Study Design. Cross-sectional study. Objective. The present study compared activity of deep and superficial cervical flexor muscles and craniocervical flexion range of motion during a test of craniocervical flexion between 10 patients with chronic neck pain and 10 controls.Summary of Background Data. Individuals with chronic neck pain exhibit reduced performance on a test of craniocervical flexion, and training of this maneuver is effective in management of neck complaints. Although this test is hypothesized to reflect dysfunction of the deep cervical flexor muscles, this has not been tested.Methods. Deep cervical flexor electromyographic activity was recorded with custom electrodes inserted via the nose and fixed by suction to the posterior mucosa of the oropharynx. Surface electrodes were placed over the superficial neck muscles (sternocleidomastoid and anterior scalene). Root mean square electromyographic amplitude and craniocervical flexion range of motion was measured during five incremental levels of craniocervical flexion in supine.Results. There was a strong linear relation between the electromyographic amplitude of the deep cervical flexor muscles and the incremental stages of the craniocervical flexion test for control and individuals with neck pain (P ϭ 0.002). However, the amplitude of deep cervical flexor electromyographic activity was less for the group with neck pain than controls, and this difference was significant for the higher increments of the task (P Ͻ 0.05). Although not significant, there was a strong trend for greater sternocleidomastoid and anterior scalene electromyographic activity for the group with neck pain.Conclusions. These data confirm that reduced performance of the craniocervical flexion test is associated with dysfunction of the deep cervical flexor muscles and support the validity of this test for patients with neck pain.Chronic cervical spine disease is becoming increasingly prevalent in society. Estimations indicate that 67% of individuals will suffer neck pain at some stage of life. 1 With an increasingly sedentary population, especially with reliance on computer technology in the workplace, it is predicated that the prevalence rate will continue to rise. Effective management of this condition is vital, not only for the relief of symptoms but perhaps more importantly, for the prevention of recurrent episodes of cervical pain, personal suffering, and lost work productivity.Craniocervical flexion exercise has been shown to be effective in the management of cervicogenic headache. 2 This intervention was based on research that indicates inferior ability to increase and hold progressively inner range positions of craniocervical flexion in individuals with neck pain of traumatic and nontraumatic origin 3,4 and the proposal that this maneuver provides a strategy to test and retrain the activity of the deep cervical flexor muscles, 3 which are considered important for control of stability of the cervical spine. 5-8 However, to date, no study has been undertaken to directly measure...

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Patients with neck pain demonstrated greater activation of accessory neck muscles during a repetitive upper limb task compared to asymptomatic controls. Greater activation of the cervical muscles in patients with neck pain may represent an altered pattern of motor control to compensate for reduced activation of painful muscles. Greater perceived disability among patients with neck pain accounted for the greater electromyographic amplitude of the superficial cervical muscles during performance of the functional task.

This study showed that people with chronic neck pain demonstrate a reduced ability to maintain an upright posture when distracted. Following intervention with an exercise program targeted at training the craniocervical flexor muscles, subjects with neck pain demonstrated an improved ability to maintain a neutral cervical posture during prolonged sitting.