Can a functional postural exercise improve performance in the cranio-cervical flexion test?--a preliminary study

Man Ther. 2012 Jun;17(3):219-24. doi: 10.1016/j.math.2011.12.005. Epub 2012 Feb 4.


Deep cervical flexor (DCF) muscle impairment is common in patients with neck pain. Retraining function is often commenced with a motor relearning approach, requiring the patient to practice and hold a cranio-cervical flexion position in supine lying. Motor relearning requires multiple repetitions which is difficult to achieve if only exercising in supine. This preliminary study investigated the effects of training the DCF with a functional exercise: assumption of an upright lumbo-pelvic and spinal postural position, adding a neck lengthening manoeuvre. The exercise effect was evaluated by changes in sternocleidomastoid (SCM) muscle activity in the cranio-cervical flexion test (CCFT). Twenty subjects with neck pain were randomly assigned to an exercise or control group. The exercise group trained for two weeks. Pre and post-intervention, electromyographic (EMG) signals were recorded from the SCM muscles during the five stages of the CCFT. Results indicated that the exercise improved performance. SCM EMG signal amplitudes decreased across all CCFT stages, albeit significant only at the first and third stages of the test; 22 mmHg (p = 0.043) and 26 mmHg (p = 0.003). No differences were evident in the control group (all p > 0.05). There was no difference between groups for pain and disability measures. This initial study indicates that a postural exercise, convenient to perform during the working day, improves the pattern of SCM muscle activity in the CCFT. Whilst further research is necessary, these observations suggest the worth of such an exercise to augment other training in the rehabilitation of patients with neck pain.

Publication types

  • Comparative Study
  • Randomized Controlled Trial

MeSH terms

  • Adolescent
  • Adult
  • Cervical Vertebrae / physiopathology
  • Disability Evaluation
  • Electromyography / methods
  • Exercise / physiology*
  • Female
  • Head Movements / physiology
  • Humans
  • Male
  • Middle Aged
  • Multivariate Analysis
  • Muscle Contraction / physiology*
  • Neck Muscles / physiopathology*
  • Neck Pain / diagnosis
  • Neck Pain / rehabilitation*
  • Pain Measurement
  • Postural Balance / physiology
  • Range of Motion, Articular / physiology*
  • Reference Values
  • Severity of Illness Index
  • Treatment Outcome
  • Young Adult