The natural history of children with joint hypermobility syndrome and Ehlers-Danlos hypermobility type: a longitudinal cohort study.

Objectives: The objective of the manuscript was to describe the natural history of complaints and disability in children diagnosed with joint hypermobility syndrome (JHS)/Ehlers-Danlos-hypermobility type (EDS-HT) and to identify the constructs that underlie functional decline. Methods: One hundred and one JHS/EDS-HT children were observed over 3 years and assessed at three time points on the following: functional impairments, quality of life, connective tissue laxity, muscle function, postural control and musculoskeletal and multi-systemic complaints. Cluster analysis was performed to identify subgroups in severity. Clinical profiles were determined for these subgroups, and differences were assessed by multivariate analysis of covariance. Mixed linear regression models were used to determine the subsequent trajectories. Finally, an exploratory factor analysis was used to uncover the underlying constructs of functional impairment. Results: Three clusters of children were identified in terms of functional impairment: mild, moderately and severely affected. Functional impairment at baseline was predictive of worsening trajectories in terms of reduced walking distance and decreased quality of life (P ⩽ 0.05) over 3 years. Multiple interactions between the secondary outcomes were observed, with four underlying constructs identified. All four constructs (multi-systemic effects, pain, fatigue and loss of postural control) contributed significantly to disability (P ⩽ 0.046). Conclusion: Children diagnosed with JHS/EDS-HT who have a high incidence of multi-systemic complaints (particularly, orthostatic intolerance, urinary incontinence and diarrhoea) and poor postural control in addition to high levels of pain and fatigue at baseline are most likely to have a deteriorating trajectory of functional impairment and, accordingly, warrant clinical prioritization.

Quality of life prediction in children with joint hypermobility syndrome.

AIMS: To assess the child- and parent-reported health-related quality of life (HRQOL) of children with joint hypermobility syndrome (JHS), to compare these with other chronic paediatric conditions and to determine whether symptoms experienced by children with JHS can predict their HRQOL. METHODS: Eighty-nine children with JHS and one of their parents completed the Pediatric Quality of Life Inventory 4.0 Generic Core Scale, the Multidimensional Fatigue Scale and the Pediatric Pain Questionnaire. Anthropometric measures and reported symptoms were recorded. Child-reported HRQOL scores were compared with parent report, and both child- and parent-reported HRQOL scores of children with JHS were compared with those of children with other chronic conditions. Stepwise multiple regression was undertaken to determine whether any combination of measures could predict HRQOL. RESULTS: Parent- and child-reported HRQOL scores were strongly correlated (r = 0.6-0.84, all P < 0.001); however, parents of children with JHS perceived lower overall HRQOL (mean difference = 4.44, P = 0.001), physical (mean difference = 7.11, P < 0.0001) and emotional functioning (mean difference = 5.24, P = 0.011) than their children. When considered together with previously reported HRQOL scores for children with other chronic conditions, parent and child scores were similarly strongly correlated (r = 0.93, P = 0.001). Multiple regression revealed that 75% of the variance in child-reported HRQOL scores was accounted for by a child's level of pain and fatigue, and presence of stress incontinence symptoms (P < 0.0001). CONCLUSION: Children with JHS experience poor HRQOL and disabling fatigue, with parent scores providing a good proxy. Pain, fatigue and the presence of stress incontinence symptoms have the greatest impact on their HRQOL.

Shoulder proprioception is not related to throwing speed or accuracy in elite adolescent male baseball players.

Understanding factors that influence throwing speed and accuracy is critical to performance in baseball. Shoulder proprioception has been implicated in the injury risk of throwing athletes, but no such link has been established with performance outcomes. The purpose of this study was to describe any relationship between shoulder proprioception acuity and throwing speed or accuracy. Twenty healthy elite adolescent male baseball players (age, 19.6 ± 2.6 years), who had represented the state of New South Wales in the past 18 months, were assessed for bilateral active shoulder proprioception (shoulder rotation in 90° of arm abduction moving toward external rotation using the active movement extent discrimination apparatus), maximal throwing speed (MTS, meters per second measured via a radar gun), and accuracy (total error in centimeters determined by video analysis) at 80 and 100% of MTS. Although proprioception in the dominant and nondominant arms was significantly correlated with each other (r = 0.54, p < 0.01), no relationship was found between shoulder proprioception and performance. Shoulder proprioception was not a significant determinant of throwing performance such that high levels of speed and accuracy were achieved without a high degree of proprioception. There is no evidence to suggest therefore that this particular method of shoulder proprioception measurement should be implemented in clinical practice. Consequently, clinicians are encouraged to consider proprioception throughout the entire kinetic chain rather than the shoulder joint in isolation as a determining factor of performance in throwing athletes.

Liking and response latency in teammate identification: processing delays below conscious awareness?

Success in fast-ball sports relies on many factors which interact at both movement and cognitive levels. Players must recognize their teammates and decide whether to pass the ball to create or take advantage of scoring affordances. Previous research has shown athletes can identify teammates from brief visual displays during fast-ball sports and this is related to the amount of time individuals train together. However, it is likely other factors also affect recognition and, consequently, decision making related to ball passing. The present study extended the Teammate Identification (TM-ID) paradigm to examine magnitude of liking of one's teammates in relation to response time components of TM-ID. An increase in movement time was found for identifying a swimmer who was the observer's "least liked" teammate, which suggests that processes below conscious awareness may influence the time taken for sport actions directed toward specific teammates, such as ball passing.

Discrimination of amount of spinal flexion for movements made with and without vision after lumbar disc replacement.

Discrimination of differences between small lumbar flexion movements made when standing may differ depending on whether vision is available. Dependence on general vision during trunk movements may be increased following surgery, in which an intervertebral disc is replaced with a prosthetic disc. This study investigated whether the availability of vision changed discrimination of small differences in lumbar forward flexion movement when standing for patients with lumbar disc replacement and healthy peers. 20 volunteers without a history of back pain and 20 with disc replacement undertook a 100-trial sequence of forward flexion movements to a set of physical stops, making an absolute judgement as to the position after each movement. General (nontarget) vision during the movement was available or removed randomly trial by trial. Availability of vision did not affect discrimination of flexion movements of the lumbar spine either in normal healthy individuals or those with disc replacement.

Comparison of lumbar proprioception as measured in unrestrained standing in individuals with disc replacement, with low back pain, and without low back pain.

STUDY DESIGN: Cross-sectional laboratory study. OBJECTIVE: To determine whether individuals with spinal pain and those who have undergone spinal surgery have difficulty discriminating small movement differences using a spinal proprioception test for active flexion movements. BACKGROUND: Structures contributing to proprioception may be affected during disc replacement surgery. Postsurgical assessment of proprioceptive ability to make discriminations in the range used for maintaining upright postural stability is needed to inform postoperative rehabilitation. METHODS: Proprioceptive sensitivity to differences between lumbar spine movements of 11 degrees, 13 degrees, 15 degrees, 17 degrees, and 19 degrees of forward flexion was measured in unrestrained standing, with vision of the target obscured. Individuals after disc replacement (n=16), with disc degeneration and discogenic back pain (n=19), and without back pain (n=18) performed 50 movement trials and stated the amount of movement performed for each trial (11 degrees, 13 degrees, 15 degrees, 17 degrees, or 19 degrees). RESULTS: The pattern of discrimination scores between adjacent lumbar flexion movement pairs shown by the individuals in the discogenic back pain group differed significantly from the disc replacement and healthy control groups (P=.024), which were not significantly different from each other. Although mean discrimination scores averaged over all movement pairs did not differ significantly between the groups, participants with discogenic back pain discriminated between the 2 smallest lumbar flexion movements significantly better than those in the other 2 groups (P=.013). CONCLUSION: The greater sensitivity of the individuals with disc pain to discriminate between the 2 smallest flexion movements was interpreted as a contrast effect arising from differences between the groups in usual upright posture, with disc replacement restoring the same pattern of posture as seen for healthy controls.

Effect of the HamSprint Drills training programme on lower limb neuromuscular control in Australian football players.

This study examined the effect of the HamSprint Drills training programme and conventional football practice warm-up on lower limb neuromuscular control. The purpose-built active movement extent discrimination apparatus was used to assess lower limb neuromuscular control in 29 footballers from one professional Australian Football League club. Without vision of the contact point, participants performed 40 backward swing movement trials with each leg and made a judgment of the magnitude of each movement. Scores representing the ability to discriminate between different movement extents were calculated as the area under the player's receiver operating characteristic curve, constructed using non-parametric signal detection theory methods. Participants were randomized to either an intervention or control group that performed different procedures in the warm-up prior to football practice sessions over a 6-week period, and then were re-tested. The intervention group performed the HamSprint programme-drills specific to the improvement of running technique, co-ordination and hamstring function. The control group performed their usual warm-up of stretching, running, and increasingly intense football drills. Backward leg swing extent discrimination was significantly better in players following the 6-week HamSprint programme when compared to discrimination scores of players who performed their usual practice warm-up only. Significant improvement was observed in lower limb neuromuscular control in movements similar to the late-swing early stance phase of running. The HamSprint programme can therefore improve control in a specific aspect of sensorimotor system performance, and this may be useful particularly in athletes who have lower function levels or those deemed at risk of hamstring injury.

Sports participation and humeral torsion.

STUDY DESIGN: Cross-sectional study. OBJECTIVE: To examine differences between arms in humeral torsion in adult and adolescent throwing and nonthrowing athletes, and nonathletic adults. BACKGROUND: It is hypothesized that humeral retrotorsion develops by, and is beneficial for, throwing. Thus throwers should demonstrate greater retrotorsion in their dominant arm relative to their nondominant arm and have more side-to-side retrotorsion difference than nonthrowing groups. In addition, adult throwers should have a greater side-to-side retrotorsion difference than adolescent throwers, and swimmers should not demonstrate a retrotorsion difference. METHODS AND MEASURES: Using ultrasound to standardize the location of the bicipital groove, the amount of humeral torsion was measured in both arms of male baseball players (85 adult, 35 adolescent), female softball players (16 adult, 37 adolescent), 29 elite adolescent swimmers (19 female), and 16 nonathletic adults (8 female). RESULTS: More retrotorsion was found in the dominant arm of almost all throwing athletes, irrespective of their gender or whether they were adults or adolescents (mean+/-SD side-to-side difference, 11.9 degrees+/-10.5 degrees). This difference was less for swimmers (6.4 degrees+/-9.9 degrees) and nonathletic adults (1.3 degrees+/-8.9 degrees). CONCLUSION: Greater dominant armhumeral retrotorsion is observed contingent with participation in throwing sports.

The effect of neoprene shorts on leg proprioception in Australian football players.

Our purpose was to assess the effect of wearing close-fitting neoprene shorts on swinging leg movement discrimination (MD) scores in elite level Australian Football players. Twenty players had their swinging leg MD assessed using the active movement extent discrimination apparatus (AMEDA), once wearing close-fitting neoprene and once wearing loose-fitting running shorts. Subjects were randomly allocated to one of the shorts conditions prior to repeating the test in the other condition. The AMEDA was used to assess the accuracy at which subjects judge the extent of a standing backward swinging leg movement corresponding to the late swing early stance phase of running. Each subject performed 40 movements made to one of five randomly set physical limits, and without the aid of vision made a judgment as to the perceived limit position. From the accuracy of these judgments, a movement discrimination (MD) score was calculated for each subject under each condition. Subjects were grouped as having low or high neuromuscular control, or ability to use proprioception when controlling active movements without vision, based on their loose-shorts MD score. Analysis was performed on the MD scores obtained for each limb from subjects in the two groups, under the two shorts-wearing conditions. There was no main effect of wearing close-fitting shorts when the cohort was treated as a whole. A significant interaction effect was obtained (F=17.027, p=0.0006) whereby the mean MD score of the low neuromuscular control ability group was improved when wearing neoprene shorts but was reduced for the high ability group. Wearing close-fitting neoprene shorts has a beneficial effect on leg swing judgment accuracy in subjects with low neuromuscular control ability. Conversely, leg swing judgment accuracy for subjects with high ability was reduced by wearing neoprene shorts.

Swing kinematics in skilled male golfers following putting practice.

STUDY DESIGN: Control laboratory study consisting of preintervention and postintervention measurements. OBJECTIVE: To determine the effects of a putting practice session on the kinematics of full golf swings made by skilled male golfers. BACKGROUND: Skilled golfers perform putting practice for prolonged periods. The combination of sustained trunk flexion with minimal trunk motion may affect the endurance capacity of the trunk extensor muscles. Because of their important role in the golf swing, any impairment of the trunk extensors may negatively influence full-swing kinematics, but this has not been previously evaluated. METHODS AND MEASURES: Three-dimensional swing kinematics and holding time on the Biering-Sørensen test of isometric trunk extensor endurance were evaluated in 29 skilled male golfers before and after performing a 40-minute putting task. RESULTS: After the intervention, peak segmental speeds were reduced and total swing duration increased (mean +/- SD, 36 +/- 55 milliseconds). There were reductions in the magnitude of pelvis and torso axial rotation during the downswing (mean +/- SD, -2.3 degrees +/- 2.6 degrees and -2.3 degrees +/- 4.7 degrees , respectively). The peak difference between torso rotation and pelvis rotation during early downswing was also significantly reduced by 0.9 degrees +/- 2.0 degrees (P<.05). The effects on pelvis and torso rotation were smallest for golfers with higher body mass index (BMI). Holding time on the Biering-Sørensen test after putting practice was significantly reduced by 25.7 +/- 23.8 seconds (P = .01). CONCLUSION: Changes in swing kinematics observed following 40 minutes of putting practice might have resulted from fatigue-related impairment of the trunk extensor muscles, a view supported by the poorer performance on the postintervention Biering-Sørensen test. Results showed that swing kinematics of golfers with high BMI were least affected by the putting practice. LEVEL OF EVIDENCE: Harm, level 5.

Observation of high and low passive ankle flexibility in stair descent.

Able-bodied people from the two extremes of the distribution of passive dorsiflexion exhibit biomechanical differences when descending stairs. Whether physical therapists could judge accurately the amount of ankle flexibility from observation of stair descent was examined with physical therapists (20 neurological 20 cardiothoracic) and 20 students. Subjects were 18 able-bodied men with high or low passive dorsiflexion. Raters viewed videotaped subjects descending stairs at normal playback speed and in slow motion and rated ankle flexibility on a 20-point scale. 'Flexible' or 'inflexible' subjects were classified correctly better than chance, but accuracy of rating flexibility was relatively poor. Both experience and slow motion playback improved accuracy. Physical therapists can detect extremes of normal flexibility in the ankle, based solely on observation of stair descent, and experienced therapists are better at this task than less experienced ones. Using slow motion videotape enhanced observational analysis.

Junior football players' classification of runners as their teammates from 400-msec. video clips.

It was hypothesized that a specialized gait recognition skill enables humans to distinguish the gait of familiar from unfamiliar individuals, and that this may have relevance in team sports. Runners seen for less than half a second can be classified as teammates or not by adult players, so it may be asked whether this skill would also be demonstrated by young team players. In the current study, junior football players (M age = 10.0 yr., SD = 0.8, N = 13) viewed 400-msec. video clips of runners sprinting past a fixed forward facing digital video camera and similarly showed teammate recognition scores significantly above chance. Given the variation among the junior players in this skill, it seems possible for researchers to assess whether improvement can be obtained with structured training for young team players, where running teammates are seen in peripheral vision during training drills.

Foot morphology and foot/ankle injury in indoor football.

While the pronated foot is implicated as a risk factor for sports injury in some studies, others suggest that a supinated foot posture increases the risk of overuse lower limb injuries. Athletes in a given sports discipline may tend to have a similar foot morphology, which varies from that observed elsewhere. Further, the foot morphology that is beneficial for performance in a sport may be detrimental with regard to injury. Intra- and inter-rater reliability of the Foot Posture Index (FPI-6) as a measure of foot morphology was determined (ICC (2,1) 0.88 and 0.69 respectively). Thereafter, in a prospective cohort study using the FPI-6, 76 adolescent male indoor football (Futsal) players were measured and followed monthly over one competition season. Coach-rated ability and reports of any overuse injuries at the ankle and/or foot over this period were obtained. A significant negative linear relationship was found between the mean FPI-6 scores and coach-rated ability (p=0.008), with supinated and under-pronated postures related to higher ability level. Overall, 33% of injuries at the ankle and/or foot were classified as overuse. Foot Posture Index scores of less than 2, indicating the supinated and under-pronated feet, were found to be associated with a significant increase in the risk of overuse injury (p=0.008). The greater rigidity of these foot types may assist adolescent, male, indoor football players to perform at a higher level in their sport. Unfortunately, these players are also more likely to sustain ankle and/or foot overuse injuries.

Discrimination of cello string height: musicianship and sex.

The aim was to investigate differences by sex and music expertise in performance of a manual proprioceptive skill. Active left hand finger-movement discrimination for differences in string height was examined in a position similar to cello playing. Men and women who were experienced cellists and nonmusicians made active string depression movements and then made absolute judgments regarding which of five string positions were presented. Although no main effect was significant, analysis yielded a sex x musicianship crossover interaction (F(1,51) = 8.4, p = .006) wherein the female cellists performed better than the female nonmusicians, and the reverse occurred for males. These significant differences in active movement discrimination across sex and musicianship may be important in further understanding focal hand dystonia, a disorder wherein the interaction of sex and expertise is observed as a strong preponderance in experienced male musicians.

Sex Differences in Drop Landing: More Apparent in Recreational Surfers Than in Competitive Surfers or Nonsurfers.

We suspected that the observed inconsistency of sex differences in drop-landing motor skills might be due to the confounding factor of prior experience. Thus, in this study, we explored the role of experience in shaping male and female surfboard riders' motor skill kinematics during drop landings while surfboard riding. We recruited 42 participants (21 females and 21 males) from three groups of surfing experience levels (competitive surfers, recreational surfers, and nonsurfers), each equally comprising seven males and seven females. Sagittal plane kinematics and vertical ground reaction force data were collected from all participants during a laboratory-based 60-cm drop-landing task. Knee flexion and ankle dorsiflexion at initial ground contact were greater among male participants, independent of experience level. In both sexes, greater range of motion at these joints was related to greater experience. Recreational female surfers landed in a more upright posture with more extended ankle and knee angles and less ankle dorsiflexion at the end of landing than participants in all other groups. We discuss our results in the context of possible remaining experience differences between male and female participants despite being grouped in the same experience levels in our study, individualized motor patterns that may still achieve similar success, and a need for continued research.

Physical and Psychosocial Characteristics of Current Child Dancers and Nondancers With Systemic Joint Hypermobility: A Descriptive Analysis.

Study Design Cross-sectional study. Background The effect of current participation in dance training on joint pain and instability, fatigue, and quality of life is unknown. Objectives To examine differences in joint pain, instability, gross motor skills, nonmusculoskeletal systemic manifestations, health-related quality of life (HRQoL), and fatigue between children with joint hypermobility syndrome/Ehlers-Danlos syndrome-hypermobility type (JHS/EDS-HT) who currently undertake formal dance training and those who do not. Methods Children with JHS/EDS-HT and 1 parent completed reports providing data on demographic variables, symptoms, organized activity participation, HRQoL, and fatigue. Physical and functional measures included extent of hypermobility, aerobic fitness, balance, and muscle endurance. Results Of the 102 participating children, 22 currently undertook dance classes, averaging 3.3 h/wk. While the dancers reported a number of painful joints similar to that reported by nondancers (mean ± SD, 5.5 ± 3.7 versus 6.4 ± 3.9 joints, respectively; P = .36), they reported significantly lower pain levels on a 0-to-10 scale (3.8 ± 3.3 versus 5.6 ± 3.4, P = .04) and found pain to be less problematic, affecting less of their body. They reported fewer unstable joints (1.0 ± 1.0 versus 2.0 ± 1.8 joints, P = .001), despite being more hypermobile (Beighton score, 7.3 ± 1.4 versus 6.6 ± 1.6 on a 9-point scale, P = .047; Lower Limb Assessment Score, 9.2 ± 2.0 versus 8.1 ± 1.9 on a 12-point scale, P = .02). The dancers had significantly better HRQoL in the subdomain of school functioning (P = .004) and reported less fatigue (P = .024). Conclusion Children with JHS/EDS-HT who are currently undertaking formal dance training have fewer joint pain and instability symptoms, less fatigue, and better HRQoL; however, the cross-sectional nature of the study means that causation cannot be determined. Level of Evidence Therapy, level 2b. J Orthop Sports Phys Ther 2017;47(10):782-791. Epub 4 Sep 2017. doi:10.2519/jospt.2017.7331.

Physiotherapy rehabilitation of the smile after long-term facial nerve palsy using video self-modeling and implementation intentions.

OBJECTIVE: To improve smiling after long-term facial nerve palsy (FNP). Physiotherapy rehabilitation of an adapted (more symmetrical) smile was investigated in FNP subjects 1 year post-onset, using video self-modeling (video replay of only best adapted smiles) and implementation intentions (preplanning adapted smiles for specific situations). STUDY DESIGN AND SETTING: Prospective, blinded clinical trial. Facial-Nerve-Palsy Clinic. RESULTS: After video self-modeling: 1) reaction time (RT) to initiation of adapted smiles became 224 ms faster whereas RT for everyday (asymmetrical) smiles became 153 ms slower; 2) adapted smiles were completed 544 ms faster; 3) adapted smiles had higher overall quality, movement control, and symmetry ratings; and 4) Facial Disability Index scores also improved. Implementation intentions after video self-modeling ensured transfer of adapted smile to everyday situations. CONCLUSION: Following intervention the smile improved, with significant changes in availability, execution speed, and quality. SIGNIFICANCE: This study supports these rehabilitation techniques to maximize quality of smiling following FNP. EBM RATING: B-2b.

Identifying runners as football teammates from 400 msec. video clips.

Ability to recognize a runner as a teammate from only a brief visual exposure is suggested from research on gait recognition with point-light displays and has particular importance for ball-passing in sports. 15 touch football players of mean age 20 yr. (SD=0.7), on two teams of 7 wk. standing, observed 31 400-msec, video clips of running individuals whose familiarity varied from high to low. These were their teammates, players from the other team, or nonfootball players. After viewing each clip, participants rated their certainty that each running player was a teammate. Despite the brevity of the visual display, overall performance at discriminating teammates from other runners was significantly better than chance, and accuracy did not differ between colour or black-and-white formats. Recognition of teammates was better if familiar nonteammates were removed from the set of analyzed clips and worse if unfamiliar nonplayers were removed.

Reliability of the "Sydney," "Sunnybrook," and "House Brackmann" facial grading systems to assess voluntary movement and synkinesis after facial nerve paralysis.

OBJECTIVE: To investigate the extent of within-system reliability and between-system correlation for the "Sydney" and "Sunnybrook" systems of grading facial nerve paralysis, and to examine the interobserver reliability and agreement of the "House Brackmann" grading system. STUDY DESIGN: A fixed-effects reliability study in which 6 otolaryngologists viewed videotapes of patients with facial nerve paralysis. SETTING: University and medical Centers. PATIENTS: Patients with unilateral lower motor neurone facial nerve dysfunction greater than 1 year after onset, none of whom had undergone surgical reanimation procedures. Intervention Twenty-one patients with facial nerve paralysis were videotaped while they performed a protocol of facial movements. Six otolaryngologists viewed the videotapes and scored them with the Sydney and Sunnybrook systems, and then gave a House Brackmann grade. MAIN OUTCOME MEASURE: The 3 systems of grading facial nerve paralysis were evaluated and compared with the use of intraclass correlation coefficients, Pearson's weighted kappa, and percentage exact agreement values. RESULTS: The Sydney and the Sunnybrook systems had good intrasystem reliability and high intersystem association for the assessment of voluntary movement. Grading of synkinesis was found to have low reliability both within and between systems. The House Brackmann system had substantial reliability as shown by weighted kappa but had a percentage exact agreement of 44%. CONCLUSIONS: For clinical grading of voluntary movement, there is good correlation between ratings given on the Sydney and Sunnybrook systems, and within each system there is good reliability. The assessment of synkinesis was far less reliable within, and less related between, systems. Although the reliability of the House Brackmann system was found to be high, examination of individual grades revealed some wide variation between trained observers.

Neck muscle endurance, self-report, and range of motion data from subjects with treated and untreated neck pain.

BACKGROUND: Despite the high prevalence and cost of neck-pain problems, there is currently little data available on the physical characteristics associated with different levels of neck pain. OBJECTIVE: To investigate associations between categories of response to neck pain/discomfort and (1) the endurance time of neck muscles, neck range of motion (ROM), and neck and head morphology, (2) sensitization or stretch effects arising from repeating end-of-range measurements, and (3) self-report data from neck pain and disability questionnaires. DESIGN: A cross-sectional study design. METHODS: Fifty-five Australian volunteers with and without neck pain, who were not taking time off work, were measured for neck muscle endurance, active neck ROM, craniocervical and thoracic posture, neck length, and head circumference and completed questionnaires about any neck pain/discomfort and disability. RESULTS: Twenty-two subjects reported a level of neck pain/discomfort that had required treatment (treated neck pain), a group of 17 subjects reported experiencing low-level neck pain/discomfort on a recurrent basis for which they had not sought treatment (untreated neck pain), whereas 16 subjects had no experience of neck pain or discomfort (no pain). Neck muscle endurance time was significantly lower for both pain groups. The affective dimension of the Short-Form McGill Pain Questionnaire and neck disability questionnaires were scored significantly higher by subjects who had sought treatment than by those in either of the untreated groups. Both pain groups showed a range decrease for most directions of neck motion at second measurement. CONCLUSIONS: Neck muscle endurance times, repeated end-ROM testing, the Short-Form McGill Pain Questionnaire, and disability questionnaires may distinguish between groups with untreated, treated, and no neck pain.