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Association of electromyographic activation patterns with pain and functional disability in people with chronic neck pain



This study examined the activation patterns of the cervical and thoracic muscles in people with and without chronic neck pain during functional activities and their associations with pain intensity and functional disability.


Thirty-four adults with chronic neck pain and 34 asymptomatic adults were recruited. They were requested to perform active cervical movements and an upper limb lifting task. Electromyographic activation patterns (EMG) of bilateral upper trapezius, cervical erector spinae, sternocleidomastoid, and thoracic erector spinae were recorded during these tasks. Correlation and multiple regression analysis were used to examine the associations between EMG variables and severity of pain and functional disability.


When performing the cervical movements, the neck pain group displayed lower EMG activity levels, especially in the cervical and thoracic extensors. In addition, significantly prolonged activation was observed in seven of the ten muscles during the upper limb lifting task. The changes in EMG amplitude and activation duration were found to be significantly correlated with severity of pain (R2 = 0.716) and functional disability (R2 = 0.623).


Significant differences in the activation patterns of multiple cervical and thoracic muscles were found in individuals with neck pain compared with those without neck pain. These were significantly associated with their degree of pain and functional limitation. The findings of this study highlight the importance of assessing and optimising the neuromuscular activation of these muscles in the rehabilitation of those suffering from chronic neck pain.

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Cervical erector spinae


Coefficient of multiple determination


Cervical spine




Intraclass correlation coefficient


Mental Component Score


Maximal isometric voluntary contraction


Neck Disability Index


Neck pain


Northwick Park Disability Questionnaire


Numeric Pain Rating Scale


Physical Component Score




Surface electromyography for the non-invasive assessment of muscles


Short Form 12 health survey


Sub-maximal isometric voluntary contraction


Thoracic erector spinae at 4th thoracic spine level


Thoracic erector spinae at 9th thoracic spine level


Thoracic spine


Upper trapezius


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All authors contributed to the preparation and revision of the manuscript. All authors have reviewed and agreed on the revision made in the manuscript.

Corresponding author

Correspondence to Sharon M. H. Tsang.

Additional information

Communicated by Guido Ferretti.

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Tsang, S.M.H., Szeto, G.P.Y., Xie, Y.F. et al. Association of electromyographic activation patterns with pain and functional disability in people with chronic neck pain. Eur J Appl Physiol 118, 1481–1492 (2018).

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  • Chronic neck pain
  • Muscle activation
  • Pain intensity
  • Functional disability
  • Cervical movements
  • Upper limb lifting task