Intratester and intertester reliability of neck isometric dynamometry

OBJECTIVE: To evaluate the reproducibility of measurement for maximum voluntary isometric contractions of the cervical musculature in different movements. DESIGN: Repeated test-retest measurements. SETTING: A department of physiotherapy. PARTICIPANTS: Thirty-three healthy subjects (17 men, 16 women; age range, 19-63 y) for the intraexaminer study and 10 healthy subjects (4 men, 6 women; age range, 20-37 y) for the interexaminer study. INTERVENTIONS: Maximum isometric strength in sitting and standing for flexion, extension, lateral flexion, and rotation using a custom isomyometer device. Three tests, performed 5 to 8 days apart, to assess intraexaminer reliability. Two examiners, each performing 1 trial, measuring on the same day to assess interexaminer reliability. MAIN OUTCOME MEASURES: Intraexaminer and interexaminer reliability of neck muscle strength. RESULTS: The standing position showed better reproducibility than the sitting position. The intraclass correlation coefficient (ICC1,3) was above .84 for all tests in any movement and position and above .93 when the first test was excluded. The standard error (SE) of measurement (<16.5 N; <.13 N-m for rotation) and smallest detectable difference (SDD) (<20.1%) were also small. For interexaminer reliability, the ICC(2,1) ranged from.88 to.94 and the SE from 10.7 to 20.8 N (<1.15 N-m for rotation); the SDD was less than 29.8% (except right rotation, which was 38.8%). CONCLUSIONS: A reliable protocol for measuring neck strength has been developed. Standing position and a full practice session produces more reliable measurements.     

Reliability of the Cervical Range of Motion Device in Measuring Upper Cervical Motion

Abstract

Limitations in upper cervical range of motion (occiput, Cl and C2) correlate highly with many pathological dysfunctions, including acute and chronic neck pain, headache, and temporomandibular joint (TMJ) pain. Although methods have been developed which provide valid and reliable measures of the middle and lower cervical spine, a quantitative method to evaluate upper cervical range of motion has not been documented in the literature thus far. The purpose of this study was to investigate the intra-tester and inter-tester reliability of the Cervical Range of Motion device (CROM) in measuring upper cervical flexion and extension. Thirty healthy volunteers, ages 23 to 37, were measured three times by three testers. Moderate to high reliability was observed for upper cervical measurements with ICC’s of .65 to .81 among testers and .89 to .97 between testers. Therefore, this method of evaluation can be used to obtain consistent quantitative measures in documenting changes in upper cervical range of motion.     

Cervical flexion: a study of dynamic surface electromyography and range of motion

BACKGROUND: In the comprehensive assessment of painful conditions, dynamic surface electromyography (sEMG) and range of motion (ROM) recordings can provide information regarding muscle spasm, antalgic postures, fear of pain (protective guarding), muscle injury, and disordered movement caused by pain. This study examines ROM and sEMG patterns observed during cervical flexion. OBJECTIVE: To demonstrate 2 distinctive sEMG recruitment and dynamic ROM patterns observed during cervical flexion and return to mid-line. DESIGN: Single-subject design with independent measurement of dynamic ROM and sEMG. SETTING: Applied clinical setting. PARTICIPANTS: Two subjects with normal ROM and cervical muscles were studied. MAIN OUTCOME MEASURE: One subject was studied with sEMG. looking at the cervical paraspinals and sternocleidomastoid muscles; the other subject was studied with an active ROM device. Three cervical movements were studied: lower cervical flexion, atlantoaxial (upper) cervical flexion, and a combination upper/lower cervical flexion. RESULTS: The active ROM device indicates larger movements (higher degrees of flexion) for the lower cervical flexion compared with upper flexion. The combined movement indicates a differential movement from 2 spinal segments. The sEMG recordings indicated differential recruitment patterns. The sternocleidomastoid recruits briskly during the flexion phase of the upper cervical flexion movement, whereas the cervical paraspinals recruit briskly during return to mid-line when the lower cervical flexion is used. The combined upper then lower cervical flexion movement recruits both sets of muscles. CONCLUSIONS: The results of the study indicate 2 distinct movement patterns associated with upper versus lower cervical flexion and 2 distinct sEMG recruitment patterns. The study suggests that these 2 distinct movements involve 2 distinct cervical segments and are associated with recruitment of different muscle groups. Applied clinical research on the cervical spine should use sEMG recordings to assess both the upper and lower flexion movements as the standard for the study of cervical flexion.     

Neck mobility measurement by means of the 'Flock of Birds' electromagnetic tracking system

OBJECTIVE: To establish the accuracy and reliability of a six-degrees-of-freedom electromagnetic tracking device, the "Flock of Birds", for measuring neck rotations and to identify the main sources of error. DESIGN: Ten human subjects made the same types of maximal neck rotation, both actively and passively: axial rotation in neutral position, from a flexed position and from an extended position, flexion/extension and lateral flexion. The same movements were mimicked in a 'dummy head' set-up. METHODS: One Flock of Birds receiver was mounted on the thorax, one on the head. By means of a third receiver, mounted on a stylus, bony landmarks on head and thorax were palpated. These served to define two anatomically based local coordinate systems, to which the rotations were referred. RESULTS: Measurements were accurate with a maximal measurement error of 2.5 degrees. No significant difference between active and passive rotation was seen. The intra-subject variation was low within the same session, SD between 2 degrees and 4 degrees. Between sessions the variability was considerable, SD between 5 degrees and 16 degrees. CONCLUSION: The Flock of Birds method is reliable and sufficiently precise. The variability in measured range of motion between sessions is a point of concern in interpreting follow-up studies in patients. RELEVANCE: A reduced range of neck motion is a major complaint in pathologies of the cervical spine or the shoulder. A method is described in which neck rotations are related to well-defined bony landmarks. In combined rotations, e.g. flexion combined with axial rotation, the measured range of motion can sometimes fluctuate strongly (up to 30 degrees ) between measurements, without apparent pathology.     

Movement coordination and differential kinematics of the cervical and thoracic spines in people with chronic neck pain

Background

Research on the kinematics and inter-regional coordination of movements between the cervical and thoracic spines in motion adds to our understanding of the performance and interplay of these spinal regions. The purpose of this study was to examine the effects of chronic neck pain on the three-dimensional kinematics and coordination of the cervical and thoracic spines during active movements of the neck.

Methods

Three-dimensional spinal kinematics and movement coordination between the cervical, upper thoracic, and lower thoracic spines were examined by electromagnetic motion sensors in thirty-four individuals with chronic neck pain and thirty-four age- and gender-matched asymptomatic subjects. All subjects performed a set of free active neck movements in three anatomical planes in sitting position and at their own pace. Spinal kinematic variables (angular displacement, velocity, and acceleration) of the three defined regions, and movement coordination between regions were determined and compared between the two groups.

Findings

Subjects with chronic neck pain exhibited significantly decreased cervical angular velocity and acceleration of neck movement. Cross-correlation analysis revealed consistently lower degrees of coordination between the cervical and upper thoracic spines in the neck pain group. The loss of coordination was most apparent in angular velocity and acceleration of the spine.

Interpretation

Assessment of the range of motion of the neck is not sufficient to reveal movement dysfunctions in chronic neck pain subjects. Evaluation of angular velocity and acceleration and movement coordination should be included to help develop clinical intervention strategies to promote restoration of differential kinematics and movement coordination.     

Range of motion in the upper and lower cervical spine in people with chronic neck pain

Reduced cervical range of motion (ROM) is a common finding in people with neck pain. With few exceptions, only the angle between head and thorax has been measured. Our aim was to use an extended model to compare active cervical flexion and extension, separate for upper and lower cervical levels, between people with chronic non-traumatic neck pain and controls. We also investigated associations between ROM measures, symptoms and self-rated functioning.In this cross-sectional study, 102 subjects with neck pain and 33 healthy controls participated. An electromagnetic tracker system was used to measure the kinematics to construct a three-segment model including the thorax, cervical spine and head. Neutral flexion/extension were defined at subjects’ self-selected seated posture.We found that in the neck pain group, extension in the upper cervical levels and predominately flexion for the lower levels were reduced. The ratio between ROM for the upper and lower levels was altered in the neck pain group so that the lower levels contributed to a lesser extent to the total sagittal ROM compared to controls. These findings could not be explained by a greater forward head posture but must have other origins. For the neck pain group, ROM measures were weakly associated to pain and self-rated functioning. Altogether, this implies that using a three-segment model for assessment of ROM can be a valuable improvement for characterisation of patients and treatment evaluation.     

Effects of dry needling of the obliquus capitis inferior on sensorimotor control and cervical mobility in people with neck pain: A double-blind,randomized sham-controlled trial

BackgroundImpairments of sensorimotor control relating to head and eye movement control and postural stability are often present in people with neck pain. The upper cervical spine and particularly the obliquus capitis inferior (OCI) play an important proprioceptive role; and its impairment may alter cervical sensorimotor control. Dry needling (DN) is a valid technique to target the OCI.ObjectivesTo investigate if a single DN session of the OCI muscle improves head and eye movement control-related outcomes, postural stability, and cervical mobility in people with neck pain.MethodsForty people with neck pain were randomly assigned to receive a single session of DN or sham needling of the OCI. Cervical joint position error (JPE), cervical movement sense, standing balance and oculomotor control were examined at baseline, immediately post-intervention, and at one-week follow-up. Active cervical rotation range of motion and the flexion rotation test were used to examine the global and upper cervical rotation mobility, respectively.ResultsLinear mixed-models revealed that the DN group showed a decrease of JPE immediately post-intervention compared to the sham group (mean difference [MD]= -0.93°; 95% confidence interval [CI]: -1.85, -0.02) which was maintained at one-week follow-up (MD= -1.64°; 95%CI: -2.85, -0.43). No effects on standing balance or cervical movement sense were observed in both groups. Upper cervical mobility showed an increase immediately after DN compared to the sham group (MD= 5.14°; 95%CI: 0.77, 9.75) which remained stable at one-week follow-up (MD= 6.98°; 95%CI: 1.31, 12.40). Both group showed an immediate increase in global cervical mobility (MD= -0.14°; 95%CI: -5.29, 4.89).ConclusionThe results from the current study suggest that a single session of DN of the OCI reduces JPE deficits and increases upper cervical mobility in patients with neck pain. Future trials should examine if the addition of this technique to sensorimotor control training add further benefits in the management of neck pain.     

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.     

激痛点缺血性压迫治疗颈肩肌筋膜疼痛综合征疗效观察

目的:观察激痛点缺血性压迫法治疗颈肩肌筋膜疼痛综合征的疗效。方法:选择颈肩肌筋疼痛膜综合征患者20例,按照随机数字表法分为对照组和治疗组,每组10例。对照组仅接受健康宣教;治疗组在对照组基础上实施激痛点缺血性压迫疗法。首先通过Booster Pro3筋膜枪渐次提高振动频率的方法松解斜方肌上束,提高痛阈,达到放松并激活上斜方肌的目的,随后使用缺血性压迫激痛点的方法进行干预,治疗1次/d,连续治疗2周。分别在治疗前、后,采用肌力与脊柱活动度测量仪测量颈部关节活动度与肌力,采用疼痛视觉模拟评分法(VAS)评价颈肩部的疼痛程度,采用颈椎功能障碍指数(NDI)评价颈部功能障碍水平。结果:与治疗前比较,治疗第1次结束即刻治疗组左右侧肌力明显增加,治疗后2周治疗组颈部关节活动度(前屈方向)、左右侧肌力明显增加,左屈、右屈、右旋方向上的VAS评分与NDI评分明显降低,差异有统计学意义(P<0.05);与对照组比较,治疗后2周治疗组颈部关节活动度(前屈方向)、左右侧肌力更高,左屈、右屈、右旋方向上的VAS评分与NDI评分更低,差异有统计学意义(P<0.05)。结论:激痛点缺血性压迫疗法治疗颈肩肌筋膜疼痛综合征,可以有效提高MPS患者颈部关节活动度、左右侧肌力,缓解颈部肌肉僵硬不适和疼痛,改善颈椎功能障碍状态,值得临床推广应用。     

Comparison of Upper Cervical Flexion and Cervical Flexion Angle of Computer Workers with Upper Trapezius and Levator Scapular Pain

[Purpose] In this study, we compared upper cervical flexion and cervical flexion angle of computer workers with upper trapezius and levator scapular pain. [Subject] Eight male computer workers with upper trapezius muscle pain and eight others with levator scapular muscle pain participated. [Methods] Each subject was assessed in terms of upper cervical flexion angle and total cervical flexion angles using a cervical range of motion instrument after one hour of computer work. [Results] The upper cervical flexion angle of the group with levator scapular pain was significantly lower than that of the group with upper trapezius pain after computer work. The total cervical flexion angle of the group with upper trapezius pain was significantly lower than that of the group with levator scapular pain after computer work. [Conclusion] For selective and effective intervention for neck pain, therapists should evaluate upper and lower cervical motion individually.Key words: Cervical range of motion, Neck pain, Upper cervical flexion     

Effects of the Sustained Computer Work on Upper Cervical Flexion Motion

[Purpose] The purpose of this study was to evaluate the effect of sustained computer work on cervical flexion, especially the upper cervical region. [Subjects] We recruited 11 sedentary workers who used a computer for at least 4 hours a day. [Methods] Total range of cervical flexion, upper cervical flexion, and their ratio were measured before and after 1 hour of computer work. [Results] The total range of cervical flexion was not significantly different between pre-and post-measurement. However, upper cervical flexion, and the ratio between the upper cervical flexion and total cervical flexion significantly decreased after 1 hour of computer work, compared to pre-measurement. [Conclusion] Sustained computer work affects the range of cervical flexion, especially in the upper cervical region.Key words: CROM, Cervical kinematics, Upper cervical     

Reduced flexion rotation test in women with chronic and episodic migraine

ObjectiveTo compare flexion rotation test and global active cervical mobility in women with chronic migraine, episodic migraine, and headache-free controls. The influence of neck pain-related disability on the flexion rotation test was also analyzed.MethodsWomen with chronic migraine (n = 25), episodic migraine (n = 30), and those who were headache-free (n = 30) were evaluated. Upper cervical mobility was measured using the flexion rotation test and global active mobility was assessed using the cervical range of motion device. Neck pain related-disability was assessed using the Neck Disability Index. Statistical analyses were performed using a MANOVA test, prevalence ratios, and linear regression.ResultsChronic (right, MD: ?15°; 95%CI: ?21° to ?11°; left, MD: ?13°; 95%CI: ?20° to ?12°) and episodic (right, MD: ?8°; 95%CI: ?13° to ?4°; left, MD: ?8°; 95%CI: ?12° to ?5°) migraine groups achieved lower flexion rotation test mobility bilaterally than headache-free women. Only chronic migraine was associated with a lower global cervical range of motion compared to that of headache-free women during flexion, (MD: ?8°; 95%CI: ?15° to ?1°), extension (MD: ?13°; 95%CI: ?20° to ?4°), right lateral flexion (MD: ?4°; 95%CI: ?9° to ?0.2°), left lateral flexion (MD: ?6°; 95%CI: ?10° to ?2°), right rotation (MD: ?9°; 95%CI: ?15° to ?4°), and left rotation (MD: ?8°; 95%CI: ?13° to ?2°). Migraine was associated with a 2.85-fold increase in the risk of a positive flexion rotation test. Flexion Rotation Test was influenced by disability-related neck pain (R² = 19.1; p = 0.001).ConclusionWomen with migraine have a lower upper cervical range of motion than headache-free women. Women with chronic migraine demonstrated reduced global cervical range of motion when compared to headache-free women. Migraine was associated with in increased likelihood of a positive Flexion Rotation Test. Reduction in mobility was influenced by migraine frequency and disability-related neck pain.     

An in vivo study of the primary and coupled rotations of the thoracic spine

OBJECTIVE: To provide preliminary data on three-dimensional thoracic spine kinematics measured in vivo. DESIGN: This study measured the three planes of thoracic spine motion in normal subjects using an external measuring device. BACKGROUND: Few studies have investigated the primary and associated coupled rotations in the thoracic spine in vivo. Most knowledge of motion characteristics comes from in vitro studies which have limitations. There is a lack of agreement on the patterns of thoracic coupled motion especially that between lateral flexion and axial rotation. METHODS: Thoracic motion was examined in 60 normal subjects (30 males, 30 females) aged 18-24 years. The primary and coupled rotations of the thoracic regions T(1-4), T(4-8), T(8-12) were measured using a 3 SPACE Fastrak system. RESULTS: The three thoracic regions displayed the characteristic variations in range and distribution of primary rotations previously described. The pattern of coupled motion varied between subjects but an ipsilateral pattern predominated between lateral flexion and axial rotation in the middle and lower thoracic regions while the upper thoracic region was found to exhibit either a contralateral or ipsilateral pattern. Gender did not influence results. CONCLUSIONS: The pattern of coupled motion in the thoracic spine demonstrated some variability between subjects in vivo. Lateral flexion and axial rotation were strongly coupled with overall, their relationship being predominantly ipsilateral.     

Clinical and goniometric evaluation of patients with spasmodic torticollis

BACKGROUND: Patients with cervical dystonia have been evaluated prospectively by the Toronto Western Spasmodic Torticollis Rating Scale and by cervical electrogoniometry. METHODS: Nineteen patients with cervical dystonia were studied. The Toronto Scale interobserver reliability was evaluated by two observers. An electrogoniometer was used to quantify cervical range of motion and velocity. The correlation between goniometric measurements and clinical evaluation was calculated. FINDINGS: The interobserver reliability was excellent for the total score (r(s) = 99) and good for the disability and the pain score (r > 0.88). However, global severity scale was shown to have a moderate reliability (r = 0.63) with r ranging from 0.37 to 0.98 for the individual items. The average loss of range of motion for flexion and extension, lateral bending and rotation was 18%, 12% and 21% respectively. For the velocity of movement, the average loss was proportionately greater than for the range of motion. (41%, 43% and 52% respectively). Correlation between the severity scale and range of motion was moderate but significant (r(s) = -0.52 to -0.67). Correlation between the Toronto severity score and the sum of movement velocities was significant for flexion-extension and lateral bending velocity sums (r(s) = -0.51; r(s) = -0.61). The lateral bending and rotation velocities were significantly correlated with pain and total scores (r(s) = -0.51). No significant correlation was observed for the disability score. INTERPRETATION: Three-dimensional electrogoniometry is helpful to quantify the velocity of neck movements and range of motion in patients with cervical dystonia.     

Comparison of the Symmetry of Right and Left Lateral Cervical Flexion and Rotation and the Cervical FRR in Young Computer Workers

[Purpose] This study compared the symmetry of right and left lateral cervical flexion and rotation, and the cervical flexion-relaxation ratio (FRR) in young computer workers in Korea. [Subjects and Methods] Twenty computer workers (14 males and 6 females) participated in this study. We measured their right and left lateral cervical flexion, rotation, and FRR. [Results] Right and left lateral flexion and right and left rotation showed no significant differences between the sides. The left cervical FRR was significantly lower than the right cervical FRR. [Conclusion] The cervical FRR, expressed as a numerical value, is a more sensitive marker for measuring neuromuscular changes associated with mild asymmetry than CROM.Key words: Cervical range of motion, Flexion-relaxation ratio, Muscle imbalance     

Variability of the helical axis during active cervical movements in people with chronic neck pain

BackgroundRecent work described parameters of the helical axis in asymptomatic people with potential for investigating kinematic changes in the cervical region. This approach could provide novel information on movement variability in people with neck pain, however this has never been investigated. This study aimed to investigate movement variability during active neck movements performed at different speeds in people with and without chronic neck pain.MethodsThis observational case-control study examined 18 participants with chronic neck pain of either idiopathic or traumatic origin and 18 gender-matched asymptomatic participants. Cervical kinematics were captured with 3D motion capture as people with and without chronic neck pain performed flexion-extension, bilateral lateral flexion and bilateral rotation at different speeds (natural, slow, and fast). The mean distance and mean angle parameters of the helical axis were extracted to describe 3D motion and quantify movement variability.FindingsA smaller mean distance was observed in those with neck pain compared to the asymptomatic participants during flexion-extension (P = 0.019) and rotation movements (P = 0.007). The neck pain group displayed smaller values for the mean angle during rotation movements with different speeds (P = 0.01). These findings indicate less variable movement for those with neck pain relative to the asymptomatic participants. No difference in the mean angle was observed between groups for flexion-extension and lateral flexion.InterpretationThe findings reiterate the importance of data derived from kinematic measures, and its potential for providing clinicians with further insight into the quality of active neck movements in people with chronic neck pain.     

Decreased isometric neck strength in women with chronic neck pain and the repeatability of neck strength measurements

OBJECTIVES: To evaluate neck flexion, extension, and, especially, rotation strength in women with chronic neck pain compared with healthy controls and to evaluate the repeatability of peak isometric neck strength measurements in patients with neck pain. DESIGN: Cross-sectional. SETTINGS: Rehabilitation center and physical and rehabilitation medicine department at a Finnish hospital. PARTICIPANTS: Twenty-one women with chronic neck pain and healthy controls matched for sex, age, anthropometric measures, and occupation. INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURES: Peak isometric strength of the cervical muscles was tested in rotation, flexion, and extension. RESULTS: Significantly lower flexion (29%), extension (29%), and rotation forces (23%) were produced by the chronic neck pain group compared with controls. When the repeated test results were compared pairwise against their mean, considerable variation was observed in the measures on the individual level. Intratester repeatability of the neck muscle strength measurements was good in all the 4 directions tested in the chronic neck pain group (intraclass correlation coefficient range,.74-.94). The coefficient of repeatability was 15N, both in flexion and extension, and 1.8 Nm in rotation. On the group level, improvement up to 10% due to repeated testing was observed. CONCLUSIONS: The group with neck pain had lower neck muscle strength in all the directions tested than the control group. This factor should be considered when planning rehabilitation programs. Strength tests may be useful in monitoring training progress in clinical settings, but training programs should be planned so that the improvement in results is well above biologic variation, measurement error, and learning effect because of repeated testing.     

A normative study of cervical range of motion measures including the flexion–rotation test in asymptomatic children: side-to-side variability and pain provocation

Objectives: Cervical movement impairment has been identified as a core component of cervicogenic headache evaluation. However, normal range of motion values in children has been investigated rarely and no study has reported such values for the flexion–rotation test (FRT). The purpose of this study was to identify normal values and side-to-side variation for cervical spine range of motion (ROM) and the FRT, in asymptomatic children aged 6–12 years. Another important purpose was to identify the presence of pain during the FRT.

Methods: Thirty-four asymptomatic children without history of neck pain or headache (26 females and 8 males, mean age 125.38 months [SD 13.14]) were evaluated. Cervical spine cardinal plane ROM and the FRT were evaluated by a single examiner using a cervical ROM device.

Results: Values for cardinal plane ROM measures are presented. No significant gender difference was found for any ROM measure. Mean difference in ROM for rotation, side flexion, and the FRT were less than one degree. However, intra-individual variation was greater, with lower bound scores of 9.32° for rotation, 5.30° for side flexion, and 10.89° for the FRT. Multiple linear regression analysis indicates that movement in the cardinal planes only explains 19% of the variance in the FRT. Pain scores reported following the FRT were less than 2/10.

Discussion: Children have consistently greater cervical spine ROM than adults. In children, side-to-side variation in rotation and side flexion ROM and range recorded during the FRT indicates that the clinician should be cautious when using range in one direction to determine impairment in another. Range recorded during the FRT is independent of cardinal movement variables, which further adds to the importance of the FRT, as a test that mainly evaluates range of movement of the upper cervical spine.     

Does the region of pain influence the presence of sensorimotor disturbances in neck pain disorders?

Impairments in sensorimotor control have been demonstrated in neck pain disorders. However, there are more anatomical and neurophysiological connections between the sensorimotor control system and the upper cervical region and thus potential for greater disturbances in those with upper region pain. This study investigated whether sensorimotor impairment was greater in those suffering pain from the upper rather than lower cervical spine region, taking the onset of pain into account.Sixty-four subjects with persistent neck pain were divided into 4 groups -upper and lower region non-traumatic and upper and lower region traumatic. Cervical Joint Position Error (JPE), smooth pursuit neck torsion (SPNT) and standing balance tests were compared between groups.The lower non-traumatic group demonstrated significantly less (p < 0.03) deficit in SPNT compared to all other groups as well as less total energy of sway on the eyes open balance tests (p < 0.05) compared to both traumatic neck pain groups. The upper traumatic group demonstrated significantly greater JPE following rotation to the right (p < 0.04) when compared to both lower groups.Less sensorimotor dysfunction appears to occur in those with lower compared to upper cervical region pain, although this depends on whether trauma is involved in the onset of pain.     

Validity and Intertester Reliability of Cervical Range of Motion Using Inclinometer Measurements

Abstract

Several procedures have been developed for using inclinometers to measure cervical range of motion. The purpose of this study was to evaluate the validity and reliability of three such methods. The subjects were thirty-four practicing physical therapists. Three individuals, who served as models, had their cervical range of motion measured by the thirty-four physical therapists using a single, double, and stabilization inclinometer method. X-ray films were then taken of the models in flexion, extension, and right and left lateral flexion. A computerized axial tomography scan was used for measuring cervical spine rotation. Results indicate that the single and double methods in flexion and single and stabilization methods in flexion were valid. Inclinometer measurements of cervical flexion, extension, lateral flexion, and rotation were found to be reliable for all three methods with ICCs ranging from .89 to .94. Although inclinometry yields consistent results, there validly is questionable. Sources of error were identified and suggestions given for improving validity and reliability of cervical range of motion while using inclinometers.