Does increased superficial neck flexor activity in the craniocervical flexion test reflect reduced deep flexor activity in people with neck pain?

The craniocervical flexion test assesses the deep cervical flexor muscles (longus capitis, longus colli). Ideally, electromyography (EMG) studies measure activity in both deep and superficial (sternocleidomastoid, anterior scalene) flexors during the test, but most studies confine recordings to superficial muscle activity as the technique to record the deep muscles is invasive. Higher activity of the superficial flexors has been interpreted as an indicator of reduced deep flexor activity in people with neck pain but how close the inverse relationship is during this test is unknown.

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