• Journal of Oral Medicine and Pain
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• v.20 no.2
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• pp.361-376
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• 1995

The purpose of this study was to investigate the relationship between the head and neck postre and the cervical curvature, especially in forward head postrue(FHP). Sixty patients with craniomandibular disorders and thirty dental students without any signs and symptoms of craniomandibular disordres participated in this study as patient groups and sa control group, respectively. The author evaluated the head and neck posture of all subjects by plumb line and CROM( Cervical Ragne of Motion), and had taken cephaograph in natural head position. On the cephalograph the angle of cervical inclination formed by true horizntal plane and 4th cervical vertebra(C4) and the radius of cervical curvature from C1 to C5 were measured. A specially designed ruler was used for measuring cervical curvature. Occlusal contac number and force with T-scan system, electromygraphic activity of cervical muscles with Bio-EMG, and distance of freeway space with Bio-ECN were recorded, respectively. The collected data were processed by SAS/STAT progrm. The obtained results were as follows : 1. In subjects with longer radius which was less cervical curvature, head positioned more anteriorly than subjects with smaller radius, and they showed slightly straight cervical vertebra. 2. Between the patients and the control group, there were no differences in cervical curvature, in forward head position by plumb line and in CROM. But the patient group had a greater cervical inclination than the control group had. 3. There were positive correlation between cervical curvature and forward head position by plumbline,between forward head position y plumb line and that by CROM in patient group. The cervical inclination, however, had negative correlation with cervical curvature, and with forward head postion by plumb line, respectively. 4. In case of showing more cervical curvature and more forward head position by plumb line the head position was defined as forward head posture. In patient group, subjects without forward head posture showed greater posterior teeth contact force than subjects with forward head posture, but in control group, there were no difference between the two subjects. 5. There were higher electromyographic activity in almost all muscles and smaller freeway space in induced forward head posture than those in natural head position in subjects without forward head posture. In conclusion, head position of patients with craniomandibular disorders were not more anterior than that of normal control person, but they had tendency to head extension. From the result of this study, forward head posture could be defined as posterior rotation of upper cervical segment with a straight lower cercial segment due to loss of normal lordosis.

• PNF and Movement
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• v.18 no.1
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• pp.45-53
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• 2020

Purpose: This study investigated the correlation between standing balance and head-forward posture in adolescents. Methods: The participants in this study were 15 female adolescents. We took photographs of the participants' craniovertebral angle with a digital camera to determine the degree of head-forward posture. Standing balance was evaluated using the 30-second Romberg test of BT4. The measurements were taken on a stable-support surface and on an unstable-support surface using a balance pad. The data measured in this study were analyzed using SPSS version 23.0, and the statistical significance level α was established as 0.05. Pearson correlation coefficient analysis was performed to identify the correlation between the degree of head-forward position of the participants and their balance ability. Results: When we measured 30 seconds of the Romberg test, we observed that, with their eyes open, the participants' head-forward posture and balance were not correlated. However, with their eyes closed, there was a strong correlation between the forward position of the head and the balance ability, which declined as the head position increased. Conclusion: Adolescents with severe head-forward posture exhibited problems with balance in posture control with closed eyes when visual information was not available. It can be inferred that an abnormality occurs in proprioceptor sensation due to their habitual head-forward posture. Education on correct posture and preventive activities should be recommended to improve the health of such adolescents and avoid possible future problems of physical deterioration.

• The Journal of Korean Physical Therapy
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• v.31 no.3
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• pp.151-156
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• 2019

Purpose: This study aimed to investigate the immediate effects of posture correction and real-time visual feedback using a video display on muscle activity and change of head position during overhead arm lift test in individuals with forward head posture. Methods: Fifteen subjects with forward head posture and fifteen normal subjects who volunteered were included in this study. During both groups performed the overhead arm lift test, the muscle activity of the upper trapezius, serratus anterior, sternocleidomastoid, and lower trapezius muscle were measured using electromyography, and head position change was measured using photographs. Then, forward head posture group was asked to perform overhead arm lift test again after posture correction and real-time visual feedback using a video display respectively. One-way analysis of variance (ANOVA) was used to analyze four conditions: pre-test, posture correction, real-time visual feedback, and the control group. Results: The upper trapezius and lower trapezius muscle activity significantly decreased posture correction, real-time visual feedback, and control group than pre-test of forward head posture group (p<0.05). The sternocleidomastoid muscle significantly decreased real-time visual feedback and control group than pre-test of forward head posture group. Head position change significantly decreased three conditions than pre-test of forward head posture group and real-time visual feedback and control group significantly decreased than posture correction. Conclusion: This study recommend for maintaining cervical stability during the overhead arm lift test, postural control using real-time visual feedback is more effective in subjects with forward head posture.

• PNF and Movement
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• v.19 no.2
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• pp.163-172
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• 2021

Purpose: This study investigated the correlation between physical function and forward head posture in spastic diplegia. Methods: The subjects of this study were 10 spastic diplegia patients. We took pictures of the subjects' craniovertebral angle with a digital camera to determine the degree of forward head posture and then analyzed them using the NIH image J program. The physical function test used the TCMS, the BBT, and a spirometer. The data in this study were measured using SPSS version 23.0, and the statistical significance level α was 0.05. A Pearson correlation coefficient analysis was performed to identify the correlation between the degree of the subject's head forward position and physical function. Results: When we performed the BBT and spirometer tests, the subjects' forward head postures were not correlated (p < 0.05). However, with the TCMS, there was a strong correlation between the forward position of the head and balance, with balance decreasing as the head position increased (p < 0.05). Conclusion: Spastic diplegia patients with severe forward head posture showed problems with static balance, dynamic balance, and equilibrium reaction when sitting. Intervention on the right posture and preventive activities will be needed to improve the health of spastic diplegia patients and prevent future problems with physical function.

• 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.

• Journal of Korean Physical Therapy Science
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• v.30 no.3
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• pp.23-30
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• 2023

Background: Flexion of cervical and lumbar joints is required when viewing a smartphone screen. Thus, these joints are overused, together with the surrounding joints and muscles. Long-term use of smartphones will cause changes in cervical and lumbar posture. The effect on forward head posture will vary, depending on the angle of cervical flexion start position in relation to the smartphone. This study investigated how forward head posture changes over time when using a smartphone at 20° and 40° cervical flexion start positions. Design: Cross-sectional study. Methods: Twenty-five subjects with a forward head posture angle of 35° or less participated in the study. A Forward Head Posture app on the participants' smartphones measured forward head posture 5 and 10 minutes after watching videos on their smartphones. Cervical range of motion was used to set a smartphone watching start posture of 20° and 40° of cervical flexion. Results: There was no significant difference in forward head posture, irrespective of cervical flexion start position, but the angle of forward head posture increased more at cervical flexion of 40° than at cervical flexion of 20°. There was no significant difference in what according to smartphone video viewing times, but the angle of forward head posture increased over time. Conclusion: An increase in forward head posture over time with smartphone usage poses a potential risk of neck and shoulder pain. Therefore, smartphone users should avoid prolonged screen time.

• Physical Therapy Korea
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• v.26 no.2
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• pp.61-68
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• 2019

Background: Forward head posture (FHP) is a postural alignment of the cervical vertebrae that leads to increased gravitational load on cervical segmental motions. The overhead arm lift test assesses the ability to actively dissociate and control low cervical flexion and move the shoulders through overhead flexion. Objects: The purpose of this study was to explore muscle activities in the upper trapezius (UT), serratus anterior (SA), sternocleidomastoid (SCM), and lower trapezius (LT) alongside changes in head position during the overhead arm lift test in individuals with FHP. Methods: Fifteen subjects with forward head posture and fifteen subjects with normal subjcects were enrolled in this study. The patients performed the overhead arm lift test, and muscle activities of the UT, SCM, SA, and LT were measured using surface electromyography and by evaluating changes in head position. Independent t-tests were used to detect significant differences between the two groups and Cohen's d was calculated to measure the size of the mean difference between the groups. Results: The FHP group demonstrated significantly increased muscle activity of the UT ($32.46{\pm}7.64$), SCM ($12.79{\pm}4.01$), and LT ($45.65{\pm}10.52$) and significantly decreased activity in the SA ($26.65{\pm}6.15$) than the normal group. The change in head position was significantly higher in the FHP group ($6.66{\pm}2.08$) than the normal group. Effect sizes for all parameters assessed were large between the two groups. Conclusion: The subjects with excessive FHP displayed were unable to fix their heads in position during the overhead arm lift test. The overhead arm lift test can thus be used in clinical settings to confirm control of the neck in these subjects.

• Journal of International Academy of Physical Therapy Research
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• v.12 no.2
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• pp.2345-2353
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• 2021

Background: This study evaluated the effectiveness of upper thoracic manipulation (UTM) and proprioceptive training versus proprioceptive training alone on forward head posture (FHP) and cervicocephalic joint position sense (CJPS) in asymptomatic university students during a short interval of time. Objectives: To evaluate whether the suggested combination would provide greater benefit, and be superior to proprioceptive training alone in improving proprioceptive acuity and head posture. Design: A single-blind randomized controlled trial. Methods: Thirty-three university student volunteers with asymptomatic FHP were recruited. Subjects were randomly assigned to a manipulation group (n=16) receiving UTM combined with proprioceptive training or a proprioception group (n=17) receiving proprioceptive training only. The intervention period lasted 5 weeks in total, and consisted of one 15 to 20-minute session per week. FHP and CJPS were assessed before and after the intervention. Results: A significant pre- to post-intervention decrease in FHP and joint position error was identified in both groups (P<.05). Subjects in the manipulation group demonstrated greater improvements in CJPS and head posture compared to the proprioception group (P<.05). Conclusion: These findings support employing either intervention for treating asymptomatic students with FHP. However, the addition of UTM to proprioceptive training was more effective than proprioceptive training alone in reducing joint position errors and improving head posture.

• Journal of Korean Physical Therapy Science
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• v.19 no.3
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• pp.31-38
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• 2012

Background : The purpose of this study was to evaluate the effect of the kinesio taping on the forward head posture and to reduce secondary pain and attitude transformation by applying kinesio taping. Methods : The subjects were the C university students(n = 30) in Chung-buk district without medical history. They were divided into two groups:experimental group(N = 15) and control group(N = 15). Control group was heard verbal instructions to keep right attitude and Experimental group was applied to kinesio taping. Change of an attitude, such as an angle, distance, CROM, CVA, CRA prices, before and after experiment was measured respectively. Result : The results of this study showed that in comparison of pre and post changes, experimental group noticeable changes in angle, CROMSI and CVA(p<.05). Angle, CROMSI and CVA were significant differed between groups(p<.05). Conclusion : Kinesio taping application was seemed to be effective on the improvement of forward head position. Therefore, it is suggested that Kinesio taping application should be one the potential methods to facillitate the forward head position. Comprehensive research is required about a point of time and duration for intervention in clinical approach for subjects.

• Korean Journal of Applied Biomechanics
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• v.23 no.3
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• pp.279-284
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• 2013

The purpose of this study was to determine the effect of head posture and respiratory pattern on muscle activities of sternocleidomastoid (SCM) and scalene during maximal respiration. The seventeen subjects with upper-costal breathing pattern were participated in this study. Surface electromyography was used to measure the muscles activities of SCM and scalene. The volume and velocity of inspiration were monitored by using the spirometer in each subject. Each subject was performed the 3-cycle of respiration in each condition. The mean values of three peak muscle activity in each muscle were used in the data analysis. A2 (head posture: forward head posture: FHP vs. neutral posture) X 2 (breathing pattern: costal vs. diaphragmatic) repeated-measures analysis of variance (ANOVA) was used to compare the normalized muscle activities of the SCM and scalene. The results showed that the muscle activities of SCM and scalene in diaphragmatic breathing were significantly lower than those in costal breathing for each head posture (p<.0125). The muscle activities of SCM in neutral position were lower than those in forward head position during costal breathing (p<.0125). The diaphragmatic breathing in neutral position of head is recommended to decrease the tension of the accessory inspiratory muscles during respiration in neck-pain patients with FHP.