STUDY DESIGN: A multivariate repeated measures independent-group study design.OBJECTIVES: To compare the effect of a craniocervical flexion exercise (CCFEx) program to that of a conventional cervical flexion exercise (CFEx) program in training isometric craniocervical flexor muscle performance. BACKGROUND: The craniocervical flexor muscles are important muscles of the cervical spine, as they have been shown to be impaired in persons with chronic neck pain. While both CCFEx and CFEx protocols have been advocated to train craniocervical flexor muscle performance, at present there is no consensus as to the most effective method. METHODS AND MEASURES: Fifty females with chronic mild neck pain and disability status were randomly allocated into a 6-week program of either CCFEx (n = 27) or CFEx (n = 23). Isometric dynamometry measurements of craniocervical flexor muscle performance (maximal voluntary contraction, endurance at 50% of maximal voluntary contraction) were recorded before and following the exercise program. Changes in craniocervical flexor muscle performance (pretraining-posttraining) within and between exercise groups were analyzed with analysis of variance models. RESULTS: Both exercise interventions significantly improved isometric craniocervical flexor muscle performance (P<.02). No significant differences in improvement of muscle performance were observed between the 2 exercise interventions.CONCLUSION: It appears that isometric craniocervical flexor muscle performance can be trained with either a CCFEx protocol or a conventional CFEx protocol in patients with mild neck pain and disability.  

J Orthop Sports Phys Ther. 2007;37(1):3-9. doi:10.2519/jospt.2007.2237 

KEY WORDS: cervical spine, craniocervical flexion, neck pain, rehabilitation

Study Design: Single-group, posttest only, using a sample of convenience. Objective: To measure the repositioning error of subjects with low back pain for lumbar sagittal movement using a simple kinesthetic test previously described. Background: Patients with low back pain are commonly observed to have difficulty in adopting a mid or neutral position of the lumbar spine. Methods and Measurements: Twenty subjects with low back pain were required to reproduce an upright neutral posture of the lumbar spine following movement into flexion in a sitting position. Trunk positioning accuracy was measured with an electromagnetic tracking device. Results: The mean absolute value of the repositioning error in the sagittal plane was 2.25° ± 0.88° on day 1 and 2.32° ± 1.62° on day 2. The performance of patients with low back pain was similar to that of asymptomatic patients in a previous study, although subjects with low back pain overshot the neutral position more frequently (79%) than did nonimpaired subjects (50%). Conclusions: Subjects with low back pain may have attempted to use extra mechanoreceptive cues to compensate for some kinesthetic deficit. Nevertheless, the kinesthetic test used was not sensitive enough to detect any repositioning deficits, and reasons for this are explored.

J Orthop Sports Phys Ther. 1999;29(5):294-299.

Key Words: kinesthesia, back pain, measurement

Poor lumbar spine kinesthetic awareness is often observed in low back pain patients and is usually evaluated qualitatively in the clinical situation. The purpose of this study was to investigate a simple, kinesthetic test for the lumbar spine. The experimental protocol utilized a 3Space Fastrak™ to determine the error, within and between days, of 10 healthy subjects in reproducing a neutral lumbopelvic (T10-S2) position following movement into flexion. The mean value of the repositioning error for the sagittal plane movement (flexion/extension) over the 3 repetitions within day 1 was 2.6 ± 1.2° and for day 2 was 2.6 ± 1.7°. No statistically significant difference existed between days. These repositioning errors were well within the ranges described by other authors for various asymptomatic joint complexes. These results provide a basis for further evaluation of this test on patients with low back pain to investigate its ability to detect any kinesthetic deficit.

J Orthop Sports Phys Ther. 1996;24(6):354-358.

Key Words: lumbar spine, kinesthesia, measurement