• Journal of the Korean Society of Physical Medicine
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• v.14 no.2
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• pp.53-61
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• 2019

PURPOSE: Forward head posture (FHP) is a head-on-trunk malalignment that results in musculoskeletal dysfunction and neck pain. To improve forward head posture, both the craniocervical flexion exercise (CCFE) and the visual guide (VG) technique have been used. This study compared the immediate effects of CCFE and VG combined with CCFE on craniovertebral angle (CVA), as well as on the activity of the sternocleidomastoid (SCM) and anterior scalene (AS) muscles during CCFE in subjects with FHP. METHODS: In total, 16 subjects (nine males, seven females) with FHP were recruited using the G-power software. Each subject conducted CCFE and CCFE combined with VG in random order. The CVA was recorded using a digital camera and the ImageJ image analysis software. The EMG data of SCM and AS were measured by surface electromyography. A paired T-test was used to assess differences between the effects of the CCFE and VG combined with CCFE interventions in the same group. RESULTS: The CVA was significantly greater for CCFE combined with the VG than for CCFE alone (p<.05). The activity of the SCM and AS muscles was also significantly greater when the VG was combined with CCFE than during CCFE alone across all craniocervical flexion exercise phases (p<.05). CONCLUSION: Use of the VG technique combined with CCFE improved FHP in subjects with FHP compared to CCFE alone.

• Physical Therapy Korea
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• v.25 no.2
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• pp.62-70
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• 2018

Background: The craniocervical flexion (CCF) exercise is one of the effective exercise in correcting forward head posture (FHP). However, some people with FHP achieve CCF with compensatory movements, for example, low cervical flexion using superficial neck flexors such as the sternocleidomastoid (SCM) muscle. No study has yet investigated whether a dual­pres ure biofeedback unit (D-PBU) method to prevent low cervical flexion would be helpful in performing pure CCF movement. Objects: The purpose of this study was to compare the effects of the CCF using D-PBU method and the traditional CCF method on the cross-sectional area (CSA) of the longus colli muscle (LCM) and the activity of SCM muscle in subjects with FHP. Methods: Twenty­four FHP subjects (male: 16, female: 8) were recruited for this study. All subjects performed CCF using two different methods: the traditional CCF method and the CCF using D-PBU method. The CSA of the LCM was measured via ultrasound, and surface electromyography was used to measure SCM muscle activity. Results: The change in CSA of the LCM was significantly larger during the CCF using D-PBU method ($1.28{\pm}.09$) compared with the traditional CCF method ($1.19{\pm}.08$) (p<.05). The SCM muscle activity using the CCF using D-PBU method ($2.01{\pm}1.97$ %MVIC) was significantly lower than when using the traditional CCF method ($2.79{\pm}2.32$ %MVIC) (p<.05). Conclusion: The CCF using D-PBU method can be recommended for increasing LCM activation and decreasing SCM muscle activity during CCF movement in subjects with FHP.

• Physical Therapy Korea
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• v.28 no.1
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• pp.47-52
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• 2021

Background: Compared with normal people, stroke patients have decreased voluntary craniocervical motion, which affects their balance. Objects: This study was conducted in order to examine the effects of active craniocervical movement training using a cognitive game on stroke patient's cervical movement control ability, balance, and functional mobility. Methods: The subject of this study were 29chronic stroke patients who were randomly allocated to either an experimental, cognitive game group (n = 15), or control group (n = 14), to which only neuro-developmental treatment (NDT) was applied. The intervention was conducted 5 times per week, 30 minutes per each time, for a total of 4 weeks. Active angle reproduction test, static stability test, limits of stability test, and Time up and Go (TUG) test, respectively, were carried out in order to evaluate cervical movement control ability, static balance, dynamic balance, and functional mobility. Paired t-test was used in order to compare differences between prior to after the intervention, along with an independent-test in order to compare prior to and after-intervention differences between the two groups. Results: After the craniocervical training with a body-driven cognitive game, the experimental group showed significant differences in flexion, extension, and lateral flexion on the affected side, and rotation on the affected side in the active angle reproduction test. The experimental group indicated significant differences in sway length both with eyes-open and with eyesclosed in the static stability test and in limits of stability test and TUG test. The control group to which NDT was applied had significant differences in flexion in the active angle reproduction test and in limits of stability test and TUG test. Conclusion: The above results mean that craniocervical training using a body-driven cognitive game positively influences stroke patient's cervical movement control ability and as a result their balance and functional mobility.

• Physical Therapy Korea
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• v.20 no.4
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• pp.32-39
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• 2013

Abdominal curl-up exercise may excessively increased superficial neck flexor such as sternocleidomastoid (SCM) muscle. Also, the muscle activity of the abdominal muscles haven't investigated during abdominal curl-up with craniocervical flexion (CCF). Therefore, the purpose of our study was to determine the effect of CCF on the muscle activity of the abdominal and SCM muscles during abdominal curl-up. Twelve healthy subjects (six men and six women) with no history of abdominal or lower back pain within 6 weeks were recruited. Surface electromyographic signals were collected on SCM, rectus abdominis (RA), internal oblique (IO), and external oblique (EO) muscles bilaterally during performing the traditional abdominal curl-up and the abdominal curl-up with CCF. Paired t-tests were used to compare the differences in the muscle activity of the bilateral SCM, RA, EO, and IO muscles between the traditional abdominal curl-up and the abdominal curl-up with CCF (p<.05). There was significantly lower electromyogram (EMG) activity of the both SCMs during the abdominal curl-up with CCF (Right SCM, $39.50{\pm}15.29%MVIC$; Left SCM, $38.24{\pm}17.31%MVIC$) than with the traditional abdominal curl-up (Right SCM, $54.85{\pm}20.05%MVIC$; Left SCM, $53.18{\pm}26.72%MVIC$) (p<.05). The activity of abdominal muscles were not significantly different between the traditional abdominal curl-up and the abdominal curl-up with CCF. The abdominal curl-up with CCF requires significantly less muscle activity of SCM. Consequently, the abdominal curl-up with CCF is recommended to prevent excessive activation of superficial cervical flexors during abdominal curl-up exercise.

• Journal of the Korean Society of Physical Medicine
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• v.15 no.2
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• pp.31-38
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• 2020

PURPOSE: The aim of this study is to find a more efficient intervention method through a study of the gait variables and dynamic balance of chronic neck pain patients. METHODS: Forty subjects aged between 40 and 60 years were allocated randomly to two groups; The first group performed PA (Posteroanterior Mobilization), and the second group conducted CCF (Craniocervical Flexion Exercise). The gait variability measured the speed, cadence, and dynamic balance in the forward, leftward, rightward, and rearward directions. An independent t-test, Wilcoxon signed-rank test, and paired t-test were used for statistical analysis. RESULTS: In the dynamic balance measurements, the variability of PA (p < .000) and CCF (p < .000) in the rightward direction, PA (p < .004) in leftward direction and forward direction increased significantly (p < .013). In an analysis of the gait variability, the cadence increased significantly in the PA group (p < .022) and not significantly in the CCF group (p < .056). On the other hand, there was no increase in the speed variable, in the PA group (p < .437). In the CCF group, the cadence increased significantly (p < .022). The differences in the PA and CCF group differences were not significant. CONCLUSION: The PA group showed a significant increase in the forward (p < .013), leftward (p < .004), and rightward directions (p < .000). Speed was significant in the CCF group, and cadence was significant in the PA group. The dynamic Balance was effective in the rightward direction in both groups, but there was no significant difference between the two groups.

• Journal of the Korean Society of Physical Medicine
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• v.16 no.3
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• pp.81-87
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• 2021

PURPOSE: This study compared the cross-sectional areas (CSA) of the cervical muscles of straight neck patients and normal participants during a craniocervical flexion exercise (CCFE) using computerized tomography (CT) to investigate the effects of CCFE on the cervical curve. METHODS: Eighteen subjects were recruited for this study. Nine subjects were allocated to the straight neck group (subjects with pain and a cervical lordosis angle of less than 20°); the remainder formed the control group (subjects with a cervical lordosis angle greater than 20°). The CSA of the subjects' neck flexors (longus colli, longus capitis, and sternocleidomastoid) were measured by CT during rest and CCFE in the supine position, and the range of motion (ROM) of neck flexion was measured using a C-ROM instrument in a sitting. RESULTS: The straight neck group had a significantly smaller CSA of the longus colli, longus capitis, and sternocleidomastoid than the control group (p < .05). Both the straight neck and control groups showed statistically significant increases in the CSA of the neck flexors during CCFE compared to that at rest (p < .05). In addition, the straight neck group showed a significantly smaller ROM of neck flexion than the control group (p < .05). CONCLUSION: The results of this study provide more concrete evidence for therapists by demonstrating that CCFE improves the neck function by strengthening the neck flexors and increasing the neck stability for straight neck patients. Therefore, it is necessary to perform CCFE and neck extension exercises to rehabilitate straight neck patients.

• The Journal of Korean Academy of Orthopedic Manual Physical Therapy
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• v.29 no.3
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• pp.43-53
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• 2023

Background: Patients with neck pain develop instability due to muscle imbalance, decreased proprioception, and balance disorders. Studies have examined various exercise methods as treatment methods, but few studies have compared the effects of cervical stabilization exercise and dynamic balance exercise. The purpose of this study was to investigate the effects of dynamic balance exercise on pain, functional level, and psychosocial level in patients with non-specific chronic neck pain. Methods: Thirty-four non-specific chronic neck pain patients were randomly assigned to the experimental group (EG, n=17) and control group (CG, n=17); the cervical stabilization exercise and dynamic balance exercise program were applied to the EG; and only the cervical stabilization exercise program was applied to the CG. The intervention was conducted twice a week, for six weeks. Assessment items evaluated pain, dysfunction (Korean version neck disability index), range of motion, craniocervical flexion test, cervical deep flexor endurance test, and psychosocial level. Data analysis was performed using intention-to-treat analysis as assigned. To analyze differences in the items assessed in the two groups, we used a repeated measures analysis of variance with an interaction between group (EG, CG) and time point (baseline, 6 weeks, 12 weeks). Results: The endurance of the cervical flexor muscles between the group and the measurement point after intervention (p<.05). Both groups showed significantly improved endurance between time points after the intervention (p<.05), with the EG showing a greater change than the CG. None of the other measurement items differed in the pattern of change between measurement points. Conclusion: In conclusion, the EG applying a cervical stabilization exercise and a dynamic balance exercise experienced a significant difference in muscle endurance improvement compared to the CG. We propose an exercise intervention program that includes stabilization exercises and dynamic balance exercises for patients with chronic cervical pain who lack muscle endurance.