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A comparative investigation of flexion relaxation phenomenon in healthy and chronic neck pain subjects

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Abstract

Purpose

The cervical flexion relaxation phenomenon (FRP) is a neck extensor myoelectric “silence” that occurs during complete cervical and lumbar flexion. In contrast to low back pain, the changes that occur during FRP in chronic neck pain (CNP) patients are still not clear. The aim of this study was to assess the characteristics of this phenomenon in the cervical region in CNP patients and controls.

Methods

Twenty-two women (23 ± 2.62 years) with chronic non-specific neck pain and 21 healthy women (23.4 ± 1.68 years) participated in this study. They accomplished a cervical flexion and extension from neutral position. Neck angle and surface electromyographic activity of cervical erector spinae (CES) and upper trapezius muscles were recorded. Appearance, onset and offset angle of the FRP were analysed and compared between the two groups.

Results

There were significant differences in the appearance of FRP between the two groups (P ≤ 0.001). The FRP in the CES muscles was observed in 85.7 % of healthy subjects and in 36.3 % of CNP patients, and no FRP was observed in the upper trapezius. Results of this study show that the onset and offset of FRP parameters were significantly different between the two groups (P ≤ 0.001).

Conclusions

The results of the present study indicate that FRP in CNP patients was seen less than the healthy subjects, and moreover the FRP period was reduced in CNP patients. Our results also suggest that the changes in FRP of CNP patients may be due to the increased CES activity in these patients.

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References

  1. Viljanen M, Malmivaara A, Uitti J, Rinne M, Palmroos P, Laippala P (2003) Effectiveness of dynamic muscle training, relaxation training, or ordinary activity for chronic neck pain: randomised controlled trial. BMJ 327(7413):475. doi:10.1136/bmj.327.7413.475

    Article  PubMed  Google Scholar 

  2. Ylinen J, Takala EP, Kautiainen H, Nykanen M, Hakkinen A, Pohjolainen T, Karppi SL, Airaksinen O (2004) Association of neck pain, disability and neck pain during maximal effort with neck muscle strength and range of movement in women with chronic non-specific neck pain. Eur J Pain 8(5):473–478. doi:10.1016/j.ejpain.2003.11.005

    Article  PubMed  Google Scholar 

  3. Carroll LJ, Hogg-Johnson S, van der Velde G, Haldeman S, Holm LW, Carragee EJ, Hurwitz EL, Cote P, Nordin M, Peloso PM, Guzman J, Cassidy JD (2008) Course and prognostic factors for neck pain in the general population: results of the bone and joint decade 2000–2010 Task force on neck pain and its associated disorders. Spine (Phila Pa 1976) 33(4 Suppl):S75–S82. doi:10.1097/BRS.0b013e31816445be

    Article  Google Scholar 

  4. Hoving JL, Koes BW, de Vet HC, van der Windt DA, Assendelft WJ, van Mameren H, Deville WL, Pool JJ, Scholten RJ, Bouter LM (2002) Manual therapy, physical therapy, or continued care by a general practitioner for patients with neck pain. A randomized, controlled trial. Ann Intern Med 136(10):713–722. 200205210-00006 [pii]

    Google Scholar 

  5. Falla D (2004) Unravelling the complexity of muscle impairment in chronic neck pain. Man Ther 9(3):125–133. doi:10.1016/j.math.2004.05.003

    Article  PubMed  CAS  Google Scholar 

  6. Airaksinen MK, Kankaanpaa M, Aranko O, Leinonen V, Arokoski JP, Airaksinen O (2005) Wireless on-line electromyography in recording neck muscle function: a pilot study. Pathophysiology 12(4):303–306. doi:10.1016/j.pathophys.2005.09.012

    Article  PubMed  Google Scholar 

  7. Colloca CJ, Hinrichs RN (2005) The biomechanical and clinical significance of the lumbar erector spinae flexion–relaxation phenomenon: a review of literature. J Manip Physiol Ther 28(8):623–631. doi:10.1016/j.jmpt.2005.08.005

    Article  Google Scholar 

  8. Gupta A (2001) Analyses of myo-electrical silence of erectors spinae. J Biomech 34(4):491–496. S002192900000213X [pii]

    Google Scholar 

  9. Floyd WF, Silver PH (1955) The function of the erectores spinae muscles in certain movements and postures in man. J Physiol 129(1):184–203

    PubMed  CAS  Google Scholar 

  10. Pialasse JP, Lafond D, Cantin V, Descarreaux M (2010) Load and speed effects on the cervical flexion relaxation phenomenon. BMC Musculoskelet Disord 11:46. doi:10.1186/1471-2474-11-46

    Article  PubMed  Google Scholar 

  11. Andersson EA, Oddsson LI, Grundstrom H, Nilsson J, Thorstensson A (1996) EMG activities of the quadratus lumborum and erector spinae muscles during flexion–relaxation and other motor tasks. Clin Biomech (Bristol, Avon) 11(7):392–400. 0268003396000332 [pii]

    Google Scholar 

  12. Callaghan JP, Dunk NM (2002) Examination of the flexion relaxation phenomenon in erector spinae muscles during short duration slumped sitting. Clin Biomech (Bristol, Avon) 17(5):353–360. S0268003302000232 [pii]

    Google Scholar 

  13. Kippers V, Parker AW (1984) Posture related to myoelectric silence of erectores spinae during trunk flexion. Spine (Phila Pa 1976) 9(7):740–745

    Article  CAS  Google Scholar 

  14. Olson M, Solomonow M, Li L (2006) Flexion–relaxation response to gravity. J Biomech 39(14):2545–2554. doi:10.1016/j.jbiomech.2005.09.009

    Article  PubMed  Google Scholar 

  15. Geisser ME, Haig AJ, Wallbom AS, Wiggert EA (2004) Pain-related fear, lumbar flexion, and dynamic EMG among persons with chronic musculoskeletal low back pain. Clin J Pain 20(2):61–69

    Article  PubMed  Google Scholar 

  16. Neblett R, Mayer TG, Gatchel RJ, Keeley J, Proctor T, Anagnostis C (2003) Quantifying the lumbar flexion–relaxation phenomenon: theory, normative data, and clinical applications. Spine (Phila Pa 1976) 28(13):1435–1446. doi:10.1097/01.BRS.0000067085.46840.5A

    Google Scholar 

  17. Shirado O, Ito T, Kaneda K, Strax TE (1995) Flexion–relaxation phenomenon in the back muscles. A comparative study between healthy subjects and patients with chronic low back pain. Am J Phys Med Rehabil 74(2):139–144

    Article  PubMed  CAS  Google Scholar 

  18. Sihvonen T, Partanen J, Hanninen O, Soimakallio S (1991) Electric behavior of low back muscles during lumbar pelvic rhythm in low back pain patients and healthy controls. Arch Phys Med Rehabil 72(13):1080–1087

    PubMed  CAS  Google Scholar 

  19. Marshall P, Murphy B (2006) Changes in the flexion relaxation response following an exercise intervention. Spine (Phila Pa 1976) 31(23):E877–E883. doi:10.1097/01.brs.0000244557.56735.05

    Article  Google Scholar 

  20. Murphy BA, Marshall PW, Taylor HH (2010) The cervical flexion–relaxation ratio: reproducibility and comparison between chronic neck pain patients and controls. Spine (Phila Pa 1976) 35(24):2103–2108. doi:10.1097/BRS.0b013e3181cbc7d8

    Article  Google Scholar 

  21. Yoo WG, Park SY, Lee MR (2011) Relationship between active cervical range of motion and flexion–relaxation ratio in asymptomatic computer workers. J Physiol Anthropol 30(5):203–207. JST.JSTAGE/jpa2/30.203 [pii]

    Google Scholar 

  22. Burnett A, O’Sullivan P, Caneiro JP, Krug R, Bochmann F, Helgestad GW (2009) An examination of the flexion–relaxation phenomenon in the cervical spine in lumbo–pelvic sitting. J Electromyogr Kinesiol 19(4):e229–e236. doi:10.1016/j.jelekin.2008.04.015

    Article  PubMed  Google Scholar 

  23. Sarti MA, Lison JF, Monfort M, Fuster MA (2001) Response of the flexion–relaxation phenomenon relative to the lumbar motion to load and speed. Spine (Phila Pa 1976) 26(18):E421–E426

    Article  CAS  Google Scholar 

  24. Netto KJ, Burnett AF (2006) Reliability of normalisation methods for EMG analysis of neck muscles. Work 26(2):123–130

    PubMed  Google Scholar 

  25. Strimpakos N, Georgios G, Eleni K, Vasilios K, Jacqueline O (2005) Issues in relation to the repeatability of and correlation between EMG and Borg scale assessments of neck muscle fatigue. J Electromyogr Kinesiol 15(5):452–465. doi:10.1016/j.jelekin.2005.01.007

    Article  PubMed  Google Scholar 

  26. Sommerich CM, Joines SM, Hermans V, Moon SD (2000) Use of surface electromyography to estimate neck muscle activity. J Electromyogr Kinesiol 10(6):377–398. S105064110000033X [pii]

    Google Scholar 

  27. Mathieu PA, Fortin M (2000) EMG and kinematics of normal subjects performing trunkflexion/extensions freely in space. J Electromyogr Kinesiol 10(3):197–209. S1050-6411(00)00008-0 [pii]

    Google Scholar 

  28. Hush JM, Maher CG, Refshauge KM (2006) Risk factors for neck pain in office workers: a prospective study. BMC Musculoskelet Disord 7:81. doi:10.1186/1471-2474-7-81

    Article  PubMed  Google Scholar 

  29. Pialasse JP, Dubois JD, Choquette MH, Lafond D, Descarreaux M (2009) Kinematic and electromyographic parameters of the cervical flexion–relaxation phenomenon: the effect of trunk positioning. Ann Phys Rehabil Med 52(1):49–58. doi:10.1016/j.rehab.2008.10.002

    PubMed  Google Scholar 

  30. Meyer JJ, Berk RJ, Anderson AV (1993) Recruitment patterns in the cervical paraspinal muscles during cervical forward flexion: evidence of cervical flexion–relaxation. Electromyogr Clin Neurophysiol 33(4):217–223

    PubMed  CAS  Google Scholar 

  31. Panjabi MM (1992) The stabilizing system of the spine. Part I. Function, dysfunction, adaptation, and enhancement. J Spinal Disord 5(4):383–389 (Discussion 397)

    Article  PubMed  CAS  Google Scholar 

  32. Johnston V, Jull G, Darnell R, Jimmieson NL, Souvlis T (2008) Alterations in cervical muscle activity in functional and stressful tasks in female office workers with neck pain. Eur J Appl Physiol 103(3):253–264. doi:10.1007/s00421-008-0696-8

    Article  PubMed  CAS  Google Scholar 

  33. Falla D, Farina D (2008) Neuromuscular adaptation in experimental and clinical neck pain. J Electromyogr Kinesiol 18(2):255–261. doi:10.1016/j.jelekin.2006.11.001

    Article  PubMed  Google Scholar 

  34. Jull G, Kristjansson E, Dall’Alba P (2004) Impairment in the cervical flexors: a comparison of whiplash and insidious onset neck pain patients. Man Ther 9(2):89–94. doi:10.1016/S1356-689X(03)00086-9

    Article  PubMed  CAS  Google Scholar 

  35. Nederhand MJ, Hermens HJ, Ijzerman MJ, Groothuis KG, Turk DC (2006) The effect of fear of movement on muscle activation in posttraumatic neck pain disability. Clin J Pain 22(6):519–525. doi:10.1097/01.ajp.0000202979.44163.da

    Article  PubMed  Google Scholar 

  36. Indahl A, Kaigle AM, Reikeras O, Holm SH (1997) Interaction between the porcine lumbar intervertebral disc, zygapophysial joints, and paraspinal muscles. Spine (Phila Pa 1976) 22(24):2834–2840

    Article  CAS  Google Scholar 

  37. McGorry RW, Lin JH (2012) Flexion relaxation and its relation to pain and function over the duration of a back pain episode. PLoS One 7(6):e39207. doi:10.1371/journal.pone.0039207

    Article  PubMed  CAS  Google Scholar 

  38. Falla D, Bilenkij G, Jull G (2004) Patients with chronic neck pain demonstrate altered patterns of muscle activation during performance of a functional upper limb task. Spine (Phila Pa 1976) 29(13):1436–1440. 00007632-200407010-00011 [pii]

    Google Scholar 

  39. Murphy B, Taylor HH, Marshall P (2010) The effect of spinal manipulation on the efficacy of a rehabilitation protocol for patients with chronic neck pain: a pilot study. J Manipulative Physiol Ther 33(3):168–177. doi:10.1016/j.jmpt.2010.01.014

    Article  PubMed  Google Scholar 

  40. lee m, Yoo W, An D, Kim M, Oh J (2011) The effect of backpack loads on FRR (Flexion–relaxation Ratio) in the cervical spine. J Phys Ther Sci 23(4):599–601

    Article  Google Scholar 

  41. Watson PJ, Booker CK, Main CJ, Chen AC (1997) Surface electromyography in the identification of chronic low back pain patients: the development of the flexion relaxation ratio. Clin Biomech (Bristol, Avon) 12(3):165–171. S026800339700065X [pii]

    Google Scholar 

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Acknowledgments

The authors thank to Dr. Sarrafzadeh for his kind contribution in preparing the drawing.

Conflict of interest

The authors declare no conflict of interest.

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Authors and Affiliations

  1. Department of Physical Therapy, School of Rehabilitation, Tehran University of Medical Sciences, P.O Box 15875-4391, Tehran, Iran

    Nader Maroufi, Amir Ahmadi & Seyedeh Roghayeh Mousavi Khatir

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  1. Nader Maroufi
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  2. Amir Ahmadi
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  3. Seyedeh Roghayeh Mousavi Khatir
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Correspondence to Amir Ahmadi.

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Maroufi, N., Ahmadi, A. & Mousavi Khatir, S.R. A comparative investigation of flexion relaxation phenomenon in healthy and chronic neck pain subjects. Eur Spine J 22, 162–168 (2013). https://doi.org/10.1007/s00586-012-2517-3

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  • DOI: https://doi.org/10.1007/s00586-012-2517-3

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