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

Thomas Rudolfsson, Martin Björklund, Åsa Svedmark, Divya Srinivasan, Mats Djupsjöbacka, Thomas Rudolfsson, Martin Björklund, Åsa Svedmark, Divya Srinivasan, Mats Djupsjöbacka

Abstract

Background: Cervical 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.

Methods: Kinematics 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.

Findings: Previous 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.

Interpretation: The 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.

Conflict of interest statement

The authors have declared that no competing interests exist.

Figures

Fig 1. Upper (UC), lower (LC) and…
Fig 1. Upper (UC), lower (LC) and thorax segment (Thx) angles from the 3-segment model (upper panel), and head center of mass migration (HCM, lower panel) for one trial of global cervical flexion (left column), global cervical extension (middle column) and head protraction (right column) for a representative subject in the neck pain sample.
Fig 2. Forest plot of parameter estimates…
Fig 2. Forest plot of parameter estimates of group differences between neck pain participants and controls along with 95% confidence intervals for adjusted (ANCOVA) and unadjusted (ANOVA) analyses of cervical range of motion (ROM).
The covariate was self-rated physical activity. Positive values favour increased ROM in the control group compared to the neck pain participants.
Fig 3
Fig 3
Scatterplot of the upper cervical angle in the natural head posture (UC_NHP) versus upper cervical ROM in extension (UC_ext) in A, and the lower cervical angle in the natural head posture (LC_NHP) versus lower cervical ROM in flexion (LC_flex) in B. Filled circles represent the neck pain subjects (n = 120) and open circles represent controls (n = 40).
Fig 4. Parameter estimates of group differences…
Fig 4. Parameter estimates of group differences in degrees along with 95% confidence intervals separately for upper cervical extension (UC_ext) and lower cervical flexion (LC_flex) for the models with (ANCOVA) and without (ANOVA) initial posture as covariate.
For UC_ext, a more negative value represents greater impairment in the NP group compared to CON. For LC_flex, a more positive value represents a greater impairment in the NP group compared to CON.
Fig 5. Interaction plot group × test…
Fig 5. Interaction plot group × test for HCM migration normalised to the averages for the CON group separately for each test, with 95% confidence intervals.

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