Extension and flexion in the upper cervical spine in neck pain patients

• Published in: Manual therapy Vol. 20; no. 4; pp. 547 - 552
• Main Authors: Ernst, Markus J, Crawford, Rebecca J, Schelldorfer, Sarah, Rausch-Osthoff, Anne-Kathrin, Barbero, Marco, Kool, Jan, Bauer, Christoph M
• Format: Journal Article
• Language: English
• Published: Scotland Elsevier Ltd 01.08.2015
• Subjects: Adult; Biomechanical Phenomena; Cervical Vertebrae; Cross-Sectional Studies; Disability; Female; Headache; Humans; Male; Manipulation, Spinal - methods; Middle Aged; Neck pain; Neck Pain - physiopathology; Neck Pain - rehabilitation; Neck Pain - therapy; Pain Measurement - methods; Physical Medicine and Rehabilitation; Range of motion; Range of Motion, Articular - physiology; Upper cervical spine; Neck pain; Disability; Headache; Range of motion; Upper cervical spine
• ISSN: 1356-689X; 1532-2769
• DOI: 10.1016/j.math.2014.12.005

Abstract Neck pain is a common problem in the general population with high risk of ongoing complaints or relapses. Range of motion (ROM) assessment is scientifically established in the clinical process of diagnosis, prognosis and outcome evaluation in neck pain. Anatomically, the cervical spine (CS) has been considered in two regions, the upper and lower CS. Disorders like cervicogenic headache have been clinically associated with dysfunctions of the upper CS (UCS), yet ROM tests and measurements are typically conducted on the whole CS. A cross-sectional study assessing 19 subjects with non-specific neck pain was undertaken to examine UCS extension-flexion ROM in relation to self-reported disability and pain (via the Neck Disability Index (NDI)). Two measurement devices (goniometer and electromagnetic tracking) were employed and compared. Correlations between ROM and the NDI were stronger for the UCS compared to the CS, with the strongest correlation between UCS flexion and the NDI-headache (r = −0.62). Correlations between UCS and CS ROM were fair to moderate, with the strongest correlation between UCS flexion and CS extension ROM (r = −0.49). UCS flexion restriction is related to headache frequency and intensity. Consistency and agreement between both measurement systems and for all tests was high. The results demonstrate that separate UCS ROM assessments for extension and flexion are useful in patients with neck pain.