Cervical Flexor Endurance Research Articles

The effects of conventional treatment in addition to Pilates on biopsychosocial status in chronic neck pain: A randomized clinical trial.

Although guidelines and systematic reviews recommend the use of exercise in the treatment of chronic pain and neck pain, there are no clear recommendations for conservative treatments frequently used in clinics. The effect of supporting clinical Pilates exercises with passive physiotherapy methods on biopsychosocial status is still unknown. The objective was to investigate the effects of conventional treatment (CT) in addition to clinical Pilates on pain levels, physical condition, functional status, and psychosocial status in individuals with chronic neck pain. Fifty women were randomly divided into 2groups, the clinical Pilates group (Pilates, n= 25), and the group receiving CT in addition to clinical Pilates (Pilates-CT, n= 25). Both groups received treatment 3days a week for 6weeks. The CT program involved the implementation of hot pack (HP) application, Transcutaneous Electrical Nerve Stimulation (TENS), and therapeutic ultrasound (US) to the cervical area. CT in addition to Pilates was more effective in reducing the Visual Analog Scale (at rest and during activity), Neck Disability Index, Fear-Avoidance Beliefs Questionnaire, NeckPix Scale, Hospital Anxiety and Depression Scale-depression, and Cognitive Exercise Therapy Approach-Biopsychosocial questionnaire scores (p< 0.05) and in increasing the degree of change in the extension range of motion (ROM) and cervical flexor endurance values and scores in the energy parameter of Short Form-36 (p< 0.05). CT provided in addition to Pilates was more effective in reducing pain levels, disability, fear of movement, depression levels, and negative biopsychosocial status and improving extension ROM and cervical flexor endurance, neck awareness, and the energy/vitality parameter of quality of life in individuals with chronic neck pain.

Influence of short bouts of stair climbing on young adults during prolonged sitting on posture, discomfort, and musculoskeletal performance outcomes: a counterbalanced pilot randomised crossover trial

Prolonged sitting is postulated to influence musculoskeletal performance (cervical flexor endurance, balance, and agility), discomfort and alter cervical spine angles during work-based computer use. Stair climbing breaks may be a great addition at typical and home offices however remain unexplored for its impact on musculoskeletal performance. In our counterbalanced pilot crossover trial, 24 adults were randomised to three interventions: (1) prolonged sitting, (2) interrupted by 2 min of self-paced, and (3) externally paced stair climbing for 2 h. Cervical spine angles were measured every 30 min while balance, agility, endurance, and discomfort were assessed before and after 120 min. Stair climbing interruptions have favourable effects on agility (F = 8.12, p = 0.009, ηp 2 = 0.26) and musculoskeletal discomfort, but failed to improve other musculoskeletal outcomes associated with prolonged sitting. Brief stair climbing interruptions are effective in improving discomfort and agility while pragmatic trials are warranted for translated effects.

Characteristics of head and neck alignment and function of deep cervical flexor muscles in patients with nonspecific neck pain

ObjectivesThe objectives were to compare forward head posture (FHP) in natural and corrected head postures between patients with nonspecific neck pain (NSNP) and controls and to clarify the relationship between natural and corrected head posture angle differences and deep cervical flexor function. This study aimed to provide useful evidence for postural assessment and treatment in patients with NSNP. MethodsIn this cross-sectional study, 19 patients with NSNP reporting a pain score of 3–7 for at least 3 months and 19 participants with no neck pain within the previous 12 months were recruited. To evaluate FHP, the cranial rotation and vertical angles were measured using lateral head and neck photographs. The craniocervical flexion test was used to evaluate deep cervical flexor activation and endurance. We evaluated the head and neck alignment in natural and corrected head postures and the relationship between the degree of change and deep cervical flexor function. ResultsFHP in the natural head posture did not differ between groups. In the corrected head posture, FHP was significantly smaller in the NSNP group than in the control group. In the NSNP group, the cranial rotation and vertical angles were significantly different between the natural and corrected head postures, and the angle difference correlated significantly with deep cervical flexor function. ConclusionsPatients with NSNP show hypercorrection in the corrected head posture, which may be correlated with deep cervical flexor dysfunction. Further investigation into the causal relationship between hypercorrection, deep neck flexor dysfunction, and neck pain is required.

The Effect of Exercise-Induced Central Fatigue on Cervical Spine Joint Position Error, Strength, and Endurance.

Fatigue is common in sports, impairing performance and increasing injury risk, yet little is known regarding fatigue and concussion. Impaired neck neuromuscular function may contribute to concussion at baseline, where central fatigue may further impair neck function resulting in increased concussion risk. These effects may be magnified in athletes with a history of concussion. To determine the effect of exercise induced central fatigue on neck joint position error, strength, and endurance in healthy subjects and those with a history of concussion. The investigators hypothesized that EICF would have a negative effect on all variables. Healthy subjects were examined using a single factor, within-subjects repeated measures design. Concussion history subjects were examined using a single-subject design. Nineteen healthy subjects and five subjects with a history of concussion were recruited for the study. Cervical joint position error, muscle strength, and neck flexor endurance were tested before and after exercise induced fatigue. There was a significant increase in constant (p = 0.0027) and absolute joint position error (JPE) (p < 0.001); decrease in neck flexor endurance (p < 0.001); and decrease neck strength into cervical flexion (p = 0.01) in healthy subjects following fatigue. Among concussion history subjects, five demonstrated a significant increase in absolute and constant JPE (p < 0.05); four demonstrated a significant decrease in neck flexor endurance (p < 0.05); one in neck flexion muscle strength (p < 0.05); and three in neck extension and rotation muscle strength (p < 0.05) following fatigue. Cervical neuromuscular function deteriorated following fatigue in healthy subjects. Resulting impairments may affect force alterations in cervical control, potentially increasing concussion risk. Concussion history subjects descriptively demonstrated similar results, however further research should examine formal comparisons involving subjects with and without concussion history. 3b.

Preseason Measures of Cervical Spine Function, Vestibulo-Ocular Reflex, Dynamic Balance, and Divided Attention in Youth Ice Hockey Players.

OBJECTIVES: Report typical scores and examine preseason cervical spine, vestibulo-ocular reflex, dynamic balance, and divided attention measures in competitive youth ice hockey players aged 10 to 18 years with and without a previous concussion history. DESIGN: Cross-sectional secondary analysis. METHODS: The exposure of interest was self-reported history of concussion. The main outcomes were cervical spine measures (Cervical Flexor Endurance [CFE; seconds], Cervical Flexion-Rotation Test [normal/abnormal], Anterolateral Cervical Spine Strength [kilograms], Head Perturbation Test (/8), and Joint Position Error [JPE; centimeters]), vestibulo-ocular reflex (Dynamic Visual Acuity [logMAR], Head Thrust Test [Positive/Negative]), dynamic balance (Functional Gait Assessment [/30]) and divided attention (Walking While Talking Test [seconds]). Multivariable linear or logistic regression, adjusted for age-group, sex, level of play, and clustered by team, were used to assess potential differences by concussion history. RESULTS: We included data from 2311 participants in this study (87.2% male, 12.8% female, 39.0% reported a previous concussion). No differences by concussion history were found across any of the measures (P values range: 0.17-0.99). Measures of cervical spine function and divided attention differed by age group (eg, Median Left Anterolateral Cervical Spine Strength [kilograms] for males: U13 = 7.46, U15 = 9.10, U18 = 9.67). CONCLUSION: Clinical outcomes scores in youth ice hockey players did not differ by concussion history. Performance on cervical spine strength, CFE, and JPE test outcomes may improve with age, highlighting the importance of developmental considerations when interpreting test scores. J Orthop Sports Phys Ther 2024;54(3):1-11. Epub 30 November 2023. doi:10.2519/jospt.2023.11958.

The Magnitude of Physical and Sensory Impairments in Post-traumatic and Non-traumatic Cervicogenic Headaches: A Comparative Study.

Background Cervicogenic headaches can significantly deteriorate the quality of life of patients and decrease their productivity. Few studies have been conducted to assess the magnitude of physical impairments among patients with non-traumatic and post-traumatic cervicogenic headaches. Therefore, this study was conducted to examine and compare the magnitude of cervical physical impairments among patients with post-traumatic cervicogenic headaches in contrast to patients with non-traumatic cervicogenic headaches, migraine, and a group of sex- and age-matched controls who did not have headaches. Methodology This was a comparative study. A total of 104 patients and 30 sex- and age-matched controls were included. The patients were stratified into three groups: post-traumatic cervicogenic headaches (n = 42), non-traumatic cervicogenic headaches (n = 30), and migraines (n = 32). The cervical active range of motion and proprioception were assessed using a goniometer, the craniovertebral angle was measured while the heads of the subjects rested in a comfortable position, the strength of the cervical flexors and extensors was assessed using a hand-held dynamometer, and endurance of the short cervical flexors was assessed while the subjects were in a supine position with no pillow. Skin roll tests were performed in the trapezius and mandibular areas, and pain was measured using the McGill Pain Questionnaire-Short Form. Results Patients in the post-traumatic cervicogenic headache group reported a significantly higher number of headache days (p < 0.001) compared to the controls, patients with migraines, and those with non-traumatic cervicogenic headaches. Patients with post-traumatic cervicogenic headaches showed a significant reduction in total rotation, flexion and extension, lateral bending, and craniovertebral angle compared to the controls, patients with migraines, and those with non-traumatic cervicogenic headaches. On the other hand, the controls endured significantly longer and had stronger neck flexors and extensors compared to the patients in the migraine, non-traumatic, and post-traumatic cervicogenic headache groups, respectively. Patients with post-traumatic cervicogenic headaches significantly reported higher affective and total pain compared to the controls and patients in the migraine group. Conclusions Patients with post-traumatic cervicogenic headaches had significant deficits in the cervical active range of motion in the different planes, endurance, and strength of cervical flexors and extensors compared to the controls and patients with migraine and non-traumatic cervicogenic headaches. Similarly, patients with post-traumatic cervicogenic headaches reported higher affective pain compared to the controls and patients with migraines. The results of this study indicated that patients with post-traumatic cervicogenic headaches have significantly higher physical impairments compared to patients with non-traumatic cervicogenic headaches. These differences warrant caution when combining data from patients with non-traumatic and post-traumatic cervicogenic headaches.

Cervical proprioception in Parkinson's disease and its correlation with manual dexterity function.

Cervical proprioception has a crucial role in posture and movement control. The study aimed to determine the relationship of cervical proprioception, cervical muscle strength and endurance with manual dexterity and hand strength in individuals with idiopathic Parkinson's disease (PD). Twenty individuals with PD (mean age:63.9 years) and 20 healthy individuals as a control group (mean age: 61.9 years) were recruited. Cervical joint position error (JPE), static endurance of neck muscles, activation of deep cervical flexor muscles (Craniocervical Flexion Test-CCFT), manual dexterity using Purdue Pegboard Test (PPT), cognitive and motor task on PPT, finger tapping test (FTT) and pinch-grip strength were assessed. Cervical JPE was significantly higher in individuals with PD than controls (p<0.05). The strength and endurance of the cervical muscles were significantly decreased in individuals with PD (p<0.05). There was a significant negative correlation of cervical JPE measurements with PPT, cognitive and motor tasks on PPT in the PD group (p<0.05). There was a significant negative correlation of the endurance of cervical flexor muscles with PPT and cognitive task on PPT (p<0.05). In addition, a significant positive correlation was found between cervical flexor endurance and hand strength in the PD group (p<0.05). Cervical proprioception and the strength and endurance of cervical muscles decrease in individuals with PD compared to healthy individuals. Impairment of cervical proprioception appears to be associated with poorer upper extremity performance. Detailed evaluation of the cervical region in PD may be useful in determining the factors affecting upper extremity function.

Balance alterations are associated with neck pain and neck muscle endurance in migraine

BackgroundMigraine patients may present with both cervical and balance dysfunctions. The neck plays an important role in balance by providing substantial proprioceptive input, which is integrated in the central nervous system and influences the balance control systems. Whether balance and neck dysfunctions are associated in patients with migraine is still to be explored. ObjectivesThis study aimed to assess the association between the sensory organization test of balance with neck pain features, cervical strength, endurance, and range of motion in patients with migraine. MethodsSixty-five patients with migraine underwent the sensory organization test assessed with the Equitest-Neurocom® device. Maximum voluntary isometric contraction, cervical flexion and extension range of motion, and cervical flexor and extensor endurance were assessed. In addition, the features of migraine and neck pain were collected. Patients were dichotomized according to cut-off scores of balance performance and the association between outcomes were explored. ResultsPatients with reduced balance performance presented a higher frequency of migraine (p = 0.035), a higher frequency of aura (p = 0.002), greater neck pain intensity (p = 0.013), and decreased endurance of cervical flexors (p = 0.010) and extensors (p < 0.0001). The total balance score was correlated with age (r = −0.33; p = 0.007), migraine frequency (r = −0.29; p = 0.021), neck pain intensity (r = −0.26; p = 0.038), and endurance of the cervical flexors (r = 0.39; p = 0.001) and extensors (r = 0.36; p = 0.001). Migraine frequency, neck pain intensity, and endurance of the cervical flexors can predict 21% of the sensory organization test variability. ConclusionNeck pain features and endurance of the cervical muscles are related to reduced balance performance in patients with migraine. These results shed light to a better understanding of balance alterations in migraine patients.

Relationship between cutaneous allodynia, cervical muscle strength and endurance in women with migraine

IntroductionMigraine is a primary headache disorder with generalized neuronal hyperexcitability. Migraine individuals have a high prevalence of cutaneous allodynia, neck pain, and reduced cervical isometric strength. Lower isometric strength is also known to correlate with greater severity of cutaneous allodynia. However, the correlation between cervical muscle endurance and cutaneous allodynia is not yet known. ObjectiveTo evaluate the correlation between cervical muscle strength and endurance with cutaneous allodynia in migraine women. MethodsSeventy migraine women were recruited by local community advertisements. Were included women aged between 18 and 55 years and migraine diagnosis. An experienced neurologist diagnosed potential participants with migraine according to the third edition of the International Classification of Headache Disorders (ICHD-3). Participants were excluded if they underwent an anesthetic nerve block; presented with any other concomitant headache, such as cervicogenic or tension-type headache, degenerative cervical conditions, or history of trauma at the neck and face, or pregnancy.The Multi Cervical Rehabilitation Unit (MCU) was used to assess cervical isometric muscle strength and cervical muscle endurance. The assessment of cervical isometric strength was obtained through three repetitions of the movement in flexion, extension, and lateral flexion. The endurance of cervical flexors and extensors muscles was obtained using 50% of the maximum voluntary isometric contraction. The MCU is a device with excellent reliability (ICC 0.92–0.99) for assessing cervical muscle strength and endurance.Cutaneous allodynia was evaluated using the Allodynia Symptom Checklist (ASC-12), a reliable, quick, and simple tool with excellent psychometric properties, compound of 12 questions that allows to classify the severity of cutaneous allodynia. The questionnaire was validated for the Portuguese language and it is able to diagnose and classify allodynia in the Brazilian population, in order to facilitate the identification of symptoms in a reliable and fast manner (ASC-12). (To see the complet abstract, please, check out the PDF.)

Evaluation of Cervical Endurance by Craniocervical Flexion Test in Patients with Subacromial Impingement Syndrome: A Preliminary Study

Aim: The aim of the study is to evaluate deep cervical flexor endurance in patients with subacromial impingement syndrome (SIS) and compare it with norm values proven in the literature in asymptomatic individuals. &#x0D; Materials and Methods: The patients’ age, weight, height, duration of complaints and dominant side information were recorded. 35 patients (25 female, 10 male) diagnosed with SIS by physicians participated in the study. Pain intensity was evaluated by numerical rating scale at rest, during elevation and at night. Craniocervical flexion test (CFT) is used for evaluating cervical endurance. “Stabilizer Pressure Biofeedback” device is used for this test. Two types of points are obtained as a result of this test. One is the CFT activation score, which expresses the activation level of the deep cervical muscles, and the other is the CFT performance index, which expresses the endurance of the deep cervical muscles. &#x0D; Results: Both the activation score (3.9±1.9) and the performance index (31.4±14.2) of CFT were significantly different in patients with SIS when compared with those of asymptomatic individuals.&#x0D; Conclusion: Cervical endurance is reduced in patients with SIS. Treatments including cervical stabilization should be planned in these patients.

Conventional Cervical Exercises Compared with a Mixed-Reality-Based Game in Asymptomatic Subjects: An Exploratory Crossover Pilot Study

Mixed reality presents itself as a potential technological tool for the management of people with musculoskeletal disorders, without having as many adverse side effects as immersive virtual reality. The objective of this study was to explore the possibilities of a mixed-reality game, performing task-oriented cervical exercises compared to conventional therapeutic exercises in sensorimotor outcome measures in asymptomatic subjects. A randomized crossover pilot study was performed with two intervention groups: a mixed-reality group (MRG) and a conventional exercise group (CEG). The cervical joint position error test (CJPET) and deep cervical flexor endurance test (DCFET) were measured as sensorimotor outcomes. Statistically significant differences were found in the pre–post comparison in the DCFET for both groups (MRG: t = −3.87, p &lt; 0.01; CEG: t = −4.01, p &lt; 0.01) and in the extension of the CJPET for the MRG (t = 3.50, p &lt; 0.01). The rest of the measurements showed no significant differences comparing both groups pre- and postintervention (p &gt; 0.05). Mixed reality has apparently the same positive effects as conventional exercises in sensorimotor outcomes in asymptomatic subjects. These results could help in future studies with mixed virtual reality in the management of people with musculoskeletal disorders.

Correlation between Deep Cervical Muscle Endurance, Cervical Proprioception, and Chronic Neck Pain: A Cross-Sectional Analysis Study

The main aim of the study was to investigate the relationship among deep cervical muscle endurance, cervical proprioception, and chronic neck pain (CNP). Subjects with CNP (n=47) aged 20 to 45 years were recruited to the study. Cervical joint position sense error (JPSE), deep cervical flexor and extensor endurance, pain intensity and neck pain associated disability were investigated by using common clinical tests. The correlations between measured variables were assessed by Spearman correlation coefficients. Only extension cervical JPSE component showed significant fair correlation with pain (σ = 0.30, p = 0.040) and disability (σ = 0.39, p = 0.006). Both the cervical flexor and extensor muscle endurance were found to have no relationship with both pain and disability. There was no association between deep cervical muscle endurance and the cervical JPSE. But a significant fair correlation was noted between the cervical flexor and extensor muscle endurance capacity (σ = 0.38, p = 0.008). Deep cervical muscle endurance and cervical proprioception were weakly associated with CNP. Chronic neck pain might not influence neck muscle endurance and cervical proprioception. Muscle endurance capacity and proprioceptive functioning also seem to be irrelevant to each other in people with CNP.

Myofascial Induction Therapy Improves the Sequelae of Medical Treatment in Head and Neck Cancer Survivors: A Single-Blind, Placebo-Controlled, Randomized Cross-Over Study.

Head and neck cancer (HNC) is the sixth most common cancer worldwide. Yet, less than 60% of HNC survivors receive adequate therapy for treatment-related sequelae. The objective of this study was to determine the efficacy of myofascial induction therapy (MIT) in improving cervical and shoulder pain and range of motion, maximal mouth opening, and cervical muscle function in HNC survivors. This crossover, blinded, placebo-controlled study involved 22 HNC survivors (average age 56.55 ± 12.71) of which 13 were males (59.1%) who received, in a crossover fashion, both a single 30-min session of MIT in the form of manual unwinding and simulated pulsed shortwave therapy (placebo), with a 4-week washout interval between the two. Cervical and shoulder pain (visual analogue scale) and range of motion (cervical range of motion device and goniometer), maximum mouth opening (digital caliper), and cervical muscle function (deep cervical flexor endurance test) were measured before and after the treatment and placebo sessions. A single session of MIT improved cervical and affected side shoulder pain, cervical range of motion, maximum mouth opening, and cervical muscle function. The associated effect sizes ranged from moderate to large. The present study suggests that MIT, in the form of manual unwinding, improves cervical (−3.91 ± 2.77) and affected-side shoulder (−3.64 ± 3.1) pain, cervical range of motion (flexion: 8.41 ± 8.26 deg; extension: 12.23 ± 6.55; affected-side rotation: 14.27 ± 11.05; unaffected-side rotation: 11.73 ± 8.65; affected-side lateroflexion: 7.95 ± 5.1; unaffected-side lateroflexion: 9.55 ± 6.6), maximum mouth opening (3.36 ± 3.4 mm), and cervical muscle function (8.09 ± 6.96 s) in HNC survivors.

Cervical Spine and CranioVertebral region function in Elite Short Track Speed Skating Athletes

<h3>Research Objectives</h3> Previous work has suggested that neck strength and control can be a protective factor against sustaining concussions during high impacts. The objective of this study was to characterize cervical spine and craniovertebral function in elite STSS and evaluate differences by athlete biological sex and skill level. <h3>Design</h3> Cross-sectional study. <h3>Setting</h3> National and Regional High Performance Athletic Training Facilities. <h3>Participants</h3> Members of the Canadian Senior National STSS team (n=25; 48% male) as well members of the Eastern Regional STSS Development Team (n=16; 56% male) were assessed as part of their pre-season baseline physical examination. <h3>Interventions</h3> N/A. <h3>Main Outcome Measures</h3> Clinical evaluations for neck pain, cervical spine range of motion (ROM) for flexion, extension, rotation, and sideflexion; cervical strength/control and endurance for flexion, extension, and sideflexion; neck postural reactions; manual spine examination/palpation as well as craniovertebral mobility. <h3>Results</h3> Athletes presented with full ROM on clinical observation for all six cervical spine movements (median %ROM = 100). Median time for cervical flexor endurance was 46 seconds (range: 16-134s) but fibrillations were observed in 56% of participants. Extensor endurance reached the pre-determined maximum time of 180 seconds for all but 2 athletes. Performance on the craniocervical flexion test revealed a mean performance index of 65.1 (95%CI 54,5-75,7). The manual spinal exam was within normal limits for mobility, but pain was elicited in some athletes (26% right; 12% left). No differences were found between senior and junior level athletes or between males and females, except for cervical sideflexion endurance where females had significantly lower performance than males (p < 0.001). <h3>Conclusions</h3> Cervical spine and craniovertebral function did not differ by skill level in elite short track speed skaters but greater superficial muscle activation and lower than expected endurance of deep cervical flexors was identified in athletes of all levels and of both sexes. Since control of deep flexors is important for neck stability, it could be the target of specific intervention in elite short track speed skaters. <h3>Author(s) Disclosures</h3> None.

Lumbar motor control training as a complementary treatment for chronic neck pain: A randomized controlled trial

Objective: We investigated whether adding lumbar motor control training with a pressure biofeedback unit improves outcomes of a conservative deep cervical flexor motor control program on neck pain, neck disability, deep cervical flexor endurance, and health status in middle-aged patients with chronic neck pain and forward head posture after eight weeks of interventions. Design: Randomized controlled trial. Setting: Outpatient setting. Subjects and interventions: A total of 113 males and females (mean age 39 ± 5 years) with chronic neck pain were randomized to three treatment groups, group 1 (n = 38) combined deep cervical flexor motor-control training and lumbar motor control exercise, group 2 (n = 37) deep cervical flexor motor control training alone, and group 3 (n = 38) passive treatment and education. Main outcome measures: Pain, neck disability, deep cervical flexor muscular endurance, and health status. Results: There were significant improvements in the combination group compared with the deep cervical flexor motor-control group alone (d = 2.03, 95% confidence interval (CI): −2.8 to −1.27, P = 0.021) for pain (d = −0.99, 95% CI = −1.75 to −0.23, P = 0.023), disability (d = 1.92, 95% CI = 0.86 to 2.98, P = 0.001), deep cervical flexor endurance, and (d = −2.75, 95% CI = −8.81 to −1.68, P = 0.037) for health status favoring the combination group. There were significant between-group differences favoring both active groups versus the passive control in all out comes. Conclusion: The addition of Lumbar motor control training as a complementary treatment may enhance effectiveness of deep cervical flexor motor control training on neck pain, neck disability, and deep cervical flexor endurance in patients with chronic moderate neck pain and forward head posture.

The benefits of manual therapy and active cervical exercises in pacients with cerviogenic headache

Abstract Introduction: Cervicogenic headache stems from a dysfunctional mechanism that frequently affects the upper region of the cervical spine, often involving multiple tissues connected with the occipital, submandibular, and orofacial region. Objectives: The main objective of this study is to demonstrate the therapeutic effectiveness of a personalized program of manual therapy and specific exercises in patients with cervicogenic headaches. Material and Methods: The study included 44 patients. Specific functional tests of the cranio-cervical-mandibular complex, namely the evaluation of the cranio-cervical-mandibular complex (according to Rocabado), cervical flexion-rotation test, cervical flexor endurance test, cervical extensors endurance test, and palpation of trigger points and cervical spine dynamics, were employed. Results: The analysis of demographic data shows a significantly increased prevalence of headache among women. The symptomatology that almost always accompanies episodes of cervicogenic headache is localized neck pain. The intensity and frequency of the symptoms are strongly associated with alterations in the dynamics of the upper cervical spine and chronic sleep disorders. Conclusion: Cranio-cervical manual therapy has proven effective in patients with cervicogenic headaches. The implementation of a strategy based on manual therapy and active exercise had a superior statistical and clinical result compared to the exclusively manual therapeutic approach.

The effect of high-intensity physical exertion on measures of cervical spine, vestibular/ocular-motor screening, and vestibulo-ocular reflex function in university level collision and combative sport athletes

ObjectivesTo examine how high-intensity physical exertion affects clinical measures of cervical spine (CSp), vestibular/ocular motor screen (VOMS), and vestibulo-ocular reflex (VOR) function. DesignCase series. SettingSports Medicine Centre. ParticipantsA total of 37 athletes consented to participate (22 rugby, 15 wrestling; 9 men, 28 women; median age = 19 years [range 17–23 years]). Main outcome measuresOutcome measures included tests of CSp (cervical flexor endurance, head perturbation test, cervical flexion rotation test and anterolateral strength), VOR (head thrust test and dynamic visual acuity [DVA]), and a quantified version of the VOMS. These metrics were assessed prior to and after completing the 30–15 Intermittent Fitness Test. Bland-Altman plots and Wilcoxon signed-rank tests were utilized to analyze the data using an alpha of p < 0.004. ResultsCervical anterolateral strength (kg) was reduced post-exertion on the left (z = 3.87; p < 0.001), but not on the right between conditions (z = −1.49; p = 0.14). Athletes reported increased dizziness (z = −3.55; p = 0.004) and had reduced DVA following exertion (z = −2.78; p < 0.001). All other metrics were not significantly different following exertion (p > 0.011). ConclusionReduced performance on DVA, decreased left-anterolateral strength, and increased dizziness occurred following high-intensity exertion in varsity collision and combative athletes, which has implications for sideline screening for sport-related concussion.

Short-Term Changes in Chronic Neck Pain After the Use of Elastic Adhesive Tape

ObjectivesThe aim of the study was to examine the short-term changes of elastic adhesive tape application on pain intensity and the range of motion (ROM), cervical region proprioception sense, and cervical flexor endurance of patients with chronic neck pain. MethodsThirty-four patients (male: 26, female: 8) between ages 20 and 55 with chronic neck pain having the complaints for at least 6 months were included in the study. Demographic information, pain intensity, cervical ROM, cervical flexor endurance, and cervical proprioception sense of the patients were evaluated. Results were examined 2 times. The first evaluation was conducted prior to elastic adhesive tape application and the second one was conducted 24 hours after the procedure. ResultsThe mean age of the patients was 39.56 ± 17.09 years, average height was 165.65 ± 9.83 cm, average weight was 71.44 ± 15.79 kg, and average body mass index was 26.24 ± 6.62. A statistically significant difference was found between the measurement results of pain intensity, ROM of the joint in flexion, extension, right and left rotation, and cervical flexor endurance before and 24 hours after the application of elastic adhesive tape (P < .05). When the proprioception sense was examined, there was a significant difference between the results before elastic adhesive tape application and 24 hours after the same application in deviation angles except for right rotation (P < .05). ConclusionThe results of this study revealed short-term changes following the use of elastic adhesive tape on cervical flexor endurance, pain, and cervical proprioception sense for patients with chronic pain.

Effectiveness of clinical Pilates and home exercises in sagittal cervical disorientation: randomized controlled study.

Aim:To compare effects of clinical Pilates and home exercises on postural disorders, strength and endurance of deep cervical flexors (DCF), cervical range of motion (CROM), pain intensity and functional disability in sagittal cervical disorientation. Patients & methods: Fourty sixpatients were included and divided intotwo groups. Clinical Pilates group performed stabilization based exercise and home exercise group performed conventional exercises. Results: Craniovertebral, head tilt, cervicothoracic angles andstrength and endurance of DCFmuscleshad improvement in favor of clinical Pilates group (p<0.05). There was no difference between groups in terms of right-left acromial distance, pain intensity, functional disability and CROM parameters (p>0.05). Conclusion: Clinical Pilates exercises have been found to provide clinically significant improvements in craniovertebral, head tilt, cervicothoracic angles and strength and endurance of DCF muscles. However, in the increase of CROM, decreasing pain severity and functional impairment parameters there was no superiority of both exercise training. Clinical trial registration number: NCT03352921(Clinicaltrials.gov).

Effect of Pressure biofeedback training on deep cervical flexors endurance in patients with mechanical neck pain: A randomized controlled trial.

Objective:To compare the effects of Cranio cervical flexion training with and without pressure biofeedback on deep cervical muscular endurance in patients with mechanical chronic neck pain.Methods:A randomized control trial was conducted at Railway General Hospital Rawalpindi, from May to December 2019. It consisted of thirty participants with the age ranging from 25 to 40 years, and having chronic mechanical neck pain. The participants were randomly allocated into two groups Group-A received Craniocervical flexion training with pressure biofeedback and Group-B received Craniocervical flexion training without pressure biofeedback. The intervention was applied for four weeks (3 sessions per week). Assessments were taken at Pre, Post intervention and after six weeks of follow up. Data analysis was done using SPSS-21 version.Results:The mean age of Group-A and Group-B was 29.40±3.08 and 31.33±4.95 respectively. Between-group analyses has shown statistically and clinically significant improvement in Group-A regarding deep neck muscles endurance (p<0.05). Whereas within group analysis of both groups A & B showed a statistical and clinically significant difference (p=0.00) for deep neck muscles endurance.Conclusions:Cranio-cervical flexion training with Pressure Biofeedback has proven to be more effective in improving endurance of deep cervical flexors in patients with mechanical neck pain.