Biomechanical Risk Factors of Cervical Pain in Pregnant Women

The VAS will be used to assess cervical pain for each pregnant woman. It is a pain rating scale, whose scores are based on self-reported measures of symptoms that are recorded with a single handwritten mark placed at one point along the length of a 10-cm line that represents a continuum between the two ends of the scale-"no pain" on the left end (0 cm) of the scale and "worst pain" on the right end of the scale (10 cm).

Pressure algometer will be used to assess the trigger points of the neck muscles of each pregnant woman in the study.

It will be placed perpendicularly to the fibers of the upper trapezius muscle, bilaterally, exactly over the myofascial trigger points. These points were pressed until the pain is reported, and the value displayed on the equipment's display will be recorded in kg/cm2.

Posture screen analysis mobile application will be used to measure the CVA for each pregnant woman The CVA is the best indicator of forward head posture. To determine this angle, two references are defined: One line runs from the swallow of the ear to the seventh cervical vertebra (C7) and another horizontal line parallel to the ground passes only through the spinous apophysis of C7. An angle of less than 50°-53° may indicate FHP. Thereby, the smaller the CVA, the greater the disability

Place the goniometer's axis over the external auditory meatus before using it. Place the stationary arm perpendicular to the floor or vertically. Place the movable arm in line with the nose's base. This should be noted as 0°.

To assess cervical flexion: ask the patient to nod forward and bring their chin towards their chest. Normal cervical flexion is usually approximately 80º

Place the goniometer's axis over the external auditory meatus before using it. Place the stationary arm perpendicular to the floor or vertically. Place the movable arm in line with the nose's base. This should be noted as 0°.To assess cervical extension: ask the patient to look upwards as far as possible, until full extension of the neck is achieved. Normal cervical extension is usually 50°.

The goniometer fulcrum will be aligned over the spinous process of the C7. The fixed arm of the goniometer will be aligned vertically along the imaginary line between the two acromion processes. The movable arm will be aligned over the external occipital protuberance.

Ask the patient to tilt his/her head laterally to the left, without rotating the head, while her shoulders remain fix. Repeat the procedure for the opposite side and note the angle of flexion of the head. Normal flexion from starting point on either side is 45°

The goniometer fulcrum will be aligned over the center of the subject's head, the fixed arm of the goniometer will be aligned with an imaginary line between the subject's acromion processes and the movable arm will be aligned with the tip of the subject's nose.

Ask the patient to rotate his/her head to the left as far as possible without tilting or tipping his/her head. Stabilize the shoulders by lightly pressing onto them. Repeat the process for the opposite direction. Normal rotation is approximately 80°.

The neck disability index will be used to assess neck disability for each pregnant woman. It is a well-validated 10-item questionnaire, with each item rated on a 0 to 5-point scale. The sum of the 10 items gives a score between 0-50. The lower the score, the less self-rated the disability. 0-4 = no disability, 5-14 = mild disability, 15-24 = moderate disability, 25-34 = severe disability, and 35 or over = complete disability

The breast size will be measured by using tape around torso on the level of the nipple to determine if breast size is a risk factor for cervical pain.