• Journal of the Korean Society of Physical Medicine
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• v.8 no.4
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• pp.655-666
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• 2013

PURPOSE: The main objective of this study is observing the effects of the functional postural trunk exercise (FPTE) on deep cranio-cervical flexor (CCF) muscle endurance applied on neck pain patients suffering from the acute whiplash-association disorder (WAD). METHODS: The study was tested with 47 patients with neck pain. All patients were equally treated with the ordinary therapy, only experimental group (n=23) was treated with FPTE: assumption of an upright lumbo-pelvic and spinal postural position, adding a neck lengthening manoeuvre in addition. Patients attended physical therapy for 3 times a week, for 4 weeks. Visual analogue scale (VAS) for pain, neck disability index (NDI), range of motion (ROM), were recorded both before and after the intervention. Also muscle activity in the CCF test was employed to analyze the changes between before and after. RESULT: After 4 weeks of training intervention, a remarkable increase in muscle endurance, rotation, extension ROM (p<.05) and decrease in pain and NDI (p<.05) in both groups. Further, the differences between groups were muscle endurance (F=60.350, p<.01), pain, and the left rotation ROM (p<.05). CONCLUSION: From the results, the experimental group had significant the increase in muscle endurance, and the significant decrease in pain. Whilst further research in this category is necessary, these observations suggest that applying exercise in early diagnosis can be of help to treat the neck pain patients suffering from the WAD.

• Physical Therapy Korea
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• v.28 no.1
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• pp.18-26
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• 2021

Previous studies have reported that deep neck flexor (DNF) exercise can improve neck problems, including neck pain, forward head posture, and headache, by targeting the deep and superficial muscles of the neck. Despite the prevailing opinion across studies, the benefits of DNF can vary according to the type of neck problems and the outcome measures adopted, ranging from positive outcomes to non-significant benefits. A meta-analysis was conducted in this study to assess conclusive evidence of the impact of DNF exercise on individuals with neck problems. We used PUBMED, MEDLINE, NDSL, EMBASE, and Web of Science to search for primary studies and the key terms used in these searches were "forward head posture (FHP)," "biofeedback," "pressure biofeedback unit," "stabilizer," "headache," and "neck pain." Twenty-four eligible studies were included in this meta-analysis and were coded according to the type of neck problems and outcome measures described, such as pain, endurance, involvement of neck muscle, craniovertebral angle (CVA), neck disability index (NDI), cervical range of motion (CROM), radiographs of the neck, posture, strength, endurance, and headache disability index. The overall effect size of the DNF exercise was 0.489. The effect sizes of the neck problems were 0.556 (neck pain), -1.278 (FHP), 0.176 (headache), and 1.850 (mix). The effect sizes of outcome measures were 1.045 (pain), 0.966 (endurance), 0.894 (deep neck flexor), 0.608 (superficial neck flexor), 0.487 (CVA), 0.409 (NDI), and 0.252 (CROM). According to the results of this study, DNF exercise can effectively reduce neck pain. Thus, DNF exercise is highly recommend as an effective exercise method for individuals suffering from neck pain.

• Physical Therapy Korea
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• v.27 no.4
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• pp.272-277
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• 2020

Background: Forward head posture (FHP) is common postural malalignment. FHP is described relatively extension to upper cervical and lower cervical is relatively flexion. Although several researchers mentioned the lower cervical flexion posture in FHP, most of the studies related to FHP is focused on the deep cervical flexor function. Objects: The purposes of present study is to compare the cervical strength (upper cervical extension [UCE], lower cervical extension [LCE], upper cervical flexion [UCF], lower cervical flexion [LCF]) between individuals with and without FHP. Methods: Fifty-one participants are recruited. Participants who have the craniovertebral angle (CVA) less than 48 degree were classified to the FHP group (n = 24) and the others were included in without FHP group (n = 27). The cervical strength (UCE, LCE, UCF, LCF) were measured using Smart KEMA strength sensor and the strength data was normalized by body weight. All strength measurement conducted at head and neck neutral position in sitting. Independent t-test was used to compare the cervical strength between individuals with and without FHP. Results: The mean value of CVA was greater in without FHP group than with FHP group (p < 0.000). The strength value of UCF (p < 0.002) and LCE (p < 0.001) was significant less in FHP group than without FHP group. But no significant differences were seen in the LCF and UCE strength between two groups. Conclusion: UCF and LCE weakness in FHP group should be considered to evaluate and manage the individuals with FHP.

• Journal of the Korea Academia-Industrial cooperation Society
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• v.22 no.2
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• pp.659-666
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• 2021

This study aimed to investigate the effect of changes in pressure levels and gaze directions on deep neck flexor muscle thickness. Twenty-seven subjects participated in this study. Ultrasound imaging of the longus colli (LC) and sternocleidomastoid (SCM) were measured in four gaze directions (0°, 20°, 40°, 60°) and five pressure levels (20 mmHg, 22 mmHg, 24 mmHg, 26 mmHg, 28 mmHg) during cranial-cervical flexor (CCF) exercises. Repeated ANOVA was performed for analysis of muscle thickness difference according to gaze direction and pressure levels in LC and SCM. Results: LC showed a significant difference between 0° and 20°, 0° and 40°, and 0° and 60° at pressures of 20 mmHg and 22 mmHg (p<.05). SCM displayed a significant difference between 0° and 20°, 20° and 40°, and 40° and 60° at 28 mmHg (p<.05). In this study, it was found that setting the gaze direction to 20° for the CCF exercise can increase the activation of LC and lower the activity of SCM to obtain the effect of exercise. Based on the results of this study, it is hoped that the beneficial effects of the CCF exercise can be increased by setting an optimal gaze direction in a clinical environment.

• The Journal of Korean Academy of Orthopedic Manual Physical Therapy
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• v.8 no.2
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• pp.57-71
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• 2002

Cervical pain is a rapid increase that is owing to a flexion-extension whiplash injury, unappropriated posture, chronical repetition injury from abdominal position of head and neck, excessive repeating work, chronical deficiency of excercise. Because of that is bring about muscle unbalance, tightness of cervical extensor muscle, weakness of cervical deep flexor muscles, instability of cervical region and reduction of proprioceptive sensor. Recent the role of muscle is more emphasized for preservation of sine stabilization. And cognition of integrated muscular system, importance for the operation and relation is increased to maintain stability of the motor system and pertinent function. Therefore we are going to introduce the sling exercise and stabilization exercise method for advanced efficient of cervical and upper limb and for the muscle strengthening to importance cervical stabilization through neurological program as control the reaction of cervical stabilization. Sling exercise therapy(SET) concept consists of a system of diagnosis and treatment. The system of diagnosis involves testing the muscle's tolerance through progressive loading in open and close kinetic chains. The SET system contains elements such as relaxation, increasing the range of movement, traction, training the stabilizing musculature, sensory-motor exercises, training in open and close kinetic chains, dynamic training of the mobilizing musculature, cardiovascular exercise, group exercise, personal exercise at home Sensory-motor training is an essential element of the SET concept. The emphasis is on closed kinetic chain exercise on an unstable surface, there by achieving optimum stimulation of the sensory-motor apparatus.

• Journal of the Korean Society of Physical Medicine
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• v.7 no.3
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• pp.329-337
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• 2012

Purpose : The purpose of this study was to assess more effective exercise prescription for the people with chronic neck pain by comparing stretching exercise and isometric exercise about strength and pain. Method : The research design of the study was that 20 young adults with mild neck disability (5-14 out of 50 in Neck Disability Index) were randomized into 2 groups and underwent stretching exercise(10 peoples) and isometric exercise(10 peoples) at 3 times a week for 5weeks. Measures of pain scale (Visual Analog Scale) and Muscle strength of deep neck flexor (Pressure Biofeedback) were assessed before and after intervention. The pre and post exercise results were compared using paired t-test and the effectiveness of intervention of two groups were compared using Independent t test. Results : The results of this study were that pain reduction was seen after stretching and isometric exercise and significantly difference. There was significantly improvement of cervical flexor strength after stretching and isometric exercise. But, there was no significant difference between stretching and isometric exercise groups. Conclusion : The stretching and isometric exercise for chronic neck pain patients may use according to preference of patient because the effects of treatment was same. Further studies are needed to analyzed psycho social factors, cost effects, group approach.

• The Journal of the Convergence on Culture Technology
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• v.5 no.4
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• pp.227-235
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• 2019

The purpose of this study was to investigate the effects of cervical vertebral height and shoulder stabilization on anterior head posture in people with turtle neck. The subjects of this study consisted of normal and healthy people with 30 turtle necks. Subjects were randomly assigned to shoulder stabilization exercise and cervical vertebrae exercise (30 men, 15 men and 15 women, height: $168.67{\pm}6.51$, $22.33{\pm}8.27$, $65.03{\pm}11.98$, and $28.66{\pm}1.91$), In the experimental group, shoulder stabilization exercise and cervical spine exercise were performed for 4 weeks. Deep neck flexor, leavator scapular, upper trapezius, rhomboid, and lower trapezius showed significant differences in shoulder stabilization and cervical vertebrae before and after the experiment. As a result, the CVA value decreased significantly and the muscle activity value increased significantly when exercise and Mckenzie program were applied. These results show that exercise and Mckenzie programs have a positive effect on turtle neck improvement.

• The Journal of Korean Academy of Orthopedic Manual Physical Therapy
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• v.23 no.1
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• pp.43-51
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• 2017

Background: This study was carried out to compare the effects of shoulder stabilization exercise and thoracic extension exercise including deep neck flexor exercise on posture and pain targeting physical therapists and occupational therapists with forward head posture. Methods: A total of 30 physical therapists and occupational therapists (15 males, 15 females), who are working in the nursing hospital at Daejeon, were randomly divided into a shoulder stabilization group (n=10), a thoracic extension exercise (n=10), and a control group (n=10), and 3 times were carried out for 8 weeks. Results: In the results of all measurements, 2 groups except for the control group showed a significant change in the recovery of forward head posture, and the should stabilization exercise group showed a relatively superior effect compared to the thoracic extension exercise group. Conclusions: These results of a study will be a basic data for the development of the forward head posture exercise therapy program.

• The Journal of Korean Physical Therapy
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• v.28 no.3
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• pp.183-188
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• 2016

Purpose: The aim of the study was to investigate neck posture, range of motion, muscle endurance and self-report of pain and disability in smartphone users. Methods: Seventy-eight university student volunteers, aged between 18 and 30 years (mean age 23.2), were assessed for: a head-neck posture by measuring cranial vertical angle, neck range of motions using cervical range of motion device, and a deep neck flexor endurance using a stabilizer. Finally, subjects were asked about their neck pain and completed disability questionnaires, ie, Short Form McGill Pain Questionnaire, Neck Disability Index, and World Health Organization Disability Assessment Schedule 2.0. Results: Thirty-eight subjects experienced recurrent neck pain with/without upper limb pain (neck pain group) and 40 reported no current neck pain with/without upper limb pain (no neck pain group). Differences were found between groups on pain and disability questionnaires. Subjects with neck pain had significantly higher disability scores than those of no neck pain group. However, there were no differences observed between groups in a head-neck posture, neck range of motions, and deep neck muscle endurance time. The smartphone usage time was negatively correlated with neck pain intensity and disability score whereas it had positive relationship with flexibility and posture. Conclusion: Group differences were observed as lower capacity not only for neck specific daily activities but for general functioning in daily routine when the neck pain and no neck pain groups were compared. Therefore, functioning in daily activities should be investigated as prevention for further developing neck pain in smartphone users.

• 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.