• 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.

• 대한물리의학회지
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• 제16권4호
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• pp.117-124
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• 2021

PURPOSE: This study examined the effect of muscle thickness of the deep cervical flexor muscle, muscle tonicity, and muscle fatigue of the superficial cervical flexor muscle by applying a functional latex pillow to patients with chronic cervical pain. METHODS: An experimental group using a functional latex pillow and a control group using a general pillow were assigned randomly to 30 people. Each pillow was applied in a comfortable lying position in the experimental group and control group. The deep cervical flexor muscle thickness was measured in the longus colli and longus capitus using ultrasonography. The muscle tonicity and muscle fatigue of the superficial cervical flexor muscle were measured separately in the sternocleidomastoid muscle using a myotonometer and electromyography. RESULTS: In the experimental group(functional latex pillow), the muscle tonicity of the superficial cervical flexor muscle like the sternocleidomastoid muscle was significantly lower than that of the control group (general pillow)(p < .01). CONCLUSION: This study suggests that the functional latex pillow may effectively reduce the muscle tonicity of the sternocleidomastoid muscle, which is the superficial cervical muscle, in patients with chronic cervical pain. On the other hand, it was not effective on the muscle thickness of the deep cervical flexor muscle and muscle fatigue of the superficial cervical flexor muscles.

• 대한물리의학회지
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• 제8권2호
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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 Journal of Korean Physical Therapy
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• 제31권1호
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• pp.1-6
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• 2019

Purpose: This paper proposes proper and effective neck exercises by comparing the deep and superficial cervical flexor muscle activities and thickness according to the pressure level during cranio-cervical flexion exercises between a normal posture group and forward head posture group. Methods: A total of 20 subjects (8 males and 12 females) without neck pain and disabilities were selected. The subjects' craniovertebral angles were measured; they were divided into a normal posture and a forward head posture group. During cranio-cervical flexion exercises, the thickness of the deep cervical flexor neck muscle and the activity of the surface neck muscles were measured using ultrasound and EMG. Results: The results showed that the thickening of the deep cervical flexor was increased significantly to 28 and 30 mmHg in the forward head posture group. The sternocleidomastoid muscle activity increased significantly to 24, 26, 28, and 30 mmHg in the forward head posture group. The anterior scalene muscle activity increased significantly to 26, 28, and 30mmHg in the forward head posture group. A significant difference of 26, 28, and 30 mmHg in the sternocleidomastoid and anterior scalene muscles was observed between two groups. Conclusion: To prevent a forward head posture and maintain proper cervical curve alignment, the use of the superficial cervical flexor muscles must be minimized. In addition, to perform a cranio-cervical flexion exercises to effectively activate the deep cervical flexor muscles, 28 and 30 mmHg for normal posture adults and 28 mmHg for adults with forward head postures are recommended.

• 대한통합의학회지
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• 제6권1호
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• pp.99-105
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• 2018

Purpose : The purpose of this study was to evaluate the effect of craniocervical flexion exercise on deep cervical flexor thickness and gait in children with hemiplegic cerebral palsy. Methods : Twelve children with hemiplegic cerebral palsy were recruited for this study. All subjects performed active craniocervical flexion exercise 3times a week over the course of 6weeks. using a pressure bio feedback unit. Ultrasonography was used to assess deep cervical flexor thickness, and a 10m walking test was used to assess gait function. For the statistical analysis, a paired t-test was used to compare the differences pre- and post-value. SPSS Statistics version 20.0 was used for statistical analysis, and statistical significance was defined as a p-value less than 0.05. Result : The results of this study indicate that children with hemiplegic cerebral palsy experienced statistically significant positive changes in both deep cervical flexor thickness (p<.05). and gait(p<.05) following the intervention. Conclusion : In conclusion, craniocervical flexion exercise can positively affect deep cervical flexor thickness in children with hemiplegic cerebral palsy, which in turn positively affects gait.

• 대한물리의학회지
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• 제6권4호
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• pp.497-504
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• 2011

Purpose : Chronic cervical pain is a common source of disability in society. There has been no research regarding the amount of pressure for the deep cervical flexors during cranio-cervical flexion exercise (CCFE). The purpose of this study is to determine optimal pressure levels to facilitate deep cervical muscles (longus colli & longus capitis) during cranio-cervical flexion exercise, using ultrasound measurement of the muscles. Methods : Using a cross-sectional design, the study was performed in an experimental group of 19 subjects (7 men, 12 women) with no cervical pain. Participants were instructed to perform the CCFE, and during the five incremental stages of the test, changes in thickness, as compared to resting baseline values, were measured using ultrasonography for sternocleidomastoid muscle (SCM) and deep cervical muscles (DCF). Results : Both DCF and SCM muscles demonstrated an increase in recruitment with each progressive phase of the test. In comparing the different pressure increments, the most significant changes found in DCF thickness were between phase 2 and phase 3 (p<.05). However no differences were found between pressure increments for SCM thickness (p>.05). Conclusion : The results suggest 26 mm Hg as the optimal pressure level during cranio-cervical flexion exercise for facilitation of deep cervical flexor.

• 한국전문물리치료학회지
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• 제23권3호
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• pp.11-20
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• 2016

Background: A forward head posture (FHP) is one of the most common types of poor head posture in patients with neck disorder. A prolonged FHP might increase pressure on the posterior cranio-cervical structure and exhibit reduced performance on a cranio-cervical flexion test (CCFT). CCFT is included to activate deep cervical flexor muscles and inhibit excessive activation of superficial cervical flexor muscles. Therefore, the selective activation of deep cervical flexors is needed for effective exercise for FHP. Objects: The purpose of this study was to compare muscle thickness between longus colli (Lco) and sternocleidomastoid (SCM) using ultrasonography in subjects with FHP depending on head support. Methods: This was a cross-sectional, case-control research design study. The ultrasonographic images of Lco and SCM were taken in 17 subjects with FHP during the 5 phases of the CCFT with and without a head support. Towel was used for supporting head to make the neutral head position in supine. Changes in muscle thickness during the test were calculated to infer muscle activation. Data were analyzed using repeated measures of two-way analysis of variance with the significance level of .05. Results: When subjects performed the CCFT with head support, there was a significant difference in muscle thickness of Lco and SCM (p<.05). According to a post hoc paired t-test, change of thickness of Lco was greater at all phases, and change of thickness of SCM muscle was less at phase 4 and 5 in condition with head support (p<.01) compared to condition without head support (p<.01). Conclusion: The result of this study suggest that applying head support for neutral head position during CCFT could be a useful method for activating Lco muscle without excessive activation of SCM muscle.

• 한국전문물리치료학회지
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• 제29권3호
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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.

• 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.

• 대한물리의학회지
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• 제11권4호
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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.