title: Extension and flexion in the upper cervical spine in neck pain patients.
abstract: Neck pain is a common problem in the general population with high risk of ongoing complaints or relapses. Range of motion (ROM) assessment is scientifically established in the clinical process of diagnosis, prognosis and outcome evaluation in neck pain. Anatomically, the cervical spine (CS) has been considered in two regions, the upper and lower CS. Disorders like cervicogenic headache have been clinically associated with dysfunctions of the upper CS (UCS), yet ROM tests and measurements are typically conducted on the whole CS. A cross-sectional study assessing 19 subjects with non-specific neck pain was undertaken to examine UCS extension-flexion ROM in relation to self-reported disability and pain (via the Neck Disability Index (NDI)). Two measurement devices (goniometer and electromagnetic tracking) were employed and compared. Correlations between ROM and the NDI were stronger for the UCS compared to the CS, with the strongest correlation between UCS flexion and the NDI-headache (r = -0.62). Correlations between UCS and CS ROM were fair to moderate, with the strongest correlation between UCS flexion and CS extension ROM (r = -0.49). UCS flexion restriction is related to headache frequency and intensity. Consistency and agreement between both measurement systems and for all tests was high. The results demonstrate that separate UCS ROM assessments for extension and flexion are useful in patients with neck pain.
authors.affiliation: School of Health Professions, Zurich University of Applied Sciences, Technikumstrasse 71, 8401 Winterthur, Switzerland. Electronic address: markus.ernst@zhaw.ch.
authors.forename: Markus J
authors.initials: MJ
authors.lastname: Ernst
authors.affiliation: School of Health Professions, Zurich University of Applied Sciences, Technikumstrasse 71, 8401 Winterthur, Switzerland; Faculty of Health Sciences, Curtin University, Perth, Australia. Electronic address: rebecca.crawford@zhaw.ch.
authors.forename: Rebecca J
authors.initials: RJ
authors.lastname: Crawford
authors.affiliation: School of Health Professions, Zurich University of Applied Sciences, Technikumstrasse 71, 8401 Winterthur, Switzerland. Electronic address: sarah.schelldorfer@zhaw.ch.
authors.forename: Sarah
authors.initials: S
authors.lastname: Schelldorfer
authors.affiliation: School of Health Professions, Zurich University of Applied Sciences, Technikumstrasse 71, 8401 Winterthur, Switzerland. Electronic address: anne-kathrin.rausch@zhaw.ch.
authors.forename: Anne-Kathrin
authors.initials: AK
authors.lastname: Rausch-Osthoff
authors.affiliation: Department of Health Sciences, University of Applied Sciences and Arts of Southern Switzerland (SUPSI), Manno, Switzerland. Electronic address: marco.barbero@supsi.ch.
authors.forename: Marco
authors.initials: M
authors.lastname: Barbero
authors.affiliation: School of Health Professions, Zurich University of Applied Sciences, Technikumstrasse 71, 8401 Winterthur, Switzerland. Electronic address: jan.kool@zhaw.ch.
authors.forename: Jan
authors.initials: J
authors.lastname: Kool
authors.affiliation: School of Health Professions, Zurich University of Applied Sciences, Technikumstrasse 71, 8401 Winterthur, Switzerland. Electronic address: christoph.bauer@zhaw.ch.
authors.forename: Christoph M
authors.initials: CM
authors.lastname: Bauer
mesh_terms: D000328:Adult; D001696:Biomechanical Phenomena; D002574:Cervical Vertebrae; D003430:Cross-Sectional Studies; D005260:Female; D006801:Humans; D008297:Male; D020393:Manipulation, Spinal / Q000379:methods*; D008875:Middle Aged; D019547:Neck Pain / Q000503:physiopathology* / Q000534:rehabilitation* / Q000628:therapy; D010147:Pain Measurement / Q000379:methods*; D016059:Range of Motion, Articular / Q000502:physiology*
keywords: Disability; Headache; Neck pain; Range of motion; Upper cervical spine