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J Manipulative Physiol Ther. 2015 Mar-Apr;38(3):210-7. doi: 10.1016/j.jmpt.2014.11.008. Epub 2015 Mar 11.

Differences in cervical multifidus muscle thickness during isometric contraction of shoulder muscles: a comparison between patients with chronic neck pain and healthy controls.

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Assistant Professor of Physiotherapy, Department of Physiotherapy, University of Social Welfare and Rehabilitation Sciences, Tehran, Iran. Electronic address:
Professor of Physiotherapy, Faculty of Rehabilitation, Physiotherapy Research Center, Shahid Behesht University of Medical Sciences, Tehran, Iran.
Assistant Professor of Physiotherapy, Faculty of Rehabilitation, Department of Physiotherapy, Shahid Behesht University of Medical Sciences, Tehran, Iran.
Radiologist, Specialist Doctor, Department of Radiology, Medical Imaging Research Center, Shiraz University of Medical sciences, Shiraz, Iran.
Associate Professor of Biostatistics, Faculty of Rehabilitation, Department of Basic Sciences, Shahid Behesht University of Medical Sciences, Tehran, Iran.



The purposes of this study were to (1) measure the thickness of cervical multifidus muscle (CMM) in different maximal voluntary contraction percentages of isometric contraction of shoulder muscles, (2) evaluate the differences of the CMM thickness in different directions of the shoulder movement, and (3) compare the changes in the CMM thickness of participants with neck pain and also of healthy individuals.


Twenty healthy men (age, 27.45 ± 4.37 years; height, 177 ± 4.66 cm; weight, 72.85 ± 6.46 kg) and 20 men with chronic mechanical neck pain (age, 28.90 ± 5.53 years; height, 176 ± 5.98 cm; weight, 73.15 ± 7.82 kg) participated in the study. Both the right and left CMM thicknesses were measured using an ultrasound device while participants performed isometric contraction of shoulder muscles in 6 movement directions.


In both groups, an increment of CMM thickness followed as the increase of isometric force (P < .01).The increase of muscle thickness of healthy participants was substantially more than the chronic mechanical neck pain participants (P = .03). Although no significant difference of CMM thickness was seen among the effects of the 6 force directions (P > .05), there was a significant difference of activity noted between the left and right sides (P = .047).


The results of the present study indicate that isometric contraction of shoulder muscles caused an increase in the CMM thickness regardless of force direction. This increase was seen in both groups of healthy participants and patients with neck pain. However, less thickness changes were observed in participants with neck pain, which may be interpreted as reduced CMM activity in such people.


Isometric Contraction; Muscle Size; Neck Muscle; Neck Pain; Shoulder; Ultrasonography

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