Relationships between sagittal postures of thoracic and cervical spine, presence of neck pain, neck pain severity and disability

Characteristics of head and neck alignment and function of deep cervical flexor muscles in patients with nonspecific neck pain

OBJECTIVES

The objectives were to compare forward head posture (FHP) in natural and corrected head postures between patients with nonspecific neck pain (NSNP) and controls and to clarify the relationship between natural and corrected head posture angle differences and deep cervical flexor function. This study aimed to provide useful evidence for postural assessment and treatment in patients with NSNP.

METHODS

In this cross-sectional study, 19 patients with NSNP reporting a pain score of 3-7 for at least 3 months and 19 participants with no neck pain within the previous 12 months were recruited. To evaluate FHP, the cranial rotation and vertical angles were measured using lateral head and neck photographs. The craniocervical flexion test was used to evaluate deep cervical flexor activation and endurance. We evaluated the head and neck alignment in natural and corrected head postures and the relationship between the degree of change and deep cervical flexor function.

RESULTS

FHP in the natural head posture did not differ between groups. In the corrected head posture, FHP was significantly smaller in the NSNP group than in the control group. In the NSNP group, the cranial rotation and vertical angles were significantly different between the natural and corrected head postures, and the angle difference correlated significantly with deep cervical flexor function.

CONCLUSIONS

Patients with NSNP show hypercorrection in the corrected head posture, which may be correlated with deep cervical flexor dysfunction. Further investigation into the causal relationship between hypercorrection, deep neck flexor dysfunction, and neck pain is required.

A comparison of neck and shoulder postures in symptomatic and asymptomatic female office workers in the actual work environment

Objective

The present study aimed to compare the static and dynamic sitting posture during computer work among symptomatic and asymptomatic office workers in actual work environment.

Methods

Seventy female office workers were divided into two groups: asymptomatic (n = 35) and symptomatic (n = 35). Subsequent to this classification, adjustments to their respective workstations were implemented in accordance with Occupational Safety and Health Administration (OSHA) guidelines. The assessment of neck (CV) and shoulder (FS) angles were conducted during both a typical seated posture and at intervals of 20 min over a duration of 3 h of computer work.

Result

The asymptomatic group had a range of age from 26 to 40 years, a BMI of 21.11 ± 2.14, and a working experience ranged from 1 to 16 years. In contrast, the symptomatic group had an age range from 24 to 40 years, a BMI of 21.12 ± 2.27, and a working experience ranged from 3 to 16 years. During static sitting posture, significant differences were observed in both CV (p = 0.01) and FS angles (p = 0.00) between the two groups. Additionally, during computer work sessions lasting for 3 h, a significant time effect (p = 0.00) was noted for the CV angle. Furthermore, the FS angle exhibited significant group (p = 0.00), time (p = 0.00), and interaction (p = 0.00) effects during work.

Conclusion

This study underscores the development of neck flexion during prolong working in both groups. In addition, asymptomatic group experienced a progression more rounded shoulder during a 3-h working period. Prolonged periods of sitting and computer use appear to have adverse effects on neck and shoulder health, underlining the importance of implementing measures to mitigate these effects.

Cervical muscle parameters and allodynia in migraine and cervical pain-A controlled study

BACKGROUND

Neck pain is common among individuals with migraine, but there is a lack of information of how this comorbidity can be associated with cervical muscle function. This controlled cross-sectional study aimed to compare cervical muscle function, activity, and sensitization in women with migraine, neck pain, both, and neither.

METHODS

This study included women, between 18 and 55 years old, with either episodic migraine with or without aura, without any concomitant headache diagnosis; chronic neck pain, with at least moderate intensity and mild disability; or neither headache nor neck pain. Pain pressure threshold, allodynia, muscle strength, and endurance and cervical muscles activity were evaluated.

RESULTS

One hundred subjects, with mean age of 30.4 years old, were stratified by diagnosis (n = 25 per group) and by self-reported pain during tests. Lower endurance during flexion was observed for migraine and neck pain (34s) relative to neck pain alone (45s), migraine (40s), and controls (58s) (p = 0.04). For extensor endurance, means were 142s, 166s, 215s, and 270s, respectively (p < 0.001). Endurance times were impacted by the presence of test-induced pain decreasing about 40%-53% of the performance. Diagnostic groups did not differ significantly in strength (p > 0.05), but all pain groups presented significantly higher proportion of test-induced pain, lower muscle activity during the maximal isometric voluntary contractions, and lower pressure pain thresholds.

CONCLUSION

Patients with migraine, chronic neck pain, and the association of both present altered cervical muscle function and activity. Also, test-induced pain impacts significantly on neck muscles endurance.

SIGNIFICANCE

The diagnosis of migraine and chronic neck pain is associated with altered function and activity of the cervical muscles. However, the test-induced pain had an important contribution to worse cervical muscle endurance. This suggests that the therapeutic approach should focus on de-sensitization of the trigeminal-cervical complex when dealing with the comorbidity of migraine and cervical pain.

Influence of sitting time on pulmonary function in computerusing office workers

PURPOSE

We aimed to identify the changes in pulmonary function after prolonged sitting. Pulmonary function tests (PFTs) allow physicians to assess the respiratory capability of patients under numerous clinical circumstances and when there are risk factors for lung sickness, occupational exposure, and pulmonary toxicity. PFTs are routinely performed in the standing or high sitting position because of the devices and patient comfort.

METHODS

A total of 180 asymptomatic office workers were recruited as eligibility criteria and divided into three groups according to their daily sitting duration (group 1:2-4 h, group 2:4-6 h, and group 3: > 6 h). PFTs were performed twice consecutively to determine the mean of the readings. A Helios 401 spirometer was used to quantify lung function. The parameters were "forced expiratory volume in 1 s (FEV1)", "forced vital capacity (FVC)", "peak expiratory flow rate (PEFR)", and the "ratio of FEV1 to FVC (FEV1/FVC)".

RESULTS

Our results suggest that noteworthy changes were present in the lung function of all the participants. For individuals with > 6 h of sitting; FVC, FEV1, and PEFR were higher compared to those of the participants with 2-4 h and 4-6 h of sitting. The FEV1/FVC ratio was also reduced in individuals with prolonged hours of sitting.

CONCLUSION

Body position impacts the result of PFTs; however, that as it may, the ideal position and extent of advantage changed between the review populaces. These results suggested that noteworthy changes occur in the lung function of healthy individuals exposed to sitting time.

Examining accuracy of and determining the best cutoff point for photographic-based postural angles to discriminate between slight and moderate-to-severe forward head posture

PURPOSE

To evaluate the accuracy of and determine the best cutoff point for craniovertebral angle (CVA) and forward shoulder angle (FSA) in discriminating between two groups of individuals with different severities of forward head posture (FHP).

METHODS

A sample of 90 subjects aged 20-50 who had different severities of FHP was recruited. Participants were categorized into two groups based on observational method, namely individuals with slight FHP and those with moderate-to-severe FHP. The CVA and FSA were assessed using the photographic device. The accuracy of these measures was determined by calculation of sensitivity, specificity, area under the receiver operating characteristic curve, likelihood ratio (LR), and predictive value (PV).

RESULTS

Our results show that CVA has high sensitivity (0.93) and acceptable area under the curve (0.88) in discriminating between the two groups of FHP (P < .01), but FSA cannot discriminate between the two groups of FHP (P = .06). The LR and PV results show that the CVA has a low negative LR (0.13) and a large negative PV (0.93). The best cutoff point for CVA was determined at 45.5 degrees.

CONCLUSION

Overall, the results of the present study showed that CVA has a good accuracy in discriminating between two groups of individuals with slight and moderate-to-severe FHP. It can be valuable in correctly identifying the slight FHP and screening the moderate and severe grades of the FHP. Researchers and clinicians can also use the optimal cutoff point for the CVA obtained in this study to accurately quantify and classify the severity of the FHP.

Influence of Spinal Sagittal Alignment in Sitting Posture on the Swallowing Speed of Older Adult Women: A Cross-Sectional Study

Thoracolumbar kyphosis in sitting posture is associated with forward head posture and may adversely affect swallowing function. However, few studies have investigated the effect of spinal alignment in the sitting posture on the swallowing function of older adults. This cross-sectional study aimed to investigate whether spinal alignment in the sitting posture influences the swallowing function of older adult women. Overall, 18 older adult women (mean age, 69.78 ± 3.66 years) without dysphagia were enrolled. Participants were positioned in two sitting postures, namely, comfortable sitting (CS) and thoracic upright sitting (TUS). In each sitting posture, the kyphosis index (using a flexicurve), sagittal angles (head, cervical, shoulder, and pelvic angles; using a digital camera), and cervical range of motion (ROM) were evaluated. Swallowing speed (100-mL water swallowing test), maximum tongue pressure (MTP), and oral diadochokinesis (ODK) were also evaluated. Compared with TUS, CS showed a greater kyphosis index, anterior head translation, and posterior pelvic tilt. CS had greater flexion (p < 0.001) and less extension (p < 0.001) of cervical ROM than TUS. Swallowing speed was significantly decreased in CS compared with TUS (p = 0.008). MTP and ODK were not significantly different between CS and TUS. Thus, changes in sitting posture with spinal alignment may affect swallowing speed. Consequently, adjustments to reduce sitting postural kyphosis in older adult women may improve swallowing speed.

Automated non-contact measurement of the spine curvature at the sagittal plane using a deep neural network

BACKGROUND

Non-radiographical techniques have been suggested to measure the spine curvature at the sagittal plane. However, a neural network has not been used to measure the curvature.

METHODS

A single video camera captured images of a standing posture at the sagittal plane from twenty healthy males. Six marker positions along the spine's contour in each image were identified for measuring inclination, thoracic kyphosis, and lumbar lordosis angles. We estimated three inflection points around the neck, hip, and between the neck and hip, followed by identifying two adjacent marker positions per inflection point to compute its tangent. The angular deviation of each tangent line from the horizontal was computed to measure inclination angles. Thoracic kyphosis and lumbar lordosis angles were computed by the angular difference between the two adjacent tangents. A deep neural network was trained with 500,000 iterations using the labeled images from 18 participants (388 and 44 images for training and test set) and then evaluated using the unseen images (2 participants, 48 images; evaluation set).

FINDINGS

The mean total training and test errors were <2 pixels (∼ 0.6 cm). The total error in the evaluation set was qualitatively comparable (∼ 3 pixels = ∼ 0.9 cm), suggesting the model performance was maintained in the unseen data. The angle values between labeled and network-predicted marker positions were similar in the evaluation set.

INTERPRETATION

The network training with a relatively small number of images was successful based on the small error values observed in the evaluation set. The model may be an affordable, automated, and non-contact measurement tool for the human spine curvature.

Evaluation of forward head posture and thoracic kyphosis in migraine

BACKGROUND

The purpose of the current study was to investigate the forward head posture (FHP), thoracic kyphosis and their relationships between individuals with migraine and healthy controls using the DIERS Formetric 4D motion imaging system.

METHODS

In this observational case-control study, a total of 39 migraine patients and 44 healthy subjects were enrolled. FHP and thoracic kyphosis were assessed by using the 4D Formetric DIERS system. The visual analogue scale (VAS) and Neck Disability Index (NDI) was used to evaluate neck pain and neck disability. Headache status were evaluated through Migraine Disability Assessment (MIDAS) and Numeric Pain Rating Scale (NPRS) questionnaires.

RESULTS

The fleche cervicale (57.72 ± 13.72 mm vs. 40.00 ± 4.75 mm; p < 0.001) and kyphotic angle (57.39 ± 8.76° vs. 38.21 ± 5.67°; p < 0.001) were significantly higher in patients with migraine compared to control group. When NDI categories were compared, the migraine group showed significantly increase in the number of patients with moderate or severe disability (p < 0.001). A positive correlation was found between fleche cervicale and thoracic kyphosis (r = 0.71, p < 0.001).

CONCLUSIONS

This study revealed that patients with migraine exhibited a greater FHP and thoracic kyphosis compared to the control group. A 3-dimensional objective measurement may be a reliable diagnostic tool to evaluate posture analysis in clinical practice in the future.

Are Rotations and Translations of Head Posture Related to Gait and Jump Parameters?

This study assessed the relationship between head posture displacements and biomechanical parameters during gait and jumping. One hundred male and female students (20 ± 3 yrs) were assessed via the PostureScreen Mobile® app to quantify postural displacements of head rotations and translations including: (1) the cranio-vertebral angle (CVA) (°), (2) anterior head translation (AHT) (cm), (3) lateral head translation in the coronal plane (cm), and (4) lateral head side bending (°). Biomechanical parameters during gait and jumping were measured using the G-Walk sensor. The assessed gait spatiotemporal parameters were cadence (steps/min), speed (m/s), symmetry index, % left and right stride length (% height), and right and left propulsion index. The pelvic movement parameters were (1) tilt symmetry index, (2) tilt left and right range, (3) obliquity symmetry index, (4) obliquity left and right range, (5) rotation symmetry index, and (6) rotation left and right range. The jump parameters measured were (1) flight height (cm), (2) take off force (kN), (3) impact Force (kN), (4) take off speed (m/s), (5) peak speed (m/s), (6) average speed concentric phase (m/s), (7) maximum concentric power (kW), (8) average concentric power (kW) during the counter movement jump (CMJ), and (9) CMJ with arms thrust (CMJAT). At a significance level of p ≤ 0.001, moderate-to-high correlations (0.4 < r < 0.8) were found between CVA, AHT, lateral translation head, and all the gait and jump parameters. Weak correlations (0.2 < r < 0.4) were ascertained for lateral head bending and all the gait and jump parameters except for gait symmetry index and pelvic symmetry index, where moderate correlations were identified (0.4 < r < 0.6). The findings indicate moderate-to-high correlations between specific head posture displacements, such as CVA, lateral head translation and AHT with the various gait and jump parameters. These findings highlight the importance of considering head posture in the assessment and optimization of movement patterns during gait and jumping. Our findings contribute to the existing body of knowledge and may have implications for clinical practice and sports performance training. Further research is warranted to elucidate the underlying mechanisms and establish causality in these relationships, which could potentially lead to the development of targeted interventions for improving movement patterns and preventing injuries.

Severity of slouched posture during smartphone use is associated with the musculoskeletal discomfort, daily usage, and school year among adolescents

Real-time measurement of the craniovertebral, thoracic kyphosis, and lumbar lordosis angles during natural and smartphone usage postures in sitting were analysed in a cohort of 560 adolescents using independent t-tests and Spearman's correlations between their reported musculoskeletal symptoms, daily device use and school year. Students with musculoskeletal symptoms (mean difference: 4.1-9.4°, p < .001) and in secondary schools (mean difference: 13.6-29.4°, p < .001) had a greater forward-head posture quantified by craniovertebral angle in both postures. Loss of lumbar lordosis was found in students spending ≥2 h/day on electronic devices (mean difference: 3.2°, p = .029) and those with musculoskeletal symptoms (mean difference: 5.4°, p = .001). Secondary school students exhibited a greater thoracic kyphosis when using smartphones (mean difference: 3.3°, p = .003). Findings suggest the urgent need for early and proactive intervention targeted to minimise the risk of developing musculoskeletal disorders related to intense device use for young adolescents.Practitioner Summary: Adolescents: (1) in higher school year had increased forward-head posture (FHP) and thoracic kyphosis; (2) with musculoskeletal symptoms had increased FHP and loss of lumbar lordosis, and; (3) with extended device use had a loss of lumbar lordosis. Early intervention targeting young adolescents promoting optimal posture and habit of device use is warranted.

Clinimetric properties of a smartphone application to measure the craniovertebral angle in different age groups and positions

Background

Craniovertebral angle (CVA) alteration is a causative factor for the neck, shoulder, and temporomandibular joints disorders. Therefore, as an outcome measure for therapeutic intervention, measuring the craniovertebral angle with the Surgimap smartphone app is a cost-effective, easily accessible, and reliable tool. This study's objective was to assess the clinimetric properties of the Surgimap smartphone application with Surgimap system software to measure the Craniovertebral Angle in different age groups and positions.

Method

Ninety subjects with neck pain were randomly allocated to aged between 18 and 30 years (Group A; n = 45) and 45-60 years (Group B; n = 45). Using the Surgimap smartphone application and Surgimap system software, the craniovertebral angle was measured objectively in the sagittal plane. Intraclass correlation coefficients were used to determine validity and reliability. Receiver operating characteristic (ROC) curves and the area under the curves (AUC) were determined to distinguish participants with and without forward head posture.

Result

The result of this study shows that Smartphone Surgimap Application and Surgimap System Software correlate 0.95 and have p-values of 0.01 for diverse positions and ages. CVA measurement in the sitting position was significantly lower than in the standing position, regardless of methodology or age. Both positions demonstrated high intra-rater reliability, as evidenced by Intraclass Correlation Coefficients (ICC) between 0.972 and 0.991. The minimum detectable change (MDC) values ranged from 1.3 to 1.733, indicating high measurement accuracy. The smartphone application demonstrated outstanding diagnostic sensitivity (100.00% for Group A standing) and specificity (93.55% for Group B standing).

Conclusion

The Surgimap smartphone application is a reliable and accurate method for craniovertebral angle measurement and is useful for measuring outcomes. Also standing posture was found to be better than sitting posture while measuring the CVA.

Impact of physical activity levels on the ability to maintain static trunk posture in older adults

PROPOSE

to assess the impact of physical activity (PA) levels on sitting posture in the older adults.

METHODS

One hundred and twenty individuals were divided into three groups according their PA levels: vigorous group (VG); moderate group (MG); low group (LG). The ability to maintain static trunk posture in sitting position as assessed based on the cervical angle (CA) and thoracic angle (TA) was measured.

RESULTS

There were no significant differences between measurements in CA for the VG. However, LG and MG participants exhibited a significant decrease in CA from minute 1 to 10 and from minute 2 to 10, respectively. In the thoracic region, only the MG exhibited significant differences in TA from minute 2 to 10 compared to minute 1 (p < 0.05). No significant differences were found in TA between measurements for either VG or LG.

CONCLUSIONS

PA has a high impact on the ability to maintain static trunk posture in the older adults.

Is Thoracic Kyphosis Relevant to Pain, Autonomic Nervous System Function, Disability, and Cervical Sensorimotor Control in Patients with Chronic Nonspecific Neck Pain?

There is great interest in thoracic kyphosis, as it is thought to be a contributor to neck pain, neck disability, and sensorimotor control measures; however, this has not been completely investigated in treatment or case control studies. This case control design investigated participants with non-specific chronic neck pain. Eighty participants with a defined hyper-kyphosis (>55°) were compared to eighty matched participants with normal thoracic kyphosis (<55°). Participants were matched for age and neck pain duration. Hyper-kyphosis was further categorized into two distinct types: postural kyphosis (PK) and Scheuermann's kyphosis (SK). Posture measures included formetric thoracic kyphosis and the craniovertebral angle (CVA) to assess forward head posture. Sensorimotor control was assessed by the following measures: smooth pursuit neck torsion test (SPNT), overall stability index (OSI), and left and right rotation repositioning accuracy. A measure of autonomic nervous system function included the amplitude and latency of skin sympathetic response (SSR). Differences in variable measures were examined using the Student's t-test to compare the means of continuous variables between the two groups. One-way ANOVA was used to compare mean values in the three groups: postural kyphosis, Scheuermann's kyphosis, and normal kyphosis group. Pearson correlation was used to evaluate the relationship between participant's thoracic kyphosis magnitude (in each group separately and as an entire population) and their CVA, SPNT, OSI, head repositioning accuracy, and SSR latency and amplitude. Hyper-kyphosis participants had a significantly greater neck disability index compared to the normal kyphosis group (p < 0.001) with the SK group having greatest disability (p < 0.001). Statistically significant differences between the two kyphosis groups and the normal kyphosis group for all the sensorimotor measured variables were identified with the SK group having the most decreased efficiency of the measures in the hyper-kyphosis group, including: SPNT, OSI, and left and right rotation repositioning accuracy. In addition, there was a significant difference in neurophysiological findings for SSR amplitude (entire sample of kyphosis vs. normal kyphosis, p < 0.001), but there was no significant difference for SSR latency (p = 0.07). The CVA was significantly greater in the hyper-kyphosis group (p < 0.001). The magnitude of the thoracic kyphosis correlated with worsening CVA (with the SK group having the smallest CVA; p < 0.001) and the magnitude of the decreased efficiency of the sensorimotor control measures and the amplitude and latency of the SSR. The PK group, overall, showed the greatest correlations between thoracic kyphosis and measured variables. Participants with hyper-thoracic kyphosis exhibited abnormal sensorimotor control and autonomic nervous system dysfunction compared to those with normal thoracic kyphosis.

It Is Time for a Multidisciplinary Rehabilitation Approach: A Scoping Review on Stomatognathic Diseases in Neurological Disorders

Patients affected by neurological disorders can develop stomatognathic diseases (SD) related to decreased bite force and quality of mastication, bruxism, severe clicking and other temporomandibular disorders (TMD), which deeply affect patients' swallowing, masticatory and phonation functions and, therefore, their quality of life. The diagnosis is commonly based on medical history and physical examination, paying attention to the temporomandibular joint (TMJ) range of movements, jaw sounds and mandibular lateral deviation. Diagnostic tools such as computed tomography and magnetic resonance imaging are used instead in case of equivocal findings in the anamnesis and physical evaluation. However, stomatognathic and temporomandibular functional training has not been commonly adopted in hospital settings as part of formal neurorehabilitation. This review is aimed at describing the most frequent pathophysiological patterns of SD and TMD in patients affected by neurological disorders and their rehabilitative approach, giving some clinical suggestions about their conservative treatment. We have searched and reviewed evidence published in PubMed, Google Scholar, Scopus and Cochrane Library between 2010 and 2023. After a thorough screening, we have selected ten studies referring to pathophysiological patterns of SD/TMD and the conservative rehabilitative approach in neurological disorders. Given this, the current literature is still poor and unclear about the administration of these kinds of complementary and rehabilitative approaches in neurological patients suffering from SD and/or TMD.

Effect of Spinal Sagittal Alignment in Sitting Posture on Swallowing Function in Healthy Adult Women: A Cross-Sectional Study

Swallowing function is both directly and indirectly related to postures, such as head and cervical angle and body position. However, the effects of different sitting postures on oropharyngeal swallowing have not been investigated. This study aimed to investigate whether the change in thoracolumbar alignment affected the oropharyngeal swallowing. A total of 58 healthy adult women (mean age 22.2 ± 1.67 years) without dysphagia were enrolled in this cross-sectional study. Participants were positioned in three sitting postures: comfortable sitting (CS), thoracic upright sitting (TUS), and slump sitting (SS). In each sitting posture, the kyphosis index (using a flexicurve), head and cervical angles (using a digital camera), swallowing speed (100-ml water swallowing test), and oral and articulatory function [by maximum tongue pressure (MTP) and oral diadochokinesis (ODK)] were evaluated. SS showed the largest kyphosis index and was associated with a greater anterior translation of the head. Swallowing speed was significantly decreased in SS compared with CS (p = 0.002) and TUS (p = 0.020) and ODK was significantly decreased in SS compared with other postures, for both /ta/ (p = 0.004) and /ka/ (p < 0.001) syllables. Further, MTP tended to decrease in SS compared with TUS (p = 0.064). Our results suggest that changes in sitting posture with different thoracolumbar alignments affect swallowing speed and oral and articulatory function. Consequently, adjustments to reduce sitting postural kyphosis may improve swallowing speed and oral and articulatory function.

Relationships between cervical sagittal posture, muscle endurance, joint position sense, range of motion and level of smartphone addiction

BACKGROUND

Frequent smartphone use in a pathological way forces the user to adopt a compromised posture. This gradually results in changes to both the postural and musculoskeletal systems. This study's objectives were evaluation of head posture, muscle endurance, neck range of motion (ROM) and joint position sense in two separate smartphone user groups, one 'Addicted', the other 'Non-Addicted'.

METHODS

A sample of convenience (n = 60) was recruited from medical students (age 24.57 ± 4.38, 53.3% male) with a history of smartphones use > 2 h/day for 1-year. Based on the cut-off values of the smartphone addiction scale-short version (SAS-SV), participants were entered into each group (cut-off for male ≥ 31, female ≥ 33). Neck muscle endurance time, joint position error and cervical ROM, along with forward head posture parameters of craniovertebral angle (CVA), shoulder angle (SA), sagittal head angle (SHA) and forward head distance (FHD)) were evaluated. A Mann-Whitney test and Spearman correlation coefficient were used to determine the difference between groups and the correlations between variables.

RESULTS

The difference between 'Addicted' and 'Non-Addicted' groups was confirmed by the values for SAS-SV scores (25.23 ± 5.5 versus 43.9 ± 6.61) (p < 0.001). There were statistically significant differences between groups for the CVA and FHD parameters (p < 0.001). Further, the neck extensor muscle endurance (97 ± 3.79 versus 74.86 ± 2.23 s), was significantly different between groups (p = 0.010) but not after Bonferroni correction. There was no notable difference in the neck flexor muscle endurance, joint position error, SA, and SHA parameters between groups (p > 0.05).

CONCLUSIONS

There is a positive correlation between smartphone addiction and both decreased extensor muscle endurance and changes in neck postural alignment.

Is Neck Pain Related to Sagittal Head and Neck Posture?: A Systematic Review and Meta-analysis

Background

Neck pain (NP) is common in all age groups and adversely affects the patients' entire lifestyle. There exists inconclusive evidence relating faulty craniocervical posture with pain-related disability. This review aims to determine whether sagittal head and neck posture differs in NP and pain-free subjects, to critically appraise the correlation of posture with NP.

Methods

Of 3796 articles identified at primary search from CINAHL, PubMed, Google Scholar, EMBASE, 26 were included based on eligibility criteria. Mean pooled difference (MPD) and effect size (ES) were calculated to establish relationship among studies, to assess postural correlation with NP measures [Visual Analogue Scale (VAS), Numeric Pain Rating Scale (NPRS), neck disability index (NDI), Northwick Park NP Questionnaire (NPQ)] and for age- and gender-wise variation. Risk of bias was assessed using Newcastle-Ottawa Quality Assessment Scale.

Results

Craniovertebral angle (CVA) had a significant MPD of - 2.93(95% CI - 4.95 to - 0.91). Sagittal head angle (SHA) and forward head posture (FHP) had an insignificant MPD of 1.15 (95% CI - 1.16 to 3.46) and - 0.26 (95% CI - 1.89 to 1.36), respectively. Age- and gender-wise CVA difference was found to be 2.36° and 2.57°, respectively. ES was significant for correlation between CVA and pain intensity [NPRS: - 0.44 (95% CI - 0.61 to - 0.26); VAS: - 0.31 (95% CI - 0.46 to - 0.16)], and between CVA and disability [NDI: - 0.18 (95% CI - 0.31 to - 0.05); NPQ: - 0.47 (95% CI - 0.61 to - 0.320)].

Conclusion

CVA differs for age, gender, and pain vs pain-free subjects, and correlates negatively with NP measures. Other surrogate measures (SHA, cranial and cervical angles, FHP) warrant further research.

PROSPERO Registration

PROSPERO 2021 CRD42021275485.

Suboccipital Muscles, Forward Head Posture, and Cervicogenic Dizziness

Dizziness or vertigo can be caused by dysfunction of the vestibular or non-vestibular systems. The diagnosis, treatment, and mechanism of dizziness or vertigo caused by vestibular dysfunction have been described in detail. However, dizziness by the non-vestibular system, especially cervicogenic dizziness, is not well known. This paper explained the cervicogenic dizziness caused by abnormal sensory input with references to several studies. Among head and neck muscles, suboccipital muscles act as stabilizers and controllers of the head. Structural and functional changes of the suboccipital muscles can induce dizziness. Especially, myodural bridges and activation of trigger point stimulated by abnormal head posture may be associated with cervicogenic dizziness.

Reduction of Thoracic Hyper-Kyphosis Improves Short and Long Term Outcomes in Patients with Chronic Nonspecific Neck Pain: A Randomized Controlled Trial

This study investigates thoracic hyper kyphosis (THK) rehabilitation using the Denneroll™ thoracic traction orthosis (DTTO). Eighty participants, with chronic non-specific neck pain (CNSNP) and THK were randomly assigned to the control or intervention group (IG). Both groups received the multimodal program; IG received the DTTO. Outcomes included formetric thoracic kyphotic angle ICT—ITL, neck pain and disability (NDI), head repositioning accuracy (HRA), smooth pursuit neck torsion test (SPNT) and overall stability index (OSI). Measures were assessed at baseline, after 30 treatment sessions over the course of 10 weeks, and 1-year after cessation of treatment. After 10 weeks, the IG improved more in neck pain intensity (p < 0.0001) and NDI (p < 0.001). No differences were found for SPNT (p = 0.48) and left-sided HRA (p = 0.3). IG improved greater for OSI (p = 0.047) and right sided HRA (p = 0.02). Only the IG improved in THK (p < 0.001). At 1-year follow-up, a regression back to baseline values for the control group was found for pain and disability such that all outcomes favored improvement in the IG receiving the DTTO; all outcomes (p < 0.001). The addition of the DTTO to a multimodal program positively affected CNSNP outcomes at both the short and 1-year follow-up.

Does Improvement towards a Normal Cervical Sagittal Configuration Aid in the Management of Lumbosacral Radiculopathy: A Randomized Controlled Trial

A randomized controlled study with a six-month follow-up was conducted to investigate the effects of sagittal head posture correction on 3D spinal posture parameters, back and leg pain, disability, and S1 nerve root function in patients with chronic discogenic lumbosacral radiculopathy (CDLR). Participants included 80 (35 female) patients between 40 and 55 years experiencing CDLR with a definite hypolordotic cervical spine and forward head posture (FHP) and were randomly assigned a comparative treatment control group and a study group. Both groups received TENS therapy and hot packs, additionally, the study group received the Denneroll cervical traction orthotic. Interventions were applied at a frequency of 3 x per week for 10 weeks and groups were followed for an additional 6-months. Radiographic measures included cervical lordosis (CL) from C2–C7 and FHP; postural measurements included: lumbar lordosis, thoracic kyphosis, trunk inclination, lateral deviation, trunk imbalance, surface rotation, and pelvic inclination. Leg and back pain scores, Oswestry Disability Index (ODI), and H-reflex latency and amplitude were measured. Statistically significant differences between the groups at 10 weeks were found: for all postural measures, CL (p = 0.001), AHT (p = 0.002), H-reflex amplitude (p = 0.007) and latency (p = 0.001). No significant difference for back pain (p = 0.2), leg pain (p = 0.1) and ODI (p = 0.6) at 10 weeks were identified. Only the study group’s improvements were maintained at the 6-month follow up while the control groups values regressed back to baseline. At the 6-month follow-up, it was identified in the study group that improved cervical lordosis and reduction of FHP were found to have a positive impact on 3D posture parameters, leg and back pain scores, ODI, and H-reflex latency and amplitude.

Hyperkyphosis among the Elderly in a Community: A Descriptive Cross-sectional Study

Introduction

Aging brings progressive changes in the physiology of the musculoskeletal system that leads to postural changes and degenerative diseases in elderly. The most common postural change is hyperkyphosis which decreases physical performance, ability to perform daily activities, overall quality of life, and increases the risk of falls in elderly. The aim of the study was to find out the prevalence of hyperkyphosis among the elderly in a community.

Methods

A descriptive cross-sectional study was done in a local community from 26 May 2019 to 8 June 2019 after obtaining ethical approval from the Institutional Review Committee (Protocol approval number: 138/19). Participants above 60 years of age were included in the study. Convenience sampling was done. A bubble inclinometer was used to measure the degree of kyphosis. Point estimate and 95% Confidence Interval were calculated.

Results

Among 144 elderly participants, hyperkyphosis was present in 90 (62.50%) (54.59-70.41, 95% Confidence Interval) with the mean hyperkyphosis being 47.07±4.83˚. The elderly in the age group of 70-75 years had a higher degree of hyperkyphosis with a mean value of 47.77±4.92˚. The mean hyperkyphosis was 48.18±5.30˚ and 45.31±3.36˚ in female and male participants respectively.

Conclusions

The prevalence of hyperkyphosis was found to be higher in our study compared to other studies conducted in similar settings. Early identification and interventions of hyperkyphosis are thus warranted to prevent the detrimental consequences in the later stages of life.

Keywords

aging; hyperkyphosis; posture.

Evaluating Differences Between Participants With Various Forward Head Posture With and Without Postural Neck Pain Using Craniovertebral Angle and Forward Shoulder Angle

OBJECTIVE

The purpose of this study was to investigate differences between individuals with various forward head posture (FHP) severities with and without postural neck pain using craniovertebral angle and forward shoulder angle.

METHOD

Ninety participants age 20 to 50 years were categorized into the following 4 groups based on observational method and presence or absence of postural neck pain: (1) slight FHP group without pain, (2) slight FHP group with pain, (3) moderate-to-severe FHP group without pain, and (4) moderate-to-severe FHP group with pain. A digital imaging technique was used to measure the craniovertebral angle and forward shoulder angle in a standing position.

RESULTS

A 1-way analysis of variance test showed a significant difference for craniovertebral angle in the 4 groups (F = 22.04, P < .001). Tukey's test showed the difference in this variable was significant between slight FHP groups (with or without pain) and moderate-to-severe FHP groups (with or without pain) (P < .001). Although overall F indicated a significant difference (F = 4.11, P < .009) of the forward shoulder angle in 4 groups, Tukey's test revealed this was only significantly different in 2 groups: slight FHP with pain and moderate-to-severe FHP with pain (P = .005).

CONCLUSION

The craniovertebral angle in the 2 groups of moderate-to-severe FHP was significantly smaller than that in the 2 groups of slight FHP. However, the forward shoulder angle in the group of moderate-to-severe FHP with pain was only significantly smaller than that in slight FHP with pain. The results showed that including pain as a factor of categorization did not lead to a significant difference between various groups regarding craniovertebral angle and forward shoulder angle.

A Single-Center Study Comparing the Effects of Thoracic Spine Manipulation vs Mobility Exercises in 26 Office Workers with Chronic Neck Pain: A Randomized Controlled Clinical Study

Background

Neck pain is associated with computer work, poor posture, imbalanced neck muscles, and fatigue, particularly in office workers. This study from a single center aimed to compare the effects of thoracic spine mobility exercise and thoracic spine manipulation to improve cervical spine range of motion in 26 office workers who had chronic neck pain for more than 12 weeks.

Material/Methods

The participants were 26 office workers with neck pain lasting >12 weeks. These participants were randomly assigned to undergo TSME (n=13) or TSM (n=13). Both groups underwent cervical joint mobilization and deep cervical flexor muscle exercises for 25 min a day, twice weekly, for 6 weeks. The TSME group additionally performed TSME 15 min a day, twice a week, for 6 weeks, while the TSM group received TSM 2 times a day, twice a week, for 6 weeks. Cervical and thoracic spine ROM, numeric pain rating scale (NPRS), and neck disability index (NDI) were measured before and after interventions. The ROM of cervical and thoracic spine was measured using a dual inclinometer.

Results

Both groups showed significant changes in cervical spine ROM, thoracic spine ROM, NPRS, and NDI after intervention compared to before intervention (P<0.05). Cervical spine right lateral flexion and right rotation differed significantly between the groups (P<0.05), while thoracic spine ROM, NPRS, and NDI did not.

Conclusions

TSME and TSM have similar effects in improving pain and disability in office workers with non-specific chronic neck pain.

Senthil Nathan, G. Mohan Kumar. Efficacy of physiotherapy intervention on craniovertebral and craniohorizontal angle using on protractor mobile app and neck muscle strength in chronic nonspecific neck pain

Introduction and Aim: The chronic nonspecific neck pain is common in all age groups since it is non-specific it may be due to any reasons right from school children to elderly. Factors like muscle strain, worn joints, nerve compression, poor posture, neck pain are found to reduce the cervical angle. The aim of the study is to find the efficacy of physiotherapy intervention on craniovertebral angle, craniohorizontal angle, neck muscle strength and hand grip in subjects with chronic nonspecific neck pain.   Materials and Methods: The subjects with chronic nonspecific neck pain (n=30) were selected randomly from the physiotherapy outpatient department of ACS medical college and hospital as per inclusion criteria and divided into two groups. The pre-test and post-test measurements of craniovertebral and craniohorizontal angles, craniovertebral angle were measured using on protractor mobile app. The neck muscle strength was measured using modified dial sphygmomanometer and hand grip was measured using hand held dynamometer. Group A received craniocervical flexion exercise and group B received stretching and strengthening for a period of 12 weeks. Post test was conducted after 12 weeks.   Results: The comparison within Group A and Group B pre- and post-test values in both groups showed highly significant difference in mean values at P ? 0.001, but group A which has a higher mean value is more effective in craniovertebral angle, craniohorizontal angle, neck muscle strength (Flexor and Extensor) and hand grip.   Conclusion: The craniocervical flexion exercise given to chronic nonspecific neck pain patients was found to reduce neck pain by improving the neck muscle strength, hand grip strength and by correcting the craniocervical and craniohorizontal angles.

The effects of neck, core, and combined stabilization practices on pain, disability, and improvement of the neck range of motion in elderly with chronic non-specific neck pain

BACKGROUND: Chronic non-specific neck pain is the most prevalent neck pain with notable impacts on the quality of life in the elderly. OBJECTIVE: The impacts of the neck, core, and combined stabilization practices on pain, disability, and improvement of the neck range of motion in the elderly with chronic non-specific neck pain were examined. METHOD: A quasi-experimental (open label) study was carried out through a cluster sampling in two phases in Tehran-Iran in 2017. Totally, 102 patients were randomly allocated to three groups of specific neck stabilization, specific core stabilization, and combined practices through envelope method. The intervention took 12 weeks. To measure the severity of pain and neck disability, the visual analog scale (VAS), neck disability index (NDI), and neck pain and disability scale (NPDS) was used. A goniometer was used to measure the range of the motion. To examine data, used SPSS (v.20). RESULT: The results, confirmed a significant decrease in pain over the time in the three therapeutic groups (p = 0.000). In addition, there was a significant difference between neck, core, and combined stabilization groups. Moreover, there was a significant increase in the angle of motion in all treatment groups with different treatment duration (P = 0.000). The highest increase in the angle of motion was after 12 weeks of practice in right lateral flexion (RLF) (p = 0.000). CONCLUSION: Twelve sessions of the neck, core, and combined stabilization practices can alleviate the pain and improve the strength in the elderly with chronic non-specific neck pain. In addition, compared to two other methods, the combined method was a more efficient way to improve the range of motion in patients.

Assessment of the head, cervical spine, thoracic spine and shoulder girdle postures in people with and without chronic headache

Background/Aims

Cervical dysfunction is one of the common symptoms of chronic headaches. This study was conducted to assess the posture of the head, cervical and thoracic spine and the shoulder girdle in people with and without cervicogenic and migraine headaches.

Methods

The postural angles of the head, cervical and thoracic spine and the shoulder girdle in frontal and sagittal planes, as well as thoracic spine curvature, were measured on 90 people who were split into three groups: 20 people with cervicogenic headache, 20 people with migraine and 50 people as the control group.

Results

There were significant differences among the three groups in the craniovertebral angle, coronal head tilt angle and scapular upward rotation angle (P<0.05). There was no relationship between postural angles.

Conclusions

The results of this study revealed that forward head posture was evident in people with cervicogenic and migraine headache. Decreased scapular upward rotation seen in the migraine headache group highlights the importance of shoulder girdle-related dysfunctions in people with chronic headaches.

Short-term effects of postural taping on pain and forward head posture: a randomized controlled trial

Background

Balance Body Tape (BBT) is a recently developed taping-method with the aim to reduce pain and improve posture through change in movement behavior. However, the potential effects of a treatment with BBT are scarcely documented. Therefore, the aim with this study was to investigate the effect of a three-week Balance body tape-treatment on the intensity of perceived neck, shoulder and back pain and forward head posture.

Methods

In this RCT study, subjects (n = 26), who reported being university students or having a sedentary work and experiencing pain in neck, back or shoulders, were randomized to either an intervention (n = 12) or control group (n = 14). The intervention group received a three-week treatment with BBT, the control group received no treatment. A questionnaire regarding pain, including a Numeric Rating Scale (NRS) measuring pain intensity, and a Photographic posture analysis measurement (PPAM) regarding the craniovertebral (CV) angle were assessed before and after the intervention for both groups. Wilcoxon’s signed rank test and Mann-Whitney U test was used to assess intra- and between group differences respectively. The relationship between pain intensity and CV angle was assessed using Spearman’s correlation.

Results

No difference in demographic and physical characteristics between the groups were noted at baseline (p > 0.05). Pain intensity at baseline was 5 for the intervention group and 4 for the control group (p = 0.330). At follow up, the intervention group reported a lower score (NRS = 2.5, p = 0.003) whereas the control group had no significant difference in pain intensity (NRS = 3, p = 0.086). No significant change was found in the CV angle (p = 0.058) and no correlation was found between NRS and the CV angle (r = 0.102, p = 0.619).

Conclusion

A short treatment period with BBT may, compared to no treatment, have a small reducing effect on pain intensity in neck, back and/or shoulders. However, no effect was found on forward head posture in this study.

Trial registration

Registered retrospectively on 08/11/2021. NCT05111704.

Trial registration page link:

Personalised gravitational loading of the cervical spine from biplanar X-rays for asymptomatic and clinical subjects in neutral standing position

BACKGROUND

As a leading cause of disability with a high societal and economic cost, it is crucial to better understand risk factors of neck pain and surgical complications. Getting subject-specific external loading is essential for quantifying muscle forces and joint loads but it requires exertion trials and load cells which are uncommon in clinical settings.

METHODS

This paper presents a method to compute the gravitational loading at four levels of the cervical spine (C3C4, C4C5, C5C6, C6C7) in neutral standing position from biplanar radiographs exclusively. The resulting load was decomposed in local disc frames and its components were used to compare different populations: 118 asymptomatic subjects and 46 patients before and after surgery (anterior cervical discectomy and fusion or total disc replacement). Comparisons were performed at C6C7 and the upper level adjacent to surgery.

FINDINGS

Significant changes in gravitational loading were observed with age in healthy subjects as well as in patients after surgery and have been associated with changes in posture.

INTERPRETATION

This approach quantifies the influence of postural changes on gravitational loading on the cervical spine. It represents a simple way to obtain necessary input for muscle force quantification models in clinical routine and to use them for patient evaluation. The study of the subsequent subject-specific spinal loading could help further the understanding of cervical spine biomechanics, degeneration mechanisms and complications following surgery.

A Systematic Review and Synthesis of Psychometric Properties of the Numeric Pain Rating Scale and the Visual Analog Scale for Use in People With Neck Pain

OBJECTIVES

To conduct a systematic search and synthesis of evidence about the measurement properties of the Numeric Pain Rating Scale (NPRS) and the Visual Analog Scale (VAS) as patient-reported outcome measures in neck pain research.

METHODS AND MATERIALS

CINAHL, Embase, PsychInfo, and MedLine databases were searched to identify studies evaluating the psychometric properties of the NPRS and the VAS used in samples of which >50% of participants were people with neck pain. Quality and consistency of findings were synthesized to arrive at recommendations.

RESULTS

A total of 46 manuscripts were included. Syntheses indicated high-to-moderate-quality evidence of good-to-excellent (intraclass correlation coefficient 0.58 to 0.93) test-retest reliability over an interval of 7 hours to 4 weeks. Moderate evidence of a clinically important difference of 1.5 to 2.5 points was found, while minimum detectable change ranged from 2.6 to 4.1 points. Moderate evidence of a moderate association (r=0.48 to 0.54) between the NPRS or VAS and the Neck Disability Index. Findings from other patient-reported outcomes indicated stronger associations with ratings of physical function than emotional status. There is limited research addressing the extent that these measures reflect outcomes that are important to patients.

DISCUSSION

It is clear NPRS and the VAS ratings are feasible to implement, provide reliable scores and relate to multi-item patient-reported outcome measures. Responsiveness (meaningful change) of the scales and interpretation of change scores requires further refinement. The NPRS can be a useful single-item assessment complimenting more comprehensive multi-item patient-reported outcome measures in neck pain research and practice.

Effect of Different Exercise Types on the Cross-Sectional Area and Lumbar Lordosis Angle in Patients with Flat Back Syndrome

Flat back syndrome (FBS) is a sagittal imbalance wherein the normal spinal curvature is reduced. This study aimed to compare the effects of different exercise programs on the cross-sectional area (CSA) of the lumbar muscles, lumbar lordosis angle (LLA), lumbar disability, and flexibility in patients with FBS. Thirty-six females with flexible FBS were randomly allocated to the corrective exercise group (CEG, n = 12), resistance exercise group (REG, n = 12), and physical therapy group (PTG, n = 12). CEG and REG patients participated in a 12-week exercise intervention for 60 min three times per week. The CSA, LLA, Oswestry disability index (ODI), and sit-and-reach test were measured before and after intervention. CSA showed a significant difference between groups (p < 0.01), with CEG and REG demonstrating a significant increase (p < 0.05 and p < 0.05, respectively). LLA showed a significant difference between groups (p < 0.001); CEG showed a higher increase than did REG (p < 0.01) and PTG (p < 0.001). ODI also showed a significant difference between groups (p < 0.001), being lower in CEG than in REG (p < 0.001) and PTG (p < 0.001). Lumbar flexibility significantly improved in all groups, albeit with a significant difference (p < 0.001). Although corrective and resistance exercise programs effectively improve these parameters, corrective exercise is superior to other interventions for patients with FBS.

Evidence for the Effectiveness of Feedback from Wearable Inertial Sensors during Work-Related Activities: A Scoping Review

Background: Wearable inertial sensor technology (WIST) systems provide feedback, aiming to modify aberrant postures and movements. The literature on the effects of feedback from WIST during work or work-related activities has not been previously summarised. This review examines the effectiveness of feedback on upper body kinematics during work or work-related activities, along with the wearability and a quantification of the kinematics of the related device. Methods: The Cinahl, Cochrane, Embase, Medline, Scopus, Sportdiscus and Google Scholar databases were searched, including reports from January 2005 to July 2021. The included studies were summarised descriptively and the evidence was assessed. Results: Fourteen included studies demonstrated a 'limited' level of evidence supporting posture and/or movement behaviour improvements using WIST feedback, with no improvements in pain. One study assessed wearability and another two investigated comfort. Studies used tri-axial accelerometers or IMU integration (n = 5 studies). Visual and/or vibrotactile feedback was mostly used. Most studies had a risk of bias, lacked detail for methodological reproducibility and displayed inconsistent reporting of sensor technology, with validation provided only in one study. Thus, we have proposed a minimum 'Technology and Design Checklist' for reporting. Conclusions: Our findings suggest that WIST may improve posture, though not pain; however, the quality of the studies limits the strength of this conclusion. Wearability evaluations are needed for the translation of WIST outcomes. Minimum reporting standards for WIST should be followed to ensure methodological reproducibility.

Text neck: An adverse postural phenomenon

BACKGROUND

The excessive use of hand-held mobile devices (HHMD) leads to a postural phenomenon known as text neck.

OBJECTIVE

The aim of this paper is to discuss the anatomical, biomechanical and muscle activation changes within the cervical and thoracic regions associated with the sustained, forward, flexed neck posture, observed with excessive usage of hand-held mobile devices. Additionally, this paper examines the relationship of gender, as well as the effects of carrying backpack loads by youth, on this forward, flexed neck posture.

METHODS

Multiple aspects of the text neck position that occur when an individual uses a HHMD are described.

RESULTS

Prolonged use of hand-held mobile devices results in adverse anatomical and biomechanical changes in the cervical and thoracic spine, muscular imbalances, and postural compensations, all of which contribute to muscular overuse and fatigue resulting in pain.

CONCLUSIONS

Physical therapists must educate their patients about proper posture while using hand-held mobile devices. Proper posture includes: holding the device close to eye level, using the device while standing or sitting and holding the device with a line of sight perpendicular to the surface of the device, using a larger screen, and texting with both hands. Also, because children are using hand held mobile devices at younger ages, parents and teachers must be educated about the dangers of prolonged use of hand-held devices.

Test - re-test reliability and concurrent validity of cervical active range of motion in young asymptomatic adults using a new inertial measurement unit device

OBJECTIVES

Cervical range of motion (CROM) is one of the first things evaluated in cervical disorders. DyCare-Lynx is an inertial measurement unit device that was recently designed to measure CROM. Therefore, the objectives of the present study were to test the reliability and validity of the DyCare-Lynx device for active CROM.

MATERIALS AND METHODS

This study included 36 healthy individuals for the reliability study and 31 individuals for the validity study. Test-retest reliability was examined in three different days, by the same examiner with a 4 ± 1-day interval between them in all cervical movements in random order. For validity, the CROM was tested with the Zebris Motion Analysis system and DyCare-Lynx simultaneously.

RESULTS

The interclass correlation coefficient (ICC) of the DyCare-Lynx ranged from 0.54 to 0.90. The standard error of measurement (SEM) ranged from 2.12°-7.65°. The smallest detectable change (SDD) ranged from 11.25% to 29.75%. The Pearson's r correlation of DyCare-Lynx with Zebris ranged from 0.655 to 0.957.

CONCLUSION

DyCare-Lynx showed moderate to excellent reliability and moderate-to-high validity. Moreover, SEM was low with acceptable SDD values for all movements. Overall, it can be suggested that DyCare-Lynx is a reliable and valid tool to evaluate active CROM.

Analysis of neck and back muscle activity during the application of various pillow designs in patients with forward head posture

BACKGROUND

There are currently no reports of biomechanical changes in patients with forward head posture (FHP) that result in altered muscle activation throughout various functions with muscle activation response during diverse sleep postures.

OBJECTIVE

This study investigated neck and back muscle activity in individuals with and without FHP during a maintained side-sleeping position by incorporating various pillow designs.

METHODS

Thirty-four participants (i.e., 17 in each group) were enrolled. The muscle activity was investigated via surface electromyography during the use of three trial pillows: orthopedic pillow, hollow pillow, and Thai neck support pillow.

RESULTS

With the application of all three trial pillow, the FHP group demonstrated significantly greater middle-lower trapezius muscle activity than the normal head posture group (p< 0.05). Sternocleidomastoid and upper trapezius (UT) muscle activity were similar between the two groups (p> 0.05). Only UT muscle activity was affected by variations in pillow design. In the normal group, no difference was observed in the muscle activity between all three pillows (p> 0.05).

CONCLUSIONS

Feasibly, the ability to appropriately modify a pillow configuration without creating undesired muscle activation was limited to those exhibiting FHP. Therefore, specially designed pillows or mattresses should be investigated in terms of their relevance to muscle fatigue and potential musculoskeletal pain in FHP patients.

Influence of neck flexion angle on gravitational moment and neck muscle activity when using a smartphone while standing

This study compares the effects of different neck flexion angles on neck gravitational moment and muscle activity of users that stand and operate a smartphone. Thirty-two healthy young adult smartphone users performed texting tasks for three minutes at four different neck flexion angles (0°, 15°, 30°, and 45°) while standing. Neck gravitational moment and cervical erector spinae (CES) and upper trapezius (UT) activity were investigated. When the neck flexion angle increased, the gravitational moment of the neck increased significantly. The muscle activity of CES significantly increased when the neck flexion angle increased, whereas that of UT decreased. The lowest gravitational moment of the neck at 0° flexion was consistent with the lowest CES muscle activity and the lowest neck discomfort score. In conclusion, for texting while standing, adults should maintain their neck posture at 0° flexion to reduce the gravitational force acting on the cervical spine and alleviate neck discomfort. Practitioner Summary: During smartphone use when standing, excessive neck flexion (30° and 45° flexion) should be avoided. The suggested neck posture when operating a smartphone while standing is 0° flexion. Abbreviations: CES: cervical erector spinae; UT: upper trapezius; COG: centre of gravity; MSDs: musculoskeletal disorders; CROM: cervical range of motion; sEMG: surface electromyography; VAS: visual analogue scale; MVCs: maximum voluntary contractions.

Cervicothoracic spinal alignment and neck flexor muscle endurance in young and older adult females with and without neck and shoulder pain (Katakori in Japanese)

[Purpose] The characteristics of neck and shoulder pain (NSP) in different age populations have not been sufficiently examined. Therefore, the purpose of this study was to compare and verify the cervicothoracic spinal alignment and neck flexor muscle endurance of young and older adult females with and without NSP. [Participants and Methods] We assessed 72 female participants (39 young participants, 33 elderly participants, 43 NSP, 29 non-NSP) aged 18–82 years who were recruited for this study. Cervicothoracic spinal alignment measurements were obtained with forward head alignment (FHA) along with the upper thoracic angle. The neck flexor endurance test was performed. [Results] There were no significant age-by-group interactions for any of the assessment variables. However, the upper thoracic angle and neck flexor muscle endurance showed significant effects in the groups. Age also had significant effects on FHA and upper thoracic angle. [Conclusion] These results suggested that the neck flexor muscle endurance was more appropriate as an evaluation tool for older adult females with NSP. It was also suggested that the cervical flexor muscle endurance and upper thoracic angle were more appropriate as evaluation tools for young adult females with NSP.

Craniocervical flexion performance in computer users: An observational study

Study aim: To compare the performance of deep cervical flexors (DCF) among computer users (CU) and non-users using the craniocervical flexion test (CCFT).

Material and methods: Eighty nine computer users and 100 non-users were recruited for evaluation of their craniocervical muscle performance. The activation score and performance index were assessed using the CCFT. Comparison of craniocervical flexor performance between the two groups was evaluated using the Mann Whitney test. A Chi-Square test was used to test the association between age, years of work and craniocervical flexion. Significance was set at p ≤ 0.05.

Results: The median activation score was lower among computer users (median pressure-24 mmHg as compared to non-users (median pressure-28 mmHg) (p < 0.01). The performance index among computer users was lower when compared to non-users. Also, age (p < 0.001) and the years of work experience (p = 0.006) were associated with the DCF performance.

Conclusion: CU have lower activation and endurance of the DCF compared to non-users. The endurance of the DCF was associated with the age and years of computer usage.

Effects of exercise on cervical muscle strength and cross-sectional area in patients with thoracic hyperkyphosis and chronic cervical pain

There is a lack of studies comparing the effects of different exercise types in patients with thoracic hyperkyphosis. Twenty-four subjects were divided into three groups: corrective exercise, resistance exercise, and physical therapy. The groups performed their respective interventions, two times per week for three months. Clinical outcomes, including the value of Cobb's angle, cervical muscle strength and endurance, and the cross-sectional area of the cervical deep muscles were measured pre- and post-intervention. There was a significant difference in the changes in the thoracic Cobb's angle between the groups (P < 0.001). The corrective exercise group revealed a significantly superior increase in muscle strength and endurance between pre- and post-intervention (P < 0.012). There was a significant difference in the cross-sectional area of the cervical deep muscles included longus capitis and multifidus between the groups (P < 0.036 and 0.007, respectively). The corrective exercise group showed the most significant increase in cross-sectional area between pre- and post-intervention (P < 0.012). A corrective exercise program is a more effective intervention than traditional resistance exercise and physical therapy for improving the thoracic Cobb's angle, cervical muscle strength and endurance, and the cross-sectional area of the deep muscles in patients with thoracic hyperkyphosis.Trial registration: KCT0005292.

An investigation of 3D spinal alignment in cervicogenic headache

BACKGROUND

There is a growing interest in the impact of body posture influences on outcome measures of cervicogenic headache (CGH).

OBJECTIVE

To evaluate differences in the 3D spinal alignment in cases suffering from chronic CGH compared to a group of strictly matched control participants without CGH.

DESIGN

A single-blinded, comparative cohort design.

METHODS

100 participants suffering from frequent headaches for at least 3 months who fulfilled the CHISG criteria for CGH were match by age and sex to 100 asymptomatic control group participants. A 4D Formetric device was used to assess participants' posture variables of: 1) thoracic kyphosis max (ICT-ITL in degrees); 2) trunk lateral imbalance (VP-DM in mm); 3) Trunk anterior inclination (VP-DM in mm); 4) lumbar lordotic angle (ITL-ILS max in degrees); 5) Vertebral rotation (rms) in degrees. A matched-pairs binary logistic regression was used to determine whether measurements of posture demonstrated an association with the likelihood of the presence of CGH.

RESULTS

There were statistically significant differences between the CGH and control group for all posture variables indicating larger posture displacements in the CGH group: ICT-ITL (p < .001), Lateral VP-DM (p < .001), Sagittal VP-DM (p < .001), ITL-ILS (p < .001), RMS (p < .001). Logistic regression revealed that as posture displacement increased, a statistically significant increased likelihood of having CGH occurred: (ICT-ITL (max) (p < .001); Trunk imbalance VP-DM (p < .004); Trunk inclination VP-DM (p < .001); and vertebral rotation (RMS) (p = .007). No such relationship was found for Lumbar Lordosis ITL-ILS max.

CONCLUSIONS

Participants with CGH exhibited increased magnitudes of thoracolumbar posture displacements which corresponded to an increased odds of suffering from CGH compared to matched control participants.

Prolonged sitting and physical inactivity are associated with limited hip extension: A cross-sectional study

BACKGROUND

It is possible that physical inactivity and prolonged sitting could lead to changes in muscle properties or bony limitations which may reduce passive hip extension.

OBJECTIVES

This study explored the association between passive hip extension and sitting/physical activity patterns.

DESIGN

Cross sectional study.

METHOD

The modified Thomas Test is a clinical test used to characterise hip flexion contracture. This test was used to measure passive hip extension across 144 individuals. In addition, sitting behaviours and physical activity patterns were quantified using the Global Physical Activity Questionnaire. Cut off points were defined for low/high physical activity (150 min per week), prolonged sitting (>7 h per day) and minimal sitting (<4 h per day). ANOVA testing was then used to compare passive hip extension between three groups, defined using the specified thresholds: low activity & prolonged sitting, high activity & minimal sitting and high activity & prolonged sitting.

RESULTS

A total of 98 participants were allocated to one of the three groups which were shown to differ significantly in passive hip extension (P < 0.001). Importantly, there was 6.1° more passive hip extension in the high activity & minimal sitting group when compared to the low activity & prolonged sitting group.

CONCLUSION

This study is the first to demonstrate an association between passive hip extension and prolonged sitting/physical inactivity. It is possible that these findings indicate a physiological adaptation in passive muscle stiffness. Further research is required to understand whether such adaptation may play a role in the aetiology of musculoskeletal pain linked to prolonged sitting.

Craniocervical Posture Assessed With Photogrammetry and the Accuracy of Palpation Methods for Locating the Seventh Cervical Spinous Process: A Cross-sectional Study

OBJECTIVE

The purpose of this study was to compare craniocervical posture assessed by photogrammetry using 2 distinct palpation methods for locating the spinous process of the seventh cervical vertebra (C7SP).

METHODS

This cross-sectional study was conducted in 2 phases. In phase I (n = 42), the assessor's accuracy in locating the C7SP using the flexion-extension and the modified thorax-rib static methods was compared to radiography. In phase II (n = 68), the craniocervical posture was analyzed with photogrammetry after palpation using the 2 methods. Neck pain intensity and disability were also determined.

RESULTS

The accuracy in locating the C7SP was higher using the modified thorax-rib static method (67%, 95% confidence interval [CI], 55-79) compared to the flexion-extension method (38%, 95% CI, 26-50, P = .016). Lower values of the craniocervical angle were obtained with the flexion-extension method than the modified thorax-rib static method (mean difference = -1.1°, 95% CI, -1.6 to -0.6, P < .001). However, both palpation methods resulted in similar classifications of participants as with or without forward head posture (P = .096). Weak correlations were observed between the craniocervical angle and neck pain intensity (ρ = -0.088 and -0.099, respectively) and disability (ρ = -0.231 and -0.249, respectively).

CONCLUSION

Craniocervical angles obtained using palpation methods with different accuracies were different, although the magnitude of the difference was insufficient to lead to different classifications of a forward head posture in adults with mild neck pain and disability. Craniocervical posture was weakly correlated with neck-pain intensity and disability.

The relationship between smartphone addiction and musculoskeletal pain prevalence among young population: a cross-sectional study

Background

In the literature, there have been debates as to whether smartphone use has negative effects on physical and mental health. The present study investigated the extent to which smartphone addiction impacts on musculoskeletal pain prevalence among university students.

Methods

The questionnaire consisted of three sections demographic information, the Smartphone Addiction Scale (SAS), and the modified Nordic Musculoskeletal Questionnaire.

Results

A total of 249 participants were included in this cross-sectional study. The body parts that were reported with highest prevalence of musculoskeletal pain were the upper back (70.3%), neck (65.9%), and wrists/hands (68.7%). The SAS scores were correlated with duration of smartphone use on a typical day (P = 0.001), duration of owning a smartphone (P = 0.027), and musculoskeletal pain prevalence in the neck (P = 0.001), wrists/hands (P = 0.001), shoulders (P = 0.025), and upper back (P = 0.023). The SAS score was significantly associated with prevalence of musculoskeletal pain in the neck (odd ratio [OR], 1.08; 95% confidence interval [CI], 0.98-1.10; P = 0.002), wrists/hands (OR, 1.07; 95% CI, 0.97-1.09; P = 0.001), and upper back (OR, 1.10; 95% CI, 0.98-1.11; P = 0.033).

Conclusions

The findings indicated that the upper back, neck, and wrists/hands have a higher prevalence of musculoskeletal pain among smartphone users, particularly those with a smartphone addiction. Smartphone addiction scores were correlated with duration of smartphone use on a typical day, duration of owning smartphone, and musculoskeletal pain prevalence in the neck, wrists/hands, shoulders, and upper back.

Influence of Forward Head Posture on Cervicocephalic Kinesthesia and Electromyographic Activity of Neck Musculature in Asymptomatic Individuals

OBJECTIVE

The purpose of this study was to compare cervicocephalic kinesthesia and electromyographic (EMG) activity of neck muscles-upper trapezius (UT) and sternocleidomastoid (SCM)-between individuals with and without forward head posture (FHP) and to examine the correlation between cervicocephalic kinesthesia and craniovertebral angle (CVA).

METHODS

Twenty-two asymptomatic individuals with FHP and 22 without FHP were recruited for the present study. Craniovertebral angle was measured, and those with CVA ≤53° were assigned to the FHP group, whereas those with CVA >53° were assigned to the control group. Thereafter, cervicocephalic kinesthesia and EMG activity of the neck muscles were assessed. Cervicocephalic kinesthesia was measured using a head repositioning accuracy test for all cervical spine motions. EMG activity of the UT and SCM muscles was recorded at rest and during activity.

RESULTS

Position-sense error values were found to be significantly greater for all directions-ie, flexion, extension, side flexion, and rotation-in participants with FHP than those without (P < .05). EMG activity of the UT and SCM muscles was found to be significantly raised both at rest and during activity in individuals with FHP relative to the non-FHP group (P < .05). Position-sense error values showed a significant inverse correlation with CVA (P < .05).

CONCLUSION

Findings of the present study suggest that cervicocephalic kinesthesia and activation patterns of the neck muscles may be significantly altered in individuals with FHP. Also, cervicocephalic kinesthesia is significantly associated with the severity of FHP.

Neck pain associated with smartphone overuse: cross-sectional report of a cohort study among office workers

PURPOSE

The aim of the current study was to investigate the extent of smartphone use, possible correlation with neck pain and/or psychological impairment in office workers.

METHOD

A convenience sample of 1,602 office workers who were using smartphone for prolonged periods (≥ 4 years) participated in a cross-sectional report of a cohort study, assessing demographic, abnormal symptoms of pain in the neck, physical activity, and psychological behavior characteristics. Participants were assessed using a short version of the Smartphone Addiction Scale (SAS-SV), Depression, Anxiety and Stress Scales (DASS-42) questionnaire, as well as International Physical Activity Questionnaire-Short Form (IPAQ-SF). Multiple logistic regression model was conducted to evaluate the adjusted effect of smartphone overuse on nuchal symptoms.

RESULTS

The prevalence of neck pain among the office workers was 30.1%. Significantly more female (33.3% vs. 24.5%) and younger (42.2 vs. 43.2 years) employees reported to have neck pain. Overall in 326 (20.3%, 95% CI: 18.4%-22.4%) of studied subjects had, SAS score ≥ 31 and ≥ 33 for male and females, respectively, and so smartphone overuse (SO) was diagnosed. The results of multiple logistic regression model revealed that those with SO were approximately 6 times more likely to have neck pain (95% CI: 4.44-8.09, P < 0.001).

CONCLUSIONS

Smartphone overuse in office workers significantly increases the chance of neck pain by 6 times. Hence SO has been associated with, not only somatic complaints, but also psychological distress such as anxiety, stress, and depression. This may necessitate adherence to neck-school, when smartphone use is associated with neck pain.

Psychometric Proprieties of a Mobile Application to Measure the Craniovertebral Angle a Validation and Reliability Study

The aim of this study was to assess the psychometric properties of the mobile application forward head posture in terms of validity, inter- and intra-rater reliability, minimum detectable change, sensitivity, and specificity to measure craniovertebral angle. In total, 44 subjects (mean age 23.30 ± 4.44 years) were evaluated in the standing position with markers on the tragus and cutaneous prominence of seventh cervical vertebra (C7). We had two experienced and trained physiotherapists assess cervical posture using the mobile application forward head posture and photogrammetry. Intraclass correlation coefficients were used to determine validity and reliability. A contingency table was made to determine sensitivity and specificity. Intra-rater reliability of the mobile application forward head posture had an intraclass correlation coefficient of 0.88. The inter-rater reliability generated an intraclass correlation coefficient of 0.83 to 0.89. Criterion validity data were above 0.82. The minimum detectable change was 4.96° for intra-rater and 5.52° for inter-rater reliability. The smartphone application exhibited 94.4% sensitivity and 84.6% specificity. The smartphone application forward head posture is a valid and reliable tool to measure craniovertebral angle in a standing position and, therefore, could be a useful assessment tool in clinical practice.

Immediate effects of cervicothoracic junction mobilization versus thoracic manipulation on the range of motion and pain in mechanical neck pain with cervicothoracic junction dysfunction: a pilot randomized controlled trial

Background

Cervicothoracic (CT) junction hypomobility has been proposed as a contributing factor for neck pain. However, there are limited studies that compared the effect of CT junction mobilization against an effective intervention in neck pain. Thoracic spine manipulation is a nonspecific intervention for neck pain where remote spinal segments are treated based on the concept of regional interdependence. The effectiveness of segment-specific spinal mobilization in the cervical spine has been researched in the last few years, and no definite conclusions could be made from the previous studies. The above reasons warrant the investigation of the effects of a specific CT junction mobilization against a nonspecific thoracic manipulation intervention in neck pain. The present study aims to compare the immediate effects of C7-T1 Maitland mobilization with thoracic manipulation in individuals with mechanical neck pain presenting with CT junction dysfunction specifically.

Methods

A randomized clinical trial is conducted where participants with complaints of mechanical neck pain and CT junction dysfunction randomly assigned to either C7-T1 level Maitland mobilization group or mid-thoracic (T3-T6) manipulation group (active control group). In both the groups, the post graduate student (SJ) pursuing Master’s in orthopedic physiotherapy delivered the intervention. The outcomes of cervical flexion, extension, side flexion & rotation range of motion (ROM) were measured before & after the intervention with a cervical range of motion (CROM) device. Self-reported pain intensity was measured with the numerical pain rating scale (NPRS). The post-intervention between-group comparison was performed using a one-way ANCOVA test.

Results

Forty-two participants with mean age CT junction group: 35.14 ± 10.13 and Thoracic manipulation group: 38.47 ± 11.47 were recruited for the study. No significant differences in the post-intervention baseline adjusted outcomes of cervical ROM & self-reported pain intensity were identified between the groups after the treatment (p = 0.08, 0.95, 0.01, 0.39, 0.29, 0.27for flexion, extension, bilateral lateral flexion & rotations respectively) & neck pain intensity (p = 0.68). However, within-group, pre, and post comparison showed significant improvements in cervical ROM and pain in both groups.

Conclusion

This preliminary study identified that CT junction mobilization is not superior to thoracic manipulation on the outcomes of cervical ROM and neck pain when level-specific CT junction mobilization was compared with remote mid-thoracic manipulation in individuals with mechanical neck pain and CT junction dysfunction.

Trial registration

CTRI: 2018/04/013088, Registered 6 April 2018, http://ctri.nic.in/Clinicaltrials/pmaindet2.php?trialid=24418

Effect of a Spinomed orthosis on balance performance, spinal alignment, joint position sense and back muscle endurance in elderly people with hyperkyphotic posture: A randomized controlled trial

BACKGROUND

Hyperkyphosis may cause balance impairment in elderly people. Although the effectiveness of orthoses for improving balance in hyperkyphotic elderly people has received much attention, the mechanisms by which devices affect balance remain unknown.

OBJECTIVES

The objective of this study was to evaluate changes in balance performance, thoracic kyphosis angle, craniovertebral angle, back muscle endurance and joint position sense after 3 months of wearing a Spinomed orthosis. The study also included a secondary exploratory analysis to determine whether changes in any of the above-mentioned outcome measures can predict balance performance improvement in elderly people with hyperkyphosis.

STUDY DESIGN

Parallel group randomized controlled trial.

METHODS

In total, 44 hyperkyphotic elderly people were randomly allocated to an experimental group, who wore a Spinomed orthosis and a control group, who did not. No other treatment or change in physical activity was permitted during the study. A blinded assessor evaluated thoracic kyphosis angle, joint position sense, craniovertebral angle, back muscle endurance, Timed Up and Go Test time and Berg Balance Scale score at baseline and after 5, 9 and 13 weeks. All dependent variables were measured without the orthosis and analyzed separately using a 2 × 4 (time × group) mixed model analysis of variance. Based on the results of correlation analysis, thoracic kyphosis angle, back muscle endurance and joint position sense were selected as independent variables in a stepwise multiple regression model.

RESULTS

The two-way (group × time) interactions were significant in terms of Berg Balance Scale (F = 11.6, P ⩽ 0.001, ηp2=0.59), Timed Up and Go Test (F = 3.74, P = 0.013, ηp2=0.46), thoracic kyphosis angle (F = 43.39, P ⩽ 0.001, ηp2=0.96), craniovertebral angle (F = 5.245, P = 0.002, ηp2=0.59) and joint position sense (F = 4.44, P = 0.005, [Formula: see text]). The two-way interaction was not significant in terms of back muscle endurance; however, the main effect of group was significant for this variable (F = 3.85, P = 0.025). Stepwise multiple regression showed that thoracic kyphosis angle and joint position sense were significant determinants of Timed Up and Go Test time (R² = 0.155, P = 0.037 and R² = 0.292, P = 0.012, respectively).

CONCLUSION

Wearing a Spinomed orthosis for 3 months improved the posture, position sense and muscle performance of hyperkyphotic elderly people. Orthoses may improve balance performance by correcting spinal alignment and increasing proprioceptive information.

Joint position error after neck protraction-retraction movements in healthy office workers: a cross-sectional study

Since the upper cervical spine (UCS) has been regarded to be distinct from the lower cervical spine (LCS), joint position error (JPE) needs to be tested separately for both regions. The purpose of this study was to investigate the JPE after cervical protraction/retraction movements, involving opposite movements of extension and flexion for the UCS and LCS. These movements are frequently performed during office work. Cervical JPEs were tracked in thirty healthy office workers while performing four tests of cervical pro-retraction movements with variations in vision and movement direction, and assessed using the Kinect head tracker (Microsoft Corp), placed in front of each participant. The JPE was expressed in constant (CE), absolute (AE) and variable errors (VE). Multilevel linear models evaluated main and interaction effects of vision, movement direction, cervical region and sex. Slightly larger JPEs have been found in the UCS. Vision showed no effect on any outcome variable. No effect exceeded typical measurement errors reported for the Kinect head tracker. This study showed, that JPEs after pro-retraction movements of the head and neck may differ for UCS and LCS. The differences were small and not beyond measurement error reported for the Kinect.

Can C7 Slope Be Used as a Substitute for T1 Slope? A Radiographic Analysis

STUDY DESIGN

Retrospective radiographic study.

OBJECTIVES

T1 slope is an important parameter of sagittal spinal balance. However, the T1 superior endplate can be difficult to visualize on radiographs due to overlying anatomical structures. C7 slope has been proposed as a potential substitute for T1 slope when the T1 superior endplate is not well visualized. The objective of this study was 2-fold: (1) to assess the correlation between C7 and T1 slopes on upright cervical spine radiographs and (2) to evaluate the interrater reliability of C7 slope.

METHODS

Cervical spine radiographs taken between December 2017 and June 2018 at a single institution were reviewed. Two observers measured upper C7 slope, lower C7 slope, and T1 slope. The correlations between upper and lower C7 slope and T1 slope were evaluated, and linear regression analyses were performed. Interrater reliability of C7 slope was also assessed.

RESULTS

In this cohort of 152 patients, there was a strong correlation between upper C7 slope and T1 slope (r = 0.91, P < .001), as well as between lower C7 slope and T1 slope (r = 0.90, P < .001). T1 slope could be estimated from the linear regression equation, T1 slope = 0.87 × C7 slope + 7, with an overall model fit of R ² = 0.8. There was strong interrater reliability for upper (intraclass correlation coefficient [ICC] = 0.95, P < .001) and lower C7 slope (ICC = 0.96, P < .001).

CONCLUSIONS

Both the upper and lower C7 slope are strongly correlated with T1 slope and can be used as a substitute to estimate T1 slope when the superior endplate of T1 is not well visualized.

Differences of Spinal Curvature, Thoracic Mobility, and Respiratory Strength Between Chronic Neck Pain Patients and People Without Cervical Pain

OBJECTIVE

To investigate the differences of spinal curvature, thoracic sagittal mobility, and respiratory strength between patients with chronic neck pain (CNP) and people without cervical pain, and to determine the correlation between respiratory strength and thoracic mobility in CNP patients.

METHODS

A total of 78 participants were finally included in this study, of whom 30 had no cervical pain and 48 had CNP. The Neck Disability Index (NDI), cervical lordotic curvature, thoracic kyphotic curvature, thoracic sagittal range of motion (ROM), maximal inspiratory pressure (MIP), and maximal expiratory pressure (MEP) were measured and analyzed.

RESULTS

In males, thoracic sagittal ROMMEP-MIP and MEP showed a significant difference between the no cervical pain group and the CNP group. In females, thoracic kyphotic curvature, thoracic sagittal ROMMEP-MIP, MIP, and MEP were significantly different between the no cervical pain group and the CNP group. Thoracic kyphotic curvature was significantly correlated with MEP and MIP in all population groups, and significantly correlated with NDI in the female group. Thoracic sagittal ROMMEP-MIP had a significant linear relationship with NDI, MEP, and MIP in all population groups.

CONCLUSION

The thoracic mobility during forced respiration was reduced in patients with CNP and was correlated with respiratory strength. Changes in the biomechanics of the cervicothoracic spine and rib cage due to CNP may contribute to impairment of respiratory strength.