favorable radiological and clinical outcome.

Intra-rater and inter-rater reliability of cervical active range of movement in young asymptomatic adults using inertial sensors

ABSTRACTObjectives: Current literature is scarce about the use of an inertial sensor to measure cervical active range of motion (aROM). The objective of the present study is to determine inter- and intra-reliability in the measurement of cervical aROM using inertial sensors in asymptomatic individuals.Materials and methods: Twenty asymptomatic individuals participated in the study. Two different physiotherapists measured each participant for cervical aROM (6 movements). The sequence of movements and the explanations given were standardized. The rater’s order of measurement was randomized.Results: For the intra-rater results, the intraclass correlation coefficient (ICC) values for all cervical movements were good for Rater A (ICC >0.90) and Rater B (ICC >0.90). For the inter-rater results, the ICC values were above 0.75 for all movements, indicating a good level of reliability. Also, values obtained in SEM, MDC90 and LOA indicate good agreement.Conclusion: The data obtained in this study suggest that inertial sensors can be used in clinics due to their high intra- and inter-rater ICC (>0.80). Also, its low economic cost, easy handling, and various utilities make this tool a useful alternative in the measurement of cervical aROM.

Effectiveness of joint mobilization and dry needling in myofascial pain syndrome with neck pain

Abstract Background and Aim Almost 70% of the population has suffered from cervical pain of a mechanical origin (CPM) at some point in their life. In myofascial pain syndrome (MPS), besides the zygapophyseal joint, the myofascial trigger point (MTrP) is involved as the main source of CPM. Manual therapy (MT) based on joint mobilization (JM) in combination with dry needling (DN), are the most used treatments in these patients. Aims 1) To compare the pain and range of motion (ROM) between the MT interventions using JM and deep DN and MT using JM and sham DN in patients with CPM and activation of MTrP 2 of the upper trapezius (UT). 2) To assess the changes in the active cervical ROM, pain pressure threshold (PPT), intensity of pain at rest and with movement (measured using the Visual Analog Scale) and post-needling soreness in these patients. Material and Methods An experimental, double blind randomized pilot study in which the effects produced by the interventions were compared among two groups: a first group (n = 5) received a treatment based on sham DN of the UT and MT using JM of C2 and a second group (n = 6) who received deep DN of the MTrP 2 of the UT and the same mobilization technique. Three prospective measurements were performed: pre-intervention, post-intervention and follow-up (1 month after the post-intervention measurement). Results 11 subjects participated in this study (7 women and 4 men; mean age: 49.9 ± 10.8 years) who completed both the four interventions (1 session/week) as well as the follow-up. According to the PPT, measured on the MTrP 2 of the UT, none of the two groups presented clinically significant changes, and only 3 patients presented increases beyond the MDC (MDC) in the follow-up measurement (1.11 kg/cm2). Regarding the VAS measured at rest, only the first group (sham DN) obtained a clinically significant post intervention improvement (56%) and at follow-up (150%). The VAS in response to movement decreased significantly with treatment in both groups for all movement planes and axes; however, the active cervical ROM did not display significant changes in any of the two groups; lastly, the mean, maximum and minimum values of post-needling soreness in the group with placebo DN were lesser to those of the group who received the real deep DN technique, for the entire treatment. Conclusion Deep DN combined with MT improved the intensity of pain in response to cervical movement, whereas sham dry needling combined with MT caused a greater decrease of intensity at rest. Although both techniques are similar for improving active cervical ROM, sham DN combined with MT increased post-needling soreness both during treatment as well as at follow-up. Further research is necessary to deepen our information of the effects of the combination of these two techniques in the treatment of MPS.

Range of motion in the cervical spine after odontoid fracture treated with anterior screw fixation

BackgroundIt is believed that direct odontoid screw fixation preserves the physiological cervical range of motion following surgery. However, there are no clinical studies confirming the motion sparing value of this technique.This study aims to (1) to assess active cervical range of motion following types II and III odontoid fracture, successfully treated with anterior odontoid screw fixation, and (2) to examine the relationship between the range of motion of the head and duration of collar usage, neck pain, quality of life, and patients’ age.MethodsThe study involved 41 patients subjected to a procedure of direct osteosynthesis of the dens with lag screw. Following the operation all the patients had to wear a cervical collar to protect the osteosynthesis. The control group consisted of 41 individuals with no clinical diagnosis of any cervical spine disorders. The spinal motion was assessed using multi-cervical unit, taking into account bending/extension, left and right lateral flexion, and left and right axial rotation.ResultsIn the study group, spine mobility correlated with the duration of hard collar usage following the operation, with a longer duration corresponding to poorer spine mobility at the end of the treatment. Statistically significant correlation was observed in the case of extension (p < 0.021) and axial rotation (p < 0.007). In the study group, there was a negative correlation between the range of motion and the patients’ age, i.e., the older the patient the poorer his/her spinal mobility (p < 0.001).ConclusionsActive cervical range of motion in patients following direct osteosynthesis of the dens, augmented with a hard collar, was significantly lower than in the control population, and it correlated negatively with the duration of collar usage, the patients’ age, and intensity of spinal pain.

Correlation Between Proprioception and Cervical Functions in Individuals with Chronic Neck Pain

Background. Neck pain can affect cervical functions: reduce cervical range of motion, muscle strength and endurance. Recently, increasing attention has been paid to the assessment of proprioception in individuals with neck pain. It is believed that neck proprioception dysfunction can be linked with neck pain, reduced cervical range-of-motion, muscles strength and endurance. The aim of research was to assess neck dysfunction and proprioception relationship with neck muscle functions, cervical range of motion in individuals with neck pain. Methods. Thirty fve neck pain patients participated in this survey. Neck pain intensity was evaluated using a visual analogue pain scale, neck position sense, cervical active range of motion, cervical muscle strength using Lafayette handheld dynamometer, cervical muscle strength endurance were also evaluated in this study. The statistical analyses were performed. The averages and standard deviations were calculated. Averages were compared with the norm rates. Spearman’s and Pearson’s correlations were used for relationship assessment. Results. The neck position sense and cervical active range of motion statistically signifcantly differed from the norm. There was a difference between lateral neck flexion to the right and to the left – 18° (p &lt; 0.05). The left neck rotation muscles were stronger than the right ones (p &lt; 0.05). Neck extensors had greater endurance than neck flexors for 94.69 seconds (p &lt; 0.05). A statistically significant inverse relationship was found between pain and muscle strength, endurance, and cervical flexion range of motion (p &lt; 0.05). The neck position sense did not correlate with pain. Neck extension position sense negatively correlated with neck muscle group strength endurance (p &lt; 0.05). Conclusions. Individuals with neck pain had neck position sense impairment, muscle imbalance between neck flexors and extensors, and reduced all cervical ranges of motion. With increasing neck pain, intensity muscle strength, muscle endurance, cervical flexion range of motion decreased, but the neck position sense did not correlate with pain. Neck extension position sense was related with all neck muscle group strength endurance.Keywords: neck pain, neck proprioception, muscle strength, muscle endurance, cervical range of motion.

Association between somatosensory, motor and psychological variables by levels of disability in patients with cervicogenic dizziness

Cervicogenic dizziness is a musculoskeletal disorder mainly characterized by dizziness associated with neck pain. The aim of this study was to assess the association between somatosensory, motor and psychological variables by levels of disability due to dizziness in patients with cervicogenic dizziness. A total of 64 patients were classified into two groups according to the presence of higher and lower levels of disability due to dizziness. The degree of disability due to dizziness, the magnitude of chronic pain, catastrophizing and kinesiophobia were evaluated by self-reports. The cervical active range of motion and the pressure pain thresholds were also assessed. The psychosocial variables showed significant differences. Higher values were found in the group with the highest level of disability due to dizziness (d = 0.80). Regarding motor variables, some differences were found in extension (d = 0.52) and in right rotation cervical movement (d = 0.90), with lower values in the group with greater disability due to dizziness. No differences were observed in the somatosensory variables (p > .05). In the group with lower levels of disability due to dizziness, negative associations were found with the range of cervical motion and positive associations were found with kinesiophobia. Our results suggest that levels of disability due to dizziness could be an important factor to consider in patients with cervicogenic dizziness. The influence of psychological factors and some ranges of cervical movement should be considered clinically.

The Neck Disability Index is Not Correlated with Some Parameters of Temporomandibular Disorders: A Cross-Sectional Study.

To test whether the Neck Disability Index (NDI) would indicate higher reported disability among people with neck pain, cervicogenic headache, and temporomandibular disorders (TMD) when compared to people with only neck pain or neck pain with cervicogenic headache. A total of 62 participants were enrolled and categorized into one of three groups: (1) neck pain only; (2) neck pain and cervicogenic headache; and (3) neck pain, cervicogenic headache, and TMD. NDI scores, pain, cervical active range of motion (AROM), and maximum mouth opening (MMO) were recorded for each subject. NDI scores were compared between groups using the Kruskal-Wallis test, and associations between the NDI and pain, cervical AROM, and MMO were tested using Pearson correlations. No statistical difference in NDI score was identified among the three groups (P = .08). NDI scores were not correlated with MMO (P = .17) or TMD pain (P = .16), but were correlated with cervical AROM (r = -0.635 to -0.311), cervicogenic headache intensity (r = 0.355; P = .004), and cervical pain ratings (r = 0.619; P < .001) across all participants. Participants' perceived disabilities were not associated with TMD pain or MMO. The NDI does not seem adequate for assessing TMD symptoms.

Neural Tension Technique Improves Immediate Conditioned Pain Modulation in Patients with Chronic Neck Pain: A Randomized Clinical Trial.

To determine the immediate effect of neural tension technique (NTT) on conditioned pain modulation in patients with chronic neck pain. A secondary objective was to determine the immediate effect of neural tensioner technique on pain intensity and cervical range of movement. Randomized clinical trial. University medical center. Fifty-four patients with neck pain (13 males and 41 females; mean± SD age = 20.91 ± 2.64 years) were randomly allocated to two groups: NTT or sham technique. Participants received a visual analog scale (VAS) and neck disability index (NDI) after inclusion. Conditioned pain modulation (CPM) and active cervical range of motion were measured before and after the intervention. Each subject received one treatment session. The results of the analysis of variance revealed a significant effect for the group × time interaction only for CPM (F = 11.09, P = 0.002, ηp2 = 0.176). No significant interactions were found for the other measures (VAS [F = 1.719, P = 0.195, ηp2 = 0.031], pressure pain threshold C2 [F = 0.731, P = 0.398, ηp2 = 0.018], flexion [F = 0.176, P = 0.677, ηp2 = 0.003], extension [F = 0.035, P = 0.852, ηp2 = 0.001], lateral flexions [F = 0.422, P = 0.519, ηp2 = 0.008], and rotations [F = 1.307 P = 0.258, ηp2 = 0.024]). Regarding CPM, intergroup interaction differences were found postintervention (P = 0.002) with a high effect size (d = 0.98). This study suggests that neural tension technique enhances immediate conditioned pain modulation in patients with chronic neck pain, but not pain intensity or cervical range of movement.

Immediate effects of thoracic spine self-mobilization in patients with mechanical neck pain: A randomized controlled trial

ObjectivesTo investigate the immediate effects of thoracic spine self-mobilization in patients with mechanical neck pain. Study designRandomized, controlled trial. BackgroundThoracic spine self-mobilization is performed after thoracic spine thrust manipulation to augment and maintain its effects. To the best of our knowledge, no study has investigated the effects of thoracic spine self-mobilization alone in individuals with mechanical neck pain. The purpose of this randomized, controlled trial was to evaluate the immediate effects of thoracic spine self-mobilization alone without any other intervention on disability, pain, and cervical range of motion in patients with mechanical neck pain. MethodsFifty-two patients (39 females and 13 males) with mechanical neck pain were randomly allocated to either a thoracic spine self-mobilization group that was performing a thoracic spine active flexion and extension activity using two tennis balls fixed by athletic tape or a placebo thoracic spine self-mobilization group. Outcome measures were collected at pre-intervention and immediately after intervention, including the Neck Disability Index, visual analogue scale, and active cervical range of motion (ROM). The immediate effect of the intervention was analyzed using two-way repeated measures analysis of variance (ANOVA). If interactions were found, a simple main effect test was performed to compare the pre-post intra-group results. ResultsThe results of two-way repeated measures ANOVA indicated that the main effect of time was significant (p < 0.05) for all measurement outcomes. The main effect of group was not significant for all measurement outcomes (p > 0.05). The group × time interactions for cervical flexion active ROM (p = 0.005) and cervical extension active ROM (p = 0.036) were significant. The tests of simple main effect in cervical flexion active ROM (p < 0.0001) and cervical extension active ROM (p < 0.0001) showed a significant difference before and after intervention in the thoracic spine self-mobilization group. ConclusionPatients with mechanical neck pain who carried out thoracic spine self-mobilization showed increases in active cervical flexion and extension ROM.

Concurrent validity and interrater reliability of a new smartphone application to assess 3D active cervical range of motion in patients with neck pain

BackgroundThere is a lack of valid, reliable, and feasible instruments for measuring planar active cervical range of motion (aCROM) and associated 3D coupling motions in patients with neck pain. Smartphones have advanced sensors and appear to be suitable for these measurements. ObjectivesTo estimate the concurrent validity and interrater reliability of a new iPhone application for assessing planar aCROM and associated 3D coupling motions in patients with neck pain, using an electromagnetic tracking device as a reference test. DesignCross-sectional study. MethodsTwo samples of neck pain patients were recruited; 30 patients for the validity study and 26 patients for the reliability study. Validity was estimated using intraclass correlation coefficients (ICCs), and by calculating 95% limits of agreement (LoA). To estimate interrater reliability, ICCs were calculated. Cervical 3D coupling motions were analyzed by calculating the cross-correlation coefficients and ratio between the main motions and coupled motions for both instruments. ResultsICCs for concurrent validity and interrater reliability ranged from 0.90 to 0.99. The width of the 95% LoA ranged from about 5° for right lateral bending to 11° for total rotation.No significant differences were found between both devices for associated coupling motion analysis. ConclusionsThe iPhone application appears to be a useful discriminative tool for the measurement of planar aCROM and associated coupling motions in patients with neck pain. It fulfills the need for a valid, reliable, and feasible instrument in clinical practice and research. Therapists and researchers should consider measurement error when interpreting scores.

Reliability and Criterion Validity of the Smartphone Inclinometer Application to Quantify Cervical Spine Mobility.

In this observational study, we compare fluid inclinometer and smartphone measures to analyze active cervical range of motion (ACROM) in healthy individuals. The purpose of this study was to investigate the reliability and the criterion validity of a smartphone application to analyze head movements. Recent studies on the reliability and the validity of customized smartphone applications to measure ACROM show good results for frontal and lateral planes' movement analysis, but poor results for the transverse plane. This can be due to the surrounding magnetic fields that affect the compass application used during head rotation valuation. Twenty-three individuals were asked to perform neck maximal (end-range) movements (frontal flex-extension and left-right side flexion in the sitting position, left-right rotation in the prone position). Two separate examiners took all ACROM measures and were assigned to each device (iPhone 5c and the inclinometer) contemporary for each individual. All measurements were taken twice to assess the intraobserver reliability. Interobserver and intraobserver reliabilities were evaluated using the intraclass correlation coefficient (ICC). The criterion validity between the 2 instruments was also assessed in terms of the ICC. The procedures used in this investigation for measuring ACROM yielded good validity (Pearson r≥0.99 and ICC≥0.99) between the 2 instruments for all movements. The Bland and Altman's 95% LoA ranged from -1.8 to 1.15 degrees. Percentage error values ranged from 1% to 3%. The intrarater and the interrater reliabilities were good (ICC≥0.9) for both instruments in all movements including the rotation movements (ICC>0.95). The minimal detectable change (MDC95) ranged from 4 to 8 degrees. This study confirms that the tested smartphone is valid and reliable to measure ACROM on the frontal and the sagittal planes; furthermore, it also demonstrates its usefulness for rotation movement analysis, using the inclinometric application.

The influence of cervical movement on eye stabilization reflexes: a randomized trial

To investigate the influence of the amount of cervical movement on the cervico-ocular reflex (COR) and vestibulo-ocular reflex (VOR) in healthy individuals. Eye stabilization reflexes, especially the COR, are changed in neck pain patients. In healthy humans, the strength of the VOR and the COR are inversely related. In a cross-over trial the amplitude of the COR and VOR (measured with a rotational chair with eye tracking device) and the active cervical range of motion (CROM) was measured in 20 healthy participants (mean age 24.7). The parameters were tested before and after two different interventions (hyperkinesia: 20 min of extensive active neck movement; and hypokinesia: 60 min of wearing a stiff neck collar). In an additional replication experiment the effect of prolonged (120 min) hypokinesia on the eye reflexes were tested in 11 individuals. The COR did not change after 60 min of hypokinesia, but did increase after prolonged hypokinesia (median change 0.220; IQR 0.168, p = 0.017). The VOR increased after 60 min of hypokinesia (median change 0.155, IQR 0.26, p = 0.003), but this increase was gone after 120 min of hypokinesia. Both reflexes were unaffected by cervical hyperkinesia. Diminished neck movements influences both the COR and VOR, although on a different time scale. However, increased neck movements do not affect the reflexes. These findings suggest that diminished neck movements could cause the increased COR in patients with neck complaints.

Reliability and validity of a Coda Motion 3-D Analysis system for measuring cervical range of motion in healthy subjects

In the past two decades, many tools have been reported to measure the cervical range of motion (CROM), but most of the results are controversial in healthy individuals and/or individuals with neck pain. The Coda Motion 3-D Analysis system is a new instrument that measures three-dimensional joint movement. However, measurements of CROM using this system have yet to be conducted. Here, we investigate the reliability and validity of the Coda Motion 3-D Analysis System for measuring CROM in healthy adults.Sixty healthy volunteers were involved in this reliability study. Two trained investigators (M1 and M2) used the Coda Motion 3-D Analysis System to measure CROM. M1 and M2 measured all the volunteers once independently; after a short rest, M1 then measured all of them again. The intraclass correlation coefficient (ICC), standard error of the measurements (SEM), smallest detectable difference (SDD), a scatter diagram, and the limits of agreement (LoAs) were applied to evaluate the inter-tester and intra-tester reliability. Thirty healthy volunteers were involved in this validity study. The cervical flexion and extension ranges of motion were measured simultaneously with both the Coda Motion 3-D Analysis System and X-ray. A scatter diagram, the Pearson correlation coefficient and LoAs were used to evaluate the validity.Excellent intra-tester and inter-tester reliabilities were observed for the Coda Motion 3-D Analysis System (intra-tester ICC: 0.84–0.95, inter-tester ICC: 0.84–0.90). Good validity was achieved in extension and flexion with Pearson correlation coefficients ranging from 0.78 to 0.91.The Coda Motion 3-D Analysis System has excellent reliability for the measurement of CROM and good validity for measurements of flexion and extension in healthy subjects. This system has the potential to be used to measure the normal active CROM in the clinic and is accurate, safe, non-invasive, and radiation free.

Physical characteristics associated with neck pain and injury in rugby union players.

Neck pain and injury are common in rugby union. Physical characteristics predisposing players to neck injury are largely unknown. This study aimed to determine physical characteristics associated with neck pain and injury in rugby union players. Semi-professional rugby union players (N.=142) underwent pre-season measurements including cervical active range of motion (AROM), strength, sensorimotor proprioception (joint position error), and anthropometry. A structured interview established previous neck injury history, current symptoms, playing position, competition level, age, and years playing rugby. Team physiotherapists and player telephone interviews identified players sustaining a neck injury during the competitive season (defined as any reported neck pain or neck injury). T-tests or Mann-Whitney U tests determined differences between neck injured and non-injured players. Logistic regression determined factors associated with neck injury history and incidence. Sixty-five (46%) players reported a previous neck injury; 11 (8%) sustained a neck injury during the competitive season. Player age (OR 1.14, 95% CI 1.03-1.25, P=0.009) was associated with neck injury history. Pre-season lateral flexion AROM was less in players sustaining a neck injury or reporting neck pain during the season (median left 23.6°, IQR 21.8-26.2°; right 27.9°, 23.6-32.5°) than in other players (left 34.8°, 28.8-41.0°, P<0.01; right 39.1°, 28.9-48.1°, P=0.03). Lateral flexion AROM was associated with increased risk of neck pain or injury (OR 0.82, 95%CI 0.71-0.94, P=0.005). Decreased cervical lateral flexion AROM may contribute to neck injury risk in rugby union players. However, few physical characteristics predicted neck injury incidence, suggesting additional factors should be explored to determine injury risk.

Neck-Related Physical Function, Self-Efficacy, and Coping Strategies in Patients With Cervical Radiculopathy: A Randomized Clinical Trial of Postoperative Physiotherapy

ObjectiveThe purpose of this study was to compare postoperative rehabilitation with structured physiotherapy to the standard approach in patients with cervical radiculopathy (CR) in a prospective randomized study at 6 months follow-up based on measures of neck-related physical function, self-efficacy, and coping strategies. MethodsPatients with persistent CR and scheduled for surgery (N = 202) were randomly assigned to structured postoperative physiotherapy or a standard postoperative approach. Structured postoperative physiotherapy combined neck-specific exercises with a behavioral approach. Baseline, 3-month, and 6-month evaluations included questionnaires and clinical examinations. Neck muscle endurance, active cervical range of motion, self-efficacy, pain catastrophizing (CSQ-CAT), perceived control over pain, and ability to decrease pain were analyzed for between-group differences using complete case and per-protocol approaches. ResultsNo between-group difference was reported at the 6-month follow-up (P = .05-.99), but all outcomes had improved from baseline (P < .001). Patients undergoing structured postoperative physiotherapy with ≥50% attendance at treatment sessions had larger improvements in CSQ-CAT (P = .04) during the rehabilitation period from 3 to 6 months after surgery compared with the patients who received standard postoperative approach. ConclusionsNo between-group difference was found at 6 months after surgery based on measures of neck-related physical function, self-efficacy, and coping strategies. However, the results confirm that neck-specific exercises are tolerated by patients with CR after surgery and may suggest a benefit from combining surgery with structured postoperative physiotherapy for patients with CR.

Group-based exercise at workplace: short-term effects of neck and shoulder resistance training in video display unit workers with work-related chronic neck pain-a pilot randomized trial.

Effectiveness of exercise therapy in video display unit (VDU) workers with work-related chronic neck pain (W-RCNP) is unclear. The aim of the study was to assess the efficacy of group-based neck-shoulder resistance exercises on symptoms and muscular function in VDU workers with W-RCNP. Thirty-five employees with CNP were randomly assigned to neck-shoulder resistance exercise (NSRE) group or to conventional stretching and postural exercise (SPE) group. Participants trained 45min, twice a week for 7weeks. Primary outcomes were pain intensity (0-10 numeric rating scale, NRS) and pain-related disability (Vernon Neck Disability Index, NDI). Secondary outcomes were cervical active range of motion (AROM), endurance of neck flexors, strength of shoulder abductors, and health-related quality of life (SF-36). Post-treatment, pain and disability decreased 2.5 and 5 points in NSRE (p=0.001) and 5 and 8 points in SPE (p=0.002), with no significant differences between groups. AROM improved significantly in both groups; between-group differences were not significant. Neck flexors endurance and shoulder abductors strength improved by 59.6 and 34.2% (p=0.001) in the NSRE group and by 27.6% (p=0.009) and 2.3% (p=0.002) in the SPE group; between-group differences were significant (p=0.016 and p<0.001, respectively). SF-36 score remained unchanged. NSRE and SPE are feasible and equally effective in reducing pain and pain-related disability as group exercises in W-RCNP. NSRE may provide some advantage in improving strength and endurance in neck muscles. Further, larger studies should confirm these findings and assess whether a better muscle function confers long-term clinical advantages.

The Effectiveness of Manual Therapy Versus Surgery on Self-reported Function, Cervical Range of Motion, and Pinch Grip Force in Carpal Tunnel Syndrome: A Randomized Clinical Trial.

Study Design Randomized parallel-group trial. Background Carpal tunnel syndrome (CTS) is a common pain condition that can be managed surgically or conservatively. Objective To compare the effectiveness of manual therapy versus surgery for improving self-reported function, cervical range of motion, and pinch-tip grip force in women with CTS. Methods In this randomized clinical trial, 100 women with CTS were randomly allocated to either a manual therapy (n = 50) or a surgery (n = 50) group. The primary outcome was self-rated hand function, assessed with the Boston Carpal Tunnel Questionnaire. Secondary outcomes included active cervical range of motion, pinch-tip grip force, and the symptom severity subscale of the Boston Carpal Tunnel Questionnaire. Patients were assessed at baseline and 1, 3, 6, and 12 months after the last treatment by an assessor unaware of group assignment. Analysis was by intention to treat, with mixed analyses of covariance adjusted for baseline scores. Results At 12 months, 94 women completed the follow-up. Analyses showed statistically significant differences in favor of manual therapy at 1 month for self-reported function (mean change, -0.8; 95% confidence interval [CI]: -1.1, -0.5) and pinch-tip grip force on the symptomatic side (thumb-index finger: mean change, 2.0; 95% CI: 1.1, 2.9 and thumb-little finger: mean change, 1.0; 95% CI: 0.5, 1.5). Improvements in self-reported function and pinch grip force were similar between the groups at 3, 6, and 12 months. Both groups reported improvements in symptom severity that were not significantly different at all follow-up periods. No significant changes were observed in pinch-tip grip force on the less symptomatic side and in cervical range of motion in either group. Conclusion Manual therapy and surgery had similar effectiveness for improving self-reported function, symptom severity, and pinch-tip grip force on the symptomatic hand in women with CTS. Neither manual therapy nor surgery resulted in changes in cervical range of motion. Level of Evidence Therapy, level 1b. Prospectively registered September 3, 2014 at www.clinicaltrials.gov (NCT02233660). J Orthop Sports Phys Ther 2017;47(3):151-161. Epub 3 Feb 2017. doi:10.2519/jospt.2017.7090.

Direction-Specific Impairments in Cervical Range of Motion in Women with Chronic Neck Pain: Influence of Head Posture and Gravitationally Induced Torque.

BackgroundCervical range of motion (ROM) is commonly assessed in clinical practice and research. In a previous study we decomposed active cervical sagittal ROM into contributions from lower and upper levels of the cervical spine and found level- and direction-specific impairments in women with chronic non-specific neck pain. The present study aimed to validate these results and investigate if the specific impairments can be explained by the neutral posture (defining zero flexion/extension) or a movement strategy to avoid large gravitationally induced torques on the cervical spine.MethodsKinematics of the head and thorax was assessed in sitting during maximal sagittal cervical flexion/extension (high torque condition) and maximal protraction (low torque condition) in 120 women with chronic non-specific neck pain and 40 controls. We derived the lower and upper cervical angles, and the head centre of mass (HCM), from a 3-segment kinematic model. Neutral head posture was assessed using a standardized procedure.FindingsPrevious findings of level- and direction-specific impairments in neck pain were confirmed. Neutral head posture was equal between groups and did not explain the direction-specific impairments. The relative magnitude of group difference in HCM migration did not differ between high and low torques conditions, lending no support for our hypothesis that impairments in sagittal ROM are due to torque avoidance behaviour.InterpretationThe direction- and level-specific impairments in cervical sagittal ROM can be generalised to the population of women with non-specific neck pain. Further research is necessary to clarify if torque avoidance behaviour can explain the impairments.

Effect of maitland mobilization in cervical and thoracic spine and therapeutic exercise on functional impairment in individuals with chronic neck pain.

[Purpose] This study evaluated joint mobilization and therapeutic exercise applied to the cervical spine and upper thoracic spine for functional impairment caused by chronic neck pain. [Subjects and Methods] Eighteen study subjects were randomly assigned to two groups of nine people each. Therapeutic exercise only was applied to the cervical and upper thoracic spine for Group I, while both therapeutic exercise and joint mobilization were applied to Group II. The visual analog scale, neck disability index, active cervical range of motion, static balance capacity, and muscle tone were assessed with a pre-test. The intervention was carried out for 60 minutes a day, three times a week, for two weeks for each group, followed by a post-test using the same protocol as the pre-test. [Results] The visual analog scale, neck disability index, and active cervical range of motion improved significantly in both groups. Group II improved significantly more on right lateral flexion and rightward rotation. Muscle tone improved significantly in the upper trapezius in both groups. [Conclusion] The joint mobilization and therapeutic exercise for functional impairments caused by chronic neck pain had a significant effect on several types of functional impairment.

Normal cervical spine range of motion using digital inclinometer in male asymptomatic subjects of Aseer, Saudi Arabia

Background: Various studies determined the normal cervical spine range of motion (ROM) of a large group of patients with diverse socioeconomic and ethnic background and varying degree of routine daily activities. The purpose of this investigation was to quantify normal cervical ROM in male asymptomatic subjects of Aseer Region, Saudi Arabia. Methodology: Two hundred and thirty-three asymptomatic subjects with age group of 10-80 years participated in the study. Digital goniometer was used to measure the ROM of the cervical spine. This tool was employed in a clinical setting to evaluate the full active ROM (AROM) of the cervical spine (i.e., flexion/extension, lateral bending, and axial rotation). All the subjects were divided into seven groups in terms of age (10-19, 20-29, 30-39, 40-49, 50-59, 60-69, and 70-80 years) and the cervical ROM was determined. Six cervical movements (i.e., flexion/extension, lateral bending, and axial rotation) of five groups were analyzed and each of the six cervical AROMs decreased significantly with age. Results: All the cervical ranges decreased as the age increased. The maximum cervical range was recorded in cervical rotation left (71.81 ± 8.75°), followed by rotation right (70.58 ± 5.83°), extension (68.42 ± 10.30°), flexion (66.96 ± 8.62°), left side bending (54.62 ± 7.13°), and right side bending (52.69 ± 7.32°). Conclusion: Normal database of normal cervical ROM from age group of 10-80 years was established in male asymptomatic population of Aseer Region, Saudi Arabia.