• Journal of International Academy of Physical Therapy Research
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• v.10 no.3
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• pp.1862-1867
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• 2019

Background: The importance of postural stabilization and cervical mobilization in subjects with pain from the anterior head posture is drawing more attention. However, studies on head and neck stabilizing intervention after mobilization are lacking. Objective: To examine the effects of Kinesiotaping and posture setting exercise on forward head posture (FHP). Design: Crossover Study Design Methods: The subjects were 17 male and female college students in their 20s with FHP. They were randomized into the Kinesiology taping group (KTG) with 9 subjects and posture stabilizing exercise group (PSEG) with 8 subjects. The intervention was conducted for 4 weeks, and changes in pain, craniovertebral angle (CVA), and proprioception were observed before and after intervention. Results: Pain was significantly reduced in the KTG and PSEG both before and after intervention. CVA and proprioception were significantly increased only in the PSEG. The differences in CVA and proprioception between the two groups were significant. Conclusions: These findings suggest that the application of posture setting exercise could decrease pain, proprioceptive error and increase CVA on FHP.

• Physical Therapy Rehabilitation Science
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• v.10 no.2
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• pp.147-155
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• 2021

Objective: This study is to investigate the effect of real-time feedback from the therapist on posture, muscle strength, pain of subjects with forward head posture based on a non-face-to-face complex exercise program. Design: Two-group pretest-posttest design. Methods: Thirty healthy men and women in their twenties with forward head posture with a Craniovertebral angle of 52° or less were targeted, the final selection was made as 15 experimental groups who performed the non-face-to-face intervention program while receiving real-time feedback and 15 control subjects who performed the non-face-to-face intervention program without providing feedback. Six of them were eliminated, and a total of 24 were conducted as subjects. All exercise groups performed an exercise program three times a week, 30 minutes each, for a total of two weeks. Before and after exercise, Craniovertebral angle (CVA), CranioRotation angle (CRA), muscle strength, and tenderness threshold were evaluated. Results: Significant differences were shown in both groups in CVA, and tenderness threshold before and after exercise (p<0.05), and CRA, the left middle trapezius muscle strength, only in the experimental group (p<0.05). In the comparison of theamount of change between exercise groups, the group that received feedback on CVA, CRA and tenderness threshold showed a significant change than the group without feedback (p<0.05). Conclusions: As a result of this study, it can be seen that the therapist's real-time feedback is more effective in improving the forward head posture. This requires feedback from the therapist on posture correction during non-face-to-face exercise intervention.

• The Journal of Korean Physical Therapy
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• v.32 no.6
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• pp.378-382
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• 2020

Purpose: This study aimed to examine the effects of forward head posture on the flexion-relaxation ratio (FRR) and muscle activity during sustained neck flexion and to investigate the correlation between craniovertebral angle and FRR. Methods: Nineteen subjects participated in this study and were allocated to a forward head posture (FHP) group or a non-forward head posture (NFHP) group. Craniovertebral angle (CVA) and FRR were measured in all subjects, and all participants performed a standardized cervical flexion-extension movement in two phases: Phase I, sustained cervical full flexion for 5s; and Phase II, cervical extension with the return to the starting position for 5s. The value of CVA has calculated three times, and the value of FRR was measured three times in order to obtain the mean value. Results: FRR values in the FHP and NFHP group were significantly different (p<0.05). Phase I was significantly different, but the Phase II was not significantly different between the FHP and NFHP group (p>0.05). There was a significant correlation between the muscle activity of Phase I and CVA (p<0.05). However, FRR and the muscle activity of the Phase II were not a significant correlation with the CVA (p>0.05). Conclusion: FHP increases the muscle activity of the cervical erector spinae during sustained neck flexion and reduces FRR, which can cause fatigue in the cervical erector spinae. In addition, for those with a smaller CVA, muscle activity of the cervical erector spinae is increased during sustained neck flexion, which can increase neck muscle tension.

• Journal of The Korean Society of Integrative Medicine
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• v.10 no.3
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• pp.13-25
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• 2022

Purpose : The purpose of this study was to investigate the effects of combined cervical stabilization exercise (CSE) and stretching exercise (SE) on office workers with forward head posture (FHP). Methods : A total of 32 office workers with forward head posture were randomly assigned to experimental (n=16) and control (n=16) groups. The experimental group underwent combined CSE and SE, and the control group underwent cervical self-myofascial release and SE. Both groups performed exercises for 40 min per day, thrice per week for a total of 6 weeks. Craniovertebral angle (CVA), respiration, disability, and joint range of motion (ROM) before and 6 weeks after intervention were measured and compared. Results : There was no significant between-group difference in the general characteristics (p>.05). The intra-group comparison showed significant differences in the visual analog scale (VAS) and neck disability index (NDI) of both groups post-intervention (p<.05). CVA and forced expiratory volume in 1 seconds (FEV₁) were significantly improved post-intervention in the experimental group only (p<.05). In the experimental group, all ROM variables were significantly improved post-intervention. In contrast, in the control group, all ROM variables improved significantly post-intervention, except for extension (p<.05). The inter-group comparison showed significant differences in NDI, left lateral flexion, right lateral flexion, and left rotation between the two groups (p<.05). Conclusion : The combination of CSE and SE, which stabilizes the cervical spine, had positive effects on cranial rotation angle, respiration, disability, and joint ROM in office workers with forward head posture. Therefore, the combination of the two exercises may be an effective option to reduce symptoms and prevent postural problems in office workers with FHP.

• Journal of The Korean Society of Integrative Medicine
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• v.11 no.3
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• pp.195-204
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• 2023

Purpose : This study applied general training (control group) or cranio-cervical flexor training (experimental group) using a pressure biofeedback unit along with general training for 4 weeks to secondary school teachers with moderate to severe neck pain and forward head posture. After that, we tried to compare the effects through differences in neck pain intensity (using numberical rating scale), functional performance (using neck disability index), and cranio-vertebral angle change. Methods : All 50 subjects were randomly assigned to either the "experimental group (n= 25)" or the "control group (n= 25)", and the measurements were evaluated in the same way before the intervention (baseline) and after the intervention (4 weeks). During the intervention period, the subject visited the physiotherapy center and made a reservation three times a week at a fixed time as much as possible, and each training session was thoroughly conducted under the 1:1 guidance of the therapist in charge so that the correct movement and number of times could be performed without compensatory action. Results : As a result of the homogeneity analysis on the general characteristics of the subjects, there were no significant differences between the groups in all variables (p>.05). Compared to the "control group", the "experimental group" showed significant improvement after intervention in all measured variables of neck pain intensity, functional performance, and cranial-vertebral angle (p<.05). Conclusion : For secondary school teachers with forward head accompanied by neck pain, cranio-cervical flexor training using a compression biofeedback unit is an excellent method to show superior pain reduction and functional performance improvement compared to general training alone. In addition, it can be presented as a more effective intervention method that can promote recovery of forward head posture, which is an essential element of the solution.

• Journal of the Korean Society of Physical Medicine
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• v.18 no.4
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• pp.145-154
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• 2023

PURPOSE: This study was conducted to investigate the effect of the sling exercise wearing a neck orthosis on the craniovertebral angle, muscle tension, and headaches in adults with a forward head posture and tension headache. METHODS: In this single-blinded, randomized, controlled, comparative study, a total of 22 adults with forward head postures and tension headaches were randomly assigned to the experimental group (sling exercise wearing a neck orthosis, n = 11) or the control group (sling exercise without a neck orthosis, n = 11). All participants undertook the sling exercise program (3×/week for 4 weeks). The craniovertebral angle, muscle tension, and headache were measured before and after the 4-week training. RESULTS: Significant improvements were observed in the craniovertebral angle, muscle tension, and headache in the experimental group (p < .05). This group also showed a larger decrease in the muscle tension and headache (upper trapezius, -4.97 Hz vs -1.70 Hz, p < .05; splenius capitis, -5.44 Hz vs -2.54 Hz, p < .05; headache, -19.73 score vs -14.64 score, p < .05, respectively). CONCLUSION: The sling exercise wearing a neck orthosis could be an effective way to relieve the symptoms caused by a forward head posture. It could also be a more effective way of decreasing muscle tension and headaches than the sling exercise without wearing a neck orthosis.

• Journal of Korean Physical Therapy Science
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• v.26 no.3
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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.

• Journal of The Korean Society of Integrative Medicine
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• v.8 no.3
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• pp.173-180
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• 2020

Purpose : The aim of this study was to assess the intra- and inter-rater reliability and validity of measurements of head, neck, and pelvis posture using a mobile application in subjects with forward head posture. Methods : Forty-eight volunteers (22 men, 26 women) participated in this study. Two raters independently examined whole body picture images in a lateral standing posture with arms crossed using a CA-Smart Posture Reminder (CA-SPR), and a rater took and calculated posture images twice to assess reliability. We measured five parameters: craniovertebral angle 1 (CVA1), anterior shoulder translation (AST), pelvic tilt (PT), knee angle (KA), and ankle angle (AA) in the subject's sagittal plane using CA-SPR. We examined whole spine X-ray images in the same position to assess validity. We measured four variables in the subjects: CVA2, translation distance (AHT), anterior pelvic plane (APP), and sacral slope (SS). The intra- and inter-rater reliability were calculated using the intraclass correlation coefficient (ICC). Convergent validity was calculated using Pearson's correlation coefficient. Results : The intra-rater reliability (ICC=.889 -.989) and inter-rater reliability (ICC=.800 -.980) were excellent for all variables measured using CA-SPR. The variables measured using CA-SPR and X-ray were significantly positively correlated (r=.623, p<.01). However, the correlation of the variables in the pelvis was not statistically significant. Conclusion : This study shows that a mobile application (CA-SPR) is a useful tool for measuring head and neck posture in subjects with forward head posture. However, further study is needed to measure pelvic variables when using a mobile application.

• PNF and Movement
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• v.17 no.3
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• pp.471-480
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• 2019

Purpose: This study examined the correlations between a forward head posture and the endurance and maximal voluntary contraction of the deep neck flexor, neck pain, and the changed position of the mandible. Methods: The subjects of this study were 50 male and female adults who work at a desk for at least four hours a day. The head-spine angle was photographed with a camera, and the endurance and maximal voluntary contraction of the deep neck flexor and the changed position of the mandible were measured using pressure biofeedback. The Neck Disability Index was used to measure neck pain. To examine the correlations between a forward head posture and the endurance and maximal voluntary contraction of the deep neck flexor as well as the changed position of the mandible, a Spearman's correlation analysis was conducted. The statistical significance was set at 0.05. Results: A forward head posture and the endurance of the deep neck flexor showed a statistically significant positive correlation, and a forward head posture and neck pain showed a statistically significant negative correlation. In addition, the endurance of the deep neck flexor and neck pain showed a statistically significant negative correlation. Conclusion: The results of this study show that a forward head posture and the endurance of the deep neck flexor were correlated; in addition, a forward head posture and neck pain were correlated. Therefore, enhancing the endurance of the deep neck flexor can assist in correcting an imbalanced forward head posture, which can reduce neck pain.

• Physical Therapy Rehabilitation Science
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• v.11 no.4
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• pp.446-453
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• 2022

Objective: The popularization of smartphones can lead to abnormal cervical alignment in university students. The aim of this study was to investigate the relationship among smartphone screen time, cervical alignment, and muscle function in university students. Design: Cross-sectional study. Methods: Seventy-five university students participated in the study. They completed the evaluation of cervical alignment and muscle function, such as handgrip strength, proprioception, and muscle quality (tone, stiffness, and relaxation time). All participants recorded their general characteristics and individual smartphone screen time before the evaluation. They were evaluated craniovertebral angle (CVA) using smartphone application (angle meter 360) for measuring cervical alignment. The muscle function was assessed using a digital hand-held dynamometer, dual inclinometer, and MyotonPRO device. Results: Of all participants, twenty-five university students had forward head posture (CVA<49°, 33.33%). Independent t-test revealed that there were significant differences on smartphone screen time, muscle stiffness, and muscle relaxation between the participants with and without forward head posture (p<0.05). There were significant correlations between the smartphone screen time and the CVA, muscle tone, and muscle relaxation (r=-0.493, 0.250, and -0.500, respectively). Conclusions: The results indicate that the university students with forward head posture had high smartphone screen time and muscle stiffness compared to the students without forward head posture, and smartphone screen time might be associated with cervical alignment and muscle quality.