• 한국전문물리치료학회지
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• 제18권4호
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• pp.1-10
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• 2011

This study compared the stability of the cervical spine according to the presence of neck pain and deep neck flexor performance. Thirty subjects with neck pain, and thirty subjects without neck pain were recruited for this study. The Cranio-cervical flexion (CCF) test was applied using a pressure biofeedback unit to classify the subjects into four subgroups; no cervical pain and good deep neck flexor performance (NG group), no cervical pain and poor deep neck flexor performance (NP group), cervical pain and good deep neck flexor performance (PG group), and cervical pain and poor deep neck flexor performance (PP group). The head sway angle was measured using a three-dimensional motion analysis system. A 3-kg weight was used for external perturbation with the subject sitting in a chair in the resting and erect head positions with voluntary contraction of the deep neck flexors. A one-way analysis of variance (ANOVA) was performed with a Bonferroni post hoc test. The deep neck flexor performance differed significantly among the four groups (p<.05). The NG group had significantly greater deep neck flexor performance than NP and PP groups. The stability of the cervical spine also differed significantly among the four groups in the resting head position (p<.05). The head sway angle was significantly smaller in NG group as compared with the other groups. The PP group had the greatest head sway angle in the resting head position. However, there was no significant difference in the stability of the cervical spine among the groups in the erect head position with voluntary contraction of deep neck flexors (p=.57). The results of this study suggest that the deep neck flexor performance is important for maintaining the stability of cervical spine from external perturbation.

• 대한정형도수물리치료학회지
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• 제24권1호
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• pp.15-21
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• 2018

Background: The purpose of this study was to determine the effects of cervical deep muscle flexion exercise (CCFE) on craniovertebral angle, pain, and neck disability for patients with chronic neck pain Methods: The subjects of this study were randomly divided into three groups of 30 patients with chronic neck pain: rectus abodominis functional massage (n=10), cervical deep muscle flexion exercises group (n=10), and the control group(n=10). To assess visual analog scale (VAS) was used to test the neck pain, To assess neck posture was used to craniovertebral angle, VAS was used to test the neck pain, neck disability index (NDI) was used to test the neck dysfunction. All measurements were performed before and after each intervention was applied 3 times a week for 4 weeks. Results: In the results of all measurements, 2 groups except for the control group showed a significant change in the recovery of posture, neck pain, neck disability index (p<.05). Conclusions: Our results of this study showed that applying cervical deep muscle flexion exercise and rectus abodominis functional massage to patients with chronic neck pain improved cervical posture, neck pain, neck disability.

• The Journal of Korean Physical Therapy
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• 제27권1호
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• pp.50-54
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• 2015

Purpose: The purpose of this study is to investigate differences of cervical flexor muscle thickness (i.e., sternocleidomastoid muscle and deep cervical flexor muscles) depending on levels of pressure bio-feedback unit and eye directions during cranial-cervical flexor exercise in healthy subjects. Methods: A total of 30 subjects (12 males and 18 females) who had no medical history related to musculoskeletal and neurological disorders were enrolled in this study. They were instructed to perform cranial-cervical flexion exercise with adjustment of five different pressures (i.e., 22 mmHg, 24 mmHg, 26 mmHg, 28 mmHg, and 30 mmHg) using a pressure biofeedback unit, according to three different eye directions (i.e., $0^{\circ}$, $20^{\circ}C$, and $40^{\circ}C$). Muscle thickness of sternocleidomastoid muscle and deep cervical flexor muscles was measured according to pressure levels and eye directions using ultrasonography. Results: In results of muscle thickness in sternocleidomastoid muscle and deep cervical flexor muscles, the thickness of those muscles was gradually increased compared to the baseline pressure level (22 mmHg), as levels in the pressure biofeedback unit during cranial-cervical flexion exercise were increasing. In addition, at the same pressure levels, muscle thickness was increased depending on ascending eye direction. Conclusion: Our findings showed that muscle thickness of sternocleidomastoid muscle and deep cervical flexor muscles was generally increased during cranial-cervical flexion exercise, according to increase of eye directions and pressure levels. Therefore, we suggested that lower eye direction could induce more effective muscle activity than the upper eye direction in the same environment during cranial-cervical flexion exercise.

• 대한통합의학회지
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• 제8권4호
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• pp.19-27
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• 2020

Purpose : We aimed to investigate the effect of cranio-cervical flexion exercises(CCFE) with visual feedback(VF) on the muscle activity of the upper trapezius in forward head posture (FHP) and whether deficits in proprioception affect the changes in muscle activity. Methods : Twenty subjects with FHP were assigned to one of 2 groups according to deficits in proprioception. The muscle activity of the upper trapezius during arm movement under three exercise conditions (resting, CCFE, and VF + CCFE). Repeated-measures analysis of variance was used to compare differences in muscle activity according to the exercise conditions between the groups and to analyze the interactions between groups and conditions. Results : Significant differences were observed in muscle activity according to the exercise condition (p<.05), with no significant differences between the groups. The muscle activity of the upper trapezius was significantly different between the resting and VF +CCFE conditions (p<.05), with no significant difference between the resting and CCFE conditions (p>.05). Conclusion : The results of this study showed that the CCFE combined with VF are an effective intervention for FHP to train deep muscles selectively. In addition, the loss of proprioceptive sensation is not related to changes in muscle activity during exercises.

• 한국전문물리치료학회지
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• 제23권2호
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• pp.57-66
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• 2016

Background: For the treatment of forward head posture (FHP) and forward shoulder posture, methods for strengthening scapular retractors and deep cervical flexors and stretching pectoralis and upper cervical extensors are generally used. No study has yet assessed whether suboccipital release (SR) followed by cranio-cervical flexion exercise (CCFE) (SR-CCFE) will result in a positive change in the shoulders and neck, showing a "downstream" effect. Objects: The purpose of this study was to investigate the immediate effects of SR-CCFE on craniovertebral angle (CVA), shoulder abduction range of motion (ROM), shoulder pain, and muscle activities of upper trapezius (UT), lower trapezius (LT), and serratus anterior (SA) and LT/UT and SA/UT muscle activity ratios during maximal shoulder abduction in subjects with FHP. Methods: In total, 19 subjects (7 males, 12 females) with FHP were recruited. The subject performed the fifth phase of CCFE immediately after receiving SR. CVA, shoulder abduction ROM, shoulder pain, muscle activities of UT, LT, and SA, and LT/UT and SA/UT muscle activity ratios during maximal shoulder abduction were measured immediately after SR-CCFE. A paired t-test and Wilcoxon signed-rank test were used to determine the significance of differences in scores between pre- and post-intervention in the same group. Results: The CVA (p<.001) and shoulder abduction ROM (p<.001) were increased significantly post-versus pre-intervention. Shoulder pain was decreased significantly (p<.001), and LT (p<.05) and SA (p<.05) muscle activities were increased significantly post- versus pre-intervention. The LT/UT muscle activity ratio was increased significantly post- versus pre-intervention (p<.05). However, there was no significant change in UT muscle activity and SA/UT muscle activity ratio between pre- and post-intervention (p>.05). Conclusion: SR-CCFE was an effective intervention to improve FHP and induce downstream effect from the neck to the trunk and shoulders in subjects with FHP.

• The Korean Journal of Pain
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• 제37권2호
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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.

• 대한물리의학회지
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• 제16권3호
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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.

• 대한물리치료과학회지
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• 제31권1호
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• pp.88-97
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• 2024

Background: This study was to investigate effects of Correlation Analysis between Cervical-Vertebra Angle and Neck Range of Motion, Muscle Strength, Sternocleidomastoid Thickness of Patients with Forward Head Posture Design: Correlation Analysis. Methods: The subjects of this study were a total of 54 people in the forward head position and their ages were between 30 and 50 years old. The subjects cranio-vertebral angles, neck extension, neck flexion, neck rotation angles, neck flexor strength, neck extensor strength, sternocleidomastoid thickness were evaluated through measuring instruments. The thickness of the sternocleidomastoid muscle was measured using an imaging ultrasound diagnostic device (ultra sound, Versana Premier, GE Medical systems, China). CVA was measured by measuring the side photo of the subject was taken with a camera and evaluated.. neck joint range of motion was measured through digital inclinometer for extension, flexion, and neck rotation. neck muscle strength was measured by measuring the using a digital sthenometer. Data analysis in this study was statistically processed using SPSS version 26.0 (IBM SPSS Inc., USA). Correlation analysis was used and the statistical significance level was set at 0.05. Results: The results neck extension(r= 0.70^**), neck flexion(r= 0.67^**), neck rotation(r= 0.56^**), neck extensor muscle strengt(r= 0.85^**), neck flexor muscle strength(r= 0.66^**), sternocleidomastoid thicknes(r= -0.81^**) It indicates that there is a correlation. Conclusion:These results improve the Cervical-vertebra angle of patients with forward head posture should include a program to improve the thickness of the SCM. In the future, study can be used as an evidentiary material for treatment interventions to improve the Cervical-vertebra angle of patients with forward head posture.

• 한국전문물리치료학회지
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• 제22권4호
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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.

• 대한통합의학회지
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• 제9권1호
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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.