The Cervical Flexion-Relaxation Ratio:
Reproducibility and Comparison Between
Chronic Neck Pain Patients and Controls

This section is compiled by Frank M. Painter, D.C.
Send all comments or additions to:    Frankp@chiro.org

FROM:   Spine (Phila Pa 1976) 2010 (Nov 15); 35 (24): 2103–2108

Murphy BA, Marshall PW, Taylor HH.

Faculty of Health Sciences,
University of Ontario Institute of Technology,
Oshawa, Ontario, Canada

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STUDY DESIGN:   Reliability study.

OBJECTIVE:   To determine the reproducibility of the cervical flexion-relaxation ratio (FRR) measured 4 weeks apart in a group of chronic neck pain patients and healthy control group and to compare the FRR between the 2 groups.

SUMMARY OF BACKGROUND DATA:   The cervical FRR measures the ability of the neck extensor muscles to relax during forward flexion, similar to the lumbar FRR. Its reliability and ability to discriminate neck pain patients from controls has not been investigated.

METHODS:   Fourteen participants with chronic neck pain and a control group of 14 individuals with no neck pain were recruited via advertisement and word of mouth. The cervical FRR was determined at baseline and 4 weeks later using standardized electromyographic data collection and analysis procedures.

RESULTS:   The mean FRR value for the combined left and right side data for the neck pain groups was 1.93 +/- 0.8, and 1.73 +/- 0.61 at 4-week follow-up. The intraclass correlation coefficient (ICC) was 0.83 (95% CI = 0.67-0.92). Three participants in the control group developed neck pain in the 4 weeks and their data were not included in the reliability calculation. For the control group, the combined (left and right side) mean FRR value was 4.09 +/- 1.58 at baseline and 4.27 +/- 1.71 on retest 4 weeks later. The ICC (intraclass r) was 0.89 (95% confidence interval = 0.76-0.95). The overall ICC for the combined groups was 0.92 (95% confidence interval = 0.86-0.95). An independent 2 group t test revealed a significant difference in the baseline FRR data between the control group and the neck pain group (P < 0.001).

CONCLUSION:   The cervical extensor muscles exhibit a consistent flexion-relaxation (FFR) phenomenon in healthy control subjects and the measurement is highly reproducible when measured 4 weeks apart in both controls and chronic neck pain patients. The FRR in neck pain patients is significantly higher than in control subjects suggesting that this measure may be a useful marker of altered neuromuscular function.

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