• Journal of the Korean Society of Physical Medicine
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• v.14 no.2
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• pp.53-61
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• 2019

PURPOSE: Forward head posture (FHP) is a head-on-trunk malalignment that results in musculoskeletal dysfunction and neck pain. To improve forward head posture, both the craniocervical flexion exercise (CCFE) and the visual guide (VG) technique have been used. This study compared the immediate effects of CCFE and VG combined with CCFE on craniovertebral angle (CVA), as well as on the activity of the sternocleidomastoid (SCM) and anterior scalene (AS) muscles during CCFE in subjects with FHP. METHODS: In total, 16 subjects (nine males, seven females) with FHP were recruited using the G-power software. Each subject conducted CCFE and CCFE combined with VG in random order. The CVA was recorded using a digital camera and the ImageJ image analysis software. The EMG data of SCM and AS were measured by surface electromyography. A paired T-test was used to assess differences between the effects of the CCFE and VG combined with CCFE interventions in the same group. RESULTS: The CVA was significantly greater for CCFE combined with the VG than for CCFE alone (p<.05). The activity of the SCM and AS muscles was also significantly greater when the VG was combined with CCFE than during CCFE alone across all craniocervical flexion exercise phases (p<.05). CONCLUSION: Use of the VG technique combined with CCFE improved FHP in subjects with FHP compared to CCFE alone.

• 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.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.31 no.1
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• pp.88-97
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• 2024

Background: This study was to investigate effects of Correlation Analysis between Cervical-Vertebra Angle and Neck Range of Motion, Muscle Strength, Sternocleidomastoid Thickness of Patients with Forward Head Posture Design: Correlation Analysis. Methods: The subjects of this study were a total of 54 people in the forward head position and their ages were between 30 and 50 years old. The subjects cranio-vertebral angles, neck extension, neck flexion, neck rotation angles, neck flexor strength, neck extensor strength, sternocleidomastoid thickness were evaluated through measuring instruments. The thickness of the sternocleidomastoid muscle was measured using an imaging ultrasound diagnostic device (ultra sound, Versana Premier, GE Medical systems, China). CVA was measured by measuring the side photo of the subject was taken with a camera and evaluated.. neck joint range of motion was measured through digital inclinometer for extension, flexion, and neck rotation. neck muscle strength was measured by measuring the using a digital sthenometer. Data analysis in this study was statistically processed using SPSS version 26.0 (IBM SPSS Inc., USA). Correlation analysis was used and the statistical significance level was set at 0.05. Results: The results neck extension(r= 0.70^**), neck flexion(r= 0.67^**), neck rotation(r= 0.56^**), neck extensor muscle strengt(r= 0.85^**), neck flexor muscle strength(r= 0.66^**), sternocleidomastoid thicknes(r= -0.81^**) It indicates that there is a correlation. Conclusion:These results improve the Cervical-vertebra angle of patients with forward head posture should include a program to improve the thickness of the SCM. In the future, study can be used as an evidentiary material for treatment interventions to improve the Cervical-vertebra angle of patients with forward head posture.

• Journal of the Korean Society of Physical Medicine
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• v.15 no.3
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• pp.29-41
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• 2020

PURPOSE: The aim of this study was to provide evidence for the treatment of Forward Head and Rounded Shoulder Posture (FHRSP) using posture correction exercises by comparing muscle activity and onset time around the neck and shoulder area during an arm elevation task. METHODS: The subjects were divided into FHRSP (21 persons) and non-FHRSP (19 persons) groups to measure muscle activity and onset time of muscle contraction. Wireless surface electromyography was used to assess the muscle activity and onset time of the right and left sternocleidomastoid (SCM), splenius capitis, anterior deltoid, middle deltoid, serratus anterior, upper trapezius, pectoralis major, and infraspinatus during an arm elevation task. After the pre-measurement, the participants performed the postural correction exercises, and then the post-measurement was conducted. RESULTS: After the posture correction exercises, there were significant differences in the muscle activity and onset time of all muscles in the FHRSP group. The results of the comparison of the muscle onset time during an arm elevation task demonstrated that after the postural correction exercises, the muscle onset time was significantly reduced in the right and left SCM and left splenius capitis, but there were no significant changes in the onset time of other muscles. CONCLUSION: The results of this study help us understand the change in muscle activities and muscle contraction onset time in a person with FHRSP when lifting the arm and suggest the relevant basis to apply the posture correction exercise in clinical settings.

• Journal of the Korea Convergence Society
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• v.9 no.12
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• pp.123-128
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• 2018

The aim of this study was to determine the effects of the action observation and visual feedback on the alignment, pain and function of forward head posture(FHP) and round shoulder(RS). A total of 24 participants with FHP and RSP were randomly assigned to general exercise(GE, n=8), action observation(AO, n=8), and visual feedback(VF, n=8). All subjects were exercised three times a week for four weeks. The groups were assessed for craniovertebral angle(CVA), round shoulder posture(RSP), visual analog scale(VAS), and neck disability index(NDI) before and after exercise, There was a significant difference in CVA in the GE, AO and RSP, VAS and NDI were significantly different in all groups. AO was more effective than GE, VF for VAS. The results of this study suggest that action observation may be effective to improve the FHP and RS.

• Journal of the Korean Society of Physical Medicine
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• v.10 no.3
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• pp.9-17
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• 2015

PURPOSE: This paper aims to present the available angle to evaluate the severity of forward head posture (FHP) with the observation method and photographic method. METHODS: A cross-sectional observation research design study consisted of 29 subjects who was divided two groups (slight FHP group, moderate FHP group) in Eulji university was used. We evaluated the FHP and the angles including CranioVertebral Angle (CVA), Head Tilting Angle (HTA), Head Position Angle (HPA) and Forward Shoulder Angle (FSA) with the Body style S-8.0 (South Korea, LU Commerce). RESULTS: The mean of CVA, FSA from the slight FHP group was shown higher than moderate severe FHP group. According to independent t-test result, but there was no difference among all angles in two groups. The linear discriminate analysis showed the size of distinction of FSA was the biggest, and then CVA, HTA and HPA were in the order. 55.6% of FSA is properly classified in the slight FHP group. CONCLUSION: The FSA is the best to distinguish the severity of FHP and then CVA as the second best. Therefore, FSA is recommended to check the FHP.

• Journal of the Korean Society of Physical Medicine
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• v.11 no.2
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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.

• Journal of the Ergonomics Society of Korea
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• v.35 no.6
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• pp.503-517
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• 2016

Objective: The aim of this study was to evaluate the effectiveness of 3 dimensional contoured pillow through analyzing contact pressure and to suggest its design guidelines through analyzing the posture of head and neck area. Background: The quality of sleep is a very important factor closely related with human's health. To improve the quality of sleep, the verification of design factors affecting the posture of the head and neck is needed, and a pillow design that can induce proper posture is required. Method: This study measured the contact pressures of the two reference groups (bead and cotton pillows) as a method to evaluate the design effectiveness of the contoured pillow. This study proposed 3-dimensional design guidelines by drawing anthropometry (head length) affecting cervical curvature angle (CCA) through the measurement of the participants' cervical curvature angles. Results: In the design effectiveness evaluation, the contact pressure of cervical region was higher than that of a reference group (cotton pillow), and contract area increased, and contract pressure decreased in the shape distributing the occipital region's body pressure. This study proposed pillow's cervical supporting height by percentile of a head length [head length (%tile) (cervical supporting height) affecting the posture of the head and neck: 14.6cm (5%tile) (6.2cm), 15.5cm (25%tile) (6.7cm), 16.4cm (50%tile) (7.1cm), and 19.3cm (75%tile) (8.9cm)]. Conclusion: This study confirmed the contoured pillow's design effectiveness maintaining cervical angle comfortable to sleep with the shape supporting the cervical vertebrae and by reducing the contact load of the occipital region. Also, this study proposed pillow design guidelines based on the 3-dimensional contoured pillow design effectiveness, through which the study laid the foundation for pillow design in a systematic method. Application: The results of this study are expected to be utilized as the basis data by which the optimum pillow type and pillow design according to main percentile can be standardized.