Cervical Strength Research Articles

Comparison of Handgrip Strength among Diabetes Mellitus with and without Cervical Radiculopathy

Background: Patients with Diabetes Mellitus type 2 have reported to be more disabled in self-care tasks and other daily living activities because of many hand complications. There is reduction in grip strength in diabetic population. The purpose of this study was to compare hand grip strength among diabetes mellitus with and without cervical radiculopathy. A dynamometer can be used to swiftly and precisely measure the link between diabetic patient’s hand grip strength and their blood sugar levels. Objective(s): The study's objective was to evaluate the comparison of hand grip strength among diabetes mellitus with and without cervical radiculopathy. Methodology: A Cross-sectional study was carried among 385 diabetic patients with and without cervical radiculopathy from age 35-75. Data collected from two hospitals of Gujrat City. The study was completed June 2022 to October 2022 within 4 months by non-probability convenient sampling. Both genders were included. Instruments used in this study were handheld dynamometer. We were start to measure handgrip strength in both dominant and non-dominant hand of diabetic patients with and without cervical radiculopathy. Result was analyzed by SPSS version 24; mean and standard deviation were calculated for quantitative variables whereas frequency and percentages were used for qualitative variables. Results: The results had been obtained from 385 diabetic patients (50.6%) were females and (49.4%) were males. In our study the data was collected on the bases of age, gender, socioeconomic status, area and dominancy of hand. 61(32.28%) diabetic patients with cervical radiculopathy hand grip strength are more effected as compared to those without cervical radiculopathy that were 15(7.94%) and there (P<0.001) which indicates it is statistically significant. Practical Implication: The study suggests that fewer patients were diagnosed with cervical radiculopathy in diabetic patients and more patients were without cervical radiculopathy. Conclusion(s): This study concluded that the hand grip strength of patients with cervical radiculopathy prone to diabetes was affected highly as compared to those of which were not diagnosed with cervical radiculopathy but with diabetes. Although our study suggests that less patients were diagnosed with cervical radiculopathy in diabetic patients and more patients were without cervical radiculopathy, our study also proves that diabetic patients are also likely to develop neuropathies in later ages. Keywords: Hand grip strength, Handheld Dynamometer, Cervical Radiculopathy, Diabetes Mellitus

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.

Quantitative strain elastography of the uterine cervix assessed by the GE Voluson E10 system in combination with a force-measuring device

Objective During pregnancy, the stiffness of the cervical tissue decreases long before the cervical length decreases. Therefore, several approaches have been proposed in order to ensure a more objective assessment of cervical stiffness than that achieved by digital evaluation. Strain elastography has shown promising results. This technique is based on an ultrasound assessment of the tissue deformation that occurs when the examiner applies pressure on the tissue with the ultrasound probe. However, the results are only semi-quantitative as they depend on the unmeasured force used by the examiner. We, therefore, hypothesized that a force-measuring device applied to the handle of the ultrasound probe may render the technique quantitative. With this approach, the stiffness is the force (measured by the device) divided by the compression (measured by the elastography platform). One perspective is the early identification of women at risk of preterm birth in whom cervical stiffness may decrease long before cervical shortening. Another perspective is cervical evaluation when planning labor induction. In this feasibility study, we aimed to evaluate how quantitative strain elastography performs when a commercially available strain elastography platform (by which the algorithm is unavailable) is combined with a custom-made, force-measuring device. We studied how the assessments were associated with the gestational age in women with uncomplicated pregnancies and how they were associated with cervical dilatation time from 4 to 10 cm in women undergoing labor induction. Methods In the analysis, we included quantitative strain elastography assessments from 47 women with uncomplicated singleton pregnancies, with gestational age between 12+0 and 40+0, and from 27 singleton term-pregnant women undergoing labor induction. The force-measuring device was mounted on the handle of a transvaginal probe. The strain values (i.e. the compression of the cervical tissue) were obtained by the elastography software of the ultrasound scanner (GE Voluson E10). The region of interest was placed within the central part of the anterior cervical lip. Based on the force data and strain values, we calculated the outcomes cervical elastography indexGE (CEIGE ) and the cervical strength indexGE (CEIGE x cervical length: CSIGE ). Results The average CEIGE was 0.24 N at week 12 and 0.15 N at week 30–34. For CSIGE these figures were 8.2 and 4.7 N mm, respectively (p = 0.002). Among women undergoing labor induction, the CEIGE was associated with a cervical dilatation time (4–10 cm) beyond 7 h. For nulliparous women, this area under the ROC curve was 0.94. Conclusion Quantitative strain elastography may constitute a tool for the evaluation of a uterine cervix with normal length in women at risk of preterm birth and in women undergoing labor induction. The performance of this tool deserves evaluation in larger clinical trials.

Bond strength of various post-core restorations with different lengths and diameters following cycle loading

PurposeThis in vitro study aims to evaluate the bonding strengths of Polyether ether ketone (PEEK), Polyether ketone (PEKK), Fiber, and Zirconia (ZrO2) post-core restorations with posts in different diameter and length following chewing simulator. Materials and methodsEndodontic treatment was performed on 256 intact maxillary central teeth. The test specimens were prepared in four groups according to the types of materials: Glass fiber post-composite core (FB-n:64), Zirconia post-core (Zr-n:64), PEEK post-core (PE-n:64), and PEKK post-core (PK-n:64). The groups were divided into four subgroups according to diameter and length (n:16): Group 1: 10 mm length 1.75 mm diameter, Group 2: 10 mm length 1.5 mm diameter, Group 3: 7 mm length 1.75 mm diameter, Group 4: 7 mm length 1.5 mm diameter. Custom PEKK, PEEK, Zirconia post-cores, and Zirconia crowns were milled on the CAD/CAM. The post-cores and crowns were cemented to the teeth with dual-cure resin cement. After that, all subgroups were divided into control and cyclic loading groups. During the cycling, the control test group was kept in distilled water at 37±1oC before the push-out test. Half of the specimens were loaded with 250,000 cycles and 50 N with a chewing simulator. All test specimens had 1.5 mm sections taken from their roots. Then, the push-out test was applied to these sections for bond strength. Data were analyzed by Mann-Whitney U test, Shapiro-Wilk, Kruskal-Wallis's test, and Chi-Square. The statistical significance level was determined as 0.05. ResultsThe bond strength of all test groups decreased after the cycling loading. The bond strength values of zirconia posts showed a statistically significant difference (p < 0.05). The 10 mm length 1.75 mm diameter posts made of Zirconium had the highest bond strength observed in all control and cyclic loading groups of test specimens (9.74 MPa-6.25 MPa). The PEEK test specimens with a 7 mm length and 1.75 mm diameter showed the weakest bond strength in all control and cyclic loading groups (5.44 MPa-3.37 MPa). The average of the cervical region's bond strength values was statistically significantly higher than the apical region (p < 0.05). ConclusionWithin the limitations of this study, one-piece custom-milled Zirconia post-cores appear promising, as they perform well under functional forces, especially in the anterior region. In addition, custom-milled PEKK post-cores might be considered a suitable alternative to prefabricated fiber-reinforced posts.

A Novel Device for Assessment and Treatment of Upper Cervical Spine: Test–Retest Reliability Study

Neck pain is one of the most frequent reasons for consultation in primary care. Clinicians evaluate different variables, including movement and cervical strength, to determine the prognosis of patients. Usually, the tools employed for this purpose are expensive and bulky, or more than one is needed. This study aims to describe a novel device designed to assess the cervical spine and describe its test-retest reliability. The Spinetrack device was designed to measure the strength of deep cervical flexor muscles and the chin-in and chin-out movement of the upper cervical spine. A test-retest reliability study was developed. The flexion, extension and strength needed to move the Spinetrack device were registered. Two measurements were developed, with one week between each assessment. Twenty healthy subjects were evaluated. The strength of the deep cervical flexor muscles in the first measurement was 21.18 ± 3.15 Newtons, the displacement movement during chin-in movement was 12.79 mm ± 3.46 and the displacement during chin-out movement was 35.99 mm ± 4.44. The test-retest reliability of strength was ICC 0.97 (95% CI (0.91-0.99)). The Spinetrack device has shown excellent test-retest reliability values for the measurement of the strength of the cervical flexor muscles and for the chin-in and chin-out movements.

Return to Driving Is Safe 6 Weeks After Anterior Cervical Surgery for Symptomatic Cervical Degenerative Disc Disease.

Prospective Cohort Study. This study aims to determine the timing and clinical parameters for a safe return to driving. Returning to driving after cervical spine surgery remains a controversial topic, with no clear consensus on how to best assess a patient's fitness to drive. Previous studies using brake reaction time or subjective questionnaires recommend a return to driving 6 weeks after surgery. Patients above 18 years of age who underwent anterior cervical spine surgery for symptomatic cervical degenerative disk disease and possessed a valid motorcar driving license were recruited from 2018 to 2020. Neck Disability Index (NDI), modified Japanese Orthopaedic Association (mJOA) scores, range of motion, and functional strength of the cervical spine were collected preoperatively and at 2-, 4-, 6- and 12 weeks postsurgery. Patients underwent a standard functional driving assessment protocol at the institution to determine their fitness to drive. This comprised of a clinic-based off-road screening tests and on-road driving test in a real-world environment. Twenty-one patients were recruited. The mean age was 56.6±8.9 years. Eighty-one percent of the patients passed the on-road driving assessment at 6 weeks. Patients who passed the driving assessment had lower mean NDI scores, 3.4±3.1 versus 10.8±8.0 ( P =0.006), and higher mean mJOA scores 16.1±0.6 versus 15.0±1.8 ( P =0.045). Patients who passed the driving assessment also had higher functional cervical flexor strength, 21.1s±5.8s versus 13.0s±10.2s ( P =0.042) in a supine position but not correlated with a range of motion of the spine in all directions. Most patients undergoing single or dual-level anterior cervical surgery for symptomatic cervical degenerative disk disease demonstrate the ability to pass a standardized driving assessment and are safe to return to driving more than 6 weeks after surgery. Driving ability appears to be correlated with NDI scores ≤3 ( P =0.006), mJOA scores ≥16 ( P =0.045), and cervical flexion endurance of ≥21s ( P =0.042). Level II.

Efficacy of Low-Level Laser Therapy in The Management of Neck Pain: Systematic Review

Background: Laser therapy is an effective therapeutic option that has helped patients with both acute and chronic neuropathies. Low-level laser therapy provides effective short-term pain relief and improvement in cervical range of motion in participants with neck pain. Objective: To explore the evidence related to the efficacy of low-level laser therapy in patients with neck pain. Methods: This systematic review comprised randomized controlled trials in which pain and range of motion were the outcomes investigated. The PEDro scale was then used to assess the quality of the studies involved. Studies from Google Scholar, PubMed, the HEC Digital Library, PEDro and the Cochrane Library were included in this review. Only randomized trials and English-language papers involved people over the age of 18 with neck discomfort and both genders. The population with psychiatric illnesses and traumatic traumas who were less than 18 years old included observational studies, copyright issues and paper in other languages.26 A PRISMA flowchart was also used to demonstrate the entire process of adding and removing articles from review. Results: PEDro scale was used to assess the quality of studies as shown in Table I, showed that all the studies are of high quality. The following variables were collected for each study: general patient information such as mean age, mean duration, percentages of male and female in sample size, country of study, year of study publication, name of first author, sample size and outcome measure (Table II). Studies revealed that laser therapy is found to be statistically significant in treating neck pain, neck range of motion and disability when compared to placebo therapy. Conclusion: This study found that laser therapy decreases pain in participants with persistent neck discomfort shortly after therapy. Laser therapy is proven to be more effective than placebo therapy in relieving arm pain and improving cervical strength and flexibility in participants with severe pain and increasing the quality of life when compared to patients treated with a placebo laser therapy.

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.)

The short-term effect of a myofascial protocol versus light touch applied to the cervical spine towards the prevention of balance disorders in the elderly: protocol of a randomised controlled trial

BackgroundFalling is a major trauma that can occur with aging, leading to very significant psychological and physical health effects with financial and societal consequences. It is therefore essential to explore therapeutic treatments that can reduce this risk. Some recognized effective treatments exist, concerning in particular the re-education of the muscles of the lower limbs. However, to our knowledge, none of them focus on the cervical spine although the latter is located at an essential physiological crossroads. Manual therapy, which has already demonstrated its impact on pain and balance parameters in the elderly, could be a painless and non-invasive tool of choice in addressing this problem.MethodsInterventional study (not related to a health product), monocentric, prospective, controlled, randomized double-blind (patient and evaluator performing the measurements). The experiment will take place over three measurement periods on D0, D7 and D21. On D0 subjects will be randomized in 2 groups: experimental and placebo group. Both groups will be assessed on: Short Physical Performance Battery test score, walking speed, lower limb strength, balance, heart rate variability and cervical spine strength and mobility. Then the experimental group will receive a myofascial release protocol applied to the cervical spine and the placebo group will receive a placebo light touch protocol. The intervention will be followed by the same measurements as before. This schedule will be reproduced on D7. On D21, only one assessment will be done.DiscussionThis study started in 2020 but could not go beyond the inclusion phase due to the COVID pandemic. It is envisaged that recruitment could resume during 2022.Trial registration: Registered by the Comité de Protection des Personnes—Sud Méditerranée; under the title “Prévention des troubles de l’équilibre chez le senior: influence de la thérapie manuelle appliquée au rachis sur les paramètres statiques et dynamiques», n° 19.12.27.47.259 in date of February 4, 2020.Registered by ClinicalTrials.gov ID: NCT05475652; under the title « The Influence of Manual Therapy Applied to the Cervical Spine in the Prevention of Balance Disorders in the Elderly (ManEq)”.

A clinical test to assess isometric cervical strength in chronic whiplash associated disorder (WAD): a reliability study

BackgroundCervical spine muscle weakness is well demonstrated in individuals with chronic neck pain. There is a lack of literature evaluating clinically applicable means of assessing isometric cervical strength in chronic whiplash associated disorder (WAD). This study assessed the reliability of self-resisted isometric cervical strength testing using a handheld dynamometer. The relationship between strength and neck pain-related disability and kinesiophobia was also investigated.MethodsTwenty subjects with chronic WAD performed maximum-effort isometric cervical flexion, extension, side flexion, and rotation against a hand held dynamometer. The dynamometer was held by the subject, who provided self-resistance. Subjects completed two sessions of testing on one day with two different examiners, and one session on a subsequent day with one of the original examiners. Subjects completed the Neck Disability Index (NDI) and Tampa Scale for Kinesiophobia (TSK) prior to the first testing session.ResultsIntraclass correlation coefficients (ICC) for directional strength measures were fair to high (0.71–0.88 for intra-rater and 0.79–0.91 for inter-rater). Total strength (sum of all directional strengths) ICCs were high for both intra-rater (ICC = 0.91) and inter-rater (ICC = 0.94) measures. All statistical tests for ICCs demonstrated significance (α < 0.05). Agreement was assessed using Bland Altman (BA) analysis with 95% limits of agreement. BA analysis demonstrated difference scores between the two testing sessions that ranged from 3.0—17.3% and 4.5—28.5% of the mean score for intra and inter-rater measures, respectively. Most measures did not meet the a priori standard for agreement. A moderate to good inverse relationship was demonstrated between kinesiophobia (TSK score) and six out of seven strength measures (α < .05). No significant correlation was found between neck disability (NDI) and cervical strength in any direction.ConclusionThis study demonstrated fair to high reliability of self resisted isometric cervical strength testing in the chronic WAD population. All directional strength measures except flexion demonstrated a significant inverse relationship with kinesiophobia. No cervical strength measures were correlated with neck disability. These results support testing cervical strength in this manner to reliably assess change over time within individual patients. The value of such measurement requires further consideration given the lack of correlation between cervical strength and disability. Further research is required to establish normative values and enhance clinical utility.

Effects of Cervical Spine Exercise Protocol on Neck Pain, Pericervical Muscle Endurance, and Range of Motion in Medical Students: A Prospective Study.

IntroductionNeck pain is a common and debilitating ailment that places a significant burden on the healthcare system. No practical protocols have been published utilizing a portable, commercially available, and affordable device that significantly reduces acute and chronic neck pain.MethodsForty-six young adults with or without mild-to-moderate neck pain completed a six-week neck stretching and strengthening protocol with a portable cervical stretching and strengthening device. The primary outcome was changes to pericervical muscle endurance. Secondary outcomes were changes to cervical range of motion (ROM), neck length, circumference, and subjective pain, flexibility, and strength. Measurements were obtained on study days 0, 21, and 42.ResultsA significant increase in pericervical muscle endurance was demonstrated across all planes of cervical motion, ranging from 84% to 105%. Cervical ROM improved across all planes of motion but was only significant in right-side bending (5.3°), left rotation (6.2°), and right rotation (7.8°). Subjective pain evaluated via the Numeric Rating Scale (NRS) saw statistically significant improvement as well (1.33 to 0.51). Subjective assessment of participant cervical pain, strength, and flexibility improved 61.3%, 95.7%, and 97.8%, respectively.ConclusionsA six-week pericervical muscle stretching and strengthening program increased pericervical endurance and ROM in young adults. Decreased cervical pain was seen using the NRS and modified pain scale across most participants.

Factors affecting the performance of the deep cervical flexors in young people using smartphones

ABSTRACT Objective To determine the factors affecting the performance of the deep cervical flexors (DCFs) in young people using smartphones. Methods Eighty-six individuals were enrolled in this study. Joint position sense errors, forward head and protracted shoulder posture, DCFs, and the superficial cervical muscles were evaluated. Smartphone Addiction Scale, State-Trait Anxiety Inventory, and International Physical Activity Questionnaire were used. Results Regression analysis indicated that smartphone addiction and superficial cervical muscle strengths affect the performance of DCFs independently (p < 0.05). SAS was correlated with JPSE-flexion (r = 0.408), DCF activity/performance score (r = −0.453/r = −0.431), forward head posture (r = −0.412), and cervical flexor/extensor muscle strengths (r = −0.313/r = −0.319). Conclusion Smartphone addiction and cervical superficial muscles are related to the performance of the DCFs in young people. Using smartphones causes impaired joint position sense in flexion, decreased DCF activity, and forward head posture.

Are Different Aged Youth Skiers and Snowboarders Experiencing Different Injury Patterns?

Background:Skiing and snowboarding have grown significantly in the past decades with millions of participants worldwide. With popularity increasing, specifically amongst youth athletes, so has the number of injuries and fatalities associated with these sports. In this study, we investigate age as a potential determinant for injury patterns for the growing population of youth skiers and snowboarders.Hypothesis/Purpose:The purpose of our study was to investigate the factors associated with different anatomical injury locations among youth skiers and snowboarders. We hypothesized that youth skiers would exhibit predominately lower body injuries, while snowboarders would predominately exhibit upper body injuries. We also expected higher rates of head injuries for the younger snowsports participants given their larger head to body ratios and decreased cervical muscular strength.Methods:This retrospective study was conducted from data acquired from the Winter Park Resort during the 2012/13–2016/17 ski seasons. The population includes youth (3-17 years old) participants injured at Winter Park Resort while skiing or snowboarding. Patients were sorted by sport and then into age bins 0-6, 7-14, and 15-17 years of age. The study population was described for gender breakdown, run difficulties, equipment usage, skill level, injury location, mechanism, anatomical location, and diagnosis. Logistic regression analysis was used to examine the association between age, sport, and other predictors of injury with different anatomical locations.Results:The study population is described in Table 1. Skiers were more likely than snowboarders to sustain a head injury (odds ratio=1.6, 95% CI=1.2, 2.2), while snowboarders were more likely to sustain upper extremity injuries (odds ratio=5.9, 95% CI=4.6, 7.6). Skiers age 0-6 suffered more head/neck/face injuries (24.2% compared to 14.46 and 14.86% respectively in age bins 7-14 and 15-17). Skiers age 0-6 suffered more fractures (48.2% compared to 28.4% and 23.8% for ages 7-14 and 15-17, where strains/sprains were leading diagnoses).Conclusion:Age was associated with injury patterns in youth skiers, as we observed more fractures, head/neck/face injuries and collision-related trauma in skiers age 0-6. Like previous studies, skiing was associated with lower extremity injuries and snowboarding was associated with upper extremity injuries. Taken together, these data support age as a determinant of injury patterns among youth skiers and snowboarders.Table 1.Descriptive statistics for youth skiers and snowboarders injured at a Colorado ski resortFigure 1.Injury patterns of injured youth skiers and snowboarders at a Colorado ski resort

Mechanical Response of Mouse Cervices Lacking Decorin and Biglycan During Pregnancy.

Cervical remodeling is critical for a healthy pregnancy. The proper regulation of extracellular matrix (ECM) turnover leads to remodeling throughout gestation, transforming the tissue from a stiff material to a compliant, extensible, viscoelastic tissue prepared for delivery. Small leucine-rich proteoglycans (SLRPs) regulate structural fiber assembly in the cervical ECM and overall tissue material properties. To quantify the SLRPs' mechanical role in the cervix, whole cervix specimens from nonpregnant and late pregnant knockout mice of SLRPs, decorin and biglycan, were subjected to cyclic load-unload, ramp-hold, and load-to-failure mechanical tests. Further, a fiber composite material model, accounting for collagen fiber bundle waviness, was developed to describe the cervix's three-dimensional large deformation equilibrium behavior. In nonpregnant tissue, SLRP knockout cervices have the same equilibrium material properties as wild-type tissue. In contrast, the load-to-failure and ramp-hold tests reveal SLRPs impact rupture and time-dependent relaxation behavior. Loss of decorin in nonpregnant (NP) cervices results in inferior rupture properties. After extensive remodeling, cervical strength is similar between all genotypes, but the SLRP-deficient tissue has a diminished ability to dissipate stress during a ramp-hold. In mice with a combined loss of decorin and biglycan, the pregnant cervix loses its extensibility, compliance, and viscoelasticity. These results suggest that decorin and biglycan are necessary for crucial extensibility and viscoelastic material properties of a healthy, remodeled pregnant cervix.

A Biomechanical Assessment of Shaken Baby Syndrome: What About the Spine?

Shaken baby syndrome occurs following inertial loading of the pediatric head, resulting in retinal hemorrhaging, subdural hematoma, and encephalopathy. However, the anatomically vulnerable cervical spine receives little attention. Automotive safety literature is replete with biomechanical data involving forward-facing pediatric surrogates in frontal collisions, an environment analogous to shaking. Publicly available data involving child occupants were utilized to study pediatric neck and head injury potential. We hypothesized that inertial loading provides a greater risk of injury to the cervical spine than to the head. Full-scale automotive crash tests (n= 131) and deceleration sled tests (n= 32) utilizing forward-facing 3-year-old surrogates with head accelerometers and cervical force sensors were analyzed. One hundred sixty-seven full-scale vehicle and 33 sled test runs were assessed in the context of published injury assessment reference values (IARVs) for closed head injury (head injury criterion 15 [HIC15]) and cervical tensile strength in the 3-year-old model. One hundred sixty-one (96%) child surrogates in full-scale crash tests exceeded the cervical peak tension IARV, while only 37 (22%) surpassed the HIC15 IARV. Similarly, in sled testing runs, 27 (82%) pediatric surrogates exceeded cervical tension IARVs, while 1 (3%) surpassed the HIC15 IARV. In both full-scale and sled tests, all surrogates surpassing the HIC15 IARV also exceeded the cervical tension IARV. Positive linear correlations were observed between HIC15 and cervical tensile forces in both full-scale vehicle (R2= 0.15) and sled testing runs (R2= 0.54). These data support the hypothesis that inertial loading of the head provides a greater injury risk to the cervical spine than to closed-head injury.

Comparison of the effectiveness of a structured exercise program on nonspecific neck pain in string and woodwind players.

To investigate the effect of a structured exercise training program on pain, functional status, physical function and quality of life (QoL) in string and woodwind players with nonspecific cervical pain. This study had a prospective cohort design and conducted on 40 musicians (26 male, 14 female) aged between 18 and 65years with persistent nonspecific neck pain in the previous 3months. Forty musicians were assigned to either violin (n = 20, median age; 26.5year, height; 1.67m, body mass; 65kg, BMI; 23.04kg/m2) or ney group (n = 20, median age; 27.5year, height; 1.81m, body mass; 75kg, BMI; 23.35kg/m2) and followed the same structured exercise program (3days/per week for 8weeks). The primary outcome was neck pain intensity and assessed on a visual analog scale (VAS). Secondary outcomes; cervical range of motion (ROM) was measured using a goniometer, the jaw-to-sternum and jaw-to-wall distances were used for the assessment of cervical mobility, neck, shoulder and back muscles strength were assessed with a hand-held dynamometer, the Northwick Park Neck Pain and Short Form 36 (SF-36) questionnaires were also used. Normality of data distribution was checked using the Kolmogorov-Smirnov test. For evaluating the training effectiveness on outcome measures, Mann-Whitney U and Wilcoxon test were used compare pre-test and post-test values with/within groups, respectively. The primary outcome (pain intensity) was lowered %33 in both groups. However, the mean change was found similar (median mean changes; -2 for both groups) (p > 0.05). The secondary outcomes; cervical mobility, cervical flexion ROM, disability and muscle strength of the left middle trapezius, left hand grip, anterior and middle parts of the right deltoid, and cervical flexors also significantly improved in both groups (p < 0.05). Only the mean changes of right serratus anterior, middle trapezius and cervical flexor muscles were higher in violin group than ney group (p < 0.05). There was no significant difference in the cervical extension, right rotation, left rotation, right lateral flexion and left lateral flexion after the treatment in both groups (p > 0.05). There was no significant difference between the groups after the exercise program in terms of pain, mobility, range of motion and SF-36 subdomains (p > 0.05). Specific exercise program had similar positive effects on pain, cervical mobility, cervical fexion ROM and disability in string and woodwind players. Although several muscles showed similar improvements in strength, some muscle groups recovered differently. Physical needs specific to the instrument and performance should be taken into account when prescribing exercises to musicians having the same problem, but playing different instruments.

Negative Psychological Factors’ Influence on Delayed Onset Muscle Soreness Intensity, Reduced Cervical Function and Daily Activities in Healthy Participants

We examined the influence of negative psychological factors (catastrophizing, distress and kinesiophobia) on delayed onset muscle soreness (DOMS) intensity, cervical function (strength and range of motion) and on daily activities (ADL), and the suitability of an exercise protocol designed to induce DOMS within the cervical region. Psychological factors and cervical function were assessed in 86 healthy participants at baseline before applying a DOMS provocation protocol in the cervical flexor muscles. After 24hour, cervical function was reassessed. In addition, at 24hour and 48hour, the intensity of DOMS and its impact on ADL were assessed using the visual analog scale (VAS). The protocol was effective given that it generated low-moderate intensity DOMS (VAS≈30 –40mm) and a statistically significant reduction in cervical strength and range of motion. Psychological distress (anxiety and depression), but not kinesiophobia and catastrophism, predicted a loss of cervical strength (explained 43% of the variance) and range of motion (explained 22% of the variance) after induction of DOMS. In addition, participants’ anxiety level predicted DOMS intensity at 24hour (explained 19% of the variance). PerspectiveThe present findings highlight the relevance of evaluating psychological distress as a preventive/therapeutic measure, given that high levels of distress could lead to more intense and disabling pain in acute injuries, and all these aspects are considered risk factors for the chronification of symptoms.

Slanted slot was the most resistant to failure of ventral slot techniques tested in rabbit cervical vertebrae

The ventral slot technique is used to relieve neural compression secondary to intervertebral disc degeneration or disease. In the present study, the biomechanical properties of three different ventral surgical procedures in the rabbit C6–C7 vertebral motion unit (VMU) were assessed and compared with the intact C6–C7 VMU. The ventral slot procedure (slanted, full, or mini; n = 8/group) was performed on these cervical vertebrae. Normal spine torsion and flexion values were compared to those of spines subjected to slanted, full, and mini slot surgery. The slanted slot spines were the most stable, maintaining 70% of normal cervical spine strength, compared to 26% with the full slot and 30% with the mini slot. Regarding torsion, slanted slot spines showed 74% stability compared to the normal cervical spine, while the full slot and mini slot spines showed 58% and 62% stability, respectively. Flexion values were lower after all versions of the ventral slot procedure than in the normal spine, with the greatest flexion difference occurring after the full slot procedure (21% of the normal flexion value). The flexion values also differed significantly between the slanted and full spine groups, and all operated spines showing roughly 60% torsion rates compared with normal spines. The slanted slot maintains more stability in rabbit cervical spine than the other procedures. To our knowledge, this was the first study to examine biomechanical failure differences between the distinct versions of this ventral slot procedure.

The effects of home exercise program on limb-girdle disease: acohort study.

This study aims to demonstrate the effectiveness of rehabilitation in patients with limb-girdle disease, who were given a home exercise program and called for follow-up in certain periods by observing the functional areas of the shoulder and pelvic groups every six months. Suitable statistical methods were conducted. Descriptive findings and continuous variables regarding the patients were presented. As a result of the analyses, no statistically significant difference was found only in pre-treatment and post-treatment wrist strength and trunk extension variables, but a statistically significant difference was found between the pre-treatment and post-treatment scores of all other types of strength. Significant differences were found between the pre-treatment and post-treatment cervical flexion strength in terms of general weakness and inability to walk, joint limitation and walking status. It is believed that the rehabilitation method to be applied to patients with limb-girdle muscular dystrophy (LGMD) detected in the early period will provide effective results and may form the basis for referring them to physicians and health professionals. It has been concluded that rehabilitation will help them lead a comfortable life.

Reliability and Validity of a Cervical Muscle Strength Test using a Load-cell-type Strength Measurement Sensor

Background : Cervical disorder is caused by abnormal cervical movement patterns and cervical muscle imbalance, which are interrelated and result in neck pain and forward head position. In individuals with postural problems, measuring cervical muscle strength allows quantitative assessment of musculoskeletal damage and the effects of neck pain. Various devices have been used to measure cervical muscle strength. However, no studies have assessed cervical muscle strength using a load cell capable of measuring muscle strength in various postures and acquiring biofeedback in real time. Objectives : To evaluate the reliability and validity of a device designed to measure cervical muscle strength in the craniocervical and cervicothoracic regions using a load cell device fixed to a support plate. Methods : The participants were 15 individuals with neck pain. Superficial cervical muscle strength in cervicothoracic flexion (CTF) and cervicothoracic extension (CTE), as well as deep cervical muscle strength in craniocervical flexion (CCF) and craniocervical extension (CCE), were measured using an Hand-held dynamometer (HHD) and fixed-base isometric (load cell) dynamometry. The reliability and validity of the outcome measures using the two devices (HHD and load cell) in four positions were analyzed using intra-class coefficient (ICC) models 3 and 2. Results : Load cell measurements showed excellent intra-rater and inter-rater reliability. HHD measurements exhibited excellent intra-rater and inter-rater reliability. The load cell and HHD measurements showed moderate to excellent validity. Conclusions : The findings revealed excellent validity and reliability of load cell and HHD measurements of muscle strength. Thus, the load cell device can be used as an effective tool for assessing cervical strength. Also, the load cell can express muscle strength in Kilogramme rather than Newton. Therefore, the load cell can be used to measure muscle strength more easily than HHD.