• The Korean Journal of Pain
• /
• 제37권2호
• /
• pp.164-177
• /
• 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.

• 대한정형도수물리치료학회지
• /
• 제30권1호
• /
• pp.15-27
• /
• 2024

Background: This study examined the effects of the muscle energy technique and cervical traction after applying conservative physical therapy to patients with cervical radiculopathy. Methods: Twenty-six patients with cervical radiculopathy were randomized into two groups: the experimental group (n=13) and the control group (n=13). The two groups performed the muscle energy technique and for 4 weeks, 3 times a week, in 70-minute sessions. Pain, range of motion, function, and muscle performance were assessed using the visual analogue scale (VAS), cervical range of motion (CROM) goniometer, neck disability index (NDI), and stabilizer pressure biofeedback, before and after training. Results: After four weeks of therapy, the VAS (p<.001), NDI (p<.01), and the maximum strength of the deep neck flexion muscles significantly decreased (p<.01) and CROM significantly increased in both groups (p<.05). Conclusion: The muscle energy technique and therapeutic modalities such as cervical traction are effective in reducing VAS and NDI and increasing CROM and muscle performance in patients with cervical radiculopathy.

• 한국전문물리치료학회지
• /
• 제16권3호
• /
• pp.9-15
• /
• 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.

• The Journal of Korean Physical Therapy
• /
• 제28권6호
• /
• pp.349-354
• /
• 2016

Purpose: The purpose of the study was to investigate the thickness of deep neck flexors (DNF) and sternocleidomastoid muscle (SCM) bilaterally during deep neck flexor endurance test using ultrasonography images. Methods: Healthy volunteers (n=22), 20-25 (mean 22.2) years old, were recruited for the study. Participants were asked to perform the craniocervical flexion test (CCFT) in a seated position to measure deep neck flexor endurance. The thickness of DNF and SCM was assessed bilaterally and was measured using ultrasonography images at resting, contracted, pre-terminal and terminal phases of the neck muscle endurance test. Muscle contraction pattern was also observed along with the changes in muscle thickness from the resting phase to the terminal phase. Repeated-measure ANOVA was employed to compare muscle thickness bilaterally at each phase. Results: The thickness of right and left muscles was found to be significantly different in DNF both at resting and contracted phases (p=0.02, p<0.01, respectively), whereas no significant difference was observed in SCM at resting or contracted phases (p=0.59, p=0.18, respectively). Thickness changes from resting to contracted phase were not significantly different both in DNF and SCM (p=0.18, p=0.22, respectively). Muscle contraction patterns in right and left muscles were shown to be similar. Conclusion: The current study, performed on (with) healthy subjects, significantly detected different right and left muscle thickness in DNF, but the muscle contraction patterns were similar in DNF and SCM bilaterally. Further study is required to investigate DNF and SCM muscle size and function in people with neck pain.

• 대한정형도수물리치료학회지
• /
• 제20권1호
• /
• pp.1-7
• /
• 2014

Background: As the increase of forward head position, we studied the change of thickness of deep cervical flexor (DCF) compared of with sternocleidomastoid (SCM). we measured and analysed the change of thickness of the neck flexor for forward head position and cranio-cervical flexion exercise (CCFE). Methods: Using a cross-sectional design, we conducted the study selecting 35 healthy adults (12 males, 23 females). We measured the craniovertebral angle (CVA), instructed them to perform the CCFE, and measured the DCF and SCM using ultrasonography during the contraction and relaxation period. Results: Intra-reliability of SCM is .96, longus capitis is .92 and longus coli is .97. we compared according to the change of forward head position, Correlation of DCF is .841, and DCF/SCM is .754 by significant positive correlation. At the comparison of CCFE and Resting muscle thickness, SCM and DCF is .00, DCF/SCM is .68. Conclusion: There is a strong positive correlation between the change amount of DCF and DCF/SCM as the increase of CVA.

• 한국전문물리치료학회지
• /
• 제25권2호
• /
• pp.44-52
• /
• 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.

• 한국전문물리치료학회지
• /
• 제28권1호
• /
• pp.18-26
• /
• 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.

• 한국전문물리치료학회지
• /
• 제22권4호
• /
• pp.44-50
• /
• 2015

This study compared the effects of the initial head position (i.e., a HHP versus a relaxed head position) of subjects with and without a FHP on the thickness of the deep and superficial neck flexor muscles during CCF. The study recruited 6 subjects with a FHP and 10 subjects without a FHP. The subjects performed CCF in two different head positions: a HHP, with the head aligned so that the forehead and chin formed a horizontal line, and a relaxed head position (RHP), with the head aligned in a self-selected comfortable position. During the CCF exercise, the thickness of the longus colli (LCo) and the thickness of the sternocleidomastoid (SCM) were recorded using ultrasonography. The thickness of each muscle was measured by Image J software. The statistical analysis was performed with a two-way mixed-model analysis of variance. The thickness of the SCM differed significantly (p<.05) between the subjects with and without FHP. According to a post $h^{\circ}C$ independent t-test, the change in thickness of the SCM increased significantly during CCF in the subjects with FHP while adopting a HHP compared to that in the subjects without FHP. The change in thickness of the SCM was not significantly different between the two positions in subjects without FHP, and there was no significant change in thickness of the LCo muscle during the CCF exercise according to the initial position in both subjects with and without FHP. The results suggest that CCF should be performed in RHP to minimize contraction of the SCM in subjects with a FHP.

• 대한통합의학회지
• /
• 제12권3호
• /
• pp.143-153
• /
• 2024

Purpose : Forward head posture (FHP), characterized by the anterior positioning of the head relative to the spine, is a common postural deviation that can lead to neck pain, reduced mobility, and muscle imbalances. Recently, high-frequency deep heat therapy (HFDT) has been gaining attention for the intervention of FHP. This research aims to investigate the efficacy of HFDT in comparison to instrument assisted soft-tissue mobilization (IASTM) for treating FHP among 30 young adults. Methods : Participants were randomly assigned to either the HFDT or IASTM group. The study focused on examining changes in neck joint mobility, pain thresholds, rounded shoulder distance, lower trapezius muscle strength, and neck dysfunction. Measurements were taken before and after the interventions. Paired t-tests were used for within-group analyses, and independent t-tests were employed for between-group comparisons. The statistical significance level α was set to .05. Results : Statistically significant improvements were observed across all measured parameters in both groups (p<.05). The HFDT group showed significantly greater enhancements in neck joint mobility, pain thresholds, rounded shoulder distance, lower trapezius muscle strength, and neck dysfunction parameters. Specifically, HFDT was more effective than IASTM in improving neck joint mobility, right upper trapezius pain threshold, left rounded shoulder distance, and right lower trapezius strength. The only exceptions were neck flexion range of motion, left upper trapezius pain threshold, right rounded shoulder distance, and left lower trapezius strength, where no significant differences were found between the groups. Conclusion : The findings suggest that HFDT, by combining the benefits of high-frequency therapy and manual therapy, effectively alleviates upper trapezius muscle pain and tension, enhances neck mobility, and strengthens lower trapezius muscles. Thus, HFDT could be considered a valuable intervention for clinicians aiming to address FHP and associated musculoskeletal problems.

• 한국전문물리치료학회지
• /
• 제27권4호
• /
• pp.272-277
• /
• 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.