Acute neck pain: cervical spine range of motion and position sense prior to and after joint mobilization

Despite the relatively high prevalence of cervical spine pain, the efficacy of treatment procedures is limited. In the current study, range of motion and proprioception was assessed prior to and after specific cervical spine mobilisation techniques. A 44-year-old male office worker presented with a history of cervical pain of 1 day duration. He had woken with pain, stiffness and a loss of range of motion. Examination findings indicated pain to be at C5–6 on the left side. Measurement of maximal three-dimensional cervical motion was undertaken using a Zebris system. A position matching task tested the individual's ability to actively reposition their head and neck. The treatment undertaken involved grade III down-slope mobilisations on the left side at C5–6 and C6–7 in supine lying. This technique was then progressed by placing the subject in an upright sitting position, and sustained natural apophyseal glides were performed at C6.Immediately following the treatment, the patient reported a considerable decrease in pain, less difficulty in movement and reduced stiffness. Motion analyses showed the most marked percentage improvements in range of motion after treatment were in flexion (55%), extension (35%), left rotation (56%), and left lateral flexion (22%). Ipsilateral lateral flexion with axial rotation was also notably improved following treatment. No change in proprioceptive ability was found following the treatment. The findings showed that the application of standardised specific mobilisation techniques led to substantial improvements in the range of motion and the restitution of normal coupled motion.     

Prevalence of pain and dysfunction in the cervical and thoracic spine in persons with and without lateral elbow pain

The purpose of this study was to survey the prevalence of pain in the cervical and thoracic spine (C2–T7) in persons with and without lateral elbow pain. Thirty-one subjects with lateral elbow pain and 31 healthy controls participated in the study. The assessment comprised a pain drawing, provocation tests of the cervical and thoracic spine, a neurodynamic test of the radial nerve, and active cervical range of motion. Seventy percent of the subjects with lateral elbow pain indicated pain in the cervical or thoracic spine, as compared to 16% in the control group (p<0.001). The frequency of pain responses to the provocation tests of the cervical and thoracic spine was significantly higher (p<0.05) in the lateral elbow pain (LEP) group, as was the frequency of pain responses to the neurodynamic test of the radial nerve (p<0.001). Cervical flexion and extension range of motion was significantly lower (p<0.01) in the LEP group. The results indicate a relation between lateral elbow pain and pain in the vertebral spine (C2–T7). The cervical and thoracic spine should be included in the assessment of patients with lateral elbow pain.     

Reproducibility and instrument validity of a new ultrasonography-based system for measuring cervical spine kinematics

OBJECTIVE: To report instrument validity of CMS 70P, a new ultrasonography-based system for spatial kinematic analysis of the spine and its application in studying the reproducibility of cervical motion findings in healthy subjects. BACKGROUND: Reproducibility of cervical motion has been investigated using various instruments and consisting in most cases of short test-retest time intervals of between minutes to days. METHODS: Performance of the instrument was validated against a digital inclinometer, at ranges of motion compatible with actual cervical motion. To study reproducibility, 25 healthy individuals, 22 women and 3 men aged 26-48 were tested twice within an average time interval of 3.3 weeks. Performed in the seated position and at a self-determined pace, cervical motion was defined in terms of head motion relative to a sternal (reference) system, in all six primary motions: flexion, extension, right rotation, left rotation, right lateral flexion and left lateral flexion. RESULTS: The system exhibited excellent agreement with the digital inclinometer, establishing its instrument validity for testing cervical motion. No significant differences were indicated between the test and retest for both the net maximal displacements and average velocities. The correlation coefficients for the single plane motions (e.g. flexion+extension) were higher than those derived for the primary motions, and ranged between 0.78 (sagittal plane) and 0.88 (frontal plane). The magnitude of the standard error of the measurement reflected the same trend with the lowest value recorded for the frontal plane. The self-selected velocity at which these motions were performed was similar in the frontal and saggital planes but was significantly higher for the transverse plane (rotations). CONCLUSIONS: This study indicates that spanned over time intervals that are measured in weeks, cervical motion findings derived from the CMS 70P are well reproducible. Findings also imply the need for a more stringent control of subject positioning and stabilization. RELEVANCE: Reduction of range of motion and average is typically observed in various pathologies of the cervical spine and is regarded, together with pain, as a major impairment. Therefore, valid assessment of cervical motion which is essential for follow-up and treatment outcome strongly depends on reproducibility of the findings. This study indicates that acceptable reproducibility is maintained over periods of time which are clinically meaningful using the system described herewith.     

Comparison of the Ferno Scoop Stretcher with the Long Backboard for Spinal Immobilization

Objectives. Spinal immobilization is essential in reducing risk of further spinal injuries in trauma patients. The authors compared the traditional long backboard (LBB) with the Ferno Scoop Stretcher (FSS) (Model 65-EXL). They hypothesized no difference in movement during application andimmobilization between the FSS andthe LBB. Methods. Thirty-one adult subjects had electromagnetic sensors secured over the nasion (forehead) andthe C3 andT12 spinous processes andwere placed in a rigid cervical collar, with movement recorded by a goniometer (a motion analysis system). Subjects were tested on both the FSS andthe LBB. The sagittal flexion, lateral flexion, andaxial rotation were recorded during each of four phases: 1) baseline, 2) application (logroll onto the LBB or placement of the FSS around the patient), 3) secured logroll, and4) lifting. Comfort andperceived security also were assessed on a visual analog scale. Results. There was approximately 6–8 degrees greater motion in the sagittal, lateral, andaxial planes during the application of the LBB compared with the FSS (both p < 0.001). No difference was found during a secured logroll maneuver. The FSS induced more sagittal flexion during the lift than the LBB (p < 0.001). The FSS demonstrated superior comfort andperceived security. Conclusion. The FSS caused significantly less movement on application andincreased comfort levels. Decreased movement using the FSS may reduce the risk of further spinal cord injury.     

Normal global motion of the cervical spine: an electrogoniometric study.

OBJECTIVE: Establishment of a normal database and clinical reference of active global cervical spine motion ranges and patterns using a commercial electrogoniometer. DESIGN: Three-dimensional cervical motion ranges and patterns were analyzed in 250 asymptomatic volunteers. BACKGROUND: In vivo out-of-plane motion patterns of the cervical spine have not yet been reported in large populations, but could be of clinical interest. METHODS: In 250 subjects (aged 14-70 yr), motion range and patterns between the first thoracic vertebra and the head were analyzed for flexion-extension, lateral bending, rotation in neutral sagittal plane position and in full flexion using the CA 6000 Spine Motion Analyzer. RESULTS AND CONCLUSIONS: Average motion range in the sagittal plane was 122 degrees (SD: 18 degrees ). Flexion was slightly more important than extension. Out-of-plane components were negligible. Global bending range averaged 88 degrees (SD: 16 degrees ), left and right bending being comparable. Homolateral rotation was associated to lateral bending. Its extent was approximately 40% of the bending range. Global rotation range in neutral sagittal plane position was 144 degrees (SD: 20 degrees ), without significant difference between right and left rotations. Associated motion components were small. During rotation in flexed head position, global range (134 degrees, SD: 24 degrees ) was comparable to the one in neutral flexion. But heterolateral bending, averaging 60% of the primary motion, was associated to flexed rotation. Significant reduction of all primary (but not conjunct) motions with age were obtained. Sex had no influence on cervical motion range. RELEVANCE: Our results agreed with previous observations, validating the methodology used. They thus constitute reference data of cervical out-of-plane motion for clinical applications.     

Objective evaluation of cervical spine mobility after surgery during free-living activity

Background

Evaluation of cervical spine mobility after surgery is mainly based on the measurement of the range of motion during imposed movements. It can thus be questionable if this assessment represents the mobility experienced during daily life. The goal of this study was to propose a new evaluation tool based on the monitoring of cervical spine movement during daily activities.

Methods

The detection of cervical movement and the determination of primary motion component (lateral bending, axial rotation or flexion–extension), using two inertial sensors, were first validated in laboratory settings. Fifteen patients who underwent a cervical arthrodesis and nine healthy control subjects were monitored during their daily activity for half a day. The frequency of cervical movement was quantified according to posture, i.e. static and walking periods. The amplitude and velocity of cervical movement were evaluated using the median and cumulative distribution function.

Findings

The movement detection and classification showed an excellent performance (sensitivity and specificity > 94%). For the daily monitoring, the patients presented a movement frequency similar to controls, whereas the amplitude and velocity in patients were lower than in controls (P < 0.05). The differences between patients and controls were larger for the velocity parameters (effect sizes > 0.37 and > 0.54 for static and walking periods respectively) than for the amplitude parameters.

Interpretation

Body-worn inertial sensors enable the quantitative evaluation of global cervical movement. The movement amplitude and velocity during free-living conditions can be used as objective parameters to evaluate the cervical spine mobility after treatment.     

Effect of the cervical flexion angle during smart phone use on muscle fatigue of the cervical erector spinae and upper trapezius

[Purpose] The purpose of this study was to examine the influence of the cervical flexion angle when using a smart phone on muscle fatigue of the cervical erector spinae (CES) and upper trapezius (UT). [Subjects] This study recruited 12 healthy adults. [Methods] Each subject sat on a chair, with his/her back against the wall and held a smart phone with both hands. Fatigue of the neck and shoulder muscles at different cervical flexion angles (0°, 30°, and 50°) was measured by electromyography. The following muscles were assessed: the right upper trapezius (RtUT), left upper trapezius (LtUT), right cervical erector spinae (RtCES), and left cervical erector spinae (LtCES). A cervical range of motion instrument was attached to the subjects’ heads to measure the cervical angle during the experiment. [Results] The RtUT and LtUT showed the highest muscle fatigue at a cervical flexion angle of 50° and the lowest fatigue at an angle of 30°. There was no significant difference in the muscle fatigue of the RtCES and LtCES at any of the cervical flexion angles. [Conclusion] UT muscle fatigue depends on the cervical flexion angle when using a smart phone.Key words: Smart phone, Muscle fatigue, Cervical flexion angle     

Do inertial sensors represent a viable method to reliably measure cervical spine range of motion?

A rise in neck pain cases has initiated an exponential interest in the assessment and treatment of cervical spine range of motion (CROM). Experimental limitations, however, have been reported as therapists strive to collect continuous, dynamic data to aid prognosis. This technical report seeks to explore the viability of using inertial sensors to reliably assess CROM. In recognition of the need for secure skin-sensor attachment, four combinations of sensor pairings were established and investigated based upon four clinically identifiable surface landmarks. Twelve participants were recruited and asked to perform three specific movement cycles in each plane (i.e. flexion-extension; rotation; lateral bending). The reliability of the peak CROM, and the movement pattern, recorded in each of the three movement cycles was statistically analysed using the intra-class correlation coefficient (ICC) and coefficient of multiple correlations (CMC). It was determined that the most reliable positions of the orientation sensors, with one adhered to the forehead and the other representing T4, enables data to be recorded with a reliability that is comparable to other CROM measuring techniques. Subsequently, it is concluded that inertial sensors represent a viable method to assess CROM.     

The direction of progressive herniation in porcine spine motion segments is influenced by the orientation of the bending axis

BACKGROUND: It has been shown that disc herniations are a cumulative injury created by repetitive flexion motion while under modest compressive loads. There is a lack of data linking the direction of nucleus tracking to the orientation of the bending motion axis. Our purpose was to determine if the direction that the nucleus tracks through the annulus during progressive herniation is predictable from the direction of bending motion (i.e. a specific side with posterio-lateral herniation). METHODS: Matched cohorts (nu=16) of porcine cervical spine (C3/4 and C5/6) motion segments were potted in aluminum cups and bent at an angle of 30 degrees to the sagittal plane flexion axis while under a sustained compressive load of 1472 N. FINDINGS: The direction of bending motion affected the tracking pattern of the nucleus through the annular fibres in a predictable pattern. Specifically, bending the motion segments at an angle of 30 degrees to the left of the sagittal plane flexion axis biased the movement of the nucleus toward the posterior right side of the disc in 15 of the 16 specimens. INTERPRETATION: Based on this animal model, shown to have similar biomechanical behaviour to humans, the direction that the nucleus tracks through the annular fibres appears to be dependent upon the direction of bending motion. This may have implications on both herniation prevention and rehabilitation of posterio-lateral bulges and herniations.     

Recurrent neck pain patients exhibit altered joint motion pattern during cervical flexion and extension movements

BackgroundImpaired sensorimotor ability has been demonstrated in recurrent neck pain patients. It is however not clear if cervical joint motion and pressure pain sensitivity in recurrent neck pain patients are different from asymptomatic controls.MethodsCervical flexion and extension motions were examined by video-fluoroscopy and pressure pain thresholds were assessed bilaterally over C2/C3, C5/C6 facet joints and right tibialis anterior in eighteen recurrent neck pain patients and eighteen healthy subjects. Individual joint motion was analyzed by dividing fluoroscopic videos into 10 epochs. The motion opposite to the primary direction (anti-directional motion) and motion along with the primary direction (pro-directional motion) of each joint were extracted across epochs. Total joint motion was the sum of anti-directional and pro-directional motions. Joint motion variability was represented by the variance of joint motions across epochs.FindingsCompared to controls, recurrent neck pain patients showed: 1) decreased anti-directional motion at C2/C3 and C3/C4 (P < 0.05) and increased anti-directional motion at C5/C6 and C6/C7 (P < 0.05) during extension motion. 2) Increased overall anti-direction motion during flexion motion (P < 0.05). 3) Lower joint motion variability at C3/C4 during extension motion (P < 0.05).InterpretationRecurrent neck pain patients showed a redistribution of anti-directional motion between the middle cervical spine and the lower cervical spine during cervical extension and increased overall anti-directional motion during cervical flexion compared with healthy controls. The anti-directional motion was more sensitive to neck pain compared to other cervical joint motion parameters in the present study.     

Feasibility of using inertial sensors to assess human movement

The aim of this study was to determine the suitability of inertial sensors for motion analysis research. Inertial sensors (Xsens Technologies, Netherlands) consisting of 3D gyroscopes, accelerometers and a magnetometer were compared against an electromagnetic motion tracking system (Fastrak, Polhemus, USA) for measuring motions of an artificial hinge joint and random 3D motions. Subsequently, to assess the feasibility of using inertial sensors for human motion analysis, the movements of the hip joint during walking were recorded in 20 normal asymptomatic subjects. The comparative study demonstrated good agreement between the inertial and electromagnetic systems. Measurements obtained for hip joint movement during walking (flexion, extension and step length) were similar to those reported in previous studies (flexion 38.8°, extension 6.6°, step frequency 1.02 Hz). We conclude that the inertial sensors studied have the potential to be used for motion analysis and clinical research.     

Assessment of the Sheffield Support Snood,an innovative cervical orthosis designed for people affected by neck muscle weakness

BackgroundThis study aimed at quantifying the biomechanical features of the Sheffield Support Snood, a cervical orthosis specifically designed for patients with neck muscle weakness. The orthosis is designed to be adaptable to a patient’s level of functional limitation using adjustable removable supports, which contribute support and restrict movement only in desired anatomical planes.MethodsThe snood was evaluated along with two commercially available orthoses, the Vista and Headmaster, in a series of flexion, extension, axial-rotation and lateral flexion movements. Characterization was performed with twelve healthy participants with and without the orthoses. Two inertial-magneto sensors, placed on the forehead and sternum, were used to quantify the neck’s range of motion.FindingsIn its less supportive configuration, the snood was effective in limiting movements to the desired planes, preserving free movement in other planes. The Headmaster was only effective in limiting flexion. The range of motion achieved with the snood in its rigid configuration was equivalent (P > 0.05, effect size < 0.4) to that achieved with the Vista, both in trials performed reaching the maximum amplitude (range of motion reduction: 25%–34% vs 24%–47%) and at maximum speed (range of motion reduction: 24%–29% vs 25%–43%).InterpretationThe Sheffield Support Snood is effectively adaptable to different tasks and, in its most supportive configuration, offers a support comparable to the Vista, but providing a less bulky structure. The chosen method is suitable for the assessment of range of motions while wearing neck orthoses and is easily translatable in a clinical context.     

What is the normal response to structural differentiation within the slump and straight leg raise tests?

The purpose of the study was to assess the effect of structural differentiation or sensitising manoeuvres on responses of normal subjects to standard neurodynamic tests of straight leg raise (SLR) and slump test. Eighty-eight (39 males and 49 females) asymptomatic subjects were examined (aged 18–39 mean age 21.9±4.1 years). Knee flexion angle was measured using a goniometer during the slump test in two conditions cervical flexion and extension. Hip flexion angle was measured using a goniometer during SLR test in two conditions; ankle dorsi-flexion and neutral. The change in knee flexion, following addition of the structural differentiating manoeuvre to the slump test, was a significant increase in knee flexion angle for both males (change in knee angle; 6.6±4.7°/18.7±17.5%, p<0.01) and females (change in knee angle5.4±5.8°/17.6±23.7%, p<0.01), though showed no difference between sides (p>0.05). During the SLR test, a significant reduction in hip flexion occurred following structural differentiation for both groups (change in hip angle; males=9.5±8.3°/21.5±18.8%, p<0.01; females=15.2±9.5°/25.9±13.9%, p<0.01), though showed no difference between sides (p>0.05). Structural differentiating manoeuvres have a significant effect on test response in terms of range of movement even in normal asymptomatic individuals. These responses should be taken into account during the assessment clinical reasoning process.     

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.     

Assessment of motion in the cervico-thoracic spine in patients with subacute whiplash-associated disorders.

OBJECTIVE: To investigate the distribution of segmental flexion mobility in the cervico-thoracic spine of men and women with whiplash-associated disorders. The study also assesses the relationship between cervical mobility and segmental flexion mobility, and whether hypomobility in C7-T1 is associated with neck pain and weakness in the hands. Finally, the study investigates the impact of fear of movement/(re)injury and pain intensity on cervical mobility. METHOD: The data in this longitudinal study was obtained from a previous trial on 47 patients. Assessments were performed at baseline and 3 and 9 months following randomization using a cervical range of motion instrument, the cervico-thoracic ratio, a Grippit, a visual analogue scale, a Painmatcher, and the Tampa Scale for Kinesiophobia. RESULTS: Women exhibited hypomobility in C7-T1. There was no significant association between the 2 cervical measurement techniques. The correlation between flexion mobility in C7-T1 and grip strength was weak but significant (r=-0.3) (p<0.05). There was also a weak but significant negative correlation between total cervical mobility and neck pain intensity. No significant correlation was found between fear of movement/(re)injury and cervical mobility. CONCLUSION: Women with whiplash-associated disorders seem to exhibit flexion hypomobility in C7-T1. The flexion mobility in C7-T1 was weakly, but significantly, correlated with grip strength, but was not shown to predict neck pain. Neck pain may give rise to restricted range of motion.     

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.     

VALIDITY OF AN MRI-COMPATIBLE MOTION CAPTURE SYSTEM FOR USE WITH LOWER EXTREMITY NEUROIMAGING PARADIGMS

Background:Emergent linkages between musculoskeletal injury and the nervous system have increased interest to evaluate brain activity during functional movements associated with injury risk. Functional magnetic resonance imaging (fMRI) is a sophisticated modality that can be used to study brain activity during functional sensorimotor control tasks. However, technical limitations have precluded the precise quantification of lower-extremity joint kinematics during active brain scanning. The purpose of this study was to determine the validity of a new, MRI-compatible motion tracking system relative to a traditional multi-camera 3D motion capture system for measuring lower extremity joint kinematics.Methods:Fifteen subjects (9 females, 6 males) performed knee flexion-extension and leg press movements against guided resistance while laying supine. Motion tracking data were collected simultaneously using the MRI-compatible and traditional multi-camera 3D motion systems. Participants’ sagittal and frontal plane knee angles were calculated from data acquired by both multi-camera systems. Resultant range of angular movement in both measurement planes were compared between both systems. Instrument agreement was assessed using Bland-Altman plots and intraclass correlation coefficients (ICC).Results:The system demonstrated excellent validity in the sagittal plane (ICCs>0.99) and good to excellent validity in the frontal plane (0.84 < ICCs < 0.92). Mean differences between corresponding range of angular movement measurements ranged from 0.186 ° to 0.295 °.Conclusions:The present data indicate that this new, MRI-compatible system is valid for measuring lower extremity movements when compared to the gold standard 3D motion analysis system. As there is growing interest regarding the neural substrates of lower extremity movement, particularly in relation to injury and pathology, this system can now be integrated into neuroimaging paradigms to investigate movement biomechanics and its relation to brain activity.Level of Evidence:3     

Origin of neck pain and direction of movement influence dynamic cervical joint motion and pressure pain sensitivity

BackgroundPatients with neck pain normally showed alterations in cervical motion and pressure pain sensitivity. Cervical joints show scattered motions opposite to (anti-directional) the primary motion direction (pro-directional) during dynamic cervical flexion and extension. This study aimed to assess dynamic cervical joint motion and pressure pain sensitivity when pain originated from different cervical muscles which may have clinical relevance in diagnosis of impairments related with neck pain.MethodsFluoroscopic video recordings of cervical flexion and extension were collected from fifteen healthy subjects before and during hypertonic saline-induced pain in right multifidus and trapezius muscles. Cervical flexion and extension motions were divided into 10 epochs with respect to time. Pro-directional, anti-directional, and total joint motion were extracted across epochs as well as joint motion variability. Pressure pain thresholds (PPTs) were assessed bilaterally over C2/C3 and C5/C6 facet joints.FindingsCompared with baseline: 1) Multifidus muscle pain increased the C3/C4 anti-directional motion (P < 0.01), decreased the C6/C7 anti-directional motion (P < 0.05) during extension, and redistributed total joint motion between joints and between half ranges during flexion (P < 0.05). 2) Trapezius muscle pain decreased pro-directional motion (P < 0.05), anti-directional motion (P < 0.05), and joint motion variability (P < 0.05) during extension. 3) Trapezius and multifidus muscle pain increased the PPTs bilaterally over C2/C3 and on the left side of C5/C6 facet joints (P < 0.05).InterpretationThe direction of motion influenced the effects of experimental muscle pain on dynamic cervical joint kinematics, and deep muscle pain showed local effects on individual joints while superficial muscle pain showed global effects spread to all joints.     

Effect of adding stretching to standardized procedures on cervical range of motion,pain, and disability in patients with non-specific mechanical neck pain: A randomized clinical trial

Objectiveto investigate the benefit of adding stretching exercises to cervical joint mobilization and active rotation exercises for patients with non-specific mechanical neck pain.MethodsThirty-eight subjects with non-specific mechanical neck pain were randomly assigned to a standard procedure group (passive cervical mobilization and active cervical rotation range of motion exercise) or a combined procedure (passive cervical mobilization, active cervical rotation range of motion exercises, and stretching procedures). Mixed factorial analysis of variance was used to compare changes between groups over time in active cervical range of motion, Numeric Pain Rating Scale, Neck Disability Index, Global Rating of Change, and Pressure Pain Threshold.ResultsThere was a significant change in mean active range of motion in all directions, Pressure Pain Threshold, perceived pain, disability levels, and global rating of change over time (p < 0.001). There was a significant group by time interaction in mean active range of motion during extension (p = 0.01), right rotation (p = 0.004), right and left lateral flexion (p = 0.05, and p = 0.02 respectively). However, there was no significant group by time interaction in mean active range of motion during flexion, left rotation, pain intensity (p = 0.09), right and left pressure pain threshold (p = 0.30, 0.47, respectively), and disability (p = 0.07).ConclusionsBoth study groups improved significantly in all subjective and objective outcome measures. However, data from this study suggest that adding stretching to the standard procedures may be more effective than the standard procedure alone at improving cervical extension, right rotation, and lateral flexion active range of motion, but not pain and disability.     

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.