BIOMECHANICAL ASSESSMENT OF KINEMATIC MEASURES ASSOCIATED WITH
AN OSTEOPATHIC CERVICAL DIAGNOSIS AND TREATMENT TECHNIQUE
By
Bradley Allen Rutledge

A THESIS
Submitted to
Michigan State University
in partial fulfillment of the requirements
for the degree of
MASTER OF SCIENCE
Mechanical Engineering
2011

ABSTRACT
BIOMECHANICAL ASSESSMENT OF KINEMATIC MEASURES ASSOCIATED WITH
AN OSTEOPATHIC CERVICAL DIAGNOSIS AND TREATMENT TECHNIQUE
By
Bradley Allen Rutledge
The purpose of this research was to evaluate the differences in motions within an
examiner, across examiners and between active and passive motions using three-dimensional
kinematic data collected during a standard manual cervical diagnostic. Additionally, kinematic
differences before and after a manual treatment were evaluated for subjects experiencing pain.
Kinematic data of healthy individuals (n=22) and individuals experiencing neck pain
(n=19) were obtained using motion capture, and assessed through Euler angles. The motions
from passive evaluations performed by two blinded osteopathic physicians as well as active
motions performed independently by the subjects were analyzed. Analyses included cervical
ranges of motion for lateral flexions (primary motion) and axial rotations (secondary motion), the
rate at which lateral flexions were performed, and the root mean square error of multiple trials.
Statistical evaluations demonstrated that diagnostic motions were performed consistently
within an examiner but not across examiners, active range and rates of motion were greater than
passive motions, healthy subjects performed motions more symmetrically and at larger ranges of
motions than subjects experiencing neck pain, and the effects of treatment were present and
reduced longitudinally.

This thesis is dedicated to my family and friends for their unwavering support.
In memory of Carl Coppola

iii

ACKNOWLEDGEMENTS

I would like to acknowledge the many people without whom this thesis would not be
possible. First and foremost, I would like to thank the subjects and physicians, Dr. Lisa
DeStefano, Dr. Tim Francisco, and Dr. Sherman Gorbis, whose participation made this a viable
study. I would like to thank my advisor, Dr. Tamara Reid Bush, for allowing me the opportunity
to conduct my research in the Biomechanical Design Research Laboratory (BDRL) and
providing patient guidance, support, and encouragement while assisting me in becoming a better
engineer. I thank the numerous undergraduate and graduate students involved with the BDRL for
assisting me in everything from theory to data processing. I would like to thank Dr. Joseph Vorro
for offering his time and knowledge during countless meetings, helping me to better understand
the clinical relevancies and theories behind this research. I would like to thank Dr. Neil Wright
for his willingness to be on my committee, providing insight and support with regard to my
thesis. To my family and friends, I thank you all for your constant support and encouragement,
which has kept me grounded through good and bad. Thank you all.

iv

TABLE OF CONTENTS
LIST OF TABLES ...................................................................................................................... VIII
LIST OF FIGURES ................................................................................................................... XIV
NOMENCLATURE .................................................................................................................... XV
INTRODUCTION ...........................................................................................................................1
LITERATURE REVIEW ................................................................................................................5
Anatomical Terms & Definitions ............................................................................................. 5
Technology to Quantify Anatomical Positions & Angles ...................................................... 9
Proprioception ......................................................................................................................... 12
Cervical Range of Motion (ROM) ......................................................................................... 13
Active versus passive motion ................................................................................................. 14
Healthy individuals versus individuals with neck pain ......................................................... 15
Manual Medicine Treatment & Diagnosis ............................................................................ 16
Inter and intra-examiner reliability of diagnosis .................................................................. 17
Effectiveness of manual treatment ......................................................................................... 18
METHODS ....................................................................................................................................20
Subject Screening & Selection ............................................................................................... 22
Screening to obtain test groups ............................................................................................. 22
Subject pool ........................................................................................................................... 23
The Cervical Diagnosis Technique used in Osteopathic Manual Medicine ....................... 23
Equipment ................................................................................................................................ 26
Experimental setup ................................................................................................................ 26
Motion capture system accuracy ........................................................................................... 28
Subject Testing Protocol ......................................................................................................... 29
Passive motion tests ............................................................................................................... 29
Active motion tests ................................................................................................................. 30
Treatment technique .............................................................................................................. 31
Post-treatment evaluation ..................................................................................................... 32
Longitudinal evaluation......................................................................................................... 32
Data Analysis ........................................................................................................................... 33
Raw kinematic data processing ............................................................................................. 33
Angles of motion for the head relative to the thorax ............................................................. 33
Minimum and maximum lateral flexion ................................................................................. 36
Root mean square error and angular velocity calculation ................................................... 37
Statistical analyses ................................................................................................................ 40
v

RESULTS ......................................................................................................................................41
Participant Demographics ...................................................................................................... 41
Intra-Examiner Comparisons ................................................................................................ 44
Range of Motion .................................................................................................................... 44
Rate of motion........................................................................................................................ 47
Root mean square error......................................................................................................... 58
Inter-Examiner Comparisons ................................................................................................ 62
Range of motion ..................................................................................................................... 62
Rate of motion........................................................................................................................ 64
Root mean square error......................................................................................................... 66
Active versus Passive Motion ................................................................................................. 68
Range of motion ..................................................................................................................... 68
Rate of motion........................................................................................................................ 71
Root mean square error......................................................................................................... 78
Secondary motion – axial rotation ........................................................................................ 81
Group Comparisons ................................................................................................................ 83
Range of motion ..................................................................................................................... 83
Rate of motion........................................................................................................................ 87
Root mean square error......................................................................................................... 90
Longitudinal Study Comparisons .......................................................................................... 92
Range of motion ..................................................................................................................... 92
DISCUSSION ................................................................................................................................95
Intra-Examiner Comparisons ................................................................................................ 95
Range of motion ..................................................................................................................... 95
Rate of motion........................................................................................................................ 96
Root mean square error......................................................................................................... 98
Inter-Examiner Comparisons ................................................................................................ 98
Range of motion ..................................................................................................................... 98
Rate of motion........................................................................................................................ 99
Active versus Passive Motion ............................................................................................... 101
Range of motion ................................................................................................................... 101
Rate of motion...................................................................................................................... 103
Root mean square error....................................................................................................... 104
Group Comparisons .............................................................................................................. 105
Within groups: Range of motion.......................................................................................... 105
Within groups: Rate of motion ............................................................................................ 107
Within groups: Root mean square error ............................................................................. 107
Across groups: Range of motion ......................................................................................... 107
Across groups: Rate of motion ............................................................................................ 108
Longitudinal Study Comparisons ........................................................................................ 109
vi

Limitations & Future Work ................................................................................................. 111
CONCLUSIONS, FUTURE IMPLICATIONS, & SUMMARY OF FINDINGS ......................113
Conclusions ............................................................................................................................ 113
Future Implications ............................................................................................................... 114
Summary of Findings ............................................................................................................ 115
APPENDICES .............................................................................................................................119
A1. Visual-Analog Scale (VAS) for Neck Pain ................................................................... 120
A2. Neck Pain and Disability Scale (NPDS) ........................................................................ 121
A3. Lifestyles Questionnaire................................................................................................. 124
A4. Subject Questionnaire Responses ................................................................................. 126
A5. Measurements of Qualysis Accuracy ............................................................................ 127
A6. Ranges of Lateral Flexions (Primary Motions) ........................................................... 128
A7. Ranges of Axial Rotation (Secondary Motions)........................................................... 146
A8. Rates of Lateral Flexions (Slope) .................................................................................. 159
A9. RMSE of Dissected Cycles ............................................................................................. 169
A10. RMSE of Complete Time Series .................................................................................. 179
BIBLIOGRAPHY ........................................................................................................................183

vii

LIST OF TABLES

Table 1. Subject age, height, and weight as divided by subject group ..........................................42
Table 2. Gender comparisons as divided by subject group ...........................................................42
Table 3. Subject handedness as divided by subject group .............................................................42
Table 4. Pre-test VAS, post-test VAS, and NPDS scores as divided by subject group .................43
Table 5. Examiner 2 intra-examiner comparisons in the Control group for left end-range, right
end-range, and full range of motion values ...................................................................................45
Table 6. Examiner 2 intra-examiner comparisons in the Experimental group pre-treatment for left
end-range, right end-range, and full range of motion values .........................................................45
Table 7. Examiner 2 intra-examiner comparisons in the Experimental group post-treatment for
left end-range, right end-range, and full range of motion values...................................................45
Table 8. Examiner 3 intra-examiner comparisons in the Control group for left end-range, right
end-range, and full range of motion values ...................................................................................46
Table 9. Examiner 3 intra-examiner comparisons in the Experimental group pre-treatment for left
end-range, right end-range, and full range of motion values .........................................................46
Table 10. Examiner 3 intra-examiner comparisons in the Experimental group post-treatment for
left end-range, right end-range, and full range of motion values...................................................46
Table 11. Examiner 2 intra-examiner comparisons in the Control group for left-slope, rightslope, and total-slope values ..........................................................................................................48
Table 12. Examiner 2 intra-examiner comparisons in the Experimental group pre-treatment for
left-slope, right-slope, and total-slope values ................................................................................48
Table 13. Examiner 2 intra-examiner comparisons in the Experimental group post-treatment for
left-slope, right-slope, and total-slope values ................................................................................48
Table 14. Examiner 3 intra-examiner comparisons in the Control group for left-slope, rightslope, and total-slope values ..........................................................................................................49

viii

Table 15. Examiner 3 intra-examiner comparisons in the Experimental group pre-treatment for
left-slope, right-slope, and total-slope values ................................................................................49
Table 16. Examiner 3 intra-examiner comparisons in the Experimental group post-treatment for
left-slope, right-slope, and total-slope values ................................................................................50
Table 17-a. Examiner 2 intra-examiner cycle-by-cycle statistical analyses for rate of right and
left cervical lateral flexion within the Control and Experimental groups ......................................52
Table 18-a. Examiner 3 intra-examiner cycle-by-cycle statistical analyses for rate of right and
left cervical lateral flexion within the Control and Experimental groups ......................................55
Table 19. Examiner 2 intra-examiner comparisons in the Control group of right, left, and total
RMSE values for all three cycles ...................................................................................................58
Table 20. Examiner 2 intra-examiner comparisons in the Experimental group pre-treatment of
right, left, and total RMSE values for all three cycles ...................................................................59
Table 21. Examiner 2 intra-examiner comparisons in the Experimental group post-treatment of
right, left, and total RMSE values for all three cycles ...................................................................59
Table 22. Examiner 2 intra-examiner comparisons of total RMSE values (degrees) for all three
cycles within the Control, Experimental pre-treatment and Experimental post-treatment groups 59
Table 23. Examiner 3 intra-examiner comparisons in the Control group of right, left, and total
RMSE values for all three cycles ...................................................................................................60
Table 24. Examiner 3 intra-examiner comparisons in the Experimental group pre-treatment of
right, left, and total RMSE values for all three cycles ...................................................................60
Table 25. Examiner 3 intra-examiner comparisons in the Experimental group post-treatment of
right, left, and total RMSE values for all three cycles ...................................................................60
Table 26. Examiner 3 intra-examiner comparisons of total RMSE values (degrees) for all three
cycles within the Control, Experimental pre-treatment and Experimental post-treatment groups 61
Table 27. Inter-examiner comparisons between Examiner 2 and Examiner 3’s average passive
motions in the Control group for left end-range, right end-range, and full range of motion values62
Table 28. Inter-examiner comparisons between Examiner 2 and Examiner 3’s average passive
motions in the Experimental group pre-treatment for left end-range, right end-range, and full
range of motion values ...................................................................................................................63
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Table 29. Inter-examiner comparisons between Examiner 2 and Examiner 3’s average passive
motions in the Experimental group post-treatment for the left end-range, right end-range, and full
range of motion values ...................................................................................................................63
Table 30. Inter-examiner statistical analyses between Examiner 2 and Examiner 3 for right endrange, left end-range, and full range of motion for the Control, Experimental pre-treatment, and
Experimental post-treatment groups ..............................................................................................64
Table 31. Inter-examiner comparisons between Examiner 2 and Examiner 3’s average rate of
passive motions in the Control group for right-slope, left-slope, and total-slope values ..............65
Table 32. Inter-examiner comparisons between Examiner 2 and Examiner 3’s average rate of
passive motions in the Experimental group pre-treatment for right-slope, left-slope, and totalslope values ....................................................................................................................................65
Table 33. Inter-examiner comparisons between Examiner 2 and Examiner 3’s average rate of
passive motions in the Experimental group post-treatment for right-slope, left-slope, and totalslope values ....................................................................................................................................65
Table 34. Inter-examiner statistical analyses between Examiner 2 and Examiner 3 for average
left-slope, right-slope, and total-slope values within the Control and Experimental groups .........66
Table 35. Inter-examiner comparisons between Examiner 2 and Examiner 3’s average right, left,
and total RMSE in the Control group ............................................................................................67
Table 36. Inter-examiner comparisons between Examiner 2 and Examiner 3’s average right, left,
and total RMSE in the Experimental group pre-treatment ............................................................67
Table 37. Inter-examiner comparisons between Examiner 2 and Examiner 3’s average right, left,
and total RMSE in the Experimental group post-treatment ...........................................................67
Table 38. Inter-examiner comparisons between Examiner 2 and Examiner 3’s average RMSE
(degrees) of the complete time-series in the Control and Experimental groups ............................68
Table 39. Active and passive motion comparisons in the Control group for average left endrange, right end-range, and full ROM values ................................................................................69
Table 40. Active and passive motion comparisons in the Experimental group pre-treatment for
average left end-range, right end-range, and full ROM values......................................................69
Table 41. Active and passive motion comparisons in the Experimental group post-treatment for
average left end-range, right end-range, and full ROM values......................................................70
x

Table 42. Active and passive motion comparisons of full ROM values (degrees) for the Control,
Experimental pre-treatment and Experimental post-treatment groups ..........................................70
Table 43. Statistical analyses of passive versus active motion testing for average full range of
motion values within the Control and Experimental groups .........................................................71
Table 44. Active and passive motion comparisons in the Control group for average right-slope,
left-slope, and total-slope values....................................................................................................72
Table 45. Active and passive motion comparisons in the Experimental group pre-treatment for
average right-slope, left-slope, and total-slope values ...................................................................72
Table 46. Active and passive motion comparisons in the Experimental group post-treatment for
average right-slope, left-slope, and total-slope values ...................................................................72
Table 47. Active and passive motion comparisons of total-slope values (deg/sec) for the Control,
Experimental pre-treatment, and Experimental post-treatment groups .........................................72
Table 48-a. Statistical analyses for consistency of active motion testing for rate of right and left
cervical lateral flexion within the Control, Experimental pre-treatment, and Experimental posttreatment groups.............................................................................................................................74
Table 49. Statistical analyses for passive versus active motion testing for rate of right, left, and
total cervical lateral flexion within the Control and Experimental groups ....................................78
Table 50. Active and passive motion comparisons in the Control group for average right, left,
and total RMSE values...................................................................................................................79
Table 51. Active and passive motion comparisons in the Experimental group pre-treatment for
average right, left, and total RMSE values ....................................................................................79
Table 52. Active and passive motion comparisons in the Experimental group post-treatment for
average right, left, and total RMSE values ....................................................................................79
Table 53. Active and passive motion comparisons for total RMSE values (degrees) of the
dissected cycles in the Control, Experimental pre-treatment, and Experimental post-treatment
groups .............................................................................................................................................80
Table 54. Active and passive motion comparisons for the average RMSE (degrees) of the full
time-series in the Control, Experimental pre-treatment and Experimental post-treatment groups80

xi

Table 55. Statistical analyses of passive versus active motion tests for RMSE values (degrees) of
the complete time series within the Control, Experimental pre-treatment and Experimental posttreatment groups.............................................................................................................................81
Table 56. Active versus passive motion comparisons of secondary motion (axial rotation) for the
Control group (“+” values indicate ipsilateral rotation and “-” values indicate contralateral
rotation) ..........................................................................................................................................82
Table 57. Active versus passive motion comparisons of secondary motion (axial rotation) for the
Experimental group pre-treatment (“+” values indicate ipsilateral rotation and “-” values indicate
contralateral rotation) .....................................................................................................................82
Table 58. Active versus passive motion comparisons of secondary motion (axial rotation) for the
Experimental group post-treatment (“+” values indicate ipsilateral rotation and “-” values
indicate contralateral rotation) .......................................................................................................82
Table 59. Statistical analyses of the average secondary full ROM (axial rotation) for comparisons
of Examiner 2, Examiner 3, and active motion within the Control and Experimental groups ......83
Table 60. Control, Experimental pre-treatment and Experimental post-treatment comparisons for
Examiner 2’s average left end-range, right end-range, and full ROM values ...............................84
Table 61. Control, Experimental pre-treatment and Experimental post-treatment comparisons for
Examiner 3’s average left end-range, right end-range, and full ROM values ...............................84
Table 62. Control, Experimental pre-treatment and Experimental post-treatment comparisons for
active motion average left end-range, right end-range, and full ROM values ...............................84
Table 63. Control, Experimental pre-treatment and Experimental post-treatment comparisons for
full ROM values (degrees) of Examiner 2, Examiner 3, and active motion ..................................85
Table 64. Average left versus right end-range values for Examiner 2, Examiner 3, and active
motion within the Control and Experimental groups .....................................................................86
Table 65. Statistical analyses for Control versus Experimental groups’ average full ROM for
Examiner 2, Examiner 3, and active motion ..................................................................................86
Table 66. Statistical analyses for the Experimental group pre-treatment versus post-treatment for
the average full ROM values of Examiner 2, Examiner 3, and active motion ..............................86
Table 67. Control, Experimental pre-treatment and Experimental post-treatment comparisons for
Examiner 2’s average left-slope, right-slope, and total-slope values ............................................87
xii

Table 68. Control, Experimental pre-treatment and Experimental post-treatment comparisons for
Examiner 3’s average left-slope, right-slope, and total-slope values ............................................87
Table 69. Control, Experimental pre-treatment and Experimental post-treatment comparisons for
active motion average left-slope, right-slope, and total-slope values ............................................88
Table 70. Control, Experimental pre-treatment and Experimental post-treatment comparisons for
total-slope values (deg/sec) of Examiner 2, Examiner 3, and active motion .................................88
Table 71. Statistical analyses for left versus right rate of cervical lateral flexion for Examiner 2,
Examiner 3, and active motion within the Control and Experimental groups ...............................89
Table 72. Statistical analyses for the Control versus the Experimental group pre-treatment
average rate of total cervical lateral flexion for Examiner 2, Examiner 3, and active motion ......89
Table 73. Control, Experimental pre-treatment and Experimental post-treatment comparisons for
Examiner 2’s average right, left, and total RMSE values ..............................................................90
Table 74. Control, Experimental pre-treatment and Experimental post-treatment comparisons for
Examiner 3’s average right, left, and total RMSE values ..............................................................91
Table 75. Control, Experimental pre-treatment and Experimental post-treatment comparisons for
active motion average right, left, and total RMSE values .............................................................91
Table 76. Control, Experimental pre-treatment and Experimental post-treatment comparisons for
Examiner 2, Examiner 3, and active motion average complete time-series RMSE values ...........91
Table 77. Longitudinal group comparisons of pre-treatment, post-treatment, and 72-hours posttreatment for Examiner 2’s average left end-range, right end-range, and full ROM values .........93
Table 78. Longitudinal group comparisons of pre-treatment, post-treatment, and 72-hours posttreatment for Examiner 3’s average left end-range, right end-range, and full ROM values .........93
Table 79. Longitudinal group comparisons of pre-treatment, post-treatment, and 72-hours posttreatment for active motion average left end-range, right end-range, and full ROM values .........93
Table 80. Longitudinal group comparisons of pre-treatment, post-treatment, and 72-hours posttreatment for the full ROM (degrees) of Examiner 2, Examiner 3, and active motion .................94

xiii

LIST OF FIGURES

Figure 1. Imaginary anatomical planes for describing regional references on the human body
(Moore and Agur, 2007). For interpretation of the references to color in this and all other
figures, the reader is referred to the electronic version of this thesis. ............................................6
Figure 2. Anatomical terms of location and direction .....................................................................7
Figure 3. The human spinal column separated by the cervical, thoracic, lumbar, and sacral
regions (Netter, 2006) ......................................................................................................................8
Figure 4. Primary movements of the head including axial rotation, lateral flexion, and
flexion/extension (RelayHealth, 2009) ............................................................................................9
Figure 5. A flow chart of the test protocol .....................................................................................21
Figure 6. Examiner conducting a cervical palpatory diagnosis on a subject while collecting
kinematic data ................................................................................................................................25
Figure 7. Retro-reflective passive markers applied to the forehead, left and right temple, and a
triad configuration on the sternum .................................................................................................27
Figure 8. Motion capture system camera configuration with global coordinate system origin on
the left, posterior stool corner relative to the subject .....................................................................28
Figure 9. Muscle energy treatment performed on a study participant ...........................................31
Figure 10. Example of a complete right lateral flexion cycle dissected from the start to peak of
the cycle .........................................................................................................................................38
Figure 11. Example of the average rate of motion calculated from the slope of linear regressions
applied to the dissected right lateral flexion cycles of two trials ...................................................39

xiv

NOMENCLATURE

3D

Three-Dimensional

BDRL

Biomechanical Design Research Laboratory

CT

Computed Tomography

HVLA

High-Velocity Low-Amplitude

MRI

Magnetic Resonance Imaging

NPDS

Neck Pain and Disability Scale

RMSE

Root Mean Square Error

ROM

Range Of Motion

VAS

Visual Analog Scale

WAD

Whiplash-Associated Disorder

Ex.

Examiner

Exp.

Experimental

Cont.

Control

n

frame number

tsv

Tab Separated Value

̂

local coordinate direction horizontally from subject left to right
̂

local coordinate direction horizontally from subject posterior to anterior

̂

local coordinate direction vertically from subject inferior to superior

X

global coordinate direction horizontally from subject left to right

Y

global coordinate direction horizontally from subject posterior to anterior

Z

global coordinate direction vertically from subject inferior to superior

θ1

angle of rotation about y-axis (lateral flexion)
xv

θ2

angle of rotation about z-axis (axial rotation)

θ3

angle of rotation about x-axis (flexion/extension)

[R]

rotation matrix

xvi

INTRODUCTION

Musculoskeletal dysfunctions have been reported by more persons in the United States
than any other health condition. For example, in the most recent assessment, these human
structural problems were estimated to cost $510 billion annually in treatment for patients,
equivalent to 4.6 percent of our gross domestic product (Andersson and American Academy of
Orthopaedic Surgeons, 2008). More specifically, in the United States cervical/neck pain
accounted for 16.4 million annual health care visits, second only to lower back pain (Andersson
and American Academy of Orthopaedic Surgeons, 2008). Nonspecific musculoskeletal spinal
dysfunctions have accounted for 80-85% of reported cases and included disorders of the muscles,
nerves, intervertebral discs, joints, cartilage, tendons and ligaments of the neck and back (World
Health Organization, 2003). In most industrialized countries, incidence of nonspecific spinal
disorders has been between 4-5% annually with lifetime prevalence between 60 and 85% (World
Health Organization, 2003). Consistently high occurrences of cervical dysfunction have been
reported throughout multiple decades (National Institute for Occupational Safety and Health,
1997), demonstrating a need for research to assess the causes of cervical spine dysfunctions as
well as improve diagnosis and treatment techniques.
Cervical dysfunction is prevalent in a wide variety of populations, often due to
osteoarthritis associated with aging. Cervical dysfunctions are commonly induced through
traumatic incidences such as whiplash (Loudon et al., 1997, Bogduk and Yoganandan, 2001,
Grifka et al., 1998), injury due to sports (Junge and Dvorak, 2004, Junge et al., 2004, McIntosh,
2005a, McIntosh, 2005b, McIntosh and McCrory, 2005), and long term repetitive work
involving movement of the head, arm, and shoulder (National Institute for Occupational Safety
and Health, 1997). In addition, several studies have provided evidence that prolonged static loads
1

or extreme working postures involving the neck and shoulder muscles have strong associations
with cervical musculoskeletal dysfunctions (National Institute for Occupational Safety and
Health, 1997).
The prevalence of neck dysfunction due to injury associated with traumatic events and
physical over-exertion has been well documented throughout literature. It has been reported that
62% of patient visits to an emergency room following a motor vehicle accident complain of neck
pain (Deans et al., 1986). Additionally, up to 6% of patients with whiplash injuries do not return
to work for a time greater than one year (Evans, 1992). Recent studies have shown that the
occurrence of neck sprains and contusions for sports such as football, soccer, hockey, and rugby
range from 2.6% to 7.5% (McIntosh, 2005a, McIntosh, 2005b, McIntosh and McCrory, 2005,
Junge and Dvorak, 2004, Junge et al., 2004).
In a prospective cohort study, Ariens et al. (2001) found a significant positive association
between sitting at work for more than 95% of the working time and neck pain as well as a strong
positive relationship between neck flexion angle and neck pain. Similarly, Viikari-Juntura et al.
(2001) reported associations between the duration of work with a hand above shoulder lever and
radiating neck pain.
Accurate diagnoses of neck pain are often difficult, requiring various techniques to
determine the specific cervical dysfunction causing the pain. Medical imaging technology such
as magnetic resonance imaging (MRI), computed axial tomography (CT scan) and radiography
(x-ray) have shown success with assisting in the diagnosis of specific spinal disorders such as
intervertebral disc herniation and vertebral fractures (Holmes et al., 2002, Klein et al., 1999,
LeVine, 2010). Although medical imaging typically involves analysis of static postures, dynamic
musculoskeletal assessments using MR and CT imaging techniques are rapidly advancing.

2

Disadvantages to dynamic medical imaging assessments include high costs, lower resolutions,
and limited accessibility to advanced MRI and CT scanners. As a result, imaging technology is
typically limited to static assessments and therefore many functional cervical disorders cannot be
assessed through these techniques.
Currently, diagnosis of cervical dysfunctions that cannot be assessed through medical
imaging can be successfully accomplished using manual palpatory analyses. Various manual
diagnostic techniques have been developed and refined, and all involve the physical interaction
between a physician and a patient to assess dynamic factors such as motion qualities, tissue
texture, and joint stability. While manual medicine is commonly practiced throughout most
medical societies, current diagnosis and treatment techniques are dependent primarily on the
subjective analysis of the physician based on his or her education and experience.
Although manual diagnostic and treatment techniques are widely accepted in the medical
field, there is a lack of objective data to support their efficacy (Seffinger et al., 2004). Therefore,
the purpose of this research was to quantify the kinematic motions during a standard manual
cervical diagnostic technique to evaluate the following:

1. Consistency of motion patterns during the manual diagnostic motion within an
examiner.
2. Consistency of motion patterns during the manual diagnostic motion across examiners.
3. Differences between cervical lateral flexion conducted passively by an examiner and
actively by the subject.
4. Differences in kinematic patterns between individuals free of neck pain and individuals
experiencing neck pain.

3

5. Differences in kinematic patterns between subjects pre- and post- manual treatment.
6. Differences in kinematic patterns between pre-treatment, post-treatment, and a 72-hour
post-treatment for a subset of subjects.

4

LITERATURE REVIEW

The cervical spine has been researched from many different perspectives and for a vast
amount of reasons. For example, the causes and effects of cervical spine dysfunction as well as
spinal stability and motion accuracy have been examined by several studies (Loudon et al., 1997,
McNair et al., 2007, Armstrong et al., 2008, Feipel et al., 2006, Swinkels and Dolan, 1998).
Additionally, clinical procedures have been researched to confirm aspects of the diagnoses and
the effectiveness of treatment for individuals experiencing a wide range of cervical somatic
dysfunctions (Burns and Wells, 2006, Bush and Vorro, 2008, Bush et al., 2010, Pool et al., 2004,
Schops et al., 2000, Cleland et al., 2005, Cleland et al., 2007, Fernandez-de-las-Penas et al.,
2007). This review of literature is divided into five sections discussing Anatomical Terms &
Definitions, Technology to Quantify Anatomical Positions & Angles, Proprioception, Cervical
Range of Motion (ROM), and Manual Medicine Diagnosis & Treatment.

Anatomical Terms & Definitions
A basic understanding of general anatomical terminology and the anatomy of the spine
must be acquired to assess the musculoskeletal function of the cervical spine. Anatomical terms
are used to describe the position and orientation of structures in relation to features on the human
body. For this research, clinical terms are frequently used and therefore are presented here rather
than as an appendix.
Imaginary anatomical planes that intersect the body (Moore and Agur, 2007), as seen in
Figure 1, are used to define specific regions of the body and include:

5



Median (median sagittal) plane: A vertical plane that passes through the center of the
body, separating the body into equal left and right halves.



Sagittal planes: Vertical planes that pass through the body parallel to the median plane.



Frontal (coronal) planes: Vertical planes passing through the body perpendicular to the
median plane, separating the body into anterior (front) and posterior (back).



Transverse planes: Horizontal planes passing through the body perpendicular to both the
median and frontal planes, separating the body into superior (upper) and inferior (lower).
Posterior

Sagittal plane
Median plane
Frontal plane

Anterior
Median plane
Frontal (coronal)
plane

Transverse plane
Sagittal plane
Figure 1. Imaginary anatomical planes for describing regional references on the human
body (Moore and Agur, 2007). For interpretation of the references to color in this and all
other figures, the reader is referred to the electronic version of this thesis.

More specific anatomical terms used to describe relative position and orientation for
individuals standing with their feet together, arms to their side, palms and head facing forward
(Moore and Agur, 2007) are shown in Figure 2 and include:
6



Anterior: Toward the front of the body, separated by the frontal plane.



Posterior: Toward the back of the body, separated by the frontal plane.



Superior: Toward the head (above), separated by the transverse plane.



Inferior: Toward the feet (below), separated by the transverse plane.



Medial: Toward the median plane of the body.



Lateral: Away from the median plane of the body.



Proximal: Nearer to the trunk or point of origin.



Distal: Farther from the trunk or point of origin.



Ipsilateral: On the same side with respect to the median plane.



Contralateral: On the opposite side with respect to the median plane.
Superior

Superior

Median
Plane
Anterior
Posterior

Lateral
Medial

Proximal

Distal

Inferior
Inferior
Figure 2. Anatomical terms of location and direction
7

The human spine consists of four separate regions shown in Figure 3: the cervical,
thoracic, lumbar, and sacral regions. The cervical region specifically contains seven vertebrae
(C1-C7) with an intervertebral disc separating each vertebra inferior from C2. This interface
between rigid vertebral bodies and a resiliently deformable intervertebral disc allows for a high
level of mobility while still maintaining structural rigidity (Moore and Agur, 2007). While the
structure of the cervical spine allows for movement of the head and neck, the motion itself is a
function of the musculoskeletal system working in concert with controls from the nervous
system.
Anterior
view

Left lateral
view

Posterior
view

Cervical
curvature

Atlas (C1)
Axis (C2) Cervical
vertebrae
C7
T1

Thoracic
curvature

Thoracic
vertebrae
T12

Lumbar
curvature

L1
Lumbar
vertebrae
L5

Sacrum
(S1-5)
Sacral
curvature

Coccyx

Figure 3. The human spinal column separated by the cervical, thoracic, lumbar, and sacral
regions (Netter, 2006)

8

Movement of the head and neck is permitted due to the functionality of the cervical spine.
The primary movements of the head are described as axial rotation, lateral flexion, and
flexion/extension as demonstrated in Figure 4.

Axial rotation

Lateral flexion

Flexion/extension

Figure 4. Primary movements of the head including axial rotation, lateral flexion, and
flexion/extension (RelayHealth, 2009)

Technology to Quantify Anatomical Positions & Angles
Significant advancements in technology associated with quantifying static and dynamic
human motions have occurred as research and medicine has demanded more precise and accurate
measurements. Specifically the regional and/or segmental range of motion (ROM) of the spine
has been an area of interest. Regional motion refers to the gross movement of the cervical,
thoracic, or lumbar sections of the spine, while segmental motion is the motion of an individual
vertebra with relation to the inferior or superior vertebrae. The quantitative methods utilized in
research include but are not limited to the use of goniometers, inclinometers, radiographs,
magnetic resonance imaging (MRI), computerized axial tomography (CAT or CT scan), and
three-dimensional (3D) motion capture (LeVine, 2010).

9

The goniometer and inclinometer have been used by physicians and physical therapists to
quantify the cervical range of motion (ROM) of a patient. The use of these devices is fairly
simplistic and quantifies the cervical ROM of a subject at static positions. A goniometer
operates much like a protractor; the origin of the goniometer placed at the joint’s center of
motion, and by extending the two rigid linkages of the device along the bones leading from the
joint, an angle can be determined. For example, a goniometer could be used on a knee joint to
obtain the angle between the thigh and lower leg. An inclinometer can be used to determine the
angle of lateral flexion or flexion/extension by determining the tilt of the inclinometer attached to
the subjects head with respect to gravity. However, since this measurement requires gravity to be
acting in the direction of the movement, the inclinometer can only measure lateral flexion of the
head when attached to the frontal plane and flexion/extension when attached to the sagittal plane
on a seated or standing individual. Several studies still use these means to quantify the cervical
ROM of the cervical spine (Rosenfeld et al., 2000, Fernandez-de-las-Penas et al., 2007). While
these instruments are advantageous in the sense that they are non-invasive and easy to
implement, errors associated with these devices are often high due to instrument accuracy and
sensitivity as well as the high potential for user error.
A second set of tools used to evaluate cervical motion are medical imaging technologies.
Imaging technologies are useful tools for quantifying regional as well as the segmental cervical
spine motions; however the equipment often requires static measurements. The most widely
utilized medical imaging technologies include:


Radiography: The use of a heterogeneous beam of X-rays to construct a 2D
representation of musculoskeletal structures of the human body based on varying tissue
densities and compositions.
10



Magnetic Resonance Imaging (MRI): The use of a powerful magnetic field and radio
frequency pulses to construct 2D images of the scanned area of the body, providing
contrast between various tissues types.



X-Ray Computed Tomography (CT): The use of X-rays to construct a large series of 2D
images taken around a single axis of a human body segment with a high- resolution.

While these medical imaging techniques allow cervical motions to be assessed based upon
specific in-vivo anatomical landmarks, they are often limited to static measurements, produce
two-dimensional images, and can’t accommodate a range of postures (Klein et al., 1999, Holmes
et al., 2002, LeVine, 2010).
A third measurement tool used to assess human kinematics is a motion capture system.
Three-dimension (3D) motion capture is used to measure dynamic motions through a multicamera setup that determines where passive markers, attached superficially to a subject’s body,
are located in three dimensional space. Over time, these systems have acquired the ability to take
3D marker positions at high sampling rates (greater than 1000 Hz) and resolutions (greater than
four megapixels). The accuracy and dynamic capabilities of modern motion capture systems
have led these systems to be widely used in spinal research studies.
While this technology boasts dynamic measurements at a high level of marker resolution,
there is often concern for measurement accuracy when determining segmental motion as opposed
to regional motion. To determine the gross regional motion of the cervical spine, many
researchers apply markers to the head and thorax in order to determine the overall movement of
the head relative to the thorax and thus determine the motion of the cervical region (Bush et al.,
2010, Bush and Vorro, 2008, Grip et al., 2007). Segmental motion often requires the examiner to
place markers superficially on the spinous processes of the vertebrae in order to assess the
11

kinematic motions of individual vertebra of a region. While criticism of this method has arisen
due to the concern of markers shifting with the skin over the bony landmarks, several studies
have shown that the relative movement between the markers placed on the skin and the bony
landmark of the spinous process through ranges of motion is minimal (Wu et al., 2007, Engsberg
et al., 2008, Morl and Blickhan, 2006). Thus, the use of motion capture can accurately determine
the gross regional motion of the cervical spine through monitoring of the head motion relative to
the thorax (Seffinger et al., 2004, Bush et al., 2010).

Proprioception
Proprioception is the ability humans have to sense body orientations in three-dimensional
space. Specifically, researchers have attempted to link cervical dysfunction to the ability a person
has to accurately position and reposition his or her head during functional tasks (Loudon et al.,
1997, Grip et al., 2007, Sterling et al., 2004, Revel et al., 1991, Heikkila and Wenngren, 1998,
Rix and Bagust, 2001, Armstrong et al., 2005). Typically these studies analyze proprioceptive
capability of an individual through position-matching tasks involving instructions for an
individual to move his or her head to a specific location, move away from that location, and then
return to the first location (Armstrong et al., 2005, Loudon et al., 1997, Revel et al., 1991,
Heikkila and Wenngren, 1998, Rix and Bagust, 2001). The difference between the initial
position and the return to that position were documented and termed repositioning errors in these
studies.
Since injuries to soft-tissue structures of the cervical spine can lead to proprioceptive
deficits (Armstrong et al., 2008), analysis of cervical dysfunction based up an individual’s head
12

and neck position sense has been widely investigated as a potential assessment technique. In a
study conducted by Revel et al. (1991), significant impairment of 30 patients with chronic neck
pain was documented in comparison to an age-matched group of healthy individuals with
repositioning errors of 6.11° and 3.50° respectively. Similarly, Heikkila and Wenngren (1998)
reported significantly greater error in whiplash groups (3.71°) when compared with a healthy
control group (2.79°). In a smaller study of eleven subjects with a history of whiplash injury
compared to eleven age-matched healthy individuals, Loudon et al. (1997) found a larger mean
position-sense error in the whiplash group of 5° in comparison to 1.8° for healthy individuals.
In contrast, several studies were unable to document significant differences between
healthy and impaired individuals. For a group of 20 subjects with cervical pain related headaches
in comparison to a healthy control group, De Hertogh et al. (2008) reported an insignificant
difference in absolute error scores of 4.2° and 3.4° respectively. As well, Rix and Bagust (2001)
observed no significant differences in repositioning accuracy between a group of subjects with
chronic and non-traumatic neck pain (6.3°) and a healthy control group (4.6°). Due to the
contradictive findings, these proprioceptive techniques cannot be scientifically accepted as a
conclusive technique for identifying cervical dysfunction.

Cervical Range of Motion (ROM)
Cervical range of motion is often evaluated by the maximum angles achieved in the
primary movement direction (flexion/extension, lateral flexion, or rotation) during active or
passive motions. Passive motion involves an examiner guiding the subject’s head through the
primary motions, while active motion requires the subject to move his or her head in prescribed
13

motions independent of an examiner. Quantification of cervical ROM is the most commonly
reported objective measure used to assess cervical dysfunction (Gross et al., 2007, Gross et al.,
1996, Borghouts et al., 1998, Kjellman et al., 1999, Nordin et al., 2008, Strimpakos, 2011).

Active versus passive motion
While most studies evaluate cervical range of motion through similar procedures,
variability is often observed in the use of passive or active cervical motion. Several studies
indicate that passive and active cervical motion differ (Lantz et al., 1999, Christensen and
Nilsson, 1998, Dvorak et al., 1992, Wong and Nansel, 1992, Castro et al., 2000). Through
extensive systematic reviews of published literature, Chen et al. (1999) and Kelvin Jordan (2000)
identified several studies that reported passive motion tests resulted in greater cervical ROM
values and higher reliability estimates than active movement tests. Wong and Nansel (1992)
found that end-range values for active motion tests were approximately five degrees less than
passive tests on the most restricted side and approximately 10 degrees less on the least restricted
side. Castro et al. (2000) and Dvorak et al. (1992) both published similar findings with passive
motion tests resulting in larger range of motion angles and smaller standard deviations than
active motion tests. In contrast, Johnston et al. (1985) found no significant differences between
active and passive cervical range of motion values in both normal and affected subject pools.
Due to geometric constraints between cervical vertebrae and vertebral joint orientation,
most cervical motion involves coupled movement patterns. Pure cervical lateral flexion is nearly
impossible to physically perform and is coupled with an ipsilateral rotation due to the orientation
of the facet joints between vertebrae as documented in several studies (Dall'Alba et al., 2001,
14

Jordan et al., 2003, Trott et al., 1996, Feipel et al., 1999). If motions are not kept in the plane of
motion, a secondary motion could be introduced resulting in range of motion angles larger than
those achieved if only primary motions are allowed. In studies performed by Malmström et al.
(2006) and Jordan et al. (2003), findings suggest that larger coupled rotation was accompanied
by larger primary lateral flexion suggesting a larger performance range with use of coupled
movements. While inconsistencies are prevalent between published results on active versus
passive motions, no protocol seems to yield significantly superior results, suggesting that both
active and passive testing can be used in evaluation of cervical motion (Strimpakos et al., 2005,
Nordin et al., 2008).

Healthy individuals versus individuals with neck pain
Assessment of an individual’s cervical range of motion is commonly used as a criterion
for evaluating neck pain and cervical dysfunction (Kjellman et al., 1999, Nordin et al., 2008,
Strimpakos, 2011). The relationship between reduction of cervical ROM and neck pain is well
documented and supported through previous studies (Dall'Alba et al., 2001, Bush et al., 2010,
Grip et al., 2007, Prushansky et al., 2006). In a study comparing the active cervical ROM in all
three primary directions (flexion/extension, lateral flexion, and rotation) for 89 asymptomatic
and 114 symptomatic individuals with persistent whiplash-associated disorders (WAD),
Dall’Alba et al. (2001) demonstrated a significant effect for groups (p<0.001) in all primary
cervical ROM directions. In comparison to the asymptomatic group, patients with persistent
WAD demonstrated a reduction in cervical ROM in all primary movement directions. Similarly,
Grip et al. (2007) compared the active cervical ROM in flexion/extension and axial rotation

15

between three subject groups: a non-specific neck pain group (n=21) with pain lasting longer
than 3 months, a WAD group (n=22) with symptoms lasting longer than 3 months, and a control
group (n=24) with no head, neck, or back pain in the past 3 months. From this study, significant
differences (p<0.05) were found between groups for all cervical ROM directions. Prushansky et
al. (2006) produced comparable findings from an investigation of active cervical ROM in all
movement directions between healthy individuals (n=75) and patients with chronic WAD
(n=101). A significant reduction (p<0.0001) in cervical ROM in patients with chronic WAD was
documented, with an average reduction of 23.6 degrees in the primary movement directions.
Analysis of cervical ROM for healthy individuals and those experiencing neck pain is
less common for passive motion evaluations. In an investigation of the kinematics during passive
motion tests, Bush et al. (2010) found significant differences (p<0.10) between the lateral flexion
ROMs of asymptomatic (n=10) and symptomatic (n=9) groups.

Manual Medicine Treatment & Diagnosis
Nonspecific neck pain is highly prevalent, with approximately 85% of reported neck pain
attributed to acute or repetitive neck injuries or chronic musculoligamentous stresses and strains
(Narayan and Haid, 2001). Diagnosis of nonspecific neck pain often cannot be conducted
through medical imaging technologies, and invasive treatment procedures are not applicable to
nonspecific cervical dysfunctions. Several disciplines including osteopathic, chiropractic,
physical therapy, and allopathic professions utilize manual medicine techniques to diagnose and
treat musculoskeletal disorders (Seffinger et al., 2003). For these professions, the diagnosis of
spinal musculoskeletal dysfunctions through palpation is a pre-requisite for the application of
16

manual treatment and palpation is essential for assessing the effectiveness of the intervention
(Seffinger et al., 2004, Seffinger et al., 2003).

Inter and intra-examiner reliability of diagnosis
Manual assessments of individuals with neck pain are often based on diagnostic criteria
such as the quantity and quality of regional and segmental joint motion, symmetry of bony
landmarks, and soft tissue abnormalities (Seffinger et al., 2004). While these diagnostic
parameters are common across manual medicine professions, the diagnostic evaluation is often
dependent on the health care provider’s education, training and experience (Carey et al., 1995).
This is apparent through many studies reporting low levels of inter-examiner agreement (across
multiple examiners) and moderate to high levels of intra-examiner agreement (within a single
examiner) for palpatory assessments of the cervical spine (Pool et al., 2004, Stochkendahl et al.,
2006, Seffinger et al., 2004, Fjellner et al., 1999, Deboer et al., 1985, Mior et al., 1985).
Inter and intra-examiner reliability of diagnosis is most often reported through Kappa
scores ranging from -1 to 1, with a score of 0.4 or greater signifying acceptable reliability.
However, evaluations of inter and intra-examiner reliability through Kappa scores are often
based upon diagnostic statements recorded by the examiners as opposed to objective measures.
Research studies conducted by Stochkendahl et al. (2006), Mior et al. (1985), and DeBoer et al.
(1985) determined through Kappa scores that intra-examiner palpatory assessments of the
cervical spine have acceptable reliability with poor inter-examiner reliability. From a subject
pool of 47 symptomatic and asymptomatic subjects, Fjellner et al. (1999) documented acceptable
agreement between examiners during regional passive motion assessments of the cervical spine
17

but poor reliability for intersegmental passive motion assessments. Pool et al. (2004) found
through a group of 32 patients with neck pain that the reproducibility of cervical mobility
assessments was highly variable between examiners. Similarly, through a systematic review of
49 articles on spinal palpation, Seffinger et al. (2004) found that intra-examiner reliability is
better than inter-examiner reliability and regional cervical ROM tests are more reliable than
segmental cervical ROM tests. With regard to measurement of inter- and intra-examiner
differences, Seffinger et al. (2004) concluded that “in general, the quality of the research on
inter- and intrareliability of spinal palpatory diagnostic procedures needs to be improved.”

Effectiveness of manual treatment
Methods used in the treatment of cervical disorders vary between and within manual
medicine disciplines. Through an evaluation of 955 questionnaires submitted by osteopathic
physicians on the use of 11 manual treatment techniques, Johnson et al. (2003) found that the top
four treatment techniques reportedly used “often” or “very often” include soft tissue therapy
(71.7%), high-velocity low-amplitude (63.4%), muscle energy (60.9%), and myofascial release
(40.3%).
Several studies have investigated the effects of high-velocity low-amplitude (HVLA)
manipulation on individuals (Cleland et al., 2005, Cleland et al., 2007, Fernandez-de-las-Penas et
al., 2007, Martinez-Segura et al., 2006). From a subject pool of 36 patients with mechanical neck
pain, Cleland et al. (2005) found significant support (p<0.001) that those subjects who received a
HVLA manipulation experienced immediate improvements in pain scores reported pre- and posttreatment. In comparison, subjects who received a sham treatment without HVLA manipulation
18

did not see a significant effect from treatment. Similarly, Fernandez-de-las-Penas et al. (2007)
found a significant reduction in pain (p<0.001) immediately and 48 hours post HVLA
manipulation treatment as well as a trend towards an increase in active cervical ROM in a group
of 70 patients with neck pain.
The effects of muscle energy treatment on active cervical ROM in asymptomatic subjects
was investigated by Burns et al. (2006). Pre-treatment, there were no significant differences in
the cervical ROM values between the muscle energy treatment group (n=18) and the sham
treatment group (n=14). Post-treatment assessments found a significant difference between
groups (p<0.001) for the magnitude of difference between pre- and post-treatment cervical
ROMs. Additionally for lateral flexion ROMs following treatment, the muscle energy treatment
group saw a significant increase in cervical ROM while the sham treatment group saw a
significant decrease in cervical ROM (p<0.05).
Currently, there is limited research on the effects of manual treatment techniques which
are often evaluated based on improvements in subjective pain scores as opposed to objective
measures. Further, investigation on the effects of treatment during active and passive motions
needs to be conducted with the use of objective measures.

19

METHODS

This study had several components including the collection of three-dimensional
kinematic data during diagnostic examinations by multiple physicians, two subject groups,
manual treatment, and tests of passive and active motions. Figure 5 demonstrates the process
through a flow chart. Following this figure, the Methods chapter will detail the Subject Screening
& Selection, The Cervical Diagnosis Technique used in Osteopathic Manual Medicine,
Equipment, Subject Testing Protocol, and Data Analysis.

20

Participant moved to another room and
underwent a screening process by
Examiner 1, resulting in two groups:
Control (n=22): Participants who were
asymptomatic (VAS = 0) and had
symmetric left and right lateral flexion
motions
Experimental (n=19): Participants who
were symptomatic (VAS ≥ 3)

Participant arrived and completed:
- Consent document
- Initial Visual Analog Scale (VAS)
for neck pain
- Neck Pain and Disability Scale
(NPDS) questionnaire
- General health history form

Examiner 3:
- Blinded to Examiner 1 and 2’s
assessment.
- Diagnosed participant through 2
trials (3 cycles per trial) of passive
cervical lateral flexion in front of the
motion capture system.

Participant moved to the laboratory and
was evaluated by Examiner 2:
- Blinded to Examiner 1’s assessment.
- Diagnosed participant through 2 trials
(3 cycles per trial) of passive cervical
lateral flexion in front of the motion
capture system.

Active motion evaluation:
- Participant performed 2 trials
(3 cycles per trial) of active
cervical lateral flexion in front
of the motion capture system.
NO

Experimental

YES

Participant completed a post-test
VAS, and then his/her
participation was concluded.

Examiner 2 performed Muscle
Energy Treatment on the cervical
region.

A selected subset of the experimental
participants (n=5) returned 72 hours
post-treatment. Examiners 2 and 3
re-screened the participant while
kinematic data were collected.
Participant completed a follow-up
pre- and post-test VAS.

- Examiner 3 performed a posttreatment assessment during the
kinematic data collection, followed by
Examiner 2.
- Participant completed a post-treatment
VAS

Figure 5. A flow chart of the test protocol
21

Subject Screening & Selection
Screening to obtain test groups
Volunteers for this study were recruited from Michigan State University’s (MSU) student
and faculty and staff population as well as MSU’s Clinical Center. Advertisements were posted
seeking individuals with acute or chronic neck pain as well as healthy, pain free individuals.
Upon arrival to the Biomedical Design Research Laboratory (BDRL), the experiment was
explained and participants were asked to read and sign the consent form. Following the subject’s
written consent (IRB# 06-464), three questionnaires were administered to document levels of
pain and overall health. The first questionnaire was a Visual-Analog Scale (VAS) (Magee, 2002)
where subjects documented their pain in the neck region on a ten centimeter scale with “0”
signifying no pain and “10” indicating severe pain (Appendix A1). The second questionnaire was
the Neck Pain and Disability Scale (NPDS) (Wheeler et al., 1999) entailing twenty questions
regarding the ability of the participant to complete daily tasks based upon levels of pain
experienced in the neck region (Appendix A2). The third questionnaire was a Lifestyles
Questionnaire (Appendix A3) containing seven questions on physical attributes and health. A
summary of subjects’ questionnaire responses can be found in the Results chapter, with subject
specific data found in Appendix A4. Following the completion of these questionnaires, subjects
were escorted into another room where an osteopathic physician (Examiner 1) performed a
palpatory cervical diagnosis (detailed in Diagnosis technique) while blinded to the subject’s
health, pain and disability scores. From the VAS and initial screening, subject groups were
established as:

22

Control: Asymptomatic – No documented pain (VAS = 0) and symmetric left and right
lateral flexion motion as determined by Examiner 1.
Experimental: Symptomatic – Documented pain (VAS ≥ 3).

Subject pool
Based on the screening of 131 total volunteers, only 41 subjects, 19 Experimental (14
males and 5 females) and 22 Control (16 males, 4 females, and 2 ‘not reported’), were selected
for kinematic testing with an average age of 27.5 years (±13.1 years) and 19.9 years (±1.9 years)
respectively. Physiological data for subject’s average height, weight, and age were collected and
summarized in the Results chapter with subject specific data found in Appendix A4.

The Cervical Diagnosis Technique used in Osteopathic Manual Medicine
The cervical palpatory diagnostic technique utilized during subject screening and testing
was a highly practiced, standard clinical diagnostic motion test, common to osteopathic manual
medicine (Johnston and Friedman, 1995). The diagnostic procedure was followed by all three
examiners, who had each been practicing physicians for over ten years. The procedure was as
follows:
1. The examiner aligned himself/herself posterior to the seated subject and asked the subject
to remain in an erect posture with his/her arms crossed across his/her chest and eyes
closed, while remaining passive to the examiners’ motions during testing. The subject’s

23

head position prior examiner-subject contact was established as the subject specific
neutral location.
2. The examiner placed his/her right hand gently on the subject’s head such that the hand
was shaped to the vertex of the subject’s head. The contralateral hand was placed lightly
over the ipsilateral posterior thoracic midline to stabilize the shoulders as shown in
Figure 6.
3. The examiner slowly guided the subject’s head with his/her right hand in lateral flexion
to the right, bringing the right ear toward the ipsilateral shoulder until a palpable sense of
end-range of motion was achieved. End-range of motion was defined as the point where
tissue texture change required a substantial increase in pressure to continue the lateral
flexion motion.
4. The subject’s head was then guided back to the neutral location, and the examiner hand
placement was switched such that his/her left hand was placed on the vertex of the
subject’s head and the right hand placed on the ipsilateral posterior thoracic midline.
5. The examiner slowly guided the subject’s head in left lateral flexion, bringing the left ear
towards the ipsilateral shoulder until a palpable sense of end-range of motion was
achieved.
6. The subject’s head was guided back to the neutral location again, and steps 2-5 were
repeated two more consecutive times resulting in six lateral flexions (three right lateral
flexions, and three left lateral flexions). This was considered a single trial. Two trials
were conducted with each subject.

24

Z
X
Y

Figure 6. Examiner conducting a cervical palpatory diagnosis on a subject while collecting
kinematic data

Following the cervical palatory diagnostic procedure, examiners made their clinical evaluations
based upon the following pre-defined assessment criteria (Johnston and Friedman, 1995, Magee,
2002),
1. A visual and proprioceptive evaluation of the magnitude and symmetry of left and right
cervical lateral flexion.
2. A palpatory assessment with the primary moving hand during lateral flexion to determine
quality of motion, where quality of motion was evaluated on:
a. Smoothness of motion during the entire passive testing protocol.

25

b. Tissue resistance (end-feel) evaluated by palpation of the cervical spine at the
end-range of motion. End-feel was considered as any resistance to movement as
the subject reached the end of the joint’s motion range.
i. Normal end-feel for cervical lateral flexion is tissue stretch or firmness at
the end-range of motion in the form of elastic resistance.
ii. Abnormal end-feel for cervical lateral flexion, suggesting dysfunction,
include hardness or bone-to-bone contact (typically abrupt, hard and
painful), muscle spasm or hard capsular sensation (increased tissue
resistance sooner than expected), empty motion (motion stops due to
pain), and springy block motion (similar to tissue stretch but occurring at a
point in the cervical range of motion not anticipated).

Equipment
Experimental setup
Eligible subjects were escorted into the Biomechanical Design Research Laboratory
where retro-reflective markers were attached to the skin via medical adhesives so that 3D
kinematic motion data could be captured. A six-camera Qualysis Motion Tracking System
(Gothenburg, Sweden) was used to gather the 3D kinematic data. Two markers placed on each
temple lateral to the creases of the eyes, and one marker centered on the forehead 2.5cm superior
to the brow (Figure 7) captured the head motions. Three additional markers were used in a rigid
triad configuration and adhered to the subject’s sternum centered 5cm inferior to the sternal

26

notch to capture the movement of the subject’s torso (Figure 7). Based on pilot tests, a sampling
frequency of 20 Hz was used for obtaining motion data.

Figure 7. Retro-reflective passive markers applied to the forehead, left and right temple,
and a triad configuration on the sternum

Through calibration of the motion capture system, a global Cartesian coordinate system
was generated within the testing space. The coordinate system was oriented such that the X-axis
progressed horizontally from the subject’s left to right, the Y-axis from posterior to anterior, and
the Z-axis vertically from inferior to superior. The global origin of the system was established to
be the left posterior corner of the clinical examining stool in relation to the subject. The system
was calibrated each day prior to testing with the coordinate system the same for all subjects. The
camera configuration can be seen in Figure 8.

27

Figure 8. Motion capture system camera configuration with global coordinate system
origin on the left, posterior stool corner relative to the subject

Motion capture system accuracy
The Qualysis six-camera motion capture system was assessed for measurement accuracy
through the use of three rigid linear “wands” with a passive marker attached to each end and a
right triangle with a passive marker attached to each vertex. Measurements were manually taken
with calipers to determine the distance between the centroids of the markers on each “wand”.
The distance between the centroids of the markers on each vertex of the 45°- 45°- 90° triangle
were measured manually and used to compute the internal angles. After the system was properly
calibrated, each object was individually moved through the calibrated space while 3D kinematic
data were obtained for the centroid of each marker. Each specimen was tested three times over
two days with a calibration of the system established each day prior to testing.
28

From the 3D kinematic data obtained for the markers on each specimen, the length of
each wand and the internal angles of each vertex could be calculated and compared to the manual
measurements. Accuracy of the Qualysis motion capture system was determined through a
comparison of the manually measured data to the mean and standard deviation of values obtained
from the motion capture system (Appendix A5). The average standard deviation for all three
trials of a specimen never exceeded ±2 mm or ±1 degree.

Subject Testing Protocol
Passive motion tests
Two different examiners conducted the motion tests in front of the motion capture
system. Examiners were blinded to subject pain scores and each other’s assessments. Further, the
order in which the examiners performed testing was controlled. Examiner 2 was called into the
testing space and aligned posterior to the subject. Examiner 2 performed two separate trials of
palpatory cervical diagnoses consisting of three left and right lateral flexion’s (Left-Right-LeftRight-Left-Right) per trial. Data were collected for 30-65 seconds during each testing trial; each
trial starting with a three second period in which the subject was instructed to remain still and
facing forward to establish a subject specific neutral location prior to the examiner initiating the
diagnosis procedure. Following Examiner 2’s testing, Examiner 3 was called into the testing
space while Examiner 2 recorded his diagnosis. The same testing protocol was used for
Examiner 3, with two trials and each trial containing three cycles of cervical lateral flexion. Both
trials were conducted in front of the motion capture system. The written diagnosis sheets were

29

immediately collected and filed by a test assistant to ensure proper blinding of each examiner to
the others’ diagnoses.

Active motion tests
The final test in the series was that of active motion. Written instructions for active motion
testing were provided to the participant and were as follows:
1. Sit with your feet flat on the ground, hands crossed in front of your chest with your back
in a comfortably erect posture.
2. Start the motions with your head in a comfortable neutral position (looking straight
forward) and with your eyes closed.
3. Hold the starting position for a count of three seconds and then begin moving your right
ear slowly towards your right shoulder, keeping your torso as still as possible.
4. When you reach your “comfortable end range” moving to the right, reverse direction.
Then begin moving your head to the left at the same pace (speed) until a comfortable end
range is reached to the left.
This procedure was re-iterated verbally prior to testing, instructing the subject to perform
three left and right lateral flexion’s (Left-Right-Left-Right-Left-Right) during two separate trials.
Following the initial testing, Control subjects were asked to complete a post-test VAS
concluding their participation while Experimental subjects moved to the treatment phase.

30

Treatment technique
All subjects qualifying for inclusion in the Experimental group were treated by Examiner
2 after the first set of kinematic tests. The primary mode of treatment conducted on all subjects
was the muscle energy technique. Treatment was performed with the subject in a supine position
and the examiner seated superior to the subject as shown in Figure 9.

Figure 9. Muscle energy treatment performed on a study participant

The muscle energy treatment technique is a common osteopathic manipulative treatment
method used to treat somatic dysfunction, especially restricted range of motion, asymmetry,
increased muscle tension and pain. This treatment technique uses isometric muscle contraction to
lengthen potentially shortened cervical muscles and fascia to normalize gross cervical range of
motion (Burns and Wells, 2006). Myofascial release was used in coordination with the muscle
energy technique. Myofascial release involves the stretching and releasing of soft tissues along
with manipulation of deep tissues by pressure application to balance the muscles involved in
cervical motion.
31

Post-treatment evaluation
The post-treatment testing protocol was conducted in an identical manner as the pretreatment testing protocol; however Examiner 3 led the testing procedure followed by Examiner
2 and then active motion. Following post-treatment testing, Experimental subjects were asked to
complete a post-test VAS, concluding their participation.

Longitudinal evaluation
Five of the 19 Experimental subjects, selected on availability and willingness to
participate, were asked to return 72 hours for additional testing and deemed the Longitudinal
group. The 72-hour follow-up tests were conducted in the same manner as the pre-treatment
testing. Upon return to the BDRL, subjects were asked to complete another consent form as well
as the VAS and NPDS. The same motion tests were performed as discussed in Passive motion
tests and Active motion tests. The testing protocol was conducted with Examiner 2 leading the
testing procedure, followed by Examiner 3 and finally active motion testing. Again, both
examiners were blinded to each other’s testing, diagnoses, and the subject’s pain scores.
Following the 72-hour testing the five Experimental subjects completed a post-test VAS,
concluding their participation.

32

Data Analysis
Raw kinematic data processing
Raw motion files were opened on a trial by trial basis and the six markers used during
testing were labeled (forehead, left temple, right temple, middle sternum, left sternum, and right
sternum) and checked for discontinuities with any artificial markers discarded. Once the
appropriate markers were identified, the raw frame-by-frame motion data for each marker were
exported as a “tab separated value” (.tsv) file. Raw data contained within the .tsv file were
copied to an Excel file that separated data by marker and coordinates (x, y, z) as well as provided
a time value (seconds) for each frame.

Angles of motion for the head relative to the thorax
A Matlab toolbox program, KineMat (Reinschmidt and Bogert, 1997), that utilized Euler
angles was used to compute the angles of the head relative to the thorax. Each Excel file
containing the raw kinematic motion data was saved into a folder containing seven separate
Matlab function files (.m): Cardan, Marker, Rad2Deg, Run, Ryzxsolv, Screw, Soder. These
Matlab function files, combined to form the KineMat toolbox, were used to compute the cervical
angles of rotation for each trial. The angles of rotation were determined using Euler (Cardan)
angle rotations in the order of rotation about the y-axis (lateral flexion), z-axis (axial rotation),
and then x-axis (flexion and extension). The order of rotation was chosen based upon the study
by Whittle and Walker (2004) who determined that the accuracy of primary and secondary
rotations were greatest when rotations were calculated around the respective axes in that order.

33

The KineMat software was validated through manual calculation of the angles of rotation
for lateral flexion, axial rotation, and flexion/extension via Euler angle rotation calculations.
First, local Cartesian coordinate systems were established on the head and thorax in the form of
unit vectors ( ̂, ̂, ̂ ). These coordinate systems were generated from the coordinates of the
markers on the head (forehead, left temple, right temple) and the sternum (middle sternum, left
sternum, right sternum). These local coordinate systems were then aligned with respect to the
global coordinate system. Based upon the unit vectors for a local coordinate system at frame ‘n’
and frame ‘n+1’, the rotation matrix between the two frames could be calculated and thus the
angles of rotation could be determined. The rotation matrix based upon a rotation sequence of
YZX was determined from the summation of the rotation matrices for rotation around the y-axis,
z-axis, and x-axis independently as follows:

 cos1 0 sin1 
R y ( 1 )   0
1
0 


 sin1 0 cos1 


cos 2
R z (  2 )   sin 2

 0


 sin 2
cos 2
0

0
1
0 cos
Rx (  3 )  
3
0 sin 3


0
0

1


0 
 sin 3 

cos 3 


R( 1,2 ,3 )  RY ( 1 )Rz ( 2 )Rx( 3 )  [ R ]

34

 cos1 cos 2 sin1 sin 3  cos1 cos 3 sin 2
[ R]  
sin 2
cos 2 cos 3

 cos 2 sin1 cos1 sin 3  cos 3 sin1 sin 2


cos1 sin 2 sin 3  cos 3 sin1 

 cos 2 sin 3

cos1 cos 3  sin1 sin 2 sin 3 


Where θ1 was the angle of rotation about the y-axis (lateral flexion), θ2 was the angle of rotation
around the z-axis (axial rotation), and θ3 was the angle of rotation around the x-axis (flexion and
extension).
The rotation matrix, R(θ1, θ2, θ3), was then multiplied with the unit vectors of the local
coordinate system at the original frame, Xn, to determine the location of the local coordinate
system in the next frame, Xn+1, such that:

X n 1  R( 1 , 2 , 3 )* X n
ˆ
i 
 ˆ
 j
ˆ
k 
 

n 1

ˆ
i 
 ˆ
 [ R] *  j 
ˆ
k 
 

n

From the known values ( ̂, ̂, ̂ ) of the local coordinate systems at frame ‘n’ and ‘n+1’ and
the rotation matrix derived above, the values for lateral flexion (θ1), axial rotation (θ2), and
flexion/extension (θ3) can be determined for the head and thorax independently. Rotation values
for the thorax are then subtracted from values of rotation of the head to account for thorax
rotation during testing.

35

To assess the accuracy of KineMat, manual Euler angle calculations were conducted on
three subjects over two trials. From the maximum left and right lateral flexion angles, the full
range of cervical motion for each cycle (left to right lateral flexion) within a trial was compared
to values obtained via KineMat. For the three subjects, the average difference between KineMat
and the manual Euler angle calculations for full range of cervical motion was 0.9 degrees (±0.7
degrees). This validated the use of KineMat as an efficient means to determine angles of rotation
for the data set.

Minimum and maximum lateral flexion
The maximum right (negative) and left (positive) lateral flexion values were determined
through Excel. Each maximum lateral flexion value was identified through Excel ‘If’ statements
requiring that the magnitude of a maximum value was greater than ten degrees (θn>10°), greater
than the previous ten values (θn>θn-1>θn-2>…>θn-10), and greater than the following ten values
(θn>θn+1>θn+2>…>θn+10). All angles were based upon a subject selected neutral position (zero
degree angle) obtained during the first three seconds of motion capture tests. Secondary ROM
values were determined as the axial rotation values at the corresponding frames identified for
maximum lateral flexion values. All values were visually checked to ensure the proper values
were obtained for maximum right and left lateral flexion.

36

Root mean square error and angular velocity calculation
To investigate the kinematic differences between trials within a subject for a given
examiner, a root mean square error (RMSE) calculation (Franks et al., 1982) was conducted on
each individual lateral flexion motion as well as the complete time series data. In order to
perform the RMSE calculation on each lateral flexion motion individually, the cycles had to be
identified and dissected from the complete time series data. An individual lateral flexion cycle
was defined as the kinematic data associated with the start of a cycle to the maximum lateral
flexion value for that cycle. This was done by first identifying each maximum left and right
lateral flexion value through the methods previously discussed, requiring that the value be larger
than ten degrees and greater than the previous or following ten frames. Each cycle was then
defined as all frames previous to the maximum value that were greater than two degrees and
constantly increasing, with the start of the cycle identified as having a minimum of five frames
constantly increasing by at least 0.25 degrees, as shown in Figure 10. With each lateral flexion
cycle identified (three right and three left) for both trials, all of the lateral flexion values for the
cycles were dissected from the complete time series with the twelve individual cycles separated
in a new Excel worksheet. The time series of each cycle was then normalized such that they
ranged from zero to one.

37

0

1

Time (seconds)
3
4

2

5

6

7

0
-5

Lateral Flexion (degrees)

-10
-15
-20

Start of a cycle:
o
 Greater than 2
 Five frames constantly
o
increasing by > 0.25

-25
-30
-35
-40
-45
-50

Complete Cycle

Peak of a cycle:
o
 Greater than 10
 Greater than the
previous or following
ten frames

Dissected Cycle

Figure 10. Example of a complete right lateral flexion cycle dissected from the start to peak
of the cycle

The calculation of the RMSE between the two trials was conducted for each lateral
flexion cycle, all right cycles, all left cycles, and all cycles. For a RMSE calculation to be
conducted between trials, each cycle must be sampled for lateral flexion values at time values
that correspond between trials. Each cycle had 50 lateral flexion values sampled at 2% intervals
of the normalized time series. The difference between the lateral flexion values of trial one (θ1)
and trial two (θ2) at each sampled time frame i, was used in the RMSE calculation as follows,
where n was the number of sampled data points.

38

(

)

∑
√

The RMSE between the complete time series of the two trials was computed in a similar
method. Excessive data was truncated from the beginning and end of the prescribed diagnostic
motion, each trial’s time series was normalized and 200 data points were sampled at 0.5%
intervals.
The average rate of motion, or angular velocity (degrees/second), of each lateral flexion
cycle was determined from the slope of calculated linear regressions for the frames identified
from the start to the peak of a cycle as shown in Figure 11.

0

0.5

1

Time (seconds)
1.5
2
2.5

3

3.5

4

0

Trial 1

-10
Lateral Flexion (degrees)

-5

Trial 2

-15

Linear (Trial 1)
Linear (Trial 2)

-20
-25
-30

y = -11.6x - 6.2

-35
-40
-45

y = -14.3x - 6.1

-50
Figure 11. Example of the average rate of motion calculated from the slope of linear
regressions applied to the dissected right lateral flexion cycles of two trials
39

Statistical analyses
Several statistical analyses were conducted to evaluate differences between examiners,
consistency within an examiner, differences between active and passive motions, and differences
within and between groups (Control, Experimental pre-treatment, Experimental post-treatment,
and Longitudinal). Statistical tests included independent samples t-tests, paired samples t-tests,
and one-way ANOVAs conducted on the following values:


Left lateral flexion ROMs (left end-range), right lateral flexion ROMs (right end-range),
and the complete ROM from maximum left to maximum right (full ROM)



Rate of left lateral flexions (left-slope), rate of right lateral flexions (right-slope), and the
rate of all lateral flexions (total-slope)



Root mean square error calculated between trial one and two of the dissected cycles for
all left lateral flexions (left RMSE), all right lateral flexions (right RMSE), and all lateral
flexions (total RMSE) as well as the RMSE calculated between trial one and trial two of
the complete time series



Left axial rotation ROMs (left end-range), right axial rotation ROMs (right end-range),
and the complete ROM from left to right axial rotations (full ROM)

All statistical tests performed are explained in further detail when presented in the Results
chapter.

40

RESULTS

All kinematic data were assessed through statistical and descriptive analyses. This Results
section outlines data obtained on the Participant Demographics, Intra-Examiner Comparisons,
Inter-Examiner Comparisons, Active versus Passive Motion, Group Comparisons, and
Longitudinal Study Comparisons. Data presented in this Results section include values for
angular range of motion, rate of cervical lateral flexion, and calculated root mean square error.

Participant Demographics
Prior to all testing procedures, age, height, weight, gender, and handedness were obtained
for each participant (Tables 1-3). Additionally, pain scores were collected via a VAS and
functionality was assessed through a Neck Pain and Disability Scale (NPDS) (Table 4 and
Appendix A4).
As noted previously in the Methods section, based on the screening process conducted on
a total of 131 volunteers, only 41 subjects, 19 Experimental (14 male and 5 female) and 22
Control (14 male, 6 female, and 2 ‘not reported’), were selected for kinematic testing with an
average age of 27.5 years (±13.1 years) and 19.9 years (±1.9 years) respectively. A total of 90
subjects were not qualified (or not needed due to full groups) for testing following the screening
process.

41

Table 1. Subject age, height, and weight as divided by subject group
Ages (years)
Height (cm)
Weight (kg)
Control Experimental Control Experimental Control Experimental
Min
Max
Average
SD

18.0
23.0
19.9
1.9

18.0
63.0
27.5
13.1

154.9
193.0
174.9
10.2

152.4
195.6
175.9
12.3

49.9
108.4
74.0
13.7

44.0
120.7
79.9
20.9

Table 2. Gender comparisons as divided by subject group
Gender
Control
Experimental
Male
Female
Not Reported

14
6
2

14
5
0

Table 3. Subject handedness as divided by subject group
Handedness
Control
Experimental
Right
Left
Not Reported

17
4
1

18
1
0

The data in Tables 1-3 express similar subject pool characteristics between the Control
and Experimental group for average height and weight, as well as the distribution of gender and
handedness. The average height and weight for the Control and Experimental group were 174.9
cm and 74.0 kg, and 175.9 cm and 79.9 kg respectively.

42

Table 4. Pre-test VAS, post-test VAS, and NPDS scores as divided by subject group
Pre-Test VAS
Post-Test VAS
NPDS
Control Experimental Control Experimental Control Experimental
Min
Max
Average
SD

0.0
0.0
0.0
0.0

3.0
8.0
4.6
1.7

0.0
0.0
0.0
0.0

1.0
7.0
3.8
2.0

0.0
13.0
2.5
4.1

12.5
77.0
46.9
21.0

As mandated in the screening protocol, to be included in the Control group it was
required that the participant select “0” on the VAS. To be included in the Experimental group,
the participant had to select a score of “3” or higher on the VAS. As shown in Table 4, the
Control subjects reported a zero VAS pain score pre- and post-test; and the Experimental group
saw a slight decrease in the average VAS score from pre-treatment to post-treatment. The NPDS
scores expressed a strong difference in disability levels between the Control and Experimental
group prior to testing with reported average scores of 2.5 (±4.1) and 46.9 (±21.0) respectively.

43

For each of the following sections, data will be presented for the kinematic results first in
the form of ranges of motion (ROM), the rate of change of motion (slope) and the results of the
root mean square error (RMSE) analysis. Subject specific data can be found in the Appendix for
ranges of lateral flexion’s (Appendix A6), ranges of axial rotations (Appendix A7), rates of
lateral flexion’s (Appendix A8), the RMSE of dissected cycles (Appendix A9) and the RMSE of
complete time series (Appendix A10). Tables documenting statistical analyses conducted present
significant findings as shaded values.

Intra-Examiner Comparisons
Range of Motion
The cervical lateral flexion angular range of motion data for Examiner 2 are presented in
Tables 5, 6, and 7 as average left end-range of motion (left end-range), average right end-range
of motion (right end-range) and the average full range of motion (full ROM) [total from left endrange to right end-range] in degrees. Table 5 presents data for trials one and two of the Control
group, Table 6 provides data for the Experimental group pre-treatment, and Table 7 provides the
average kinematic data for trials one and two of the Experimental group post-treatment. The
average full range of motion (ROM) for trial one and two of Examiner 2 in the Control group
was 71.0 (±11.6) and 71.7 (±11.5) degrees, respectively. The average full ROM for trial one and
two of Examiner 2 in the Experimental group was 67.7 (±12.3) and 64.9 (±11.8) degrees for pretreatment, and 67.0 (±11.4) and 66.5 (±12.00) degrees for post-treatment.

44

Table 5. Examiner 2 intra-examiner comparisons in the Control group for left end-range,
right end-range, and full range of motion values
Left End-Range (Deg) Right End-Range (Deg)
Trial 1
Trial 2
Trial 1
Trial 2
Min
Max
Average
SD

22.6
45.4
35.5
5.6

24.3
46.9
35.5
5.7

15.9
50.5
35.6
7.2

23.0
50.9
36.2
6.7

Full ROM (Deg)
Trial 1
Trial 2

39.6
89.0
71.0
11.6

51.5
94.8
71.7
11.4

Table 6. Examiner 2 intra-examiner comparisons in the Experimental group pre-treatment
for left end-range, right end-range, and full range of motion values
Left End-Range (Deg) Right End-Range (Deg)
Trial 1
Trial 2
Trial 1
Trial 2
Min
Max
Average
SD

23.4
49.6
34.6
7.0

23.2
47.7
33.0
6.3

18.9
47.9
33.0
7.1

19.6
48.7
31.8
6.2

Full ROM (Deg)
Trial 1
Trial 2

44.4
92.7
67.7
12.2

43.1
93.7
64.9
11.8

Table 7. Examiner 2 intra-examiner comparisons in the Experimental group posttreatment for left end-range, right end-range, and full range of motion values
Left End-Range (Deg) Right End-Range (Deg)
Trial 1
Trial 2
Trial 1
Trial 2
Min
Max
Average
SD

23.5
50.4
34.1
6.6

19.6
46.4
33.3
6.3

21.5
45.2
33.0
6.1

16.8
45.4
33.3
6.7

Full ROM (Deg)
Trial 1
Trial 2

49.0
90.2
67.0
11.4

48.6
89.5
66.5
12.0

Similarly, the average cervical lateral flexion ROM data for Examiner 3 is presented in
Tables 8, 9, and 10 for left end-range, right end-range, and full ROM values in degrees. Range of
motion data for trial one and two of Examiner 3 are documented for the Control group in Table
8, the Experimental group pre-treatment in Table 9 and the Experimental group post-treatment in
Table 10. The average full ROM for trial one and two of Examiner 3 in the Control group was
65.9 (±11.7) and 66.3 (±11.3) degrees respectively. The average full ROM for trial one and two
45

of Examiner 3 in the Experimental group was 58.3 (±11.4) and 57.7 (±12.0) degrees for pretreatment, and 59.8 (±11.4) and 62.3 (±12.7) degrees for post-treatment.
Table 8. Examiner 3 intra-examiner comparisons in the Control group for left end-range,
right end-range, and full range of motion values
Left End-Range (Deg) Right End-Range (Deg)
Trial 1
Trial 2
Trial 1
Trial 2
Min
Max
Average
SD

21.5
44.6
33.1
6.3

21.4
44.3
33.6
5.9

13.8
45.4
32.6
7.1

15.4
47.0
32.7
7.1

Full ROM (Deg)
Trial 1
Trial 2

35.7
87.6
65.8
11.7

37.9
87.1
66.3
11.3

Table 9. Examiner 3 intra-examiner comparisons in the Experimental group pre-treatment
for left end-range, right end-range, and full range of motion values
Left End-Range (Deg) Right End-Range (Deg)
Trial 1
Trial 2
Trial 1
Trial 2
Min
Max
Average
SD

13.8
41.2
29.7
6.7

18.5
40.3
29.4
6.5

16.0
42.8
28.5
5.8

13.5
42.4
28.3
6.9

Full ROM (Deg)
Trial 1
Trial 2

35.8
83.8
58.2
11.4

34.4
80.6
57.7
12.0

Table 10. Examiner 3 intra-examiner comparisons in the Experimental group posttreatment for left end-range, right end-range, and full range of motion values
Left End-Range (Deg) Right End-Range (Deg)
Trial 1
Trial 2
Trial 1
Trial 2
Min
Max
Average
SD

16.0
42.0
29.6
6.4

15.5
44.8
31.6
6.8

17.1
46.9
30.2
6.6

18.3
47.4
30.6
6.6

Full ROM (Deg)
Trial 1
Trial 2

35.9
87.7
59.8
11.4

33.8
92.2
62.3
12.6

The lateral flexion ROM data were statistically analyzed for intra-examiner consistency
of motion using one-way ANOVAs conducted on each examiners’ data (Examiner 2 and
Examiner 3) within each test group (Control, Experimental pre-treatment, and Experimental

46

post-treatment). Each of the six ANOVAs tested for significant differences between cycles one
through six (three cycles per trial over two trials) for right end-range, left end-range, and full
ROM values and included the following cases:




Examiner 2

Examiner 3

o Control

o Control

o Experimental pre-treatment

o Experimental pre-treatment

o Experimental post-treatment

o Experimental post-treatment

No significant differences between each of the six cycles were reported for right end-range, left
end-range, or full ROM data for Examiner 2 or Examiner 3 within the Control or either
Experimental groups.

Rate of motion
As previously indicated in the Methods section, the rate of change, or average angular
velocity, of cervical lateral flexion was determined through the slope of the values from the start
of a cycle to the maximum lateral flexion value of a cycle such that an average rate was
calculated for cervical lateral flexion to the left (left-slope), cervical lateral flexion to the right
(right-slope) and all cervical lateral flexion’s (total-slope). The data for average rate of left, right,
and total cervical lateral flexion for cycles one through three (trial one) and cycles four through
six (trial two) of Examiner 2 are presented in Tables 11-13. The average slope data for trial one
and two of Examiner 2 are presented in Table 11 for the Control group, Table 12 for the
Experimental group pre-treatment and Table 13 for the Experimental group post-treatment. The
average rate of all cervical lateral flexion’s performed (total-slope) for trial one and two of
47

Examiner 2 within the Control group was 10.6 (±2.9) and 11.5 (±3.3) degrees/second,
respectively. The average total-slope for trial one and two of Examiner 2 in the Experimental
group was 9.5 (±3.1) and 9.0 (±3.3) degrees/second for pre-treatment testing, and 9.2 (±2.6) and
8.9 (±2.5) degrees/second for post-treatment testing.
Table 11. Examiner 2 intra-examiner comparisons in the Control group for left-slope,
right-slope, and total-slope values
Right-slope (Deg/sec)
Trial 1
Trial 2
Min
Max
Average
SD

4.2
19.9
10.5
2.9

5.7
21.8
11.8
3.4

Left-slope (Deg/sec)
Trial 1
Trial 2

4.9
17.8
10.7
2.9

4.9
19.8
11.3
3.3

Total-slope (Deg/sec)
Trial 1
Trial 2

4.2
19.9
10.6
2.9

4.9
21.8
11.5
3.3

Table 12. Examiner 2 intra-examiner comparisons in the Experimental group pretreatment for left-slope, right-slope, and total-slope values
Right-slope (Deg/sec)
Trial 1
Trial 2
Min
Max
Average
SD

4.3
18.7
9.7
3.1

4.2
18.1
9.1
3.1

Left-slope (Deg/sec)
Trial 1
Trial 2

4.2
18.7
9.4
3.0

4.2
18.1
9.0
3.4

Total-slope (Deg/sec)
Trial 1
Trial 2

4.2
18.7
9.5
3.0

4.2
18.1
9.0
3.3

Table 13. Examiner 2 intra-examiner comparisons in the Experimental group posttreatment for left-slope, right-slope, and total-slope values
Right-slope (Deg/sec)
Trial 1
Trial 2
Min
Max
Average
SD

5.9
20.0
9.8
2.7

4.8
16.6
9.4
2.6

Left-slope (Deg/sec)
Trial 1
Trial 2

4.5
15.4
8.7
2.5

48

4.0
13.7
8.5
2.4

Total-slope (Deg/sec)
Trial 1
Trial 2

4.5
20.0
9.2
2.6

4.0
16.6
8.9
2.5

The data for average rate of left, right, and total cervical lateral flexion of trial one and
trial two for Examiner 3 are documented in Tables 14-16. The average slope data for trial one
and two of Examiner 3 are presented in Table 14 for the Control group, Table 15 for the
Experimental group pre-treatment and Table 16 for the Experimental group post-treatment. The
average total-slope for trial one and two of Examiner 3 within the Control group was 11.5 (±3.6)
and 12.0 (±3.5) degrees/second, respectively. For the Experimental group, the average total-slope
for trial one and two of Examiner 3 was 9.5 (±3.1) and 10.1 (±3.3) degrees/second for pretreatment testing, and 9.4 (±2.5) and 10.5 (±3.5) degrees/second for post-treatment testing.
Table 14. Examiner 3 intra-examiner comparisons in the Control group for left-slope,
right-slope, and total-slope values
Right-slope (Deg/sec)
Trial 1
Trial 2
Min
Max
Average
SD

3.5
23.0
11.1
3.7

5.6
20.8
11.6
3.5

Left-slope (Deg/sec)
Trial 1
Trial 2

2.3
20.2
11.8
3.4

2.8
19.8
12.3
3.5

Total-slope (Deg/sec)
Trial 1
Trial 2

3.5
23.0
11.5
3.6

2.3
20.8
12.0
3.5

Table 15. Examiner 3 intra-examiner comparisons in the Experimental group pretreatment for left-slope, right-slope, and total-slope values
Right-slope (Deg/sec)
Trial 1
Trial 2
Min
Max
Average
SD

3.8
18.1
9.7
3.2

3.9
17.4
10.0
3.3

Left-slope (Deg/sec)
Trial 1
Trial 2

3.9
14.6
9.4
2.9

49

4.0
17.8
10.1
3.4

Total-slope (Deg/sec)
Trial 1
Trial 2

3.8
18.1
9.5
3.1

3.9
17.8
10.1
3.3

Table 16. Examiner 3 intra-examiner comparisons in the Experimental group posttreatment for left-slope, right-slope, and total-slope values
Right-slope (Deg/sec)
Trial 1
Trial 2
Min
Max
Average
SD

5.6
15.9
9.5
2.4

Left-slope (Deg/sec)
Trial 1
Trial 2

4.8
18.7
10.3
3.3

5.2
16.3
9.2
2.7

Total-slope (Deg/sec)
Trial 1
Trial 2

4.8
21.3
10.7
3.6

5.2
16.3
9.4
2.5

4.8
21.3
10.5
3.5

Statistical analyses conducted on the intra-examiner consistency for the rate of cervical
lateral flexion of Examiner 2 and Examiner 3 included one-way repeated measures ANOVAs
performed within each group (Control, Experimental pre-treatment, and Experimental posttreatment) for both right-slope and left-slope. Each of the twelve ANOVAs tested for significant
differences between the slope of cycle six and the slopes of each remaining cycles (one through
five), and included the following cases:


Examiner 2
o Right-slope

o Left-slope




Control



Experimental pre-treatment



Experimental pre-treatment




Control

Experimental post-treatment



Experimental post-treatment

Examiner 3
o Right-slope

o Left-slope


Control



Control



Experimental pre-treatment



Experimental pre-treatment



Experimental post-treatment



Experimental post-treatment

50

Statistical results from Examiner 2 are presented in Table 17-a, demonstrating a
significant difference between cycle one and cycle six for the right-slope of the Experimental
group pre- and post-treatment (p<0.05) and the left-slope of the Experimental group posttreatment (p<0.10). Significant differences between cycle four and cycle six were reported in all
three groups for right-slope (p<0.10) as well as the left-slope of the Experimental group posttreatment (p<0.05). Table 17 (b-g) contains the descriptive statistics for each ANOVA,
documenting the mean, standard error, and confidence interval for each cycle.
Similarly, statistical results from Examiner 3 are presented in Table 18-a, demonstrating a
significant difference between cycle one and cycle six for the right-slope of the Control group
(p<0.05) and the left-slope of the Control and Experimental group post-treatment (p<0.05).
Significant differences between cycle four and cycle six were found for the left-slope of the
Control and Experimental group post-treatment (p<0.10). Table 18 (b-g) contain the descriptive
statistics for each ANOVA, documenting the mean, standard error, and confidence interval for
each cycle.

51

Table 17-a. Examiner 2 intra-examiner cycle-by-cycle statistical analyses for rate of right
and left cervical lateral flexion within the Control and Experimental groups
Group
Control
Control
Control
Control
PrePrePrePrePostPostPostPost-

Test

Type III Sum
of Squares

df

Mean Square

F

Sig.

Left-slope (Cycle 1 v. 6)
Error
Right-slope (Cycle 1 v. 6)
Error
Left-slope (Cycle 4 v. 6)
Error
Right-slope (Cycle 4 v. 6)
Error
Left-slope (Cycle 1 v. 6)
Error
Right-slope (Cycle 1 v. 6)
Error
Left-slope (Cycle 4 v. 6)
Error
Right-slope (Cycle 4 v. 6)
Error
Left-slope (Cycle 1 v. 6)
Error
Right-slope (Cycle 1 v. 6)
Error
Left-slope (Cycle 4 v. 6)
Error
Right-slope (Cycle 4 v. 6)
Error

13.2
259.9
0.9
366.1
5.8
63.2
28.4
131.1
3.0
103.4
34.5
104.5
2.5
85.7
18.8
67.5
9.4
47.3
63.3
116.1
17.7
53.4
14.6
73.6

1
18
1
21
1
18
1
21
1
16
1
17
1
16
1
17
1
18
1
18
1
18
1
18

13.2
14.4
0.9
17.4
5.8
3.5
28.4
6.2
3.0
6.5
34.5
6.1
2.5
5.4
18.8
4.0
9.4
2.6
63.3
6.4
17.7
3.0
14.6
4.1

0.9

0.351

0.1

0.820

1.7

0.213

4.6

0.045

0.5

0.505

5.6

0.030

0.5

0.508

4.7

0.044

3.6

0.075

9.8

0.006

6.0

0.025

3.6

0.075

52

Table 17-b. Cycle-by-cycle descriptive statistics of right-slope for Examiner 2 within the
Control group
* All values in deg/sec
Cycle

Mean

1
2
3
4
5
6

11.3
10.2
10.1
12.2
12.0
11.1

95% Confidence Interval

Std. Error Lower Bound Upper Bound

0.6
0.6
0.7
0.7
0.8
0.7

10.0
9.0
8.7
10.7
10.5
9.6

12.5
11.4
11.5
13.6
13.6
12.5

Table 17-c. Cycle-by-cycle descriptive statistics of left-slope for Examiner 2 within the
Control group
* All values in deg/sec
Cycle

Mean

1
2
3
4
5
6

10.6
10.1
10.8
12.0
10.7
11.5

95% Confidence Interval

Std. Error Lower Bound Upper Bound

0.8
0.5
0.7
0.8
0.7
0.8

9.0
9.0
9.4
10.4
9.3
9.8

12.2
11.2
12.3
13.7
12.1
13.2

Table 17-d. Cycle-by-cycle descriptive statistics of right-slope for Examiner 2 within the
Experimental group pre-treatment
* All values in deg/sec
Cycle

Mean

1
2
3
4
5
6

10.2
9.7
9.8
9.8
9.4
8.8

95% Confidence Interval

Std. Error Lower Bound Upper Bound

0.6
0.7
0.9
0.6
0.8
0.8

9.0
8.2
7.9
8.5
7.8
7.2

53

11.4
11.2
11.6
11.1
11.0
10.4

Table 17-e. Cycle-by-cycle descriptive statistics of left-slope for Examiner 2 within the
Experimental group pre-treatment
* All values in deg/sec
Cycle

Mean

1
2
3
4
5
6

9.9
9.6
9.7
9.8
8.9
9.4

95% Confidence Interval

Std. Error Lower Bound Upper Bound

0.6
0.7
0.8
0.7
0.9
0.9

8.7
8.2
8.0
8.4
7.0
7.5

11.0
11.0
11.3
11.3
10.7
11.4

Table 17-f. Cycle-by-cycle descriptive statistics of right-slope for Examiner 2 within the
Experimental group post-treatment
* All values in deg/sec
Cycle

Mean

1
2
3
4
5
6

10.6
9.8
8.9
9.6
9.7
8.8

95% Confidence Interval

Std. Error Lower Bound Upper Bound

0.7
0.7
0.5
0.6
0.7
0.5

9.1
8.4
7.8
8.4
8.3
7.6

12.0
11.2
10.1
10.9
11.1
9.9

Table 17-g. Cycle-by-cycle descriptive statistics of left-slope for Examiner 2 within the
Experimental group post-treatment
* All values in deg/sec
Cycle

Mean

1
2
3
4
5
6

9.0
8.4
8.7
9.2
8.1
8.3

95% Confidence Interval

Std. Error Lower Bound Upper Bound

0.6
0.5
0.6
0.6
0.6
0.5

7.7
7.2
7.5
8.0
6.9
7.2

54

10.2
9.5
9.9
10.4
9.2
9.3

Table 18-a. Examiner 3 intra-examiner cycle-by-cycle statistical analyses for rate of right
and left cervical lateral flexion within the Control and Experimental groups
Group
Control
Control
Control
Control
PrePrePrePrePostPostPostPost-

Test

Type III Sum
of Squares

df

Mean Square

F

Sig.

Left-slope (Cycle 1 v. 6)
Error
Right-slope (Cycle 1 v. 6)
Error
Left-slope (Cycle 4 v. 6)
Error
Right-slope (Cycle 4 v. 6)
Error
Left-slope (Cycle 1 v. 6)
Error
Right-slope (Cycle 1 v. 6)
Error
Left-slope (Cycle 4 v. 6)
Error
Right-slope (Cycle 4 v. 6)
Error
Left-slope (Cycle 1 v. 6)
Error
Right-slope (Cycle 1 v. 6)
Error
Left-slope (Cycle 4 v. 6)
Error
Right-slope (Cycle 4 v. 6)
Error

25.6
106.0
48.9
107.8
18.6
99.2
26.8
191.9
5.8
95.6
16.6
112.7
0.9
107.9
12.5
77.9
81.1
207.2
13.9
152.5
24.6
118.8
3.7
147.0

1
21
1
21
1
21
1
21
1
18
1
18
1
18
1
18
1
17
1
17
1
17
1
17

25.6
5.0
48.9
5.1
18.6
4.7
26.8
9.1
5.8
5.3
16.6
6.3
0.9
6.0
12.5
4.3
81.1
12.2
13.9
9.0
24.6
7.0
3.7
8.6

5.1

0.035

9.5

0.006

3.9

0.061

2.9

0.102

1.1

0.310

2.7

0.121

0.2

0.700

2.9

0.106

6.7

0.020

1.5

0.230

3.5

0.078

0.4

0.524

55

Table 18-b. Cycle-by-cycle descriptive statistics of right-slope for Examiner 3 within the
Control group
* All values in deg/sec
Cycle

Mean

1
2
3
4
5
6

10.4
11.2
11.8
10.8
11.9
11.9

95% Confidence Interval

Std. Error Lower Bound Upper Bound

0.7
0.9
0.8
0.7
0.7
0.7

9.1
9.4
10.1
9.3
10.4
10.4

11.8
13.0
13.5
12.4
13.5
13.5

Table 18-c. Cycle-by-cycle descriptive statistics of left-slope for Examiner 3 within the
Control group
* All values in deg/sec
Cycle

Mean

1
2
3
4
5
6

11.7
11.4
12.3
11.9
12.3
12.8

95% Confidence Interval

Std. Error Lower Bound Upper Bound

0.6
0.7
0.8
0.7
0.8
0.7

10.4
9.9
10.6
10.5
10.6
11.3

13.1
12.9
14.0
13.3
14.1
14.3

Table 18-d. Cycle-by-cycle descriptive statistics of right-slope for Examiner 3 within the
Experimental group pre-treatment
* All values in deg/sec
Cycle

Mean

1
2
3
4
5
6

9.3
10.1
9.7
9.4
10.4
10.2

95% Confidence Interval

Std. Error Lower Bound Upper Bound

0.8
0.7
0.7
0.6
0.9
0.7

7.6
8.5
8.3
8.0
8.5
8.7

56

11.0
11.6
11.1
10.7
12.2
11.7

Table 18-e. Cycle-by-cycle descriptive statistics of left-slope for Examiner 3 within the
Experimental group pre-treatment
* All values in deg/sec
Cycle

Mean

1
2
3
4
5
6

9.2
9.4
9.6
10.0
10.7
9.7

95% Confidence Interval

Std. Error Lower Bound Upper Bound

0.7
0.6
0.7
0.7
0.8
0.8

7.7
8.1
8.1
8.5
9.0
8.0

10.7
10.6
11.1
11.4
12.4
11.5

Table 18-f. Cycle-by-cycle descriptive statistics of right-slope for Examiner 3 within the
Experimental group post-treatment
* All values in deg/sec
Cycle

Mean

1
2
3
4
5
6

9.2
9.3
10.1
9.6
10.1
10.1

95% Confidence Interval

Std. Error Lower Bound Upper Bound

0.5
0.5
0.6
0.7
0.7
0.8

8.1
8.2
8.9
8.2
8.6
8.4

10.4
10.4
11.3
11.1
11.6
11.8

Table 18-g. Cycle-by-cycle descriptive statistics of left-slope for Examiner 3 within the
Experimental group post-treatment
* All values in deg/sec
Cycle

Mean

1
2
3
4
5
6

8.8
8.7
10.2
9.8
10.7
10.9

95% Confidence Interval

Std. Error Lower Bound Upper Bound

0.6
0.6
0.7
0.6
1.0
0.8

7.6
7.4
8.7
8.4
8.5
9.1

57

10.1
10.0
11.7
11.1
12.9
12.7

Root mean square error
The root mean square error (RMSE) between the cervical lateral flexion of trial one and
trial two for an examiner’s passive motion within a subject was calculated according to the
protocol outlined in the Methods section. Investigation of intra-examiner consistency of motion
was conducted through the RMSE calculations of the individually dissected lateral flexion cycles
from the start of the cycle to the maximum lateral flexion value of that cycle. Tables 19-21
present the average RMSE data of each of the three cycles performed for right lateral flexion
(right RMSE), left lateral flexion (left RMSE), and both right and left lateral flexion combined
(total RMSE) of Examiner 2. The average RMSE values for each cycle of Examiner 2’s passive
motions are reported in Table 19 for the Control group, Table 20 for the Experimental group pretreatment and Table 21 for the Experimental group post-treatment. The average total RMSE
between trial one and two for each of the three cycles of Examiner 2 within the Control,
Experimental pre-treatment and Experimental post-treatment groups are summarized in Table
22, with a range of 2.5 to 3.3 degrees.
Table 19. Examiner 2 intra-examiner comparisons in the Control group of right, left, and
total RMSE values for all three cycles
Right RMSE (Deg)
Left RMSE (Deg)
Total RMSE (Deg)
Cycle 1 Cycle 2 Cycle 3 Cycle 1 Cycle 2 Cycle 3 Cycle 1 Cycle 2 Cycle 3
Min
Max
Average
SD

0.7
10.4
3.0
2.0

0.8
9.7
2.7
2.1

0.8
8.0
3.1
1.7

0.6
10.7
2.4
2.2

0.6
8.3
3.1
1.8

58

0.8
12.0
3.1
2.5

1.3
10.5
2.8
1.9

1.2
9.0
3.0
1.7

0.8
10.2
3.2
1.9

Table 20. Examiner 2 intra-examiner comparisons in the Experimental group pretreatment of right, left, and total RMSE values for all three cycles
Right RMSE (Deg)
Left RMSE (Deg)
Total RMSE (Deg)
Cycle 1 Cycle 2 Cycle 3 Cycle 1 Cycle 2 Cycle 3 Cycle 1 Cycle 2 Cycle 3
Min
Max
Average
SD

0.7
5.8
2.2
1.2

0.5
11.2
2.7
2.5

0.8
5.9
3.0
1.6

0.5
7.1
2.4
1.7

0.5
6.4
2.1
1.6

0.9
7.5
3.1
1.8

0.9
5.1
2.5
1.2

0.9
7.9
2.7
1.7

0.9
5.5
3.2
1.3

Table 21. Examiner 2 intra-examiner comparisons in the Experimental group posttreatment of right, left, and total RMSE values for all three cycles
Right RMSE (Deg)
Left RMSE (Deg)
Total RMSE (Deg)
Cycle 1 Cycle 2 Cycle 3 Cycle 1 Cycle 2 Cycle 3 Cycle 1 Cycle 2 Cycle 3
Min
Max
Average
SD

0.7
7.2
2.9
1.6

0.5
10.7
2.9
2.6

0.8
7.3
3.0
1.7

0.6
5.7
2.8
1.7

0.7
6.1
2.3
1.6

0.7
4.0
2.2
1.1

1.6
6.4
3.0
1.3

0.8
8.4
2.8
1.9

0.8
5.9
2.7
1.3

Table 22. Examiner 2 intra-examiner comparisons of total RMSE values (degrees) for all
three cycles within the Control, Experimental pre-treatment and Experimental posttreatment groups
Control
Exp. Pre-Treatment
Exp. Post-Treatment
Cycle 1 Cycle 2 Cycle 3 Cycle 1 Cycle 2 Cycle 3 Cycle 1 Cycle 2 Cycle 3
Min
Max
Average
SD

1.3
10.5
2.8
1.9

1.2
9.0
3.0
1.7

0.8
10.2
3.2
1.9

0.9
5.1
2.5
1.2

0.9
7.9
2.7
1.7

0.9
5.5
3.2
1.3

1.6
6.4
3.0
1.3

0.8
8.4
2.8
1.9

0.8
5.9
2.7
1.3

Similarly, Tables 23-25 present the average RMSE data of each of the three cycles
performed for right lateral flexion (right RMSE), left lateral flexion (left RMSE), and both right
and left lateral flexion combined (total RMSE) of Examiner 3. The average RMSE values for
each cycle of Examiner 3’s passive motions are reported in Table 23 for the Control group, Table

59

24 for the Experimental group pre-treatment and Table 25 for the Experimental group posttreatment. The average total RMSE between trial one and two for each of the three cycles of
Examiner 3 within the Control, Experimental pre-treatment and Experimental post-treatment
groups are summarized in Table 26, with a range of 2.3 to 3.1 degrees.
Table 23. Examiner 3 intra-examiner comparisons in the Control group of right, left, and
total RMSE values for all three cycles
Right RMSE (Deg)
Left RMSE (Deg)
Total RMSE (Deg)
Cycle 1 Cycle 2 Cycle 3 Cycle 1 Cycle 2 Cycle 3 Cycle 1 Cycle 2 Cycle 3
Min
Max
Average
SD

0.5
6.8
2.6
1.9

0.5
6.2
3.3
1.8

0.8
5.9
2.2
1.4

0.4
7.3
2.9
1.8

1.1
7.4
2.6
1.5

0.8
4.7
2.1
1.2

0.7
6.1
2.9
1.5

0.9
6.4
3.1
1.4

0.9
5.1
2.3
1.1

Table 24. Examiner 3 intra-examiner comparisons in the Experimental group pretreatment of right, left, and total RMSE values for all three cycles
Right RMSE (Deg)
Left RMSE (Deg)
Total RMSE (Deg)
Cycle 1 Cycle 2 Cycle 3 Cycle 1 Cycle 2 Cycle 3 Cycle 1 Cycle 2 Cycle 3
Min
Max
Average
SD

0.6
4.4
2.4
1.3

0.9
7.2
3.4
1.8

0.7
5.6
2.8
1.5

0.8
7.7
2.9
2.0

0.6
5.3
2.5
1.5

0.5
5.4
2.6
1.3

1.0
5.5
2.8
1.4

1.1
6.1
3.1
1.3

0.6
4.3
2.8
1.0

Table 25. Examiner 3 intra-examiner comparisons in the Experimental group posttreatment of right, left, and total RMSE values for all three cycles
Right RMSE (Deg)
Left RMSE (Deg)
Total RMSE (Deg)
Cycle 1 Cycle 2 Cycle 3 Cycle 1 Cycle 2 Cycle 3 Cycle 1 Cycle 2 Cycle 3
Min
Max
Average
SD

0.8
6.5
2.5
1.7

1.0
5.8
2.5
1.4

0.7
6.2
2.7
1.6

0.7
15.6
3.0
3.3

0.5
11.3
2.9
2.7

60

1.1
9.5
2.8
2.2

1.4
11.1
3.0
2.3

0.8
8.1
2.9
1.8

1.2
7.1
2.9
1.7

Table 26. Examiner 3 intra-examiner comparisons of total RMSE values (degrees) for all
three cycles within the Control, Experimental pre-treatment and Experimental posttreatment groups
Control
Exp. Pre-Treatment
Exp. Post-Treatment
Cycle 1 Cycle 2 Cycle 3 Cycle 1 Cycle 2 Cycle 3 Cycle 1 Cycle 2 Cycle 3
Min
Max
Average
SD

0.7
6.1
2.9
1.5

0.9
6.4
3.1
1.4

0.9
5.1
2.3
1.1

1.0
5.5
2.8
1.4

1.1
6.1
3.1
1.3

0.6
4.3
2.8
1.0

1.4
11.1
3.0
2.3

0.8
8.1
2.9
1.8

1.2
7.1
2.9
1.7

The RMSE data was statistically analyzed for intra-examiner consistency of motion
through one-way ANOVAs conducted on each examiner (Examiner 2 and Examiner 3) within
each test group (Control, Experimental pre-treatment, and Experimental post-treatment). Each of
the six ANOVAs tested for significant differences between cycles one through three of right, left,
and total RMSE for the following cases:




Examiner 2

Examiner 3

o Control

o Control

o Experimental pre-treatment

o Experimental pre-treatment

o Experimental post-treatment

o Experimental post-treatment

No significant differences between cycles one through three were reported for the right, left, or
total RMSE data of Examiner 2 or Examiner 3 within the Control or Experimental group.

61

Inter-Examiner Comparisons
Range of motion
The data for Examiner 2 and Examiner 3’s passive lateral flexion ranges of motion were
averaged over all six cycles within trial one and two and presented in Tables 27-29 as average
left end-range, right-end range, and full ROM values. A comparison of Examiner 2 and
Examiner 3’s average left end-range, right end-range, and full ROM is presented in Table 27 for
the Control group, Table 28 for the Experimental group pre-treatment and Table 29 for the
Experimental group post-treatment. The average full ROM for Examiner 2 was consistently
greater than Examiner 3 for the Control, Experimental pre-treatment, and Experimental posttreatment. The average full ROM for Examiner 2 and Examiner 3 respectively were 71.4 (±11.5)
and 66.1 (±11.5) degrees for the Control group, 66.3 (±12.0) and 58.0 (±11.7) degrees for the
Experimental group pre-treatment, and 66.8 (±11.7) and 61.04 (±12.0) degrees for the
Experimental group post-treatment.
Table 27. Inter-examiner comparisons between Examiner 2 and Examiner 3’s average
passive motions in the Control group for left end-range, right end-range, and full range of
motion values
Left End-Range (Deg) Right End-Range (Deg)
Ex. 2
Ex. 3
Ex. 2
Ex. 3
Min
Max
Average
SD

23.5
46.1
35.5
5.7

21.4
44.4
33.4
6.1

19.5
50.7
35.9
6.9

62

14.6
46.2
32.7
7.1

Full ROM (Deg)
Ex. 2
Ex. 3

45.5
91.9
71.4
11.5

36.8
87.4
66.1
11.5

Table 28. Inter-examiner comparisons between Examiner 2 and Examiner 3’s average
passive motions in the Experimental group pre-treatment for left end-range, right endrange, and full range of motion values
Left End-Range (Deg) Right End-Range (Deg)
Ex. 2
Ex. 3
Ex. 2
Ex. 3
Min
Max
Average
SD

23.3
48.6
33.8
6.7

16.1
40.8
29.6
6.6

19.2
48.3
32.4
6.7

14.8
42.6
28.4
6.4

Full ROM (Deg)
Ex. 2
Ex. 3

43.7
93.2
66.3
12.0

35.1
82.2
58.0
11.7

Table 29. Inter-examiner comparisons between Examiner 2 and Examiner 3’s average
passive motions in the Experimental group post-treatment for the left end-range, right endrange, and full range of motion values
Left End-Range (Deg) Right End-Range (Deg)
Ex. 2
Ex. 3
Ex. 2
Ex. 3
Min
Max
Average
SD

21.5
48.4
33.7
6.4

15.8
43.4
30.6
6.6

19.2
45.3
33.1
6.4

17.7
47.1
30.4
6.6

Full ROM (Deg)
Ex. 2
Ex. 3

48.8
89.9
66.8
11.7

34.8
89.9
61.0
12.0

Statistical analyses for inter-examiner ROM comparisons were conducted as independent
samples t-tests of Examiner 2 versus Examiner 3’s average passive ranges of motion.
Independent samples t-tests were used to compare Examiner 2 and Examiner 3’s data for left
end-range, right end-range, and full ROM values within the Control, Experimental pre-treatment
and Experimental post-treatment groups. As shown in Table 30, a significant difference between
Examiner 2 and Examiner 3’s ROM (left, right, and full) was found for the Experimental group
pre-treatment (p<0.10). No significant differences were reported between the passive motions of
Examiner 2 and Examiner 3 for the Control group or Experimental group post-treatment.

63

Table 30. Inter-examiner statistical analyses between Examiner 2 and Examiner 3 for right
end-range, left end-range, and full range of motion for the Control, Experimental pretreatment, and Experimental post-treatment groups
* Values in degrees
Group
Control
Control
Control
PrePrePrePostPostPost-

Levene's Test for
Equality of Variances

t-test for Equality of Means

Test

F

Sig.

t

df

Right
Left
Full ROM
Right
Left
Full ROM
Right
Left
Full ROM

0.029
0.558
0.003
0.012
0.128
0.064
0.001
0.082
0.009

0.866
0.459
0.956
0.912
0.723
0.802
0.970
0.776
0.927

1.6
1.2
1.6
2.3
2.0
2.1
1.3
1.5
1.5

42
42
42
35
36
36
36
36
36

Mean
Sig.
Difference* (2-tailed)

3.2
2.0
5.3
4.4
4.1
8.0
2.6
2.9
5.5

0.111
0.223
0.118
0.029
0.053
0.040
0.200
0.145
0.146

Rate of motion
The data for Examiner 2 and Examiner 3’s rate of passive lateral flexion were averaged
over all six cycles within trial one and two and presented in Tables 31-33. Inter-examiner
comparisons are presented for right-slope (average of all six right lateral flexions), left-slope
(average of all six left lateral flexions), and total-slope (average of all twelve lateral flexions) in
Table 31 for the Control group, Table 32 for the Experimental group pre-treatment, and Table 33
for the Experimental group post-treatment. The average total-slope of Examiner 2 and Examiner
3 within the Control group was 11.1 (±2.4) and 11.7 (±3.0) degrees/second, respectively. Within
the Experimental group the average total-slope of Examiner 2 and Examiner 3 respectively was
9.2 (±2.9) and 9.8 (±2.8) degrees/second for pre-treatment, and 9.1 (±2.3) and 10.1 (±2.6)
degrees/second for post-treatment testing.
64

Table 31. Inter-examiner comparisons between Examiner 2 and Examiner 3’s average rate
of passive motions in the Control group for right-slope, left-slope, and total-slope values
Right-slope (Deg/sec)
Ex. 2
Ex. 3
Min
Max
Average
SD

7.3
15.8
11.1
2.5

5.9
18.7
11.4
3.2

Left-slope (Deg/sec)
Ex. 2
Ex. 3

6.4
15.0
11.0
2.5

6.9
18.2
12.1
3.1

Total-slope (Deg/sec)
Ex. 2
Ex. 3

6.9
15.2
11.1
2.4

6.9
18.5
11.7
3.0

Table 32. Inter-examiner comparisons between Examiner 2 and Examiner 3’s average rate
of passive motions in the Experimental group pre-treatment for right-slope, left-slope, and
total-slope values
Right-slope (Deg/sec)
Ex. 2
Ex. 3
Min
Max
Average
SD

5.0
15.8
9.4
2.9

4.8
15.2
9.8
2.9

Left-slope (Deg/sec)
Ex. 2
Ex. 3

4.5
15.5
9.1
3.0

4.8
15.0
9.8
2.8

Total-slope (Deg/sec)
Ex. 2
Ex. 3

4.8
15.0
9.2
2.9

5.4
14.8
9.8
2.8

Table 33. Inter-examiner comparisons between Examiner 2 and Examiner 3’s average rate
of passive motions in the Experimental group post-treatment for right-slope, left-slope, and
total-slope values
Right-slope (Deg/sec)
Ex. 2
Ex. 3
Min
Max
Average
SD

6.3
15.4
9.6
2.4

5.9
16.0
10.1
2.6

Left-slope (Deg/sec)
Ex. 2
Ex. 3

5.5
13.6
8.6
2.2

5.7
14.4
10.1
2.7

Total-slope (Deg/sec)
Ex. 2
Ex. 3

6.0
14.5
9.1
2.3

5.8
15.1
10.1
2.6

Statistical analyses for inter-examiner comparisons of average rates of passive lateral
flexions were conducted as independent samples t-tests of Examiner 2 versus Examiner 3.
Independent samples t-tests were used to compare the left-slope, right-slope, and total-slope
values of Examiner 2 versus Examiner 3 for the Control, Experimental pre-treatment, and

65

Experimental post-treatment groups. As shown in Table 34, a significant difference between
Examiner 2 and Examiner 3’s the left-slope values was found for all groups (p<0.10) and totalslope values for the Experimental group post-treatment (p<0.05).
Table 34. Inter-examiner statistical analyses between Examiner 2 and Examiner 3 for
average left-slope, right-slope, and total-slope values within the Control and Experimental
groups
Group
Control
Control
Control
PrePrePrePostPostPost-

Test

df

t-value

Pr > |t|

Left-slope
Right-slope
Total-slope
Left-slope
Right-slope
Total-slope
Left-slope
Right-slope
Total-slope

21
21
21
18
18
18
18
18
18

-2.1
-0.4
-1.2
-1.9
-1.0
-1.6
-3.9
-1.1
-2.5

0.050
0.716
0.241
0.077
0.324
0.125
0.001
0.277
0.022

Root mean square error
The root mean square error (RMSE) values calculated between trial one and trial two of
all dissected cycles combined for Examiner 2 and Examiner 3’s passive motions are presented in
Tables 35-37. Inter-examiner comparisons of the calculated right (all three right lateral flexions),
left (all three left lateral flexions), and total (all right and left lateral flexions) RMSE of the
dissected cycles combined are presented in Table 35 for the Control group, Table 36 for the
Experimental group pre-treatment, and Table 37 for the Experimental group post-treatment. The
average total RMSE of all dissected cycles for Examiner 2 and Examiner 3 respectively were 3.1
(±1.6) and 2.9 (±1.0) degrees within the Control group, 2.9 (±1.1) and 3.0 (±0.9) degrees within

66

the Experimental group pre-treatment, and 2.9 (±1.3) and 3.1 (±1.7) degrees within the
Experimental group post-treatment.
Table 35. Inter-examiner comparisons between Examiner 2 and Examiner 3’s average
right, left, and total RMSE in the Control group
Right RMSE (Deg)
Ex. 2
Ex. 3
Min
Max
Average
SD

1.6
10.5
3.0
1.8

1.0
5.4
2.7
1.1

Left RMSE (Deg)
Ex. 2
Ex. 3

0.9
9.4
3.1
1.7

0.9
4.8
2.9
1.3

Total RMSE (Deg)
Ex. 2
Ex. 3

1.7
9.9
3.1
1.6

1.0
4.7
2.9
1.0

Table 36. Inter-examiner comparisons between Examiner 2 and Examiner 3’s average
right, left, and total RMSE in the Experimental group pre-treatment
Right RMSE (Deg)
Ex. 2
Ex. 3
Min
Max
Average
SD

0.9
4.8
2.7
1.3

0.6
5.3
2.8
1.3

Left RMSE (Deg)
Ex. 2
Ex. 3

0.9
7.6
2.7
1.6

1.4
5.0
3.1
1.0

Total RMSE (Deg)
Ex. 2
Ex. 3

0.9
5.5
2.9
1.1

1.4
4.2
3.0
0.9

Table 37. Inter-examiner comparisons between Examiner 2 and Examiner 3’s average
right, left, and total RMSE in the Experimental group post-treatment
Right RMSE (Deg)
Ex. 2
Ex. 3
Min
Max
Average
SD

1.0
4.7
2.6
1.3

1.3
12.4
3.1
2.5

Left RMSE (Deg)
Ex. 2
Ex. 3

1.8
7.7
3.1
1.7

1.2
5.6
2.7
1.2

Total RMSE (Deg)
Ex. 2
Ex. 3

1.6
6.2
2.9
1.3

1.6
8.9
3.1
1.7

The average RMSE values calculated between trial one and trial two for the complete
time series of Examiner 2 and Examiner 3’s passive motions are presented in Table 38 for the
Control, Experimental pre-treatment, and the Experimental post-treatment groups. The average
67

RSME of the complete time series’ for Examiner 2 and Examiner 3 respectively are 8.1 (±2.5)
and 8.1 (±3.4) degrees for the Control group, 8.3 (±3.2) and 7.6 (±3.5) degrees for the
Experimental group pre-treatment, and 8.5 (±3.8) and 9.0 (±3.1) degrees for the Experimental
group post-treatment.
Table 38. Inter-examiner comparisons between Examiner 2 and Examiner 3’s average
RMSE (degrees) of the complete time-series in the Control and Experimental groups
Control
Ex. 2
Ex. 3
Min
Max
Average
SD

3.6
12.9
8.0
2.5

3.4
18.5
8.1
3.4

Exp. Pre-Treatment Exp. Post-Treatment
Ex. 2
Ex. 3
Ex. 2
Ex. 3

3.0
16.6
8.3
3.2

3.0
17.9
7.6
3.5

5.3
18.5
8.5
3.8

4.1
14.7
9.0
3.1

Statistical analyses for inter-examiner comparisons of calculated RMSE values included
one-way ANOVAs for the Control and Experimental groups. Each ANOVA tested for
differences between Examiner 2 and Examiner 3’s average right, left, and total RMSE of the
dissected cycles combined as well as the RMSE of the complete time series. No statistically
significant differences were found for inter-examiner comparisons of calculated root mean
square errors.

Active versus Passive Motion
Range of motion
The cervical lateral flexion range of motion data for Examiner 2 and Examiner 3’s
passive motion testing as well as active motion testing performed independently by the subjects
were averaged over all six cycles within trial one and two and presented in Tables 39-41.
68

Comparisons of passive (Examiner 2 and Examiner 3) and active motions for average left endrange, right end-range, and full ROM values are presented in Table 39 for the Control group,
Table 40 for the Experimental group pre-treatment, and Table 41 for the Experimental group
post-treatment. These data demonstrate a consistent trend in which the average ROM for active
motion tests were greater than the average ROM during passive motions tests performed by both
Examiner 2 and Examiner 3. Comparisons of the average full ROM values for Examiner 2,
Examiner 3, and active motion are summarized in Table 42 for the Control, Experimental pretreatment and Experimental post-treatment groups, with differences between active and passive
ROMs ranging from 10.3 to 21.3 degrees.
Table 39. Active and passive motion comparisons in the Control group for average left endrange, right end-range, and full ROM values
Left End-Range (Deg) Right End-Range (Deg)
Full ROM (Deg)
Ex. 2 Ex. 3 Active Ex. 2 Ex. 3 Active Ex. 2 Ex. 3 Active
Min
Max
Average
SD

23.5
46.1
35.5
5.7

21.4
44.4
33.4
6.1

29.4
58.0
44.3
6.3

19.5
50.7
35.9
6.9

14.6
46.2
32.7
7.1

26.5
56.8
43.1
7.4

45.5
91.9
71.4
11.5

36.8
87.4
66.1
11.5

56.0
113.6
87.4
12.5

Table 40. Active and passive motion comparisons in the Experimental group pre-treatment
for average left end-range, right end-range, and full ROM values
Left End-Range (Deg) Right End-Range (Deg)
Full ROM (Deg)
Ex. 2 Ex. 3 Active Ex. 2 Ex. 3 Active Ex. 2 Ex. 3 Active
Min
Max
Average
SD

23.3
48.6
33.8
6.7

16.1
40.8
29.6
6.6

27.7
59.4
39.6
8.2

19.2
48.3
32.4
6.7

69

14.8
42.6
28.4
6.4

23.9
50.2
37.3
6.7

43.7
93.2
66.3
12.0

35.1
82.2
58.0
11.7

54.0
106.0
77.0
13.5

Table 41. Active and passive motion comparisons in the Experimental group posttreatment for average left end-range, right end-range, and full ROM values
Left End-Range (Deg) Right End-Range (Deg)
Full ROM(Deg)
Ex. 2 Ex. 3 Active Ex. 2 Ex. 3 Active Ex. 2 Ex. 3 Active
Min
Max
Average
SD

21.5
48.4
33.7
6.4

15.8
43.4
30.6
6.6

18.8
52.2
40.6
6.8

19.2
45.3
33.1
6.4

17.7
47.1
30.4
6.6

22.0
52.0
38.3
6.7

48.8
89.9
66.8
11.7

34.8
89.9
61.0
12.0

46.8
101.1
78.9
11.6

Table 42. Active and passive motion comparisons of full ROM values (degrees) for the
Control, Experimental pre-treatment and Experimental post-treatment groups
Control
Ex. 2 Ex. 3 Active
Min
Max
Average
SD

Exp. Pre-Treatment
Ex. 2 Ex. 3 Active

Exp. Post-Treatment
Ex. 2 Ex. 3 Active

45.5
91.9
71.4
11.5

43.7
93.2
66.3
12.0

48.8
89.9
66.8
11.7

36.8
87.4
66.1
11.5

56.0
113.6
87.4
12.5

35.1
82.2
58.0
11.7

54.0
106.0
77.0
13.5

34.8
89.9
61.0
12.0

46.8
101.1
78.9
11.6

Statistical analyses included one-way ANOVAs with a Bonferroni comparing the
averaged full ROM data of Examiner 2, Examiner 3, and active motion within the Control group
and Experimental group pre- and post-treatment. As presented in Table 43, the average active
full ROM data was significantly greater than the passive motions of Examiner 2 and Examiner 3
for all comparisons.

70

Table 43. Statistical analyses of passive versus active motion testing for average full range
of motion values within the Control and Experimental groups
95% Confidence Interval

*Values in degrees
Group
Control
Control
PrePrePostPost-

Test
Act v.
Act v.
Act v.
Act v.
Act v.
Act v.

Ex 2
Ex 3
Ex 2
Ex 3
Ex 2
Ex 3

Mean
Std.
Difference* Error*

16.0
21.3
10.4
18.4
12.1
17.6

3.5
3.5
3.9
3.9
3.6
3.6

Lower
Bound*

Upper
Bound*

Sig.

7.5
12.8
0.7
8.7
3.1
8.7

24.5
29.8
20.1
28.1
21.1
26.6

0.000
0.000
0.031
0.000
0.005
0.000

Rate of motion
The data for rate of cervical lateral flexion of Examiner 2 and Examiner 3’s passive
motion testing as well as active motion testing performed independently by the subjects were
averaged over all six cycles within trial one and two and presented in Tables 44-46. Comparisons
of passive (Examiner 2 and Examiner 3) and active motions for average left-slope (rate of left
lateral flexions), right-slope (rate of right lateral flexions), and total-slope (rate of all lateral
flexions) values are presented in Table 44 for the Control group, Table 45 for the Experimental
group pre-treatment, and Table 45 for the Experimental group post-treatment. These data present
a noticeable trend in which the average rate of lateral flexion during active motion tests was
greater than the rate of passive motions performed by both Examiner 2 and Examiner 3.
Comparisons of the average total-slope values for Examiner 2, Examiner 3, and active motion
are summarized in Table 47 for the Control, Experimental pre-treatment and Experimental posttreatment groups, with differences between active and passive rates of motions ranging from 4.6
to 6.8 degrees per second.

71

Table 44. Active and passive motion comparisons in the Control group for average rightslope, left-slope, and total-slope values
Right-Slope (Deg/sec)
Ex. 2 Ex. 3 Active
Min
Max
Average
SD

Left-Slope (Deg/sec)
Ex. 2 Ex. 3 Active

Total-Slope (Deg/sec)
Ex. 2 Ex. 3 Active

7.3
15.8
11.1
2.5

6.4
15.0
11.0
2.5

6.9
15.2
11.1
2.4

5.9
18.7
11.4
3.2

9.1
26.1
16.4
4.4

6.9
18.2
12.1
3.1

10.0
32.7
18.2
4.9

6.9
18.5
11.7
3.0

9.6
29.4
17.3
4.6

Table 45. Active and passive motion comparisons in the Experimental group pre-treatment
for average right-slope, left-slope, and total-slope values
Right-Slope (Deg/sec)
Ex. 2 Ex. 3 Active
Min
Max
Average
SD

Left-Slope (Deg/sec)
Ex. 2 Ex. 3 Active

Total-Slope (Deg/sec)
Ex. 2 Ex. 3 Active

5.0
15.8
9.4
2.9

4.5
15.5
9.1
3.0

4.8
15.0
9.2
2.9

4.8
15.2
9.8
2.9

5.2
22.9
14.2
4.8

4.8
15.0
9.8
2.8

6.4
24.3
16.0
5.7

5.4
14.8
9.8
2.8

5.8
22.1
15.1
5.1

Table 46. Active and passive motion comparisons in the Experimental group posttreatment for average right-slope, left-slope, and total-slope values
Right-Slope (Deg/sec)
Ex. 2 Ex. 3 Active
Min
Max
Average
SD

Left-Slope (Deg/sec)
Ex. 2 Ex. 3 Active

Total-Slope (Deg/sec)
Ex. 2 Ex. 3 Active

6.3
15.4
9.6
2.4

5.5
13.6
8.6
2.2

6.0
14.5
9.1
2.3

5.9
16.0
10.1
2.6

8.1
27.0
14.6
4.7

5.7
14.4
10.1
2.7

8.5
25.4
15.3
4.9

5.8
15.1
10.1
2.6

8.9
26.2
15.0
4.7

Table 47. Active and passive motion comparisons of total-slope values (deg/sec) for the
Control, Experimental pre-treatment, and Experimental post-treatment groups
Control
Ex. 2 Ex. 3 Active
Min
Max
Average
SD

Exp. Pre-Treatment
Ex. 2 Ex. 3 Active

Exp. Post-Treatment
Ex. 2 Ex. 3 Active

6.9
15.2
11.1
2.4

4.8
15.0
9.2
2.9

6.0
14.5
9.1
2.3

6.9
18.5
11.7
3.0

9.6
29.4
17.3
4.6

72

5.4
14.8
9.8
2.8

5.8
22.1
15.1
5.1

5.8
15.1
10.1
2.6

8.9
26.2
15.0
4.7

Statistical analyses used to investigate the rate of right and left cervical lateral flexion
during active motion testing included one-way repeated measures ANOVAs for each group
(Control, Experimental pre-treatment, and Experimental post-treatment). Each of the six
ANOVAs tested for significant differences between the slope of cycle six and the slopes of the
remaining cycles (one through five) for the following cases:




Left-slope

Right-slope

o Control

o Control

o Experimental pre-treatment

o Experimental pre-treatment

o Experimental post-treatment

o Experimental post-treatment

Statistical findings are presented in Table 48-a for the Control and Experimental groups,
demonstrating that the first cycle in a trial (cycle one and cycle four) was significantly slower
than the last cycle (cycle six) for right lateral flexion (right-slope) and left lateral flexion (leftslope) (p<0.05). Table 48 (b-g) contains the descriptive statistics for each analysis, documenting
the mean, standard error, and confidence interval of each cycle.

73

Table 48-a. Statistical analyses for consistency of active motion testing for rate of right and
left cervical lateral flexion within the Control, Experimental pre-treatment, and
Experimental post-treatment groups
Group
Control
Control
Control
Control
PrePrePrePrePostPostPostPost-

Test

Type III Sum
of Squares

Left-slope (Cycle 1 v. 6)
Error
Right-slope (Cycle 1 v. 6)
Error
Left-slope (Cycle 4 v. 6)
Error
Right-slope (Cycle 4 v. 6)
Error
Left-slope (Cycle 1 v. 6)
Error
Right-slope (Cycle 1 v. 6)
Error
Left-slope (Cycle 4 v. 6)
Error
Right-slope (Cycle 4 v. 6)
Error
Left-slope (Cycle 1 v. 6)
Error
Right-slope (Cycle 1 v. 6)
Error
Left-slope (Cycle 4 v. 6)
Error
Right-slope (Cycle 4 v. 6)
Error

394.4
162.4
517.2
343.6
275.5
204.0
431.4
255.6
227.0
230.5
322.5
293.9
70.2
133.7
106.1
148.9
113.6
255.1
464.5
260.0
90.3
314.0
341.8
215.1

74

df Mean Square

1
21
1
21
1
21
1
21
1
15
1
16
1
15
1
16
1
18
1
18
1
18
1
18

394.4
7.7
517.2
16.4
275.5
9.7
431.4
12.2
227.0
15.4
322.5
18.4
70.2
8.9
106.1
9.3
113.6
14.2
464.5
14.4
90.3
17.4
341.8
11.9

F

Sig.

51.0

0.000

31.6

0.000

28.4

0.000

35.4

0.000

14.8

0.002

17.6

0.001

7.9

0.013

11.4

0.004

8.0

0.011

32.2

0.000

5.2

0.035

28.6

0.000

Table 48-b. Cycle-by-cycle descriptive statistics of right-slope for active motion within the
Control group
* All values in deg/sec
Cycle

Mean

1
2
3
4
5
6

13.3
17.1
19.1
13.7
16.8
18.1

95% Confidence Interval

Std. Error Lower Bound Upper Bound

1.0
1.1
1.1
1.1
1.1
1.0

11.3
14.8
16.7
11.4
14.6
16.0

15.3
19.4
21.4
16.0
19.0
20.3

Table 48-c. Cycle-by-cycle descriptive statistics of left-slope for active motion within the
Control group
* All values in deg/sec
Cycle

Mean

1
2
3
4
5
6

15.6
18.6
20.7
16.3
18.3
19.8

95% Confidence Interval

Std. Error Lower Bound Upper Bound

1.0
1.1
1.4
1.0
1.1
1.3

13.6
16.4
17.8
14.2
16.0
17.1

17.6
20.8
23.5
18.3
20.7
22.5

Table 48-d. Cycle-by-cycle descriptive statistics of right-slope for active motion within the
Experimental group pre-treatment
* All values in deg/sec
Cycle

Mean

1
2
3
4
5
6

11.4
14.7
15.0
13.3
15.5
15.8

95% Confidence Interval

Std. Error Lower Bound Upper Bound

1.1
1.6
1.2
1.2
1.5
1.2

9.0
11.2
12.3
10.7
12.3
13.2

75

13.9
18.1
17.6
15.9
18.7
18.4

Table 48-e. Cycle-by-cycle descriptive statistics of left-slope for active motion within the
Experimental group pre-treatment
* All values in deg/sec
Cycle

Mean

1
2
3
4
5
6

14.1
16.2
18.2
15.8
16.9
17.8

95% Confidence Interval

Std. Error Lower Bound Upper Bound

1.2
1.4
1.7
1.3
1.3
1.4

11.4
13.3
14.6
12.9
14.1
14.9

16.7
19.0
21.8
18.6
19.6
20.8

Table 48-f. Cycle-by-cycle descriptive statistics of right-slope for active motion within the
Experimental group post-treatment
* All values in deg/sec
Cycle

Mean

1
2
3
4
5
6

11.9
15.6
16.6
12.6
14.2
16.8

95% Confidence Interval

Std. Error Lower Bound Upper Bound

0.8
1.5
1.4
1.0
0.8
1.4

10.2
12.5
13.6
10.5
12.4
13.8

13.6
18.7
19.6
14.7
16.0
19.8

Table 48-g. Cycle-by-cycle descriptive statistics of left-slope for active motion within the
Experimental group post-treatment
* All values in deg/sec
Cycle

Mean

1
2
3
4
5
6

14.2
15.5
16.4
14.5
14.8
16.7

95% Confidence Interval

Std. Error Lower Bound Upper Bound

1.2
1.6
1.4
1.1
1.5
1.2

11.7
12.1
13.5
12.1
11.8
14.2

76

16.8
18.8
19.2
16.9
17.9
19.2

Statistical analyses conducted on rate of active versus passive motions included
independent samples t-tests of average right-slope, left-slope, and total-slope values for the
Control and both Experimental groups. The following were evaluated:




Control
o Ex. 2 v. Active

Exp. pre-treatment
o Ex. 2 v. Active



Exp. post-treatment
o Ex. 2 v. Active



Right-slope



Right-slope



Right-slope



Left-slope



Left-slope



Left-slope



Total-slope



Total-slope



Total-slope

o Ex. 3 v. Active

o Ex. 3 v. Active

o Ex. 3 v. Active



Right-slope



Right-slope



Right-slope



Left-slope



Left-slope



Left-slope



Total-slope



Total-slope



Total-slope

Significantly reduced average rates of cervical lateral flexion for the passive motions as
compared to active motions were found for all comparisons (p≤0.0001). The full set of statistical
results are presented in Table 49.

77

Table 49. Statistical analyses for passive versus active motion testing for rate of right, left,
and total cervical lateral flexion within the Control and Experimental groups
Group
Control
Control
Control
Control
Control
Control
PrePrePrePrePrePrePostPostPostPostPostPost-

Test

df

t-value

Pr > |t|

Right-slope (Ex. 2 v. Act)
Left-slope (Ex. 2 v. Act)
Total-slope (Ex. 2 v. Act)
Right-slope (Ex. 3 v. Act)
Left-slope (Ex. 3 v. Act)
Total-slope (Ex. 3 v. Act)
Right-slope (Ex. 2 v. Act)
Left-slope (Ex. 2 v. Act)
Total-slope (Ex. 2 v. Act)
Right-slope (Ex. 3 v. Act)
Left-slope (Ex. 3 v. Act)
Total-slope (Ex. 3 v. Act)
Right-slope (Ex. 2 v. Act)
Left-slope (Ex. 2 v. Act)
Total-slope (Ex. 2 v. Act)
Right-slope (Ex. 3 v. Act)
Left-slope (Ex. 3 v. Act)
Total-slope (Ex. 3 v. Act)

21
21
21
21
21
21
18
18
18
18
18
18
18
18
18
18
18
18

-6.6
-7.9
-7.5
-6.0
-6.0
-6.2
-5.6
-5.9
-6.0
-5.2
-5.5
-5.5
-5.9
-7.5
-6.9
-4.8
-5.8
-5.4

< 0.0001
< 0.0001
< 0.0001
< 0.0001
< 0.0001
< 0.0001
< 0.0001
< 0.0001
< 0.0001
< 0.0001
< 0.0001
< 0.0001
< 0.0001
< 0.0001
< 0.0001
0.0001
< 0.0001
< 0.0001

Root mean square error
The root mean square error (RMSE) values calculated between trial one and trial two of
all dissected cycles combined for passive and active motions are documented in Tables 50-52.
Active versus passive motion comparisons of the calculated right (all three right lateral flexions),
left (all three left lateral flexions), and total (all right and left lateral flexions) RMSE of the
dissected cycles combined are presented in Table 50 for the Control group, Table 51 for the
Experimental group pre-treatment, and Table 52 for the Experimental group post-treatment.

78

Table 50. Active and passive motion comparisons in the Control group for average right,
left, and total RMSE values
Right RMSE (Deg)
Ex. 2 Ex. 3 Active
Min
Max
Average
SD

1.6
10.5
3.0
1.8

1.0
5.4
2.7
1.1

1.9
7.8
3.0
1.4

Left RMSE (Deg)
Ex. 2 Ex. 3 Active

0.9
9.4
3.1
1.7

0.9
4.8
2.9
1.3

1.3
5.5
2.8
1.1

Total RMSE (Deg)
Ex. 2 Ex. 3 Active

1.7
9.9
3.1
1.6

1.0
4.7
2.9
1.0

1.7
5.8
3.0
1.0

Table 51. Active and passive motion comparisons in the Experimental group pre-treatment
for average right, left, and total RMSE values
Right RMSE (Deg)
Ex. 2 Ex. 3 Active
Min
Max
Average
SD

0.9
4.8
2.7
1.3

0.6
5.3
2.8
1.3

1.6
7.5
3.5
1.8

Left RMSE (Deg)
Ex. 2 Ex. 3 Active

0.9
7.6
2.7
1.6

1.4
5.0
3.1
1.0

1.5
7.3
3.3
1.7

Total RMSE (Deg)
Ex. 2 Ex. 3 Active

0.9
5.5
2.9
1.1

1.4
4.2
3.0
0.9

1.7
6.4
3.5
1.5

Table 52. Active and passive motion comparisons in the Experimental group posttreatment for average right, left, and total RMSE values
Right RMSE (Deg)
Ex. 2 Ex. 3 Active
Min
Max
Average
SD

1.0
4.7
2.6
1.3

1.3
12.4
3.1
2.5

1.2
17.5
4.0
3.6

Left RMSE (Deg)
Ex. 2 Ex. 3 Active

1.8
7.7
3.1
1.7

1.2
5.6
2.7
1.2

1.3
5.2
3.1
1.1

Total RMSE (Deg)
Ex. 2 Ex. 3 Active

1.6
6.2
2.9
1.3

1.6
8.9
3.1
1.7

1.8
12.9
3.7
2.5

Comparisons of passive and active average total RMSE values calculated from the
dissected cycles are summarized in Table 53 for the Control, Experimental pre-treatment, and
Experimental post-treatment groups. The average RMSE values calculated between trial one and
trial two for the complete time series of passive and active motions are presented in Table 54 for
the Control, Experimental pre-treatment, and Experimental post-treatment groups. While no

79

observable trends can be documented for passive and active motion comparisons of total RMSE
values for the dissected cycles, it can be noted that the average RMSE values for the complete
time series of active motion tests was consistently greater than passive motion tests for all
groups.
Table 53. Active and passive motion comparisons for total RMSE values (degrees) of the
dissected cycles in the Control, Experimental pre-treatment, and Experimental posttreatment groups
Control
Ex. 2 Ex. 3 Active
Min
Max
Average
SD

1.7
9.9
3.1
1.6

1.0
4.7
2.9
1.0

1.7
5.8
3.0
1.0

Exp. Pre-Treatment
Ex. 2 Ex. 3 Active

0.9
5.5
2.9
1.1

1.4
4.2
3.0
0.9

1.7
6.4
3.5
1.5

Exp. Post-Treatment
Ex. 2 Ex. 3 Active

1.6
6.2
2.9
1.3

1.6
8.9
3.1
1.7

1.8
12.9
3.7
2.5

Table 54. Active and passive motion comparisons for the average RMSE (degrees) of the
full time-series in the Control, Experimental pre-treatment and Experimental posttreatment groups
Control
Ex. 2
Min
Max
Average
SD

Ex. 3

Active

3.6
12.9
8.0
2.5

3.4
18.5
8.1
3.4

3.2
36.9
12.3
7.6

Experimental
Pre-Treatment
Ex. 2 Ex. 3 Active

Experimental
Post-Treatment
Ex. 2 Ex. 3 Active

3.0
16.6
8.3
3.2

5.3
18.5
8.5
3.8

3.0
17.9
7.6
3.5

3.8
38.2
10.4
8.3

4.1
14.7
9.0
3.1

3.4
22.2
10.2
5.7

One-way ANOVAs with a Bonferroni was conducted on the average RMSE of the
complete time series for active versus passive motions within the Control, Experimental pretreatment and Experimental post-treatment groups, as shown in Table 55. Significantly reduced
RMSE values was found for the passive motions of Examiner 2 and Examiner 3 compared to
active motion tests for the complete time series within the Control group (p≤0.05).

80

Table 55. Statistical analyses of passive versus active motion tests for RMSE values
(degrees) of the complete time series within the Control, Experimental pre-treatment and
Experimental post-treatment groups
95% Confidence Interval
Group
Control
Control
PrePrePostPost-

Test
Ex.
Ex.
Ex.
Ex.
Ex.
Ex.

2 v.
3 v.
2 v.
3 v.
2 v.
3 v.

Act.
Act.
Act.
Act.
Act.
Act.

Mean
Std. Error Lower Bound Upper Bound
Difference

4.3
4.3
2.1
2.8
1.7
1.2

1.5
1.5
1.8
1.8
1.4
1.5

0.6
0.5
-2.3
-1.6
-1.8
-2.4

8.0
8.0
6.6
7.3
5.3
4.8

Sig.

0.018
0.020
0.726
0.359
0.666
1.000

Secondary motion – axial rotation
The secondary motion, or axial rotation, that occurred at the point of maximum lateral
flexion was recorded for each subject and averaged for all cycles over trial one and trial two for
Examiner 2, Examiner 3, and active motion within each group. Positive axial rotation values are
associated with ipsilateral lateral flexion values such that the left lateral flexion end-range was
accompanied by axial rotation to the left, and right lateral flexion end-range was associated with
axial rotation to the right. A negative axial rotation value indicates contralateral rotation, or axial
rotation in the opposite direction as the lateral flexion performed. The secondary motion data of
Examiner 2, Examiner 3, and active motion testing for the Control, Experimental pre-treatment,
and Experimental post-treatment group are documented in Tables 56, 57, and 58 respectively.
From the full ROM values, or the range of left and right axial rotation values that occurred
between maximum left and right lateral flexions, a trend can be observed such that active motion
rotation was greater than Examiner 2’s rotation which was greater than Examiner 3’s rotation.

81

Table 56. Active versus passive motion comparisons of secondary motion (axial rotation)
for the Control group (“+” values indicate ipsilateral rotation and “-” values indicate
contralateral rotation)
Left End-Range (Deg) Right End-Range (Deg)
Full ROM (Deg)
Ex. 2 Ex. 3 Active Ex. 2 Ex. 3 Active Ex. 2 Ex. 3 Active
Min
Max
Average
SD

-10.7
23.3
10.6
5.4

-3.2
22.7
6.9
5.2

-1.9
27.0
10.3
6.7

-1.9
21.5
9.1
4.6

-5.7
21.4
8.6
4.7

-3.9
28.1
11.5
6.3

-3.4
40.9
19.6
8.5

-3.2
37.1
15.4
8.2

1.9
47.5
21.8
11.3

Table 57. Active versus passive motion comparisons of secondary motion (axial rotation)
for the Experimental group pre-treatment (“+” values indicate ipsilateral rotation and “-”
values indicate contralateral rotation)
Left End-Range (Deg) Right End-Range (Deg)
Full ROM (Deg)
Ex. 2 Ex. 3 Active Ex. 2 Ex. 3 Active Ex. 2 Ex. 3 Active
Min
Max
Average
SD

-6.1
35.5
11.1
8.5

-13.3
31.6
6.8
8.4

-17.0
46.2
11.5
11.5

-0.2
27.1
11.5
4.8

-4.2
20.5
10.2
4.6

-10.4
36.0
13.4
9.6

-2.3
56.8
22.6
11.5

-9.7
45.2
17.0
11.5

-24.2
65.5
25.0
19.5

Table 58. Active versus passive motion comparisons of secondary motion (axial rotation)
for the Experimental group post-treatment (“+” values indicate ipsilateral rotation and “-”
values indicate contralateral rotation)
Left End-Range (Deg) Right End-Range (Deg)
Full ROM (Deg)
Ex. 2 Ex. 3 Active Ex. 2 Ex. 3 Active Ex. 2 Ex. 3 Active
Min
Max
Average
SD

-9.0
27.0
11.3
7.5

-14.7
28.7
6.3
8.3

-10.9
48.8
12.5
10.8

-2.4
25.6
11.7
5.0

-8.2
22.9
9.2
6.0

-19.1
32.7
13.5
10.2

-4.8
51.4
23.0
10.9

-19.9
45.2
15.5
12.4

-24.6
65.7
26.0
19.0

Statistical analyses of passive versus active average full range of secondary motions were
performed on the Control, Experimental pre-treatment and Experimental post-treatment groups.
The statistical tests performed included one-way ANOVAs with a Bonferroni comparing the
average full ROM values for axial rotation during Examiner 2, Examiner 3, and active motion
82

tests. A significant difference was found between the secondary full ROM values of Examiner 3
and active motion tests within the Control group and Experimental group post-treatment as
documented in Table 59.
Table 59. Statistical analyses of the average secondary full ROM (axial rotation) for
comparisons of Examiner 2, Examiner 3, and active motion within the Control and
Experimental groups

Group
Control
Control
Control
PrePrePrePostPostPost-

Ex.
Ex.
Ex.
Ex.
Ex.
Ex.
Ex.
Ex.
Ex.

Test
2 v. Ex. 3
2 v. Active
3 v. Active
2 v. Ex. 3
2 v. Active
3 v. Active
2 v. Ex. 3
2 v. Active
3 v. Active

95% Confidence
Interval
Mean Diff. Std. Error Lower Upper

4.2
-2.4
-6.6
4.2
-3.0
-7.2
7.5
-3.0
-10.5

2.5
2.5
2.5
4.4
4.6
4.5
4.5
4.5
4.5

-1.8
-8.6
-12.6
-6.8
-14.4
-18.4
-3.7
-14.0
-21.6

10.3
3.7
-0.7
15.2
8.5
4.0
18.7
8.0
0.7

Sig.

0.278
1.000
0.023
1.000
1.000
0.348
0.309
1.000
0.073

Group Comparisons
Range of motion
The cervical lateral flexion range of motion data of trial one and trial two were averaged
for Examiner 2, Examiner 3, and active motions. These data for left end-range, right end-range,
and full ROM are presented in Tables 60, 61, and 62. Comparisons of average ROM values
between the Control group, Experimental group pre-treatment, and Experimental group posttreatment are presented in Table 60 for Examiner 2, Table 61 for Examiner 3 and Table 62 for
active motion tests. From these data, it can be observed that the range of motion of the Control
group was greater than that of the Experimental group pre- and post-treatment. The average full
83

ROM data of the Control group, Experimental group pre-treatment and Experimental group posttreatment are summarized in Table 63.
Table 60. Control, Experimental pre-treatment and Experimental post-treatment
comparisons for Examiner 2’s average left end-range, right end-range, and full ROM
values
Left End-Range (Deg) Right End-Range (Deg)
Full ROM (Deg)
Cont. Pre- Post- Cont. PrePost- Cont. PrePostMin
Max
Average
SD

23.5
46.1
35.5
5.7

23.3
48.6
33.8
6.7

21.5
48.4
33.7
6.4

19.5
50.7
35.9
6.9

19.2
48.3
32.4
6.7

19.2
45.3
33.1
6.4

45.5
91.9
71.4
11.5

43.7
93.2
66.3
12.0

48.8
89.9
66.8
11.7

Table 61. Control, Experimental pre-treatment and Experimental post-treatment
comparisons for Examiner 3’s average left end-range, right end-range, and full ROM
values
Left End-Range (Deg) Right End-Range (Deg)
Full ROM (Deg)
Cont. Pre- Post- Cont. PrePost- Cont. PrePostMin
Max
Average
SD

21.4
44.4
33.4
6.1

16.1
40.8
29.6
6.6

15.8
43.4
30.6
6.6

14.6
46.2
32.7
7.1

14.8
42.6
28.4
6.4

17.7
47.1
30.4
6.6

36.8
87.4
66.1
11.5

35.1
82.2
58.0
11.7

34.8
89.9
61.0
12.0

Table 62. Control, Experimental pre-treatment and Experimental post-treatment
comparisons for active motion average left end-range, right end-range, and full ROM
values
Left End-Range (Deg) Right End-Range (Deg)
Full ROM (Deg)
Cont. Pre- Post- Cont. PrePost- Cont. PrePostMin
Max
Average
SD

29.4
58.0
44.3
6.3

27.7
59.4
39.6
8.2

18.8
52.2
40.6
6.8

26.5
56.8
43.1
7.4

84

23.9
50.2
37.3
6.7

22.0
52.0
38.3
6.7

56.0
113.6
87.4
12.5

54.0
106.0
77.0
13.5

46.8
101.1
78.9
11.6

Table 63. Control, Experimental pre-treatment and Experimental post-treatment
comparisons for full ROM values (degrees) of Examiner 2, Examiner 3, and active motion
Examiner 2
Cont. Pre- PostMin
Max
Average
SD

Examiner 3
Cont. PrePost-

Active motion
Cont. PrePost-

45.5
91.9
71.4
11.5

36.8
87.4
66.1
11.5

56.0
113.6
87.4
12.5

43.7
93.2
66.3
12.0

48.8
89.9
66.8
11.7

35.1
82.2
58.0
11.7

34.8
89.9
61.0
12.0

54.0
106.0
77.0
13.5

46.8
101.1
78.9
11.6

Statistical analyses were conducted on the average left end-range versus right end-range
values within the Control group, Experimental group pre-treatment and Experimental group posttreatment. Paired samples t-tests were performed for Examiner 2, Examiner 3, and active motion
as presented in Table 64. A marginally significant difference between left and right end-range
values was found only for active motion testing in the Experimental group post-treatment
(p<0.10).
Independent samples t-tests were used to evaluate differences between the average full
ROM of the Control and Experimental groups for Examiner 2, Examiner 3, and active motion as
presented in Table 65. Significant differences between the Control group and Experimental
group pre-treatment were documented for Examiner 3 and active motion, and a significant
difference between the Control group and Experimental group post-treatment was found only for
active motion (p<0.05).
Analysis of the Experimental group pre-treatment versus post-treatment included paired
samples t-tests conducted on the average full ROM values of Examiner 2, Examiner 3, and active
motion as documented in Table 66. Examiner 3’s data demonstrated a significant difference
between the Experimental group pre-treatment and post-treatment (p<0.05).

85

Table 64. Average left versus right end-range values for Examiner 2, Examiner 3, and
active motion within the Control and Experimental groups
95% Confidence
Interval

Group Test
Control
Control
Control
PrePrePrePostPostPost-

Ex. 2
Ex. 3
Active
Ex. 2
Ex. 3
Active
Ex. 2
Ex. 3
Active

Mean

Std.
Std. Error
Lower Upper
Deviation
Mean

0.4
-0.8
-1.2
-1.4
-1.1
-2.3
-0.5
-0.2
-2.2

4.6
5.5
4.7
4.4
4.8
5.6
4.1
4.2
5.4

1.0
1.2
1.0
1.0
1.1
1.4
0.9
1.0
1.2

-1.6
-3.2
-3.2
-3.6
-3.4
-5.2
-2.5
-2.2
-4.8

2.5
1.7
0.9
0.8
1.2
0.6
1.4
1.8
0.4

t

df

Sig.
(2-tailed)

0.5
-0.7
-1.1
-1.3
-1.0
-1.7
-0.6
-0.2
-1.8

21
21
21
17
18
16
18
18
18

0.657
0.522
0.266
0.197
0.313
0.109
0.567
0.832
0.086

Table 65. Statistical analyses for Control versus Experimental groups’ average full ROM
for Examiner 2, Examiner 3, and active motion
Levene's Test
for Equality of
Variances

Examiner
Ex. 2
Ex. 2
Ex. 3
Ex. 3
Active
Active

t-test for Equality of Means
Mean Std. Error
Sig.
Diff.
Diff.
(2-tailed)

Test

F

Sig.

t

df

Pre- v. Control
Post- v. Control
Pre- v. Control
Post- v. Control
Pre- v. Control
Post- v. Control

0.0
0.2

0.855
0.676

1.5
1.3

39
39

5.4
4.6

3.5
3.5

0.136
0.192

0.3
0.1
0.6
0.3

0.608
0.734
0.453
0.619

2.3
1.4
2.8
2.3

39
39
39
39

8.1
4.8
10.9
8.5

3.5
3.6
4.0
3.6

0.027
0.182
0.009
0.025

Table 66. Statistical analyses for the Experimental group pre-treatment versus posttreatment for the average full ROM values of Examiner 2, Examiner 3, and active motion
95% Confidence
Interval

Examiner Mean
Ex. 2
Ex. 3
Active

-0.8
-3.3
-2.5

Std.
Std. Error
Lower
Deviation
Mean

5.1
4.0
8.3

1.2
0.9
1.9

-3.2
-5.2
-6.5

86

Upper

t

df

Sig.
(2-tailed)

1.7
-1.4
1.5

-0.7
-3.6
-1.3

18
18
18

0.508
0.002
0.208

Rate of motion
The rate of cervical lateral flexion data from trial one and trial two were averaged for
Examiner 2, Examiner 3, and active motion tests. The average rate of left lateral flexions (leftslope), right lateral flexions (right-slope), and all lateral flexions (total-slope) are presented in
Tables 67-69. Comparisons of average rate of motion values between the Control group,
Experimental group pre-treatment, and Experimental group post-treatment are presented in Table
67 for Examiner 2, Table 68 for Examiner 3 and Table 69 for active motion. From these data, it
can be observed that the rate of motion of the Control group was greater than that of the
Experimental group pre-treatment and post-treatment. This was true for Examiner 2, Examiner 3,
and active motion as demonstrated in Table 70.
Table 67. Control, Experimental pre-treatment and Experimental post-treatment
comparisons for Examiner 2’s average left-slope, right-slope, and total-slope values
Left-slope (Deg/sec)
Cont. Pre- PostMin
Max
Average
SD

6.4
15.0
11.0
2.5

4.5
15.5
9.1
3.0

5.5
13.6
8.6
2.2

Right-slope (Deg/sec)
Cont. PrePost-

7.3
15.8
11.1
2.5

5.0
15.8
9.4
2.9

6.3
15.4
9.6
2.4

Total-slope (Deg/sec)
Cont. PrePost-

6.9
15.2
11.1
2.4

4.8
15.0
9.2
2.9

6.0
14.5
9.1
2.3

Table 68. Control, Experimental pre-treatment and Experimental post-treatment
comparisons for Examiner 3’s average left-slope, right-slope, and total-slope values
Left-slope (Deg/sec)
Cont. Pre- PostMin
Max
Average
SD

6.9
18.2
12.1
3.1

4.8
15.0
9.8
2.8

5.7
14.4
10.1
2.7

Right-slope (Deg/sec)
Cont. PrePost-

5.9
18.7
11.4
3.2

87

4.8
15.2
9.8
2.9

5.9
16.0
10.1
2.6

Total-slope (Deg/sec)
Cont. PrePost-

6.9
18.5
11.7
3.0

5.4
14.8
9.8
2.8

5.8
15.1
10.1
2.6

Table 69. Control, Experimental pre-treatment and Experimental post-treatment
comparisons for active motion average left-slope, right-slope, and total-slope values
Left-slope (Deg/sec)
Cont. Pre- PostMin
Max
Average
SD

10.0
32.7
18.2
4.9

6.4
24.3
16.0
5.7

8.9
26.2
15.0
4.7

Right-slope (Deg/sec)
Cont. PrePost-

9.1
26.1
16.4
4.4

5.2
22.9
14.2
4.8

8.1
27.0
14.6
4.7

Total-slope (Deg/sec)
Cont. PrePost-

9.6
29.4
17.3
4.6

5.8
22.1
15.1
5.1

8.9
26.2
15.0
4.7

Table 70. Control, Experimental pre-treatment and Experimental post-treatment
comparisons for total-slope values (deg/sec) of Examiner 2, Examiner 3, and active motion
Examiner 2
Cont. Pre- PostMin
Max
Average
SD

6.9
15.2
11.1
2.4

4.8
15.0
9.2
2.9

6.0
14.5
9.1
2.3

Examiner 3
Cont. PrePost-

6.9
18.5
11.7
3.0

5.4
14.8
9.8
2.8

5.8
15.1
10.1
2.6

Active motion
Cont. PrePost-

9.6
29.4
17.3
4.6

5.8
22.1
15.1
5.1

8.9
26.2
15.0
4.7

Statistical analyses were conducted on average left-slope versus right-slope values within
the Control group, Experimental group pre-treatment, and Experimental group post-treatment for
Examiner 2, Examiner 3, and active motion in the form of paired samples t-tests. A significant
difference between left and right rate of lateral flexion values was found within the Control
group for Examiner 3 and active motion, within the Experimental group pre-treatment for active
motion, and within the Experimental group post-treatment for Examiner 2 (Table 71).
For comparisons of the average total-slope of the Control group and Experimental group
pre-treatment, independent samples t-tests were conducted for Examiner 2, Examiner 3, and
active motion. Significant differences between the Control group and Experimental group pretreatment were documented for Examiner 2 and Examiner 3 (Table 72). Analysis of the
Experimental group pre-treatment versus post-treatment included paired samples t-tests
88

conducted on the average total-slope values of Examiner 2, Examiner 3, and active motion. No
significant differences between the Experimental group pre-treatment and post-treatment were
found for the average rate of cervical lateral flexion of Examiner 2, Examiner 3, or active
motion.
Table 71. Statistical analyses for left versus right rate of cervical lateral flexion for
Examiner 2, Examiner 3, and active motion within the Control and Experimental groups
95% Confidence
Interval

Group Test
Control
Control
Control
PrePrePrePostPostPost-

Ex. 2
Ex. 3
Active
Ex. 2
Ex. 3
Active
Ex. 2
Ex. 3
Active

Mean

Std.
Std. Error
Lower Upper
Deviation
Mean

0.2
-0.7
-1.8
0.3
0.1
-1.7
1.0
0.0
-0.7

1.4
1.8
2.0
1.5
1.1
2.6
0.9
1.2
1.8

0.3
0.4
0.4
0.3
0.2
0.6
0.2
0.3
0.4

-0.4
-1.5
-2.7
-0.4
-0.4
-3.0
0.5
-0.6
-1.6

0.8
0.1
-1.0
1.0
0.6
-0.5
1.4
0.6
0.2

t

df

Sig.
(2-tailed)

0.6
-1.9
-4.4
0.8
0.3
-2.9
4.6
0.0
-1.7

21
21
21
18
18
18
18
18
18

0.575
0.076
0.000
0.430
0.738
0.010
0.000
0.971
0.103

Table 72. Statistical analyses for the Control versus the Experimental group pre-treatment
average rate of total cervical lateral flexion for Examiner 2, Examiner 3, and active motion
Levene's Test
for Equality of
Variances

Examiner
Ex. 2
Ex. 3
Active

Test
Pre- v. Control
Pre- v. Control
Pre- v. Control

t-test for Equality of Means
Mean Std. Error
Sig.
Diff.
Diff.
(2-tailed)

F

Sig.

t

df

0.9

0.346

2.2

39

1.8

0.8

0.033

0.3
1.4

0.585
0.247

2.1
1.4

39
39

1.9
2.2

0.9
1.5

0.043
0.156

89

Root mean square error
The root mean square error (RMSE) between trial one and trial two was calculated for
Examiner 2, Examiner 3, and active motion testing within the Control group, Experimental group
pre-treatment and Experimental group post-treatment. The RMSE values of the dissected cycles
were calculated for all three cycles of right lateral flexion (right RMSE), all three cycles of left
lateral flexion (left RMSE), and all six lateral flexion cycles combined (total RMSE).
Comparisons of dissected RMSE values between the Control group, Experimental group pretreatment, and Experimental group post-treatment are presented in Table 73 for Examiner 2,
Table 74 for Examiner 3 and Table 75 for active motion testing. Group comparisons of the
RMSE values calculated between trial one and trial two for the complete time-series are
documented in Table 76 for Examiner 2, Examiner 3, and active motion.
Statistical analyses conducted included paired and independent samples t-tests comparing
right RMSE and left RMSE values, RMSE values of the Control versus Experimental group, and
RMSE values of the Experimental group pre-treatment versus post-treatment. No significant
differences were found from the aforementioned statistical analyses.
Table 73. Control, Experimental pre-treatment and Experimental post-treatment
comparisons for Examiner 2’s average right, left, and total RMSE values
Right RMSE (Deg)
Cont. Pre- PostMin
Max
Average
SD

1.6
10.5
3.0
1.8

0.9
4.8
2.7
1.3

1.0
4.7
2.6
1.3

Left RMSE (Deg)
Cont. PrePost-

0.9
9.4
3.1
1.7

0.9
7.6
2.7
1.6

90

1.8
7.7
3.1
1.7

Total RMSE (Deg)
Cont. PrePost-

1.7
9.9
3.1
1.6

0.9
5.5
2.9
1.1

1.6
6.2
2.9
1.3

Table 74. Control, Experimental pre-treatment and Experimental post-treatment
comparisons for Examiner 3’s average right, left, and total RMSE values
Right RMSE (Deg)
Cont. Pre- PostMin
Max
Average
SD

1.0
5.4
2.7
1.1

0.6
5.3
2.8
1.3

1.3
12.4
3.1
2.5

Left RMSE (Deg)
Cont. PrePost-

0.9
4.8
2.9
1.3

1.4
5.0
3.1
1.0

1.2
5.6
2.7
1.2

Total RMSE (Deg)
Cont. PrePost-

1.0
4.7
2.9
1.0

1.4
4.2
3.0
0.9

1.6
8.9
3.1
1.7

Table 75. Control, Experimental pre-treatment and Experimental post-treatment
comparisons for active motion average right, left, and total RMSE values
Right RMSE (Deg)
Cont. Pre- PostMin
Max
Average
SD

1.9
7.8
3.0
1.4

1.6
7.5
3.5
1.8

1.2
17.5
4.0
3.6

Left RMSE (Deg)
Cont. PrePost-

1.3
5.5
2.8
1.1

1.5
7.3
3.3
1.7

1.3
5.2
3.1
1.1

Total RMSE (Deg)
Cont. PrePost-

1.7
5.8
3.0
1.0

1.7
6.4
3.5
1.5

1.8
12.9
3.7
2.5

Table 76. Control, Experimental pre-treatment and Experimental post-treatment
comparisons for Examiner 2, Examiner 3, and active motion average complete time-series
RMSE values
Examiner 2
Cont. Pre- PostMin
Max
Average
SD

3.6
12.9
8.0
2.5

3.0
16.6
8.3
3.2

5.3
18.5
8.5
3.8

Examiner 3
Cont. PrePost-

3.4
18.5
8.1
3.4

91

3.0
17.9
7.6
3.5

4.1
14.7
9.0
3.1

Active Motion
Cont. PrePost-

3.2
36.9
12.3
7.6

3.8
38.2
10.4
8.3

3.4
22.2
10.2
5.7

Longitudinal Study Comparisons
Range of motion
Five subjects were selected from the Experimental group to participate in a 72-hour
follow-up assessment. Data from these five individuals were analyzed and were termed the
Longitudinal group. The cervical lateral flexion range of motion data for trial one and trial two of
the Longitudinal group were averaged for Examiner 2, Examiner 3, and active motion. These
data for left end-range, right end-range, and full ROM are presented in Tables 77, 78, and 79.
Comparisons of average ROM values between the Longitudinal group pre-treatment, posttreatment and 72-hours post-treatment are presented in Table 77 for Examiner 2, Table 78 for
Examiner 3 and Table 79 for active motion tests. From these data it can be observed that, in
general, the average ROM of the subject’s pre-treatment and 72-hours post-treatment was less
than post-treatment for the initial test session. Differences between the average full ROMs pretreatment and post-treatment ranged from 0.3 to 2.2 degrees, and differences between posttreatment and 72-hours ranged from 0.1 to 1.6 degrees. The average full ROM data of the
Longitudinal group pre-treatment, post-treatment, and 72-hours post-treatment are summarized
in Table 80.
Statistical analyses conducted included paired samples t-tests comparing the average full
ROM values of the Longitudinal group pre-treatment, post-treatment, and 72-hour post-treatment
for Examiner 2, Examiner 3, and active motion. No significant differences were found from the
statistical tests performed.

92

Table 77. Longitudinal group comparisons of pre-treatment, post-treatment, and 72-hours
post-treatment for Examiner 2’s average left end-range, right end-range, and full ROM
values
Left End-Range (Deg) Right End-Range (Deg)
PrePost- 72 Hr PrePost- 72 Hr
Min
Max
Average
SD

25.6
42.2
35.1
4.9

29.5
40.9
35.3
3.5

27.3
43.5
35.4
5.4

17.8
43.4
32.4
8.1

22.2
43.2
34.4
6.8

18.8
41.0
32.7
7.4

Full ROM (Deg)
PrePost- 72 Hr

50.6
80.7
67.5
11.4

53.0
82.1
69.7
9.0

46.3
83.8
68.1
12.4

Table 78. Longitudinal group comparisons of pre-treatment, post-treatment, and 72-hours
post-treatment for Examiner 3’s average left end-range, right end-range, and full ROM
values
Left End-Range (Deg) Right End-Range (Deg)
PrePost- 72 Hr PrePost- 72 Hr
Min
Max
Average
SD

22.2
42.3
32.5
5.6

27.7
40.5
34.0
4.5

24.0
39.2
31.5
5.0

16.1
43.5
30.9
8.9

17.4
43.0
30.8
8.2

17.9
42.2
33.2
8.2

Full ROM (Deg)
PrePost- 72 Hr

46.7
79.2
63.4
12.0

45.2
82.7
64.8
12.0

41.8
78.7
64.7
12.4

Table 79. Longitudinal group comparisons of pre-treatment, post-treatment, and 72-hours
post-treatment for active motion average left end-range, right end-range, and full ROM
values
Left End-Range (Deg) Right End-Range (Deg)
PrePost- 72 Hr PrePost- 72 Hr
Min
Max
Average
SD

34.1
46.6
41.9
3.8

38.6
47.7
42.2
2.9

31.1
48.2
40.0
5.5

28.6
47.9
39.2
6.4

93

27.6
51.4
39.3
7.5

28.0
49.4
41.0
7.2

Full ROM (Deg)
PrePost- 72 Hr

63.6
92.5
81.1
8.9

69.2
98.0
81.5
9.3

60.5
97.1
81.0
12.0

Table 80. Longitudinal group comparisons of pre-treatment, post-treatment, and 72-hours
post-treatment for the full ROM (degrees) of Examiner 2, Examiner 3, and active motion
Examiner 2
PrePost- 72 Hr
Min
Max
Average
SD

Examiner 3
PrePost- 72 Hr

Active motion
PrePost- 72 Hr

50.6
80.7
67.5
11.4

46.7
79.2
63.4
12.0

63.6
92.5
81.1
8.9

53.0
82.1
69.7
9.0

46.3
83.8
68.1
12.4

94

45.2
82.7
64.8
12.0

41.8
78.7
64.7
12.4

69.2
98.0
81.5
9.3

60.5
97.1
81.0
12.0

DISCUSSION

This section has been formatted to parallel to the Results section and discusses
descriptive trends, statistical findings, and clinical relevancies related to Intra-Examiner
Comparisons, Inter-Examiner Comparisons, Active versus Passive Motions, Group
Comparisons, and Longitudinal Study Comparisons as well as the Limitations & Future Work of
this study.

Intra-Examiner Comparisons
The primary objective of the intra-examiner comparisons was to investigate the
consistency in the passive diagnostic motions performed by each examiner within a given
subject. The consistency of passive diagnostic motions performed by Examiner 2 and Examiner
3 were assessed through data obtained on cervical lateral flexion range of motion, rate of motion,
and the calculated root mean square error.

Range of motion
The data obtained for the cervical lateral flexion ROM from Examiner 2 demonstrated no
statistical differences between the six cycles performed during the two trials for a given subject.
The same held true for Examiner 3’s data. Furthermore, the difference between the average full
ROM values did not exceed three degrees across trial one and two for either examiner. This was
true for all groups.

95

Thus, these data demonstrate that the motions produced by an examiner during a clinical
assessment were consistent not only across cycles, but across trials. This intra-examiner
consistency of cervical palpatory diagnostic testing has been well documented through findings
from previous studies exhibiting agreement (Deboer et al., 1985, Mior et al., 1985, Stochkendahl
et al., 2006, Seffinger et al., 2004). However, most studies have used Kappa scores to determine
intra-examiner consistency based on the final diagnosis as opposed to objective values such as
range of motion (Deboer et al., 1985, Mior et al., 1985, Stochkendahl et al., 2006, Seffinger et
al., 2004).
There are potential limitations to this conclusion. For example, all of the examiners who
participated in this research had over 10 years of experience and were teaching colleagues. If an
array of examiners were sampled with different experience levels and different types of training
this conclusion may not hold true.

Rate of motion
To recall from the Methods section, the rate of motion was defined as the average angular
velocity from the start to the peak of a cervical lateral flexion cycle. While the difference
between the average rate of cervical lateral flexion for trial one and trial two did not exceed 1.1
degrees per second for Examiner 2 or Examiner 3, statistical analyses conducted on the average
rate of each cycle resulted in significant differences within a trial. Specifically, the average rate
of the first cycle in a trial was significantly different than successive cycles.
For Examiner 2, the average rate of lateral flexion during cycle one of trial one and cycle
one of trial two was greater than subsequent cycles in the trial. This indicated that on the first
96

cycle of each trial, Examiner 2 moved slightly faster than in following cycles. Of the six possible
evaluations for trial one (right and left slopes for the Control, Experimental pre-treatment, and
Experimental post-treatment groups) three demonstrated the first cycle to be faster than
subsequent cycles. Additionally for trial two, four of the six evaluations showed the first cycle to
be faster.
In contrast, the average rate of lateral flexion during the first cycle of a trial was less than
subsequent cycles within a given trial for Examiner 3. The average rate of cycle one was
significantly less for three of six evaluations for trial one, and two of six evaluations for trial two.
These findings suggested that the first cycle within a cervical palpatory diagnosis was
conducted at a slightly different rate than the successive cycles. This was most likely because the
examiners focused on acclimating themselves to an individual subject as opposed to the
diagnostic cues associated with cervical dysfunction. Subjects, specifically those in pain, can
often be guarded to passive motions performed by an examiner, artificially inducing tissue
tensions not related to dysfunction (Seffinger and Hruby, 2007). Guarding often makes diagnoses
difficult, and can result in false identification of dysfunction (Seffinger and Hruby, 2007). Also,
this different rate during the first cycle allowed the examiner to become acclimated with a
subject and allowed the subject a time period to become comfortable with the motion and relax
during subsequent movements. This finding was also supported by Bush et al. (2010), who found
trial one differed significantly from other trials; however this was based on standard error
differences and not speed.
Although guarding may be a possibility, it would seem as though this effect would be
reduced after the first trial within an examiner and would not be present in the following cycles.

97

No previous research was found during the review of literature in which the rate of
passive motions was investigated for intra-examiner consistency of cervical palpatory diagnostic
motions.

Root mean square error
For the calculated left, right, and total RMSE between trial one and trial two of the three
dissected cycles, no statistically significant differences were found for either Examiner 2 or
Examiner 3. This finding was supported across all three test groups. Since this measure
documented the differences between two trials, and no statistically significant differences were
found in the RMSE comparisons, it also supported the conclusion that examiners were consistent
within themselves for a given subject.

Inter-Examiner Comparisons
The primary objective of the inter-examiner comparisons was to investigate the
consistency in passive diagnostic motions across examiners.

Range of motion
The data obtained for the cervical lateral flexion ROM produced by Examiner 2 and
Examiners 3’s diagnostic assessments demonstrated a consistent trend within the Control,
Experimental pre-treatment and Experimental post-treatment groups in which Examiner 2’s

98

average ROM was greater than Examiner 3’s average ROM. The differences between the
average full ROM values for Examiner 2 and Examiner 3 were 5.3, 8.3, and 5.8 degrees for the
Control, Experimental group pre-treatment, and Experimental group post-treatment respectively.
Statistical analyses demonstrated that the average right end-range, left end-range, and full ROM
values of Examiner 2 were significantly greater than Examiner 3 within the Experimental group
pre-treatment only, as documented in Table 30.
These findings demonstrated that the examiners moved individuals through different
ranges of motion. Specifically, this indicated that the examiners were makings their diagnostic
assessment at different end-points. These data demonstrated that the variability between
examiners was more predominant in people with pain and/or cervical dysfunction prior to
treatment. While differences between the passive ROM values for each examiner were observed
in healthy individuals (Control group) and subjects who had just received treatment
(Experimental post-treatment), these differences lacked statistical significances and were not as
substantial as the Experimental group pre-treatment.

Rate of motion
Differences between passive cervical diagnostic motions for Examiner 2 and Examiner 3
were also documented for the rate of motion values; Examiner 3 moved at a slightly greater
average angular velocity than Examiner 2. The differences between the average rates of lateral
flexion during all cycles (total-slope) of Examiner 3 and Examiner 2 were 0.7, 0.6, and 1.0
degrees per second for the Control, Experimental pre-treatment, and Experimental post-treatment
groups respectively. Statistical analyses demonstrated significant differences between the
99

average rate of left lateral flexions for all groups and the average rate of all lateral flexions for
the Experimental group post-treatment, as presented in Table 34.
The difference between the rates of passive motions performed by each examiner again
demonstrated that there was variability in the standard cervical palpatory diagnostic procedures
performed by highly practiced physicians. The average rate of left lateral flexions was
significantly greater for Examiner 3 in comparison to Examiner 2 for all groups, but not during
right lateral flexions.
The significantly different rates of lateral flexions performed between examiners in the
Experimental group post-treatment suggested different diagnostic approaches to subjects that
were previously diagnosed and treated. Examiner 3 moved subjects to a greater range of motion
at a quicker rate in both directions during the post-treatment diagnoses. In contrast, Examiner 2
remained consistent in the ranges of motion performed pre-treatment and post-treatment but at a
slower overall rate post-treatment. This could be attributed to the fact that Examiner 2 treated the
subjects and therefore investigated the diagnostic cues near the end-range values with more care
post-treatment to determine if the treatment applied to the region was successful.
Inconsistency between the cervical mobility assessments performed by different
examiners has been well documented throughout previous studies (Deboer et al., 1985, Mior et
al., 1985, Pool et al., 2004, Seffinger et al., 2004, Stochkendahl et al., 2006). However, as with
intra-examiner comparisons, most of the previous investigations of inter-examiner consistency
were analyzed through Kappa scores of subjective diagnostic measures instead of objective data
(Deboer et al., 1985, Mior et al., 1985, Seffinger et al., 2004, Stochkendahl et al., 2006). Studies
by Stochkendahl et al. (2006), Mior et al.(1985), DeBoer et al. (1985), and Pool et al. (2004)

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found poor levels of inter-examiner agreement through Kappa scores. These inter-examiner
differences in diagnoses could have been found because assessments were being made by each
examiner at different end-points. To recall, cervical palpatory diagnoses were based upon
magnitude and symmetry of motion as well as the tissue texture and resistance at end-range. An
eight degree difference between examiners ROMs, as seen in the Experimental group pretreatment, could result in examiners making diagnoses based upon motion symmetry, tissue
texture and resistances at different points in a subject’s motion. This different assessment point
may produce increased resistance, yielding a difference in symmetry and texture, thus resulting
in different diagnoses.

Active versus Passive Motion
Investigations of the differences between the passive diagnostic motions performed by
Examiner 2 and Examiner 3 to active motions were assessed through lateral flexion range and
rate of motion, the calculated root mean square errors, and secondary (axial rotation) range of
motion.

Range of motion
From the data obtained on cervical lateral flexion range of motion, it was shown that the
average ranges of motion achieved during active motions were statistically greater than passive
motions (Table 43). This was observed within the Control, Experimental pre-treatment, and
Experimental post-treatment groups, with average active full ROM over ten degrees greater than

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Examiner 2’s average full ROM and over seventeen degrees greater than Examiner 3’s average
full ROM. The data obtained on secondary (axial rotation) range of motion demonstrated a
similar trend with the average axial rotation full ROM for active motions over two degrees
greater than Examiner 2’s average secondary full ROM and over six degrees greater than
Examiner 3’s average secondary full ROM. Statistical analyses found that the average secondary
full ROM of active motions were significantly greater than the passive motions performed by
Examiner 3 for the Control and Experimental group post-treatment, as exemplified in Table 59.
The finding that active motions produced greater cervical ROMs was contradictive to
most previously published results (Dvorak et al., 1992, Wong and Nansel, 1992, Christensen and
Nilsson, 1998, Lantz et al., 1999, Chen et al., 1999, Jordan, 2000, Castro et al., 2000). Wong and
Nansel (1992) reported average passive cervical ROM values greater than active motion values.
Castro et al. (2000) and Dvorak et al. (1992) both documented similar findings with passive
motion tests that resulted in larger ROM values and smaller standard deviations than active
motions. In comparison, this study produced findings that passive motion tests resulted in
smaller ranges of motion and smaller standard deviations than active motions. However, when
evaluating the lateral flexion and axial rotation angles coupled together, Malmström et al. (2006)
and Jordan et al. (2003) cited that larger coupled axial rotation was accompanied by larger
primary lateral flexion. For this study, the active motion instructions presented to the subjects did
not include specific instructions requiring the subjects to conduct all motions within the primary
motion plane (frontal plane). This resulted in subjects performing larger secondary motions
(axial rotation) than achieved during passive tests. This allowed subjects to alter the anatomical
orientation of their vertebrae through axial rotation, artificially increasing their performance
range and thus the primary ROMs achievable due to anatomical geometric restrictions.
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This could furthermore be used to explain differences between the average lateral flexion
ROMs of Examiner 2 and Examiner 3, following the trend of increased lateral flexion with
increased axial rotation.

Rate of motion
A cycle-by-cycle statistical analysis demonstrated that the first cycle within an active
motion trial was significantly different than the following cycles in terms of the average speed of
movement. As shown in Table 48 for the active motion tests, the average rate of left and right
lateral flexion during the first cycle of a trial was significantly slower than the following two
cycles in a trial for the Control, Experimental pre-treatment, and Experimental post-treatment
(p<0.05). This demonstrated that the participants may have been more focused at the start of the
trial, and as it progressed they became less focused and more comfortable, therefore speeding up
the movement.
Comparing the data obtained on the rate of cervical lateral flexion for active and passive
motions, it was shown that average rate of active motions were approximately five degrees per
second greater than passive motions performed by Examiner 2 or Examiner 3 (Table 47).
Statistical analyses presented in Table 49 demonstrated that the average rate of left lateral flexion
(left-slope), right lateral flexion (right-slope) and all lateral flexions (total-slope) were
significantly greater during active motions for the Control and Experimental groups. While
published literature was not available for comparison, some inferences were made. Since the
subjects were comfortable with their limitations of cervical movement and did not assess their
own dysfunction during the movement, their lateral flexions during active motions were less
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inhibited and therefore could be performed more quickly. In addition, the examiners were
blinded to whether the participants were in pain, and proceeded at a slower rate as they
conducted the diagnosis so they did not move any subject too quickly and cause pain.

Root mean square error
While there were no discernible differences between active and passive motions for the
calculated RMSE values of the dissected cycles, differences were documented for the calculated
RMSE values of the complete time series within all groups. Statistical analyses found the
average calculated RMSE of the complete time series to be greater for active motions in
comparison to the passive motions performed by Examiner 2 or Examiner 3 within the Control
group only.
The reason this significant difference was only observed for the RMSE of the complete
time series, and more specifically within the Control group, was because of the fast rate in which
active motions were performed by subjects. Since the calculation of RMSE values for the
complete time series was based upon the differences of lateral flexion values sampled at specific
times within the normalized time series of each trial, if the overall rate in which the trials were
performed differed by a large amount then the possibility of comparing lateral flexions at
substantially different portions of a lateral flexion cycle caused the RMSE values to be higher.
For example, if the second trial of an active motion evaluation within a subject was performed at
a much faster rate than the first, then sampled lateral flexion values at the same time point in the
normalized time series of each trial may have resulted in a comparison of a lateral flexion value
associated with the start of a cycle to a value near the peak of a cycle. This circumstance was not
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as evident within the RMSE values of the dissected cycles because the time series for each cycle
was normalized such that the start and peak of each cycle was the same time value for each trial.
While this finding did not suggest any significant clinical relevancies, it demonstrated the
limitations and potential concerns for the use of calculated RMSE values in the evaluation of
clinical diagnostic motions.

Group Comparisons
The groups contained within this study included the Control group, Experimental group
pre-treatment and Experimental group post-treatment. These groups were evaluated for
symmetry of motion (left versus right) within each group, as well as for differences across
groups.

Within groups: Range of motion
Recall from the Methods section, based upon the subject screening inclusion criteria, it
was required that participants in the Control group exhibited left and right range of motion
symmetry as determined by Examiner 1, while inclusion in the Experimental group required a
VAS of three or greater.
From the data obtained on lateral flexion ranges of motion, it was shown that the average
difference between left and right end-range values was greater for active motions in comparison
to passive motions. In addition, the Experimental group pre-treatment had larger difference
values of average left and right end-range values than the Control group or Experimental group
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post-treatment. Statistical analyses of left versus right lateral flexion end-range values found a
marginally significant difference for active motions within the Experimental group posttreatment, (p<0.10). The average motion asymmetry for active motions was slightly larger for the
Experimental group pre-treatment in contrast to the Experimental group post-treatment; however
the higher variability in the pre-treatment group resulted in a lack of statistical significance. For
passive motion tests, the largest difference between average left and right lateral flexion endrange values was observed within the Experimental group pre-treatment with a reduction in the
average difference following treatment.
For passive motions, the Control group exhibited the lowest standard deviations and for
active motions the Control group exhibited a lower standard deviation than the Experimental
group pre-treatment but not post-treatment. Findings on range of motion symmetry within the
Control group supported the results of the subject screening process, in that the Control group
did not demonstrate significant differences between left and right motions, producing the lowest
difference values between left and right lateral flexions for both active and passive motions.
Furthermore, these data demonstrated that groups of individuals in pain had a larger
range of motion asymmetry which could be reduced through manual medicine treatment. This
reduction in asymmetry post-treatment was likely due to the muscle energy technique used to
reduce tissue tension in portions of the cervical region that inhibited motion, thus extending the
ranges of motion on the affected side. One potential reason for a lack of significant differences in
motion asymmetry in the Experimental group was that some of the participants showed reduced
ranges of motions to the right while other exhibited reduced ranges of motion to the left,
ultimately reducing the mean difference of left and right end-range values. Previous studies have

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not investigated variability in kinematic range of motion asymmetries between healthy and
affected groups.

Within groups: Rate of motion
From the data obtained on rate of left and right lateral flexions, mixed results on motion
asymmetry within groups were observed. While no consistent trends were found between the the
average rates of left and right lateral flexions, significant differences were documented for
Examiner 3 and active motion within the Control group, active motion within the Experimental
group pre-treatment, and Examiner 2 within the Experimental group post-treatment.

Within groups: Root mean square error
There were no asymmetries noted between left and right RMSE values for the dissected
cycle for Examiner 2, Examiner 3, and active motion for any group.

Across groups: Range of motion
From the data obtained for the lateral flexion ranges of motion during Examiner 2,
Examiner 3, and active motion evaluations it was shown that the ROM of the Control group was
greater than the Experimental group post-treatment which was greater than the Experimental
group pre-treatment (Table 63). The statistical analyses (Table 65) documented significant
differences between the average full ROM values of the Control and Experimental pre-treatment

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groups for Examiner 3 and active motions, and the Control and Experimental post-treatment
groups for active motions only.
These findings demonstrated that the average lateral flexion ROM of the Control group
was substantially greater than the Experimental group. This was strongly supported through
previous studies that documented reduced cervical ROMs in groups of individuals that exhibited
cervical dysfunction in comparison to healthy individuals (Dall'Alba et al., 2001, Prushansky et
al., 2006, Grip et al., 2007, Bush et al., 2010, Johnston et al., 1985). Although the effects of
manual treatment on cervical dysfunction have been documented by several studies as an
increase in cervical ROM post-treatment (Cleland et al., 2005, Cleland et al., 2007, Burns and
Wells, 2006, Fernandez-de-las-Penas et al., 2007), a positive effect of treatment was only
observed in this study for Examiner 3’s diagnostic movements. It was likely that a significant
increase in lateral flexion ROM post-treatment was only observed in Examiner 3 due to a
decrease in axial rotation ROM. In contrast, Examiner 2 and active motions demonstrated an
insignificant increase in lateral flexion but showed an increase in axial rotation ROM posttreatment. This increase in secondary motion could have masked the effects of treatment
observed in the primary motions performed by Examiner 2 and active motions.

Across groups: Rate of motion
The data obtained on the rate of lateral flexion demonstrated that the Control group
moved at a faster rate than the Experimental group pre-treatment and post-treatment, but there
were no differences in rate of motion between the Experimental group pre-treatment and posttreatment. Active and passive motions were performed at a rate of approximately two degrees
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per second faster within the Control group compared to the Experimental group pre-treatment
and post-treatment. Statistical analyses found a significant difference between the Control and
Experimental group pre-treatment for the average rate of all lateral flexions. While the
differences between the average rates of the Control and Experimental group post-treatment were
just as large for Examiner 2, Examiner 3, and active motions, the variability of values obtained
for the Experimental group post-treatment were greater than those obtained pre-treatment.
Findings on rate of motion suggested that healthy individuals were able to perform
cervical motions at a greater rate than individuals in pain. Furthermore, passive motions were
performed at a significantly greater rate on healthy individuals in contrast to those in pain who
had not received treatment, most likely because the affected subjects were slightly guarded and
the soft tissues associated with cervical mobility had greater tension on the affected side(s).
These findings also demonstrated that manual treatment did not affect the rate at which an
evaluation was performed.
It should be noted that the examiners were blinded to the group assignment of the
participant, so the fact that the data showed differences in the passive movement rates of healthy
subjects versus those in pain further enhanced the efficacy of those palpatory assessments.
Examiners were detecting differences in the affected groups of individuals, which were
expressed by movements at different rates.

Longitudinal Study Comparisons
To recall, the Longitudinal group consisted of five subjects selected from the
Experimental group who participated in a 72-hour follow-up assessment. These five individuals
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were investigated for immediate and long-term (72-hours) effects of treatment. While statistical
analyses of these data produced no significant findings, a trend was observed in which the
Longitudinal group post-treatment had a slightly larger average full ROM than pre-treatment or
72-hours post-treatment.
For passive motion tests performed by Examiner 2 and Examiner 3, the average full
ROM data followed the trend that post-treatment was greater than 72-hours post-treatment which
was greater than the pre-treatment assessment. This suggested that the effects of a single manual
treatment were immediate, but diminished over time. Average differences between posttreatment and pre-treatment average full ROM values were 1.4 and 2.2 degrees for Examiner 3
and Examiner 2 respectively. For active motions, the trend was followed in which the average
full ROM values were greater post-treatment than pre-treatment or 72-hour post-treatment.
However, differences in average active full ROM values between test sessions never exceeded
0.5 degrees, suggesting that the effects of treatment were less apparent during active motion
evaluations, or may have been a result of the additional rotation permitted during active motions.
Although these trends observed were not supported through statistical analyses, likely
due to a small sample size and small magnitudes of change, similar findings have been
documented by other researchers. Fernandez-de-las-Penas et al. (2007) found a trend towards an
increase in active cervical ROM immediately and 48 hours post HVLA treatment in a group of
70 patients with neck pain that was not supported through statistical findings. The Fernandez-delas-Penas et al. (2007) study suggested that the effects of a single manual treatment had a
positive effect on the achievable cervical ROMs that was immediate but reduced with time.

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Limitations & Future Work
The technique of cervical palpatory diagnosis included evaluations of ranges and
symmetry of cervical motions, tissue texture characteristics, and tissue resistances at the endranges of motion. While the investigations of cervical range and symmetry of motion were
possible through the kinematic data obtained in this study, the tissue resistances and associated
forces applied by the examiner were not analyzed in this study. The addition of force data may
further strengthen trends observed in the kinematic data, but not confirmed through statistical
analyses. For example, an examiner may have moved a subject in symmetric motions and based
the diagnosis on asymmetries in tissue resistances at left and right end-ranges. In the current
study, the kinematics would have signified healthy cervical motion (based upon symmetry)
although the examiner diagnosis would have indicated that the individual demonstrated signs of
cervical dysfunction. Quantification of the forces applied during the palpatory assessment may
help evaluate changes in tissue resistance, and allow for further objectification of parameters
essential to diagnosis of cervical dysfunction. Future studies aimed at quantifying the passive
diagnostic motions conducted on the cervical spine should include kinetic measures, so that
evaluations can be based upon both the kinematic cervical motions and the tissue resistance at
end-ranges.
This study was also limited by the prescribed protocol for active motions. Cervical ranges
of active motion in this study produced results that contradicted results from previously
published literature. Specifically, other research found active lateral flexion ranges of motion to
be significantly less than passive motions, while for this work the opposite was true. Future
studies of active motion should require participants to maintain lateral flexion motion in the
frontal plane. The lack of instruction regarding out of plane motion could have resulted in
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uncontrolled coupled axial rotations that were larger than the axial rotations produced during
passive motion tests. Similarly, in future studies coupling of the motions should be highly
controlled.
An obstacle encountered during this study was the organization and implementation of a
longitudinal study. Organization of a study that required practicing osteopathic physicians to
attend five separate testing dates each requiring two to five hours of their time, posed a
challenge. Furthermore, recruiting five subjects who were all experiencing neck pain and
scheduling them for two separate testing dates over a 72-hour time period that coincided with the
physicians’ availability required significant effort. To facilitate future longitudinal studies,
testing should be conducted in conjunction with the examiners’ and patients’ clinical schedules.
Ultimately, this would allow for multiple longitudinal testing dates involving a larger subject
pool, with decreased scheduling conflicts.

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CONCLUSIONS, FUTURE IMPLICATIONS, & SUMMARY OF FINDINGS

The purpose of this study was to quantify motions of a standard manual medicine cervical
diagnostic procedure, as well as the effects of manual treatment, through kinematic measures.
Previous literature has demonstrated a lack of objective data obtained to investigate osteopathic
palpatory diagnosis and treatment techniques. Much of the previous research conducted on intraand inter-examiner reliability of diagnosis, as well as the effects of treatment, has been based
upon subjective measures and analyzed through Kappa scores. Furthermore, no previous
research has evaluated intra- and inter-examiner reliability, active versus passive motions, within
and across group comparisons, and the effects of treatment all through a single data set, as done
in this research study. This chapter will discuss Conclusions, Future Implications, and a
Summary of Findings based upon the objective data obtained through this study.

Conclusions
Based upon the findings presented in the Discussions chapter, several conclusions could
be derived. Specifically, the objective kinematic data obtained through this study produced
significant findings associated with the palpatory cervical diagnosis technique and active motion
evaluations, with support through literature.
This study demonstrated that objective measures in the form of 3D kinematic data were
successful in characterizing passive and active motion evaluations. Furthermore, these data were
effective in identifying differences between patient groups, differences between examiners’
motions, and consistency in the diagnostic motions within an examiner. In contrast, these
kinematic measures alone were not able to demonstrate significant differences between pre- and
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post-treatment in most of the evaluations. While Examiner 3 demonstrated a significant effect of
manual treatment, this trend did not produce statistically significant results for Examiner 2 or
active motion evaluations. Kinematics alone were not sufficient in capturing significant effects
of treatment, both immediately and 72-hours post-treatment. In addition, active motion
evaluations were successfully quantified through 3D kinematic measures, and demonstrated the
capability to identify differences between groups, as well as differences between subject induced
movements and passive motions performed by examiners.
Many of these findings, derived from kinematic data, were also paralleled through
conclusions made in other studies that primarily collected only subjective information.
Specifically, conclusions associated with intra- and inter-examiner reliability of diagnosis,
healthy versus pain groups, and the effects of manual treatment were supported through previous
studies. The inclusion of objective data coupled with subjective information in future studies will
produce a more robust data set, improve the repeatability of data, and allow for detailed
comparisons of manual techniques within and across examiners. The objective results and
findings of this study are essential to advance the understanding and ability to conduct
comparative research related to manual diagnosis and treatment techniques.

Future Implications
Biomechanical measures, such as motions and forces, have the potential to be used as a
means to establish a reference and associated procedures for teaching a cervical palpatory
diagnostic technique. This technique could be implemented as a ‘gold standard’ for osteopathic
cervical diagnosis, which could be used by instructors as the basis for teaching and evaluating
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medical students. For example, in the teaching process, an instructor could move a patient to a
position, that position and the force applied to the subject could be objectified, and the cues felt
to determine a dysfunction identified. The students could then move the same patient to the
identical position using the same force and feel the cues described by the instructor. In other
words, objective measures could be used as a biofeedback mechanism to evaluate the
performance of a student during an osteopathic diagnosis technique. Ultimately, these objective
biomechanical measures could be used to normalize the standards associated with the manual
diagnosis technique, increasing the effectiveness and consistency of teaching and implementing
the techniques.

Summary of Findings
The data obtained during this study were used in six primary evaluations, resulting in the
several findings. These findings were thoroughly discussed in the Results and Discussion
chapters. Below, a summary in the form of a list is provided for the convenience of the reader.
1. Consistency of motion patterns during the manual diagnostic motion within an
examiner.
a. Examiners were highly consistent within themselves for cervical ranges of motion
achieved during passive lateral flexions for a given subject.
b. The rate, or angular velocity, in which an examiner performed passive lateral
flexions was different for the first cycle of a trial compared to the following two
cycles.
i. Examiner 2 had a faster rate in the first cycle of a trial.
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ii. Examiner 3 had a slower rate in the first cycle of a trial.
2. Consistency of motion patterns during the manual diagnostic motion across examiners.
a. Examiners did not perform passive cervical lateral flexions through the same
ranges of motion. Greater inter-examiner differences occurred during diagnosis of
individuals in pain prior to treatment.
i. Examiner 2 had larger average lateral flexion ranges of motion than
Examiner 3.
b. Examiners did not perform passive cervical lateral flexions at the same rate of
motion. Greater inter-examiner differences occurred during diagnosis of
individuals in pain post-treatment.
i. Examiner 3 had an average faster rate of lateral flexion than Examiner 2.
3. Differences between cervical lateral flexion conducted passively by an examiner and
actively by the subject.
a. The ranges of motion achieved during active motions were greater than passive
motion tests performed by Examiners 2 or 3.
i. The average primary (lateral flexion) ROM of active motions were greater
than the average lateral flexion ROM of Examiner 2 or Examiner 3.
ii. The average secondary (axial rotation) ROM of active motions were
greater than the average axial rotation ROM of Examiner 2 or Examiner 3.
1. Due to the geometric orientation of the vertebral column, the
uncontrolled, larger axial rotations performed during active
motions allowed for less restriction of lateral flexion and therefore
greater ROMs.

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b. Similar to passive motion tests, the first cycle in an active motion trial was
performed at a different rate than the following cycles.
i. During active motions, the first cycle was faster than the following two
cycles in a trial.
c. The rate in which lateral flexions were performed was greater during active
motions in comparison to the passive motions performed by Examiner 2 or
Examiner 3.
d. The calculated RMSE of the dissected cycles did not express differences between
active and passive motion evaluations, but did for the RMSE of the complete time
series.
i. The calculated RMSE of the complete time series was greater for active
motion in comparison to passive motion tests.
4. Differences in kinematic patterns between individuals free of neck pain and individuals
experiencing neck pain.
a. Symmetry of left and right lateral flexion ranges of motion was different in
healthy and pain groups.
i. The Control group demonstrated no differences between left and right
end-range values.
ii. The Experimental group demonstrated a larger difference between left and
right end-range values.
b. Individuals free of neck pain had a larger cervical ROM than individuals
experiencing neck pain.

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i. The Control group had a greater average lateral flexion ROM in
comparison to the Experimental group.
c. Individuals free of neck pain moved at a faster rate during active and passive
motion evaluations in comparison to those experiencing neck pain.
i. The Control group moved at a faster rate during passive and active lateral
flexions than the Experimental group.
5. Differences in kinematic patterns between subjects pre- and post- manual treatment.
a. The effects of manual treatment were minimal when evaluated through active and
passive motion tests.
i. Only Examiner 3 demonstrated a significant increase in lateral flexion
ROM following treatment.
6. Differences in kinematic patterns between pre-treatment, post-treatment, and a 72-hour
post-treatment for a subset of subjects.
a. Trends in the data of manual treatment demonstrated an immediate increase in
lateral flexion ROM that was not sustained during the 72-hour follow-up.

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APPENDICES

119

A1. Visual-Analog Scale (VAS) for Neck Pain
A visual analogue scale (VAS) will be used to assess our subject’s estimate of pain at
the time of the experiment.
VAS scales have been proven to be effective for measuring pain, especially when they
are anchored by word descriptors.
In our experiment, subjects will be requested to mark the point on the line they feel
represents their perception of their current pain status.

Visual Analogue Pain Scale

Date____________
Time: ___________

How severe is your pain today? Please circle a number on the line to indicate your
current level of pain specifically in your head, neck and shoulder region.

No pain 0-----1-----2-----3-----4-----5-----6-----7-----8-----9-----10Very severe pain

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A2. Neck Pain and Disability Scale (NPDS)

1. How bad is your pain today?

Score

0|____:____|____:____|____:____|____:____|____:____|5
NO PAIN

_____

MOST SEVERE PAIN

2. How bad is your pain on the average?
0|____:____|____:____|____:____|____:____|____:____|5
NO PAIN

_____

MOST SEVERE PAIN

3. How bad is your pain at its worst?
0|____:____|____:____|____:____|____:____|____:____|5
NO PAIN

_____

CANNOT TOLERATE

4. Does your pain interfere with your sleep?
0|____:____|____:____|____:____|____:____|____:____|5

_____

CAN’T SLEEP

NOT AT ALL

5. How bad is your pain with standing?
0|____:____|____:____|____:____|____:____|____:____|5
NO PAIN

_____

MOST SEVERE PAIN

6. How bad is your pain with walking?
0|____:____|____:____|____:____|____:____|____:____|5
NO PAIN

_____

MOST SEVERE PAIN

7. Does your pain interfere with driving or riding a car?
0|____:____|____:____|____:____|____:____|____:____|5

_____

CAN’T DRIVE OR RIDE

NOT AT ALL

8. Does your pain interfere with social activities?
0|____:____|____:____|____:____|____:____|____:____|5
NOT AT ALL

_____

ALWAYS

9. Does your pain interfere with recreational activities?
0|____:____|____:____|____:____|____:____|____:____|5
NOT AT ALL

ALWAYS

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_____

A2. (cont’d)

10. Does your pain interfere with work activities?
0|____:____|____:____|____:____|____:____|____:____|5

_____

CAN’T WORK

NOT AT ALL

11. Does your pain interfere with your personal care (eating, dressing, bathing, etc.)?
0|____:____|____:____|____:____|____:____|____:____|5
NOT AT ALL

_____

ALWAYS

12. Does your pain interfere with your personal relationships (family, friends, sex, etc.)?
0|____:____|____:____|____:____|____:____|____:____|5
NOT AT ALL

_____

ALWAYS

13. How has your pain changed your outlook on life and the future (depression, hopelessness)?
0|____:____|____:____|____:____|____:____|____:____|5
NO CHANGE

_____

COMPLETELY CHANGED

14. Does pain affect your emotions?
0|____:____|____:____|____:____|____:____|____:____|5
NOT AT ALL

_____

COMPLETELY

15. Does your pain affect your ability to think or concentrate?
0|____:____|____:____|____:____|____:____|____:____|5
NOT AT ALL

_____

COMPLETELY

16. How stiff is your neck?
0|____:____|____:____|____:____|____:____|____:____|5

_____

CAN’T MOVE NECK

NOT STIFF

17. How much trouble do you have turning your neck?
0|____:____|____:____|____:____|____:____|____:____|5

_____

CAN’T MOVE NECK

NO TROUBLE

18. How much trouble do you have looking up or down?
0|____:____|____:____|____:____|____:____|____:____|5
CAN’T LOOK UP OR DOWN

NO TROUBLE

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_____

A2. (cont’d)

19. How much trouble do you have working overhead?
0|____:____|____:____|____:____|____:____|____:____|5

_____

CAN’T WORK OVERHEAD

NO TROUBLE

20. How much do pain pills help?
0|____:____|____:____|____:____|____:____|____:____|5
COMPLETE RELIEF

_____

NO RELIEF

TOTAL

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_____

A3. Lifestyles Questionnaire
CONFIDENTIAL

Lifestyle Questionnaire
Please be as thorough and accurate as possible when answering the following
questions. If anything is unclear, please ask the test administrator for clarification on the
day of testing.
1. What is your current age? _________yrs, measurement of height___ft.___in,
measurement of weight _________ lbs.
Male Female (circle one)
2. Are you currently under medical care? Yes ____, No ______
Explain:______________________________________________

3. Have you been injured recently in the head/ neck region?
Yes____ No _____
How long ago? _________________________________________________
Is it a reoccurring pain/injury?________________If so, how often?_________
Are you under current treatment for this condition? Yes___ No___
Who is your current treating physician?______________________________
Has this condition impaired your daily activities? Yes___ No___
Explain: ________________________________________

4. Have you experienced any back or neck pain today? Yes___,No ____
Do you know the cause?_____________________________________________

5. Are you currently taking any pain medications?
Yes _________, No____________
If so, which medication(s)____________________________________________
________________________________________________________________

What are the medications for?________________________________________

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A3. (cont’d)

6. Are you right_____ or left _______ handed?

7. Are you pregnant? Yes ___No ___
(If the subject is pregnant, she may be excused from the testing.)

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A4. Subject Questionnaire Responses

Subject

Group

Age

Sex

Height
(m)

Weight
(kg)

Pre-Test
VAS/10

Post-Test
VAS/10

NDPS/100

4
5
27
41
46
51
56
59
63
67
68
69
77
79
83
85
88
90
96
106
111
117
6
9
12
14
23
25
54
55
57
70
72
80
84
91
95
98
112
115
125

Cont.
Cont.
Cont.
Cont.
Cont.
Cont.
Cont.
Cont.
Cont.
Cont.
Cont.
Cont.
Cont.
Cont.
Cont.
Cont.
Cont.
Cont.
Cont.
Cont.
Cont.
Cont.
Exp.
Exp.
Exp.
Exp.
Exp.
Exp.
Exp.
Exp.
Exp.
Exp.
Exp.
Exp.
Exp.
Exp.
Exp.
Exp.
Exp.
Exp.
Exp.

22
22
23
22
18
20
18
18
18
19
18
18
18
23
22
21
18
22
20
21
19
18
21
18
21
18
20
37
27
43
22
21
53
22
20
21
38
18
18
21
63

M
F
M
F
M
NR
M
F
M
M
M
M
M
F
F
M
M
M
F
M
M
NR
M
M
M
M
F
F
M
M
M
M
M
M
M
F
F
M
F
M
M

NR
1.68
1.73
1.70
1.70
1.83
1.88
1.57
1.78
1.93
1.73
1.88
1.78
1.57
1.55
1.73
1.85
1.80
1.70
1.80
1.75
1.78
1.91
1.80
1.88
1.78
1.55
1.73
1.85
1.80
1.83
1.83
1.68
1.80
1.68
1.63
1.52
1.83
1.57
1.80
1.96

NR
56.7
69.9
72.6
68.0
NR
75.8
54.4
74.8
90.7
72.6
80.3
72.6
49.9
56.7
90.7
77.1
108.4
77.1
70.3
86.2
74.8
94.4
74.8
79.4
70.3
47.6
94.4
99.8
86.2
90.7
63.5
59.9
68.0
108.9
61.2
120.7
65.8
44.0
83.9
104.3

0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
8
5
4
5
4
3
6
4
3
3
7
3
3
6
3
3
7
7
4

0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
7
3
2
4
2
2
6
4
4
2
6
1
2
4
1
4
7
7
5

12
1
7
0
0
13
0
0
6
8
4
0
0
0
1
0
0
1
0
3
0
0
74
56
15/50
31
35
77
73
66
25
29
58
21.5
12.5
54.5
24
53.5
56
28
70

NR = Not Reported

126

A5. Measurements of Qualysis Accuracy

The Qualysis six-camera motion capture system was assessed for measurement accuracy
through the use of three rigid linear “wands” with a passive marker attached to each end and a
right triangle with a passive marker attached to each vertex. Accuracy of the Qualysis motion
capture system was determined through a comparison of the manually measured data to the mean
and standard deviation of values obtained from the motion capture system.

Qualysis Measures
Manual
Average Mean Average SD
Measures
Wand 1 (mm)
Wand 2 (mm)
Wand 3 (mm)
Angle AB (deg)
Angle AC (deg)
Angle CB (deg)

173
176
156
90
45
45

173.6
176.2
156.9
90.3
44.9
44.9

127

0.7
1.0
1.3
0.8
0.4
0.6

A6. Ranges of Lateral Flexions (Primary Motions)

Right End Range Values (degrees)

Left End Range Values (degrees)

Subject

Test

Group

1

2

3

4

5

6

1

2

3

4

5

6

4
4
4
5
5
5
27
27
27
41
41
41
46
46
46
51
51
51
56
56
56
59
59
59
63
63
63

Ex. 2
Ex. 3
Active
Ex. 2
Ex. 3
Active
Ex. 2
Ex. 3
Active
Ex. 2
Ex. 3
Active
Ex. 2
Ex. 3
Active
Ex. 2
Ex. 3
Active
Ex. 2
Ex. 3
Active
Ex. 2
Ex. 3
Active
Ex. 2
Ex. 3
Active

Cont.
Cont.
Cont.
Cont.
Cont.
Cont.
Cont.
Cont.
Cont.
Cont.
Cont.
Cont.
Cont.
Cont.
Cont.
Cont.
Cont.
Cont.
Cont.
Cont.
Cont.
Cont.
Cont.
Cont.
Cont.
Cont.
Cont.

30.2
24.2
46.8
48.5
39.0
52.1
32.8
36.5
44.0
42.5
29.3
47.5
48.5
41.9
54.2
40.4
34.2
41.4
39.0
44.6
54.9
35.9
37.8
42.9
26.5
15.8
31.9

32.8
28.8
46.6
45.2
33.5
53.4
37.2
38.1
47.6
37.4
28.9
43.7
44.5
44.9
56.0
37.9
32.8
37.5
40.3
38.0
51.4
35.2
34.7
41.9
23.7
13.8
29.8

29.4
28.3
48.7
44.3
37.8
54.8
36.7
39.0
47.5
39.3
23.4
41.3
43.1
45.4
55.5
33.7
34.5
42.5
42.9
44.0
54.3
38.8
34.0
40.1
26.3
16.2
30.7

29.3
24.4
41.1
46.0
36.7
53.8
37.4
33.9
47.9
39.9
28.9
44.5
50.9
47.0
53.0
36.9
35.8
32.4
44.4
44.6
54.4
36.0
30.2
36.4
23.0
15.4
23.9

29.8
26.3
46.6
47.9
40.1
57.2
42.4
31.8
49.0
36.6
25.0
43.9
50.5
44.8
54.8
34.6
35.5
36.4
39.1
42.6
50.3
31.1
39.6
40.1
24.2
16.9
31.5

29.1
26.4
47.6
44.2
41.0
56.4
42.4
34.5
52.5
37.0
24.6
40.8
45.3
46.4
54.4
38.9
35.1
37.9
44.3
44.1
55.7
33.3
34.7
40.9
28.3
16.6
29.4

27.7
22.9
43.6
40.5
35.5
56.0
40.6
43.5
49.9
42.9
35.6
53.1
39.0
34.9
45.5
35.3
36.8
45.3
41.0
40.1
52.4
32.3
34.0
45.9
29.5
22.2
29.5

32.6
23.2
43.9
42.0
35.7
56.0
39.2
42.6
49.5
44.0
34.8
45.9
35.8
34.9
48.4

28.3
24.3
44.6
44.4
39.0
56.1
42.6
41.5
50.3
44.1
36.8
51.6
33.4
31.6
45.4
35.5
40.9
41.3
38.7
49.4
31.4
31.7
40.9
36.9
21.5
35.5

27.7
26.1
42.8
46.9
44.3
58.5
42.0
40.0
52.6
40.7
36.4
47.4
32.1
34.3
44.5
31.6
34.1
45.0
46.7
43.9
47.9
38.4
28.7
41.1
27.5
22.5
37.0

29.3
31.0
44.3
46.4
41.3
59.9
42.1
41.6
52.1
39.5
36.2
49.5
31.0
35.7
47.1

36.4
45.2
42.8
40.6
48.7
31.6
32.4
43.7
32.7
22.0
32.0

24.6
23.0
41.6
44.2
43.3
55.8
41.6
37.1
53.5
42.3
39.5
46.2
37.6
38.5
43.6
33.2
34.0
41.6
43.0
42.6
49.9
34.7
31.4
39.9
28.7
22.5
32.2

128

34.5
39.2
46.4
42.7
50.7
29.1
45.3
30.0
21.4
35.2

A6. (cont’d)
Right End Range Values (degrees)

Left End Range Values (degrees)

Subject

Test

Group

1

2

3

4

5

6

1

2

3

4

5

6

67
67
67
68
68
68
69
69
69
77
77
77
79
79
79
83
83
83
85
85
85
88
88
88
90
90
90

Ex. 2
Ex. 3
Active
Ex. 2
Ex. 3
Active
Ex. 2
Ex. 3
Active
Ex. 2
Ex. 3
Active
Ex. 2
Ex. 3
Active
Ex. 2
Ex. 3
Active
Ex. 2
Ex. 3
Active
Ex. 2
Ex. 3
Active
Ex. 2
Ex. 3
Active

Cont.
Cont.
Cont.
Cont.
Cont.
Cont.
Cont.
Cont.
Cont.
Cont.
Cont.
Cont.
Cont.
Cont.
Cont.
Cont.
Cont.
Cont.
Cont.
Cont.
Cont.
Cont.
Cont.
Cont.
Cont.
Cont.
Cont.

46.5
40.3
53.9
25.7
19.6
34.9
43.7
32.1
51.3
35.0
37.4
40.8
35.3
33.6
41.8
39.1
35.0
43.8
30.1
30.2
30.3
27.9
24.5
29.2
37.1
34.0
41.0

50.3
44.6
53.5
28.4
26.4
35.8
41.8
32.4
52.7
35.1
34.5
42.0
30.7
38.1
44.0
40.2
33.6
42.7
33.3
31.2
29.7
29.6
31.0
32.7
33.4
29.9
43.8

50.5
40.9
56.5
24.6
29.6
34.1
44.9
28.4
50.4
34.1
35.1
39.4
31.2
36.3
42.3
40.5
34.1
42.8
34.9
30.5
32.3
25.3
28.8
35.0
29.6
32.7
43.1

43.2
39.7
48.8
30.0
27.2
34.3
47.3
35.6
49.9
32.7
28.0
37.8
31.2
27.9
42.7
38.5
33.5
42.2
31.3
30.0
30.1
27.8
25.7
28.4
35.3
38.8
41.4

44.5
40.1
49.2
31.0
30.3
37.7
45.1
26.4
47.4
37.9
34.2
43.7
38.2
29.1
45.4
38.9
33.0
43.1
31.4
33.3
30.2
28.6
30.6
33.9
34.9
37.1
37.5

42.5
34.6
51.5
31.6
30.9
38.2
46.4
26.8
45.1
36.9
32.5
44.2
36.8
34.7
44.3
37.9
32.8
43.9
31.8
30.0
33.2
30.9
30.2
36.1
33.3
35.3
40.6

37.2
34.0
43.3
25.1
24.8
33.8
45.4
32.5
55.0
30.1
35.4
37.9
36.7
40.2
43.6
31.1
26.0
45.4
37.7
36.5
38.9
31.0
25.7
26.7
36.4
44.6
48.5

37.0
33.2
42.2
23.0
22.0
38.1
38.9
34.6
49.9
30.8
32.6
34.9
34.7
38.6
42.3
33.8
29.5
44.0
39.2
33.9
36.3
27.4
23.9
29.8
35.7
37.7
53.0

37.3
30.7
40.5
24.3
23.4
36.9
35.6
33.3
49.7
30.8
32.3
35.0
35.5
39.1
44.2
35.7
32.4
42.3
41.3
33.1
37.7
30.9
28.3
33.4
33.9
37.2
52.7

36.3
30.6
43.1
29.0
25.9
33.2
43.6
34.0
47.8
34.3
30.7
40.4
36.3
39.4
39.7
35.7
31.8
41.7
35.6
36.1
39.2
32.7
26.2
39.8
35.3
35.2
46.9

34.1
32.1
41.2
28.7
24.0
38.6
34.8
30.1
46.1
35.6
29.2
40.7
36.9
41.0
42.6
34.7
29.3
41.3
33.8
36.3
38.5
25.3
25.1
37.4
36.1
36.0
45.1

35.7
32.4
43.5
33.1
26.3
39.1
46.2
35.6
52.1
33.2
31.5
40.1
38.1
40.6
42.7
36.3
33.6
41.6
37.5
34.7
40.2
26.5
26.5
38.5
38.3
34.5
46.9

129

A6. (cont’d)
Right End Range Values (degrees)

Left End Range Values (degrees)

Subject

Test

Group

1

2

3

4

5

6

1

2

3

4

5

6

96
96
96
106
106
106
111
111
111
117
117
117

Ex. 2
Ex. 3
Active
Ex. 2
Ex. 3
Active
Ex. 2
Ex. 3
Active
Ex. 2
Ex. 3
Active

Cont.
Cont.
Cont.
Cont.
Cont.
Cont.
Cont.
Cont.
Cont.
Cont.
Cont.
Cont.

38.2
29.1
40.9
27.2
26.9
42.3
38.2
44.0
47.0
30.5
29.8
41.9

32.2
18.3
41.5
30.3
28.7
40.2
36.7
35.6
46.5
29.0
31.5
42.9

24.7
27.4
39.4
32.4
27.3
42.2
41.4
39.4
48.6
15.9
32.3
41.1

39.0
25.1
38.9
34.3
30.3
41.1
36.3
42.2
44.5
26.5
33.0
42.6

35.0
26.0
39.6
33.3
26.8
42.2
39.7
42.1
44.9
27.2
32.4
40.3

29.1
24.1
41.7
32.3
27.9
43.0
37.9
44.7
43.8
23.1
32.0
40.9

38.4
38.9
44.5
35.7
30.5
53.9
39.8
43.7
49.0
29.4
24.0
43.0

37.0
35.4
43.3
36.6
27.4
49.5
41.5
40.4
46.4
22.6
25.1
43.1

37.0
38.4
46.3
38.8
34.4
50.9
41.7
40.9
46.6
23.7
28.9
41.8

38.7
39.4
45.9
33.6
31.9
45.9
35.8
36.4
50.5
28.1
29.0
43.3

36.2
36.8
45.7
30.9
31.8
46.9

35.0
38.8
45.2
33.9
31.9
45.8
39.3
41.2
49.9
31.1
30.4
39.5

40.1
48.1
24.3
29.6
40.1

Pre-Treatment
Right End Range Values (degrees)

Left End Range Values (degrees)

Subject

Test

Group

1

2

3

4

5

6

1

2

3

4

5

6

6
6
6
9
9
9
12
12
12

Ex. 2
Ex. 3
Active
Ex. 2
Ex. 3
Active
Ex. 2
Ex. 3
Active

Exp.
Exp.
Exp.
Exp.
Exp.
Exp.
Exp.
Exp.
Exp.

39.0
30.5
35.0
28.2
19.6
34.2
40.2
16.2
41.9

47.9
33.6

34.9
25.1

24.9
29.7
40.9
25.2
22.9
22.5
25.7
16.8
29.4

28.0
13.8
31.5
34.2
26.3
33.6
30.2
19.6
34.2

24.7
19.7

29.4
17.0
33.2
33.5
16.0
36.5

27.7
25.4
37.2
31.0
13.5
27.5
27.0
16.5
31.1

26.1
21.7

24.9
19.4
31.9
34.5
20.4
39.1

32.8
25.4
38.3
25.1
19.9
25.0
31.2
13.6
34.7

34.7
26.9
31.1
28.2
21.1
36.6

34.0
28.7
34.3
25.5
19.8
35.5

30.2
20.0
37.1
28.3
25.4
32.8
28.6
20.8
34.3

27.0
19.1
38.7
26.0
24.8
31.1
27.8
20.4
31.3

28.2
20.8
40.1
28.7
24.4
35.8
31.0
19.9
30.5

130

A6. (cont’d)
Pre-Treatment
Right End Range Values (degrees)

Left End Range Values (degrees)

Subject

Test

Group

1

2

3

4

5

6

1

2

3

4

5

6

14
14
14
23
23
23
25
25
25
54
54
54
55
55
55
57
57
57
70
70
70
72
72
72
80
80
80

Ex. 2
Ex. 3
Active
Ex. 2
Ex. 3
Active
Ex. 2
Ex. 3
Active
Ex. 2
Ex. 3
Active
Ex. 2
Ex. 3
Active
Ex. 2
Ex. 3
Active
Ex. 2
Ex. 3
Active
Ex. 2
Ex. 3
Active
Ex. 2
Ex. 3
Active

Exp.
Exp.
Exp.
Exp.
Exp.
Exp.
Exp.
Exp.
Exp.
Exp.
Exp.
Exp.
Exp.
Exp.
Exp.
Exp.
Exp.
Exp.
Exp.
Exp.
Exp.
Exp.
Exp.
Exp.
Exp.
Exp.
Exp.

41.1
42.8
43.6
43.1
37.7
44.9
31.6
26.5
35.4
26.4
33.3
37.1
23.1
28.2
25.9
39.8
31.7
41.4
38.9
29.1
38.2
30.9
27.3
41.6
39.2
30.3
40.7

40.2
33.5
48.2
42.5
31.6
41.4
32.8
24.2
36.8
28.1
29.1
39.5
22.1
32.2
31.3
40.5
27.9
40.1
34.6
28.0
38.5
28.1
31.4
41.0
36.8
33.6
41.4

37.0
32.8
42.0
43.6
35.0
43.9
28.5
26.5
38.6
32.2
29.6
38.8

39.0
42.4
45.8
45.5
38.1
46.4
31.9
30.8
35.7
28.0
26.4
35.0
23.7
22.7
26.9
40.1
34.8
37.7
32.7
27.7
38.2
28.0
27.5
42.4
34.3
34.0
33.1

39.1
34.4
40.0
47.6
33.7
44.4
32.8
33.1
40.0
34.5
28.0
35.7
23.3
21.5
26.2
39.2
35.0
38.3
32.0
30.5
38.5
28.5
25.3
43.7
34.3
35.7
44.6

39.1
34.7
44.0
48.7
31.9
47.3
26.0
32.5
38.8
32.0
30.5
38.5
19.6
21.1
26.8
39.3
39.3
43.2
28.9
30.3
40.4
29.7
22.8
44.7
34.3
31.3
38.4

45.5
41.0
43.9
49.6
40.1
51.5
27.6
25.1
28.6
32.6
35.6
46.7
23.5
21.3
30.8
37.9
38.0
44.4
34.7
25.8
40.2
29.9
23.5
38.7
35.8
35.0
44.0

44.8
30.4
37.7
49.0
38.6
48.9
30.8
24.8
29.5
42.9
34.2
54.0
24.2
30.8
32.4
45.2
36.7
44.2
35.3
25.3
38.1
33.1
29.0
43.7
33.8
31.8
44.5

48.3
35.7
48.0
47.6
37.7
54.8
30.2
22.8
31.1
42.2
34.0
54.2

43.8
35.0
49.6
43.0
40.3
46.3
28.6
22.5
29.5
36.9
28.5
45.5
24.1
23.5
30.0
47.7
35.2
42.2
35.1
25.3
37.1
32.8
36.0
43.7
30.9
36.8
44.2

42.1
35.1
47.2
43.6
39.1
44.3
25.4
20.1
31.1
36.5
30.2
47.5
23.5
23.6
31.7
47.3
33.0
44.3
35.7
27.9
37.7
35.4
27.7
42.3
33.8
37.4
45.4

42.5
31.1
53.3
45.0
39.7
46.5
26.5
18.5
31.9
33.3
29.3
50.3
23.5
19.3
33.8
44.5
34.0
47.0
32.8
25.2
39.1
38.5
31.4
41.9
33.3
37.6
43.8

22.2
26.8
42.6
32.0
43.8
36.3
28.8
38.6
31.8
30.7
42.8
35.6
34.1
40.3

131

21.7
45.8
41.0
45.5
37.6
29.0
40.3
31.8
28.1
47.0
33.5
35.0
43.6

A6. (cont’d)
Pre-Treatment
Right End Range Values (degrees)

Left End Range Values (degrees)

Subject

Test

Group

1

2

3

4

5

6

1

2

3

4

5

6

84
84
84
91
91
91
95
95
95
98
98
98
112
112
112
115
115
115
125
125
125

Ex. 2
Ex. 3
Active
Ex. 2
Ex. 3
Active
Ex. 2
Ex. 3
Active
Ex. 2
Ex. 3
Active
Ex. 2
Ex. 3
Active
Ex. 2
Ex. 3
Active
Ex. 2
Ex. 3
Active

Exp.
Exp.
Exp.
Exp.
Exp.
Exp.
Exp.
Exp.
Exp.
Exp.
Exp.
Exp.
Exp.
Exp.
Exp.
Exp.
Exp.
Exp.
Exp.
Exp.
Exp.

21.4
22.8
30.4
36.9
36.2
44.0
33.9
32.3
35.0
28.2
29.6
53.1
39.7
32.7
38.2
25.2
24.5
25.3
25.7
24.7
26.4

18.9
23.0
29.0
40.1
39.1
47.8
34.7
33.0
35.3
24.9
28.9
45.4
35.8
31.6
39.0
22.0
21.4
30.1
26.1
23.0
28.2

20.8
21.3
29.5
41.2
37.6
52.1
31.9
29.7
36.7
26.8
29.7
40.1
42.9
29.9
38.0
26.7
21.9
29.1
23.3
24.7
26.5

25.1
26.6
30.4
39.9
40.3
45.5
31.4
29.8
37.2
29.4
24.0
35.9
35.2
34.2
32.4
27.5
20.9

26.3
28.3
29.8
39.7
40.2
46.0
33.5
30.6
38.3
26.4
22.7
39.3
34.7
35.1
40.3
27.9
19.3

27.2
25.7
29.0
40.6
40.2
47.0
31.9
31.8
37.9
30.3
26.0
41.2
33.9
32.4
42.4
29.0
20.0

28.1
27.0
30.3
35.9
40.3
39.9
34.8
32.9
34.0
36.5
36.8
57.2
34.2
28.2
29.6
33.8
34.6

25.5
25.5
26.8
35.0
38.6
44.7
33.3
34.9
35.9
33.8
34.3
54.5
31.6
28.7
34.7
29.9
30.1

26.3
26.0
27.5
33.0
40.0
44.8
33.1
35.8
35.5
31.6
31.0
54.2
34.0
29.3
36.4
36.1
31.4

26.7
24.5
25.9

26.6
20.0
23.7

25.6
28.0
38.1
39.6
38.0
43.5
34.8
32.2
38.8
37.2
39.1
61.3
33.2
28.3
31.4
31.3
26.9
33.4
25.8
22.9
30.4

28.8
27.6
36.9
40.2
38.1
44.2
33.2
33.4
38.9
42.2
35.4
57.3
31.2
29.5
35.9

27.6
23.9
24.5

28.3
28.6
35.8
39.9
37.9
43.6
34.0
34.4
35.0
39.7
41.2
61.7
32.0
27.5
30.8
31.7
23.7
38.7
26.5
22.5
30.2

27.0
23.2
27.2

23.2
23.4
28.9

25.2
24.3
28.5

132

28.7
32.3
29.0
21.9
29.8

A6. (cont’d)
Post-Treatment
Right End Range Values (degrees)

Left End Range Values (degrees)

Subject

Test

Group

1

2

3

4

5

6

1

2

3

4

5

6

6
6
6
9
9
9
12
12
12
14
14
14
23
23
23
25
25
25
54
54
54
55
55
55
57
57
57

Ex. 2
Ex. 3
Active
Ex. 2
Ex. 3
Active
Ex. 2
Ex. 3
Active
Ex. 2
Ex. 3
Active
Ex. 2
Ex. 3
Active
Ex. 2
Ex. 3
Active
Ex. 2
Ex. 3
Active
Ex. 2
Ex. 3
Active
Ex. 2
Ex. 3
Active

Exp.
Exp.
Exp.
Exp.
Exp.
Exp.
Exp.
Exp.
Exp.
Exp.
Exp.
Exp.
Exp.
Exp.
Exp.
Exp.
Exp.
Exp.
Exp.
Exp.
Exp.
Exp.
Exp.
Exp.
Exp.
Exp.
Exp.

34.9
24.4
39.7
31.2
24.2
39.2
31.0
17.2
39.5
39.5
37.9
45.9
39.8
34.5
44.3
34.8
29.2
41.1
40.9
31.2
41.2
21.5
21.8
25.8
39.0
32.8
38.1

30.9
27.0
39.4
31.5
26.0
37.9
29.2
20.6
34.1
30.7
40.1
38.6
41.5
34.4
42.5
34.9
32.1
38.2
35.6
34.4
42.7
23.6
23.8
28.3
42.7
30.2
44.3

34.9
27.9
40.9
29.8
27.0
40.6
31.6
17.2
34.1
30.8
37.0
32.9
36.7
33.8
40.6
35.3
30.9
42.2
31.8
33.6
45.6
22.7
25.4
28.2
44.8
31.4
44.9

28.8
25.7
35.9
40.5
26.9
36.6
31.0
18.3
36.3
40.8
34.5
45.9
42.8
33.4
41.0
35.7
28.4
41.3
37.2
31.8
41.7
25.2
22.8
26.0
40.7
32.3
40.5

28.4
25.4
39.7
42.2
25.6
43.4
25.6
18.9
35.7
44.7
36.4
32.8
45.5
35.3
42.6
35.9
30.5
45.3
32.2
28.5
42.2
24.2
25.7
27.7
43.0
32.5
38.8

29.3
25.9
40.2
39.9
18.7
43.9
26.7
18.3
33.7
38.8
39.3
34.2
41.5
28.2
44.0
35.9
31.1
42.5
35.8
29.5
44.5
25.6
19.4
29.5
43.2
37.2
41.4

34.8
25.6
38.5
38.4
26.3
38.6
34.4
18.8
30.7
36.2
18.1
48.4
50.4
35.5
49.0
25.5
22.8
36.6
41.0
30.3
46.7
28.1
27.8
32.4
43.8
40.6
46.0

29.6
21.4
37.9
33.4
23.2
39.3
30.3
16.0
31.6
39.7
24.5
47.0
48.6
37.6
44.6
25.7
19.5
37.6
39.4
34.2
48.7
26.1
29.6
34.4
45.3
40.3
46.9

32.1
22.8
38.6
35.2
28.1
38.8
29.3
18.7
30.4
31.5
28.7
35.7
47.9
37.8
45.3
26.6
24.8
36.9
37.4
36.8
51.8
26.3
34.4
36.7
43.2
40.3
48.3

32.6
26.2
34.1
29.9
23.7
36.8
32.9
15.5
37.3
41.5
44.0
41.6
42.7
41.2
42.5
26.4
26.3
29.4
36.6
31.4
47.1
27.3
30.7
39.0
45.3
37.3
50.4

31.9
23.7
35.7
33.9
24.0
36.3
25.7
15.9
35.6
36.9
41.9
48.1
41.6
40.9
41.8
27.7
26.2
30.0
38.7
34.1
47.3
26.8
29.8
39.8
45.0
38.3
49.1

32.9
26.5
37.6
32.3
26.8
40.4
31.7
16.7
37.7
41.1
43.8
47.3
42.3
37.4
44.0
31.0
27.0
31.4
36.2
37.1
52.7
26.7
24.4
39.5
46.4
40.1
52.5

133

A6. (cont’d)
Post-Treatment
Right End Range Values (degrees)

Left End Range Values (degrees)

Subject

Test

Group

1

2

3

4

5

6

1

2

3

4

5

6

70
70
70
72
72
72
80
80
80
84
84
84
91
91
91
95
95
95
98
98
98
112
112
112
115
115
115

Ex. 2
Ex. 3
Active
Ex. 2
Ex. 3
Active
Ex. 2
Ex. 3
Active
Ex. 2
Ex. 3
Active
Ex. 2
Ex. 3
Active
Ex. 2
Ex. 3
Active
Ex. 2
Ex. 3
Active
Ex. 2
Ex. 3
Active
Ex. 2
Ex. 3
Active

Exp.
Exp.
Exp.
Exp.
Exp.
Exp.
Exp.
Exp.
Exp.
Exp.
Exp.
Exp.
Exp.
Exp.
Exp.
Exp.
Exp.
Exp.
Exp.
Exp.
Exp.
Exp.
Exp.
Exp.
Exp.
Exp.
Exp.

29.0
32.0
39.4
34.0
22.8
41.2
36.4
34.8
42.5
29.1
25.7
28.1
44.1
41.0
47.8
34.2

28.8
33.6
38.6
34.1
31.8
40.6
37.6
35.7
40.5
27.8
28.1
29.5
45.2
46.9
54.7
33.4

30.3
34.9
45.5
31.2
32.5
41.5
36.2
35.7
43.6
23.5
26.3
26.1
43.8
45.7
55.4
32.7

43.5
30.7
46.0
26.3
29.2
47.9
34.9
35.2
43.5
28.2
30.6
36.7
40.5
42.0
49.6
29.6

38.0
24.9
25.1
32.8
39.3
38.0
43.4
26.0
23.4
31.6

32.3
36.3
45.1
24.3
29.5
42.8
35.4
36.5
41.7
23.2
22.6
37.2
41.9
46.3
48.6
32.4
35.0
39.0
28.6
26.1
32.7
36.7
39.3
46.1
30.6
26.1
26.5

38.3
34.7
40.3
28.7
30.3
43.1
39.0
35.2
46.2
27.3
28.6
36.1
39.3
37.5
49.0
30.0

40.6
24.8
23.0
36.5
40.0
38.5
43.0
27.9
22.2
26.0

30.2
36.4
44.5
32.5
27.8
41.4
33.0
34.1
39.2
27.0
23.2
34.8
42.6
47.4
48.4
32.2
37.5
37.0
24.2
25.1
30.9
37.8
35.5
46.3
31.7
27.3
28.8

38.0
30.4
44.5
31.3
28.0
43.2
36.6
36.0
47.3
28.1
28.0
36.4
39.3
39.6
46.2
32.3

37.8
27.0
32.5
34.6
40.5
33.9
43.4
25.4
24.4
18.5

32.3
30.8
48.2
31.4
30.8
38.9
30.5
37.8
38.8
23.3
24.5
30.6
42.7
42.0
47.5
33.4
34.2
38.3
16.8
27.7
32.8
38.3
35.6
41.6
29.7
26.1
27.0

37.6
39.6
37.0
45.2
34.1
29.7
35.5
31.1
26.5
39.1

37.3
34.3
31.4
43.3
34.0
27.5
34.9
28.2
24.9
44.7

38.6
31.5
32.5
46.3
34.9
28.9
36.0
27.3
26.7
49.5

31.6
30.9
46.1
25.8
31.3
45.5
36.1
37.9
43.2
29.9
28.0
39.0
40.5
40.2
45.2
32.2
33.3
37.7
34.1
33.4
45.7
36.7
30.5
37.7
26.2
24.2
35.7

33.6
32.8
44.1
19.6
30.5
47.6
36.8
36.8
43.3
26.9
27.0
36.8
41.9
44.8
45.5
30.1
34.8
39.7
34.1
33.8
43.7
36.6
28.9
38.3
28.2
25.9
7.3

36.2
35.5
47.2
27.9
31.1
47.0
37.0
35.3
42.8
26.7
27.2
37.6
42.5
40.9
45.8
29.7
31.8
43.1
31.5
33.9
44.7
40.0
28.6
38.0
24.7
25.7
18.4

134

A6. (cont’d)
Post-Treatment
Right End Range Values (degrees)

Left End Range Values (degrees)

Subject

Test

Group

1

2

3

4

5

6

1

2

3

4

5

6

125
125
125

Ex. 2
Ex. 3
Active

Exp.
Exp.
Exp.

26.2
24.8
29.3

26.3
25.0
32.4

27.3
25.3
30.2

27.6
34.3
25.6

27.4
34.3
29.4

26.2
34.3
30.0

27.3
25.4
31.9

25.5
24.8
33.5

23.5
24.8
31.4

27.0
30.9
31.7

25.7
33.8
31.4

22.4
33.3
31.9

Pre-Treatment
Right End Range Values (degrees)

Left End Range Values (degrees)

Subject

Test

Group

1

2

3

4

5

6

1

2

3

4

5

6

126
126
126
127
127
127
128
128
128
129
129
129
131
131
131

Ex. 2
Ex. 3
Active
Ex. 2
Ex. 3
Active
Ex. 2
Ex. 3
Active
Ex. 2
Ex. 3
Active
Ex. 2
Ex. 3
Active

Long.
Long.
Long.
Long.
Long.
Long.
Long.
Long.
Long.
Long.
Long.
Long.
Long.
Long.
Long.

34.9
30.0

30.3
30.3

29.1
31.1

32.8
28.9

34.8
31.8

33.0
30.6

39.6
33.5

36.6
31.4

36.3
35.2

34.6
33.6

35.3
33.1

34.8
30.1

31.6
23.8
37.1
36.7
36.8
39.8
18.8
22.1
29.9
42.0
42.6
48.7

29.4
24.2
40.8
36.9
39.9
42.2
18.0
19.8
31.6
40.5
46.6
49.2

30.3
25.9
39.7
36.8
36.5
40.7
18.2
20.1
30.7
43.2
40.7
47.1

30.5
27.4
36.3
39.4
37.9
40.0
17.6
17.6
31.4
41.0
39.6
46.6

30.2
28.2
38.7
38.5
39.2
41.1
21.0
17.2
30.9
43.5
39.8
46.0

30.4
27.4
39.9
38.5
40.3
40.0
22.2
12.5
27.4
42.1
39.1
44.4

28.8
25.2
36.8
41.6
36.5
43.5
32.4
32.9
41.3
35.3
35.1
45.7

26.5
24.0
38.0
41.6
39.3
44.7
33.4
25.2
41.3
36.1
34.3
45.3

23.2
27.8
38.0
41.3
39.2
45.2
31.6
31.7
37.7
36.1
34.1
44.0

29.6
24.4
40.0
35.4
33.1
44.1
33.8
31.4
47.6
40.7
37.9
43.1

29.8
20.3
40.8
40.8
35.6
43.9
33.9
33.0
41.4
38.5
36.4
41.6

28.0
22.8
40.2
42.8
37.1
45.2
34.1
45.3
31.4
39.6
36.4
46.0

135

A6. (cont’d)
Post-Treatment
Right End Range Values (degrees)

Left End Range Values (degrees)

Subject

Test

Group

1

2

3

4

5

6

1

2

3

4

5

6

126
126
126
127
127
127
128
128
128
129
129
129
131
131
131

Ex. 2
Ex. 3
Active
Ex. 2
Ex. 3
Active
Ex. 2
Ex. 3
Active
Ex. 2
Ex. 3
Active
Ex. 2
Ex. 3
Active

Long.
Long.
Long.
Long.
Long.
Long.
Long.
Long.
Long.
Long.
Long.
Long.
Long.
Long.
Long.

32.1
32.5
31.1
33.1
30.2
39.5
42.9
36.4
41.2
25.2
17.6
26.9
42.8
41.1
49.0

29.6
32.6
36.1
33.5
24.3
41.4
41.4
35.3
43.5
21.4
14.9
29.0
37.7
39.6
52.6

28.4
31.4
36.4
34.6
28.4
41.3
42.7
35.3
44.5
21.8
17.3
28.6
38.5
42.7
51.8

35.9
30.5
33.4
34.2
26.8
34.7
42.6
40.1
44.1
23.0
20.6
33.6
38.6
43.3
49.7

36.2
27.9
41.0
31.9
28.3
36.3
43.5
35.9
39.1
25.5
19.9
30.6
39.8
40.4
50.3

35.5
28.2
36.2
30.0
27.9
38.3
39.6
38.1
42.8
27.9
20.3
28.2
41.2
37.7
47.4

36.6
31.6
38.5
32.6
26.9
39.1
38.7
37.8
40.7
35.7
28.5
45.4
38.2
37.6
47.2

33.2
36.1
38.9
31.9
27.4
41.7
41.1
37.6
41.5
30.1
26.8
40.8
35.8
39.8
45.0

35.9
35.7
39.3
33.5
26.5
40.0
39.0
38.7
41.7
28.0
31.7
46.3
37.2
39.9
45.8

30.9
35.3
39.4
31.4
32.7
41.9
37.7
32.6
39.9
33.3
33.5
40.9
38.0
39.6
45.9

31.8
35.2
41.1
33.8
31.0
41.8
38.4
35.3
40.5
40.7
28.9
38.8
38.3
41.1
48.2

32.1
37.2
40.8
32.2
29.5
44.6
37.0
34.8
42.5
39.8
30.6
40.6
37.9
39.6
46.3

136

A6. (cont’d)
72-Hours Post-Treatment
Right End Range Values (degrees)

Left End Range Values (degrees)

Subject

Test

Group

1

2

3

4

5

6

1

2

3

4

5

6

126
126
126
127
127
127
128
128
128
129
129
129
131
131
131

Ex. 2
Ex. 3
Active
Ex. 2
Ex. 3
Active
Ex. 2
Ex. 3
Active
Ex. 2
Ex. 3
Active
Ex. 2
Ex. 3
Active

Long.
Long.
Long.
Long.
Long.
Long.
Long.
Long.
Long.
Long.
Long.
Long.
Long.
Long.
Long.

27.8
29.6
34.1
40.2
39.0
44.4
23.2
20.3
27.0
39.8
37.4
45.1
39.8
37.4
45.1

29.7
29.1
37.3
39.4
39.0
47.6
19.0
20.3
29.7
38.9
37.4
48.5
38.9
37.4
48.5

30.9
30.4
36.2
39.7
38.1
48.7
18.8
16.7
29.9
39.8
37.1
49.7
39.8
37.1
49.7

28.2
26.7
37.8
41.9
40.9
44.3
22.4
19.1
32.4
38.7
36.3
47.1
38.7
36.3
47.1

28.6
28.0
38.3
39.1
43.2
44.2
18.8
23.9
30.9
36.2
40.3
48.5
36.2
40.3
48.5

28.6
27.3
38.5
36.1
43.1
46.8
22.9
22.6
29.0
40.9
41.8
49.1
40.9
41.8
49.1

30.6
27.8
35.1
44.2
36.9
45.3
28.9
29.8
36.3
41.6
38.4
43.5
41.6
38.4
43.5

31.9
27.6
36.8
44.6
37.0
47.7
30.2
25.4
34.7
43.1
38.8
46.1
43.1
38.8
46.1

32.2
29.4
36.8
39.8
36.3
48.6
28.0
23.1
31.7
42.6
39.4
47.0
42.6
39.4
47.0

31.8
27.7
35.2
35.6
35.1
43.7
31.1
24.8
40.7
41.0
36.0
44.8
41.0
36.0
44.8

31.2
25.4
37.5
35.2
33.6
45.4
27.0
26.0
32.5
42.0
37.2
46.5
42.0
37.2
46.5

33.1
28.2
38.2
36.1
35.1
46.0
26.7
27.2
30.4
42.4
39.1
47.7
42.4
39.1
47.7

137

A6. (cont’d)

ROM (End Range Left + End Range Right)
(degrees)
Subject

Test

Group

1

2

3

4

5

6

4
4
4
5
5
5
27
27
27
41
41
41
46
46
46

Ex. 2
Ex. 3
Active
Ex. 2
Ex. 3
Active
Ex. 2
Ex. 3
Active
Ex. 2
Ex. 3
Active
Ex. 2
Ex. 3
Active

Cont.
Cont.
Cont.
Cont.
Cont.
Cont.
Cont.
Cont.
Cont.
Cont.
Cont.
Cont.
Cont.
Cont.
Cont.

58.0
47.0
90.4
89.0
74.6
108.1
73.4
80.0
93.8
85.4
64.9
100.6
87.5
76.8
99.7

65.4
52.0
90.5
87.2
69.2
109.5
76.4
80.6
97.1
81.4
63.7
89.6
80.3
79.8
104.4

57.7
52.6
93.2
88.7
76.8
110.9
79.3
80.5
97.7
83.4
60.3
93.0
76.5
77.0
100.9

53.9
47.4
82.8
90.2
80.0
109.6
79.0
71.0
101.4
82.2
68.4
90.6
88.5
85.5
96.6

57.5
52.4
89.4
94.8
84.4
115.7
84.4
71.8
101.6
77.3
61.4
91.3
82.6
79.1
99.3

58.4
57.4
91.9
90.6
82.3
116.3
84.5
76.1
104.6
76.5
60.7
90.3
76.3
82.2
101.4

138

A6. (cont’d)
ROM (End Range Left + End Range Right)
(degrees)
Subject

Test

Group

1

2

3

4

5

51
51
51
56
56
56
59
59
59
63
63
63
67
67
67
68
68
68
69
69
69
77
77
77
79
79
79

Ex. 2
Ex. 3
Active
Ex. 2
Ex. 3
Active
Ex. 2
Ex. 3
Active
Ex. 2
Ex. 3
Active
Ex. 2
Ex. 3
Active
Ex. 2
Ex. 3
Active
Ex. 2
Ex. 3
Active
Ex. 2
Ex. 3
Active
Ex. 2
Ex. 3
Active

Cont.
Cont.
Cont.
Cont.
Cont.
Cont.
Cont.
Cont.
Cont.
Cont.
Cont.
Cont.
Cont.
Cont.
Cont.
Cont.
Cont.
Cont.
Cont.
Cont.
Cont.
Cont.
Cont.
Cont.
Cont.
Cont.
Cont.

75.8
71.0
86.6
80.0
84.7
107.3
68.2
71.8
88.8
56.0
38.0
61.4
83.7
74.3
97.3
50.8
44.5
68.6
89.0
64.6
106.2
65.1
72.8
78.6
72.0
73.7
85.4

69.2
82.7
83.1
78.6
100.1
66.8
67.1
85.6
56.4
35.7
61.8
87.2
77.8
95.7
51.4
48.4
74.0
80.7
67.0
102.6
65.9
67.1
76.8
65.5
76.7
86.3

70.0
83.3
84.2
82.7
103.7
70.2
65.6
81.0
63.3
37.6
66.1
87.8
71.6
97.0
48.9
53.0
71.0
80.5
61.7
100.1
64.9
67.4
74.5
66.7
75.4
86.5

70.1
69.8
73.9
87.3
87.1
104.3
70.7
61.6
76.3
51.7
37.9
56.1
79.5
70.4
91.8
59.0
53.0
67.5
91.0
69.5
97.8
66.9
58.7
78.2
67.5
67.3
82.4

66.2
69.5
81.4
85.9
86.5
98.1
69.5
68.3
81.1
51.7
39.4
68.5
78.6
72.3
90.5
59.7
54.3
76.3
79.9
56.5
93.5
73.5
63.4
84.4
75.1
70.1
88.1

139

6
69.6
77.1
90.7
86.7
106.4
63.8
86.2
58.4
38.0
64.6
78.2
67.0
95.0
64.7
57.2
77.3
92.6
62.4
97.1
70.0
64.1
84.3
74.8
75.3
87.0

A6. (cont’d)
ROM (End Range Left + End Range Right)
(degrees)
Subject

Test

Group

1

2

3

4

5

6

83
83
83
85
85
85
88
88
88
90
90
90
96
96
96
106
106
106
111
111
111
117
117
117

Ex. 2
Ex. 3
Active
Ex. 2
Ex. 3
Active
Ex. 2
Ex. 3
Active
Ex. 2
Ex. 3
Active
Ex. 2
Ex. 3
Active
Ex. 2
Ex. 3
Active
Ex. 2
Ex. 3
Active
Ex. 2
Ex. 3
Active

Cont.
Cont.
Cont.
Cont.
Cont.
Cont.
Cont.
Cont.
Cont.
Cont.
Cont.
Cont.
Cont.
Cont.
Cont.
Cont.
Cont.
Cont.
Cont.
Cont.
Cont.
Cont.
Cont.
Cont.

70.2
61.0
89.2
67.9
66.8
69.1
58.8
50.2
55.9
73.6
78.6
89.5
76.6
68.0
85.4
62.9
57.4
96.2
77.9
87.7
95.9
59.9
53.8
84.9

74.0
63.1
86.7
72.4
65.1
65.9
56.9
54.9
62.6
69.1
67.6
96.8
69.2
53.6
84.9
67.0
56.1
89.6
78.2
76.0
92.9
51.6
56.7
86.0

76.2
66.4
85.1
76.3
63.6
69.9
56.1
57.0
68.4
63.5
69.9
95.8
61.7
65.8
85.7
71.1
61.8
93.0
83.0
80.3
95.2
39.6
61.2
82.9

74.2
65.3
83.9
66.9
66.2
69.3
60.5
51.8
68.1
70.6
74.0
88.3
77.6
64.5
84.7
67.9
62.2
87.0
72.1
78.6
95.0
54.7
61.9
85.9

73.7
62.3
84.4
65.2
69.6
68.7
53.9
55.6
71.3
71.0
73.1
82.5
71.1
62.8
85.3
64.2
58.6
89.2

74.2
66.4
85.6
69.3
64.7
73.4
57.4
56.7
74.6
71.6
69.9
87.5
64.1
62.9
86.9
66.2
59.7
88.8
77.2
85.8
93.8
54.3
62.4
80.5

140

82.1
93.0
51.5
62.0
80.3

A6. (cont’d)

Subject

Test

Group

6
6
6
9
9
9
12
12
12
14
14
14
23
23
23
25
25
25
54
54
54
55
55
55
57
57
57

Ex. 2
Ex. 3
Active
Ex. 2
Ex. 3
Active
Ex. 2
Ex. 3
Active
Ex. 2
Ex. 3
Active
Ex. 2
Ex. 3
Active
Ex. 2
Ex. 3
Active
Ex. 2
Ex. 3
Active
Ex. 2
Ex. 3
Active
Ex. 2
Ex. 3
Active

Exp.
Exp.
Exp.
Exp.
Exp.
Exp.
Exp.
Exp.
Exp.
Exp.
Exp.
Exp.
Exp.
Exp.
Exp.
Exp.
Exp.
Exp.
Exp.
Exp.
Exp.
Exp.
Exp.
Exp.
Exp.
Exp.
Exp.

Pre-Treatment
ROM (End Range Left + End Range Right)
(degrees)
1
2
3
4
5
6

Post-Treatment
ROM (End Range Left + End Range Right)
(degrees)
1
2
3
4
5
6

67.0
44.3
66.6
62.5
45.9
67.8
70.5
35.8
76.1
86.6
83.8
87.5
92.7
77.8
96.4
59.2
51.5
64.0
59.0
68.9
83.8
46.5
49.5
56.7
77.7
69.7
85.8

69.7
50.0
78.2
69.5
50.5
77.8
65.5
35.9
70.2
75.7
56.0
94.2
90.2
70.1
93.3
60.3
52.0
77.7
81.9
61.5
87.9
49.6
49.7
58.1
82.8
73.5
84.1

74.0
55.3

59.6
44.8

59.6
46.2
63.0
62.7
41.5
75.8
85.0
63.9
85.9
91.5
70.2
90.3
63.6
49.0
66.3
71.0
63.3
93.5
46.2
63.0
63.7
85.7
64.6
84.3

63.4
45.7
67.6
59.0
35.8
72.0
85.3
68.6
90.0
91.1
72.7
98.7
58.7
49.3
69.7
74.4
63.6
93.1
43.9
88.4
73.0
89.3

63.0
45.4
75.4
53.4
45.3
57.8
59.8
34.4
69.1
82.8
77.4
95.4
88.6
78.3
92.6
60.5
53.3
65.2
64.8
54.9
80.5
47.8
46.2
56.9
87.7
70.0
79.9

54.7
44.5
75.9
56.9
38.3
58.7
54.8
36.9
62.4
81.2
69.5
87.2
91.2
72.8
88.7
58.2
53.2
71.1
71.0
58.2
83.2
46.8
45.1
57.8
86.5
68.0
82.6

141

53.1
50.5
81.0
53.8
47.3
58.4
56.6
36.7
59.9
81.6
65.8
97.2
93.7
71.6
93.8
52.5
51.0
70.6
65.3
59.8
88.8
43.1
40.4
60.6
83.8
73.3
90.2

60.5
48.3
77.2
65.0
49.2
77.2
59.4
36.6
65.7
70.3
64.6
85.6
90.1
72.0
87.2
60.7
51.6
75.9
74.9
68.6
91.4
49.7
53.4
62.7
88.1
70.5
91.1

67.1
50.7
79.5
65.0
55.2
79.4
60.9
35.9
64.5
62.3
65.7
68.6
84.6
71.6
85.9
62.0
55.7
79.0
69.1
70.4
97.4
49.0
59.8
64.9
88.0
71.6
93.1

61.4
51.9
70.0
70.4
50.6
73.4
63.9
33.8
73.5
82.3
78.5
87.5
85.5
74.7
83.5
62.0
54.7
70.7
73.7
63.3
88.7
52.6
53.5
65.0
86.0
69.6
90.9

60.3
49.0
75.3
76.1
49.6
79.7
51.2
34.8
71.3
81.6
78.3
80.9
87.0
76.2
84.5
63.5
56.7
75.2
70.9
62.6
89.4
51.0
55.4
67.5
88.0
70.7
87.8

62.2
52.3
77.7
72.2
45.5
84.4
58.4
35.0
71.4
79.9
83.2
81.5
83.8
65.6
87.9
66.9
58.1
73.8
72.0
66.6
97.2
52.3
43.8
69.0
89.5
77.3
93.9

A6. (cont’d)

Subject

Test

Group

70
70
70
72
72
72
80
80
80
84
84
84
91
91
91
95
95
95
98
98
98
112
112
112

Ex. 2
Ex. 3
Active
Ex. 2
Ex. 3
Active
Ex. 2
Ex. 3
Active
Ex. 2
Ex. 3
Active
Ex. 2
Ex. 3
Active
Ex. 2
Ex. 3
Active
Ex. 2
Ex. 3
Active
Ex. 2
Ex. 3
Active

Exp.
Exp.
Exp.
Exp.
Exp.
Exp.
Exp.
Exp.
Exp.
Exp.
Exp.
Exp.
Exp.
Exp.
Exp.
Exp.
Exp.
Exp.
Exp.
Exp.
Exp.
Exp.
Exp.
Exp.

Pre-Treatment
ROM (End Range Left + End Range Right)
(degrees)
1
2
3
4
5
6
73.6
55.0
78.4
60.9
50.8
80.3
74.9
65.3
84.7
49.7
51.4
66.2
76.8
74.1
87.6
67.8
66.6
70.0
67.9
70.9
114.8
71.7
60.2
69.0

69.9
53.3
76.6
61.2
60.4
84.7
70.6
65.4
85.9
44.4
51.0
67.1
79.7
77.0
91.3
69.5
65.2
74.2
62.1
68.0
106.7
68.9
59.9
70.5

73.8
57.8
78.9
63.5
58.7
89.7
69.1
69.1
83.8
49.6
48.8
66.4
81.4
75.7
96.3
65.1
63.1
75.6
69.0
65.1
97.4
74.1
59.4
73.9

67.8
53.0
75.2
60.8
63.5
86.2
65.2
70.8
77.3
53.2
53.6
60.7
75.8
80.6
85.4
66.1
62.7
71.2
65.9
60.8
93.0
69.3
62.4
62.0

67.7
58.3
76.2
63.8
53.0
86.1
68.1
73.1
90.0
51.8
53.8
56.6
74.7
78.8
90.7
66.8
65.5
74.3
60.2
57.0
93.8
66.3
63.8
75.0

142

61.7
55.6
79.4
68.3
54.3
86.5
67.7
68.9
82.2
53.6
51.6
56.4
73.5
80.3
91.8
65.0
67.6
73.4
61.9
57.1
95.4
67.9
61.7
78.9

Post-Treatment
ROM (End Range Left + End Range Right)
(degrees)
1
2
3
4
5
6
67.0
62.3
83.9
65.3
50.7
84.4
73.0
70.8
89.8
57.2
53.7
64.5
83.4
80.7
94.0
66.5

67.0
68.3
78.9
62.8
62.2
83.7
76.7
71.0
86.7
55.1
56.7
65.6
84.5
84.3
103.7
63.4

73.8
65.5
91.5
57.5
61.7
89.4
71.2
70.9
87.2
51.8
56.8
62.8
84.2
87.7
105.0
62.3

75.5
66.5
69.6
79.8
74.6
63.6
79.0

77.9
59.2
54.3
79.8
74.1
66.0
77.9

76.6
56.4
57.6
79.1
74.2
66.9
79.4

63.9
61.6
94.3
57.1
62.1
84.4
66.6
75.7
82.0
53.2
52.6
69.7
83.2
82.2
92.7
65.6
67.5
76.0
50.9
61.1
78.5
74.9
66.0
79.3

63.7
69.2
88.6
52.1
58.3
89.0
69.8
71.0
82.4
53.9
50.2
71.6
84.6
92.2
93.8
62.3
72.3
76.7
58.2
58.9
74.6
74.4
64.4
84.6

68.5
71.7
92.3
52.2
60.6
89.8
72.4
71.8
84.5
49.9
49.9
74.8
84.4
87.2
94.4
62.1
66.8
82.1
60.1
60.1
77.4
76.8
68.0
84.1

A6. (cont’d)

Test

Group

115
115
115
125
125
125

Ex. 2
Ex. 3
Active
Ex. 2
Ex. 3
Active

Exp.
Exp.
Exp.
Exp.
Exp.
Exp.

Post-Treatment
ROM (End Range Left + End Range Right)
(degrees)
1
2
3
4
5
6

56.8
48.1
64.0
52.2
47.2
56.6

Subject

Pre-Treatment
ROM (End Range Left + End Range Right)
(degrees)
1
2
3
4
5
6

56.5
50.8
57.6
53.5
50.2
61.2

53.3
48.3
63.4
51.9
45.9
58.6

50.5
61.3
52.4
46.6
56.2

61.4
55.5

57.8
49.4

65.1
51.3

54.5
47.1
51.7

49.9
47.9
54.9

51.8
44.2
52.2

56.1
47.1
70.7
51.7
49.8
65.9

53.3
50.1
81.1
50.7
50.0
61.6

Pre-Treatment
ROM (End Range Left + End Range Right)
(degrees)
3
4

Subject

Test

Group

1

2

5

6

126
126
126
127
127
127
128
128
128
129
129
129

Ex. 2
Ex. 3
Active
Ex. 2
Ex. 3
Active
Ex. 2
Ex. 3
Active
Ex. 2
Ex. 3
Active

Long.
Long.
Long.
Long.
Long.
Long.
Long.
Long.
Long.
Long.
Long.
Long.

74.4
63.4

67.0
61.7

65.4
66.3

67.4
62.4

70.1
64.9

67.8
60.7

60.4
48.9
74.0
78.3
73.3
83.3
51.2
55.0
71.2

56.0
48.2
78.8
78.5
79.2
87.0
51.4
45.0
72.9

53.5
53.7
77.7
78.1
75.8
85.9
49.8
51.8
68.4

60.1
51.8
76.3
74.8
70.9
84.0
51.4
49.0
79.0

60.0
48.5
79.5
79.3
74.7
85.0
54.9
50.3
72.3

58.4
50.2
80.1
81.3
77.4
85.2
56.3
57.8
58.7

143

56.0
50.3
62.7
54.6
65.2
57.3

59.9
53.2
36.1
53.1
68.1
60.8

55.3
51.8
44.9
48.7
67.7
61.9

A6. (cont’d)
Pre-Treatment
ROM (End Range Left + End Range Right)
Subject

Test

Group

1

2

131
131
131

Ex. 2
Ex. 3
Active

Long.
Long.
Long.

77.3
77.7
94.4

76.6
80.9
94.5

(degrees)
3
4
79.4
74.8
91.1

81.7
77.5
89.7

5

6

82.1
76.2
87.6

81.8
75.5
90.5

Post-Treatment
ROM (End Range Left + End Range Right)
Subject

Test

Group

1

2

126
126
126
127
127
127
128
128
128
129
129
129
131
131
131

Ex. 2
Ex. 3
Active
Ex. 2
Ex. 3
Active
Ex. 2
Ex. 3
Active
Ex. 2
Ex. 3
Active
Ex. 2
Ex. 3
Active

Long.
Long.
Long.
Long.
Long.
Long.
Long.
Long.
Long.
Long.
Long.
Long.
Long.
Long.
Long.

68.7
64.0
69.6
65.7
57.1
78.6
81.6
74.1
81.9
61.0
46.1
72.4
81.0
78.7
96.2

62.9
68.7
75.0
65.5
51.7
83.1
82.4
73.0
85.0
51.4
41.7
69.7
73.4
79.3
97.7

144

(degrees)
3
4
64.3
67.1
75.8
68.1
54.9
81.3
81.6
74.0
86.2
49.8
49.0
74.9
75.7
82.6
97.5

66.8
65.8
72.8
65.6
59.5
76.6
80.2
72.6
84.0
56.3
54.0
74.5
76.7
82.9
95.6

5

6

68.0
63.1
82.1
65.7
59.4
78.0
81.8
71.2
79.6
66.2
48.7
69.5
78.0
81.5
98.5

67.6
65.5
77.0
62.2
57.4
82.9
76.6
73.0
85.3
67.7
50.9
68.8
79.1
77.2
93.7

A6. (cont’d)
72-Hours Post-Treatment
ROM (End Range Left + End Range Right)
Subject

Test

Group

1

2

126
126
126
127
127
127
128
128
128
129
129
129
131
131
131

Ex. 2
Ex. 3
Active
Ex. 2
Ex. 3
Active
Ex. 2
Ex. 3
Active
Ex. 2
Ex. 3
Active
Ex. 2
Ex. 3
Active

Long.
Long.
Long.
Long.
Long.
Long.
Long.
Long.
Long.
Long.
Long.
Long.
Long.
Long.
Long.

72.6
67.0
77.3
58.4
57.3
69.1
84.3
75.9
89.6
52.1
50.2
63.3
81.4
75.8
88.6

66.9
70.4
83.2
61.6
56.7
74.1
84.0
76.0
95.3
49.2
45.7
64.4
82.0
76.3
94.6

145

(degrees)
3
4
70.0
70.5
84.7
63.0
59.8
72.9
79.5
74.3
97.3
46.9
39.8
61.6
82.4
76.5
96.7

72.4
69.8
78.0
60.0
54.4
73.1
77.5
76.0
88.0
53.5
43.9
73.0
79.7
72.4
92.0

5

6

71.7
62.7
80.6
59.8
53.4
75.8
74.3
76.9
89.6
45.8
50.0
63.4
78.2
77.5
95.0

68.9
68.4
83.0
61.7
55.5
76.8
72.2
78.2
92.8
49.6
49.8
59.4
83.2
80.8
96.8

A7. Ranges of Axial Rotation (Secondary Motions)

Right End Range Values (degrees)
(“+” ipsilateral & “-” contralateral)

Left End Range Values (degrees)
(“+” ipsilateral & “-” contralateral)

Subject

Test

Group

1

2

3

4

5

6

1

2

3

4

5

6

4
4
4
5
5
5
27
27
27
41
41
41
46
46
46
51
51
51
56
56
56
59
59
59
63
63
63

Ex. 2
Ex. 3
Active
Ex. 2
Ex. 3
Active
Ex. 2
Ex. 3
Active
Ex. 2
Ex. 3
Active
Ex. 2
Ex. 3
Active
Ex. 2
Ex. 3
Active
Ex. 2
Ex. 3
Active
Ex. 2
Ex. 3
Active
Ex. 2
Ex. 3
Active

Cont.
Cont.
Cont.
Cont.
Cont.
Cont.
Cont.
Cont.
Cont.
Cont.
Cont.
Cont.
Cont.
Cont.
Cont.
Cont.
Cont.
Cont.
Cont.
Cont.
Cont.
Cont.
Cont.
Cont.
Cont.
Cont.
Cont.

5.8
7.5
16.7
5.8
4.6
16.7
-1.6
-4.6
4.6
0.4
5.6
8.9
9.4
3.8
13.9
4.6
4.5
1.9
9.7
8.1
10.3
10.0
1.3
2.9
11.5
9.3
17.1

11.9
11.0
6.9
11.9
12.5
6.9
-1.9
-5.7
3.0
0.5
8.1
15.4
3.4
4.4
14.4
4.6
5.8
1.3
7.7
8.3
9.3
9.9
5.7
6.5
19.9
6.8
17.2

8.2
13.5
10.8
8.2
13.4
10.8
1.1
-3.7
3.8
4.7
6.0
15.7
1.9
5.9
16.4
7.6
6.0
1.0
12.1
11.9
9.3
8.8
8.8
4.7
18.3
8.3
18.8

5.7
9.9
14.4
7.0
6.0
6.4
0.5
2.2
4.1
3.2
4.8
9.9
8.5
6.8
15.5
3.3
3.1
-3.9
12.0
9.5
13.3
9.7
6.3
5.4
11.1
10.5
14.0

12.4
13.2
11.2
14.2
10.1
3.1
-1.5
0.6
2.1
10.0
2.0
19.9
11.7
5.4
14.6
10.2
-1.6
2.8
9.0
10.1
15.8
8.1
11.5
3.7
16.0
9.8
14.8

11.0
10.4
11.6
11.7
13.3
-0.2
0.2
-5.2
2.9
7.3
4.6
13.5
6.4
8.4
15.2
9.0
5.1
4.4
9.2
7.7
16.2
12.6
10.0
6.3
19.1
11.1
14.8

10.9
1.7
11.2
10.9
4.6
11.2
5.9
3.2
5.4
4.1
-0.9
2.6
12.6
8.5
15.7
14.0
3.5
9.4
9.0
7.0
3.0
6.0
5.3
0.8
18.5
14.3
21.0

8.1
0.5
0.7
8.1
2.3
0.7
8.2
2.5
0.1
9.9
-1.2
-0.2
8.7
9.7
14.5

6.9
1.7
5.9
6.9
2.6
5.9
7.9
5.2
-1.9
11.5
-0.7
4.0
4.8
6.4
15.6
2.5
8.2
13.8
6.2
9.7
4.7
6.0
2.9
10.4
10.6
22.3

8.4
0.8
8.5
3.8
1.4
-0.4
3.2
5.3
2.4
1.2
4.2
12.6
7.2
6.9
13.4
18.3
0.8
14.7
11.6
6.8
10.3
8.0
2.2
0.7
17.1
12.3
27.0

11.5
2.0
15.3
4.1
2.0
3.2
3.1
4.6
-0.2
-10.7
3.6
18.3
2.8
6.3
17.7

4.2
9.3
15.7
10.2
7.6
5.5
-1.2
0.3
7.8
10.5
19.3

4.1
0.5
8.7
6.7
2.7
1.2
9.8
4.9
7.3
1.8
-0.1
4.6
10.3
8.6
16.8
12.1
3.3
10.8
9.7
8.5
11.5
14.8
8.2
2.1
20.1
15.1
25.6

146

2.2
6.3
14.2
7.4
9.6
-1.0
2.5
15.2
13.5
25.0

A7. (cont’d)
Right End Range Values (degrees)
(“+” ipsilateral & “-” contralateral)

Left End Range Values (degrees)
(“+” ipsilateral & “-” contralateral)

Subject

Test

Group

1

2

3

4

5

6

1

2

3

4

5

6

67
67
67
68
68
68
69
69
69
77
77
77
79
79
79
83
83
83
85
85
85
88
88
88
90
90
90

Ex. 2
Ex. 3
Active
Ex. 2
Ex. 3
Active
Ex. 2
Ex. 3
Active
Ex. 2
Ex. 3
Active
Ex. 2
Ex. 3
Active
Ex. 2
Ex. 3
Active
Ex. 2
Ex. 3
Active
Ex. 2
Ex. 3
Active
Ex. 2
Ex. 3
Active

Cont.
Cont.
Cont.
Cont.
Cont.
Cont.
Cont.
Cont.
Cont.
Cont.
Cont.
Cont.
Cont.
Cont.
Cont.
Cont.
Cont.
Cont.
Cont.
Cont.
Cont.
Cont.
Cont.
Cont.
Cont.
Cont.
Cont.

8.6
7.1
13.2
7.4
5.5
4.7
18.0
11.2
10.6
6.6
6.6
6.2
7.6
9.2
13.2
4.9
6.3
16.1
9.1
8.2
2.8
10.1
8.9
18.3
17.3
14.2
14.6

11.1
8.2
13.5
8.0
12.2
10.2
14.0
12.4
13.3
11.7
6.2
0.2
10.3
6.4
9.1
6.2
9.4
10.1
8.8
8.5
6.8
8.6
17.8
20.2
21.5
12.3
10.5

9.1
8.0
17.7
3.6
14.2
6.4
13.8
12.6
7.1
6.5
8.8
2.1
5.8
8.6
10.3
9.7
8.5
10.0
6.7
9.3
5.6
3.3
13.4
19.9
19.4
11.8
11.4

6.3
4.1
18.2
6.0
8.8
10.1
19.9
15.0
18.0
7.5
4.6
5.1
10.1
6.5
14.6
6.7
2.7
19.9
7.4
7.2
2.2
12.8
12.2
16.0
14.0
14.9
9.6

6.3
5.9
16.2
8.3
9.6
13.1
13.1
13.7
10.7
5.4
3.6
3.1
11.5
6.7
13.7
7.2
5.6
11.3
10.4
8.3
6.9
8.6
17.4
18.3
15.3
15.5
11.8

10.8
2.5
18.5
11.1
14.0
17.8
13.8
16.8
11.0
9.7
-0.2
7.1
7.0
6.8
14.8
2.5
3.6
12.9
11.0
8.6
6.3
8.9
15.6
19.3
16.2
8.7
12.5

7.0
9.1
12.5
11.7
1.1
9.1
17.3
11.3
7.6
7.8
8.3
12.8
16.6
10.7
13.8
4.5
-1.5
1.9
8.3
5.1
6.1
12.5
14.4
19.1
23.3
15.3
19.0

7.4
8.1
12.9
17.2
-3.0
15.3
10.2
11.1
19.6
5.4
11.1
3.5
14.6
11.4
15.8
2.7
0.0
-0.6
10.4
8.8
8.8
6.7
10.8
18.1
19.4
12.9
17.2

7.5
7.4
13.8
17.7
-3.2
16.1
10.6
10.7
16.5
10.9
8.9
0.9
13.9
10.1
15.0
-2.8
-1.9
1.4
8.4
1.2
8.0
13.3
15.8
16.4
18.1
16.8
10.5

15.2
6.5
15.9
6.4
4.0
6.6
20.3
3.0
8.4
10.6
7.1
4.9
16.7
10.9
17.4
2.4
0.0
-0.1
10.1
3.9
0.9
13.3
10.0
15.2
15.4
14.9
17.9

10.0
7.8
17.1
3.8
3.6
6.8
11.0
4.5
13.0
11.4
6.1
5.3
11.5
7.9
17.8
3.4
2.7
-0.9
5.3
4.0
6.6
7.0
12.6
15.1
18.2
9.7
16.1

13.4
8.8
14.2
5.8
6.8
0.8
21.9
4.4
14.3
9.3
4.9
-0.9
11.9
9.6
15.0
1.8
-1.1
-0.1
9.0
7.2
3.1
9.5
12.6
11.3
20.2
9.4
15.8

147

A7. (cont’d)
Right End Range Values (degrees)
(“+” ipsilateral & “-” contralateral)

Left End Range Values (degrees)
(“+” ipsilateral & “-” contralateral)

Subject

Test

Group

1

2

3

4

5

6

1

2

3

4

5

6

96
96
96
106
106
106
111
111
111
117
117
117

Ex. 2
Ex. 3
Active
Ex. 2
Ex. 3
Active
Ex. 2
Ex. 3
Active
Ex. 2
Ex. 3
Active

Cont.
Cont.
Cont.
Cont.
Cont.
Cont.
Cont.
Cont.
Cont.
Cont.
Cont.
Cont.

9.4
11.7
11.7
10.4
13.5
16.5
8.6
7.1
22.7
12.1
10.8
12.5

8.9
7.5
7.5
12.6
21.4
9.9
7.5
9.1
22.4
8.0
10.0
10.7

8.9
10.4
10.4
12.6
18.1
18.3
12.8
9.2
25.5
7.4
10.0
9.3

11.6
9.5
9.5
9.2
15.1
27.8
2.2
17.3
20.1
5.8
11.1
12.2

17.5
8.4
8.4
9.9
16.7
24.6
14.3
8.0
23.1
5.6
10.2
11.4

12.1
6.8
6.8
11.7
14.4
20.2
4.2
10.2
28.1
7.8
8.0
13.8

12.0
11.0
11.0
17.2
15.0
14.6
17.4
7.0
13.7
13.1
4.1
10.7

13.8
13.3
13.3
16.4
5.8
13.6
16.5
9.5
10.7
5.5
1.3
10.4

10.2
9.9
9.9
14.2
13.7
12.8
12.3
9.0
10.3
11.5
8.8
8.4

10.1
7.5
7.5
16.5
20.4
12.0
18.4
13.3
20.2
10.1
8.4
18.4

10.4
7.9
7.9
14.2
17.9
11.0

13.5
11.7
11.7
16.9
22.7
9.7
7.9
19.9
19.3
20.3
4.8
17.3

11.5
17.4
13.5
2.7
13.2

Pre-Treatment
Right End Range Values (degrees)
(“+” ipsilateral & “-” contralateral)

Left End Range Values (degrees)
(“+” ipsilateral & “-” contralateral)

Subject

Test

Group

1

2

3

4

5

6

1

2

3

4

5

6

6
6
6
9
9
9
12
12
12

Ex. 2
Ex. 3
Active
Ex. 2
Ex. 3
Active
Ex. 2
Ex. 3
Active

Exp.
Exp.
Exp.
Exp.
Exp.
Exp.
Exp.
Exp.
Exp.

11.6
18.5
19.4
3.4
7.0
15.8
16.4
11.0
22.0

14.1
16.0

9.8
13.5

2.1
6.5
18.4
13.5
20.5
22.4

6.4
4.1
17.6
14.9
15.0
21.7

13.2
7.6
21.1
11.5
9.0
3.4
13.0
7.0
20.5

11.1
8.6
16.7
14.0
6.0
6.0
12.1
16.6
23.8

6.6
9.7
13.4
9.5
4.3
-1.6
12.2
14.9
19.7

9.1
1.8
15.4
10.1
11.2
10.6
15.0
3.7
9.2

9.6
5.0
0.0
13.3
10.8
11.7
10.6
5.0
13.0

11.2
-0.1
0.0
11.0
9.2
10.6
13.4
5.5
12.4

1.9
6.8
22.9
7.7
10.9
9.6
15.2
5.6
11.1

5.7
3.8
21.1
5.7
8.4
10.4
18.6
5.0
11.3

7.1
7.1
28.1
9.4
11.6
11.3
18.8
7.1
14.9

148

A7. (cont’d)
Pre-Treatment
Right End Range Values (degrees)
(“+” ipsilateral & “-” contralateral)

Left End Range Values (degrees)
(“+” ipsilateral & “-” contralateral)

Subject

Test

Group

1

2

3

4

5

6

1

2

3

4

5

6

14
14
14
23
23
23
25
25
25
54
54
54
55
55
55
57
57
57
70
70
70
72
72
72
80
80
80

Ex. 2
Ex. 3
Active
Ex. 2
Ex. 3
Active
Ex. 2
Ex. 3
Active
Ex. 2
Ex. 3
Active
Ex. 2
Ex. 3
Active
Ex. 2
Ex. 3
Active
Ex. 2
Ex. 3
Active
Ex. 2
Ex. 3
Active
Ex. 2
Ex. 3
Active

Exp.
Exp.
Exp.
Exp.
Exp.
Exp.
Exp.
Exp.
Exp.
Exp.
Exp.
Exp.
Exp.
Exp.
Exp.
Exp.
Exp.
Exp.
Exp.
Exp.
Exp.
Exp.
Exp.
Exp.
Exp.
Exp.
Exp.

12.6
16.4
18.4
6.1
13.5
9.5
1.5
0.3
6.1
3.0
6.2
7.5
6.7
5.9
5.6
9.4
9.9
2.8
15.0
8.0
17.7
8.3
11.9
0.1
9.7
7.7
15.1

13.1
14.2
28.9
7.6
15.2
7.8
7.2
5.3
10.3
8.0
3.5
6.1
12.1
5.5
3.9
9.6
4.8
4.8
15.0
10.7
19.5
9.2
11.7
-10.4
10.8
10.1
16.3

18.3
12.1
11.6
5.3
13.9
6.9
4.6
5.8
10.0
7.2
7.1
5.0

11.6
11.4
19.3
9.1
5.4
5.2
2.3
6.4
6.6
-0.2
-1.4
5.4
8.2
3.9
7.5
10.8
6.2
2.6
18.3
8.4
15.6
6.0
4.1
-9.8
10.7
7.9
13.7

10.8
5.6
-6.3
12.0
3.4
5.6
8.3
6.8
11.8
7.0
-4.3
3.8
10.4
7.1
7.1
7.5
5.0
9.6
18.1
12.6
16.3
14.2
6.2
-7.5
7.3
8.4
19.7

19.3
7.6
3.0
14.5
8.2
4.5
3.3
6.1
13.6
4.8
2.8
3.9
7.5
6.4
8.1
10.8
2.2
4.3
13.7
10.6
21.1
11.6
8.8
-7.2
13.3
9.9
15.2

7.4
6.1
-0.5
7.2
4.6
8.6
-2.8
2.3
10.6
-5.4
-10.4
-1.1
11.8
0.3
5.9
14.5
11.1
6.1
8.6
-0.9
11.0
6.8
0.5
4.9
16.2
7.5
18.5

7.0
10.0
3.0
9.4
7.7
12.7
-2.0
-0.1
9.7
-6.1
-13.3
2.9
22.8
6.6
8.8
19.6
7.9
6.2
-0.1
-4.6
5.2
9.5
5.1
-5.8
17.0
7.9
16.2

9.0
12.1
-9.7
10.8
6.1
46.2
-5.0
0.0
10.7
-5.5
-8.4
4.7

6.0
13.3
16.0
3.5
2.4
7.3
0.3
-0.5
9.3
7.8
-7.9
5.7
16.3
3.8
2.6
21.3
11.1
3.2
7.7
-3.2
17.3
9.1
0.7
-14.3
14.4
13.9
10.2

18.2
-1.5
-2.2
3.1
3.7
9.3
1.7
-2.2
6.6
-1.6
-4.6
7.8
15.8
6.1
3.3
19.9
9.1
8.5
6.4
-0.4
15.5
8.5
2.6
-10.0
17.6
12.3
8.7

9.2
6.6
3.3
-0.9
3.3
9.7
-0.7
0.0
5.2
-0.6
-12.3
6.9
16.5
2.8
3.1
19.0
10.1
3.1
5.5
-5.0
14.6
8.0
1.9
-17.0
17.7
13.1
7.2

4.3
1.7
10.2
4.8
7.9
13.4
11.1
19.0
8.8
9.3
-7.4
14.6
7.2
16.3

149

2.2
0.0
15.9
6.8
6.5
7.6
-1.8
7.7
3.1
1.6
-15.9
13.5
8.5
13.6

A7. (cont’d)
Pre-Treatment
Right End Range Values (degrees)
(“+” ipsilateral & “-” contralateral)

Left End Range Values (degrees)
(“+” ipsilateral & “-” contralateral)

Subject

Test

Group

1

2

3

4

5

6

1

2

3

4

5

6

84
84
84
91
91
91
95
95
95
98
98
98
112
112
112
115
115
115
125
125
125

Ex. 2
Ex. 3
Active
Ex. 2
Ex. 3
Active
Ex. 2
Ex. 3
Active
Ex. 2
Ex. 3
Active
Ex. 2
Ex. 3
Active
Ex. 2
Ex. 3
Active
Ex. 2
Ex. 3
Active

Exp.
Exp.
Exp.
Exp.
Exp.
Exp.
Exp.
Exp.
Exp.
Exp.
Exp.
Exp.
Exp.
Exp.
Exp.
Exp.
Exp.
Exp.
Exp.
Exp.
Exp.

7.4
10.2
18.7
8.6
10.4
9.5
11.3
11.1
12.5
11.2
18.8
30.1
22.5
14.5
14.6
16.9
16.8
20.2
13.2
11.9
22.1

7.7
11.3
19.4
8.4
10.3
11.3
14.2
12.0
12.1
13.9
20.5
28.0
18.5
13.0
16.6
10.4
17.0
22.4
17.1
15.2
25.7

6.4
12.4
21.1
8.7
8.5
11.7
15.2
10.8
15.9
13.4
17.0
27.3
16.7
14.3
16.5
17.9
17.2
28.4
13.8
14.4
27.0

11.0
11.0
23.3
10.2
15.4
10.5
9.4
11.7
11.6
17.5
18.0
36.0
19.3
14.5
13.7
20.1
13.6

15.2
10.6
25.1
7.2
11.7
9.0
13.2
10.8
15.1
16.8
17.1
30.5
10.8
12.2
15.7
22.8
14.3

20.2
9.5
23.4
9.0
11.9
10.7
17.8
11.3
15.3
15.8
16.5
25.2
16.3
11.7
12.0
27.1
13.8

9.8
22.8
25.9
0.0
4.1
4.2
9.0
0.2
8.0
22.5
13.5
25.3
15.7
16.3
17.1
29.7
26.8

8.8
12.5
25.8

13.0
11.2
24.3
3.0
0.0
-5.1
11.7
1.6
4.0
23.9
15.3
16.0
11.8
16.6
16.5
0.0
27.3
32.3
16.9
8.0
37.4

9.3
13.6
27.0
-6.0
1.1
8.3
9.0
2.7
5.0
20.5
18.6
23.7
16.1
12.9
12.0
26.9
26.4

11.6
14.8
28.8

5.2
13.2
25.5
3.2
4.2
-1.5
6.7
-0.5
2.9
22.1
23.5
29.8
10.3
7.1
11.9
35.5
22.8
30.1
18.5
7.9
32.9

17.4
18.5
21.7
5.0
6.1
1.7
6.4
3.2
-0.4
26.4
20.2
22.0
19.5
12.8
8.0
26.6
31.6

12.9
12.7
21.8

17.2
13.3
20.6
7.2
-1.1
-0.8
9.4
2.4
5.3
24.2
22.8
35.3
13.0
8.1
17.9
30.4
22.2
29.8
12.0
7.6
29.1

18.9
8.9
24.6

18.6
2.2
30.6

21.0
4.5
30.0

150

A7. (cont’d)
Post-Treatment
Right End Range Values (degrees)
(“+” ipsilateral & “-” contralateral)

Left End Range Values (degrees)
(“+” ipsilateral & “-” contralateral)

Subject

Test

Group

1

2

3

4

5

6

1

2

3

4

5

6

6
6
6
9
9
9
12
12
12
14
14
14
23
23
23
25
25
25
54
54
54
55
55
55
57
57
57

Ex. 2
Ex. 3
Active
Ex. 2
Ex. 3
Active
Ex. 2
Ex. 3
Active
Ex. 2
Ex. 3
Active
Ex. 2
Ex. 3
Active
Ex. 2
Ex. 3
Active
Ex. 2
Ex. 3
Active
Ex. 2
Ex. 3
Active
Ex. 2
Ex. 3
Active

Exp.
Exp.
Exp.
Exp.
Exp.
Exp.
Exp.
Exp.
Exp.
Exp.
Exp.
Exp.
Exp.
Exp.
Exp.
Exp.
Exp.
Exp.
Exp.
Exp.
Exp.
Exp.
Exp.
Exp.
Exp.
Exp.
Exp.

10.8
14.6
23.5
7.4
4.6
15.0
9.8
7.0
19.8
10.9
8.3
8.3
4.4
8.7
9.7
-0.4
5.3
1.9
8.0
-0.2
11.3
6.8
1.0
2.9
7.0
4.8
7.6

13.4
17.8
25.8
0.8
11.3
25.6
9.2
10.4
22.1
9.8
10.5
-0.4
3.2
8.3
9.5
0.9
10.2
7.4
9.6
7.4
5.7
9.1
4.9
2.4
11.5
2.6
14.3

16.1
14.5
30.9
2.4
9.0
16.5
13.2
10.1
24.2
6.9
9.6
-8.7
-2.4
4.2
10.6
6.1
10.2
6.4
3.0
5.0
8.3
8.1
4.9
3.4
9.3
-1.2
10.2

8.7
10.9
17.4
10.8
12.4
17.9
9.6
7.1
18.5
11.9
4.4
4.0
7.6
7.4
4.2
8.5
7.0
9.7
14.1
0.8
10.6
11.3
0.6
6.4
6.0
9.2
13.6

9.8
8.9
19.5
12.4
-8.2
19.5
9.7
11.6
23.4
16.3
5.5
-9.4
6.1
8.7
11.3
12.1
6.8
12.1
10.7
-2.3
14.0
12.9
3.6
3.3
6.3
7.4
14.3

12.4
9.3
18.8
10.8
-8.2
21.3
13.1
9.1
19.0
14.3
5.5
-10.3
4.2
7.1
8.9
13.6
6.4
12.9
8.1
-1.7
17.0
10.3
1.7
4.1
10.7
6.3
10.8

15.9
5.3
20.8
15.5
5.9
9.2
20.5
3.7
8.8
-7.2
1.2
-10.9
6.5
6.5
9.8
-0.7
-3.0
7.9
4.5
-10.9
3.1
16.9
3.7
9.9
12.4
8.3
12.2

14.0
3.2
26.8
17.4
3.6
9.6
15.5
1.5
12.8
4.4
-3.9
19.1
2.4
8.2
11.9
-0.7
-3.7
7.4
2.5
-12.9
2.9
14.6
4.8
8.4
16.0
5.8
1.9

12.7
7.1
24.1
21.9
6.3
8.8
11.8
6.5
12.2
-3.5
-1.4
13.5
-1.5
7.2
11.8
3.2
-7.0
7.0
6.4
-14.7
4.5
14.8
4.7
8.7
13.0
8.2
3.3

13.5
7.9
22.7
15.0
20.3
17.6
15.7
5.0
11.8
9.1
-0.5
10.6
-1.5
10.4
6.8
1.9
-3.7
6.2
1.7
-2.4
2.7
11.5
5.6
9.3
17.5
7.8
5.7

15.6
5.0
25.7
16.4
-11.7
15.9
9.4
6.2
11.5
16.6
-6.6
-5.8
-5.8
8.1
10.0
0.6
-3.1
3.0
16.6
-2.9
4.7
6.5
4.9
9.6
10.2
3.4
7.3

7.8
5.2
27.7
15.1
2.8
7.7
1.0
11.5
15.0
15.1
-0.6
18.6
-9.0
9.1
6.0
0.9
-5.5
0.6
9.0
3.8
12.2
8.0
1.7
9.6
18.7
1.8
3.2

151

A7. (cont’d)
Post-Treatment
Right End Range Values (degrees)
(“+” ipsilateral & “-” contralateral)

Left End Range Values (degrees)
(“+” ipsilateral & “-” contralateral)

Subject

Test

Group

1

2

3

4

5

6

1

2

3

4

5

6

70
70
70
72
72
72
80
80
80
84
84
84
91
91
91
95
95
95
98
98
98
112
112
112

Ex. 2
Ex. 3
Active
Ex. 2
Ex. 3
Active
Ex. 2
Ex. 3
Active
Ex. 2
Ex. 3
Active
Ex. 2
Ex. 3
Active
Ex. 2
Ex. 3
Active
Ex. 2
Ex. 3
Active
Ex. 2
Ex. 3
Active

Exp.
Exp.
Exp.
Exp.
Exp.
Exp.
Exp.
Exp.
Exp.
Exp.
Exp.
Exp.
Exp.
Exp.
Exp.
Exp.
Exp.
Exp.
Exp.
Exp.
Exp.
Exp.
Exp.
Exp.

13.9
7.2
14.7
8.5
-0.2
-0.6
10.4
5.4
15.4
13.4
7.4
17.0
10.7
11.9
8.6
13.2

13.4
14.6
15.6
8.8
0.4
-9.1
14.1
7.6
15.5
14.6
7.7
23.1
10.1
13.1
8.9
19.0

15.7
15.6
18.5
5.1
2.1
-10.2
13.5
5.7
12.2
11.6
10.8
20.2
10.3
10.1
9.6
14.5

19.1
2.1
16.1
4.0
-3.0
-9.6
17.0
13.3
9.9
11.3
18.8
21.0
11.5
-1.5
2.3
6.5

11.9
11.8
17.5
24.7
17.6
14.8
12.6

15.2
22.9
24.2
7.1
2.0
-16.1
15.5
6.5
11.0
13.5
5.6
24.7
10.5
13.1
17.8
18.3
11.2
15.8
22.1
18.1
32.7
17.9
14.4
9.4

21.6
1.7
17.5
7.8
-1.0
-3.9
21.6
12.9
12.4
11.4
13.4
29.8
6.2
-5.2
5.2
12.6

11.1
13.9
16.3
27.8
16.8
12.0
14.1

16.6
20.2
22.1
4.9
2.4
-19.1
14.1
8.6
12.1
14.2
9.5
25.3
11.5
14.3
13.0
17.2
13.4
9.6
20.1
19.2
29.3
15.7
10.7
9.6

11.2
4.9
15.1
2.1
0.2
-1.6
17.0
8.6
12.3
10.6
16.8
26.1
6.3
0.1
4.4
11.7

10.9
12.9
20.8
31.0
19.1
10.9
14.6

12.7
13.4
19.2
6.3
0.9
-8.8
8.6
11.4
11.5
12.6
10.8
19.0
10.3
13.2
10.5
15.5
14.8
11.4
13.6
18.2
27.8
17.2
11.2
10.1

-0.8
21.2
18.7
20.2
13.2
11.1
10.3

5.8
15.6
11.9
19.5
9.9
14.6
11.8

13.6
13.9
13.7
10.8
11.0
19.1
9.3

12.5
5.3
20.0
0.3
4.1
-1.6
15.3
13.5
9.3
15.6
14.3
19.6
3.9
3.4
-4.1
10.6
4.4
4.8
22.4
14.8
15.6
14.1
15.4
12.2

18.5
6.2
18.9
-3.2
1.2
0.8
15.1
12.1
5.3
11.9
16.5
23.5
8.1
5.1
1.5
12.5
0.8
5.9
16.8
13.4
22.3
15.6
14.3
10.9

14.4
3.6
19.7
4.8
2.3
-8.5
16.6
11.7
7.1
10.7
17.8
26.3
6.1
4.8
6.5
8.0
4.3
-3.3
15.1
11.4
21.0
23.6
18.2
9.6

152

A7. (cont’d)
Post-Treatment
Right End Range Values (degrees)
(“+” ipsilateral & “-” contralateral)

Left End Range Values (degrees)
(“+” ipsilateral & “-” contralateral)

Subject

Test

Group

1

2

3

4

5

6

1

2

3

4

5

6

115
115
115
125
125
125

Ex. 2
Ex. 3
Active
Ex. 2
Ex. 3
Active

Exp.
Exp.
Exp.
Exp.
Exp.
Exp.

19.2
19.1
13.1
13.2
11.9
22.1

21.1
15.6
14.1
17.1
15.2
25.7

19.0
18.6
24.1
13.8
14.4
27.0

22.2
16.4
17.3
12.9
12.7
21.8

24.7
16.6
27.4
11.6
14.8
28.8

25.6
18.2
21.2
8.8
12.5
25.8

27.0
20.2
23.4
12.0
7.6
29.1

24.1
22.0
48.8
18.5
7.9
32.9

9.6
23.3
32.8
16.9
8.0
37.4

24.1
24.7
20.9
18.9
8.9
24.6

26.8
28.7
30.0
18.6
2.2
30.6

6.3
25.3
44.5
21.0
4.5
30.0

ROM (End Range Left + End Range Right)
(degrees)
Subject

Test

Group

1

2

3

4

5

6

4
4
4
5
5
5
27
27
27
41
41
41
46
46
46

Ex. 2
Ex. 3
Active
Ex. 2
Ex. 3
Active
Ex. 2
Ex. 3
Active
Ex. 2
Ex. 3
Active
Ex. 2
Ex. 3
Active

Cont.
Cont.
Cont.
Cont.
Cont.
Cont.
Cont.
Cont.
Cont.
Cont.
Cont.
Cont.
Cont.
Cont.
Cont.

16.8
9.2
27.9
16.8
9.2
27.9
4.3
-1.4
10.0
4.5
4.7
11.4
22.0
12.4
29.6

20.0
11.5
7.6
20.0
14.8
7.6
6.3
-3.2
3.1
10.4
6.9
15.2
12.2
14.1
28.9

15.1
15.2
16.7
15.1
16.1
16.7
8.9
1.5
1.9
16.2
5.3
19.7
6.6
12.2
32.0

9.9
10.4
23.1
13.7
8.7
7.6
10.2
7.1
11.4
5.0
4.7
14.6
18.9
15.4
32.3

20.8
14.0
19.7
18.0
11.5
2.7
1.7
5.9
4.5
11.2
6.2
32.4
18.9
12.2
28.0

22.4
12.4
26.8
15.8
15.3
3.0
3.3
-0.7
2.7
-3.4
8.2
31.8
9.2
14.7
32.9

153

A7. (cont’d)
ROM (End Range Left + End Range Right)
(degrees)
Subject

Test

Group

1

2

3

4

5

51
51
51
56
56
56
59
59
59
63
63
63
67
67
67
68
68
68
69
69
69
77
77
77
79
79
79

Ex. 2
Ex. 3
Active
Ex. 2
Ex. 3
Active
Ex. 2
Ex. 3
Active
Ex. 2
Ex. 3
Active
Ex. 2
Ex. 3
Active
Ex. 2
Ex. 3
Active
Ex. 2
Ex. 3
Active
Ex. 2
Ex. 3
Active
Ex. 2
Ex. 3
Active

Cont.
Cont.
Cont.
Cont.
Cont.
Cont.
Cont.
Cont.
Cont.
Cont.
Cont.
Cont.
Cont.
Cont.
Cont.
Cont.
Cont.
Cont.
Cont.
Cont.
Cont.
Cont.
Cont.
Cont.
Cont.
Cont.
Cont.

18.6
7.9
11.3
18.6
15.1
13.3
15.9
6.5
3.7
30.0
23.6
38.0
15.6
16.2
25.7
19.1
6.6
13.8
35.3
22.5
18.1
14.4
14.8
19.0
24.2
19.9
26.9

10.0
10.6
23.5
18.5
16.9
15.4
4.5
6.7
27.7
17.3
36.4
18.4
16.2
26.4
25.2
9.2
25.5
24.2
23.4
32.9
17.1
17.3
3.7
24.8
17.8
24.9

8.5
9.2
25.9
18.1
19.1
13.6
14.7
7.6
28.7
18.9
41.1
16.6
15.4
31.4
21.3
11.0
22.5
24.4
23.3
23.6
17.3
17.7
3.0
19.7
18.8
25.3

15.4
6.4
7.0
21.7
18.0
24.8
24.5
14.4
7.6
31.2
25.6
39.6
21.5
10.6
34.1
12.4
12.8
16.7
40.2
18.0
26.5
18.1
11.7
10.0
26.9
17.4
32.1

28.5
-0.8
17.4
20.6
16.9
26.0
16.1
13.7
4.4
33.0
22.1
41.9
16.3
13.8
33.3
12.1
13.3
19.9
24.1
18.1
23.7
16.7
9.6
8.3
23.0
14.6
31.5

154

6
7.3
10.7
23.4
15.1
25.7
9.1
8.8
34.4
24.7
39.8
24.1
11.2
32.8
16.9
20.7
18.5
35.7
21.2
25.2
18.9
4.6
6.2
18.9
16.3
29.8

A7. (cont’d)
ROM (End Range Left + End Range Right)
(degrees)
Subject

Test

Group

1

2

3

4

5

6

83
83
83
85
85
85
88
88
88
90
90
90
96
96
96
106
106
106
111
111
111
117
117
117

Ex. 2
Ex. 3
Active
Ex. 2
Ex. 3
Active
Ex. 2
Ex. 3
Active
Ex. 2
Ex. 3
Active
Ex. 2
Ex. 3
Active
Ex. 2
Ex. 3
Active
Ex. 2
Ex. 3
Active
Ex. 2
Ex. 3
Active

Cont.
Cont.
Cont.
Cont.
Cont.
Cont.
Cont.
Cont.
Cont.
Cont.
Cont.
Cont.
Cont.
Cont.
Cont.
Cont.
Cont.
Cont.
Cont.
Cont.
Cont.
Cont.
Cont.
Cont.

9.5
4.7
18.0
17.4
13.2
8.9
22.6
23.3
37.4
40.7
29.5
33.6
21.4
22.6
22.6
27.6
28.6
31.1
26.0
14.1
36.4
25.2
14.9
23.2

8.9
9.4
9.5
19.1
17.3
15.6
15.4
28.6
38.3
40.9
25.2
27.7
22.6
20.8
20.8
29.0
27.2
23.5
24.0
18.6
33.1
13.4
11.3
21.1

6.9
6.7
11.4
15.1
10.5
13.6
16.6
29.2
36.3
37.5
28.6
21.8
19.1
20.4
20.4
26.8
31.7
31.1
25.1
18.2
35.8
18.9
18.7
17.7

9.1
2.7
19.8
17.5
11.1
3.1
26.0
22.2
31.2
29.4
29.9
27.5
21.7
17.0
17.0
25.8
35.5
39.8
20.6
30.7
40.2
15.9
19.5
30.6

10.6
8.3
10.4
15.7
12.2
13.6
15.6
29.9
33.4
33.5
25.2
27.9
27.9
16.3
16.3
24.1
34.6
35.6

4.3
2.5
12.8
19.9
15.8
9.4
18.4
28.2
30.6
36.4
18.1
28.4
25.5
18.5
18.5
28.6
37.1
29.9
12.1
30.1
47.5
28.1
12.8
31.2

155

19.5
40.5
19.1
12.9
24.5

A7. (cont’d)
Pre-Treatment

Post-Treatment

ROM (End Range Left + End Range Right)
(degrees)

ROM (End Range Left + End Range Right)
(degrees)

Subject

Test

Group

1

2

3

4

5

6

1

2

3

4

5

6

6
6
6
9
9
9
12
12
12
14
14
14
23
23
23
25
25
25
54
54
54
55
55
55
57
57
57

Ex. 2
Ex. 3
Active
Ex. 2
Ex. 3
Active
Ex. 2
Ex. 3
Active
Ex. 2
Ex. 3
Active
Ex. 2
Ex. 3
Active
Ex. 2
Ex. 3
Active
Ex. 2
Ex. 3
Active
Ex. 2
Ex. 3
Active
Ex. 2
Ex. 3
Active

Exp.
Exp.
Exp.
Exp.
Exp.
Exp.
Exp.
Exp.
Exp.
Exp.
Exp.
Exp.
Exp.
Exp.
Exp.
Exp.
Exp.
Exp.
Exp.
Exp.
Exp.
Exp.
Exp.
Exp.
Exp.
Exp.
Exp.

20.7
20.3
34.8
13.5
18.2
26.3
31.4
14.6
31.2
20.0
22.5
17.9
13.2
18.0
18.1
-1.3
2.6
16.7
-2.3
-4.2
6.4
18.5
6.2
11.5
23.8
21.0
8.9

23.7
21.0

21.0
13.3

15.4
17.3
30.1
24.0
25.4
35.4
20.2
24.2
31.9
17.0
22.9
20.5
5.2
5.2
19.9
1.9
-9.7
9.1
34.9
12.1
12.7
29.3
12.7
11.0

17.5
13.2
28.1
28.3
20.6
34.0
27.3
24.1
1.9
16.1
20.0
53.1
-0.4
5.8
20.7
1.7
-1.3
9.7

15.1
14.4
44.0
19.2
19.9
13.0
28.2
12.6
31.6
17.6
24.6
35.3
12.6
7.8
12.5
2.6
5.8
15.9
7.6
-9.3
11.1
24.4
7.7
10.1
32.2
17.3
5.8

16.8
12.5
37.8
19.8
14.3
16.3
30.8
21.6
35.2
28.9
4.1
-8.5
15.0
7.1
14.9
9.9
4.6
18.5
5.4
-8.9
11.6
26.3
13.2
10.4
27.4
14.0
18.1

13.7
16.8
41.6
18.9
15.9
9.8
31.0
22.0
34.5
28.4
14.1
6.3
13.7
11.5
14.2
2.6
6.1
18.8
4.1
-9.5
10.8
24.0
9.1
11.2
29.8
12.3
7.4

26.7
19.8
44.3
22.9
10.4
24.1
30.3
10.7
28.5
3.7
9.5
-2.6
10.9
15.2
19.5
-1.1
2.3
9.8
12.4
-11.1
14.3
23.8
4.7
12.8
19.5
13.1
19.8

27.4
21.0
52.6
18.2
15.0
35.2
24.7
11.9
34.9
14.1
6.6
18.7
5.6
16.4
21.4
0.2
6.5
14.8
12.1
-5.4
8.6
23.7
9.7
10.8
27.6
8.5
16.2

28.8
21.7
55.0
24.3
15.4
25.3
25.1
16.6
36.4
3.4
8.2
4.8
-3.9
11.4
22.4
9.3
3.2
13.4
9.4
-9.7
12.7
22.9
9.6
12.0
22.3
6.9
13.5

22.2
18.8
40.0
25.7
32.7
35.5
25.2
12.0
30.3
21.0
3.9
14.6
6.2
17.8
11.0
10.4
3.3
15.9
15.8
-1.7
13.3
22.8
6.2
15.7
23.5
17.0
19.3

25.3
13.9
45.2
28.9
-19.9
35.4
19.2
17.9
35.0
32.9
-1.1
-15.2
0.4
16.7
21.3
12.7
3.7
15.0
27.3
-5.2
18.7
19.4
8.5
12.9
16.4
10.8
21.6

20.2
14.5
46.5
25.9
-5.4
29.0
14.1
20.6
34.0
29.4
4.9
8.3
-4.8
16.2
14.9
14.4
0.9
13.5
17.1
2.2
29.2
18.4
3.4
13.7
29.4
8.2
13.9

6.5
26.0
11.6
14.4

156

A7. (cont’d)
Pre-Treatment

Post-Treatment

ROM (End Range Left + End Range Right)
(degrees)

ROM (End Range Left + End Range Right)
(degrees)

Subject

Test

Group

1

2

3

4

5

6

1

2

3

4

5

6

70
70
70
72
72
72
80
80
80
84
84
84
91
91
91
95
95
95
98
98
98

Ex. 2
Ex. 3
Active
Ex. 2
Ex. 3
Active
Ex. 2
Ex. 3
Active
Ex. 2
Ex. 3
Active
Ex. 2
Ex. 3
Active
Ex. 2
Ex. 3
Active
Ex. 2
Ex. 3
Active

Exp.
Exp.
Exp.
Exp.
Exp.
Exp.
Exp.
Exp.
Exp.
Exp.
Exp.
Exp.
Exp.
Exp.
Exp.
Exp.
Exp.
Exp.
Exp.
Exp.
Exp.

23.6
7.1
28.6
15.0
12.4
5.0
25.8
15.2
33.7
24.6
23.5
39.4
15.8
9.4
8.8
20.7
13.5
17.8
35.4
41.6
65.5

15.0
6.0
24.7
18.7
16.9
-16.3
27.8
18.0
32.5
12.8
24.5
44.9
11.6
14.4
9.8
20.9
11.4
14.9
36.0
44.0
57.8

21.0
9.3
26.7
11.9
10.9
-23.3
28.1
15.7
29.9
19.4
23.6
45.4
11.7
8.5
6.6
26.9
12.4
19.8
37.3
32.3
43.3

26.1
5.2
32.8
15.0
4.8
-24.1
25.1
21.8
23.9
28.3
29.5
45.0
15.2
21.5
12.2
15.8
14.9
11.2
43.9
38.2
58.0

24.5
12.1
31.8
22.7
8.8
-17.5
24.9
20.7
28.4
24.4
24.2
52.2
1.1
12.9
17.3
22.2
13.4
20.1
37.2
35.7
54.1

19.2
5.6
35.6
19.5
10.8
-24.2
31.0
22.9
22.4
30.0
32.3
49.3
9.0
16.0
14.9
26.8
11.5
23.2
38.3
29.9
50.4

25.2
12.1
29.8
10.6
-0.1
-2.3
27.4
13.9
27.7
24.0
24.2
43.1
17.0
12.0
13.0
24.9

35.0
16.3
33.1
16.6
-0.6
-13.0
35.7
20.5
27.9
26.0
21.1
52.8
16.3
7.9
14.2
31.6

34.8
17.7
34.6
9.1
-0.9
-19.8
30.5
19.0
22.1
22.9
29.6
41.2
21.8
8.6
11.8
20.9

10.1
34.2
39.5
51.2

16.9
29.5
28.2
47.3

25.5
25.7
31.2
35.6

25.2
18.7
39.2
6.6
4.9
-10.4
23.9
24.9
20.9
28.1
25.2
38.6
14.2
16.6
6.5
26.1
19.2
16.2
36.0
33.1
43.4

35.1
26.4
40.9
1.7
3.6
-18.3
29.1
20.7
17.4
26.1
25.9
48.7
19.6
19.4
14.5
29.7
14.3
15.5
37.0
32.7
51.5

29.5
26.4
43.9
11.8
4.3
-24.6
32.1
18.2
18.1
24.1
23.4
51.1
16.6
17.9
24.3
26.3
15.5
12.5
37.2
29.5
53.6

157

A7. (cont’d)
Pre-Treatment

Post-Treatment

ROM (End Range Left + End Range Right)
(degrees)

ROM (End Range Left + End Range Right)
(degrees)

Subject

Test

Group

1

2

3

4

5

6

1

2

3

4

5

6

112
112
112
115
115
115
125
125
125

Ex. 2
Ex. 3
Active
Ex. 2
Ex. 3
Active
Ex. 2
Ex. 3
Active

Exp.
Exp.
Exp.
Exp.
Exp.
Exp.
Exp.
Exp.
Exp.

35.5
22.6
32.5
47.2
39.0
49.9
25.2
19.4
51.2

28.7
20.0
28.5
45.9
39.8
52.5
35.6
23.0
58.7

28.5
30.9
33.0

38.8
27.3
21.7
46.8
45.2

26.9
25.1
27.7
49.7
40.7

32.0
28.0
29.1
56.8
40.5

31.8
21.6
46.4

30.2
17.0
59.4

29.9
17.0
55.8

32.3
22.0
24.9
46.1
39.2
36.5
25.2
19.4
51.2

26.7
26.6
25.9
45.2
37.6
62.9
35.6
23.0
58.7

28.6
33.9
21.9
28.6
28.2
56.9
30.7
22.4
64.4

31.3
26.6
22.2
46.3
41.0
38.2
31.8
21.6
46.4

31.3
25.0
20.6
51.4
45.3
57.4
30.2
17.0
59.4

41.4
32.6
18.9
31.9
43.5
65.7
29.9
17.0
55.8

44.4
60.7
30.7
22.4
64.4

158

A8. Rates of Lateral Flexions (Slope)

Rate of Right Lateral Flexion (right-slope)
(degrees/second)

Rate of Left Lateral Flexion (left-slope)
(degrees/second)

Subject

Test

Group

1

2

3

4

5

6

1

2

3

4

5

6

4
4
4
5
5
5
27
27
27
41
41
41
46
46
46
51
51
51
56
56
56
59
59
59
63
63
63

Ex. 2
Ex. 3
Active
Ex. 2
Ex. 3
Active
Ex. 2
Ex. 3
Active
Ex. 2
Ex. 3
Active
Ex. 2
Ex. 3
Active
Ex. 2
Ex. 3
Active
Ex. 2
Ex. 3
Active
Ex. 2
Ex. 3
Active
Ex. 2
Ex. 3
Active

Cont.
Cont.
Cont.
Cont.
Cont.
Cont.
Cont.
Cont.
Cont.
Cont.
Cont.
Cont.
Cont.
Cont.
Cont.
Cont.
Cont.
Cont.
Cont.
Cont.
Cont.
Cont.
Cont.
Cont.
Cont.
Cont.
Cont.

7.2
5.6
7.1
7.2
14.9
12.2
10.2
10.7
16.3
12.7
8.5
10.2
10.9
10.7
20.5
10.4
12.4
9.8
13.1
13.2
16.8
12.5
13.8
13.8
8.2
6.9
10.9

6.5
7.7
9.8
6.4
12.7
22.9
11.6
14.7
18.0
8.7
11.1
15.8
9.6
13.1
27.6
7.6
12.7
10.8
12.1
13.2
15.3
10.5
12.3
19.4
8.0
3.6
11.8

9.0
8.5
11.3
9.0
16.3
21.4
12.7
13.6
18.8
11.0
10.0
18.4
9.8
14.3
29.4
6.3
13.4
16.0
10.8
11.4
23.9
10.6
11.4
19.6
7.4
6.1
14.9

8.6
6.4
7.0
16.8
10.0
15.8
9.0
9.3
18.8
10.5
8.7
8.7
15.2
14.4
21.0
10.4
14.1
9.6
13.5
10.9
16.6
10.6
9.5
11.2
7.5
6.3
10.9

8.1
7.9
9.6
18.7
16.5
32.1
13.0
12.5
20.9
8.8
10.2
12.9
13.5
14.9
18.5
8.9
14.6
14.3
12.6
12.3
18.5
8.2
12.3
17.9
9.4
5.6
13.3

8.2
7.4
9.8
21.8
14.1
25.5
11.4
14.0
24.8
8.7
8.9
18.7
11.3
16.0
22.6
10.3
17.3
13.7
12.1
11.8
19.9
8.1
12.9
19.7
8.2
6.9
12.2

4.9
10.0
8.3
4.9
14.3
19.2
13.8
16.2
16.9
9.9
12.7
13.2
10.5
8.4
19.9
8.3
12.7
11.9
13.5
12.6
16.4
10.4
14.0
16.0
8.3
7.6
8.9

7.0
7.2
10.6
6.4
14.2
27.8
12.4
15.0
17.4
10.3
11.3
17.5
8.5
11.7
27.2

8.3
6.5
11.7
7.8
18.9
27.7
17.7
18.2
18.7
11.8
11.8
22.6
9.4
13.4
24.7
10.5
14.0
11.6
13.5
22.8
10.1
12.1
21.8
8.0
9.5
18.2

6.7
6.9
11.5
16.6
17.3
23.5
11.4
16.3
22.3
10.9
12.6
15.1
9.4
12.5
18.7
8.6
15.5
15.7
13.8
12.9
19.0
10.3
11.2
18.1
5.6
6.7
15.2

7.8
9.1
9.0
18.6
16.0
25.8
17.8
18.3
23.0
9.1
12.0
19.2
10.6
11.8
22.9

16.1
15.2
11.4
14.0
19.6
10.3
16.0
18.8
7.3
8.8
12.9

7.5
8.2
9.0
19.8
18.2
22.4
14.1
15.5
19.0
9.1
13.6
12.6
13.1
12.4
15.7
8.5
12.5
13.3
12.4
14.0
18.0
7.9
10.3
13.2
6.8
7.7
10.7

159

17.7
16.2
12.3
15.5
21.9
11.4
21.0
7.9
6.9
14.6

A8. (cont’d)
Rate of Right Lateral Flexion (right-slope)
(degrees/second)

Rate of Left Lateral Flexion (left-slope)
(degrees/second)

Subject

Test

Group

1

2

3

4

5

6

1

2

3

4

5

6

67
67
67
68
68
68
69
69
69
77
77
77
79
79
79
83
83
83
85
85
85
88
88
88
90
90
90

Ex. 2
Ex. 3
Active
Ex. 2
Ex. 3
Active
Ex. 2
Ex. 3
Active
Ex. 2
Ex. 3
Active
Ex. 2
Ex. 3
Active
Ex. 2
Ex. 3
Active
Ex. 2
Ex. 3
Active
Ex. 2
Ex. 3
Active
Ex. 2
Ex. 3
Active

Cont.
Cont.
Cont.
Cont.
Cont.
Cont.
Cont.
Cont.
Cont.
Cont.
Cont.
Cont.
Cont.
Cont.
Cont.
Cont.
Cont.
Cont.
Cont.
Cont.
Cont.
Cont.
Cont.
Cont.
Cont.
Cont.
Cont.

12.5
14.3
18.6
8.0
6.4
14.0
12.1
11.9
17.2
11.5
10.1
10.3
9.9
16.1
12.6
10.3
12.9
11.4
12.0
10.6
8.8
9.0
6.4
9.7
19.9
10.3
26.2

15.0
16.4
21.2
6.4
8.5
18.5
12.8
12.7
21.8
14.0
9.2
20.3
10.0
23.0
18.9
10.9
12.7
13.7
11.4
12.6
9.5
9.4
7.8
15.4
13.9
13.5
28.9

15.4
13.4
21.9
5.1
9.4
22.6
12.9
14.3
28.5
8.7
12.5
22.8
9.9
21.7
20.8
10.5
13.0
14.1
15.5
13.0
11.0
8.4
8.2
16.6
11.9
17.5
26.6

16.1
12.1
18.7
8.8
7.5
11.3
14.4
11.4
18.2
11.1
11.2
19.4
9.5
13.9
11.9
9.5
18.0
9.4
15.1
8.1
8.3
10.4
7.1
10.9
18.9
19.0
27.8

16.9
15.8
14.1
8.6
9.6
17.2
14.6
9.9
22.4
11.7
11.7
22.8
14.9
16.7
14.9
11.0
15.1
14.4
13.1
13.3
10.3
9.4
9.6
17.4
17.5
18.4
20.6

14.0
12.8
19.3
7.7
7.7
18.6
13.8
11.3
23.1
12.2
12.4
19.5
11.0
20.8
18.8
10.7
14.0
14.2
13.4
11.2
11.5
8.6
12.2
20.5
12.8
12.1
26.4

13.7
12.5
17.7
7.9
9.0
12.5
12.3
13.6
21.0
9.0
13.2
19.9
8.1
16.4
17.2
9.8
9.3
13.2
12.1
13.1
10.4
9.1
7.2
13.0
14.7
16.5
27.8

11.7
13.2
17.4
7.7
6.4
17.2
12.0
11.6
24.2
10.3
9.5
19.6
12.6
18.2
22.6
10.9
10.7
15.8
14.7
12.1
11.0
9.6
6.9
16.0
11.3
14.3
28.1

14.5
12.6
19.1
7.0
8.0
19.2
10.8
10.7
27.6
9.3
11.9
22.0
10.9
20.2
21.6
11.0
15.6
17.4
15.0
16.6
11.7
10.5
9.5
16.1
12.7
14.1
40.8

13.6
13.0
18.1
7.8
6.2
11.3
13.7
12.6
21.9
11.0
10.3
23.7
12.7
16.4
15.9
10.2
14.0
12.0
14.7
13.8
13.2
11.3
7.4
18.5
16.2
11.2
26.8

10.6
13.8
16.3
8.0
7.3
16.7
12.0
10.1
24.0
11.7
9.3
21.7
12.7
19.8
16.7
10.0
18.5
14.8
12.4
17.6
9.3
8.8
8.7
18.3
14.4
14.2
35.5

13.1
13.2
19.2
9.3
10.9
18.0
13.5
12.9
27.5
9.6
10.0
27.8
9.4
18.5
16.8
10.9
14.1
14.4
13.6
16.5
12.2
9.0
9.6
18.4
16.8
15.4
37.1

160

A8. (cont’d)
Rate of Right Lateral Flexion (right-slope)
(degrees/second)

Rate of Left Lateral Flexion (left-slope)
(degrees/second)

Subject

Test

Group

1

2

3

4

5

6

1

2

3

4

5

6

96
96
96
106
106
106
111
111
111
117
117
117

Ex. 2
Ex. 3
Active
Ex. 2
Ex. 3
Active
Ex. 2
Ex. 3
Active
Ex. 2
Ex. 3
Active

Cont.
Cont.
Cont.
Cont.
Cont.
Cont.
Cont.
Cont.
Cont.
Cont.
Cont.
Cont.

15.2
7.9
14.8
10.9
7.5
9.3
14.5
11.9
12.0
9.6
7.0
9.9

7.8
6.3
13.0
9.2
6.9
15.0
14.5
8.7
14.3
8.3
7.0
14.8

6.4
6.2
10.5
10.6
7.2
17.7
15.7
9.5
15.0
4.2
9.1
17.9

13.4
8.2
11.4
13.4
10.0
11.8
16.9
13.2
10.9
8.8
8.9
12.3

9.5
7.2
11.1
11.3
7.6
14.2
18.0
11.7
16.5
7.0
9.2
16.3

9.2
6.9
10.0
11.3
8.8
18.7
12.9
12.7
17.1
5.7
10.5
14.7

17.7
12.3
16.6
13.3
9.8
16.6
13.8
11.3
14.2
8.5
5.9
11.7

11.6
9.0
13.2
9.9
8.5
20.1
13.9
10.0
20.2
6.6
5.8
17.4

13.2
10.0
16.4
11.3
9.1
26.7
17.8
11.7
15.2
5.5
6.4
19.0

16.1
14.2
18.4
10.7
11.3
14.7
15.5
11.3
16.4
7.6
7.9
13.1

12.4
10.9
15.8
10.2
9.8
17.6

12.0
11.4
15.9
11.8
9.9
18.4
13.9
13.2
21.5
4.9
7.8
15.2

11.4
20.8
5.5
7.4
16.9

Pre-Treatment
Rate of Right Lateral Flexion (right-slope)
(degrees/second)

Rate of Left Lateral Flexion (left-slope)
(degrees/second)

Subject

Test

Group

1

2

3

4

5

6

1

2

3

4

5

6

6
6
6
9
9
9
12
12
12

Ex. 2
Ex. 3
Active
Ex. 2
Ex. 3
Active
Ex. 2
Ex. 3
Active

Exp.
Exp.
Exp.
Exp.
Exp.
Exp.
Exp.
Exp.
Exp.

9.1
6.1
4.1
8.9
5.9
9.7
12.7
4.4
7.4

9.5
8.2

7.4
7.3

4.2
5.8
13.3
5.4
9.8
7.9
5.9
4.2
9.1

7.1
3.9
3.4
10.2
8.2
10.3
7.5
5.1
7.6

5.0
5.0

5.8
8.6
9.4
8.4
3.8
11.9

5.9
3.9
12.3
7.5
5.0
9.9
6.2
6.2
10.2

5.0
6.9

6.4
8.0
11.4
9.6
5.5
9.9

8.4
7.1
7.6
5.9
7.1
7.2
8.6
4.7
7.6

9.3
8.1
15.0
6.7
6.5
9.2

7.8
8.7
13.4
6.7
6.1
9.4

8.0
5.1
9.6
7.7
8.9
11.0
6.1
6.6
7.4

4.9
4.2
9.8
5.2
8.9
13.8
5.5
6.6
11.4

5.8
4.0
12.7
6.5
8.3
14.8
7.2
5.7
11.7

161

A8. (cont’d)
Pre-Treatment
Rate of Right Lateral Flexion (right-slope)
(degrees/second)

Rate of Left Lateral Flexion (left-slope)
(degrees/second)

Subject

Test

Group

1

2

3

4

5

6

1

2

3

4

5

6

14
14
14
23
23
23
25
25
25
54
54
54
55
55
55
57
57
57
70
70
70
75
75
75
80
80
80

Ex. 2
Ex. 3
Active
Ex. 2
Ex. 3
Active
Ex. 2
Ex. 3
Active
Ex. 2
Ex. 3
Active
Ex. 2
Ex. 3
Active
Ex. 2
Ex. 3
Active
Ex. 2
Ex. 3
Active
Ex. 2
Ex. 3
Active
Ex. 2
Ex. 3
Active

Exp.
Exp.
Exp.
Exp.
Exp.
Exp.
Exp.
Exp.
Exp.
Exp.
Exp.
Exp.
Exp.
Exp.
Exp.
Exp.
Exp.
Exp.
Exp.
Exp.
Exp.
Exp.
Exp.
Exp.
Exp.
Exp.
Exp.

11.2
16.8
12.6
11.6
12.4
13.0
7.3
7.8
6.2
8.2
9.7
14.0
5.3
8.9
3.3
11.3
8.3
9.3
12.6
8.4
12.9
10.8
7.6
5.8
13.4
11.3
19.9

9.5
11.4
27.1
15.3
11.5
16.8
6.5
7.1
9.9
6.9
10.5
14.1
4.4
8.4
5.1
11.1
8.3
13.1
12.5
8.2
15.3
9.0
9.0
8.5
12.8
17.4
22.4

8.2
11.1
14.4
18.7
12.7
20.6
6.4
8.3
10.2
7.3
10.7
18.8

12.1
16.6
22.7
14.3
12.3
13.1
8.1
7.3
9.8
7.6
8.0
17.0
5.2
8.4
4.9
11.6
9.4
10.1
10.0
10.2
16.9
8.3
10.8
14.6
13.9
11.7
18.7

11.3
12.4
24.1
18.1
13.0
19.3
7.2
9.0
12.8
8.0
11.6
13.3
5.6
9.9
4.9
11.2
9.8
14.2
9.8
10.6
18.5
7.9
7.8
17.4
13.6
16.9
28.2

10.0
13.2
20.1
16.5
12.8
20.3
5.5
10.6
14.0
7.7
10.8
20.6
4.8
7.3
5.8
9.0
13.0
16.5
9.4
11.2
19.1
9.5
7.7
19.7
11.8
15.4
20.5

11.6
11.8
21.7
15.0
13.0
15.6
6.6
8.2
7.3
9.2
9.8
18.7
4.4
7.0
5.0
10.0
8.0
16.2
10.8
9.5
14.5
8.8
6.9
7.8
10.9
13.5
20.0

11.2
7.5
26.8
14.3
13.5
17.5
6.5
10.1
8.8
10.7
11.6
23.8
4.3
9.2
5.4
9.6
8.4
17.0
10.7
8.6
18.1
8.7
9.2
11.7
10.3
13.5
20.5

11.7
11.8
22.3
12.3
14.6
19.3
7.3
8.0
11.2
10.3
12.8
25.0

12.6
16.8
25.0
16.4
14.1
12.5
7.3
8.0
8.1
8.8
10.3
21.6
5.1
7.5
6.7
10.3
9.6
15.8
11.4
7.8
21.3
8.7
12.1
16.5
12.1
13.9
22.8

14.5
16.4
15.9
12.8
13.4
16.7
5.5
6.2
10.9
8.6
12.6
22.3
4.7
11.3
8.7
12.7
12.1
15.3
9.3
10.9
28.6
7.8
8.4
18.8
10.7
17.0
22.6

18.1
9.5
21.9
14.3
15.0
18.3
6.8
6.4
10.5
10.8
12.1
22.9
4.2
5.1
6.4
7.8
8.9
19.3
8.0
8.3
26.9
9.8
10.6
16.6
9.4
17.8
23.0

6.1
7.2
11.1
9.9
18.0
12.9
9.9
19.9
8.4
10.0
10.1
12.6
14.1
20.6

162

5.2
9.3
11.2
20.9
10.2
10.8
35.0
8.4
7.8
14.2
11.0
14.5
20.5

A8. (cont’d)
Pre-Treatment
Rate of Right Lateral Flexion (right-slope)
(degrees/second)

Rate of Left Lateral Flexion (left-slope)
(degrees/second)

Subject

Test

Group

1

2

3

4

5

6

1

2

3

4

5

6

84
84
84
91
91
91
95
95
95
98
98
98
112
112
112
115
115
115
125
125
125

Ex. 2
Ex. 3
Active
Ex. 2
Ex. 3
Active
Ex. 2
Ex. 3
Active
Ex. 2
Ex. 3
Active
Ex. 2
Ex. 3
Active
Ex. 2
Ex. 3
Active
Ex. 2
Ex. 3
Active

Exp.
Exp.
Exp.
Exp.
Exp.
Exp.
Exp.
Exp.
Exp.
Exp.
Exp.
Exp.
Exp.
Exp.
Exp.
Exp.
Exp.
Exp.
Exp.
Exp.
Exp.

7.4
7.5
11.0
11.8
10.6
18.5
13.4
18.1
14.0
8.5
8.9
18.8
11.8
8.5
9.1
5.1
5.4
14.9
8.1
9.6
9.1

5.4
12.2
9.4
12.5
15.9
27.3
13.6
14.5
11.4
8.5
9.4
24.2
12.0
11.7
14.6
5.2
6.2
18.3
8.2
8.2
8.9

6.5
7.3
9.6
13.0
12.8
23.0
14.8
14.7
14.4
8.9
12.2
20.9
12.5
9.9
16.5
5.5
5.5
21.9
7.0
9.5
9.2

7.4
8.4
12.6
13.7
12.0
20.7
9.6
12.9
17.4
9.8
7.4
10.8
12.6
9.2
11.1
6.7
6.3

5.5
11.5
10.0
10.8
16.0
25.7
13.0
17.4
11.7
8.9
8.0
15.0
10.3
13.5
17.0
5.9
6.6

6.1
9.5
9.4
12.0
14.6
22.1
13.6
13.8
16.3
9.0
9.2
16.6
9.5
10.0
16.7
5.6
6.1

5.9
7.9
12.3
10.9
12.2
19.3
13.8
13.1
14.5
8.9
10.4
19.9
9.9
7.0
12.0
7.0
8.4

4.8
8.7
12.1
11.8
14.3
23.4
15.8
14.7
12.8
7.7
8.8
19.1
7.2
10.0
14.9
4.8
7.6

4.5
9.1
9.1
11.0
14.1
25.9
16.6
15.3
15.0
6.5
9.1
21.0
9.2
9.8
16.7
7.2
8.1

8.1
8.3
11.8

7.7
9.1
14.0

6.3
6.8
11.3
11.3
10.7
21.5
15.4
13.7
15.9
9.0
11.8
19.4
10.7
10.5
12.5
5.0
4.7
20.9
8.5
7.0
9.7

6.0
9.1
11.2
13.1
12.7
19.2
18.7
13.1
17.7
8.5
10.8
25.4
9.8
6.3
15.1

8.2
8.8
10.9

6.6
7.9
13.1
12.1
12.7
18.5
12.8
13.3
11.5
9.2
9.2
21.4
9.9
9.0
9.4
5.3
4.6
29.1
9.4
13.1
11.5

8.1
9.6
12.2

6.3
10.5
11.2

8.3
8.1
12.0

163

6.6
22.7
8.2
7.3
10.9

A8. (cont’d)
Post-Treatment
Rate of Right Lateral Flexion (right-slope)
(degrees/second)

Rate of Left Lateral Flexion (left-slope)
(degrees/second)

Subject

Test

Group

1

2

3

4

5

6

1

2

3

4

5

6

6
6
6
9
9
9
12
12
12
14
14
14
23
23
23
25
25
25
54
54
54
55
55
55
57
57
57

Ex. 2
Ex. 3
Active
Ex. 2
Ex. 3
Active
Ex. 2
Ex. 3
Active
Ex. 2
Ex. 3
Active
Ex. 2
Ex. 3
Active
Ex. 2
Ex. 3
Active
Ex. 2
Ex. 3
Active
Ex. 2
Ex. 3
Active
Ex. 2
Ex. 3
Active

Exp.
Exp.
Exp.
Exp.
Exp.
Exp.
Exp.
Exp.
Exp.
Exp.
Exp.
Exp.
Exp.
Exp.
Exp.
Exp.
Exp.
Exp.
Exp.
Exp.
Exp.
Exp.
Exp.
Exp.
Exp.
Exp.
Exp.

7.9
5.8
9.4
10.1
8.7
10.1
6.7
5.6
7.5
12.4
14.3
19.5
10.1
11.2
11.4
8.0
9.5
6.7
11.8
12.2
12.9
7.0
7.6
6.3
12.0
8.9
13.5

6.3
6.0
12.2
10.4
10.0
13.5
5.9
7.3
8.7
10.2
9.0
36.0
12.5
11.4
13.8
9.7
9.4
10.3
10.5
11.5
17.6
6.5
7.8
8.0
13.4
10.5
16.5

6.9
8.3
13.8
8.8
8.0
15.6
6.7
6.0
11.3
7.6
8.7
28.4
9.0
15.9
15.2
7.9
8.9
10.3
12.4
12.2
20.3
6.7
8.7
7.8
10.3
12.1
24.6

6.4
5.4
7.5
11.9
8.8
10.0
7.8
4.8
7.7
9.6
15.1
21.5
11.3
11.0
12.9
10.7
8.4
6.9
9.2
11.6
18.7
7.4
7.2
6.6
11.4
8.8
13.0

6.6
6.0
12.0
11.8
9.7
14.0
6.3
5.1
11.3
10.1
9.0
21.4
10.9
14.6
13.3
9.2
9.3
11.6
8.6
9.9
14.9
8.4
8.1
9.3
16.6
11.3
19.3

5.0
5.6
15.7
11.4
7.5
15.9
7.4
6.9
10.8
7.8
13.4
35.2
10.2
9.7
16.3
8.1
9.9
11.1
7.7
9.1
19.8
6.1
7.6
10.8
11.6
15.3
21.4

5.9
6.4
9.7
10.3
8.5
9.7
7.2
6.9
9.1
9.3
5.7
25.0
11.4
14.5
12.6
5.9
8.6
6.3
12.5
9.2
19.4
4.9
5.5
9.1
10.0
12.5
14.2

5.6
5.4
10.3
9.3
7.7
15.0
6.2
6.0
9.8
11.2
9.5
38.2
10.2
12.2
14.4
5.8
8.4
9.0
9.9
12.6
21.5
5.9
6.4
7.9
10.1
11.4
16.4

4.6
8.3
10.6
10.3
9.5
15.1
7.3
5.2
10.4
8.7
10.8
14.6
12.5
16.1
15.1
7.0
9.0
7.8
11.8
16.3
27.6
7.1
8.4
8.8
7.9
10.5
23.8

6.1
5.6
11.9
8.8
7.7
11.6
7.5
4.8
9.5
10.5
15.2
15.0
12.8
13.0
11.3
7.6
10.6
7.7
11.0
11.5
22.9
5.9
8.9
9.3
10.6
9.8
18.8

5.5
7.1
11.5
9.3
9.0
11.0
6.3
6.0
9.4
8.6
19.4
32.9
9.4
17.2
13.8
6.8
8.3
9.5
10.9
13.2
22.6
4.9
9.1
11.3
11.9
9.4
19.0

5.7
7.4
13.3
10.9
10.8
15.7
7.3
5.6
10.6
7.1
18.0
27.0
9.5
12.6
16.2
9.5
10.5
10.5
10.4
18.0
26.6
6.5
6.4
12.0
7.8
11.7
21.8

164

A8. (cont’d)
Post-Treatment
Rate of Right Lateral Flexion (right-slope)
(degrees/second)

Rate of Left Lateral Flexion (left-slope)
(degrees/second)

Subject

Test

Group

1

2

3

4

5

6

1

2

3

4

5

6

70
70
70
72
72
72
80
80
80
84
84
84
91
91
91
95
95
95
98
98
98
112
112
112

Ex. 2
Ex. 3
Active
Ex. 2
Ex. 3
Active
Ex. 2
Ex. 3
Active
Ex. 2
Ex. 3
Active
Ex. 2
Ex. 3
Active
Ex. 2
Ex. 3
Active
Ex. 2
Ex. 3
Active
Ex. 2
Ex. 3
Active

Exp.
Exp.
Exp.
Exp.
Exp.
Exp.
Exp.
Exp.
Exp.
Exp.
Exp.
Exp.
Exp.
Exp.
Exp.
Exp.
Exp.
Exp.
Exp.
Exp.
Exp.
Exp.
Exp.
Exp.

9.9
8.6
13.3
9.8
5.8
11.4
12.9
11.2
14.9
10.6
10.3
9.0
20.0
10.8
18.2
13.1

10.3
8.7
18.9
8.1
6.4
13.8
11.4
13.0
14.4
8.6
9.3
9.9
16.8
14.3
25.0
12.1

9.7
9.6
17.7
9.1
9.0
16.0
10.9
11.8
23.1
7.1
10.6
9.0
15.0
11.8
28.8
9.3

10.9
10.9
25.7
6.5
7.7
15.7
11.0
14.3
17.2
6.5
10.1
10.7
13.7
12.9
22.4
9.5

14.2
7.4
9.5
11.4
12.1
12.2
21.0

10.2
7.4
18.4
7.1
9.7
16.1
11.8
12.3
20.0
7.1
6.7
9.9
11.7
18.7
25.3
10.2
17.0
11.6
11.2
9.7
12.8
10.5
12.1
17.0

9.1
9.5
16.5
7.6
6.4
14.9
10.2
14.1
14.6
6.5
6.8
11.1
14.4
10.9
24.0
6.9

17.8
8.7
8.3
15.3
11.7
9.0
17.8

10.1
9.8
13.9
9.8
9.6
15.7
9.2
10.5
18.9
8.0
10.1
9.6
13.8
18.4
18.2
11.3
18.2
13.0
7.9
9.6
8.3
13.6
8.3
18.2

8.9
7.9
17.5
6.5
8.1
13.2
12.0
11.2
14.1
7.5
8.4
10.8
15.4
12.4
22.4
10.1

13.9
8.7
9.5
12.8
12.1
9.8
13.5

11.7
9.7
15.3
7.7
8.1
13.3
11.1
14.1
13.5
7.9
9.4
8.9
15.0
10.9
19.8
12.4
12.7
13.7
4.8
8.0
8.9
12.6
11.2
13.0

14.1
8.7
9.5
15.1
9.2
6.9
13.1

13.4
7.5
7.4
11.7
9.9
7.4
14.9

13.6
6.7
9.3
18.0
9.4
9.2
21.7

10.1
10.3
16.3
7.3
10.9
15.0
10.4
7.5
16.8
8.5
9.4
12.7
12.6
13.4
23.3
13.6
14.9
11.6
8.6
8.3
12.6
11.4
9.3
13.7

9.0
11.1
15.3
5.3
8.6
18.1
9.8
9.9
14.8
7.2
6.6
12.3
12.0
21.3
22.4
9.3
16.7
8.5
7.5
8.4
10.3
10.5
8.7
18.6

7.7
11.4
20.3
6.1
9.0
16.2
9.7
13.0
17.7
7.9
8.1
11.8
13.7
15.7
25.5
9.4
11.0
14.2
7.4
12.4
13.7
10.3
8.3
16.8

165

A8. (cont’d)

Subject

Test

Group

115
115
115
125
125
125

Ex. 2
Ex. 3
Active
Ex. 2
Ex. 3
Active

Exp.
Exp.
Exp.
Exp.
Exp.
Exp.

Subject

Test

Group

126
126
126
127
127
127
128
128
128
129
129
129
131
131
131

Ex. 2
Ex. 3
Active
Ex. 2
Ex. 3
Active
Ex. 2
Ex. 3
Active
Ex. 2
Ex. 3
Active
Ex. 2
Ex. 3
Active

Long.
Long.
Long.
Long.
Long.
Long.
Long.
Long.
Long.
Long.
Long.
Long.
Long.
Long.
Long.

Post-Treatment
Rate of Right Lateral Flexion (right-slope)
Rate of Left Lateral Flexion (left-slope)
(degrees/second)
(degrees/second)
1
2
3
4
5
6
1
2
3
4
5
6
10.1
7.0
11.4
8.2
8.9
10.1

6.6
5.7
16.5
6.8
9.8
11.1

6.3
6.3
15.5
6.5
11.7
11.5

8.3
7.0
16.2
6.0
13.9
11.8

6.3
9.7
15.7
5.0
13.6
11.6

6.1
8.2
20.0
5.5
11.8
11.8

7.8
6.9
23.9
6.8
9.6
11.5

7.1
6.5
20.3
5.9
8.0
10.1

7.4
6.8
20.9
6.2
7.9
11.7

6.2
7.5
25.1
5.7
12.1
10.7

5.1
8.2
5.8
4.0
10.7
14.6

5.1
9.0
13.7
5.0
9.3
13.7

Pre-Treatment
Rate of Right Lateral Flexion (right-slope)
Rate of Left Lateral Flexion (left-slope)
(degrees/second)
(degrees/second)
1
2
3
4
5
6
1
2
3
4
5
6
9.6
10.1
13.4
7.6
9.2
10.2
11.0
11.6
16.0
4.7
10.4
13.5
10.0
10.0
16.8

8.2
11.5
12.8
7.5
10.4
14.2
10.1
11.4
18.3
4.1
8.9
14.3
9.7
13.2
16.8

8.4
11.8
12.6
8.1
9.7
14.4
10.4
11.8
17.5
4.4
6.4
20.4
8.1
12.8
18.1

9.7
10.5
13.9
7.9
9.6
13.3
11.3
12.6
16.7
3.8
7.2
17.5
11.0
10.5
11.2

10.2
12.0
13.6
7.1
8.9
18.0
10.9
13.7
16.0
5.9
7.0
16.9
11.0
10.8
13.9

166

9.6
11.2
11.8
7.1
9.8
19.0
12.5
12.3
19.3
5.4
6.0
19.1
9.5
12.7
14.5

9.8
10.5
10.9
6.8
9.1
10.5
12.5
11.1
19.7
6.1
8.1
19.3
7.9
9.1
13.5

10.6
8.2
10.3
4.9
9.3
15.4
12.9
11.6
19.6
7.4
7.5
19.6
7.9
9.2
19.2

9.8
12.4
11.0
4.6
10.0
15.4
13.8
16.1
21.8
6.4
10.1
17.9
9.5
10.2
17.1

8.6
12.3
12.1
6.8
11.9
16.4
11.8
10.6
16.3
6.5
7.8
22.6
9.6
9.0
16.5

9.4
11.2
10.7
6.8
8.3
18.0
12.7
13.3
20.4
8.2
8.5
18.2
9.0
8.5
12.0

8.5
9.3
9.4
6.6
7.1
17.0
14.3
15.5
24.6
6.6
8.9
15.8
10.7
11.1
18.0

A8. (cont’d)
Post-Treatment
Rate of Right Lateral Flexion (right-slope)
(degrees/second)

Rate of Left Lateral Flexion (left-slope)
(degrees/second)

Subject

Test

Group

1

2

3

4

5

6

1

2

3

4

5

6

126
126
126
127
127
127
128
128
128
129
129
129
131
131
131

Ex. 2
Ex. 3
Active
Ex. 2
Ex. 3
Active
Ex. 2
Ex. 3
Active
Ex. 2
Ex. 3
Active
Ex. 2
Ex. 3
Active

Long.
Long.
Long.
Long.
Long.
Long.
Long.
Long.
Long.
Long.
Long.
Long.
Long.
Long.
Long.

10.9
10.4
10.8
7.5
8.5
10.4
10.6
12.0
13.7
10.0
6.9
16.8
11.0
10.3
13.8

7.9
11.1
15.9
7.5
8.8
12.8
12.6
14.3
14.4
6.9
5.4
17.4
9.2
12.8
17.4

7.7
12.6
19.6
8.6
10.4
12.7
10.5
10.9
15.8
6.8
8.4
15.3
10.4
12.3
18.3

9.0
13.7
10.8
9.0
9.3
12.0
10.8
11.0
13.8
7.1
9.5
17.3
10.4
12.6
13.6

9.3
12.2
18.7
6.4
11.4
13.6
9.4
12.6
13.0
7.8
7.9
18.6
10.8
14.9
14.6

7.8
9.2
21.0
6.1
10.0
13.9
8.4
12.3
16.9
7.1
9.0
15.5
10.4
15.5
15.9

9.2
9.5
16.7
6.5
6.5
11.4
10.0
11.8
13.5
6.6
8.0
15.5
9.4
9.3
15.3

8.5
9.8
17.5
6.2
8.6
14.6
11.1
13.5
15.8
7.8
10.7
21.7
9.4
10.5
16.5

7.8
11.3
21.7
8.6
9.3
16.0
9.0
13.6
19.6
6.4
9.8
21.9
9.8
8.9
20.8

7.8
12.3
16.1
8.4
11.2
15.8
8.9
10.9
12.7
8.7
11.6
16.8
10.9
12.1
16.7

5.0
10.7
20.0
6.6
11.6
15.0
9.3
12.5
17.7
8.3
8.1
16.6
10.6
13.5
13.1

6.7
9.8
19.7
5.9
10.9
16.1
7.9
12.6
16.0
12.8
10.7
19.2
11.1
13.8
17.1

167

A8. (cont’d)
72-Hours Post-Treatment
Rate of Right Lateral Flexion (right-slope)
(degrees/second)

Rate of Left Lateral Flexion (left-slope)
(degrees/second)

Subject

Test

Group

1

2

3

4

5

6

1

2

3

4

5

6

126
126
126
127
127
127
128
128
128
129
129
129
131
131
131

Ex. 2
Ex. 3
Active
Ex. 2
Ex. 3
Active
Ex. 2
Ex. 3
Active
Ex. 2
Ex. 3
Active
Ex. 2
Ex. 3
Active

Long.
Long.
Long.
Long.
Long.
Long.
Long.
Long.
Long.
Long.
Long.
Long.
Long.
Long.
Long.

12.0
11.3
14.1
10.9
8.4
10.8
12.1
10.1
18.1
8.0
6.9
15.9
11.8
9.8
12.7

12.5
13.5
16.7
9.4
12.0
14.2
13.9
8.6
19.8
6.5
8.6
14.6
10.3
11.3
14.0

11.6
14.9
19.8
9.2
10.0
13.7
13.6
11.9
22.9
6.1
7.3
16.8
11.8
10.3
14.4

14.6
12.6
18.1
9.4
8.4
14.0
17.4
14.7
20.3
9.1
7.6
16.8
10.6
10.5
12.2

12.8
11.3
18.0
8.9
9.8
14.1
16.1
12.1
20.8
5.2
9.5
16.8
10.2
10.6
14.0

10.9
15.4
16.8
8.9
12.7
15.6
12.1
13.5
22.5
7.1
9.9
18.4
13.8
12.5
16.8

11.0
8.7
11.8
11.9
6.3
13.5
15.4
12.0
19.4
7.3
7.5
18.1
10.9
9.5
13.7

12.3
10.4
14.0
9.0
9.3
14.3
16.0
11.2
21.6
7.6
7.5
18.2
12.2
10.0
12.6

11.5
9.9
18.6
9.2
10.4
16.2
15.3
13.1
22.5
5.9
9.0
17.1
12.4
10.3
14.5

14.8
11.3
18.0
9.5
9.9
15.9
14.5
12.9
19.1
9.2
7.6
20.5
10.4
9.7
13.1

11.1
7.6
16.0
8.8
7.3
15.9
13.4
13.0
20.6
9.5
10.2
16.6
12.0
10.6
13.2

11.1
10.9
20.5
7.5
10.0
17.3
13.0
12.6
23.9
5.9
10.4
13.4
12.5
11.4
17.0

168

A9. RMSE of Dissected Cycles

Right Lateral Flexion
(degrees)

Left Lateral Flexion
(degrees)

Lateral Flexion Cycle
(degrees)

RMSE Total
(degrees)

Subject

Test

Group

1

2

3

1

2

3

1

2

3

Right

Left

Cycle

4
4
4
5
5
5
27
27
27
41
41
41
46
46
46
51
51
51
56
56
56
59
59
59
63
63
63

Ex. 2
Ex. 3
Active
Ex. 2
Ex. 3
Active
Ex. 2
Ex. 3
Active
Ex. 2
Ex. 3
Active
Ex. 2
Ex. 3
Active
Ex. 2
Ex. 3
Active
Ex. 2
Ex. 3
Active
Ex. 2
Ex. 3
Active
Ex. 2
Ex. 3
Active

Cont.
Cont.
Cont.
Cont.
Cont.
Cont.
Cont.
Cont.
Cont.
Cont.
Cont.
Cont.
Cont.
Cont.
Cont.
Cont.
Cont.
Cont.
Cont.
Cont.
Cont.
Cont.
Cont.
Cont.
Cont.
Cont.
Cont.

0.7
1.2
2.5
10.4
2.2
3.0
4.3
2.2
2.5
3.2
0.9
3.6
3.2
2.5
1.0
2.4
1.2
4.6
2.7
0.6
0.5
1.2
6.1
2.8
2.1
0.6
5.3

1.1
2.3
2.5
9.7
5.1
3.5
2.9
3.8
2.0
0.9
3.0
2.1
4.8
0.6
2.4
3.9
3.2
0.9
1.7
4.0
2.6
2.6
3.3
2.3
0.8
1.9
5.1

0.8
1.1
1.9
8.0
3.9
3.9
3.4
5.9
2.6
1.8
0.9
0.7
1.5
1.6
0.7
3.6
1.1
3.8
1.3
2.0
0.9
2.6
1.1
2.5
2.0
1.3
0.8

2.1
0.4
1.4
10.7
4.9
1.8
3.8
4.7
2.5
2.9
1.7
2.5
1.2
2.3
1.6
1.8
1.9
1.5
1.5
3.2
2.0
2.3
1.5
3.1
0.6
0.7
2.4

5.0
2.5
0.9
8.3
7.4
2.3
2.1
1.5
1.8
3.5
2.0
2.0
2.5
1.4
1.8

0.8
4.1
3.9
12.0
2.9
1.7
2.0
4.2
1.2
4.1
1.1
2.1
2.3
4.7
2.2

3.6
2.4
1.8
9.0
6.4
3.0
2.6
2.9
1.9
2.6
2.6
2.0
3.8
1.1
2.1

0.8
3.0
3.1
10.2
3.4
3.0
2.8
5.1
2.0
3.1
1.0
1.6
2.0
3.5
1.6

1.9
2.1
2.7
3.5
1.8
4.1
2.6
2.8
2.6
1.3
6.2

2.1
3.0
3.3
3.3
2.7

1.6
0.9
2.0
10.6
3.8
2.5
4.1
3.7
2.5
3.0
1.4
3.1
2.4
2.4
1.3
2.2
1.6
3.4
2.2
2.3
1.4
1.8
4.4
3.0
1.5
0.7
4.1

2.7
1.6
2.3
3.8
2.2
3.4
3.0
2.5
1.9
1.6
5.7

1.7
3.4
2.5
2.8
2.0

0.9
1.6
2.3
9.4
3.9
3.5
3.6
4.3
2.4
2.2
1.9
2.4
3.4
1.8
1.6
3.4
2.1
3.5
2.0
2.6
1.6
2.2
4.0
2.5
1.7
1.4
4.3

3.2
2.8
2.4
10.5
5.4
2.0
2.8
3.7
1.9
3.5
1.7
2.2
2.1
3.1
1.9
1.8
2.0
2.3
2.6
3.3
2.2
3.3
2.3
4.4
2.9
1.0
3.9

2.3
2.3
2.4
9.9
4.7
2.8
3.2
4.0
2.2
2.9
1.8
2.3
2.8
2.5
1.7
3.1
2.0
2.9
2.3
3.0
1.9
2.7
3.3
3.6
2.4
1.2
4.1

169

2.5
6.5
4.2
0.8
1.1

1.9
4.9
3.3
1.1
1.0

A9. (cont’d)
Right Lateral Flexion
(degrees)

Left Lateral Flexion
(degrees)

Lateral Flexion Cycle
(degrees)

RMSE Total
(degrees)

Subject

Test

Group

1

2

3

1

2

3

1

2

3

Right

Left

Cycle

67
67
67
68
68
68
69
69
69
77
77
77
79
79
79
83
83
83
85
85
85
88
88
88
90
90
90

Ex. 2
Ex. 3
Active
Ex. 2
Ex. 3
Active
Ex. 2
Ex. 3
Active
Ex. 2
Ex. 3
Active
Ex. 2
Ex. 3
Active
Ex. 2
Ex. 3
Active
Ex. 2
Ex. 3
Active
Ex. 2
Ex. 3
Active
Ex. 2
Ex. 3
Active

Cont.
Cont.
Cont.
Cont.
Cont.
Cont.
Cont.
Cont.
Cont.
Cont.
Cont.
Cont.
Cont.
Cont.
Cont.
Cont.
Cont.
Cont.
Cont.
Cont.
Cont.
Cont.
Cont.
Cont.
Cont.
Cont.
Cont.

4.3
0.6
5.0
1.9
5.8
0.9
3.6
3.9
1.1
2.8
6.8
6.0
3.2
4.7
3.7
3.3
2.4
2.5
1.7
0.5
2.4
1.9
1.4
1.0
2.0
4.5
0.8

4.5
3.4
5.7
2.8
3.0
3.1
1.5
5.4
3.2
3.1
1.2
2.3
5.4
6.0
4.4
1.7
1.2
2.8
0.9
2.7
1.8
1.1
0.5
3.2
1.1
4.9
3.7

4.1
4.2
4.3
5.6
3.4
2.8
2.0
1.2
1.9
2.2
1.7
7.0
4.0
3.6
1.7
3.6
2.5
1.9
1.4
0.8
1.3
3.7
0.8
2.2
2.6
2.4
2.5

0.6
3.9
1.6
3.3
3.1
1.5
2.6
3.1
3.1
2.0
4.2
3.3
1.1
2.0
2.6
5.0
6.2
3.3
0.9
3.0
2.0
1.0
0.8
10.0
2.4
7.3
1.3

1.3
2.6
4.4
3.7
2.7
2.8
4.6
3.7
4.0
3.5
2.4
5.1
3.5
4.2
1.6
0.6
1.8
2.6
2.7
2.4
2.4
1.3
1.2
7.5
1.9
1.2
7.2

2.5
0.9
1.8
4.2
1.7
1.5
6.1
1.0
4.3
1.8
1.1
4.0
1.0
1.4
1.3
0.9
3.1
1.3
1.9
1.8
2.9
2.2
0.9
5.1
3.0
3.0
4.0

3.1
2.8
3.7
2.7
4.6
1.3
3.2
3.5
2.3
2.4
5.7
4.8
2.4
3.6
3.2
4.2
4.7
2.9
1.3
2.1
2.2
1.5
1.1
7.1
2.2
6.1
1.1

3.3
3.1
5.1
3.3
2.9
3.0
3.4
4.7
3.6
3.3
1.9
4.0
4.5
5.2
3.3
1.3
1.5
2.7
2.0
2.6
2.1
1.2
0.9
5.8
1.6
3.6
5.7

3.4
3.0
3.3
5.0
2.7
2.3
4.5
1.1
3.3
2.0
1.4
5.7
2.9
2.7
1.5
2.6
2.8
1.6
1.7
1.4
2.3
3.0
0.9
3.9
2.8
2.7
3.4

4.3
3.1
5.0
3.8
4.2
2.5
2.5
3.9
2.2
2.7
4.1
5.5
4.3
4.9
3.4
3.0
2.1
2.4
1.4
1.7
1.9
2.5
1.0
2.3
2.0
4.1
2.6

1.7
2.7
2.9
3.8
2.6
2.0
4.7
2.9
3.8
2.5
2.9
4.2
2.2
2.8
1.9
3.0
4.1
2.5
1.9
2.4
2.5
1.6
1.0
7.8
2.5
4.6
4.8

3.3
2.9
4.1
3.8
3.5
2.3
3.8
3.4
3.1
2.6
3.5
4.9
3.4
4.0
2.8
3.0
3.3
2.5
1.7
2.1
2.2
2.1
1.0
5.8
2.3
4.4
3.9

170

A9. (cont’d)
Right Lateral Flexion
(degrees)

Left Lateral Flexion
(degrees)

Lateral Flexion Cycle
(degrees)

RMSE Total
(degrees)

Subject

Test

Group

1

2

3

1

2

3

1

2

3

Right

Left

Cycle

96
96
96
106
106
106
111
111
111
117
117
117

Ex. 2
Ex. 3
Active
Ex. 2
Ex. 3
Active
Ex. 2
Ex. 3
Active
Ex. 2
Ex. 3
Active

Cont.
Cont.
Cont.
Cont.
Cont.
Cont.
Cont.
Cont.
Cont.
Cont.
Cont.
Cont.

3.1
2.6
2.3
5.0
2.0
0.9
1.0
2.5
4.5
3.0
2.5
0.9

2.3
6.1
3.0
3.2
1.9
1.6
2.6
6.2
3.2
0.8
1.7
3.9

3.8
2.0
1.4
1.2
1.6
1.3
2.7
4.3
4.0
5.5
1.1
1.0

1.5
1.9
1.7
1.5
1.1
3.6
2.2
3.4
0.9
1.4
2.8
1.0

0.8
1.1
3.2
5.0
3.2
2.2

2.4
1.8
1.4
2.6
1.2
4.0
1.8
1.4
3.1
3.7
1.6
2.1

2.4
2.3
2.0
3.7
1.6
2.6
1.7
3.0
3.3
2.4
2.6
0.9

1.7
4.4
3.1
4.2
2.6
1.9

3.2
1.9
1.4
2.1
1.4
3.0
2.3
3.2
3.6
4.7
1.4
1.7

3.1
4.0
2.4
3.5
1.9
1.3
2.2
4.6
4.0
3.7
1.8
2.4

1.7
1.7
2.2
3.4
2.1
3.4
1.6
2.3
2.9
2.6
3.2
2.2

2.5
3.1
2.3
3.4
2.0
2.6
2.0
3.6
3.5
3.2
2.6
2.3

Right Lateral Flexion
(degrees)

1.3
3.8
2.1
4.6
3.1

4.5
3.6
1.6
3.5
3.5

Pre-Treatment
Left Lateral Flexion Lateral Flexion Cycle
(degrees)
(degrees)

RMSE Total
(degrees)

Subject

Test

Group

1

2

3

1

2

3

1

2

3

Right

Left

Cycle

6
6
6
9
9
9
12
12
12

Ex. 2
Ex. 3
Active
Ex. 2
Ex. 3
Active
Ex. 2
Ex. 3
Active

Exp.
Exp.
Exp.
Exp.
Exp.
Exp.
Exp.
Exp.
Exp.

3.5
2.6
1.7
2.9
0.7
8.7
5.9
1.5
5.7

11.2
5.7

5.9
4.2

0.7
1.4

2.6
2.2

4.6
3.3

3.1
3.9
8.2
5.6
0.7
5.0

6.4
1.2
1.1
0.5
0.6
7.4

2.8
3.6
1.9
4.1
0.5
5.2

2.7
3.9
3.2
3.7
2.0
6.9
4.2
1.2
4.1

8.0
4.2

4.3
3.5
4.2
3.7
2.8
6.6

1.5
4.9
4.3
4.3
2.8
4.3
1.2
0.8
1.5

5.4
2.6
3.1
2.7
2.1
7.0

2.9
3.7
6.0
4.9
0.6
5.1

7.6
4.4
1.7
3.5
3.0
7.3
5.2
1.9
5.8

1.8
3.2
4.3
4.7
2.7
2.8
2.5
0.7
5.3

5.5
3.8
3.2
4.1
2.9
5.5
4.0
1.4
5.5

171

A9. (cont’d)
Pre-Treatment
Right Lateral Flexion
(degrees)

Left Lateral Flexion
(degrees)

Lateral Flexion Cycle
(degrees)

RMSE Total
(degrees)

Subject

Test

Group

1

2

3

1

2

3

1

2

3

Right

Left

Cycle

14
14
14
23
23
23
25
25
25
54
54
54
55
55
55
57
57
57
70
70
70
72
72
72
80
80
80

Ex. 2
Ex. 3
Active
Ex. 2
Ex. 3
Active
Ex. 2
Ex. 3
Active
Ex. 2
Ex. 3
Active
Ex. 2
Ex. 3
Active
Ex. 2
Ex. 3
Active
Ex. 2
Ex. 3
Active
Ex. 2
Ex. 3
Active
Ex. 2
Ex. 3
Active

Exp.
Exp.
Exp.
Exp.
Exp.
Exp.
Exp.
Exp.
Exp.
Exp.
Exp.
Exp.
Exp.
Exp.
Exp.
Exp.
Exp.
Exp.
Exp.
Exp.
Exp.
Exp.
Exp.
Exp.
Exp.
Exp.
Exp.

1.1
3.8
4.6
2.1
0.6
2.4
1.1
4.0
1.7
1.6
4.4
2.0
0.7
4.4
2.1
1.4
1.9
1.8
3.8
3.4
1.3
1.7
0.8
5.1
2.2
1.6
3.7

1.2
2.5
6.1
2.2
1.2
1.6
1.3
6.6
3.3
4.9
1.6
2.0
1.1
7.2
3.8
2.3
5.0
1.9
2.1
2.0
0.8
0.5
3.4
2.1
1.2
1.0
1.8

2.4
1.1
4.2
3.1
4.0
2.2
3.4
3.5
3.8
0.8
1.3
1.4

1.6
3.0
9.9
5.1
1.3
4.5
1.5
1.8
0.8
3.3
6.2
4.4
1.2
2.1
2.5
7.1
1.7
3.2
0.6
1.0
2.2
2.3
7.7
2.9
2.5
1.5
0.7

2.0
4.1
4.8
4.5
1.3
3.4
4.0
3.4
2.4
3.2
5.3
5.1
0.6
4.8
2.2
2.5
2.5
1.2
0.9
1.8
1.9
1.5
0.7
4.0
3.0
3.3
3.4

3.6
5.4
6.9
1.5
1.6
2.6
2.4
3.1
1.0
6.6
4.1
2.4

1.3
3.4
7.7
3.9
1.0
3.6
1.3
3.1
1.3
2.6
5.4
3.4
1.0
3.4
2.3
5.1
1.8
2.6
2.7
2.5
1.8
2.0
5.5
4.1
2.4
1.5
2.7

1.7
3.4
5.5
3.6
1.2
2.7
3.0
5.3
2.9
4.2
4.0
3.9
0.9
6.1
3.1
2.4
4.0
1.6
1.6
1.9
1.4
1.1
2.5
3.2
2.3
2.5
2.7

3.1
3.9
5.7
2.5
3.1
2.4
2.9
3.3
2.7
4.7
3.0
2.0

1.7
2.7
5.0
2.5
2.4
2.1
2.2
4.9
3.1
3.0
2.8
1.8
0.9
5.0
2.7
2.0
3.8
1.8
3.9
2.4
1.5
1.2
3.3
3.3
1.6
1.4
2.7

2.5
4.3
7.5
4.0
1.4
3.6
2.8
2.9
1.6
4.7
5.3
4.2
0.9
3.2
2.4
4.4
3.0
2.2
1.5
1.6
1.9
3.0
4.6
3.3
2.3
2.4
2.2

2.2
3.6
6.4
3.4
2.0
2.9
2.5
4.0
2.4
3.9
4.2
3.2
0.9
4.2
2.6
3.4
3.4
2.0
2.9
2.0
1.7
2.3
4.0
3.3
2.0
2.0
2.5

1.9
1.6
2.1
3.7
1.7
5.1
1.2
2.0
1.1
4.6
1.6
0.9
1.7
2.0

172

1.6
1.8
4.2
1.6
2.4
1.7
1.7
4.5
1.9
2.9
0.9
1.9
1.8

1.7
2.0
3.9
1.6
4.0
1.5
1.9
3.3
3.5
2.3
0.9
1.8
1.9

A9. (cont’d)
Pre-Treatment
Right Lateral Flexion
(degrees)

Left Lateral Flexion
(degrees)

Lateral Flexion
Cycle (degrees)

RMSE Total
(degrees)

Subject

Test

Group

1

2

3

1

2

3

1

2

3

Right

Left

Cycle

84
84
84
91
91
91
95
95
95
98
98
98
112
112
112
115
115
115
125
125
125

Ex. 2
Ex. 3
Active
Ex. 2
Ex. 3
Active
Ex. 2
Ex. 3
Active
Ex. 2
Ex. 3
Active
Ex. 2
Ex. 3
Active
Ex. 2
Ex. 3
Active
Ex. 2
Ex. 3
Active

Exp.
Exp.
Exp.
Exp.
Exp.
Exp.
Exp.
Exp.
Exp.
Exp.
Exp.
Exp.
Exp.
Exp.
Exp.
Exp.
Exp.
Exp.
Exp.
Exp.
Exp.

1.8
2.6
1.0
1.7
2.6
1.5
2.8
1.7
2.0
1.4
3.7
9.8
1.9
1.2
4.1
2.7
2.7

5.1
4.6
2.1
1.0
2.6
2.7
2.5
3.6
3.4
1.8
4.0
4.7
0.9
3.4
2.0
3.1
2.5

4.4
4.1
3.2
2.0
3.0
3.4
1.1
5.6
2.6
2.1
2.2
2.2
4.9
1.6
2.5
2.7
1.0

0.5
1.2
4.1
3.2
1.8
2.4
4.4
2.4
6.0
2.2
4.1
3.6
1.7
2.4
0.8
1.2
6.6

1.2
1.7
10.1
2.0
2.7
2.2
0.8
4.0
4.1
2.7
2.6
5.3
1.2
0.8
1.8
1.1
3.7

2.1
2.3
6.2
4.3
3.8
1.3
1.1
2.2
3.1
7.5
3.8
4.4
2.5
1.1
2.1

3.7
3.4
7.3
1.6
2.7
2.5
1.9
3.8
3.8
2.3
3.4
5.0
1.0
2.4
1.9
2.3
3.2

3.4
3.3
5.0
3.4
3.4
2.6
1.1
4.3
2.9
5.5
3.1
3.5
3.9
1.4
2.3

2.4

1.3
2.0
3.0
2.6
2.3
2.0
3.7
2.1
4.4
1.8
3.9
7.4
1.8
1.9
2.9
2.1
5.1

1.9

4.0
3.8
2.3
1.6
2.8
2.7
2.3
4.0
2.7
1.8
3.4
6.4
3.1
2.3
3.0
2.8
2.2

1.4
1.8
7.2
3.3
2.9
2.0
2.7
3.0
4.6
4.8
3.5
4.5
1.9
1.6
1.6
1.1
4.6

3.0
3.0
5.4
2.6
2.8
2.4
2.5
3.5
3.8
3.6
3.5
5.5
2.6
2.0
2.4
2.3
3.6

0.9
1.5
2.4

0.5
0.9
2.6

2.4
3.8
3.4

1.0
1.6
2.3

1.8
1.3
1.5

2.2
1.5
1.5

0.9
1.5
2.3

1.3
1.1
2.1

2.3
2.9
2.6

1.5
2.4
2.8

1.7
1.5
1.8

1.6
2.0
2.4

173

A9. (cont’d)
Post-Treatment
Right Lateral Flexion
(degrees)

Left Lateral Flexion
(degrees)

Lateral Flexion
Cycle (degrees)

RMSE Total
(degrees)

Subject

Test

Group

1

2

3

1

2

3

1

2

3

Right

Left

Cycle

6
6
6
9
9
9
12
12
12
14
14
14
23
23
23
25
25
25
54
54
54
55
55
55
57
57
57

Ex. 2
Ex. 3
Active
Ex. 2
Ex. 3
Active
Ex. 2
Ex. 3
Active
Ex. 2
Ex. 3
Active
Ex. 2
Ex. 3
Active
Ex. 2
Ex. 3
Active
Ex. 2
Ex. 3
Active
Ex. 2
Ex. 3
Active
Ex. 2
Ex. 3
Active

Exp.
Exp.
Exp.
Exp.
Exp.
Exp.
Exp.
Exp.
Exp.
Exp.
Exp.
Exp.
Exp.
Exp.
Exp.
Exp.
Exp.
Exp.
Exp.
Exp.
Exp.
Exp.
Exp.
Exp.
Exp.
Exp.
Exp.

4.6
1.2
2.0
7.2
2.3
2.2
0.7
1.9
3.4
3.0
2.0
4.9
1.5
0.8
2.9
2.0
1.0
1.4
2.2
3.5
3.1
2.1
1.4
1.7
2.1
1.2
3.7

2.7
1.0
0.5
8.5
1.3
3.9
3.5
1.0
2.0
10.7
2.0
3.5
4.3
2.1
2.2
1.0
1.6
5.0
1.7
3.8
5.3
1.1
1.7
1.7
3.3
1.6
3.4

3.7
1.5
0.9
7.4
6.2
3.3
4.0
0.7
2.0
6.2
3.2
1.1
3.5
2.7
3.3
2.4
1.5
2.1
3.5
3.0
2.3
2.2
5.0
1.2
1.7
4.5
2.8

2.4
1.6
3.0
5.6
2.0
2.4
2.8
2.3
4.7
5.1
15.6
3.9
5.7
2.9
4.3
1.7
2.8
7.2
3.3
1.2
2.0
0.9
1.7
4.2
1.2
2.3
2.4

2.1
2.2
4.3
1.5
0.8
2.1
4.1
0.5
1.9
5.1
11.3
1.4
4.7
5.1
2.5
1.4
6.2
6.9
1.2
1.5
3.4
1.7
0.8
3.6
1.5
2.3
1.9

1.4
2.4
2.1
4.0
2.1
1.3
2.6
2.1
4.4
3.7
9.5
11.0
3.1
3.0
1.1
3.1
1.3
6.5
1.1
1.4
2.6
1.5
6.1
2.1
3.8
2.1
4.7

3.7
1.4
2.6
6.5
2.2
2.3
2.1
2.1
4.1
4.2
11.1
4.5
4.1
2.2
3.7
1.9
2.1
5.2
2.8
2.6
2.6
1.6
1.6
3.2
1.7
1.8
3.1

2.4
1.7
3.1
6.1
1.1
3.1
3.8
0.8
2.0
8.4
8.1
2.7
4.5
3.9
2.3
1.2
4.5
6.0
1.5
2.9
4.5
1.4
1.3
2.8
2.6
2.0
2.7

2.8
2.0
1.6
5.9
4.6
2.5
3.4
1.6
3.4
5.1
7.1
7.8
3.3
2.8
2.4
2.8
1.4
4.8
2.6
2.3
2.5
1.9
5.6
1.7
2.9
3.5
3.9

3.8
1.2
1.3
7.7
3.9
3.2
3.1
1.3
2.6
7.3
2.5
3.6
3.3
2.0
2.8
1.9
1.4
3.2
2.6
3.4
3.8
1.8
3.1
1.6
2.4
2.8
3.3

2.0
2.1
3.3
4.0
1.7
2.0
3.2
1.8
3.9
4.7
12.4
6.8
4.6
3.8
3.0
2.2
4.0
6.9
2.1
1.4
2.8
1.4
3.7
3.4
2.5
2.2
3.3

3.0
1.7
2.5
6.2
3.0
2.7
3.2
1.6
3.3
6.2
8.9
5.4
4.0
3.1
2.9
2.1
3.0
5.4
2.4
2.6
3.3
1.6
3.4
2.7
2.4
2.5
3.3

174

A9. (cont’d)
Post-Treatment
Right Lateral Flexion
(degrees)

Left Lateral Flexion
(degrees)

Lateral Flexion Cycle
(degrees)

RMSE Total
(degrees)

Subject

Test

Group

1

2

3

1

2

3

1

2

3

Right

Left

Cycle

70
70
70
72
72
72
80
80
80
84
84
84
91
91
91
95
95
95
98
98
98
112
112
112

Ex. 2
Ex. 3
Active
Ex. 2
Ex. 3
Active
Ex. 2
Ex. 3
Active
Ex. 2
Ex. 3
Active
Ex. 2
Ex. 3
Active
Ex. 2
Ex. 3
Active
Ex. 2
Ex. 3
Active
Ex. 2
Ex. 3
Active

Exp.
Exp.
Exp.
Exp.
Exp.
Exp.
Exp.
Exp.
Exp.
Exp.
Exp.
Exp.
Exp.
Exp.
Exp.
Exp.
Exp.
Exp.
Exp.
Exp.
Exp.
Exp.
Exp.
Exp.

2.9
1.9
5.3
2.0
6.5
1.9
2.9
1.3
2.1
3.0
2.3
4.5
2.4
3.7
2.5
3.5

1.1
3.0
5.0
0.9
4.2
1.6
3.7
1.2
3.9
0.5
4.3
4.7
1.7
4.2
7.3
1.9

2.2
3.4
0.9
4.9
1.7
2.4
2.0
1.1
1.1
1.3
2.2
6.0
1.7
1.2
3.7
0.8

5.4
0.7
2.0
4.5
3.6
1.9
0.6
2.8
3.1
1.6
1.1
4.4
2.5
3.6
2.1
0.6

2.7
1.5
5.3
6.1
2.0
3.1
2.2
1.3
2.0
0.9
1.3
3.8
1.8
3.5
4.3
1.5

3.6
3.7
2.2
2.0
1.7
1.4
1.3
1.3
1.2
1.2
1.8
2.6
1.4
2.6
4.8
0.7

4.4
1.4
4.0
3.5
5.2
1.9
2.1
2.2
2.7
2.4
1.8
4.5
2.4
3.6
2.3
2.5

2.1
2.4
5.2
4.4
3.3
2.5
3.0
1.3
3.1
0.8
3.2
4.3
1.7
3.8
6.0
1.7

3.0
3.5
1.7
3.8
1.7
2.0
1.7
1.2
1.1
1.3
2.0
4.7
1.6
2.1
4.3
0.8

2.2
2.8
4.2
3.1
4.6
2.0
3.0
1.2
2.6
1.9
3.1
5.1
1.9
3.3
4.9
2.4

4.1
2.3
3.5
4.5
2.6
2.2
1.5
1.9
2.2
1.3
1.4
3.7
1.9
3.3
3.9
1.0

3.3
2.6
3.9
3.9
3.7
2.1
2.4
1.6
2.5
1.6
2.4
4.5
1.9
3.3
4.5
1.8

2.1
6.1
3.6
1.9
1.6
2.6
1.2

2.9
1.4
2.3
3.3
2.1
1.6
3.9

1.3
1.8
0.8
1.2
1.8
2.0
1.5

1.7
3.3
3.7
1.0
3.0
0.9
2.4

1.1
0.9
2.5
1.1
2.7
1.9
2.3

3.7
1.2
2.0
1.5
3.7
1.1
2.4

1.9
4.9
3.6
1.5
2.4
2.0
1.9

2.2
1.2
2.4
2.4
2.4
1.7
3.2

2.8
1.5
1.6
1.3
2.9
1.6
2.0

2.2
3.8
2.5
2.3
1.8
2.1
2.5

2.4
2.1
2.8
1.2
3.2
1.3
2.4

2.3
3.0
2.7
1.8
2.6
1.8
2.4

175

A9. (cont’d)
Post-Treatment
Right Lateral Flexion
(degrees)

Left Lateral Flexion
(degrees)

Lateral Flexion Cycle
(degrees)

RMSE Total
(degrees)

Subject

Test

Group

1

2

3

1

2

3

1

2

3

Right

Left

Cycle

115
115
115
125
125
125

Ex. 2
Ex. 3
Active
Ex. 2
Ex. 3
Active

Exp.
Exp.
Exp.
Exp.
Exp.
Exp.

2.9
1.2
6.3
2.5
6.2
2.9

2.5
3.3
2.5
1.9
5.8
4.5

3.9
2.4
5.8
1.6
4.9
1.4

2.5
1.8
2.0
0.8
3.2
1.4

0.7
1.9
20.8
1.3
5.8
1.8

1.7
1.2
21.9
0.9
5.2
1.8

2.7
1.6
4.7
1.9
4.9
2.3

1.8
2.7
14.8
1.6
5.8
3.5

3.0
1.9
16.0
1.3
5.0
1.6

3.1
2.4
5.2
2.1
5.6
3.2

1.8
1.7
17.5
1.0
4.9
1.7

2.6
2.1
12.9
1.6
5.3
2.6

Pre-Treatment
Right Lateral Flexion
(degrees)

Left Lateral Flexion
(degrees)

Lateral Flexion Cycle
(degrees)

RMSE Total
(degrees)

Subject

Test

Group

1

2

3

1

2

3

1

2

3

Right

Left

Cycle

126
126
126
127
127
127
128
128
128
129
129
129
131
131
131

Ex. 2
Ex. 3
Active
Ex. 2
Ex. 3
Active
Ex. 2
Ex. 3
Active
Ex. 2
Ex. 3
Active
Ex. 2
Ex. 3
Active

Long.
Long.
Long.
Long.
Long.
Long.
Long.
Long.
Long.
Long.
Long.
Long.
Long.
Long.
Long.

1.5
1.3
2.2
1.3
3.1
2.7
1.9
0.6
1.1
1.3
4.0
1.1
2.1
1.8
2.1

4.0
0.6
1.2
1.8
3.6
3.3
1.4
2.0
2.4
1.7
3.0
0.9
2.4
3.4
4.2

3.5
1.2
0.9
1.8
2.8
1.5
3.2
3.7
0.7
2.6
6.8
3.2
0.9
2.8
4.6

2.2
1.4
2.5
1.8
0.8
2.5
3.8
2.3
2.9
1.0
1.1
4.5
5.1
4.0
1.8

2.4
1.4
3.0
2.4
3.0
1.5
1.1
4.9
0.5
1.7
5.6
0.9
3.5
2.2
3.5

1.0
3.1
0.9
4.4
3.6
1.8
1.1
1.5
0.7
1.9
2.9
6.1
2.5
1.9
2.8

1.9
1.4
2.4
1.6
2.2
2.6
3.0
1.7
2.2
1.2
2.9
3.3
3.9
3.1
2.0

3.3
1.1
2.3
2.2
3.3
2.6
1.3
3.8
1.7
1.7
4.4
0.9
3.0
2.9
3.9

2.6
2.3
0.9
3.4
3.2
1.7
2.4
2.8
0.7
2.3
5.2
4.9
1.9
2.4
3.8

3.2
1.1
1.6
1.7
3.2
2.6
2.3
2.5
1.5
2.0
4.8
2.0
1.9
2.8
3.8

2.0
2.1
2.3
3.1
2.7
2.0
2.4
3.2
1.8
1.6
3.7
4.4
3.9
2.8
2.8

2.7
1.7
2.0
2.5
3.0
2.3
2.3
2.9
1.7
1.8
4.3
3.4
3.1
2.8
3.3

176

A9. (cont’d)
Post-Treatment
Right Lateral Flexion
(degrees)

Left Lateral Flexion
(degrees)

Lateral Flexion Cycle
(degrees)

RMSE Total
(degrees)

Subject

Test

Group

1

2

3

1

2

3

1

2

3

Right

Left

Cycle

126
126
126
127
127
127
128
128
128
129
129
129
131
131
131

Ex. 2
Ex. 3
Active
Ex. 2
Ex. 3
Active
Ex. 2
Ex. 3
Active
Ex. 2
Ex. 3
Active
Ex. 2
Ex. 3
Active

Long.
Long.
Long.
Long.
Long.
Long.
Long.
Long.
Long.
Long.
Long.
Long.
Long.
Long.
Long.

1.7
2.9
3.2
1.3
3.4
5.1
1.7
1.6
2.7
1.9
3.6
3.2
2.6
1.6
0.9

4.1
3.1
3.5
1.3
3.3
5.1
3.8
1.7
4.2
4.2
3.9
1.1
2.1
1.7
2.4

5.6
1.4
0.9
3.9
0.7
1.9
2.2
1.8
1.4
5.0
2.1
0.9
1.2
4.8
1.7

3.5
2.0
1.6
1.6
3.8
1.7
1.6
6.0
2.5
2.0
3.2
4.0
0.6
1.8
2.5

1.9
3.1
3.1
1.2
2.0
3.6
3.4
1.6
0.5
6.4
1.6
1.0
1.2
2.4
2.5

2.1
0.7
2.7
0.8
3.0
3.7
1.7
2.4
1.9
6.6
2.1
3.9
0.8
1.6
2.0

2.8
2.5
2.5
1.5
3.6
3.8
1.7
4.4
2.6
1.9
3.4
3.6
1.9
1.7
1.9

3.2
3.1
3.3
1.3
2.7
4.4
3.6
1.7
3.0
5.4
3.0
1.1
1.7
2.1
2.5

4.2
1.1
2.0
2.8
2.2
3.0
2.0
2.1
1.7
5.9
2.1
2.9
1.0
3.6
1.9

4.1
2.6
2.8
2.5
2.7
4.3
2.7
1.7
3.0
3.9
3.3
2.0
2.0
3.1
1.8

2.6
2.2
2.6
1.3
3.0
3.1
2.4
3.8
1.8
5.4
2.4
3.3
0.9
2.0
2.4

3.5
2.4
2.7
2.0
2.9
3.8
2.6
3.0
2.5
4.7
2.9
2.7
1.6
2.6
2.1

177

A9. (cont’d)
72-Hours Post-Treatment
Right Lateral Flexion
(degrees)

Left Lateral Flexion
(degrees)

Lateral Flexion Cycle
(degrees)

RMSE Total
(degrees)

Subject

Test

Group

1

2

3

1

2

3

1

2

3

Right

Left

Cycle

126
126
126
127
127
127
128
128
128
129
129
129
131
131
131

Ex. 2
Ex. 3
Active
Ex. 2
Ex. 3
Active
Ex. 2
Ex. 3
Active
Ex. 2
Ex. 3
Active
Ex. 2
Ex. 3
Active

Long.
Long.
Long.
Long.
Long.
Long.
Long.
Long.
Long.
Long.
Long.
Long.
Long.
Long.
Long.

1.8
1.6
1.0
0.5
2.9
2.0
1.4
1.8
1.9
1.5
0.7
3.6
1.1
0.6
1.1

1.6
5.9
1.4
0.8
1.7
0.5
3.0
2.5
1.9
1.0
3.2
0.7
1.5
1.5
0.6

2.6
1.6
1.7
1.8
2.1
1.0
2.3
3.4
1.6
2.5
4.2
1.4
1.5
4.2
1.2

1.0
3.0
1.5
0.9
1.5
1.1
7.4
0.8
2.4
2.6
3.2
2.3
0.8
1.6
2.7

1.7
2.3
3.3
1.9
1.3
1.2
6.6
3.2
4.0
3.9
0.6
3.8
1.5
1.3
2.9

3.2
2.6
3.3
1.2
0.9
1.4
2.6
1.6
6.0
1.5
2.7
1.5
0.8
1.2
1.7

1.5
2.4
1.3
0.8
2.3
1.6
5.4
1.4
2.2
2.1
2.3
3.0
1.0
1.2
2.0

1.7
4.5
2.5
1.5
1.5
0.9
5.1
2.9
3.1
2.9
2.3
2.8
1.5
1.4
2.1

2.9
2.2
2.6
1.5
1.6
1.2
2.5
2.6
4.4
2.1
3.5
1.4
1.2
3.1
1.5

2.1
3.7
1.4
1.2
2.3
1.3
2.3
2.6
1.8
1.8
3.1
2.3
1.4
2.6
1.0

2.1
2.6
2.8
1.4
1.3
1.3
6.0
2.1
4.4
2.8
2.4
2.7
1.1
1.4
2.5

2.1
3.2
2.2
1.3
1.9
1.3
4.5
2.4
3.4
2.4
2.8
2.5
1.2
2.1
1.9

178

A10. RMSE of Complete Time Series
RMSE (degrees)
Subject

Test

Group

RMSE
(degrees)

Subject

Test

Group

4
4
4
5
5
5
27
27
27
41
41
41
46
46
46
51
51
51
56
56
56
59
59
59
63
63
63

Ex. 2
Ex. 3
Active
Ex. 2
Ex. 3
Active
Ex. 2
Ex. 3
Active
Ex. 2
Ex. 3
Active
Ex. 2
Ex. 3
Active
Ex. 2
Ex. 3
Active
Ex. 2
Ex. 3
Active
Ex. 2
Ex. 3
Active
Ex. 2
Ex. 3
Active

Cont.
Cont.
Cont.
Cont.
Cont.
Cont.
Cont.
Cont.
Cont.
Cont.
Cont.
Cont.
Cont.
Cont.
Cont.
Cont.
Cont.
Cont.
Cont.
Cont.
Cont.
Cont.
Cont.
Cont.
Cont.
Cont.
Cont.

12.6
6.6
17.6
12.9
8.3
22.7
7.8
6.1
8.6
7.6
11.2
5.6
7.7
18.5
9.7
8.8
10.1
15.1
6.1
5.1
13.6
8.0
5.2
10.9
8.2
4.7
12.0

6
6
6
9
9
9
12
12
12
14
14
14
23
23
23
25
25
25
54
54
54
55
55
55
57
57
57

Ex. 2
Ex. 3
Active
Ex. 2
Ex. 3
Active
Ex. 2
Ex. 3
Active
Ex. 2
Ex. 3
Active
Ex. 2
Ex. 3
Active
Ex. 2
Ex. 3
Active
Ex. 2
Ex. 3
Active
Ex. 2
Ex. 3
Active
Ex. 2
Ex. 3
Active

Exp.
Exp.
Exp.
Exp.
Exp.
Exp.
Exp.
Exp.
Exp.
Exp.
Exp.
Exp.
Exp.
Exp.
Exp.
Exp.
Exp.
Exp.
Exp.
Exp.
Exp.
Exp.
Exp.
Exp.
Exp.
Exp.
Exp.

179

PrePostTreatment Treatment
7.3
9.0
4.2
12.0
6.1
6.9
6.6
3.9
6.7
16.7
17.9
38.2
8.7
4.2
5.4
5.6
6.9
14.0
10.3
5.9
6.0
3.0
9.8
3.8
7.3
8.1
19.5

5.4
10.7
6.3
7.5
8.8
5.8
6.8
12.1
18.5
10.9
21.8
12.2
11.6
10.2
7.9
5.9
22.2
8.5
4.1
10.7
5.4
10.5
9.3
7.6
9.2
10.0

A10. (cont’d)
RMSE (degrees)
Subject

Test

Group

RMSE
(degrees)

Subject

Test

Group

67
67
67
68
68
68
69
69
69
77
77
77
79
79
79
83
83
83
85
85
85
88
88
88
90
90
90

Ex. 2
Ex. 3
Active
Ex. 2
Ex. 3
Active
Ex. 2
Ex. 3
Active
Ex. 2
Ex. 3
Active
Ex. 2
Ex. 3
Active
Ex. 2
Ex. 3
Active
Ex. 2
Ex. 3
Active
Ex. 2
Ex. 3
Active
Ex. 2
Ex. 3
Active

Cont.
Cont.
Cont.
Cont.
Cont.
Cont.
Cont.
Cont.
Cont.
Cont.
Cont.
Cont.
Cont.
Cont.
Cont.
Cont.
Cont.
Cont.
Cont.
Cont.
Cont.
Cont.
Cont.
Cont.
Cont.
Cont.
Cont.

11.6
5.3
10.4
8.1
7.6
4.7
7.0
7.7
19.7
3.6
12.6
36.9
8.3
5.5
7.9
6.1
11.1
3.2
4.5
10.0
8.4
3.8
3.4
5.7
7.1
11.2
16.3

70
70
70
72
72
72
80
80
80
84
84
84
91
91
91
95
95
95
98
98
98
112
112
112
115
115
115

Ex. 2
Ex. 3
Active
Ex. 2
Ex. 3
Active
Ex. 2
Ex. 3
Active
Ex. 2
Ex. 3
Active
Ex. 2
Ex. 3
Active
Ex. 2
Ex. 3
Active
Ex. 2
Ex. 3
Active
Ex. 2
Ex. 3
Active
Ex. 2
Ex. 3
Active

Exp.
Exp.
Exp.
Exp.
Exp.
Exp.
Exp.
Exp.
Exp.
Exp.
Exp.
Exp.
Exp.
Exp.
Exp.
Exp.
Exp.
Exp.
Exp.
Exp.
Exp.
Exp.
Exp.
Exp.
Exp.
Exp.
Exp.

180

PrePostTreatment Treatment
8.5
3.0
13.7
8.8
10.1
6.6
10.6
5.5
5.7
5.6
4.9
7.1
7.1
5.1
13.6
10.8
11.4
5.0
6.1
11.0
12.0
12.2
6.0
14.9
5.2
7.8

7.2
14.7
4.3
8.3
6.7
4.9
5.4
7.2
5.7
5.3
5.9
4.8
16.7
12.8
8.1
8.8
11.4
6.8
8.6
10.3
11.7
12.5
9.0
5.7
10.4
20.9

A10. (cont’d)
RMSE (degrees)
Subject

Test

Group

RMSE
(degrees)

96
96
96
106
106
106
111
111
111
117
117
117

Ex. 2
Ex. 3
Active
Ex. 2
Ex. 3
Active
Ex. 2
Ex. 3
Active
Ex. 2
Ex. 3
Active

Cont.
Cont.
Cont.
Cont.
Cont.
Cont.
Cont.
Cont.
Cont.
Cont.
Cont.
Cont.

9.6
5.7
6.4
8.5
6.5
6.4
8.0
6.6
17.6
11.2
9.2
12.3

Subject

Test

Group

125
125
125

Ex. 2
Ex. 3
Active

Exp.
Exp.
Exp.

181

PrePostTreatment Treatment
5.4
7.5
4.6

6.2
5.0
3.4

A10. (cont’d)
RMSE (degrees)
Subject

Test

Group

126
126
126
127
127
127
128
128
128
129
129
129
131
131
131

Ex. 2
Ex. 3
Active
Ex. 2
Ex. 3
Active
Ex. 2
Ex. 3
Active
Ex. 2
Ex. 3
Active
Ex. 2
Ex. 3
Active

Long.
Long.
Long.
Long.
Long.
Long.
Long.
Long.
Long.
Long.
Long.
Long.
Long.
Long.
Long.

PrePostTreatment Treatment
3.7
5.1
10.6
4.8
6.0
12.1
11.7
11.5
13.6
4.4
7.5
11.7
5.8
10.0
9.3

182

7.7
10.9
5.0
12.1
9.6
6.8
3.9
8.1
5.8
6.5
7.2
7.4
4.1
12.0
15.8

72Hours
11.3
7.1
15.1
5.9
5.6
10.5
6.7
15.9
16.6
4.5
7.4
7.7
4.0
6.8
10.6

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