Original articleCan neck exercises enhance the activation of the semispinalis cervicis relative to the splenius capitis at specific spinal levels?
Introduction
Exercise is an effective treatment for people with chronic neck pain (Miller et al., 2010). Several neck exercises have been shown to alleviate pain including motor control training (Jull et al., 2002, Falla et al., 2013) and resistance training (Bronfort et al., 2001, Ylinen et al., 2003) probably by facilitating endogenous analgesia via different mechanisms (Bialosky et al., 2009). Furthermore, exercise may have positive psychological effects including reduced pain castastrophizing (Slepian et al., 2014). Therefore various training approaches are appropriate for pain management.
In contrast to the similar effects on clinical symptoms, neuromuscular changes in response to training are typically specific to the mode of exercise performed. For instance, craniocervical flexion exercise, designed to emphasise the activation of the deep cervical flexors and minimise activation of the superficial flexors (Jull et al., 2008, Falla et al., 2012) enhances the activation of the deep cervical flexors (Jull et al., 2009) which are often less activated in patients with neck pain (Falla et al., 2004). Moreover, this exercise reduces the activation of the sternocleidomastoid muscle (Jull et al., 2009) which is often overactive in association with reduced deep cervical flexor activity (Falla et al., 2004; O'Leary et al., 2011b). Enhanced activation of the deep cervical flexor muscles was not achieved with general resistance training of the neck (Falla et al., 2007a, Jull et al., 2009), despite comparable changes in pain.
The deep cervical extensor muscle, semispinalis cervicis, may also display reduced activation in people with neck pain (Schomacher et al., 2012b, Schomacher et al., 2013, Schomacher and Falla, 2013). Moreover, studies have shown higher levels of superficial extensor muscle activation in people with neck pain including that of the splenius capitis (e.g. Lindstrom et al., 2011). Training of the deep spinal muscles is generally considered to be an important component of a multimodal intervention for low back (Hodges et al., 2013) and neck pain (Jull et al., 2008). Yet there is limited knowledge on how the activation of the deep semispinalis cervicis can be facilitated with training whilst minimising the activation of the splenius capitis muscle, that is, an exercise analogous to craniocervcal flexion exercise used to emphasize the activation of the deep cervical flexor muscles relative to the superficial flexors.
A recent study showed that the activity of the semispinalis cervicis recorded at the level of C3 can be enhanced relative to the splenius capitis in patients with chronic neck pain by applying localized resistance over the vertebral arch of C2 compared to resistance applied at the head and over C5 (Schomacher et al., 2012c). However, measurements were performed at one spinal level only (C3), and given that synaptic input is distributed independently and non-uniformly to different fascicles of the semispinalis cervicis (Schomacher et al., 2012a), it is necessary to consider whether the activity of the semispinalis cervical can be enhanced relative to the splenius capitis at different spinal levels.
Emphasizing the activation of muscles at selected spinal levels may be clinically relevant since movement dysfunction is often observed at single segments. For example, the physiological limits of extension are often exceeded in the lower cervical spine during whiplash trauma (Bogduk and Yoganandan, 2001) causing facet joint injuries most frequently in C5–C6 and C6–C7 segments (Pearson et al., 2004). Furthermore, people with traumatic onset of neck pain have an increased prevalence of combined rotational and translational hypermobility in the segments C3–4 to C5–6 (Kristjansson et al., 2003). In addition, reduced cross sectional area was noted for the semispinalis cervicis muscle at the spinal levels of C3, C5 and C6 levels in people following a whiplash injury (Elliott et al., 2008). Considering possible changes in semispinalis cervicis activation and structure in people with neck pain, targeted exercise interventions to enhance the activation of the semispinalis cervicis muscles may be relevant.
In this descriptive and exploratory study we evaluate the activation of the semispinalis cervicis and splenius capitis muscles at two spinal levels (C2, C5) in healthy volunteers during various neck exercises. The aim was to evaluate whether neck exercise could enhance the activation of the semispinalis cervicis relative to the splenius capitis muscle thus the ratio between the amplitude of activity of the semispinalis cervicis and the splenius capitis muscle was calculated and compared across exercises.
Section snippets
Participants
Ten healthy volunteers (3 men and 7 women; age, mean ± SD: 30.7 ± 7.4 years; height: 170.0 ± 8.8 cm; weight: 67.6 ± 24.8 kg) were recruited from the University Medical Center Göttingen, Germany, via e-mail and advertisements on the university's notice board. The experiment was conducted at the Laboratory for Spinal Pain Research, Center for Anesthesiology, Emergency and Intensive Care Medicine, University Hospital Göttingen, Germany.
Subjects were included if they were aged between 18 and 50
Results
The normalised RMS values and the ratio between both muscles are presented in Table 1 for all exercises.
Discussion
This study evaluated, for the first time, the ability to enhance the activation the semispinalis cervicis muscle relative to the splenius capitis muscle at different spinal levels for targeted exercise interventions. The results confirm the possibility of emphasizing the activation of the semispinalis cervicis relative to the splenius capitis.
Conclusion
This study showed that manual resistance applied in extension over the vertebral arch emphasized the activation of the semispinalis cervicis muscle relative to the splenius capitis at the spinal level directly caudal to the site of resistance. These findings suggest that this exercise may be useful to enhance the activation of the seminspinalis cervicis muscle for targeted exercise interventions in people with neck pain showing signs of impaired activation of this muscle on clinical testing.
Acknowledgement
The authors are grateful to Dr. Leonardo Gizzi for his technical assistance during the experiments.
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