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Javanshir K, Akbarnejad-Basra Z, Saadat P, Mousavi-Khatir R. Investigating cervical flexion-relaxation ratio in subjects with cervical lateral spinal stenosis compared with asymptomatic controls: A case control study. J Bodyw Mov Ther 2024; 40:893-898. [PMID: 39593692 DOI: 10.1016/j.jbmt.2024.04.047] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2022] [Revised: 04/13/2024] [Accepted: 04/19/2024] [Indexed: 11/28/2024]
Abstract
INTRODUCTION The cervical flexion-relaxation ratio (FRR) is known as a quantitative measure of the ability of the cervical extensor muscles to relax during the full flexion of the cervical spine. Compared with subjects suffering from non-specific neck pain, the changes occurring in the pattern of the neck muscles' functions in cases with cervical spinal stenosis are not yet well understood. Therefore, this study aimed to compare cervical FRR in subjects with cervical lateral spinal stenosis and asymptomatic controls. METHODS In total, 25 subjects with cervical lateral spinal stenosis (aged 44.7 ± 10.4) and 25 asymptomatic individuals (aged 44.3 ± 10.8) were included in this study. These participants performed full-neck flexion, and at the same time, the electrical activity of the cervical erector spinae (CES) muscles was recorded bilaterally. Cervical FRR was further calculated by analyzing the electromyographic data recorded for each muscle. RESULTS The mean cervical FRR was significantly lower (P = 0.015) and the FRR asymmetry (ΔFRR) was significantly higher (P = 0.003) in the patients than asymptomatic controls. In addition, the cervical FRR of the involved side was significantly lower in the subjects with cervical pain compared with that in the non-involved one (P = 0.004). There was also a significant difference in the cervical extension (CE) angle between both study groups (P < 0.001), while the cervical flexion (CF) angle was not different (P = 0.25). CONCLUSION According to the study results, FRR and its asymmetry in the subjects with cervical lateral spinal stenosis were significantly different from that in asymptomatic controls and the CE angle declined in these subjects.
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Affiliation(s)
- Khodabakhsh Javanshir
- Department of Physical Therapy, School of Rehabilitation Mobility Impairment Research Center, Health Research Institute, Babol University of Medical Sciences, Babol, Iran
| | | | - Payam Saadat
- Mobility Impairment Research Center, Health Research Institute, Babol University of Medical Sciences, Babol, Iran
| | - Roghayeh Mousavi-Khatir
- Department of Physical Therapy, School of Rehabilitation Mobility Impairment Research Center, Health Research Institute, Babol University of Medical Sciences, Babol, Iran.
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He P, Yang Y, Wang M, Li D, Yuan H, Wang J, He Q, Feng D, Liu X. Is the disappearance of the cervical flexion-relaxation phenomenon associated with cervical degeneration in healthy people? EUROPEAN SPINE JOURNAL : OFFICIAL PUBLICATION OF THE EUROPEAN SPINE SOCIETY, THE EUROPEAN SPINAL DEFORMITY SOCIETY, AND THE EUROPEAN SECTION OF THE CERVICAL SPINE RESEARCH SOCIETY 2024; 33:2997-3007. [PMID: 38869650 DOI: 10.1007/s00586-024-08355-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/11/2023] [Revised: 05/06/2024] [Accepted: 06/02/2024] [Indexed: 06/14/2024]
Abstract
PURPOSE This study aims to explore the differences in cervical degeneration between healthy people with and without cervical flexion-relaxation phenomenon (FRP) and to identify whether the disappearance of cervical FRP is related to cervical degeneration. METHODS According to the flexion relaxation ratio (FRR), healthy subjects were divided into the normal FRP group and the abnormal FRP group. Besides, MRI was used to evaluate the degeneration of the passive subsystem (vertebral body, intervertebral disc, cervical sagittal balance, etc.) and the active subsystem (deep flexors [DEs], deep extensors [DFs], and superficial extensors [SEs]). In addition, the correlation of the FRR with the cervical degeneration score, C2-7Cobb, Borden method, relative total cross-sectional area (rTCSA), relative functional cross-sectional area (rFCSA), and fatty infiltration ratio (FIR) was analyzed. RESULTS A total of 128 healthy subjects were divided into the normal FRP group (n=52, 40.63%) and the abnormal FRP group (n=76, 59.38%). There were significant differences between the normal FRP group and the abnormal FRP group in the cervical degeneration score (z=-6.819, P<0.001), C2-7Cobb (t=2.994, P=0.004), Borden method (t=2.811, P=0.006), and FIR of DEs (t=-4.322, P<0.001). The FRR was significantly correlated with the cervical degeneration score (r=-0.457, P<0.001), C2-7Cobb (r=0.228, P=0.010), Borden method (r=0.197, P=0.026), and FIR of DEs (r=-0.253, P=0.004). CONCLUSION The disappearance of cervical FRP is related to cervical degeneration. A new hypothesis mechanism for FRP is proposed. The cervical FRP test is an effective and noninvasive examination for the differential diagnosis of healthy people, people with potential NSNP, and patients with NSNP.
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Affiliation(s)
- Peifeng He
- Department of Orthopaedic Surgery, Chengdu 363 Hospital of Southwest Medical University, Chengdu City, China
| | - Yunbo Yang
- Department of Spinal Surgery, Affiliated Hospital of Southwest Medical University, Luzhou City, China
| | - Minglang Wang
- Department of Spinal Surgery, Affiliated Hospital of Southwest Medical University, Luzhou City, China
| | - Dan Li
- Department of Rehabilitation, Southwest Medical University, Luzhou City, China
| | - Hao Yuan
- Department of Spinal Surgery, Affiliated Hospital of Southwest Medical University, Luzhou City, China
| | - Jianxiong Wang
- Department of Rehabilitation, Southwest Medical University, Luzhou City, China
| | - Qiang He
- Department of Orthopaedic Surgery, Bazhong City Traditional Medical Hospital, Bazhong City, China
| | - Daxiong Feng
- Department of Spinal Surgery, Affiliated Hospital of Southwest Medical University, Luzhou City, China.
| | - Xuanwen Liu
- Department of Orthopaedic Surgery, Chengdu 363 Hospital of Southwest Medical University, Chengdu City, China.
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Chen YL, Chan YC, Alexander H. Gender differences in neck muscle activity during near-maximum forward head flexion while using smartphones with varied postures. Sci Rep 2024; 14:12994. [PMID: 38844574 PMCID: PMC11156881 DOI: 10.1038/s41598-024-63734-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2023] [Accepted: 05/31/2024] [Indexed: 06/09/2024] Open
Abstract
Women frequently express heightened neck discomfort even though they exhibit smaller neck flexion (NF) during smartphone use. Differences in natural posture while using smartphones may result in varying muscle activation patterns between genders. However, no study focused on this issue. This study investigated the influence of gender on neck muscle activity and NF when using smartphones, ranging from slight (20°) to nearly maximal forward head flexion, across different postures. We analyzed smartphone usage patterns in 16 men and 16 women and examined these behaviors across different scenarios: standing, supported sitting, and unsupported sitting, at 20°, 30°, 40°, and the maximum head angles. During data collection, muscle activity was measured, expressed as a percentage of the maximum voluntary contraction (%MVC), in the cervical erector spinae (CES) and upper trapezius (UTZ), along with NF. Results show significant influences of gender, head angle, and posture on all measures, with notable interactions among these variables. Women displayed higher muscle activities in CES and UTZ, yet exhibited lesser NF, while using smartphones in both standing (12.3%MVC, 10.7% MVC, and 69.0°, respectively) and unsupported sitting (10.8%MVC, 12.3%MVC, and 71.8°, respectively) compared to men (standing: 9.5%MVC, 8.8%MVC, and 76.1°; unsupported sitting: 9.7%MVC, 10.8%MVC, and 76.1°). This study provides a potential rationale for gender-related disparities in injury outcomes, emphasizing that women experience higher neck and shoulder discomfort level, despite their smaller NF during smartphone use, as found in previous research. Additionally, the cervical flexion-relaxation phenomenon may occur when the head angle exceeded 40°. The near-maximum head angle during smartphone use might induce the cervical flexion-relaxation phenomenon, potentially aggravating neck issues. We recommend limiting smartphone usage postures that exceed the near-maximum head angle, as they are commonly adopted by individuals in the daily smartphone activities.
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Affiliation(s)
- Yi-Lang Chen
- Department of Industrial Engineering and Management, Ming Chi University of Technology, 84 Gung-Juan Road, Taishan, New Taipei, 243303, Taiwan.
| | - You-Chun Chan
- Department of Industrial Engineering and Management, Ming Chi University of Technology, 84 Gung-Juan Road, Taishan, New Taipei, 243303, Taiwan
- Formosa Plastics Group, Taipei, 114030, Taiwan
| | - Hans Alexander
- Department of Industrial Engineering and Management, Ming Chi University of Technology, 84 Gung-Juan Road, Taishan, New Taipei, 243303, Taiwan
- Apical Group, Singapore, 048624, Singapore
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De Carvalho D, Mackey S, To D, Summers A, Frey M, Romme K, Hogg-Johnson S, Howarth SJ. A systematic review and meta analysis of measurement properties for the flexion relaxation ratio in people with and without non specific spine pain. Sci Rep 2024; 14:3260. [PMID: 38332128 PMCID: PMC10853169 DOI: 10.1038/s41598-024-52900-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2023] [Accepted: 01/24/2024] [Indexed: 02/10/2024] Open
Abstract
This review sought to identify, critically appraise, compare, and summarize the literature on the reliability, discriminative validity and responsiveness of the flexion relaxation ratio (FRR) in adults (≥ 18 years old) with or without spine pain (any duration), in either a clinical or research context. The review protocol was registered on Open Science Framework ( https://doi.org/10.17605/OSF.IO/27EDF ) and follows COSMIN, PRISMA, and PRESS guidelines. Six databases were searched from inception to June 1, 2022. The search string was developed by content experts and a health services librarian. Two pairs of reviewers independently completed titles/abstracts and full text screening for inclusion, data extraction, and risk of bias assessment (COSMIN RoB Toolkit). At all stages, discrepancies were resolved through consensus meetings. Data were pooled where possible with a three-level random effects meta-analyses and a modified GRADE assessment was used for the summary of findings. Following duplicate removal, 728 titles/abstracts and 219 full texts were screened with 23 included in this review. We found, with moderate certainty of evidence, that the cervical FRR has high test-retest reliability and lumbar FRR has moderate to high test-retest reliability, and with high certainty of evidence that the cervical and lumbar FRR can discriminate between healthy and clinical groups (standardized mean difference - 1.16 [95% CI - 2.00, - 0.32] and - 1.21 [- 1.84, - 0.58] respectively). There was not enough evidence to summarize findings for thoracic FRR discriminative validity or the standard error of measurement for the FRR. Several studies used FRR assuming responsiveness, but no studies were designed in a way that could confirm responsiveness. The evidence supports adequate reliability of FRR for the cervical and lumbar spine, and discriminative validity for the cervical and lumbar spine only. Improvements in study design and reporting are needed to strengthen the evidence base to determine the remaining measurement properties of this outcome.
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Affiliation(s)
- Diana De Carvalho
- Division of Population Health and Applied Health Sciences, Faculty of Medicine, Memorial University of Newfoundland, St. John's, NL, Canada.
| | - Sarah Mackey
- Division of Population Health and Applied Health Sciences, Faculty of Medicine, Memorial University of Newfoundland, St. John's, NL, Canada
| | - Daphne To
- Department of Clinical Education, Canadian Memorial Chiropractic College, Toronto, ON, Canada
| | - Allyson Summers
- Division of Population Health and Applied Health Sciences, Faculty of Medicine, Memorial University of Newfoundland, St. John's, NL, Canada
| | - Mona Frey
- Division of BioMedical Sciences, Faculty of Medicine, Memorial University of Newfoundland, St. John's, NL, Canada
| | - Kristen Romme
- Health Sciences Library, Faculty of Medicine, Memorial University of Newfoundland, St. John's, NL, Canada
| | - Sheilah Hogg-Johnson
- Division of Research and Innovation, Canadian Memorial Chiropractic College, Toronto, ON, Canada
| | - Samuel J Howarth
- Division of Research and Innovation, Canadian Memorial Chiropractic College, Toronto, ON, Canada
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He P, Wang M, Li D, Zheng L, Yuan H, Yang Y, Wang J, He Q, Feng D, Liu X. Comparison of Flexion Relaxation Phenomenon After Single-Level and Multi-Level Anterior Cervical Discectomy and Fusion. World Neurosurg 2023; 178:e265-e274. [PMID: 37473868 DOI: 10.1016/j.wneu.2023.07.041] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2023] [Accepted: 07/10/2023] [Indexed: 07/22/2023]
Abstract
BACKGROUND This prospective cohort study aimed to assess the influence of the number of fused segments in cervical paravertebral muscles by comparing the changes of the cervical flexion relaxation phenomenon (FRP) after single-level versus multilevel anterior cervical discectomy and fusion (ACDF). METHODS A total of 115 patients who had undergone ACDF were retrospectively recruited and divided into a 1-level group (n = 44), a 2-level group (n = 40) and a 3- to 4-level group (n = 31). The flexion relaxation experiment was carried out 3 days preoperatively and 12 months postoperatively by surface electromyography (SEMG). Patients were examined using the neck visual analog scale, cervical Japanese Orthopedic Association score, Neck Disability Index, and C2-C7 range of motion (ROM). RESULTS There was a significant difference in the time-related changes in flexion relaxation ratio (FRR) among the 3 study groups before and after surgery (F = 85.701; P < .001). Thirty-five patients (79.55%) with 1-level ACDF and 11 patients (27.5%) with 2-level ACDF had FRP were restored to normal at 12 months postoperatively; however, only 1 patient (3.33%) had normalized FRP after 3- to 4-level ACDF. There were significant differences in the time-related changes of the normalized SEMG root mean square values in each phase before and after surgery (P = .018, <.001, <.001, and <.001). A significant correlation was found between the changes in C2-C7 ROM and FRR in the 3 study groups (P = .007 for 1 level, P = .003 for 2 levels, and P = .036 for 3-4 levels). CONCLUSIONS Single-level ACDF contributes to normalizing the FRP of cervical paravertebral muscles, which is not ideally recovered by 2-level ACDF. In contrast, 3- or 4-level ACDF could not normalize the cervical FRP. Our research supports the passive structure hypothesis.
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Affiliation(s)
- Peifeng He
- Department of Orthopaedic Surgery, Chengdu 363 Hospital of Southwest Medical University, Chengdu City, People's Republic of China
| | - Minglang Wang
- Department of Spinal Surgery, The Affiliated Hospital of Southwest Medical University, Luzhou City, People's Republic of China
| | - Dan Li
- Department of Rehabilitation, Southwest Medical University, Luzhou City, People's Republic of China
| | - Lipeng Zheng
- Department of Spinal Surgery, The Affiliated Hospital of Southwest Medical University, Luzhou City, People's Republic of China
| | - Hao Yuan
- Department of Spinal Surgery, The Affiliated Hospital of Southwest Medical University, Luzhou City, People's Republic of China
| | - Yunbo Yang
- Department of Spinal Surgery, The Affiliated Hospital of Southwest Medical University, Luzhou City, People's Republic of China
| | - Jianxiong Wang
- Department of Rehabilitation, Southwest Medical University, Luzhou City, People's Republic of China
| | - Qiang He
- Department of Orthopaedic Surgery, Bazhong City Traditional Medical Hospital, Bazhong City, People's Republic of China
| | - Daxiong Feng
- Department of Spinal Surgery, The Affiliated Hospital of Southwest Medical University, Luzhou City, People's Republic of China
| | - Xuanwen Liu
- Department of Orthopaedic Surgery, Chengdu 363 Hospital of Southwest Medical University, Chengdu City, People's Republic of China.
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Characteristics of Surface Electromyograph Activity of Cervical Extensors and Flexors in Nonspecific Neck Pain Patients: A Cross-Sectional Study. MEDICINA (KAUNAS, LITHUANIA) 2022; 58:medicina58121770. [PMID: 36556971 PMCID: PMC9781307 DOI: 10.3390/medicina58121770] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 10/19/2022] [Revised: 11/26/2022] [Accepted: 11/28/2022] [Indexed: 12/03/2022]
Abstract
Background and Objectives: We identified typical surface electromyogram (sEMG) activities of the cervical extensors and flexors during motions in the three anatomical planes in healthy adults. The aim of this study was to explore characteristics of sEMG activities of these cervical muscles in nonspecific neck pain (NSNP) patients based on healthy adults. Materials and Methods: Participants were 24 NSNP patients (NSNP group, mean ± SD of age, 47.5 ± 15.5) and 24 healthy adults (control group, 20.5 ± 1.4). For each participant, sEMG of the cervical extensors and flexors was recorded during neck flexion, extension, bilateral lateral flexion, bilateral rotation, and at the neutral position in Phase I (the neck from the neutral position to the maximum range of motion), Phase II (at the maximum range of motion), and Phase III (from the maximum range of motion to the neutral position), yielding a total of 42 phases. A percentage of maximum voluntary contraction to normalize muscle activity in each phase was calculated to obtain the ratio of muscle activities in the extensors and flexors in each of 36 phases of the motions to the neutral position and ratio of the flexors to extensors in activity for 21 phases. Results: In 28 of 36 phases of the motions, the ratios of muscle activities in the extensors and flexors to the neutral position in the NSNP group were significantly larger than the control group (p < 0.05). In 6 of 21 phases, the ratios of the flexors to extensors in activity in the NSNP group were significantly larger than in the control group (p < 0.05). Conclusions: In NSNP patients, the activity of the cervical extensors and flexors associated with neck motion increased with an imbalance in activity between these muscles compared to their activity in healthy adults. The results of this study will be useful in understanding the pathogenesis of NSNP and in constructing an objective evaluation of the treatment efficacy on NSNP patients.
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Ward JS. Influence of a Sacroiliac Belt on Pain and Functional Impairment in Patients With Low Back Pain: A Randomized Trial. J Chiropr Med 2022; 21:141-148. [PMID: 36118104 PMCID: PMC9479175 DOI: 10.1016/j.jcm.2022.06.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2019] [Revised: 06/03/2022] [Accepted: 06/08/2022] [Indexed: 10/17/2022] Open
Abstract
Objective The purpose of this study was to assess the protective influence of the Serola Sacroiliac Belt on pain and functional impairment in individuals with low back pain (LBP) during 5 days of strenuous manual labor. Methods Thirty-three participants (mean ± standard deviation: age, 43.2 ± 11.4 years; height, 1.74 ± 0.11 m; body mass index, 88.3 ± 16.7 kg) with LBP were randomized to either condition A (wearing the Serola Sacroiliac Belt during a 10-minute daily repeated strenuous lifting task) during week 1 or condition B (not wearing a Serola Sacroiliac Belt during the same lifting task) in week 2 or vice versa. All 33 participants completed 1 week under condition A and 1 week under condition B for comparison. At the beginning and end of each week, the following dependent variables were measured: lumbar spine pain on a 0 to 10 Numeric Rating Scale (NRS), spine and thigh discomfort on a Nordic Musculoskeletal Questionnaire, and completion of a toe-touch surface electromyography flexion relaxation phenomenon test. Results During the week that participants used the Serola Sacroiliac Belt, spine pain increased 0.2 compared with 0.9 on the NRS for those who did not use the belt. No statistically significant difference was observed for Nordic Musculoskeletal Questionnaire data or the flexion relaxation phenomenon test in this study. Conclusion The findings of this preliminary study suggest participants using the Serola Sacroiliac Belt while performing a daily repeated lifting task had less progression of their LBP. However, this protective value did not meet the recommended NRS for minimally clinically important difference, and there was no effect on functional impairment.
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Affiliation(s)
- John S. Ward
- Corresponding author: John S. Ward, DC, MA, MS, 5912 Spencer Highway, Pasadena, TX 77504
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Immediate Effects of Cervical Spine Manipulation Compared With Muscle Energy Technique on Neck Muscle Activity and Range of Motion in Asymptomatic Participants: A Randomized Study. J Chiropr Med 2022; 21:241-248. [DOI: 10.1016/j.jcm.2022.04.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2020] [Revised: 03/30/2022] [Accepted: 04/01/2022] [Indexed: 11/18/2022] Open
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The Mode of Activity of Cervical Extensors and Flexors in Healthy Adults: A Cross-Sectional Study. MEDICINA (KAUNAS, LITHUANIA) 2022; 58:medicina58060728. [PMID: 35743991 PMCID: PMC9230391 DOI: 10.3390/medicina58060728] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/20/2022] [Revised: 05/26/2022] [Accepted: 05/26/2022] [Indexed: 12/04/2022]
Abstract
Background and Objectives: The purpose of this study was to investigate the activity of bilateral cervical extensors and flexors on the sagittal, frontal, and horizontal planes of healthy adults during motions of the neck in a sitting position, which has not been satisfactorily investigated by surface electromyogram (sEMG). Materialand Methods: We recruited 35 healthy participants (mean ± standard deviation of age, 20.3 ± 2.4). sEMG recordings of the cervical extensors and flexors were performed for a total of nine seconds in three phases: Phase I involved the motion of the neck from the neutral position to the maximum range of motion; Phase II involved maintaining the neck at the maximum range of motion; and Phase III involved the motion of the neck from the maximum range of motion to the neutral position during neck flexion, extension, right and left lateral flexion, right and left rotation, and maintaining the neck in the neutral position. Muscle activities in each motion were normalized as a percentage of maximal voluntary contraction (%MVC) so that the muscles could be compared. Results: The %MVC of the extensors was significantly larger than that of the flexors in the neutral position (p < 0.001). In addition, the %MVCs of the following were significantly larger than the %MVC in the neutral position: the extensors in flexion (p = 0.014) and extension (p = 0.020), the ipsilateral extensors (p = 0.006) and flexors (p < 0.001) in lateral flexion in Phase I; the flexors in flexion (p < 0.001), the extensors in extension (p = 0.010), and the ipsilateral extensors and flexors in lateral flexion (p < 0.001) in Phase II; the extensors and flexors in flexion (p < 0.001), the flexors in extension (p < 0.001), the ipsilateral flexors (p < 0.001), the contralateral flexors (p = 0.004) and the contralateral extensors (p = 0.018) in lateral flexion in Phase III; and the bilateral extensors and contralateral flexors during rotation in all three phases (p < 0.001). Conclusion: The typical sEMG activities of the extensors and flexors during motion of the neck in healthy adults were identified in this study; this information can be used to understand the pathophysiology of non-specific neck pain and to provide an index for evaluating the effect of treatment.
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Tetteh E, Hallbeck MS, Mirka GA. Effects of passive exoskeleton support on EMG measures of the neck, shoulder and trunk muscles while holding simulated surgical postures and performing a simulated surgical procedure. APPLIED ERGONOMICS 2022; 100:103646. [PMID: 34847371 DOI: 10.1016/j.apergo.2021.103646] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/20/2021] [Revised: 11/08/2021] [Accepted: 11/10/2021] [Indexed: 06/13/2023]
Abstract
Exoskeletons have shown significant impact at reducing the biomechanical demand on muscles during repetitive lifting and overhead tasks in non-healthcare industries. However, the benefits of exoskeletons are yet to be realized in the operating room, particularly as work-related musculoskeletal disorders continue to be a concern for surgeons. This study quantified the effect of using neck, arm, and trunk exoskeletons on muscle activity while assuming typical postures held in the operating room. Fourteen participants were recruited to participate in this study. In this two-part experiment participants were asked to 1) hold a series of neck flexion, arm abduction and trunk flexion postures seen in surgical procedures, and 2) perform a simulated surgical task requiring five different trunk flexion posture levels. Participants were required to complete these tasks with and without passive exoskeleton(s). This study showed that even for postures held short time periods, exoskeletons are beneficial at reducing the demand on muscles; however, the reduction in muscle demand depends on body segment and postural angle, as intended with these passive exoskeletons. Furthermore, for the simulated surgical task with awkward trunk flexion postures (10-65°), the trunk exoskeletons showed a significant reduction in the rate of rise in back muscle sEMG (+1.365%MVC/min vs. +0.769%MVC/min for non-dominant lumbar extensor muscles, p = 0.0108; +1.377%MVC/min vs. +0.770%MVC/min for the dominant lumbar extensor muscles, p = 0.0196) over 25 min, consequently resulting in improved trunk subjective discomfort scores (7.34 vs. 4.30, p < 0.05), with no impact on the neck and shoulder biomechanical demand. The results from this study indicate that exoskeletons may be a potential intervention to reduce biomechanical loading during surgery.
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Affiliation(s)
- Emmanuel Tetteh
- Department of Industrial and Manufacturing Systems Engineering, Iowa State University, Ames, IA, USA; Robert D. and Patricia E. Kern Center for the Science of Healthcare Delivery, Mayo Clinic, Rochester, MN, USA; Division of Health Care Delivery Research, Mayo Clinic, Rochester, MN, USA.
| | - M Susan Hallbeck
- Department of Industrial and Manufacturing Systems Engineering, Iowa State University, Ames, IA, USA; Robert D. and Patricia E. Kern Center for the Science of Healthcare Delivery, Mayo Clinic, Rochester, MN, USA; Division of Health Care Delivery Research, Mayo Clinic, Rochester, MN, USA
| | - Gary A Mirka
- Department of Industrial and Manufacturing Systems Engineering, Iowa State University, Ames, IA, USA; Robert D. and Patricia E. Kern Center for the Science of Healthcare Delivery, Mayo Clinic, Rochester, MN, USA
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Hofstetter L, Häusler M, Schweinhardt P, Heggli U, Bron D, Swanenburg J. Influence of Axial Load and a 45-Degree Flexion Head Position on Cervical Spinal Stiffness in Healthy Young Adults. Front Physiol 2022; 12:786625. [PMID: 35002768 PMCID: PMC8733818 DOI: 10.3389/fphys.2021.786625] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2021] [Accepted: 12/03/2021] [Indexed: 11/13/2022] Open
Abstract
Background: Neck pain is a major cause of disability worldwide. Poor neck posture such as using a smartphone or work-related additional cervical axial load, such headgear of aviators, can cause neck pain. This study aimed at investigating the role of head posture or additional axial load on spinal stiffness, a proxy measure to assess cervical motor control. Methods: The posterior-to-anterior cervical spinal stiffness of 49 young healthy male military employees [mean (SD) age 20 ± 1 years] was measured in two head positions: neutral and 45-degree flexed head position and two loading conditions: with and without additional 3 kg axial load. Each test condition comprised three trials. Measurements were taken at three cervical locations, i.e., spinous processes C2 and C7 and mid-cervical (MC). Results: Cervical spinal stiffness measurements showed good reliability in all test conditions. There was a significant three-way interaction between location × head position × load [F(2, 576) = 9.305, p < 0.001]. Significant two-way interactions were found between measurement locations × loading [F(2, 576) = 15.688, p < 0.001] and measurement locations × head position [F(2, 576) = 9.263, p < 0.001]. There was no significant interaction between loading × head position [F(1, 576) = 0.692, p = 0.406]. Post hoc analysis showed reduction of stiffness in all three measurement locations in flexion position. There was a decrease in stiffness in C2 with loading, increase in stiffness in C7 and no change in MC. Discussion: A flexed head posture leading to decreased stiffness of the cervical spine might contribute to neck pain, especially if the posture is prolonged and static, such as is the case with smartphone users. Regarding the additional load, stiffness decreased high cervical and increased low cervical. There was no change mid cervical. The lower spinal stiffness at the high cervical spine might be caused by capsular ligament laxity due to the buckling effect. At the lower cervical spine, the buckling effect seems to be less dominant, because the proximity to the ribs and sternum provide additional stiffness.
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Affiliation(s)
- Léonie Hofstetter
- Integrative Spinal Research ISR, Department of Chiropractic Medicine, Balgrist University Hospital, Zurich, Switzerland.,Faculty of Medicine, University of Zurich, Zurich, Switzerland
| | - Melanie Häusler
- Integrative Spinal Research ISR, Department of Chiropractic Medicine, Balgrist University Hospital, Zurich, Switzerland.,Faculty of Medicine, University of Zurich, Zurich, Switzerland
| | - Petra Schweinhardt
- Integrative Spinal Research ISR, Department of Chiropractic Medicine, Balgrist University Hospital, Zurich, Switzerland.,Faculty of Medicine, University of Zurich, Zurich, Switzerland
| | - Ursula Heggli
- AeMC, Aeromedical Center, Swiss Air Forces, Dubendorf, Switzerland
| | - Denis Bron
- AeMC, Aeromedical Center, Swiss Air Forces, Dubendorf, Switzerland
| | - Jaap Swanenburg
- Integrative Spinal Research ISR, Department of Chiropractic Medicine, Balgrist University Hospital, Zurich, Switzerland.,Faculty of Medicine, University of Zurich, Zurich, Switzerland
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Ahn SH, Jung SH, Kim HA, Kim JH, Weon YS, Kwon OY. Differences in neck muscle activity according to lying positions using a smartphone. J Back Musculoskelet Rehabil 2022; 35:383-391. [PMID: 34334376 DOI: 10.3233/bmr-200315] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
BACKGROUND Due to the extended use of smartphones, people spend a lot of time on these devices while lying down. OBJECTIVE The purpose of the present study was to compare the differences in neck muscle activity of participants while they watched videos on a smartphone in four different lying positions (supine (SUP), prone on elbows (PE), side lying (SIDE), and 45∘ head turn while side lying (45-SIDE)). METHODS Twenty-three healthy volunteers (22.4 ± 1.7 years) were enrolled in this study. We assessed the activities of their right and left sternocleidomastoid (SCM), anterior scalene, cervical erector spinae (CES), and upper trapezius (UT) muscles while they watched videos on a smartphone in four different lying positions. RESULTS The right and left SCM and CES had significantly different muscle activities depending on the lying positions. The SCM activity had a significantly greater asymmetry in the 45-SIDE position, while the CES activity had a significantly greater asymmetry in the SIDE and 45-SIDE positions. Moreover, the UT activity had a significantly greater asymmetry in the SUP, PE, and SIDE positions. CONCLUSIONS Neck muscle activity and asymmetry were the lowest in the SUP position relative to the other positions. Therefore, lying down in the SUP position may minimize neck muscle activation while using a smartphone.
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Affiliation(s)
- Sun-Hee Ahn
- Department of Rehabilitation Therapy, Graduate School, Yonsei University, Wonju, Korea
| | - Sung-Hoon Jung
- Department of Rehabilitation Therapy, Graduate School, Yonsei University, Wonju, Korea
| | - Hyun-A Kim
- Department of Physical Therapy, Graduate School of Medicine, Nagoya University, Aichi, Japan
| | - Jun-Hee Kim
- Department of Rehabilitation Therapy, Graduate School, Yonsei University, Wonju, Korea
| | - Young-Soo Weon
- Department of Rehabilitation Therapy, Graduate School, Yonsei University, Wonju, Korea
| | - Oh-Yun Kwon
- Department of Physical Therapy, College of Health Science, Laboratory of Kinetic Ergocise Based on Movement Analysis, Yonsei University, Wonju, Korea
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Shamsi H, Khademi-Kalantari K, Akbarzadeh-Baghban A, Izadi N, Okhovatian F. Cervical flexion relaxation phenomenon in patients with and without non-specific chronic neck pain. J Back Musculoskelet Rehabil 2021; 34:461-468. [PMID: 33492275 DOI: 10.3233/bmr-200137] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
BACKGROUND The cervical flexion relaxation phenomenon (FRP) is a myoelectric silence of neck extensor muscles which occurs after a certain degree of flexion. Impaired flexion relaxation can impose the vertebral structures to excessive loading resulting from the persistence of muscular contraction. OBJECTIVE This study aimed to investigate the incidence or absence of FRP in cervical erector spinae (CES) and upper trapezius muscles in patients with chronic neck pain (CNP). METHODS Twenty-five patients with CNP and 25 healthy volunteers were recruited. They accomplished cervical flexion and extension from a neutral position in four phases in the sitting position. The surface electromyography activity of both CES and upper trapezius muscles was recorded in each phase. Cervical flexion and extension movements were simultaneously measured using an electrogoniometer. RESULTS FRP in CES was observed in 84% and 36% of healthy subjects and CNP patients, respectively. Flexion relaxation ratio (FRR) in CES was lower in CNP patients than in healthy subjects (mean diff = 1.33; 95% CI: 0.75-1.91) (P< 0.001). Only in CNP patients, FRR in right erector spinea was significantly higher than that in the left erector spinea (P= 0.04). CONCLUSIONS FRP incidence in CNP patients was less than in healthy subjects. Moreover, this phenomenon begins later in CNP patients than in healthy subjects indicating prolonged activity of CES muscles during flexion in the CNP group. The difference between FRR in the right and left sides of erector spinea muscles can result in CNP.
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Affiliation(s)
- Hasan Shamsi
- Student Research Committee, Department of Physiotherapy, School of Rehabilitation, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Khosro Khademi-Kalantari
- Physiotherapy Research Centre, School of Rehabilitation, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | | | - Neda Izadi
- Student Research Committee, Department of Epidemiology, School of Public Health and Safety, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Farshad Okhovatian
- Physiotherapy Research Centre, School of Rehabilitation, Shahid Beheshti University of Medical Sciences, Tehran, Iran
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Cervical Extensor Muscles Play the Role on Malalignment of Cervical Spine: A Case Control Study With Surface Electromyography Assessment. Spine (Phila Pa 1976) 2021; 46:E73-E79. [PMID: 33038198 DOI: 10.1097/brs.0000000000003742] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
STUDY DESIGN A case control study. OBJECTIVE The aim of this study was to identify the potential impact of cervical spine malalignment on muscle parameters. SUMMARY OF BACKGROUND DATA Muscular factors are associated with cervical alignment. Nevertheless, only muscle dimensions or imaging changes have been evaluated, function of cervical muscles has scarcely been investigated. METHODS Thirty-four patients diagnosed as cervical spine degeneration associated with cervical malalignment and 32 control subjects were included in this case control study. Visual analogue scale (VAS) and the neck disability index (NDI) were used. The sagittal alignment parameters and cervical range of motion (ROM) were measured on cervical spine lateral radiographs, included C2-C7 lordosis, C2-C7 sagittal vertical axis (C2-C7 SVA), cervical gravity-sagittal vertical axis (CG-SVA), T1-Slope, and spinal canal angle (SCA). Surface electromyography (SEMG)-based flexion-relaxation ratio (FRR) was measured. RESULTS The result showed VAS score of the neck significantly lower in controls (P<0.05), C2-C7 lordosis, C2-C7 SVA, CG-SVA, T1-Slope and ROM showed significantly different (P<0.001) between malalignment group and control group, FRR of splenius capitis (FRRSpl) and upper trapezius (FRRUTr) of the malalignment group were lower than in the control group, which correlated well with NDI (rSpl = -0.181 rUTr = -0.275), FRRSpl correlated well with VAS (rSpl = -0.177). FRRSpl correlated strongly with C2-C7 SVA (r = 0.30), CG-SVA (r = 0.32), T1-Slope (r = 0.17), ROM (r = 0.19), FRRUTr correlated with C2-C7 lordosis (r = -0.23), CG-SVA (r = 0.19), T1-Slope (r = 0.28), ROM (r = 0.23). CONCLUSION Cervical malalignment patients had more tensional posterior cervical muscle and poor muscle functions. CG-SVA showed advantages in evaluating cervical malalignment.Level of Evidence: 3.
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A Comparison Study of Posture and Fatigue of Neck According to Monitor Types (Moving and Fixed Monitor) by Using Flexion Relaxation Phenomenon (FRP) and Craniovertebral Angle (CVA). INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17176345. [PMID: 32878184 PMCID: PMC7504159 DOI: 10.3390/ijerph17176345] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/24/2020] [Revised: 08/14/2020] [Accepted: 08/28/2020] [Indexed: 01/14/2023]
Abstract
This study quantified the neck posture and fatigue using the flexion relaxation phenomenon (FRP) and craniovertebral angle (CVA); further, it compared the difference between the level of fatigue and neck posture induced by two types of monitors (regular fixed monitor and moving monitor). Twenty-three male participants were classified into two groups—the low-flexion relaxation ratio (FRR) group and the normal-FRR group, depending on the FRR value. All participants performed a document task for 50 min using both types of monitors. It was found that the FRR values significantly decreased after the documentation task. The CVA analysis showed that the moving monitor’s frequency of forward head posture (FHP) was lower than that for the fixed monitor. Overall, the moving monitor worked better than the fixed monitor; this can be interpreted as proof that such monitors can reduce neck fatigue.
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Lascurain-Aguirrebeña I, Newham DJ, Irazusta J, Seco J, Critchley DJ. Reliability of a Method to Measure Neck Surface Electromyography, Kinematics, and Pain Occurrence in Participants With Neck Pain. J Manipulative Physiol Ther 2019; 41:413-424. [PMID: 30041737 DOI: 10.1016/j.jmpt.2017.10.013] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2017] [Revised: 08/11/2017] [Accepted: 10/19/2017] [Indexed: 01/28/2023]
Abstract
OBJECTIVE To investigate the reliability of a novel method to measure neck surface electromyography (SEMG), kinematics, and pain during active movements in participants with neck pain. METHODS This test-retest study evaluated 23 participants with chronic neck pain. Each was measured twice within a single session. Three-dimensional kinematics and SEMG were recorded in 10° increments during forward and side flexion, extension, and rotation of the neck. Neck position during pain occurrence was also measured. RESULTS Intraclass correlation coefficients were >0.80 for 96% and 100% of SEMG and kinematic data, respectively. The percentage of standard error of the measurement (SEM) values were <25% for 91% of all SEMG measures; most were <15%, and some were <10%. For ranges of motion in the primary plane, percentage of SEM values were all <6% (SEM 1°-3°). Intraclass correlation coefficients for neck position during pain occurrence were all >0.60, except for right rotation (0.48) (SEM values 2°-8°). Pain occurred approximately 59% to 75% into the total range of motion and persisted to its end. CONCLUSIONS This methodology showed good reliability. It may be suitable for neck pain subclassification to evaluate the effects of treatment on pain, kinematics, and muscle activity during functional neck movements. The point of pain occurrence suggests increasing mechanical load on tissues may be one of the causative factors for movement-associated neck pain.
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Affiliation(s)
- Ion Lascurain-Aguirrebeña
- School of Population Sciences and Health Services Research, King's College London, London, United Kingdom; Department of Physiology, University of the Basque Country, Leioa, Spain.
| | - Di J Newham
- Centre of Human & Aerospace Physiological Sciences, King's College London, London, United Kingdom
| | - Jon Irazusta
- Department of Physiology, University of the Basque Country, Leioa, Spain
| | - Jesús Seco
- Institute of Biomedicine (IBIOMED), University of León, León, Spain
| | - Duncan J Critchley
- School of Population Sciences and Health Services Research, King's College London, London, United Kingdom
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Doroudian A, Roostayi MM, Naimi SS, Rahimi A, Baghban AA. Effect of using the Flexi-Bar tool on erector spinae muscle activation under different standing weight-bearing conditions. J Back Musculoskelet Rehabil 2019; 32:505-509. [PMID: 30883330 DOI: 10.3233/bmr-171011] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
OBJECTIVES The Flexi-Bar and Bodyblade are oscillatory tools used in rehabilitation centers worldwide to enhance muscle activity. Because of a lack of reports on the Flexi-Bar, this study focused on erector spinae (ES) muscle activation under different conditions. METHODS Twelve university students (age 21 ± 2.5 years old) were recruited in this study and were tested while using a loaded Flexi-Bar for 10 seconds. Comparison between muscle activation on the right and left sides in the cervical, thoracic, and lumbar regions was measured by electromyography during two-leg and one-leg (left and right) standing. RESULTS The results showed that during oscillation using the right hand, the right cervical muscles showed significantly higher activation levels than the left cervical muscles, while the thoracic and lumbar regions showed significantly higher muscle activities on the left side. CONCLUSION The current study showed that the Flexi-Bar might be used for muscle activation and reeducation, as well as for specific exercise therapy in spinal muscle imbalance.
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Affiliation(s)
- Alireza Doroudian
- Physiotherapy Research Center, School of Rehabilitation, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Mohammad Mohsen Roostayi
- Physiotherapy Research Center, School of Rehabilitation, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Sedigheh Sadat Naimi
- Physiotherapy Research Center, School of Rehabilitation, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Abbas Rahimi
- Physiotherapy Research Center, School of Rehabilitation, Shahid Beheshti University of Medical Sciences, Tehran, Iran
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Roghani T, Khalkhali Zavieh M, Talebian S, Akbarzadeh Baghban A, Katzman W. Back Muscle Function in Older Women With Age-Related Hyperkyphosis: A Comparative Study. J Manipulative Physiol Ther 2019; 42:284-294. [PMID: 31257003 DOI: 10.1016/j.jmpt.2018.11.012] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2018] [Revised: 11/08/2018] [Accepted: 11/15/2018] [Indexed: 11/18/2022]
Abstract
OBJECTIVE The purpose of this study was to compare static maximal back extensor muscle force, endurance, and characteristics of flexion relaxation phenomenon (FRP) in older women with and without age-related hyperkyphosis. METHODS Maximum back extensor force and endurance measured in a sitting position with a designed load cell setup; appearance, onset, and offset angles of FRP; and extension relaxation ratio (ERR) during a dynamic flexion-extension task were compared between 24 older women with hyperkyphosis (thoracic kyphosis angle ≥50°), mean age 65 ± 4.4 years, and 24 older women without hyperkyphosis (thoracic kyphosis angle ≪50°), mean age 63 ± 4.3 years. Variables of force, endurance, angles of FRP, and ERR were analyzed using an independent sample t test. A χ2 test was used to identify differences between groups in FRP appearance. RESULTS Static back extensor force and endurance were significantly lower among those with versus those without hyperkyphosis (P ≪ .001). Although the 2 groups did not differ in FRP appearance and ERR in the superficial erector spinal muscles (P ≫ .05), FRP in the hyperkyphosis group started sooner and ended later than in the group without hyperkyphosis (P ≪ .05). CONCLUSION Our study indicates that women with age-related hyperkyphosis had decreased static maximal force and endurance of the back extensor muscles and prolonged myoelectrical silence of the superficial erector spinal muscles. Reduced endurance of the superficial erector spinal muscles may trigger early onset of FRP and prolonged relaxation of these muscles.
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Affiliation(s)
- Tayebeh Roghani
- Musculoskeletal Research Center, Rehabilitation Research Institute and Department of Physical Therapy, Faculty of Rehabilitation Sciences, Isfahan University of Medical Sciences, Isfahan, Iran; Department of Physiotherapy, School of Rehabilitation, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Minoo Khalkhali Zavieh
- Department of Physiotherapy, School of Rehabilitation, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
| | - Saeed Talebian
- Department of Physiotherapy, School of Rehabilitation, Tehran University of Medical Sciences and Health Services, Tehran, Iran
| | - Alireza Akbarzadeh Baghban
- Proteomics Research Center, School of Rehabilitation, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Wendy Katzman
- Department of Physical Therapy and Rehabilitation Sciences, University of California, San Francisco, California
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Lascurain-Aguirrebeña I, Newham DJ, Galarraga-Gallastegui B, Critchley DJ. Differences in neck surface electromyography, kinematics and pain occurrence during physiological neck movements between neck pain and asymptomatic participants. A cross-sectional study. Clin Biomech (Bristol, Avon) 2018; 57:1-9. [PMID: 29864606 DOI: 10.1016/j.clinbiomech.2018.05.010] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/12/2017] [Revised: 04/25/2018] [Accepted: 05/21/2018] [Indexed: 02/07/2023]
Abstract
BACKGROUND Neck pain has been associated with altered muscle activity and impaired kinematics. Patients frequently report pain during physiological neck movements. Previously, the average muscle activity during these movements has been measured. However, muscle activity is modulated by the position in the range of movement, hence the study of neck muscle activity in discrete sections of the range of movement is warranted. Evidence is conflicting regarding range of movement restriction in neck pain. No study has assessed the point in the range of movement at which pain occurs. This study aimed to investigate neck kinematics, muscle activity and pain during physiological neck movements in participants with and without neck pain. METHODS Neck kinematics and surface electromyography were recorded continuously and analysed in 10° increments during forward and side flexion, extension and rotation of the neck in 20 neck pain and 20 asymptomatic participants. Point of pain occurrence in the range of movement was recorded. FINDINGS Neck pain participants demonstrated significantly lower activity of scalene during flexion and extension, and a non-significant higher activity in sternocleidomastoids during rotation. No differences in neck kinematics were observed. 65% of neck pain participants reported pain during at least one neck movement. Pain was reported in the last ≈20-40% of the range of movement. INTERPRETATION Exercises used in current practice to minimise scalene activity may not be appropriate for all neck pain patients. Restricted range of movement is not a consistent feature of neck pain. Movement associated neck pain is present at the end of range of movement, which has implications for the study of neck pain and rehabilitation.
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Affiliation(s)
- Ion Lascurain-Aguirrebeña
- School of Population Sciences and Health Services Research, Faculty of Life Sciences & Medicine, King's College London, London SE1 1UL, United Kingdom; Department of Physiology, Faculty of Medicine & Odontology, University of the Basque Country, Leioa 48940, Spain.
| | - Di J Newham
- Centre of Human & Aerospace Physiological Sciences, Faculty of Life Sciences & Medicine, King's College London, London SE1 1UL, United Kingdom.
| | | | - Duncan J Critchley
- School of Population Sciences and Health Services Research, Faculty of Life Sciences & Medicine, King's College London, London SE1 1UL, United Kingdom.
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Douglas EC, Gallagher KM. Are the Neck Positions and Muscle Activity Observed when Reading a Tablet Similar to That of the Cervical Flexion-Relaxation Onset? IISE Trans Occup Ergon Hum Factors 2018. [DOI: 10.1080/24725838.2018.1450310] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Affiliation(s)
- Ethan C. Douglas
- Undergraduate Student, Exercise Science Research Center, University of Arkansas, Fayetteville, Arkansas, United States
| | - Kaitlin M. Gallagher
- Exercise Science Research Center, University of Arkansas, Fayetteville, Arkansas, United States
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Novel Electromyographic Protocols Using Axial Rotation and Cervical Flexion-Relaxation for the Assessment of Subjects With Neck Pain: A Feasibility Study. J Chiropr Med 2016; 15:102-11. [PMID: 27330512 DOI: 10.1016/j.jcm.2016.04.013] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2015] [Revised: 01/25/2016] [Accepted: 02/03/2016] [Indexed: 11/21/2022] Open
Abstract
OBJECTIVE The purpose of this study is to examine the feasibility of novel variations to the way cervical flexion-relaxation phenomenon (FRP) studies are conducted and the feasibility of using cervical axial rotation as an alternative objective measure of cervical pain/dysfunction. METHODS Electromyographic data were collected from cervical paraspinal muscles of 5 participants with neck pain and 5 asymptomatic controls. Cervical FRP was conducted as reported in the literature with the participants seated, except that they started with the head fully flexed instead of being erect. Data were also collected with participants laying prone, starting with their head hanging over the edge of the table. Additional data were collected from cervical paraspinal and sternocleidomastoid (SCM) muscles while the seated participants rotated their head fully to the right and left. Ratios were obtained for each type of test by dividing the electromyographic amplitude when muscles were most active by that when they were relaxed or in contralateral rotation. RESULTS In each case, the ratio was higher for the controls than for those with neck pain, suggesting that any of the 4 methods could be used to distinguish between 2 groups. The ratios were most pronounced from SCMs during axial rotation. There appeared to be a negative relationship between pain level and the ratios obtained from each method. CONCLUSION The findings from this small study are encouraging for all methods used, with axial rotation using SCMs appearing to be the most promising. These results indicate that larger, powered studies are warranted.
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Stewart DM, Gregory DE. The use of intermittent trunk flexion to alleviate low back pain during prolonged standing. J Electromyogr Kinesiol 2016; 27:46-51. [DOI: 10.1016/j.jelekin.2016.01.007] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2015] [Revised: 01/11/2016] [Accepted: 01/18/2016] [Indexed: 11/28/2022] Open
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Mousavi-Khatir R, Talebian S, Maroufi N, Olyaei GR. Effect of static neck flexion in cervical flexion-relaxation phenomenon in healthy males and females. J Bodyw Mov Ther 2016; 20:235-42. [DOI: 10.1016/j.jbmt.2015.07.039] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2015] [Revised: 06/23/2015] [Accepted: 07/22/2015] [Indexed: 11/25/2022]
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Flexion–relaxation ratio in computer workers with and without chronic neck pain. J Electromyogr Kinesiol 2016; 26:8-17. [DOI: 10.1016/j.jelekin.2015.12.011] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2015] [Revised: 10/29/2015] [Accepted: 12/19/2015] [Indexed: 11/20/2022] Open
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Zabihhosseinian M, Holmes MWR, Ferguson B, Murphy B. Neck muscle fatigue alters the cervical flexion relaxation ratio in sub-clinical neck pain patients. Clin Biomech (Bristol, Avon) 2015; 30:397-404. [PMID: 25843481 DOI: 10.1016/j.clinbiomech.2015.03.020] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/03/2014] [Revised: 03/19/2015] [Accepted: 03/21/2015] [Indexed: 02/07/2023]
Abstract
BACKGROUND The cervical flexion relaxation ratio is lower in neck pain patients compared to healthy controls. Fatigue modulates the onset and offset angles of the silent period in both the lumbar and cervical spine in healthy individuals; however, this response has not been studied with neck pain patients. The purpose of this study was to determine if cervical extensor fatigue would alter the parameters of the cervical flexion relaxation more in a neck pain group than a healthy control group. METHODS Thirteen healthy and twelve neck pain patients participated. Cervical extensor activity was examined bilaterally and kinematics of the neck and head were collected. An isometric, repetitive neck extension task at 70% of maximum elicited fatigue. Participants performed 3 trials of maximal cervical flexion both pre and post fatigue. FINDINGS The healthy controls and neck pain groups fatigued after 56 (41) and 39 (31) repetitions, respectively. There was a significant interaction effect for the flexion relaxation ratio between the control and neck pain groups from pre to post fatigue trials (F1,96=22.67, P=0.0001), but not for onset and offset angles (F1, 96=0.017, P=0.897), although the onset and offset angles did decrease significantly for both groups following fatigue (F1,96=9.26, P=0.002). INTERPRETATION Individuals with mild to moderate neck pain have significant differences in their neuromuscular control relative to controls, experienced myoelectric fatigue with fewer repetitions in a shorter time, had a lower cervical flexion relaxation ratio at baseline and had an inability to decrease this ratio further in response to fatigue.
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Affiliation(s)
- Mahboobeh Zabihhosseinian
- Faculty of Health Sciences, University of Ontario Institute of Technology, 2000 Simcoe St. North, Oshawa, ON L1H 7K4, Canada.
| | - Michael W R Holmes
- Faculty of Health Sciences, University of Ontario Institute of Technology, 2000 Simcoe St. North, Oshawa, ON L1H 7K4, Canada.
| | - Brad Ferguson
- Department of Graduate Studies, Canadian Memorial Chiropractic College, 6100 Leslie St, North York, ON M2H 3J1, Canada.
| | - Bernadette Murphy
- Faculty of Health Sciences, University of Ontario Institute of Technology, 2000 Simcoe St. North, Oshawa, ON L1H 7K4, Canada.
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Bonnechère B, Salvia P, Dugailly PM, Maroye L, Van Geyt B, Feipel V. Influence of movement speed on cervical range of motion. EUROPEAN SPINE JOURNAL : OFFICIAL PUBLICATION OF THE EUROPEAN SPINE SOCIETY, THE EUROPEAN SPINAL DEFORMITY SOCIETY, AND THE EUROPEAN SECTION OF THE CERVICAL SPINE RESEARCH SOCIETY 2014; 23:1688-93. [PMID: 24610237 DOI: 10.1007/s00586-014-3249-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/04/2013] [Revised: 02/13/2014] [Accepted: 02/16/2014] [Indexed: 10/25/2022]
Abstract
PURPOSE Cervical range of motion (RoM) has been the subject of many studies. However, only very few of these studies have considered the influence of movement execution speed on the cervical kinematics. The aim of this study is to evaluate the influence of movement speed on cervical RoM. METHOD Cervical RoM was recorded using an optoelectronic system; 32 healthy subjects performed movements in two modes: the best possible and as fast as possible. OUTCOME MEASURES The primary movements (flexion-extension, lateral bending, axial rotation) and coupled movements were studied. Paired Student's tests were performed to compare the two modes of movement. RESULTS The results showed that cervical RoM differed significantly between movement speeds. Amplitudes were higher for each movement (p < 0.001 for flexion-extension, p < 0.001 for lateral flexion, p = 0.008 for axial rotations) when movements were performed as quickly as possible. The range of movements carried out the best possible reached only 95% of those during movements carried out as fast as possible. Concerning coupled movements, an increase in rotational movements coupled to lateral flexion during fast movements was observed. CONCLUSION The range of motion reported in the literature corresponds to movement carried out in a mode resembling the best possible of our study. Movements made as quickly as possible can display larger motion ranges.
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Affiliation(s)
- Bruno Bonnechère
- Laboratory of Anatomy, Biomechanics and Organogenesis (LABO), Faculty of Medicine, Université Libre de Bruxelles, Route de Lennik 808, 1070, Brussels, Belgium,
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Vikne H, Bakke ES, Liestøl K, Engen SR, Vøllestad N. Muscle activity and head kinematics in unconstrained movements in subjects with chronic neck pain; cervical motor dysfunction or low exertion motor output? BMC Musculoskelet Disord 2013; 14:314. [PMID: 24188070 PMCID: PMC3840692 DOI: 10.1186/1471-2474-14-314] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/25/2013] [Accepted: 10/22/2013] [Indexed: 11/13/2022] Open
Abstract
Background Chronic neck pain after whiplash associated disorders (WAD) may lead to reduced displacement and peak velocity of neck movements. Dynamic neck movements in people with chronic WAD are also reported to display altered movement patterns such as increased irregularity, which is suggested to signify impaired motor control. As movement irregularity is strongly related to the velocity and displacement of movement, we wanted to examine whether the increased irregularity in chronic WAD could be accounted for by these factors. Methods Head movements were completed in four directions in the sagittal plane at three speeds; slow (S), preferred (P) and maximum (M) in 15 men and women with chronic WAD and 15 healthy, sex and age-matched control participants. Head kinematics and measures of movement smoothness and symmetry were calculated from position data. Surface electromyography (EMG) was recorded bilaterally from the sternocleidomastoid and splenius muscles and the root mean square (rms) EMG amplitude for the accelerative and decelerative phases of movement were analyzed. Results The groups differed significantly with regard to movement velocity, acceleration, displacement, smoothness and rmsEMG amplitude in agonist and antagonist muscles for a series of comparisons across the test conditions (range 17 – 121%, all p-values < 0.05). The group differences in peak movement velocity and acceleration persisted after controlling for movement displacement. Controlling for differences between the groups in displacement and velocity abolished the difference in measures of movement smoothness and rmsEMG amplitude. Conclusions Simple, unconstrained head movements in participants with chronic WAD are accomplished with reduced velocity and displacement, but with normal muscle activation levels and movement patterns for a given velocity and displacement. We suggest that while reductions in movement velocity and displacement are robust changes and may be of clinical importance in chronic WAD, movement smoothness of unconstrained head movements is not.
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Affiliation(s)
- Harald Vikne
- Department of Health Sciences, Institute of Health and Society, University of Oslo, P,O, Box 1089, Blindern, NO-0317 Oslo, Norway.
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