J Rehabil Med 45

ORIGINAL REPORT
J Rehabil Med 2013; 45: 900905
2013 The Authors. doi: 10.2340/16501977-1196
Journal Compilation 2013 Foundation of Rehabilitation Information. ISSN 1650-1977
Objective: Guild boards and pulleys are apparatus common-
ly used to train cervical muscle function for their purported
beneft in facilitating activity of the deeper muscle layers, al-
though this effect has not been substantiated. The objective
of this study was to compare the activity of the different lay-
ers of cervical muscles when performing exercise with these
2 types of apparatus.
Subjects: A total of 19 healthy persons (mean age 28 years,
(standard deviation 7 years).
Design: Ultrasound measurements of muscle deformation
and deformation rate were recorded from the dorsal and
ventral neck muscle layers during extension and fexion ex-
ercises. Pulley exercises were performed in the upright sit-
ting position against a standardized resistance (men 2 kg,
women 1 kg) and guild board exercises at an angle of 45.
Results: The dorsal muscles generally showed greater levels
of deformation and deformation rate during exercise with
the guild board compared with the pulley system (p < 0.05),
but with no signifcant differences in relative activity between
the deep and superfcial muscle layers (condition muscle
interaction (p > 0.05)). No differences were observed for the
ventral muscles between exercise methods (p > 0.05).
Conclusion: While both exercise methods appear to train
cervical muscle function, neither appear to be more selective
in facilitating deep cervical muscle activity, probably as they
involve very similar cervical kinematics.
Key words: neck muscles; muscle activity; ultrasonography; ex-
ercise.
J Rehabil Med 2013; 45: 900905
Correspondence address: Anneli Peolsson, NHMRC CCRE
(Spinal Pain, Injury and Health), The University of Queens-
land, St Lucia, QLD 4072, Brisbane, Australia. E-mail:
[email protected]; [email protected]
Accepted Apr 8, 2013; Epub ahead of print Jul 4, 2013
INTRODUCTION
Disability due to neck pain is common; annual prevalence
values of up to 65% have been reported in the general popu-
lation (1). Defcits in strength (25), endurance (6, 7) and
coordination (810) of both the ventral and dorsal cervical
muscles are a known feature of chronic neck pain disorders
(11). Exercise that facilitates the function of the deep cervical
fexor and extensor muscle layers is therapeutically desirable,
as these muscles form a deep sleeve that envelopes the cervical
vertebral column. Muscles that form this deep sleeve have the
appropriate morphology and composition to control segmental
cervical motion (12, 13), lordotic orientation (13, 14), and
unwanted intersegmental buckling and rotary motion, which
can result from contraction of the larger and more superfcial
cervical muscles (15). Thus, exercises that bias training of the
deep cervical muscles are strongly recommended clinically (11,
16, 17), as they have been shown to be impaired in mechanical
neck pain (11, 17), and targeted training of their performance
has been shown to be of beneft in the clinical management
of these disorders (1618). While many different approaches
have been proposed to train the performance of the cervical
muscles, 2 common methods used by Nordic physiotherapists
for many years include exercise with a guild board or with a
pulley system (19).
While performing exercise using guild boards and pulleys
(19) has been touted as effective in facilitating the deeper cervi-
cal muscle layers, to date, there have been no studies that have
investigated cervical muscle usage patterns when performing
exercise with these types of apparatus. This information would
be valuable when using these types of apparatus, as our previ-
ous studies have shown that different methods of exercising
the ventral and dorsal cervical muscles can result in varying
patterns of activity between the deeper and superfcial muscle
layers (2023).
The purpose of this study was to compare the activity of
the different layers of cervical muscles when performing
exercise with the guild board and pulley system. Specifcally,
we measured the mechanical activity of the ventral and dorsal
neck muscles using an ultrasound method during standardized
fexion and extension exercises, respectively, using both guild
board and pulley apparatus. We hypothesized frst, that both
exercise approaches would result in similar activation of the
IS THERE A DIFFERENCE IN THE PATTERN OF MUSCLE ACTIVITY
WHEN PERFORMING NECK EXERCISES WITH A GUILD BOARD VERSUS
A PULLEY?
Anneli Peolsson, PT, PhD
1,2,
Michael Peolsson, MSc CE, PhD
3
, Gwendolen Jull, PT, PhD
2

and Shaun OLeary, PT, PhD
2,4
From the
1
Department of Medical and Health Sciences, Division of Physiotherapy, Faculty of Health Sciences,
Linkping University, Linkping, Sweden,
2
NHMRC CCRE (Spinal Pain, Injury and Health), The University of
Queensland, Brisbane, Australia,
3
Computational Life Science Cluster and Department of Chemistry, Ume University,
Ume, Sweden and
4
Physiotherapy Department, Royal Brisbane and Womens Hospital, Queensland Health,
Queensland, Australia
901 Muscle activity during neck exercises
deep muscles. Secondly, that the relative activation of the
deep and superfcial muscle layers would be similar between
exercise methods. These hypotheses are based on the similarity
in technique of both exercise methods with regard to cervical
kinematics, despite using different apparatus and set-up.
METHODS
Participants
A total of 19 healthy volunteers (10 women and 9 men; mean age
28 years (standard deviation (SD) 7), age range 2148 years) were
included in the study after answered advertising for the study at a
university. Eighteen of the volunteers were right-handed and one
ambidextrous. Participants were included if they reported negligible
current neck pain (< 10 mm on the visual analogue scale (VAS) (24,
25) (group mean 0.2 mm (SD 0.5) in the present study), or neck dis-
ability (< 20% on the Neck Disability Index (NDI) (26) (group mean
0.7% (SD 0.8) in the present study).
Participants were excluded from the study if they reported a previous
history of neck pain for which they had sought treatment, previous
trauma to the neck or head, rheumatological or neurological diseases
affecting the muscles of their spine or upper quadrant, generalized
myalgia, or severe pain in other region of the spine, such as the thorax
or lumbar spine. They were also excluded if they had undertaken spe-
cifc exercises to train the cervical muscles in the previous 6 months.
Although eligible participants had not performed specifc exercises
for their cervical spine they were, on average, physically active, as
measured by a physical activity scale (group mean 3.9 (SD 0.2) (out
of high level maximum score 4) (27).
All procedures were conducted according to the Declaration of
Helsinki. The study was approved by the Regional Ethics Committee
and the participants provided written informed consent.
Ultrasound measurements of muscle activity
Ultrasound images of cervical muscles were recorded with a 14.0 MHz
linear transducer (38-mm footprint) and Ultrasound Vivid 9 Dimension
(GE Healthcare, Horten, Norway) with high frame rate (78 frames/s)
operated in B-mode, and a 2D ultrasound imaging system. Images
of the dorsal (trapezius, splenius, semispinalis capitis, semispinalis
cervicis, multifdus) (Fig. 1A and B) and ventral (longus colli, longus
capitis, semispinalis capitis muscle) neck muscles were recorded on
the right side (dominant side in all participants) of the neck at the C4
vertebral level (identifed via the C4 spinous process dorsally and the
carotid artery bifurcation ventrally). For both dorsal and ventral record-
ings, the transducer was frst positioned in a transverse orientation at
the C4 level to permit identifcation of the appropriate articular and
muscular tissues. Once the correct position was achieved the transducer
was rotated 90 to a longitudinal orientation relative to the imaged
muscles, which is optimal for ultrasound imaging and speckle track-
ing analysis. Recording of ultrasound videos were made of the dorsal
and ventral muscles during each exercise condition for later analysis.
Speckle tracking analysis. Speckle tracking analysis was performed post-
process using the recorded ultrasound movie sequences in AVI format.
This process utilizes software to identify and track a distinct pattern
of acoustic markers (an interference pattern referred to as a speckle
pattern), that occurs when muscle tissue is imaged with ultrasound. A
region of interest frame (ROI; 10 2 mm) is positioned over a stand-
ardized location within the speckle pattern of each muscle in the frst
frame (in the resting position) of the video sequence. The ROI tracks
its contained unique speckle pattern frame by frame through the movie
sequence. The contained speckle pattern changes length with muscle
activity, resulting in a change in length of the ROI. The change in the ROI
length is measured as muscle deformation and 2 measures are extracted.
The muscle deformation measure is calculated as the percentage change
in the longitudinal median length variation of the ROI compared with
that at rest (expressed as % strain). The muscle deformation rate measure
is expressed as deformation per time unit (% strain 1/s).
The technique of speckle tracking analysis utilizes research software
containing a speckle tracking algorithm based on a stable mathematical
model (Farneback). The calculating algorithm tracks the ROI (con-
taining the unique speckle pattern) and measures deformation of each
ROI in each frame sequentially, comparing it with its length in the
initial resting movie frame. This software is dependent on at least 80%
agreement of the speckle pattern between each frame of the movie for
the ROI to be positively identifed (28).
It was ensured that the ROI representing each muscle was located
in a standardized position between participants. For each muscle the
ROI was positioned at the midpoint of the muscle belly and orientated
longitudinal to the muscle fbres. In each video sequence the optimal
position of the ROI was checked by observing the video sequence in
slow motion with the ROIs in situ. This process ensured that each ROI
was recognized by the measurement software, and that there was no
interference between different ROI frames during the video sequence.
Once the investigator was satisfed with the location of each ROI the
analysis was performed using the software.
These ultrasound measurements have been shown to have moder-
ate to excellent test-retest reliability both for dorsal (2-way random
absolute agreement single measure intra-class correlation coeffcient
(ICC) 0.610.99) and ventral (ICC 0.800.99) neck muscles (28, 29).
Fig. 1. Longitudinal ultrasound image of (A) dorsal and (B) ventral
neck muscles with regions of interest (ROIs; 10 2 mm, containing
hundreds of measuring points) from superfcial to the deep: (A) trapezius,
splenius, semispinalis capitis, semispinalis cervicis and multifdus and
(B) sternocleidomastoid, longus capitis and longus colli. Each ROI was
positioned in the frst image (frame) of the video at the mid-point of the
muscle belly to avoid facial borders (clear white longitudinal structures
in the image).
J Rehabil Med 45
902 A. Peolsson et al.
The deformation measurement has been reported to be reproducible by
Lopata et al. (30) and to be correlated with electrical stimulation with
electromyography (EMG) and voluntary muscular contraction (30).
Exercise conditions
Guild board exercises. The participant reclined on the Guild board,
which was positioned at an angle of 45 to the horizontal and attached
to wall bars (Fig. 2A and B). For the ventral neck muscle exercise,
participants reclined on their back with their head supported so that
their lower cervical spine was in a neutral position and the upper cervi-
cal spine in slight fexion. The exercise required the participant to lift
the torso from guild board en bloc from the pelvis, while maintaining
a static head and neck orientation against gravity. For the dorsal neck
muscles exercise, participants were positioned in prone with their fore-
head supported with the cervical spine and head in the same orientation
at rest as for the ventral muscle exercise. The exercise required the
participant to extending the torso from the pelvis, while maintaining
a static head and neck orientation against gravity.
Pulley exercises. The participant sat upright on a bench so that their
cervical spine was in a neutral position and the upper cervical spine in
slight fexion (Fig. 2C and D). A leather strap was fxed to the head just
above the ears and attached to a weight. A standardized load was used
for all participants (men 2 kg, women 1 kg). This load was selected
because it was considered relatively equivalent to the exercise resist-
ance provided by gravity during the guild board exercises (performed
at 45). For the ventral muscle exercise, participants faced away from
the pulley and fexed their trunk en bloc from the pelvis, while main-
taining a static head and neck orientation against the resistance of the
pulley system. For the dorsal muscle exercise, participants faced the
pulley and extended their trunk en bloc from the pelvis, while again
maintaining a static head and neck orientation against the resistance
of the pulley system.
The same instructions and trunk movement were used for both
exercise conditions (guild board and pulley), the difference being the
starting position and apparatus used. Participants were given standard-
ized instructions by the researcher: I will count to 3, and on 3 start the
exercise gently, holding the neck still in line with the body (keeping
your chin down), and slowly bend from the hips so that your trunk
and head lifts off the supporting surface (guild board)/away from the
pulley. Hold the position for 1 s and lower to the starting position.
Procedure
For each of the 4 experimental conditions (ventral and dorsal muscle
exercises on the guild board and the pulley system) all participants
performed 2 repetitions as a warm-up and familiarization before per-
forming the experimental exercise. During each exercise, a researcher
recorded the ultrasound imaging and saved the image sequences (vid-
eos) for post-processing speckle tracking analysis and calculation of
the deformation and deformation rate measurements. Recordings for
each condition commenced at rest with no resistance (the reference
analysis video frame), and then continued as the participant performed
the exercise against the resistance (gravity for the guild board exercise
and the standard weights for the pulley system exercise). Participants
were instructed to cease the testing procedure if they experienced any
neck symptoms.
Data management and statistical analysis
Measurements of muscle deformation and deformation rate were
calculated from the ultrasound video sequences of the experimental
exercise conditions, and all values were expressed as the root mean
square (RMS) over the duration of the exercise condition. The RMS
values are based on the curve of the changes in deformation and
deformation rate in the longitudinal ultrasound projection over the
entire exercise sequence.
Analyses were performed using a statistical package (SPSS ver-
sion 20: IBM). A repeated measures general linear model was used
to evaluate main effects for exercise (guild board, pulley system) as
well as exercise muscle interactions for the deformation and de-
formation rate measurements. Separate analyses were conducted for
the ventral and dorsal neck muscles. Post-hoc tests of simple effects
were performed when indicated. Statistical signifcance was accepted
at the 0.05 alpha level.
Fig. 2. Exercise technique for (A) dorsal and
(B) ventral neck muscles on the guild board and
exercise technique for (C) dorsal and (D) ventral
neck muscles in the pulley. The fgures are published
with permission from the person.
J Rehabil Med 45
903 Muscle activity during neck exercises
RESULTS
Data for the measures of deformation and deformation rate
of the dorsal and ventral neck muscles for all experimental
exercise conditions are shown in Tables I and II, respectively.
Dorsal neck muscles
For the measurement of muscle deformation there was a
signifcant main effect of exercise condition (p = 0.01), but
no exercise muscle interaction (p > 0.51). Exploratory tests
of simple effects revealed signifcantly greater deformation
for the splenius capitis (p = 0.03) and semispinalis cervicis
(p = 0.01) muscles during the guild board compared with the
pulley exercise (Table I). Analysis of muscle deformation
rate revealed a signifcant main effect of exercise condition
(p = 0.02), but no exercise muscle interaction (p = 0.22). Tests
of simple effects revealed signifcantly greater deformation
rate for the semispinalis cervicis (p = 0.04), and multifdus
(p = 0.02) muscles during the guild board compared with the
pulley exercise (Table I).
Ventral neck muscles
There were no signifcant main effects for exercise condi-
tion for either the deformation (p = 0.34) or deformation rate
(p = 0.22) measurements for the ventral muscles. Similarly,
there were no signifcant exercise muscle interactions for the
deformation (p = 0.72) or deformation rate (p = 0.73) measure-
ments (Table I).
DISCUSSION
The frst hypothesis of this study was not fully supported,
with some differences observed in deep muscle activity (de-
formation, deformation rate) during the 2 different exercise
methods, but only for the dorsal and not the ventral muscles.
Greater levels of muscle deformation as well as deformation
rate were observed when exercising the dorsal neck muscles
with the guild board compared with the pulley method in the
deeper semispinalis cervicis and cervical multifdus muscle
layers. While this study found that the exercise performed
on the guild board may facilitate greater deep dorsal muscle
activity compared with the pulley exercise, there is no support
for greater selective activity of the deep muscles relative to the
more superfcial muscles. The observed greater activity levels
of the deeper dorsal muscle layers during the guild board exer-
cise compared with the pulley exercise coincided with greater
levels of activity of some of the superfcial muscles, such as the
splenius capitis and trapezius muscles. These fndings explain
the lack of signifcant exercise condition by muscle interactions
observed in this study and support our second hypothesis. The
exercise approaches despite their different modes of resistance
(gravity vs weights) show similar relative activity of the deep
and superfcial muscle layers, which is probably attributable
to their similar static positioning of the mid/lower cervical
spine (neutral) and upper cervical spine (in slight fexion)
during the exercise.
We have shown previously that a factor that infuences the
interaction between the activity of the deep and superfcial cer-
vical muscle layers during exercise of the neck is the relative
kinematics of the upper and mid/lower cervical spine during the
performance of exercise (2123). Specifcally, performing an
extension exercise with the upper cervical spine in extension
induces signifcantly greater activity of the superfcial semi-
spinalis capitis muscle than performing the same exercise in a
neutral upper cervical orientation (23). This is probably due to
the attachment of the semispinalis capitis muscle to the head and
its subsequent capacity to exert extensor moments to the upper
and lower cervical regions (23). On a similar anatomical basis it
has been shown that performing a cervical fexion exercise with
the upper cervical spine in fexion is more facilitatory of deep
cervical fexor muscle activity compared with performing it in
a neutral upper cervical orientation (22), and that exercise that
combines upper and lower cervical fexion induces far greater
activity of the superfcial fexor muscles than upper cervical
fexion alone (21, 22). On this basis it is not surprising that the
relative muscle usage patterns of the deep and superfcial muscle
layers were similar for the 2 exercises performed in this current
study, as both had identical kinematics of the mid/lower and
upper cervical spine during their performance.
Table I. Descriptive statistics (mean values and standard deviations (SD) of root mean square) for dorsal and ventral neck muscle deformation (strain)
(%) and deformation rate (% deformation/s) measurements during the 2 different exercise (guild board and pulley system) methods
Muscle
Deformation (%) Deformation rate (%/s)
Pulley
Mean (SD)
Guild board
Mean (SD)
Pulley
Mean (SD)
Guild board
Mean (SD) p-value p-value
Dorsal
Trapezius 2.45 (2.78) 4.09 (6.07) 0.13 0.007 (0.005) 0.012 (0.013) 0.06
Splenius capitis 3.24 (4.82) 4.82 (5.04) 0.03 0.012 (0.01) 0.017 (0.015) 0.06
Semispinalis capitis 3.78 (2.97) 7.26 (8.96) 0.1 0.015 (0.014) 0.024 (0.027) 0.18
Semispinalis cervicis 2.93 (2.00) 4.67 (3.15) 0.01 0.013 (0.008) 0.024 (0.025) 0.04
Multifdus 3.16 (2.48) 6.43 (7.68) 0.06 0.011 (0.006) 0.026 (0.029) 0.02
Ventral
Sternocleidomastoid 6.3 (5.14) 6.96 (5.33) 0.02 0.018 (0.007) 0.025 (0.009) 0.22
Longus capitis 7.18 (5.07) 8.98 (7.2) 0.72 0.026 (0.018) 0.031 (0.014) 0.69
Longus colli 7.26 (5.18) 7.34 (3.73) 0.89 0.032 (0.027) 0.037 (0.016) 0.75
J Rehabil Med 45
904 A. Peolsson et al.
Exercise performed with the guild board resulted in gen-
eralized elevated levels of deformation and deformation rate
of the dorsal muscles (but not the ventral muscles) compared
with the pulley system, despite attempts to make the relative
loads between the exercises similar. One factor may be the sig-
nifcant difference between the relative strength of the ventral
and dorsal neck muscles. The dorsal muscles are substantially
stronger (nearly twice as strong) than the ventral neck muscles
consistent with their larger size (31). Perhaps a reason for
the discrepancy may have been a mismatch between the rela-
tive challenge imposed on the fexor and extensor muscles.
Notwithstanding this, the comparison in this study was made
between exercise conditions (guild board, pulley), within
muscles groups separately (ventral and dorsal), and therefore
theoretically each muscle group should have been challenged
under a similar load between exercise conditions. Future stud-
ies, however, will have to compare the effect of different load
on muscle usage during these exercise approaches, as we have
shown previously that load intensity of exercise can affect the
relative activity of the different layers of cervical muscles (21).
There are other limitations to this study. Findings can only
be extrapolated to healthy individuals; however, in this initial
study we wanted to see what the normal muscle usage re-
sponse was between these 2 different exercises. Future studies
will need to assess the muscle response in individuals with neck
pain who are most likely to be prescribed these exercises, to
determine if the muscle response is different to that observed
in this study. This will be important, as individuals with neck
pain have been shown to have altered muscle performance
between muscle layers compared with healthy people (110,
32, 33). There are also some technical limitations in this study.
Firstly, our 2D ultrasound method was only able to measure
longitudinal muscle deformation during muscle contraction,
with no capacity to measure any rotational components of
muscle motion. Secondly, we could not account for individual
anatomical variations in muscle properties (anatomical archi-
tecture and position) which may affect results, but this issue
should be minimal as the same volunteers were investigated
for both exercises. Notwithstanding this, there is evidence
of a positive relationship between the magnitude of muscle
deformation (recorded with Speckle Tracking analysis) and
the magnitude of muscle activity using other measurements
(force, progressive electrical stimulation, electromyography)
providing justifcation for the use of the measurements per-
formed in this study (30).
In conclusion, this study compared the muscle activity of
the ventral and dorsal neck muscles during exercise performed
with a guild board and pulley system. The response to exercise
between the exercise conditions was similar for the ventral
muscles, while muscle activity (as inferred by measures of
muscle deformation and deformation rate) of the dorsal muscles
was generally greater during the guild board exercise for both
the deeper and more superfcial dorsal muscle layers. While
both exercise methods appear to be legitimate approaches to
training cervical muscle function, neither approach appears to
be more selective in facilitating deep cervical muscle activ-
ity. Future studies will need to explore the effect of different
relative load/resistance on muscle usage patterns of these 2
exercise methods.
ACKNOWLEDGEMENTS
The study is fnancially supported by the Swedish Medical Research
Council, the Wenner-Gren foundations and a Health Practitioner Research
Fellowship (Queensland Health and University of Queensland (NHMRC
CCRE Spinal Pain, Injury and Health)).
The authors declare no conficts of interests.
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