• Journal of the Korean Society of Physical Medicine
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• v.15 no.2
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• pp.11-21
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• 2020

PURPOSE: This study examined the effects of posture improvement exercise using virtual reality programs on the posture and balance of patients with forward head postures. METHODS: Thirty men and women in their 20 s, who had a forward head posture, were divided randomly into a group with posture correction exercise and a group with posture correction exercise combined with virtual reality programs. The posture correction exercise was composed of squats, XCO training, and chin-tuck exercise. In contrast, exercise with virtual reality games involved the Hot Squat, Climbey, and Baskhead programs while wearing a headset. Both groups performed the exercises 15 min a day, three times per week, for four weeks. The balance ability, distance between the acromion and earlobe, and neck joint range of motion were assessed before and after the exercises. RESULTS: Both groups showed significant reductions in the distance between the acromion and the earlobe, along with significant improvements in the range of joint motion. The group that performed the virtual reality exercises showed a significant increase in the limit of stability. Both groups showed a significant decrease in the sway length. In contrast, the group given the virtual reality exercises showed a significant reduction in the sway speed while standing with their eyes closed. CONCLUSION: Exercise applying virtual reality programs can be used in clinical and home programs to correct the postures of individuals with a forward head posture because they can trigger interest in inducing active participation.

• 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.

• Physical Therapy Korea
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• v.30 no.3
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• pp.174-183
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• 2023

Background: Office workers experience neck or back pain due to poor posture, such as flexed head and forward head posture, during long-term sedentary work. Posture correction is used to reduce pain caused by poor posture and ensures proper alignment of the body. Several assistive devices have been developed to assist in maintaining an ideal posture; however, there are limitations in practical use due to vast size, unproven long-term effects or inconsistency of maintaining posture alignment. We developed a headphone and necklace posture correction system (HANPCS) for posture correction using an inertial measurement unit (IMU) sensor that provides visual or auditory feedback. Objects: To demonstrate the test-retest reliability and concurrent validity of neck and upper trunk flexion measurements using a HANPCS, compared with a three-dimensional motion analysis system (3DMAS). Methods: Twenty-nine participants were included in this study. The HANPCS was applied to each participant. The angle for each action was measured simultaneously using the HANPCS and 3DMAS. The data were analyzed using the intraclass correlation coefficient (ICC) = [3,3] with 95% confidence intervals (CIs). Results: The angular measurements of the HANPCS for neck and upper trunk flexions showed high intra- (ICC = 0.954-0.971) and inter-day (ICC = 0.865-0.937) values, standard error of measurement (SEM) values (1.05°-2.04°), and minimal detectable change (MDC) values (2.92°-5.65°). Also, the angular measurements between the HANPCS and 3DMAS had excellent ICC values (> 0.90) for all sessions, which indicates high concurrent validity. Conclusion: Our study demonstrates that the HANPCS is as accurate in measuring angle as the gold standard, 3DMAS. Therefore, the HANPCS is reliable and valid because of its angular measurement reliability and validity.

• 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.

• 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.

• The Journal of Korean Academy of Orthopedic Manual Physical Therapy
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• v.23 no.1
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• pp.43-51
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• 2017

Background: This study was carried out to compare the effects of shoulder stabilization exercise and thoracic extension exercise including deep neck flexor exercise on posture and pain targeting physical therapists and occupational therapists with forward head posture. Methods: A total of 30 physical therapists and occupational therapists (15 males, 15 females), who are working in the nursing hospital at Daejeon, were randomly divided into a shoulder stabilization group (n=10), a thoracic extension exercise (n=10), and a control group (n=10), and 3 times were carried out for 8 weeks. Results: In the results of all measurements, 2 groups except for the control group showed a significant change in the recovery of forward head posture, and the should stabilization exercise group showed a relatively superior effect compared to the thoracic extension exercise group. Conclusions: These results of a study will be a basic data for the development of the forward head posture exercise therapy program.

• 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.

• Journal of International Academy of Physical Therapy Research
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• v.10 no.2
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• pp.1763-1767
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• 2019

Background: Although previous researches have developed interventions for neck problems, headache, and temporomandibular disorder in patients with forward head posture (FHP), changes in masticatory muscle tone or stiffness as FHP worsening have not been investigated. Objective: To examine changes in masticatory muscle tone and stiffness through craniovertebral angle (CVA). Design: Cross sectional study Methods: The subjects were 21 healthy males with normal head posture. Three CVA were established for posture measurement in which the bilateral anterior temporal and masseter muscles were measured during the subjects maintained a series of postures. Results: The Right masseter muscle significantly increased in stiffness with advancing FHP (p < 0.05). No significant changes were observed in the muscle tone or stiffness of any other masticatory muscles, and no significant differences were found in bilateral masticatory muscle tone or stiffness in each measurement posture. Conclusions: This study suggests that the increased stiffness of the right masseter muscle as the FHP worsened requires consideration in physical therapy assessment and intervention.

• 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.

• PNF and Movement
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• v.19 no.2
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• pp.243-250
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• 2021

Purpose: The purpose of this study was to observe office workers' postural behaviors during computer work to identify the risk factors for head and thorax postural behaviors. Methods: The participants included 57 office workers who worked longer than 20 hours on a computer. Postural behaviors during computer work were measured using 3-D wearable motion sensors on the forehead and sternum. A multivariate linear regression model evaluated the association between various risk factors (neck pain, demographics, and environmental factors) and non-head and thorax postural behaviors. Results: The participants maintained their head and thorax in neutral postures (defined as 10° extension~10° flexion and 5° extension~10° flexion, respectively) for 24.7% and 39.3% of the total recorded time. Those who reported neck pain at the measurement of postural behaviors showed less time spent in thorax postures. Current neck pain, high desk height, and the distance between the keyboard and the edge of the desk (cm) were found to be related to less time spent in a neutral thorax posture. Conclusion: Office environment factors and current neck pain might affect workers' thorax postures, which might also determine the orientation of head postures during computer work.