Effect of active cranio-cervical flexion exercise

7th January 2014

This week Kari Niemi, our tutor in Finland posts a comment on a recent article in Manual Therapy

'With mobilisation we can reduce pain but if our aim is also to improve function and to reduce the risk of recurrent pain it is necessary to add specific exercises to our patient rehabilitation program'. 


Immediate effects of active cranio-cervical flexion exercise versus passive mobilisation of the upper cervical spine on pain and performance on the cranio-cervical flexion test

Enrique Lluch, Jochen Schomacher, Leonardo Gizzi, Frank Petzke, Dagmar Seegar, Deborah Falla

Manual Therapy
Volume 19, Issue 1, February 2014, Pages 25–31


This study compared the immediate effects of an assisted plus active cranio-cervical flexion exercise (exercise group) versus a passive mobilisation plus assisted cranio-cervical flexion (mobilisation group) on performance of the cranio-cervical flexion test (CCFT), cervical range of motion (ROM) and pain in patients with chronic neck pain. Eighteen volunteers with chronic idiopathic neck pain participated in the study and were randomised to one of the two intervention groups. Current level of pain, cervical ROM and pain perceived during movement, pressure pain threshold (PPT) and surface electromyography (EMG) during performance of the CCFT were measured before and immediately after the intervention. A significant reduction in resting pain and PPT measured over cervical sites was observed immediately following both interventions, although a greater change was observed for the exercise group. No change in cervical ROM was observed after either intervention. Reduced sternocleidomastoid and anterior scalene EMG amplitude were observed during stages of the CCFT but only for the participants in the active exercise group. Although both active and passive interventions offered pain relief, only the exercise group improved on a task of motor function highlighting the importance of specific active treatment for improved motor control of the cervical spine.

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Keywords: Review 2014