Three-dimensional analysis of active cervical motion: the effect of age and gender

doi:10.1016/0268-0033(95)00072-0

Clinical Biomechanics

Volume 11, Issue 4, June 1996, Pages 201-206

https://doi.org/10.1016/0268-0033(95)00072-0 Get rights and content

Abstract

Objective. To describe the effects of age and gender on three-dimensional (3D) active cervical spine motion.

Design. This was a descriptive study. Background. This study expanded on previous investigations of age and gender effects on single plane motion of the cervical spine.

Methods. Sixty female and 60 male asymptomatic, normal volunteers, aged between 20 and 59 years, were examined in a standardized seated position. The 3 space Isotrak system was used to measure simultaneous 3D motion of the cervical spine.

Results. The mean range of all the primary movements decreased significantly with age. For flexion/extension the greatest decrease occurred between the 20- and 30-year-olds, whereas for both lateral flexion and rotation, significant differences were demonstrated in subjects aged two decades apart. The coupling of motion associated with rotation was significantly related to age.

Conclusion. Age had a significant effect on all of the primary movements. Age had less effect on the range of the coupled movements, in that the only movements to be affected were lateral flexion and extension occurring during cervical rotation. Gender had no marked effect on the primary or the coupled movements.

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Few studies comprehensively analyse 3D neck kinematics in individuals with chronic idiopathic neck pain during functional tasks considered challenging. This critical knowledge is needed to assist clinicians to recognise and address how altered movement strategies might contribute to pain.
Are there differences in 3D neck kinematics (angles, timing, velocity) during functional tasks in people with chronic neck pain compared to matched asymptomatic control participants?
Participants with chronic idiopathic neck pain (n = 33) and matched asymptomatic controls (n = 30) performed four functional tasks (overhead reach forward, right and left, and putting on a seatbelt) while evaluated using 3D motion capture. Kinematic variables included joint angles, range of motion (ROM,°), velocity (m s⁻¹) and timing (% of movement phase) for joint angles (head-neck [HN joint], head+neck-upper trunk [HNT], and thoracolumbar) and segments (head, neck, head+neck [HN segment], upper trunk, and trunk. Generalised linear mixed models examined between-group differences.
There were few between-group differences. The neck pain group had less HN segment extension that controls (mean difference [MD] left −2.06°; 95% CI −3.82, −0.29; p = .023; and right reach −2.52°; −4.67, −0.37; P = .022), and had less total sagittal HNT ROM across all tasks (−1.28; 95% CI −2.25, −0.31; p = .010). Approaching significance was the pain group having less thoracolumbar left rotation than controls (MD −2.14, 95% CI −4.41 to 0.13, p = .064). The pain group had higher neck segment peak flexion velocity than controls across all tasks (MD −3.09; 95% CI −5.21 to −0.10; P = .004). Timing of joint angle peaks did not differ between groups.
When performing an overhead reach task to the left and right and putting on a seatbelt, people with neck pain maintain a more flexed HN segment, use less sagittal ROM and have higher velocity peaks. These findings can assist clinicians in their assessment of patients by identifying possible underlying contributors to neck pain.
Is there a relationship between sagittal cervical spine mobility and generalised joint hypermobility? A cross-sectional study of 1000 healthy Australians
2021, Physiotherapy (United Kingdom)
The primary aim was to determine the association between sagittal cervical mobility and the presence and extent of GJH across the lifespan. Secondary aims were to determine which features explain variability in cervical range of motion (CROM) and to establish the sagittal cervical hypermobile range in both genders across the lifespan.
Cross-sectional observational study. Spearman’s rho determined the relationship between presence and extent of GJH and CROM, age, gender and ethnicity. Multiple regression identified the factors explaining variability in CROM. The hypermobile CROM was identified as the upper 5% of flexion, extension and combined ranges for age and gender.
University laboratory in Sydney Australia.
One thousand healthy individuals, aged 3–101 years.
Cervical active range of motion was assessed using an inclinometer, extent of and presence of generalised joint hypermobility were assessed using the Beighton scoring system and age- and gender-specific criteria respectively.
CROM correlated positively with GJH (Beighton score as a continuous or dichotomous age and gender specific variable) (rho = 0.12–0.50; p < 0.001) and negatively with age (rho = 0.54; p < 0.001). Age, gender and extent of GJH (Beighton as a continuous score) accounted for 19 to 51% of variability in CROM. Cut-offs for cervical hypermobility were calculated across the lifespan.
Increased sagittal CROM was observed in individuals identified with GJH. Extension CROM decreased with age more than flexion; the greatest loss in the second and third decades. CROM screening is warranted for patients identified with GJH and for rehabilitation goal-setting.
Analysis of three-dimensional facet joint displacement during two passive upper cervical mobilizations
2020, Musculoskeletal Science and Practice
Understanding the 3D-kinematics of the upper cervical spine during manual mobilization is essential for clinical examination and therapy. Some information about rotational motion is available in literature but translational components are often ignored, complicating the understanding of the complex inter-segmental motions.
This study aims to describe the amount, trajectories and reproducibility of atlanto-occipital facet joints’ displacement during a flexion-extension mobilization and of the atlanto-axial facet joints during an axial rotation mobilization.
Original research using quantitative data.
20 fresh frozen human cervical specimens were examined with a Zebris® CMS20 ultrasound-based motion tracking system. Two physiotherapists performed regionalmobilizations in flexion-extension and axial rotation. The amount of displacement and the trajectories were calculated along the XYZ axes. Difference between measurements was evaluated with the Friedman two-way ANOVA test. Intra- and inter-rater reliability were estimated through ICC scores.
3D-displacement (2.6–23.4 mm) was larger at C1–C2 during axial rotation, Atlanto-occipital flexion displayed the greatest variability in the C0 trajectory. During a right rotation, the left C1 facet moved mainly forward, and the right C1 facet moved backward. During a left rotation, the left C1 facet moved backward, while the right C1 facet moved forward. Intra-tester and Inter-tester ICCs varied between 0.5 and 0.90 (p < 0.005).
During passive spinal motion, there is an important variability in magnitude and trajectory of joints’ displacement. Nevertheless, different clinicians may be able to achieve the same position at the end of the mobilization.
Normative values of cervical range of motion for both children and adults: A systematic review
2020, Musculoskeletal Science and Practice
Systematic review.
To synthesize studies reporting normative values of active cervical range of motion (ROM) in healthy children and adults.
Evaluating active cervical ROM is part of routine assessment of patients with neck pain. Interpretation of outcomes necessitates having normative data per age category. Currently available normative values differ across studies, perhaps due to (the measurement properties of) the devices used.
A systematic review according to PRISMA guidelines was conducted. Electronic searches included EMBASE, MEDLINE, Web of Science, Cochrane, CINAHL and Google Scholar databases from inception to August 2018. Included studies had to involve healthy subjects in which active cervical ROM was assessed or when determining normative values was the aim of the study. Methodological quality of the included studies was assessed using an adapted version of the QUADAS. A mean value was re-calculated for the total group in case data were presented per gender per age-category only. When possible, data were pooled.
From 2151 unique hits, 217 articles were selected for full text assessment, after which 162 articles were excluded. Data were extracted from 55 articles using 16 different measurement devices. Twenty-five studies were rated as being of “low risk of bias”. Only data from studies evaluating the CROM device and Zebris could be pooled.
This systematic review revealed that although a large number of studies assessed normative data for active cervical ROM, the methodological quality of most studies was low and the heterogeneity between studies was high. Only the normative data for active cervical ROM using the CROM device seems to be useful. Overall, reference values for measuring active cervical ROM is unclear for most measurement devices.
Normative values of cervical range of motion for both children and adults: a systematic review.
Intervertebral range of motion characteristics of normal cervical spinal segments (C0-T1) during in vivo neck motions
2020, Journal of Biomechanics
The in vivo intervertebral range of motion (ROM) is an important predictor for spinal disorders. While the subaxial cervical spine has been extensively studied, the motion characteristics of the occipito-atlantal (C0-1) and atlanto-axial (C1-2) cervical segments were less reported due to technical difficulties in accurate imaging of these two segments. In this study, we investigated the intervertebral ROMs of the entire cervical spine (C0-T1) during in vivo functional neck motions of asymptomatic human subjects, including maximal flexion-extension, left-right lateral bending, and left-right axial torsion, using previously validated dual fluoroscopic imaging and model registration techniques. During all neck motions, C0-1, similar to C7-T1, was substantially less mobile than other segments and always contributed less than 10% of the cervical rotations. During the axial rotation of the neck, C1-2 contributed 73.2 ± 17.3% of the cervical rotation, but each of other segments contributed less than 10% of the cervical rotation. During both lateral bending and axial torsion neck motions, regardless of primary or coupled motions, the axial torsion ROM of C1-2 was significantly greater than its lateral bending ROM (p < 0.001), whereas the opposite differences were consistently observed at subaxial segments. This study reveals that there are distinct motion patterns at upper and lower cervical segments during in vivo neck motions. The reported data could be useful for the development of new diagnosis methods of cervical pathologies and new surgical techniques that aim to restore normal cervical segmental motion.
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2020, Comparative Kinesiology of the Human Body: Normal and Pathological Conditions
While occipito-cervical junction primarily contributes to rotational movements, sub-axial spine provides flexion-extension and lateral flexion to the cervical spine. The occipito-cervical junction acts as a hinge between the skull and the cervical vertebrae, which translates the coronal plane movements into axial plane movements. Two and/or three dimensional imaging methods are used to measure kinematic properties of the region. Range of neck motions increase with coupled movements compared to motions with single joint movement. However, during flexion rotational movements are lesser compared to rotational movements during extension of the neck. Pathological conditions and surgical interventions affect kinematic measurements as they alter the position of facet joints and discs. For this reason, kinetic and kinematic studies may be helpful to identify and treat underlying pathologies.

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PaperThree-dimensional analysis of active cervical motion: the effect of age and gender

Abstract

Clin Biomech

Reliability of measurements of cervical spine range of motion — comparison of three methods

Phys Ther

Cervical spine motion in the sagittal plane (1) Range of motion of actually performed movements, an Xray cinematographic study

Eur J Morphol

Three-dimensional motion analysis of the cervical spine with special reference to the axial rotation

Spine

CT-functional diagnostics of the rotary instability of the upper cervical spine. Part 2 An evaluation on healthy adults and patients with suspected instability

Spine

Rotation of the cervical spine. A CT study in normal subjects

Spine

Three-dimensional analysis of neck motion. A clinical method

Spine

Measurement of neck range and pattern of movement

Paper
Three-dimensional analysis of active cervical motion: the effect of age and gender