DOI QR코드

DOI QR Code

A Comparison Study of Cervical Flexion-Relaxation Ratio in the Normal and Forward Head Postures

  • Yeo, Sang-Seok (Department of Physical Therapy, College of Health Sciences, Dankook University) ;
  • Kwon, Jung-Won (Department of Physical Therapy, College of Health Sciences, Dankook University)
  • Received : 2020.11.27
  • Accepted : 2020.12.29
  • Published : 2020.12.31

Abstract

Purpose: This study aimed to examine the effects of forward head posture on the flexion-relaxation ratio (FRR) and muscle activity during sustained neck flexion and to investigate the correlation between craniovertebral angle and FRR. Methods: Nineteen subjects participated in this study and were allocated to a forward head posture (FHP) group or a non-forward head posture (NFHP) group. Craniovertebral angle (CVA) and FRR were measured in all subjects, and all participants performed a standardized cervical flexion-extension movement in two phases: Phase I, sustained cervical full flexion for 5s; and Phase II, cervical extension with the return to the starting position for 5s. The value of CVA has calculated three times, and the value of FRR was measured three times in order to obtain the mean value. Results: FRR values in the FHP and NFHP group were significantly different (p<0.05). Phase I was significantly different, but the Phase II was not significantly different between the FHP and NFHP group (p>0.05). There was a significant correlation between the muscle activity of Phase I and CVA (p<0.05). However, FRR and the muscle activity of the Phase II were not a significant correlation with the CVA (p>0.05). Conclusion: FHP increases the muscle activity of the cervical erector spinae during sustained neck flexion and reduces FRR, which can cause fatigue in the cervical erector spinae. In addition, for those with a smaller CVA, muscle activity of the cervical erector spinae is increased during sustained neck flexion, which can increase neck muscle tension.

Keywords

References

  1. Koseki T, Kakizaki F, Hayashi S et al. Effect of forward head posture on thoracic shape and respiratory function. J Phys Ther Sci. 2019;31(1):63-8. https://doi.org/10.1589/jpts.31.63
  2. Fernandez-de-las-Penas C, Alonso-Blanco C, Cuadrado ML et al. Trigger points in the suboccipital muscles and forward head posture in tension-type headache. Headache. 2006;46(3):454-60. https://doi.org/10.1111/j.1526-4610.2006.00288.x
  3. Szeto GP, Straker L, Raine S. A field comparison of neck and shoulder postures in symptomatic and asymptomatic office workers. Appl Ergon. 2002;33(1):75-84. https://doi.org/10.1016/S0003-6870(01)00043-6
  4. Park JH, Kim JH, Kim JG et al. The effects of heavy smartphone use on the cervical angle, pain threshold of neck muscles and depression. Adv Sci Technol Lett. 2015;91(3):12-7.
  5. Hansraj KK. Assessment of stresses in the cervical spine caused by posture and position of the head. Surg Technol Int. 2014;25(25):277-9.
  6. Patwardhan AG, Khayatzadeh S, Havey RM et al. Cervical sagittal balance: A biomechanical perspective can help clinical practice. Eur Spine J. 2018;27(1):25-38.
  7. Patwardhan AG, Havey RM, Muriuki M et al. Postural compensation and disc mechanics in forward head posture: A novel laboratory model of cervical sagittal balance. Spine J. 2013;13(9):S100.
  8. Kwon JW, Son SM, Lee NK. Changes in upper-extremity muscle activities due to head position in subjects with a forward head posture and rounded shoulders. J Phys Ther. 2015;27(6):1739-42.
  9. Pop MS, Mihancea P, Debucean D. Posture optimization-is it the key to myofascial neck pain relief? Arch Balk Medical Union. 2018;53(4);573-9. https://doi.org/10.31688/abmu.2018.53.4.14
  10. Murphy BA, Marshall PW, Taylor HH. The cervical flexion-relaxation ratio: Reproducibility and comparison between chronic neck pain patients and controls. Spine. 2010;35(24):2103-8. https://doi.org/10.1097/BRS.0b013e3181cbc7d8
  11. Callaghan JP, Dunk NM. Examination of the flexion relaxation phenomenon in erector spinae muscles during short duration slumped sitting. Clin Biomech. 2002;17(5):353-60. https://doi.org/10.1016/S0268-0033(02)00023-2
  12. Alschuler KN, Neblett R, Wiggert E et al. Flexion-relaxation and clinical features associated with chronic low back pain: A comparison of different methods of quantifying flexion-relaxation. Clin J Pain. 2009;25 (9):760-6. https://doi.org/10.1097/AJP.0b013e3181b56db6
  13. Colloca CJ, Hinrichs RN. The biomechanical and clinical significance of the lumbar erector spinae flexion-relaxation phenomenon: A review of literature. J Manipulative Physiol Ther. 2005;28(8):623-31. https://doi.org/10.1016/j.jmpt.2005.08.005
  14. Choi KH, Cho MU, Park CW et al. A comparison study of posture and fatigue of neck according to monitor types (moving and fixed monitor) by using flexion relaxation phenomenon (FRP) and craniovertebral angle (CVA). Int J Environ Res Public Health. 2020;17(17):6345. https://doi.org/10.3390/ijerph17176345
  15. Alessa FM, Ning X. Lumbar range of motion and flexion relaxation phenomenon onset during static trunk bending postures. Proc Hum Factors Ergon Soc Annu Meet. 2018;62:915-9. https://doi.org/10.1177/1541931218621210
  16. Neblett R, Mayer TG, Brede E et al. Correcting abnormal flexion-relaxation in chronic lumbar pain: Responsiveness to a new biofeedback training protocol. Clin J Pain. 2010;26(5):403. https://doi.org/10.1097/AJP.0b013e3181d2bd8c
  17. Neblett R, Brede E, Mayer TG et al. What is the best surface emg measure of lumbar flexion-relaxation for distinguishing chronic low back pain patients from pain-free controls? Clin J Pain. 2013;29(4):334. https://doi.org/10.1097/AJP.0b013e318267252d
  18. Pialasse JP, Dubois JD, Choquette MHP et al. Kinematic and electromyographic parameters of the cervical flexion-relaxation phenomenon: The effect of trunk positioning. Ann Phys Rehabil Med. 2009;52(1):49-58. https://doi.org/10.1016/j.rehab.2008.10.002
  19. Yoo WG, Park SY, Lee MR. Relationship between active cervical range of motion and flexion-relaxation ratio in asymptomatic computer workers. J Physiol Anthropol. 2011;30(5):203-7. https://doi.org/10.2114/jpa2.30.203
  20. Sommerich CM, Joines SM, Hermans V et al. Use of surface electromyography to estimate neck muscle activity. J Electromyogr Kinesiol. 2000;10(6):377-98. https://doi.org/10.1016/S1050-6411(00)00033-X
  21. Kim YH, Jung JH. Effects of pnf program on neck pain, cervical range of motion, pressure pain, and cervical flexion-relaxation ratio in vdt worker: A case study. PNF & Mov. 2015;13(4):197-202.
  22. Bonney RA, Corlett EN. Head posture and loading of the cervical spine. Appl Ergon. 2002;33(5):415-7. https://doi.org/10.1016/S0003-6870(02)00036-4
  23. Singla D, Veqar Z. Association between forward head, rounded shoulders, and increased thoracic kyphosis: A review of the literature. J Chiropr Med. 2017;16(3):220-9. https://doi.org/10.1016/j.jcm.2017.03.004
  24. Mousavi-Khatir R, Talebian S, Maroufi N et al. Effect of static neck flexion in cervical flexion-relaxation phenomenon in healthy males and females. J Bodyw Mov Ther. 2016;20(2):235-42.
  25. Indahl A, Kaigle AM, Reikeras O et al. Interaction between the porcine lumbar intervertebral disc, zygapophysial joints, and paraspinal muscles. Spine. 1997;22(24):2834-40. https://doi.org/10.1097/00007632-199712150-00006

Cited by

  1. The Effect of Coordinative Locomotor Training Using Elastic Bands on the Flexibility and Body Alignment of Elementary School Right-Handed Baseball Players vol.33, pp.5, 2020, https://doi.org/10.18857/jkpt.2021.33.5.217