Neck Flexor Research Articles

Repeatability and reproducibility of the pressure biofeedback unit

IntroductionAlthough the pressure biofeedback unit (PBU) is used for muscular assessment and training, there is little evidence of its reproducibility and repeatability. ObjectiveThis study aims to assess intra- and inter-rater reproducibility and repeatability of the PBU in the assessment of the transverse abdominal (TrA), internal oblique (IO), low back multifidi, and deep neck flexors (DNF). MethodsFifty individuals had three muscular groups tested: TrA/IO, lower back multifidi, and DNF. For repeatability, one rater did three consecutive measures; for intra-rater reproducibility the same rater did two measures with seven-day intervals, and for inter-rater reproducibility, three raters, on the same day, did the measures. Data were analyzed with: Intraclass Correlation Coefficient (ICC), Standard Error of Measurement (SEM), and Minimal Detectable Change (MDC). (α = 0,05). ResultsRepeatability: TrA/IO (ICC = 0.847), Multifidi (ICC = 0.860), DNF (ICC = 0.831). Inter-rater reproducibility: TrA/IO (ICC = 0.876), Multifidi (ICC = 0.508), DNF (ICC = 0.442). Intra-rater reproducibility: TrA/IO (ICC = 0.747), Multifidi (ICC = 0.293), DNF (ICC = 0.685). Except for Multifidi, all the SEM values were less than 10 mmHg and the MDC values were less than 15 mmHg. ConclusionsThe PBU can be used with reliability by different evaluators, although the evaluation of multifidi is not indicated.

Are There Gender Differences in Neck Pain and Musculoskeletal Disorders of the Cervical Spine Associated with Migraine?

To evaluate gender differences in clinical characteristics of migraine by examining presence and severity of cutaneous allodynia, migraine-related disability, neck pain and its associated disability, passive mobility of the upper cervical spine, and performance of the deep neck flexor muscles. Cross-sectional study. 30 men and 30 women with migraine. Participants responded to the questionnaires Migraine Disability Assessment questionnaire, 12-item Allodynia Symptom Checklist, and Neck Disability Index. The mobility of the upper cervical spine was assessed by using the Flexion-Rotation Test. Performance of the deep neck flexor muscles was evaluated by applying the Craniocervical Flexion Test. Comparison of the groups was carried out by using the Student's t-test or the χ2 test. The prevalence ratio was also calculated. Women showed a higher prevalence of cutaneous allodynia (P = .001) and a 4 times greater risk of having severe cutaneous allodynia than to men (P = 0.007). No gender differences were observed in migraine-related disability (P = .08). Women showed higher prevalence of self-reported neck pain (P = .03) and increased risk of having this symptom in comparison to men (Prevalence Ratio = 1.69; P = 0.025). However, there were no gender differences in neck pain-related disability (P = .25), mobility of the upper cervical spine (P = .92), or performance of the deep neck flexor muscles (P = .52). Women with migraine had a higher frequency of self-reported neck pain and higher prevalence and severity of cutaneous allodynia when compared to men. However, the two groups did not differ regarding neck pain-related disability and performance in the physical tests.

Improved a Guillain-Barre Syndrome Patient with Positive PCR Test for Coronavirus in Cerebrospinal Fluid After Plasmapheresis: A Case Report

Introduction: Coronavirus disease 2019 (COVID-19), started in December 2019, affects many organs and systems of the body, such as the central nervous system. Case Presentation: We describe a case of a 66-year-old female patient with positive results for COVID-19 using real-time PCR (RT-PCR) testing from her cerebrospinal fluid (CSF) and the coronavirus antibodies (Ig G and Ig M) using serology test. Her clinical presentation showed the misbalance and acute weakness of upper and lower limbs with preference of proximal parts of the limbs, pinprick, and the absence of deep tendon reflexes. Taken together, these symptoms, neurological tests and the result of CSF analysis (high protein) were in favor of Guillain-Barre syndrome (GBS). In addition, because the neurological symptoms worsted four days after hospitalization, plasmapheresis was started over the course of 8 days (on every alternate day) with a volume of 2000 mL. Although the results of electromyogram (EMG) - nerve conduction velocity (NCV) following plasmapheresis showed the motor and sensory neuropathy, which was generally accompanied by demyelination, but it leads to the recovery of upper and lower limbs from 2/5 to 4/5 and improvement of neck flexor muscles from 3/5 to 5/5. Conclusions: GBS should be considered as a neurological outcome of COVID-19. In addition, regarding the beneficial effects of plasmapheresis on GBS (following coronavirus infection), it can be suggested as a part of the treatment protocol in these patients.

Effectiveness of Active Release Technique verses Conventional Physiotherapy in Management of Upper Cross Syndrome

Background: In upper cross syndrome (UCS), weaker neck flexors, anterior and middle serratus and lowertrapezius along with rhomboids usually develop, and tightness of the levator scapulae, pectoralis major andupper trapezius are biomechanically adapted. Active Release Technique (ART) helps to reduce discomfortand improve the range of movement. Also, Active Release Technique (ART) is a manual procedure which isalso being used for other soft tissue rehabilitation as well as for the management of the scar tissues. UCS andneck pain is common with uncomfortable job postures as well as in stress and anxiety, due to which muscledysfunction starts which can further followed by altered posture around the neck.Aim and Objective: To evaluate the effects of Active Release Technique verses conventional physiotherapyin management of upper cross syndrome physiotherapy.Materials and Method: 35 patients will be grouped in two groups. Both groups will be treated for sixsessions. Group A will be treated with active release technique and static stretching along with hydrocollatorpack. The patients coming under Group B, conventional physiotherapy would be given which include uppertrapezoid stretching, levator scapulae and pectoralis major as well as rhomboid strengthening, deep neckflexors, lower trapezius along with the hydrocollator pack.Result: The parameters of outcome measures in interval of pre and post treatment will be analysed using thestatistical test namely students paired T test.Conclusion: Based on the previous data of ART we assume it will be beneficial in relieving the symptomsinvolved in UCS.

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.

Understanding the Inflammatory Biomarkers in Patients with Acrochordons: A Case-control Study

Introduction: Acrochordons kown as Skin Tags (ST) are common benign skin tumours usually occurring on the neck and major flexors of older and obese people. A few studies with conflicting results have been reported regarding the abnormalities of carbohydrate or lipid metabolisms, and the involvement of some inflammatory markers in patients with acrochordons. Aim: Comparison of Fasting Blood Sugar (FBS), lipid profile, and C-Reactive Protein (CRP) between patients with acrochordon, and healthy controls. Materials and Methods: The case-control study was conducted in the Department of Biochemistry and Dermatology of Pramukhswami Medical College, Karamsad, Gujarat, India. A total number of 160 subjects (80 healthy controls and 80 cases with acrochordons) were included. The FBS, lipid profile, and CRP were measured. Statistical analysis was performed by Independent t-test, one-way Analysis of Variance (ANOVA), frequency, descriptive statistics and Pearson’s correlation coefficient (r). Results: Total 160 subjects were included in study, 80 in each case and control group (51 female and 29 male in both groups). Age and sex between two groups were matched with mean age 47.68 years. The mean FBS for cases and controls were 133.24 and 84.9 mg/dL respectively. The mean CRP for cases and controls were 17.33 and 1.66 mg/L respectively. Significant differences were recognised for means of BMI, FBS and CRP between two groups (p-value <0.001). These parameters had significant difference between two groups in aspect of various size, colour and number of acrochordons (p-value <0.001). Conclusion: Threat of progress of metabolic syndrome is significantly higher in patients with acrochordons. Among the many elements of inflammations and metabolic syndrome, BMI, CRP, lipid profile and plasma sugar are remarkably linked with acrochordons.

Developmental delay in congenital hypothyroidism.

We report the case of a 5-month-old male, born out of a nonconsanguineous marriage, who presented with an inability to hold neck. As per the parents, he had diminished spontaneous movements since birth and described him as lethargic. He was clinically diagnosed with cretinism by a pediatric neurologist. He was referred by to the department of physiotherapy for evaluation and advice for the associated motor delay. On observation, the infant displayed peculiar clinical features of sparse hair, periorbital edema and macroglossia (A). Irritability, hoarse cry, abdominal distension and frog leg position was observed in supine lying position (B). Examination revealed generalized hypotonia, wide fontanelles, feeding difficulties and global developmental delay. He was neither able to roll over from supine to prone nor was he able to hold neck adequately. He had head lag during pull to sit test. Due to financial constraints, they were not willing to attend physiotherapy sessions on a regular basis. Thus, parents were educated about the home exercise program that included active assisted rolling, neck extensor muscles facilitation against gravity while lying prone on forearm, active assisted reaching out for objects while lying, neck flexor muscles facilitation in gravity minimized plane and active neck rotations to look at objects of interest while side lying on forearm support. Congenital hypothyroidism is still a common cause of developmental delay in newborns of the developing countries. Awareness, universal newborn screening, prompt recognition and medical treatment along with physiotherapy can minimize adverse effect on the physical and neurocognitive development.

Effects of Cervical Instability on Function of Deep Neck Flexor Muscle and Muscle Tonus of Neck Muscles

Effects of Cervical Instability on Function of Deep Neck Flexor Muscle and Muscle Tonus of Neck Muscles

Assessing the Reliability of Echo Intensity of Craniovertebral Muscle Group using B-Mode Ultrasound: A Technical Note.

An acceptable reliability is needed for each scale and a valid decision-making process. Ultrasonography is a simple, cost-effective, and accessible tool compared to magnetic resonance imaging (MRI) to assess echo intensity (EI) as a biomarker of muscle function in neck musculoskeletal problems. However, no evidence is available regarding the reliability of neck muscle echogenicity according to rehabilitative ultrasonography in clinical studies on forward head posture (FHP). We determined the reliability of neck muscles EI in individuals with and without FHP. Transverse images of deep neck flexors (Longus Coli) and suboccipital (Rectus capitis posterior minor) muscles were acquired from 20 individuals with FHP and 20 controls in one session. The intraclass correlation coefficient (ICC), minimum detectable change (MDC), and standard error of measurement (SEM) for EI were measured in this study. The ICC, SEM, and MDC ranges were 0.50 - 0.51, 2.73 - 3.41, and 7.56 - 9.46 for the Longus colli muscle and 0.48 - 0.49, 3.29 - 4.98, and 9.13 - 13.81 for the rectus capitis posterior minor (RCPm) muscle, respectively. Based on the present findings, EI showed acceptable reliability; therefore, it can be used for assessment of neck muscle morphology.

Effect of deep neck flexor strengthening on forward head posture: A systemic review and meta-analyses

Effect of deep neck flexor strengthening on forward head posture: A systemic review and meta-analyses

깊은 목 굽힘 근 강화 운동이 경추 정렬과 경부 근 체력 및 통증에 미치는 영향

본 연구는 25-45세 여성 경부 통증 환자를 대상으로 깊은 목 굽힘 근 강화 운동과 흉추 가동 운동이 머리 척추각 (CVA), 머리 회전각(CRA), 경추 전만각, 그리고 통증과 깊은 목 굽힘 근의 근력, 근지구력 등에 미치는 영향을 분석하여, 경추의 정렬, 통증 완화, 체형 변화, 근 체력 강화에 영향이 있는가를 규명하는 것이다. 연구 목적 달성을 위하여 통제집단 (CG) 8명, 깊은 목 굽힘 근 강화 운동집단(DG) 8명, 깊은 목 굽힘 근 강화 운동과 흉추가동 운동을 함께한 운동집단(DTG) 8명, 총 24명의 연구 대상을 3개 집단으로 분류하여 실험을 진행하였다. 각 집단은 주 3회 빈도로, 1회 50분간, 8주에 걸쳐서 24회의 운동 프로그램을 진행하였다. 통제집단은 같은 기간에 일반 물리치료(hot pack, tens, ultra sound)를 실시하였다. 통제군과 경부 운동군, 경 흉부 운동군은 실험 전, 후 척추 머리각, 척추 회전각, 경추 전만각, 경부 기능 장애지 수, 통증지수, 뉴욕 주 자세평가 지수, 깊은 목 굽힘 근의 근력 및 근지구력을 측정하였다. 측정한 자료를 통계적으로 분석 한 결과 경부 운동군과 경 흉부 운동군 모두 실험 후 척추 머리각, 척추 회전각, 경추 전만각, 뉴욕 주 자세평가 지수, 깊은 목 굽힘 근의 근력 및 근지구력은 0.1% 수준에서 유의한 변화가 있었다. 또한 세 집단 모두에서 경부 기능 장애지수, 통증 지수에서 0.1% 수준에서 유의한 변화가 있었다.

Neck flexor weakness at diagnosis predicts respiratory impairment in amyotrophic lateral sclerosis.

The purpose was to assess the prognostic role of neck muscle weakness at diagnosis in amyotrophic lateral sclerosis (ALS) patients with respect to survival and respiratory impairment. A retrospective cohort study was conducted. All ALS patients seen in the Turin ALS Centre from 2007 to 2014 were included. Muscle strength at diagnosis was evaluated using the Medical Research Council (MRC) scale. Survival was considered as the time from diagnosis to death or tracheostomy; time to respiratory impairment was considered as the interval from diagnosis to the first event amongst an ALS Functional Rating Scale revised item 10 <4, forced vital capacity <70%, start of non-invasive ventilation or tracheostomy. Time from diagnosis to dysarthria, dysphagia and walking impairment were considered as secondary outcomes. Cox proportional hazard regression models adjusted for sex, age at diagnosis, diagnostic delay, onset site, genetics status and the MRC scores of other muscle groups were used to assess the prognostic role of neck muscles. A total of 370 patients were included in the study. Fifty-nine (15.9%) patients showed neck flexor weakness at diagnosis; MRC values were mostly in agreement for neck extensors. Neck flexors were the only muscles able to predict survival (hazard ratio 0.49, 95% confidence interval 0.28-0.86; p=0.01). Furthermore, neck flexor normal strength decreased the risk of respiratory impairment (hazard ratio 0.46, 95% confidence interval 0.22-0.96; p=0.04) but did not influence any secondary outcomes. Neck flexor weakness at diagnosis predicts survival and respiratory impairment in ALS. This result could be valuable for both planning of patients' interventions and clinical trials' design.

DEEP NECK FLEXORS IMPACT RECTUS ABDOMINIS MUSCLE ACTIVITY DURING ACTIVE STRAIGHT LEG RAISING.

Active straight leg raising (ASLR) is commonly performed to test fundamental movement competency. Head control or positioning can affect the abdominal muscle activity during movements. To investigate whether abdominal muscle activity differs when the head is extended or when deep neck flexor (DNF) muscles are selectively activated during the ASLR. Cross-sectional. Participants were included based on the following criteria: 1) age>17 years; 2) no spinal or lower extremity pain in the prior month; 3) the vertical line of the malleolus in an elevated the lower limb resides below the knee joint line of a non-moving lower limb during ASLR and above during a passive straight leg raising in each lower limb; and 4) no history of diagnosed spinal deformities or central nervous system disorders. Participants with > 39% reference voluntary contraction in the sternocleidomastoid muscle during the craniocervical flexion test (CCFT) of 24 mmHg target were excluded from the analyses. Right ASLR was repeated in each of the following three head conditions in a random order: 1) neutral head position, 2) head extended by 25 °, and 3) CCFT maintained with a 24 mmHg target. Among the three head conditions, the relative latency for the onset of the right rectus femoris (RF) muscle during the right ASLR and the muscle activity amplitude for 50ms were compared after the onset of RF muscular activity in the following muscles: left rectus abdominis (RA), bilateral external obliques, bilateral internal obliques, and left gluteus maximus muscles. Data from 31 participants (21 women and 10 men, mean age=22.5 years) were analyzed. The relative latency of the left RA (Hedges' g = 0.39, p=.038) was higher in the CCFT condition (mean±SD=112.1ms±86.0ms) than that in the neutral head condition (82.9ms±58.6ms). However, no difference (all p>.05) was observed in other measures between the groups. In people with impaired movement competency in ASLR, head extension did not alter the abdominal muscle activities in ASLR. However, selective activation of the DNF muscles delayed the onset of RA muscle activity during the ASLR. 4.

Correlation Between Central Sensitization and Remote Muscle Performance in Individuals With Chronic Low Back Pain

ObjectiveThe purpose of this study was to examine associations between the degree of central sensitization (CS) and remote muscle performance in people with chronic low back pain (CLBP). MethodsThe 2011 fibromyalgia (FM) criteria and severity scales (2011 FM survey) were used as a surrogate measure of CS to divide the participants into 2 groups: FM-positive CLBP and FM-negative CLBP. Measures related to central sensitization included the 2011 FM survey and pressure pain threshold of the thumbnail. Measures related to muscle performance included neck flexor muscle strength and endurance and plantar flexor muscle strength. Between-groups and correlation analyses were performed. ResultsSixty people with CLBP were enrolled (30 FM-positive, 30 FM-negative). There was no significant difference between the subgroups in age, sex, or pain duration (P > .05). The FM-positive CLBP group showed poorer neck flexor muscle endurance (P = .01) and plantar flexor muscle strength (P = .002) than the FM-negative CLBP group, whereas neck flexor muscle strength was not different between the groups (P = .175). Scores for FM and values for pressure pain thresholds of the thumbnail were associated with neck flexor muscle strength (respectively, r = −0.320, P = .013, and r = 0.467, P < .001), endurance (r = −0.242, P < .001, and r = 0.335, P = .009), and plantar flexor muscle strength (r = −0.469, P < .001, and r = 0.500, P < .001). ConclusionWe found associations between the degree of CS and remote muscle strength and endurance, suggesting that poor remote muscle performance is possibly a clinical sign of CS in people with CLBP.

Muscle endurance training of the neck triggers migraine attacks.

Most migraine patients report neck pain as part of their migraine symptomatology, but it is unknown whether triggering neck pain would induce migraine attacks. Our aim was to assess the occurrence of headache and/or neck pain after an endurance test of the neck muscles among migraineurs and controls. Sixty-five patients with migraine and 32 headache-free participants underwent a manual examination of the cervical spine by an assessor blinded towards the diagnosis and were sub-classified according to the appearance or absence of neck pain. Subsequently, the endurance of the neck flexors and extensors was tested three times, in a random order. The maximum sustained duration was recorded and the test was terminated when the subject was unable to maintain the position or reported pain. On the day after the assessment, participants were asked to report the potential occurrence of headache or neck symptoms. None of the controls reported headache after assessment, while migraine-like headache was reported by 42% of the patients with migraine (p < 0.001) after 15.8 h (SD: 10.0). Neck pain was more prevalent in migraineurs compared to controls (45% vs. 16%, p = 0.006). When considering the neck pain subtype, there were no differences among the three profiles regarding neck pain but participants with referred pain to the head reported a migraine attack more often (45%, p = 0.03). Patients with migraine are more likely to report neck pain and migraine attacks following a neck muscle endurance test. Participants with neck pain referred to the head during manual examination had a greater prevalence of migraine attacks than those without or with only local pain.

Does focus of attention alter craniocervical flexion test motor learning? A randomized controlled trial.

To evaluate the effects of three different foci of attention (internal, external and mixed) on motor learning using craniocervical flexion test in inexperienced participants. Ninety healthy young adults, with no experience in the task, practiced the craniocervical flexion test under three different focus of attention: a) Mixed Focus (internal plus external), b) Internal Focus, and c) External Focus. We assessed immediate, post-training, and retention (one week after the last training session) aspects of motor learning by quantifying (i) the activity of the superficial cervical flexors muscles, (ii) craniocervical range of motion, and (iii) the performance on the craniocervical flexion test. None of the groups showed any significant immediate, post-training, or retention effects on superficial neck flexors activity and craniocervical range of motion progression. At immediate assessment, mixed focus had greater craniocervical flexion performance than external (MD 0.9, 95%CI 0.2 to 1.5), and internal foci (MD 1.4, 95%CI 0.8 to 2.1). At post-training, mixed focus led to better craniocervical performance compared to external (MD 1.6, 95%CI 0.8 to 2.4) and internal foci (MD 2.7, 95%CI 1.9 to 3.5). External focus had better scores on the craniocervical flexion test performance than internal focus (MD 1.1, 95%CI 0.3 to 1.9). Results remained similar at retention, with mixed focus being superior to internal (MD 2.3, 95%CI 1.7 to 3) and external foci (MD 1.5, 95%CI 0.9 to 2.1) on craniocervical flexion test performance. Similarly, the performance on the craniocervical flexion test performance remained similar at retention between external and internal foci (MD 0.9, 95%CI 0.2 to 1.5). In inexperienced asymptomatic participants, different foci of attention were not able to change cervical muscle activity and craniocervical range of motion during the craniocervical flexion test. Mixed focus was better than external and internal focus on the craniocervical flexion test. These findings were retained after one week.

The Importance of Optimal Gaze Direction on Deep Neck Flexor Activation in Chronic Neck Pain.

Chronic neck pain (CNP) patients have weak deep neck flexors (DNF) and a hyperactive sternocleidomastoid (SCM). The cranio-cervical flexion test (CCFT) promotes activation of the DNF and decreases activity of the SCM, promoting pain recovery, but research suggests SCM activation increases with increasing gaze direction. We aimed to investigate how DNF and SCM activation varies according to gaze direction in the CCFT, and to prescribe the appropriate gaze direction for CNP. Twenty-eight CNP subjects had their maximum strength pressure level determined by CCFT for strength (20–~30 mmHg) and at each of the measured pressures, DNF and SCM thickness in each of four gaze directions (0°, 20°, 40°, and 60°) was measured by ultrasound imaging. The DNF to SCM ratio varied significantly according to gaze direction (p < 0.05), with gaze directions of 20° and 0° being significantly different from 40° (p < 0.05). Although there was no significant difference in DNF activation according to gaze direction, there was in SCM activation (p < 0.05), with SCM 60° significantly different from SCM 20° and SCM 40° (p < 0.05). In order to increase DNF activation efficiency during the CCFT, SCM activation should be controlled, and a gaze direction below 20° is the most efficient. This can inform DNF training of CNP patients in a clinical environment.

Delayed Development of Head Control and Rolling in Infants With Tracheostomies.

Objective: Advances in neonatal care lead to an increased survival rate of critically ill babies. Infantile tracheostomies are not uncommon. However, only a few studies have addressed the effect of infant tracheostomy on early motor function. By comparing the scores of the Gross Motor Function Measure-88 (GMFM) on head control and rolling of infants with and without tracheostomies, the authors aimed to evaluate the effect of infant tracheostomy on early motor development.Methods: Medical records and the GMFM of subjects were retrospectively reviewed. Thirty-three infants with tracheostomies and 132 infants without tracheostomies were matched by gestational age, birth weight, and corrected age when the GMFM was performed using propensity score matching. GMFM scores in head control and rolling in different positions were compared by using generalized estimating equation (GEE).Results: Infants with tracheostomy showed lower values for head control in the supine position and in the pull to sit maneuver in multivariate GEE (p = 0.008, 0.004, respectively). However, the results of head control in a prone position and head lift while the examiner held the thorax showed no difference between the groups. Rolling from prone to supine was delayed in the infants with tracheostomy (p = 0.002), while rolling from supine to prone was not delayed compared to the non-tracheostomized group. More than half (54%) of the tracheostomy group scored better in rolling from a prone to supine position than in head control in supine position, which was a higher ratio compared to the non-tracheostomy group (p = 0.00).Conclusions: Tracheostomy seems to influence early motor development in infants. In particular, head control skills related to neck flexor muscle activation and rolling from prone to supine were delayed. Interventions may be required to facilitate these activities.

Immediate Effect of Cervico-thoracic Mobilization on Deep Neck Flexors Strength in Individuals with Forward Head Posture: A Randomized Controlled Trial

ABSTRACT Introduction Forward head posture is the most frequently observed postural deviations and is said to be associated with shortening of posterior cervical extensors and weakening of the anterior deep cervical flexors. Manual therapy has the potential to achieve reflexogenic changes in muscle and enhance the motor activity and strength. Purpose of the study To evaluate the immediate effect of grade IV cervicothoracic Maitland mobilization on deep neck flexors strength in individuals with forward head posture. Study design A Single-blinded randomized placebo-controlled trial. Method Sixty individuals were randomly divided into two groups. Placebo-controlled (PBO) group (n = 30) received the grade I and experimental (EXP) group (n = 30) received grade IV posteroanterior central and unilateral Maitland mobilization from the upper cervical to the upper thoracic spine. Outcome measure: Clinical Cranio-cervical flexion test (CCFT) was used to measure the motor activity and the strength of deep neck flexors. Results The strength of deep neck flexors effectively increased (p = <0.0001) after advocating grade IV mobilization. Conclusion This study concluded that grade IV central and unilateral posteroanterior Maitland mobilization demonstrated significant increase in the deep neck flexors strength in individuals with forward head posture.

Effect of Deep Cervical Flexor training on Respiratory Functions in Chronic Neck Pain patients with Forward Head Posture

Protruded chin posture is one of the commonly seen postural problem associated with patients having chronic neck pain. It is also known by names Forward Head Posture (FHP) or anteriorly translated head posture. The FHP causes an alteration in mechanics of rib cage which leads to a reduction in mobility of thorax and abdomen, decreased movement of the diaphragm, reduced ventilatory effectiveness of diaphragm and reduced efficacy of abdominals and intercostals muscles during respiration. Therefore this study was executed to check the effectiveness of deep cervical flexor exercises on Craniovertebral angle and pulmonary functions. It was a comparative experimental study design. Based on the study's selection criteria, the total numbers of 100 subjects were taken and divided into Experimental and Control groups. In-depth Cervical flexor training with the conventional Physiotherapy was given to subjects of the experimental group. Control group subjects received only Conventional Physiotherapy for six weeks. The baseline measurement was taken on day one of the studies. The digital camera assessed the Forward head posture by measuring Craniovertebral Angle (CVA). Spirometry determined pulmonary functions (FEV1&amp;amp; FVC). All measurements were repeated at the end of the 6th week. The baseline measurement and measurement at the end of 6th week were compared by using the t-test. Considerable improvement in Craniovertebral angle and functional status of the lung, resulted in subjects who were given in-depth cervical flexor training along with the conventional Physiotherapy treatment (p&amp;lt; 0.05). Therefore it is suggested that deep cervical flexor exercises improve the head posture and also correct the biomechanics of respiratory muscles. Deep neck flexor training can be considered as an efficient technique in lessening protruded chin posture.