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

Overview

Journal Healthcare (Basel)

Specialty Health Services

Date 2020 Nov 3

PMID 33139645

Authors

Byoung-Kwon Lee

Dong-Kwon Seo

Affiliations

Soon will be listed here.

Abstract

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 ( < 0.05), with gaze directions of 20° and 0° being significantly different from 40° ( < 0.05). Although there was no significant difference in DNF activation according to gaze direction, there was in SCM activation ( < 0.05), with SCM 60° significantly different from SCM 20° and SCM 40° ( < 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.

References

Cromer J, Waitzman D . Neurones associated with saccade metrics in the monkey central mesencephalic reticular formation. J Physiol. 2005; 570(Pt 3):507-23. PMC: 1479872. DOI: 10.1113/jphysiol.2005.096834. View

Cagnie B, Danneels L, Van Tiggelen D, De Loose V, Cambier D . Individual and work related risk factors for neck pain among office workers: a cross sectional study. Eur Spine J. 2006; 16(5):679-86. PMC: 2213555. DOI: 10.1007/s00586-006-0269-7. View

Jesus F, Ferreira P, Ferreira M . Ultrasonographic measurement of neck muscle recruitment: a preliminary investigation. J Man Manip Ther. 2009; 16(2):89-92. PMC: 2565110. DOI: 10.1179/106698108790818486. View

Falla D, Jull G, Russell T, Vicenzino B, Hodges P . Effect of neck exercise on sitting posture in patients with chronic neck pain. Phys Ther. 2007; 87(4):408-17. DOI: 10.2522/ptj.20060009. View

Cote P, Cassidy D, Carroll L, Kristman V . The annual incidence and course of neck pain in the general population: a population-based cohort study. Pain. 2004; 112(3):267-273. DOI: 10.1016/j.pain.2004.09.004. View

Cagnie B, Dolphens M, Peeters I, Achten E, Cambier D, Danneels L . Use of muscle functional magnetic resonance imaging to compare cervical flexor activity between patients with whiplash-associated disorders and people who are healthy. Phys Ther. 2010; 90(8):1157-64. DOI: 10.2522/ptj.20090351. View

Dusunceli Y, Ozturk C, Atamaz F, Hepguler S, Durmaz B . Efficacy of neck stabilization exercises for neck pain: a randomized controlled study. J Rehabil Med. 2009; 41(8):626-31. DOI: 10.2340/16501977-0392. View

OLeary S, Falla D, Jull G, Vicenzino B . Muscle specificity in tests of cervical flexor muscle performance. J Electromyogr Kinesiol. 2006; 17(1):35-40. DOI: 10.1016/j.jelekin.2005.10.006. View

Ghamkhar L, Kahlaee A . Are Ultrasonographic Measures of Cervical Flexor Muscles Correlated With Flexion Endurance in Chronic Neck Pain and Asymptomatic Participants?. Am J Phys Med Rehabil. 2017; 96(12):874-880. DOI: 10.1097/PHM.0000000000000778. View

10.

Park J, Ko D, Her J, Woo J . What is a more effective method of cranio-cervical flexion exercises?. J Back Musculoskelet Rehabil. 2018; 31(3):415-423. DOI: 10.3233/BMR-170860. View

11.

Javanshir K, Amiri M, Mohseni Bandpei M, de Las Penas C, Rezasoltani A . The effect of different exercise programs on cervical flexor muscles dimensions in patients with chronic neck pain. J Back Musculoskelet Rehabil. 2015; 28(4):833-40. DOI: 10.3233/BMR-150593. View

12.

Kim M . Neck kinematics and sternocleidomastoid muscle activation during neck rotation in subjects with forward head posture. J Phys Ther Sci. 2015; 27(11):3425-8. PMC: 4681919. DOI: 10.1589/jpts.27.3425. View

13.

Smedmark V, Wallin M, Arvidsson I . Inter-examiner reliability in assessing passive intervertebral motion of the cervical spine. Man Ther. 2000; 5(2):97-101. DOI: 10.1054/math.2000.0234. View

14.

Turville K, Psihogios J, Ulmer T, Mirka G . The effects of video display terminal height on the operator: a comparison of the 15 degree and 40 degree recommendations. Appl Ergon. 1998; 29(4):239-46. DOI: 10.1016/s0003-6870(97)00048-3. View

15.

Bexander C, Mellor R, Hodges P . Effect of gaze direction on neck muscle activity during cervical rotation. Exp Brain Res. 2005; 167(3):422-32. DOI: 10.1007/s00221-005-0048-4. View

16.

Jull G, OLeary S, Falla D . Clinical assessment of the deep cervical flexor muscles: the craniocervical flexion test. J Manipulative Physiol Ther. 2008; 31(7):525-33. DOI: 10.1016/j.jmpt.2008.08.003. View

17.

Ghaderi F, Jafarabadi M, Javanshir K . The clinical and EMG assessment of the effects of stabilization exercise on nonspecific chronic neck pain: A randomized controlled trial. J Back Musculoskelet Rehabil. 2016; 30(2):211-219. DOI: 10.3233/BMR-160735. View

18.

Song K, Choi B, Choi B, Seo G . Cross-cultural adaptation and validation of the Korean version of the neck disability index. Spine (Phila Pa 1976). 2010; 35(20):E1045-9. DOI: 10.1097/BRS.0b013e3181df78e9. View

19.

De Hertogh W, Vaes P, Vijverman V, De Cordt A, Duquet W . The clinical examination of neck pain patients: the validity of a group of tests. Man Ther. 2006; 12(1):50-5. DOI: 10.1016/j.math.2006.02.007. View

20.

Harris K, Heer D, Roy T, Santos D, Whitman J, Wainner R . Reliability of a measurement of neck flexor muscle endurance. Phys Ther. 2005; 85(12):1349-55. View