Background: Various intervention methods are being used to treat subacromial impingement syndrome. However, there is a lack of research on intervention using manual therapy and kinesiotaping together. Objectives: To investigated the effect of subacromial impingement syndrome on the mobilization with kinesiotaping. Design: A quasi-experimental clinical trial. Methods: An experiment was conducted by allocated twenty-nine patients with shoulder impingement syndrome to the mobilization with kinesiotaping group (MKG, n=15) and the kinesiotaping group (KG, n=14). The intervention of MKG and KG was conducted 3 times a week for 6 weeks. The outcome was The Shoulder Pain and Disability Index (SPADI) and range of motion (ROM). The collected data was analyzed using the SPSS ver. 21.0 program by paired t-test and independent t-test. Results: After the intervention, MKG had significant improvements in SPADI pain, SPADI disability, external rotation and internal rotation in MKG. However In KG, there was no significant decrease in SPADI pain, SPADI disability, external rotation and internal rotation. And in MKG, there was a statistically significant decrease in SPADI pain, SPADI disability and increase in external rotation and internal rotation. Conclusion: The mobilization with kinesiotaping was effective in improving pain, disability, and ROM in patients with subacromial impingement syndrome.

Background: Limitations of shoulder range of motion (ROM), particularly shoulder internal rotation (SIR), are commonly associated with musculoskeletal disorders in both the general population and athletes. The limitation can result in connective tissue lesions such as superior labrum tears and symptoms such as rotator cuff tears and shoulder impingement syndrome. Maintaining the center of rotation of the glenohumeral joint during SIR can be challenging due to the compensatory scapulothoracic movement and anterior displacement of the humeral head. Therefore, observing the path of the instantaneous center of rotation (PICR) using the olecranon as a marker during SIR may provide valuable insights into understanding the dynamics of the shoulder joint. Objects: The aim of the study was to compare the displacement of the olecranon to measure the rotation control of the humeral head during SIR in individuals with and without restricted SIR ROM. Methods: Twenty-four participants with and without restricted SIR ROM participated in this study. The displacement of olecranon was measured during the shoulder internal rotation control test (SIRCT) using a Kinovea (ver. 0.8.15, Kinovea), the 2-dimensional marker tracking analysis system. An independent t-test was used to compare the horizontal and vertical displacement of the olecranon marker between individuals with and without restricted SIR ROM. The statistical significance was set at p < 0.05. Results: Vertical displacement of the olecranon was significantly greater in the restricted SIR group than in the control group (p < 0.05). However, no significant difference was observed in the horizontal displacement of the olecranon (p > 0.05). Conclusion: The findings of this study indicated that individuals with restricted SIR ROM had significantly greater vertical displacement of the olecranon. The results suggest that the limitation of SIR ROM may lead to difficulty in rotation control of the humeral head.

Background: Mobilization with movement (MWM) is an effective intervention for increasing range of motion (ROM) and function without pain. Objectives: The purpose of this study is to comprehensively characterize the functional effects of MWM applied to the ankle joint in patients with stroke. Design: Systematic Review and Meta-analysis. Methods: International electronic databases, CINAHL, Embase, MEDLINE, PubMed, and Google scholar were included and identified after review by two investigators in July 2023 according to PRISMA guidelines. Data were synthesized using software provided by Cochran and analyzed using a random effects model with reweighting to account for heterogeneity between participants. Results: After excluding duplicate studies, 14 of the 19 articles screened through the abstracts were excluded, resulting in a total of five studies involving 109 participants with stroke. MWM showed significant differences in ankle ROM [overall effect (Z=3.27, P=0.00)], gait speed [overall effect (Z=3.33, P=0.00)], and cadence [overall effect (Z=2.49, P=0.01)]. Conclusion: The results of the meta-analysis confirmed that MWM is effective in improving ankle ROM and gait parameters in patients with stroke.

Background: Among the various rehabilitation methods for stroke patients, one method involves the use of vibration. Recently, vibration foam rollers, combining vibration with foam rolling, have been developed and are widely used. Objectives: The purpose of this study was to investigate the effects of vibration foam rolling on ankle range of motion (ROM), and gait speed in patients with stroke. Design: A randomized controlled trial. Methods: Thirty stroke patients volunteered to participate and were randomly assigned to the vibrating foam roller group (n=15) and the non-vibrating foam roller group (n=15). Active dorsiflexion ROM, and 10-meter walk (10MW) were used to evaluate ankle ROM, and gait speed before and after each exercise. The two groups performed a 30-minute foam roller exercise program. The non-vibrating foam roller group performed the same exercise program as the vibrating foam roller group, but without vibration. Results: The within-group change in active dorsiflexion ROM after the exercise was significant for both the vibrating foam roller group and the non-vibrating foam roller group (P<.05). The within-group change in 10MW after the exercise was significant for the vibrating foam roller group (P<.05), while it was not significant for the non-vibrating foam roller group (P>.05). Additionally, there was no significant difference in active dorsiflexion ROM and 10MW between the vibrating foam roller group and the non-vibrating foam roller group (P>.05). Conclusion: This study confirmed that a vibrating foam roller exercise program immediately improves ankle ROM and gait speed in stroke patients.

Background: There is a lack of research on sling neurac exercise interventions for craniovertebral angle (CVA), head rotation angle, range of motion (ROM), and neck postural alignment in adults with forward head posture Objectives: To investigate the Immediate effects of sling neurac exercise on craniosacral angulation, ROM, and neck postural alignment in adults with forward head posture. Design: Quaxi-experimental study. Methods: Fifty young adults in their 20s were divided into a sling neurac exercise group (SNEG) and a control group (CG). SNEG conducted sling neurac exercise intervention for one day, and CG did not implement intervention. Craniosacral angulation, ROM, and postural alignment before and after exercise was evaluated for each group. Results: In the sling neurac exercise group (SNEG), CVA, cranial rotation angle (CRA), ROM, and postural alignment improved significantly after intervention (all P<.01). There were no significant differences in the control group (CG) (all P>.05). After the intervention, there were significant differences between the groups in craniosacral angulation, ROM, and postural alignment (all P<.01). Conclusion: The Sling neurac exercise can significantly improve CVA, CRA, ROM, and postural alignment. Therefore, it is suggested to consider sling neurac exercise as an intervention.

Background: Most non-pharmacological interventions for tension-type headache (TTH) focus on direct intervention in areas associated with headaches, with limited research exploring the indirect effects of interventions utilizing the fascia. Objectives: To investigate the effects of superficial back line (SBL) stretching and head-neck massage interventions on the range of motion (ROM) and neck disability index (NDI) of TTH. Design: Randomized controlled trial. Methods: The study participants were randomly allocated into three groups: SBL stretching group (n=9), head-neck massage group (n=9), and combined group (n=9). Prior to the intervention, measurements were taken for neck flexion ROM, straight leg raising test (SLRT) ROM, and NDI. The intervention consisted of 30-minute sessions conducted twice a week for 8 weeks. The second measurement took place 4 weeks after the intervention, followed by a third measurement conducted after an additional 4 weeks of intervention. Results: Comparing neck flexion ROM within each group, a significant increase was observed in the SBL stretching group after 8 weeks compared to before the intervention (P<.05). Regarding the comparison of SLRT ROM within each group, a significant increase was noted after 8 weeks compared to before the intervention in the SBL stretching, head-neck massage, and combined groups (P<.05). In terms of the comparison of NDI within each group, a significant decrease was observed in all three group after the intervention compared to before the intervention (P<.05). Conclusion: 8-week intervention involving SBL stretching, head-neck massage, and their combined application demonstrated effectiveness in improving neck flexion ROM, SLRT ROM, and the NDI for individuals with TTH.

본 연구는 일회성 발목가동성 운동프로그램이 만성적인 발목불안정성(CAI)에 나타나는 발목가 동범위와 통증 수준에 미치는 영향을 확인하는데 목적이 있다. 연구 대상자는 발목불안정성 설문지 검사에 서 좌, 우측 평균 점수가 24점 이하인 성인여성 20명을 선정 하였으며 집단은 일회성 발목 가동성 운동프 로그램 집단(Ankle mobility exercise program, AE, n=10)과 대조군(CON, n=10)으로 구분하였다. AE 처 치는 일회성 운동에 대한 반응을 확인하기 위해 좌·우측 발목을 각각 1회(20분) 실시하였으며 처치 전후 발목불안정성 검사, 통증 및 발목가동범위를 확인하였다. 먼저 AE 프로그램을 실시한 AE 집단의 통증 수 준은 사전과 비교하여 사후 유의하게 감소하는 것으로 나타났다(p<.01). 또한 AE 프로그램 처치한 AE 집 단에서 배측굴곡이 사전과 비교하여 증가하는 것으로 나타났다(p<.05). 이러한 결과를 종합해 보면 일회성 발목 가동성 운동 프로그램은 CAI에서 나타나는 발목 통증과 발목의 가동범위를 개선시켜 결과적으로 발 목 불안정성을 완화시킬 수 있는 효과적인 운동 중재 방법이라고 생각된다.

본 연구는 요부 근막통증증후군이 있는 직장인 44명을 캐리어 오일 피부마사지 그룹과 대조군으로 나누어 캐리어 오일 피부마사지가 요부 통증 및 관절 가동성 에 미치는 영향을 알아보고자 실시하였다. 일주일에 3회, 6주 동안 캐리어 오일 피부마사지 그룹은 호호바 오일 약 3㎖를 도포하고 대조군은 오일 없이 요추부위 에 쓰다듬기 테크닉을 적용하였다. 실험 전후를 비교한 결과 캐리어 오일 피부마 사지 그룹에서 시각 통증 상사척도, 압통 역치, 요부 관절가동성에서 유의한 효과 가 있었다. 따라서 캐리어 오일 피부마사지는 요부 근막통증증후군에 적용하였을 때 물리치료 도수기법 프로그램 및 대체 요법으로 활용될 수 있다.

Background: The Trunk Stabilization Exercise and Respiratory Muscle Exercise may help address the complex biomechanical and neuromuscular issues that contribute to shoulder joint disorders and can help improve patient outcomes in terms of pain relief, range of motion, and functional ability. Objectives: To investigated the effects of conventional physical therapy, trunk stabilization exercise, and respiratory muscle exercise, on the Range of Motion (ROM), ULF and balance in patients with shoulder joint disorder. Design: A randomized controlled trial. Methods: This study randomly allocated 18 subjects to the control group, 19 to the trunk stabilization exercise group, and 19 to the respiratory muscle exercise group, while all interventions were performed five times a week for four weeks. The result measurement involved the ROM, the upper limb function test (ULT), and balance tests. Results: The respiratory muscles exercise group indicated significant improvement in ROM and balance tests than the trunk stabilization exercise group and control group. Conclusion: The respiratory muscle exercise is a more effective way to improve ROM and balance ability than trunk stabilization exercise for patients with shoulder joint disorder.

Background: Technological developments have led to the creation of a mechanical device capable of providing a representative massage as a passive treatment. The use of mechanical massage offers the distinct advantage of being user-friendly and available for use at any given time. Objectives: To investigated present the outcomes of utilizing a massage bed on the range of motion (ROM) and pressure pain threshold (PPT) in patients diagnosed with chronic low back pain. Design: ABA design of a single case study. Methods: To measure the ROM of the subject's trunk flexion, extension, lateral flexion, and rotation, a tape measure and goniometer were utilized. Furthermore, PPT was measured using an electronic pressure pain meter. Baseline A and Baseline A’ periods were conducted for 5 consecutive days without intervention. Following the baseline periods, a massage bed intervention was administered for 1 hour daily for a total of 10 days during the Intervention B period. Daily assessments were performed, and the Intervention B period was conducted after the intervention. Results: The ROM effect was confirmed in trunk lateral flexion and rotation, while the PPT was effective in both L1, right L2, left L4, and left L5. Conclusion: The results of this study confirmed that the use of a massage bed improved the ROM and PPT in patients suffering from chronic back pain. Further randomized controlled trials involving a larger sample size are necessary to validate these findings.

Background: Studies using Smovey and Vibration foam rollers are mostly conducted with normal adults, breast cancer patients, and athletes. However, there are not many studies applied to stroke patients to date. Objectives: The purpose of this study is to investigate the effect of vibration exercise on the range of motion of the shoulder and knee joints in stroke patients. Design: A randomized controlled trial. Methods: A total of 36 stroke patients, with 12 in the Smovey and Vibration foam roller group (SVG), 12 in the Smovey and Non-Vibration foam roller group (SNVG), and 12 in the control group (CG) were randomly assigned to exercise three times a week for 6 weeks. The range of motion of the shoulder and knee joints was measured for each group before and after 6 weeks of exercise. For joint range of motion, shoulder flexion and extension and knee flexion and extension were measured using BPMpro. Results: In terms of the difference in time, the flexion and extension of the shoulder and the flexion and extension of the knee on the paretic side were significant in the SVG and SNVG. The CG was not significant. Shoulder flexion and extension and knee flexion and extension on the unaffected side were all insignificant. The differences between each group were significant between the SVG and the CG and the SNVG and the CG. SVG and SNVG were not significant. Conclusion: It was found that vibration exercise had a positive effect on the range of motion of the shoulder and knee joints. Therefore, it is thought that vibration exercise can be provided as a clinical intervention method for shoulder and knee range of motion.

Background: The application of exercise therapy and manual therapy to the thoracic spine is a widely used method of treating neck pain. Nevertheless, studies on the application of foam rollers and vibrating foam rollers to patients with neck pain are lacking. Objectives: To investigated the immediate effects of thoracic spine foam rolling and vibration foam rolling on pain and range of motion (ROM) in patients with chronic neck pain. Design: Randomized crossover trials. Methods: 24 patients with chronic neck pain participated in the study. The study subjects measured pain and ROM. Subjects were divided into vibration foam roller group, foam roller group, and control group. Results: Pain was not significantly different between and within groups (P<.05). There was a significant difference in flexion, extension, left rotation, and right rotation ROM in the vibration foam roller group after intervention (P<.05). There was a significant difference in flexion and extension ROM in the foam roller group after intervention (P<.05). There was a significantly greater increased extension ROM in vibration foam roller and foam roller groups compared with the control group (P<.0167). Conclusion: Thoracic spine foam rolling and vibration foam rolling improve ROM when treating patients with chronic neck pain. Therefore, it is recommended to use it in combination with other treatments

Background: The range of motion (ROM) and balance ability of the ankle joint affect the stability of the ankle and prevent injuries or hurts from falling. In the clinical tests conducted recently, the floss band is widely used to enhance the range of joint motion and exercise performance, and there are many studies that have applied it to ankle joint increasing dorsi flexion (DF) angle. Objects: This study compared the effects on the range of ankle motion and static/dynamic balance ability of the ankle through three conditions (before floss band intervention, after floss band intervention, and after active exercise intervention) for adults. Methods: One intervention between floss band and active exercise was applied randomly and another intervention was applied the next day. After each intervention, the ROM of the ankle joints and the static balance was checked by measuring conducting one leg test. And the dynamic balance was checked by conducting a Y-balance test. Results: In the case of DF, the range of joint motion showed a significant increase after floss band intervention compared to before floss band intervention (p < 0.05). Static balance ability showed a significant increase after the intervention of floss band and active exercise compared to before the intervention of floss band (p < 0.05). The dynamic balance ability showed a significant increase after the intervention of the floss band compared to before intervention of the floss band and after active exercise intervention (p < 0.05). Conclusion: Based on these results, it was confirmed that the application of floss band to the ankle joint increases DF and improves the static and dynamic balance ability. Based on this fact, we propose the application of a floss band as an intervention method to improve the ROM of the ankle joint and improve the stability of the ankle in clinical field.

Background: Low back pain is a very common musculoskeletal disorder. Since low back pain can indicate physical and psychological problems, reducing the pain level of low back pain can be the primary goal of rehabilitation. Objectives: This study was performed to explain the personalized treatment protocol of Maitland orthopedic physiotherapy based on the brick wall concept for low back pain patients with hypomobility. Design: Randomized controlled study. Methods: A total of 14 chronic low back pain patients were divided into two groups. The experimental group received orthopedic manual physical therapy intervention. The control group received traditional physical therapy intervention. After the 3 days intervention, the joint range of motion and pain of the low back were measured. Results: The low back flexion, extension, lateral flexion, and rotation joint range of motion was significantly increased in the experimental group than in the control group (P<.05). Low back pain was significantly reduced in the experimental group than in the control group (P<.05). Conclusion: It was confirmed that Maitland orthopedic physical therapy was an effective method as an intervention method to improve the joint range of motion and pain of chronic low back pain patients.

Background: Pectoralis minor tightness is associated with reduced glenohumeral internal rotation range of motion (ROM) and scapular anterior tilt alignment. However, the synergistic effects of the pectoralis minor stretching exercise and scapular posterior tilt strategy on glenohumeral internal rotation ROM and pectoralis minor length remain unexplored. Objectives: This study examined the effects of doorway stretching with scapular posterior tilt on pectoralis minor length, scapular alignment, and glenohumeral internal rotation ROM. Design: A case series study. Methods: Fifteen adults with pectoralis minor tightness performed doorway stretching with scapular posterior tilt. Pectoralis minor length, acromion–table distance, and glenohumeral internal rotation ROM were measured before and immediately after stretching. The pectoralis minor length was calculated using the pectoralis minor index. The measured variables were analyzed using a paired t-test. Results: While the pectoralis minor index and glenohumeral internal rotation ROM significantly increased, the acromion–table distance markedly decreased after doorway stretching with scapular posterior tilt (P<.05). Conclusion: Based on the present findings, doorway stretching with scapular posterior tilt could be an effective exercise for increasing glenohumeral internal rotation ROM and pectoralis minor length.

Background: Trunk movements are an important factor in activities of daily living; however, these movements can be impaired by stroke. It is difficult to quantify and measure the active range of motion (AROM) of the trunk in patients with stroke. Objects: To determine the reliability and validity of measurements using a digital goniometer (DG) and smart phone (SP) applications for trunk rotation and lateral flexion in stroke patients. Methods: This is an observational study, in which twenty participants were clinically diagnosed with stroke. Trunk rotation and lateral flexion AROM were assessed using the DG and SP applications (Compass and Clinometer). Intrarater reliability was determined using intraclass correlation coefficients (ICCs) with 95% confidence intervals. Pearson correlation coefficient was used to determine the validity of the DG and SP in AROM measurement. The level of agreement between the two instruments was shown by Bland–Altman plot and 95% limit of agreement (LoA) was calculated. Results: The intrarater reliability (rotation with DG: 0.96–0.98, SP: 0.98; lateral flexion with DG: 0.97–0.98, SP: 0.96) was excellent. A strong and significant correlation was found between DG and SP (rotation hemiplegic side: r = 0.95; non-hemiplegic side: r = 0.90; lateral flexion hemiplegic side: r = 0.88; non-hemiplegic side: r = 0.78). The level of agreement between the two instruments was rotation (hemiplegic side: 23.02° [LoA 17.41°, –5.61°]; non-hemiplegic side: 31.68° [LoA 23.87°, –7.81°]) and lateral flexion (hemiplegic side: 20.94° [LoA 17.48°, –3.46°]; non-hemiplegic side: 27.12° [LoA 18.44°, –8.68°]). Conclusion: Both DG and SP applications can be used as reliable methods for measuring trunk rotation and lateral flexion in patients with stroke. Although, considering the level of clinical agreement, DG and SP could not be used interchangeably for measurements.

Background: Neck pain is a major health problem in developed countries and has a lifetime prevalence of 50%. Major problems include a reduced cervical range of motion, muscle stiffness, dysfunction, postural changes, and decrease in psychosocial level. Objects: This study aimed to investigate the effects of applying the upper trapezius inhibition dynamic taping to patients with chronic neck pain on their neck pain, functional level, cervical range of motion, psychosocial level, and neck posture. Methods: The study design was a randomized controlled trial. A total of 40 patients with neck pain participated in this study and were randomly assigned to a Dynamic Taping group (n = 20) or Sham Taping group (n = 20). In both groups, basic intervention cervical pain control therapy and shoulder stabilization exercise program were performed. In addition, dynamic taping and sham taping were applied to participants in the Dynamic Taping and Sham Taping groups to inhibit the trapezius muscle, respectively. All interventions were performed three times a week and a total of 12 times for 4 weeks, and the participants’ neck pain, functional impairment level, cervical range of motion, psychosocial level, and neck posture were measured and compared before and after the intervention. Results: Both groups showed significant differences in neck pain, functional level, cervical range of motion, psychosocial level, and neck postural before and after the intervention (p < 0.05). Moreover, there were significant differences between the two groups regarding the functional level and neck posture (p < 0.05). Conclusion: Inhibition dynamic taping of the upper trapezius muscle suppression is an effective method with clinical significance in reducing pain in individuals with chronic neck pain and improving the functional level, cervical range of motion, psychosocial level, and neck posture.

Background: Patients who underwent rotator cuff repair (RCR) require management to control pain and prevent re tear and stiffness. Thoracic mobilization has been applied for the improvement of vertebra and shoulder movements and pain reduction. Also, core stability exercise is an intervention necessary for rehabilitation after shoulder surgery. Objectives: To examine the short term benefits of thoracic mobilization and core stability exercise for patients after RCR. Design: Randomized controlled trial with multi arm parallel group and single blind assessor. Methods: 30 participants after RCR were recruited. Participants were categorized into conventional physical therapy (CPT) group, thoracic mobilization (TM) group, and core stability exercise (CSE) group according to the randomization program. Each treatment, transcutaneous electrical nerve stimuli (TENS), TM, and CSE was applied to each group. 3 physical therapists only conducted evaluations; VAS (visual analogue scale), ROM (range of motion), and Korean version of Shoulder Pain and Disability Index (SPADI). Results: VAS and SPADI were statistically reduced, and ROM was statistically improved in all 3 groups. In between three group comparisons of changes in outcome variables, there was not a significant difference in VAS, but there was a significant difference in ROM and SPADI. In the post hoc test, ROM and SPADI showed a significant difference in TM and CSE compared to CPT. Conclusion: TM according to Maitland concept and CSE had beneficial effects compared to CPT in patients after RCR.

Background: Previous studies have been reported that when instrument assisted soft tissue mobilization (IASTM) and the self-myofascial release technique were used on the muscles. However, studies that applied the IASTM and self-stretching to the gastrocnemius muscle are thought to be necessary but there is no such previous study. Objectives: To investigate the effects of IASTM and self-stretching on gastrocnemius muscle thickness and the range of motion of joint in dorsiflexion in healthy college student. Design: Quasi-experimental design (single blind). Methods: The subjects were healthy college students in their 20s with a healthy body. As for the experimental method in this study, comparison between before and after the experiment was performed to compare the effects of myofascial release using IASTM and stretching. The preliminary survey investigated the range of motion (ROM) of ankle joint of the subjects. The thicknesses of gastrocnemius muscles were measured using ultrasonography. One day after the preliminary survey, IASTM interventions and self-stretching interventions were randomly selected. If IASTM intervention is selected, the IASTM of the gastrocnemius muscle was applied for 5 minutes. After than, muscle thickness and the ankle dorsiflexion ROM were measured. Subjects were asked to take a break for about one day after performing the intervention. Self-stretching was applied to the gastrocnemius muscle for 5 minutes identically. After than, muscle thickness and the ankle dorsiflexion ROM were measured. Results: The thickness of the gastrocnemius muscle decreased significantly IASTM intervention, and the ankle dorsiflexion ROM increased significantly IASTM intervention. Ankle dorsiflexion ROM increased significantly the selfstretching intervention. The amounts of change in ankle dorsiflexion ROM through the IASTM was significantly greater than that through self-stretching. Conclusion: In order to immediately increase muscle flexibility in a short time, the IASTM is more effective although the self-stretching method is also effective.

Background: Cervical spine mobilization is an effective intervention method to increase cervical range of motion (ROM). However, whether using a sling with cervical spine mobilization can provide a similar positive effect in improving ROM and muscle stiffness as conventional cervical spine mobilization has not yet been proven. Objectives: To investigated the effects of sling with cervical spine lateral mobilization on improving neck ROM and muscle stiffness in healthy subjects. Design: A two-group pre-posttest design. Methods: A total of 20 healthy subjects were allocated to a sling with cervical spine mobilization (SWCM) group (n=10) and a cervical spine mobilization (CM) group (n=10). The mobilization exercise at grade Ⅳ+ amplitude was applied to the left-side and right-side C3-C4 and C4-C5 of each group for three sets. The mobilization exercise was performed for 30 seconds (frequency of two vibrations per second), with a 30-second resting time. The active cervical ROM, muscle tone, and muscle stiffness of the cervical region of each group was measured and compared before and after the intervention. Results: The active cervical ROM of both groups significantly improved after the intervention (p<.05). However, no significant differences in the cervical active ROM, cervical muscle tone, and muscle stiffness were observed between two groups. Conclusion: The application of sling with cervical spine lateral mobilization is an intervention method that can be effectively used to improve the physiological movement of the neck, as well as cervical muscle tone and stiffness.