Prevalence of Cervical Spine Dysfunction in Patients Seeking Physiotherapy for Chronic Lower Back Pain

Abstract

Background: Chronic low back pain is commonly evaluated using a region-specific approach, although impairments may coexist across different spinal regions. Evidence regarding cervical dysfunction among patients primarily seeking treatment for chronic low back pain remains limited. Objective: To determine the prevalence of cervical spine dysfunction among adults seeking physiotherapy for chronic low back pain and examine its associations with pain intensity and lumbar-related disability. Methods: This cross-sectional study included 72 adults aged 20–60 years recruited consecutively from physiotherapy outpatient departments in the Islamabad–Rawalpindi region. Low back pain intensity was assessed using the Visual Analogue Scale, lumbar disability using the Oswestry Disability Index, and cervical impairment using the Neck Disability Index, cervical range-of-motion assessment, and postural examination. Cervical dysfunction was defined by the presence of at least two cervical impairment criteria. Prevalence, Pearson correlations, Welch t-tests, confidence intervals, and Hedges’ g were calculated. Results: Cervical spine dysfunction was identified in 44 participants, producing a prevalence of 61.1% (95% CI: 49.6–71.5%). Neck Disability Index scores correlated with Oswestry Disability Index (r=0.52; p<0.001) and Visual Analogue Scale scores (r=0.47; p=0.002). Participants with cervical dysfunction had higher pain scores than those without dysfunction (6.8 ± 1.2 versus 5.5 ± 1.3; mean difference 1.30; 95% CI: 0.69–1.91) and greater lumbar disability (36.9 ± 7.8 versus 26.1 ± 6.5; mean difference 10.80; 95% CI: 7.40–14.20). Conclusion: Cervical spine dysfunction was common and was associated with greater pain and lumbar-related disability. Broader spinal assessment may help identify coexisting impairments, although causal and treatment-related conclusions cannot be drawn