Generalized joint hypermobility and chronic neck pain: associations with dynamic cervical spine instability

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Project Summary/Abstract Chronic neck pain is a significant socioeconomic burden and a leading cause of disability in the United States. Static imaging and physical examination often fail to identify a specific source of pain, hindering the development of targeted interventions and contributing to poor outcomes. Evidence suggests that individuals with generalized joint hypermobility (GJH), an excessive range of motion across multiple joints affecting approximately 20% of the population, are more likely to develop chronic neck pain. The long-term objective of this research is to develop effective and targeted interventions to improve outcomes in chronic neck pain. As a step towards this goal, the objective of the proposed study is to identify clinical features and biomechanical mechanisms of chronic neck pain in GJH. Aim 1 will determine the prevalence and clinical features of chronic neck pain in GJH. Data collection for this first phase of the study will take place at a research facility at the Minnesota State Fair, providing a large, diverse sample of the general public across the lifespan. Aim 2 will determine the extent to which dynamic intersegmental instability is associated with chronic neck pain, and mediated by neck strength and endurance, in individuals with GJH. Study groups will include GJH with chronic neck pain, asymptomatic GJH, and age- and sex- matched healthy controls. The measurement of dynamic intersegmental instability requires in vivo cervical spine kinematics. We will utilize an advanced imaging technique, biplane videoradiography, to capture dynamic intervertebral motion during active movement. The results will elucidate the roles of dynamic intersegmental instability and neck strength and endurance in chronic neck pain and GJH. Identification of biomarkers will provide a mechanistic basis for development of targeted therapies for chronic neck pain. This proposal provides training from an outstanding mentorship team in a research-rich environment within the Medical School at the University of Minnesota. Included in the training plan are training in the techniques of biplane videoradiography and optical motion capture, didactic courses and mentorship in biostatistics and human subjects research design, and engagement in career development activities including manuscript and grant preparation. The research in this proposal aligns closely with the missions of the NIH and participating institutions, identifying mechanisms in neck pain for the development of treatment strategies to improve outcomes in a chronic, disabling condition. The proposed study will provide foundational knowledge and exceptional fellowship training as the trainee transitions to an independent investigator role.