Published in 1991, the Neck Disability Index (NDI) was the first instrument designed to assess self-rated disability in patients with neck pain. This article reviews the history of the NDI and the current state of the research into its psychometric properties—reliability, validity, and responsiveness—as well as its translations. Focused reviews are presented into its use in studies of the prognosis of whiplash-injured patients as well as its use in clinical trials of conservative therapies for neck pain.
Background: Published in 1991, the Neck Disability Index (NDI) was the first instrument designed to assess self-rated disability in patients with neck pain. This article reviews the history of the NDI and the current state of the research into its psychometric properties—reliability, validity, and responsiveness—as well as its translations. Focused reviews are presented into its use in studies of the prognosis of whiplash-injured patients as well as its use in clinical trials of conservative therapies for neck pain. Special Features: The NDI is a relatively short, paper-pencil instrument that is easy to apply in both clinical and research settings. It has strong psychometric characteristics and has proven to be highly responsive in clinical trials. As of late 2007, it has been used in approximately 300 publications; it has been translated into 22 languages, and it is endorsed for use by a number of clinical guidelines. Summary: The NDI is the most widely used and most strongly validated instrument for assessing self-rated disability in patients with neck pain. It has been used effectively in both clinical and research settings in the treatment of this very common problem. (J Manipulative Physiol Ther 2008;31:491-502) Key Indexing Terms: Neck Pain; Treatment Outcome; Reliability and Validity; Outcome Assessment (Health Care); Spine; Cervical Vertebrae. Vernon H. The Neck Disability Index: State-of-the-art, 1991-2008. Journal of Manipulative and Physiological Therapeutics. 2008 Sep;31(7):491-502. PubMed PMID: WOS:000259635600002.
The Relationship between Posture and Curvature of the Cervical Spine ABSTRACT Objective: To study the relationship between posture and curvature of the cervical spine in healthy subjects. Subjects: The study was composed of 54 healthy students (25 men and 29 women) aged 20-31 yr with a mean age of 24.7 yr. Methods: Lateral radiographs were taken of the head and cervical spine of the subjects while standing in a neutral position. Cervical spine posture was quantified by the angle of a reference line, composed of reference points of the upper six cervical vertebrae, with the horizontal axis. The curvature of the cervical spine was classified visually as lordotic, straight or reversed. Results: A relationship was found between posture and curvature of the cervical spine (p = .006); a more forward posture of the cervical spine was related to a partly reversed curvature; and a more upright posture was related to a 1ordotic curvature. Moreover, men more often exhibited a straight curvature, and women more often exhibited a partly reversed curvature. Conclusion: The curvature of the cervical spine is related to the subject's posture and gender. (J Manipulative Physiol Ther 1998; 21:388-91). Key Indexing Terms: Cervical Spine; Gender; Posture Visscher CM, de Boer W, Naeije M. The relationship between posture and curvature of the cervical spine. Journal of Manipulative and Physiological Therapeutics. 1998 Jul-Aug;21(6):388-91. PubMed PMID: WOS:000075676000002.
Postural control during quiet standing following cervical muscular fatigue: effects of changes in sensory inputs
Abstract The purpose of the present experiment was to investigate the effects of cervical muscular fatigue on postural control during quiet standing under different conditions of reliability and/or availability of somatosensory inputs from the plantar soles and the ankles and visual information. To this aim, 14 young healthy adults were asked to sway as little as possible in three sensory conditions (No vision, No vision-Foam support andVision) executed in two conditions of No fatigue and Fatigue of the scapula elevator muscles. Centre of foot pressure (CoP) displacements were recorded using a force platform. Results showed that (1) the cervical muscular fatigue yielded increased CoP displacements in the absence of vision, (2) this effect was more accentuated when somatosensation was degraded by standing on a foam surface and (3) the availability of vision allowed the individuals to suppress this destabilizing effect. On the whole, these findings not only stress the importance of intact cervical neuromuscular function on postural control during quiet standing, but also suggest a reweigthing of sensory cues in balance control following cervical muscular fatigue by increasing the reliance on the somatosensory inputs from the plantar soles and the ankles and visual information. Results of the present experiment showed that (1) the cervical muscular fatigue yielded increased CoP displacements in the absence of vision, (2) this effect was more accentuated when somatosensory information was disrupted by standing on a foam surface and (3) the availability of vision allowed the individuals to suppress this destabilising effect. On the whole, these findings not only stress the importance of intact cervical muscle function on postural control during quiet standing, but also suggest a reweigthing of sensory cues in balance control following to cervical muscular fatigue by increasing the reliance on the somatosensory inputs from the plantar soles and the ankles and visual information. Finally, we would like to mention that some subjects reported sensation of cervical pain at the end of the fatiguing exercise. Indeed, pain often develops following fatiguing muscle contractions. This sensation probably arises from firing of the groups III and IV afferents, that are sensitive to metabolites and inflammatory substances (e.g., potassium, lactic acid, bradykinin and arachidonic acid) accumulated within the muscle during activity to fatigue (e.g., ). There is thus a possibility that pain per se might affect postural control. Such a proposal is yet speculative and warrants additional investigations. Vuillerme N, Pinsault N, Vaillant J. Postural control during quiet standing following cervical muscular fatigue: effects of changes in sensory inputs. Neuroscience Letters. 2005 Apr 22;378(3):135-9. PubMed PMID: WOS:000228112600003.
Objective: While sensorimotor alterations have been observed in patients with neck pain, it is uncertain whether such changes distinguish whiplash-associated disorders from chronic neck pain without trauma. The aim of this study was to investigate head steadiness during isometric neck flexion in subjects with chronic whiplash-associated disorders (WAD), those with chronic non-traumatic neck pain and healthy subjects. Associations with fatigue and ef- fects of pain and dizziness were also investigated. Methods: Head steadiness in terms of head motion velocity was compared in subjects with whiplash (n = 59), non-traumatic neck pain (n = 57) and healthy controls (n = 57) during 2 40-s isometric neck flexion tests; a high load test and a low load test. Increased velocity was expected to reflect decreased head steadiness. Results: The whiplash group showed significantly decreased head steadiness in the low load task compared with the other 2 groups. The difference was explained largely by severe levels of neck pain and dizziness. No group differences in head steadiness were found in the high load task. Conclusion: Reduced head steadiness during an isometric holding test was observed in a group of patients with whip- lash-associated disorders. Decreased head steadiness was related to severe pain and dizziness. Key words: whiplash; isometric hold; head steadiness; neck pain; dizziness. J Rehabil Med 2010; 42: 35–41 Correspondence address: Astrid Woodhouse, Department of Public Health & General Practice, Faculty of Medicine, Norwegian University of Science and Technology (NTNU), NO-7489 Trondheim, Norway. E-mail: astrid.woodhouse@ ntnu.no Submitted December 12, 2008; accepted October 7, 2009
Stretching promotes normal metabolic activity of the inter-vertebral discs, muscles and ligaments. It should be done in a smooth, controlled manner and should never be painful. If you do experience any pain, please consult your health care professional. These stretches should be done at least twice each day (first thing in the morning and last thing in the evening before bed). You will also benefit from stretching throughout the day whenever you feel your muscles stiffen. Ten repetitions to each side are suggested for each stretch. 1. Spinal Rotations: Sitting upright, slowly twist your spine as far as it will go (look over your shoulder) to both sides. 2. Spinal Extension/Flex: Sitting upright, place hands on knees. Slowly pull head back as pelvis is tilted forward, then bend your head forward as your pelvis tips backwards. 3. Spinal Lateral Bending: Sitting upright, bend fully to one side and then to the other (bring your ear towards your shoulder as far as you can). Spinal Molding This exercise enhances spinal curves and prepares you and your spine for a restful sleep, following your evening stretches. Lay on a neck and back roll for 10 minutes before sleeping. Place neck roll under your neck, pressed against your shoulders. Place lower back roll below your rib cage and above your pelvis. You can add a bolster under your knees for added comfort (skip this exercise if you are using the ThoracicPillow®).
Abstract Lesions in the cerebellum produce various symptoms related to balance and motor coordination. However, the relationship between the exact topographical localization of a lesion and the resulting symptoms is not well understood in humans. In this study, we analyzed 66 consecutive patients with isolated cerebellar infarctions demonstrated on diffusion-weighted magnetic resonance imaging. We identified the involved lobules in these patients using a cross-referencing tool of the picture archiving and communication system, and we investigated the relationships between the sites of the lesions and specific symptoms using χ2 tests and logistic regression analysis. The most common symptoms in patients with isolated cerebellar infarctions were vertigo (87%) and lateropulsion (82%). Isolated vertigo or lateropulsion without any other symptoms was present in 38% of patients. On the other hand, limb ataxia was a presenting symptom in only 40% of the patients. Lateropulsion, vertigo, and nystagmus were more common in patients with a lesion in the caudal vermis. Logistic regression analysis showed that lesions in the posterior paravermis or nodulus were independently associated with lateropulsion. Lesions in the nodulus were associated with contralateral pulsion, and involvement of the culmen was associated with ipsilateral pulsion and isolated lateropulsion without vertigo. Nystagmus was associated with lesions in the pyramis lobule, while lesions of the anterior paravermis were associated with dysarthria and limb ataxia. Our results showed that the cerebellar lobules are responsible for producing specific symptoms in cerebellar stroke patients. Conclusion With MRI and clinical data obtained from patients with isolated cerebellar infarctions, we determined lobular localization of cerebellar lesions using a PACS system and statistical analyses. Our results showed that vertigo and lateropulsion are the most common symptoms of isolated cerebellar infarctions. Our findings also suggest that contralateral pulsion was associated with lesions involving the nodulus, while ipsilateral pulsion was associated with lesions involving the culmen. Nystagmus was associated with lesions in the pyramis lobule, while dysarthria and limb ataxia were associated with lesions of the anterior paravermis. Ye BS, Kim YD, Nam HS, Lee HS, Nam CM, Heo JH. Clinical Manifestations of Cerebellar Infarction According to Specific Lobular Involvement. Cerebellum. 2010 Dec;9(4):571-9. PubMed PMID: WOS:000284955800011.
Study Design. A prospective clinical study. Objective. To quantitatively evaluate impairment of postural stability in patients with cervical myelopathy. Summary of Background Data. Proprioceptive sensation plays an important role in coordinated movement of the lower extremities and postural stability. Nevertheless, although disturbance of proprioceptive information will have an influence on the maintenance of postural stability, there have been few studies dealing with deterioration of postural stability in patients with cervical myelopathy. Methods. We investigated 52 cervical myelopathy paients who could stand without support and compared the results with those of 29 age-matched healthy volunteers. Postural stability was examined using a stabilometer. In the stabilometer, sway of gravity center was measured at upright position with eyes closed for 30 seconds. We used 2 parameters for evaluation: environmental area (EA), which measures degree of sway of the gravity center, and locus length per environmental area (L/EA), which measures fine control of standing posture by proprioceptive reflexes. Results. The mean EA of the patient group was 13.9, whereas that of the control group was 2.74, revealing signifi- cantly larger postural instability in the patient group compared to the control group. The L/EA of the patient group was significantly worse than the control group. It was also shown that postural instability was significantly larger in the myelopathy patients with the severe clinical symptoms. Conclusion. The results of the present study demonstrate impairment of postural stability in patients with cervical myelopathy. The stabilometer can objectively evaluate the postural stability, which may reflect the function of the dorsal columns and the corticospinal tracts. Thus, stabilometry is a useful method for measuring a part of proprioceptive function and for objective assessment of the lower limb function of cervical myelopathy. Yoshikawa M, Doita M, Okamoto K, Manabe M, Sha N, Kurosaka M. Impaired postural stability in patients with cervical myelopathy - Evaluation by computerized static stabilometry. Spine. 2008 Jun 15;33(14):E460-E4. PubMed PMID: WOS:000256837500020.
Abstract: Dysfunction of cervical receptors in neck disorders has been shown to lead to disturbances in postural stability. The neck torsion manoeuvre used in the smooth pursuit neck torsion (SPNT) test is thought to be a specific measure of neck afferent dysfunction on eye movement in those with neck pain. This study aimed to determine whether neck torsion could change balance responses in those with persistent whiplash-associated disorders (WADs). Twenty subjects with persistent WAD and 20 healthy controls aged between 18 and 50 years stood on a computerised force plate with eyes closed in comfortable stance under 5 conditions: neutral head, head turned to left and right and neck torsion to left and right. Root mean square (rms) amplitude of sway was measured in the anterioreposterior (AP) and medial elateral (ML) directions. The whiplash group had significantly greater rms amplitude in the AP direction following neck torsion compared to the control group (p < 0.03). The results show that the neck torsion manoeuvre may lead to greater postural deficits in individuals with persistentWAD and provides further evidence of neck torsion to identify abnormal cervical afferent input, as an underlying cause of balance disturbances in WAD. Further research is warranted. Conclusion The results of this study suggest that the neck torsion manoeuvre may adversely change balance responses in some subjects with persistent WAD and that deficits in standing balance exist particu-larly in the anterioreposterior direction when compared to asymptomatic control subjects. The results also indicate that somatosensory impairment is the most likely cause of the balance disturbances following whiplash. The disturbances are probably related to a combination of proprioceptive and nociceptive factors. Overall, these findings have implications for future studies and for the clinical assessment and management of balance disturbances in persistent whiplash-associated disorders, although, further research with greater subject numbers is required. Yu L-J, Stokell R, Treleaven J. The effect of neck torsion on postural stability in subjects with persistent whiplash. Manual Therapy. 2011 Aug;16(4):339-43. PubMed PMID: WOS:000293245000006.
Age-related changes in osseous anatomy, alignment, and range of motion of the cervical spine. Part I: Radiographic data from over 1,200 asymptomatic subjects
Abstract Purpose This study aimed to establish radiographic standard values for cervical spine morphometry, alignment, and range of motion (ROM) in both male and female in each decade of life between the 3rd and 8th and to eluci- date these age-related changes. Methods: A total of 1,230 asymptomatic volunteers underwent anteroposterior (AP), lateral, flexion, and exten-sion radiography of the cervical spine. There were at least 100 men and 100 women in each decade of life between the 3rd and 8th. AP diameter of the spinal canal, vertebral body, and disc were measured at each level from the 2nd to 7th cervical vertebra (C2–C7). C2–C7 sagittal alignment and ROM during flexion and extension were calculated using a computer digitizer. Results The AP diameter of the spinal canal was 15.8 ± 1.5 mm at the mid-C5 level, and 15.5 ± 2.0 mm at the C5/6 disc level. The disc height was 5.8 ± 1.3 mm at the C5/6 level, which was the minimum height, and the maximum height was at the C6/7 level. Both the AP diameter of the spinal canal and disc height decreased gradually with increasing age. The C2–C7 sagittal alignment and total ROM were 13.9 ± 12.3 in lordosis and 55.3 ± 16.0, respectively. The C2–C7 lordotic angle was 8.0 ± 11.8 in the 3rd decade and increased to 19.7 ± 11.3 in the 8th decade, whereas the C2–C7 ROM was 67.7 ± 17.0 in the 3rd decade and decreased to 45.0 ± 12.5 in the 8th decade. The extension ROM decreased more than the flexion ROM, and lordotic alignment progressed with increasing age. There was a significant difference in C2–C7 alignment and ROM between men and women. Conclusions The standard values and age-related changes in cervical anatomy, alignment, and ROM for males and females in each decade between the 3rd and 8th wereestablished. Cervical lordosis in the neutral position develops with aging, while extension ROM decreases gradually. These data will be useful as normal values for the sake of comparison in clinical practice. Conclusion: Standard values and those age-related changes in cervical spine morphometry, alignment, and ROM were established from cervical X-ray data of 1,230 healthy subjects. The sagittal diameter (mm) of the cervical canal at the mid-C5 level was 16.2 ± 1.5 mm in males and 15.4 ± 1.4 mm in females. If the sagittal diameter was B13 mm in males or B12 mm in females, the subject was considered to have a narrow spinal canal. The extension ROM decreased more than the flexion ROM, and lordotic alignment increased with advancing age. Yukawa Y, Kato F, Suda K, Yamagata M, Ueta T. Age-related changes in osseous anatomy, alignment, and range of motion of the cervical spine. Part I: Radiographic data from over 1,200 asymptomatic subjects. European Spine Journal. 2012 Aug;21(8):1492-8. PubMed PMID: WOS:000307294200008.