RESEARCH - Stability of the upper neck during isometric neck exercises in RA patients with atlantoaxial disorders

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Scandinavian Journal of Rheumatology

2008

" Stability of the upper neck during isometric neck exercises in

rheumatoid arthritis patients with atlantoaxial disorders " :

Abstract

Objective: To study the effect of isometric neck strength exercises on

upper cervical stability in patients with rheumatoid arthritis (RA).

Methods: Twenty patients with a mean (SD) age of 58 (9) years and

duration of RA of 27 (10) years volunteered for the study. Lateral

radiographs of the cervical spine were taken to measure the current

atlantoaxial distance (AAD) in flexion and extension. Maximal

isometric neck flexion and extension strength values were measured by

a dynamometer. Thereafter, AADs were measured from radiographs taken

at 80-90% resistance of maximal strength.

Results: According to the full flexion radiographs at baseline, the

patients were classified into three groups: eight patients without

anterior atlantoaxial subluxation (aAAS) [AAD = 2.1 (2-3) mm], seven

with unstable aAAS [AAD = 6.6 (5-8) mm], and five with stable aAAS

[AAD = 5.5 (5-7) mm]. During resisted flexion the AAD decreased by 5

(3-7) mm (p<0.001) in the unstable aAAS group, while in the other two

groups the changes were minor. During resisted extension the AAD

increased by 3 (2-6) mm (p<0.001) in the cases with unstable aAAS

only.

Conclusion: Isometric exercising towards flexion decreases the AAD in

cases with unstable aAAS. Submaximal loading of the neck extensors by

pushing the back of the head against the resistance even in the

neutral position of the cervical spine leads to a decrease in the

width of the cervical spine canal and is not recommended in unstable

aAAS.

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