• 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.

• The Journal of Korean Physical Therapy
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• v.28 no.6
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• pp.349-354
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• 2016

Purpose: The purpose of the study was to investigate the thickness of deep neck flexors (DNF) and sternocleidomastoid muscle (SCM) bilaterally during deep neck flexor endurance test using ultrasonography images. Methods: Healthy volunteers (n=22), 20-25 (mean 22.2) years old, were recruited for the study. Participants were asked to perform the craniocervical flexion test (CCFT) in a seated position to measure deep neck flexor endurance. The thickness of DNF and SCM was assessed bilaterally and was measured using ultrasonography images at resting, contracted, pre-terminal and terminal phases of the neck muscle endurance test. Muscle contraction pattern was also observed along with the changes in muscle thickness from the resting phase to the terminal phase. Repeated-measure ANOVA was employed to compare muscle thickness bilaterally at each phase. Results: The thickness of right and left muscles was found to be significantly different in DNF both at resting and contracted phases (p=0.02, p<0.01, respectively), whereas no significant difference was observed in SCM at resting or contracted phases (p=0.59, p=0.18, respectively). Thickness changes from resting to contracted phase were not significantly different both in DNF and SCM (p=0.18, p=0.22, respectively). Muscle contraction patterns in right and left muscles were shown to be similar. Conclusion: The current study, performed on (with) healthy subjects, significantly detected different right and left muscle thickness in DNF, but the muscle contraction patterns were similar in DNF and SCM bilaterally. Further study is required to investigate DNF and SCM muscle size and function in people with neck pain.

• 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.8 no.2
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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.

• Journal of the Korean Society of Physical Medicine
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• v.19 no.1
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• pp.53-60
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• 2024

PURPOSE: The study aimed to analyze the effect of pillow height on upper trapezius and sternocleidomastoid (SCM) muscle activity and overall human body comfort to determine the optimal pillow height. METHODS: The study included 32 healthy college students, of both genders, who provided prior consent. It examined three pillow heights (flat, 6cm, 12cm) and measured the upper trapezius and SCM muscles using ultrasonography, myotone, and electromyography(EMG). Muscle activation, thickness, and fatigue were assessed. RESULTS: The study found significant differences in muscle thickness and muscle tone based on the pillow heights (flat, 6cm, and 12cm) with a p < .05. The SCM and upper trapezius muscles were thinnest at a pillow height of 6cm. Muscle tone in the SCM was lower at both 6cm and 12cm pillow heights. Post-hoc measurements showed significant differences in both the SCM and upper trapezius muscles thickness at the 6cm pillow height (p < .05). Also, significant differences in muscle tone were observed only in the SCM, particularly between the 6cm and 12cm pillow heights. CONCLUSION: The ultrasonography and myotone measurements showed a significant difference in muscle thickness and muscle tension, both of which were above 6cm, while there was no difference in muscle activation. Based on the strong correlation between muscle tension and muscle thickness with pillow height, this study concluded that the human body feels comfortable with a 6cm pillow height. Therefore, it is recommended to use a pillow height of 6cm when lying in a supine position.

• Journal of the Korean Society of Physical Medicine
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• v.12 no.4
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• pp.133-138
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• 2017

PURPOSE: The purpose of this study was to investigate the effect of modified motor developmental intervention on the SCM muscle thickness and the range of motion (ROM) of neck in subjects with congenital muscular torticollis. METHODS: Thirteen subjects who had congenital muscular torticollis were participated in this study and they were offered the modified motor developmental interventions for 8 weeks by pediatric physical therapist. SCM thickness of affected and non-affected side and ROM of neck rotation were collected between before and after intervention. SCM thickness was measured by using Ultrasound Unit (IU 22, Ultrasound system, Philips, Netherlands) and ROM of neck was measured by using the goniometer (Arthrodial protractor, North coast, USA). Data were represented as means ${\pm}SD$. Paired t-test was used to determine the effect of interventions on the SCM muscle thickness and neck ROM. RESULTS: SCM thickness of affected side was significantly decreased after the modified motor developmental interventions and that of non-affected side was generally increased but it was not significantly difference between pre and post interventions. ROM of neck rotation and lateral flexion was significantly increased after interventions. CONCLUSION: These results suggested that the modified motor developmental interventions could improve the recovery of SCM muscle thickness and neck ROM.

• Journal of The Korean Society of Integrative Medicine
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• v.8 no.3
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• pp.93-101
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• 2020

Purpose : Temporomandibular joint disorder (TMJD) is often accompanied by pain and limited range of motion of the jaw joint, which affect patients' quality of life and result in hypertrophy or hyperactivity of the muscles around the jaw joint. In this study, we compared the muscle thickness and tone of the masseter and sternocleidomastoid (SCM) muscles and the jaw range of motion in individuals with and without TMJD. Correlation comparison was performed on the results of the TMJD group. Methods : This study included 40 patients; 20 patients were assigned to an experimental group (TMJD group) and 20 to a control group (non-TMJD group). Ultrasonography, myotonometry, and measurements performed with digital Vernier calipers were used to determine the changes in muscle thickness, muscle tone, and maximum jaw opening, respectively. The independent t-test was used for intergroup comparison of data, and Pearson correlation coefficients were used to compare correlations in the TMJD group results. Results : We observed a significant intergroup difference in the masseter and SCM thickness during the relaxed and clenched phases (p<.05). A significant intergroup difference was also observed in maximum jaw opening (p<.05). With regard to muscle tone, we observed a significant intergroup difference in frequency (p=.011) and stiffness (p=.011) of the masseter, as well as in the frequency (p=.009) and stiffness (p=.026) of the SCM. We observed a moderate negative correlation (r=-.524) between maximum jaw opening and the frequency of the masseter. Additionally, we observed a moderately negative correlation between jaw opening and muscle stiffness (r=-.321). Conclusion : Planning exercise programs to treat patients with TMJD who present with pain should focus on efforts to reduce muscle thickness and achieve muscle relaxation (to reduce muscle tension) for improved jaw range of motion.

• Physical Therapy Korea
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• v.26 no.4
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• pp.1-9
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• 2019

Background: Cervical dysfunction is a common pathomechanical marker in individuals with forward head posture (FHP). To overcome the limitations of the isometric chin-tuck (ICT) exercise, dynamic neuromuscular stabilization (DNS), which emphasizes an entire spinal chain exercise, has recently shown promising clinical results. Objects: Purpose of this study was to compare the immediate effects between ICT and DNS techniques. Methods: 43 young subjects (mean age, $24.0{\pm}5.0$ years) were recruited. Group of subjects with FHP were measured under baseline, ICT, and DNS conditions. Outcome measures included sitting height, longus colli (LC) and sternocleidomastoid (SCM) muscle thickness and LC/SCM thickness ratio. One-way repeated measures ANOVA was used to compare the continuous dependent variables among FHP, ICT, and DNS conditions at p<.016. Results: Both ICT and DNS exercise conditions yielded significantly increased LC muscle thickness, LC/SCM thickness ratio and sitting height than did FHP condition (p<.0001, respectively). Sitting height was significantly greater in DNS exercise than in the ICT exercise (p<.0001). Conclusion: The present results demonstrated that sitting height was greater in the DNS exercise than in the ICT exercise, as well as both corrective postural training exercises were effective on LC/SCM muscle balance ratio when compared with the baseline FHP condition. Therefore, it is considered that DNS exercise can be the recommended exercise for people with FHP.

• Physical Therapy Korea
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• v.23 no.3
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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.

• Physical Therapy Korea
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• v.22 no.4
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• pp.44-50
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• 2015

This study compared the effects of the initial head position (i.e., a HHP versus a relaxed head position) of subjects with and without a FHP on the thickness of the deep and superficial neck flexor muscles during CCF. The study recruited 6 subjects with a FHP and 10 subjects without a FHP. The subjects performed CCF in two different head positions: a HHP, with the head aligned so that the forehead and chin formed a horizontal line, and a relaxed head position (RHP), with the head aligned in a self-selected comfortable position. During the CCF exercise, the thickness of the longus colli (LCo) and the thickness of the sternocleidomastoid (SCM) were recorded using ultrasonography. The thickness of each muscle was measured by Image J software. The statistical analysis was performed with a two-way mixed-model analysis of variance. The thickness of the SCM differed significantly (p<.05) between the subjects with and without FHP. According to a post $h^{\circ}C$ independent t-test, the change in thickness of the SCM increased significantly during CCF in the subjects with FHP while adopting a HHP compared to that in the subjects without FHP. The change in thickness of the SCM was not significantly different between the two positions in subjects without FHP, and there was no significant change in thickness of the LCo muscle during the CCF exercise according to the initial position in both subjects with and without FHP. The results suggest that CCF should be performed in RHP to minimize contraction of the SCM in subjects with a FHP.