MATERIAL AND METHODOLOGYMATERIAL Following are the materials used in the studyX-rays of cervical spine (lateral view), marker,

, ruler, protractor, view box, camera. ASSESSMENT TOOLSVisual analogue scale (VAS), Neck disability index (NDI) and Clinical prediction rule for cervical radiculopathy (CPR for CR) (31,32,33).

METHODSStudy design- Observational study. Duration of study- 6 months. Subjects- Patients with non-specific chronic axial neck pain. Sampling criteria- Random sampling Inclusion criteria1. Both male and female subjects of age between 20 to 40 years. 2. Subjects with non-specific axial neck pain of more than 6 months duration. 3. Subjects willing to participate in study. Exclusion criteria1. Subjects having history of trauma of cervical spine. 2. Subjects having systemic disease involving cervical spine e.g. (rheumatoid arthritis, tuberculosis etc.). 3. Subjects having radiculopathy.

STATISTICAL TOOLSNeck pain prevalence (gender wise), neck pain intensity, disability due to neck pain and cervical spine curvature were tabulated for each of the patient. These values were tested for statistically significant differences using Fishers z-test. The whole study population was used to calculate the prevalence estimates. Spearman rank correlation coefficients were used to measure the correlation between neck pain intensity, disability due to neck pain and cervical spine curvature.

PROCEDURE110 volunteers with an average age of 34 years agreed to participate in the study which was approved by Ethics cum Research Committee of our college. The volunteers were patients of non-specific chronic axial neck pain between 20 to 40 years of age that were visiting the outpatient department of our hospital. All patients provided informed consent prior to their enrollment in the study. All patients were screened for eligibility using exact inclusion and exclusion criteria. The patients underwent a standardized history and physical examination which included items in CPR, pain and disability assessment. Demographic information was collected

including age, sex, location and nature of patients symptoms and number of days since onset of symptoms. Details regarding the physical examination are published later and include cervical spine curvature, pain intensity, neck disability and cervical spine ROM.

Clinical prediction rules for identifying cervical radiculopathySpurling test Distraction test Upper limb tension test 1 Ipsilateral cervical rotation<60

If 3 or 4 tests of clinical prediction rule are positive, patients are likely to have cervical radiculopathy and are excluded from study.

CERVICAL SPINE CURVATURE MEASUREMENT-

The subjects stood in relaxed position, they were instructed to simply close their eyes, flex,
extend the head twice, come to their most neutral relaxed position, hold this position still, and then open their eyes, so as to position their cervical spine in neutral position (34). Weights

in the form of dumbbells were held in both the hands to depress the shoulders (to obtain a clear view of all seven cervical vertebra). The beam of the radiograph was centered 15 cm below the ear at a distance of 150 cm to the film plate. Cervical spine angles were evaluated from the lateral radiographs using the posterior tangent technique originally described by Albers (35) and Gore et al. Harrison et al (36) re-examined this technique and reported good inter and reliability, with a lower standard error of measurement (less than 2) than that typically reported for Cobb angle measurements. The angle between the posterior wall of the vertebral body of C2 and C7 gave the total cervical curvature. In ten patients it was not possible to visualize C7 due to unfavorable anatomical conditions. As clinically normal range of cervical lordosis is between 31 to 40 degrees, the curvature of cervical spine was assessed.

Schematic diagram of the posterior tangent method of Harrison et al.(36) tangent lines at the posterior vertebral body margins (here of C2 and C7) are drawn and the angle of these intersecting lines is measured

DISABILITY MEASUREMENTThe NDI (37,38,39) is most widely used condition specific disability scale for patients with neck pain and consists of 10 items addressing different aspects of function, each scoring from 0 to 5, with a maximum score of 50 points. The score is then doubled and interpreted as a percentage of the patient perceived disability. Higher scores represent increased levels of disability. The NDI has been reported to be a reliable and valid outcome measure for patients with neck pain. The patients were asked to fill the NDI and the percentage disability was calculated.

PAIN ASSESSMENTPain rating was done by Visual Analogue Scale (VAS) (60). It is an arbitrary scale of 10 cm with 10 mark as extreme of pain and 0 mark as no pain. The patients were asked to rate the intensity of their pain on the scale using a pen.

Data so collected was analyzed to find correlation between different variables.