Physical Therapy Korea
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Phys. Ther. Korea 2022; 29(3): 180-186
Published online August 20, 2022
https://doi.org/10.12674/ptk.2022.29.3.180
© Korean Research Society of Physical Therapy
Comparison of Muscle Thickness and Changing Ratio for Cervical Flexor Muscles During the Craniocervical Flexion Test Between Subjects With and Without Forward Head Posture
Jae-hyun Lee1 
, PT, BPT, Ui-jae Hwang2,3 , PT, PhD, Oh-yun Kwon2,3 , PT, PhD
1Department of Physical Therapy, The Graduate School, Yonsei University, 2Kinetic Ergocise Based on Movement Analysis Laboratory, 3Department of Physical Therapy, College of Software and Digital Healthcare Convergence, Yonsei University, Wonju, Korea
Correspondence to: Oh-yun Kwon
E-mail: kwonoy@yonsei.ac.kr
https://orcid.org/0000-0002-9699-768X
This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/4.0) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.
Background: The craniocervical flexion test (CCFT) was developed for the activation and endurance of deep cervical flexors. However, the muscle thickness and muscle thickness changing ratio of the sternocleidomastoid (SCM) and deep cervical flexor (DCF) muscles in subjects with and without forward head posture (FHP) have not been reported. Objects: To determine the difference in thickness of the SCM and DCF muscles and the difference in the muscle thickness changing ratio between SCM, DCF, and DCF/SCM 20 mmHg and DCF/SCM 30 mmHg between subjects with and without FHP.
Methods: Thirty subjects with and without FHP were enrolled. The muscle thickness of the SCM and DCF was measured when maintained at a baseline pressure of 20 mmHg and a maximum pressure of 30 mmHg using a pressure biofeedback unit during the CCFT. Ultrasonography was used to capture images of SCM and DCF muscle thickness during the CCFT, which was calculated using the picture archiving and communication system (PACS).
Results: We observed a significant difference within the pressure main effect between SCM and DCF at a baseline pressure of 20 mmHg and a maximum pressure of 30 mmHg (p < 0.05). However, there was no significant difference in the muscle thickness and muscle thickness changing ratio for SCM and DCF during CCFT between subjects with and without FHP.
Conclusion: There was no significant difference in the muscle thickness recruitment pattern during CCFT in posture changes between subjects with and without FHP.
Keywords: Neck muscles, Posture, Ultrasonography
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Original Article
Phys. Ther. Korea 2022; 29(3): 180-186
Published online August 20, 2022 https://doi.org/10.12674/ptk.2022.29.3.180
Copyright © Korean Research Society of Physical Therapy.
Comparison of Muscle Thickness and Changing Ratio for Cervical Flexor Muscles During the Craniocervical Flexion Test Between Subjects With and Without Forward Head Posture
Jae-hyun Lee1 , PT, BPT, Ui-jae Hwang2,3 , PT, PhD, Oh-yun Kwon2,3 , PT, PhD
1Department of Physical Therapy, The Graduate School, Yonsei University, 2Kinetic Ergocise Based on Movement Analysis Laboratory, 3Department of Physical Therapy, College of Software and Digital Healthcare Convergence, Yonsei University, Wonju, Korea
Correspondence to:Oh-yun Kwon
E-mail: kwonoy@yonsei.ac.kr
https://orcid.org/0000-0002-9699-768X
This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/4.0) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.
Abstract
Background: The craniocervical flexion test (CCFT) was developed for the activation and endurance of deep cervical flexors. However, the muscle thickness and muscle thickness changing ratio of the sternocleidomastoid (SCM) and deep cervical flexor (DCF) muscles in subjects with and without forward head posture (FHP) have not been reported. Objects: To determine the difference in thickness of the SCM and DCF muscles and the difference in the muscle thickness changing ratio between SCM, DCF, and DCF/SCM 20 mmHg and DCF/SCM 30 mmHg between subjects with and without FHP.
Methods: Thirty subjects with and without FHP were enrolled. The muscle thickness of the SCM and DCF was measured when maintained at a baseline pressure of 20 mmHg and a maximum pressure of 30 mmHg using a pressure biofeedback unit during the CCFT. Ultrasonography was used to capture images of SCM and DCF muscle thickness during the CCFT, which was calculated using the picture archiving and communication system (PACS).
Results: We observed a significant difference within the pressure main effect between SCM and DCF at a baseline pressure of 20 mmHg and a maximum pressure of 30 mmHg (p < 0.05). However, there was no significant difference in the muscle thickness and muscle thickness changing ratio for SCM and DCF during CCFT between subjects with and without FHP.
Conclusion: There was no significant difference in the muscle thickness recruitment pattern during CCFT in posture changes between subjects with and without FHP.
Keywords: Neck muscles, Posture, Ultrasonography
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Table 1 . Characteristics of the subjects (N = 30).
Variable With FHP (n=15) Without FHP (n=15) p-value Age (y) 28.0 ± 5.0 30.1 ± 3.0 0.467 Height (cm) 162.3 ± 29.1 168.1 ± 9.0 0.186 Weight (kg) 73.7 ± 16.9 64.1 ± 13.8 0.097 CV angle 45.6 ± 3.3 53.9 ± 1.9 0.001* Values are presented as mean ± standard deviation. FHP, forward head posture; CV angle, cranio-vertebral angle. *Significant difference (p < 0.05)..
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Table 2 . Within (20 and 30 mmHg) and between (with and without FHP) differences in muscle thickness of the SCM (cm).
Pressure With FHP Without FHP Within-pressure
main effect (p)Between-group
main effect (p)Within x between
interaction effect (p)20 mmHg 0.76 ± 0.14 0.79 ± 0.17 0.001* 0.716 0.899 30 mmHg 0.89 ± 0.22 0.91 ± 0.24 Values are presented as mean ± standard deviation. FHP, forward head posture; SCM, sternocleidomastoid. *Significant difference (p < 0.05)..
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Table 3 . Within (20 and 30 mmHg) and between (with and without FHP) differences in muscle thickness of the DCF (cm).
Pressure With FHP Without FHP Within-pressure
main effect (p)Between-group
main effect (p)Within x between
interaction effect (p)20 mmHg 1.23 ± 0.24 1.26 ± 0.32 0.001* 0.951 0.273 30 mmHg 1.37 ± 0.26 1.34 ± 0.38 Values are presented as mean ± standard deviation. FHP, forward head posture; DCF, deep cervical flexor. *Significant difference (p < 0.05)..
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Table 4 . Comparison of the muscle thickness changing ratio for SCM 30/20 mmHg and DCF 30/20 mmHg between subjects with and without FHP.
Pressure With FHP (n=15) Without FHP (n=15) t p-value SCM 30/20 mmHg 1.17 ± 0.22 1.17 ± 0.25 0.05 0.96 DCF 30/20 mmHg 1.12 ± 0.11 1.07 ± 0.13 1.26 0.22 Values are presented as mean ± standard deviation. SCM, sternocleidomastoid; DCF, deep cervical flexor; FHP, forward head posture..
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Table 5 . Within (DCF/SCM 20 mmHg and DCF/SCM 30 mmHg) and between (with and without FHP) differences in muscle thickness changing ratio.
Pressure With FHP Without FHP Within-pressure
main effect (p)Between-group
main effect (p)Within x between
interaction effect (p)20 mmHg 1.66 ± 0.44 1.64 ± 0.41 0.144 0.732 0.637 30 mmHg 1.60 ± 0.39 1.52 ± 0.40 Values are presented as mean ± standard deviation. DCF, deep cervical flexor; SCM, sternocleidomastoid; FHP, forward head posture..