Cervical Flexor Research Articles

Lumbar motor control training as a complementary treatment for chronic neck pain: A randomized controlled trial

Objective: We investigated whether adding lumbar motor control training with a pressure biofeedback unit improves outcomes of a conservative deep cervical flexor motor control program on neck pain, neck disability, deep cervical flexor endurance, and health status in middle-aged patients with chronic neck pain and forward head posture after eight weeks of interventions. Design: Randomized controlled trial. Setting: Outpatient setting. Subjects and interventions: A total of 113 males and females (mean age 39 ± 5 years) with chronic neck pain were randomized to three treatment groups, group 1 (n = 38) combined deep cervical flexor motor-control training and lumbar motor control exercise, group 2 (n = 37) deep cervical flexor motor control training alone, and group 3 (n = 38) passive treatment and education. Main outcome measures: Pain, neck disability, deep cervical flexor muscular endurance, and health status. Results: There were significant improvements in the combination group compared with the deep cervical flexor motor-control group alone (d = 2.03, 95% confidence interval (CI): −2.8 to −1.27, P = 0.021) for pain (d = −0.99, 95% CI = −1.75 to −0.23, P = 0.023), disability (d = 1.92, 95% CI = 0.86 to 2.98, P = 0.001), deep cervical flexor endurance, and (d = −2.75, 95% CI = −8.81 to −1.68, P = 0.037) for health status favoring the combination group. There were significant between-group differences favoring both active groups versus the passive control in all out comes. Conclusion: The addition of Lumbar motor control training as a complementary treatment may enhance effectiveness of deep cervical flexor motor control training on neck pain, neck disability, and deep cervical flexor endurance in patients with chronic moderate neck pain and forward head posture.

The Effect of Joint Mobilization and Deep Neck Flexor Training on the Range of Motion in Adults with Non-specific Neck Dysfunction-A Pilot Study

This study was conducted to identify the effects of mobilization, deep cervical flexor training(DCFT), and mixed training on the mobility of adults with nonspecific neck dysfunction. Thirty adults with nonspecific neck dysfunction were selected as subjects through the Korean version of the neck disability index (K-NDI) and classified into a joint mobilization group, deep neck flexor training group, and mixed group. They were then subjected to an intervention for four weeks. To examine the effect of the intervention on the range of motion of the neck, the range of motion of the neck before and after the experiment was measured. As the result of the four-week intervention, the flexion and extension of the joint mobilization group and the mixed group increased significantly compared to that of the deep neck flexor training group (p < .05). As a result, joint mobilization and mixed training for nonspecific neck dysfunction were effective in increasing the range of motion of the neck. Based on these results, an intervention program including joint mobility can be effective in treating adults with nonspecific neck dysfunction caused by various factors.

The benefits of manual therapy and active cervical exercises in pacients with cerviogenic headache

Abstract Introduction: Cervicogenic headache stems from a dysfunctional mechanism that frequently affects the upper region of the cervical spine, often involving multiple tissues connected with the occipital, submandibular, and orofacial region. Objectives: The main objective of this study is to demonstrate the therapeutic effectiveness of a personalized program of manual therapy and specific exercises in patients with cervicogenic headaches. Material and Methods: The study included 44 patients. Specific functional tests of the cranio-cervical-mandibular complex, namely the evaluation of the cranio-cervical-mandibular complex (according to Rocabado), cervical flexion-rotation test, cervical flexor endurance test, cervical extensors endurance test, and palpation of trigger points and cervical spine dynamics, were employed. Results: The analysis of demographic data shows a significantly increased prevalence of headache among women. The symptomatology that almost always accompanies episodes of cervicogenic headache is localized neck pain. The intensity and frequency of the symptoms are strongly associated with alterations in the dynamics of the upper cervical spine and chronic sleep disorders. Conclusion: Cranio-cervical manual therapy has proven effective in patients with cervicogenic headaches. The implementation of a strategy based on manual therapy and active exercise had a superior statistical and clinical result compared to the exclusively manual therapeutic approach.

Investigation of Relationship Between Body Mass Index and Neck Biomechanics in Healty Young Adults: A Cross-Sectional Study in a Single Center

Purpose: The aim of this study is to examine the effects of body mass index above normal limits on forward head posture and deep cervical flexor muscle endurance, which are considered to be predisposing factors of mechanical neck pain. Methods: Twenty-four individuals (mean age of 20.50 ± 2.02 years) with a body mass index (BMI) between 19.9 kg /m2 and 24.9 kg /m2 were included in the Normal Body Mass Index (N-BMI group) and 24 individuals with a BMI over 24.9 kg /m2 (mean age of 24.41 ± 2.90 years) were included in the Owerweight-Obese (OW-O group). Cranicervical Angles (CCA) of individuals was measured digitally to determine forward head posture. Deep Cervical Flexor Muscle Endurance Test (DCFMET) was used for endurance of deep cervical flexor muscles. Results: The CCA values of the OW-O group were less than in the N-BMI group, indicating an increased forward head posture (p = 0.043). There was no statistically significant difference in terms of the endurance of the deep cervical flexor muscles between the groups (p = 0.817). A moderate negative correlation was found between the BMI values and CCA of all individuals participating in the study (p = 0.012, r= -0.503). There was no correlation between BMI and DCFMET (p=0.887, r = 0.031). Conclusion: Knowing that overweight and obese young people are in the risk group for mechanical neck pain and various cervical pathologies, plays a very important role in increasing awareness about preventive approaches such as postural correction exercises and weight management strategies.

Effectiveness of Deep Cervical Flexor (DCF) Exercise on Neck Functional Scores in Helicopter Crew with Mechanical Neck Pain

Background: Mechanical neck pain is defined as neck pain due to biomechanical dysfunction in the neck or upper back. Exercise can reduce muscle tension and strengthen deep cervical flexor (DCF) muscles by helping to relieve pain. The prevalence of neck pain is considered high in helicopter crews compared to the general population. Aim: To investigate the effectiveness of DCF exercise on neck functional scores (study of helicopter crews with mechanical neck pain).Material and Methods: Experimental one pre and post-test group design. The samples were 14 squadron-31/serbu helicopter crew performing conventional DCF muscle exercise 12 times for 4 weeks with a frequency of 3 times each week. Neck function was assessed using the Neck Outcome Score (NOOS) which consists of domains of mobility, stiffness, symptoms, sleep disturbances, everyday activity and pain, participating in everyday life, and quality of life.Results: This study showed that the mean NOOS score before intervention was 30.64 (SD: 9.44) and the mean NOOS score after intervention was 8.57 (SD: 5.33). There was a significant difference in the NOOS score before and after deep cervical flexor exercise (p = 0.001).Conclusion: DCF exercises are effective for improving neck functionality in helicopter crew with mechanical neck pain.

Reliability and validity of the novel self-reported spine functional scale (SSFS) in healthy participants

ObjectivesTo develop the novel self-reported spine functional scale (SSFS) and conduct reliability and validity analysis, so that the public can better understand their own spine function in a more simple and scientific way, so as to effectively prevent spinal disorders and improve the quality of life through targeted rehabilitation therapeutic measures.MethodsThis study was approved by an institutional review board, and all subjects gave informed consent to participate.Results(1) Using Spearman correlation analysis to evaluate the content validity, each item was significantly correlated with the total score, and the project design was reasonable. The exploratory factor analysis method is used to evaluate the structural validity of the scale, and the standing position and the lying position of the posture evaluation can be attributed to the factor 2, which is called posture evaluation: the cervical flexor strength, the flat support, the prone back, and the supine knee. The back arch of the wall and the angel on the wall is attributed to factor 1, called the overall spine function test, and the cumulative contribution rate of the two factors was 46.057%. Confirmatory factor analysis showed that the two-factor model fits well (χ2/df = 2.440, RMSEA = 0.04 < 0.05, GFI = 0.945, AGFI = 0.920, CFI = 0.967, IFI = 0.967, TLI = 0.951, GFI, AGFI, CFI, IFI, and TLI are > 0.90) and the validity is ideal. (2) The test-retest reliability shows that the test-retest reliability of each entry, each dimension, and the total score is greater than 0.5, and the test-retest reliability is high. The Cronbach α coefficient was used to evaluate the overall internal consistency of the scale, α > 0.70, indicating that the scale has high reliability. After deleting each item one by one, the α coefficient is 0.692–0.717, and there is no significant increase. (3) Sex and occupation did not affect the level of spinal function (P > 0.05), and there was interaction. Different BMI levels significantly affected the score of spinal function (P < 0.05). The rate of spinal dysfunction in overweight and obese subjects was significantly higher than the normal group; the overall score of spinal function was worse than the normal group.DiscussionThe reliability and validity analyses of this study verified the reliability and scientificity of SSFS in the young healthy population. Body weight had a significant influence on SSFS score, and the performance levels were different for the two sexes.ConclusionThe novel Self-Reported Spine Functional Scale (SSFS) has high reliability and validity and is applicable to the self-assessment and maintenance of spinal health and the prevention of related spinal disorders in the young healthy population. Body weight has a significant influence on the SSFS score in healthy young people. Overweight and obese males were found to be more likely to have spinal dysfunction, while underweight males displayed poor cervical flexor muscle strength. Underweight females were found to have better overall spinal function and stronger cervical flexor muscle strength.

Upper Quadrant Pain and Disability Associated with a Cross-Sectional Area of Deep and Superficial Neck Muscles: A Computed Tomography Study.

An analytical cross-sectional computed tomography (CT) study. To investigate the association of the cross-sectional area (CSA) and density of neck muscles (sternocleidomastoid, upper trapezius, levator scapulae, anterior scalene, longus coli, longus capitis) with upper quadrant pain and disability. Neck pain, a common condition, causes substantial disability to individuals. The deep cervical flexor muscles are impaired in persons with neck pain. These muscles play a greater role in maintaining stable head postures, whereas, superficial muscles are responsible for peak exertions and reinforcing spinal stability at terminal head postures. Two hundred thirty consecutive individuals suffering from neck pain were referred to CT scans; 124/230 complied with the inclusion and exclusion criteria. Subjects were interviewed and the measurements of the CSA and muscle density were extracted from the scans. Muscles associated with quick disability of the arms, shoulders, and hand questionnaire (QDASH) were the lateral posterior group (LPG) CSA C3-C4 on the right side (beta = -0.31, P = 0.029); the sternocleidomastoid (SCM) CSA C3-C4 on the left side (beta = 0.29, P = 0.031); the LPG CSA C3-C4 on the left side (beta = -0.49, P = 0.000); the LCM CSA C5-C6 on the right side (beta = -0.19, P = 0.049); the LPG CSA C5-C6 on the right side (beta = -0.36, P = 0.012); and the LPG CSA C5-C6 on the left side (beta = -0.42, P = 0.002). Further analyses with radiculopathy acting as an augmenting/enhancing variable (moderator), showed an increase in the model strength (r2 = 0.25) with a stronger prediction of pain and disability. Muscle measurements did not predict neck disability index (NDI) scores. By using an accurate measuring tool, we found an association of the deep and superficial neck muscles' CSA with upper extremities' pain and disability. When performing manual work, a special load is placed on the shoulders and neck muscles. Future research should focus on examining the effectiveness of exercise-type intervention programs to strengthen the deep neck and upper extremities' muscles in order to prevent muscle fatigue.Level of Evidence: 2.

The effect of high-intensity physical exertion on measures of cervical spine, vestibular/ocular-motor screening, and vestibulo-ocular reflex function in university level collision and combative sport athletes

ObjectivesTo examine how high-intensity physical exertion affects clinical measures of cervical spine (CSp), vestibular/ocular motor screen (VOMS), and vestibulo-ocular reflex (VOR) function. DesignCase series. SettingSports Medicine Centre. ParticipantsA total of 37 athletes consented to participate (22 rugby, 15 wrestling; 9 men, 28 women; median age = 19 years [range 17–23 years]). Main outcome measuresOutcome measures included tests of CSp (cervical flexor endurance, head perturbation test, cervical flexion rotation test and anterolateral strength), VOR (head thrust test and dynamic visual acuity [DVA]), and a quantified version of the VOMS. These metrics were assessed prior to and after completing the 30–15 Intermittent Fitness Test. Bland-Altman plots and Wilcoxon signed-rank tests were utilized to analyze the data using an alpha of p < 0.004. ResultsCervical anterolateral strength (kg) was reduced post-exertion on the left (z = 3.87; p < 0.001), but not on the right between conditions (z = −1.49; p = 0.14). Athletes reported increased dizziness (z = −3.55; p = 0.004) and had reduced DVA following exertion (z = −2.78; p < 0.001). All other metrics were not significantly different following exertion (p > 0.011). ConclusionReduced performance on DVA, decreased left-anterolateral strength, and increased dizziness occurred following high-intensity exertion in varsity collision and combative athletes, which has implications for sideline screening for sport-related concussion.

Fatty infiltration in cervical flexors and extensors in patients with degenerative cervical myelopathy using a multi-muscle segmentation model.

In patients with degenerative cervical myelopathy (DCM) that have spinal cord compression and sensorimotor deficits, surgical decompression is often performed. However, there is heterogeneity in clinical presentation and post-surgical functional recovery. Primary: a) to assess differences in muscle fat infiltration (MFI) in patients with DCM versus controls, b) to assess association between MFI and clinical disability. Secondary: to assess association between MFI pre-surgery and post-surgical functional recovery. Cross-sectional case control study. Eighteen patients with DCM (58.6 ± 14.2 years, 10 M/8F) and 25 controls (52.6 ± 11.8 years, 13M/12 F) underwent 3D Dixon fat-water imaging. A convolutional neural network (CNN) was used to segment cervical muscles (MFSS- multifidus and semispinalis cervicis, LC- longus capitis/colli) and quantify MFI. Modified Japanese Orthopedic Association (mJOA) and Nurick were collected. Patients with DCM had significantly higher MFI in MFSS (20.63 ± 5.43 vs 17.04 ± 5.24, p = 0.043) and LC (18.74 ± 6.7 vs 13.66 ± 4.91, p = 0.021) than controls. Patients with increased MFI in LC and MFSS had higher disability (LC: Nurick (Spearman's ρ = 0.436, p = 0.003) and mJOA (ρ = -0.399, p = 0.008)). Increased MFI in LC pre-surgery was associated with post-surgical improvement in Nurick (ρ = -0.664, p = 0.026) and mJOA (ρ = -0.603, p = 0.049). In DCM, increased muscle adiposity is significantly associated with sensorimotor deficits, clinical disability, and functional recovery after surgery. Accurate and time efficient evaluation of fat infiltration in cervical muscles may be conducted through implementation of CNN models.

Short-Term Changes in Chronic Neck Pain After the Use of Elastic Adhesive Tape

ObjectivesThe aim of the study was to examine the short-term changes of elastic adhesive tape application on pain intensity and the range of motion (ROM), cervical region proprioception sense, and cervical flexor endurance of patients with chronic neck pain. MethodsThirty-four patients (male: 26, female: 8) between ages 20 and 55 with chronic neck pain having the complaints for at least 6 months were included in the study. Demographic information, pain intensity, cervical ROM, cervical flexor endurance, and cervical proprioception sense of the patients were evaluated. Results were examined 2 times. The first evaluation was conducted prior to elastic adhesive tape application and the second one was conducted 24 hours after the procedure. ResultsThe mean age of the patients was 39.56 ± 17.09 years, average height was 165.65 ± 9.83 cm, average weight was 71.44 ± 15.79 kg, and average body mass index was 26.24 ± 6.62. A statistically significant difference was found between the measurement results of pain intensity, ROM of the joint in flexion, extension, right and left rotation, and cervical flexor endurance before and 24 hours after the application of elastic adhesive tape (P < .05). When the proprioception sense was examined, there was a significant difference between the results before elastic adhesive tape application and 24 hours after the same application in deviation angles except for right rotation (P < .05). ConclusionThe results of this study revealed short-term changes following the use of elastic adhesive tape on cervical flexor endurance, pain, and cervical proprioception sense for patients with chronic pain.

Efficacy of Suboccipital Release and Stabilization Exercise Training in Type 1 Chiari Malformation Patient Undergoing Surgical Treatment: A Case Report

In Chiari malformation, some symptoms are known to recur after decompression surgery. To our knowledge, this is the first case for symptomatic outcome after suboccipital release and stabilization exercises the patient with type 1 Chiari malformation who has experienced surgery. The present study aims to investigate the efficacy of suboccipital release and stabilization exercise training in a patient with Type 1 Chiari Malformation undergoing surgical treatment. A 47- year-old female patient with Chiari malformation received suboccipital release and stabilization exercise training for 10 weeks. Her symptomatic parameters were evaluated, such as pain, grip and pinch strength, deep cervical flexor strength, balance and gait. After the treatment, there were improvements in pain perception, the score of performance index of deep cervical muscles, grip force, static balance and gait parameters. Suboccipital oscillation and stabilization exercises are thought to be safe and effective in patients with Chiari malformation undergoing decompression surgery

Botulinum toxin treatment of dystonic anterocollis: What to inject

BackgroundAnterocollis (AC) is a rare form of cervical dystonia, which responds poorly to botulinum toxin treatment. ObjectivesTo recognise the different clinical phenotypes of AC and to detail the selection of muscles from the results of treating a cohort of 15 AC patients with Botulinum Toxin. MethodsThe study was performed using prospectively collected data. We included 15 patients with cervical dystonia and AC posture, treated between 2016 and 2019 in our joint Neuro-ENT clinic. We excluded patients with posterior cervical muscle weakness and patients with Parkinsonism. We characterised the primary dystonic posture of every AC patient as posterior sagittal shift, head flexion or neck flexion, or a combination of the three. ResultsAll AC patients had a more widespread dystonic picture with a majority having Meige syndrome, but AC was the most problematic feature. Treatment with botulinum toxin required the injection not only of the deep cervical flexor (DCF), but also the sterno-cleido-mastoid (SCM) and moreover the supra-hyoid (SH) muscles. The choice between the longus capiti and the longus colli depended on the AC posture. Half of the patients had a dramatic improvement with 90% satisfaction or above. ConclusionAC posture is a complex but treatable type of CD. A joint Neuro-ENT clinic is an ideal setting in which to target all the dystonic muscles. This allows the injection of the longus capiti (under nasal endoscopic approach) as well as the supra-hyoid and SCM muscles in the same session.

Effect of Deep Cervical Flexor Muscle Training Using Pressure Biofeedback on Pain and Forward Head Posture in School Teachers with Neck Pain: An Observational Study.

Background Teaching is one of the professions where incidence and prevalence of neck pain is high. Prolonged use of computers, which has further increased due to online teaching amid pandemic, is known to cause neck pain and alter posture, while people with forward head posture (FHP) are prone to develop neck pain and related disability. Research has shown that impairment of deep cervical flexor (DCF) muscles leads to insufficiency in coordination, activation, overload, and poor support on cervical structures that further lead to development of neck pain and altered neck posture. The objective of this study was to see the effect of DCF muscle training using pressure biofeedback on pain and FHP in school teachers with neck pain. Methods This observational study was conducted at medical center in school premises. Fifty-five school teachers aged between 25 and 40 years with experience of more than 5 years were invited to participate in this study. Subjects were divided in two groups. Both the groups received conventional exercises while in experimental group DCF muscle training using pressure biofeedback was given additionally. Pain and FHP were assessed using NPRS and cranio-vertebral angle using digital photograph technique, respectively, at baseline and end of four weeks of treatment. Results Although pain and FHP improved in both the groups, mean improvement in both the measures was more in the group that also received DCF training using pressure biofeedback. Conclusions This study shows that although pain and FHP improved following conventional exercises in school teachers with neck pain, mean improvement was more significant among those who received additional DCF muscle training using pressure biofeedback.

Cervico-thoracic pain and associated impairments in air force personnel: a cross-sectional study

BackgroundPain and impaired function in the cervical region are common in Air Force personnel (AFP), but evidence is limited regarding the thoracic region. This cross-sectional cohort study examined associations between cervico-thoracic pain and physical performance among Swedish AFP and explored possible differences and similarities in test performance between fighter pilots (FP), helicopter pilots (HP) and rear crew (RC).MethodsAFP (n = 73) from one airbase performed eight tests of movement control of the spine, active cervical range of motion (ROM) in all six directions and isometric strength and endurance of the cervical flexors and extensors. The association between test performance and cervico-thoracic pain (based on the ‘Musculoskeletal screening protocol’ questionnaire) were analysed in a multiple binary logistic regression model.ResultsFor AFP with cervico-thoracic pain (30%), movement control was impaired in the ‘neck flexion test’ (OR [95%CI] =3.61 [1.06–12.34]) and the ‘forward lean test’ (OR [95%CI] =3.43[1.04–11.37]), together with reduced flexion ROM (OR [95%CI] =0.93 [0.87–0.99]). Test performance was in general similar between the three groups, but FP and HP could control the ‘forward lean test’ to a significantly higher degree than RC (p = 0.000). Further, FP showed significantly greater ROM in lateral flexion to the right compared to HP and RC (mean: 40.3°, 36.2° and 33.4°, respectively, p = 0.000), and they showed higher, although not significant, flexor strength than RC (p = 0.026).ConclusionsThe impaired function associated with cervico-thoracic pain highlights the need for a deeper understanding of such relationships when designing tools to systematically optimize the physical performance and prevent pain among AFP. Studies with a longitudinal design are warranted to examine any causative associations between pain and impairments.

Significance of Cervical Flexors Strength Training Using EMG Bio-feedback on Forward Head Posture among College Students

Background and Purpose: Forward Head Posture is found to be more among college students resulting indecreased Cervical flexors strength &amp; reduction in physical performances. EMG Biofeedback is effectiveintervention in retraining the muscle strength &amp; facilitates the correction of abnormal Cranio-Vertebral Angle(CVA) and purpose of this study is to find out the effectiveness of Cervical flexors strength training usingEMG Biofeedback among college students, to improve Forward Head Posture. Materials and Methods:Totally 30 college students selected under selection criteria ages between 18-25 with Forward Head Postureand randomly allocated equally into experimental group (EMG Biofeedback cervical flexors strengthening)and control group (only cervical flexors strengthening ex’s).The outcome tools used were Kinovea Softwarefor CVA and Neck Disability Index (NDI) which was measured before and after the treatment. Statisticalanalysis: Analyzed by paired and unpaired t test. Results: The results shows that Group A cervical flexorsstrength training using EMG Biofeedback has significant improvement on FHP by improving CVA andNDI (p &lt;0.0001).Conclusion: This study concluded that the experimental group received cervical flexorsstrength Training using EMG Biofeedback is found to be effective than the control group received onlycervical flexors strengthening ex’s.

Effectiveness of clinical Pilates and home exercises in sagittal cervical disorientation: randomized controlled study.

Aim:To compare effects of clinical Pilates and home exercises on postural disorders, strength and endurance of deep cervical flexors (DCF), cervical range of motion (CROM), pain intensity and functional disability in sagittal cervical disorientation. Patients & methods: Fourty sixpatients were included and divided intotwo groups. Clinical Pilates group performed stabilization based exercise and home exercise group performed conventional exercises. Results: Craniovertebral, head tilt, cervicothoracic angles andstrength and endurance of DCFmuscleshad improvement in favor of clinical Pilates group (p<0.05). There was no difference between groups in terms of right-left acromial distance, pain intensity, functional disability and CROM parameters (p>0.05). Conclusion: Clinical Pilates exercises have been found to provide clinically significant improvements in craniovertebral, head tilt, cervicothoracic angles and strength and endurance of DCF muscles. However, in the increase of CROM, decreasing pain severity and functional impairment parameters there was no superiority of both exercise training. Clinical trial registration number: NCT03352921(Clinicaltrials.gov).

Vestibular Physiotherapy and Yoga in Vasovagal Syndrome: case report

This study aimed to report the effects of vestibular physiotherapy (VP) associated with Yoga in a vasovagal syndrome (VVS) patient with dizziness and body imbalance complaints. We described a 22-year-old patient who underwent one year of VP with a frequency of one to two times per week (totaling 31 sessions). The treatment for the cervical region was performed using manual therapy and motor control training of the deep cervical flexor muscles. The patient started to practice Yoga three months after the beginning of the VP. After one year of treatment, a substantial improvement in the symptoms of dizziness and postural balance were observed. However, the cervical pain remained present and cervical mobility was slightly limited after two years. These findings lasted one year after the end of the VP program, a period in which the patient performed only Yoga. Despite the promising results, future studies with larger sample sizes and adequate methodological quality are necessary to confirm the effects of therapeutic exercises in individuals with VVS.

Comparison between velocity\u2010specific exercise and isometric exercise on neck muscle functions and performance: a randomised clinical trial

BackgroundEvidence has shown that velocity-specific exercise results in additional benefits for peripheral joint muscles by promoting their functions, however, its effects on spinal muscles are yet to be investigated. This study aimed to examine the feasibility and effects of velocity-specific exercise compared to isometric exercise on cervical muscle functions and performance in healthy individuals.MethodsThirty healthy adults were randomised to practise either the velocity-specific exercise (VSE, n = 15) or isometric exercise (IE, n = 15) for 6 weeks. Functions and performance of the cervical extensors and flexors were assessed pre- and post-program, by analyzing the peak torque and electromyography during the isokinetic testing, and cross-sectional area of the deep cervical muscles at rest. The self-reported level of difficulty and post-exercise soreness during the exercise were recorded to evaluate the feasibility and safety of the two exercise programs.ResultsBoth VSE and IE exercises resulted in significant improvement of the muscle functions and performance while there were no between-group differences at reassessment of the (a) cross-sectional area of longus colli and semispinalis capitis; (b) EMG amplitude in sternocleidomastoid and cervical erector spinae, and (c) peak torque values. Further analysis revealed that degree of correlation between extension torque and EMG amplitude of cervical erector spinae increased in both groups. However, significant correlation was found only in VSE group post-program. There were no significant differences for the level of difficulty and post-exercise soreness found between two groups.ConclusionsBoth velocity-specific and isometric exercises significantly promoted cervical muscle functions and performance. The present study confirms that velocity-specific exercise can be practised safely and it also contributes to a greater enhancement in neuromuscular efficiency of the cervical extensors. These findings indicate that the velocity-specific exercise can be considered as a safe alternative for training of the cervical muscles. Further study is recommended to examine its benefit and application for promoting the muscle functions and recovery in symptomatic individuals.

Efficacy of Deep Cervical Flexor Muscle Training on Neck Pain, Functional Disability, and Muscle Endurance in School Teachers: A Clinical Trial.

Background Neck pain (NP) is a common work-related disorder, with high prevalence in the profession of teaching. The daily duties of a school teacher involve head-down postures while reading and writing, which expose them to the risk of developing NP. Deep cervical flexor (DCF) muscles have been reported to have lower endurance in patients with cervical impairment, which has additionally been associated with disability. There is limited evidence regarding the efficacy of training of DCF muscles in occupational NP. The objective of this study was to investigate the effects of DCF muscle training on pain, muscle endurance, and functional disability using pressure biofeedback in school teachers with NP. Methods Sixty-five teachers (age, 25-45 years) with more than 5 years of teaching experience participated in this study. They were randomly divided into two groups: the experimental (E) and control (C) groups. In the E group, the subjects underwent DCF muscle training using pressure biofeedback in addition to conventional exercises for neck pain, while those in the C group underwent conventional exercises only. Pain, muscle endurance, and disability were measured at day 0 (before the treatment) and days 14 and 42 after the treatment. Endurance of DCF muscles was measured by the craniocervical flexion test using pressure biofeedback, pain intensity was measured using the numeric pain rating scale, and functional disability was assessed using the neck disability index questionnaire. This study was performed in accordance with CONSORT guidelines. Results On day 0, there were no significant differences in the age, pain, muscle endurance, and disability levels between the groups. After initiating the intervention, although there were improvements in both groups, there was a statistically significant improvement in muscle endurance, pain, and disability in subjects who received additional training with pressure biofeedback. Conclusions Besides increasing muscle endurance, specific training of DCF muscles in addition to conventional exercises can improve neck pain and functional disability. These results should be further correlated clinically. A dedicated time for exercises at school could help prevent the development of NP in teachers. This trial is registered with ClinicalTrials.gov NCT03537300 May 24, 2018 (retrospectively registered).

Cervicothoracic spinal alignment and neck flexor muscle endurance in young and older adult females with and without neck and shoulder pain (Katakori in Japanese).

[Purpose] The characteristics of neck and shoulder pain (NSP) in different age populations have not been sufficiently examined. Therefore, the purpose of this study was to compare and verify the cervicothoracic spinal alignment and neck flexor muscle endurance of young and older adult females with and without NSP. [Participants and Methods] We assessed 72 female participants (39 young participants, 33 elderly participants, 43 NSP, 29 non-NSP) aged 18–82 years who were recruited for this study. Cervicothoracic spinal alignment measurements were obtained with forward head alignment (FHA) along with the upper thoracic angle. The neck flexor endurance test was performed. [Results] There were no significant age-by-group interactions for any of the assessment variables. However, the upper thoracic angle and neck flexor muscle endurance showed significant effects in the groups. Age also had significant effects on FHA and upper thoracic angle. [Conclusion] These results suggested that the neck flexor muscle endurance was more appropriate as an evaluation tool for older adult females with NSP. It was also suggested that the cervical flexor muscle endurance and upper thoracic angle were more appropriate as evaluation tools for young adult females with NSP.