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Research Review - Deep Neck Flexors

man with neck pain

Explain relevance of deep neck flexors in neck and upper back pain

· Research has shown dysfunctional cervical flexor motor control and strength in individuals with neck pain

· Patients with neck pain exhibit increased EMG amplitude of the superficial sternocleidomastoid and anterior scalene muscles

· Decreased activation of the deep cervical flexors and reduced range of Craniocervical Flexion (CCF) motion compared to individuals without neck pain

· Program of CCF exercises focusing on motor control of the deep neck flexors has been shown through clinical trials to reduce neck pain and headache frequency and severity

· This type of training has been shown to enhance the pattern of deep and superficial flexor activity in the CCF test when compared to strength training

· Patients have shown improved temporal characteristics of deep neck flexor muscle activation following CCF training

Review clinical testing procedures

Craniocervical Flexion Action

· Within Jull et al research CCF is Stage 1

· Activation, endurance, and isometric contraction of the deep cervical flexors in progressive range positions

· Patient slowly nods "yes" on top of 20mmHg blood pressure cuff

· Progression to 2, 4, 6, 8 and 10 mmHg increase with 2s isometric hold

· Goal of 10 reps and 10s hold

· Record the number of times the patient can hold the pressure level

· Multiply that by the pressure increment

· The highest performance index possible is 100 (10mmHg x 10 reps)

· Low load CCF targets the deep neck flexors longus capitis and longus colli specifically

Isometric Pressure Endurance

· Within Jull et al research this is Stage 2 after correctly performing the CCF

· Perform the head nod action to first target the lowest level (22 mmHg) and holds the position for 10s

· Perform at least 3 repetitions of 10s holds without substitution strategies, the test is progressed to the next pressure target

Endurance Hold

· Normative data suggests those with neck pain were found to have significantly decreased deep neck flexor endurance

· Average of 21.4s

· Endurance goals for outcome measures: Men: 38.9s & Women: 29.4s

Dynamic Active Cervical Range of Motion

· Other than craniocervical flexion test and the deep neck flexor endurance test, evidence related to reliability of cervical movement control dysfunction tests is insufficient

· Screened movements include (9): Cervical flexion, extension, rotation, and rocking 4 point kneeling, bilateral and unilateral standing arm flexion, sitting rotation, neutral to extension, and extension

· Inter-tester reliability (κ = 0.69; 95% CI: 0.62, 0.76)

· Intra-rater reliability values for the expert (κ = 0.86; 95% CI: 0.79, 0.92)

· Novice (κ = 0.76; 95% confidence intervals (CI): 0.68, 0.84) were overall comparable suggesting that novices can achieve good accuracy with dynamic tests

· Further research in neck pain populations is required to explore these tests in order to establish their diagnostic accuracy for identifying clinically relevant cervical movement control dysfunction



Dr. Mike Hadbavny

Chiropractor, Sports Sciences Resident RCCSS(C)

If you are interested in learning more about how chiropractic care can be effective for your particular condition or health goals, contact Dr. Mike Hadbavny at 250-881-7881 today to make an appointment and discover the many benefits of seeing a chiropractor in Victoria, BC. Contact us today.

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