Search

OBJECTIVE Ponticulus posticus is an anomaly of the atlas. Odontoid fracture type 2 fracture occurs by hyperflexion, hyperextension, lateral flexion, and a combination of these movements. The presence of Ponticulus Posticus anomaly may affect the occurrence of odontoid fractures of the C2 vertebra. In this study, the relationship between the presence of PP anomaly and occurring of the odontoid type 2 fracture was investigated. PATIENTS AND METHODS Cervical CTs of a total of 14 patients with odontoid type 2 fracture were retrospectively evaluated for PP, and compared with 13 patients with cervical trauma without odontoid type 2 fracture. RESULTS Ponticulus posticus anomaly was noted in 7 of 14 patients with odontoid type 2 fractures on the upper cervical CT; therefore, the prevalence was 50.%, but only 3 cases (23.07%) were seen in 13 patients of the control group. In binominal regression analysis showed that the presence of PP anomaly increases 12,075 times to occur odontoid type 2 fracture after cervical trauma. CONCLUSION Ponticulus posticus is often not recognized, but this study shows that ponticulus posticus is a risk factor for odontoid type 2 fracture after cervical trauma.

Background: Mechanical neck pain (MNP) is the most common type of pain confined in the posterior aspect of neck, also known as nonspecific or simple neck pain affecting two thirds of the general population at some time in their lives. Prevalence: Neck pain is most common muscular skeletal condition affecting up to 70% of individual and 5% to 10% of adults having a disabling neck pain problem. Neck pain is more common in women than men. The prevalence of neck pain in the general population has been reported to be 15% for men and 23% for women. Objectives of the Study: To find out the effect of Post Isometric Relaxation (PIR) along with Deep Neck Flexor (DNF) exercises in reducing pain and disability and improving ROM in patient with sub-acute mechanical neck pain. To find out the effect of Deep Neck Flexor exercise alone in reducing pain and disability and improving ROM in patient with sub-acute mechanical neck pain. To compare whether Post Isometric Relaxation (PIR) along with Deep Neck Flexor exercises or Deep Neck Flexor exercises alone are effective in reducing pain and disability and improving ROM in patient with sub-acute mechanical neck pain Methods: Study included 30 patients with lateral epicondylitis between ages 30-50 years. The subjects were randomly divided into 2 groups: Group-A and Group-B. Group A (n = 15) was treated using Cyriax physiotherapy, group B (n = 15) was treated with movement with mobilization. Patients were treated for 3 times a week for 4 weeks. Outcome measures are NPRS (Numeric Pain Rating Scale) and DASH (The Disabilities of the Arm, Shoulder and Hand). Results: The results of the study indicate that there were highly statistically significant improvement in functional disability on NDI, cervical lateral flexion(Right & Left), rotation (Right & Left) ROM and reduction in pain on VAS in Group-A as compared to Group-B. There was no significant difference observed when the groups were compared for cervical flexion and extension ROM. Conclusion: From the result it is concluded that Post isometric relaxation with DNF exercise is effective in mechanical neck pain. Key words: Mechanical neck pain (MNP), Post Isometric Relaxation (PIR), Deep Neck Flexor (DNF) exercise.

Faulty postural habits lead to upper trapezius spasm causing pain and affection of neck mobility. The study aimed to compare the immediate effect of Strong Surged Faradic Stimulation and self-stretching in Less Tensed Position in chronic trapezius spasm in young females. 46 female subjects with unilateral chronic trapezius spasm between the age 18-25 years were randomly allocated into Strong Surged Faradic Stimulation group and self-stretching group. Pre and post intervention Numeric Pain Rating Scale and cervical lateral flexion range of motion was measured. Both the interventions were effective in reducing pain (p < 0.0001) and improving range of motion (p

We report a case of a 35-year-old man injured in a road traffic accident and who sustained a lateral flexion type of cervical spine injury with no obvious vertebral fracture. Allen and Ferguson in 1980 classified cervical spine injuries into 6 types, out of which lateral flexion type is less common. In lateral flexion type of injuries, there is always a bony fracture unilaterally. In this case, we report a cervical spine injury which mimics lateral flexion type of injury without any bony fracture. We found that the cervical disc at C3–C4 was protruded postero-laterally leading to subluxation and unilateral dilatation of the facet joint. This injury does not fit to any classification. Manual reduction was attempted which failed, and then the patient was taken up for surgery. Anterior decompression was planned, and during surgery the disc was found to be protruded postero-lateral, and reduction was achieved after removal of the disc. Iliac crest bone graft was placed and fixed with a plate. The lateral flexion type of cervical spine injuries occurs at a low frequency. Most of them require surgery. Manual reduction by traction should not be attempted, and careful examination of radiology along with MRI is necessary.

Muscle imbalances are a leading cause of musculoskeletal problems. One example are leg length inequalities (LLIs). This study aimed to analyze the effect of different (simulated) LLIs on back and leg muscles in combination with kinematic compensation mechanics. Therefore, 20 healthy volunteers were analyzed during walking with artificial LLIs (0–4 cm). The effect of different amounts of LLIs and significant differences to the reference condition without LLI were calculated of maximal joint angles, mean muscle activity, and its symmetry index. While walking, LLIs led to higher muscle activity and asymmetry of back muscles, by increased lumbar lateral flexion and pelvic obliquity. The rectus femoris showed higher values, independent of the amount of LLI, whereas the activity of the gastrocnemius on the shorter leg increased. The hip and knee flexion of the long leg increased significantly with increasing LLIs, like the knee extension and the ankle plantarflexion of the shorter leg. The described compensation mechanisms are explained by a dynamic lengthening of the short and shortening of the longer leg, which is associated with increased and asymmetrical muscle activity. Presenting this overview is important for a better understanding of the effects of LLIs to improve diagnostic and therapy in the future.

Context Lateral-flexion range of movement (LF ROM) is used to assess and monitor recovery of side strain injury in athletes. Objective To establish a reliable and pragmatic measure of LF ROM and investigate the stability of the measure over time in athletes. Design (1) Cross-sectional reliability study and (2) cohort longitudinal study. Setting Elite cricket teams in Australia and England. Patients or Other Participants Ten healthy first-class cricket players recruited from Australia and England domestic and international competitions. Main Outcome Measures (1) The intrarater and interrater reliability of 2 methods of measuring LF ROM toward and away from the bowling arm was assessed (distance to the floor or distance to the fibular head). Three experienced physiotherapists obtained the measures. Intraclass correlations [2,1] were calculated for absolute agreement for all 3 testers. (2) Lateral-flexion ROM was measured monthly during the preseason and competitive season. A 1-way repeated-measures analysis of variance was performed to identify differences within the preseason, within the competitive season, and between competitive seasons. Results Both methods had good intratest and intertest reliability (intraclass correlations > 0.84). As LF ROM measurement to the floor was easier for clinicians, it was used for the longitudinal study. Lateral-flexion ROM did not alter throughout the preseason and competitive season or between seasons (P values > .05). Conclusions This new method of measuring LF ROM demonstrated good intrarater and interrater reliability and stability over time and can be used as an outcome measure in side strain injury.

Introduction Syndactyly has a cosmetic, functional, and psychosocial impact, and surgical treatment is indicated in most cases. This study aimed to retrospectively identify whether patients undergoing surgical release of syndactyly younger than 1 year presented different results compared with those operated older than 1 year. Methods Patients were assessed through photographic records by 3 independent specialist surgeons for the quality of scar, presence of web creep, rotational, flexion-extension, and lateral flexion deformities using the Withey score. Results Thirty-four patients were included in the study, totaling 51 commissures operated. The score was higher in the group operated younger than 1 year (5.83 ± 2.39) compared with the group older than 1 year (3.94 ± 1.93), being statistically significant, with a P value of 0.011. Conclusions Children with syndactyly operated younger than 1 year have worse postoperative outcomes measured by the Withey score than those operated older than 1 year.

This study aimed to evaluate the concurrent validity and reliability of a low-cost digital dynamometer to assess maximal isometric strength in neck movements.Twelve recreationally active participants (6 women, 6 men; age: 24.1 ± 3.4 years; height: 1.71 ± 0.06 m; weight: 64.6 ± 11.7 kg) performed neck flexion, extension, and lateral flexion, and maximal isometric strength was simultaneously measured using an isokinetic dynamometer (gold standard) and a digital dynamometer to evaluate the concurrent validity of the latter. One week later, all the participants repeated 3 trials of each neck movement (3 minutes apart) registered only with the digital dynamometer. The first and second trial were guided by tester 1 and the third trial was guided by tester 2.The concurrent validity of the digital dynamometer showed a nearly perfect correlation between both devices (r0.986, P.001), with Bland-Altman plots showing absolute agreement. Intertester and intratester reliability were nearly perfect for all neck movements (intraclass correlation coefficient0.86).The low-cost digital dynamometer showed valid and reliable measurements of maximal isometric strength in neck movements.

Summary Background It is unclear how rib protectors may affect trunk mobility in American football players. The purposes of the study were: 1) to determine which flexibility protocol (active-assisted, maximal-speed, self-selected) exhibits the highest range of motion for trunk lateral flexion and axial rotation and 2) to determine the effect of rib protectors (hard-rib and soft-rib protectors and control: compression shirt only) on trunk range of motion. Methods Eleven male participants with competitive quarterback experience were recruited. Participants were instructed to rotate the trunk in the lateral flexion and axial rotation directions during each flexibility protocol and rib protector condition. The lower-thoracic range of motion were measured. Results Two-way repeated measures ANOVA (flexibility protocol by rib protector) demonstrated significant main effect of flexibility protocol for lateral flexion, but not axial rotation. The range of motion during self-selected protocol was significantly greater than maximal-speed protocol by approximately 7° (p = .009). Conclusions Self-selected and maximal-speed protocol produced the highest lateral flexion and axial rotation range of motion, respectively, and can be used to test the influence of rib protectors and potentially other sports equipment on thoraco-lumbar range of motion. Additionally, rib protectors likely do not affect trunk range of motion needed to throw long-distance passes or other movements as performed by football quarterbacks.

Background: Mechanical neck pain is a widespread sig-nificant health problem with a huge burden on the individual and economy. Finding a noninvasive effective treatment that's non exhaustive for the therapist and non painful for the patient is highly needed. Aim of Study: This study investigated and compared the effects of instrument assisted soft tissue mobilization (IASTM) using m2t blade and trigger point release (TPR) in terms of neck lateral flexion and rotation range of motion on upper trapezius (UT) myofascial trigger points (MTrPs) in mechanical neck pain. Methods: Forty patients between 18 and 55 years were randomized to one either group A or B. Group A received one session of TPR and passive stretching while group B received one session of IASTM using M2t blade and passive stretching. Tape measurement was used to evaluate patients pretreatment, post treatment and at follow-up. Results: Within group analysis, there was a significant increase in neck lateral flexion and rotation at immediate post treatment and at follow-up in both groups (p 0.05) Conclusion: IASTM using M2t blade and TPR were effective in treating patients with mechanical neck pain and UT MTrPs.

Background: Myofascial release has beneficial effects on trigger points. Many studies have been done on myofascial release but a comparative study with cryo-stretching is lacking. Aims and Objectives: To find the effectiveness of cryo-stretching on trigger points and compare between myofascial release and cryo-stretching. Materials and Methods: 54 participants were included in the study and were allocated into two groups: Myofascial release (deep transverse friction, cross-hand technique) and cryo-stretching (static stretch, isometric contraction). Pre and post-assessments were taken for pain using VAS, pressure threshold by digital algometer and cervical lateral flexion using a universal goniometer. Results: Analysis was done using unpaired t-test and Mann Whitney U test for comparison of ROM and pressure threshold and pain respectively between the two groups. Differences between the two groups were statistically insignificant (p > 0.05). Paired t-tests and Wilcoxon’s test for within-group study showed significant improvement for VAS PPT, and ROM in both groups. Conclusion: The study found that both MFR and cryo-stretching were effective in management of upper trapezius trigger point. Keywords: Myofascial release, Trigger points, Cryostretch, Trapezius.

Objective: This study aimed to determine the effectiveness of the Integrated Neuromuscular Inhibition Technique (INIT) for treating Myofascial Trigger Points (MTrPs) in the upper trapezius muscle on outcomes of pain, Range of Motion (ROM) and disability. Methods: 18 patients mean age 27± of 14.78 years were screened for inclusion/exclusion criteria. The INIT was administered three times a week for 4 weeks. The verbal Numerical Pain Rating scale (NPRS), cervical lateral flexion ROM and Neck Disability Index (NDI) were recorded at baseline, 2 and 4 weeks. Results and Conclusion: There were positive changes in all outcome measures for all eighteen participants. An increase in ROM and reduced levels of pain and disability were noted. This case series suggests that a short-term multimodal therapy would be beneficial for individuals with upper trapezius MTrPs. Important preliminary data was collected that will inform more rigorous research in this field of research.

BACKGROUND:Plastic hypertonia (rigidity), presented by individuals with Parkinson's disease (PD), leads to reduced range of motion (ROM), impairing daily activities and balance reactions. Connective tissue massage (CTM) promotes increased ROM in normotonic muscles, however its effects on hypertonic muscles are not yet known. AIM: To verify the immediate and acute (1h after) effects of CTM on cervical ROM in individuals with PD. METHOD: Cervical ROM during anterior flexion, extension, lateral flexion, and rotation was evaluated using a fleximeter at three moments: before (M1), immediately after (M2), and one hour after (M3) CTM in 14 older people with PD (PDG) and 13 neurologically healthy older people (CG). RESULTS: The CG presented a higher ROM than the PDG for the cervical rotation movement. In addition, there was interaction between group*intervention time. The cervical rotation movement was higher for the CG than PDG at M2 and M3. On the other hand, there was no main effect of intervention time. CONCLUSION: It was concluded that a single session of CTM was not sufficient to promote an increase in ROM in either normotonic or hypertonic muscles in older people, but the higher ROM for cervical rotation in the CG versus PDG was evident after CTM.

Lumbar loading causes increased intervertebral pressure and is an important factor in low back pain. However, it is difficult to quantitatively judge the actions that affect lumbar load and the magnitude of lumbar load increase. Low back pain occurs not only in the workplace but also during activities of daily living. Therefore, it is necessary to investigate the factors inducing low back pain by measuring movements in various planes and determining the magnitude of the lumbar load. Accordingly, the lumbar spine should be examined during various movements. Several studies have examined vertebral bodies in the anteflexion posture. However, the relationship between body flexion angle and vertebral body angle during lateral flexion and rotation remains unknown. In this study, we proposed an estimation method for changes in vertebral body angle during lateral flexion and rotation in the lumbosacral region using a wearable sensor system we previously developed. The accuracy of the proposed estimation method was evaluated and demonstrated using X-ray images.

Summary Study aim: High heel footwear (HHF) alters posture and kinetics of the lower limbs and spine. Various musculoskeletal disorders in the lower quadrant can occur as a consequence of HHF use. This study aimed to investigate the effect of habitual use of HHF on lumbar spine proprioception. Material and methods: Thirty young healthy women (mean age: 21.6 ± 1.6 years; height: 157.6 ± 5.9 cm; weight: 57 ± 10.2 kg) participated in this study. Participants were randomly allocated to one of the two sequences of walking with HHF or walking barefoot for five minutes on a predetermined walkway consisting of an even surface, ramp and stairs. A 24-hour washout period was incorporated between each walking condition. Lumbar spine repositioning error was measured using a Back Range of Motion II (BROM II) device before and after walking for lumbar spine forward flexion, right, and left lateral flexion. Results: Measurements showed that repositioning error was significantly higher in all spinal movements after walking with HHF (forward flexion p = 0.0044; right lateral flexion p = 0.0243 left lateral flexion p = 0.0379) as compared to barefoot walking. Conclusion: The findings of this study suggest that HHF alters lumbar spine proprioception. This study provides evidence to support early assessment of proprioception and incorporation of retraining exercises in habitual users of HHF.

Purpose Ring gantry radiotherapy devices are often limited to deliver beams in the axial plane, severely limiting beam entrance angles and rendering noncoplanar beam delivery impossible. However, a ring gantry geometry greatly simplifies delivery machines and increases the efficiency of treatment with the potential to decrease the overall costs of radiotherapy. This study explores the use of lateral head flexion in order to increase beam entrance angles and extend the available solid angle space for a ring gantry stereotactic radiosurgery (SRS) application. Materials and methods A 1.5 T magnetic resonance imaging scanner was used to scan seven healthy volunteers at three different head positions: a neutral position, a left lateral flexion position and a right lateral flexion position. The lateral flexion scans were co-registered to the neutral head position scan using rigid registration and extracting the rotational transformation. The head pitch, roll, and yaw were computed for each registration to evaluate the natural range of motion for all volunteers. A ring gantry plan geometry was used to generate two sets of single fraction SRS plans (21 Gy): one coplanar set for head neutral scans, and a three-arc plan set using the head neutral and lateral head flexion scans. The conformity index (CI), intermediate dose fall-off (R50), low dose spillage (R10), and gradient measure (GM) were used to evaluate both sets of plans. The treatment plans were generated for a ring-gantry linear accelerator (linac) (Varian Halcyon 2.0) as well as radiosurgery linac (Varian Edge) for comparison. Results The average pitch, yaw, and roll for the lateral head flexion scans were 4.1° ± 4.7°, 16.9° ± 3.7°, and 2.5° ± 4.9° for the right flexion and 4.9° ± 4.3°, 14.0° ± 3.7° and 2.8° ± 5.4° for left flexion. When comparing the head flexion technique with a fully coplanar geometry, the ring gantry plans showed an average improvement in CI of 7.3% (1.46 ± 0.25 vs 1.36 ± 0.28), a decrease of 13% in R50 (5.46 ± 1.14 vs 4.78 ± 1.12), a decrease of 32% in R10 (85.7 ± 20.3 vs 58.2 ± 15.1), and a decrease of 7.8% in GM (0.53 ± 0.05 vs 0.49 ± 0.04). The Edge plans showed an average improvement in CI of 3.0% (1.49 ± 0.26 vs 1.45 ± 0.25), a decrease of 6.8% in R50 (5.19 ± 1.03 vs 4.82 ± 0.83), a decrease of 29% in R10 (84.1 ± 16.3 vs 59.9 ± 12.5), and a decrease of 5.0% in GM (0.50 ± 0.04 vs 0.47 ± 0.03). Conclusion Lateral head flexion was shown to increase beam entrance angles considerably improving plan conformity and normal tissue sparing in this pilot study of seven sets of plans. Rigid registrations demonstrated each lateral flexion to be analogous to a 15° couch kick. The head flexion technique outlined here was shown to be a feasible solution for SRS treatments being delivered on ring gantry devices.

Objective To compare the change in cervical range of motion (CROM) after the 2 most widely used techniques for multilevel cervical spondylotic myelopathy (CSM): anterior cervical corpectomy and fusion (ACCF) and laminoplasty. Methods Patients with multilevel CSM treated in our hospital between 2014 and 2018 were divided into an ACCF group and a laminoplasty (LAMP) group according to the treatment received. Their demographic data, preoperative and postoperative Japanese Orthopedic Association (JOA) scores, and CROM, measured using the Coda Motion system, were analyzed and compared. Results A total of 53 patients were enrolled, including 29 patients in the ACCF group and 24 patients in the LAMP group. Age, sex, duration of follow-up, and preoperative and postoperative JOA scores were comparable in the 2 groups. Compared with preoperative measurements, ACCF group lost an average of 9.8%, 28.5%, 8.9%, 9.9%, 10.6%, and 7.8% of their CROM in flexion, extension, left and right lateral flexion, and left and right rotation, respectively, at the latest follow-up. For the LAMP group, these average losses were 3.5%, 16.4%, 3.2%, 6.3%, 7.0%, and 5.7%, respectively. Thus, the ACCF group exhibited greater average CROM loss than the LAMP group in all directions at the latest follow-up. Conclusions Both ACCF and laminoplasty cause significant CROM loss in patients with multilevel CSM. The laminoplasty technique preserved more CROM than ACCF in all 6 directions after at least 1 year of follow-up. These results can be used when counseling patients undergoing surgery.

Introduction To compare the effectiveness of a molded fleece jacket with that of a standard cervical collar at limiting movement of the cervical spine in 3 different directions. Methods This is a prospective study using 24 healthy volunteers to measure cervical flexion/extension, rotation, and lateral flexion with both the fleece collar and the standard cervical collar. A hand-held goniometer was used for measurements. The results were then analyzed for the 3 independent movements using a noninferiority test. Results The fleece collar was determined to be noninferior at limiting the designated motions. Comfort was greater while wearing the improvised fleece collar. Conclusions Our small study demonstrated that mountain travelers and rescuers may be able to use an improvised fleece jacket collar in place of a standard collar if spine trauma is suspected after a backcountry accident. Further research should examine different types of improvised collars, their ability to remain in place over extended evacuations, and when to apply collars to backcountry patients.

BACKGROUND: Pisa syndrome (PS) is a postural disorder characterised by lateral flexion of the spine (> 10°), predisposing the affected individuals to falls, and contributing to increased mortality in neurodegenerative diseases. OBJECTIVE: An overview of currently applied therapeutic management options, primarily focused on specifically structured rehabilitation exercises, in conjunction with falls-risk assessment in the individuals affected by PS. METHODS: A narrative literature review, augmented with the authors’ own experience in physical rehabilitation management. RESULTS: As individuals affected by PS are evidenced to be intrinsically exposed to higher falls-risk through acquired postural deformities, they often fall victims of traumatic accidents, occasionally also facing relocation into 24-hour nursing facilities due to the injuries sustained/resultant disability, consequently having overall quality of their life appreciably reduced. CONCLUSIONS:s A comprehensive approach is postulated in designing optimal therapeutic management, comprised of the exercises controlling postural stability, whilst reducing lower back pain, and the ones also promoting specific skills essential for coping unassisted after an accidental fall effectively. Rehabilitation of individuals affected by PS should be a fully integrated service, eliminating all identified risk factors for falls. As clinical PS symptoms tend to recur after completion of a full course of therapeutic management, all PS patients should continue the pursuit of therapeutic exercises on an individual basis, to effectively retard their recurrence. In view of overall scarcity of clinical studies completed on the large population samples of PS patients, further in-depth research is still required to ensure higher credence to overall efficacy of the presently proposed therapeutic solutions.

Valgus knees have inferior outcomes compared to varus knees. There is little data regarding soft-tissue balance in flexion which may influence outcome in valgus knees undergoing TKA. The purpose of this study was to evaluate whether there is imbalance between medial and lateral flexion gaps in valgus deformity. A secondary aim was to compare soft-tissue balance in knees with valgus deformity less than 10° with those exceeding 10°. The null hypothesis was that there was no soft-tissue imbalance in 90° of flexion irrespective of magnitude of deformity.64 valgus knees (52 female and 12 male) with deformity from 0.5 to 27.5° (mean 188.77, SD 6.21) were studied in 54 patients (mean age 67.81 y, SD 8.69) undergoing navigated TKA. Medial and lateral gaps in extension and at 90° of flexion were compared (using Independent-samples t test) between knees with valgus 10° with those 10° using a validated dynamic method after resection of cruciates, menisci and osteophytes, and then after final trialling.Mean initial medial-lateral (ML) gap difference in extension was 2.63 mm (SD 2.63) and 2.09 mm (SD 3.78) in flexion, being tighter laterally. Initial ML gap differences in extension and flexion correlated with valgus deformity (R = - 0.514; p = 0.00001; R = - 0.325; p = 0.01, respectively). Initial ML gap differences in extension correlated with those in flexion (R = 0.42; p = 0.0005). Mean ML flexion and extension gap differences were 1.30 mm (SD 3.67) and 1.26 mm (SD 1.92) in knees with 10° valgus, and 3.17 mm (SD 3.71) and 4.29 mm (SD 2.45) in those 10° valgus; p values were 0.026 and 0.001 respectively.The lateral flexion gap in valgus knees may be narrower than the medial flexion gap, especially in knees with 10° deformity. This contrasts with native and varus knees, in which it exceeds the medial gap. This novel study indicates the need to identify valgus knees with lateral flexion gap tightness by distracting the posterior femoral condyles from the proximal tibia by dynamic stressing of the soft-tissues after resection of cruciates, menisci, and osteophytes, with the knee flexed to 90°. These findings, highlighting the need for restoring flexion gap balance, may improve the inferior outcomes in valgus knees.IV.

Aim: An observational cohort study to determine whether localised manual therapy results in a preferential increase in mobility of the targeted motion segment. Method: Eighteen participants with mechanical neck pain had three MRIs of their cervical spine. The first two were taken prior to treatment in neutral and at the end of active rotation in their more limited rotation. Participants received localised manual therapy targeting a motion segment deemed to be relevant to their presentation until either their range increased by >10 degrees or eight minutes, whichever came first. A third MRI was performed immediately after treatment with their head in the same rotated position as pre-treatment. In the images, each vertebra was segmented using a semi-automated process. Movement between neutral and rotated positions was calculated as Euler angles and distance of facet translations for each motion segment. Results: Rotation and lateral flexion at the targeted location increased by 40% (mean 0.86o (CI: 0.24-1.48) and 15% (mean 0.52o (CI: -0.17-1.21) respectively with only the CIs for rotation not containing zero. The mean changes for the non-targeted locations were less than 0.1o for each axis and all CIs contained zero. Facet translations at the targeted location increased by 25% (0.419mm) and decreased by >4% (>0.01mm) at the untreated locations but the wide CIs both contained zero. Conclusion: Localised manual therapy seems to have a preferential effect on mobility of the targeted motion segment. The findings support considering segmental dysfunction in clinical reasoning and the use of specifically targeted manual therapy interventions.

To achieve a higher level of satisfaction in patients having undergone Total Knee Arthroplasty (TKA), a more personalized approach has been discussed recently. It can be assumed that a more profound knowledge of bony morphology and ligamentous situation would be beneficial. While CT/MRI can give 3D information on bone morphology, the understanding of the ligamentous situation in different flexion angles is still incomplete. In this study, the dynamic gap widths of a large number of varus knees were assessed in various flexion angles, to find out whether all varus knees behave similar or have more individual soft tissue patterns. Additionally, it was investigated whether the amount of varus deformity or other patient factors have an effect on joint gap widths. A series of 1000 consecutive TKA patients, including their CAS data and patient records were analyzed. Joint gap widths in multiple flexion angles (0°, 30°, 60°, 90°) were measured in mm and differences between the joint gaps were compared. A “standard” varus knee was defined as follows: (1) Lateral extension gap greater than medial, (2) lateral flexion gap greater than medial, and (3) flexion gap greater than extension gap. The percentage of fulfillment was tested for each and all criteria. To measure the influence of varus deformity on gap width difference, three subgroups were formed based on the deformity. Data were analyzed at 0°, 30°, 60° and 90° flexion. The effect of patient factors (gender, BMI, age) on gap sizes was tested by performing subgroup analyses. Only 444 of 680 (65%) patients met all three varus knee criteria. The lateral extension gap (4.1 mm) was significantly larger than the medial extension gap (0.6 mm) in 657 (97%) patients and the gap difference highly correlated with the amount of varus deformity (r2 = 0.62). In all flexion positions, however, no correlation between gap differences and varus deformity existed. Women had significantly larger extension and flexion gaps. Age and BMI showed no significant effect on gap widths. Varus knees show a large inter-individual variability regarding gap widths and gap differences. The amount of varus deformity correlates highly with the medio-lateral gap difference in extension, but not in any flexion angle. As varus knees are not all alike, a uniform surgical technique will not treat all varus knees adequately and the individual gap sizes need to be analyzed and addressed accordingly with an individualized balancing technique. Which final balancing goal should be achieved needs to be analyzed in future studies. Level III.

The myodural bridge (MDB) connects the suboccipital musculature to the spinal dura mater (SDM) as it passed through the posterior atlanto-occipital and the atlanto-axial interspaces. Although the actual function of the MDB is not understood at this time, it has recently been proposed that head movement may assist in powering the movement of cerebrospinal fluid (CSF) via muscular tension transmitted to the SDM via the MDB. But there is little information about it. The present study utilized dogs as the experimental model to explore the MDB’s effects on the CSF pressure (CSFP) during stimulated contractions of the suboccipital muscles as well as during manipulated movements of the atlanto-occiptal and atlanto-axial joints. The morphology of MDB was investigated by gross anatomic dissection and by histological observation utilizing both light microscopy and scanning electron microscopy. Additionally biomechanical tensile strength tests were conducted. Functionally, the CSFP was analyzed during passive head movements and electrical stimulation of the suboccipital muscles, respectively. The MDB was observed passing through both the dorsal atlanto-occipital and the atlanto-axial interspaces of the canine and consisted of collagenous fibers. The tensile strength of the collagenous fibers passing through the dorsal atlanto-occipital and atlanto-axial interspaces were 0.16 ± 0.04 MPa and 0.82 ± 0.57 MPa, respectively. Passive head movement, including lateral flexion, rotation, as well as flexion–extension, all significantly increased CSFP. Furthermore, the CSFP was significantly raised from 12.41 ± 4.58 to 13.45 ± 5.16 mmHg when the obliques capitis inferior (OCI) muscles of the examined specimens were electrically stimulated. This stimulatory effect was completely eliminated by severing the myodural bridge attachments to the OCI muscle. Head movements appeared to be an important factor affecting CSF pressure, with the MDB of the suboccipital muscles playing a key role this process. The present study provides direct evidence to support the hypothesis that the MDB may be a previously unappreciated significant power source (pump) for CSF circulation.

A reduced capacity to generate and sustain cervical muscle force over a range of contraction intensities is a feature of some participants with neck pain. To date there have been no studies comparing the accuracy of force perception in participants with and without neck pain.Cross-sectional observational study.Participants with (n = 25) and without (n = 25) neck pain performed isometric muscle contractions at three progressive self-perceived (no feedback provided) intensities (10, 25, 50) % of their maximal voluntary contraction (MVC) in cervical: flexion, extension, right and left lateral flexion. Absolute error (AE), constant error (CE), and variable error (VE) between actual and targeted force values were calculated.The neck pain group had: (1) AE-combined direction -significantly higher at 10% and lower at 50% (p 0.05); (2) significantly lower CE in most measures (p 0.05); (3) higher mean VE in all measures, with 10, 25, and 50% combined direction and overall combined % extension significantly higher (p 0.05).Findings indicate higher variability in force generation perception across all directions and intensities in participants with neck pain compared to healthy controls. Potentially this greater variability might suggest impaired force sense, a construct of proprioception in participants with neck pain. Reduced force sense may have implications for participants with neck pain during functional activities requiring precision and may need to be trained. Further research is required.

Objectives Provide normative values for cervical range of motion and describe trends in school age rugby union players. Design Cross-sectional study. Setting National 3 level club. Participants 59 school age rugby union players across under 8 (n = 8), under 9 (n = 9), under 10 (n = 15), under 13 (n = 13) and under 15 (n = 15) categories. Main outcome measures Cervical range of motion using a cervical range of motion device (CROM) to determine values for active range of motion. Results This study established mean ranges of motion for each age group. Pooled mean ranges with standard deviations for each direction were, flexion 66° (±11), extension 73° (±17), left rotation 69° (±9), right rotation 74° (±10), left lateral flexion 53° (±10) and right lateral flexion 49° (±12). No statistically significant differences were observed between the age groups, however, downward trends in lateral flexion were observed as age increased. School age rugby players had greater range of motion than senior playing counterparts. Conclusions No statistically significant differences in ranges of motion were observed between the age groups of under 8 through to under 15. However, downward trends in some ranges of motion highlight the need for age specific monitoring for potential adaptations to continued playing and comparison to age matched non-rugby players. Inclusion of other risk factors such as head re-positioning sense should also be evaluated to help guide injury risk reduction strategies.

Background: the prevalence of gadget was increased between university students. They use it for entertainment rather than learning. The long use of smartphone would be risk factor to musculoskeletal disorder, early neck pain, neck problems and poor work habits that load cervical region. Purpose: this study was conducted to study the effect of smartphone addiction on cervical range of motion and neck function among undergraduate students in the faculties of physical therapy. Design: Cross-sectional one–shot, controlled observational study. Methods: one hundred students selected from different physical therapy colleges in Cairo and Giza using short version of smartphone addiction scale (SAS sv). For selection, the students were assigned into two groups; Group A, consisted of 62 students who were non–addicted smartphone users and Group B, consisted of 38 students who were addicted smartphone users. Cervical range of motion (ROM) assessed by CROM and Copenhagen neck function disability index was used to assess neck function. Result: There were no statistical significant differences between both groups regarding BMI., regard to the cervical range of motion there were statistical significant differences between both group in all direction (flexion, left lateral flexion, right lateral flexion, left rotation and right rotation) except extension and Copenhagen neck functional disability index was significantly higher among smartphone addicted group. Conclusion: Smartphone addiction affects cervical range of motion and neck function so, it is recommended that physical therapy students should not use smartphone in addicted manner to prevent long term neck disability. Ergonomics advises for smartphone use will be preventive therapy programmers.