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Reduction of Posture Hyperkyphosis Improves Short and Long Term Outcomes in Patients with Neck Pain

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Abstract Purpose/Hypothesis: Because of biomechanical, anatomical and nerve relationships between the cervical and thoracic spine, disturbances in the thoracic region could contribute to the maintenance of neck pain. For these reasons, it seems possible that therapeutic interventions directed at the thoracic spine may have therapeutic effects on the cervical spine. However, there is a lack of controlled studies evaluating the effect of thoracic hyper kyphosis rehabilitation in chronic nonspecific neck pain. The purpose of this study was to investigate the immediate and 1-year effects of a multimodal program, with thoracic hyper kyphosis rehabilitation using the denneroll thoracic traction orthosis (DTTO), on the pain, disability, sensorimotor function; head and eye movement control (smooth pursuit ) and postural stability for subjects with chronic non-specific neck pain and thoracic hyper-kyphosis. Number of Subjects: 80 (37 males) patients, with chronic, nonspecific neck pain and thoracic hyper-kyphosis were recruited and voluntarily consented to participate in the study after Research Ethics Board Approval from Cairo University. Materials and Methods: Subjects were randomly assigned to the control (33.9 ± 5.2 years of age) or an intervention group (31.5 ± 3.7 years of age). Both groups received the multimodal program; additionally, the intervention group received the DTTO. Outcome measures included kyphotic angle ICT-ITL (max.), neck pain and disability (NDI), sensorimotor control outcomes; head repositioning accuracy (HRA), smooth pursuit neck torsion test (SPNT) and overall stability index (OSI). Measures were assessed at three time intervals: baseline, 10 weeks, and 1 year after the 10 week follow up. Results: After 10 weeks of treatment, between group statistical analysis, showed equal improvements for both the intervention and control groups in neck pain intensity (p=0.08), and NDI (p=0.09). Significant differences were found between groups, favoring the intervention group for kyphotic angle ICT-ITL (max), HRA (p˂0.005), smooth pursuit neck torsion test (SPNT) (p˂0.005) and overall stability index (OSI) (p˂0.005). The 1-year follow-up, between group analysis identified a regression back to baseline values for the control group. Thus, all variables were significantly different favoring the intervention group at 1-year follow up period: kyphotic angle ICT-ITL (max.) (P˂0.005), neck pain intensity (P˂0.005), NDI (P˂0.005), HRA (P˂0.005), SPNT (P˂0.005), OS (P˂0.005) in favor of the denneroll group. Conclusions: The addition of the DTTO to a multimodal program positively affected chronic nonspecific neck pain outcomes at long term follow up. We speculate the reduction of thoracic hyper kyphosis contributed to our findings. Clinical Relevance: This study aids in the understanding of the association between thoracic alignment and cervical pain intensity, disability, and sensorimotor control measures. Reduction in thoracic hyper kyphosis with the DTTO, had a positive impact on the outcomes of and at long term follow up in patients with chronic nonspecific neck pain. In populations with chronic nonspecific neck pain, it would seem of value to conservatively restore the normal thoracic alignment as a first line of management. The DTTO investigated in this study is a simple orthotic that can be prescribed for home use or under the supervision of a treating clinician as used in this investigation
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... It has furthermore strongly been associated with headaches such as migraines, tension-type, and cervicogenic headache [5,6], neck pain, and even shoulder problems [7][8][9][10]. Additionally FHP is associated with impairments related to decreased neck proprioception such as balance [11][12][13] and visual impairments [14]. Cervical range of motion (ROM) has been found reduced when performed out of a FHP [15] and altered for coupled movements [16]. ...
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Neck pain is a frequent health complaint. Prolonged protracted malpositions of the head are associated with neck pain and headaches and could be prevented using biofeedback systems. A practical biofeedback system to detect malpositions should be realized with a simple measurement setup. To achieve this, a simple biomechanical model representing head orientation and translation relative to the thorax is introduced. To identify the parameters of this model, anthropometric data were acquired from eight healthy volunteers. In this work we determine (i) the accuracy of the proposed model when the neck length is known, (ii) the dependency of the neck length on the body height, and (iii) the impact of a wrong neck length on the models accuracy. The resulting model is able to describe the motion of the head with a maximum uncertainty of 5 mm only. To achieve this high accuracy the effective neck length must be known a priory. If however, this parameter is assumed to be a linear function of the palpable neck length, the measurement error increases. Still, the resulting accuracy can be sufficient to identify and monitor a protracted malposition of the head relative to the thorax.
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