• 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.

• Journal of the Korean Society of Physical Medicine
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• v.6 no.4
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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.

• The Journal of Korean Physical Therapy
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• v.29 no.5
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• pp.265-270
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• 2017

Purpose: This study examined the effects of neck stabilization exercises with vibratory stimulation on the neck disability index and thickness of the deep neck flexor. Methods: Thirty subjects (control group=15, experimental group=15) with mild neck pain were enrolled in the study. The control group underwent craniocervical flexion exercise (control group, CG) and the experimental group was given craniocervical flexion exercise with vibratory stimulus (experimental group, EG) (3 sets, 3 times per week for 6 weeks). To examine the effects of exercise, the subjects were evaluated using the neck disability index (NDI), the thickness of the deep neck flexor muscle, and muscle strength. An independent and paired t-test were used to compare the effects of the exercise between the groups. Results: The NDI score of the two groups increased significantly after 6 weeks of treatment (p<0.001) and there was a significant difference between the EG group at 3 weeks (p<0.05) and 6 weeks (p<0.01). The thickness of the deep neck flexor in the CG group increased significantly after 6 weeks of treatment in all pressure stages (p<0.001). The EG group showed a significant increase after 3 and 6 weeks of treatment in all pressure stage (p<0.001), and 22 mmHg, a significant difference between 3 and 6 weeks (p<0.05) and among 24, 28, and 30 mmHg at 6 weeks (p<0.05). The maximum muscle strength of the deep neck flexion muscles increased significantly in the two groups after 6 weeks of treatment (p<0.001) and there was significant difference between the EG group at 6 weeks (p<0.01). Conclusion: Craniocervical flexion exercise with vibratory stimulus decreases the NDI, and increases the thickness of the deep neck flexor and maximum muscle strength of the deep neck flexion muscles in patients with mild neck pain.

• Transactions of the Korean Society of Mechanical Engineers A
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• v.28 no.9
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• pp.1262-1269
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• 2004

This study predicts muscle forces acting on the lower extremity when the knee joint is in deep flexion. The whole body was approximated as a link model, and then the moment equilibrium equations at the lower extremity joints were derived far given reaction farces against the ground. Measurement of deep flexion was carried out by placing ten markers on the body. This study calculated the moment acting at each Joint from the equations of force and moment, classified the complicated muscles around the knee joint, and then predicted the muscle forces to balance the joint moment. Two models were proposed in this study: the simpler one that consists of three groups of muscle and the more detailed one of nine groups of muscle.

• Proceedings of the Korean Society of Precision Engineering Conference
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• 2003.06a
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• pp.1288-1293
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• 2003

This study predicts muscle forces acting on the lower extremity when the knee joint is in deep flexion. The whole bodies were approximated as a link model, and then the moment equilibrium equations at the lower extremity joints were derived for given reaction forces against the ground. Measurement of deep flexion was carried out by placing ten markers on the body. This study calculated the moment acting at each joint from the equations of force and moment, classified the complicated muscles around the knee joint. and then predicted the muscle forces to balance the joint moment. Two models were proposed in this study: the simpler one that consists of three groups of muscle and the more detailed one of nine groups of muscle.

• 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.

• Physical Therapy Korea
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• v.16 no.3
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• pp.9-15
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• 2009

The purpose of this study was to examine contraction of abdominal muscles on surface electromyographic (EMG) activity of superficial cervical flexors, rib cage elevation and angle of craniocervical flexion during deep cervical flexion exercise in supine position. Fifteen healthy subjects were participated for this study. All subjects performed deer cervical flexion exercise with two methods. The positions of two methods were no volitional contraction of abdominal muscles in hook-lying position with 45 degree hip flexion (method 1) and 90 degrees hip and knee flexion with feet off floor for inducing abdominal muscle contraction (method 2). Surface EMG activities were recorded from five muscles (sternocleidmastoid, anterior scaleneus, recuts abdominis, external oblique, internal oblique). And distance of rib cage elevation and angle of craniocervical flexion were measured using a three dimensional motion analysis system. The EMG activity of each muscle was normalized to the value of reference voluntary contraction (%RVC). The EMG activities, distance of rib cage elevation. and angle of craniocervical were compared using a paired t-test between two methods. The results showed that the EMG activities of sternocleidmastoid and anterior scaleneus during deep cervical flexion exercise in method 2 were significantly decreased compared to method 1 (p<.05). Distance of rib cage elevation and angle of craniocervical flexion were significantly decreased in method 2 (p<.05). The findings of this study indicated that deep cervical flexion exercise with contraction of abdominal muscles could be an effective method to prevent substitute motion for rib cage elevation and contraction of superficial neck flexor muscles.

• Proceedings of the Korean Society of Precision Engineering Conference
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• 2013.05a
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• pp.1507-1508
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• 2013

• 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.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.