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Characteristics of Surface Electromyograph Activity of Cervical Extensors and Flexors in Nonspecific Neck Pain Patients: A Cross-Sectional Study. MEDICINA (KAUNAS, LITHUANIA) 2022; 58:medicina58121770. [PMID: 36556971 PMCID: PMC9781307 DOI: 10.3390/medicina58121770] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 10/19/2022] [Revised: 11/26/2022] [Accepted: 11/28/2022] [Indexed: 12/03/2022]
Abstract
Background and Objectives: We identified typical surface electromyogram (sEMG) activities of the cervical extensors and flexors during motions in the three anatomical planes in healthy adults. The aim of this study was to explore characteristics of sEMG activities of these cervical muscles in nonspecific neck pain (NSNP) patients based on healthy adults. Materials and Methods: Participants were 24 NSNP patients (NSNP group, mean ± SD of age, 47.5 ± 15.5) and 24 healthy adults (control group, 20.5 ± 1.4). For each participant, sEMG of the cervical extensors and flexors was recorded during neck flexion, extension, bilateral lateral flexion, bilateral rotation, and at the neutral position in Phase I (the neck from the neutral position to the maximum range of motion), Phase II (at the maximum range of motion), and Phase III (from the maximum range of motion to the neutral position), yielding a total of 42 phases. A percentage of maximum voluntary contraction to normalize muscle activity in each phase was calculated to obtain the ratio of muscle activities in the extensors and flexors in each of 36 phases of the motions to the neutral position and ratio of the flexors to extensors in activity for 21 phases. Results: In 28 of 36 phases of the motions, the ratios of muscle activities in the extensors and flexors to the neutral position in the NSNP group were significantly larger than the control group (p < 0.05). In 6 of 21 phases, the ratios of the flexors to extensors in activity in the NSNP group were significantly larger than in the control group (p < 0.05). Conclusions: In NSNP patients, the activity of the cervical extensors and flexors associated with neck motion increased with an imbalance in activity between these muscles compared to their activity in healthy adults. The results of this study will be useful in understanding the pathogenesis of NSNP and in constructing an objective evaluation of the treatment efficacy on NSNP patients.
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The Mode of Activity of Cervical Extensors and Flexors in Healthy Adults: A Cross-Sectional Study. MEDICINA (KAUNAS, LITHUANIA) 2022; 58:medicina58060728. [PMID: 35743991 PMCID: PMC9230391 DOI: 10.3390/medicina58060728] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/20/2022] [Revised: 05/26/2022] [Accepted: 05/26/2022] [Indexed: 12/04/2022]
Abstract
Background and Objectives: The purpose of this study was to investigate the activity of bilateral cervical extensors and flexors on the sagittal, frontal, and horizontal planes of healthy adults during motions of the neck in a sitting position, which has not been satisfactorily investigated by surface electromyogram (sEMG). Materialand Methods: We recruited 35 healthy participants (mean ± standard deviation of age, 20.3 ± 2.4). sEMG recordings of the cervical extensors and flexors were performed for a total of nine seconds in three phases: Phase I involved the motion of the neck from the neutral position to the maximum range of motion; Phase II involved maintaining the neck at the maximum range of motion; and Phase III involved the motion of the neck from the maximum range of motion to the neutral position during neck flexion, extension, right and left lateral flexion, right and left rotation, and maintaining the neck in the neutral position. Muscle activities in each motion were normalized as a percentage of maximal voluntary contraction (%MVC) so that the muscles could be compared. Results: The %MVC of the extensors was significantly larger than that of the flexors in the neutral position (p < 0.001). In addition, the %MVCs of the following were significantly larger than the %MVC in the neutral position: the extensors in flexion (p = 0.014) and extension (p = 0.020), the ipsilateral extensors (p = 0.006) and flexors (p < 0.001) in lateral flexion in Phase I; the flexors in flexion (p < 0.001), the extensors in extension (p = 0.010), and the ipsilateral extensors and flexors in lateral flexion (p < 0.001) in Phase II; the extensors and flexors in flexion (p < 0.001), the flexors in extension (p < 0.001), the ipsilateral flexors (p < 0.001), the contralateral flexors (p = 0.004) and the contralateral extensors (p = 0.018) in lateral flexion in Phase III; and the bilateral extensors and contralateral flexors during rotation in all three phases (p < 0.001). Conclusion: The typical sEMG activities of the extensors and flexors during motion of the neck in healthy adults were identified in this study; this information can be used to understand the pathophysiology of non-specific neck pain and to provide an index for evaluating the effect of treatment.
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Shamsi H, Khademi-Kalantari K, Akbarzadeh-Baghban A, Izadi N, Okhovatian F. Cervical flexion relaxation phenomenon in patients with and without non-specific chronic neck pain. J Back Musculoskelet Rehabil 2021; 34:461-468. [PMID: 33492275 DOI: 10.3233/bmr-200137] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
BACKGROUND The cervical flexion relaxation phenomenon (FRP) is a myoelectric silence of neck extensor muscles which occurs after a certain degree of flexion. Impaired flexion relaxation can impose the vertebral structures to excessive loading resulting from the persistence of muscular contraction. OBJECTIVE This study aimed to investigate the incidence or absence of FRP in cervical erector spinae (CES) and upper trapezius muscles in patients with chronic neck pain (CNP). METHODS Twenty-five patients with CNP and 25 healthy volunteers were recruited. They accomplished cervical flexion and extension from a neutral position in four phases in the sitting position. The surface electromyography activity of both CES and upper trapezius muscles was recorded in each phase. Cervical flexion and extension movements were simultaneously measured using an electrogoniometer. RESULTS FRP in CES was observed in 84% and 36% of healthy subjects and CNP patients, respectively. Flexion relaxation ratio (FRR) in CES was lower in CNP patients than in healthy subjects (mean diff = 1.33; 95% CI: 0.75-1.91) (P< 0.001). Only in CNP patients, FRR in right erector spinea was significantly higher than that in the left erector spinea (P= 0.04). CONCLUSIONS FRP incidence in CNP patients was less than in healthy subjects. Moreover, this phenomenon begins later in CNP patients than in healthy subjects indicating prolonged activity of CES muscles during flexion in the CNP group. The difference between FRR in the right and left sides of erector spinea muscles can result in CNP.
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Affiliation(s)
- Hasan Shamsi
- Student Research Committee, Department of Physiotherapy, School of Rehabilitation, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Khosro Khademi-Kalantari
- Physiotherapy Research Centre, School of Rehabilitation, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | | | - Neda Izadi
- Student Research Committee, Department of Epidemiology, School of Public Health and Safety, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Farshad Okhovatian
- Physiotherapy Research Centre, School of Rehabilitation, Shahid Beheshti University of Medical Sciences, Tehran, Iran
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Shiravi S, Letafatkar A, Bertozzi L, Pillastrini P, Khaleghi Tazji M. Efficacy of Abdominal Control Feedback and Scapula Stabilization Exercises in Participants With Forward Head, Round Shoulder Postures and Neck Movement Impairment. Sports Health 2019; 11:272-279. [PMID: 31013190 DOI: 10.1177/1941738119835223] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND Signs and symptoms of impaired function of the musculoskeletal system may be targeted by treating dysfunction located elsewhere. HYPOTHESIS Abdominal control feedback and scapular stabilization exercise interventions would result in positive changes in pain intensity, strength, electromyography, and flexion-relaxation phenomena in women with forward head and round shoulder postures and neck movement impairment. STUDY DESIGN Pretest-posttest intervention. LEVEL OF EVIDENCE Level 1. METHODS A total of 135 women (aged 27.23 ± 1.9 years) with forward head and round shoulder postures were randomized to 3 groups. Group 1 received 6-week scapular stabilization exercises with abdominal control feedback (n = 45), group 2 received 6-week scapular stabilization exercises without abdominal control feedback (n = 45), and group 3 received active self-exercise as a control group (n = 45). Posture, pain, proprioception, strength, and electromyography were assessed before and after the interventions. RESULTS There were significant between-group differences in pain, proprioception, strength, and electromyography favoring group 1. There were significant within-group changes in posture, pain, proprioception, strength, and electromyography in both groups 1 and 2. No significant change was observed for muscle strength. CONCLUSION The addition of abdominal control feedback to the scapular stabilization exercises was shown to be superior to the scapular stabilization exercises alone for decreasing neck pain and restoring proper proprioception, strength, and electromyography in females with forward head and round shoulder postures and neck movement impairment. CLINICAL RELEVANCE The addition of abdominal control feedback to scapular stabilization exercises is superior to scapular stabilization exercises alone on the neck for improving electromyography, strength, and function in females with forward head and round shoulder postures and neck movement impairment.
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Affiliation(s)
- Shirin Shiravi
- Department of Biomechanics and Sport Injuries, Faculty of Physical Education and Sport Sciences, Kharazmi University, Tehran, Republic of Iran
| | - Amir Letafatkar
- Department of Biomechanics and Sport Injuries, Faculty of Physical Education and Sport Sciences, Kharazmi University, Tehran, Republic of Iran
| | - Lucia Bertozzi
- Department of Physiotherapy, University of Bologna, Bologna, Italy
| | - Paolo Pillastrini
- Department of Biomedical and Neuromotor Sciences, University of Bologna, Bologna, Italy
| | - Mehdi Khaleghi Tazji
- Department of Biomechanics and Sport Injuries, Faculty of Physical Education and Sport Sciences, Kharazmi University, Tehran, Republic of Iran
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Wang N, Huang X, Rao Y, Xiao J, Lu J, Wang N, Cui L. A Convenient Non-harm Cervical Spondylosis Intelligent Identity method based on Machine Learning. Sci Rep 2018; 8:17430. [PMID: 30479349 PMCID: PMC6258664 DOI: 10.1038/s41598-018-32377-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2018] [Accepted: 08/23/2018] [Indexed: 11/09/2022] Open
Abstract
Cervical spondylosis (CS), a most common orthopedic diseases, is mainly identified by the doctor's judgment from the clinical symptoms and cervical change provided by expensive instruments in hospital. Owing to the development of the surface electromyography (sEMG) technique and artificial intelligence, we proposed a convenient non-harm CS intelligent identify method EasiCNCSII, including the sEMG data acquisition and the CS identification. Faced with the limit testable muscles, the data acquisition method are proposed to conveniently and effectively collect data based on the tendons theory and CS etiology. Faced with high-dimension and the weak availability of the data, the 3-tier model EasiAI is developed to intelligently identify CS. The common features and new features are extracted from raw sEMG data in first tier. The EasiRF is proposed in second tier to further reduce the data dimension, improving the performance. A classification model based on gradient boosted regression tree is developed in third tier to identify CS. Compared with 4 common machine learning classification models, the EasiCNCSII achieves best performance of 91.02% in mean accuracy, 97.14% in mean sensitivity, 81.43% in mean specificity, 0.95 in mean AUC.
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Affiliation(s)
- Nana Wang
- Institute of Computing Technology(ICT), Chinese Academy of Sciences(CAS), Beijing, China
- University of Chinese Academy of Sciences, Beijing, China
| | - Xi Huang
- Institute of Computing Technology(ICT), Chinese Academy of Sciences(CAS), Beijing, China
| | - Yi Rao
- Xiyuan Hospital, China Academy of Chinese Medical Sciences(CACMS), Beijing, China
| | - Jing Xiao
- Xiyuan Hospital, China Academy of Chinese Medical Sciences(CACMS), Beijing, China
| | - Jiahui Lu
- Institute of Computing Technology(ICT), Chinese Academy of Sciences(CAS), Beijing, China
- University of Chinese Academy of Sciences, Beijing, China
| | - Nian Wang
- Institute of Computing Technology(ICT), Chinese Academy of Sciences(CAS), Beijing, China
- University of Chinese Academy of Sciences, Beijing, China
| | - Li Cui
- Institute of Computing Technology(ICT), Chinese Academy of Sciences(CAS), Beijing, China.
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Novel Electromyographic Protocols Using Axial Rotation and Cervical Flexion-Relaxation for the Assessment of Subjects With Neck Pain: A Feasibility Study. J Chiropr Med 2016; 15:102-11. [PMID: 27330512 DOI: 10.1016/j.jcm.2016.04.013] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2015] [Revised: 01/25/2016] [Accepted: 02/03/2016] [Indexed: 11/21/2022] Open
Abstract
OBJECTIVE The purpose of this study is to examine the feasibility of novel variations to the way cervical flexion-relaxation phenomenon (FRP) studies are conducted and the feasibility of using cervical axial rotation as an alternative objective measure of cervical pain/dysfunction. METHODS Electromyographic data were collected from cervical paraspinal muscles of 5 participants with neck pain and 5 asymptomatic controls. Cervical FRP was conducted as reported in the literature with the participants seated, except that they started with the head fully flexed instead of being erect. Data were also collected with participants laying prone, starting with their head hanging over the edge of the table. Additional data were collected from cervical paraspinal and sternocleidomastoid (SCM) muscles while the seated participants rotated their head fully to the right and left. Ratios were obtained for each type of test by dividing the electromyographic amplitude when muscles were most active by that when they were relaxed or in contralateral rotation. RESULTS In each case, the ratio was higher for the controls than for those with neck pain, suggesting that any of the 4 methods could be used to distinguish between 2 groups. The ratios were most pronounced from SCMs during axial rotation. There appeared to be a negative relationship between pain level and the ratios obtained from each method. CONCLUSION The findings from this small study are encouraging for all methods used, with axial rotation using SCMs appearing to be the most promising. These results indicate that larger, powered studies are warranted.
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Mousavi-Khatir R, Talebian S, Maroufi N, Olyaei GR. Effect of static neck flexion in cervical flexion-relaxation phenomenon in healthy males and females. J Bodyw Mov Ther 2016; 20:235-42. [DOI: 10.1016/j.jbmt.2015.07.039] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2015] [Revised: 06/23/2015] [Accepted: 07/22/2015] [Indexed: 11/25/2022]
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Flexion–relaxation ratio in computer workers with and without chronic neck pain. J Electromyogr Kinesiol 2016; 26:8-17. [DOI: 10.1016/j.jelekin.2015.12.011] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2015] [Revised: 10/29/2015] [Accepted: 12/19/2015] [Indexed: 11/20/2022] Open
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Maroufi N, Ahmadi A, Mousavi Khatir SR. A comparative investigation of flexion relaxation phenomenon in healthy and chronic neck pain subjects. EUROPEAN SPINE JOURNAL : OFFICIAL PUBLICATION OF THE EUROPEAN SPINE SOCIETY, THE EUROPEAN SPINAL DEFORMITY SOCIETY, AND THE EUROPEAN SECTION OF THE CERVICAL SPINE RESEARCH SOCIETY 2012; 22:162-8. [PMID: 23053754 DOI: 10.1007/s00586-012-2517-3] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/29/2012] [Revised: 08/19/2012] [Accepted: 09/16/2012] [Indexed: 11/26/2022]
Abstract
PURPOSE The cervical flexion relaxation phenomenon (FRP) is a neck extensor myoelectric "silence" that occurs during complete cervical and lumbar flexion. In contrast to low back pain, the changes that occur during FRP in chronic neck pain (CNP) patients are still not clear. The aim of this study was to assess the characteristics of this phenomenon in the cervical region in CNP patients and controls. METHODS Twenty-two women (23 ± 2.62 years) with chronic non-specific neck pain and 21 healthy women (23.4 ± 1.68 years) participated in this study. They accomplished a cervical flexion and extension from neutral position. Neck angle and surface electromyographic activity of cervical erector spinae (CES) and upper trapezius muscles were recorded. Appearance, onset and offset angle of the FRP were analysed and compared between the two groups. RESULTS There were significant differences in the appearance of FRP between the two groups (P ≤ 0.001). The FRP in the CES muscles was observed in 85.7 % of healthy subjects and in 36.3 % of CNP patients, and no FRP was observed in the upper trapezius. Results of this study show that the onset and offset of FRP parameters were significantly different between the two groups (P ≤ 0.001). CONCLUSIONS The results of the present study indicate that FRP in CNP patients was seen less than the healthy subjects, and moreover the FRP period was reduced in CNP patients. Our results also suggest that the changes in FRP of CNP patients may be due to the increased CES activity in these patients.
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Affiliation(s)
- Nader Maroufi
- Department of Physical Therapy, School of Rehabilitation, Tehran University of Medical Sciences, P.O Box 15875-4391, Tehran, Iran
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Cheng CH, Lin KH, Lin JJ, Wang JL. CERVICAL ELECTROMYOGRAPHIC ACTIVITIES DURING NECK MOVEMENTS AT DIFFERENT SPEEDS IN HEALTHY SUBJECTS: VOLUNTARY RESPONSE INDEX ANALYSIS. BIOMEDICAL ENGINEERING-APPLICATIONS BASIS COMMUNICATIONS 2012. [DOI: 10.4015/s1016237207000458] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
The assessment of cervical muscle control patterns is important for the diagnosis of cervical dysfunction. Voluntary response index (VRI), including the similarity index (SI) and the magnitude (MAG), provides quantitative analysis of the surface electromyography (sEMG) pattern and total muscle voluntary activities respectively. This study was to investigate the effect of movement directions and speeds of the VRI response of cervical muscles in healthy subjects. The sEMG of bilateral sternocleidomastoid, semispinalis capitis, and splenius capitis were measured in thirteen asymptomatic young subjects. The subjects performed voluntary neck movements in flexion, extension, left and right side bending at fast, medium, and slow speeds. The results showed that SI ranged from 1–0.8 and MAG was generally less than 40 μV. The SI was significantly smallest and the MAG was largest at fast speed. The MAG was also significantly different among directions but the effect of direction on SI was only significant at fast speed. In conclusion, the movement speed and direction could affect the magnitude and control pattern of cervical muscles, such that both the speed and direction of the examined tasks should be carefully monitored during the assessment of cervical muscle activation.
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Affiliation(s)
- Chih-Hsiu Cheng
- Institute of Biomedical Engineering, College of Medicine and College of Engineering, National Taiwan University, Taipei, Taiwan
| | - Kwan-Hwa Lin
- School and Graduate Institute of Physical Therapy, College of Medicine, National Taiwan University, Taipei, Taiwan
| | - Jiu-Jenq Lin
- School and Graduate Institute of Physical Therapy, College of Medicine, National Taiwan University, Taipei, Taiwan
| | - Jaw-Lin Wang
- Institute of Biomedical Engineering, College of Medicine and College of Engineering, National Taiwan University, Taipei, Taiwan
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Pialasse JP, Lafond D, Cantin V, Descarreaux M. Load and speed effects on the cervical flexion relaxation phenomenon. BMC Musculoskelet Disord 2010; 11:46. [PMID: 20219131 PMCID: PMC2850324 DOI: 10.1186/1471-2474-11-46] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/07/2009] [Accepted: 03/10/2010] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The flexion relaxation phenomenon (FRP) represents a well-studied neuromuscular response that occurs in the lumbar and cervical spine. However, the cervical spine FRP has not been investigated extensively, and the speed of movement and loading effects remains to be characterized. The objectives of the present study were to evaluate the influence of load and speed on cervical FRP electromyographic (EMG) and kinematic parameters and to assess the measurement of cervical FRP kinematic and EMG parameter repeatability. METHODS Eighteen healthy adults (6 women and 12 men), aged 20 to 39 years, participated in this study. They undertook 2 sessions in which they had to perform a standardized cervical flexion/extension movement in 3 phases: complete cervical flexion; the static period in complete cervical flexion; and extension with return to the initial position. Two different rhythm conditions and 3 different loading conditions were applied to assess load and speed effects. Kinematic and EMG data were collected, and dependent variables included angles corresponding to the onset and cessation of myoelectric silence as well as the root mean square (RMS) values of EMG signals. Repeatability was examined in the first session and between the 2 sessions. RESULTS Statistical analyses revealed a significant load effect (P < 0.001). An augmented load led to increased FRP onset and cessation angles. No load x speed interaction effect was detected in the kinematics data. A significant load effect (P < 0.001) was observed on RMS values in all phases of movement, while a significant speed effect (P < 0.001) could be seen only during the extension phase. Load x speed interaction effect was noted in the extension phase, where higher loads and faster rhythm generated significantly greater muscle activation. Intra-session and inter-session repeatability was good for the EMG and kinematic parameters. CONCLUSIONS The load increase evoked augmented FRP onset and cessation angles as well as heightened muscle activation. Such increments may reflect the need to enhance spinal stability under loading conditions. The kinematic and EMG parameters showed promising repeatability. Further studies are needed to assess kinematic and EMG differences between healthy subjects and patients with neck pain.
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Affiliation(s)
- Jean-Philippe Pialasse
- Département des sciences de l'activité physique, Université du Québec à Trois-Rivières, Trois-Rivières, Québec, Canada.
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Burnett A, O’Sullivan P, Caneiro JP, Krug R, Bochmann F, Helgestad GW. An examination of the flexion-relaxation phenomenon in the cervical spine in lumbo-pelvic sitting. J Electromyogr Kinesiol 2009; 19:e229-36. [DOI: 10.1016/j.jelekin.2008.04.015] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2007] [Revised: 04/29/2008] [Accepted: 04/30/2008] [Indexed: 10/21/2022] Open
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