This study aimed to (1) assess the inter-rater reliability of lateral atlantodental distance measurements in digital open-mouth radiographs of infants with upper cervical spine dysfunction, and (2) investigate correlations between lateral atlantodental distance values and clinical findings. 72 digital radiographs of the odontoid region from infants aged 3–12 months were analyzed (Aug 2021–Dec 2023). Lateral atlantodental distance was measured bilaterally by three independent raters. Inter-rater reliability and measurement precision was assessed using intraclass correlation coefficients (ICC), standard error of measurement (SEM), and minimal detectable change (MDC). Side differences were evaluated using paired t-tests. Mean lateral atlantodental distance values were further examined for their association with the clinically assessed side of cervical rotational malposition using logistic regression and receiver operating characteristic (ROC) analysis. Inter-rater reliability was excellent for right (ICC=0.91 [95

Deficient descending pain inhibition assessed by conditioned pain modulation (CPM) is considered a common feature of various chronic pain disorders. Typically, CPM studies focus on one particular disorder making direct comparisons between disorders difficult. This cross-sectional study aimed to compare CPM effects between three clearly distinct chronic pain disorders and pain-free controls. Furthermore, patients were pooled with controls to explore whether subgroups showing different CPM effects could be separated independent of cohort membership. One hundred and forty participants (patients: 53 non-specific chronic low back pain [nsCLBP], 15 complex regional pain syndrome [CRPS], 14 neuropathic pain after spinal cord injury [painSCI]; 58 controls) were included. CPM effects were assessed in a remote, pain-free area using pressure pain thresholds as test stimulus and a cold water bath as conditioning stimulus. Cohort differences in CPM effects were analyzed using linear mixed models. The presence of subgroups showing different CPM effects was tested using latent class linear mixed models. CPM effects differed between cohorts (p = 0.011), driven mainly by reduced inhibitory CPM effects in patients with nsCLBP compared to patients with painSCI. Latent class analysis detected 3 subgroups with varying degrees of significant inhibitory CPM effects (p's ≤ 0.002). All subgroups comprised patients and controls. These results oppose deficient descending pain inhibition as a common feature of chronic pain disorders. Additionally, the failure to identify subgroups without inhibitory CPM effects within a heterogenous patient/control sample challenges the utility of deficient CPM as predictor of chronic pain or treatment efficacy.

Abstract Background Fluctuations in pain intensity are intrinsic to non-specific chronic low back pain (nsCLBP). Nevertheless, pain fluctuations have rarely been considered when investigating pathophysiological mechanisms. Therefore, a novel study protocol was developed and implemented to systematically assess the impact of fluctuating pain states on pain-related measures. Methods The final study cohort consisted of 45 nsCLBP patients and 47 age- and sex-matched healthy controls (HCs). Patients participated in three visits, conducted during different pain states (i.e. clinically relevant pain, low-intensity clinical pain / pain-free, clinically irrelevant pain induced using a Qutenza 8% capsaicin patch). Pain fluctuations were monitored through online assessments every four days and guided the pseudorandomized visit scheduling. HCs participated in a single visit. Each study visit comprised a multimodal battery of pain-related measures. Results 93.33% of patients completed all three visit types in a pseudorandomized order (χ²=1.50, p=0.826). Visit scheduling was possible due to the high self-report adherence (median=93.48%), unrelated to self-report burden (ρ=-0.097, p=0.53). Study visits were conducted during different pain states, as indicated by: i) the significantly higher low back pain intensity in the clinically relevant pain visit (mean[SD]: 3.98[0.90]), compared to the low-intensity clinical pain (1.03[0.86]) and clinically irrelevant pain (1.13[0.82]) visits (p-values<0.001), as well as by ii) the successful induction of a moderate-to-high clinically irrelevant pain across assessments. Conclusion Despite scheduling complexity and pain state transition uncertainty, a pain state-dependent pseudorandomized study design is feasible and could improve the understanding of nsCLBP mechanisms.

BACKGROUND:Neurophysiological assessments might advance the understanding of nonspecific chronic low back pain (nsCLBP) by quantifying altered pain processing and associated autonomic responses. Contact heat-evoked potentials (CHEPs) and sympathetic skin responses (SSRs) were compared between nsCLBP patients and healthy controls (HCs), and their relationships with experimental and clinical pain ratings were explored. METHODS:A total of 56 nsCLBP patients and 40 age- and sex-matched HCs were included in this study. All participants underwent simultaneous recordings of CHEPs and SSRs in response to two blocks of 15 heat stimuli applied at the back (i.e., the patients' clinical pain area) and the hand (nonpainful control area). Participants rated the perceived pain intensity of each contact heat stimulus using a numerical rating scale (0-10). The change of pain ratings, CHEP, and SSR amplitudes between blocks was calculated as habituation index. RESULTS:SSR latencies were prolonged in patients compared to HCs (F = 9.5, p = 0.003) and were shorter after back stimulation compared to hand stimulation (F = 9.6, p < 0.001). No other group differences were observed. Clinical pain intensities in patients correlated (1) with contact heat pain ratings in both areas (back: rho = 0.27, p = 0.041, control area: rho = 0.272, p = 0.042) and (2) inversely with CHEP P2 latencies after hand stimulation (current pain: rho = -0.324, p = 0.019; average 4 weeks: rho = -0.320, p = 0.022). CONCLUSION:Prolonged SSR latencies in nsCLBP might indicate a dysregulated pain-autonomic response. TRIAL REGISTRATION:Clinicaltrials.gov_identifier: NCT04433299.

BACKGROUND:Spinal manipulative therapy uses high-velocity low-amplitude (HVLA) thrusts which are clinically effective, but underlying mechanisms are still unknown. OBJECTIVE:To summarize the evidence for biomechanical effects of HVLA thrusts in asymptomatic and symptomatic humans as well as for a possible link between biomechanical effects and clinical effectiveness. STUDY DESIGN:Systematic review of randomized controlled trials. METHODS:An information specialist conducted systematic literature searches in six databases [Medline (OvidSP), Premedline (PubMed), CINAHL, EMBASE, Cochrane, and Biosis]. Studies were selected by two authors and classified using the revised Cochrane risk-of-bias tool for randomized trials (RoB 2). Results were qualitatively summarized per biomechanical output [range of motion (ROM) according to the spinal region where HVLA thrusts were applied, facet joint gapping, and spinal stiffness]. RESULTS:The thirty-three included studies were heterogeneous regarding participant characteristics, intervention frequency and outcomes. Twenty-seven studies reported on the effects of HVLA thrusts on spinal ROM. There is evidence increased cervical ROM following cervical HVLA thrusts on cervical ROM [9/15 studies with a positive treatment effect (5 low risk of bias/4 some concern) and increased cervical ROM following thoracic HVLA thrusts [8/8 studies (4 low risk of bias/4 some concern)]. The effects of a thoracic and lumbar HVLA thrusts on the respective ROM were less clear. Three (2 low risk/1 some concern) studies on facet joint gapping showed increased gapping following HVLA thrusts compared to side-posture positioning, and a single study (some concern) on spinal stiffness showed no effect of HVLA thrusts. Only one study (some concern) linked the biomechanical to clinical outcomes. CONCLUSION:HVLA thrusts, either applied to the cervical or the thoracic spine, appear to increase cervical ROM, based on studies with low risk and studies with some concern regarding risk of bias. For all other outcomes, the included studies were too heterogeneous and too few to draw any sound conclusion. Future studies on the biomechanical effects of HVLA thrusts should link the biomechanical to clinical outcomes such as pain and disability. PROSPERO REGISTRATION:CRD42018096963.

Mechanisms underlying chronic pain are insufficiently understood, hampering effective treatment approaches. Preclinical evidence suggests a potential contribution of decreased excitatory (glutamatergic) and increased inhibitory (γ-aminobutyric acid [GABA]ergic) neurotransmission in the periaqueductal gray (PAG), a key descending pain modulatory brainstem area. This magnetic resonance spectroscopy (MRS) study investigated (1) whether a lower excitatory/inhibitory balance is also observed in the PAG of patients with nonspecific chronic low back pain (CLBP) and (2) whether the excitatory/inhibitory balance relates to psychophysical measures of descending pain modulation and pain sensitivity. Magnetic resonance spectroscopy was acquired on a 3T MR system in 41 patients with CLBP and 29 age- and sex-matched controls. Descending pain modulation and pain sensitivity were evaluated using conditioned pain modulation and pressure pain stimuli, respectively, which were both assessed at the lower back as the most painful area and the nondominant hand as a pain-free, remote area. Patients with CLBP presented with a lower glutamate + glutamine (Glx)/GABA ratio compared with controls ( P = 0.002), driven by both decreased Glx ( P = 0.012) and increased GABA ( P = 0.038). Controls with lower Glx/GABA were more sensitive to pressure pain in both areas, but this association was missing in the patients (lower back: P = 0.004; hand: P = 0.002). Patients with more severe clinical pain showed impaired descending pain modulation at the hand ( P = 0.003). In line with preclinical evidence, these findings support a dysregulated PAG in patients with CLBP that might be associated with dysfunctional descending pain inhibition.

Background: We aimed to assess (1) the awareness of parents regarding the cervical rotation preference of their infant and the agreement of the parent, clinician and objective assessments, and (2) the test–retest reliability for objective (measured) rotation, lateral flexion and combined flexion–rotation. Methods: This was a cross-sectional study including 69 infants aged three to six months with upper cervical spine dysfunction, without general health issues or specific cervical spine impairments. No treatment was applied. The primary outcomes were parent and clinician assessments of cervical spine rotation preference. The secondary outcome was the cervical range of motion measured by inertial measurement units (IMUs) at two different timepoints. Spearman correlation was performed for the parent, clinician and objective assessments. IMU data were dichotomized into the preferred and unpreferred sides, and test–retest reliability was assessed (ICC). Results: The mean age of infants was 145 days ± 29.1 days, birth length 49.40 cm ± 2.7 cm, birth weight 3328 g ± 530.9 g and 24 were female. In total, 33 infants were assessed by their parents as right-preferred, 30 as left-preferred and 6 as having no preference. The clinician assessed 38 infants as right-preferred and 31 as left-preferred. The correlation between parents and the clinician was rs = 0.687 (p < 0.001), the clinician and the IMU rs = 0.408 (p = 0.005) and parents and the IMU rs = 0.301 (p = 0.044). The ICC of cervical range of motion measurements ranged from poor to moderate. Conclusions: Clinicians can use the parents’ assessment of cervical spine rotation preference as a foundation for their clinical examination. IMU measurements are difficult in infants, possibly due to their lack of cooperation during measurements. Clinical Trial Registration Number: clinicaltrails.gov (NCT04981782).

Introduction:In 85% of patients with chronic low back pain (CLBP), no specific pathoanatomical cause can be identified. Besides primary peripheral drivers within the lower back, spinal or supraspinal sensitization processes might contribute to the patients' pain. Objectives:The present study conceptualized the most painful area (MP) of patients with nonspecific CLBP as primarily affected area and assessed signs of peripheral, spinal, and supraspinal sensitization using quantitative sensory testing (QST) in MP, a pain-free area adjacent to MP (AD), and a remote, pain-free control area (CON). Methods:Fifty-nine patients with CLBP (51 years, SD = 16.6, 22 female patients) and 35 pain-free control participants individually matched for age, sex, and testing areas (49 years, SD = 17.5, 19 female participants) underwent a full QST protocol in MP and a reduced QST protocol assessing sensory gain in AD and CON. Quantitative sensory testing measures, except paradoxical heat sensations and dynamic mechanical allodynia (DMA), were Z-transformed to the matched control participants and tested for significance using Z-tests (α = 0.001). Paradoxical heat sensations and DMA occurrence were compared between cohorts using Fisher's exact tests (α = 0.05). The same analyses were performed with a high-pain and a low-pain CLBP subsample (50% quantile). Results:Patients showed cold and vibration hypoesthesia in MP (all Ps < 0.001) and mechanical hyperalgesia (P < 0.001) and more frequent DMA (P = 0.044) in AD. The results were mainly driven by the high-pain CLBP subsample. In CON, no sensory alterations were observed. Conclusion:Mechanical hyperalgesia and DMA adjacent to but not within MP, the supposedly primarily affected area, might reflect secondary hyperalgesia originating from spinal sensitization in patients with CLBP.

Introduction: Once more, plans are underway to send humans to the Moon or possibly even to Mars. It is therefore, important to know potential physiological effects of a prolonged stay in space and to minimize possible health risks to astronauts. It has been shown that spinal motor control strategies change during microgravity induced by parabolic flight. The way in which spinal motor control strategies change during partial microgravity, such as that encountered on the Moon and on Mars, is not known. Methods: Spinal motor control measurements were performed during Earth, lunar, Mars, and micro-gravity conditions and two hypergravity conditions of a parabola. Three proxy measures of spinal motor control were recorded: spinal stiffness of lumbar L3 vertebra using the impulse response, muscle activity of lumbar flexors and extensors using surface electromyography, and lumbar curvature using two curvature distance sensors placed at the upper and lower lumbar spine. The participants were six females and six males, with a mean age of 33 years (standard deviation: 7 years). Results: Gravity condition had a statistically significant (Friedmann tests) effect spinal stiffness (p < 0.001); on EMG measures (multifidus (p = 0.047), transversus abdominis (p < 0.001), and psoas (p < 0.001) muscles) and on upper lumbar curvature sensor (p < 0.001). No effect was found on the erector spinae muscle (p = 0.063) or lower curvature sensor (p = 0.170). Post hoc tests revealed a significant increase in stiffness under micro-, lunar-, and Martian gravity conditions (all p's < 0.034). Spinal stiffness decreased under both hypergravity conditions (all p's ≤ 0.012) and decreased during the second hypergravity compared to the first hypergravity condition (p = 0.012). Discussion: Micro-, lunar-, and Martian gravity conditions resulted in similar increases in spinal stiffness, a decrease in transversus abdominis muscle activity, with no change in psoas muscle activity and thus modulation of spinal motor stabilization strategy compared to those observed under Earth's gravity. These findings suggest that the spine is highly sensitive to gravity transitions but that Lunar and Martian gravity are below that required for normal modulation of spinal motor stabilization strategy and thus may be associated with LBP and/or IVD risk without the definition of countermeasures.

Mechanisms underlying chronic pain are insufficiently understood. Preclinical evidence suggests a potential contribution of excitatory glutamatergic and inhibitory GABAergic imbalances in pain-relevant brain areas, such as a lower excitatory/inhibitory tone in the brainstem periaqueductal grey (PAG). This cross-sectional magnetic resonance spectroscopy (MRS) study investigated whether a lower excitatory/inhibitory tone is also observed in the PAG of patients with non-specific chronic low back pain (CLBP) and whether this would relate to altered psychophysical measures of descending pain modulation and experimental pressure pain sensitivity. Specifically, the ratio between pooled glutamate and glutamine and GABA levels (Glx/GABA), Glx and GABA in the PAG were compared between CLBP patients and pain-free controls. Further, associations of Glx/GABA with conditioned pain modulation (CPM) effects and pressure pain thresholds (PPTs) were assessed.MRS was acquired on a 3T Philipps MR system using a point-resolved spectroscopy sequence optimized with very selective saturation pulses (OVERPRESS) and voxel-based flip angle calibration in a 1.1 mL volume of interest. Data from 41 CLBP patients (median [interquartile range]: 54 years [41 - 65], 22 females) and 29 age- and sex-matched controls (47 years [34 - 67], 17 females) fulfilled MRS quality criteria. CPM and PPTs were assessed at the lower back as most painful area and the non-dominant hand as pain-free control area. The CPM paradigm consisted of PPTs applied before, during (parallel CPM effect) and after a cold water bath and an ambient temperature water bath as control paradigm to identify ‘true’ CPM effects.In the PAG of CLBP patients, a lower Glx/GABA ratio, i.e. a lower excitatory/inhibitory tone, was observed ( P = 0.002, partial η2 = 0.14) driven by decreased Glx ( P = 0.012, partial η2 = 0.11) and increased GABA ( P = 0.038, d = 0.46). CLBP patients showed disrupted associations between Glx/GABA and PPTs compared to controls in both areas (lower back: P = 0.004, partial η2 = 0.12; hand: P = 0.002, partial η2 = 0.16). In controls, lower Glx/GABA was associated with lower PPTs (lower back: r = 0.48, P = 0.009, hand: r = 0.53, P = 0.003), but this link was missing in CLBP patients ( r’s > -0.23, P’s > 0.150). Additionally, CLBP patients with more severe clinical pain showed smaller CPM effects at the hand ( rho = 0.54, P = 0.003).These findings suggest a dysfunction of the PAG in patients with CLBP and might indicate altered descending inhibition of deep tissue afferents.### Competing Interest StatementThe authors have declared no competing interest.### Funding StatementThis study was funded by the Clinical Research Priority Program "Pain" of the University of Zurich. L. Sirucek is supported by the Theodor und Ida Herzog-Egli Stiftung. The authors express their gratitude to Emma Louise Kessler, MD, for her generous donation to the Zurich Institute of Forensic Medicine, University of Zurich, Switzerland.### Author DeclarationsI confirm all relevant ethical guidelines have been followed, and any necessary IRB and/or ethics committee approvals have been obtained.YesThe details of the IRB/oversight body that provided approval or exemption for the research described are given below:Ethics committee of "Kantonale Ethikkommission Zurich" gave ethical approval for this work (Nr.: 2019-00136).I confirm that all necessary patient/participant consent has been obtained and the appropriate institutional forms have been archived, and that any patient/participant/sample identifiers included were not known to anyone (e.g., hospital staff, patients or participants themselves) outside the research group so cannot be used to identify individuals.YesI understand that all clinical trials and any other prospective interventional studies must be registered with an ICMJE-approved registry, such as ClinicalTrials.gov. I confirm that any such study reported in the manuscript has been registered and the trial registration ID is provided (note: if posting a prospective study registered retrospectively, please provide a statement in the trial ID field explaining why the study was not registered in advance).YesI have followed all appropriate research reporting guidelines, such as any relevant EQUATOR Network research reporting checklist(s) and other pertinent material, if applicable.YesData of participants who gave informed consent for further use of their anonymized data will be made available upon request.

The aim of our study was (I) To compare back muscle oxygenation and perfusion as well as Biering–Sorensen muscle endurance (BSME) test holding times between chronic non-specific low back pain (CNSLBP) patients and asymptomatic controls matched for age, body mass index (BMI), sex and physical activity, and (II) to investigate factors associated with BSME holding times. Muscle perfusion (tHb) and oxygenation (SmO 2 ) were measured by near-infrared spectroscopy (NIRS) based oximetry in three back muscles during the BSME. Reliability of tHb and SmO 2 was assessed in a separate sample. BSME holding time and SmO 2 were compared between patients (n = 45) and controls (n = 45) and factors associated with BSME holding time were assessed using multiple linear regression. Reliability for SmO 2 was excellent (ICC = 0.87–0.99). THb showed poor to moderate reliability and was not further used. Groups differed for BSME holding time ( P = 0.03), pain intensity ( P ≤ 0.0005) and subcutaneous tissue thickness ( P = 0.01) but not for NIRS measures. Physical activity and BMI were associated with BSME holding times. Insufficient muscle oxygenation does not seem to be a major factor contributing to CNSLBP. Future investigation should evaluate other determinants of BSME holding times, such as motivation and recruitment of auxiliary muscles.

Abstract Background The need for an efficient and feasible strategy to deal with neck pain has a high priority for many countries. Validated assessment tools like the Neck Disability Index (NDI) to evaluate the functional status of a neck pain patient are urgently needed to treat and to follow-up patients purposefully. A German version (NDI-G) was shown to be valid and reliable, but has so far not been tested for responsiveness. The aim of this study was to evaluate the NDI-G`s responsiveness. Methods This was a prospective cohort study with a seven-week follow-up. Fifty chronic neck pain patients filled out NDI-G twice. Additionally, the Patients’ Global Impression of Change score (PGIC) was assessed at follow-up. Wilcoxon and Spearman tests were used to assess direction and strength of the association between the change in NDI-G and PGIC. The receiver operating characteristics method and the area under the curve (AUC) were calculated to assess sensitivity and specificity of the NDI-G change over time. Results The Wilcoxon test showed statistically significant differences for NDI-G at baseline and follow-up in the total sample, the “clinically improved” and “clinically not improved” subgroups as indicated in the PGIC. Spearman test resulted in a moderate correlation between the NDI-G and the PGIC (rS = -0.53, p = 0.01) at follow-up. AUC showed an acceptable discrimination [AUC = 0.78 (95% confidence interval 0.64 – 0.91)] of the NDI-G, with a cutoff score of 1.5, between clinically improved and clinically not improved patients, based on the PGIC. Conclusions The NDI-G is responsive to change in chronic neck pain. Together with the results of a previous study on its validity and reliability, the NDI-G can be recommended for research and clinical settings in patients with neck pain in German speaking countries. Trial registration NCT02676141. February 8, 2016.

BACKGROUND:Unlike Western opera singing, Carnatic singing requires powerful low pitched, loud voice. Singing in the right Shruti or pitch and appropriate breathing is given the main emphasis in this style of music. The present study was conducted to explore the prevalence of and possible risk factors for the self-reported voice problem (VP) in Carnatic singers.METHOD:This cross-sectional survey was conducted by distributing the self-reporting questionnaires to 190 Carnatic singers in and around the Mysuru and Bengaluru districts of Karnataka state, India, from December 2016 to April 2017.RESULTS:The Carnatic singers were found to have high career (35%) and point (23%) prevalence rates of VP. Clenching of teeth, frequent cold, difficulty in hearing, stress related to the profession, and regular intake of medications for different health-related problems were some of the risk factors found to have a significant association with high prevalence of self-reported VPs. Around 22% of the Carnatic singers missed at least 2-5 singing performances due to VP during their career.CONCLUSIONS:Overall, the results of this study reveal a high prevalence rate of self-reported VP in Carnatic singers, and they also suggest that the VPs are associated with different risk factors like any other form of singers. Further studies are needed to understand the effect of VP and to prevent it in this group of professional voice users.

The objective of this study was to determine the response of the lumbar spinal motor control in different gravitational conditions. This was accomplished by measuring indicators of lumbar motor control, specifically lumbar spinal stiffness, activity of lumbar extensor and flexor muscles and lumbar curvature, in hypergravity and microgravity during parabolic flights. Three female and five male subjects participated in this study. The mean age was 35.5 years (standard deviation: 8.5 years). Spinal stiffness of the L3 vertebra was measured using impulse response; activity of the erector spinae, multifidi, transversus abdominis, and psoas muscles was recorded using surface electromyography; and lumbar curvature was measured using distance sensors mounted on the back-plate of a full-body harness. An effect of gravity condition on spinal stiffness, activity of all muscles assessed and lumbar curvature (p’s < 0.007) was observed (Friedman tests). Post hoc analysis showed a significant reduction in stiffness during hypergravity (p < 0.001) and an increase in stiffness during microgravity (p < 0.001). Activity in all muscles significantly increased during hypergravity (p’s < 0.001). During microgravity, the multifidi (p < 0.002) and transversus abdominis (p < 0.001) increased significantly in muscle activity while no significant difference was found for the psoas (p = 0.850) and erector spinae muscles (p = 0.813). Lumbar curvature flattened in hypergravity as well as microgravity, albeit in different ways: during hypergravity, the distance to the skin decreased for the upper (p = 0.016) and the lower sensor (p = 0.036). During microgravity, the upper sensor showed a significant increase (p = 0.016), and the lower showed a decrease (p = 0.005) in distance. This study emphasizes the role of spinal motor control adaptations in changing gravity conditions. Both hypergravity and microgravity lead to changes in spinal motor control. The decrease in spinal stiffness during hypergravity is interpreted as a shift of the axial load from the spine to the pelvis and thoracic cage. In microgravity, activity of the multifidi and of the psoas muscles seems to ensure the integrity of the spine. Swiss (BASEC-NR: 2018-00051)/French “EST-III” (Nr-ID-RCB: 2018-A011294-51/Nr-CPP: 18.06.09).

Study Design. Mixed-method. Objective. To evaluate the association between objective and subjective cervical range of motion (ROM) among patients with neck pain, and to assess the awareness of impairments. Summary of Background Data. Cervical ROM is frequently used to evaluate neck pain, but it is also important to know what a patient expects from treatment, because this can profoundly affect treatment outcomes and patient satisfaction. Methods. We used a cervical ROM instrument, the Neck Disability Index (NDI), and a self-administered ROM questionnaire for the neck (S-ROM-Neck). Ten patients took part in semi-structured interviews. Correlations were analyzed using Spearman rank order correlations (rs). Differences between patient and assessor were evaluated by the Mann-Whitney U test. Qualitative data were analyzed by content analysis. Results. Thirty participants (mean age 43.80 years; 21 females) were included. The correlation (rs) for the S-ROM-Neck between patient and assessor was 0.679 [95% confidence interval (95% CI) 0.404–0.884; P = 0.000]. The correlation between the NDI and S-ROM-Neck was 0.178 (95% CI −0.233 to -0.533; P = 346) for the assessor and −0.116 (95% CI −0.475 to −0.219, P = 0.541) for the patient (U = 448, z = −0.030, P = 0.976). Qualitative analysis revealed that patients had general restrictions in daily life and with specific movements, but that they adjusted their behavior to avoid impairment. Conclusion. There was a significant correlation between patient and therapist ratings of cervical spine mobility. Although patients experience restriction while moving and are impaired in specific activities, they adjust their lifestyle to accommodate their limitations. Level of Evidence: 4

Background: Cervical spine (CS) range of motion (ROM) is commonly used to assess neck pain. However, this measurement is often limited by the clinician's experience and perception. Therefore, the integration of perceptual feedback of the patient can optimize and personalize treatment. Objective: Develop and validate a questionnaire (S-ROM-Neck) to evaluate ROM of the CS from the patient's perspective. Design: Validation study. Methods: The assessment tool was developed and optimized during pretest sessions. Reliability and construct validity of the questionnaire were tested. 50 participants (age > 18 years) with neck pain for > 90 days, able to fluently speak, read, and write in German were included. Exclusion criteria included any condition that limited manual therapy to the CS. Participants completed S-ROM-Neck twice within seven days, along with the visual analogue scale (VAS) for pain intensity and the German version of the Neck Disability Index (NDI-G). The relative reliability, internal consistency, and absolute reliability were analyzed, and Bland-Altman plots were generated. Construct validity was established by correlating the total score of S-ROM-Neck with VAS and NDI-G based on pre-set hypotheses. Results: S-ROM-Neck demonstrated moderate reliability with an intraclass correlation coefficient of 0.718 (Cronbach's alpha of 0.83). There was a medium negative correlation between VAS and S-ROM-Neck [Spearman's rank correlation coefficient (r(s) ) = - 0.30, p = 0.031] and the NDI-G and S-ROM-Neck (r(s) = - 0.40, p = 0.002). Conclusions: These results indicate the reliability and internal consistency of S-ROM-Neck. This scale provides patient feedback and perspectives to optimize assessment of neck pain.

INTRODUCTION:The purpose of this study was to analyze posterior-to-anterior spinal stiffness in Earth, hyper-, and microgravity conditions during both prone and upright postures.CASE REPORT:During parabolic flight, the spinal stiffness of the L3 vertebra of a healthy 37-yr-old man was measured in normal Earth gravity (1.0 g), hypergravity (1.8 g), and microgravity (0.0 g) conditions induced in the prone and upright positions. Differences in spinal stiffness were significant across all three gravity conditions in the prone and upright positions. Most effect sizes were large; however, in the upright posture, the effect size between Earth gravity and microgravity was medium. Significant differences in spinal stiffness between the prone and upright positions were found during Earth gravity and hypergravity conditions. No difference was found between the two postures during microgravity conditions.DISCUSSION:Based on repeated measurements of a single individual, our results showed detectable changes in posterior-to-anterior spinal stiffness. Spinal stiffness increased during microgravity and decreased during hypergravity conditions. In microgravity conditions, posture did not impact spinal stiffness. More data on spinal stiffness in variable gravitational conditions is needed to confirm these results.Swanenburg J, Meier ML, Langenfeld A, Schweinhardt P, Humphreys BK. Spinal stiffness in prone and upright postures during 0-1.8 g induced by parabolic flight. Aerosp Med Hum Perform. 2018; 89(6):563-567.

Objectives To validate the German version of OMPSQ (OMPSQ-G) for patients with chronic neck pain. Results After translating OMPSQ to German, we assessed the discriminant validity between patients and healthy adults. Convergent validity was assessed using Pearson’s correlation coefficients between domains of OMPSQ-G and the German version of neck disability index (NDI-G) and visual analogue scale (VAS) of neck pain intensity. Floor and ceiling effects, internal consistency, test–retest and relative reliability were assessed. Fifty patients with chronic neck pain (mean age, 43.6 years; 34 females) and 24 healthy adults (mean age, 50.4 years; 18 females) participated. Mann–Whitney U tests showed significant differences in OMPSQ scores between both groups at the baseline (z = − 4.6; p < 0.001) and second time point (z = − 4.8; p < 0.001). OMPSQ-G scores highly and moderately correlated with NDI-G (ρ = 0.70) and VAS (ρ = 0.41) scores, respectively. There were no floor or ceiling effects. Cronbach’s alpha was 0.94. OMPSQ-G showed high reliability (intraclass correlation 2.1: 0.93; standard error of measurement, 6.9; smallest detectable change, 20 points). The Bland–Altman plot indicated no systematic error. OMPSQ-G showed good validity and reliability in patients with neck pain. Trial registration NCT02540343

Background: Manipulations of the thoracic spine are a common treatment option in patients with neck pain. This approach avoids the risk of cervical arterial dissection. Currently there are different options available which have been evaluated for their efficacy. The aim of this study was to assess short- and long-term effects of two different methods of manipulating the thoracic spine in combination with a standardized exercise program for neck pain. Methods: This pilot study included patients who were over 18 years of age, able to speak and read German or English, had acute or chronic neck pain, and had not previously undergone manual therapy for the thoracic spine. Patients were recruited from private physical therapy practices. Patients were randomly assigned to two treatment groups by using block randomization. The objective was to compare the effects of manually performed manipulations and electromechanical manipulations on the thoracic spine in patients with neck pain. Primary outcome was the visual analogue pain rating scale. Secondary outcomes included Neck Disability Index, European Quality of Life scale, and Patients’ Global Impression of Change Scale. Results: Ten patients were recruited. Five patients received manual manipulations, and five received electromechanical manipulations. Both groups showed an improvement in pain scores (VAS) (X2 (5) = 14.161, p = 0.015) with no difference between the groups. There were no significant changes in the secondary outcomes. The electromechanical (Impulse iQ®) manipulations group showed a clinically relevant reduction in the neck disability index. Conclusion: Both manual and electromechanical manipulations are well tolerated, and show that they can be both successful treatments for neck pain in combination with exercises. Thoracic manipulations seem to be beneficial for the patient’s complaint of neck pain, while electromechanical manipulations seem to be able to reduce neck disability. Trial registration: Current Controlled Trials ISRCTN88585962, registered in January 2013.