Lee Byoung-Kwon, Seo Dong-Kwon
Department of Physical Therapy, Konyang University, Daejeon 35365, Korea.
Healthcare (Basel). 2020 Nov 1;8(4):449. doi: 10.3390/healthcare8040449.
Chronic neck pain (CNP) patients have weak deep neck flexors (DNF) and a hyperactive sternocleidomastoid (SCM). The cranio-cervical flexion test (CCFT) promotes activation of the DNF and decreases activity of the SCM, promoting pain recovery, but research suggests SCM activation increases with increasing gaze direction. We aimed to investigate how DNF and SCM activation varies according to gaze direction in the CCFT, and to prescribe the appropriate gaze direction for CNP. Twenty-eight CNP subjects had their maximum strength pressure level determined by CCFT for strength (20-~30 mmHg) and at each of the measured pressures, DNF and SCM thickness in each of four gaze directions (0°, 20°, 40°, and 60°) was measured by ultrasound imaging. The DNF to SCM ratio varied significantly according to gaze direction ( < 0.05), with gaze directions of 20° and 0° being significantly different from 40° ( < 0.05). Although there was no significant difference in DNF activation according to gaze direction, there was in SCM activation ( < 0.05), with SCM 60° significantly different from SCM 20° and SCM 40° ( < 0.05). In order to increase DNF activation efficiency during the CCFT, SCM activation should be controlled, and a gaze direction below 20° is the most efficient. This can inform DNF training of CNP patients in a clinical environment.
慢性颈痛（CNP）患者的颈深屈肌（DNF）较弱，胸锁乳突肌（SCM）过度活跃。颅颈屈曲试验（CCFT）可促进DNF的激活并降低SCM的活动，从而促进疼痛恢复，但研究表明，随着注视方向的增加，SCM的激活会增加。我们旨在研究在CCFT中DNF和SCM的激活如何随注视方向而变化，并为CNP患者规定合适的注视方向。28名CNP受试者通过CCFT确定其最大力量压力水平（20~30 mmHg），并在每个测量压力下，通过超声成像测量四个注视方向（0°、20°、40°和60°）下的DNF和SCM厚度。DNF与SCM的比值根据注视方向有显著差异（<0.05），20°和0°的注视方向与40°有显著差异（<0.05）。尽管根据注视方向，DNF激活没有显著差异，但SCM激活有显著差异（<0.05），SCM 60°与SCM 20°和SCM 40°有显著差异（<0.05）。为了在CCFT期间提高DNF激活效率，应控制SCM激活，20°以下的注视方向最有效。这可为临床环境中CNP患者的DNF训练提供参考。
