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Background The sequence of segmental contributions (SSC) offers insight into cervical spine motion, yet accurately analyzing these movements remains challenging. This study compares two tracking methods, developed at two independent centers (AECC and MUMC), to establish their agreement and reliability in measuring SSCs across segments C4 to C7. Understanding spinal biomechanics is crucial for future research into cervical spine pathology and dysfunction. Methods Twelve asymptomatic participants (ages 18–35 for “young” and 55–70 for “elderly”) performed flexion-extension movements. MUMC + utilized self-directed motion, while AECC used a guided protocol. To ensure comparability, 26 frames from the second half of each extension movement were analyzed. Agreement was assessed using ICCs, Spearman’s Rho, and Bland-Altman analysis. Although the sample size is small, a post-hoc power analysis indicated sufficient power, supported by a high volume of analyzed data points. Findings High intraclass correlation coefficients (ICCs) for the cumulative vertebral rotation (0.97), cumulative intervertebral rotation (0.97) and relative intervertebral rotation (0.93) indicated strong agreement between the two methods. Bland-Altman analysis showed minimal median differences (< 0.2˚) but wider limits of agreement at C6-C7. Normative SSC patterns appeared in 77.8% of younger participants but were absent in elderly participants. Interpretation This study confirms the reliability of SSC measurement between the two methods, laying the foundation for broader applications. SSC patterns observed in young adults follow a normative pattern, in alignment with previous research. The absence of a fixed pattern in elderly participants could indicate age-related changes or sample variation, warranting cautious interpretation due to the small sample size. Future studies with larger, diverse samples and AI-driven approaches could enhance SSC analysis, enabling better clinical relevance.

Background: Intervertebral motion is a fundamental aspect of spinal biomechanics, crucial for understanding lumbar spine function, pain mechanisms, and surgical outcomes. Various methods exist for measuring and interpreting it, each with its own advantages, limitations, and specific applications. However, a comprehensive and standard taxonomy of study types for the measurement and interpretation of in vivo intervertebral motion in the lumbar spine is lacking. Objectives: This review aimed to systematically identify, characterise, and categorise the diverse study types deposited in the literature. Eligibility criteria: Only studies in English and of lumbar spine intervertebral motion in living subjects were considered, and only those that employed objective measurement of motion sequences were included. Sources of evidence: A comprehensive literature search was performed in PubMed, CINAHL, and SCOPUS for articles published between January 2000 and October 2025. Charting methods: After removal of duplicates, all studies were subjected to Title and abstract screening, followed by full-text screening of potentially eligible studies. Data selected were charted into tables under the headings: author, year, country, purpose, technology, participants, measurement, interpretation, radiation dosage, and significance of findings. Results: Forty-nine studies were abstracted and are described under 11 study types. These formed a taxonomy constituting the following six categories: normal biomechanical mechanisms, pathological and injury mechanisms, direct kinematic measurement, spinal stabilisation, dynamic radiography, and clinical markers. The resulting taxonomy will serve as a resource for researchers, clinicians, and policymakers by facilitating a more coherent understanding of the field and promoting standardisation in research design and reporting.

Background The term ‘physiological motion of the spine’ is commonly used although no proper definition exists. Previous work has revealed a consistent sequence of cervical segmental contributions in 80–90% of young healthy individuals. Age has been shown to be associated with a decreased quantity of motion. Therefore, it is of interest to study whether this sequence persists throughout aging. The aim of this prospective cohort study is to investigate if the consistent sequence of cervical segmental contributions in young asymptomatic individuals remains present in elderly asymptomatic individuals. Methods In this prospective cohort study, dynamic flexion to extension cinematographic recordings of the cervical spine were made in asymptomatic individuals aged 55–70 years old. Individuals without neck pain and without severe degenerative changes were included. Two recordings were made in each individual with a 2-to-4-week interval (T1 and T2). Segmental rotation of each individual segment between C4 and C7 was calculated to determine the sequence of segmental contributions. Secondary outcomes were segmental range of motion (sRoM) and sagittal alignment. Results Ten individuals, with an average age of 61 years, were included. The predefined consistent sequence of segmental contributions was found in 10% of the individuals at T1 and 0% at T2. sRoM and total range of motion (tRoM) were low in all participants. There was no statistically significant correlation between sagittal alignment, degeneration and sRoM in the respective segments, nor between cervical lordosis and tRoM. Conclusions This study shows that aging is associated with loss of the consistent motion pattern that was observed in young asymptomatic individuals. The altered contribution of the cervical segments during extension did not appear to be correlated to the degree of degeneration or sagittal alignment. Trial registration clinicaltrials.gov NCT04222777, registered 10.01.2020.

Background Involving patients and members of the public, together with researchers, in decisions about how studies are designed and conducted can create a study that is more person‐centred. The aim of this consultation process was to explore ways of designing a study which takes the person into consideration for the randomized clinical study entitled ‘Biomechanical Effects of Manual Therapy—A Feasibility Study’ using the novel approach of usability testing. Design Patient and public volunteers were sought with experience of low back pain. Volunteers were invited to participate in usability testing (a physical walkthrough) of the proposed study method. This was followed by a discussion of areas where usability testing could not be used, such as recruitment strategies, continuity of participant care and dissemination of results. Resulting feedback was considered by the research team and alterations to the original study method were incorporated, provided the research questions could be answered and were practical within the resources available. Results Additional recruitment strategies were proposed. Alterations to the study included reduction in study time burden; completion of study paperwork in a quieter location; continuity of participant care after the study; and methods of dissemination of overall study results to participants. Conclusion The consultation process used the unique method of usability testing, together with a post‐usability discussion, and resulted in alterations to the future study which may facilitate making it more person‐centred. Patient and Public Contribution Patients and public developed the future study design but did not participate in manuscript preparation.

Background Stakeholder involvement includes not just patients and public, but also those delivering treatment for example clinicians and students. Each stakeholder brings unique experiences to the process. The aim of this stakeholder exercise was to explore readability and understanding of the trial material for the future trial to be conducted by the authors: Biomechanical Effects of Manual Therapy—A Feasibility Study. Design Volunteers from identified stakeholder groups were provided with trial material which included the information sheet, consent form, questionnaires and home management booklet. They provided feedback on content (readability, understanding) and style (font, layout). An additional document was provided with genres of pictures to choose the most appropriate style to be used in the booklet. Readability formulas were used to calculate reading age before and after feedback to objectively measure ease of reading. Results The public group provided a layperson's perspective to clarify the information sheet for patients, whereas practitioner and intern groups indicated where information could be clarified. The reading age of all documentation decreased following feedback; however, templated sections of the documentation did not. The majority (87%) of volunteers chose coloured classic cartoons for the booklet. Conclusion This process highlighted the importance of involving different stakeholder groups in the development of research materials as each group made a unique contribution. Readability and understanding of the trial material were improved, feeding back into the consent process contributing towards fully informed consent. Patient or Public Contribution Public helped develop materials for a future trial but not with manuscript preparation.

While neck pain can be defined in clinical terms, in most cases the underlying pathophysiology is largely unknown. Regional cervical spine range of motion is often found to be reduced in patients with neck pain compared to persons without pain although it is not clear if the decreased range is cause or effect. Less is known about the role of intervertebral kinematics and how that might be related to the presence of disc degeneration. In this study, the prevalence of intervertebral disc degeneration and continuous cervical intervertebral motion were both measured utilizing quantitative fluoroscopy (QF) in patients with subacute or chronic neck pain (n = 29) and gender-matched healthy controls (n = 30). A composite disc degeneration (CDD) score was calculated for each participant from the first, neutral, lateral fluoroscopic image. Intervertebral motion sharing parameters of motion-sharing inequality (MSI) and motion-sharing variability (MSV) were derived from the active cervical motion sequences obtained while patients were seated. The objective was to determine if average age, CDD, MSI, and MSV values were correlated and if there were differences in these variables between the neck pain group and the healthy control group. Correlation analysis was conducted for age, CDD, MSI, and MSV in each group. Age was moderately correlated with MSV in cervical spine extension in patients only (r = 0.63, p < 0.001). There were no significant differences in the prevalence of disc degeneration (CDD) between patients, who had on average mild pain and related disability, and healthy controls (median CDD 2 both groups, p = 0.94). There were also no significant differences in either flexion or extension intervertebral motion-sharing inequality or variability (MSI or MSV) between groups as measured during active cervical motion.

Introduction Chronic migraine is a largely refractory condition affecting between 1 and 2.2% of the overall population worldwide, with females more affected than males. There are also high health and socioeconomic costs associated both for the individual and society. The mainstay of chronic migraine management is pharmacological, but the options available have limited efficacy and there are often unwanted side effects. There is some evidence for manual therapy as a treatment option for migraine, but its effectiveness for chronic migraine is unknown. Therefore, we have designed a pragmatic randomised control trial to investigate whether adding manual therapy to the tertiary specialist treatment of chronic migraine improves patient-reported outcomes. Methods A pragmatic, randomised controlled trial in a hospital tertiary headache clinic . Participants will be randomised into one of two groups: treatment as usual or treatment as usual plus manual therapy. The primary outcome measure will be a change in the Headache Impact Test score. Secondary outcomes will also be measured over the 12-week study period including changes in headache frequency, migraine specific quality of life and reductions in relevant medicine consumption. The manual therapy group will have five treatment sessions each lasting 30 min. The recruitment target of 64 participants will allow power at 80% with p  = 0.05 using minimal clinical difference for Headache Impact Test of 3.7 and includes provision for a 10% dropout rate. Recruitment will take place between August 2018 and February 2019. The results will form part of a doctoral study and be published in peer-reviewed journals and presented at national/international conferences. Discussion Current pharmacological approaches have limited effects in the management of chronic migraine and there is a requirement to improve treatment options and reduce the health and economic burden of the condition. Manual therapy has been shown to be effective in other chronic pain conditions as well as other primary headaches. This study will explore the effectiveness of manual therapy as an adjunctive approach to the management of chronic migraine. Trial registration The trial has received a favourable opinion from the UK Health Research Authority (IRAS 228901) and is registered at ClinicalTrials.gov.number NCT03395457 . Registered 1st March 2018.

Background The association between cervical lordosis (sagittal alignment) and neck pain is controversial. Further, it is unclear whether spinal manipulative therapy can change cervical lordosis. This study aimed to determine whether cervical lordosis changes after a course of spinal manipulation for non-specific neck pain. Methods Posterior tangents of C2 and C6 were drawn on the lateral cervical fluoroscopic images of 29 patients with subacute/chronic non-specific neck pain and 30 healthy volunteers matched for age and gender, recruited August 2011 to April 2013. The resultant angle was measured using ‘Image J’ digital geometric software. The intra-observer repeatability (measurement error and reliability) and intra-subject repeatability (minimum detectable change (MDC) over 4 weeks) were determined in healthy volunteers. A comparison of cervical lordosis was made between patients and healthy volunteers at baseline. Change in lordosis between baseline and 4-week follow-up was determined in patients receiving spinal manipulation. Results Intra-observer measurement error for cervical lordosis was acceptable (SEM 3.6°) and reliability was substantial ICC 0.98, 95 % CI 0.962–0991). The intra-subject MDC however, was large (13.5°). There was no significant difference between lordotic angles in patients and healthy volunteers ( p  = 0.16). The mean cervical lordotic increase over 4 weeks in patients was 2.1° (9.2) which was not significant ( p  = 0.12). Conclusions This study found no difference in cervical lordosis (sagittal alignment) between patients with mild non-specific neck pain and matched healthy volunteers. Furthermore, there was no significant change in cervical lordosis in patients after 4 weeks of cervical spinal manipulation.

Purpose In vivo studies of continuous lumbar sagittal plane motion have found passive intervertebral motion to be more uneven in patients with chronic nonspecific low back pain (CNSLBP) than healthy controls, but the mechanisms are unclear. This study aimed to compare patients with CNSLBP with a matched group of pain-free controls for intervertebral restraint during passive recumbent bending. Methods Seventeen patients with CNSLBP and minimal disc degeneration who had quantitative fluoroscopy investigations were matched to 17 healthy controls from a database acquired using the same imaging protocol. The entire database ( n  = 136) was examined for clustering of peaking times, magnitudes and ROM of the first derivatives of the intervertebral angle/motion curves (PTFD, PMFD and ROM) during flexion and return that might introduce confounding. The groups were then compared for differences in these variables. Results There were significant segmental ROM differences among clusters in the database when PMFD and ROM were used as clustering variables, indicating heterogeneity. However, in the patient–control study, it was PTFD (velocity) that differentiated the groups. At L5-S1, this was at 10.82% of the motion path compared with 25.06% in the controls ( p  = 0.0002). For L4-5, PTFD was at 23.42% of the motion path in patients and 16.33% in controls ( p  = 0.0694) suggesting a reduced initial bending moment there. There were no significant differences for PMFD or ROM. Conclusion Peaking time of passive intervertebral velocity occurs early at L5-S1 in patients with CNSLBP; however, these findings should be treated with caution pending their replication. Future studies should explore relationships with altered disc pressures and biochemistry. Usefulness for monitoring regenerative disc therapies should be considered.