Differences in the kinematics of the cervical and thoracic spine during functional movement in individuals with or without chronic neck pain: a systematic review

Association between clinical biomechanical metrics of cervical spine function and pain or disability in people with neuromusculoskeletal neck pain: Protocol for a systematic review and planned meta-analysis

INTRODUCTION/BACKGROUND

Neck pain is a burdensome condition associated with pain, disability, and economic cost. Neck pain has been associated with observable changes in neuromuscular function and biomechanics. Prior research shows impairments in kinematic control, including reduced mobility, velocity, and smoothness of cervical motion. However, the strength of association between these impairments and patient-reported pain and disability is unclear rendering development of novel and relevant rehabilitation strategies difficult. The aim of this systematic review is to synthesize existing evidence on the strength of association between clinical biomechanical metrics of neck function (ROM, strength, acceleration, accuracy, smoothness, etc.) and patient-reported neck pain and disability.

METHODS/ANALYSIS

This protocol follows Cochrane guidelines and adheres to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Protocols (PRISMA-P). MEDLINE, EMBASE, CINAHL, SPORTDiscus, Web of Science and Scopus will be searched, along with the gray literature, up to 20 November 2023, using terms and keywords derived from initial scoping searches. Observational studies, including cohorts and cross-sectional studies, that explore associations between clinical biomechanics of the neck and patient-reported outcomes of neck pain or disability will be included. Two reviewers will independently perform study selection, data extraction, and risk of bias assessment (National Institute of Health tool). Data will be synthesized using either a random effects meta-analytic approach or qualitatively using a modified Grading of Recommendations, Assessment, Development and Evaluation (GRADE) approach, dependent on the homogeneity of data available.

DISCUSSION AND RELEVANCE

This review addresses a gap in the literature by systematically synthesizing findings on the relationship between neck function impairments and patient-reported outcomes. It will identify priorities for neck pain rehabilitation and gaps in current knowledge.

DISSEMINATION

The results of this review will be disseminated through a peer-reviewed publication, conference presentation, and lay language summaries posted on an open-access website.

TRIAL REGISTRATION

PROSPERO Registration number: CRD42023417317. https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42023417317.

Validity of an inertial measurement unit for the assessment of range and quality of movement during head and thoracic spine movements

BACKGROUND

Patients with spinal pain often exhibit movement limitations and altered motor control, which can be challenging to measure accurately in clinical practice. Inertial measurement sensors present a promising new opportunity to develop valid, low-cost, and easy-to-use methods for assessing and monitoring spinal motion in a clinical setting.

AIM

This study aimed to investigate the agreement of an inertial sensor and a 3D camera system for assessing the range of motion (ROM) and quality of movement (QOM) in head and trunk single-plane movements.

METHODS

Thirty-three healthy, pain-free volunteers were included. Each participant performed movements of the head (cervical flexion, extension, and lateral flexion) and trunk (trunk flexion, extension, rotation, and lateral flexion), which were simultaneously recorded by a 3D camera system and an inertial measurement unit (MOTI, Aalborg, Denmark). Agreement and consistency were analyzed for ROM and QOM by determining intraclass correlation coefficients (ICC), mean bias, and with Bland-Altman plots.

RESULTS

The agreement between systems was excellent for all movements (ICC between 0.91 and 1.00) for ROM and good to excellent for the QOM (ICC between 0.84 and 0.95). The mean bias for all movements (0.1-0.8°) was below the minimum acceptable difference between devices. The Bland-Altman plot indicated that MOTI systematically measured a slightly greater ROM and QOM than the 3D camera system for all neck and trunk movements.

CONCLUSION

This study showed that MOTI is a feasible and potentially applicable option to assess ROM and QOM for head and trunk movements in experimental and clinical settings.

Head-Mounted Display for Clinical Evaluation of Neck Movement Validation with Meta Quest 2

Neck disorders have a significant impact on people because of their high incidence. The head-mounted display (HMD) systems, such as Meta Quest 2, grant access to immersive virtual reality (iRV) experiences. This study aims to validate the Meta Quest 2 HMD system as an alternative for screening neck movement in healthy people. The device provides data about the position and orientation of the head and, thus, the neck mobility around the three anatomical axes. The authors develop a VR application that solicits participants to perform six neck movements (rotation, flexion, and lateralization on both sides), which allows the collection of corresponding angles. An InertiaCube3 inertial measurement unit (IMU) is also attached to the HMD to compare the criterion to a standard. The mean absolute error (MAE), the percentage of error (%MAE), and the criterion validity and agreement are calculated. The study shows that the average absolute errors do not exceed 1° (average = 0.48 ± 0.09°). The rotational movement's average %MAE is 1.61 ± 0.82%. The head orientations obtain a correlation between 0.70 and 0.96. The Bland-Altman study reveals good agreement between the HMD and IMU systems. Overall, the study shows that the angles provided by the Meta Quest 2 HMD system are valid to calculate the rotational angles of the neck in each of the three axes. The obtained results demonstrate an acceptable error percentage and a very minimal absolute error when measuring the degrees of neck rotation; therefore, the sensor can be used for screening neck disorders in healthy people.

Plasmonic/magnetic nanoarchitectures: From controllable design to biosensing and bioelectronic interfaces

Controllable design of the nanocrystal-assembled plasmonic/magnetic nanoarchitectures (P/MNAs) inspires abundant methodologies to enhance light-matter interactions and control magnetic-induced effects by means of fine-tuning the morphology and ordered packing of noble metallic or magnetic building blocks. The burgeoning development of multifunctional nanoarchitectures has opened up broad range of interdisciplinary applications including biosensing, in vitro diagnostic devices, point-of-care (POC) platforms, and soft bioelectronics. By taking advantage of their customizability and efficient conjugation with capping biomolecules, various nanoarchitectures have been integrated into high-performance biosensors with remarkable sensitivity and versatility, enabling key features that combined multiplexed detection, ease-of-use and miniaturization. In this review, we provide an overview of the representative developments of nanoarchitectures that being built by plasmonic and magnetic nanoparticles over recent decades. The design principles and key mechanisms for signal amplification and quantitative sensitivity have been explored. We highlight the structure-function programmability and prospects of addressing the main limitations for conventional biosensing strategies in terms of accurate selectivity, sensitivity, throughput, and optoelectronic integration. State-of-the-art strategies to achieve affordable and field-deployable POC devices for early multiplexed detection of infectious diseases such as COVID-19 has been covered in this review. Finally, we discuss the urgent yet challenging issues in nanoarchitectures design and related biosensing application, such as large-scale fabrication and integration with portable devices, and provide perspectives and suggestions on developing smart biosensors that connecting the materials science and biomedical engineering for personal health monitoring.

A network analysis reveals the interaction between fear and physical features in people with neck pain

Although neck pain is known to be a complex and multifactorial condition characterised by the interplay between physical and psychological domains, a comprehensive investigation examining the interactions across multiple features is still lacking. In this study, we aimed to unravel the structure of associations between physical measures of neuromuscular function and fear of movement in people with a history of neck pain. One hundred participants (mean age 33.3 ± 9.4) were assessed for this cross-sectional study, and the neuromuscular and kinematic features investigated were the range of motion, velocity of neck movement, smoothness of neck movement, neck proprioception (measured as the joint reposition error), and neck flexion and extension strength. The Tampa Scale for Kinesiophobia was used to assess fear of movement. A network analysis was conducted to estimate the associations across features, as well as the role of each feature in the network. The estimated network revealed that fear of movement and neuromuscular/kinematic features were conditionally dependent. Higher fear of movement was associated with a lower range of motion, velocity, smoothness of neck movement, neck muscle strength, and proprioception (partial correlations between − 0.05 and − 0.12). Strong interactions were also found between kinematics features, with partial correlations of 0.39 and 0.58 between the range of motion and velocity, and between velocity and smoothness, respectively. The velocity of neck movement was the most important feature in the network since it showed the highest strength value. Using a novel approach to analysis, this study revealed that fear of movement can be associated with a spectrum of neuromuscular/kinematic adaptations in people with a history of neck pain.

Differences in upper body posture between individuals with and without chronic idiopathic neck pain during computerised device use: A 3D motion analysis study

BACKGROUND

Computer use is associated with poor postures and increased risk of developing neck pain. Evaluating differences in working posture of individuals with and without chronic neck pain may assist the development of strategies to lessen or prevent pain.

OBJECTIVE

To identify if upper body kinematics differs between individuals with and without chronic idiopathic neck pain during four conditions (tablet, laptop, and desktop computer sitting and standing).

METHODS

Three-dimensional (3D) motion capture measured upper body kinematics in 44 individuals with chronic idiopathic neck pain > 90 days (Cases n = 22) and without pain (Control n = 22), during a typing task under four conditions: tablet, laptop, desktop computer (sitting and standing). Differences between groups were evaluated using generalised linear mixed models.

RESULTS

Across all conditions and compared to controls, cases had significantly less flexion between their head-neck and upper trunk segments (between group mean difference 7.15°, 2.1, 12.2, p = .006), greater upper trunk flexion relative to the laboratory (-6.15°, -10.9, -1.3, p = .012), greater shoulder flexion bilaterally (left 12.35°, 6.7, 17.9, p < .001; right 13.49°, 7.9, 19.1, p < .001) and less right elbow flexion (-6.87°, -12.1, -1.7, p = .010). Approaching significance, the case group had less left elbow flexion (between group mean difference -5.36°, -10.9, 0.1, p = .056) and a smaller mean craniocervical angle for the seated desktop condition (group x condition interaction -6.37°; 95% CI -12.7, -0.1, p = .052).

SIGNIFICANCE

Individuals with neck pain consistently used different upper body postures compared to individuals without pain when working on computerised devices under varying workstation conditions. This finding suggests that people with neck pain work in potentially aggravating postures that may be associated with their pain.

Head Pitch Angular Velocity Discriminates (Sub-)Acute Neck Pain Patients and Controls Assessed with the DidRen Laser Test

Understanding neck pain is an important societal issue. Kinematic data from sensors may help to gain insight into the pathophysiological mechanisms associated with neck pain through a quantitative sensorimotor assessment of one patient. The objective of this study was to evaluate the potential usefulness of artificial intelligence with several machine learning (ML) algorithms in assessing neck sensorimotor performance. Angular velocity and acceleration measured by an inertial sensor placed on the forehead during the DidRen laser test in thirty-eight acute and subacute non-specific neck pain (ANSP) patients were compared to forty-two healthy control participants (HCP). Seven supervised ML algorithms were chosen for the predictions. The most informative kinematic features were computed using Sequential Feature Selection methods. The best performing algorithm is the Linear Support Vector Machine with an accuracy of 82% and Area Under Curve of 84%. The best discriminative kinematic feature between ANSP patients and HCP is the first quartile of head pitch angular velocity. This study has shown that supervised ML algorithms could be used to classify ANSP patients and identify discriminatory kinematic features potentially useful for clinicians in the assessment and monitoring of the neck sensorimotor performance in ANSP patients.

Assessment of Neuromuscular and Psychological Function in People with Recurrent Neck Pain during a Period of Remission: Cross-Sectional and Longitudinal Analyses

The aim of this study was to examine for the presence of differences in neuromuscular and psychological function in individuals with recurrent neck pain (RNP) or chronic neck pain (CNP) following a whiplash trauma compared to healthy controls. A secondary aim was to examine whether neuromuscular characteristics together with psychological features in people with RNP were predictive of future painful episodes. Multiple features were assessed including neck disability, kinesiophobia, quality of life, cervical kinematics, proprioception, activity of superficial neck flexor muscles, maximum neck flexion and extension strength, and perceived exertion during submaximal contractions. Overall, those with RNP (n = 22) and CNP (n = 8) presented with higher neck disability, greater kinesiophobia, lower quality of life, slower and irregular neck movements, and less neck strength compared to controls (n = 15). Prediction analysis in the RNP group revealed that a higher number of previous pain episodes within the last 12 months along with lower neck flexion strength were predictors of higher neck disability at a 6-month follow-up. This preliminary study shows that participants with RNP presented with some degree of altered neuromuscular features and poorer psychological function with respect to healthy controls and these features were similar to those with CNP. Neck flexor weakness was predictive of future neck disability.

Head kinematics in patients with neck pain compared to asymptomatic controls: a systematic review

BACKGROUND

Neck pain is one of the most common musculoskeletal disorders encountered by healthcare providers. A precise assessment of functional deficits, including sensorimotor control impairment, is regarded necessary for tailored exercise programmes. Sensorimotor control can be measured by kinematic characteristics, such as velocity, acceleration, smoothness, and temporal measures, or by assessing movement accuracy. This systematic review aims to identify movement tasks and distinct outcome variables used to measure kinematics and movement accuracy in patients with neck pain and present their results in comparison to asymptomatic controls.

METHODS

Electronic searches were conducted in MEDLINE, PEDro, Cochrane Library and CINAHL databases from inception to August 2020. Risk of bias of included studies was assessed. Movement tasks and specific outcome parameters used were collated. The level of evidence for potential group differences in each outcome variable between patients with neck pain and controls was evaluated.

RESULTS

Twenty-seven studies examining head kinematics and movement accuracy during head-aiming, functional and unconstrained movement tasks of the head were included. Average Risk of Bias of included studies was moderate. In total, 23 different outcome variables were assessed. A strong level of evidence for an increased movement time and for an increased number of errors during head aiming tasks was found. Moderate evidence was found in traumatic neck pain for a decreased mean velocity, peak acceleration, and reaction time, and for point deviation and time on target during head aiming tasks. Moderate evidence was found for decreased acceleration during unconstrained movements, too. Results on the remaining movement task and outcome variables showed only limited, very limited or even conflicting level of evidence for patients with neck pain to differ from controls.

CONCLUSIONS

Sensorimotor control in NP in the way of kinematic and movement accuracy characteristics of head motion was examined in head aiming, functional or unconstrained movement tasks. The results from this review indicate that for some characteristics that describe sensorimotor control, patients with NP differ from healthy controls.

SYSTEMATIC REVIEW REGISTRATION

PROSPERO registration number: CRD42020139083.

Analysis of sensorimotor control in people with and without neck pain using inertial sensor technology: study protocol for a 1-year longitudinal prospective observational study

INTRODUCTION

Neck pain is a very common musculoskeletal disorder associated with high socioeconomic costs derived from work absenteeism and medical expenses. Previous studies have suggested that patients with neck pain of different origins present sensorimotor control impairments compared with the asymptomatic population. However, there is a small number of published studies focusing on these with conflicting results. In addition, the existing methodological limitations highlight the need for more and better quality studies. Moreover, longitudinal studies are necessary to investigate whether changes in pain or disability in individuals with chronic neck pain over time associate with changes in cervical sensorimotor control.

METHODS AND ANALYSIS

This is a descriptive, observational, longitudinal, prospective study consecutively enrolling 52 patients with non-specific neck pain and 52 age-matched asymptomatic participants.Intensity of pain, neck disability, duration of symptoms, topography of pain and comorbidities will be registered at baseline. Sensorimotor control variables including active range of motion, movement speed, acceleration, smoothness of motion, head repositioning accuracy and motion coupling patterns will be recorded as primary outcomes by means of inertial sensors during the following tests consecutively performed in two sessions separated by 12 months: (1) kinematics of planar movements, (2) kinematics of the craniocervical flexion movement, (3) kinematics during functional tasks and (4) kinematics of task-oriented neck movements in response to visual targets.Secondary outcomes will include: (1) Regular physical activity levels, (2) Kinesiophobia, (3) Symptoms related to central sensitisation and (4) The usability of the inertial measurement unit sensor technology.

ETHICS AND DISSEMINATION

This study was approved by the Research Ethics Committee of CEU San Pablo University (495/21/39). Patients will be recruited after providing written informed consent and they will be able to withdraw their consent at any time. Only the study investigators will have access to the study data. The results will be disseminated through scientific publications, conferences and media.

TRIAL REGISTRATION NUMBER

NCT05032911.

Comparisons of cervical and thoracic spine kinematic joint and body segment angles, timing, and velocity between individuals with and without chronic idiopathic neck pain during functional tasks

BACKGROUND

Few studies comprehensively analyse 3D neck kinematics in individuals with chronic idiopathic neck pain during functional tasks considered challenging. This critical knowledge is needed to assist clinicians to recognise and address how altered movement strategies might contribute to pain.

RESEARCH QUESTION

Are there differences in 3D neck kinematics (angles, timing, velocity) during functional tasks in people with chronic neck pain compared to matched asymptomatic control participants?

METHODS

Participants with chronic idiopathic neck pain (n = 33) and matched asymptomatic controls (n = 30) performed four functional tasks (overhead reach forward, right and left, and putting on a seatbelt) while evaluated using 3D motion capture. Kinematic variables included joint angles, range of motion (ROM,°), velocity (m s^-1) and timing (% of movement phase) for joint angles (head-neck [HN joint], head+neck-upper trunk [HNT], and thoracolumbar) and segments (head, neck, head+neck [HN segment], upper trunk, and trunk. Generalised linear mixed models examined between-group differences.

RESULTS

There were few between-group differences. The neck pain group had less HN segment extension that controls (mean difference [MD] left -2.06°; 95% CI -3.82, -0.29; p = .023; and right reach -2.52°; -4.67, -0.37; P = .022), and had less total sagittal HNT ROM across all tasks (-1.28; 95% CI -2.25, -0.31; p = .010). Approaching significance was the pain group having less thoracolumbar left rotation than controls (MD -2.14, 95% CI -4.41 to 0.13, p = .064). The pain group had higher neck segment peak flexion velocity than controls across all tasks (MD -3.09; 95% CI -5.21 to -0.10; P = .004). Timing of joint angle peaks did not differ between groups.

SIGNIFICANCE

When performing an overhead reach task to the left and right and putting on a seatbelt, people with neck pain maintain a more flexed HN segment, use less sagittal ROM and have higher velocity peaks. These findings can assist clinicians in their assessment of patients by identifying possible underlying contributors to neck pain.

Real-Time Tracking of Human Neck Postures and Movements

Improper neck postures and movements are the major causes of human neck-related musculoskeletal disorders. To monitor, quantify, analyze, and detect the movements, remote and non-invasive based methods are being developed for prevention and rehabilitation. The purpose of this research is to provide a digital platform for analyzing the impact of human neck movements on the neck musculoskeletal system. The secondary objective is to design a rehabilitation monitoring system that brings accountability in the treatment prescribed, which is shown in the use-case model. To record neck movements effectively, a Smart Neckband integrated with the Inertial Measurement Unit (IMU) was designed. The initial task was to find a suitable position to locate the sensors embedded in the Smart Neckband. IMU-based real-world kinematic data were captured from eight research subjects and were used to extract kinetic data from the OpenSim simulation platform. A Random Forest algorithm was trained using the kinetic data to predict the neck movements. The results obtained correlated with the novel idea proposed in this paper of using the hyoid muscles to accurately detect neck postures and movements. The innovative approach of integrating kinematic data and kinetic data for analyzing neck postures and movements has been successfully demonstrated through the efficient application in a rehabilitation use case with about 95% accuracy. This research study presents a robust digital platform for the integration of kinematic and kinetic data that has enabled the design of a context-aware neckband for the support in the treatment of neck musculoskeletal disorders.

Normative cervical spine kinematics of a circumduction task

Neck pain is a prevalent condition and clinical examination techniques are limited and unable to assess out-of-plane motion. Recent works investigating cervical kinematics during neck circumduction (NC), a dynamic 3D task, has shown the ability to discern those with and without neck pain. The purposes of this study were to establish 1) confidence and prediction intervals of head-to-torso kinematics during NC in a healthy cohort, 2) a baseline summative metric to quantify the duration and magnitude of deviations outside the prediction interval, and 3) the reliability of NC. Thirty-nine participants (25.6 ± 6.3 years, 19F/20M) without neck pain completed left and right NC. A two-way smoothing spline analysis of variance was utilized to determine the mean-fitted values and 90% confidence and prediction intervals for NC. A standardized effect size was calculated and aggregated across all axes (Delta RMSD aggregate), as a summative metric of motion quality. Confidence and prediction intervals were comparable for left and right NC and demonstrated excellent reliability. The average sum of the Delta RMSD aggregate was 2.76 ± 0.55 for left NC and 2.74 ± 0.63 for right NC. The results of this study demonstrate the feasibility of utilizing normative intervals of a NC task to assess head-to-torso kinematics.

Cervical movement kinematic analysis in patients with chronic neck pain: A comparative study with healthy subjects

BACKGROUND

Several studies have investigated cervical kinematic performance in patients with chronic neck pain, especially with fast movements. A recent systematic review recommended further study of cervical spine kinematics cervical motions in individuals with neck pain.

OBJECTIVES

This study aimed to examine cervical spine kinematics of naturally paced cervical motions in patients with chronic neck pain compared with a group of asymptomatic participants. Also, the relationships between cervical kinematic measures with neck pain intensity and disability were determined.

METHOD

Kinematic performance was measured in 20 individuals with chronic nonspecific neck pain and 20 healthy controls. Data were captured using a 7-camera motion analysis system. Parameters were range of cervical motion, peak velocity, duration of movement, and jerk index (smoothness of movement). Pain intensity and Neck Disability Index were also measured.

RESULTS

Duration of movements, peak velocities, and jerk indexes were significantly different between the two groups (p < 0.05). Pain intensity was significantly associated with duration of movement, range of motion, peak velocity, and smoothness predominantly in extension (r range = 0.4 to 0.6, p < 0.05).

CONCLUSION

This study's findings indicated altered cervical kinematic performance during naturally paced motions (particularly reduced smoothness of movement)in patients with chronic nonspecific neck pain compared to asymptomatic participants. Also, pain intensity was moderately associated with most kinematic measures, especially in extension. This study's results can help to understand better the impairments associated with chronic nonspecific neck pain.

Physical therapist attitude and opinion about cervical spine examination: A national Spanish survey

OBJECTIVE

A correct examination is essential during a differential diagnosis of neck pain patients. Therefore, the objective of this study was to provide an update on the properties considered most important by physical therapists (PTs) when conducting accessory and physiological movement tests during the cervical spine physical examination.

METHODS

A total of 84 private physiotherapy centres participated in this online cross-sectional survey including 415 active physiotherapists and members of one autonomous Spanish Physiotherapists School. This survey included information about the characteristics of the respondents (eg, weekly patient care, highest qualification and specific training in osteopathy and manual therapy), their opinion about the accuracy and reliability of accessory and physiological movement tests, the frequency and importance of mobility and pain responses, and the most commonly reference used to make a judgement.

RESULTS

Pain responses are most frequently used by physiotherapists at a rate of 79.8% and also rated as important by 42.65% respondents mobility aspects such as quality of end-feel (17.3%), quantity of translation (16.4%) and quality of resistance (13.3%) during passive accessory intervertebral movement tests. During passive and active physiological movement tests, the most frequent properties assessed were the quality of motion path (80.5% and 84.3%, respectively) and quantity of angle bending (81.7% and 77.6%, respectively). Pain responses are used as reference by 54.7% to make a clinical judgement during passive accessory intervertebral movement tests.

CONCLUSION

Physical therapists face validity in relation to passive accessory intervertebral movement test for assessing spinal segmental motion aspects has been decreasing with more attention devoted to pain responses. The current scepticism regarding the motion properties assessed with these tests is associated with utility aspects such as validity, sensitivity, accuracy and specificity.

Estimating Movement Smoothness From Inertial Measurement Units

Inertial measurement units (IMUs) are increasingly used to estimate movement quality and quantity to the infer the nature of motor behavior. The current literature contains several attempts to estimate movement smoothness using data from IMUs, many of which assume that the translational and rotational kinematics measured by IMUs can be directly used with the smoothness measures spectral arc length (SPARC) and log dimensionless jerk (LDLJ-V). However, there has been no investigation of the validity of these approaches. In this paper, we systematically evaluate the use of these measures on the kinematics measured by IMUs. We show that: (a) SPARC and LDLJ-V are valid measures of smoothness only when used with velocity; (b) SPARC and LDLJ-V applied on translational velocity reconstructed from IMU is highly error prone due to drift caused by integration of reconstruction errors; (c) SPARC can be applied directly on rotational velocities measured by a gyroscope, but LDLJ-V can be error prone. For discrete translational movements, we propose a modified version of the LDLJ-V measure, which can be applied to acceleration data (LDLJ-A). We evaluate the performance of these measures using simulated and experimental data. We demonstrate that the accuracy of LDLJ-A depends on the time profile of IMU orientation reconstruction error. Finally, we provide recommendations for how to appropriately apply these measures in practice under different scenarios, and highlight various factors to be aware of when performing smoothness analysis using IMU data.

In vivo intervertebral kinematics and disc deformations of the human cervical spine during walking

The kinematics of the cervical spine during various functional neck motions has been widely reported. However, no data has been reported on the cervical intervertebral kinematics during walking, the most frequently performed daily functional activity. In this study, we evaluated cervical kinematics and disc deformation of asymptomatic subjects during a gait cycle using a dual fluoroscopic imaging system. Our measurements showed that the vertical translation of the cervical spine (1.6 ± 0.1 Hz) occurred at twice the frequency of the gait cycle (0.8 ± 0.1 Hz). The overall ranges of motion (ROMs) of the entire (C2-T1) cervical spine were 5.0 ± 3.1° in the flexion-extension rotation, 3.4 ± 1.0° in the lateral-bending rotation, and 5.8 ± 2.1° in the axial-twisting rotation during walking. Each intervertebral disc (measured at the disc centre location) dynamically deformed in its axial direction in a range of 16.2 ± 5.7% ~ 23.7 ± 8.7% (without significant differences among different segment levels, p > 0.05), similar to the ranges of shear deformations of the same disc (p > 0.05, except for the C7-T1 disc, where p = 0.010). These data could be useful for improvements of diagnosis and treatment methods of cervical pathologies.

Self-Kinematic Training for Flight-Associated Neck Pain: a Randomized Controlled Trial

BACKGROUND: Flight-associated neck pain (FANP) is a serious problem in fighter pilots. Despite the high impact of FANP there is little evidence for effective management. However, self-kinematic training showed a positive effect in the general population. The purpose of this study was to investigate the effectiveness of a self-kinematic training program using virtual reality in improving neck pain in fighter pilots.METHODS: There were 45 pilots with FANP who were randomized to a control group (N 23) or a training group (N 22). Training participants were instructed to exercise using a personalized self-training program, for 20 min/wk, for 4 wk. Primary outcome measures were neck disability (NDI%) and mean velocity ( s¹), and secondary were pain, health status, accuracy, and isometric strength. Assessments were conducted by a blinded assessor and intention-to-treat analysis by a blinded statistician.RESULTS: There were 40 pilots who completed the postintervention assessments, and 35 completed the 6-mo follow-up. Baseline measurements showed mild pain and disability (mean VAS 43 22.73, NDI 17.76 9.59%) and high kinematic performance. Compliance with self-training was poor. No differences were observed in self-reported measures and strength. Exercise duration was correlated with NDI% improvement.DISCUSSION: This self-kinematic training promoted kinematic performance, but was ineffective in engaging the pilots to exercise, and consequently did not improve pain and disability. Poor compliance was previously reported in self-training for FANP, suggesting further studies should prioritize supervised training. Considering the high baseline kinematic performance, kinematics does not seem to be a key factor in FANP, and future exercise research should aim for intense strengthening to increase endurance to the high G_z pilots experience.Sarig Bahat H, German D, Palomo G, Gold H, Frankel Nir Y. Self-kinematic training for flight-associated neck pain: a randomized controlled trial. Aerosp Med Hum Perform. 2020; 91(10):790797.

Posture during the use of electronic devices in people with chronic neck pain: A 3D motion analysis project

BACKGROUND

Non-neutral postures during computerised device use coupled with increased usage may increase the risk of neck pain. Greater knowledge of postures that individuals with neck pain adopt during computerised device use is warranted.

OBJECTIVE

To evaluate neck and upper limb posture while using a tablet, laptop and desktop computer (sitting and standing) in individuals with chronic neck pain.

METHODS

Differences in three-dimensional kinematic variables were assessed during four conditions: tablet, laptop, desktop computer (sitting and standing) in 22 individuals with chronic neck pain >3 months. Differences between kinematic variables were determined using one-way repeated measures ANOVA with Bonferroni post-hoc tests.

RESULTS

Compared to the desktop (sitting), tablet and laptop use resulted in increased neck flexion (mean difference tablet - 14.42°, 95% CI - 19.88, -8.96, P < 0.001; laptop -7.19°, -12.08, -2.31, P = .020); upper trunk flexion (tablet -14.89°, -20.22, -9.56, P < 0.001; laptop -5.56°, -10.02, -1.09, P = .009) and tablet bilateral shoulder elevation (left 11.01 mm, 2.01, 20.04, P < .016; right 13.08 mm, 3.09, 23.11, P < .006).

CONCLUSIONS

Tablet and laptop use resulted in greater neck flexion, bilateral shoulder elevation and upper trunk flexion compared to a standard desktop computer, suggesting individuals with chronic neck pain should be mindful of their posture when using these smaller devices. Future research should explore how differences in posture may influence neck pain.

A Pilot Longitudinal Study of 3-Dimensional Head and Neck Kinematics During Functional Tasks in Individuals With Chronic Idiopathic Neck Pain Either Wait-Listed for or Receiving Chiropractic Spinal Manipulative Therapy With Exercise

OBJECTIVE

The purpose of this study was to determine if there is a relationship between pain and movement kinematics during functional tasks, evaluated over time, in individuals with chronic idiopathic neck pain.

METHODS

Ten participants with chronic idiopathic neck pain performed 2 functional tasks (overhead reach to the right and putting on a seatbelt) while evaluated using 8 Oqus 300+ cameras. Kinematic variables included joint angles and range of motion (ROM) (°), head segment relative to neck segment (head-neck [HN]); and head/neck segment relative to upper thoracic segment (head/neck-trunk), velocity (m/s), and time (% of movement phase). Pain was quantified using a 100-mm visual analog scale. Linear mixed effects regression models were used to analyze associations between pain and kinematic variables adjusting for treatment group.

RESULTS

For overhead reach, higher pain was associated with less HN peak rotation at baseline (β = -0.33; 95% CI -0.52 to -0.14, P = .003) and less HN total rotation ROM at 6 months (β = -0.19; 95% CI -0.38 to -0.003, P = .048). For the seatbelt task, higher pain was associated with less HN peak rotation (β = -0.52; 95% CI -0.74 to -0.30 to -0.74, P < .001) and less HN total rotation ROM at baseline (β = -0.32; 95% CI -0.53 to -0.10, P = .006). No other movement variables demonstrated meaningful relationships with pain for the reach or seatbelt tasks.

CONCLUSION

Higher pain is associated with less HN peak and total rotation during functional reaching tasks requiring head rotation. Recognizing altered functional kinematics in individuals with chronic neck pain may assist patient management.

Are neuromuscular adaptations present in people with recurrent spinal pain during a period of remission? A protocol for a systematic review

INTRODUCTION

The course of spinal pain (neck or low back pain) is often described as episodic and intermittent, with more than one-third of people continuing to experience episodic symptoms 1 year after first onset. Although ongoing neuromuscular adaptations could contribute to recurrent episodes of pain, no systematic review has synthesised evidence of ongoing neuromuscular changes in people with recurrent spinal pain during a period of symptom remission.

METHODS AND ANALYSIS

This protocol is developed and reported following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses-P, the Update of the Cochrane Back and Neck Group guidelines and the Methodological Expectations of Cochrane Intervention Reviews. PubMed, Web of Science, MEDLINE, EMBASE, CINAHL, ZETOC, Google Scholar, grey literature sources and key journals will be searched up to September 2019. Observational studies investigating neuromuscular changes in people with recurrent spinal pain during a period of remission will be included. Neuromuscular function will be considered under five outcome domains of muscle activity, spine kinematics, muscle properties, sensorimotor control and neuromuscular performance. Two independent reviewers will search, screen studies, extract data and assess risk of bias (Newcastle-Ottawa Scale). Data will be synthesised per outcome domain. Where clinical and methodological homogeneity across studies exists, a random-effects meta-analysis will be conducted. Otherwise, results will be synthesised narratively. The overall quality of evidence will be assessed using the Grading of Recommendations, Assessment, Development and Evaluation guidelines.

ETHICS AND DISSEMINATION

Findings of this review may aid the identification of factors that could contribute to spinal pain recurrence and aid the development of interventions for secondary prevention aimed at the restoration of optimal neuromuscular function. The results will be submitted for publication in a peer-reviewed journal and presented at conferences. No ethical approval was required.

PROSPERO REGISTRATION NUMBER

CRD42019141527.