Novel Electromyographic Protocols Using Axial Rotation and Cervical Flexion-Relaxation for the Assessment of Subjects With Neck Pain: A Feasibility Study

J Chiropr Med. 2016 Jun;15(2):102-11. doi: 10.1016/j.jcm.2016.04.013. Epub 2016 May 20.


Objective: The purpose of this study is to examine the feasibility of novel variations to the way cervical flexion-relaxation phenomenon (FRP) studies are conducted and the feasibility of using cervical axial rotation as an alternative objective measure of cervical pain/dysfunction.

Methods: Electromyographic data were collected from cervical paraspinal muscles of 5 participants with neck pain and 5 asymptomatic controls. Cervical FRP was conducted as reported in the literature with the participants seated, except that they started with the head fully flexed instead of being erect. Data were also collected with participants laying prone, starting with their head hanging over the edge of the table. Additional data were collected from cervical paraspinal and sternocleidomastoid (SCM) muscles while the seated participants rotated their head fully to the right and left. Ratios were obtained for each type of test by dividing the electromyographic amplitude when muscles were most active by that when they were relaxed or in contralateral rotation.

Results: In each case, the ratio was higher for the controls than for those with neck pain, suggesting that any of the 4 methods could be used to distinguish between 2 groups. The ratios were most pronounced from SCMs during axial rotation. There appeared to be a negative relationship between pain level and the ratios obtained from each method.

Conclusion: The findings from this small study are encouraging for all methods used, with axial rotation using SCMs appearing to be the most promising. These results indicate that larger, powered studies are warranted.

Keywords: Cervical pain; Pain assessment; Surface electromyography.