Direction-Specific Impairments in Cervical Range of Motion in Women with Chronic Neck Pain: Influence of Head Posture and Gravitationally Induced Torque

Abstract

BackgroundCervical range of motion (ROM) is commonly assessed in clinical practice and research. In a previous study we decomposed active cervical sagittal ROM into contributions from lower and upper levels of the cervical spine and found level- and direction-specific impairments in women with chronic non-specific neck pain. The present study aimed to validate these results and investigate if the specific impairments can be explained by the neutral posture (defining zero flexion/extension) or a movement strategy to avoid large gravitationally induced torques on the cervical spine.MethodsKinematics of the head and thorax was assessed in sitting during maximal sagittal cervical flexion/extension (high torque condition) and maximal protraction (low torque condition) in 120 women with chronic non-specific neck pain and 40 controls. We derived the lower and upper cervical angles, and the head centre of mass (HCM), from a 3-segment kinematic model. Neutral head posture was assessed using a standardized procedure.FindingsPrevious findings of level- and direction-specific impairments in neck pain were confirmed. Neutral head posture was equal between groups and did not explain the direction-specific impairments. The relative magnitude of group difference in HCM migration did not differ between high and low torques conditions, lending no support for our hypothesis that impairments in sagittal ROM are due to torque avoidance behaviour.InterpretationThe direction- and level-specific impairments in cervical sagittal ROM can be generalised to the population of women with non-specific neck pain. Further research is necessary to clarify if torque avoidance behaviour can explain the impairments.

Electronic measures of movement impairment, repositioning, and posture in people with and without neck pain—a systematic review

“…1. We identified a total of 37 papers reporting on 36 studies [21, 27, 29, 30, 34, 42–67]. These studies had case populations ranging between 7 and 120 participants with an average of 33 participants, and control populations ranging between 11 and 150 with an average of 35 participants.…”

“…In 12 studies, patients with WAD defined as Québec Task Force grades type I–III [68] were included [27, 34, 42, 45, 46, 48–50, 53, 57, 66]. A total of 15 studies included people with non-specific neck pain labelled idiopathic neck pain [47, 71], non-specific neck pain [54, 67], no traumatic neck pain [66], myofascial neck pain [60], unilateral posterior neck pain [57], insidious neck pain [58], neck or shoulder disorder [44], or simply neck pain [47]. One study [48] defined postural neck pain as a pain in the neck aggravated by postural load and relieved with postural modification.…”

“…Active range of motion was reported in 24 studies [21, 27, 30, 42, 45, 46, 48–55, 57, 59–61, 64, 67, 69] (Table 3). There were three different ways of reporting range of motion: half cycle range of motion, which is the range from neutral starting position to end position in a given direction; full cycle range of motion, which is the range from endpoint in one direction to the opposite endpoint; and a division between upper and lower cervical range of motion in the sagittal plane.…”

In Vivo Evidence of Early Instability and Late Stabilization in Motion Segments Immediately Superior to Anterior Cervical Arthrodesis

“…Quantitative MRI, such as T2 mapping, may provide an early indication of changes in disc tissue composition41 and provide additional insight into the relationship between disc health and changes in adjacent segment motion after ACDF. Finally, preoperative ROM may have been affected by neck pain which may have confounded the results 42…”

Surgery-related Factors Do Not Affect Short-term Adjacent Segment Kinematics After Anterior Cervical Arthrodesis

“…Finally, preoperative ROM may have been limited by neck pain which may have confounded the results. 35 One strength of the study was the multivariate analysis, which accounted for relationships between the independent variables (covariation) that can confound results and can be used to discern the relative effects of each surgical factor on the change in ROM. Previous studies have used multivariate analysis to assess the roles of age, sex, and disc degeneration on cervical ROM in healthy individuals, but not factors related to surgical technique.…”