Browse > Article
http://dx.doi.org/10.13066/kspm.2022.17.2.29

Effects of a Combination of Scapular Stabilization and Thoracic Extension Exercises on Respiration, Pain, Craniovertebral Angle and Cervical Range of Motion in Elementary School Teachers with a Forward Head Posture: A Randomized Controlled Trial  

Kang, Na-Yeon (Department of Physical Therapy, Daegu University, College of Rehabilitation Science)
Kim, Kyoung (Department of Physical Therapy, Daegu University, College of Rehabilitation Science)
Publication Information
Journal of the Korean Society of Physical Medicine / v.17, no.2, 2022 , pp. 29-40 More about this Journal
Abstract
PURPOSE: This study examined the effects of an exercise program for the thoracic spine and scapula rather than the neck, which is the primary site of pain. METHODS: Thirty-two elementary school teachers with a forward head posture (FHP) were assigned randomly to either the experimental group (n = 16) or the control group (n = 16). The experimental group performed scapular stabilization exercise (SSE) and thoracic extension exercise (TEE), and the control group performed cervical self-myofascial release exercise and stretching exercise. The pulmonary functions, pain, craniovertebral angle (CVA), and cervical range of motion (CROM) were measured before the intervention and six weeks after. RESULTS: The within-group comparisons showed that the VAS and CROM (except for extension) in both groups were significantly different before and after the intervention (p < .05). The changes in the maximum inspiratory pressure (MIP), maximum expiratory pressure (MEP), forced vital capacity (FVC), forced expiratory volume at 1 sec (FEV1), and CVA were significant only in the experimental group (p < .05). The between-group comparisons showed a significant difference in the FVC, FEV1, VAS, CVA, and left lateral flexion (p < .05). CONCLUSION: The combination of SSE and TEE in the experimental group was more effective in improving the FHP and breathing ability. Moreover, the experimental group and control combination appeared to be effective in reducing pain and improving the CROM. The combination of SSE and TEE, which are exercises that do not target the cervical spine directly, was effective in improving the posture, respiration, neck pain, and CROM in elementary school teachers with FHP.
Keywords
Cervical spine; Exercise; Forward head posture; Neck pain;
Citations & Related Records
연도 인용수 순위
  • Reference
1 Takahashi S, Suzuki N, Asazuma T, et al. Factors of thoracic cage deformity that affect pulmonary function in adolescent idiopathic thoracic scoliosis, Spine, 2007;32(1):106-12.   DOI
2 Sueki DG, Cleland JA, Wainner RS. A regional interdependence model of musculoskeletal dysfunction: research, mechanisms, and clinical implications, J Man Manip Ther, 2013;21(2):90-102.   DOI
3 Kanlayanaphotporn R, Chiradejnant A, Vachalathiti R. The immediate effects of mobilization technique on pain and range of motion in patients presenting with unilateral neck pain: a randomized controlled trial, Arch Phys Med Rehabil, 2009;90(2):187-92.   DOI
4 Dunning JR, Cleland JA, Waldrop MA, et al. Upper cervical and upper thoracic thrust manipulation versus nonthrust mobilization in patients with mechanical neck pain: a multicenter randomized clinical trial, J Orthop Sports Phys Ther, 2012;42(1):5-18.   DOI
5 Lee MY, Lee HY, Yong MS. Characteristics of cervical position sense in subjects with forward head posture, J Phys Ther Sci, 2014;26(11):1741-3.   DOI
6 Kim M, Lee M, Kim Y, et al. Myofascial pain syndrome in the elderly and self-exercise: a single-blind, randomized, controlled trial, J Altern Complement Med, 2016;22(3):244-51.   DOI
7 Clarkson HM. Musculoskeletal assessment: joint range of motion and manual muscle strength. Lippincott Williams & Wilkins, 2000.
8 Kim Y-J, Lee S-B, Jeon B-S, et al. The effects of shoulder stabilization and thoracic extensor exercises combined with deep neck flexor exercise on posture and pressure pain threshold of physical therapist and occupational therapist with turtle neck syndrome, The Journal of Korean Academy of Orthopedic Manual Physical Therapy, 2017;23(1):43-51.
9 Hickey ER, Rondeau MJ, Corrente JR, et al. Reliability of the cervical range of motion (CROM) device and plumb-line techniques in measuring resting head posture (RHP), J Man Manip Ther, 2000;8(1):10-7.   DOI
10 Diab AA, Moustafa IM. The efficacy of forward head correction on nerve root function and pain in cervical spondylotic radiculopathy: a randomized trial, Clinical rehabilitation, 2012;26(4):351-61.   DOI
11 Bijur PE, Silver W, Gallagher EJ. Reliability of the visual analog scale for measurement of acute pain, Acad Emerg Med, 2001;8(12):1153-7.   DOI
12 Cardoso JP, Ribeiro IdQB, Araujo TMd, et al. Prevalence of musculoskeletal pain among teachers, Rev Bras Epidemiol, 2009;12:604-14.   DOI
13 McCarthy M, Grevitt M, Silcocks P, et al. The reliability of the Vernon and Mior neck disability index, and its validity compared with the short form-36 health survey questionnaire, Eur Spine J, 2007;16(12):2111-7.   DOI
14 Fernandez-de-Las-Penas C, Alonso-Blanco C, Cuadrado M, et al. Forward head posture and neck mobility in chronic tension-type headache: a blinded, controlled study, Cephalalgia, 2006;26(3):314-9.   DOI
15 TNemmers TM, Miller JW, Hartman MD. Variability of the forward head posture in healthy community- dwelling older women, J Geriatr Phys Ther, 2009;32(1):10-49.   DOI
16 Rahman N, Warikoo D. Association of blackboard teaching with scapular positioning and shoulder pain and disability among school teachers in Dehradun, Int J Pharm Biol Sci, 2013;3(2):475-85.
17 Shim JH, Oh DW, Lee GW. The effects of thoracic flexibility exercise on vital capacity and chest expansion in patients with idiopathic scoliosis, Physical Therapy Korea, 2002;9(2):145-56.
18 Choi S-Y, Choi J-H. The effects of cervical traction, cranial rhythmic impulse, and Mckenzie exercise on headache and cervical muscle stiffness in episodic tension-type headache patients, J Phys Ther Sci, 2016;28(3):837-43.   DOI
19 Ohmure H, Miyawaki S, Nagata J, et al. Influence of forward head posture on condylar position, J Oral Rehabil, 2008;35(11):795-800.   DOI
20 Ludvigsson ML, Peterson G, O'Leary S, et al. The effect of neck-specific exercise with, or without a behavioral approach, on pain, disability, and self-efficacy in chronic whiplash-associated disorders: a randomized clinical trial, Clin J Pain, 2015;31(4):294.   DOI
21 Ylinen J, Ruuska J. Clinical use of neck isometric strength measurement in rehabilitation, Arch Phys Med Rehabil, 1994;75(4):465-9.   DOI
22 Harman K, Hubley-Kozey CL, Butler H. Effectiveness of an exercise program to improve forward head posture in normal adults: a randomized, controlled 10-week trial, J Man Manip Ther, 2005;13(3):163-76.   DOI
23 Iqbal ZA, Rajan, Khan SA, et al. Effect of deep cervical flexor muscles training using pressure biofeedback on pain and disability of school teachers with neck pain, J Phys Ther Sci, 2013;25(6):657-61.   DOI
24 Salahzadeh Z, Maroufi N, Ahmadi A, et al. Assessment of forward head posture in females: observational and photogrammetry methods, J Back Musculoskeletal Rehabil, 2014;27(2):131-9.   DOI
25 Fejer R, Kyvik KO, Hartvigsen J. The prevalence of neck pain in the world population: a systematic critical review of the literature, Eur Spine J, 2006;15(6):834-48.   DOI
26 Chong EY, Chan AH. Subjective health complaints of teachers from primary and secondary schools in Hong Kong, Int J Occup Saf Ergon, 2010;16(1):23-39.   DOI
27 Ariens GAM, Bongers PM, Douwes M, et al. Are neck flexion, neck rotation, and sitting at work risk factors for neck pain? Results of a prospective cohort study, Occup Environ Med e, 2001;58(3):200-7.   DOI
28 Falla D. Unravelling the complexity of muscle impairment in chronic neck pain, Manual therapy, 2004;9(3):125-33.   DOI
29 McDonnell MK, Sahrmann SA, Van Dillen L. A specific exercise program and modification of postural alignment for treatment of cervicogenic headache: a case report, J Orthop Sports Phys Ther, 2005;35(1):3-15.   DOI
30 Han J, Park S, Kim Y, et al. Effects of forward head posture on forced vital capacity and respiratory muscles activity, J Phys Ther Sci, 2016;28(1):128-31.   DOI
31 McDonnell G, Bell K, Hawkins s. A pain in the neck, Postgraduate medical journal, 2000;76(891):57-60.   DOI
32 Lynch SS, Thigpen CA, J. P. Mihalik, et al. The effects of an exercise intervention on forward head and rounded shoulder postures in elite swimmers, Br J Sports Med, 2010;44(5):376-81.   DOI
33 Cho J, Lee E, Lee. Upper thoracic spine mobilization and mobility exercise versus upper cervical spine mobilization and stabilization exercise in individuals with forward head posture: a randomized clinical trial, BMC musculoskelet Disord, 2017;18(1):1-10.   DOI
34 Won DY, Kim SY, Kim YS, et al. The effects of the neck extensor strength exercise and the thoracic extensor strength exercise on the forward head posture and the cervical range of motion, Journal of Korean Physical Therapy Science, 2011;18(2):41-9.
35 Harrison DE, Harrison DD, Betz JJ, et al. Increasing the cervical lordosis with chiropractic biophysics seated combined extension-compression and transverse load cervical traction with cervical manipulation: nonrandomized clinical control trial, J Manipulative Physiol Ther, 2003;26(3):139-51.   DOI
36 Kim S-Y, Kim N-S, Kim LJ. Effects of cervical sustained natural apophyseal glide on forward head posture and respiratory function, J Phys Ther Sci, 2015;27(6):1851-4.   DOI
37 Janda V. Muscles and motor control in cervicogenic disorders: assessment and management, Physical therapy of the cervical and thoracic spine, 1994.
38 Wang CH, McClure P, Pratt NE, et al. Stretching and strengthening exercises: their effect on three-dimensional scapular kinematics, Arch Phys Med Rehabil, 1999;80(8):923-9.   DOI
39 Raine S, Twomey LT. Head and shoulder posture variations in 160 asymptomatic women and men, Arch Phys Med Rehabil, 1997;78(11):1215-23.   DOI
40 Grob D, Frauenfelder H, Mannion A. The association between cervical spine curvature and neck pain, Eur Spine J, 2007;16(5):669-78.   DOI
41 Sheikhhoseini R, Shahrbanian S, Sayyadi P, et al. Effectiveness of therapeutic exercise on forward head posture: a systematic review and meta-analysis, J Manipulative Physiol Ther, 2018;41(6):530-9.   DOI
42 Jull G, Sterling M, Falla D, et al. Whiplash, headache, and neck pain: research-based directions for physical therapies. Elsevier Health Sciences, 2008.
43 Yoo W-G. Effect of thoracic stretching, thoracic extension exercise and exercises for cervical and scapular posture on thoracic kyphosis angle and upper thoracic pain, J Phys Ther Sci, 2013;25(11):1509-10.   DOI
44 Kang JI, Choi HH, Jeong DK, et al. Effect of scapular stabilization exercise on neck alignment and muscle activity in patients with forward head posture, J Phys Ther Sci, 2018;30(6):804-8.   DOI
45 Kotwani S, Bid D, Ghatamaneni D, et al. Determining the reliability of craniocervical flexion test in asymptomatic individuals, Hong Kong Physiotherapy J, 2018;38(1):33-40.   DOI
46 Yozbatiran N, Gelecek N, Karadibak D. Influence of physiotherapy programme on peak expiratory flow rate (PEFR) and chest expansion in patients with neck and low back pain, J Back Musculoskeletal Rehabil, 2006;19(1):35-40.   DOI
47 Perri MA, Halford E. Pain and faulty breathing: a pilot study, J Bodyw Mov Ther, 2004;8(4):297-306.   DOI
48 Ghamkhar L, Arab AM, Nourbakhsh MR, et al. Examination of regional interdependence theory in chronic neck pain: interpretations from correlation of strength measures in cervical and pain-free regions, Pain Med, 2020;21(2):182-90.
49 Wainner R, Flynn T, Whitman J. Spinal and extremity manipulation: the basic skill set for physical therapists, Evidence In Motion, 2001.
50 Kapreli E, Vourazanis E, Billis E, et al. Respiratory dysfunction in chronic neck pain patients. A pilot study, Cephalalgia, 2009;29(7):701-10.   DOI