Craniocervical Flexion Exercise Research Articles

The effect of craniocervical flexion and neck endurance exercises plus pulmonary rehabilitation on pulmonary function in spinal cord injury: a pilot single-blinded randomised controlled trial.

Randomised controlled trial with computerised allocation, assessor blinding and intention-to-treat analysis. This study wanted to prove that cervicocranial flexion exercise (CCFE) and superficial neck flexor endurance training combined with common pulmonary rehabilitation is feasible for improving spinal cord injury people's pulmonary function. Taoyuan General Hospital, Ministry of Health and Welfare: Department of Physiotherapy, Taiwan. Thirteen individuals who had sustained spinal cord injury for less than a year were recruited and randomised assigned into two groups. The experimental group was assigned CCFEs and neck flexor endurance training plus normal cardiopulmonary rehabilitation. The control group was assigned general neck stretching exercises plus cardiopulmonary rehabilitation. Lung function parameters such as forced vital capacity (FVC), forced expiratory volume in 1 s (FEV1), FEV1/FVC, peak expiratory flow rate (PEFR), inspiratory capacity (IC), dyspnoea, pain, and neck stiffness were recorded once a week as short-term outcome measure. The experimental group showed significant time effects for FVC (pre-therapy: 80.4 ± 21.4, post-therapy: 86.9 ± 16.9, p = 0.021, 95% CI: 0.00-0.26) and PEFR (pre-therapy: 67.0 ± 33.4; post-therapy: 78.4 ± 26.9, p = 0.042, 95% CI: 0.00-0.22) after the therapy course. Furthermore, the experimental group showed significant time effects for BDI (experimental group: 6.3 ± 3.0; control group: 10.8 ± 1.6, p = 0.012, 95% CI: 0.00-0.21). The exercise regime for the experimental group could efficiently increase lung function due to the following three reasons: first, respiratory accessory muscle endurance increases through training. Second, posture becomes less kyphosis resulting increasing lung volume. Third, the ratio between superficial and deep neck flexor is more synchronised. TYGH108045. NCT04500223.

McKenzie neck exercise versus cranio-cervical flexion exercise on strength and endurance of deep neck flexor muscles, pain, disability, and craniovertebral angle in individuals with chronic neck pain: a randomized clinical trial

ABSTRACT Purpose To compare the effectiveness of McKenzie neck exercise and cranio-cervical flexion (CCF) exercise on strength and endurance of deep neck flexor (DNF) muscles, pain, disability, and craniovertebral angle (CVA) in individuals with chronic neck pain. Methods Forty individuals with chronic neck pain were randomly allocated to the McKenzie neck or CCF exercise group. Each group performed exercises at home daily. The strength and endurance of DNF muscles were measured at baseline, immediately after the first exercise session, and each week follow-up for six weeks. Average pain over the past week was measured at baseline and each week follow-up for six weeks. Disability and CVA were measured at baseline and the end of six weeks. Results At six weeks, both groups exhibited significant improvements across all outcome variables (p < 0.001) but there were no differences between groups (p > 0.05). The significant difference from baseline in the strength of DNF muscles was observed as early as the second week of each intervention (p ≤ 0.001). The significant difference from baseline in the endurance of DNF muscles was observed as early as the first week in the CCF exercise group (p < 0.05) and the second week in the McKenzie neck exercise group (p < 0.05). A significant decrease in pain intensity from baseline was observed after the first week in the McKenzie neck exercise group (p < 0.001) while it was after the second week in the CCF exercise group (p < 0.05). Conclusion Both the McKenzie neck exercise and CCF exercise produced similar effects in enhancing the strength and endurance of the DNF muscles, decreasing pain, alleviating neck disability, and improving the CVA.

Real time ultrasound imaging shows changes in deep neck flexor activation during exercise in individuals with mechanical neck pain.

Deep neck flexor muscle atrophy and increased superficial neck muscle activation are associated with disability and pain intensity in individuals with neck pain. There is a lack of evidence to support direct assessment of deep neck flexor muscles in a non-invasive way during exercise performance to help determine the effectiveness of different neck strengthening exercises. Compare longus colli (LC) and sternocleidomastoid (SCM) activation between individuals with and without neck pain using real time ultrasound (RTUS) during a series of craniocervical exercises. This cross-sectional cohort study recruited 10 control and 10 neck pain participants to complete four deep neck flexor activation activities involving varying levels of craniocervical flexion. Dimensions of the LC and SCM were measured using RTUS at rest and during exercise. Independent t-tests assessed baseline differences and analysis of variance examined activation changes. At rest, the neck pain group had significantly smaller cross-sectional area and thickness of the LC compared to the control group (p< 0.05). During exercise, the neck pain group showed significantly larger increases in LC thickness and cross-sectional area across exercise compared to the control group, with no differences in SCM activation between groups. Despite atrophy, individuals with neck pain can activate their deep neck flexor muscles appropriately without activating their superficial neck flexor muscles in a supine series of craniocervical flexion exercise as measured by non-invasive ultrasound imaging.

Immediate effect of craniocervical flexion exercise and Mulligan mobilisation in patients with mechanical neck pain- A randomised clinical trial.

Mechanical neck pain (MNP) is one of the most prevalent musculoskeletal pathologies in the present time. Physiotherapy management strategies comprising manual therapy and exercise therapy are routinely administered in patients with MNP. To compare the immediate effect of craniocervical flexion (CCF) exercise and Mulligan mobilisation on pain, active cervical range of motion (CROM) and CCF test performance in patients with MNP. This prospective, randomised, single-blinded study involved 26 patients with MNP (16 females; mean age; years) randomised to a single session of active CCF exercise (3 sets of 10 repetitions) or Mulligan mobilisation (3 sets of 6-10 repetitions). Pain intensity was measured on a numerical pain rating scale (NPRS), active CROM was measured using CROM device, and CCF test performance with surface electromyography (EMG) from bilateral sternocleidomastoid (SCM) and anterior scalene (AS) muscles recorded pre- and immediately post-intervention by an assessor blinded to the treatment groups. Mann-Whitney U test was used to analyse between groups and Wilcoxon signed rank test was used to analyse within-group significance for pain and CROM, Cochran-Mantel-Haenszel correlation test was used to analyse the CCF test performance on EMG from the bilateral SCM and AS muscles. Comparison between pre- and post-intervention readings revealed statistically significant within-group () and no between-group significant difference for pain, ROM, and CCF test performance, indicating both interventions were equally effective. Patients with MNP who received active CCF exercise or Mulligan mobilisation exhibited similar reduction in pain intensity and increased CROM and CCF test performance post-intervention. Surprisingly, AS surface EMG amplitudes were increased post-intervention in both groups warranting further exploration of its role in neck pain.

필라테스 호흡을 적용한 목 안정화운동이 전방머리자세의 근지구력과 손의 악력에 미치는 영향

Objective: The purpose of this study was to compare the effect on the cranio-cervical flexion exercise which is a neck stabilization exercise, and cranio-cervical flexion exercise applying Pilates breathing on neck muscle endurance, pain, and grip strength. Method: This study was conducted for 8 weeks, 30 minutes twice a week for 27 people, The control group performed cranio-cervical flexion exercise which is a neck stabilization exercise, and the experimental group performed cranio-cervical flexion exercise applying Pilates breathing. Visual Analog Scale was used to evaluate pain, a pressure biofeedback instrument and a stop-watch were used to evaluate the muscle endurance of deep neck flexor muscles, and a Jamar Hand evaluation kit was used to evaluate hand pressure. In this data, Kolmogorov-Smirnov was used to assume the normality of all dependent variables, and descriptive statistics were used for the general characteristics of the subjects. ANCOVA statistical method was used to verify validity, and the significance level was p&lt;.05. Results: There were significant differences in muscle endurance, pain, and grip strength in the group applying Pilates breathing in the cranio-cervical flexion exercise of the neck stability exercises. Conclusion: In the group of applying Pilates breathing in the cranio-cervical flexion exercise of the neck stability exercises, neck muscle endurance and hand grip strength increased and pain decreased.

Effects of Sub-Occipital Muscles Inhibition Technique and Cranio-Cervical Flexion Exercise for Mechanical Neck Pain

Aim: To compare the effects of Suboccipital muscle Release (SMI) techniques and Cranio-Cervical Flexion Exercise (CCFE) for Range of motion, pain, neck disability and forward head posture (FHP) in mechanical neck pain patients. Methodology: This Randomize Clinical Trial was conducted in Railway General Hospital Rawalpindi, within a duration of 6 months.Total 28 patients who fullfilled inclusion criteria such as were randomly allocated equall into two treatment groupthrough lottery method. Group A received suboccipital muscle inhibition technique while Group B received craniocerviacal flexion exercises. Both groups were evaluated at baseline and after four weeks through numeric pain rating scale (NPRS), Neck Disability Index (NDI), Goniometer, and craniovertebral angle. IBM SPSS 24 was used for statistical analysis.Parametric test i.e., independent t test was applied on normal distributed data for between group analysis and Paired t test was applied for within group analysis for NDI. Non-parametric test i.e., Mann- Whitney U test was applied for between group analysis and Wilcoxon test were applied for within group analysis for FHP, NPRS and ROM. Results: Groups A and Group B showed significant improvement (p˂0.05) in within group analysis in Numeric Pain Rating Scale, forward head posture, neck disability index and cervical range of motion. Practical implication: Mechanical neck pain accounts approximately 50% to neck pain and may induce functional disability in many patients. The current study findings can be used to formulate effective, accessible andeconomical treatment strategies for Mechanical neck pain, so it may be interesting to the readers ofyour journal. Conclusion: Sub occipital muscle inhibition technique and cranio cervical flexion exercises areequally effective techniques to increase cervical range of motion, decrease neck disability, decrease pain intensity, and improvecranio-vertebral angle in patients with mechanical neck pain. Keywords: Cranio-cervical flexion exercises, Cranio-vertebral angle, Neck Disability Index, Range of Motion,

Immediate neck hypoalgesic effects of craniocervical flexion exercises and cervical retraction exercises among individuals with non-acute neck pain and a directional preference for retraction or extension: preliminary pretest-posttest randomized experimental design

ABSTRACT Background Selective deep neck flexor muscle activation through craniocervical flexion exercises has been considered to be different from cervical retraction exercises. Objective To compare the immediate analgesic effect of craniocervical flexion versus cervical retraction exercises in individuals with nonacute, directional preference (DP) for cervical retraction or extension Methods A two-arm, assessor-blinded, pretest-posttest randomized experiment was conducted. Participants were randomly assigned to either craniocervical flexion or cervical retraction exercises and those who were confirmed at the post-intervention examination to have a DP for cervical retraction or extension were analyzed. The primary outcome measure was pressure pain thresholds at the C2 and C5-C6 levels. Results A total of 10 (mean age = 20.6 years) and nine participants (mean age = 19.4 years) undertook craniocervical flexion and retraction exercises, respectively. One-way analysis of variance demonstrated no statistically significant (p > 0.05) interaction effect regardless of the neck level. In the pre-post change percentages, retraction exercises provided greater analgesic effects compared to craniocervical flexion exercises at the C2 (Hedges’ g = 0.679) and C5-C6 levels (g = 0.637). Conclusion This study showed a comparable or greater immediate neck analgesic effect from cervical retraction exercises compared to craniocervical flexion exercises in individuals with a DP for cervical retraction or extension.

Effect of Craniocervical Flexor Training on Pain, Strength, and Quality of Life in Subjects with Chronic Neck Pain

Background: In context, neck pain is the most prevalent musculoskeletal complaint. Common causes of neck pain include poor posture at work, nervousness, stress, strain, carrying heavy objects, and strenuous physical activity. To enhance a patient’s functional status and quality of life (QOL), knowledge of the structures that can cause pain impairment is essential. It was found that a craniocervical flexor training course provides an improved method of isolating the deep cervical flexors. Objective: The purpose of this training was to assess the effectiveness of craniocervical flexion training in reducing pain, increasing strength, and enhancing well-being in those with persisting neck pain. Methodology: Two sets of 20 subjects were used in this study. The treatment (craniocervical flexion training) was administered 5 days a week for 4 weeks. Pain was evaluated using a Visual Analog Scale (VAS), strength was assessed using the craniocervical flexor test, and QOL was measured with the short form 36 before and after treatment. Results: Both groups improved their strength and QOL from pretreatment levels, and the VAS scores of both groups decreased from pretreatment levels. In contrast, both pain and QOL improved more in Group A. Conclusion: This study concludes that, when it comes to managing chronic neck pain, craniocervical flexion exercise is more effective than isometric exercise, scapulothoracic exercise, and transcutaneous electrical nerve stimulation alone.

Efficacy of physiotherapy intervention on craniovertebral and craniohorizontal angle using on protractor mobile app and neck muscle strength in chronic nonspecific neck pain

Introduction and Aim: The chronic nonspecific neck pain is common in all age groups since it is non-specific it may be due to any reasons right from school children to elderly. Factors like muscle strain, worn joints, nerve compression, poor posture, neck pain are found to reduce the cervical angle. The aim of the study is to find the efficacy of physiotherapy intervention on craniovertebral angle, craniohorizontal angle, neck muscle strength and hand grip in subjects with chronic nonspecific neck pain. Materials and Methods: The subjects with chronic nonspecific neck pain (n=30) were selected randomly from the physiotherapy outpatient department of ACS medical college and hospital as per inclusion criteria and divided into two groups. The pre-test and post-test measurements of craniovertebral and craniohorizontal angles, craniovertebral angle were measured using on protractor mobile app. The neck muscle strength was measured using modified dial sphygmomanometer and hand grip was measured using hand held dynamometer. Group A received craniocervical flexion exercise and group B received stretching and strengthening for a period of 12 weeks. Post test was conducted after 12 weeks. Results: The comparison within Group A and Group B pre- and post-test values in both groups showed highly significant difference in mean values at P ? 0.001, but group A which has a higher mean value is more effective in craniovertebral angle, craniohorizontal angle, neck muscle strength (Flexor and Extensor) and hand grip. Conclusion: The craniocervical flexion exercise given to chronic nonspecific neck pain patients was found to reduce neck pain by improving the neck muscle strength, hand grip strength and by correcting the craniocervical and craniohorizontal angles.

Immediate effects of static and proprioceptive neuromuscular facilitation stretching of hamstring muscles on straight leg raise, craniovertebral angle, and cervical spine range of motion in neck pain patients with hamstring tightness: A prospective randomized controlled trial.

The cranio-cervical flexion exercise and sub-occipital muscle inhibition technique have been used to improve a forward head posture among neck pain patients with straight leg raise (SLR) limitation. However, little is known about the cranio-vertebral angle (CVA) and cervical spine range of motion (CROM) after applying stretching methods to the hamstring muscle. To compare the immediate effects of static stretching and proprioceptive neuromuscular facilitation stretching on SLR, CVA, and CROM in neck pain patients with hamstring tightness. 64 subjects were randomly allocated to the static stretching (n1= 32) or proprioceptive neuromuscular facilitation (n2= 32) stretching group. The SLR test was performed to measure the hamstring muscle's flexibility and tightness between the two groups, with CROM and CVA also being measured. The paired t-test was used to compare all the variables within each group before and after the intervention. The independent t-test was used to compare the two groups before and after the stretching exercise. There were no between-group effects for any outcome variables (P> 0.05). However, all SLR, CVA, and CROM outcome variables were significantly improved within-group (P< 0.05). There were no between-group effects for any outcome variable; however, SLR, CVA, and CROM significantly improved within-group after the one-session intervention in neck pain patients with hamstring tightness.

Comparison of Cross-sectional Areas using Computerized Tomography of the Cervical Muscles between Straight Neck Patients and Normal Participants during Cranio-cervical Flexion Exercise

Comparison of Cross-sectional Areas using Computerized Tomography of the Cervical Muscles between Straight Neck Patients and Normal Participants during Cranio-cervical Flexion Exercise

EFFICACY ON PRESSURE-BIOFEEDBACK GUIDED CRANIOCERVICAL FLEXION EXERCISE IN NECK PAIN: A RANDOMIZED CONTROLLED TRIAL

Objective: Neck pain is a common cause of disability and costly problem, especially in the working population. However, there is a paucity of studies examining the efficacy of pressure-biofeedback guided craniocervical flexion exercise (CCFE) in neck pain. Therefore, this study aims to find out the efficacy of Pressure-Biofeedback guided CCFE on the treatment of neck pain. Methods: This randomized controlled trial included 60 participants with neck pain who were randomly assigned to the experimental group ([Formula: see text]) and control group ([Formula: see text]). The experimental group received pressure-biofeedback guided CCFE for four times per week for four weeks, whereas the control group received physical therapy agents (PTA) (radiant heat and transcutaneous electrical nerve stimulation). Outcome measures included the Visual Analogue Scale (VAS) and Neck Disability Index (NDI). Results: The baseline demographics and outcome measurements were not significantly different between the two groups. More significant reduction in VAS of the experimental group was found in comparison with control group at week 2 and week 4, respectively ([Formula: see text]). Regarding the NDI, there was a more significant reduction in the experimental group than the control group at week 4 ([Formula: see text]). Conclusion: Pressure-biofeedback guided CCFE was useful for improving pain and functional disability of neck for the management of neck pain.

Effects of Cervical Mobilization and Craniocervical Flexion Exercise on the Dynamic Balance and Gait Variability in Chronic Neck Pain Patients: Randomized Controlled Trial

Effects of Cervical Mobilization and Craniocervical Flexion Exercise on the Dynamic Balance and Gait Variability in Chronic Neck Pain Patients: Randomized Controlled Trial

Effectiveness of Craniocervical Flexion Exercise on Pain, Disability, and Cervical Range of Motion in Patients with Neck Pain

Effectiveness of Craniocervical Flexion Exercise on Pain, Disability, and Cervical Range of Motion in Patients with Neck Pain

Immediate Effects of Posteroanterior Cervical Mobilization on Pressure Pain Threshold and Gait Parameters in Patients with Chronic Neck Pain: A Pilot Study

Background: Mobilization and cranio-cervical flexion exercise has been reported in reducing pain from cervical part and improving its motor function; also, has been represented that alleviate of neck pain and recover of neck muscles improve the normal gait performance. However, few studies have identified the effects of mobilization and exercise on pain and gait parameters with preceding issues. Objective: To examine the effects or changes of pressure pain threshold (PPT) and gait parameters in patients with chronic neck pain. Design: Cross-Sectional Clinical Trials Methods: Twenty patients with the history of neck pain (>3 months) performed the cervical mobilization and cranio-cervical flexion exercise. Gait parameters were assessed with wireless device and collected data were transmitted to the personal computer via Bluetooth. The PPT was measured posteroanterior direction at the prone position and the mean of subsequent three PPT meas­urements was used for the final analysis. Results: Both cervical central posteroanterior mobilization (CCPAM) (p<.000) and sling-based cranio-cervical flexion exercise (SBCCFE) (p<.000) group showed a significant increase in the PPT and the gait parameters, cadence (p<.023), was significantly increased in the CCPAM group, however slightly increased in the SBCCFE group. The comparison between the CCPAM and the SBCCFE groups after treatment did not show significant differences for the score on the PPT and gait parameters. Conclusions: This study suggests that CCPAM and SBCCFE increase PPT, cadence, and gait speed.

The Investigation of the Acute Effect of Craniocervical Flexion Exercise and Local Vibration on Semispinalis Cervicis and Multifidus Muscle Activation in a Healthy Individual

Aim: The aim of this study is to investigate the acute effects of craniocervical flexion exercise (CCFE) and vibration on the activation of the semispinalis cervicis and multifidus muscles in a healthy case. Materials and Methods: Our study was carried out on a healthy male without neck pain at the age of 21 at Hacettepe University Faculty of Health Sciences, Physiotherapy and Rehabilitation Department and Hacettepe University Faculty of Medicine, Radiology Department. First, the individual was taught craniocervical flexion exercise (CCFE). Later on, cervical MR images of the 3-T magnet MRG device were taken at the National Magnetic Resonance Research Center of Bilkent University. The sections obtained from the deep paravertebral region muscles by "T2 map color mapping method" and the muscle areas of activation were drawn by observation. T2 relaxation values associated with muscle activation were calculated. Later on, case was asked to perform CCF exercise with 10 seconds of contraction and 5 seconds of rest and 20 repetitions. MRI measurements were repeated after exercise. After a resting period of forty-five minutes, the images of the paravertebral muscles were recorded with MRI again before the vibration and the neck of the case was vibrated for 5 minutes. After the vibration, the MRI measurements were repeated and compared with the results of the first measurement. Results: It has been found that the results obtained immediately after the KSF exercise and after the application of vibration have some limited variations in the activation of the deep paravertebral neck muscles when compared to the results before CCF and vibration. Conclusion: At the end of this study it was thought that the CCF exercise and the application of vibration may have a limited and positive effect on the deep paravertebral muscles and studies with different exercise protocol and vibration intensity on more cases are needed in order to clarify this effect more clearly.

Motor control using cranio-cervical flexion exercises versus other treatments for non-specific chronic neck pain: A systematic review and meta-analysis

BackgroundChronic neck pain affects a significant percentage of the adult population. Commonly, the pain is of unknown origin. In those cases, some alterations in motor control (MC) can appear in the deep cervical muscles. The specific training of these muscles could improve muscular function and reduce pain and disability. ObjectiveTo determine whether MC, using cranio-cervical flexion (CCF), is more effective than other treatments for non-specific chronic neck pain (NSCNP). DesignSystematic review with meta-analysis. MethodsA search was done in journals and in a variety of databases, between December 2017 and March 2018. Randomized clinical trials (RCTs) and systematic reviews of RCTs comparing MC with other treatments in adults with NSCNP, regarding pain and disability, were included. Risk of bias was analysed using the Cochrane risk of bias tool. Data was analysed using a random effects model. Heterogeneity was evaluated using the I2statistic. The quality of the evidence was measured using the Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach. ResultsTen articles were included for qualitative review; nine were used for a quantitative analysis about the effect of MC on pain and eight for the analysis regarding disability. The meta-analysis comparing MC versus other treatments showed significant differences regarding pain and disability. ConclusionsMC interventions for NSCNP patients reduces pain and disability. MC seems to be more effective to reduce pain and disability than other treatments.

Comparison of the muscle activity in the normal and forward head postures based on the pressure level during cranio-cervical flexion exercises

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.

Effects of cranio-cervical flexion with transcranial direct current stimulation on muscle activity and neck functions in patients with cervicogenic headache.

[Purpose] To present an efficient treatment regimen for patients with cervicogenic headache by comparatively analyzing the neck disability index (NDI) and cervical muscle activity after an exercise intervention. [Participants and Methods] Thirty patients with cervicogenic headache were assigned to the cranio-cervical flexion group (n=15) and cranio-cervical flexion plus transcranial direct current stimulation (tDCS) group (n=15). Intervention was administered for four weeks, after which the participants’ NDI and sternocleidomastoid muscle activity were measured. [Results] The treatment group demonstrated a significantly greater change in NDI after the intervention compared to the control group. The treatment group also showed a significantly greater change in sternocleidomastoid muscle activity than the control group. [Conclusion] Our results show that applying tDCS during cranio-cervical flexion exercise can strengthen the sternocleidomastoid muscle more effectively while improving pain and associated functions in patients with cervicogenic headache. These results would contribute towards developing a more efficient treatment for patients with cervicogenic headache.

Effect of Active Cranio Cervical Flexion Exercise of Upper Cervical Spine on Pain, Cervical Range of Motion and Craniocervical Flexion Test (CCFT) in Patients with Age Group 20–40 Years of Chronic Neck Pain

Background: Cervical spine is surrounded by a complex arrangement of muscles that controls head and neck, protects the spinal cord and facilitates blood flow to the brain through vertebral openings which are only present in cervical spine.Pain is only a single, non- recurrent event in 6.3%of patients experiencing neck pain. Between half and three quarters of people with neck pain experience recurrence within 1-5 years. The deep cervical flexor muscle is an important stabilizer of head and neck posture located on anterior and lateral surface of cervical spine. Neck pain is chronic if it lasts for more than 3 months. Purpose of Study: To find whether active cranio-cervical flexion exercise could reduce pain, improve cervical ROM and CCFT in patients with chronic neck pain. Aim: To observe the effect of active cranio-cervical flexion exercise of upper cervical spine on pain, cervical ROM and CCFT in patients with chronic neck pain. Objective: To find out the effect of active cranio-cervical flexion exercise on pain,cervical ROM and CCFT in patients with chronic neck pain. Method: Experimental study was conducted on 35 chronic neck patients between age 20-40 years and according to inclusion criteria were recruited in study. Pain, cervical ROM and CCFT was assessed. Results: P value: less than 0.05 for NPRS, cervical ROM and CCFT. Conclusion: active cranio-cervical flexion exercise of upper cervical spine is effective in reducing pain, improve cervical ROM and CCFT in patients with chronic neck pain.