title: Posteroanterior Movements of the Cervical Spine
Creators: name: Tuttle, Neil
Publisher: name: Griffith University
Year: 2008
Subjects: subject: Posteroanterior (PA) movements
subject: Cervical spine.
subject: Musculoskeletal neck pain

description: Abstract :Posteroanterior (PA) movements are commonly used to assess and treat musculoskeletal neck pain but little is known about their relationship to symptoms or treatment effectiveness. The general purpose of this research program was to determine relationships between the manual therapy techniques known as PA movements of the cervical spine and symptoms in patients with neck pain. The specific aims of the studies were to: • Establish a reliable immediate indicator of symptoms in patients with non-acute neck pain that is a good predictor of longer-term change in symptoms. • Develop and establish the repeatability of a methodology for measuring PA movements of the cervical spine. • Determine how changes in PA movements are related to: o local tenderness as an indicator of potential symptoms in an asymptomatic population and o change in symptoms in a population with non-acute neck pain. In the first two studies change in impairments predicted change in the same impairment both between treatment sessions and by the end of treatment. Change in impairments did not however predict changes in other impairments or activity limitations. Of the impairments considered, change in active range of motion (AROM) was found to be the best predictor of longer-term change in symptoms. In the third study, the repeatability of a custom made Posteroanterior Movement Assessment Device (PMAD) was assessed using coefficients of multiple determination (CMDs) and adjusted CMDs for inter-rater intra-day (Inter-rater), intra-rater inter-day (Inter-day) and intra-rater intra-day (Intra-rater) repeated measurements. The PMAD was found to produce repeatable measurements of PA movements of the cervical spine and maximum repeatability was achieved if the same operator reassessed the patient on the same day. In the fourth study PA movements were measured on each side of the cervical spines of ten asymptomatic subjects. Locations with a difference in tenderness to pressure between sides were used for analysis. The tender side demonstrated greater variation of both displacement and stiffness. The tender sides demonstrated greater within-subject stiffness for all force levels above 12 N. All individual stiffness-force curves of the tender sides were significantly different from the control side. Expected differences in single measures of either displacement or stiffness were not detected. The results suggest that the pattern of stiffness is a more effective method of characterising PA mobility than single measures used in previous studies. In the fifth study one symptomatic and one asymptomatic location were selected in 20 patients with neck pain of more than two weeks duration. PA stiffness at each location and AROM were measured before and after each of four manual therapy interventions consisting of posteroanterior movements to each location, a general treatment and a control intervention. Following treatment to the symptomatic location, PA stiffness at forces above 8 N demonstrated significant correlations with total AROM. Following manual therapy, increased AROM is related to decreased posteroanterior stiffness in patients with neck pain, but only for the treated location and only when that location had been identified previously as symptomatic. Overall findings The results of the studies indicated that change in active range of movement is a good predictor of longer-term change in symptoms. The PMAD provides a repeatable method for measuring PA movements of the cervical spine. Stiffness of PA movements is related to local tenderness in an asymptomatic population. In a symptomatic population, stiffness of PA movements is related to immediate changes in AROM. Immediate changes in AROM are related to between session and end of treatment changes in AROM. Differences in PA stiffness can therefore be considered to be related to symptoms as indicated by local tenderness and changes in PA stiffness can be considered to be related to end of treatment outcomes.