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The effect of age and sex on the cervical range of motion A systematic review
and meta-analysis
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Journal of Biomechanics
journal homepage: www.elsevier.com/locate/jbiomech
www.JBiomech.com
Review
The effect of age and sex on the cervical range of motion – A systematic
review and meta-analysis
Fumin Pan a, Rizwan Arshad a, Thomas Zander a, Sandra Reitmaier a, Arno Schroll b, Hendrik Schmidt a,⇑
a
Julius Wolff Institut, Charité – Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Germany
b
Department of Training and Movement Sciences, Humboldt-Universität zu Berlin, Germany
a r t i c l e i n f o a b s t r a c t
Article history: Cervical-flexibility examination is routinely performed in neck-pain patients. However, diagnosis of
Accepted 26 April 2018 cervical-flexibility impairment requires physiological reference values, which vary widely among the
population. Although there is a general understanding that the cervical range of motion (RoM) alters with
age and sex, the consolidated details of these variations remain lacking. A systematic review and meta-
Keywords: analysis was performed to evaluate the difference of cervical RoM in different age and sex populations.
Cervical The quality-assessment tool for quantitative studies was applied to assess methodological quality.
Range of motion
We identified 4,034 abstracts through a database search and 3 publications through a manual search.
Age
Sex
Thirty-four cross-sectional studies were selected for the systematic review and measuring technologies
Systematic review were identified. The difference in age descriptions was substantial and a strong discrepancy existed
Meta-analysis between the mobility measured by radiological and non-radiological devices. Therefore, only 11 non-
radiological studies with similar age descriptions were selected for meta-analysis. Cervical RoMs varied
considerably among the populations and generally decreased with age. However, this diminishment
started earlier and ended later in males, and was not continuous across age in both sexes. Females nor-
mally displayed a greater RoM than males, except in lateral bending. In young subjects, the difference
between males and females was not significant. For subjects in their 50s, males displayed a non-
significantly greater RoM than females.
The variability of cervical RoMs can be explained by different devices as well as age and sex. However,
the age-dependent reduction is not continuous and differs between males and females. These findings lay
the foundation for a better understanding of the incidence of age- and sex-dependent cervical disorders,
and may have important implications for the long-term success of different clinical interventions.
Ó 2018 Elsevier Ltd. All rights reserved.
Contents
1. Introduction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 14
2. Materials and methods . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 14
2.1. Literature search and inclusion criteria . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 14
2.2. Methodological assessment . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 15
2.3. Data extraction and management . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 15
2.4. Data synthesis and meta-analysis . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 20
3. Results. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 21
3.1. Search procedure. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 21
3.2. Characteristics and quality of studies . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 21
3.3. Differences between radiological and non-radiological devices . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 21
3.4. Effect of age on the ‘‘half-cycle” RoM (sex not distinguished) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 22
3.5. Effect of age on the ‘‘full-cycle” RoM (sex distinguished). . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 22
3.6. Effect of sex on the ‘‘full-cycle” RoM . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 22
⇑ Corresponding author at: Julius Wolff Institut, Charité – Universitätsmedizin Berlin, Augustenburger Platz 1, 13353 Berlin, Germany.
E-mail address: hendrik.schmidt@charite.de (H. Schmidt).
https://doi.org/10.1016/j.jbiomech.2018.04.047
0021-9290/Ó 2018 Elsevier Ltd. All rights reserved.
14 F. Pan et al. / Journal of Biomechanics 75 (2018) 13–27
1. Introduction Functional x-rays have long been the gold standard for deter-
mining functional deficits, because they can directly expose
Observation of cervical motion is a basic component of the anatomical structures and provide objective and reliable RoM
physical examination of patients suffering from neck pain results (except in the axial plane) (Liu et al., 2015; Machino
(Dvorak et al., 1992; Hogg-Johnson et al., 2008; Hole et al., 1995; et al., 2016; Park et al., 2014; Wolfenberger et al., 2002; Yukawa
Hoy et al., 2010), which is partly due to a common belief that cor- et al., 2012). However, a frequent use of this technology is ethically
recting motion aberrations and restoring functional capacity can illicit in both neck-pain patients for closed-meshed monitoring of a
reduce pain (Gao et al., 2013). The examination typically includes treatment success and asymptomatic individuals for collecting
basic kinematic assessments, including the voluntary range of normative (reference) data. Therefore, multiple non-radiological
motion (RoM) in flexion, extension, lateral bending, and/or axial devices have been developed in recent years, including goniome-
rotation. A multitude of studies report a reduced cervical RoM in ter, inclinometer, electromagnetic, ultrasonic, and optoelectronic
neck-pain patients (Falla et al., 2017; Machino et al., 2016; systems (Weerts et al., 2017; Williams et al., 2010). Here, the ques-
Mohammad et al., 2015; Rutledge et al., 2013). However, the tion arises, whether these measurement instruments (radiological
reported measurements vary considerably (Doriot and Wang, and non-radiological) lead to comparable results of cervical RoMs
2006), mainly because of differences in inclusion criteria for symp- in different anatomical planes.
tomatic and asymptomatic subjects, measurement instruments In this systematic review, we first aim to create a normative
(radiological or non-radiological), setups (constrained or uncon- (reference) database of cervical RoM data of asymptomatic individ-
strained), protocols, and individual differences. When clinicians uals and categorize them into different sex- and age-dependent
aim to ‘normalize’ dysfunctional motion, however, an empirical classes. Secondly, we analyze the differences in the outcome
basis for differentiating between normal and dysfunctional motion between radiological and non-radiological methods. In a meta-
is needed, and in determining whether correction of dysfunctional analysis, we further aim to determine the influence of age and
motion might reduce pain and activity limitation. sex on the cervical RoM assessed by non-radiological methods.
While the majority of the literature reports a reduced RoM with
increasing age (Lansade et al., 2009; Lind et al., 1989; Nilsson et al.,
2. Materials and methods
1996; Seacrist et al., 2012; Swinkels and Swinkels-Meewisse,
2014), few failed to identify a significant age effect (Mayer et al.,
This review was performed in accordance with the Preferred
1993; Tommasi et al., 2009). Similar controversial results can be
Reporting Items for Systematic Reviews and Meta-Analyses
seen for sex differences. Several studies stated that females have
(PRISMA) statement (Moher et al., 2009).
a greater cervical RoM than males (Castro et al., 2000; Dvorak
et al., 1992; Kuhlman, 1993; Nilsson et al., 1996; Peolsson et al.,
2000; Schöps et al., 1997; Wolfenberger et al., 2002; Youdas 2.1. Literature search and inclusion criteria
et al., 1992), whereas others reported no significant difference
between the sexes (Feipel et al., 1999; Hole et al., 1995; Mayer The electronic databases PubMed, EMBASE and Web of Science
et al., 1993; Trott et al., 1996; Walmsley et al., 1996). Therefore, were searched using combinations of the terms shown in Fig. 1
the influence of age and sex on the cervical RoM still merits discus- from inception to April 2018. A manual search of bibliographies
sion. Consequently, a general inference on the impact of age and and references was conducted to include possible studies not cap-
sex could not be drawn until the present. tured by the electronic search. The following criteria were applied
to determine the eligibility of each study for inclusion in the sys- 2.2. Methodological assessment
tematic review: (1) having assessed asymptomatic subjects with-
out neck pain or stiffness; (2) having measured the cervical RoM Quality assessment of the included studies was performed inde-
in different age and sex groups; (3) studies with adult participants pendently by two authors using the Effective Public Health Practice
(18 years); (4) studies concerning active cervical RoM (subject Project (EPHPP), the quality assessment tool for quantitative stud-
controlled), which reflects the subject’s ability to move his/her ies (http://www.ephpp.ca/tools.html), developed by the Effective
head with muscular effort. Passive RoM is tester controlled during Public Health Practice 2003, Canada (Jackson and Waters, 2005).
the measurement and reflects the limits of RoM set by passive
structures such as joint capsule, tendons, and bony structures. 2.3. Data extraction and management
Multiple studies have proved that the passive RoM is much greater
than the active RoM and depends on the applied force and pain- Data for means and standard deviations (SDs) of the cervical RoM
tolerance level (Dvorak et al., 1992; Hakkinen et al., 2007; in different age groups, sex and sample size were extracted from
Nilsson et al., 1996; Salo et al., 2009). For subsequent meta- reported values or figures in selected studies. For the ‘‘full-cycle”
analysis, we only included papers with similar age descriptions RoM (flexion plus extension, bilateral bending and biaxial rotation),
(20s, 30s, 40s, 50s and 60s). the data of males and females were separately collected. For the
Study eligibility was assessed by two independent authors. The ‘‘half-cycle” RoM (only flexion, extension, left or right lateral bend-
main difference of opinion for inclusion would be discussed and a ing, left or right axial rotation), we did not discriminate the sexes
third review author facilitated consensus. No data was considered because of a lack of a sufficient number of studies. Unpublished
more than once to avoid duplication. data discussed in the text was requested from the original authors,
Non-radiological studies
with similar age
descripons included in
quantave synthesis
(meta-analysis)
(n = 11)
16
Characteristics of included studies for cervical range of motion (RoM) change with age and sex.
Author (year) Country n Sex Age Device Original Level Warm-up Gender Half- or Full- Primary Plane Coupled Result
Category Posture Exercise Seperated Cycle RoM Measured Motion
Measured
Lemmers et al. (2018) Netherlands 50 m 18–25 Electromagnetic Sitting Head- Y N Full & Half Sagittal Y Significant decrease in cervical
50f 26–35 system neutral Thorax Coronal RoM with age
36–45
46–55
56–65
66
a
Alahmari (2017) Saudi 233 m 10–19 Digital Sitting Head- NA Y Half Sagittal N Significant decrease in cervical
Arabia 20–29 inclinometer neutral Thorax Coronal RoM with age
30–39 Transverse
40–49
50–59
60–69
70–80
Machino et al. (2016) Japan 642 m 20–29 X-ray Standing C2-7 N Y Half Sagittal N Significant difference in cervical
383f 30–39 neutral RoM with sex;
17
18
Table 1 (continued)
Author (year) Country n Sex Age Device Original Level Warm-up Gender Half- or Full- Primary Plane Coupled Result
Category Posture Exercise Seperated Cycle RoM Measured Motion
Measured
Wolfenberger et al. USA 66 m 20–29 Bubble gonimeter Sitting Head- NA Y Full Sagittal N Significant difference in cervical
(2002) a 39f 30–39 neutral Thorax RoM with sex;
40–49 Significant decrease in cervical
RoM with age
Sforza et al. (2002) Italy 70 m 15–16 Optoelectronic Sitting Head- NA Y Full & Half Sagittal Y Significant decrease in cervical
19–25 system neutral Thorax Coronal RoM with age
31–45 Transverse
Peolsson et al. (2000) Sweden 51 m 25–34 CMS device Sitting Head- NA Y Full & Half Sagittal N Significant difference in cervical
50f 35–44 neutral Thorax Coronal RoM with sex;
45–54 Transverse Significant decrease in cervical
55–64 RoM with age
a
Castro et al. (2000) Germany 86f 20–29 Zebris Sitting Head- NA Y Full Sagittal N Mostly significant difference in
71 m 30–39 neutral shoulder Coronal cervical RoM with sex;
40–49 Transverse Mostly significant decrease in
50–59 cervical RoM with age
60–69
n: Number of subjects
a
Studies included for meta-analysis; CROM: Cervical range of motion device; CMS: Cervical measurement device; m: Males; f: Females; NA: Not available; Y:Yes; N: No
19
20 F. Pan et al. / Journal of Biomechanics 75 (2018) 13–27
Table 2
Quality of studies (n = 34) based on the quality assessment tool for quantitative studies (Jackson and Waters, 2005).
Selection bias – Were the selected participants likely to be representative of the target population? Study design – Was the study design method appropriate? Confounders –
Were there important differences between groups prior to the intervention? Blinding – Were the study participants and examiners aware of the research question? Data
collection methods – Was reliability or validity been reported? Withdraws and drop-outs – Were withdrawals and drop-outs reported? Measurement Integrity – Did all
participants undergo the consistent measurement? Statistical Analysis – Were the statistical methods appropriate for the study design?
a
Studies included for Meta-analysis. S: Strong; M: Moderate; W: Weak; Y: Yes; N: No.
if necessary omitted (O’Driscoll and Tomenson, 1982). For two stud- 2.4. Data synthesis and meta-analysis
ies (Hole et al., 1995; Youdas et al., 1992), which presented data for
the ‘‘half-cycle” RoM of both, males and females, we calculated the Mean values of the cervical RoM as well as the sample size in
mean values (m) and SDs of the pooled sample using the formulas each age and sex group were pooled using Review Manager Soft-
recommended by the Cochrane Handbook for Systematic Reviews ware (RevMan5.3, Copenhagen: The Nordic Cochrane Centre, The
of Interventions (Higgins and Green, 2011): Cochrane Collaboration). The meta-analysis was performed using
a random-effect model for consideration of heterogeneity (incon-
m1 n1 þ m2 n2 sistency) among studies due to different study designs, methods
m¼
n1 þ n2 and populations. Statistical heterogeneity was evaluated based
on the inconsistency (I2) index, which estimates the percentage
sffiffiffiffiffiffiffiffiffiffiffiffiffiffiffiffiffiffiffiffiffiffiffiffiffiffiffiffiffiffiffiffiffiffiffiffiffiffiffiffiffiffiffiffiffiffiffiffiffiffiffiffiffiffiffiffiffiffiffiffiffiffiffiffiffiffiffiffiffiffiffiffiffiffiffiffiffiffiffiffiffiffiffiffiffiffiffiffiffiffiffiffiffiffiffiffiffiffiffiffiffiffiffiffiffiffiffiffiffiffiffiffiffiffiffiffi of total variation across studies that is ascribed to heterogeneity;
ðn1 1ÞSD21 þ ðn2 1ÞSD22 þ nn11þn n2
ðm21 þ m22 2m1 m2 Þ <25% indicates low, 25% to 75% medium and >75% high hetero-
SD ¼ 2
Fig. 3. Cervical ranges of motion in the sagittal plane of asymptomatic subjects, and comparison between radiological and non-radiological results. a. Cervical Range of
Flexion (RoF), b. Cervical Range of Extension (RoE), c. Cervical Range of Flexion plus Extension (RoFE).
<0.00001
<0.00001
<0.00001
<0.00001
<0.00001
<0.00001
<0.0001
p-Value
0.0005
0.001
The results from seven studies were pooled for the age effect on
0.11
the ‘‘half-cycle” RoM (Alahmari, 2017; Hole et al., 1995;
Malmstrom et al., 2006; Ramiro et al., 2012; Swinkels and
Mean ± 95% CI Swinkels-Meewisse, 2014; Trott et al., 1996; Youdas et al., 1992)
11.74 ± 1.95
13.06 ± 1.93
3.39 ± 1.56
8.95 ± 1.59
2.41 ± 1.35
5.19 ± 1.77
8.96 ± 1.95
0.99 ± 1.23
7.81 ± 1.30
4.08 ± 2.50
(Table 3, Fig. 4). Flexion decreased both from the 20s to 30s and
from the 40s to 50s age ranges (p < 0.05). Extension and both-
Right
<0.00001
<0.00001
<0.00001
<0.00001
p-Value
30s to the 60s (p < 0.05). With an increase in age of up to two dec-
0.002
0.002
0.11
0.01
ades, the ‘‘half-cycle” cervical RoMs in all three planes decreased
significantly (p < 0.05).
Mean ± 95% CI
Axial rotation
11.94 ± 3.37
1.52 ± 1.89
5.62 ± 3.54
8.43 ± 1.66
3.65 ± 2.34
3.21 ± 2.46
7.95 ± 2.93
7.08 ± 1.42
5.18 ± 2.04
For both males and females, the results from four studies
Left
<0.00001
<0.0001
<0.0001
p-Value
0.0001
0.0003
Schöps et al., 1997) for lateral bending and axial rotation (Table 4,
0.002
0.004
Fig. 5). From the 20s to the 30s, the cervical RoM of males
decreased significantly in all directions except lateral bending (p
< 0.01). With a single decade increase from the 30s to the 40s
Mean ± 95% CI
12.92 ± 4.50
2.97 ± 1.34
2.23 ± 1.41
5.33 ± 3.61
3.58 ± 1.95
5.54 ± 2.05
8.60 ± 4.06
<0.00001
<0.00001
nal planes in females, which was the same from the 50s to the 60s.
<0.0001
p-Value
0.0005
0.005
0.001
0.007
Both from the 30s to the 40s and the 40s to the 50s, the cervical
Mean and 95% confidence interval (CI) difference (°) of ‘‘half-cycle” cervical range of motion between two age groups.
Mean ± 95% CI
5.31 ± 1.57
3.13 ± 1.88
6.24 ± 2.72
4.39 ± 3.21
9.40 ± 2.74
1.99 ± 1.40
9.11 ± 4.09
occurred from the 40s to the 50s in all directions (p < 0.05). For
both sexes, with an increase in age of up to two decades, the cer-
Left
<0.00001
p-Value
0.003
0.002
0.17
0.03
21.67 ± 11.88
12.82 ± 8.47
15.30 ± 3.96
3.18 ± 1.71
2.77 ± 1.78
4.81 ± 6.85
8.45 ± 3.09
6.05 ± 1.78
9.30 ± 8.36
Extension
<0.00001
<0.00001
0.004
0.92
0.11
0.01
Mean ± 95% CI
3.69 ± 1.51
3.25 ± 2.21
4.60 ± 2.96
2.09 ± 2.58
8.18 ± 2.60
5.27 ± 2.07
4.22 ± 3.20
0.08 ± 1.53
4.99 ± 3.00
Flexion
Eight studies have investigated the effect of age and sex on the
coupled RoM as shown in Table 1 and Appendix 3. Results of these
studies are substantial different. Primary movement in the sagittal
Group 2
axial rotation. Some studies found that coupled motion was most
evident during primary movements in the coronary and transvers
Age group
20s
30s
40s
50s
sex. However, the effect of age was not continuous and differed
among studies.
F. Pan et al. / Journal of Biomechanics 75 (2018) 13–27 23
Fig. 4. The effect of age on ‘‘half-cycle” cervical ranges of motion in three planes. r Mean pooled difference (°); Whiskers: 95% confidence interval (°); * p < 0.05.
4. Discussion 2014; Trott et al., 1996; Wang et al., 2005; Whitcroft et al., 2010;
Youdas et al., 1992; Yukawa et al., 2012). Chen et al. (1999) in their
This literature review aimed to collect information concerning review indicated a consistent tendency for the cervical RoM to
cervical spine kinematics of asymptomatic subjects. Given suffi- decrease with age. However, the authors did not present quantita-
cient homogenous data with similar age descriptions, a meta- tive data to confirm whether this tendency is continuous with age
analysis was conducted. The results show a strong discrepancy in and differs between sexes. Furthermore, there remains consider-
the obtained RoMs between radiological and non-radiological able disagreement over the effect of sex on the cervical RoM
measurements. For example, when females aged 20–29 years per- (Cagnie et al., 2007; Hwang and Jung, 2015; Kalscheur et al.,
formed a flexion, radiological devices result in an up to 35° smaller 2003). In the present study, we provided consolidated details on
RoM than non-radiological devices (Fig. 3a), mainly because that the change in the cervical RoM with age and sex. We demonstrated
radiological measurements normally assessed the RoM from C2– that across the 20s to 60s age categories, both the ‘‘half-cycle” and
7, whereas non-radiological devices mostly assess the cervical ‘‘full-cycle” cervical RoMs displayed a decrease in RoMs in all
RoM between the head and thorax. However, whether there are planes, which might arise from spine degeneration with aging
other additional factors could not be clarified because no study (Machino et al., 2016; Okada et al., 2009; Simpson et al., 2008;
in this review used both radiological and non-radiological devices Yukawa et al., 2012). However, the decrease of the ‘‘full-cycle” cer-
within the same cohort or measured at the same spinal levels to vical RoM in both males and females was not continuous with age.
allow a direct comparison. There were two neighbor age groups that displayed no significant
Radiological studies can only assess the cervical RoMs in the differences in the RoM between each other and age groups that
sagittal or coronal planes, but not in the axial plane, and are rela- displayed a large significant reduction in the RoM (up to 15°).
tively laborious in a clinical setting. Furthermore, the radiation These findings may result from a variety of factors, including dif-
exposure limits the usage of these devices. Therefore, it is very ferent occupational patterns (e.g., females on average work fewer
important to generate a normative reference database of cervical hours per job than males) (Locke et al., 2014), anatomical structure
RoMs assessed by non-radiological devices for asymptomatic indi- (e.g., males have smaller upper cervical lordosis and greater lower
viduals as well as for neck-pain patients during follow-up. In this cervical lordosis than females) (Been et al., 2017), and daily activ-
study, we created such a database and categorized them into dif- ities (e.g., males spend more time than females in moderate and
ferent sex- and age-dependent classes, which is given in Appendix vigorous physical activity) (Hagstromer et al., 2007) between
2. This database can be used as a reference tool to diagnose dys- males and females.
functional motion in patients with neck diseases and to evaluate Regarding the effect of sex on the cervical RoM, there was no
whether a surgical or non-surgical correction reduces the dysfunc- significant difference in the 20s age group, because the youngest
tional motion. age group in most populations displayed the greatest mobility.
As reported, age and sex are two main factors influencing the Males in their 30s and 40s displayed less mobility than females
cervical RoM and have been investigated over many decades in sagittal and axial motions. It is interesting to note, that males
(Castro et al., 2000; Chen et al., 1999; Demaille-Wlodyka et al., in their 50s displayed greater mobility, although not significant,
2007; Dvorak et al., 1992; Feipel et al., 1999; Hole et al., 1995; than females. It could be hypothesized that the females during this
Lansade et al., 2009; Liu et al., 2015; Machino et al., 2016; age range underwent menopause, which could decrease spine
Malmstrom et al., 2006; Netzer and Payne, 1993; Niederer et al., mobility (Cunha-Henriques et al., 2011; Kyllonen et al., 1998).
2015; Nilsson et al., 1996; Schenkman et al., 1996; Schöps et al., After this period, females in their 60s again displayed greater cer-
1997; Sforza et al., 2002; Swinkels and Swinkels-Meewisse, vical mobility than males.
24 F. Pan et al. / Journal of Biomechanics 75 (2018) 13–27
<0.00001
<0.00001
<0.00001
p-Value Primary movement in the sagittal plane was only accompanied
0.0006
0.003
0.007
0.009
0.007
wth slight coupled motion, but not in the coronary and trans-
0.93
0.1
vers planes. Sex usually did not alter coupled motion behaviors
but age did. However, we could not quantify the effect of age on
Mean ± 95% CI
17.40 ± 4.86
5.49 ± 3.58
9.83 ± 5.64
7.52 ± 5.62
7.69 ± 5.64
0.25 ± 5.87
6.84 ± 8.20 several studies, the younger and older subjects tended to have
greater coupled motion than the mid-aged subjects did
Male
<0.00001
<0.00001
<0.0001
p-Value
0.006
0.02
0.02
22.15 ± 7.35
30.76 ± 9.03
15.07 ± 6.06
16.08 ± 7.80
5.58 ± 4.17
7.97 ± 5.64
7.23 ± 6.26
8.30 ± 6.95
0.0005
0.13
0.09
0.05
0.03
0.04
15.67 ± 14.24
11.79 ± 6.61
18.32 ± 5.05
25.39 ± 5.01
3.07 ± 12.06
12.09 ± 5.04
8.75 ± 8.71
6.61 ± 6.25
5.03 ± 6.46
<0.00001
<0.00001
<0.0001
p-Value
0.0002
0.43
0.02
Mean and 95% confidence interval (CI) difference (°) of ‘‘full-cycle” cervical range of motion between two age groups.
Mean ± 95% CI
12.32 ± 5.91
22.56 ± 5.01
10.43 ± 4.72
20.48 ± 4.39
10.47 ± 5.57
7.36 ± 5.99
2.24 ± 5.54
2.30 ± 4.06
<0.00001
<0.00001
p-Value
0.008
0.001
0.67
0.35
0.55
0.01
22.82 ± 16.96
19.20 ± 13.99
13.01 ± 10.14
34.10 ± 10.44
18.44 ± 5.82
14.55 ± 8.88
5.92 ± 12.34
2.90 ± 13.18
2.38 ± 7.80
0.003
0.002
0.76
0.04
0.02
0.02
12.48 ± 10.71
14.12 ± 9.21
26.49 ± 5.27
14.16 ± 8.86
1.55 ± 10.15
30.00 ± 7.94
3.90 ± 8.36
9.03 ± 8.83
20s
30s
40s
50s
therapy
F. Pan et al. / Journal of Biomechanics 75 (2018) 13–27 25
Fig. 5. The effect of age on ‘‘full-cycle” cervical ranges of motion in three planes. r Mean pooled difference (°); Whiskers: 95% confidence interval (°); * p < 0.05.
Table 5
Mean and 95% confidence interval (CI) difference (°) of ‘‘full-cycle” cervical range of motion (RoM) between males and females.
If mean difference <0°, it represents males have a smaller RoM than females; if mean difference >0°, it represents males have a larger RoM than females.
Fig. 6. The effect of sex on ‘‘full-cycle” cervical ranges of motion (RoM) in three planes. r Mean pooled difference (°); Whiskers: 95% confidence interval (°); * p < 0.05.
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