• The Journal of Korean Physical Therapy
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• v.23 no.1
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• pp.29-35
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• 2011

Purpose: The purpose of this study was to identify the effect of neck exercises on neck-shoulder posture and pain of high school students with neck disorders. Methods: Twenty seven subjects were randomly assigned to one of 3 groups a craniocervical flexion training group (CCFT), a neck strengthening exercise group (ST), and a basic stretching exercise group (CG). CCFT and ST exercised five times a week for eight weeks under the researcher's guidance. The control group performed basic stretching exercises. Diagnostic radiologic equipment was used for the measurement of neck-shoulder posture. Neck disability index, and numeric rating scales were used. Results: The CCFT showed a significant pre-post treatment difference on measures of neck flexion angle and forward shoulder angle changes compared to the ST and CG groups (p<0.05). The CCFT group also showed a significantly greater improvement on the neck disability index and numeric rating scales changes than the ST and CG groups (p<0.01). Conclusion: Because CCFT decreases neck flexion angle, forward shoulder angle, neck disability index, and pain in the forward head posture, it is useful for treating patients with neck disorders.

• 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.

• Physical Therapy Korea
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• v.25 no.2
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• pp.44-52
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• 2018

Background: The deep cervical flexor (DCF) muscles have a crucial role in the management of neck pain. For preventing neck pain by activation of the DCF, craniocervical flexion (CCF) is an effective exercise. However, sternocleidomastoid (SCM) muscle is considered to affect negatively the activation of the DCF. SCM muscle which is an accessory muscle for respiration is activated differently depending on types of breathing patterns. It's not certain that breathing patterns affect the SCM and DCF muscles thickness during CCF exercise. Objects: The purpose of this study was to investigate the influence of breathing patterns on the SCM and DCF muscles thickness during CCF exercise. Methods: Forty-five subjects participated in this study, and they were classified according to their breathing pattern, as follows: costodiaphragmatic breathing (CDB) and upper costal breathing (UCB) groups. Ultrasonographic imaging of the SCM and DCF muscles was performed during five incremental levels of CCF during tidal breathing and expiration. Results: There was a significant interaction between the breathing pattern and the phase of CCF for percentage of SCM muscle thickness changes (p<.05). In phase 1 CCF, a percentage of SCM muscle thickness changes was increased in the UCB group than in the CDB group (p<.05). There was an increase in DCF muscles thickness with each additional CCF phase (p<.05). Conclusion: Recruitment of SCM muscle was increased in the UCB group while performing CCF with a low intensity. There were no significant differences on DCF recruitment between the breathing pattern groups. Higher CCF exercise intensities elicited a higher DCF recruitment.

• Journal of the Korean Society of Physical Medicine
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• v.14 no.2
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• pp.53-61
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• 2019

PURPOSE: Forward head posture (FHP) is a head-on-trunk malalignment that results in musculoskeletal dysfunction and neck pain. To improve forward head posture, both the craniocervical flexion exercise (CCFE) and the visual guide (VG) technique have been used. This study compared the immediate effects of CCFE and VG combined with CCFE on craniovertebral angle (CVA), as well as on the activity of the sternocleidomastoid (SCM) and anterior scalene (AS) muscles during CCFE in subjects with FHP. METHODS: In total, 16 subjects (nine males, seven females) with FHP were recruited using the G-power software. Each subject conducted CCFE and CCFE combined with VG in random order. The CVA was recorded using a digital camera and the ImageJ image analysis software. The EMG data of SCM and AS were measured by surface electromyography. A paired T-test was used to assess differences between the effects of the CCFE and VG combined with CCFE interventions in the same group. RESULTS: The CVA was significantly greater for CCFE combined with the VG than for CCFE alone (p<.05). The activity of the SCM and AS muscles was also significantly greater when the VG was combined with CCFE than during CCFE alone across all craniocervical flexion exercise phases (p<.05). CONCLUSION: Use of the VG technique combined with CCFE improved FHP in subjects with FHP compared to CCFE alone.

• Journal of the Korean Society of Physical Medicine
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• v.1 no.1
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• pp.109-116
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• 2006

Purpose : To identify the effects of flexion-extension of stretching on the functional improvement of patients with neck myofascial pain syndrome. Methods : the present research investigated 30 patients with neck myofascial syndrome, dividing them into a group doing flexion-extension of stretching. This study examined degree of recovery from neck pain by comparing their neck myofascial pain syndrome before and after the treatment, and compared to find difference in the degree of recovery from myofascial pain syndrome. Results : The results are as follows. For the flexion of stretching, 1. For the visual analogue scale (VAS) decreased significantly for six weeks treatment, 2. For the flexion decreased significantly for six weeks treatment. and the range of motion of cervical vertebrae increased significantly(p>.05). 3. For Stretching, range of motion left rotation indicated significant difference after pre test and after two week but no significant difference after six week. 4. For the left rotation decreased significantly for six weeks treatment. and the range of motion of cervical vertebrae increased significantly(p>.05). 5. For the right rotation decreased significantly for six weeks treatment. and the range of motion of cervical vertebrae increased significantly(p>.05). Conclusion : This study suggest that flexion-extension of stretching have an effect on the functional improvement of patients with neck myofascial pain syndrome.

• The Journal of Korean Physical Therapy
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• v.31 no.1
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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.

• Journal of the Korean Society of Physical Medicine
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• v.15 no.2
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• pp.31-38
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• 2020

PURPOSE: The aim of this study is to find a more efficient intervention method through a study of the gait variables and dynamic balance of chronic neck pain patients. METHODS: Forty subjects aged between 40 and 60 years were allocated randomly to two groups; The first group performed PA (Posteroanterior Mobilization), and the second group conducted CCF (Craniocervical Flexion Exercise). The gait variability measured the speed, cadence, and dynamic balance in the forward, leftward, rightward, and rearward directions. An independent t-test, Wilcoxon signed-rank test, and paired t-test were used for statistical analysis. RESULTS: In the dynamic balance measurements, the variability of PA (p < .000) and CCF (p < .000) in the rightward direction, PA (p < .004) in leftward direction and forward direction increased significantly (p < .013). In an analysis of the gait variability, the cadence increased significantly in the PA group (p < .022) and not significantly in the CCF group (p < .056). On the other hand, there was no increase in the speed variable, in the PA group (p < .437). In the CCF group, the cadence increased significantly (p < .022). The differences in the PA and CCF group differences were not significant. CONCLUSION: The PA group showed a significant increase in the forward (p < .013), leftward (p < .004), and rightward directions (p < .000). Speed was significant in the CCF group, and cadence was significant in the PA group. The dynamic Balance was effective in the rightward direction in both groups, but there was no significant difference between the two groups.

• Physical Therapy Korea
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• v.20 no.4
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• pp.32-39
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• 2013

Abdominal curl-up exercise may excessively increased superficial neck flexor such as sternocleidomastoid (SCM) muscle. Also, the muscle activity of the abdominal muscles haven't investigated during abdominal curl-up with craniocervical flexion (CCF). Therefore, the purpose of our study was to determine the effect of CCF on the muscle activity of the abdominal and SCM muscles during abdominal curl-up. Twelve healthy subjects (six men and six women) with no history of abdominal or lower back pain within 6 weeks were recruited. Surface electromyographic signals were collected on SCM, rectus abdominis (RA), internal oblique (IO), and external oblique (EO) muscles bilaterally during performing the traditional abdominal curl-up and the abdominal curl-up with CCF. Paired t-tests were used to compare the differences in the muscle activity of the bilateral SCM, RA, EO, and IO muscles between the traditional abdominal curl-up and the abdominal curl-up with CCF (p<.05). There was significantly lower electromyogram (EMG) activity of the both SCMs during the abdominal curl-up with CCF (Right SCM, $39.50{\pm}15.29%MVIC$; Left SCM, $38.24{\pm}17.31%MVIC$) than with the traditional abdominal curl-up (Right SCM, $54.85{\pm}20.05%MVIC$; Left SCM, $53.18{\pm}26.72%MVIC$) (p<.05). The activity of abdominal muscles were not significantly different between the traditional abdominal curl-up and the abdominal curl-up with CCF. The abdominal curl-up with CCF requires significantly less muscle activity of SCM. Consequently, the abdominal curl-up with CCF is recommended to prevent excessive activation of superficial cervical flexors during abdominal curl-up exercise.

• Physical Therapy Korea
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• v.29 no.3
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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.

• Journal of the Korean Society of Physical Medicine
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• v.16 no.3
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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.