• 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.

• 대한물리치료과학회지
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• 제26권2호
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• pp.61-73
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• 2019

Purpose: This study was to evaluate the effect of cranio-cervical flexion based trunk stabilization exercise on gross motor function and posture alignment change in children with spastic cerebral palsy. Design: Randomized Controlled Trial. Methods: Twenty-six children participated in this study. All subjects were randomly assigned to either the Cranio-Cervical Flexion Based Trunk Stabilization Exercise (CCFTS) group (n=13) or the Trunk Stabilization Exercise (TS) group (n=13). In both groups were trained general physical therapy for 10 minutes, in the CCFTS group was trained cranio-cervical flexion based trunk stabilization exercise for 20 minutes and in the TS group was trained trunk stabilization exercise for 20 minutes. The training was provided 2 times a week during 8 weeks. All subjects were measured with the Gross Motor Function Measure (GMFM) and Cranio-Vertebral Angle (CVA) before and after intervention. Results: The results showed that the CCFTS have increased significantly in GMFM (B, C, D and E-dimension) and CVA, and the TS group have increased significantly in GMFM (B, C D and E-dimension). In particular, the CCFTS group improved significantly than TS group in GMFM (B, C and D-dimension) and CVA. Therefore, the cranio-cervical flexion based trunk stabilization exercise improved gross motor function and posture alignment in children with spastic cerebral palsy. Conclusion: These results suggest that cranio-cervical flexion based trunk stabilization exercise is feasible and suitable for individuals with a spastic cerebral palsy and can be used in addition to conventional physical therapy.

• 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.

• 대한물리의학회지
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• 제11권3호
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• pp.65-72
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• 2016

PURPOSE: The purpose of this study is to determine the differences between the muscle activity of cranio-cervical flexion and extension muscles according to the types of tools used through a short-term intervention of cranio-cervical static stabilization exercises using small tools. METHODS: A total of fifteen male and female adults in their 20s who showed forward head posture in the overall body posture measurement system participated in this study. Each subject performed cranio-cervical static stabilization exercises about flexion and extension while using a sling, a foam roller, a TOGU ball, and without tools separately, and the muscle activity of the sternocleidomastoid muscle, scalenus anterior and splenius capitis was measured. Each value was measured for 10 seconds a total of three times. The maximum voluntary isometric contraction value was computed using the average during the middle four seconds. RESULTS: Cranio-cervical flexion exercises using various tool types, the average activity of the sternocleidomastoid and scalenus anterior muscles was significantly higher when applying the TOGU ball (p<.05). According to the results of implementing cranio-cervical flexion exercise using various tools, the maximum muscle activity of the sternocleidomastoid muscle was significantly higher for the TOGU ball (p<.05). CONCLUSION: Based on these results, the provision of an unstable surface using small tools rather than a stable surface is recommended as an exercise scheme for proprioceptive stimulation in a forward head posture. Particularly, we recommend using the TOGU ball for the provision of an unstable surface to increase the muscle activity of the sternocleidomastoid muscle and scalenus anterior.

• 국제물리치료학회지
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• 제10권4호
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• pp.1914-1920
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• 2019

Background: Mobilization and cranio-cervical flexion exercise has been reported in reducing pain from cervical part and improving its motor function; also, has been represented that alleviate of neck pain and recover of neck muscles improve the normal gait performance. However, few studies have identified the effects of mobilization and exercise on pain and gait parameters with preceding issues. Objective: To examine the effects or changes of pressure pain threshold (PPT) and gait parameters in patients with chronic neck pain. Design: Cross-Sectional Clinical Trials Methods: Twenty patients with the history of neck pain (>3 months) performed the cervical mobilization and cranio-cervical flexion exercise. Gait parameters were assessed with wireless device and collected data were transmitted to the personal computer via Bluetooth. The PPT was measured posteroanterior direction at the prone position and the mean of subsequent three PPT measurements was used for the final analysis. Results: Both cervical central posteroanterior mobilization (CCPAM) (p<.000) and sling-based cranio-cervical flexion exercise (SBCCFE) (p<.000) group showed a significant increase in the PPT and the gait parameters, cadence (p<.023), was significantly increased in the CCPAM group, however slightly increased in the SBCCFE group. The comparison between the CCPAM and the SBCCFE groups after treatment did not show significant differences for the score on the PPT and gait parameters. Conclusions: This study suggests that CCPAM and SBCCFE increase PPT, cadence, and gait speed.

• 정형스포츠물리치료학회지
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• 제14권2호
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• pp.33-44
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• 2018

Purpose: The primary purpose of this study was to investigate the effects of cervical stabilization exercise (CSE) on hamstring flexibility in patients with neck pain. A secondary purpose of this study was to investigate the effects of cervical range of motion (CROM) and craniovertebral angle (CVA). Methods: This study was a single-blind, randomized, comparative trial. Twenty patients were allocated into either the cranio-cervical flexion exercise (CCFE) group or the CSE group. Before and after the intervention, we measured straight leg raise (SLR), popliteal angle (PA), CROM, and CVA in the sitting and standing positions. Fisher's exact test, the Mann-Whitney test, and Wilcoxon's signed-rank test were used to analyze our data. Results: Both groups showed significant improvements in the value of SLR, PA, cervical extension, cervical rotation, and CVA in the standing position (both, p<.05) after intervention. However, only the CSE group showed significant improvements in cervical right lateral flexion (z=-2.209; p<.01) and cervical left lateral flexion (z=-2.537; p<.05) after intervention. The CSF group showed more significant improvements in SLR, PA, both cervical lateral flexions, and both cervical rotations than the CCFE group. Conclusions: The results of this study will guide future research in identifying the effectiveness of CSE. In conclusion, it can be inferred that CSE has a positive effect on SLR, PA, CROM, and CVA in the standing position in patients with chronic neck pain.

• 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.

• 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.

• 대한정형도수물리치료학회지
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• 제20권1호
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• pp.1-7
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• 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.

• 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.