• 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 Korean Physical Therapy Science
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• v.26 no.2
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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.

• Journal of the Korean Society of Physical Medicine
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• v.11 no.3
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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.

• Journal of The Korean Society of Integrative Medicine
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• v.11 no.3
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• pp.195-204
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• 2023

Purpose : This study applied general training (control group) or cranio-cervical flexor training (experimental group) using a pressure biofeedback unit along with general training for 4 weeks to secondary school teachers with moderate to severe neck pain and forward head posture. After that, we tried to compare the effects through differences in neck pain intensity (using numberical rating scale), functional performance (using neck disability index), and cranio-vertebral angle change. Methods : All 50 subjects were randomly assigned to either the "experimental group (n= 25)" or the "control group (n= 25)", and the measurements were evaluated in the same way before the intervention (baseline) and after the intervention (4 weeks). During the intervention period, the subject visited the physiotherapy center and made a reservation three times a week at a fixed time as much as possible, and each training session was thoroughly conducted under the 1:1 guidance of the therapist in charge so that the correct movement and number of times could be performed without compensatory action. Results : As a result of the homogeneity analysis on the general characteristics of the subjects, there were no significant differences between the groups in all variables (p>.05). Compared to the "control group", the "experimental group" showed significant improvement after intervention in all measured variables of neck pain intensity, functional performance, and cranial-vertebral angle (p<.05). Conclusion : For secondary school teachers with forward head accompanied by neck pain, cranio-cervical flexor training using a compression biofeedback unit is an excellent method to show superior pain reduction and functional performance improvement compared to general training alone. In addition, it can be presented as a more effective intervention method that can promote recovery of forward head posture, which is an essential element of the solution.

• Physical Therapy Korea
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• v.28 no.2
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• pp.138-145
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• 2021

Background: Forward head posture (FHP) causes various posture imbalances associated with the head and neck. Myofascial release is an effective treatment method used for relaxing muscles and reducing muscle hyperactivity, but no studies have been conducted on suboccipital and neck muscles related to FHP. Objects: The purpose of this study was to investigate the immediate effect of roller massages on the cranio-cervical flexion (CCF) range of motion (ROM) and CCF strength applied to suboccipital and neck muscles in subject with forward head posture. Methods: Twenty-four FHP subjects (male: 13, female: 11) were recruited for this study. All subjects were recruited with a craniovertebral angle (CVA) of 53 degrees or less and a head tilt angle (HTA) of 20.66 degrees or higher. CCF strength was measured using Pressure biofeedback unit (PBU) in the supine posture and CCF ROM was measured using smartphone-based inclinometer. Roller massage (RM) was applied to suboccipital and neck muscles for 2 minutes and CCF ROM and strength were remeasured. Results: These results of this study showed that CCF ROM was a significant difference in CCF ROM before and after RM (p < 0.05). CCF strength also showed a significant difference before and after RM (p < 0.05). Conclusion: RM method might be recommended to increase the immediate ROM and strength of CCF in subjects with forward head posture.

• 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.

• The Journal of Korean Academy of Orthopedic Manual Physical Therapy
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• v.24 no.1
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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.

• Physical Therapy Korea
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• v.23 no.2
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• pp.57-66
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• 2016

Background: For the treatment of forward head posture (FHP) and forward shoulder posture, methods for strengthening scapular retractors and deep cervical flexors and stretching pectoralis and upper cervical extensors are generally used. No study has yet assessed whether suboccipital release (SR) followed by cranio-cervical flexion exercise (CCFE) (SR-CCFE) will result in a positive change in the shoulders and neck, showing a "downstream" effect. Objects: The purpose of this study was to investigate the immediate effects of SR-CCFE on craniovertebral angle (CVA), shoulder abduction range of motion (ROM), shoulder pain, and muscle activities of upper trapezius (UT), lower trapezius (LT), and serratus anterior (SA) and LT/UT and SA/UT muscle activity ratios during maximal shoulder abduction in subjects with FHP. Methods: In total, 19 subjects (7 males, 12 females) with FHP were recruited. The subject performed the fifth phase of CCFE immediately after receiving SR. CVA, shoulder abduction ROM, shoulder pain, muscle activities of UT, LT, and SA, and LT/UT and SA/UT muscle activity ratios during maximal shoulder abduction were measured immediately after SR-CCFE. A paired t-test and Wilcoxon signed-rank test were used to determine the significance of differences in scores between pre- and post-intervention in the same group. Results: The CVA (p<.001) and shoulder abduction ROM (p<.001) were increased significantly post-versus pre-intervention. Shoulder pain was decreased significantly (p<.001), and LT (p<.05) and SA (p<.05) muscle activities were increased significantly post- versus pre-intervention. The LT/UT muscle activity ratio was increased significantly post- versus pre-intervention (p<.05). However, there was no significant change in UT muscle activity and SA/UT muscle activity ratio between pre- and post-intervention (p>.05). Conclusion: SR-CCFE was an effective intervention to improve FHP and induce downstream effect from the neck to the trunk and shoulders in subjects with FHP.

• Journal of The Korean Society of Integrative Medicine
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• v.8 no.4
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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.

• Journal of The Korean Society of Integrative Medicine
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• v.4 no.4
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• pp.83-90
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• 2016

Purpose : Recommended posture according to the location of operating teeth have been standardized in dental clinic to prevent musculoskeletal disorder. However, clinicians do not comply with this rule in many cases. This study investigated the effects of operating posture on cranio-cervical range of motion (CROM) and muscles activity of neck and upper extremity. Methods : Sixteen healthy dental hygiene students were participated. During operating posture (3 recommended and 3 experimental postures which were set front, side, back, respectively), CROM in the fronal and sagittal plane were measured by Cervical Range of Motion Instrument and muscle activities of Sternocleidomastoid, upper trapezius, middle deltoid, extensor carpi radialis, brachioradialis, and abductor pollicis brevis were measured by Pocket EMG system. Result : CROM were significantly decreased in recommended posture in comparison with experimental posture (p<.05). In addition, muscle activity of middle deltoid was significantly decreased in recommended front posture. Moreover, brachioradialis and extensor carpi radialis showed the same result in recommended back posture (p<.05). Conclusion : Recommended posture is close to neutral posture and to reduce muscle fatigue and overuse, which may considered as a preventing musculoskeletal disorder and partially explain its efficacy in dental clinic.