|Year : 2017 | Volume
| Issue : 1 | Page : 40-44
Normal cervical spine range of motion using digital inclinometer in male asymptomatic subjects of Aseer, Saudi Arabia
Khalid A Alahmari
Department of Medical Rehabilitation Sciences, College of Applied Medical Sciences, King Khalid University, Abha, KSA
|Date of Web Publication||3-Jan-2017|
Dr. Khalid A Alahmari
Department of Medical Rehabilitation Sciences, College of Applied Medical Sciences, King Khalid University, Abha
Source of Support: None, Conflict of Interest: None
Background: Various studies determined the normal cervical spine range of motion (ROM) of a large group of patients with diverse socioeconomic and ethnic background and varying degree of routine daily activities. The purpose of this investigation was to quantify normal cervical ROM in male asymptomatic subjects of Aseer Region, Saudi Arabia. Methodology: Two hundred and thirty-three asymptomatic subjects with age group of 10-80 years participated in the study. Digital goniometer was used to measure the ROM of the cervical spine. This tool was employed in a clinical setting to evaluate the full active ROM (AROM) of the cervical spine (i.e., flexion/extension, lateral bending, and axial rotation). All the subjects were divided into seven groups in terms of age (10-19, 20-29, 30-39, 40-49, 50-59, 60-69, and 70-80 years) and the cervical ROM was determined. Six cervical movements (i.e., flexion/extension, lateral bending, and axial rotation) of five groups were analyzed and each of the six cervical AROMs decreased significantly with age. Results: All the cervical ranges decreased as the age increased. The maximum cervical range was recorded in cervical rotation left (71.81 ± 8.75°), followed by rotation right (70.58 ± 5.83°), extension (68.42 ± 10.30°), flexion (66.96 ± 8.62°), left side bending (54.62 ± 7.13°), and right side bending (52.69 ± 7.32°). Conclusion: Normal database of normal cervical ROM from age group of 10-80 years was established in male asymptomatic population of Aseer Region, Saudi Arabia.
مدى الحركة الطبيعي للشوكة العنقية باستخدام مقياس الميلان الرقمي في اختبار بعض المرضى من الذكور من منطقة عسير، في المملكة العربية السعودية
الخلفية: حددت دراسات متنوعة مدى الحركة الطبيعية للشوكة العنقية (ROM) لمجموعة كبيرة من المرضى بخلفيات عرقية، اجتماعية واقتصادية مختلفة ويختلفون في درجات الانشطة اليومية الروتينية. كان الغرض من الدراسة لتحديد كمية الحركة العنقية الطبيعية (ROM) لاختباربعض المرض الذكور ليست لديهم أعراض في منطقة عسير بالمملكة العربية السعودية.
الطريقة: شملت الدراسة مئتين وثلاثة وثلاثين من الافراد ليس لديهم اعراض وتتراوح اعمارهم بين 10-80 عاماً شاركوا في هذه الدراسة. تم استخدام منقلة رقمية لقياس الشوكة العنقية (الثني\ التمدد, الانحناء الجانبي و الالتفاف المحوري). جميع المختبرين قسموا لسبع محموعات حسب أعمارهم (10-19, 20-29, 30-39, 40-49, 50-59, 60-69, (70-80 كما حددت الحركة العنقية. ست حركات عنقية (الثني\ التمدد, الانحناء الجانبي والالتفات المحوري) تم تحليلها لخمس مجموعات لكل واحدة من الست حركات AROMS العنقية تقلصت بشكل بارز مع العمر.
النتائج: ينقص مدى الحركات العنقية مع ازدياد العمر. أقصى مدى للحركة العنقية تم تسجيله كان للالتفات العنقي لليسار (8.75–±71.81) ,يعقبه الالتفات لليمين (5.83 (70.58+_, التمدد ((68.42+_ 10.30, الثني (66.96_+ 8.62) , الانحناء الى اليسار (7.13 (54.62+_, والانحناء الى اليمين ((52.69+_ 7.32.
الخلاصة: تم انشاء قاعدة معلومات طبيعية عن الحركة الطبيعية للعنق ROM للمجموعة العمرية من 10-80 للسكان الذكور بمنطقة عسير في المملكة العربية السعودية.
Keywords: Cervical spine, range of motion, test and measurements
|How to cite this article:|
Alahmari KA. Normal cervical spine range of motion using digital inclinometer in male asymptomatic subjects of Aseer, Saudi Arabia. Saudi J Sports Med 2017;17:40-4
|How to cite this URL:|
Alahmari KA. Normal cervical spine range of motion using digital inclinometer in male asymptomatic subjects of Aseer, Saudi Arabia. Saudi J Sports Med [serial online] 2017 [cited 2023 Sep 21];17:40-4. Available from: https://www.sjosm.org/text.asp?2017/17/1/40/197469
| Introduction|| |
Evaluating the cervical spine range of motion (ROM) and patterns of motion is a key concern for clinicians in the diagnostic and functional assessment of patients with neck pain or musculoskeletal disease. These (cervical ROM) measures are also used to obtain records of an individual's degree of permanent impairment. Currently, clinicians use all or any of visual estimations, a universal goniometer, an inclinometer, or a tape measure to make these assessments. Patients are followed over a long period for many diseases, particularly those considered chronic. Measurements of the cervical spine are recorded in a patient's medical record as they are considered to be acceptable clinical data for the evaluation of physical movement impairment.,,
The inclinometer method is the standard technique for measuring cervical spine motions in different rotations, including sagittal, frontal, transversal, and rotational. Goniometry and inclinometry have been described as a tool with which to measure ROM; it gives the physician a useful method to diagnose musculoskeletal function in terms of ROM, to monitor the progress of an intervention, to record the data or future follow-up, and to meet statutory and legal requirements for impairment rating and disability determinations, where applicable.
ROM of the joint is one of the factors that determine function of the musculoskeletal system. Inflammatory as well as mechanical insults to the cervical spine can cause restriction of cervical spine joint motion. Early detection of restriction of joint motions in disease states requires that the normal range of joint motions be known. The key to effective therapy, in these conditions, largely depends on the knowledge and understanding of normal and abnormal ranges of joint motions, which vary with the patient's age and gender, as well as the applied technique of measuring the joint motion.,
The normative data of cervical ROM for the Abha (Saudi Arabia) population were lacking in the literature. Its variation with different parameters has not been studied comprehensively. As such, the present study is designed to check the age variation of ROM characteristics of selected members of the Abha population. Cervical spine active ROM (AROM) has been studied in healthy subjects by numerous investigators. Various studies have determined the normal cervical spine ROM of a large group of patients with diverse socioeconomic and ethnic backgrounds and varying degrees of routine daily activities. The current data sources do not address this issue with respect to the Saudi Arabian population; as such, this study's objective is to provide a database specific to the Abha population to determine any trend of cervical spine ranges that correspond to various age categories. The objective of this study is to find normative data for normal cervical spine ROM in the Abha population of Saudi Arabia.
| Methodology|| |
A cross-sectional study design was used to conduct this study. Two hundred and thirty-three asymptomatic male subjects with age groups ranging from 20 to 70 years participated in the study. The University Ethical Committee approval was obtained before the study's commencement. Advertisement in the form of posters and verbal announcement was done to generate voluntary participation of subjects, both from within the university and public places. Subjects were also recruited through personal contact from one of the authors, through advertisements placed in weekly newsletters at local community centers. After screening, subjects who met the inclusion-exclusion criteria [Table 1] were invited to participate in the study and were given further verbal and written information. Subjects who were above 18 were asked to read and sign an informed consent form, and for the subjects below 18 years, consent was obtained from the parents. All subjects completed a questionnaire as part of the inclusion-exclusion procedure. Capturing demographic information and all measurement procedures was conducted in the same room on each occasion.
The digital inclinometer (Dualer IQ Pro) was used to measure the cervical joint position error in terms of natural head position and target head position. The digital dual inclinometer is the faster, easier way to measure spine ROM without a computer. The literature includes numerous studies that use a digital inclinometer to measure ROM.,,, The digital inclinometer spine evaluation protocols are recommended by the American Medical Association (AMA). A digital inclinometer allows clinicians to evaluate motion using dynamic dual inclinometry and static single inclinometry (similar to using goniometer) protocols, which also allows for automatic data collection. Digital inclinometers have good test-retest reliability for measuring the spine's ROM.,
Before collecting normative data, we (physical therapists) conducted two pilot studies to investigate the intra- and inter-tester reliability for measurements of cervical ROM obtained through the digital inclinometer instruments. To decrease between-tester variability, we standardized placement of the digital inclinometer according to the manufacturer's suggestions. The digital inclinometer was mounted over the subject's vertex of the head. Each subject sat on a wooden-framed chair so that the thoracic spine maintained contact with the chair's backrest, and the lumbosacral spine filled the gap between the seat and the backrest. The subject's feet were positioned flat on the floor, and the subject's arms rested freely at his side. As instructed by the tester, each subject performed three repetitions of neck flexion, extension, and left and right components of lateral flexion and rotation, in that order, so as to increase compliance of the neck' soft tissues. This movement sequence was arbitrarily selected by us to ensure consistency of the AROM measurements of cervical movements. The tester instructed each subject to move his head until the AROM was stopped by muscle tightness or pain or until a substitution movement occurred. The tester then measured the subject's cervical AROM in both directions within a cardinal plane using the digital inclinometer. A recorder wrote down both the start and end points of the cervical AROM. Immediately after the first six measurements, the tester removed the digital inclinometer from the subject and then repositioned it. The subject repeated the same movements, providing two sets of six measurements. We did not request that subjects perform warm-ups in each direction to increase compliance of the soft tissues of the neck because we believe this procedure is not routinely done in a clinical setting. To remain consistent with standard clinical practice, we recorded one measurement of each subject's available active neck flexion, extension, right side bending, left side bending, right rotation, and left rotation, in that order. Each of the active cervical ROM measurements was taken three times and the average was computed for analysis.
| Data Analysis and Results|| |
SPSS software version 20 (IBM, SPSS, statistics). was used for data analysis. Descriptive statistics and frequency statistics were used to summarize the data. The AROM data for neck flexion-extension are summarized in [Table 2]. The maximum ROM for cervical flexion (66.96 ± 8.62°) and extension (68.42 ± 10.30°) was recorded in subjects with 10-20 years of age and the least ROM for flexion (56.33 ± 9.29°) and extension (53.00 ± 8.83°) was recorded in subjects with 70-79 years. The maximum ROM for right side bending (52.69 ± 7.32°) and left side bending (54.62 ± 7.13°) was recorded in subjects with 10-20 years of age and the least ROM for right side bending (38.33 ± 9.29°) and left side bending (39.00 ± 8.83°) recorded in subjects with 70-79 years [Table 3]. The AROM data for cervical right rotation and left rotation are summarized in [Table 4]. The maximum ROM for right rotation (70.58 ± 5.83°) and left rotation (71.81 ± 8.75°) was recorded in subjects with 10-20 years of age and the least ROM for right rotation (53.33 ± 12.58°) and left rotation (52.67 ± 11.24°) was recorded in subjects with 70-79 years. All the cervical ranges decreased as the age increased. The maximum cervical range was recorded in cervical rotation left (71.81 ± 8.75°), followed by rotation right (70.58 ± 5.83°), extension (68.42 ± 10.30°), flexion (66.96 ± 8.62°), left side bending (54.62 ± 7.13°), and right side bending (52.69 ± 7.32°).
|Table 2: Descriptive statistics for active range of motion of neck flexion and extension|
Click here to view
|Table 3: Descriptive statistics for active range of motion of neck right side bending and left side bending|
Click here to view
|Table 4: Descriptive statistics for active range of motion of neck right rotation and left rotation|
Click here to view
| Discussion|| |
This is the first study to determine the normal cervical spine ROM among the healthy male population of Saudi Arabia. The measurements were performed using a digital inclinometer which is a reliable method that is supported in the literature.,, The digital inclinometer is superior to conventional universal goniometers, inclinometers, and other protracted-based measurements of the cervical spine. As a subject's age increases, there is a decreased ROM in the cervical spine. The same results have been demonstrated by several authors.,, The investigators who collected the data were all possessed more than 8 years of experience in the field of physiotherapy, and hence, data variability was negligible.
Our data indicate that cervical rotation has the greatest ROM, followed in the descending order by extension and lateral flexion. In contrast, Youdas et al. indicate that for both genders, cervical extension has the greatest AROM, followed in the descending order of right rotation, left rotation, flexion, right lateral flexion, and left lateral flexion. As with the findings from our study, the AMA publication 15 reports that cervical rotation has the largest available AROM, followed in the descending order by neck extension, flexion, and both components of lateral flexion. The AAOS publication likewise predicts that cervical rotation will have the greatest AROM whereas the remaining four AROMs will have the same values.
A relationship exists between each of the six cervical AROMs and the age of a healthy subject. This finding has been reported by others who have also studied large numbers of healthy subjects and used goniometric measurement procedures. For instance, Lind et al. reported an age effect for all cervical AROMs, except neck flexion. However, they obtained sagittal- and frontal-plane measurements using radiographic techniques. With the exception of neck flexion, our data indicate a significant relationship between cervical AROMs and a subject's gender. A similar finding was reported by Alund and Larsson. Because age has been found to be related to five of the six cervical AROM measurements, we believe that it is misleading to use one value to represent cervical AROM for all ages.
This study demonstrated that as age increases there is decrease in cervical ROM. This finding was noticed in all of the cervical movements. The decrease in cervical range can be attributed to age-related degeneration.,, The sample collected was from among the general population so that the results can be generalized to the total population of Saudi Arabia.
Moving forward, studies should examine whether certain physical parameters, including sex, have any relationship to cervical ROM in this population. Future research is necessary to assess the normal cervical spine ROM in female subjects, so as to see if there are any change in cervical spine ROM when compared to males.
| Conclusion|| |
The current study used noninvasive digital inclinometer to measure the ROM of the cervical spine. This tool was employed in a clinical setting to evaluate the full AROM of the cervical spine (i.e., flexion/extension, side bending, and rotation) of 233 asymptomatic male subjects, with age groups ranging from 10 to 80 years. The cervical ROM decreased as the age increases. Normative cervical spine ROM values for healthy subjects of Aseer, Saudi Arabia, are established.
Financial support and sponsorship
Conflicts of interest
There are no conflicts of interest.
| References|| |
Lind B, Sihlbom H, Nordwall A, Malchau H. Normal range of motion of the cervical spine. Arch Phys Med Rehabil 1989;70:692-5.
Youdas JW, Garrett TR, Suman VJ, Bogard CL, Hallman HO, Carey JR. Normal range of motion of the cervical spine: An initial goniometric study. Phys Ther 1992;72:770-80.
Youdas JW, Carey JR, Garrett TR. Reliability of measurements of cervical spine range of motion - Comparison of three methods. Phys Ther 1991;71:98-104.
Dvorak J, Antinnes JA, Panjabi M, Loustalot D, Bonomo M. Age and gender related normal motion of the cervical spine. Spine (Phila Pa 1976) 1992;17 10 Suppl: S393-8.
Capuano-Pucci D, Rheault W, Aukai J, Bracke M, Day R, Pastrick M. Intratester and intertester reliability of the cervical range of motion device. Arch Phys Med Rehabil 1991;72:338-40.
Feipel V, Rondelet B, Le Pallec J, Rooze M. Normal global motion of the cervical spine: An electrogoniometric study. Clin Biomech (Bristol, Avon) 1999;14:462-70.
Castro WH, Sautmann A, Schilgen M, Sautmann M. Noninvasive three-dimensional analysis of cervical spine motion in normal subjects in relation to age and sex. An experimental examination. Spine (Phila Pa 1976) 2000;25:443-9.
Ordway NR, Seymour R, Donelson RG, Hojnowski L, Lee E, Edwards WT. Cervical sagittal range-of-motion analysis using three methods. Cervical range-of-motion device, 3space, and radiography. Spine (Phila Pa 1976) 1997;22:501-8.
Chen J, Solinger AB, Poncet JF, Lantz CA. Meta-analysis of normative cervical motion. Spine (Phila Pa 1976) 1999;24:1571-8.
Benson KF, Ager DM, Landes B, Aruoma OI, Jensen GS. Improvement of joint range of motion (ROM) and reduction of chronic pain after consumption of an ergothioneine-containing nutritional supplement. Prev Med 2012;54:S83-9.
Jensen GS, Ager DM, Redman KA, Mitzner MA, Benson KF, Schauss AG. Pain reduction and improvement in range of motion after daily consumption of an açai (Euterpe oleracea Mart.) pulp-fortified polyphenolic-rich fruit and berry juice blend. J Med Food 2011;14:702-11.
Sohn JH, Choi HC, Lee SM, Jun AY. Differences in cervical musculoskeletal impairment between episodic and chronic tension-type headache. Cephalalgia 2010;30:1514-23.
Beyerman KL, Palmerino MB, Zohn LE, Kane GM, Foster KA. Efficacy of treating low back pain and dysfunction secondary to osteoarthritis: Chiropractic care compared with moist heat alone. J Manipulative Physiol Ther 2006;29:107-14.
Nitschke JE, Nattrass CL, Disler PB, Chou MJ, Ooi KT. Reliability of the American Medical Association guides′ model for measuring spinal range of motion. Its implication for whole-person impairment rating. Spine (Phila Pa 1976) 1999;24:262-8.
Nattrass CL, Nitschke JE, Disler PB, Chou MJ, Ooi KT. Lumbar spine range of motion as a measure of physical and functional impairment: An investigation of validity. Clin Rehabil 1999;13:211-8.
Cho YR, Hong BY, Lim SH, Kim HW, Ko YJ, Im SA, et al.
Effects of joint effusion on proprioception in patients with knee osteoarthritis: A single-blind, randomized controlled clinical trial. Osteoarthritis Cartilage 2011;19:22-8.
Azevedo DC, Melo RM, Alves Corrêa RV, Chalmers G. Uninvolved versus target muscle contraction during contract: Relax proprioceptive neuromuscular facilitation stretching. Phys Ther Sport 2011;12:117-21.
Alund M, Larsson SE. Three-dimensional analysis of neck motion. A clinical method. Spine (Phila Pa 1976) 1990;15:87-91.
Lowery WD Jr., Horn TJ, Boden SD, Wiesel SW. Impairment evaluation based on spinal range of motion in normal subjects. J Spinal Disord Tech 1992;5:398-402.
Wolfenberger VA, Bui Q, Batenchuk GB. A comparison of methods of evaluating cervical range of motion. J Manipulative Physiol Ther 2002;25:154-60.
Norkin CC, White DJ. Measurement of Joint Motion: A Guide to Goniometry. Philadelphia: FA Davis; 2009.
[Table 1], [Table 2], [Table 3], [Table 4]