Performance in the cranio-cervical flexion test is altered in elderly subjects

The cranio-cervical flexion test (CCFT) tests the coordination of the deep and superficial cervical flexor muscles during a cranio-cervical flexion task. The test has revealed impairments in muscle function in younger/middle aged patients with various neck pain disorders. Neck pain and headache are common in elders but it is unknown if age alone affects performance in the CCFT. This study compared performance in the CCFT between healthy asymptomatic elderly and younger subjects. Electromyographic (EMG) amplitude in the sternocleidomastoid (SCM), angle of cranio-cervical flexion and ability to target the pressure levels of each test stage were examined in 44 elderly and 39 young participants. The results indicated that the elderly group had higher measures of normalized EMG signal amplitude in the SCM during the test (p<0.001), greater shortfalls from the target pressures of all stages of the test (p<0.01), except for the 22 mm Hg stage (p=0.13), and larger variability of the cranio-cervical flexion range of motion for the five successive stages of the test (particularly at 26, 28 and 30 mm Hg stages) compared to young subjects. Clinicians must be aware of this occurrence when assessing performance in the CCFT in elders with neck pain.