Comparison of visual and electronic assessments of active cervical range of motion in university varsity level American football players: a three-point cohort study

BACKGROUND: Neck pain is common in contact sports such as football, where rapid and accurate cervical range of motion (ROM) assessment is essential. Electronic goniometers provide reliable measurements but are impractical in field settings, leading clinicians to rely on visual estimation. The accuracy of this method and its improvement with repeated exposure remain unclear. OBJECTIVE: To evaluate the agreement (trueness) between subjective visual assessments of active cervical range of motion and measurements obtained using an electronic goniometer, and to determine whether repeated assessments improve agreement over time. METHODS: A three-time-point cohort study was conducted between August and December 2023 in male varsity-level American football players. At each time point, participants completed questionnaires on neck pain and disability and performed active cervical ROM (flexion, extension, side bending, rotation) assessed both subjectively and objectively. RESULTS: Agreement between subjective and objective evaluations was generally poor to moderate, with flexion and extension showing the lowest concordance. Repeated-measures ANOVA, assessing improvement due to exposition revealed no significant changes for flexion, extension, or rotations (p > 0.05). Significant improvements occurred for right side bending (p = 0.004) and left side bending (p < 0.001), with preseason-to-postseason differences of -0.44° and -1.64°, respectively, suggesting a limited learning effect for lateral movements. CONCLUSION: Subjective cervical ROM assessment varies by movement plane. Although repeated exposure improves trueness, subjective measures should be interpreted cautiously, and objective tools remain preferable for precise evaluation.