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Summary Respiratory function of patients with neck pain has not been given much consideration in usual clinical practice. The problem has however been highlighted occasionally by renown clinical scientists and recently there is a growing interest in the investigation of respiratory function in this clinical population. The aim of this review is to critically present the emerging evidence and discuss the similarities and differences observed. Although the evidence for some respiratory parameters is conflicting, it seems to be generally agreed that others such as maximal voluntary ventilation, strength of respiratory muscles, chest mechanics and partial pressure of arterial carbon dioxide are affected in patients with chronic neck pain. The effect size of the respiratory dysfunction regarding these respiratory parameters can be approximately described as moderate. These findings not only suggest a more thoughtful drug prescription, but they may lead to consideration of incorporation of respiratory assessment and treatment into routine physiotherapy practice. Indeed preliminary studies exploring the incorporation of such a treatment into usual practice have provided very promising results not only in relation to respiratory function, but also for other parameters of clinical interest. There remains however imminent need for randomized controlled trials to confirm the evidence base for such an approach. [ABSTRACT FROM AUTHOR]

BACKGROUND: Chronic neck pain is one of the most common musculoskeletal pain conditions experienced by many people during their lives. Although patients with neck pain are managed predominantly as musculoskeletal patients, there are indications that they also have poor pulmonary function. The aim of this study was to examine whether patients with chronic neck pain have spirometric abnormalities and whether neck pain problems and psychological states are associated with these abnormalities. METHODS: Forty-five participants with chronic neck pain and 45 well-matched healthy controls were recruited. Spirometry was used to assess participants' pulmonary function. Neck muscle strength, endurance of deep neck flexors, cervical range of motion, forward head posture, psychological states, disability, and pain intensity were also evaluated. RESULTS: The results showed that patients with chronic neck pain yielded significantly reduced vital capacity, FVC, expiratory reserve volume, and maximum voluntary ventilation (P < .05), but peak expiratory flow, FEV1, and FEV1/FVC ratio were not affected (P > .05). Strength of neck muscles, pain intensity, and kinesiophobia were found to be significantly correlated (r > 0.3, P < .05) with respiratory function. CONCLUSIONS: Patients with chronic neck pain do not have optimal pulmonary function. Cervical spine muscle dysfunction in parallel with pain intensity and kinesiophobia are factors that are associated mainly with this respiratory dysfunction. [ABSTRACT FROM AUTHOR]

Abstract: Respiratory muscle strength is one parameter that is currently proposed to be affected in patients with chronic neck pain. This study was aimed at examining whether patients with chronic neck pain have reduced respiratory strength and with which neck pain problems their respiratory strength is associated. In this controlled cross-sectional study, 45 patients with chronic neck pain and 45 healthy well-matched controls were recruited. Respiratory muscle strength was assessed through maximal mouth pressures. The subjects were additionally assessed for their pain intensity and disability, neck muscle strength, endurance of deep neck flexors, neck range of movement, forward head posture and psychological states. Paired t-tests showed that patients with chronic neck pain have reduced Maximal Inspiratory (MIP) (r = 0.35) and Maximal Expiratory Pressures (MEP) (r = 0.39) (P < 0.05). Neck muscle strength (r > 0.5), kinesiophobia (r < −0.3) and catastrophizing (r < −0.3) were significantly associated with maximal mouth pressures (P < 0.05), whereas MEP was additionally negatively correlated with neck pain and disability (r < −0.3, P < 0.05). Neck muscle strength was the only predictor that remained as significant into the prediction models of MIP and MEP. It can be concluded that patients with chronic neck pain present weakness of their respiratory muscles. This weakness seems to be a result of the impaired global and local muscle system of neck pain patients, and psychological states also appear to have an additional contribution. Clinicians are advised to consider the respiratory system of patients with chronic neck pain during their usual assessment and appropriately address their treatment. [Copyright &y& Elsevier]

Abstract: Quantitative documentation of physical deficits such as muscle strength and endurance/fatigue in the cervical spine may provide objective information, not only helping the diagnostic procedures, but also monitoring rehabilitation progress and documenting permanent impairments. The reliable and valid evaluation of muscle strength and endurance both in clinical and research environments are a difficult task since there are many factors that could affect the assessment procedure and the obtained values. The aim of the second part of this critical review is to identify the factors influencing the assessment of strength and endurance/fatigue of the muscles in the cervical spine. [Copyright &y& Elsevier]

BACKGROUND: Respiratory muscle strength is an important part of lung function. Assessment of the respiratory muscles' ability to generate force is important for recognizing respiratory muscle weakness in both sick and healthy people. OBJECTIVE: To assess the test/retest reliability of the MicroRPM portable manometer's measurements of maximum inspiratory pressure (MIP) and maximum expiratory pressure (MEP) in the sitting and standing positions; the number of expiratory maneuvers needed with the MicroRPM for reliability in MIP and MEP measurement; and the MicroRPM's test/retest reliability in other respiratory function indices, such as the maximum rate of pressure development (MRPD), the time constant of relaxation (tau), and the maximum relaxation rate (MRR). METHODS: We recruited 15 healthy volunteers (mean age 21.6 ± 1.1 years). We assessed respiratory muscle strength on 3 separate occasions, each a week apart. We calculated reliability with the intraclass correlation coefficient (ICC), the standard error of measurement (SEM) and the smallest detectable difference (SDD). RESULTS: MicroRPM reliably measured MIP and MEP in both the sitting position (ICC 0.86-0.90, SEM 9-10, SDD 18-22) and standing position (ICC 0.78-0.83, SEM 12-14, SDD 23-26). After a 5-breath practice, 2 expiratory/inspiratory maneuvers on each testing occasion gave adequate MIP and MEP reliability (ICC > 0.90). MRR reliability was moderate to excellent (ICC 0.58-0.87), MRPD reliability was moderate (ICC 0.59-0.64), and tau reliability was insufficient (ICC 0.27- 0.67). CONCLUSIONS: The MicroRPM reliably measures MIP and MEP, but its MRPD, MRR, and tau measurements should be considered with caution. [ABSTRACT FROM AUTHOR]

Summary: Neck pain and headache of cervical origin are complaints affecting an increasing number of the general population. Mechanical factors such as sustained neck postures or movements and long-term “abnormal” physiologic loads on the neck are believed to affect the cervical structures and compromise neck function. A comprehensive assessment of neck function requires evaluation of its physical parameters such as range of motion, proprioception, strength and endurance/fatigue. The complicated structure of the cervical spine however, makes it difficult for any clinician to obtain reliable and valid results. The aim of the first part of this systematic critical review is to identify the factors influencing the assessment of range of motion and proprioception of the cervical spine. [Copyright &y& Elsevier]

Summary: This paper describes a presumptive mechanism for the development of changes in respiratory function due to chronic neck pain. The patient with neck pain presents a number of factors that could constitute a predisposition of leading to a respiratory dysfunction: (a) the decreased strength of deep neck flexors and extensors, (b) the hyperactivity and increased fatigability of superficial neck flexors, (c) the limitation of range of motion, (d) the decrease in proprioception and disturbances in neuromuscular control, (e) the existence of pain and (f) the psychosocial influence of dysfunction. The possible connection of neck pain and respiratory function could have a great impact on various clinical aspects notably patient assessment, rehabilitation and pharmacological prescription. [Copyright &y& Elsevier]