Cervical Flexor Research Articles

Reliability and usability of a novel inertial sensor-based system to test craniocervical flexion movement control

BackgroundNeck pain has a significant global impact, ranking as the fourth leading cause of disability. Recurrent neck pain often leads to impaired sensorimotor control, particularly in craniocervical flexion (CFF). The Craniocervical Flexion Test (CCFT) has been widely investigated to assess the performance of deep cervical flexor muscles. However, its use requires skilled assessors who need to subjectively detect compensations, progressive increases in range of motion (ROM) or excessive superficial flexor activation during the test. The aim of this study was to design and develop a novel Craniocervical Flexion Movement Control Test (CFMCT) based on inertial sensor technology and real-time computer feedback and to evaluate its safety and usability, as well as inter and intra-rater reliability in both healthy individuals and patients with neck pain.MethodsWe used inertial sensor technology associated with new software that provides real-time computer feedback to assess CCF movement control through two independent test protocols, the progressive consecutive stages protocol (including progressive incremental stages of ROM) and the random stages protocol (providing dynamic and less predictable movement patterns). We determined intra and inter-rater reliability and standard error of the measurement for both protocols. The participants rated their usability was analysed through the System Usability Scale (SUS) and possible secondary effects associated with the tests were registered.ResultsThe progressive consecutive stages protocol and the random stages protocol were safe and easy to use (SUS scores of 82.00 ± 11.55 in the pain group and 79.56 ± 13.36 in the asymptomatic group). The progressive consecutive stages protocol demonstrated good inter-rater reliability (intraclass correlation coefficient [ICC] ≥ 0.75) and moderate to good intra-rater reliability (ICC 0.62–0.80). However, the random stages protocol exhibited lower intra-rater reliability, especially in the neck pain group, where the reliability values were poor in some cases (ICC 0.48–0.72).ConclusionThe CFMCT (progressive consecutive stages protocol) is a promising instrument to evaluate CCF motor control in patients with chronic neck pain. It has potential for telehealth assessment and easy adherence for exercise prescription and seems to be a safe and usable tool for patients with pain and asymptomatic individuals. Its use as a test or for exercise needs to be further investigated to facilitate its transfer to clinical practice.

Global postural re-education versus Egoscue exercises in upper cross syndrome on neck pain, forward head and rounded shoulder posture: a randomised clinical trial

Abstract Upper crossed syndrome (UCS) is a condition that is caused due to alternating tightness and weakness in the opposite muscle groups of the neck, shoulders, and upper back which results in abnormal postural deviations. Global postural re-education (GPR) and Egoscue exercises (EE) aim to improve postural alignment and reduce musculoskeletal discomfort by maintaining certain postures. There is a lack of literature where these approaches are not compared and hence the need arises to evaluate their efficacy in the management of UCS. A randomised clinical trial was conducted on 34 individuals with UCS, where 17 individuals were randomly allocated into two groups, i.e. Group A (GPR) and Group B (EE). Both groups received conventional therapy (hot moist pack and interferential current therapy) 3 times/week for 4 weeks. Outcome measures like craniovertebral angle (CVA), pectoralis minor index (PMI), tragus to wall test (TTW), deep cervical flexors endurance, neck disability index (NDI), and patient satisfaction were assessed at baseline and on day 12 post-treatment. Within group analysis has shown statistical significant improvement in all the outcomes (). Between group analysis has shown both interventions to be equally effective in CVA (), PMI (), TTW (), deep cervical flexors endurance (), NDI () and patient satisfaction scale (PSS) () in individuals with UCS. In conclusion, both the interventions were equally effective and can be included in the protocol for the better outcomes in musculoskeletal dysfunctions. This present trial was prospectively registered in the Clinical Trial Registry of India with registration number CTRI/2023/10/059361.

The association between mobile phone usage duration, neck muscle endurance, and neck pain among university students

The mobile phone is essential in daily life, especially during the pandemic. Prolonged use can cause postural issues, leading to common neck pain. This study aims to determine the correlation between mobile phone use duration, addiction, neck muscle endurance, and neck pain in university students. The study included 62 participants (30 female, 32 male) aged 18–35 years. Inclusion criteria required participants to have experienced neck pain at least twice in the past year and to have no other concomitant issues, as well as to volunteer for the study. Demographic information and daily mobile phone usage time were collected. Neck pain was assessed with the Visual Analogue Scale, smartphone addiction with the Smartphone Addiction Scale, and cervical muscle endurance was evaluated. Correlation analysis reveals a moderate relationship between neck pain severity (NPS) and cervical extensor muscle endurance (CEME), a strong relationship between NPS and cervical flexor muscle endurance (CFME), as well as a strong relationship among daily phone usage time (DPUT), CFME, and NPS, with a moderate relationship between DPUT and CEME. Participants were divided into two groups based on their DPUT, revealing that those who used their phone for four hours or more showed significantly higher levels of pain (p < 0.05) and reduced endurance in cervical flexor muscles. Our study found a strong correlation between neck pain, muscle endurance, and daily phone usage. Participants using their phones for more than four hours daily reported increased neck pain and decreased muscle endurance. We suggest integrating phone usage duration into neck pain assessments, promoting ergonomic practices, and offering detailed usage guidelines for users.

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.

Dropped head syndrome suspected due to oxaliplatin used in adjuvant chemotherapy for gastric cancer: a case report

BackgroundDropped head syndrome (DHS) is caused by dysfunction of the cervical musculature. It is classified into two groups according to the cause: one is weakness of the neck extensors and the other is hypercontraction of the cervical flexors associated with Parkinson’s disease and other disorders. Although some drugs have previously been reported as suspected causes of DHS, we are unaware of any reports in which oxaliplatin was suspected. In this report, we describe a case of DHS during adjuvant chemotherapy for gastric cancer, along with a review of the relevant literature.Case presentationA 72-year-old man was diagnosed with gastric cancer, cT3N0M0 cStage IIB, and underwent laparoscopic total gastrectomy with D2 lymphnode dissection and Roux-en-Y reconstruction. The operative time was 311 min, intraoperative blood loss was 40 g, and he was discharged without any post-operative complications. The histopathological diagnosis was pT4aN2M0 pStage IIIA, and S-1 + oxaliplatin (SOX) therapy was started as adjuvant chemotherapy. On the 4th course of SOX, he complained of neck heaviness and a blood test revealed that his creatine kinase (CK) level was elevated to 2464 IU/L. After consultation with an orthopedic surgeon and a neurologist, DHS due to localized cervical extensor myositis was suspected. Therefore, the 6th course of SOX was postponed, and 30 mg of oral steroids were initiated. His symptoms improved, and his CK level decreased within 2 weeks. After resuming S-1 monotherapy and tapering off oral steroids, no recurrence of symptoms has been observed.ConclusionsWe experienced one case of DHS during adjuvant chemotherapy for gastric cancer. If DHS develops after starting oxaliplatin, involvement of the drug should be suspected, and discontinuation of chemotherapy and introduction of oral steroids should be considered.

Reliability and construct validity of the Craniocervical Flexion Test in patients with migraine

BackgroundMigraine may be accompanied by several cervical musculoskeletal dysfunctions, for example an altered performance on the Craniocervical Flexion Test (CCFT). However, CCFT measurement properties are still unclear in patients with migraine. ObjectivesTo determine intra- and inter-examiner reliability, construct validity, standard measurement error (SEM), and minimal detectable change (MDC) of the CCFT in patients with migraine. MethodsWomen diagnosed with migraine were considered eligible for this study. Participants were assessed by two examiners for the inter-examiner reliability, and with 7–10 days interval for the intra-examiner reliability. Construct validity was assessed considering headache and neck pain frequency and intensity, and self-reported questionnaires, including the Headache Impact Test – 6 items (HIT-6), the 12-item Allodynia Symptom Checklist/Brazil (ASC-12), and the Neck Disability Index (NDI). In addition, participants performed cervical endurance and maximal voluntary isometric contraction of the cervical flexors. ResultsA total of 103 women with migraine were recruited. The intra-examiner reliability was rated as good (ICC= 0.81, 95% CI: 0.73, 0.87), while the inter-examiner reliability was rated as moderate (ICC= 0.55, 95% CI: 0.40, 0.67). The intra and inter-examiner SEM were 1.31 and 1.36 mmHg respectively, and MDC were 3.63 and 3.77 mmHg. The HIT-6 and the cervical endurance flexion test were associated with the CCFT in a multiple linear regression model (p = 0.004, R = 0.35). ConclusionThe CCFT presents adequate intra- and inter-examiner reliability. Better performance on the CCFT test was associated with better HIT-6 scores and greater cervical endurance time, which was not influenced by the presence of neck pain.

Physical Factors Associated with Non-Specific Neck Pain: Correlations Among Pain, Disability, Posture, Endurance, and Compensatory Movement.

BACKGROUND This study was conducted to investigate physical risk factors in patients with non-specific neck pain. The correlations among pain intensity, pressure pain threshold, range of motion (ROM), and disability index were analyzed in 50 patients with non-specific neck pain at a hospital in Korea. MATERIAL AND METHODS We enrolled 50 patients diagnosed with non-specific neck pain by a doctor. All subjects were evaluated for pain intensity, pressure threshold, degree of disability, active range of motion (ROM) of the neck, upper cervical rotation ROM, muscular endurance of deep cervical flexor, compensatory movements for neck flexion, forward head posture, shoulder height difference, and rounded shoulder posture. The correlation between each variable was analyzed. RESULTS Pain intensity had a significant correlation between cervical rotation ROM, cervical flexion-rotation ROM, rounded shoulder posture, shoulder height difference, and forward head posture (P<.05). There was a significant correlation between the pressure pain threshold and the cervical extension ROM, cervical flexion-rotation ROM, and rounded shoulder height (P<.05). The disability index had a significant correlation between the cervical rotation ROM, cervical flexion-rotation ROM, rounded shoulder posture, and the compensatory movement of neck flexion (P<.05). CONCLUSIONS Physical risk factors for non-specific neck pain included cervical rotation ROM, upper cervical rotation ROM, rounded shoulder posture, shoulder height difference, and cervical flexion compensatory movements, which can affect pain intensity and pressure pain threshold.

Effective Exercises Revolutionize Neck Health by Combating Forward Head Posture

This study investigated the effectiveness of deep cervical flexor exercise and neck callet exercise in improving neck functionality among university students with forward head posture. Through a quasi-experimental design, both exercises were implemented three times per week for four weeks, with neck functionality assessed using the Neck Disability Index. Results revealed significant improvements in both groups post-intervention, with mean pre-test scores decreasing from 38.166 to 31.500 for deep cervical flexor exercise and from 37.333 to 31.166 for neck callet exercise. A significant difference was observed between the two groups. These findings highlight the efficacy of targeted exercises in enhancing neck functionality and addressing the negative impacts of forward head posture associated with prolonged gadget use. Highlight: Improved neck function after targeted exercises in university students. Both exercises effective for addressing forward head posture. Quasi-experimental design supports efficacy of targeted exercises. Keyword: Neck functionality, Forward head posture, Exercise intervention, University students, Quasi-experimental design

Effect of Maitland mobilization versus deep cervical flexors muscles training on proprioception in adults with chronic mechanical neck pain: a randomized controlled trial

ObjectiveTo examine the effect of adding Maitland mobilization (MM) versus deep cervical flexors muscles training (DCFMT) to conventional physical therapy (CPT) on proprioception in adults with chronic mechanical neck pain (CMNP).Materials and methodsA randomized controlled study was carried out at the outpatient clinics of physical therapy at Cairo and Suez universities. Sixty participants (27 males, 33 females) with CMNP were randomized into 3 equivalent groups. Group I received MM plus CPT, group II received DCFMT in addition to CPT, and group III received CPT only. All individuals were given three sessions a week for 4 weeks. The primary outcomes were proprioception (CROM), and pain (VAS). The secondary outcomes were cranio-vertebral angle (CVA), and upper cervical angle (C0–C2). Outcomes were evaluated at baseline and following 4 weeks of treatment.ResultsFollowing 4 weeks of treatment, the DCFMT group showed statistically significant improvement to the MM group as well as the CPT group in all outcome measures (p > 0.05). Also, the MM group was remarkably better than the CPT group in all measured outcomes (p > 0.05). The mean signed difference (M±SD) post-treatment within the group of VAS were 6.87 ± 1.26, 7.15 ± 1.38, and 7.20 ± 1.39 cm for MM, DCFMT, and CPT groups respectively. The (M±SD) of CVA were 42.61 ± 4.36, 42.24 ± 3.64, and 42.32 ± 4.81 degrees for MM, DCFMT, and CPT groups respectively. The (M±SD) of C0–C2 were 24.25 ± 2.98, 23.37 ± 1.94, and 24.95 ± 3.01 degrees for MM, DCFMT, and CPT groups respectively. The (M±SD) of flexion JPE to target were 3.62 ± 0.91, 2.86 ± 0.77, and 4.35 ± 0.91 degrees for MM, DCFMT, and CPT groups respectively. The (M±SD) of flexion JPE to neutral were 3.96 ± 0.78, 2.66 ± 1.03, and 5.23 ± 1.52 degrees for MM, DCFMT, and CPT groups respectively.ConclusionAdding MM and DCFMT to CPT revealed significant enhancement, favoring DCFMT, on proprioception, pain, cranio-vertebral angle (CVA), upper cervical angle (C0–C2), and intensity than CPT alone in adults with CMNP.Trial registrationPan African Clinical Trails Registry with a registration No. PACTR202211651838599 on the 3rd of November 2022.

The effect of craniocervical flexors endurance training on suprahyoid muscle activation in healthy adults: A randomised controlled trial.

Cervical posture affects swallowing function through contractile and non-contractile structures. Craniocervical flexor endurance training (CCFET), which focuses on the activation of deep cervical muscles, is used to ensure cervical posture stability. The aim of this study was to investigate the effect of CCFET on the suprahyoid muscles (SH), which play an important role in swallowing function. Eighty healthy individuals (52 female and 28 male, mean age 21.77 ± 1.81 years) were recruited and randomly assigned to groups that underwent either deep cervical flexor (DCF) training with a pressure biofeedback unit (CCFET group, n = 41) or no intervention (control group, n = 39). The intervention was applied for 4 weeks (five sessions per week). Static endurance and activation of DCF muscles (Craniocervical Flexion Test, CCFT), tragus-wall distance (TWD) for forward head posture and surface electromyographic (sEMG) activation of suprahyoid muscles were evaluated. The endurance and activation of the DCF muscles were significantly increased in the CCFET group (p = <.001). In the CCFET group, TWD significantly lower than the control group (p = <.001) Peak SH amplitude and mean SH amplitude were lower in the CCFET group compared to the control group (p = .013, p = .003). The study shows that 4 weeks of CCFET reduced SH muscle activation, allowing the same work to be done with fewer motor units. CCFET can be included in rehabilitation programs as an additional method that has an effect on the muscles involved in swallowing by providing cervical motor control.

Relationship between cervical lordotic angle and cervical segmental motion during craniocervical flexion test: A cross-sectional study.

The craniocervical flexion test (CCFT) is commonly used for assessing the performance and function of the deep cervical flexor muscles; however, objective measurements of cervical segmental motion during craniocervical flexion (CCF) are lacking. Therefore, the purpose of this study aimed to investigate cervical segmental motions during CCFT and determine the relationship between changes of cervical segmental motions and the cervical lordotic angle. A cross-sectional study of prospectively collected data. Twenty healthy participants without neck pain underwent standing cervical radiography (lateral view) to measure the cervical lordotic angle, followed by radiography in supine position during the CCFT. The occipito-atlantal (OA) joint angle, atlantoaxial (AA) joint angle, and cervical spinous process posterior displacement (CSPPD) of the C1-C6 vertebrae were measured using lateral cervical radiographs taken during the initial (20 mm Hg) and low-stage (24 mm Hg) CCFT conditions. The CCF motion during the low-stage CCFT was characterized by a significantly increased OA joint angle, decreased AA joint angle, and increased C1-C6 CSPPD compared with the initial stage (P < .05). The change in the value of C1-C6 CSPPD at low-stage CCFT showed a significant positive correlation with the cervical lordotic angle. These results indicate that the cervical lordotic angle is important in minimizing CSPPD and performing appropriately-isolated CCF motion during CCFT.

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.

Effectiveness of strengthening deep cervical flexors using pressure biofeedback on vertical mandibular opening &amp; craniovertebral angle in young adults with forward head posture - An experimental study

Background and objectives. Forward head posture is associated with weakness in deep cervical short flexor &amp; shortening of the opposing cervical extensor &amp; Pectoralis muscles. Deep cervical flexor (DCF) has a major postural function in supporting and straightening the cervical lordosis. There were few studies on the correlation between craniovertebral angle &amp; vertical mandibular opening. So there was a need to evaluate the effect of deep cervical muscle strengthening on forward head posture and vertical mandibular opening and find out the correlation between vertical mandibular opening (VMO) and craniovertebral angle(CVA). Materials and methods. A total of 84 subjects were included in an experimental study. Subjects were screened according to the inclusion and exclusion criteria. Selected CVA were assessed using MB ruler software (ICC= 0.88). Selected VMO was measured using a ruler (ICC= 0.95-0.96). Subjects received DCF strengthening using pressure biofeedback, 2 sets of 10 repetitions, 5 days per week for 4 weeks. “Paired t test” was used within the group to test the change in quantitative data, pre-intervention and post-intervention. For the correlation between VMO &amp; CVA, Pearson’s correlation coefficient test was used. Results. Strengthening of DCF using pressure biofeedback was effective in improving CVA &amp; VMO (p value &lt;0.0001) and moderate the positive correlation (r=0.4509) exist between CVA &amp; VMO (p value &lt;0.0001). Conclusions. The study concluded that strengthening of deep cervical flexors using pressure biofeedback is effective on improving vertical mandibular opening &amp; craniovertebral angle in young adults (18-30 years) with forward head posture.

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.

Effect of pain on cranio-cervico-mandibular function and postural stability in people with temporomandibular joint disorders.

Neck and jaw pain is common and is associated with jaw functional limitations, postural stability, muscular endurance, and proprioception. This study aimed to investigate the effect of jaw and neck pain on craniocervico- mandibular functions and postural stability in patients with temporomandibular joint disorders (TMJDs). Fifty-two patients with TMJDs were included and assessed using Fonseca's Questionnaire and the Helkimo Clinical Dysfunction Index. An isometric strength test was performed for the TMJ depressor and cervical muscles. The TMJ position sense (TMJPS) test and cervical joint position error test (CJPET) were employed for proprioception. Total sway degree was obtained for the assessment of postural stability. Deep neck flexor endurance (DNFE) was assessed using the craniocervical flexion test. The mandibular function impairment questionnaire (MFIQ) was employed to assess mandibular function, and the craniovertebral angle (CVA) was measured for forward head posture. Jaw and neck pain negatively affected CVA (R2 = 0.130), TMJPS (R2 = 0.286), DNFE (R2 = 0.355), TMJ depressor (R2 = 0.145), cervical flexor (R2 = 0.144), and extensor (R2 = 0.148) muscle strength. Jaw and neck pain also positively affected CJPET for flexion (R2 = 0.116) and extension (R2 = 0.146), as well as total sway degree (R2 = 0.128) and MFIQ (R2 = 0.230). Patients with painful TMJDs, could have impaired muscle strength and proprioception of the TMJ and cervical region. The jaw and neck pain could also affect postural stability, and the endurance of deep neck flexors as well as mandibular functions in TMJDs.

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.

Relationship Between Temporomandibular Joint Disorder Level and Clinical Parameters in Patients with Fibromyalgia Syndrome

Relationship Between Temporomandibular Joint Disorder Level and Clinical Parameters in Patients with Fibromyalgia Syndrome

Is adding dry needling to a standard care protocol beneficial in patients with chronic neck pain? A randomized placebo-controlled trial

PurposeTo evaluate the short-term effects of adding a dry needling therapy to a standard care protocol based on education, exercise and electrotherapy, compared to a sham procedure and to a standard care protocol in isolation in patients with chronic neck pain. Material and methodsA randomized placebo-controlled trial was performed. The participants in the dry needling group received a standard care protocol based on patient education, therapeutic exercise and electrotherapy, as well as two sessions of dry needling in the upper trapezius, levator scapulae, and/or sternocleidomastoid muscles. The participants in the sham dry needling group received the same standard care protocol and two sessions of sham dry needling. The participants in the control group received the same standard care protocol. The outcomes measured were pain intensity, pressure pain threshold, neck disability, range of movement, activation of deep cervical flexor muscles, kinesiophobia, pain catastrophizing, anxiety, and depression. ResultsNo significant group by time interactions were found for any of the outcome variables except for lower cervical spine range of movement (F = 3.79; p = 0.030). ConclusionThe addition of two sessions of dry needling in the superficial neck muscles to a standard protocol did not yield superior results compared to either the standard care alone or the standard care plus sham dry needling in patients with chronic neck pain in any outcome except for cervical range of movement.

Age and flexors as risk factors for cervical radiculopathy: A new machine learning method.

This study aimed to investigate the risk factors for cervical radiculopathy (CR) along with identifying the relationships between age, cervical flexors, and CR. This was a retrospective cohort study, including 60 patients with CR enrolled between December 2018 and June 2020. In this study, we measured C2 to C7 Cobb angle, disc degeneration, endplate degeneration, and morphology of paraspinal muscles and evaluated the value of predictive methods using receiver operating characteristic curves. Next, we established a diagnostic model for CR using Fisher discriminant model and compared different models by calculating the kappa value. Age and cervical flexor factors were used to construct clinical predictive models, which were further evaluated by C-index, receiver operating characteristic curve, calibration curve, and decision curve analysis. Multivariate analysis showed that age and cervical flexors were potential risk factors for CR, while the diagnostic model indicated that both exerted the best diagnostic effect. The obtained diagnostic equation was as follows: y1 = 0.33 × 1 + 10.302 × 2-24.139; y2 = 0.259 × 1 + 13.605 × 2-32.579. Both the C-index and AUC in the training set reached 0.939. Moreover, the C-index and AUC values in the external validation set reached 0.961. We developed 2 models for predicting CR and also confirmed their validity. Age and cervical flexors were considered potential risk factors for CR. Our noninvasive inspection method could provide clinicians with a more potential diagnostic value to detect CR accurately.

Cervical Multifidus and Longus Colli Ultrasound Differences among Patients with Cervical Disc Bulging, Protrusion and Extrusion and Asymptomatic Controls: A Cross-Sectional Study.

The aim of this study was to analyze the differences in morphological and histological features of the cervical multifidus (CM) and longus colli (LC) muscles among patients with cervical disc bulging, protrusion, or extrusion. Fifteen patients with cervical disc bulging (20% male, mean age: 48.5, standard deviation (SD) 7.5 years), fifteen with cervical disc protrusion (6% male, mean age: 43, SD 7.8 years), and fifteen with cervical disc extrusion (40% male, mean age: 44, SD 8 years) diagnosed via clinical and imaging findings participated in this study. Additionally, fifteen asymptomatic controls (40% male, mean age: 40.4, SD 9.7 years) were also included. The following ultrasound measurements, cross-sectional area (CSA), anterior-posterior distance (APD), lateral dimension (LD), and mean echo-intensity (EI) of the CM and LC at C5-C6 level were examined by an assessor blinded to the subject's condition. The results revealed no group ×side significant differences among the groups (p > 0. 00625). However, group effects were found for APD and MEI of the CM (p = 0.006 and p < 0.001, respectively) and CSA, APD and MEI of the LC (all, p < 0.001). The LD of the LC muscle and the APD and LD of the CM were negatively associated with related disability (p < 0.01; p < 0.05 and p < 0.01, respectively), and pain intensity was negatively associated with LC APD and LD (both p < 0.05). These results suggest that US can be used to detect bilateral morphological changes in deep cervical flexors and extensors to discriminate patients with cervical disc alterations.