title: Influence of pressure changes on recruitment pattern and neck muscle activities during Cranio-Cervical Flexion Tests (CCFTs).
abstract: BACKGROUND
  The muscle activity of the deep cervical flexors is emphasized more than that of the superficial cervical flexors, and it has been reported that functional disorders of the longuscolli are found in patients who experience neck pain.
  
  
  OBJECTIVE
  The objective of this study was to analyze the recruitment patterns and muscle activities of the cervical flexors during Cranio-Cervical Flexion Tests (CCFTs) through real-time ultrasonography and surface electromyography with a view to presenting appropriate pressure levels for deep cervical flexor exercise protocols based on the results of the analysis.
  
  
  METHODS
  The twenty subjects without neck pain were trained until they became accustomed to CCFTs, and the pressure level was increased gradually from 20 mmHg to 40 mmHg by increasing the pressure level 5 mmHg at a time. Real-time ultrasonography images of the longuscolli and the sternocleidomastoid were taken to measure the amounts of changes in the thicknesses of these muscles, and surface electromyography was implemented to observe the muscle activity of the sternocleidomastoid. The measured value is RMS.
  
  
  RESULTS
  According to the results of the ultrasonography, the muscle thicknesses of both the longuscolli and the sternocleidomastoid showed significant increases, as the pressure increased up to 40 mmHg (p< 0.05). The differences in the muscle thicknesses at all individual pressure levels showed significant increases (p< 0.05). According to the results of the electromyography, the muscle activity of the sternocleidomastoid gradually increased as the pressure increased up to 40 mmHg, the increases were significant between 20 mmHg and 25 mmHg, between 30 mmHg and 35 mmHg (p< 0.05).
  
  
  CONCLUSIONS
  The pressure levels of exercise methods at which the muscle activity of the deep cervical flexors is maximally increased and the muscle activity of the superficial cervical flexors is minimally increased are 25 mmHg-30 mmHg.
authors.affiliation: Department of Rehabilitation Therapy, Graduate School of Hallym University, Chuncheon, Korea.
authors.forename: Junhyung
authors.initials: J
authors.lastname: Park
authors.affiliation: Department of Rehabilitation Therapy, Graduate School of Hallym University, Chuncheon, Korea.
authors.forename: Jingang
authors.initials: J
authors.lastname: Hur
authors.affiliation: Department of Physical Therapy, Daewon University College, Daewon, Korea.
authors.forename: Taesung
authors.initials: T
authors.lastname: Ko
mesh_terms: D000328:Adult; D004576:Electromyography; D005080:Exercise Test; D005260:Female; D006801:Humans; D008297:Male; D009334:Neck Muscles / Q000000981:diagnostic imaging* / Q000502:physiology*; D011312:Pressure; D011999:Recruitment, Neurophysiological / Q000502:physiology*; D014463:Ultrasonography
keywords: Cranio-cervical flexion test; longuscolli; real-time ultrasonography; surface electromyography