Cranio‐cervical Flexion Test: Difference between revisions

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== Purpose<br>  ==
== Purpose<br>  ==


The cranio cervical flexion test (CFFT) is a clinical test of the anatomical action of the deep cervical flexor muscles[2, C]. The test could be described as a test of neuromotor control. The features that are tested are the activation of the deep flexors and the isometric endurance of the muscles<ref name="GWENDOLEN">GWENDOLEN A.J., O’LEARY S.P., FALLA D.; Clinical assessment of the deep cervical flexor muscles: the craniocervical flexion test</ref> [2, C]. The test also allows to assess the interaction of the deep cervical flexor muscles with the superficial flexors<ref name="GWENDOLEN">GWENDOLEN A.J., O’LEARY S.P., FALLA D.; Clinical assessment of the deep cervical flexor muscles: the craniocervical flexion test</ref> [2, C] i.e. the sternocleidomastoid and the anterior scalene muscles [3, B] . It can also be used as a clinical indicator of impaired activation of the deep cervical flexor muscles [1D,3B] , to measure the muscle activity of the deep[6,C] and superficial[7,C] cervical muscles or as a therapy approach [3B, 8, 5D]
The cranio cervical flexion test (CFFT) is a clinical test of the anatomical action of the deep cervical flexor muscles <ref name="GWENDOLEN">GWENDOLEN A.J., O’LEARY S.P., FALLA D.; Clinical assessment of the deep cervical flexor muscles: the craniocervical flexion test</ref>. The test could be described as a test of neuromotor control. The features that are tested are the activation of the deep flexors and the isometric endurance of the muscles<ref name="GWENDOLEN">GWENDOLEN A.J., O’LEARY S.P., FALLA D.; Clinical assessment of the deep cervical flexor muscles: the craniocervical flexion test</ref>. The test also allows to assess the interaction of the deep cervical flexor muscles with the superficial flexors<ref name="GWENDOLEN">GWENDOLEN A.J., O’LEARY S.P., FALLA D.; Clinical assessment of the deep cervical flexor muscles: the craniocervical flexion test</ref>&nbsp;i.e. the sternocleidomastoid and the anterior scalene muscles<ref name="JULL">JULL G.A., FALLA D., VICENZINO B., HODGES P.W.; The effect of therapeutic exercise on activation of the deep cervical flexor muscles in people with chronic neck pain; Elsevier; 2009</ref>. It can also be used as a clinical indicator of impaired activation of the deep cervical flexor muscles <ref name="JULL">JULL G.A., FALLA D., VICENZINO B., HODGES P.W.; The effect of therapeutic exercise on activation of the deep cervical flexor muscles in people with chronic neck pain; Elsevier; 2009</ref><ref name="FERNAN">FERNANDEZ-DE-LAS-PENAS C., ARENDT-NIELSEN L., GERWIN R.D.;  Tension type and cervicogenic headache: pathophysiology, diagnosis and management</ref>, to measure the muscle activity of the deep <ref name="FALLA">FALLA D., GWENDOLEN A.J., DALL’ALBA P., RAINOLDI A., MERLETTI R.; An electromyographic analysis of the deep cervical flexor muscles in performance of craniocervical flexion; Physical therapy; Vol. 83; nr. 10; Oct. 2003</ref>&nbsp;and superficial <ref name="STERLING">STERLING M., GWENDOLEN J., VICENZINO B., KENARDY J., DARNELL R.; Development of motor system dysfunction following whiplash injury; Elsevier; 2002</ref>&nbsp;cervical muscles or as a therapy approach<ref name="JULL">JULL G.A., FALLA D., VICENZINO B., HODGES P.W.; The effect of therapeutic exercise on activation of the deep cervical flexor muscles in people with chronic neck pain; Elsevier; 2009</ref><ref name="AUEE">AUEE J.; De rol van spierdisfunctie bij chronische nekpijn; afstudeer artikel; HvU afdeling
fysiotherapie.</ref><ref name="WILSON">WILSON- O’TOOLE F., GORMLEY J., HUSSEY J.; Exercise therapy in the management of musculoskeletal disorders; Blackwell Publishing Ltd; 2011</ref>.


<br>


Evolution


Evolution
The test has evolved over fifteen years. It was originally developed in response to increased interest in the functional roles of muscles, particularly in active spinal segment stabilization, and the clinical need for more directed and specific therapeutic exercises for patients with neck pain disorders<ref name="GWENDOLEN">GWENDOLEN A.J., O’LEARY S.P., FALLA D.; Clinical assessment of the deep cervical flexor muscles: the craniocervical flexion test</ref>.


The test has evolved over fifteen years. It was originally developed in response to increased interest in the functional roles of muscles, particularly in active spinal segment stabilization, and the clinical need for more directed and specific therapeutic exercises for patients with neck pain disorders [2, C].
<br>


Clinical importance


There is reason to believe that an impaired and delayed activation of the deep cervical flexor muscles causes headaches <ref name="FERNAN">FERNANDEZ-DE-LAS-PENAS C., ARENDT-NIELSEN L., GERWIN R.D.;  Tension type and cervicogenic headache: pathophysiology, diagnosis and management</ref><ref name="JULL">JULL G.A., FALLA D., VICENZINO B., HODGES P.W.; The effect of therapeutic exercise on activation of the deep cervical flexor muscles in people with chronic neck pain; Elsevier; 2009</ref><ref name="PEREZ">FERNANDEZ-DE-LAS-PENAS C., PEREZ-DE-HEREDIA M., MOLERO-SANCHEZ A., MIANGOLARRAPAGE J.C.; Performance of the craniocervical flexion test, forward head posture and headache clinical parameters in patients with chronic tension type headache: a pilot study; Journal of orthopaedic and sport physical therapy; vol. 37; nr. 2; Feb. 2007</ref><ref name="STERLING">STERLING M.,  GWENDOLEN J., VICENZINO B., KENARDY J., DARNELL R.; Development of motor system dysfunction following whiplash injury; Elsevier; 2002</ref><ref name="BEETON">BEETON K.S.; Manual therapy masterclasses, the Vertebral column; Elsevier; 2003</ref>. As mentioned earlier, the CCFT is also indicative if the deep cervical flexors are impaired.


Clinical importance
<br>


There is reason to believe that an impaired and delayed activation of the deep cervical flexor muscles causes headaches [1D,3B,4B,7C,9D] . As mentioned earlier, the CCFT is also indicative if the deep cervical flexors are impaired.
Research


 
Since 2001 the test is commonly being used in research, for example when investigating the development of motor dysfunction following a whiplash injury<ref name="STERLING">STERLING M.,  GWENDOLEN J., VICENZINO B., KENARDY J., DARNELL R.; Development of motor system dysfunction following whiplash injury; Elsevier; 2002</ref>&nbsp;(http://www.physio-pedia.com/index.php/Whiplash_Associated_Disorders). The CCFT was also used in research about the performance of the cranio cervical flexion test in patients with chronic tension type headache <ref name="PEREZ">FERNANDEZ-DE-LAS-PENAS C., PEREZ-DE-HEREDIA M., MOLERO-SANCHEZ A., MIANGOLARRAPAGE J.C.; Performance of the craniocervical flexion test, forward head posture and headache clinical parameters in patients with chronic tension type headache: a pilot study; Journal of orthopaedic and sport physical therapy; vol. 37; nr. 2; Feb. 2007</ref>. (http://www.physio-pedia.com/index.php/Tension-type_headache)
 
Research
 
Since 2001 the test is commonly being used in research, for example when investigating the development of motor dysfunction following a whiplash injury [7,C] (http://www.physio-pedia.com/index.php/Whiplash_Associated_Disorders). The CCFT was also used in research about the performance of the cranio cervical flexion test in patients with chronic tension type headache [4,B] . (http://www.physio-pedia.com/index.php/Tension-type_headache)


== Technique<br>  ==
== Technique<br>  ==

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Purpose
[edit | edit source]

The cranio cervical flexion test (CFFT) is a clinical test of the anatomical action of the deep cervical flexor muscles [1]. The test could be described as a test of neuromotor control. The features that are tested are the activation of the deep flexors and the isometric endurance of the muscles[1]. The test also allows to assess the interaction of the deep cervical flexor muscles with the superficial flexors[1] i.e. the sternocleidomastoid and the anterior scalene muscles[2]. It can also be used as a clinical indicator of impaired activation of the deep cervical flexor muscles [2][3], to measure the muscle activity of the deep [4] and superficial [5] cervical muscles or as a therapy approach[2][6][7].


Evolution

The test has evolved over fifteen years. It was originally developed in response to increased interest in the functional roles of muscles, particularly in active spinal segment stabilization, and the clinical need for more directed and specific therapeutic exercises for patients with neck pain disorders[1].


Clinical importance

There is reason to believe that an impaired and delayed activation of the deep cervical flexor muscles causes headaches [3][2][8][5][9]. As mentioned earlier, the CCFT is also indicative if the deep cervical flexors are impaired.


Research

Since 2001 the test is commonly being used in research, for example when investigating the development of motor dysfunction following a whiplash injury[5] (http://www.physio-pedia.com/index.php/Whiplash_Associated_Disorders). The CCFT was also used in research about the performance of the cranio cervical flexion test in patients with chronic tension type headache [8]. (http://www.physio-pedia.com/index.php/Tension-type_headache)

Technique
[edit | edit source]

Describe how to carry out this assessment technique here

Evidence[edit | edit source]

Provide the evidence for this technique here

References
[edit | edit source]

  1. ↑ 1.0 1.1 1.2 1.3 GWENDOLEN A.J., O’LEARY S.P., FALLA D.; Clinical assessment of the deep cervical flexor muscles: the craniocervical flexion test
  2. ↑ 2.0 2.1 2.2 2.3 JULL G.A., FALLA D., VICENZINO B., HODGES P.W.; The effect of therapeutic exercise on activation of the deep cervical flexor muscles in people with chronic neck pain; Elsevier; 2009
  3. ↑ 3.0 3.1 FERNANDEZ-DE-LAS-PENAS C., ARENDT-NIELSEN L., GERWIN R.D.; Tension type and cervicogenic headache: pathophysiology, diagnosis and management
  4. ↑ FALLA D., GWENDOLEN A.J., DALL’ALBA P., RAINOLDI A., MERLETTI R.; An electromyographic analysis of the deep cervical flexor muscles in performance of craniocervical flexion; Physical therapy; Vol. 83; nr. 10; Oct. 2003
  5. ↑ 5.0 5.1 5.2 STERLING M., GWENDOLEN J., VICENZINO B., KENARDY J., DARNELL R.; Development of motor system dysfunction following whiplash injury; Elsevier; 2002
  6. ↑ AUEE J.; De rol van spierdisfunctie bij chronische nekpijn; afstudeer artikel; HvU afdeling fysiotherapie.
  7. ↑ WILSON- O’TOOLE F., GORMLEY J., HUSSEY J.; Exercise therapy in the management of musculoskeletal disorders; Blackwell Publishing Ltd; 2011
  8. ↑ 8.0 8.1 FERNANDEZ-DE-LAS-PENAS C., PEREZ-DE-HEREDIA M., MOLERO-SANCHEZ A., MIANGOLARRAPAGE J.C.; Performance of the craniocervical flexion test, forward head posture and headache clinical parameters in patients with chronic tension type headache: a pilot study; Journal of orthopaedic and sport physical therapy; vol. 37; nr. 2; Feb. 2007
  9. ↑ BEETON K.S.; Manual therapy masterclasses, the Vertebral column; Elsevier; 2003
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