Investigation of Flexion-Relaxation Ratio Symmetry in Subjects with and without Non-Specific Chronic Neck Pain
Abstract
Introduction: Neuromuscular imbalance between right and left sides of Cervical Erector Spinae (CES) muscles can induce pain by applying the asymmetric loads on the spine incorrectly. This study evaluated the symmetry of the right and left cervical flexion-relaxation ratio (FRR) in patients with Non-Specific Chronic Neck Pain (NSCNP) and healthy subjects.We aimed to investigate the symmetry of FRR on the right and left sides of the CES muscles in individuals with and without NSCNP.
Materials and Methods: A total of 25 patients with NSCNP and 25 healthy subjects participated in this study. The surface electromyography activity of CES muscles during four phases of flexion and extension tasks were measured and recorded. Unilateral FRR in the right and left sides of CES muscles was calculated and compared in each group.
Results: Only in NSCNP patients, FRR in the right CES muscle was significantly higher than that in the left one (P<0.05). Also, FRR for bilateral CES muscles was significantly higher in healthy subjects than in NSCNP patients (P<0.001).
Conclusion: The study results indicated a greater FRR asymmetry in CES muscles in NSCNP patients than in healthy subjects. This asymmetry is probably due to the dominance of the limb. Moreover, asymmetric FRR as a kind of neuromuscular imbalance may cause pain due to imposing asymmetric loads on spine structures.
1. Fejer R, Kyvik KO, Hartvigsen J. The prevalence of neck pain in the world population: A systematic critical review of the literature. European Spine Journal. 2006; 15(6):834-48. [DOI:10.1007/s00586-004-0864-4] [PMID] [PMCID]
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6. Hoving JL, Koes BW, De Vet HC, Van der Windt DA, Assendelft WJ, Van Mameren H, et al. Manual therapy, physical therapy, or continued care by a general practitioner for patients with neck pain: A randomized, controlled trial. Annals of Internal Medicine. 2002; 136(10):713-22. [DOI:10.7326/0003-4819-136-10-200205210-00006] [PMID]
7. Borghouts JA, Koes BW, Bouter LM. The clinical course and prognostic factors of non-specific neck pain: A systematic review. Pain. 1998; 77(1):1-13. [DOI:10.1016/S0304-3959(98)00058-X]
8. Ylinen J, Takala E-P, Kautiainen H, Nykänen M, Häkkinen A, Pohjolainen T, et al. 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. European Journal of Pain. 2004; 8(5):473-8. [DOI:10.1016/j.ejpain.2003.11.005] [PMID]
9. Falla D, Bilenkij G, Jull G. Patients with chronic neck pain demonstrate altered patterns of muscle activation during performance of a functional upper limb task. Spine. 2004; 29(13):1436-40. [DOI:10.1097/01.BRS.0000128759.02487.BF] [PMID]
10. Sjölander P, Michaelson P, Jaric S, Djupsjöbacka M. Sensorimotor disturbances in chronic neck pain-range of motion, peak velocity, smoothness of movement, and repositioning acuity. Manual Therapy. 2008; 13(2):122-31. [DOI:10.1016/j.math.2006.10.002] [PMID]
11. Falla D, Farina D. Neural and muscular factors associated with motor impairment in neck pain. Current Rheumatology Reports. 2007; 9(6):497-502. [DOI:10.1007/s11926-007-0080-4] [PMID]
12. Barton PM, Hayes KC. Neck flexor muscle strength, efficiency, and relaxation times in normal subjects and subjects with unilateral neck pain and headache. Archives of Physical Medicine and Rehabilitation. 1996; 77(7):680-7. [DOI:10.1016/S0003-9993(96)90008-8]
13. Fredin Y, Elert J, Britschgi N, Nyberg V, Vaher A, Gerdle B. A decreased ability to relax between repetitive muscle contractions in patients with chronic symptoms after whiplash trauma of the neck. Journal of Musculoskeletal Pain. 1997; 5(2):55-70. [DOI:10.1300/J094v05n02_05]
14. Maroufi N, Ahmadi A, Mousavi Khatir SR. A comparative investigation of flexion relaxation phenomenon in healthy and chronic neck pain subjects. European Spine Journal. 2013; 22(1):162-8. [DOI:10.1007/s00586-012-2517-3] [PMID] [PMCID]
15. Shamsi H, Khademi-Kalantari K, Akbarzadeh-Baghban A, Izadi N, Okhovatian F. Cervical flexion relaxation phenomenon in patients with and without non-specific chronic neck pain. Journal of Back and Musculoskeletal Rehabilitation. 2021; 34(3):461-8. [DOI:10.3233/BMR-200137] [PMID]
16. Floyd WF, Silver PH. The function of the erectores spinae muscles in certain movements and postures in man. The Journal of Physiology. 1955; 129(1):184-203. [DOI:10.1113/jphysiol.1955.sp005347] [PMID] [PMCID]
17. Maroufi N, Ahmadi A, Khatir SRM. A comparative investigation of flexion relaxation phenomenon in healthy and chronic neck pain subjects. European Spine Journal. 2013; 22(1):162-8. [DOI:10.1007/s00586-012-2517-3] [PMID] [PMCID]
18. Marras WS, Davis KG, Ferguson SA, Lucas BR, Gupta P. Spine loading characteristics of patients with low back pain compared with asymptomatic individuals. Spine. 2001; 26(23):2566-74. [DOI:10.1097/00007632-200112010-00009] [PMID]
19. Grabiner MD, Koh TJ, el Ghazawi A. Decoupling of bilateral paraspinal excitation in subjects with low back pain. Spine. 1992; 17(10):1219-23. [DOI:10.1097/00007632-199210000-00015] [PMID]
20. Renkawitz T, Boluki D, Grifka J. The association of low back pain, neuromuscular imbalance, and trunk extension strength in athletes. The spine Journal. 2006; 6(6):673-83. [DOI:10.1016/j.spinee.2006.03.012] [PMID]
21. Freiwald J, Engelhardt M, Reuter I. Die Messung der Muskulatur mittels isokinetischer und kombinierte elektromyographischer Meßstationen. Die Muskulatur Wehr: Ciba-Geigy Verlag. 1994:69-89. https://www.sponet.de/Record/3027590
22. Murphy BA, Marshall PW, Taylor HH. The cervical flexion-relaxation ratio: Reproducibility and comparison between chronic neck pain patients and controls. Spine. 2010; 35(24):2103-8. [DOI:10.1097/BRS.0b013e3181cbc7d8] [PMID]
23. Rose-Dulcina K, Genevay S, Dominguez D, Armand S, Vuillerme N. Flexion-relaxation ratio asymmetry and its relation with trunk lateral ROM in individuals with and without chronic nonspecific low back pain. Spine. 2020; 45(1):E1-9. [DOI:10.1097/BRS.0000000000003196] [PMID]
24. Pialasse JP, Lafond D, Cantin V, Descarreaux M. Load and speed effects on the cervical flexion relaxation phenomenon. BMC Musculoskeletal Disorders. 2010; 11:46. [DOI:10.1186/1471-2474-11-46] [PMID] [PMCID]
25. Zabihhosseinian M, Holmes MW, Ferguson B, Murphy B. Neck muscle fatigue alters the cervical flexion relaxation ratio in sub-clinical neck pain patients. Clinical Biomechanics. 2015; 30(5):397-404. [DOI:10.1016/j.clinbiomech.2015.03.020] [PMID]
26. Burnett A, O’Sullivan P, Caneiro JP, Krug R, Bochmann F, Helgestad GW. An examination of the flexion-relaxation phenomenon in the cervical spine in lumbo-pelvic sitting. Journal of Electromyography and Kinesiology. 2009; 19(4):e229-36. [DOI:10.1016/j.jelekin.2008.04.015] [PMID]
27. Black KM, McClure P, Polansky M. The influence of different sitting positions on cervical and lumbar posture. Spine. 1996; 21(1):65-70. [DOI:10.1097/00007632-199601010-00015] [PMID]
28. Shin H, Kim K. Effects of cervical flexion on the flexion-relaxation ratio during smartphone use. Journal of Physical Therapy Science. 2014; 26(12):1899-901. [DOI:10.1589/jpts.26.1899] [PMID] [PMCID]
29. Mousavi-Khatir R, Talebian S, Maroufi N, Olyaei GR. Effect of static neck flexion in cervical flexion-relaxation phenomenon in healthy males and females. Journal of Bodywork and Movement Therapies. 2016; 20(2):235-42. [DOI:10.1016/j.jbmt.2015.07.039] [PMID]
30. Stegeman D, Hermens H. Standards for surface electromyography: The European project Surface EMG for non-invasive assessment of muscles (SENIAM). Enschede: Roessingh Research and Development. 2007; 10:108-12. https://citeseerx.ist.psu.edu/viewdoc/download?doi=10.1.1.623.2040&rep=rep1&type=pdf
31. Maroufi N, Ahmadi A, Mousavi Khatir SR. A comparative investigation of flexion relaxation phenomenon in healthy and chronic neck pain subjects. European Spine Journal. 2013; 22(1):162-8. [DOI:10.1007/s00586-012-2517-3] [PMID] [PMCID]
32. Frericks B. The recommendations for sensors and sensor placement procedures for surface electromyography. SENIAM deliverable 8, European Recommendations for Surface Electromyography. 1999:15-53. [Link Not Found]
33. Nimbarte AD, Zreiqat M, Ning X. Impact of shoulder position and fatigue on the flexion-relaxation response in cervical spine. Clinical Biomechanics. 2014; 29(3):277-82. [DOI:10.1016/j.clinbiomech.2013.12.003] [PMID]
34. Yoo WG. Comparison of the symmetry of right and left lateral cervical flexion and rotation and the cervical FRR in young computer workers. Journal of Physical Therapy Science. 2014; 26(5):783-4. [DOI:10.1589/jpts.26.783] [PMID] [PMCID]
35. Pialasse JP, Dubois JD, Choquette MH, Lafond D, Descarreaux M. Kinematic and electromyographic parameters of the cervical flexion-relaxation phenomenon: The effect of trunk positioning. Annals of Physical and Rehabilitation Medicine. 2009; 52(1):49-58. [DOI:10.1016/j.rehab.2008.10.002] [PMID]
36. Madeleine P, Leclerc F, Arendt-Nielsen L, Ravier P, Farina D. Experimental muscle pain changes the spatial distribution of upper trapezius muscle activity during sustained contraction. Clinical Neurophysiology. 2006; 117(11):2436-45. [DOI:10.1016/j.clinph.2006.06.753] [PMID]
37. Falla D, Farina D. Neuromuscular adaptation in experimental and clinical neck pain. Journal of Electromyography and Kinesiology. 2008; 18(2):255-61. [DOI:10.1016/j.jelekin.2006.11.001] [PMID]
38. Maihöfner C, Baron R, DeCol R, Binder A, Birklein F, Deuschl G, et al. The motor system shows adaptive changes in complex regional pain syndrome. Brain. 2007; 130(Pt 10):2671-87. [DOI:10.1093/brain/awm131] [PMID]
39. Yassin M, Talebian S, Ebrahimi Takamjani I, Maroufi N, Ahmadi A, Sarrafzadeh J, et al. The effects of arm movement on reaction time in patients with latent and active upper trapezius myofascial trigger point. Medical Journal of The Islamic Republic of Iran. 2015; 29:295. [PMID]
40. Peck CC, Murray GM, Gerzina TM. How does pain affect jaw muscle activity? The Integrated Pain Adaptation Model. Australian Dental Journal. 2008; 53(3):201-7. [DOI:10.1111/j.1834-7819.2008.00050.x] [PMID]
41. Airaksinen MK, Kankaanpää M, Aranko O, Leinonen V, Arokoski JP, Airaksinen O. Wireless on-line electromyography in recording neck muscle function: A pilot study. Pathophysiology. 2005; 12(4):303-6. [DOI:10.1016/j.pathophys.2005.09.012] [PMID]
42. Pinheiro CF, dos Santos MF, Chaves TC. Flexion-relaxation ratio in computer workers with and without chronic neck pain. Journal of Electromyography and Kinesiology. 2016; 26:8-17. [DOI:10.1016/j.jelekin.2015.12.011] [PMID]
43. Arguisuelas MD, Lisón JF, Doménech-Fernández J, Martínez-Hurtado I, Salvador Coloma P, Sánchez-Zuriaga D. Effects of myofascial release in erector spinae myoelectric activity and lumbar spine kinematics in non-specific chronic low back pain: Randomized controlled trial. Clinical Biomechanics. 2019; 63:27-33. [DOI:10.1016/j.clinbiomech.2019.02.009] [PMID]
2. Nederhand MJ, Hermens HJ, Ijzerman MJ, Groothuis KG, Turk DC. The effect of fear of movement on muscle activation in posttraumatic neck pain disability. The Clinical Journal of Pain. 2006; 22(6):519-25. [DOI:10.1097/01.ajp.0000202979.44163.da] [PMID]
3. Stanton TR, Leake HB, Chalmers KJ, Moseley GL. Evidence of impaired proprioception in chronic, idiopathic neck pain: Systematic review and meta-analysis. Physical Therapy. 2016; 96(6):876-87. [DOI:10.2522/ptj.20150241] [PMID] [PMCID]
4. Ariëns GA, Bongers PM, Douwes M, Miedema MC, Hoogendoorn WE, van der Wal G, et al. Are neck flexion, neck rotation, and sitting at work risk factors for neck pain? Results of a prospective cohort study. Occupational and Environmental Medicine. 2001; 58(3):200-7. [DOI:10.1136/oem.58.3.200] [PMID] [PMCID]
5. Shahidi B, Curran-Everett D, Maluf KS. Psychosocial, physical, and neurophysiological risk factors for chronic neck pain: A prospective inception cohort study. The Journal of Pain. 2015; 16(12):1288-99. [DOI:10.1016/j.jpain.2015.09.002] [PMID]
6. Hoving JL, Koes BW, De Vet HC, Van der Windt DA, Assendelft WJ, Van Mameren H, et al. Manual therapy, physical therapy, or continued care by a general practitioner for patients with neck pain: A randomized, controlled trial. Annals of Internal Medicine. 2002; 136(10):713-22. [DOI:10.7326/0003-4819-136-10-200205210-00006] [PMID]
7. Borghouts JA, Koes BW, Bouter LM. The clinical course and prognostic factors of non-specific neck pain: A systematic review. Pain. 1998; 77(1):1-13. [DOI:10.1016/S0304-3959(98)00058-X]
8. Ylinen J, Takala E-P, Kautiainen H, Nykänen M, Häkkinen A, Pohjolainen T, et al. 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. European Journal of Pain. 2004; 8(5):473-8. [DOI:10.1016/j.ejpain.2003.11.005] [PMID]
9. Falla D, Bilenkij G, Jull G. Patients with chronic neck pain demonstrate altered patterns of muscle activation during performance of a functional upper limb task. Spine. 2004; 29(13):1436-40. [DOI:10.1097/01.BRS.0000128759.02487.BF] [PMID]
10. Sjölander P, Michaelson P, Jaric S, Djupsjöbacka M. Sensorimotor disturbances in chronic neck pain-range of motion, peak velocity, smoothness of movement, and repositioning acuity. Manual Therapy. 2008; 13(2):122-31. [DOI:10.1016/j.math.2006.10.002] [PMID]
11. Falla D, Farina D. Neural and muscular factors associated with motor impairment in neck pain. Current Rheumatology Reports. 2007; 9(6):497-502. [DOI:10.1007/s11926-007-0080-4] [PMID]
12. Barton PM, Hayes KC. Neck flexor muscle strength, efficiency, and relaxation times in normal subjects and subjects with unilateral neck pain and headache. Archives of Physical Medicine and Rehabilitation. 1996; 77(7):680-7. [DOI:10.1016/S0003-9993(96)90008-8]
13. Fredin Y, Elert J, Britschgi N, Nyberg V, Vaher A, Gerdle B. A decreased ability to relax between repetitive muscle contractions in patients with chronic symptoms after whiplash trauma of the neck. Journal of Musculoskeletal Pain. 1997; 5(2):55-70. [DOI:10.1300/J094v05n02_05]
14. Maroufi N, Ahmadi A, Mousavi Khatir SR. A comparative investigation of flexion relaxation phenomenon in healthy and chronic neck pain subjects. European Spine Journal. 2013; 22(1):162-8. [DOI:10.1007/s00586-012-2517-3] [PMID] [PMCID]
15. Shamsi H, Khademi-Kalantari K, Akbarzadeh-Baghban A, Izadi N, Okhovatian F. Cervical flexion relaxation phenomenon in patients with and without non-specific chronic neck pain. Journal of Back and Musculoskeletal Rehabilitation. 2021; 34(3):461-8. [DOI:10.3233/BMR-200137] [PMID]
16. Floyd WF, Silver PH. The function of the erectores spinae muscles in certain movements and postures in man. The Journal of Physiology. 1955; 129(1):184-203. [DOI:10.1113/jphysiol.1955.sp005347] [PMID] [PMCID]
17. Maroufi N, Ahmadi A, Khatir SRM. A comparative investigation of flexion relaxation phenomenon in healthy and chronic neck pain subjects. European Spine Journal. 2013; 22(1):162-8. [DOI:10.1007/s00586-012-2517-3] [PMID] [PMCID]
18. Marras WS, Davis KG, Ferguson SA, Lucas BR, Gupta P. Spine loading characteristics of patients with low back pain compared with asymptomatic individuals. Spine. 2001; 26(23):2566-74. [DOI:10.1097/00007632-200112010-00009] [PMID]
19. Grabiner MD, Koh TJ, el Ghazawi A. Decoupling of bilateral paraspinal excitation in subjects with low back pain. Spine. 1992; 17(10):1219-23. [DOI:10.1097/00007632-199210000-00015] [PMID]
20. Renkawitz T, Boluki D, Grifka J. The association of low back pain, neuromuscular imbalance, and trunk extension strength in athletes. The spine Journal. 2006; 6(6):673-83. [DOI:10.1016/j.spinee.2006.03.012] [PMID]
21. Freiwald J, Engelhardt M, Reuter I. Die Messung der Muskulatur mittels isokinetischer und kombinierte elektromyographischer Meßstationen. Die Muskulatur Wehr: Ciba-Geigy Verlag. 1994:69-89. https://www.sponet.de/Record/3027590
22. Murphy BA, Marshall PW, Taylor HH. The cervical flexion-relaxation ratio: Reproducibility and comparison between chronic neck pain patients and controls. Spine. 2010; 35(24):2103-8. [DOI:10.1097/BRS.0b013e3181cbc7d8] [PMID]
23. Rose-Dulcina K, Genevay S, Dominguez D, Armand S, Vuillerme N. Flexion-relaxation ratio asymmetry and its relation with trunk lateral ROM in individuals with and without chronic nonspecific low back pain. Spine. 2020; 45(1):E1-9. [DOI:10.1097/BRS.0000000000003196] [PMID]
24. Pialasse JP, Lafond D, Cantin V, Descarreaux M. Load and speed effects on the cervical flexion relaxation phenomenon. BMC Musculoskeletal Disorders. 2010; 11:46. [DOI:10.1186/1471-2474-11-46] [PMID] [PMCID]
25. Zabihhosseinian M, Holmes MW, Ferguson B, Murphy B. Neck muscle fatigue alters the cervical flexion relaxation ratio in sub-clinical neck pain patients. Clinical Biomechanics. 2015; 30(5):397-404. [DOI:10.1016/j.clinbiomech.2015.03.020] [PMID]
26. Burnett A, O’Sullivan P, Caneiro JP, Krug R, Bochmann F, Helgestad GW. An examination of the flexion-relaxation phenomenon in the cervical spine in lumbo-pelvic sitting. Journal of Electromyography and Kinesiology. 2009; 19(4):e229-36. [DOI:10.1016/j.jelekin.2008.04.015] [PMID]
27. Black KM, McClure P, Polansky M. The influence of different sitting positions on cervical and lumbar posture. Spine. 1996; 21(1):65-70. [DOI:10.1097/00007632-199601010-00015] [PMID]
28. Shin H, Kim K. Effects of cervical flexion on the flexion-relaxation ratio during smartphone use. Journal of Physical Therapy Science. 2014; 26(12):1899-901. [DOI:10.1589/jpts.26.1899] [PMID] [PMCID]
29. Mousavi-Khatir R, Talebian S, Maroufi N, Olyaei GR. Effect of static neck flexion in cervical flexion-relaxation phenomenon in healthy males and females. Journal of Bodywork and Movement Therapies. 2016; 20(2):235-42. [DOI:10.1016/j.jbmt.2015.07.039] [PMID]
30. Stegeman D, Hermens H. Standards for surface electromyography: The European project Surface EMG for non-invasive assessment of muscles (SENIAM). Enschede: Roessingh Research and Development. 2007; 10:108-12. https://citeseerx.ist.psu.edu/viewdoc/download?doi=10.1.1.623.2040&rep=rep1&type=pdf
31. Maroufi N, Ahmadi A, Mousavi Khatir SR. A comparative investigation of flexion relaxation phenomenon in healthy and chronic neck pain subjects. European Spine Journal. 2013; 22(1):162-8. [DOI:10.1007/s00586-012-2517-3] [PMID] [PMCID]
32. Frericks B. The recommendations for sensors and sensor placement procedures for surface electromyography. SENIAM deliverable 8, European Recommendations for Surface Electromyography. 1999:15-53. [Link Not Found]
33. Nimbarte AD, Zreiqat M, Ning X. Impact of shoulder position and fatigue on the flexion-relaxation response in cervical spine. Clinical Biomechanics. 2014; 29(3):277-82. [DOI:10.1016/j.clinbiomech.2013.12.003] [PMID]
34. Yoo WG. Comparison of the symmetry of right and left lateral cervical flexion and rotation and the cervical FRR in young computer workers. Journal of Physical Therapy Science. 2014; 26(5):783-4. [DOI:10.1589/jpts.26.783] [PMID] [PMCID]
35. Pialasse JP, Dubois JD, Choquette MH, Lafond D, Descarreaux M. Kinematic and electromyographic parameters of the cervical flexion-relaxation phenomenon: The effect of trunk positioning. Annals of Physical and Rehabilitation Medicine. 2009; 52(1):49-58. [DOI:10.1016/j.rehab.2008.10.002] [PMID]
36. Madeleine P, Leclerc F, Arendt-Nielsen L, Ravier P, Farina D. Experimental muscle pain changes the spatial distribution of upper trapezius muscle activity during sustained contraction. Clinical Neurophysiology. 2006; 117(11):2436-45. [DOI:10.1016/j.clinph.2006.06.753] [PMID]
37. Falla D, Farina D. Neuromuscular adaptation in experimental and clinical neck pain. Journal of Electromyography and Kinesiology. 2008; 18(2):255-61. [DOI:10.1016/j.jelekin.2006.11.001] [PMID]
38. Maihöfner C, Baron R, DeCol R, Binder A, Birklein F, Deuschl G, et al. The motor system shows adaptive changes in complex regional pain syndrome. Brain. 2007; 130(Pt 10):2671-87. [DOI:10.1093/brain/awm131] [PMID]
39. Yassin M, Talebian S, Ebrahimi Takamjani I, Maroufi N, Ahmadi A, Sarrafzadeh J, et al. The effects of arm movement on reaction time in patients with latent and active upper trapezius myofascial trigger point. Medical Journal of The Islamic Republic of Iran. 2015; 29:295. [PMID]
40. Peck CC, Murray GM, Gerzina TM. How does pain affect jaw muscle activity? The Integrated Pain Adaptation Model. Australian Dental Journal. 2008; 53(3):201-7. [DOI:10.1111/j.1834-7819.2008.00050.x] [PMID]
41. Airaksinen MK, Kankaanpää M, Aranko O, Leinonen V, Arokoski JP, Airaksinen O. Wireless on-line electromyography in recording neck muscle function: A pilot study. Pathophysiology. 2005; 12(4):303-6. [DOI:10.1016/j.pathophys.2005.09.012] [PMID]
42. Pinheiro CF, dos Santos MF, Chaves TC. Flexion-relaxation ratio in computer workers with and without chronic neck pain. Journal of Electromyography and Kinesiology. 2016; 26:8-17. [DOI:10.1016/j.jelekin.2015.12.011] [PMID]
43. Arguisuelas MD, Lisón JF, Doménech-Fernández J, Martínez-Hurtado I, Salvador Coloma P, Sánchez-Zuriaga D. Effects of myofascial release in erector spinae myoelectric activity and lumbar spine kinematics in non-specific chronic low back pain: Randomized controlled trial. Clinical Biomechanics. 2019; 63:27-33. [DOI:10.1016/j.clinbiomech.2019.02.009] [PMID]
| Files | ||
| Issue | Vol 16 No 2 (2022) | |
| Section | Research Article(s) | |
| DOI | https://doi.org/10.18502/jmr.v16i2.9305 | |
| Keywords | ||
| Flexion-relaxation phenomenon Flexion-Relaxation ratio asymmetry Non-specific chronic neck pain Cervical erector spinae | ||
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How to Cite
1.
Shamsi H, Khademi K, Okhovatian F. Investigation of Flexion-Relaxation Ratio Symmetry in Subjects with and without Non-Specific Chronic Neck Pain. jmr. 2022;16(2):180-188.
