Accessory Movements and Associated Factors During Active Cervical Range of Motion

NCT ID: NCT07267507

Last Updated: 2025-12-05

Basic Information

• Recruitment Status: ACTIVE_NOT_RECRUITING
• Total Enrollment: 180 participants
• Study Classification: OBSERVATIONAL
• Study Start Date: 2024-04-30
• Study Completion Date: 2026-01-15

Brief Summary

This project aims to quantify accessory movements that occur during cervical range of motion (ROM) assessment in young adults and to examine their relationship with functional and psychological factors. Although cervical ROM is widely used in clinical practice, accurate measurement is challenged by the complex anatomy of the cervical spine and coupled movements, which may alter true motion values. Despite their clinical relevance, accessory movements have been largely overlooked in both research and routine assessment.

This cross-sectional observational study will include volunteers aged 18-30 years, recruited between January and August 2025 following ethical approval. Individuals with cervical trauma or surgery, neurological disease, recent treatment, musculoskeletal injury, or medications affecting movement will be excluded. Accessory movements will be measured using the CROM device while participants perform flexion-extension, lateral flexion, and rotation, maintaining end-range for 20 seconds to record primary and accessory motions.

Clinical outcomes will include cervical disability (Neck Disability Index), pain intensity (Visual Analog Scale), cervical mechanosensitivity (pressure algometry at the upper trapezius and C2-C7 regions), psychological status (Depression, Anxiety, Stress Scale-21), and sleep quality (Pittsburgh Sleep Quality Index).

Detailed Description

Range of motion (ROM) is a routinely accepted parameter used by physiotherapists and other health professionals in the evaluation of spinal movements, serving as both a baseline and outcome measure for documenting disability and the effects of interventions, as well as for adjusting physiotherapy treatment plans. However, due to the complex anatomy of the cervical spine and its associated movements, accurate measurement of cervical ROM remains challenging.

A variety of tools have been developed to assess cervical mobility, ranging from simple visual inspection to advanced three-dimensional motion analysis systems, including goniometers, inclinometers, CROM devices, Optotrak and Vicon systems, radiographic techniques, and smartphone applications.

The anatomy of the cervical spine and the presence of "coupled movements" make the measurement of cervical ROM particularly difficult. Coupled movements refer to accessory motions that accompany a primary target movement. For example, when an individual flexes the head forward while simultaneously rotating it laterally, flexion is considered the primary movement, whereas the accompanying lateral flexion and axial rotation are accessory movements. The complex structure of the functional units of the cervical spine permits the combination of multi-axial movements rather than isolated single-axis motions. Movements of adjacent vertebrae are guided by the geometry of the articular surfaces, which allows the combination of ipsilateral rotation with lateral flexion. At the lower cervical levels, the orientation of the apophyseal joints and the presence of cervical lordosis may lead lateral flexion to be accompanied by ipsilateral rotation and slight extension. Other studies have emphasized the variability in movement patterns that arise due to the presence of these coupled motions, even during simple tasks. Additionally, research has demonstrated that accessory movements can cause substantial variation in the magnitude of the primary movement.

At the structural level of the cervical spine, multiple movement strategies may be used to achieve a specific functional goal. The number of studies describing accessory movements as involuntary patterns developed in the presence of cervical pain is limited, and those that exist vary depending on the measurement technique and participant characteristics. By revealing the impact of often-neglected accessory movements during the assessment of active cervical ROM, the present project aims to introduce conceptual and methodological innovations to cervical mobility evaluation methods. Considering the scarcity of research on this topic, the proposed project will provide a unique contribution to clinical assessment and treatment strategies.

To the best of our knowledge, although there are a limited number of studies investigating the presence of accessory movements during cervical ROM measurement, no research has explored the factors associated with these movements. A better understanding of the characteristics of ROM impairments may help clarify the clinical significance of these relationships. However, in both the literature and clinical practice, the magnitude of accessory movements occurring during cervical ROM has generally been overlooked. The present project addresses this important gap by quantifying accessory movements and, for the first time, comprehensively examining their relationship with both physical and psychological limitations in young individuals. In this context, the project is expected to contribute to the development of more specific and individualized treatment algorithms for individuals with cervical spine dysfunction.

Conditions

Asymptomatic Condition; Neck Pain

Study Design

• Observational Model Type: OTHER
• Study Time Perspective: CROSS_SECTIONAL

Study Groups

Proprioceptive Dysfunction Group

Individuals with proprioceptive error (more than 4 degree)

No interventions assigned to this group

Non-Error Group

Individuals without proprioceptive error-less than 4 degree

No interventions assigned to this group

Eligibility Criteria

Inclusion Criteria

Are between 18 and 30 years of age

Volunteer to participate in the study

Provide written informed consent.

Exclusion Criteria

A history of cervical trauma

A history of cervical spine surgery

Any neurological disorder

Received treatment related to the cervical region within the past 6 months

Any musculoskeletal injury that may affect cervical movement

Use of medications that could influence movement or neuromuscular function.

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• Minimum Eligible Age: 18 Years
• Maximum Eligible Age: 35 Years
• Eligible Sex: ALL
• Accepts Healthy Volunteers: Yes

Sponsors

Atılım University

OTHER

Sponsor Role: lead

Responsible Party

Nagihan Acet

Asst. Prof.

Responsibility Role: PRINCIPAL_INVESTIGATOR

Locations

Atılım University

Ankara, Ankara, Turkey (Türkiye)

Countries

Turkey (Türkiye)

References

Ağargün, M.Y., H. Kara, and Ö. Anlar, The validity and reliability of the Pittsburgh Sleep Quality Index. Turk Psikiyatri Derg, 1996. 7(2): p. 107-15.

Reference Type: BACKGROUND

Buysse DJ, Reynolds CF 3rd, Monk TH, Berman SR, Kupfer DJ. The Pittsburgh Sleep Quality Index: a new instrument for psychiatric practice and research. Psychiatry Res. 1989 May;28(2):193-213. doi: 10.1016/0165-1781(89)90047-4.

Reference Type: BACKGROUND

PMID: 2748771 (View on PubMed)

Sariçam, H., The psychometric properties of Turkish version of Depression Anxiety Stress Scale-21 (DASS-21) in health control and clinical samples. Journal of Cognitive Behavioral Psychotherapies and Research, 2018. 7(1): p. 19.

Reference Type: BACKGROUND

Lovibond, S.H., Manual for the depression anxiety stress scales. Sydney psychology foundation, 1995.

Reference Type: BACKGROUND

McCormack HM, Horne DJ, Sheather S. Clinical applications of visual analogue scales: a critical review. Psychol Med. 1988 Nov;18(4):1007-19. doi: 10.1017/s0033291700009934.

Reference Type: BACKGROUND

PMID: 3078045 (View on PubMed)

Vernon H, Mior S. The Neck Disability Index: a study of reliability and validity. J Manipulative Physiol Ther. 1991 Sep;14(7):409-15.

Reference Type: BACKGROUND

PMID: 1834753 (View on PubMed)

Aslan E, Karaduman A, Yakut Y, Aras B, Simsek IE, Yagly N. The cultural adaptation, reliability and validity of neck disability index in patients with neck pain: a Turkish version study. Spine (Phila Pa 1976). 2008 May 15;33(11):E362-5. doi: 10.1097/BRS.0b013e31817144e1.

Reference Type: BACKGROUND

PMID: 18469684 (View on PubMed)

Law EY, Chiu TT. Measurement of cervical range of motion (CROM) by electronic CROM goniometer: a test of reliability and validity. J Back Musculoskelet Rehabil. 2013;26(2):141-8. doi: 10.3233/BMR-2012-00358.

Reference Type: BACKGROUND

PMID: 23640315 (View on PubMed)

Lysell E. Motion in the cervical spine. An experimental study on autopsy specimens. Acta Orthop Scand. 1969:Suppl 123:1+. doi: 10.3109/ort.1969.40.suppl-123.01. No abstract available.

Reference Type: BACKGROUND

PMID: 4907116 (View on PubMed)

Harrison DE, Harrison DD, Cailliet R, Janik TJ, Troyanovich SJ. Cervical coupling during lateral head translations creates an S-configuration. Clin Biomech (Bristol). 2000 Jul;15(6):436-40. doi: 10.1016/s0268-0033(99)00098-4.

Reference Type: BACKGROUND

PMID: 10771122 (View on PubMed)

Boussion, L. and L. Chèze, Étude cinématique tridimensionnelle du rachis cervical: Comparaison entre sujets asymptomatiques et "pathologiques". Kinésithérapie, la Revue, 2011. 11(109-110): p. 36-37.

Reference Type: BACKGROUND

Mangone M, Bernetti A, Germanotta M, Di Sipio E, Razzano C, Ioppolo F, Santilli V, Venditto T, Paoloni M. Reliability of the Cervical Spine Device for the Assessment of Cervical Spine Range of Motion in Asymptomatic Participants. J Manipulative Physiol Ther. 2018 May;41(4):342-349. doi: 10.1016/j.jmpt.2018.01.003.

Reference Type: BACKGROUND

PMID: 29751851 (View on PubMed)

Cuesta-Vargas AI, Galan-Mercant A, Williams JM. The use of inertial sensors system for human motion analysis. Phys Ther Rev. 2010 Dec;15(6):462-473. doi: 10.1179/1743288X11Y.0000000006.

Reference Type: BACKGROUND

PMID: 23565045 (View on PubMed)

Tucci SM, Hicks JE, Gross EG, Campbell W, Danoff J. Cervical motion assessment: a new, simple and accurate method. Arch Phys Med Rehabil. 1986 Apr;67(4):225-30.

Reference Type: BACKGROUND

PMID: 3964055 (View on PubMed)

Frost M, Stuckey S, Smalley LA, Dorman G. Reliability of measuring trunk motions in centimeters. Phys Ther. 1982 Oct;62(10):1431-7. doi: 10.1093/ptj/62.10.1431.

Reference Type: BACKGROUND

PMID: 7122701 (View on PubMed)

Sukari AAA, Singh S, Bohari MH, Idris Z, Ghani ARI, Abdullah JM. Examining the Range of Motion of the Cervical Spine: Utilising Different Bedside Instruments. Malays J Med Sci. 2021 Apr;28(2):100-105. doi: 10.21315/mjms2021.28.2.9. Epub 2021 Apr 21.

Reference Type: BACKGROUND

PMID: 33958964 (View on PubMed)

Audette I, Dumas JP, Cote JN, De Serres SJ. Validity and between-day reliability of the cervical range of motion (CROM) device. J Orthop Sports Phys Ther. 2010 May;40(5):318-23. doi: 10.2519/jospt.2010.3180.

Reference Type: BACKGROUND

PMID: 20436238 (View on PubMed)

Yoon TL, Kim HN, Min JH. Validity and Reliability of an Inertial Measurement Unit-based 3-Dimensional Angular Measurement of Cervical Range of Motion. J Manipulative Physiol Ther. 2019 Jan;42(1):75-81. doi: 10.1016/j.jmpt.2018.06.001.

Reference Type: BACKGROUND

PMID: 31054596 (View on PubMed)

Jonas R, Demmelmaier R, Hacker SP, Wilke HJ. Comparison of three-dimensional helical axes of the cervical spine between in vitro and in vivo testing. Spine J. 2018 Mar;18(3):515-524. doi: 10.1016/j.spinee.2017.10.065. Epub 2017 Oct 23.

Reference Type: BACKGROUND

PMID: 29074465 (View on PubMed)

de Koning CH, van den Heuvel SP, Staal JB, Smits-Engelsman BC, Hendriks EJ. Clinimetric evaluation of active range of motion measures in patients with non-specific neck pain: a systematic review. Eur Spine J. 2008 Jul;17(7):905-21. doi: 10.1007/s00586-008-0656-3. Epub 2008 Apr 22.

Reference Type: BACKGROUND

PMID: 18427843 (View on PubMed)

Other Identifiers

Atılım University-25

Identifier Type: -

Identifier Source: org_study_id