• Physical Therapy Korea
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• v.25 no.2
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• pp.44-52
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• 2018

Background: The deep cervical flexor (DCF) muscles have a crucial role in the management of neck pain. For preventing neck pain by activation of the DCF, craniocervical flexion (CCF) is an effective exercise. However, sternocleidomastoid (SCM) muscle is considered to affect negatively the activation of the DCF. SCM muscle which is an accessory muscle for respiration is activated differently depending on types of breathing patterns. It's not certain that breathing patterns affect the SCM and DCF muscles thickness during CCF exercise. Objects: The purpose of this study was to investigate the influence of breathing patterns on the SCM and DCF muscles thickness during CCF exercise. Methods: Forty-five subjects participated in this study, and they were classified according to their breathing pattern, as follows: costodiaphragmatic breathing (CDB) and upper costal breathing (UCB) groups. Ultrasonographic imaging of the SCM and DCF muscles was performed during five incremental levels of CCF during tidal breathing and expiration. Results: There was a significant interaction between the breathing pattern and the phase of CCF for percentage of SCM muscle thickness changes (p<.05). In phase 1 CCF, a percentage of SCM muscle thickness changes was increased in the UCB group than in the CDB group (p<.05). There was an increase in DCF muscles thickness with each additional CCF phase (p<.05). Conclusion: Recruitment of SCM muscle was increased in the UCB group while performing CCF with a low intensity. There were no significant differences on DCF recruitment between the breathing pattern groups. Higher CCF exercise intensities elicited a higher DCF recruitment.

• Journal of the Korean Society of Physical Medicine
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• v.11 no.4
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• pp.139-146
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• 2016

PURPOSE: The purpose of this study was to determine the effect of craniocervical flexion exercise with masticatory muscle contraction in patients with neck pain. Patients with neck pain also experience muscle weakness and limitation of activities of daily living. Craniocervical flexion exercise with masticatory muscle contraction may increase the thickness of the deep cervical flexor muscles, thereby reducing pain and limitations on activities of daily living. METHODS: Twenty-six volunteers participated in this study. The subjects were randomly divided into an experimental group (n=13) and a control group (n=13). Both groups performed craniocervical flexion exercise using a pressure biofeedback unit; the experimental group performed craniocervical flexion exercise with masticatory muscle contraction for 20 minutes, 3 times a week for 4 weeks. Assessment tools included ultrasonography for measurement of muscle thickness and the Neck Disability Index for the level of pain and function. RESULTS: The rate of change in muscle thickness in both groups significantly increased (p<.05), with a significantly greater increase in the experimental group than in the control group (p<.05). The Neck Disability Index score significantly improved (p<.05) in both groups, with significantly greater improvement in the experimental group compared with the control group (p<.05). CONCLUSION: These results suggest that craniocervical flexion exercise with masticatory muscle contraction can be effective in increasing muscle thickness and improving the Neck Disability Index score in patients with neck pain.

• The Journal of Korean Academy of Orthopedic Manual Physical Therapy
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• v.19 no.2
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• pp.23-29
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• 2013

Background: People who have painful neck have reduced proprioception in the neck. Reduced proprioception in the neck is related to the muscle spindle activity in the deep neck flexors. The aim of this study was to know that proprioception in the neck was increased by strengthening exercise of the deep neck flexors. Methods: Thirty subjects with chronic neck pain were randomly assigned to the experimental group (n=15) and the control group (n=15). Deep neck flexor muscle exercise with stabilizer were conducted for the study group three times a week for six weeks. Relocation errors in 30 degree rotation to the left were measured three times before and after intervention each. Results: Neck disability index were decreased in the experimental group (p<.05) but not in the control group (p>.05). Relocation errors were decreased in the experimental group after intervention (p<.05), but not in the control group (p>.05). Conclusions: Proprioception in the neck can be increased by the strengthening exercise of deep neck flexors in the subject with chronic neck pain.

• The Korean Journal of Pain
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• v.37 no.2
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• pp.164-177
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• 2024

Background: Neck and jaw pain is common and is associated with jaw functional limitations, postural stability, muscular endurance, and proprioception. This study aimed to investigate the effect of jaw and neck pain on cranio-cervico-mandibular functions and postural stability in patients with temporomandibular joint disorders (TMJDs). Methods: Fifty-two patients with TMJDs were included and assessed using Fonseca's Questionnaire and the Helkimo Clinical Dysfunction Index. An isometric strength test was performed for the TMJ depressor and cervical muscles. The TMJ position sense (TMJPS) test and cervical joint position error test (CJPET) were employed for proprioception. Total sway degree was obtained for the assessment of postural stability. Deep neck flexor endurance (DNFE) was assessed using the craniocervical flexion test. The mandibular function impairment questionnaire (MFIQ) was employed to assess mandibular function, and the craniovertebral angle (CVA) was measured for forward head posture. Results: Jaw and neck pain negatively affected CVA (R² = 0.130), TMJPS (R² = 0.286), DNFE (R² = 0.355), TMJ depressor (R² = 0.145), cervical flexor (R² = 0.144), and extensor (R² = 0.148) muscle strength. Jaw and neck pain also positively affected CJPET for flexion (R² = 0.116) and extension (R² = 0.146), as well as total sway degree (R² = 0.128) and MFIQ (R² = 0.230). Conclusions: Patients with painful TMJDs, could have impaired muscle strength and proprioception of the TMJ and cervical region. The jaw and neck pain could also affect postural stability, and the endurance of deep neck flexors as well as mandibular functions in TMJDs.

• 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.

• Physical Therapy Rehabilitation Science
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• v.9 no.4
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• pp.302-308
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• 2020

Objective: The endurance and strength of deep neck flexor (DNF) muscles have a major role on the function and stability of the cervical spine. In recent years, there has been a lack of research that have investigated the muscle tone of the superficial neck muscles. The purpose of this study was to examine the relationship of between contraction ratio of the DNF and sternocleidomastoid (SCM) muscles, DNF endurance, and muscle tension of the neck muscles. Design: Cross-sectional study. Methods: Forty-seven subjects (male=20, female=27) participated in this study. The muscle tone of the upper trapezius (UT), SCM, and suboccipital (SO) muscle was measured using a contact soft tissue tone-measuring instrument. For the contraction ratio of the SCM and longus colli muscle, the thickness of the relaxation and maximum contraction state of the SCM and longus colli muscles were assessed using a diagnostic ultrasound measuring instrument and a pressure biofeedback unit. The deep neck flexor endurance test (DNFET) was performed in a cranio-cervical flexion posture. The correlations between the measured variables were investigated. Results: The relationship between the DNFET and SO tone showed a significant negative correlation (p<0.05). The relationship between the DNFET and contraction ratio showed a significant positive correlation (p<0.01). There was no significant correlation between the DNFET and SCM and UT tone. Conclusions: This study confirmed that there is a relationship between DNF endurance, DNF activation, and SO tone. The information on the results of this study may be used as a reference that can be actively applied in the clinical environment.

• Physical Therapy Rehabilitation Science
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• v.7 no.4
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• pp.186-190
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• 2018

Objective: Deep neck flexor muscle endurance (DNFET) is important to cervical pain patients. However, there is no normative data of the DNFET hold time of Korean university students. The purpose of this study was to provide normative data and the reliability of the DNFET times of Korean university students and to compare the DNFET hold times between male and female subjects. Design: Cross-sectional study. Methods: The participants included 39 male and 39 female students with no cervical pain. Each DNFET was measured while the subjects kept their chin tucked in while in a supine (hook-lying) position and with the head lifted 2.5 cm off the bed. The DNFET was conducted on each subject twice and the mean values were obtained. After each measurement, the participants rested for 5 minutes. Inter-rater reliability was measured by intraclass correlation coefficient (ICC) by three separate evaluators. Results: The inter-rater reliability was good, showing an ICC (2,3) value = 0.785 (95% confidence interval, 0.370-0.942). The DNFET time scores for men and women were $25.14{\pm}9.96$ seconds and $15.23{\pm}6.10$ seconds, respectively, in which the time scores of the men were significantly longer compared to women (p<0.05). Conclusions: Asymptomatic men displayed higher DNFET scores than women. This study can help clinicians test cervical function of patients and set an interventional goal. These findings serve as a basis that insists Korean women to increase their amount of physical activity.

• Physical Therapy Korea
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• v.29 no.3
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• pp.180-186
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• 2022

Background: The craniocervical flexion test (CCFT) was developed for the activation and endurance of deep cervical flexors. However, the muscle thickness and muscle thickness changing ratio of the sternocleidomastoid (SCM) and deep cervical flexor (DCF) muscles in subjects with and without forward head posture (FHP) have not been reported. Objects: To determine the difference in thickness of the SCM and DCF muscles and the difference in the muscle thickness changing ratio between SCM, DCF, and DCF/SCM 20 mmHg and DCF/SCM 30 mmHg between subjects with and without FHP. Methods: Thirty subjects with and without FHP were enrolled. The muscle thickness of the SCM and DCF was measured when maintained at a baseline pressure of 20 mmHg and a maximum pressure of 30 mmHg using a pressure biofeedback unit during the CCFT. Ultrasonography was used to capture images of SCM and DCF muscle thickness during the CCFT, which was calculated using the picture archiving and communication system (PACS). Results: We observed a significant difference within the pressure main effect between SCM and DCF at a baseline pressure of 20 mmHg and a maximum pressure of 30 mmHg (p < 0.05). However, there was no significant difference in the muscle thickness and muscle thickness changing ratio for SCM and DCF during CCFT between subjects with and without FHP. Conclusion: There was no significant difference in the muscle thickness recruitment pattern during CCFT in posture changes between subjects with and without FHP.

• Journal of Korean Medicine Rehabilitation
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• v.25 no.4
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• pp.139-146
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• 2015

We researched two patients complaining about chronic neck pain with kyphotic cervical curvature. We assumed that the patients' symptom was caused by weakened deep neck flexor and activated superficial muscles around neck. So, acupuncture therapy, SCENAR therapy and self exercise with wooden neck pillow were used to treat the patients. We measured their pain by numerical rating scale (NRS) and neck disability index (NDI) before and after treatment. And cervical curvature was evaluated by Cobb method (C1-C7) and Ishihara Index. As a result, NRS and NDI significantly reduced and cervical curvature was also improved. Therefore, we conclude that acupuncture therapy with SCENAR therapy and self exercise using wooden neck pillow is an effective treatment to reduce chronic neck pain with kyphotic cervical curvature. But there is a limit on this study due to insufficient number of cases and absence of control group. Further studies will be needed.

• Physical Therapy Korea
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• v.16 no.3
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• pp.9-15
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• 2009

The purpose of this study was to examine contraction of abdominal muscles on surface electromyographic (EMG) activity of superficial cervical flexors, rib cage elevation and angle of craniocervical flexion during deep cervical flexion exercise in supine position. Fifteen healthy subjects were participated for this study. All subjects performed deer cervical flexion exercise with two methods. The positions of two methods were no volitional contraction of abdominal muscles in hook-lying position with 45 degree hip flexion (method 1) and 90 degrees hip and knee flexion with feet off floor for inducing abdominal muscle contraction (method 2). Surface EMG activities were recorded from five muscles (sternocleidmastoid, anterior scaleneus, recuts abdominis, external oblique, internal oblique). And distance of rib cage elevation and angle of craniocervical flexion were measured using a three dimensional motion analysis system. The EMG activity of each muscle was normalized to the value of reference voluntary contraction (%RVC). The EMG activities, distance of rib cage elevation. and angle of craniocervical were compared using a paired t-test between two methods. The results showed that the EMG activities of sternocleidmastoid and anterior scaleneus during deep cervical flexion exercise in method 2 were significantly decreased compared to method 1 (p<.05). Distance of rib cage elevation and angle of craniocervical flexion were significantly decreased in method 2 (p<.05). The findings of this study indicated that deep cervical flexion exercise with contraction of abdominal muscles could be an effective method to prevent substitute motion for rib cage elevation and contraction of superficial neck flexor muscles.