Special thanks to star physical therapist Brace Hayden, DPT, CSCS of Alpine Physical Therapy for providing this write up on a recent article from Spine.
Our neck mobility seems to gradually get worse as we celebrate birthdays and suffer our share of accidents and uncomfortable hotel pillows. The garden variety pain or achy stiffness in the neck, categorized in the healthcare world as ‘nonspecific neck pain’ sends a lot of people to their care providers for some sort of treatment and medical relief. In order to best assess neck complaints, providers perform an examination of the spine. The physical therapist (or other provider of choice) will measure their range of motion (ROM), as in many cases one of the goals for patients with nonspecific neck pain is to improve the neck’s mobility.
Normative values for the neck’s mobility are memorized by clinicians during their respective education, so relative stiffness measured in degrees, documented and treated for hopeful improvements. For example, we learned in PT school that the “normal” neck flexes and extends about 60 degrees, rotates 90 degrees and side bends 45 degrees. But, “normal range of motion” changes with age, and thus ‘normal’ for a 20 year old is quite a bit more generous than the age-reduced ‘normal’ for a 60 year old.
Enter the work of Dr. Swinkels and his team of researchers from the Zuyd University’s Department of Physiotherapy in the Netherlands. They recently published a paper on their investigation on the range of motion differences in the cervical spine as we age. They studied four hundred people without neck issues and quartered the data set with 100 for each decade of age from 20 years to 60 years and in each quarter subgroup. Each subgroup also had an even balance of genders with 50 males and 50 females. The mobility of the neck was measured with a special cervical range of motion device called the ‘CROM’ (see Figure 1). Swinkels’s team crunched the nitty-gritty analyses of variance, linear regressions and even further dredged the data with Scheffé post hoc tests to investigate the differences in neck mobility between the decades of age and any possible relationships of age and/or gender.
As one may expect, they found that age does have a significant effect on active ROM of the neck. Table 2 beautifully illustrates the diminishing trend of neck ROM in healthy adults without neck pain. Recall the “normal” ROM for neck flexion we committed to memory was 60 degrees. This normal mobility of 60 degrees in Swinkels’s study was assessed as typical for 20-somethings, but each decade men and women evenly lose a degree or two, until the 50-something decade. 50 years and older, active ROM declines greatly in all directions except neck extension and side bending. Neck flexion on average is reduced 12 percent (7 degrees) to 53 degrees. Clinically this is relevant, as we in the physical therapy profession tend to council a lot of people on improving their stiff neck’s mobility. In all due fairness, the “new normal” should be on an age-adjusted sliding scale when goal setting for target neck mobility. ]
Raymond A. H. M. Swinkels, PhD et al. Normal Values for Cervical Range of Motion. In Spine. 2014, Volume 39 , Number 5 , pp 362 – 367.
1/10/2012 0 Comments
Patients with typical neck pain may benefit from a physical therapy program that includes upper neck and upper back manipulation. Potential benefits include less pain, better neck motion, and improved ability to perform daily activities. Although this treatment was very successful for this group of patients with neck pain, it may not be effective or even appropriate for all patients with neck pain.
Your physical therapist will perform a thorough evaluation to help determine if you are a good candidate for this treatment, as part of a program designed to help get rid of the aching in your neck. The benefits in this study were only measured for the first 48 hours after treatment; further research is needed to determine long-term benefits.
Here are the nuts and bolts of the supportive research study that appeared in this month’s Journal of Orthopedic and Sports Physical Therapy (2012;42(1):5-18. doi:10.2519/jospt.2012.3894).
In this study, James R. Dunning,DPT, MSc Manip Ther, FAAOMPT and fellow researchers treated 107 patients. About half of these patients received a manipulation of the neck, on the part closest to the head, and of the upper back. The other patients received manual therapy that mobilized the spine without using manipulation.
After 48 hours, the patients who received the manipulation treatment experienced a 58% decrease in pain and a 50% decrease in disability. By contrast, patients who received the mobilization treatment only had a 13% decrease in pain and actually showed a 13% increase in disability. In addition, the patients who received the manipulation had increased motion and improved control of their neck muscles compared to the patients in the mobilization group.
The researchers concluded that the combination of upper neck and back manipulation was more effective in the first 48 hours of treatment than the mobilization treatment.
Two of our physical therapists at Alpine Physical Therapy have studied extensively with Dr. James R. Dunning. To schedule an appointment and to get your neck feeling better quickly, you are invited to call our office at 406-251-2323.
Get more information on neck pain by visiting the patient resource section of our clinic website by clicking here.
Join Brent Dodge, PT, OCS, CMPT, CSCS in a key interview with Dr. Randale Sechrest, MD on The Physical Therapist’s Role in Treating Neck Pain.
For more information on neck pain, locate A Patient’s Guide to Neck Pain in the Patient Resources section of our website by clicking here.
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