Cervical Range Of Motion Measurements Research Articles

Subjective and Objective Assessment of the Preferred Rotational Cervical Spine Position in Infants with an Upper Cervical Spine Dysfunction: A Cross-Sectional Study.

We aimed to assess (1) the awareness of parents regarding the cervical rotation preference of their infant and the agreement of the parent, clinician and objective assessments, and (2) the test-retest reliability for objective (measured) rotation, lateral flexion and combined flexion-rotation. This was a cross-sectional study including 69 infants aged three to six months with upper cervical spine dysfunction, without general health issues or specific cervical spine impairments. No treatment was applied. The primary outcomes were parent and clinician assessments of cervical spine rotation preference. The secondary outcome was the cervical range of motion measured by inertial measurement units (IMUs) at two different timepoints. Spearman correlation was performed for the parent, clinician and objective assessments. IMU data were dichotomized into the preferred and unpreferred sides, and test-retest reliability was assessed (ICC). The mean age of infants was 145 days ± 29.1 days, birth length 49.40 cm ± 2.7 cm, birth weight 3328 g ± 530.9 g and 24 were female. In total, 33 infants were assessed by their parents as right-preferred, 30 as left-preferred and 6 as having no preference. The clinician assessed 38 infants as right-preferred and 31 as left-preferred. The correlation between parents and the clinician was rs = 0.687 (p < 0.001), the clinician and the IMU rs = 0.408 (p = 0.005) and parents and the IMU rs = 0.301 (p = 0.044). The ICC of cervical range of motion measurements ranged from poor to moderate. Clinicians can use the parents' assessment of cervical spine rotation preference as a foundation for their clinical examination. IMU measurements are difficult in infants, possibly due to their lack of cooperation during measurements. clinicaltrails.gov (NCT04981782).

Tissue-Specific Quantification of Radiation-Induced Cervical Fibrosis and Correlation with Cervical Range of Motion.

Cervical fibrosis (CF) as a late consequence in patients after radiotherapy significantly impacts the long-term symptoms, functionality, and quality of life of these cancer patients due to a hardening process of different histological tissues. Modern Shear Wave Ultrasound Elastography now enables a differentiated analysis of the changes in various tissue types. In this study, tissue-specific changes in CF induced by radiation therapy in head and neck (ENT) cancer patients were quantified and correlated with cervical range of motion (CROM). 16 patients after radiation of the cervical lymphatic drainage were selected as the observation group (OG). Further, 16 people without radiation in the head and neck region were matched by gender, age, and BMI as the control group (CG). Stiffness measurements in kilopascal (kPa; 1 Pa = 1 N m-2) were performed using shear wave elastography (SWE) to assess the elasticity of muscle, fascia, and subcutaneous tissue within and surrounding the sternocleidomastoid muscle (SCM). Specific parameters of the OG were compared to the CG and correlated with functional parameters and quality of life (QoL). The OG exhibited significantly higher stiffness values (Emean, Emax, Emin) across all tissue types than the CG, suggesting a tangible effect of radiation therapy on tissue stiffness. Muscle compartment analysis revealed the most significant stiffness differences. Thickness measurements indicated changes in the muscle and skin but not in the subcutaneous tissue. CROM measurements within the OG fell within normal ranges, suggesting a possible homogenizing effect of radiation treatment on CROM variability. Strong correlations were observed between age and specific stiffness measures, particularly in the OG group, indicating a broader impact of aging or radiation therapy on physiological measures. Significant correlations between tissue stiffness and CROM were found. CF after radiotherapy occurs primarily in the muscle tissue and its fascia, with the hardening being about twice as pronounced as in the average population and becoming more pronounced with increasing age and correlates with CROM.

A novel virtual reality application for autonomous assessment of cervical range of motion: development and reliability study.

BackgroundNeck pain, one of the most common musculoskeletal diseases, affects 222 million people worldwide. The cervical range of motion (CROM) is a tool used to assess the neck’s state across three movement axes: flexo-extension, rotation, and lateral flexion. People with neck pain often have a reduced CROM, and they feel pain at the end-range and/or accompany neck movements with compensatory trunk movements. Virtual reality (VR) setups can track the movement of the head and other body parts in order to create the sensation of immersion in the virtual environment. Using this tracking position information, a CROM assessment can be performed using a VR setup that may be carried out autonomously from the user’s home. The objectives of this study were to develop a VR experience that could be used to perform a CROM assessment, and to evaluate the intra-rater and inter-rater reliability of the CROM measures guided by this VR experience. To the best of our knowledge, a study of this type has not been carried out before.Materials & MethodsA total of 30 asymptomatic adults were assessed using a VR device (HTC Vive Pro Eye™). Two raters provided support with the VR setup, and the participants were guided by the VR experience as they performed the movements. Each rater tested each subject twice, in random order. In addition to a head-mounted display (HMD), a tracker located on the subject’s back was used to measure trunk compensatory movements. The CROM was estimated using only the HMD position and this measurement was corrected using the tracker data. The mean and standard deviation were calculated to characterize the CROM. To evaluate the reliability, the interclass correlation coefficients (ICC) were calculated for intra-rater and inter-rater analysis. The standard error of measurement and minimum detectable change were also calculated. The usability of the VR system was measured using the Spanish version of the System Usability Scale.ResultsThe mean CROM values in each axis of movement were compatible with those described in the literature. ICC values ranged between 0.86 and 0.96 in the intra-rater analysis and between 0.83 and 0.97 in the inter-rater analysis; these values were between good and excellent. When applying the correction of the trunk movements, both the intra-rater and inter-rater ICC values slightly worsened except in the case of the lateral flexion movement, where they slightly improved. The usability score of the CROM assessment/VR system was 86 points, which is an excellent usability score.ConclusionThe reliability of the measurements and the usability of the system indicate that a VR setup can be used to assess CROM. The reliability of the VR setup can be affected by slippage of the HMD or tracker. Both slippage errors are additive, i.e., only when the sum of these two errors is less than the compensatory movement do the measurements improve when considering the tracker data.

Validity and reliability of Veloflex to measure active cervical range of motion in asymptomatic and symptomatic subjects.

BackgroundNeck pain has a high annual incidence and decreases the cervical active range of motion (ROM). Clinicians use various methods to evaluate cervical range of motion (CROM) that some of them have also been proposed to give instant feedback. Accordingly, this study aimed to examine the validity and reliability of Veloflex (VF) to measure the CROM by comparison with the cervical range of motion (CROM) device, and to examine their test-retest reliability.MethodsThirty-eight healthy and 20 symptomatic participants were evaluated. Cervical flexion-extension, side bending, and rotations were tested in two sessions, first by the CROM and VF and in the second only with the VF. To evaluate the concurrent validity and agreement between CROM and VF, Pearson correlation coefficient (r) and Bland–Altmann plots were used. Reliability were evaluated using intra-class correlation (ICC), standard error of measurement (SEM) and minimal detectable change (MDC).ResultsCROM and VF showed excellent correlation for all movements (r > 0.960). Both devices provided small mean ‘bias’ (≤1.29%) in all movements regarding CROM measures. The intra-rater and inter-rater reliability of the VF was excellent (ICC > 0.98). SEMs ranging from 0.72% to 2.38% and the MDC ranging from 1.22° to 2.60° in all participants. The results support the validity and reliability of VF to measure CROM. For its use, with a basic training is enough to get reliable measurements.

Effect of Ardh Matsyendrasana, OM Chanting and Proprioceptive Neuromuscular Facilitation on Cervical Range of Motion and Health Related Quality of Life in Subacute Bilateral Mechanical Neck Pain: A Randomised Controlled Trial

Introduction: Mechanical Neck pain is evoked by sustained poor neck posture, movement of neck, and on palpation. Patient experiences pain in cervical muscles with absence of any pathology. Previous studies found that Proprioceptive Neuromuscular Facilitation (PNF) as well as yoga asana is effective for treatment of mechanical neck pain. This study was designed to assess the efficacy of neck PNF, Ardh Matsyendrasana with OM chanting and its combination approach on neck Range Of Motion (ROM) and quality of life of people suffering from subacute mechanical neck pain. Aim: To assess the effectiveness of Ardh Matsyendrasana, OM chanting and PNF and its combined approach on neck ROM and quality of life of patients suffering from bilateral subacute mechanical neck pain. Materials and Methods: This randomised controlled trial was conducted in Amity Institute of Physiotherapy Out Patient Department (OPD), Amity University, Noida, Uttar Pradesh, India. The study was conducted between January 2019 to January 2021. A total of 103 subjects of bilateral mechanical neck pain were randomised into four groups (group 1-4): PNF group (n=27), yoga group performed Ardh Matsyendrasana with OM chanting (n=25), combined group performed both PNF, Ardh Matsyendrasana with OM chanting (n=26) and control group (n=25) performed bilateral active stretching of neck muscles. Interventions were given for four weeks with five sessions per week. Outcome measures were Cervical Range of Motion (CROM) assessed using digital cervical goniometer and health related quality of life assessed using SF- 36v2 tool. Data were assessed at baseline and four weeks post intervention. Within group analysis was done using paired t-test with p&lt;0.05 was considered significant. Results: Both CROM measurements as well as health related quality of life parameters showed statistically significant improvement for all four groups from baseline to four weeks postintervention (p&lt;0.05). Improvement scores showed that the group performing Ardh Matsyendrasana with OM chanting and combined PNF neck patterns with Ardh Matsyendrasana and OM chanting showed better improvement in neck flexion, extension, right and left lateral flexion and right and left rotation ROM as well improved mental and physical component scores of quality of life parameter for bilateral subacute mechanical neck pain cases. Conclusion: In this study, neck PNF patterns, Ardh Matsyendrasana with OM chanting, combined PNF, Ardh Matsyendrasana with OM chanting and active stretching exercise of neck muscles specifically sternocleidomastoid and rhomboids, all interventions were found to be effective in improving neck ROM and quality of life in bilateral subacute mechanical neck pain post four weeks of intervention. But yoga group (Ardh Matsyendrasana with OM chanting) and combined group which performed combined PNF neck pattern with Ardh Matsyendrasana and OM chanting proved them to be an effective treatment for improving CROM and health related quality of life in bilateral subacute mechanical neck pain.

Assessment of Interrater and Intrarater Reliability of Cervical Range of Motion (CROM) Goniometer.

Purpose The current study was designed to assess interrater and intrarater validity of cervical range of motion measurements performed with a CROM goniometer. Material and Methods. The study involved 95 healthy university students (31 males and 64 females) aged 20-24 years. Two examiners performed measurements of cervical range of motion using a CROM goniometer. The same subjects were examined again after two weeks, in the same conditions. The results acquired by one rater during the first and the second examination were compared for reproducibility, while the results obtained by the two examiners were compared to assess validity and reliability of the tool. Cronbach's alpha was applied to determine intrarater reliability, and the values of correlations were used to assess the interrater agreement. Results Analysis of the results showed both intrarater and interrater agreement in all the measures of cervical range of motion. The highest intrarater and interrater concordance was observed in the measure of extension. Intrarater agreement for Examiner 1 was reflected by Cronbach's alpha = 0.85, and for Examiner 2 by Cronbach's alpha = 0.89. As for the interrater agreement in the measure of extension, the value of correlation in both the first and the second measurement amounted to r = 0.89. Conclusions Measurements performed with the CROM goniometer show interrater and intrarater agreement in assessments of cervical range of motion. The CROM goniometer can be recommended for use in daily clinical practice.

Smartphone Applications as a Suitable Alternative to CROM Device and Inclinometers in Assessing the Cervical Range of Motion in Patients With Nonspecific Neck Pain

ObjectiveThe purpose of this study was to compare the reliabilities of the cervical range-of-motion (CROM) device and a dual digital inclinometer (as accepted clinical tools) and iPhone or Android smartphone applications (clinometer and compass; as new technologies) in measuring cervical range of motion in patients with neck pain. MethodsTwenty participants (13 women, 7 men; age 19-33 years) with neck pain persisting for at least 4 weeks were enrolled. Neck movements were measured in each participant using 4 noninvasive devices in random order. ResultsThe CROM device showed excellent intra- and interrater reliabilities in assessing cervical range of motion except in right rotation for which it showed moderate intrarater reliability. The dual digital inclinometer demonstrated moderate to excellent intra- and interrater reliabilities. Cervical range of motion measurements using iPhone applications showed good to excellent intra- and interrater reliabilities, whereas Android applications had poor to excellent intra- and interrater reliabilities. Based on the validity results, all assessment tools differed from the CROM device depending on the direction of movement, although the iPhone applications showed fewer differences than the other 2 devices. ConclusionGenerally, the CROM device showed the highest reproducibility, and iPhone applications showed more acceptable intra- and interrater reliabilities than the digital inclinometer and Android applications. The clinometer application of smartphones could be reliable in measuring frontal and sagittal cervical range of motion in patients with neck pain and in a sitting position. However, the compass application of the iPhone showed acceptable results, whereas that of the Android device could not be recommended for clinical use.

A normative study of cervical range of motion measures including the flexion–rotation test in asymptomatic children: side-to-side variability and pain provocation

Objectives: Cervical movement impairment has been identified as a core component of cervicogenic headache evaluation. However, normal range of motion values in children has been investigated rarely and no study has reported such values for the flexion–rotation test (FRT). The purpose of this study was to identify normal values and side-to-side variation for cervical spine range of motion (ROM) and the FRT, in asymptomatic children aged 6–12 years. Another important purpose was to identify the presence of pain during the FRT.Methods: Thirty-four asymptomatic children without history of neck pain or headache (26 females and 8 males, mean age 125.38 months [SD 13.14]) were evaluated. Cervical spine cardinal plane ROM and the FRT were evaluated by a single examiner using a cervical ROM device.Results: Values for cardinal plane ROM measures are presented. No significant gender difference was found for any ROM measure. Mean difference in ROM for rotation, side flexion, and the FRT were less than one degree. However, intra-individual variation was greater, with lower bound scores of 9.32° for rotation, 5.30° for side flexion, and 10.89° for the FRT. Multiple linear regression analysis indicates that movement in the cardinal planes only explains 19% of the variance in the FRT. Pain scores reported following the FRT were less than 2/10.Discussion: Children have consistently greater cervical spine ROM than adults. In children, side-to-side variation in rotation and side flexion ROM and range recorded during the FRT indicates that the clinician should be cautious when using range in one direction to determine impairment in another. Range recorded during the FRT is independent of cardinal movement variables, which further adds to the importance of the FRT, as a test that mainly evaluates range of movement of the upper cervical spine.

Neck motion kinematics: an inter-tester reliability study using an interactive neck VR assessment in asymptomatic individuals.

The use of virtual reality (VR) for assessment and intervention of neck pain has previously been used and shown reliable for cervical range of motion measures. Neck VR enables analysis of task-oriented neck movement by stimulating responsive movements to external stimuli. Therefore, the purpose of this study was to establish inter-tester reliability of neck kinematic measures so that it can be used as a reliable assessment and treatment tool between clinicians. This reliability study included 46 asymptomatic participants, who were assessed using the neck VR system which displayed an interactive VR scenario via a head-mounted device, controlled by neck movements. The objective of the interactive assessment was to hit 16 targets, randomly appearing in four directions, as fast as possible. Each participant was tested twice by two different testers. Good reliability was found of neck motion kinematic measures in flexion, extension, and rotation (0.64-0.93 inter-class correlation). High reliability was shown for peak velocity globally (0.93), in left rotation (0.9), right rotation and extension (0.88), and flexion (0.86). Mean velocity had a good global reliability (0.84), except for left rotation directed movement with moderate reliability (0.68). Minimal detectable change for peak velocity ranged from 41 to 53°/s, while mean velocity ranged from 20 to 25°/s. The results suggest high reliability for peak and mean velocity as measured by the interactive Neck VR assessment of neck motion kinematics. VR appears to provide a reliable and more ecologically valid method of cervical motion evaluation than previous conventional methodologies.

Cervical range of motion, cervical and shoulder strength in senior versus age-grade Rugby Union International front-row forwards

ObjectivesTo provide normative values for cervical range of motion (CROM), isometric cervical and shoulder strength for; International Senior professional, and International Age-grade Rugby Union front-row forwards. DesignCross-sectional population study. SettingAll international level front-row players within a Rugby Union Tier 1 Nation. ParticipantsNineteen Senior and 21 Age-grade front-row forwards underwent CROM, cervical and shoulder strength testing. Main outcome measuresCROM was measured using the CROM device and the Gatherer System was used to measure multi-directional isometric cervical and shoulder strength. ResultsThe Age-grade players had significantly lower; cervical strength (26–57% deficits), cervical flexion to extension strength ratios (0.5 vs. 0.6), and shoulder strength (2–36% deficits) than the Senior players. However, there were no differences between front-row positions within each age group. Additionally, there were no differences between age groups or front-row positions in the CROM measurements. ConclusionsSenior Rugby Union front-row forwards have greater cervical and shoulder strength than Age-grade players, with the biggest differences being in cervical strength, highlighting the need for age specific normative values. Importantly, Age-grade players should be evaluated to ensure they have developed sufficient cervical strength prior to entering professional level Rugby Union.

Assessment of neck pain and cervical mobility among female computer workers at Hail University

The aims of this study were to investigate the prevalence of neck pain among computer workers at Hail University, Saudi Arabia and to compare the cervical range of motion (ROM) of female computer workers suffering from neck pain to the cervical ROM of healthy female computer workers. One hundred and seventy-six female volunteers between 20 and 46 years of age were investigated. Fifty-six of these volunteers were staff members, 22 were administrators and 98 were students. The Cervical Range of Motion (CROM) instrument was used to measure the ROM of the cervical spine. A questionnaire was used to assess participants for the presence of neck pain. The data were analyzed using the Statistical Package for Social Sciences (SPSS) software, and the level of significant was set at p < .05 for all statistical tests. There was a high prevalence of neck pain (75%) among computer workers at Hail University, particularly among students. There were significant differences in cervical lateral flexion, rotation to the right side and protraction range between the pain and pain-free groups. Our results demonstrated that cervical ROM measurements, particularly cervical lateral flexion, rotation and protraction, could be useful for predicting changes in head and neck posture after long-term computer work.

Changes in Pressure Pain in the Upper Trapezius Muscle, Cervical Range of Motion, and the Cervical Flexion^|^ndash;relaxation Ratio after Overhead Work

This study examined the changes in pressure pain in the upper trapezius muscle, cervical range of motion, and cervical flexion-relaxation ratio after overhead work. 14 workers were recruited. Pressure pain in the upper trapezius muscle, active cervical range of motion, and cervical flexion-relaxation ratio were measured in all subjects once before and once after overhead work. The pressure-pain threshold of the left upper trapezius muscle was 8.6 ± 2.5 lb before overhead work and 7.3 ± 2.4 lb after overhead work; that of the right upper trapezius muscle was 8.8 ± 2.9 and 7.3 ± 2.8 lb, respectively, revealing a significant decrease in pressure-pain threshold with overhead work. All cervical range of motion measures decreased significantly with overhead work. The cervical flexion-relaxation ratio on the left side was 1.3 ± 0.2 before overhead work and 1.1 ± 0.2 after overhead work; the respective values for the right side were 1.4 ± 0.5 and 1.2 ± 0.3 before and after overhead work, revealing a significant decrease with overhead work. We postulate that overhead work can reduce the pressure-pain threshold in the upper trapezius muscle and cause changes in the cervical range of motion and cervical flexion-relaxation ratio.

Neck Pain Assessment in a Virtual Environment

Neck-pain and control group comparative analysis of conventional and virtual reality (VR)-based assessment of cervical range of motion (CROM). To use a tracker-based VR system to compare CROM of individuals suffering from chronic neck pain with CROM of asymptomatic individuals; to compare VR system results with those obtained during conventional assessment; to present the diagnostic value of CROM measures obtained by both assessments; and to demonstrate the effect of a single VR session on CROM. Neck pain is a common musculoskeletal complaint with a reported annual prevalence of 30% to 50%. In the absence of a gold standard for CROM assessment, a variety of assessment devices and methodologies exist. Common to these methodologies, assessment of CROM is carried out by instructing subjects to move their head as far as possible. However, these elicited movements do not necessarily replicate functional movements which occur spontaneously in response to multiple stimuli. To achieve a more functional approach to cervical motion assessment, we have recently developed a VR environment in which electromagnetic tracking is used to monitor cervical motion while participants are involved in a simple yet engaging gaming scenario. CROM measures were collected from 25 symptomatic and 42 asymptomatic individuals using VR and conventional assessments. Analysis of variance was used to determine differences between groups and assessment methods. Logistic regression analysis, using a single predictor, compared the diagnostic ability of both methods. Results obtained by both methods demonstrated significant CROM limitations in the symptomatic group. The VR measures showed greater CROM and sensitivity while conventional measures showed greater specificity. A single session exposure to VR resulted in a significant increase in CROM. Neck pain is significantly associated with reduced CROM as demonstrated by both VR and conventional assessment methods. The VR method provides assessment of functional CROM and can be used for CROM enhancement. Assessment by VR has greater sensitivity than conventional assessment and can be used for the detection of true symptomatic individuals.

Reproducibility and validity of digital inclinometry for measuring cervical range of motion in normal subjects

Measurements of cervical range of motion (CROM) have been extensively reported in the past decade employing simple (goniometers) as well as sophisticated (electro-, magneto- and ultrasonography-based) systems. The recent introduction of the simple, user-friendly and relatively cheap digital inclinometer (DI) has opened a potentially new venue for measurement of this segment's motion. The purpose of the present study was to assess intra-tester reproducibility of DI-based findings as well as its validity in comparison to the ultrasonography-based Zebris CMS 70P (Zebris Medizintechnik Gmbh, Isny, Germany) for measuring CROM in normal subjects. Active CROM of healthy women (n = 15) and men (n = 15) aged 24.2(2.4) years was measured on two sessions, Test 1 and Test 2, spread over 7.2(+/-0.7) days apart. On Test 1, the six primary movements of the neck (flexion, F; extension, E; right and left lateral flexion, RLF and LLF; and right and left rotations, RR and LR) were measured using the DI and the Zebris. On Test 2, the same measurements were performed using the DI only. All measurements were conducted by the same tester, with the subject in the seated position. The only exception was DI measurement of cervical rotation that was performed in the supine position due to the DI gravity-dependence, rendering DI measurements in the transverse plane irrelevant. No significant differences were revealed between the two instruments with respect to the sagittal and frontal planes, whereas the DI-based CROM in rotation was significantly greater then its Zebris-based counterpart. The inter-device interclass correlation coefficients (ICCs) for the frontal were 0.72 (RLF) and 0.62 (LLF), and 0.77 (F) and 0.83 (E). Poor correlations were indicated for the rotations. The intra-tester reproducibility derived from the test-retest DI measurement indicated good to excellent reproducibility in all planes with ICCs ranging from 0.82 (LLF) to 0.94 (E). The Standard Error of Measurement ranged from 1.6 degrees (RR) to 2.6 degrees (F). DI-based CROM measurements are reproducible and valid for recording sagittal and frontal plane motions in healthy subjects. The higher range in rotations, relative to the Zebris-based findings, is most probably attributable to the test position. Being relatively cheap, portable and convenient for tester and subject alike, the DI seems to be an effective instrument for assessing CROM.

The Relationship between the Active Cervical Range of Motion and Changes in Head and Neck Posture after Continuous VDT Work

This study investigated the relationship between the active cervical range of motion (ROM) and changes in the head and neck posture after continuous visual display terminal (VDT) work. Twenty VDT workers were recruited from laboratories. The active cervical ROM of the participants was measured and videotaped to capture the craniocervical and cervicothoracic angles using a single video camera before and after VDT work. Pearson correlation coefficients were used to quantify the linear relationship between active cervical ROM measurements and the changes in the craniocervical and cervicothoracic angles after continuous VDT work. Active neck extension (r=-0.84, p<0.01) was negatively correlated with the mean craniocervical angle, and active neck flexion (r=-0.82, p<0.01) and left lateral flexion (r=-0.67, p<0.01) were negatively correlated with the mean cervicothoracic angle.

Range of Motion of the Cervical Spine in Adult Rugby Athletes Compared to Non-Athletes

H and neck range of motion is a measure of functional status as well as an assessment of anatomical pathology and can be used as an indication of dysfunction in the cervical spine. Veteran rugby athletes have shown spinal degeneration in previous studies, although few have measured range of motion. PURPOSE: The purposes of our study were to measure cervical ranges of motion and compare our results between rugby athletes and non-athletes. METHODS: Our study recruited nineteen adult rugby athletes and ten non-athletes from the Quad Cities area, with a mean age of 27.3 years [27.3 (3.15)]. Using electromagnetic sensors, we collected gross and coupled cervical range of motion data in three planes. RESULTS: The intraobserver test-retest reliability of our system and study procedures were found reliable for measuring full-cycle (ICC = 0.75, 0.93, 0.72) and total cervical range of motion measurements (ICC = 0.82). Borderline significant differences between groups were found between rugby athletes and non-athletes in right lateral bending; (P= 0.07); rugby athletes demonstrated decreased ranges of motion when compared to non-athletes. CONCLUSIONS: Observed differences in the ranges of motion, although not statistically significant, may be a result of strenuous athletic activity and may play an important role in future morbidity. This investigation was conducted in a facility constructed with support from Research Facilities Improvement Program Grant Number C06 RR15433-01 from the National Center for Research Resources, National Institute of Health.

The Audible Pop from Thoracic Spine Thrust Manipulation and Its Relation to Short-Term Outcomes in Patients with Neck Pain

Clinicians routinely consider the success of a thrust manipulation technique based on the presence or absence of an audible pop despite the lack of evidence suggesting that this pop is associated with improved outcomes. The purpose of this study was to determine the relationship between the number of audible pops with thoracic spinal manipulation and improvement in pain and function in patients with mechanical neck pain. In this prospective cohort study, 78 patients referred to physical therapy with mechanical neck pain underwent a standardized examination and thoracic spine manipulation treatment protocol. All patients were treated with a total of 6 thrust manipulation techniques directed to the thoracic spine followed by a basic cervical range of motion exercise. The treating clinician recorded the presence or absence of a pop during each manipulation. Outcomes were assessed at a 2-4 day follow-up with an 11-point numeric pain rating (NPRS), the Neck Disability Index, the patient Global Rating of Change (GROC), and measurements of cervical range of motion (CROM). The relationship between the number of pops and change scores for pain, disability, and CROM was first examined using Pearson correlation coefficients. Individuals were then categorized as having received ≤3 or >3 pops. Repeated measures analyses of variance were used to examine whether achievement of >3 pops resulted in improved outcome. Seventy-eight patients with a mean age of 42 (SD 11.3) years participated in the study. Pearson correlation coefficients revealed no significant correlation existed between the number of pops and outcomes with the exception of 3 of the 6 CROM measurements, which were inversely related. There was no significant interaction for group X time for any of the dependent measures (P>0.05). The odds ratio for patients experiencing dramatic improvement was in favor of the group experiencing ≤3 pops but this was not clinically meaningful (1.3: 95% CI 0.46, 3.7). The results of this analysis provide preliminary evidence for the hypothesis that there is no relationship between the number of audible pops during thoracic spine thrust manipulation and clinically meaningful improvements in pain, disability, or CROM in patients with mechanical neck pain. Additionally, a greater number of audible pops experienced was not associated with a dramatic improvement with manipulation treatment.

Reproducibility of cervical range of motion in patients with neck pain.

BackgroundReproducibility measurements of the range of motion are an important prerequisite for the interpretation of study results. The aim of the study is to assess the intra-rater and inter-rater reproducibility of the measurement of active Range of Motion (ROM) in patients with neck pain using the Cybex Electronic Digital Inclinometer-320 (EDI-320).MethodsIn an outpatient clinic in a primary care setting 32 patients with at least 2 weeks of pain and/or stiffness in the neck were randomly assessed, in a test- retest design with blinded raters using a standardized measurement protocol. Cervical flexion-extension, lateral flexion and rotation were assessed.ResultsReliability expressed by the Intraclass Correlation Coefficient (ICC) was 0.93 (lateral flexion) or higher for intra-rater reliability and 0.89 (lateral flexion) or higher for inter-rater reliability. The 95% limits of agreement for intra-rater agreement, expressing the range of the differences between two ratings were -2.5 ± 11.1° for flexion-extension, -0.1 ± 10.4° for lateral flexion and -5.9 ± 13.5° for rotation. For inter-rater agreement the limits of agreement were 3.3 ± 17.0° for flexion-extension, 0.5 ± 17.0° for lateral flexion and -1.3 ± 24.6° for rotation.ConclusionIn general, the intra-rater reproducibility and the inter-rater reproducibility were good. We recommend to compare the reproducibility and clinical applicability of the EDI-320 inclinometer with other cervical ROM measures in symptomatic patients.

The Effect of Sacro Occipital Technique Category II Blocking on Spinal Ranges of Motion: A Case Series

To describe changes in lumbar and cervical range of motion measurements after supine pelvic blocking as used in Sacro Occipital Technique (SOT). Five subjects with sacroiliac distortion and instability were recruited and selected for SOT. Cervical and lumbar ranges of motion were measured before and after category II blocking procedures used to change pelvic mechanics. Pre- and post-measurements were taken by a blinded assessor using a Zebris ultrasonic motion detector. Changes were found in the lumbar spine only. Increased ranges of lumbar motion occurred in all planes except extension (21%-57%). Supine pelvic blocking as used in SOT affected lumbar ranges of motion in these 5 cases. This may indicate that functional change in the pelvis results in changes in lumbar motion, especially lumbar flexion. Larger data sets are needed for further study.

Errors in precise examiner head placement during cervical range-of-motion measurements

Objective: To quantify errors associated with examiner-assisted neutral head placement in cervical range of motion measurements in normal subjects and to investigate the influence of these errors on range of motion measurements. Design: Repeated-measures design with cervical range of motion and errors in placement measured in 20 volunteers with no symptoms with the OSI CA-6000. Methods: Examiner placement of head position was achieved with inclinometers and triangulation. Subjects estimated pain experienced during measurements with numeric pain scales. Angular data around 3 axes were analyzed with descriptive statistics. Possible correlations between errors and other variables were investigated. Results: Drift, defined as displacement from original head positioning at first data acquisition and before initiation of motion, was negligible (±0.8°). Standard errors in neutral head placement ranged from 1.0° in axial rotation to 3.2° in flexion/extension. Within-trial variability of neutral position did not correlate with between-trial differences in ranges of motion. Conclusion: Head position errors were not the primary sources of variability for between-trial measurements of cervical range of motion. The largest errors were in flexion/extension, and least, in axial rotation. Neutral position errors up to approximately 5° for lateral bending, 3° for rotation, and 9° for flexion and extension fall within 95% CI and are the recommended lower limits for significant changes in clinical settings. (J Manipulative Physiol Ther 2001;24:327-30)