The assessment of the cervical spine. Part 1: Range of motion and proprioception

An Additive Effect of Instrument-Assisted Soft Tissue Mobilization with Spinal Manipulation in Cervicogenic Headache: a Randomized Controlled Trial

INTRODUCTION

There is a multitude of evidence supporting the use of manual and manipulative therapy techniques for patients with cervicogenic headache (CGH). However, evidence in finding and comparing the efficacy of instrument assisted soft tissue mobilization with manual therapy in unilateral cervicogenic headache is lacking. Therefore, the objective of the study is to find and compare the long term effects of instrument assisted soft tissue mobilization along with spinal manipulation therapy in patients with cervicogenic headache.

METHODS

It is a randomized, single-blinded controlled study conducted at University hospital. Overall, 64 participants with CGH were divided into spinal manipulation therapy group (SMT; n = 32) and spinal manipulation therapy with instrument assisted soft tissue mobilization (ISM) group (SMT + ISM; n = 32) and they received the respective treatment for 4 weeks. In addition, both groups received 10 min of heat therapy and neck isometric exercises three times a day. The primary (CGH frequency) and secondary (CGH pain intensity, CGH disability neck pain frequency, pain intensity, pain threshold, neck disability index and quality of life) scores were measured at baseline, after 4 weeks, and at 6 months.

RESULTS

The reports of the SMT and SMT + ISM group were compared. Following 4 weeks of training, and at 6 months follow up the SMT + ISM group showed more significant changes in the primary outcome (CGH frequency) with a -4.3 [(95% confidence interval (CI) -4.80 to -3.79] and -1.7 (95% CI -1.92 to -1.47), when compared with the SMT group alone (p = 0.001). The secondary outcomes (CGH pain intensity, CGH disability, neck pain frequency, neck pain intensity, neck disability index, and quality of life) also shows more significant changes in the SMT + ISM group than the SMT group (p = 0.001). The same gradual improvement can be seen in the above variables at 6 months follow up. At the same time, neck pain threshold level does not show any improvement at 4 weeks (p ≥ 0.05) but shows a statistical difference at 6 months follow up. No such adverse effects or consequences were noted during or after the intervention.

CONCLUSIONS

The study concluded that spinal manipulation therapy with instrument assisted soft tissue mobilization provided better long-term outcomes in patients with cervicogenic headache. This study provided a piece of sound physical therapy evidence for a widespread and costly clinical condition, such as cervicogenic headache.

CLINICAL TRIAL REGISTRATION

The trial was registered prospectively in the Indian clinical trial registry with CTRI/2020/06/026243 on 30/06/2020.

Differentiating the Structural and Functional Instability of the Craniocervical Junction

This paper presents the anatomical and biomechanical aspects of chronic instability of the craniocervical junction (CCJ) with a discussion on clinical diagnostics based on mobility tests and provocative tests related to ligamentous system injuries, as well as radiological criteria for CCJ instability. In addition to the structural instability of the CCJ, the hypothesis of its functional form resulting from cervical proprioceptive system (CPS) damage is discussed. Clinical and neurophysiological studies have shown that functional disorders or organic changes in the CPS cause symptoms similar to those of vestibular system diseases: dizziness, nystagmus, and balance disorders. The underlying cause of the functional form of CCJ instability may be the increased activity of mechanoreceptors, leading to "informational noise" which causes vestibular system disorientation. Due to the disharmony of mutual stimulation and the inhibition of impulses between the centers controlling eye movements, the cerebellum, spinal motoneurons, and the vestibular system, inadequate vestibulospinal and vestibulo-ocular reactions occur, manifesting as postural instability, dizziness, and nystagmus. The hyperactivity of craniocervical mechanoreceptors also leads to disturbances in the reflex regulation of postural muscle tone, manifesting as "general instability". Understanding this form of CCJ instability as a distinct clinical entity is important both diagnostically and therapeutically as it requires different management strategies compared to true instability. Chronic CCJ instability significantly impacts the quality of life (QOL) of affected patients, contributing to chronic pain, psychological distress, and functional impairments. Addressing both structural and functional instability is essential for improving patient outcomes and enhancing their overall QOL.

Evaluation of Apparatus and Protocols to Measure Human Passive Neck Stiffness and Range of Motion

Understanding of human neck stiffness and range of motion (ROM) with minimal neck muscle activation ("passive") is important for clinical and bioengineering applications. The aim of this study was to develop, implement, and evaluate the reliability of methods for assessing passive-lying stiffness and ROM, in six head-neck rotation directions. Six participants completed two assessment sessions. To perform passive-lying tests, the participant's head and torso were strapped to a bending (flexion, extension, lateral bending) or a rotation (axial rotation) apparatus, and clinical bed, respectively. The head and neck were manually rotated by the researcher to the participant's maximum ROM, to assess passive-lying stiffness. Participant-initiated ("active") head ROM was also assessed in the apparatus, and seated. Various measures of apparatus functionality were assessed. ROM was similar for all assessment configurations in each motion direction except flexion. In each direction, passive stiffness generally increased throughout neck rotation. Within-session reliability for stiffness (ICC > 0.656) and ROM (ICC > 0.872) was acceptable, but between-session reliability was low for some motion directions, probably due to intrinsic participant factors, participant-apparatus interaction, and the relatively low participant number. Moment-angle corridors from both assessment sessions were similar, suggesting that with greater sample size, these methods may be suitable for estimating population-level corridors.

Clinical, Kinematic and Muscle Assessment of Bilateral Coordinated Upper-Limb Movements Following Cervical Spinal Cord Injury

Cervical spinal cord injury (cSCI) often results in bilateral impairment of the arms, leading to difficulties in performing daily activities. However, little is known about the neuromotor alterations that affect the ability of individuals with cSCI to perform coordinated movements with both arms. To address this issue, we developed and tested a functional assessment that integrates clinical, kinematic, and muscle activity measures, including the evaluation of bilateral arm movements. Twelve subjects with a C5-C7 spinal lesion and six unimpaired subjects underwent an evaluation that included three tests: the Manual Muscle Test, Range Of Motion test and Arm stabilisation test, a subsection of the "Van Lieshout arm/hand function test". During the latter, we recorded kinematic and muscle activity data from the upper-body during the execution of a set of movements that required participants to stabilize both arms against gravity at different configurations. Analytical methods, including muscle synergies, spinal maps, and Principal Component Analysis, were used to analyse the data. Clinical tests detected limitations in shoulder abduction-flexion of cSCI participants and alterations in elbows-wrists motor function. The instrumented assessment provided insight into how these limitations impacted the ability of cSCI participants to perform bilateral movements. They exhibited severe difficulty in performing movements involving over-the-shoulder motion and shoulder internal rotation due to altered patterns of activity of the scapular stabilizer muscles, latissimus dorsi, pectoralis, and triceps. Our findings shed light on the bilateral neuromotor changes that occur post-cSCI addressing not only motor deficits, but also the underlying abnormal, weak, or silent muscle activations.

Mediation Effect of Kinesiophobia on the Relationship between Cervical Joint Position Sense and Limits of Stability in Individuals with Fibromyalgia Syndrome: A Cross-Sectional Study Using Mediation Analysis

(1) Background: Individuals with fibromyalgia syndrome (FMS) may experience proprioceptive and balance impairments. Kinesiophobia is a factor that can mediate the relationship between cervical joint position sense (JPS) and limits of stability. The objectives of this study were to (1) compare the cervical JPS and limits of stability between FMS and asymptomatic individuals, (2) assess the relationship between cervical JPS and limits of stability, and (3) assess the mediation effect of kinesiophobia on the relationship between cervical JPS and limits of stability in FMS individuals. (2) Methods: In this comparative cross-sectional study, 100 individuals with FMS and 100 asymptomatic individuals were recruited. Cervical JPS was assessed using a cervical range of motion device, limits of stability (reaction time, maximum excursion, and direction control) were assessed using dynamic posturography, and FMS individuals' kinesiophobia was assessed using the Tampa scale of kinesiophobia (TSK). Comparison, correlation, and mediation analyses were performed. (3) Results: The magnitude of the mean cervical joint position error (JPE) was significantly larger in FMS individuals (p < 0.001) compared to the asymptomatic individuals. The limits of the stability test showed that FMS individuals had a longer reaction time (F = 128.74) and reduced maximum excursion (F = 976.75) and direction control (F = 396.49) compared to the asymptomatic individuals. Cervical JPE showed statistically significant moderate-to-strong correlations with reaction time (r = 0.56 to 0.64, p < 0.001), maximum excursion (r = -0.71 to -0.74, p < 0.001), and direction control (r = -0.66 to -0.68, p < 0.001) parameters of the limits of the stability test. (4) Conclusions: Cervical JPS and limits of stability were impaired in FMS individuals, and the cervical JPS showed a strong relationship with limits of stability variables. Moreover, kinesiophobia mediated the relationship between JPS and limits of stability. These factors may be taken into consideration when evaluating and developing treatment strategies for FMS patients.

The reliability and validity of the Turkish version of the self-administered neck mobility assessment tool (s-rom-neck) in patients with chronic neck pain

BACKGROUND

The self-administered neck mobility assessment tool (S-ROM-Neck) is the subjective cervical region range of motion (S-ROM) assessment scale. The study aimed to demonstrate the reliability and validity of the Turkish version of the S-ROM-Neck in patients with chronic neck pain.

METHODS

: A cross-sectional study was conducted with a total of 60 chronic neck pain patients in the Physical Therapy and Rehabilitation Clinic of Pamukkale University Hospital between January and August 2021. The mean age of the individuals was 34.1 ± 9.9 years. Patients were assessed with S-ROM-Neck twice to prove the test-retest reliability. In addition, Visual Analogue Scale (VAS), Neck Disability Index (NDI) and bubble inclinometer measurement were used to analyze the construct validity of S-ROM-Neck.

RESULTS

The intraclass correlation coefficients of the S-ROM-Neck were higher than 0.80 (ICC > 80, CI: 0.90-98). The internal consistency of the S-ROM-Neck total score was within the acceptable limits (α = 0.754). Construct validity was high regarding the correlation analysis (r > 0.05, p < 0.01).

DISCUSSION

Turkish S-ROM-Neck is a valid and reliable tool to assess the S-ROM of individuals with chronic neck pain.

Typical Cockpit Ergonomics Influence on Cervical Motor Control in Healthy Young Male Adults

INTRODUCTION: Neck pain and injury are common problems in military high-performance aircraft and helicopter aircrews. A contributing factor may be the reclined sitting position in cockpits. This study aimed to determine the effect of typical cockpit ergonomics on cervical proprioception, assessed by using the cervical joint position error (cJPE).METHODS: A total of 49 healthy male military employees (mean age 19.9 ± 2.2 yr) were examined. Measurements of the cJPE were obtained in the flexion, extension, and rotation directions in an upright and in a 30°-reclined sitting position. Each condition comprised three trials, with an additional 3-kg head load to mimic real world working conditions.RESULTS: A smaller cJPE was noted in the 30°-reclined sitting position (mean cJPE = 3.9 cm) than in the upright sitting position (mean cJPE = 4.6 cm) in the flexion direction. The cJPE decreased significantly in all movement directions across the three trials; for example, in the flexion direction in the 30°-reclined sitting position: Trial 1/2/3 mean cJPE = 5.0/3.8/3.1 cm.CONCLUSION: It seems that a reclined seating position has a positive influence on cJPE. However, the result is weak. In both sitting positions and all three directions, the first tests of the cJPE showed the highest values. Already after one or two further measurement runs, a significantly reduced cJPE was observed. This rapid improvement might indicate that an exercise similar to the cJPE test may improve the pilots' cervical proprioception and possibly reduce the risk of injury or pain.Heggli U, Swanenburg J, Hofstetter L, Häusler M, Schweinhardt P, Bron D. Typical cockpit ergonomics influence on cervical motor control in healthy young male adults. Aerosp Med Hum Perform. 2023; 94(3):107-112.

Variability of Active Cervical Range of Motion Within and Between Days in Healthy Participants: A Prospective Observational Study

OBJECTIVE

The purpose of this study was to determine the intraday and interday variability and systematic change over the day of active cervical range of motion (aCROM) measurements in asymptomatic persons using a clinically applicable measurement device.

METHODS

A prospective observational study was performed. Sixteen adults (8 men and 8 women, median age 51 years) without neck pain in the last 3 months were recruited in 2 physiotherapy practices. Active cervical range of motion was estimated using the Apple iPhone application "3D Range of Motion." Measurements were performed 3 times a day for 7 days and spread over a period of 3 weeks. Mean values of aCROM were calculated. Intraday and interday variability was estimated by calculating limits of agreement.

RESULTS

The limits of agreement for intraday variability ranged from ±12.1° for left rotation to ±15.5° for total rotation. For interday variability, the limits of agreement ranged from ±14.2° for right rotation to ±20.1° for total rotation. No systematic change over the day was found.

CONCLUSION

This study showed substantial intraday and interday variability of aCROM measurements in asymptomatic people. No trend toward an increased or decreased aCROM was observed during the course of the day. When interpreting aCROM values, clinicians should consider the degree of variation in aCROM measurements over time.

Are there differences between a real C0-C1 mobilization and a sham technique in function and pressure pain threshold in patients with chronic neck pain and upper cervical restriction? A randomised controlled clinical trial

BACKGROUND

Chronic neck pain is one of the main reasons for visiting a healthcare professional. In recent years, it has been shown that upper cervical restriction may be a factor involved in neck pain.

OBJECTIVE

To compare the immediate effects of a real cervical mobilization technique versus a sham cervical mobilization technique in patients with chronic neck pain and upper cervical restriction.

METHODS

This was a randomised, controlled, double-blind clinical trial. Twenty-eight patients with chronic neck pain were recruited and divided into two groups (14 = real cervical mobilization; 14 = sham mobilization). Both groups received a single 5-minute treatment session. Upper cervical range motion, flexion-rotation test, deep cervical activation and pressure pain threshold were measured.

RESULTS

In the between-groups comparison, statistically significant differences were found in favour of the real cervical mobilization group in upper cervical extension (p= 0.003), more restricted side of flexion-rotation test (p< 0.001) and less restricted side of flexion-rotation test (p= 0.007) and in the pressure pain threshold of the right trapezius (p= 0.040) and right splenius (p= 0.049). No differences in deep muscle activation were obtained.

CONCLUSION

The real cervical mobilization group generates improvements in upper cervical spine movement and pressure pain threshold of right trapezius and right splenius compared to the sham group in patients with chronic neck pain and upper cervical restriction.

Comparative Effects of Mulligan's Mobilization, Spinal Manipulation, and Conventional Massage Therapy in Cervicogenic Headache-A Prospective, Randomized, Controlled Trial

Background: There is ample evidence supporting the use of manual therapy techniques for the treatment of cervicogenic headache (CGH). Objective: The objective of this study was to find and compare the effects of different manual therapy approaches to cervicogenic headache. Methods: A randomized, controlled study was conducted on 84 CGH participants at the university hospital. The participants were divided into a Mulligan mobilization therapy group (MMT; n = 28), a spinal manipulation therapy group (SMT; n = 28), and a control group (Control; n = 28); they received the respective treatments for four weeks. The primary outcome (CGH frequency) and secondary outcomes (CGH pain intensity, CGH disability, neck pain frequency, pain intensity, pain threshold, flexion rotation (right and left), neck disability index, and quality of life scores) were measured at baseline, after 4 weeks, after 8 weeks, and at a 6-month follow-up. The one-way ANOVA test and repeated measures analysis of variance (rANOVA) test were performed to find the difference between the inter- and intra-treatment group effects. Results: Four weeks following training, the MMT group showed a statistically significant difference in the primary (CGH frequency) and secondary (CGH pain intensity, CGH disability, neck pain frequency, neck pain intensity, flexion rotation test, neck disability index, and quality of life) scores than those of the SMT and control groups (p < 0.001). The same difference was seen in the above variables at 8 weeks and at the 6-month follow-up. At the same time, the neck pain threshold level did not show any difference at the 4-week and the 8-week follow-up (p ≥ 0.05) but showed statistical difference at the 6-month follow-up. Conclusion: The study concluded that Mulligan’s mobilization therapy provided better outcomes in cervicogenic headache than those of spinal manipulation therapy and conventional massage therapy.

Clinical and Psychological Variables in Female Patients with Cervical Syndromes: A Cross-Sectional and Correlational Study

Background: The objectives of this study were: (1) to compare the pain intensity, cervical range of motion (ROM), psychological distress and kinesiophobia in patients with cervicogenic dizziness (CGD), tension-type headache (TTH), and mechanical chronic neck pain (MCNP); and (2) to investigate the relationships between pain intensity and cervical ROM and between psychological distress and kinesiophobia. Methods: a cross-sectional and correlational study was designed. In total, 109 patients (32 patients with CGD, 33 with TTH and 44 with MCNP) were included. Pain intensity, cervical ROM, psychological distress and kinesiophobia were assessed. Results: Statistically significant differences were found between the groups in pain intensity, psychological distress and kinesiophobia. The patients with MCNP showed higher pain intensity compared to the other groups (p < 0.001). The patients with CGD showed higher depression and kinesiophobia values compared to the MCNP and TTH groups (p < 0.05). No differences were found for cervical flexion, extension, lateral flexion, or rotation ROM (p > 0.05). The CGD and MCNP groups found a moderate positive correlation between psychological distress and kinesiophobia (p < 0.05). The patients with TTH and MCNP showed a moderate positive correlation between pain intensity, psychological distress and kinesiophobia (p < 0.05). Conclusion: Pain intensity, psychological distress and kinesiophobia should be considered in the three groups. Psychological distress was correlated with kinesiophobia in the CGD and MCNP groups. The MCNP group showed a correlation between pain intensity, psychological distress and kinesiophobia.

Choreography Controlled (ChoCo) brain MRI artifact generation for labeled motion-corrupted datasets

MRI is a non-invasive medical imaging modality that is sensitive to patient motion, which constitutes a major limitation in most clinical applications. Solutions may arise from the reduction of acquisition times or from motion-correction techniques, either prospective or retrospective. Benchmarking the latter methods requires labeled motion-corrupted datasets, which are uncommon. Up to our best knowledge, no protocol for generating labeled datasets of MRI images corrupted by controlled motion has yet been proposed. Hence, we present a methodology allowing the acquisition of reproducible motion-corrupted MRI images as well as validation of the system's performance by motion estimation through rigid-body volume registration of fast 3D echo-planar imaging (EPI) time series. A proof-of-concept is presented, to show how the protocol can be implemented to provide qualitative and quantitative results. An MRI-compatible video system displays a moving target that volunteers equipped with customized plastic glasses must follow to perform predefined head choreographies. Motion estimation using rigid-body EPI time series registration demonstrated that head position can be accurately determined (with an average standard deviation of about 0.39 degrees). A spatio-temporal upsampling and interpolation method to cope with fast motion is also proposed in order to improve motion estimation. The proposed protocol is versatile and straightforward. It is compatible with all MRI systems and may provide insights on the origins of specific motion artifacts. The MRI and artificial intelligence research communities could benefit from this work to build in-vivo labeled datasets of motion-corrupted MRI images suitable for training/testing any retrospective motion correction or machine learning algorithm.

Neck Strength Evaluated With Fixed and Portable Dynamometers in Asymptomatic Individuals: Correlation, Concurrent Validity, and Agreement

OBJECTIVE

The purpose of this study was to assess the correlation, concurrent validity, and agreement between the isometric cervical force measurements obtained with fixed and portable dynamometers in asymptomatic individuals.

METHODS

Fifty asymptomatic individuals performed 3 maximal isometric contractions for flexion, extension, and lateral flexion of the cervical spine using fixed and portable dynamometers. The correlation and concurrent validity for the measurements of the portable and fixed dynamometers were analyzed using Spearman's correlation coefficient and the intraclass correlation coefficient (ICC), respectively. The agreement between the force values of the portable and fixed dynamometers was measured using the Bland-Altman method.

RESULTS

Isometric cervical force measurements obtained with the fixed dynamometer and portable dynamometer showed a moderately to highly significant correlation for flexion (r_s = 0.74), extension (r_s = 0.82), right lateral flexion (r_s = 0.74), and left lateral flexion (r_s = 0.68). The concurrent validity was moderate to good for all measurements (ICC_2,3 = 0.67-0.80). The fixed and portable dynamometers did not agree, with a significant mean difference between the methods of 2.8 kgf (95% confidence interval [CI], 2.1-3.4 kgf) for cervical flexion, 5.3 kgf (95% CI, 4.2-6.4 kgf) for extension, and 9.1 kgf (95% CI, 0.4-2.1 kgf) for left lateral flexion. The limits of agreement were broad for all movements, with errors that varied between 61% and 77% of the mean force obtained with the fixed dynamometer.

CONCLUSION

The neck strength measurements obtained with the fixed and portable dynamometers demonstrated high to moderate correlation and had moderate to good comparability for asymptomatic participants. However, they did not agree in that the 2 methods did not provide equivalent measurements, and, therefore, based on these findings, the same equipment should always be used when reassessing an individual.

Correlation analysis of national elite Chinese male table tennis players’ shoulder proprioception and muscle strength

BACKGROUND

Shoulder is the most injured part in table tennis players, and it takes multiple roles in transmitting power and striking the center of the ball during the stroke. Proprioception is strongly correlated with high level of athletic performance. It is customary to assume that there is a correlation between proprioception and muscle strength and therefore proprioceptive assessment and rehabilitation is often neglected.

AIM

To investigate the correlation between isokinetic muscle strength and proprioception in the internal and external rotation muscle groups of elite Chinese male table tennis players, to provide reference for physical training and rehabilitation of elite table tennis players.

METHODS

A total of 19 national elite table tennis players from the Chinese National Table Tennis Team were recruited in this research. All of them had more than 10 years training experience and had participated major competitions such as the National Games and World Youth Championships. IsoMed 2000 was used to test the peak torque of internal and external rotation isokinetic concentric contraction of the athletes' bilateral shoulder joints at low speed (60°/s) and high speed (180°/s) respectively; IsoMed 2000 was used to conduct the Joint Position Reproduction test to evaluate the athletes' proprioceptive ability capacity at low speed (60°/s) and high speed (180°/s) respectively. If the data satisfied the normal distribution, the correlation between the differences in peak torque s and angles in different directions was analyzed using a Pearson simple linear model; otherwise, Spearman correlation analysis was used. The comparison of proprioceptive ability between the table tennis racket-holding hand and non-racket-holding hands was performed using independent samples t-test if the data satisfied a normal distribution; otherwise, the Mann-Whitney U test was used.

RESULTS

There was no direct linear correlation between the strength and proprioceptive correlation analysis at slow speed (60°/s) and fast speed (180°/s) in the racket-holding hand; At the slow speed (60°/s) and fast speed (180°/s), there was no correlation between muscle strength and proprioception in the non-racket-holding hand except for the internal rotation variable error (VE) and external rotation relative peak torque, which showed a moderate positive correlation (r = 0.477, P < 0.05), (r = 0.554, P < 0.05). The internal rotation’s constant error (CE) and VE were 1.06 ± 3.99 and 2.94 ± 2.16, respectively, for the racket-holding hand, and -3.36 ± 2.39 and 1.22 ± 0.93, respectively, for the non-racket-holding hand; the internal rotation’s CE, VE of the racket-holding hand was lower than that of the non-racket-holding hand, and there was a highly significant difference (P < 0.01).

CONCLUSION

There was no correlation between muscle strength and proprioceptive function in the internal and external rotation of the racket-holding hand’s shoulder in elite Chinese male table tennis players. These results may be useful for interventions for shoulder injuries and for the inclusion of proprioceptive training in rehabilitation programs.

Neck Pain: Do We Know Enough About the Sensorimotor Control System?

Neck pain is a worldwide health problem. Clarifying the etiology and providing effective interventions are challenging for the multifactorial nature of neck pain. As an essential component of cervical spine function, the sensorimotor control system has been extensively studied in both healthy and pathological conditions. Proprioceptive signals generated from cervical structures are crucial to normal cervical functions, and abnormal proprioception caused by neck pain leads to alterations in neural plasticity, cervical muscle recruitment and cervical kinematics. The long-term sensorimotor disturbance and maladaptive neural plasticity are supposed to contribute to the recurrence and chronicity of neck pain. Therefore, multiple clinical evaluations and treatments aiming at restoring the sensorimotor control system and neural plasticity have been proposed. This paper provides a short review on neck pain from perspectives of proprioception, sensorimotor control system, neural plasticity and potential interventions. Future research may need to clarify the molecular mechanism underlying proprioception and pain. The existing assessment methods of cervical proprioceptive impairment and corresponding treatments may need to be systematically reevaluated and standardized. Additionally, new precise motor parameters reflecting sensorimotor deficit and more effective interventions targeting the sensorimotor control system or neural plasticity are encouraged to be proposed.

Interexaminer Reliability and Validity of Quantity of Cervical Mobility during Online Dynamic Inspection

Background: Physical therapists routinely measure range of motion (ROM) of cervical spine. The reliability of the cervical range of motion (CROM) device has been demonstrated in several studies, but current evidence on the validity and reliability of the visual inspection is contradictory. The aim is to assess the validity and interexaminer reliability of the online visual inspection of active cervical ROM in physiotherapy students. Methods: Flexion, extension, both lateral flexions and rotations of a single participant were measured using CROM. Online visual inspection of 18 physiotherapy students against CROM was registered. Results: The validity, against CROM, of the online visual inspection of the active ROM ranged from good to excellent (Intraclass Correlation Coefficient (ICC) 0.83–0.97). Interexaminer reliability of the online visual inspection had favorable outcomes in all cervical movements in the three physiotherapy courses (ICC 0.70–0.96), with the visual inspection of the rotations being the most reliable (ICC 0.93–0.97). Interexaminer reliability of the classification of mobility was poor to good (Kappa 0.03–0.90). Conclusions: The interexaminer reliability and validity of the quantification of active cervical movement during online visual inspection was shown to be good to excellent for flexion-extension and lateral flexions and excellent for rotations.

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

Objectives

The aim of the study was to examine the short-term changes of elastic adhesive tape application on pain intensity and the range of motion (ROM), cervical region proprioception sense, and cervical flexor endurance of patients with chronic neck pain.

Methods

Thirty-four patients (male: 26, female: 8) between ages 20 and 55 with chronic neck pain having the complaints for at least 6 months were included in the study. Demographic information, pain intensity, cervical ROM, cervical flexor endurance, and cervical proprioception sense of the patients were evaluated. Results were examined 2 times. The first evaluation was conducted prior to elastic adhesive tape application and the second one was conducted 24 hours after the procedure.

Results

The mean age of the patients was 39.56 ± 17.09 years, average height was 165.65 ± 9.83 cm, average weight was 71.44 ± 15.79 kg, and average body mass index was 26.24 ± 6.62. A statistically significant difference was found between the measurement results of pain intensity, ROM of the joint in flexion, extension, right and left rotation, and cervical flexor endurance before and 24 hours after the application of elastic adhesive tape (P < .05). When the proprioception sense was examined, there was a significant difference between the results before elastic adhesive tape application and 24 hours after the same application in deviation angles except for right rotation (P < .05).

Conclusion

The results of this study revealed short-term changes following the use of elastic adhesive tape on cervical flexor endurance, pain, and cervical proprioception sense for patients with chronic pain.

ANALYSIS OF THE EFFECT OF THE DIFFERENCE BETWEEN STANDING AND SITTING POSTURES ON NECK PROPRIOCEPTION USING JOINT POSITION ERROR TEST

The proprioceptive sense is a very important function for the body, and joint position error test (JPET) is commonly used to measure it. This study was to analyze the difference of proprioception in standing and sitting postures through the JPET. A total of 60 students (M/F, 12/48) in D University in Gyeongsangbuk-do, South Korea participated in this study. A JPET was performed with the subject’s eyes closed to assess the neck proprioception. The movement of the neck was measured in flexion, extension, and lateral flexion, and separately measured when sitting and standing. The difference in repositioning errors between sitting and standing postures was analyzed using paired [Formula: see text]-test. There was a significant difference in repositioning errors between sitting and standing posture in neck extension. There was no significant difference in repositioning errors between sitting and standing posture in neck flexion and lateral flexion. In conclusion, in a sitting posture, posterior neck muscles are used more than in the standing posture, which may negatively affect the proprioceptive accuracy of the neck and may also increase the neck repositioning errors.

Effects of increasing axial load on cervical motor control

To investigate the effects of increasing axial load on cervical motor control. Surrogates of cervical motor control were active cervical range of motion (C-ROM) and joint position error (JPE) assessed in flexion, extension, lateroflexion and rotation directions in 49 healthy young men (mean age: 20.2 years). All measurements were executed with 0-, 1-, 2-, and 3-kg axial loads. Linear mixed models were used to assess the effects of axial loading and cervical movement-direction on C-ROM and JPE. Post-hoc analysis was performed to compare load levels. Axial loading (p = 0.045) and movement direction (p < 0.001) showed significant main effects on C-ROM as well as an interaction (p < 0.001). C-ROM significantly changed with 3-kg axial load by decreaseing extension (− 13.6%) and increasing lateroflexion (+ 9.9%). No significant main effect was observed of axial loading on JPE (p = 0.139). Cervical motor control is influenced by axial loading, which results in decreased C-ROM in extension and increased C-ROM lateroflexion direction.

Short-term effects of an upper cervical spine traction-manipulation program in patients with cervicogenic dizziness: A case series study

BACKGROUND

Damage on the somatosensory system could cause sensation of dizziness, a condition known as cervicogenic dizziness (CD). Manual physical therapy has shown beneficial effects, relieving the symptoms of cervicogenic dizziness. However, the effect of upper cervical spine manipulation is unknown, as this is a technique that respects the International Federation of Orthopedic Manipulative Physical Therapists (IFOMPT) safety criteria.

OBJECTIVE

To assess the effects of upper cervical spine traction-manipulation in subjects with cervicogenic dizziness.

METHODS

This was a descriptive case series study. Treatment focused on the upper cervical spine manipulation procedure. Evaluation was performed before and after the treatment. Variables recorded include upper and lower cervical range of motion, Cervical Flexion-Rotation Test (CFRT), dizziness intensity and cervical pain (VAS), self-perceived dizziness measured with Dizziness Handicap Inventory (DHI) and subjective perception of outcome (GROC-scale).

RESULTS

Ten subjects were recruited. After the treatment protocol, there was an increased range of movement towards the most restricted side, as measured by the CFRT (p< 0.001), decreased intensity of dizziness (p< 0.001) and intensity of pain (p< 0.001). Functional capacity also improved after the intervention (p< 0.011).

CONCLUSION

Upper cervical spine manipulation may decrease dizziness intensity and cervical pain and improve functional ability and upper cervical spine mobility in patients with cervicogenic dizziness.

Effects of Acupressure on Pain, Flexibility, and Substance P in Middle-Age Women with Chronic Neck Pain

Introduction: Acupressure is known to be effective for some types of chronic pain. However, the effect of acupressure on chronic neck pain has not been investigated. Accordingly, the authors aimed to evaluate effects of the 4-week acupressure treatment on pain, neck function, and substance P in women with chronic neck pain. Methods: The acupressure treatment was performed two times a week for 4 weeks in an acupressure group (n = 24), meanwhile a control group (n = 26) was untreated. Before and after intervention, pain intensity and physical disability were measured by visual analogue scale (VAS) and neck disability index (NDI), respectively. In addition, cervical range of motion (CROM) and serum substance P were evaluated. Results: Results of two-way analysis of variance with repeated measures revealed that time × group interactions were significant in all outcomes (all p < 0.001) except substance P. These results indicate that after 4 weeks, VAS and NDI significantly decreased in the acupressure group compared with those changes in the control group. The CROM values for six cervical movements significantly increased in the acupressure group compared with those changes in the control group. Serum substance P did not change significantly in both groups. However, when the pre- and postintervention data from all subjects were pooled, substance P was significantly correlated with VAS (r = 20; p < 0.05; n = 100). Conclusions: The 4-week acupressure intervention showed significant reduction in pain and improvement in neck disability and flexibility, suggesting that acupressure intervention is an effective treatment for chronic neck pain. This study was registered with the Korean Clinical Trial Registry and WHO Clinical Trial Registry (KCT0005363).

Does the Addition of Manual Therapy Approach to a Cervical Exercise Program Improve Clinical Outcomes for Patients with Chronic Neck Pain in Short- and Mid-Term? A Randomized Controlled Trial

Chronic neck pain is one of today’s most prevalent pathologies. The International Classification of Diseases categorizes four subgroups based on patients’ associated symptoms. However, this classification does not encompass upper cervical spine dysfunction. The aim is to compare the short- and mid-term effectiveness of adding a manual therapy approach to a cervical exercise protocol in patients with chronic neck pain and upper cervical spine dysfunction. Fifty-eight subjects with chronic neck pain and upper cervical spine dysfunction were recruited (29 = Manual therapy + Exercise; 29 = Exercise). Each group received four 20-min sessions, one per week during four consecutive weeks, and a home exercise regime. Upper flexion and flexion-rotation test range of motion, neck disability index, craniocervical flexion test, visual analogue scale, pressure pain threshold, global rating of change scale, and adherence to self-treatment were assessed at the beginning, end of the intervention and at 3- and 6-month follow-ups. The Manual therapy + Exercise group statistically improved short- and medium-term in all variables compared to the Exercise group. Four 20-min sessions of Manual therapy + Exercise along with a home-exercise program is more effective in the short- to mid-term than an exercise protocol and a home-exercise program for patients with chronic neck pain and upper cervical dysfunction.

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

Objective

The 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.

Methods

Twenty 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.

Results

The 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.

Conclusion

Generally, 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.

No Differences Between Individuals With Chronic Idiopathic Neck Pain and Asymptomatic Individuals on 7 Cervical Sensorimotor Control Tests: A Cross-sectional Study

OBJECTIVE

Cervical sensorimotor outcomes have been suggested to be important in the assessment of individuals with neck pain. However, the large variety of sensorimotor control tests used in varying populations makes it difficult to draw conclusions about their clinical value. We aimed to compare cervical sensorimotor control outcomes between individuals with chronic idiopathic neck pain and asymptomatic individuals using a battery of recommended tests, and to investigate the correlation between cervical sensorimotor control outcomes and pain intensity and neck disability.

DESIGN

Case-control study.

METHODS

Fifty participants with chronic idiopathic neck pain and 50 age- and sex-matched asymptomatic controls completed 7 cervical sensorimotor control tests: joint position error (including joint position error torsion), postural balance, subjective visual vertical, head-tilt response, "the Fly," smooth pursuit neck torsion, and head steadiness. Between-group differences were investigated with the Mann-Whitney U test. Correlations between tests and levels of neck pain and disability were investigated using the Spearman rho.

RESULTS

There were no differences in cervical sensorimotor outcomes between participants with chronic idiopathic neck pain and asymptomatic controls for any test (P = .203-.981). For each test, "poor performers" consisted of both individuals with and without neck pain. Correlations were weak between tests and levels of neck pain (r = 0.010-0.294) and neck disability (r = 0.007-0.316).

CONCLUSION

These findings suggest that sensorimotor control disturbances in individuals with chronic idiopathic neck pain may not be present, spawning debate on the clinical usefulness of these tests. J Orthop Sports Phys Ther 2020;50(1):33-43. Epub 23 Aug 2019. doi:10.2519/jospt.2020.8846.

Head repositioning accuracy is influenced by experimental neck pain in those most accurate but not when adding a cognitive task

Background and aims Neck pain can impair perception of cervical movement, but how this is affected by attention is unknown. In this study, the effects of experimental neck pain on head repositioning accuracy during standardized head movements were investigated. Methods Experimental neck pain was induced by injecting hypertonic saline into the right splenius capitis muscle in 28 healthy participants (12 women). Isotonic saline was used as control. Participants were blindfolded while performing standardized head movements from neutral (start) to either right-rotation, left-rotation, flexion or extension, then back to neutral (end). Movements were triplicated for each direction, separated by 5-s, and performed with or without a cognitive task at baseline, immediately after the injection, and 5-min after pain disappeared. Repositioning accuracy was assessed by 3-dimensional recordings of head movement and defined as the difference between start and end position. Participants were grouped into most/least accurate based on a median split of head repositioning accuracy for each movement direction at baseline without the cognitive task. Results The most accurate group got less accurate following hypertonic injection during right-rotation without a cognitive task, compared with the least accurate group and the isotonic condition (p < 0.01). No group difference was found when testing head repositioning accuracy while the participants where distracted by the cognitive task. Conclusions Experimental neck pain alters head repositioning accuracy in healthy participants, but only in those who are most accurate at baseline. Interestingly, this impairment was no longer present when a cognitive task was added to the head repositioning accuracy test. Implications The results adds to our understanding of what factor may influence the head repositioning accuracy test when used in clinical practice and thereby how the results should be interpreted.

Validity and reliability of two Smartphone applications to measure the lower and upper cervical spine range of motion in subjects with chronic cervical pain

BACKGROUND

Cervical pain is the biggest musculoskeletal health problem in industrialised countries. There is an important association between this and decrease in range of motion.

OBJECTIVE

Estimate the validity and reliability intra and inter examiner of two Smartphone apps regarding the measurement of lower and upper cervical spine range of motion in subjects with chronic cervical pain.

METHODS

A cross-sectional study was conducted. The sample consisted of 25 subjects with chronic cervical pain. An examiner made a measurement of the range of motion using the CROM device as a gold standard, afterwards, another examiner did the same using a Smartphone, in order to establish validity. After this, the Smartphone examiner and a new examiner simultaneously conducted the intra and inter examiner reliability.

RESULTS

Measurement of the lower and upper cervical spine range show an excellent validity (> 0.75), with an excellent intra and inter reliability (> 0.75) in all movements except flexion of upper cervical spine (0.75-0.65).

CONCLUSION

The two Smartphone applications used in this study showed an excellent validity compared to the CROM. The intra and inter reliability is excellent for all movements, except for the upper cervical spine flexion.

Multibody Models for the Analysis of a Fall From Height: Accident, Suicide, or Murder?

The final subject position is often the only evidence in the case of the fall of a human being from a given height. Foreseeing the body trajectory and the respective driving force may not be trivial due to the possibility of rotations and to an unknown initial position and momentum of the subject. This article illustrates how multibody models can be used for this aim, with specific reference to an actual case, where a worker fell into a stair well, prior to stair mounting, and he was found in an unexpected posture. The aim of the analysis was establishing if this worker was dead in that same place, if he had been pushed, and which was his initial position. A multibody model of the subject has been built ("numerical android"), given his stature and his known mass. Multiple simulations have been performed, following a design of experiments where various initial positions and velocity as well as pushing forces have been considered, while the objective function to be minimized was the deviation of the numerical android position from the actual worker position. At the end of the analysis, it was possible to point how a very limited set of conditions, all including the application of an external pushing force (or initial speed), could produce the given final posture with an error on the distance function equal to 0.39 m. The full analysis gives a demonstration of the potentiality of multibody models as a tool for the analysis of falls in forensic inquiries.

No Differences Between Individuals With Chronic Idiopathic Neck Pain and Asymptomatic Individuals on Seven Cervical Sensorimotor Control Tests: A Cross-Sectional Study

STUDY DESIGN

Case-control study.

BACKGROUND

Cervical sensorimotor outcomes have been suggested to be important in the assessment of individuals with neck pain. However, the large variety of sensorimotor control tests used in varying populations makes it difficult to draw conclusions about their clinical value.

OBJECTIVES

To compare cervical sensorimotor control outcomes between individuals with chronic idiopathic neck pain and asymptomatic individuals using a battery of recommended tests, and to investigate the correlation between cervical sensorimotor control outcomes and pain intensity and neck disability.

METHODS

Fifty participants with chronic idiopathic neck pain and 50 age and sex-matched asymptomatic controls completed seven cervical sensorimotor control tests: joint position error, joint position error torsion, postural balance, subjective visual vertical, head tilt response, The Fly, smooth pursuit neck torsion, and head steadiness. Between-group differences were investigated with Mann-Whitney U tests. Correlations between tests and levels of neck pain and disability were investigated using Spearman's rho.

RESULTS

There were no differences in cervical sensorimotor outcomes between participants with chronic idiopathic neck pain and asymptomatic controls for any test (p-values ranged from p=0.203 to p=0.981). For each test, 'poor performers' consisted of both individuals with and without neck pain. Correlations were weak between tests and levels of neck pain (r values ranged from 0.010 to 0.294) and neck disability (0.007 to 0.316).

DISCUSSION

These findings suggest sensorimotor control disturbances in individuals with chronic idiopathic neck pain may not be present, spawning debate on the clinical usefulness of these tests. J Orthop Sports Phys Ther, Epub 23 Aug 2019. doi:10.2519/jospt.2019.8846.

Comparative study of the effects of two inhibitory suboccipital techniques in non-symptomatic subjects with limited cervical mobility

BACKGROUND

Hypomobility on a cervical segment is a frequent finding which is sometimes asymptomatic. The effects of inhibitory suboccipital techniques on cervical mobility have not been evaluated.

OBJECTIVE

To compare the effect on cervical mobility, of pressure maintained suboccipital inhibition manual technique versus a self-treatment using an Occipivot cushion, in asymptomatic subjects with limited mobility assessed by the flexion-rotation test.

METHODS

Before-after randomized uncontrolled trial. Thirty-two subjects were recruited and randomized into two groups: Manual Group and Instrumental Group, receiving a single session of the assigned technique. Upper and overall cervical spine mobility was measured. Subjective sensation during technique application and post-treatment, and number and intensity of headache episodes during the following 15 days after treatment were also registered.

RESULTS

Comparing with the Instrumental Group, the Manual Group showed statistically significant improvements on flexion-rotation test (p< 0.01 to p< 0.03), upper cervical extension (p< 0.01), overall right rotation (p< 0.05) and overall right (p< 0.01) and left (p< 0.01) side-bending.

CONCLUSION

In asymptomatic subjects with limited cervical mobility, pressure maintained suboccipital inhibition manual technique achieves further improvement on cervical range of motion than the technique using the Occipivot cushion.

Comparison of proprioceptive acuity of the cervical spine in healthy adults and adults with chronic non-specific low back pain: A cross-sectional study

Background

It has been suggested that patients with chronic non-specific low back pain (CNSLBP) perform poorly in postural tasks when compared to healthy individuals. Despite its importance in posture and alignment of the trunk in relation to the head, neck proprioception has not been examined in patients with low back pain. The purpose of this study was to compare neck proprioception in patients with CNSLBP with healthy individuals.

Methods

Cervical joint reposition error was measured five times consecutively in the neutral head position, 30° and 60° left and right head rotation. The main outcome measure was the mean cervical joint repositioning error of the head.

Results

Forty-six participants with (n = 24, 54 ± 16yrs SD, 14 females) and without (n = 22, 36 ± 13yrs SD, 13 females) CNSLBP were included in the study. Comparison of mean cervical joint repositioning error between patients and healthy controls showed no statistically significant group difference in any of the applied positions. The range of deviation in CNSLBP patients was between 1.57° and 3.27° compared to 1.46° to 2.26° in healthy controls. An overshooting tendency for both groups was found in the neutral head position.

Conclusion

The ability to accurately position the head does not seem to be impaired in patients with CNSLBP. This may suggest that sensorimotor control is affected on other levels of the movement system and future research should focus on methods to identify the source of these aberrations.

Seven cervical sensorimotor control tests measure different skills in individuals with chronic idiopathic neck pain

BACKGROUND

Sensorimotor control is commonly reported in neck pain research and rapidly gaining interest in clinical practice. Joint position error (conventional and torsion), postural balance, subjective visual vertical, head tilt response, The Fly®, smooth pursuit neck torsion and head steadiness are tests that have been reported to assess cervical sensorimotor control. However, it is unknown whether clinicians could use one test, or a test battery, to appropriately assess cervical sensorimotor control and improve efficiency. Our main research question is: Do seven cervical sensorimotor control tests measure unique or similar characteristics of sensorimotor control in individuals with chronic idiopathic neck pain?

METHODS

Principle components factor analysis. Data from seven cervical sensorimotor control tests of 50 participants with chronic idiopathic neck pain were included. Individual factors, potentially related to sensorimotor control, were determined by Eigen values >1.00 and inspection of a loading plot. Items with loadings ≥0.40 were considered satisfactory for inclusion in a factor.

RESULTS

All cervical sensorimotor control tests were found to measure unique skills. Four factors were isolated with two, postural balance and head steadiness, accounting for most of the variance across tests. The remaining two factors, continuous movement accuracy and perceived verticality, contributed less to the observed variance.

CONCLUSION

Postural balance and head steadiness were the major underlying factors explaining cervical sensorimotor control in the current sample. However, our results imply that all seven tests are independent and measure different skills. It is not possible to recommend a test battery for clinical practice, as all tests measure unique skills which appear to be independent of each other.

Patient's Subjective Impression of Cervical Range of Motion: A Mixed-methods Approach

STUDY DESIGN

Mixed-method.

OBJECTIVE

To evaluate the association between objective and subjective cervical range of motion (ROM) among patients with neck pain, and to assess the awareness of impairments.

SUMMARY OF BACKGROUND DATA

Cervical ROM is frequently used to evaluate neck pain, but it is also important to know what a patient expects from treatment, because this can profoundly affect treatment outcomes and patient satisfaction.

METHODS

We used a cervical ROM instrument, the Neck Disability Index (NDI), and a self-administered ROM questionnaire for the neck (S-ROM-Neck). Ten patients took part in semi-structured interviews. Correlations were analyzed using Spearman rank order correlations (rs). Differences between patient and assessor were evaluated by the Mann-Whitney U test. Qualitative data were analyzed by content analysis.

RESULTS

Thirty participants (mean age 43.80 years; 21 females) were included. The correlation (rs) for the S-ROM-Neck between patient and assessor was 0.679 [95% confidence interval (95% CI) 0.404-0.884; P = 0.000]. The correlation between the NDI and S-ROM-Neck was 0.178 (95% CI -0.233 to -0.533; P = 346) for the assessor and -0.116 (95% CI -0.475 to -0.219, P = 0.541) for the patient (U = 448, z = -0.030, P = 0.976). Qualitative analysis revealed that patients had general restrictions in daily life and with specific movements, but that they adjusted their behavior to avoid impairment.

CONCLUSION

There was a significant correlation between patient and therapist ratings of cervical spine mobility. Although patients experience restriction while moving and are impaired in specific activities, they adjust their lifestyle to accommodate their limitations.

LEVEL OF EVIDENCE

4.

Relationship Between Proprioception and Endurance Functionality of the Cervical Flexor Muscles in Chronic Neck Pain and Asymptomatic Participants

OBJECTIVE

The purpose of this study was to compare the relationship between flexion endurance capacity and joint position error in participants with or without chronic neck pain (CNP).

METHODS

Sixty-one CNP and 60 asymptomatic volunteers participated in this cross-sectional, case-control, and correlational analysis study. The measured variables included absolute and constant joint repositioning errors in the sagittal and horizontal directions, clinical flexor endurance test score, pain intensity, and neck disability index.

RESULTS

The groups did not statistically differ in flexion endurance (P > .05). The CNP group had a smaller absolute error on the right (P < .01) and left (P = .01) rotation and an overshooting error pattern in the flexion direction (P < .05). But the asymptomatic group did not exhibit any over-/undershooting pattern tendency (P > .05). Although flexion endurance was not correlated with any of the joint repositioning error components in either group, pain and disability scores were significantly correlated with left rotation absolute error (r = -0.34 and ρ = -0.37, respectively).

CONCLUSION

The clinical cervical flexor endurance test, ignoring the relative contribution of the deep and superficial groups of muscles, may not efficiently characterize CNP patients.

Reliability and Criterion Validity of the Smartphone Inclinometer Application to Quantify Cervical Spine Mobility

STUDY DESIGN

In this observational study, we compare fluid inclinometer and smartphone measures to analyze active cervical range of motion (ACROM) in healthy individuals.

OBJECTIVE

The purpose of this study was to investigate the reliability and the criterion validity of a smartphone application to analyze head movements.

SUMMARY OF BACKGROUND DATA

Recent studies on the reliability and the validity of customized smartphone applications to measure ACROM show good results for frontal and lateral planes' movement analysis, but poor results for the transverse plane. This can be due to the surrounding magnetic fields that affect the compass application used during head rotation valuation.

METHODS

Twenty-three individuals were asked to perform neck maximal (end-range) movements (frontal flex-extension and left-right side flexion in the sitting position, left-right rotation in the prone position). Two separate examiners took all ACROM measures and were assigned to each device (iPhone 5c and the inclinometer) contemporary for each individual.

RESULTS

All measurements were taken twice to assess the intraobserver reliability. Interobserver and intraobserver reliabilities were evaluated using the intraclass correlation coefficient (ICC). The criterion validity between the 2 instruments was also assessed in terms of the ICC. The procedures used in this investigation for measuring ACROM yielded good validity (Pearson r≥0.99 and ICC≥0.99) between the 2 instruments for all movements. The Bland and Altman's 95% LoA ranged from -1.8 to 1.15 degrees. Percentage error values ranged from 1% to 3%. The intrarater and the interrater reliabilities were good (ICC≥0.9) for both instruments in all movements including the rotation movements (ICC>0.95). The minimal detectable change (MDC95) ranged from 4 to 8 degrees.

CONCLUSIONS

This study confirms that the tested smartphone is valid and reliable to measure ACROM on the frontal and the sagittal planes; furthermore, it also demonstrates its usefulness for rotation movement analysis, using the inclinometric application.

Effectiveness of a specific manual approach to the suboccipital region in patients with chronic mechanical neck pain and rotation deficit in the upper cervical spine: study protocol for a randomized controlled trial

BACKGROUND

Mechanical neck pain is a highly prevalent problem in primary healthcare settings. Many of these patients have restricted mobility of the cervical spine. Several manual techniques have been recommended for restoring cervical mobility, but their effectiveness in these patients is unknown. The aim of the present study is to compare the effectiveness of two types of specific techniques of the upper neck region: the pressure maintained suboccipital inhibition technique (PMSIT) and the translatory dorsal glide mobilization (TDGM) C0-C1 technique, as adjuncts to a protocolized physiotherapy treatment of the neck region in subjects with chronic mechanical neck pain and rotation deficit in the upper cervical spine.

METHODS

A randomized, prospective, double-blind (patient and evaluator) clinical trial. The participants (n = 78) will be randomly distributed into three groups. The Control Group will receive a protocolized treatment for 3 weeks, the Mobilization Group will receive the same protocolized treatment and 6 sessions (2 per week) of the TDGM C0-C1 technique, and the Pressure Group will receive the same protocolized treatment and 6 sessions (2 per week) of the PMSIT technique. The intensity of pain (VAS), neck disability (NDI), the cervical range of motion (CROM), headache intensity (HIT-6) and the rating of clinical change (GROC scale) will be measured. The measurements will be performed at baseline, post-treatment and 3 months after the end of treatment, by the same physiotherapist blinded to the group assigned to the subject.

DISCUSSION

We believe that an approach including manual treatment to upper cervical dysfunction will be more effective in these patients. Furthermore, the PMSIT technique acts mostly on the musculature, while the TDGM technique acts on the joint. We expect to clarify which component is more effective in improving the upper cervical mobility.

TRIAL REGISTRATION

ClinicalTrials.gov NCT02832232 . Registered on July 13th, 2016.

Cervico-ocular Reflex Is Increased in People With Nonspecific Neck Pain

BACKGROUND

Neck pain is a widespread complaint. People experiencing neck pain often present an altered timing in contraction of cervical muscles. This altered afferent information elicits the cervico-ocular reflex (COR), which stabilizes the eye in response to trunk-to-head movements. The vestibulo-ocular reflex (VOR) elicited by the vestibulum is thought to be unaffected by afferent information from the cervical spine.

OBJECTIVE

The aim of the study was to measure the COR and VOR in people with nonspecific neck pain.

DESIGN

This study utilized a cross-sectional design in accordance with the STROBE statement.

METHODS

An infrared eye-tracking device was used to record the COR and the VOR while the participant was sitting on a rotating chair in darkness. Eye velocity was calculated by taking the derivative of the horizontal eye position. Parametric statistics were performed.

RESULTS

The mean COR gain in the control group (n=30) was 0.26 (SD=0.15) compared with 0.38 (SD=0.16) in the nonspecific neck pain group (n=37). Analyses of covariance were performed to analyze differences in COR and VOR gains, with age and sex as covariates. Analyses of covariance showed a significantly increased COR in participants with neck pain. The VOR between the control group, with a mean VOR of 0.67 (SD=0.17), and the nonspecific neck pain group, with a mean VOR of 0.66 (SD=0.22), was not significantly different.

LIMITATIONS

Measuring eye movements while the participant is sitting on a rotating chair in complete darkness is technically complicated.

CONCLUSIONS

This study suggests that people with nonspecific neck pain have an increased COR. The COR is an objective, nonvoluntary eye reflex and an unaltered VOR. This study shows that an increased COR is not restricted to patients with traumatic neck pain.

Evaluating the neck joint position sense error with a standard computer and a webcam

Joint Position Sense Error (JPSE) is a measure of cervical spine proprioception, and a simple method for measuring the JPSE could help in monitoring and evaluating the outcomes of rehabilitation of people with neck pain. In this study we demonstrate preliminary results of a method for measuring JPSE that does not require the participant to wear any equipment. Based on free publicly available head tracking software, compatible with any webcam, we developed a webpage which instructs the participant in performing a self-administered version of the test. The aim of this proof-of-concept study was to demonstrate the viability of this system. We compared our absolute error values (3.68 ± 1.2° after extension, 3.46 ± 1.66° after flexion, 3.89 ± 2.34° after rotation to the left and 4.02 ± 1.82°after rotation to the right) to values from literature, finding that our results do not differ from those of 6 out of 11 studies (which used more complex and expensive setups). The results indicate that our system allows assessment of the JPSE with a standard computer. Being based on a website, the system has potential for telemedicine use. Further research is required to validate the system before it can be recommended for use in clinical practice.

Mobile Phone-Based Joint Angle Measurement for Functional Assessment and Rehabilitation of Proprioception

Assessment of joint functional and proprioceptive abilities is essential for balance, posture, and motor control rehabilitation. Joint functional ability refers to the capacity of movement of the joint. It may be evaluated thereby measuring the joint range of motion (ROM). Proprioception can be defined as the perception of the position and of the movement of various body parts in space. Its role is essential in sensorimotor control for movement acuity, joint stability, coordination, and balance. Its clinical evaluation is commonly based on the assessment of the joint position sense (JPS). Both ROM and JPS measurements require estimating angles through goniometer, scoliometer, laser-pointer, and bubble or digital inclinometer. With the arrival of Smartphones, these costly clinical tools tend to be replaced. Beyond evaluation, maintaining and/or improving joint functional and proprioceptive abilities by training with physical therapy is important for long-term management. This review aims to report Smartphone applications used for measuring and improving functional and proprioceptive abilities. It identifies that Smartphone applications are reliable for clinical measurements and are mainly used to assess ROM and JPS. However, there is lack of studies on Smartphone applications which can be used in an autonomous way to provide physical therapy exercises at home.

Local Muscle Fatigue and 3D Kinematics of the Cervical Spine in Healthy Subjects

The authors aimed to further explore the effects of local muscle fatigue on cervical 3D kinematics and the interrelationship between these kinematic characteristics and local muscle endurance capacity in the unimpaired cervical spine. Twenty healthy subjects (38 ± 10 years; 5 women) performed 2 × 10 maximal cervical flexion-extension movements. Isometric muscle endurance tests (prone/supine lying) were applied between sets to induce local muscle fatigue quantified by Borg scale rates of perceived exertion (RPE) and slope in mean power frequency (MPF; surface electromyography; m. sternocleidomastoideus, m. splenius capitis). Cervical motion characteristics (maximal range of motion [ROM], coefficient of variation of the 10 repetitive movements, mean angular velocity, conjunct movements in transversal and frontal plane) were calculated from raw 3D ultrasonic movement data. Average isometric strength testing duration for flexion and extension correlated to the cervical ROM (r = .49/r = .48; p < .05). However, Student's t test demonstrated no significant alterations in any kinematic parameter following local muscle fatigue (p > .05). Although subjects' cervical muscle endurance capacity and motor output seems to be conjugated, no impact of local cervical muscle fatigue on motor function was shown. These findings underline the importance of complementary measures to address muscular performance and kinematic characteristics in outcome assessment and functional rehabilitation of the cervical spine.

Joint position sense error in people with neck pain: A systematic review

BACKGROUND

Several studies in recent decades have examined the relationship between proprioceptive deficits and neck pain. However, there is no uniform conclusion on the relationship between the two. Clinically, proprioception is evaluated using the Joint Position Sense Error (JPSE), which reflects a person's ability to accurately return his head to a predefined target after a cervical movement.

OBJECTIVES

We focused to differentiate between JPSE in people with neck pain compared to healthy controls.

STUDY DESIGN

Systematic review according to the PRISMA guidelines.

METHOD

Our data sources were Embase, Medline OvidSP, Web of Science, Cochrane Central, CINAHL and Pubmed Publisher. To be included, studies had to compare JPSE of the neck (O) in people with neck pain (P) with JPSE of the neck in healthy controls (C).

RESULTS/FINDINGS

Fourteen studies were included. Four studies reported that participants with traumatic neck pain had a significantly higher JPSE than healthy controls. Of the eight studies involving people with non-traumatic neck pain, four reported significant differences between the groups. The JPSE did not vary between neck-pain groups.

CONCLUSIONS

Current literature shows the JPSE to be a relevant measure when it is used correctly. All studies which calculated the JPSE over at least six trials showed a significantly increased JPSE in the neck pain group. This strongly suggests that 'number of repetitions' is a major element in correctly performing the JPSE test.