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BACKGROUND: The cervical flexion relaxation phenomenon (FRP) is a myoelectric silence of neck extensor muscles which occurs after a certain degree of flexion. Impaired flexion relaxation can impose the vertebral structures to excessive loading resulting from the persistence of muscular contraction. OBJECTIVE: This study aimed to investigate the incidence or absence of FRP in cervical erector spinae (CES) and upper trapezius muscles in patients with chronic neck pain (CNP). METHODS: Twenty-five patients with CNP and 25 healthy volunteers were recruited. They accomplished cervical flexion and extension from a neutral position in four phases in the sitting position. The surface electromyography activity of both CES and upper trapezius muscles was recorded in each phase. Cervical flexion and extension movements were simultaneously measured using an electrogoniometer. RESULTS: FRP in CES was observed in 84% and 36% of healthy subjects and CNP patients, respectively. Flexion relaxation ratio (FRR) in CES was lower in CNP patients than in healthy subjects (mean diff = 1.33; 95% CI: 0.75–1.91) (P< 0.001). Only in CNP patients, FRR in right erector spinea was significantly higher than that in the left erector spinea (P= 0.04). CONCLUSIONS: FRP incidence in CNP patients was less than in healthy subjects. Moreover, this phenomenon begins later in CNP patients than in healthy subjects indicating prolonged activity of CES muscles during flexion in the CNP group. The difference between FRR in the right and left sides of erector spinea muscles can result in CNP.

Introduction: Neuromuscular imbalance between right and left sides of Cervical Erector Spinae (CES) muscles can induce pain by applying the asymmetric loads on the spine incorrectly. This study evaluated the symmetry of the right and left cervical flexion-relaxation ratio (FRR) in patients with Non-Specific Chronic Neck Pain (NSCNP) and healthy subjects. We aimed to investigate the symmetry of FRR on the right and left sides of the CES muscles in individuals with and without NSCNP. Materials and Methods: A total of 25 patients with NSCNP and 25 healthy subjects participated in this study. The surface electromyography activity of CES muscles during four phases of flexion and extension tasks were measured and recorded. Unilateral FRR in the right and left sides of CES muscles was calculated and compared in each group. Results: Only in NSCNP patients, FRR in the right CES muscle was significantly higher than that in the left one (P<0.05). Also, FRR for bilateral CES muscles was significantly higher in healthy subjects than in NSCNP patients (P<0.001). Conclusion: The study results indicated a greater FRR asymmetry in CES muscles in NSCNP patients than in healthy subjects. This asymmetry is probably due to the dominance of the limb. Moreover, asymmetric FRR as a kind of neuromuscular imbalance may cause pain due to imposing asymmetric loads on spine structures.

Background and Aims: Massage therapy is widely used by athletes for various reasons such as recovery from fatigue, preventing injury, and relaxation. It is believed that massage improves the performance of the athletes by increasing their blood flow, removing lactic acid, and stimulating the nervous system. This review study aims to investigate the physiological and neurophysiological effects of sports massage on the athletes’ performance, to find out whether the clinical beliefs of sports physiotherapists about the effects of sports massage on sports injuries are supported by scientific evidence or not. Methods: In this review study, a search was conducted in Google Scholar PubMed, and ScienceDirect databases on studies published in English from 1975 to 2020 using the keywords: Sports massage, sports injuries, physiological mechanisms, neurophysiological mechanisms, and performance of athletes. Fifty articles about the effects of sports massage were assessed for eligibility. Finally, 14 clinical trial studies and one case report study were included in the review. Results: Few studies have been conducted on the effect of sports massage on the athletes’ performance. The existing studies are heterogeneous, i.e., they have examined the effect of massage on different factors and reported contradictory results. It seems that the effects of sports massage on the athletes’ performance are more due to its psychological effects rather than its clinical effects. The effects of sports massage on athletes’ performance have not yet been supported by scientific evidence. Conclusion: Many scholars consider that the effects of sports massage are due to increasing blood flow, but there is insufficient scientific evidence. In treatment of tendonitis and muscle strains, there is insufficient evidence that sports massage can reduce pain and accelerate healing. It seems the therapeutic effects of sport massage are more psychological and less physiological.

Background: The effect of therapeutic exercise on cervical flexion relaxation phenomenon (FRP) is questionable. This study aimed at investigating the effect of eight weeks of cervical stability exercise on FRP, pain, and disability in NSCNP patients.Methods: This quasi-experimental study was conducted on 25 subjects with NSCNP. Surface electromyographic signals of the cervical erector spinae (CES) muscles in a sitting position were recorded before and after the intervention. The occurrence of FRP and flexion relaxation ratio (FRR) were analyzed before and after the eight weeks of cervical stability exercise. The low-load craniocervical flexion exercise was performed by the subjects in crook lying position. In addition, the intensity of pain and disability were assessed via visual analogue index (VAS) and neck disability index (NDI).Results: The FRR of CES muscles increased after the intervention. Similarly, the occurrence of FRP increased among NSCNP patients after the intervention. The average changes of VAS, NDI, and FRR were not associated with gender and duration of pain. Moreover, VAS and NDI scores significantly decreased after the intervention. Conclusions: Flexion relaxation phenomenon can be improved via specific stability exercises. The improvement of flexion relaxation phenomenon apparently can pain and disability.