• Journal of International Academy of Physical Therapy Research
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• v.10 no.2
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• pp.1803-1809
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• 2019

Background: Cervical mobilization has been applied mainly for the improvement of arm and neck movements and pain reduction, and little research has been done to improve the executive function. Since this kind of so-called mechanical neck pain is one of most common symptoms, there are controversial issues about this with spine alignment. Posteroanterior (PA) mobilization from the Maitland concept is a process of examination, assessment, and treatment of neuromusculoskeletal disorder by manipulative physical therapy. Objective: To examine the short-term benefits of mobilization for patients with non-specific neck pain. Design: Dual-group Pretest-Posttest Design from the Quasi-Experimental research Methods: Fourteen participants (male 8, female 6; 20's of their age) with non-specific neck pains which are distributed all the unilateral or bilateral body side were recruited. Participants were categorized to Neck Pain with Movement Coordination Impairments (NPMCI) and Neck Pain with Mobility Deficits (NPMD) groups according to the results of physical examination. Professional physical therapist who has over 15-years-of clinical experience applicated manipulative therapy for the neck pain, an occupational therapist only conducted evaluations; K-NDI (Korean version of the Neck Disability Index), VAS (Visual Analog Scale), BDS-K (Korean version of Behavioral Dyscontrol Scale) for decreasing possible adverse effects; there were no person who reported other symptoms followed 4 weeks from the trial. Results: In the NPMCI group, data analysis indicated statistical differences between the PA mobilization interventions in NDI and BDS-K; even though, pain was reduced in VAS, this is not a significantly differ. In the NPMD group, data analysis represented statistical differences between the PA mobilization interventions in NDI, VAS and BDS-K; the scores were represented to be increased or the pain got relief. Conclusions: PA mobilization techniques according to Maitland concept have beneficial effects in patients with neck pain and other clinical positive effects which included neck disability, pain itself and motor function of upper extremity.

• Journal of International Academy of Physical Therapy Research
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• v.11 no.1
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• pp.1960-1968
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• 2020

Background: The alignment of the neck and shoulder is important in people with forward head posture. However, previous studies have mainly conducted fragmentary studies on the neck and shoulders, and studies on the combined movement of the neck and shoulders are incomplete. Objective: To investigate the effects of 6 week dynamic exercise program using Thera-band on craniovertebral angle (CVA) in adults with forward head posture. Design: Quasi-experimental study. Methods: The study was conducted on 24 adults with forward head posture and experimented with neck and shoulder exercises and divided them into groups of neck exercises, shoulder exercises, and neck and shoulder exercises to measure CVA values before and after the experiment. The neck exercise program included flexion and extension muscles of the neck and shoulder exercises included dynamic exercise of the upper extremities such as the trapezius muscles and serratus anterior muscle. The CVA results were measured using PA200. Results: Following the interventions, neck exercise group showed significant improvement in CVA (P<.05), but shoulder exercise group and combined exercise group did not show any significant results (P>.05). However, both groups showed some positive results. Significant differences were seen in the comparisons between the three groups (P<.05), and the results of the post-hoc test showed significant differences in neck exercise group and shoulder exercise, neck exercise and combine exercise group. Conclusion: This study suggested that the Thera-band neck exercise is beneficial for foward head posture patients and is expected to be used in clinical trials.

• The Journal of Korean Physical Therapy
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• v.31 no.1
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• pp.1-6
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• 2019

Purpose: This paper proposes proper and effective neck exercises by comparing the deep and superficial cervical flexor muscle activities and thickness according to the pressure level during cranio-cervical flexion exercises between a normal posture group and forward head posture group. Methods: A total of 20 subjects (8 males and 12 females) without neck pain and disabilities were selected. The subjects' craniovertebral angles were measured; they were divided into a normal posture and a forward head posture group. During cranio-cervical flexion exercises, the thickness of the deep cervical flexor neck muscle and the activity of the surface neck muscles were measured using ultrasound and EMG. Results: The results showed that the thickening of the deep cervical flexor was increased significantly to 28 and 30 mmHg in the forward head posture group. The sternocleidomastoid muscle activity increased significantly to 24, 26, 28, and 30 mmHg in the forward head posture group. The anterior scalene muscle activity increased significantly to 26, 28, and 30mmHg in the forward head posture group. A significant difference of 26, 28, and 30 mmHg in the sternocleidomastoid and anterior scalene muscles was observed between two groups. Conclusion: To prevent a forward head posture and maintain proper cervical curve alignment, the use of the superficial cervical flexor muscles must be minimized. In addition, to perform a cranio-cervical flexion exercises to effectively activate the deep cervical flexor muscles, 28 and 30 mmHg for normal posture adults and 28 mmHg for adults with forward head postures are recommended.

• Journal of the Korean Society of Physical Medicine
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• v.14 no.2
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• pp.137-144
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• 2019

PURPOSE: The continued use of smartphones has resulted in an abnormal body posture and neck alignment changes. Maintaining this posture for a long time weakens the flexor muscles in the neck and shortens the extensor muscles in the neck. This study examined the correlation between the suboccipital muscle tension and deep neck flexor muscle physical endurance according to the craniovertebral angles. METHODS: The craniovertebral angle, tension of the suboccipital muscle and endurance of the deep neck flexor muscle were measured in 58 healthy 20-year-old male and female college students. The tension of suboccipital muscle and endurance of the deep neck flexor muscle were then divided according to the body mass index (BMI). Their correlation with the craniovertebral angle was then examined. Each parameter was measured three times to determine the interrater reliability. RESULTS: The craniovertebral angle and suboccipital muscle tension showed differed significantly. On the other hand, the craniovertebral angle and deep neck flexor muscle physical endurance showed no significant differences. CONCLUSION: The results show that the craniovertebral angle and deep neck flexor muscle physical endurance were not correlated, but a smaller craniovertebral angle resulted in a higher suboccipital muscle tension.

• PNF and Movement
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• v.18 no.3
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• pp.333-341
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• 2020

Purpose: The purpose of this study was to investigate the effect of open and closed kinetic chain exercises with a sling on neck flexor thickness during chin-in movement in office workers with forward head posture. Methods: Thirty-one selected subjects randomly performed chin-in movement in open kinetic chain and closed kinetic chain exercises using a sling. All subjects were measured for their neck flexor thickness using ultrasound measurement equipment during the performance of chin-in movement in open and closed kinetic chain exercised. A paired t-test was used to compare the thickness of the total neck flexor, superficial, and deep neck flexor, respectively, between open and closed kinetic chain exercises with chin-in movement. Results: The thickness of the superficial neck flexor diminished in size more greatly during the chin-in movement with the closed kinetic chain than the open kinetic chain, but this was not a statistically significant difference (p > 0.05). On the other hand, the thickness of the total neck flexor and deep neck flexor had more greatly increased during the chin-in movement with the closed kinetic chain than the open kinetic chain, and this was a statistically significant differences (p < 0.05). Conclusion: This study suggested that chin-in movement with a closed kinetic chain is more effective in activating the deep neck flexor than the open kinetic chain. Thus, we believe that the closed kinetic chain exercise using a sling is an effective intervention to correct the postural alignment of individuals with forward head posture.

• Radiation Oncology Journal
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• v.30 no.1
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• pp.36-42
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• 2012

Purpose: To evaluate the radial displacement of clinical target volume in the patients with node negative head and neck (H&N) cancer and to quantify the relative positional changes compared to that of normal healthy volunteers. Materials and Methods: Three node-negative H&N cancer patients and five healthy volunteers were enrolled in this study. For setup accuracy, neck thermoplastic masks and laser alignment were used in each of the acquired computed tomography (CT) images. Both groups had total three sequential CT images in every two weeks. The lymph node (LN) level of the neck was delineated based on the Radiation Therapy Oncology Group (RTOG) consensus guideline by one physician. We use the second cervical vertebra body as a reference point to match each CT image set. Each of the sequential CT images and delineated neck LN levels were fused with the primary image, then maximal radial displacement was measured at 1.5 cm intervals from skull base (SB) to caudal margin of LN level V, and the volume differences at each node level were quantified. Results: The mean radial displacements were 2.26 (${\pm}1.03$) mm in the control group and 3.05 (${\pm}1.97$) in the H&N cancer patients. There was a statistically significant difference between the groups in terms of the mean radial displacement (p = 0.03). In addition, the mean radial displacement increased with the distance from SB. As for the mean volume differences, there was no statistical significance between the two groups. Conclusion: This study suggests that a more generous radial margin should be applied to the lower part of the neck LN for better clinical target coverage and dose delivery.

• Journal of The Korean Society of Integrative Medicine
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• v.10 no.4
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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.

• Journal of the Korean Society of Physical Medicine
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• v.15 no.1
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• pp.19-24
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• 2020

PURPOSE: This paper describes the effects of the myofascial release (MFR) approach in a 20-year-old female patient with neuroforaminal encroachment and regional kyphosis in the cervical area, who also had neck pain. METHODS: A 20-year-old female presented with the chief complaint of neck pain while studying with a level of seven on the rating analogue scale (RAS) and was not taking any drugs or undergoing treatment for the control of neck pain prior to visiting. The cervical radiograph demonstrated neuroforaminal encroachment from C4-5. The patient showed 3.5° kyphosis at C4-5 and 22.9° lordosis at C2-7 according to the Harrison posterior tangent method. The anterior head translation (AHT) was 13.9mm. She reported pain of RAS 5 at the scapular medial border while rotating her neck in the left direction and flexing forward. The patient was treated a total 16 times, three times/week for six weeks using the MFR approach. RESULTS: After the treatment sessions, studying without pain was possible for approximately two hours, but after approximately two hours of studying, she experienced pain of RAS 6 and a stiff feeling in front of the neck. Neuroforaminal encroachment was not detected in the radiographs taken after applying MFR. Improvement of C4-5 kyphosis was noted (from 3.5° kyphosis to 3.8° lordosis). AHT was decreased by 13.6 mm (from 13.9 mm to 0.3 mm). The pain with motion had disappeared. CONCLUSION: The MFR approach in this patient with neuroforaminal encroachment could reduce the pain related to motion and restore the regional cervical lordosis.

• Journal of The Korean Society of Integrative Medicine
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• v.9 no.3
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• pp.193-201
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• 2021

Purpose : The purpose of this study was to compare the effect of pelvic exercise on the CVA and spinal curve in adults with forward head posture compared to the group using only neck exercise when pelvic exercise was performed in parallel with conventional neck exercise. Methods : GPS 400 and Formetric were used to identify craniovertebral angle (CVA), thoracic kyphosis, lumbar lordosis, and pelvic torsion and were measured by an experienced research manager. Forward head posture (FHP) was selected for people whose angle between the line connecting the ear ball and the seventh cervical spine and the horizontal line is 50 degrees or less. The 30 selected students were randomly divided into 15 experimental groups and 15 control groups. Mackenzie exercise and sling exercise were performed for neck exercise in both the experimental group and the control group, and pelvic exercise using a Swiss ball was additionally performed in the experimental group. All data collected in this study were analyzed using SPSS statistics 21.0. Cervical vetebral angle (CVA), thoracic kyphosis, lumbar lordosis, and pelvic torsion were compared at 0 weeks, 3 weeks, and 6 weeks for each measurement factor using ANOVA with repeated measures. For the statistical significance test, the significance level of α was set to .05. Results : The changes of pelvic torsion, thoracic kyphosis and CVA due to pelvic exercise using Swiss Ball and neck exercise were changed over time, but lumbar lordosis were not changed. And there were no significant differences among the groups. Conclusion : In conclusion, the pelvic correction exercise is considered to be an effective exercise for correcting the FHP and requires regular pelvic correction exercises. We expect the results to be used in clinical trials.

• Journal of Mechanical Science and Technology
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• v.17 no.1
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• pp.32-39
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• 2003

In this study we examined connections between vertebral motion and patterns of muscle activation during voluntary head tracking movements. A Rhesus (Maraca mulatta) monkey was trained to produce sinusoidal tracking movements of the head in the sagittal plane while seated. Radio-opaque markers were placed in the cervical vertebrae, and intramuscular patch electrodes were implanted to record from eight neck muscles. Videofluoroscopic images of cervical vertebral motion, and EMG (electromyographic) responses were simultaneously re-corded. Experimental results demonstrated that head and vertebrae moved synchronously and that motion occurred primarily at skull-C$_1$, C$\_$6/-C$\_$7/ and Csub 7/-C$_1$. Our findings illustrate that although the biomechanical constraints of each species may limit the number of solutions available, it is the task requirements that appear to govern CNS (central nervous system) selection of movement behaviors.