Sex and posture dependence of neck muscle size-strength relationships

Quantitatively assessing the effect of cervical sagittal alignment on dynamic intervertebral kinematics by video-fluoroscopy technique

BACKGROUND

Cervical sagittal alignment is crucial for distributing the head load to lower cervical segments and maintaining normal cervical spine function, but its biomechanical effect on the cervical spine was not fully elucidated.

OBJECTIVE

To investigate the effect of cervical sagittal alignment on dynamic intervertebral kinematics.

DESIGN

Cross-sectional study.

METHODS

Healthy participants without neck pain were recruited and divided into lordosis, straight and kyphosis groups according to the C2-C7 Cobb angle at the neutral position. The anti-directional and total joint motions were extracted across 10 epochs of dynamic cervical flexion and extension movements.

RESULTS

/findings: The overall anti-directional joint motion during flexion is larger in the kyphosis group when compared with the lordosis group (p = 0.021), while the range of flexion is smaller in the kyphosis group than that in the lordosis group (p = 0.017). The C2/C3 anti-directional joint motion during extension in the straight group is larger than that in the lordosis group (p = 0016). The range of extension in the kyphosis group (p < 0.001) and the straight group (p = 0.002) are larger than that in the lordosis group. The increased range of extension in the kyphosis and straight groups were mainly from the C3/C4, C4/C5, and C5/C6 joints(p < 0.05).

CONCLUSION

Changes in cervical sagittal alignment alter both the quality and quantity of the individual joint motions. More adjustments are required by the cervical joints to complete neck movements with the loss of lordosis. The lordotic curvature is a relatively effort-saving mode for the cervical spine from a biomechanical perspective.

Architecture of head and neck soft tissues and associated entheses: An exploration of sexual dimorphism in, and population differences between, New Zealand and Thai individuals

Understanding the musculoskeletal anatomy of soft tissues of the head and neck is important for surgical applications, biomechanical modelling and management of injuries, such as whiplash. Additionally, analysing sex and population differences in cervical anatomy can inform how biological sex and population variation may impact these anatomical applications. Although some muscles of the head and neck are well-studied, there is limited architectural information that also analyses sex and population variation, for many small cervical soft tissues (muscles and ligaments) and associated entheses (soft tissue attachment sites). Therefore, the aim of this study was to present architectural data (e.g., proximal and distal attachment sites, muscle physiological cross-sectional area, ligament mass, enthesis area) and analyse sex and population differences in soft tissues and entheses associated with sexually dimorphic landmarks on the cranium (nuchal crest and mastoid process) and clavicle (rhomboid fossa). Through the dissection and three-dimensional analysis of 20 donated cadavers from New Zealand (five males, five females; mean age 83 ± 8 years; range 67-93 years) and Thailand (five males, five females; 69 ± 13 years; range 44-87 years), the following soft tissues and their associated entheses were analysed: upper trapezius, semispinalis capitis and the nuchal ligament (nuchal crest); sternocleidomastoid, splenius capitis and longissimus capitis (mastoid process); the clavicular head of pectoralis major, subclavius, sternohyoid and the costoclavicular (rhomboid) ligament (rhomboid fossa). Findings indicate that although muscle, ligament and enthesis sizes were generally similar to previously published data, muscle size was smaller for six of the eight muscles in this study, with only the upper trapezius and subclavius demonstrating similar values to previous studies. Proximal and distal attachment sites were largely consistent with the current research. However, some individuals (six of 20) had proximal upper trapezius attachments on the cranium, with most attaching solely to the nuchal ligament, contrasting with existing literature, which often describes attachment to the occipital bone. With respect to sexual dimorphism, the Thai sample exhibited more sex differences in muscle size than the New Zealand sample, but for enthesis size (area), both samples had the same amount of statistically significant sex differences (5 of 10). Additionally, some significant population differences were found when comparing muscle and enthesis size data between the New Zealand and Thai samples. Despite these findings, no sex or population differences were found for ligament size (mass) in either group. This paper presents new architectural data for several understudied areas of the head and neck, as well as providing analyses on sex and population differences, two areas that have limited representation in anatomy.

Biomechanics of Traumatic Head and Neck Injuries on Women: A State-of-the-Art Review and Future Directions

The biomechanics of traumatic injuries of the human body as a consequence of road crashes, falling, contact sports, and military environments have been studied for decades. In particular, traumatic brain injury (TBI), the so-called "silent epidemic", is the traumatic insult responsible for the greatest percentage of death and disability, justifying the relevance of this research topic. Despite its great importance, only recently have research groups started to seriously consider the sex differences regarding the morphology and physiology of women, which differs from men and may result in a specific outcome for a given traumatic event. This work aims to provide a summary of the contributions given in this field so far, from clinical reports to numerical models, covering not only the direct injuries from inertial loading scenarios but also the role sex plays in the conditions that precede an accident, and post-traumatic events, with an emphasis on neuroendocrine dysfunctions and chronic traumatic encephalopathy. A review on finite element head models and finite element neck models for the study of specific traumatic events is also performed, discussing whether sex was a factor in validating them. Based on the information collected, improvement perspectives and future directions are discussed.

Intra and Inter-Rater Reliability of a Novel Isometric Test of Neck Strength

There is no single, universally accepted method of measuring isometric neck strength to inform exercise prescription and injury risk prediction. This study aimed to establish the inter- and intra-rater reliability of a commercially available fixed frame dynamometer in measuring peak isometric neck strength. A convenience sample of male (n = 16) and female (n = 20) university students performed maximal isometric contractions for flexion (Flex), extension (Ext), left- (LSF) and right-side flexion (RSF) in a quadruped position over three sessions. The intra-rater reliability results were good-to-excellent for both males (ICC = 0.83−0.90) and females (ICC = 0.86−0.94) and acceptable (CV < 15%) across all directions for both males and females. The inter-rater reliability results were excellent (ICC = 0.96−0.97) and acceptable (CV < 11.1%) across all directions. Findings demonstrated a significant effect for sex (p ≤ 0.05): males were stronger in all four directions, and a significant effect for direction (p ≤ 0.05): Ext tested stronger (193 N) than Flex (176 N), LSF (130 N) and RSF (125 N). The findings show that the VALD fixed frame dynamometer can reliably assess isometric neck strength and can provides reference values for healthy males and females.

Improvement of cervical spine mobility and stance stability by wearing a custom-made mandibular splint in male recreational athletes

OBJECTIVES

The range of motion (ROM) of the cervical spine and postural stability are important for an economical and motorically adequate adaptation of the body to any situation. Therefore, this study aims to analyze whether these two components of postural and movement control can be influenced by means of a splint in a centric position compared to habitual occlusion.

METHODS

38 recreational male athletes volunteered. Cervical spine ROM was recorded using an ultrasound system and the a pressure measuring plate for postural stability (length of center of pressure (CoP) movement, area of CoP). The two dental occlusion conditions employed were the habitual occlusion and wearing a splint in an idealized, condylar position close to the centric position. Level of significance was set at ρ ≤ 0.05.

RESULTS

The cervical spine mobility increased significantly by wearing the splint regarding rotation to the left (+3.9%) and right (+2.7%) and lateral flexion to the left (+4.4%) and right (+6.7%). Wearing the splint reduced the area of sway deflections by about 31.5% in the bipedal stance and by about 2.4% (left) and 28.2% (right) in the unipedal stance. The CoP trace was reduced in the sagittal plane by approximately 8.2% in the right single-leg stance.

CONCLUSIONS

The major findings seem to demonstrate that wearing a splint that keeps the jaw close to the centric relation may increase the cervical ROM and may improve balance stability in male recreational athletes. Changing the jaw relation in athletes can possibly aid the release of performance potentials by improving coordination skills.

Sex-related differences in sternocleidomastoid muscle morphology in healthy young adults: A cross-sectional magnetic resonance imaging measurement study

BACKGROUND

Changes in sternocleidomastoid (SCM) muscle cross-sectional area (CSA) and volume may contribute to neck-related concussion symptoms and whiplash-associated disorders. Magnetic resonance imaging (MRI) data on healthy SCM morphology can provide information that may lead to targeted treatment protocols.

OBJECTIVES

To examine sex-related differences in MRI-based SCM CSA, SCM volume and neck area in healthy young adults, to analyze associations between measurements and participant variables and to assess inter-rater reliability for measurement quantification.

DESIGN

Cross-sectional study.

METHODS

13 males and 14 females underwent MRI scans. Slices obtained from C3-C7 were analyzed by three raters. SCM CSA at C4, total SCM volume from C3-C7 and neck area at C4 were quantified. Measurements were calculated as absolute and normalized values by body mass. Multivariable regression was used to analyze associations between normalized measurement values and participant variables. Inter-rater reliability was determined using intraclass correlation coefficients (ICC).

RESULTS

Females had significantly lower normalized overall average SCM CSA (mean difference 1.3 mm²/kg (95% CI 0.4-2.2, p = 0.006) and total SCM volume (mean difference 140.8 mm3/kg (95% CI 66.1-215.5, p < 0.001) than males. Regression models indicated female sex was associated with lower normalized overall average SCM CSA (p = 0.004) and total SCM volume (p < 0.001). Inter-rater reliability was excellent for SCM CSA (ICC_3,3 = 0.909), SCM volume (ICC_3,3 = 0.910) and neck area (ICC_3,3 = 0.995).

CONCLUSIONS

These results enhance our understanding of sex-related differences in SCM morphology and will inform future research and clinical practice related to cervical muscle injury.

The Speed of Optic Flow Stimuli Influences Body Sway

Optic flow is a perceptual cue processed for self-motion control. The aim of this study was to investigate whether postural control is modulated by the speed of radial optic flow stimuli. The experiments were performed on 20 healthy volunteers using stabilometry and surface electromyography (EMG). The subjects were instructed to fixate a central fixation point while radial optic flow stimuli were presented full field, in the foveal and in the peripheral visual field at different dots speed (8, 11, 14, 17 and 20°/s). Fixation in the dark was used as control stimulus. The EMG analysis showed that male and female subjects reacted to the stimuli with different muscle activity (main effects for gender, muscle and laterality: p < 0.001). The analysis of the center of pressure (COP) parameters showed that optic flow stimuli had a different effect on the left and right limbs of males and females (main effects of laterality: p < 0.015; interaction effects of gender and laterality: p < 0.016). The low speed of optic flow stimuli (8 and 11°/s) evoked non-uniform directions of oscillations especially in peripheral stimulation in all subjects, meaning that optic flow simulating slow self-motion stabilizes body sway.