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This study aims to compare the effects of posture education and corrective games on the alignment of the thoracic and cervical spine, as well as the daily habits in children. This is a three-armed individual-randomized trial design of three groups in blinded evaluators. The statistical population of this study was formed by elementary students with malalignments in the thoracic and cervical spine of Baharestan city (Iran). A total of 60 participants were assigned to this study and using a simple random method with computer-generated random numbers divided into posture education group (PE, n  = 20) corrective games group (CG, n  = 20) and control group (CON, n  = 20) groups. Kyphosis angle, forward head posture and forward shoulder posture measured with a flexible ruler, goniometer, and double square, respectively. Also, daily habits measured with students’ daily functional activities questioner. A repeated measures ANOVA analysis of variance (3 × 3, Group×Time) was utilized to analyze data. Significance was set at p  ≤ 0.05. Both the PE and CG showed significant improvements in kyphosis ( p  = 0.01 for PE, p  = 0.02 for CG), forward head posture ( p  = 0.02 for PE, p  = 0.04 for CG), forward shoulder posture ( p  = 0.001 for PE, p  = 0.02 for CG), and daily habits ( p  = 0.02 for PE, p  = 0.03 for CG) after an 8-week training intervention compared to the CON group. Also, after the training period, the analysis revealed no statistically significant differences in the dependent variables between the PE group and the CG, with a p-value greater than 0.05. However, after a 3-month detraining period, the changes in both the PE and CG were found to be statistically insignificant ( p  > 0.05). The interventions effectively enhanced participants’ posture and daily activity patterns, with no significant differences between the PE and CG groups. The sustainability of these improvements indicates that participants developed lasting skills and habits that promote spinal health. This study highlights the importance of integrating educational and engaging physical activities into curricula to support children’s musculoskeletal well-being. Trial registration : IRCT registration number: IRCT20250316065103N1, Registration date: 2025-03-25 (Retrospectively registered), Trial Id: 82539.

Prolonged smartphone use can lead to cervical posture deformities, with cervical extension type being a common condition characterized by increased cervical lordosis, forward head posture, and thoracic kyphosis. These changes may contribute to neck pain, restricted cervical range of motion (ROM), and increased muscle tone. Additionally, cervical extension type is linked to temporomandibular joint (TMJ) dysfunction, affecting mandibular movement and muscle activity. Given the biomechanical connection between the cervical spine and TMJ, addressing cervical dysfunction may benefit TMJ related conditions. This study compared the effects of jaw exercises combined with cervicoscapular exercises versus cervicoscapular exercises alone on mouth opening ROM, mastication muscle properties, and pressure pain threshold (PPT) in individuals with cervical extension type. Thirty-four subjects were randomly assigned to two groups: the experimental group (seventeen subjects) performed jaw exercises combined with cervicoscapular exercises, while the control group (seventeen subjects) performed only cervicoscapular exercises. After 4 weeks, significant improvements were observed in both groups in the mouth opening ROM, muscle properties, and PPT ( p  < 0.05). The experimental group showed significantly greater improvements in protrusive excursion, the masseter muscle tone, and the stiffness of the masseter and temporalis anterior muscles compared to the control group ( p  < 0.025). Both groups demonstrated significant increases in the PPT ( p  < 0.05). These findings suggest that incorporating jaw exercises into cervicoscapular training may provide additional benefits for individuals with cervical extension type, particularly those experiencing temporomandibular joint (TMJ) dysfunction. Further studies are needed to validate these results in a larger and more diverse population.

Background Suboccipital myofascial release (MR) is widely used in manual therapy for addressing cervical dysfunction. However, its specific therapeutic effects remain unclear, especially when compared to sham interventions, raising questions about the roles of contextual and placebo influences. Objective This study aimed to evaluate the immediate effects of suboccipital MR on pain pressure threshold(PPT), cervical range of motion (ROM), and proprioception, while considering the influence of non-specific effects such as placebo and contextual factors. Methods A single-blind, sham-controlled randomized study was conducted with 30 asymptomatic participants (15 per group). The MR group received five minutes of suboccipital myofascial release, while the sham group received light touch without therapeutic pressure.Outcomes included PPT, cervical ROM (flexion, extension, and rotation), and proprioception, measured before and immediately after the intervention. A 2 × 2 mixed ANOVA was used to analyze group × time interaction and main effects. Paired t-tests were used as supportive within-group analyses. Results The MR group showed within-group improvements in PPT (e.g., left-side PPT increased from 7.31 ± 2.58 to 8.67 ± 1.98 kg/cm², p  = 0.028), cervical ROM (e.g., flexion improved from 57.00 ± 9.05° to 64.00 ± 9.60°, p  = 0.0004), and proprioception (e.g., flexion reposition error decreased from 5.77 ± 2.24° to 3.70 ± 2.40°, p  = 0.006). However, no significant group × time interactions were observed for any outcome, suggesting similar changes in both MR and sham groups. Conclusions Suboccipital MR produced significant within-group improvements in PPT, cervical ROM, and proprioception. However, the absence of significant differences between the MR and sham interventions suggests that non-specific or contextual factors may account for the observed effects. Further studies are needed in symptomatic populations with longer follow-up and objective outcome measures to determine the specific efficacy of MR. Trial registration This study was retrospectively registered with ClinicalTrials.gov under the identifier NCT06761391 on January 5, 2025.

The assessment of smoothness, range of motion (ROM), and head repositioning accuracy (HRA) has gained attention in identifying sensorimotor impairments. Uncertainty persists on the approach for acquiring reliable measures, including choice of smoothness metric, normalization factors, and the required number of measurements for reliable results. This study aimed to address this uncertainty. Thirty healthy participants were included in this single-session randomized cross-over study. The experiment consisted of two parts. One focused on the test–retest assessment of head ROM into right rotation to the end of range from a neutral position using a self-selected movement speed and the HRA when returning to the start-position. In the other part, participants repeated the previous tasks and performed head rotations at slower and faster speeds than their self-selected pace and to the beat of a metronome. All tasks were repeated ten times. For the test–retest, the inter-class-correlation (ICC) values for ROM were between 0.84–0.91, 0.20–0.31 for HRA, and 0.65–0.90 for jerk for 1–10 repetitions. Normalizing jerk through vmean and vpeak had similar variability and appeared equally valid for our data. However, normalizing by vmax ensures desirable properties in the smoothness metric. Lower variability was observed when standardizing movements using a metronome. Based on test–retest findings, three repetitions are recommended, as ICC values show marginal improvement beyond 2–3 repetitions, providing limited additional value.

Background The increasing use of smartphones and other digital devices has contributed to a rise in forward head posture (FHP) among younger populations due to prolonged poor neck positioning. The aim of this study was to evaluate the effect of cervical stabilization exercises (CSE) and cervical proprioception training (CPT) on FHP. Methods In this single-blinded randomized controlled trial, where only the outcome assessors were blinded, 99 participants (aged 18–24) with FHP were randomly allocated into three groups: Group-I ( n  = 32), which received no exercises; Group-II ( n  = 34), which received CSE; and Group-III ( n  = 33), which received both CSE and CPT. Groups II and III performed the exercises three times per week for six weeks. The joint position error (JPE) test was used to assess proprioception, the craniovertebral angle (CVA) was used to evaluate posture, and the Stork and Y Balance tests were used to assess balance at baseline and after six weeks. Results: The study included 99 participants (mean age: 18.1–19.6 years; BMI: 21.4–23.1 kg/m²). Technology usage analysis revealed that 19.2% of participants reported > 7 h/day of phone use, while the majority (80.8%) used computers for ≤ 1 h/day. Significant group × time interactions were found for JPE (flexion/extension/rotation, p  < 0.001), with Group III showing superior gains versus Group II and controls ( p  ≤ 0.001). Dynamic balance improved in intervention groups ( p  ≤ 0.04), and CVA increased significantly in Group II/III ( p  ≤ 0.03). Static balance improved over time ( p  < 0.001) but without intergroup differences. No sex-based effects were observed ( p  > 0.05) Conclusions The addition of CPT to CSE was found to be more effective than CSE alone in restoring proper proprioception and balance and in reducing poor posture in individuals with FHP. Trial registration This study is registered with ClinicalTrials.gov website with registration no: NCT06932965, date: 10/04/2025. Retrospectively registered.

Applying a cervical collar during videolaryngoscopic intubation can increase the lifting force required to achieve adequate glottic view, potentially increasing cervical spine motion. We aimed to compared cervical spine motion during videolaryngoscopic intubation between applying only the posterior piece (posterior-only group) and applying both the anterior and posterior pieces (anterior-posterior group) in patients wearing a cervical collar. We conducted a dingle-centre, parallel-group, randomized controlled trial in 102 patients (each group, N = 51). We used a videolaryngoscope (AceScope™, Ace Medical, Seoul, Republic of Korea) with a Macintosh-style blade (AceBlade™, Ace Medical, Seoul, Republic of Korea) for videolaryngoscopic intubation. In each group (posterior-only vs anterior-posterior), we measured cervical spine motion during intubation, defined as change in cervical spine angle (calculated as cervical spine angle at intubation minus that before intubation) at three cervical spine segments on lateral cervical spine radiographs. The differences in mean cervical spine motion during intubation between the posterior-only and anterior-posterior groups were 1.2° (98.3% confidence interval [CI], -0.7 to 3.0), 1.0° (98.3% CI, -0.6 to 2.6), and -0.3° (98.3% CI, -2.2 to 1.7) at the occiput-C1, C1-C2, and C2-C5 segments, respectively. Mean (standard deviation) cervical spine angles at the occiput-C1, C1-C2, and C2-C5 segments in the posterior-only vs anterior-posterior groups were 10.8° (4.2) vs 9.6° (3.3) (P = 0.13), 5.6° (3.0) vs 4.7° (3.5) (P = 0.14), and 1.2° (3.7) vs 1.5° (4.3) (P = 0.74), respectively. Intubation times were shorter in the posterior-only group (median [interquartile range], 23 [19-28] sec vs 33 [20-47] sec; P = 0.003). In patients wearing a cervical collar, the differences in mean cervical spine motions during intubation between applying only the posterior piece and applying both the anterior and posterior pieces were approximately 1°. Intubation times were significantly shorter without the anterior piece of a cervical collar. These findings can be referred to when removal of the anterior piece of a cervical collar is considered to address difficult videolaryngoscopic intubation conditions. CRIS.nih.go.kr ( KCT0008151 ); first submitted 17 January 2023.

Background There is a growing interest concerning the understanding of and rehabilitation of the sagittal configuration of the cervical spine as a clinical outcome. However, the literature on the topic specific to conservative treatment outcomes of patients with chronic myofascial cervical pain syndrome (CMCPS) has not adequately addressed the relationship between cervical sagittal alignment and improved pain, disability and range of motion. Methods A randomized controlled study with a 1-year follow-up. Here, 120 (76 males) patients with chronic CMCPS and defined cervical sagittal posture abnormalities were randomly assigned to the control or an intervention group. Both groups received the Integrated neuromuscular inhibition technique (INIT); additionally, the intervention group received the denneroll cervical traction device. Alignment outcomes included two measures of sagittal posture: cervical angle (CV), and shoulder angle (SH). Patient relevant outcome measures included: neck pain intensity (NRS), neck disability (NDI), pressure pain thresholds (PPT), cervical range of motion using the CROM. Measures were assessed at three intervals: baseline, 10 weeks, and 1 year after the 10 week follow up. Results After 10 weeks of treatment, between group statistical analysis, showed equal improvements for both the intervention and control groups in NRS ( p  = 0.36) and NDI ( p  = 0.09). However, at 10 weeks, there were significant differences between groups favoring the intervention group for PPT ( p <0.001) and all measures of CROM ( p <0.001). Additionally, at 10 weeks the sagittal alignment variables showed significant differences favoring the intervention group for CV p <0.001 and SH ( p <0.001) indicating improved CSA. Importantly, at the 1-year follow-up, between group analysis identified a regression back to baseline values for the control group for the non-significant group differences (NRS and NDI) at the 10-week mark. Thus, all variables were significantly different between groups favoring the intervention group at 1-year follow up: NRS ( p <0.001), NDI ( p <0.001), PPT p <0.001), CROM ( p <0.001), CV ( p <0.001), SH ( p <0.001). Conclusion The addition of the denneroll cervical orthotic to a multimodal program positively affected CMCPS outcomes at long term follow up. We speculate the improved sagittal cervical posture alignment outcomes contributed to our findings. Trial registration Pan African Clinical Trial Registry Clinical Trial Registry: PACTR201801002968301 , registered 11 January 2018 (retrospectively registered).

Anterior cervical discectomy and fusion (ACDF) may be considered to be the gold standard for treatment of symptomatic degenerative disc disease within the cervical spine. However, fusion of the segment may result in progressive degeneration of the adjacent segments. Therefore, dynamic stabilization procedures have been introduced. Among these, artificial disc replacement by disc prosthesis seems to be promising. However, to be so, segmental motion must be preserved. This, again, is very difficult to judge and has not yet been proven. The aim of the current study was to first analyse the segmental motion following artificial disc replacement using a disc prosthesis. A second aim was to compare both segmental motion as well as clinical result to the current gold standard (ACDF). This is a prospective controlled study. Twenty-five patients with cervical disc herniation were enrolled and assigned to either study group (receiving a disc prosthesis) or control group (receiving ACDF, using a cage with bone graft and an anterior plate.) Radiostereometric analysis was used to quantify intervertebral motion immediately as well as 3, 6, 12 and 24 weeks postoperatively. Further, clinical results were judged using visual analogue scale and neuro-examination. Cervical spine segmental motion decreased over time in the presence of disc prosthesis or ACDF. However, the loss of segmental motion is significantly higher in the ACDF group, when looked at 3, 6, 12 and 24 weeks after surgery. We observed significant pain reduction in neck and arm postoperatively, without significant difference between both groups (P > 0.05). Cervical spine disc prosthesis preserves cervical spine segmental motion within the first 6 months after surgery. The clinical results are the same when compared to the early results following ACDF.

Background The popping produced during high-velocity, low-amplitude (HVLA) thrust manipulation is a common sound; however to our knowledge, no study has previously investigated the location of cavitation sounds during manipulation of the upper cervical spine. The primary purpose was to determine which side of the spine cavitates during C1-2 rotatory HVLA thrust manipulation. Secondary aims were to calculate the average number of pops, the duration of upper cervical thrust manipulation, and the duration of a single cavitation. Methods Nineteen asymptomatic participants received two upper cervical thrust manipulations targeting the right and left C1-2 articulation, respectively. Skin mounted microphones were secured bilaterally over the transverse process of C1, and sound wave signals were recorded. Identification of the side, duration, and number of popping sounds were determined by simultaneous analysis of spectrograms with audio feedback using custom software developed in Matlab. Results Bilateral popping sounds were detected in 34 (91.9%) of 37 manipulations while unilateral popping sounds were detected in just 3 (8.1%) manipulations; that is, cavitation was significantly (P < 0.001) more likely to occur bilaterally than unilaterally. Of the 132 total cavitations, 72 occurred ipsilateral and 60 occurred contralateral to the targeted C1-2 articulation. In other words, cavitation was no more likely to occur on the ipsilateral than the contralateral side (P = 0.294). The mean number of pops per C1-2 rotatory HVLA thrust manipulation was 3.57 (95% CI: 3.19, 3.94) and the mean number of pops per subject following both right and left C1-2 thrust manipulations was 6.95 (95% CI: 6.11, 7.79). The mean duration of a single audible pop was 5.66 ms (95% CI: 5.36, 5.96) and the mean duration of a single manipulation was 96.95 ms (95% CI: 57.20, 136.71). Conclusions Cavitation was significantly more likely to occur bilaterally than unilaterally during upper cervical HVLA thrust manipulation. Most subjects produced 3–4 pops during a single rotatory HVLA thrust manipulation targeting the right or left C1-2 articulation; therefore, practitioners of spinal manipulative therapy should expect multiple popping sounds when performing upper cervical thrust manipulation to the atlanto-axial joint. Furthermore, the traditional manual therapy approach of targeting a single ipsilateral or contralateral facet joint in the upper cervical spine may not be realistic.

Background Evidence indicates that supervised home exercises, combined or not with manual therapy, can be beneficial for patients with non-specific chronic neck pain (NCNP). The objective of the study is to investigate the efficacy of preventive spinal manipulative therapy (SMT) compared to a no treatment group in NCNP patients. Another objective is to assess the efficacy of SMT with and without a home exercise program. Methods Ninety-eight patients underwent a short symptomatic phase of treatment before being randomly allocated to either an attention-group (n = 29), a SMT group (n = 36) or a SMT + exercise group (n = 33). The preventive phase of treatment, which lasted for 10 months, consisted of meeting with a chiropractor every two months to evaluate and discuss symptoms (attention-control group), 1 monthly SMT session (SMT group) or 1 monthly SMT session combined with a home exercise program (SMT + exercise group). The primary and secondary outcome measures were represented by scores on a 10-cm visual analog scale (VAS), active cervical ranges of motion (cROM), the neck disability index (NDI) and the Bournemouth questionnaire (BQ). Exploratory outcome measures were scored on the Fear-avoidance Behaviour Questionnaire (FABQ) and the SF-12 Questionnaire. Results Our results show that, in the preventive phase of the trial, all 3 groups showed primary and secondary outcomes scores similar to those obtain following the non-randomised, symptomatic phase. No group difference was observed for the primary, secondary and exploratory variables. Significant improvements in FABQ scores were noted in all groups during the preventive phase of the trial. However, no significant change in health related quality of life (HRQL) was associated with the preventive phase. Conclusions This study hypothesised that participants in the combined intervention group would have less pain and disability and better function than participants from the 2 other groups during the preventive phase of the trial. This hypothesis was not supported by the study results. Lack of a treatment specific effect is discussed in relation to the placebo and patient provider interactions in manual therapies. Further research is needed to delineate the specific and non-specific effects of treatment modalities to prevent unnecessary disability and to minimise morbidity related to NCNP. Additional investigation is also required to identify the best strategies for secondary and tertiary prevention of NCNP. Trial registration ClinicalTrials.gov: NCT00566930