Right Side Bending Research Articles

The Effects of Deep Neck Muscle Exercises on Chronic Non-Specific Neck Pain

Introduction: The study aimed to investigate the effects of deep neck flexor (DNF) and deep neck extensor (DNE) muscle exercises on pain, passive range of motion (PROM), craniovertebral angle (CVA), neck flexor endurance (NFE), neck extensor endurance (NEE), and the number of weekly painkiller usage (NWPKU) in chronic non-specific neck pain (CNNP) patients. Materials and Methods: A total of 27 CNNP patients, incuding intervention group (n=15) and control group (n=12), were recruited for this study. Patients in the intervention group participated in 6 weeks of DNF and DNE exercises plus traditional physiotherapy. After 10 sessions (3 weeks), the exercise protocol was followed for 3 weeks of the home-based exercise form. Control group patients received traditional physiotherapy alone. The numeric pain rating scale (NPRS), PROM, CVA, NFE, NEE, and NWPKU were examined and compared between groups, at the baseline and after six weeks. Results: Numeric pain rating scale, PROM, CVA, NFE, NEE, and NWPKU improved significantly in both groups after treatment (P<0.001). The NPRS, passive flexion, passive extension, passive right-side bending, passive left rotation, CVA, NFE, NEE, and NWPKU differences were significant (P<0.05). Conclusion: The study supports the positive effects of combination therapy (DNF and DNE exercises plus traditional physiotherapy) on pain, passive neck range of motion, neck lordosis posture, and neck muscle endurance in CNNP patients.

Effects of fasciatherapy versus fascial manipulation on pain, range of motion and function in patients with chronic neck pain

BackgroundNeck pain is among the common musculoskeletal problem that hinders a person’s daily activities. Fascial tightness is a familiar cause of chronic neck pain that is often neglected and can further cause neck disability and a limited range of motion.ObjectiveThe purpose was to compare the effects of fascia therapy and fascial manipulation on pain, range of motion and function in patients with chronic neck pain.MethodsA randomized clinical trial was conducted from February to August 2022 in the Riphah Rehabilitation Centre, Lahore, Pakistan. Fifty-two participants of both genders, aged 18–40 years with chronic neck pain of at least 3–6 months were included. Group A (n = 26) received fascia therapy along with a conventional physical therapy protocol of hot pack, strengthening and stretching, while group B (n = 26) received the fascial manipulation treatment with conventional physical therapy. All the participants were assessed at baseline and after 3 weeks (3 sessions per week). Numeric Pain Rating Scale (NPRS), Neck Disability Index (NDI) and Goniometer (range of motions) were the outcome measures. SPSS 25 was used for the data analysis and normality of the data through the Shaphiro-Wilk test (p > 0.05), and parametric tests were applied.ResultsThe mean age of group A was 24.82 ± 2.64 years, and group B was 24.17 ± 2.20 years. The independent t-test result showed no significant difference (p ≥ 0.05) in all parameters except in cervical extension and right-side bending (p < 0.05). At the same time, the pair-wise comparison showed significant results (p < 0.05) for all outcome measures in both groups.ConclusionDBM fascia therapy improved cervical extension and side bending (right) more than the fascial manipulation group.It is concluded that DBM fascia therapy shows more improvement as compared to other group.Trial registration numberThis study was registered at ClinicalTrials.gov ID: NCT05272111 on 09/03/2022.

Posterior spinal fusion with lowest instrumented vertebra at L4 in idiopathic scoliosis: optimizing radiographic outcomes using pre-operative flexibility radiographs.

In idiopathic scoliosis (IS), there is general agreement ending PSFs at L3 or more cranial is preferred to optimize spinal motion, and extending PSFs to L4 may be necessary; however, this may also cause coronal imbalance or caudal disc wedging post-operatively due to leveling of L4 tilt. The purpose of this study was to identify a pre-operative radiographic measurement, which can be used to quantify the optimal amount of L4 tilt for ideal post-operative radiographic alignment. The study was a retrospective analysis of IS patients who underwent PSF to L4, with minimum 2-year follow-up post-operatively. Optimal outcome was defined by coronal balance, and L4-5 and L5-S1 disc wedging. 44 patients (84% females, mean age 13.6years) were included. Analysis of pre-operative flexibility radiographs determined only the L5 tilt on the right side-bending (RSB) radiograph correlated with optimal outcome 2 (p = 0.03). To confirm the validity, the RSB value was subtracted from the post-operative C7-L4 tilt and the odds ratio analysis which was significantly correlated with optimal outcome 1 at final follow-up (OR 1.04, 95% CI 1-1.09). In PSF to L4 for IS, L5 tilt measured from the pre-operative supine RSB radiograph can be used to optimize radiographic outcomes. Matching the pre-operative L5 tilt on RSB radiograph by leaving L4 tilted at the end of the PSF construct during surgery, quantified by the C7-L4 acute angle tilt, appears to be a useful method to achieve the desired post-operative alignment.

Immediate Effects of a Single Session of Cervical Spine Manipulation on Cervical Movement Patterns in People With Nonspecific Neck Pain: A Randomized Controlled Trial

ObjectiveThe aim of the present study was to assess the immediate effects of a single session of cervical spine manipulation on cervical movement patterns, disability, and the patient's perceived improvement in people with nonspecific neck pain. MethodsA single-blinded, randomized, sham-controlled trial was carried out at a biomechanics institute. Fifty participants diagnosed with acute and chronic nonspecific neck pain (minimum duration of the symptoms being 1 month) were randomized to an experimental group (EG, n = 25) or a sham-control group (CG, n = 25, 23 of whom completed the study). EG received a single cervical spine manipulation session; CG received a single placebo intervention. Both groups received manipulation or sham from the same physiotherapist. Main outcome measures were neck kinematics (ie, range of motion and movement harmony) during cyclic movements, self-reported neck disability, and impression of change assessed before and 5 minutes after treatment. ResultsThe EG showed no significant improvements (P > .05) in any of the studied biomechanical variables, except for right-side bending and left rotation, in which we found a range of motion significant mean difference of 1.97° and 1.95°, respectively (P < .05). The CG showed enhanced harmonic motion during flexion (P < .05). Both groups showed a significant decrease in self-reported neck disability after treatment (P < .05), and EG participants perceived a significantly larger improvement after manipulation compared with the CG (P < .05). ConclusionsA single session of cervical manipulation provided by a physiotherapist had no impact on cervical motion during cyclic movements, but rather induced self-reported perceived improvement in neck disability and impression of change after treatment in people with nonspecific neck pain.

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.

Finite Element Analysis of Unilateral versus Bipedicular Bone-Filling Mesh Container for the Management of Osteoporotic Compression Fractures.

The effect of unilateral and bilateral bone-filling mesh containers (BFC) on osteoporotic vertebral compression fracture (OVCF) was analyzed by the finite element method. The CT scan data of the T12-L2 vertebral body were obtained from a healthy female volunteer with no history of lumbar spine injury or obvious abnormality of vertebral body morphology. The normal finite element model of the T12-L2 vertebral body and the finite element model of osteoporosis were established, and the models were validated. The L1 in the normal model of the vertebral body was used to simulate the vertebral compression fracture, after which the unilateral and bilateral BFC were simulated to establish models representing the two surgical approaches. We analyzed changes in the deformation and von Mises stress in vertebral bodies and intervertebral discs in the two models under seven working conditions (axial direction, anteflexion, rear protraction, left-side bending, right-side bending, left rotation, and right rotation) and found that the unilateral and bilateral approaches are biomechanically comparable, with no statistical difference between the two overall models.

Atypical Nontraumatic Shoulder Pain In A Baseball Player

HISTORY:15 year old male high school baseball player with past medical history of asthma, who presented with right shoulder pain. Pain started after swinging in a baseball tournament, with no specific trauma. Pain was located posterior. He was able to continue playing baseball, however pain persisted. Initially he tried heat, ice and ibuprofen with no improvement. Pain progressively worsened over the week with walking, deep breathing and coughing. Additional symptoms included radiation into his neck and shallow breathing. He pursued evaluation at the Emergency Department. His vitals were stable with mild tachypnea, saturating 100% on room air and pulse of 72. Right first rib fracture was noted on CXR. He was discharged with ibuprofen and referral to Sports Medicine. PHYSICAL EXAMINATION: Vital signs stable. Respiratory exam clear to auscultation with good air movement throughout and no distress. Cervical exam with full range of motion and strength in flexion, extension, side bending and rotation with mild pain with resistant right-side bending. Right shoulder exam showed no obvious deformities, swelling or bruising. Tenderness over right supra and infraclavicular areas. Hypertonic scalene and trapezius muscles on the right. Range of motion demonstrated glenohumeral internal rotation deficiency with internal rotation of 20 degrees and external rotation of 110. DIFFERENTIAL DIAGNOSIS: Clavicle fracture. Pneumothorax. Scalene muscle strain. Scapula fracture. SC or AC separation. TEST AND RESULTS: CXR 2 views demonstrated a transverse fracture of the first rib on the right with minimal displacement DIAGNOSIS: Right first rib fracture TREATMENT AND OUTCOMES: 1. Repeat imaging at 3 weeks post injury showed minimal callous formation 2. Advised strict rest with non-weight bearing of the right upper extremity until repeat imaging 3. Physical therapy for glenohumeral internal rotation deficiency found on evaluation. Including aggressive stretching and strengthening exercises for 4-6 weeks. 4. Re-evaluation at 7 weeks post injury showed no tenderness with palpation. 5. Repeat imaging at 7 weeks post injury finally showed callous formation. 6. Return to play with no restrictions at 7 weeks post injury after repeat x-rays showed callus formation, no tenderness with palpation, and full strength and range of motion.

Biomechanics of artificial intervertebral disc with different materials using finite element method

The main objective of this paper is to help the orthopaedic in selecting the most suitable artificial intervertebral disc material that can be used in intervertebral disc replacement surgery based on the finite element method. The study uses a three-dimensional model for the lumber 4–lumber 5 spine vertebras for real patient DICOM dataset and saves as stereolithography format. The stereolithography file for the vertebras is converted into a computer-aided diagnostic file to be suitably imported in SolidWorks software. The integrated three-dimensional model assembles and boundary conditions are applied to the model, including axial force applied on the lumber 4–lumber 5 spine. The disc is designed and constructed using SolidWorks, and then four materials are applied to the artificial intervertebral disc. The results show that cobalt–chromium material is the most suitable material to be used in artificial spinal disc according to the maximum stress under an axial compression force of 300 N for cobalt–chromium and titanium was 109,308,136 N/m2 and 95,111,200 N/m2, while the maximum stress under an axial extension for cobalt–chromium and titanium was 109,308,136 N/m2 and 95,111,184 N/m2. The maximum stress under a right-side bending for cobalt–chromium and titanium was 30,456,905,728 N/m2 and 29,162,355,200 N/m2, and the maximum stress under a right-side bending for cobalt–chromium and titanium was 34,716,794,880 N/m2 and 33,086,228,480 N/m2.

Relationship between cervical muscle morphology evaluated by MRI, cervical muscle strength and functional outcomes in patients with degenerative cervical myelopathy

BackgroundCervical muscle alterations have been reported in patients with chronic neck pain, but the assessment of muscle morphology and strength has been overlooked in patients with degenerative cervical myelopathy (DCM). ObjectivesThis study aimed to investigate the relationship between cervical muscle degenerative changes observed on MRI, muscle strength and symptoms severity in patients diagnosed with DCM. DesignObservational study. MethodsCervical muscle measurements of total cross-sectional area (CSA), functional CSA (fat free area, FCSA) and ratio of FCSA/CSA (e.g. fatty infiltration) were obtained from T2-weighted axial MR images from C2-C3 to C6-C7 in 20 patients. Muscle strength was assessed manually using a microFET2 dynamometer. The association between cervical muscle morphology parameters, muscle strength, symptoms severity and functional status was investigated. ResultsGreater mean CSA and FCSA was associated with greater overall muscle strength. The mean FCSA explained 37%, 76%, 39%, 20% and 65% of the total variance in flexion, extension, right-side bending, left-side bending and overall muscle strength, respectively. The mean ratio of FCSA/CSA was not significantly associated with cervical muscle strength in any direction. However, greater FCSA/CSA ratio (e.g. less fatty infiltration) was associated with lower disability score (p = 0.02, R2 = 0.20). ConclusionsCervical muscle lean muscle mass was positively associated with cervical muscle strength in patients with DCM. Moreover, greater fatty infiltration in the cervical extensor muscles was associated with lower functional score. Such findings suggest that clinicians should pay greater attention to cervical muscle morphology and function in patients with DCM.

Is it possible to relate accommodative visual dysfunctions to neck pain?

The aim of this study was to establish whether there is a relationship between conditions of accommodative visual dysfunctions and cervical complaints. Fifty-two participants were included. Variables were accommodative amplitude, positive and negative relative accommodation (NRA), accommodative response, and accommodative facility. Subjects were classified as accommodative insufficiency, accommodative excess, or normal. Neck complaints were measured with the Neck Disability Index, the Visual Analogue Scale, and by cervical range of motion, deep flexor muscle activation score, and performance index. We found the following significant relationships: between NRA and both performance index and left-side bending; accommodative amplitude right-eye with right-side bending and with left-side bending; accommodative amplitude left-eye with right-side bending; and accommodative facility left-eye with both performance index and left-side bending. In accommodative amplitude right-eye, aIl participants showed significant values and greater than those with accommodative excess. In both groups, performance index values were decreased. Greater pain and lower right-rotation were found in participants with accommodative excess than in those with accommodative insufficiency. We conclude that accommodative dysfunctions are related to low performance index, decreased range of motion, as well as greater neck pain.

Flexibility assessment of the unfused thoracic segments above the “potential upper instrumented vertebrae” using the supine side bending radiographs in Lenke 5 and 6 curves for adolescent idiopathic scoliosis patients

Background ContextSelection of upper instrumented vertebra for Lenke 5 and 6 curves remains debatable, and several authors have described different selection strategies. ObjectiveThis study analyzed the flexibility of the unfused thoracic segments above the “potential upper instrumented vertebrae (UIV)” (T1–T12) and its compensatory ability in Lenke 5 and 6 curves using supine side bending (SSB) radiographs. Study DesignA retrospective study was used. Patient SampleThis study comprised 100 patients. Outcome MeasuresThe ability of the unfused thoracic segments above the potential UIV, that is, T1–T12, to compensate in Lenke 5 and 6 curves was determined. We also analyzed postoperative radiological outcome of this cohort of patients with a minimum follow-up of 12 months. MethodsRight and left SSB were obtained. Right side bending (RSB) and left side bending (LSB) angles were measured from T1 to T12. Compensatory ability of thoracic segments was defined as the ability to return to neutral (center sacral vertical line [CSVL]) with the assumption of maximal correction of lumbar curve with a horizontal UIV. The Lenke 5 curves were classified as follows: (1) Lenke 5−ve (mobile): main thoracic Cobb angle <15° and (2) Lenke 5+ve (stiff): main thoracic Cobb angle 15.0°–24.9°. This study was self-funded with no conflict of interest. ResultsThere were 43 Lenke 5−ve, 31 Lenke 5+ve, and 26 Lenke 6 curves analyzed. For Lenke 5−ve, >70% of thoracic segments were able to compensate when UIV were at T1–T8 and T12 and >50% at T9–T11. For Lenke 5+ve, >70% at T1–T6 and T12, 61.3% at T7, 38.7% at T8, 3.2% at T9, 6.5% at T10, and 22.6% at T11 were able to compensate. For Lenke 6 curve, >70% at T1–T6, 69.2% at T7, 19.2% at T8, 7.7% at T9, 0% at T10, 3.8% at T11, and 34.6% at T12 were able to compensate. There was a significant difference between Lenke 5–ve versus Lenke 5+ve and Lenke 5–ve versus Lenke 6 from T8 to T11. There were no significance differences between Lenke 5+ve and Lenke 6 curves from T1 to T11. ConclusionsThe compensatory ability of the unfused thoracic segment of Lenke 5+ve curves was different from the Lenke 5–ve curves, and it demonstrated characteristics similar to the Lenke 6 curves.

Assessing the Flexibility of the Proximal Thoracic Segments Above the "Potential Upper Instrumented Vertebra" Using the Cervical Supine Side Bending Radiographs in Lenke 1 and 2 Curves for Adolescent Idiopathic Scoliosis Patients.

A prospective study. The aim of this study was to analyze the proximal thoracic (PT) flexibility and its compensatory ability above the "potential UIV." Shoulder and neck imbalance can be caused by overcorrection of the main thoracic (MT) curve due to inability of PT segment to compensate. Cervical supine side bending (CSB) radiographs of 100 Lenke 1 and 2 patients were studied. We further stratified Lenke 1 curves into Lenke 1-ve: PT side bending (PTSB) < 15° (n = 33) and Lenke 1+ve: PTSB 15° to 24.9° (n = 37). The right side bending (RSB) and left side bending (LSB) angles were measured (T1-T6). Compensatory ability of the PT segment was analyzed with assumption of a "horizontal UIV" position. From T1 to T6 vertebrae, the RSB angle values showed increasing positive values. The LSB angle, comparing Lenke 1-ve versus 2 and Lenke 1+ve versus 2, showed significant difference at T2 to T6. The LSB angle comparing Lenke 1-ve versus 1+ve achieved significant difference at T5 and T6. In Lenke 2 curves, >80.0% of cases of the PT segment were unable to compensate at T3-T6. In Lenke 1+ve curves, 78.4% were unable to compensate at T6, followed by T5 (75.7%), T4 (73.0%), T3 (59.5%), T2 (27.0%), and T1 (21.6%). In Lenke 1-ve curves, 36.4% of cases were unable to compensate at T6, followed by T5 (45.5%), T4 (45.5%), T3 (30.3%), T2 (21.2%), and T1 (15.2%). A significant difference between Lenke 1-ve and Lenke 1+ve was observed from T3 to T6. The difference between Lenke 1+ve and Lenke 2 curves was significant only at T2. The compensation ability and the flexibility of the PT segments of Lenke 1-ve and Lenke 1+ve curves were different. Lenke 1+ve curves demonstrated similar characteristics to Lenke 2 curves. 3.