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. 2020 Nov 1;8(4):449.
doi: 10.3390/healthcare8040449.

The Importance of Optimal Gaze Direction on Deep Neck Flexor Activation in Chronic Neck Pain

Byoung-Kwon Lee  1 , Dong-Kwon Seo  1
Affiliations

The Importance of Optimal Gaze Direction on Deep Neck Flexor Activation in Chronic Neck Pain

Byoung-Kwon Lee et al. Healthcare (Basel). .

Abstract

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 (p < 0.05), with gaze directions of 20° and 0° being significantly different from 40° (p < 0.05). Although there was no significant difference in DNF activation according to gaze direction, there was in SCM activation (p < 0.05), with SCM 60° significantly different from SCM 20° and SCM 40° (p < 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.

Keywords: chronic neck pain; cranio-cervical flexion test; deep neck flexor; gaze direction; sternocleidomastoid.

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Conflict of interest statement

The authors declare no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Figures

Figure 1
Figure 1
Study protocols.
Figure 2
Figure 2
Ultrasound imaging for gaze directions.
Figure 2
Figure 2
Ultrasound imaging for gaze directions.
Figure 3
Figure 3
DNF-SCM (different ratio) for gaze directions (post-hoc results). Abbreviations: SCM, sternocleidomastoid; DNF, deep neck flexors; F, F-value * p < 0.05 and ** p < 0.01 vs. DNF-SCM for gaze directions of 20°.
See this image and copyright information in PMC

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