Alsultan F1,2, Cescon C3, Marco De Nunzio A1, Barbero M3, R. Heneghan N1, Rushton A1, Falla D1
1University of Birmingham, Centre of Precision Rehabilitation for Spinal Pain (CPR Spine), Birmingham, United Kingdom, 2Qassim University, Physical Therapy Department, College of Medical Rehabilitation, Buraidah, Saudi Arabia, 3University of Applied Sciences and Arts of Southern Switzerland, Rehabilitation Research Laboratory, Department of Business Economics, Health and Social Care, Manno, Switzerland

Background: As well as pain, people with chronic neck pain (CNP) typically present with functional impairments including decreased range of neck motion. While most studies have focused on the quantity of movement, typically measuring static variables during planar cervical motion, knowledge of the quality and variability of movement may provide more detaliled and precise information of movement deficits in people with CNP.

Purpose: This study investigated the variability of active neck movement in people with CNP compared to healthy people, using measures of the helical axis (HA) to identify differences in movement variability.

Methods: An observational case-control study was conducted in a laboratory setting following ethical approval. The sample comprised asymptomatic (n=18) and CNP (n=18) participants. The CNP group presented with a Neck Disability Index (NDI) score of mean(SD): 12.94(6.84), pain intensity using the Numerical Rating Scale (NRS) of 4.08(1.89) Tampa Scale for Kinesiophobia (TSK) of 36.53(6.58). Participants performed 10 repetitions of flexion-extension, bilateral lateral flexion and bilateral rotation movements at different speeds (at a natural self-selected speed, slow speed (30 beats per second (bps)) and fast speed (60 bps)) as cervical kinematic data was recorded using a 3D motion capture system (BTS Bioengineering, Milan,Italy). Mean distance (MD) and mean angle (MA) parameters of the HA were extracted to examine 3Dmotion and movement variability. Two-way analysis of variance (ANOVA) was used to evaluate MD and MA between groups, with lower values indicative of less movement variability.

Results: A smaller MD during flexion-extension (p=0.019) and rotation movements (p=0.007) was observed in participants with CNP compared to asymptomatic participants. The mean(SD) for the CNP participants at a natural speed was: flexion-extension 1.46cm(0.33) and rotation 0.83cm(0.15), whereas for asymptomatic participants values were 1.61cm(0.28) and 1.07cm(0.33) respectively. No difference between groups was observed for MD measured during lateral flexion (p=0.28). In addition, smaller values of the MA (p 0.05) were observed in the CNP group during rotation at different speeds.The mean (SD) for the CNP group were as follows: natural speed 4.98°(0.85), slow speed 4.89°(0.71), and fast speed 3.98°(0.42). The asymptomatic group valueswere: natural speed 5.21°(1.04), slow speed 5.44°(1.64), and fast speed 4.99°(1.02). No difference in MA parameters was observed between groups for flexion-extension (p=0.92) or lateral flexion (p=0.21) movements.

Conclusion(s): This is the first study to evaluate the variability of active neck movement in people with CNP by utilising parameters of the HA. Decreased movement variability was observed in people with CNP, especially during flexion-extension and rotation movements. These results provide novel insights regarding neck movement behaviour in people with CNP, which may have implications for the persistence of pain.

Implications: Examining neck movements using HA parameters can be difficult in typical clinical settings. However, the findings reiterate the importance of data derived from kinematic measures, and its potential for giving clinicians further insight into active neck movement behaviour in people with CNP. Further studies should evaluate movement measures that are simple to collect and use in a clinical setting. These measures have potential for identifying changes in movement quality in people with CNP.

Keywords: Chronic neck pain, movement variability, helical axis

Funding acknowledgements: This study was funded by a Ph.D. scholarship awarded to the first author by Qassim University in Saudi Arabia.

Topic: Musculoskeletal: spine

Ethics approval required: Yes
Institution: University of Birmingham
Ethics committee: Ethics/Health and Safety Committee
Ethics number: CM06/03/17-1

All authors, affiliations and abstracts have been published as submitted.

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