title: Does rehabilitation of cervical lordosis influence sagittal cervical spine flexion extension kinematics in cervical spondylotic radiculopathy subjects?
abstract: OBJECTIVE
  To test the hypothesis that improvement of cervical lordosis in cervical spondylotic radiculopathy (CSR) will improve cervical spine flexion and extension end range of motion kinematics in a population suffering from CSR.
  
  
  METHODS
  Thirty chronic lower CSR patients with cervical lordosis < 25° were included. IRB approval and informed consent were obtained. Patients were assigned randomly into two equal groups, study (SG) and control (CG). Both groups received stretching exercises and infrared; the SG received 3-point bending cervical extension traction. Treatments were applied 3 × per week for 10 weeks, care was terminated and subjects were evaluated at 3 intervals: baseline, 30 visits, and 3-month follow-up. Radiographic neutral lateral cervical absolute rotation angle (ARA C2-C7) and cervical segmental (C2-C7 segments) rotational and translational flexion-extension kinematics analysis were measured for all patients at the three intervals. The outcome were analyzed using repeated measures one-way ANOVA. Tukey's post-hoc multiple comparisons was implemented when necessary. Pearson correlation between ARA and segmental translational and rotational displacements was determined.
  
  
  RESULTS
  Both groups demonstrated statistically significant increases in segmental motion at the 10-week follow up; but only the SG group showed a statistically significant increase in cervical lordosis (p < 0.0001). At 3-month follow up, only the SG improvements in segmental rotation and translation were maintained.
  
  
  CONCLUSIONS
  Improved lordosis in the study group was associated with significant improvement in the translational and rotational motions of the lower cervical spine. This finding provides objective evidence that cervical flexion/extension is partially dependent on the posture and sagittal curve orientation. These findings are in agreement with several other reports in the literature; whereas ours is the first post treatment analysis identifying this relationship.
authors.affiliation: Department of Physiotherapy, College of Health Sciences, University of Sharjah, UAE.|Basic Science Department, Faculty of Physical Therapy, Cairo University, Egypt.
authors.forename: Ibrahim Moustafa
authors.initials: IM
authors.lastname: Moustafa
authors.affiliation: Basic Science Department, Faculty of Physical Therapy, Cairo University, Egypt.
authors.forename: Aliaa Attiah Mohamed
authors.initials: AAM
authors.lastname: Diab
authors.affiliation: Department of Physiotherapy, College of Health Sciences, University of Sharjah, UAE.
authors.forename: Fatma A
authors.initials: FA
authors.lastname: Hegazy
authors.affiliation: CBP NonProfit (a Spine Research Foundation) and Private Practice, Eagle, ID, USA.
authors.forename: Deed E
authors.initials: DE
authors.lastname: Harrison
mesh_terms: D001696:Biomechanical Phenomena; D002574:Cervical Vertebrae / Q000502:physiology*; D006801:Humans; D008141:Lordosis / Q000534:rehabilitation*; D009333:Neck; D026741:Physical Therapy Modalities; D011187:Posture; D011843:Radiculopathy / Q000209:etiology* / Q000534:rehabilitation; D016059:Range of Motion, Articular; D012399:Rotation; D055009:Spondylosis / Q000150:complications* / Q000534:rehabilitation; D014143:Traction
keywords: Cervical spine; flexion and extension; lordosis; spondylotic radiculopathy; traction