• 대한통합의학회지
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• 제9권4호
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• pp.149-158
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• 2021

Purpose : Forward head posture (FHP) is one of the most common postural malalignment of the cranio-cervical region. Previous studies have reported that FHP might affect both temporomandibular joint (TMJ) and cervical muscles, but still remains unclear. The purpose of this study was to compare the changes of craniovertebral angle (CVA) and muscle properties after smartphone use in healthy individuals with and without FHP. Methods : Fifteen healthy individuals aged 18 to 22 years were included. CVA was evaluated using Dartfish motion analysis, and the subjects were divided into two groups according to their CVA: a FHP group (n = 7, CVA less than 48 °) and a control group (n = 8, CVA more than 48 °). MyotonPro was used to measure muscle properties of masseter, digastric and sternocleidomastoid muscles (SCM). Each subject underwent 15-minutes of smartphone task (web browsing or video watching) in relaxed sitting posture. CVA and muscles properties were assessed both before and after the smartphone task. Results : There were significant changes in post measurements of CVA between the groups. Masseter muscle showed significant differences in pre and post measurements of all muscle properties, and digastric muscle showed significance only in muscle tone. Amount of changes (post-pre), however, showed no significant difference in this study. Conclusion : 15-minutes of smartphone task did not affect CVA and muscle properties of masseter, digastric and SCM in both groups, however, there were significant changes in pre and post measurements of CVA and some muscle properties of masseter and digastric muscles. Therefore, CVA, masseter and digastric muscles might be significantly changed in a heavy duration of smartphone usage more than 15-minutes. Further studies are needed regarding duration of smartphone task, assessments in other various TMJ muscle groups, and participants with pathological FHP conditions.

• 대한통합의학회지
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• 제10권4호
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• pp.23-34
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• 2022

Purpose : This study examined the effects of pain, neck dysfunction, psychosocial level, headache impact test (HIT), postural alignment, and trapezius muscle tone of the complex exercise program using dynamic taping in patients with tension headache and chronic neck pain with forward head posture. Methods : The design of this is a randomized controlled trial (RCT). Thirty-four patients with chronic neck pain were screened using a randomized assignment program and assigned to experimental group (n=17) and control group (n=17). Both groups underwent a complex exercise program. In addition, the experimental group dynamic taping was applied to the upper trapezius muscle. All interventions were applied three times per week for four weeks. The visual analogue scale (VAS), the neck disability index (NDI), short form-12 health survey questionnaire (SF-12), Headache impact test-6 (HIT-6), Craniovertebral angle (CVA), Cranial rotation angle (CRA), upper trapezius muscle tone were compared to evaluate the effect on intervention. Results : Both groups showed significant differences before and after the intervention in VAS, NDI, SF-12, HIT-6, and CVA, CRA (p<.05). In addition, significant differences in NDI and upper trapezius muscle tone were observed between the experimental group and control group (p<.05). Conclusion : A complex exercise program using dynamic taping for patients with tension headache and chronic neck pain with forward head posture are effective method with clinical significance in improving the function and reducing upper trapezius muscle tone.

• 대한물리의학회지
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• 제17권2호
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• pp.29-40
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• 2022

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.

• 한국전문물리치료학회지
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• 제30권4호
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• pp.261-267
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• 2023

Forward head posture (FHP) is a musculoskeletal disorder that causes neck pain. Several exercise interventions have been used in South Korea to improve craniovertebral angle (CVA) and relieve neck pain. There has been no domestic literature review study over the past 5 years that has investigated trends and effects of exercise intervention methods for CVA with neck pain. This domestic literature review aimed to evaluate the trends and effects of exercise interventions on CVA and neck pain in persons with FHP. A review of domestic literature published in Korean or English language between 2018 and 2022 was performed. Literature search was conducted on Google Scholar and Korea Citation Index by using the following keywords: "exercise," "exercise therapy," "exercise program," "forward head posture," and "neck pain." Ten studies were included in this review. All of the studies showed positive improvements after intervention programs that included exercises. Notably, four of these studies demonstrated significant differences in results between the experimental and control groups. Among the 10 studies, nine measured visual analogue scale or numerical rating scale scores and reported significant reductions in pain following interventions, including exercise programs. Five of these studies showed significant differences in results between the experimental and control groups. Furthermore, six studies that used neck disability index exhibited a significant decrease in symptoms after implementing intervention programs that included exercise, and significant differences in results were found between the experimental and control groups. This domestic literature review provides consistent evidence to support the application of various exercise intervention programs to improve CVA and relieve neck pain from FHP. Further studies are warranted to review the effects of various exercise interventions on FHP reported not only in domestic but also in international literature.

• Journal of Oral Medicine and Pain
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• 제21권2호
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• pp.393-405
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• 1996

This study was performed to investigate the effects of changes of head posture and cervical spine shape on the mandibular resting or clenching electromyographic(EMG) activity in anterior temporalis(TA), masseter(MM), sternocleidomastoid muscle(SCM) and trapezius insertion(TI). 30 patients with Temporomandibular Disorders(TMDs) participated in this study. EMG activity($\mu$V) at rest and clenching was observed in four head postures, namely natural head posture(NHP), forward head posture(FHP), upward head posture(UHP), and downward head posture(DHP). For taking in upward or downward head posture head was inclined 10$^{\circ}$ upward or downward and CROM$^\textregistered$(cervical-range-of motion, Performance attainment Inc., USA) was used to maintain same posture during the procedure, and BioEMG$^\textregistered$ (Bioelectromyograph, Bioresearch Inc., USA) was used to record EMG activity in the above four muscles at eight locations on both sides. The recorded EMG activity($\mu\textrm{V}$) were compared and analyzed by cervical spine shape such as the head position from plum line, cervical curvature, and cervical inclination. Head position from plum line was measured in vertical plate calibrated with cm scale, comical curvature by radius was measured with adjustable curved ruler, and cervical inclination by cervical vertebrae tangent(CVT)was measured in lateral cephalograph. The results obtained were as follows : 1. Mean value of head position from plum line, cervical curvature, and cervical inclination were 4.8cm, 26.7cm, and 86.6$^{\circ}$, respectively, And There were no correlationship among these items. 2. For resting EMG activity by head posture, the value in anterior temporalis was higher at FHP than at DHP, the value in masseter was higher at FHP than at NHP, and DHP, the value in sternocleidomastoid muscle was higher at UHP than at NHP, and the value in trapezius insertion was higher at FHP and DHP than, NHP and UHP. The clenching EMG activity, however, did not show any difference by head posture. 3. Comparison of resting and clenching EMG activity between higher and lower groups by head position from plum line, cervical curvature, and cervical inclination did not show any significant difference. From this result, the author concluded that the cervical spine shape had not significantly affected to EMG activity in usual patients with TMDs.

• 대한물리의학회지
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• 제11권2호
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• pp.41-52
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• 2016

PURPOSE: This study was conducted to compare the levels of usage of the superficial neck muscles during head rotation in forward head posture and in multimodal postures for improvement of cervical rotation movement impairment. METHODS: To acquire electromyography (EMG) signals from the sternocleidomastoid (SCM-M), upper trapezius (UPT-M), and the splenius capitis (SPC-M) muscles, 11 subjects practiced right rotation of the head in forward head postures (FHP), upright sitting postures (USP), upright sitting postures with supported arms (SUP), standing postures with the arms leaning against the wall (WSP), and four feet postures (FFP), respectively. RESULTS: The left SCM-M was used significantly more in the FFP compared to the FHP, but not in other postures (p<0.01). The left UPT-M was used significantly more in all postures other than the FHP. The right SPC-M was used significantly more in the FFP (p<0.001) and significantly less (p<0.05) in the SUP compared to the FHP. CONCLUSION: During the rotation of the head, although the usage of the SPC-M significantly decreased in SUP compared to FHP but the usage of the SCM-M and UPT-M did not decrease significantly in other postures compared to FHP. Further research is necessary to prove the hypothesis that special postures may reduce the activity of the superficial neck muscles during head rotation.

• 대한물리치료과학회지
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• 제26권3호
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• pp.57-69
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• 2019

Background: The purpose of this study was to compare and analyze the effects of neck and trunk combined exercise program and single exercise on neck angle and neck and shoulder muscle activity. Design: Randomized controlled trial. Methods: In the single exercise group, the basic stretching, head bending and neck bending exercises were performed. The neck and trunk combined exercise group performed torso strength and trunk stability exercises to stabilize the trunk, and then performed the same neck exercise as the single exercise group. The exercise program was conducted 5 days per week for 2 weeks. One-way repeated ANOVA was used to investigate the statistical analysis of neck angle, neck and upper and middle trapezius muscle activity. Results: 1) There was no significant difference in neck angle degree after exercise in neck single exercise group. 2) In the neck and trunk combined exercise, the neck angle degree decreased continuously with the increase of the experimental period and showed a significant difference. 3) In the single exercise group, the muscles which showed significant difference compared to the post-exercise were the right upper, left and right middle trapezius. 4) In the neck and trunk combined exercise group, the right neck muscles showed significant difference after the exercise before the experiment. Conclusion: It was found that the neck and trunk combined exercise was more effective in reducing neck angle and the muscle activity of the subjects with forward head posture was decreased and increased. However, both exercises showed positive effects.

• 대한물리의학회지
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• 제17권4호
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• pp.141-150
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• 2022

PURPOSE: This study was conducted to investigate the effects of non-elastic and elastic tapes on pain, craniovertebral angle, and balance in forward head posture (FHP) patients. METHODS: A total of 44 adults with FHP were randomly assigned to a group that performed a stretching exercise after non-elastic taping (n = 22) and another group that performed the stretching exercise after elastic taping (n = 22), respectively. The stretching exercise was performed five times a week for 30 minutes per session. The visual analogue scale was used to compare neck pain, the craniovertebral angle was measured to compare alignment, and the limit of stability was measured to compare balance. RESULTS: The groups that performed the stretching exercise after both elastic and non-elastic taping showed significant positive changes in pain and the craniovertebral angle of the head in pre- post measurements (p < .05). In the follow-up test for the pain and craniovertebral angle, there was no significant difference from the post-test in the non-elastic group (p > .05), but a significant difference was seen in the elastic group (p < .05). CONCLUSION: Stretching exercises with taping for patients with a FHP are more effective in improving pain and alignment. However, the short-duration tape application did not affect the balancing ability. When the non-elastic tape was used, the effect lasted longer than that of the elastic tape, and pain relief was effective in the case of the elastic tape. Therefore, tape therapy would be more effective if customized according to the patient's condition.

• 대한통합의학회지
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• 제12권3호
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• pp.83-91
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• 2024

Purpose : This case study aimed to investigate the effects of backward walking exercises with a front-loaded bag on craniovertebral angle (CVA), craniorotational angle (CRA), and gait variables in subjects with forward head posture (FHP). Methods : Two individuals in their twenties with FHP performed backward walking exercises on a treadmill while carrying a front-loaded bag with a load equivalent to 20 % of their body weight, for 30 minutes per day, three times a week, over two weeks. CVA and CRA were measured before and after the intervention using side view photographs taken from 1.5 meters away. CVA was calculated by marking C7, the tragus of the ear, and the outer canthus of the eye, and CRA was determined using the same landmarks. Image J software was used for angle analysis, with measurements taken three times and averaged. Gait variables such as step length and cadence were recorded using a step analysis treadmill and analyzed with the software included with the equipment, with measurements taken at baseline and after the two-week intervention. Results : Both participants demonstrated notable improvements in the CVA, indicating enhanced head alignment relative to the cervical spine. There was also a marked decrease in the CRA, suggesting a reduction in rotational misalignment. Although differences were observed in gait variables, such as step length and cadence, these changes were not consistent across measurements. The results suggest that backward walking exercises with a load carried in front can positively influence postural adjustments by aligning the cervical spine in individuals with FHP. Conclusion : The findings of this case study indicate that backward walking exercises with a front-loaded bag can effectively improve cervical spine alignment in individuals with FHP. Differences were observed in gait variables, such as step length and cadence, but these changes were not consistent across measurements. Future studies should explore these effects more comprehensively and consider optimizing the exercise protocol for better therapeutic outcomes.

• 대한통합의학회지
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• 제12권3호
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• pp.143-153
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• 2024

Purpose : Forward head posture (FHP), characterized by the anterior positioning of the head relative to the spine, is a common postural deviation that can lead to neck pain, reduced mobility, and muscle imbalances. Recently, high-frequency deep heat therapy (HFDT) has been gaining attention for the intervention of FHP. This research aims to investigate the efficacy of HFDT in comparison to instrument assisted soft-tissue mobilization (IASTM) for treating FHP among 30 young adults. Methods : Participants were randomly assigned to either the HFDT or IASTM group. The study focused on examining changes in neck joint mobility, pain thresholds, rounded shoulder distance, lower trapezius muscle strength, and neck dysfunction. Measurements were taken before and after the interventions. Paired t-tests were used for within-group analyses, and independent t-tests were employed for between-group comparisons. The statistical significance level α was set to .05. Results : Statistically significant improvements were observed across all measured parameters in both groups (p<.05). The HFDT group showed significantly greater enhancements in neck joint mobility, pain thresholds, rounded shoulder distance, lower trapezius muscle strength, and neck dysfunction parameters. Specifically, HFDT was more effective than IASTM in improving neck joint mobility, right upper trapezius pain threshold, left rounded shoulder distance, and right lower trapezius strength. The only exceptions were neck flexion range of motion, left upper trapezius pain threshold, right rounded shoulder distance, and left lower trapezius strength, where no significant differences were found between the groups. Conclusion : The findings suggest that HFDT, by combining the benefits of high-frequency therapy and manual therapy, effectively alleviates upper trapezius muscle pain and tension, enhances neck mobility, and strengthens lower trapezius muscles. Thus, HFDT could be considered a valuable intervention for clinicians aiming to address FHP and associated musculoskeletal problems.