Manual Therapy 12 (2007) 139–143 Original article Recruitment of the deep cervical flexor muscles during a postural-correction exercise performed in sitting $ Deborah Falla a,b,Ã , Shaun O’Leary a , Amy Fagan a , Gwendolen Jull a a Division of Physiotherapy, The University of Queensland, Brisbane, Australia b Center for Sensory-Motor Interaction (SMI), Department of Health Science and Technology, Aalborg University, Aalborg, Denmark Received 7 September 2005; received in revised form 6 February 2006; accepted 2 June 2006 Abstract Specific strategies to optimally facilitate postural muscles to retrain postural form are advocated in the clinical management of neck pain. The purpose of this study was to compare the activation of selected cervical, thoracic and lumbar muscles during independent and facilitated postural correction in sitting in 10 subjects with chronic neck pain. Deep cervical flexor (DCF) muscle activity was recorded with custom electrodes inserted via the nose and fixed by suction to the posterior mucosa of the oropharynx. Surface electrodes were placed over the thoracic erector spinae and lumbar multifidus muscles. Root-mean-square EMG amplitude was measured for each muscle across two conditions. In the first condition, subjects were instructed to spontaneously ‘‘sit up straight’’ from a slumped posture without any other guidance from the therapist. In the second condition the therapist provided specific manual and verbal facilitation to assist the patient to correct to an upright pelvic position with a neutral spinal lumbo-pelvic position. Activation of the DCF and lumbar multifidus muscles (Po0.05) were significantly greater when the therapist facilitated postural correction compared to independent sitting correction. Specific postural-correction strategies result in better facilitation of key postural muscles compared to non-specific postural advice. The results of this study highlight the need for clinical skill and precision in postural training of patients with neck pain. r 2006 Elsevier Ltd. All rights reserved. Keywords: Posture; Exercise; Neck pain; Electromyography 1. Introduction The primary function of the cervical spine is to orientate the head against the opposing forces of gravity whilst permitting multi-directional movement. To ac- complish this task the cervical spine must be mechani- cally stable, both in static and dynamic postures. In upright neutral postures, passive resistance to cervical spine motion is minimal (Oatis, 2004) and destabilizing gravitational forces are counteracted by moments of the anterior and posterior cervical muscles. In particular, the deep more segmental cervical muscles such as the deep cervical flexors (DCF), are important for the control and support of the cervical lordosis and maintenance of cervical spine postural form (Mayoux- Benhamou et al., 1994; Conley et al., 1995; Vasavada et al., 1998; Boyd Clark et al., 2001, 2002). Our previous research has identified impaired activa- tion of the DCF muscles, longus colli and longus capitis, in people with chronic neck pain (Falla et al., 2004a, b). These findings, in addition to evidence of altered control of functional working postures in persons with neck pain (Szeto et al., 2002), has directed the use of clinical posture-correction strategies as an early ther- apeutic exercise intervention in the management of neck pain (Jull et al., 2004). To retrain a neutral sitting posture patients are firstly taught to achieve a neutral ARTICLE IN PRESS www.elsevier.com/locate/math 1356-689X/$ - see front matter r 2006 Elsevier Ltd. All rights reserved. doi:10.1016/j.math.2006.06.003 $ This research was undertaken in the Division of Physiotherapy, The University of Queensland, Australia. Ã Corresponding author. Center for Sensory-Motor Interaction (SMI), Department of Health Science and Technology, Faculty of Engineering and Science, Aalborg University, Fredrik Bajers Vej 7D-3, DK-9200 Aalborg, Denmark. Tel.: +45 96 35 74 59; fax: +45 98 15 40 08. E-mail address: deborahf@hst.aau.dk (D. Falla).