Variability of neck and trunk movement during single- and dual-task gait in people with chronic neck pain

BackgroundPrevious findings reported that people with chronic neck pain walk with reduced range trunk rotation, especially when walking in more challenging conditions. Quantification of the quality of neck and trunk movement during gait could provide further insight into biomechanical changes that occur in people with neck pain. This study uniquely compared the variability of trunk and neck rotation during single-task and dual-task gait in people with chronic neck pain and asymptomatic individuals.MethodsAn observational case-control study was conducted on 20 asymptomatic individuals and 24 people with chronic neck pain of idiopathic or traumatic origin. Participants performed rectilinear walking whilst keeping the head in a neutral position (single-task) and whilst rotating the head at a natural speed (dual-task). Trunk and head rotation angles were averaged across gait cycles for the task trials. The data were normalised in time, and the average variability of angular distribution along the normalised cycle was extracted. The Tampa Scale for Kinesiophobia was used to assess fear of movement.FindingsDuring single-task gait, there were no group differences for the variability of trunk (p = 0.862) or neck (p = 0.427) rotation. For dual-task gait, there was no difference between groups for the variability of neck rotation (p = 0.636), however, the participants with neck pain displayed reduced variability of trunk rotation (p = 0.021). The neck pain group also walked at a significantly slower speed during dual-task gait (p = 0.043) compared to asymptomatic individuals and the speed of their gait was associated with the extent of fear of movement.InterpretationThe strategy observed in participants with chronic neck pain likely reflects adaptive behaviour when faced with more challenging conditions for postural control.     

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

ObjectiveThe 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.MethodsTen 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.ResultsFor 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.ConclusionHigher 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.     

Movement behaviour in patients with chronic neck pain

Background and Purpose. The present study evaluated whether patients with chronic neck pain demonstrate characteristic angular movement deviations during repeated cervical spine movements. Method. Sixteen patients with chronic neck pain and a group of 18 aged‐matched healthy control subjects performed 10 repetitive maximal cervical movement cycles (flexion/extension, rotation, lateral flexion) at a self‐determined velocity. To collect the kinematic data of the cervical spine, a three‐dimensional ultrasonic movement analysis system (Zebris CMS70^©, Germany) was used. To describe the movement variability in the maximum oscillation amplitudies the intra‐subject coefficients of variation (CV %) was calculated. The maximum difference was characterized by the absolute differences between the minimum and maximum oscillation amplitudes of iterated movement cycles. Pain intensity was obtained by visual analogue scales (VAS). Results. The average pain rating of the patients with chronic neck pain indicated moderate neck pain intensity (3.7 (±0.8)). Independent Student's t‐tests revealed a significantly decreased range of movement (ROM) in the chronic neck pain group for all anatomic values (p < 0.05), except for the lateral flexion to the right. The maximum differences and variability parameters showed significantly increased values in the chronic neck pain group in all directions (p < 0.001). Conclusion. Maximal cervical ROM was significantly lower, and movement variability was significantly higher, in patients compared with healthy control subjects. The differences of cervical motion variability point towards increased movement irregularities in patients with chronic neck pain. The present study shows evidence to support the hypothesis that additional information may be gained from the analysis of movement variability. Copyright © 2007 John Wiley & Sons, Ltd.     

The effect of neck pain on cervical kinematics, as assessed in a virtual environment

Sarig Bahat H, Weiss PL, Laufer Y. The effect of neck pain on cervical kinematics, as assessed in a virtual environment.ObjectiveTo compare cervical kinematics during functional motion in patients with neck pain and in asymptomatic participants using a novel virtual reality assessment.DesignClinical comparative trial.SettingParticipants were recruited from university staff and students, and from a local physical therapy clinic.ParticipantsPatients with chronic neck pain (n=25) and asymptomatic participants (n=42).InterventionsNot applicable.Main Outcome MeasuresKinematic measures (response time, peak and mean velocity, number of velocity peaks, time to peak velocity percentage) were sampled while participants were engaged in the virtual game. Group and motion direction differences were assessed with a 2-way repeated-measures analysis of variance, Tukey-Kramer testing, and contrast analysis when relevant.ResultsParticipants with neck pain had lower peak and mean velocities than the asymptomatic participants (P<.0001). They also demonstrated a greater number of velocity peaks, indicating impaired motion smoothness (P=.0036). No significant group differences were found for response time or for time to peak velocity percentage. Cervical rotations were significantly faster and smoother than flexion and extension movements (P<.05). The overall impairment percentage in velocity and smoothness of cervical motion in patients with neck pain ranged from 22% to 44% compared with asymptomatic participants.ConclusionsVelocity and smoothness of cervical motion were more restricted in patients with chronic neck pain than found previously. Unlike range of motion and other static measurements, these dynamic variables reflect functional cervical motion and therefore contribute to a better understanding of the impairment associated with neck pain. Because the ability to move quickly in response to external stimuli is a commonly occurring phenomenon, this deficit is highly relevant to clinical assessment and management.     

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

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

Differences in lumbopelvic motion between people with and people without low back pain during two lower limb movement tests

Background

Clinical data suggest that active limb movements may be associated with early lumbopelvic motion and increased symptoms in people with low back pain.

Methods

Forty-one people without low back pain who did not play rotation-related sports and 50 people with low back pain who played rotation-related sports were examined. Angular measures of limb movement and lumbopelvic motion were calculated across time during active knee flexion and active hip lateral rotation in prone using a three-dimensional motion capture system. Timing of lumbopelvic motion during the limb movement tests was calculated as the difference in time between the initiation of limb movement and lumbopelvic motion normalized to limb movement time.

Findings

During knee flexion and hip lateral rotation, people with low back pain demonstrated a greater maximal lumbopelvic rotation angle and earlier lumbopelvic rotation, compared to people without low back pain (P < 0.05).

Interpretation

The data suggest that people with low back pain who play rotation-related sports may move their lumbopelvic region to a greater extent and earlier during lower limb movements than people without low back pain. Because people perform many of their daily activities in early to midranges of joint motion the lumbopelvic region may move more frequently across the day in people with low back pain. The increased frequency may contribute to increased lumbar region tissue stress and potentially low back pain symptoms. Lower limb movements, therefore, may be important factors related to the development or persistence of low back pain.     

Trunk,pelvic and hip kinematics during the Stork test in pregnant women with pelvic girdle pain,asymptomatic pregnant and non-pregnant women

BackgroundPelvic girdle pain is prevalent during pregnancy, and women affected report weight-bearing activities to be their main disability. The Stork test is a commonly used single-leg-stance test. As clinicians report specific movement patterns in those with pelvic girdle pain, we aimed to investigate the influence of both pregnancy and pelvic girdle pain on performance of the Stork test.MethodsIn this cross-sectional study, 25 pregnant women with pelvic girdle pain, 23 asymptomatic pregnant and 24 asymptomatic non-pregnant women underwent three-dimensional kinematic analysis of the Stork test. Linear mixed models were used to investigate between-group differences in trunk, pelvic and hip kinematics during neutral stance, weight shift, leg lift and single leg stance.FindingsFew and small significant between-group differences were found. Pregnant women with pelvic girdle pain had significantly less hip adduction during single leg stance compared to asymptomatic pregnant women (estimated marginal means (95% confidence intervals) -1.1° (−2.4°, 0.3°) and 1.0° (−0.4°, 2.4°), respectively; P = 0.03). Asymptomatic pregnant women had significantly less hip internal rotation compared to non-pregnant women 4.1° (1.6°, 6.7°) and 7.9° (5.4°, 10.4°), respectively (P = 0.04) and greater peak hip flexion angle of the lifted leg in single leg stance 80.4° (77.0°, 83.9°) and 74.1° (70.8°, 77.5°), respectively (P = 0.01). Variation in key kinematic variables was large across participants in all three groups.InterpretationOur findings indicate that trunk, pelvic and hip movements during the Stork test are not specific to pregnancy and/or pelvic girdle pain in the 2nd trimester. Instead, movement strategies appear unique to each individual.     

Three-dimensional kinematics of the cervical spine using an electromagnetic tracking device. Differences between healthy subjects and subjects with non-specific neck pain and the effect of age

BackgroundA cross-sectional observational study of three-dimensional cervical kinematics in 35 non-specific neck pain patients and 100 asymptomatic controls.To compare qualitative and quantitative aspects of cervical kinematics between healthy subjects and subjects with non-specific neck pain and to determine the effect of age on cervical kinematics in healthy subjects.MethodsThree-dimensional kinematics of active lateral bending and flexion-extension of 35 patients and 100 controls were registered by means of an electromagnetic tracking system. The means of several kinematic parameters were compared using t-tests. In addition, we assessed the age-dependency of the three-dimensional kinematic parameters by stratifying the 100 control subjects in 6 age categories.FindingsComparison of the patient group with the control group reveals no statistically significant differences in qualitative and quantitative parameters. Analysis of the effect of age showed that the range of motion decreases significantly (p < 0.01) with increasing age. In lateral bending, the ratio between axial rotation and lateral bending increases significantly (p < 0.01) among older subjects. Differences in acceleration, jerk and polynomial fit are seen between the age categories, but are not significant.InterpretationThis study demonstrates no significant differences in kinematic parameters between healthy subjects and subjects with non-specific neck pain. Healthy subjects in higher age categories demonstrate higher ratios of coupled movements and lower ranges of motion.Future research should focus on classifying patients with non-specific neck pain in order to gain a better insight on possible subgroup specific differences in kinematics. More studies on this subject are warranted.Level of evidence: 4.     

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

ObjectiveThe 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).MethodsThis 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.ResultsThe 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).ConclusionCraniocervical 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.     

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

BackgroundChronic neck pain is common, impacting a person’s ability to complete functional tasks. One method of quantifying functional movement is three dimensional (3D) motion analysis, however, it is unknown whether it may detect alterations in movement kinematics in individuals with neck pain.ObjectiveTo systematically review studies to determine possible differences in cervical and thoracic kinematics during functional movement as measured by 3D motion analysis in individuals with neck pain compared to controls.Data sourcesMedline, Amed, Scopus, Cochrane, Embase, CINAHL searched on 11/11/2017.Study selectionStudies reported 3D kinematics of functional movement (based on real-world situational biomechanics, i.e., multi-planar movements) of the cervical and thoracic spine in individuals with and without neck pain.Study appraisal and synthesisTwo reviewers assessed study quality; studies were summarised using discussion.ResultsFour thousand four hundred and sixteen title/abstracts were screened, 11 full texts retrieved. Common reasons for exclusion were participants ≤8 years of age and studies that did not investigate functional movement. Included studies (n = 5) used 3D motion analysis to assess kinematics during functional tasks including typing, gaming and resting posture. Participants with neck pain displayed greater neck flexion postures, reduced head velocity and smoothness of movement.LimitationsVariations in measurement methods and participant samples prevented meta-analysis.ConclusionThough few studies were identified, altered kinematics were observed in individuals with neck pain, suggesting further research examining cervical spine kinematics is warranted. Recognising kinematic differences is important for clinicians to identify possible movement risk factors in individuals with neck pain that may be targeted with treatment.Systematic review registration number PROSPEROCRD42017076053.     

Lumbar kinematic variability during gait in chronic low back pain and associations with pain,disability and isolated lumbar extension strength

BackgroundChronic low back pain is a multifactorial condition with many dysfunctions including gait variability. The lumbar spine and its musculature are involved during gait and in chronic low back pain the lumbar extensors are often deconditioned. It was therefore of interest to examine relationships between lumbar kinematic variability during gait, with pain, disability and isolated lumbar extension strength in participants with chronic low back pain.MethodsTwenty four participants with chronic low back pain were assessed for lumbar kinematics during gait, isolated lumbar extension strength, pain, and disability. Angular displacement and kinematic waveform pattern and offset variability were examined.FindingsAngular displacement and kinematic waveform pattern and offset variability differed across movement planes; displacement was highest and similar in frontal and transverse planes, and pattern variability and offset variability higher in the sagittal plane compared to frontal and transverse planes which were similar. Spearman's correlations showed significant correlations between transverse plane pattern variability and isolated lumbar extension strength (r = − .411) and disability (r = .401). However, pain was not correlated with pattern variability in any plane. The r² values suggested 80.5% to 86.3% of variance was accounted for by other variables.InterpretationConsidering the lumbar extensors role in gait, the relationship between both isolated lumbar extension strength and disability with transverse plane pattern variability suggests that gait variability may result in consequence of lumbar extensor deconditioning or disability accompanying chronic low back pain. However, further study should examine the temporality of these relationships and other variables might account for the unexplained variance.     

Cervical Proprioception in a Young Population Who Spend Long Periods on Mobile Devices: A 2-Group Comparative Observational Study

Objectives

The purpose of this study was to evaluate if young people with insidious-onset neck pain who spend long periods on mobile electronic devices (known as “text neck") have impaired cervical proprioception and if this is related to time on devices.

Lumbar Spine Kinematics in Asymptomatic People When Changing Body Position From Sitting to Standing

ObjectiveThe purpose of this study was to assess the lumbar spine kinematics in 3 movement axes in asymptomatic individuals in the sit-to-stand (STS) movement performed in a habitual, flexion, or extension manner.MethodsThere were 30 participants (16 women, 14 men), aged 23 to 37 years. Each participant performed an STS test. We registered the total time of the STS movement and the maximum acceleration of the lumbar spine in the vertical, anteroposterior, and mediolateral axes. The examination of the movement pattern was performed with the use of a BTS G-sensor device.ResultsThe highest movement dynamics in the lumbar spine were observed during the STS performed in a habitual manner in the 3 axes (P < .01). The lowest movement dynamics ere associated with the extension STS pattern. The flexion pattern differed from the habitual one in total performance time in both groups (P < .01). There were no significant differences in kinematic lumbar spine between sexes.ConclusionThe kinematics of the STS movement for asymptomatic individuals were characterized by significant variability in the maximum acceleration in the 3 axes. The highest movement dynamics were observed during the STS performed in a habitual manner, and the lowest dynamics with the extension pattern of STS.     

Investigation of Joint Position Sense and Balance in Individuals With Chronic Idiopathic Neck Pain: A Cross-Sectional Study

ObjectiveThe aim of this study was to determine the relationship between joint position sense and static and dynamic balance in female patients with chronic neck pain compared with healthy controls.MethodsThe study sample comprised 25 female patients with chronic neck pain and 25 healthy (asymptomatic) female controls. Pain severity with the visual analog scale, joint position sense with the laser pointer method, static balance with the Single-Leg Balance Test, and dynamic balance with the Y Balance Test were assessed.ResultsThe deviation in cervical joint position sense was greater in extension (P < .001), right rotation (P < .001), and left lateral rotation (P < .05) in the patients with chronic neck pain compared with the healthy controls. The results of the patients with chronic neck pain were worse than the healthy controls in the Single-Leg Balance Test with both eyes open (P < .05) and eyes closed (P < .05). The patients with chronic neck pain had worse dynamic balance only in the anterior direction reach of the left leg (P < .05).ConclusionCervical joint position sense and static balance were worse in female patients with chronic idiopathic neck pain when compared with asymptomatic controls. Dynamic balance in all other directions except for the anterior direction was not negatively affected in individuals with chronic idiopathic neck pain.     

3-Dimensional Cervical Movement Characteristics and the Influence of Thoracic Treatment on a Subgroup of Acute Neck Pain Patients

Objective

The purpose of this study was to investigate the influence of thoracic high-velocity low-amplitude thrust (HVLAT) manipulation on quantitative and qualitative 3-dimensional cervical spine kinematic patterns in a subgroup of patients with acute neck pain.

The influence of extreme speeds on scapula kinematics and the importance of controlling the plane of elevation

BackgroundThe effect of high-speed movement on scapula kinematics is not clear from the literature. Understanding these effects is important for clinicians examining, managing and understanding scapula kinematic pathologies: impingement, glenohumeral instability, muscle patterning instability and athletic injuries. The scapula tracking methodology and the lack of quantified control of the movement's plane of elevation limits previous studies. The aim of the present study is to use improved dynamic scapula kinematic measurement to assess differences during planar movements across different speeds. Athletic and maximal speeds, neglected in previous studies, are the focus.MethodsThirteen subjects performed slow, fast and maximal scapula plane abduction and forward flexion. A previously validated skin-fixed scapula tracker was used and optimally calibrated. A stiff board controlled the plane of elevation. Scapula kinematics were consistent with the literature.FindingsLarge and statistically significant differences were found to exist between scapula kinematics at slow speeds compared to fast and maximal speeds in lateral rotation and protraction. Although some differences were observed in the plane of elevation between speeds, these were not considered to effect the conclusions.InterpretationThe speed of movement should be considered an important factor affecting scapula kinematics. Clinical studies analysing muscle recruitment strategies and causes of injury in athletic tasks must account for changing kinematics rather than extrapolating slow or static measures and effective clinical examination and management of pathology must take these kinematic changes into account. Control of the plane of movement is challenging and its effectiveness must be quantified in future kinematic studies.     

Effect of Seated Thoracic Manipulation on Changes in Scapular Kinematics and Scapulohumeral Rhythm in Young Asymptomatic Participants: A Randomized Study

Objective

The purpose of this study was to evaluate the immediate effects of seated thoracic manipulation on scapulothoracic kinematics and scapulohumeral rhythm during arm flexion in young asymptomatic participants.

Methods

A convenience sample of 42 young asymptomatic participants was randomly divided in 2 groups: manipulation and sham group. Measurements were taken before and after the intervention. All participants completed the Disabilities of the Arm, Shoulder, and Hand questionnaire to assess pain and physical function. The manipulation group received the manipulation (high velocity, low amplitude), which was performed by a physical therapist with the patient in the seated position and with the arms crossed over the chest and hands passed over the shoulders. For the sham group, the same procedure was performed, with the exception that the high-velocity thrust was not applied. Three-dimensional (3D) kinematic data were collected with the participants in a relaxed standing position using a 3D electromagnetic tracking system. All participants performed 3 repetitions of arm flexion before and after manipulation.

Results

There were no differences (P = .79) in Disabilities of the Arm, Shoulder, and Hand scores when the manipulation (3.37 ± 3.72) was compared with the sham group (3.68 ± 4.27). The 3-way analysis of variance showed no significant interaction among group, angle, and time differences for the outcomes (scapulothoracic internal/external rotation [F = 0.43; P = .82], upward/downward rotation [F = 0.08; P = .99], tilt [F = 0.23; P = .94], and scapulohumeral rhythm [F = 4; P = .86]). The intragroup effect was small for the outcomes measured in both groups.

Conclusions

Thoracic manipulation in the seated position did not affect scapulohumeral rhythm and 3D scapular kinematics during arm flexion in young asymptomatic participants.     

An immediate effect of axial neck rotation training with real time visual feedback using a smartphone inclinometer on improvement in axial neck rotation function

Objectives: The purpose of this study was to compare the immediate effects of axial neck rotation training (Axi-NRT) with and without real-time visual feedback (VF) using a smartphone inclinometer on the range of motion (ROM) for axial neck rotation and the onset of compensatory neck lateral bending and extension during active neck rotation.Methods: Twenty participants with restricted ROM for neck rotation but no neck pain (21.1 ± 1.6 years and 8 males, 12 females) were recruited for Axi-NRT with VF, and twenty age- and gender-matched participants with restricted ROM for neck rotation were recruited for Axi-NRT without VF. Changes in ROM for neck rotation and the onset time of compensatory neck movement during active neck rotation were measured using an electromagnetic tracking system. Results: Axi-NRT with VF was more effective in increasing ROM for neck rotation and decreasing and delaying the onset of compensatory neck movements during active neck rotation compared with Axi-NRT without VF. Conclusions: Repeated Axi-NRT using VF is useful to educate participants in maintaining the axis of the cervical spine and to increase ROM for axial neck rotation with less compensatory neck motion in participants with a restricted range of neck rotations.     

Neck Strength in Coronal and Sagittal Head Movement in Military Pilots and Aircrew With Chronic Neck Pain: A Systematic Review With Meta-Analysis

ObjectiveThis systematic review aimed to assess whether there is a difference in neck strength between military pilots and aircrew with and without chronic neck pain.MethodsThe PubMed, Embase, and Scopus databases were searched. Two independent reviewers selected relevant full articles comparing neck strength between military pilots and aircrew with and without chronic neck pain. Two independent reviewers extracted the data from the full articles selected. A meta-analysis was used to assess standardized mean differences in neck strength based on a random-effects model.ResultsThe search returned 3554 results; 5 articles were included in the study. Military pilots and aircrew with chronic neck pain showed no difference in neck strength from military pilots and aircrew without chronic neck pain for flexion and extension, but did show a neck strength reduction for right and left lateral flexion -0.29 (95% confidence interval, -0.52 to -0.06; I² = 3%) and -0.23 (95% confidence interval, -0.45 to 0.00; I² = 0%), respectively.ConclusionBased on this meta-analysis with a 3a level of evidence, military pilots and aircrew with chronic neck pain have reduced neck strength for coronal head movement, but not sagittal movement compared with military pilots and aircrew without chronic neck pain.     

Effects of supplemental heat therapy in multimodal treated chronic low back pain patients on strength and flexibility

BackgroundThe beneficial effects of thermotherapy on analgesia and relaxation are widely known for various diseases. To date, however, thermotherapy in chronic low back pain is not explicitly recommended in international guidelines. The effects of thermotherapy on biomechanical parameters within a multimodal back pain treatment concept are also unknown.MethodsWithin a multimodal treatment concept, 176 patients with chronic low back pain were treated either with or without supplemental heat wrap therapy. The range of movement and strength parameters of the trunk in flexion, extension, lateral flexion and rotation were measured before and after 12 weeks of treatment.FindingsThe range of movement as well as strength parameters of the trunk improved on average within the multimodal treatment. Patients receiving additional thermotherapy supplemental to basic multimodal treatment showed a further improvement of strength parameters regarding extension (P = 0.09, 1 − β = 0.41), rotation to the right (P = 0.09, 1 − β = 0.41) and rotation to the left (P = 0.08, 1 − β = 0.42) in comparison to those conducting only the multimodal treatment. No group differences were detected in flexibility.InterpretationThe implementation of thermotherapy for several hours a day (heat wrap therapy) in daily clinical practice additional to an individualized, evidence-based multimodal treatment concept can be recommended to enhance strength parameters. The potential causes of improved strength parameters as well as the meaning for the patients in activity of daily living are discussed.