• Physical Therapy Korea
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• v.21 no.2
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• pp.48-56
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• 2014

The aim of this study to investigate the effects of craniocervical flexion on muscle activities of scapular upward rotators during push-up plus exercise in subjects with winging scapula. Eighteen males with scapular winging were recruited, and each subject performed knee push-up plus and other exercises, in two conditions (craniocervical flexion vs. natural head positions). A surface electromyography (EMG) was used to measure upper trapezius (UT), serratus anterior (SA), and lower trapezius (LT) muscle activity. A paired t-test was used to determine the statistical significance between the different condition with/without applying of craniocervical flexion. UT EMG activity significantly decreased and SA EMG activity significantly increased during knee push-up plus involving the craniocervical flexion compared to the natural head position. However, no significant differences (p>.05) were found in the activity of the LT muscle. The UT/SA ratios with and without craniocervical flexion showed a significant difference (p<.05). These results showed that the knee push-up plus other exercises performed with craniocervical flexion could strengthen the serratus anterior muscle and minimize the activity of the UT muscle.

• Journal of the Ergonomics Society of Korea
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• v.29 no.3
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• pp.331-336
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• 2010

The purpose of this study was to identify the effect of the craniocervical posture on swallowing and hyoid bone movement with sitting posture in wheelchair, and to provide basic data for developing a treatment program for dysphagia. A total of sixty healthy adults without a history of dysphagia who were guardians or care assistants of inpatients at Hospital K underwent video fluoroscopy performed by physiatrists from April to July 2009. The results of the fluoroscopy were analyzed based on the measurement of hyoid bone movements. The hyoid bone movement(horizontal, vertical, and diagonal) was significantly high in the neutral craniocervical, chin-tuck, and sixty degrees extension postures, in descending order(p<.05). It was found that the neutral craniocervical posture is the most effective posture for hyoid bone movement with sitting posture in wheelchair.

• Journal of the Korean Society of Physical Medicine
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• v.11 no.4
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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.

• Physical Therapy Korea
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• v.26 no.1
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• pp.8-18
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• 2019

Background: Numerous studies have used smartphone applications to measure the range of motion in different joints. In addition, studies measuring the active range of motion (AROM) of the craniocervical joint have revealed high reliability. However, the subjects in these studies were all healthy subjects. No study has yet been conducted to measure the inter-rater reliability for the AROM of the craniocervical joint in stroke patients. Objects: The purpose of this study was to investigate the inter-rater reliability of the AROM of the craniocervical joint using a smartphone. Methods: The participants included 21 subjects who had strokes (17 males and 4 females). Two raters evaluated six types of craniocervical AROM, including flexion, extension, lateral flexion to the hemiplegic side, lateral flexion to the non-hemiplegic side, rotation to the hemiplegic side, and rotation to the non-hemiplegic side, using a goniometer and a smartphone to investigate inter-rater reliability. The inter-rater reliability was analyzed by intraclass correlation coefficients (ICC). Results: The inter-rater reliability of the smartphone was good for extension, lateral flexion to the hemiplegic side, lateral flexion to the non-hemiplegic side, and rotation to the hemiplegic side [ICC(2,k)=.86~.88] and excellent for flexion [ICC(2,k)=.95]. The inter-rater reliability for rotation to the non-hemiplegic side was moderate [ICC(2,k)=.72]. Conclusion: These results suggest that the smartphone offers high inter-rater reliability for measurements of the craniocervical AROM in patients with stroke.

• The Journal of Korean Physical Therapy
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• v.21 no.4
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• pp.9-16
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• 2009

Purpose: This study was done to assess the effect of changes in forward head posture (FHP), neck mobility and headache clinical parameters on episodic tension-type headache (ETTH) and chronic tension-type headache (CTTH) who did craniocervial exercises. Methods: Twelve CTTH subjects and twelve ETTH subjects were studied. Side-view pictures of subjects were taken in both sitting and standing positions, in order to assess FHP by measuring the craniovertebral angle. Cervical range of motion (CROM) was employed to measure cervical mobility. A headache diary was kept to assess headache intensity, frequency, and duration. All subjects did three types of craniocervical exercise over 8 weeks. Measurements were done at pre-treatment, and at 4 and 8 weeks post-treatment. Results: Forward head posture and headache-related clinical parameters showed a significant improvement after craniocervical exercise (p<0.05). Flexion/extension and left/right rotation of CROM was significantly increased after the intervention (p<0.05), whereas changes in left/right bending did not reach statistical significance. Conclusion: This study indicates that craniocervical exercise may be effective in the management of tension-type headache.

• Anatomy and Cell Biology
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• v.56 no.3
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• pp.342-349
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• 2023

This study was conducted to investigate the clinical and anatomical importance of the relevant region from the perspective of surgical approaches by determining the morphometric analysis of the craniocervical junction and foramen magnum (FM) region and determining their distances from important anatomical points. This research was carried out with 59 skulls found at the Anatomy Laboratories of Erciyes and Ankara Medipol University. Metric measurements of FM and condyle, FM shape, condyle-fossa relationship, and pharyngeal tubercle (PT) were made in mm-based dry bone samples of unknown age and sex. The distance between the anterior notches and the FM was 87.01±4.35, the distance between the anterior notches and the PT was 77.70±4.24, the distance between the PT-sphenooccipital junction was 13.23±2.42, and the FM index was 81.86±7.47. The anteroposterior and transverse lengths of FM were determined as 33.80±2.99 and 27.72±2.30, respectively. The morphometric and morphological data available regarding the craniocervical junction showed significant differences between populations. Comprehensive knowledge of this topic will provide a better approach to treat Arnold Chiari Malformation, FM meningiomas, and other posterior cranial fossa lesions. Therefore, we believe that FM and craniocervical junction morphology will be a guide not only for anatomists, but also for radiologists, neurosurgeons, ENT surgeons, and orthopedists.

• Journal of The Korean Society of Integrative Medicine
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• v.6 no.1
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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.

• The Journal of Korean Physical Therapy
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• v.30 no.2
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• pp.47-53
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• 2018

Purpose: To find the effect of visual feedback of head angle with using a mobile posture-aware system on craniocervical angle and neck and shoulder muscles fatigue for preventing or decreasing the forward head posture. Methods: Twenty-four healthy young adults in Chungbuk to participate in this study. The subjects started to watch a movie clip for 10 minutes with visual feedback in $0^{\circ}$, $30^{\circ}$, and $60^{\circ}$ of head angles. During the task, surface electromyography (EMG) was used to collect data from the upper trapezius (UT), sternocleidomasetoid muscle (SCM), cervical erecter spinae (CES) during watching the smartphone. Craniocervical angles were measured using a sagittal-view photograph of the subject in a sitting posture. A one-way repeated analysis of variance with a significant level of 0.05 used for statistical analysis. Results: Craniocervical angle with $0^{\circ}$ visual feedback was significantly greater than $30^{\circ}$ and $60^{\circ}$. Craniocervical angle with $30^{\circ}$ visual feedback was significantly greater than $60^{\circ}$. In addition, MDF of UT muscles in $0^{\circ}$ and $30^{\circ}$ of visual feedback was significantly greater than $60^{\circ}$. Conclusion: We concluded that $0^{\circ}$ visual feedback of head angle with using a mobile posture-aware system would be beneficial to prevent or decrease forward head posture during watching a smartphone. We also could recommend using of $30^{\circ}$ visual feedback in case of caring UT muscle fatigue primarily.

• Journal of the Ergonomics Society of Korea
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• v.29 no.6
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• pp.889-895
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• 2010

This study compared the effects of craniocervical flexion exercise with conservative cervical flexion exercise in workers with chronic neck pain. Subjects were randomly allocated to two groups: control (n=20) and experimental group (n=20), respectively. The conservative exercise for the control group consisted of cervical flexion exercise, whereas the experimental group performed a craniocervical flexion exercise. To compare the two groups, the visual analogue scale (VAS) for a pain, neck disability index (NDI) for a neck disability scale, and cross sectional area (CSA) of longus colli muscle using ultrasound image were assessed on pre-intervention, post-intervention, and 2 weeks follow-up. 2-way repeated ANOVA was used with Bonferroni post-hoc test. (1) There were significant main effects (within and between groups) (p<0.05) and interaction effect (p<0.05) in VAS. Post-hoc test revealed that there were significant differences in all pair-wise comparisons. (2) There were significant main effects (within and between groups) (p<0.05) and interaction effect (p<0.05) in NDI. Post-hoc test revealed that there were significant differences between pre-intervention and post-intervention, pre-intervention and 2 weeks follow-up. (3) There were significant main effects (within and between groups) (p<0.05) and interaction effect (p<0.05) in CSA of longus colli muscle. Post-hoc test revealed that there were significant differences in all pair-wise comparisons. The findings indicate that craniocervical flexion exercise are more effective for improving pain, neck disability, and CSA of longus colli muscle than cervical flexion exercise in workers with chronic neck pain.

• Journal of the Ergonomics Society of Korea
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• v.27 no.4
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• pp.59-64
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• 2008

The aims of this study were to compare and analyze two types of deep cervical flexion exercises, craniocervical flexion and cervical flexion, and to ascertain their relative effects on neck and shoulder pain and functional improvement. The participants of the study were individuals who work in sedentary jobs in an office environment. 54 appropriate subjects were chosen and randomly divided into two groups: one group underwent a craniocervical flexion exercise program and the other a cervical flexion exercise program. The six week exercise program consisted of home exercises performed by each subject five times a week and education once a week. Neck-shoulder pain, muscle strengthening, cervical alignment were measured prior to commencement of the exercise programs and again after six weeks. At completion of the six week, both exercise programs decreased neck pain (p<.05). Forward head postures were reduced, and the craniocervical flexion exercise program was more effective in reducing forward head posture (p<.05). The maximum muscle strength and 50% of maximum muscle strength maintaining time of the deep cervical flexor muscles were significantly increased. There were no significant changes of the cervical lordotic curve. The results of this study showed deep cervical flexion exercise was effective in the treatment of neck and shoulder pain, however craniocervical flexion exercise was more effective than cervical flexion exercise.