title: Normal functional range of motion of the cervical spine during 15 activities of daily living.
abstract: METHODS
  Prospective clinical study.
  
  
  OBJECTIVE
  The purpose of this investigation was to quantify normal cervical range of motion (ROM) and compare these results to those used to perform 15 simulated activities of daily living (ADLs) in asymptomatic subjects.
  
  
  BACKGROUND
  Previous studies looking at cervical ROM during ADLs have been limited and used measuring devices that do not record continuous motion. The purpose of this investigation was to quantify normal cervical ROM and compare these results with those used to perform 15 simulated ADLs in asymptomatic subjects.
  
  
  METHODS
  A noninvasive electrogoniometer and torsiometer were used to measure the ROM of the cervical spine. The accuracy and reliability of the devices were confirmed by comparing the ROM values acquired from dynamic flexion/extension and lateral bending radiographs to those provided by the device, which was activated while the radiographs were obtained. Intraobserver reliability was established by calculating the intraclass correlation coefficient for repeated measurements on the same subjects by 1 investigator on consecutive days. These tools were employed in a clinical laboratory setting to evaluate the full active ROM of the cervical spines (ie, flexion/extension, lateral bending, and axial rotation) of 60 asymptomatic subjects (30 females and 30 males; age, 20 to 75 y) as well as to assess the functional ROM required to complete 15 simulated ADLs.
  
  
  RESULTS
  When compared with radiographic measurements, the electrogoniometer was found to be accurate within 2.3+/-2.2 degrees (mean+/-SD) and the intraobserver reliabilities for measuring the full active and functional ROM were both excellent (intraclass correlation coefficient of 0.96 and 0.92, respectively). The absolute ROM and percentage of full active cervical spinal ROM used during the 15 ADLs was 13 to 32 degrees and 15% to 32% (median, 20 degrees/19%) for flexion/extension, 9 to 21 degrees and 11% to 27% (14 degrees/18%) for lateral bending, and 13 to 57 degrees and 12% to 92% (18 degrees/19%) for rotation. Backing up a car required the most ROM of all the ADLs, involving 32% of sagittal, 26% of lateral, and 92% of rotational motion. In general, personal hygiene ADLs such as washing hands and hair, shaving, and applying make-up entailed a significantly greater ROM relative to locomotive ADLs including walking and traveling up and down a set of stairs (P<0.0001); in addition, compared with climbing up these steps, significantly more sagittal and rotational motion was used when descending stairs (P=0.003 and P=0.016, respectively). When picking up an object from the ground, a squatting technique required a lower percentage of lateral and rotational ROM than bending at the waist (P=0.002 and P<0.0001).
  
  
  CONCLUSIONS
  By quantifying the amounts of cervical motion required to execute a series of simulated ADLs, this study indicates that most individuals use a relatively small percentage of their full active ROM when performing such activities. These findings provide baseline data which may allow clinicians to accurately assess preoperative impairment and postsurgical outcomes.
authors.affiliation: Department of Orthopaedics and Rehabilitation, Yale University School of Medicine, New Haven, CT 06520-8071, USA.
authors.forename: Jesse E
authors.initials: JE
authors.lastname: Bible
authors.forename: Debdut
authors.initials: D
authors.lastname: Biswas
authors.forename: Christopher P
authors.initials: CP
authors.lastname: Miller
authors.forename: Peter G
authors.initials: PG
authors.lastname: Whang
authors.forename: Jonathan N
authors.initials: JN
authors.lastname: Grauer
mesh_terms: D000203:Activities of Daily Living; D000328:Adult; D000368:Aged; D000886:Anthropometry; D001175:Arthrography / Q000379:methods; D053587:Arthrometry, Articular / Q000295:instrumentation / Q000379:methods; D001696:Biomechanical Phenomena; D002574:Cervical Vertebrae / Q000033:anatomy & histology / Q000000981:diagnostic imaging / Q000502:physiology*; D002933:Cineradiography / Q000379:methods; D005260:Female; D019416:Head Movements / Q000502:physiology*; D006801:Humans; D007403:Intervertebral Disc / Q000033:anatomy & histology / Q000000981:diagnostic imaging / Q000502:physiology; D008297:Male; D008875:Middle Aged; D009068:Movement / Q000502:physiology; D009334:Neck Muscles / Q000502:physiology; D011446:Prospective Studies; D016059:Range of Motion, Articular / Q000502:physiology*; D012016:Reference Values; D055815:Young Adult; D021801:Zygapophyseal Joint / Q000033:anatomy & histology / Q000502:physiology