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The effect of poor posture on the cervical range of motion in young subjects
... Depending on the type of posture disorders, the following consequences might develop [4,5]: ...
The work is devoted to the development of a system for monitoring the rehabilitation process of patients with musculoskeletal disorders, as well as identifying possible postural distortions in both children and adults based on anthropometric data, which confirms the relevance and practical significance of the work during the period of military operations in Ukraine and a large number of people with musculoskeletal injuries. The paper proposes a model of a system consisting of two subsystems: a subsystem for collecting pododynamic parameters based on a dynamic baropodometric platform and a visual posture monitoring subsystem. The combination of different gait and posture analysis methods in a single system provides high diagnostic and prognostic value. The main purpose of the proposed system is to monitor the progress of patient rehabilitation using hardware and computer-optical diagnostic methods without radiation exposure with the ability to easily transport the created system, the possibility of high-precision diagnostics in real time, as well as the ability to store and analyze changes in the musculoskeletal system over time. For the collection and analysis of pododynamometric parameters, computer data visualization methods, methods of statistical and dynamic data analysis, and data segmentation methods were used. To collect and analyze anthropometric parameters, methods of detecting objects in the image, methods of computer classification, segmentation and image processing, methods of analyzing graphic information were used. In addition, the paper researches the influence of marker characteristics (shape, color model of representation) and lighting conditions during the acquisition of kinematic parameters on the accuracy of marker detection for further determination of the angles of the pelvis and shoulder line. The results obtained by using the hybrid marker detection algorithm show that the representation of any of the used shapes in all the colors under study in the presence of additional lighting gives 100% marker detection accuracy, only in the HSV color model for a simple scene. The RGB model provides 100% accuracy in detecting only yellow markers with additional lighting. In the absence of the possibility of using additional lighting, only round markers in all the studied colors represented in the HSV color model can achieve 100% accuracy. For a complex scene, representing the input images in the RGB color model does not allow achieving 100% accuracy for any of the marker shapes and colors, even with additional lighting. The highest accuracy for a complex scene is also shown by round markers colored in green or orange, regardless of the presence of additional lighting. Further research will focus on expanding the range of system parameters necessary for diagnosing the patient's condition and analyzing the course of treatment using electromyographic indicators.
... The study included adult individuals aged from 18 to 30 years 22 . The participants had a CVA of less than 49 0 and experience neck pain, chronic nonspecific neck pain. ...
Introduction: Anterior translation, also recognized as Forward Head Posture (FHP), is a pathology that happens when the
head moves forward from the vertical line of gravity. FHP can cause significant problems, such as fascial stretching at the
lower cervical level, shortening of the upper cervical segment, hamstring tightness, and back fascial limitation at the
hamstring and calf muscles levels.
Aim of this study: This study aimed to determine the correlation between forward head posture and hamstring, calf muscles
tightness.
Methods: The study involved 84 university students of both sexes, with a mean age of 21.96 ± 2.25 years for males and a
mean age of 22.05 ± 2 years for females, and a mean BMI of 22.32 ± 1.68 kg/m2
for males and a mean of 22 ± 1.7 kg/m2
for
females. The sample size included only those with a craniovertebral angle (CVA) measurement of less than 490
, which was
determined using the photogrammetry method. The study was conducted to establish the degree of correlation among FHP
and hamstring-calf muscles by using the active knee extension test (AKE test), as well as the passive straight leg raise test
(PSLR) for hamstring muscles tightness using the ankle dorsiflexion with the knee extended (ADFKE), in addition to ankle
dorsiflexion with the knee flexed (ADFKF) for calf muscles tightness.
Results: There was a weak significant direct correlation (r=0.300, p=0.034) between CVA and right hamstring tightness as
measured by PSLR in males with a normal BMI.
Conclusion: Forward head posture (FHP) weakly correlates with hamstring tightness in males with normal BMI, therefore
treatment program should include hamstring muscles stretching.
Keywords: Craniovertebral angle (CVA), Forward head posture (FHP), Hamstring muscle tightness, Flexibility, Calf
muscles tightness
... Neck pain can be classified as acute if it is less than a period of 6 weeks, sub-acute (less than three months), and if the duration of neck pain is more than three to six months, then it is classified as chronic neck pain [2,6]. There can be many risk factors and causes that can lead to neck pain which include poor posture [7], female gender, high job demands, and old age are some of them [6]. ...
Background
Neck pain is among the common musculoskeletal problem that hinders a person’s daily activities. Fascial tightness is a familiar cause of chronic neck pain that is often neglected and can further cause neck disability and a limited range of motion.
Objective
The purpose was to compare the effects of fascia therapy and fascial manipulation on pain, range of motion and function in patients with chronic neck pain.
Methods
A randomized clinical trial was conducted from February to August 2022 in the Riphah Rehabilitation Centre, Lahore, Pakistan. Fifty-two participants of both genders, aged 18–40 years with chronic neck pain of at least 3–6 months were included. Group A (n = 26) received fascia therapy along with a conventional physical therapy protocol of hot pack, strengthening and stretching, while group B (n = 26) received the fascial manipulation treatment with conventional physical therapy. All the participants were assessed at baseline and after 3 weeks (3 sessions per week). Numeric Pain Rating Scale (NPRS), Neck Disability Index (NDI) and Goniometer (range of motions) were the outcome measures. SPSS 25 was used for the data analysis and normality of the data through the Shaphiro-Wilk test (p > 0.05), and parametric tests were applied.
Results
The mean age of group A was 24.82 ± 2.64 years, and group B was 24.17 ± 2.20 years. The independent t-test result showed no significant difference (p ≥ 0.05) in all parameters except in cervical extension and right-side bending (p < 0.05). At the same time, the pair-wise comparison showed significant results (p < 0.05) for all outcome measures in both groups.
Conclusion
DBM fascia therapy improved cervical extension and side bending (right) more than the fascial manipulation group.It is concluded that DBM fascia therapy shows more improvement as compared to other group.
Trial registration number
This study was registered at ClinicalTrials.gov ID: NCT05272111 on 09/03/2022.
... Numerous studies revealed that FHP was linked to a wide range of health issues, including chronic low back pain [9], carpal tunnel syndrome [10], impaired respiratory function [11], temporomandibular joint dysfunction [12], uneven weight distribution in the plantar arches [13], and emotional stress [14]. FHP also has adverse effects on dynamic balance [15], cervical spine range of motion [16], and the strength and endurance of the neck muscles [17]. ...
Background
One of the most prevalent musculoskeletal issues in dentistry is forward head posture (FHP). Proprioception and core endurance are crucial for maintaining proper posture.
Objective
The aim of this study was to compare dental students with and without FHP in terms of their core endurance and shoulder proprioception.
Methods
Using kinovea software, a cross-sectional study was conducted on 30 dental students who had FHP with a craniovertebral angle less than 49 degrees. The control group consisted of 30 additional dental students without FHP. Trunk anterior flexor, posterior extensor, right and left flexors were tested using the McGill method to determine core endurance. The isokinetic Biodex system was used to measure shoulder proprioception.
Results
Independent t-test results revealed that core endurance was significantly lower in the group with forward head posture compared to the control group ( p 0.05), while shoulder proprioception did not differ significantly between groups ( p > 0.05).
Conclusion
In comparison to dental students without forward head posture, male dental students with FHP have normal shoulder joint proprioception and impaired core endurance holding time. This could be a risk factor for a variety of musculoskeletal issues in dentists.
... Participants were considered with FHP if they exhibit a craniovertebral angle of less than 49 degrees. [13,14]. ...
Abstract
Background: Carpal tunnel syndrome (CTS) is the most common entrapment neuropathy. Cervical spine may be involved in individuals with CTS, due to the possibility of double compression. A cervical lesion resulting from postural abnormality like forward head posture (FHP) may predispose patients to CTS. Objective: To investigate the relationship between FHP and nerve conduction studies in patients with CTS. Subjects: The study involved ninety patients with FHP. They were distributed into two groups: sixty patients with mild to moderate CTS (study group) and thirty healthy matched subjects (control group), Methods: Both groups underwent electrophysiological studies including motor and sensory nerve conduction velocities (NCV) and motor and sensory distal latencies (DL). Cranio-vertebral angle (CVA) was measured by lateral photography. Results: In comparing the mean values of measured variables there was a significant difference between both groups (P>0.05). There was a statistically significant positive correlation between CVA and motor NCV and a significant negative correlation between (CVA) and motor DL, (p= 0.00001 & 0.007 respectively). However, there was no significant correlation between CVA with neither sensory NCV nor sensory DL (P=0.101 & 0.492 respectively).
Keywords
Forward head posture, Carpal tunnel syndrome, Nerve conduction studies
Purpose of Review
Forward head posture (FHP) is the most common cervical postural fault in the sagittal plane that is found with different severity levels in almost all populations. Despite claims that FHP may be related to neck pain, this relation seems to be controversial. Thus, our purpose is to determine whether FHP differs between asymptomatic subjects and those with neck pain and to investigate if there is a relationship between head posture and neck pain.
Recent Findings
A total of 15 cross-sectional studies were eligible for inclusion for this systematic review and meta-analysis. Ten studies compared FHP between a group of asymptomatic participants and a group of participants with neck pain and an overall mean difference (MD) of 4.84 (95% CI = 0.14, 9.54), indicating a significant between-group difference, contrary to adolescent (MD = − 1.05; 95% CI = − 4.23, 2.12). Eight studies showed significant negative correlations between FHP and neck pain intensity (r = − 0.55; 95% CI = − 0.69, − 0.36) as well as disability (r = − 0.42; 95% CI = − 0.54, − 0.28) in adults and older adults, while in adolescents, only lifetime prevalence and doctor visits due to neck pain were significant predictors for FHP.
Summary
This systematic review found that age played an important role as a confounding factor in the relation between FHP and neck pain. Also, the results showed that adults with neck pain show increased FHP when compared to asymptomatic adults and that FHP is significantly correlated with neck pain measures in adults and older adults. No association was found between FHP and most of neck pain measures in adolescents.
The current study aimed to assess the repeatability and validity of cervical range of motion (CROM) measurements using an optical motion capture system (OMCS), compared with a CROM device. A total of 20 healthy volunteers were selected and enrolled in the current study after informed consent was received. The motion of the cervical spine in all directions was measured using the OMCS and CROM devices. Reproducibility of data was assessed using the intra-group correlation coefficient (ICC), standard error of measurement (SEM) and minimum detectable change (MDC). Validity was assessed using the coefficient of determination (R2) in combination with Pearson's correlation coefficient. Bland-Altman plot were presented for the two measurement methods. The range of motion (ROM) was measured by using the OMCS and the CROM device during the same session. Both procedures evidenced high ICCs [OMCS: ICC (1,2) =0.802-0.981; CROM device: ICC (1,2) =0.768-0.948], low SEM values (OMCS: 0.98°-1.38°; CROM device: 1.04°-2.45°) and low MDC values (OMCS: 2.72°-3.81°; CROM device: 2.89°-6.78°). A high R2 (0.568-0.882) and Pearson's correlation coefficient (0.753-0.939) were determined. The Bland-Altman plots demonstrated that most of the data were within the 95% consistency limit. In summary, the OMCS has good repeatability and validity when measuring CROM and is an effective way to evaluate cervical vertebral range of motion.
Objectives
The purpose of this study was to determine whether the cranial vertebral angle (CVA) and the range of motion (ROM) was different between participants with a forward head posture (FHP), with or without pain.
Methods
Forty-four participants who had FHP participated in this study. The FHP was assessed digitally by measuring a lateral view the CVA for each subject. A cervical ROM device measured the cervical ROM. The volunteers were allocated to either, with pain (n = 22), or without pain (n = 22) groups, and pain was evaluated using the Numeric Pain Rating Scale.
Results
The FHP in the pain group showed a significant difference in the CVA, and the cervical ROM in both flexion and extension, compared with those in the FHP without pain group (p < 0.05). Logistic regression analysis indicated that the occurrence of cervical area pain was higher amongst subjects who had a decreased CVA and flexion motion.
Conclusion
This study suggested that decreased CVA and cervical flexion range, were predictive factors for the occurrence of pain in the cervical region.
[Purpose] This case presents the reduction of both forward head posture and thoracic hyperkyphosis in a young male with chronic back pain and headaches by a comprehensive posture rehabilitation program as a part of Chiropractic BioPhysics® methods. [Participant and Methods] A 32 year old male presented with constant pain and headaches for seven years since he was involved in a work related injury. He had seen five different MDs, undergone multiple imaging tests, and received multiple prescriptions, thirteen steroid injections and was recommended for a spine surgery that he had denied. He was on long-term disability. Upon comprehensive posture and spine assessment, the patient had exaggerated forward head translation and thoracic hyperkyphosis. The patient was treated 36 times over 13-weeks with cervical and thoracic extension exercises, traction, and manipulation. [Results] After treatment the patient reported dramatic improvement in symptoms as indicated on valid disability questionnaires and substantial improvements in posture. [Conclusion] Posture-related pain and disability is not often addressed in allopathic medicine but substantial posture improvements are achievable in short time periods as this case illustrates. Poor postures in young patients should be corrected to avoid long-term consequences. Radiography as used in spinal rehabilitation is safe and reliable.
Purpose:
The aim of this study was to investigate whether there is an association between text neck and neck pain in young adults.
Methods:
Observational cross-sectional study with 150 18-21-year-old young adults from a public high school in the state of Rio de Janeiro was performed. In the self-report questionnaire, the participants answered questions on sociodemographic factors, anthropometric factors, time spent texting or playing on a mobile phone, visual impairments, and concern with the body posture. The neck posture was assessed by participants' self-perception and physiotherapists' judgment during a mobile phone texting message task. The Young Spine Questionnaire was used to evaluate the neck pain. Four multivariate logistic regression models were fitted to investigate the association between neck posture during mobile phone texting and neck pain, considering potential confounding factors.
Results:
There is no association between neck posture, assessed by self-perception, and neck pain (OR = 1.66, p = 0.29), nor between neck posture, assessed by physiotherapists' judgment, and neck pain (OR = 1.23, p = 0.61). There was also no association between neck posture, assessed by self-perception, and frequency of neck pain (OR = 2.19, p = 0.09), nor between neck posture, assessed by physiotherapists' judgment, and frequency of neck pain (OR = 1.17, p = 0.68).
Conclusion:
This study did not show an association between text neck and neck pain in 18-21-year-old young adults. The findings challenge the belief that neck posture during mobile phone texting is associated to the growing prevalence of neck pain.
Objective
. To assess the correlation of abnormal trunk postures and reposition sense of subjects with forward head neck posture (FHP).
Methods
. In all, postures of 41 subjects were evaluated and the FHP and trunk posture including shoulder, scapular level, pelvic side, and anterior tilting degrees were analyzed. We used the head repositioning accuracy (HRA) test to evaluate neck position senses of neck flexion, neck extension, neck right and left side flexion, and neck right and left rotation and calculated the root mean square error in trials for each subject. Spearman’s rank correlation coefficients and regression analysis were used to assess the degree of correlation between the trunk posture and HRA value, and a significance level of
α
= 0.05 was considered.
Results
. There were significant correlations between the HRA value of right side neck flexion and pelvic side tilt angle
(
p
<
0.05
)
. If pelvic side tilting angle increases by 1 degree, right side neck flexion increased by 0.76 degrees
(
p
=
0.026
)
. However, there were no significant correlations between other neck motions and trunk postures.
Conclusion
. Verifying pelvic postures should be prioritized when movement is limited due to the vitiation of the proprioceptive sense of neck caused by FHP.
[Purpose] The purpose of this study was to investigate the effect of forward head posture (FHP) on proprioception by determining the cervical position-reposition error. [Subjects and Methods] A sample population was divided into two groups in accordance with the craniovertebral angle: the FHP group and the control group. We measured the craniovertebral angle, which is defined as the angle between a horizontal line passing through C7 and a line extending from the tragus of the ear to C7. The error value of the cervical position sense after cervical flexion, extension, and rotation was evaluated using the head repositioning accuracy test. [Results] There were significant differences in the error value of the joint position sense (cervical flexion, extension, and rotation) between the FHP and control groups. In addition, there was an inverse correlation between the craniovertebral angle and error value of the joint position sense. [Conclusion] FHP is associated with reduced proprioception. This result implies that the change in the muscle length caused by FHP decreases the joint position sense. Also, proprioception becomes worse as FHP becomes more severe.
To estimate the effects of a relatively protruded head and neck posture on postural balance, in computer based worker.
Thirty participants, who work with computers for over 6 hrs per day (Group I), and thirty participants, who rarely work with computers (Group II), were enrolled. The head and neck posture was measured by estimating angles A and B. A being the angle between the tragus of the ear, the lateral canthus of the eye, and horizontal line and B the angle between the C7 spinous process, the tragus of the ear, and the horizontal line. The severity of head protrusion with neck extension was assessed by the subtraction of angle A from angle B. We also measured the center of gravity (COG) and postural balance by using computerized dynamic posturography to determine the effect of computer-based work on postural balance.
Results indicated that group I had a relatively more protruded head with extensive neck posture (angle B-A of group I and group II, 28.2±8.3, 32.9±6.0; p<.05). The COG of group I tended more toward the anterior than that of group II. Postural imbalance and impaired ability to regulate movement in forward and backward direction were also found.
The results of this study suggest that forward head postures during computer-based work may contribute to some disturbance in the balance of healthy adults. These results could be applied to education programs regarding correct postures when working at a computer for extended periods of time.
While many assume hyperkyphosis reflects underlying spinal osteoporosis and vertebral fractures, our results suggest hyperkyphosis is independently associated with decreased mobility. Hyperyphosis is associated with slower Timed Up and Go performance times and may be a useful clinical marker signaling the need for evaluation of vertebral fracture and falling risk.
While multiple studies have demonstrated negative effects of hyperkyphosis on physical function, none have disentangled the relationship between hyperkyphosis, impaired function, and underlying spinal osteoporosis. The purpose of this study is to determine whether kyphosis, independent of spinal osteoporosis, is associated with mobility on the Timed Up and Go, and to quantify effects of other factors contributing to impaired mobility.
We used data for 3,108 community-dwelling women aged 55-80 years in the Fracture Intervention Trial. All participants had measurements of kyphosis, mobility time on the Timed Up and Go test, height, weight, total hip bone mineral density (BMD), grip strength, and vertebral fractures at baseline visits in 1993. Demographic characteristics included age and smoking status. We calculated mean Timed Up and Go time by quartile of kyphosis. Using multivariate linear regression, we estimated the independent association of kyphosis with mobility time, and quantified effects of other covariates on mobility.
Mean mobility time increased from 9.3 s in the lowest to 10.1 s in the highest quartile of kyphosis. In a multivariate-adjusted model, mobility time increased 0.11 s (p = 0.02) for each standard deviation (11.9°) increase in kyphosis. Longer performance times were significantly associated with increasing age, decreasing grip strength, vertebral fractures, body mass index ≥25, and total hip BMD in the osteoporotic range.
Kyphosis angle is independently associated with decreased mobility on the Timed Up and Go, which is in turn correlated with increased fall risk. Hyperkyphosis may be a useful clinical marker signaling the need for evaluation of vertebral fracture and falling risk.
Study Design
Controlled laboratory study, case-control design.
Objective
To evaluate spine kinematics and gait characteristics in people with nonspecific chronic neck pain.
Background
People with chronic neck pain present with a number of sensorimotor and biomechanical alterations, yet little is known about the influence of neck pain on gait and motions of the spine during gait.
Methods
People with chronic nonspecific neck pain and age- and sex-matched asymptomatic controls walked on a treadmill at 3 different speeds (self-selected, 3 km/h, and 5 km/h), either with their head in a neutral position or rotated 30°. Tridimensional motion capture was employed to quantify body kinematics. Neck and trunk rotations were derived from the difference between the transverse plane component of the head and thorax and thorax and pelvis angles to provide an indication of neck and trunk rotation during gait.
Results
Overall, the patient group showed shorter stride length compared to the control group (P<.001). Moreover, the patients with neck pain showed smaller trunk rotations (P<.001), regardless of the condition or speed. The difference in the amount of trunk rotation between groups became larger for the conditions of walking with the head rotated.
Conclusion
People with chronic neck pain walk with reduced trunk rotation, especially when challenged by walking with their head positioned in rotation. Reduced rotation of the trunk during gait may have long-term consequences on spinal health. J Orthop Sports Phys Ther 2017;47(4):268–277. Epub 3 Feb 2017. doi:10.2519/jospt.2017.6768
The Second Edition of Kinesiology: The Mechanics and Pathomechanics of Human Movement relates the most current understanding of anatomy and mechanics with clinical practice concerns. Featuring seven chapters devoted to biomechanics, straightforward writing, and over 900 beautiful illustrations, the text provides detailed coverage of the structure, function and kinesiology of each body region. Readers will gain an in-depth understanding of the relationship between the quality of movement and overall human health. © 2009, 2004 Lippincott Williams & Wilkins, a Wolters Kluwer business. All rights reserved.
[Purpose] This study was conducted in order to examine the correlations between cervical lordosis angles (Absolute Rotation Angle, ARA, forward head posture, FHP, Anterior Weight Bearing, AWB), the range of flexion and extension (RFEM), the strength and endurance of the deep neck flexor (DNF) and cervical pain. [Subjects] The study enrolled 24 university students (female: 12, male:12) aged in their 20s. [Methods] ARA, AWB and RFEM were analyzed using radiographs of lateral views. Strength and endurance were assessed using a Pressure Biofeedback Unit (PBU) and cervical pain and physical functions were assessed using the Neck Disability Index (NDI).[Results]As ARA increased, extension and RFEM also increased, and as AWB decreased, extension and endurance increased. As extension increased, RFEM and endurance increased and NDI decreased. As flexion became larger, RFEM and NDI increased, and as RFEM increased, endurance increased. [Conclusion] The study results indicate that the posture of the cervical spine affects the endurance rather than the strength of the DNF. Therefore, as therapeutic interventions to enhance the endurance of the DNF, posture control to reduce AWB and approaches to increase extension and RFEM should be considered.
Thoracic kyphosis is one of the manifestations of spinal osteoporosis. Since kyphosis is associated with patient symptoms and is a risk factor for loss of function, it would be beneficial to have simple, noninvasive measurement techniques that can be applied in clinical practice. The purpose of this study was to assess the test–retest reliability of the measurement of thoracic kyphosis using the flexicurve ruler in individuals with osteoporosis. Twenty-six females (mean age, 67 yr) diagnosed with osteoporosis had measurements of kyphosis taken in standing by aligning a flexible drafting ruler before and after a 12-week exercise program. The time period was chosen to be consistent with the duration of a physiotherapy intervention. Measures of kyphosis height (cm), length (cm), and an index of kyphosis (height/length) were recorded. Data analysis (intraclass correlation coefficients [ICC]) indicated that the reliability between the trials of the measurement of kyphosis height (0.89) and index of kyphosis (0.93) were high; however, the reliability estimate of kyphosis length was less with an ICC value of (0.54). This study supports the use of the flexicurve ruler for the measurement of kyphosis in elderly women with osteoporosis based on reliability outcomes and the fact that it is noninvasive, inexpensive, and easy to use in a clinical setting. The measurement of kyphosis may be used to determine the response to a therapeutic intervention and in monitoring kyphotic progression.
Study design:
Narrative review.
Objective:
To provide a comprehensive narrative review of cervical alignment parameters, the methods for quantifying cervical alignment, normal cervical alignment values, and how alignment is associated with cervical deformity and myelopathy with discussions of health-related quality of life.
Summary of background data:
Indications for surgery to correct cervical alignment are not well-defined and there is no set standard to address the amount of correction to be achieved. In addition, classifications of cervical deformity have yet to be fully established and treatment options defined and clarified.
Methods:
A survey of the cervical spine literature was conducted.
Results:
New normative cervical alignment values from an asymptomatic volunteer population are introduced, updated methods for quantifying cervical alignment are discussed, and describing the relationship between cervical alignment, disability, and myelopathy are outlined. Specifically, methods used to quantify cervical alignment include cervical lordosis, cervical sagittal vertical axis, and horizontal gaze with the chin-brow vertical angle. Updated methods include T1 slope. Evidence from a few recent studies suggests correlations between radiographical parameters in the cervical spine and health-related quality of life. Analysis of the cervical regional alignment with respect to overall spinal pelvic alignment is emerging and critical. Cervical myelopathy and sagittal alignment of the cervical spine are closely related as cervical deformity can lead to spinal cord compression and tension.
Conclusion:
Cervical deformity correction should take on a comprehensive approach in assessing global cervical-pelvic relationships and the radiographical parameters that effect health-related quality of life scores are not well-defined. Cervical alignment may be important in assessment and treatment of cervical myelopathy. Future work should concentrate on correlation of cervical alignment parameters to disability scores and myelopathy outcomes. SUMMARY STATEMENTS: STATEMENT 1: Cervical sagittal alignment (cervical SVA and kyphosis) is related to thoracolumbar spinal pelvic alignment and to T1 slope. STATEMENT 2: When significant deformity is clinically or radiographically suspected, regional cervical and relative global spinal alignment should be evaluated preoperatively via standing 3-foot scoliosis X-rays for appropriate operative planning. STATEMENT 3: Cervical sagittal alignment (C2-C7 SVA) is correlated to regional disability, general health scores and to myelopathy severity. STATEMENT 4: When performing decompressive surgery for CSM, consideration should be given to correction of cervical kyphosis and cervical sagittal imbalance (C2-C7 SVA) when present.
Background:
Neck and shoulder pain (NSP), called katakori in Japanese, is one of the most common medical symptoms in the Japanese population; however, the pathogenesis of NSP has not yet been adequately elucidated. The purpose of this study was to investigate the associations between NSP and sagittal spinal alignment among the general population in Japan.
Materials and methods:
Medical examinations were conducted in the northeast village of Gunma, Japan. A questionnaire regarding NSP was distributed among 329 Japanese subjects (125 men and 204 women). Regarding the prevalence of NSP, the participants were asked to report the occurrence of NSP over the previous two weeks. For each participant, the parameters for sagittal spinal alignment, including thoracic kyphosis angle, lumbar lordosis angle, and spinal inclination relative to a perpendicular line, were measured with a SpinalMouse(®) (Idiag, Vplkerswill, Switzerland), an electronic computer-aided measuring device. We investigated the associations between the prevalence of NSP and the parameters obtained with the SpinalMouse(®). Statistical analyses were performed using Student's t test, Welch's t test, the chi-squared test, and a multivariate logistic regression analysis. A P value of 0.05 was considered to be statistically significant.
Results:
The prevalence of NSP within the two weeks prior to questioning was 52.0 % (171 of 329 subjects). The subjects in the NSP group were significantly younger than those in the non-NSP group. There was a significant gender difference between the NSP group and the non-NSP group, as significantly more females complained of NSP than males. No significant association between the thoracic kyphosis angle and NSP was observed. However, the lumbar lordosis angles measured in the subjects in the NSP group were significantly larger than those in the non-NSP group, and the inclinations relative to a perpendicular line measured in the subjects in the NSP group were significantly larger than those in the non-NSP group. Furthermore, we performed a logistic regression analysis on each factor that showed a significant difference; age, gender, and the lumbar lordosis angle were each found to be significant.
Conclusions:
We investigated the associations between NSP and spinal sagittal alignment using the SpinalMouse(®) system, and demonstrated that some spinal alignment parameters are associated with NSP.
It is unclear how age-related postural changes such as thoracic spine kyphosis influence cervical range-of-motion (ROM) in patients with cervical spine dysfunction. The purpose of this study was to explore the mediating effects of forward head posture (FHP) on the relationship between thoracic kyphosis and cervical mobility in older adults with cervical spine dysfunction. Fifty-one older adults (30 females, mean[SD]age = 66[4.9] years) with cervical spine dysfunction - that is, cervical pain with or without referred pain, numbness or paraesthesia - participated. Pain-related disability was measured using the neck disability index (NDI). Thoracic kyphosis was measured using a flexicurve. FHP was assessed via the craniovertebral angle (CVA) measured from a digitized, lateral-view photograph of each subject. Cervical ROM - namely, upper and general cervical rotation and cervical flexion - was measured by the Cervical Range-of-Motion (CROM) device. Greater thoracic kyphosis was significantly associated with lesser CVA (Spearman ρ = -0.48) whereas greater CVA was significantly associated with greater cervical flexion (Spearman ρ = 0.30) and general rotation ROM (ρ = 0.33), but not with upper cervical rotation ROM (ρ = 0.15). Bootstrap mediational analyses, adjusted for age, gender, weight and NDI, revealed significant indirect effects of thoracic kyphosis on cervical flexion and general rotation ROM through a FHP. Our results show that FHP mediated the relationship between thoracic kyphosis and cervical ROM, specifically general cervical rotation and flexion. These results not only support the justifiable attention given to addressing FHP to improve cervical impairments, but they also suggest that addressing thoracic kyphosis impairments may constitute an "upstream" approach.
The Flexion-Rotation Test (FRT) is proposed to assess mobility primarily at C1-C2. However, there is no in vivo measurement investigating the validity of the FRT. The purpose of this study was 1) to examine measurement reliability of segmental upper cervical movements using magnetic resonance imaging and 2) to investigate the content validity of the FRT. Nineteen asymptomatic female subjects (mean age: 22.2 years) were evaluated with a 0.2-T horizontally open MRI unit. The segmental rotation angles from Occiput-C1 to C3-C4 and the C4 vertebra were assessed with the head maximally rotated to both the right and the left in two conditions - neck in neutral and in flexion. Good reliability of the method of measurement was suggested by error considerations. A repeated measure ANOVA revealed an interaction between the two different neck starting positions and segment levels (P < 0.0001). Post-hoc analysis revealed that there were significant reductions in the flexed position (P < 0.0001) except for at Occiput-C1. While there was only a 16.3% reduction in rotation range at C1-C2, the reduction was 68.1% at C2-C3, 61.4% at C3-C4, and 76.9% at segments below C4, respectively, supporting the content validity of the FRT as a clinical measure of atlanto-axial mobility.
Case control study.
To compare the amount of forward head posture (FHP) and cervical range of motion between patients with moderate carpal tunnel syndrome (CTS) and healthy controls. We also sought to assess the relationships among FHP, cervical range of motion, and clinical variables related to the intensity and temporal profile of pain due to CTS.
It is plausible that the cervical spine may be involved in patients with CTS. No studies have investigated the possible associations among FHP, cervical range of motion, and symptoms related to CTS.
FHP and cervical range of motion were assessed in 25 women with CTS and 25 matched healthy women. Side-view pictures were taken in both relaxed-sitting and standing positions to measure the craniovertebral angle. A CROM device was used to assess cervical range of motion. Posture and mobility measurements were performed by an experienced therapist blinded to the subjects' condition. Differences in cervical range of motion were examined using the nonparametric Mann-Whitney U test. A 2-way mixed-model analysis of variance (ANOVA) was used to evaluate differences in FHP between groups and positions.
The ANOVA revealed significant differences between groups (F = 30.4; P<.001) and between positions (F = 6.5; P<.01) for FHP assessment. Patients with CTS had a smaller craniovertebral angle (greater FHP) than controls (P<.001) in both standing and sitting. Additionally, patients with CTS showed decreased cervical range of motion in all directions when compared to controls (P<.001). Only cervical flexion (rs = -0.43; P = .02) and lateral flexion contralateral to the side of the CTS (rs = -0.51; P = .01) were associated with the reported lowest pain experienced in the preceding week. A positive association between FHP and cervical range of motion was identified in both groups: the smaller the craniovertebral angle (reflective of a greater FHP), the smaller the range of motion (r values between 0.27 and 0.45; P<.05). Finally, cervical range of motion and FHP were negatively associated with age in the control group but not in the group with CTS.
Patients with mild/moderate CTS exhibited a greater FHP and less cervical range of motion, as compared to healthy controls. Additionally, a greater FHP was associated with a reduction in cervical range of motion. However, a cause-and-effect relationship cannot be inferred from this study. Future research should investigate if FHP and restricted cervical range of motion is a consequence or a causative factor of CTS and related symptoms (eg, pain).
Excessive kyphosis may be associated with earlier mortality, but previous studies have not controlled for clinically silent vertebral fractures, which are a known mortality risk factor.
To determine whether hyperkyphosis predicts increased mortality independent of vertebral fractures.
Prospective cohort study.
Four clinical centers in Baltimore County, Maryland; Portland, Oregon; Minneapolis, Minnesota; and the Monongahela Valley, Pennsylvania.
610 women, age 67 to 93 years, from a cohort of 9704 women recruited from community-based listings between 1986 and 1988.
Kyphosis was measured by using a flexicurve. Prevalent radiographic vertebral fractures at baseline were defined by morphometry, and mortality was assessed during an average follow-up of 13.5 years.
In age-adjusted models, each SD increase in kyphosis carried a 1.14-fold increased risk for death (95% CI, 1.02 to 1.27; P = 0.023). After adjustment for age and other predictors of mortality, including such osteoporosis-related factors as low bone density, moderate and severe prevalent vertebral fractures, and number of prevalent vertebral fractures, women with greater kyphosis were at increased risk for earlier death (relative hazard per SD increase, 1.15 [CI, 1.01 to 1.30]; P = 0.029). On stratification by prevalent vertebral fracture status, only women with prevalent fractures were at increased mortality risk from hyperkyphosis, independent of age, self-reported health, smoking, spine bone mineral density, number of vertebral fractures, and severe vertebral fractures (relative hazard per SD increase, 1.58 [CI, 1.06 to 2.35]; P = 0.024).
The study population included only white women.
In older women with vertebral fractures, hyperkyphosis predicts an increased risk for death, independent of underlying spinal osteoporosis and the extent and severity of vertebral fractures.
National Institute of Arthritis and Musculoskeletal and Skin Diseases and National Institute on Aging.
To compare standing head posture measurements between patients with nontraumatic neck pain (NP) and pain-free individuals.
Single-blind (assessor) cross-sectional study.
Hospital and general community.
Consecutive patients (n=40) with chronic nontraumatic NP and age- and sex-matched pain-free participants (n=40).
Not applicable.
Three angular measurements: the angle between C7, the tragus of the ear, and the horizontal; the angle between the tragus of the ear, the eye, and the horizontal; and the angle between the inferior margins of the right and the left ear and the horizontal were calculated through the digitization of video images.
NP patients were found to have a significantly smaller angle between C7, the tragus, and the horizontal, resulting in a more forward head posture than pain-free participants (NP, mean +/- SD, 45.4 degrees +/-6.8 degrees ; pain-free, mean +/- SD, 48.6 degrees +/-7.1 degrees ; P<.05; confidence interval [CI] for the difference between groups, 0.9 degrees -6.3 degrees ). Dividing the population according to age into younger (</=50y) and older (>50y) revealed an interaction, with a statistically significant difference in head posture for younger participants with NP compared with younger pain-free participants (NP, mean +/- SD, 46.1 degrees +/-6.7 degrees ; pain-free, mean +/- SD, 51.8 degrees +/-5.9 degrees ; P<.01; CI for the difference between groups, 1.8 degrees -9.7 degrees ) but no difference for the older group (NP, mean +/- SD, 44.8 degrees +/-7.1 degrees ; pain-free, mean +/- SD, 45.1 degrees +/-6.7 degrees ; P>.05; CI for the difference between groups, -4.9 degrees -4.2 degrees ). No other differences were found between patients and pain-free participants.
Younger patients with chronic nontraumatic NP were shown to have a more forward head posture in standing than matched pain-free participants. However, the difference, although statistically significant, was perhaps too small to be clinically meaningful.
Forward head posture (FHP) and neck mobility were objectively assessed in 25 patients with chronic tension-type headache (CTTH) and 25 healthy controls. Side-view pictures were taken in a sitting position to measure the cranio-vertebral angle. A cervical goniometer was employed to measure the range of all cervical motions. Patients with CTTH showed a smaller cranio-vertebral angle (45.3 degrees +/- 7.6 degrees) than controls (54.1 degrees +/- 6.3 degrees), thus presenting a greater FHP (P < 0.001). Patients also had lesser neck mobility for all cervical movements, except for right lateral flexion (P < 0.01). There was a positive correlation between the cranio-vertebral angle and neck mobility. Within the CTTH group, a negative correlation was found between the cranio-vertebral angle and headache frequency, but neck mobility did not correlate with headache parameters. Further research is needed to define a potential role of FHP and restricted neck mobility in the origin or maintenance of TTH.
Management of common musculoskeletal disorders
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