• 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 Journal of Korean Academy of Orthopedic Manual Physical Therapy
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• v.21 no.2
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• pp.33-37
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• 2015

Background: The purpose of this study on the effects of deep cervical flexors strengthening exercise to forward head posture and pain of neck in patients with chronic neck pain. Method: We selected 30 subjects among neck pain patients and carried out measurements. The subjects' forward head posture was measured including head tilt angle (HTA), neck flexion angle (NFA) and forward shoulder angle (FSA), neck disability index (NDI), numeric rating scale (NRS). The subjects underwent deep cervical flexors muscle strengthening with pressure bio-feedback device for 4 weeks. Then, after intervention, the subjects' forward head posture was measured again. It was performed Wilcoxon signed-ranks test for confirming the effect of deep cervical flexor muscles strengthening exercise. Results: As a result of comparison of measurements before and after intervention, we found that there were statistically significant improvement in the subjects' NDI, NRS and forward head posture including head tilt angle, neck flexion angle and forward shoulder angle. Conclusion: We concluded that deep cervical flexors strengthening exercise has the effect of alleviation of neck pain patients and is effective for forward head posture.

• 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.

• The Journal of Korean Academy of Orthopedic Manual Physical Therapy
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• v.25 no.1
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• pp.9-19
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• 2019

Background: This study was planned to assess and compare the effectiveness of cervical region stabilization exercise and strengthening exercise on pain and range of motion in patient with chronic neck pain. Methods: Fifty-one patient with chronic neck pain were randomly allocated into strengthening and stabilization exercise (SSE) group (n=27) and Strengthening exercise (SE) group (n=24). The program was carried for 12 sessions, 3 days/week in 4weeks. Pain intensity with visual analog scale (VAS), cervical range of motion, deep cervical flexor strengthening were evaluated before and after the intervention. Results: After the program, pain intensity decreased in group SE and SSE were found (p<.05). Range of motion and deep cervical muscle strength increased in group SE and SSE were found(p<.05). The intergroup comparison showed that significant difference in range of motion and deep cervical muscle strength (p<.05). Conclusions: The study suggest that both SSE program and SE program might be a useful treatment for patients with chronic neck pain. However SSE program might be superior in improving cervical range of motion and deep cervical flexor strength compare to SE program.

• Physical Therapy Korea
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• v.22 no.1
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• pp.19-29
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• 2015

Impaired respiratory function is common in patients with stroke. The purpose of this study were to investigate the effectiveness of exercises and to assess forced vital capacity and peak cough flow after completion of neck stabilizing and respiratory reeducation exercises (combining diaphragmatic breathing and pursed-lip breathing exercises). The 45 participants were randomly assigned to an experimental group 1 ($n_1=15$), experimental group 2 ($n_2=15$), and a control group ($n_3=15$). All subjects performed conservative physical therapy for 30 minutes. Experimental group 1 undertook the neck stabilizing exercise and the respiratory reeducation exercise. Experimental group 2 undertook the respiratory reeducation exercise. Additional exercise did not exceed 30 minutes, five times a week for six weeks. The subjects were assessed for deep neck flexor thickness and breathing function (forced vital capacity, forced expiratory volume at one second, forced expiratory volume at one second/forced vital capacity, peak expiratory flow, and manual assisted peak cough flow) at pre-post value. The results of this study were as follows. Experimental group 1 showed a significant increase only in deep neck flexor thickness change rate (p<.05). All groups showed significant increases in forced vital capacity, forced expiratory volume at one second, and peak expiratory flow in pre-post measurement (p<.05). Experimental groups 1 and 2 showed an increase in manual assisted peak cough flow in pre-post measurement (p<.05). There was no significant difference between experimental group 1 and experimental group 2, but experimental group 1 improved more than experimental group 2 in respiratory function as a whole. In conclusion, these findings suggest that the neck stabilizing exercise in combination with the respiratory reeducation exercise can improve forced vital capacity and peak cough flow in patients with stroke.

• Journal of Korean Medicine Rehabilitation
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• v.27 no.1
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• pp.37-51
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• 2017

Objectives This study was designed to identify the effect of acupuncture combined with wooden neck pillow self-exercise program (WSP). Methods 25 eligible subjects with chronic neck pain were recruited from September 2015 to August 2016. Subjects were treated by acupuncture twice a week for 4 weeks, also were educated WSP and exercised every day for 4 weeks. They were assessed using PI-NRS, NDI and the maximum muscle strength of deep cervical flexor muscles (DCF) before and after treatment. Also the Cobb's angle (C1-C7), Ishihara index, Park method were assessed for evaluating the radiographical changes. Variables were compared using paired t-test. And correlates analysis was used for analyzing relationship between differentials in the maximum muscle strength of DCF and differentials in cervical spine curvature measurement methods. Results Among the 25 subjects, 4 subjects were lost to follow-up or excluded in accordance with the criteria. Significant differences on NRS, NDI and the maximum muscle strength of DCF were seen after treatment (p<0.001). In radiological finding, cervical spine curvature measurement methods were significantly increased (p<0.001, p<0.05, p<0.05). Differentials in the maximum muscle strength of DCF significantly correlates to differentials in Ishihara index (R=0.479, p<0.05). Conclusions Acupuncture combined with WSP may decrease neck pain intensity and associated disability, and also increase the muscle strength of DCF and cervical lordosis, in patients with chronic neck pain. Especially, Improving the muscle strength of DCF has a relationship with improving Ishihara index. However, due to the design of this study, this treatment can not be compared with other treatments. Future randomized project should be needed.

• Journal of the Korean Society of Physical Medicine
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• v.8 no.2
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• pp.253-261
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• 2013

PURPOSE: The Purpose of this study was to investigate the changes in the thickness of Sternocleidomastoid muscle(SCM) and deep cervical flexor muscle(DCF) through CranioCervical Flexion Exercise(CCFEx) Using Sling. METHODS: Subjects were randomly allocated two group: control group (n=21) without neck pain, experimental group (n=17) with pain. Muscle thickness was measured using CranioCervical Flexion Test(CCFT) and ultrasonography before or after intervention. RESULTS: In experimental group, compared with muscle thickness of exercise before, SCM thickness rate of change was slightly decreased according to pressure increased after exercise(p<.05). CONCLUSION: The results of this study showed that CCFEx using sling is effective for SCM and DCF of choric neck pain patients.

• The Korean Journal of Pain
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• v.36 no.2
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• pp.242-252
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• 2023

Background: Neck pain is a common problem in the general population and second only to low back pain in musculoskeletal problems. The aim of this study is to compare three different types of exercise training in patients with chronic neck pain. Methods: This study was conducted on 45 patients with neck pain. Patients were divided into 3 groups: Group 1 (conventional treatment), Group 2 (conventional treatment plus deep cervical flexor training), and Group 3 (conventional treatment plus stabilization of the neck and core region). The exercise programs were applied for four weeks, three days a week. The demographic data, pain intensity (verbal numeric pain scale), posture (Reedco's posture scale), cervical range of motion ([ROM] goniometer), and disability (Neck Disability Index [NDI]) were evaluated. Results: In all groups, a significant improvement was found in terms of pain, posture, ROM, and NDI values in all groups (P < 0.001). Between the groups, analyses showed that the pain and posture improved more in Group 3, while the ROM and NDI improved more in Group 2. Conclusions: In addition to conventional treatment, applying core stabilization exercises or deep cervical flexor muscle training to patients with neck pain may be more effective in reducing pain and disability and increasing ROM than conventional treatment alone.

• Journal of The Korean Society of Integrative Medicine
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• v.9 no.1
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• pp.123-131
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• 2021

Purpose : The time spent using smart devices is constantly increasing, particularly in recent times. Using smart devices for a long time with an incorrect posture may lead to cerebral palsy (CP), instability, and abnormal muscle tone. Therefore, we aimed to investigate the relationships among cervical instability, deep neck flexor (DNF) activity, range of motion (ROM), and muscle tonus. Methods : Fifty subjects with CP participated in this study, and they were physiotherapists at W Hospital in Daejeon. Those who voluntarily participated in the research were selected as candidates who fulfilled the selection criteria. According to an instability test, 25 subjects were assigned to the instability and control groups. All subjects first underwent the instability test to be allocated to the appropriate group. Those in the instability group tested positive on the instability test. The Neck Disability Index (NDI), ROM, muscle tone, and DNF activity were measured to evaluate their relationships. The DNF strength and endurance were measured using a cranio-cervical flexion test. The upper trapezius (UT), sternocleidomastoid (SCM), and suboccipital (SO) muscle tones were measured using a contact soft tissue tone measuring instrument. The statistical significance level was set to .05. Results : There were significant differences in the flexion, extension, and rotation of the cervical ROM (CROM) between the two groups (p<.05). The SCM, UT, and SO muscle tones were significantly different between the two groups (p<.05). The DNF strength and endurance showed a significant difference between the two groups (p<.05). Conclusion : We found that there were significant increases in the CROM and muscle tone and decrease in the DNF strength and endurance in the instability group. This indicated that cervical instability is affected by the DNF strength and endurance. We may recommend DNF exercises in cases of cervical instability in clinical environments.

• Physical Therapy Korea
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• v.22 no.4
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• pp.44-50
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• 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.