Background: Forward head posture affects many individuals and can cause pain and dysfunction in the muscles and joints of the head, neck, and shoulders. Objectives: This study aimed to assess muscle activity and onset time of cervical and scapular muscles during 180° shoulder flexion and abduction in individuals with normal head posture (NHP) and in those with forward head posture (FHP), both before and after correction. Design: Cross-sectional study. Methods: Thirty-six individuals were divided into FHP and NHP groups. Muscle activity and muscle contraction onset time of the splenius capitis, sternocleidomastoid, upper middle and lower trapezius, and serratus anterior muscles were measured during shoulder flexion and abduction using wireless surface electromyography. Results: The FHP group exhibited increased muscle activity compared to the NHP group (P<.05), notably in the sternocleidomastoid and middle trapezius muscles, more so during shoulder abduction than flexion (P<.05). Regarding muscle contraction onset time, sternocleidomastoid onset was fastest during shoulder abduction in the FHP group (P<.05), while serratus anterior onset was slowest during both shoulder abduction and flexion (P<.05). Conclusion: These findings highlight distinct muscle activity and muscle contraction onset time patterns based on head posture and shoulder movement. Selective muscle activation strategies may help reduce heightened sternocleidomastoid and trapezius activity and enhance serratus anterior engagement in individuals with FHP.

Background: Sleep accounts for approximately one-third of a person’s lifetime. It is a relaxing activity that relieves mental and physical fatigue. Pillows of different sizes, shapes, and materials have been designed to improve sleep quality by achieving an optimal sleep posture. Objects: This study aimed to determine which pillow provides the most comfortable and supports the head and neck during sleep, which may enhance sleep quality. Methods: Twenty-eight healthy adults (19 males and 9 females) with an average age of 29 years participated in this cross-sectional study. This experiment was conducted while the participants laid down for 5 minutes in four different pillow conditions: (1) no pillow (NP), (2) neck support foam pillow (NSFP), (3) standard microfiber filled pillow (SFP), and (4) hybrid foam pillow (HFP). The head-neck peak pressure, cranio-vertebral angle in supine (CVAs), cranio-horizontal angle in supine (CHAs), chin-sternum distance (CSD), and muscle tone of sternocleidomastoid were analyzed using one-way repeated measures analysis of variance (ANOVA). The significance level was set at p < 0.05. Results: The head-neck peak pressure was the highest in the NSFP condition, followed by the NP, SFP, and HFP conditions. The CVAs, CHAs, and CSD of the SFP were lower than those of the other pillows. Muscle tone was the highest in the NP condition, followed by the of NSFP, HFP, and SFP conditions. The participants subjective comfort level in both the supine and side-lying postures was highest in the HFP condition, followed by the SFP and NSFP conditions. Conclusion: This study can be used to establish the importance of pillow selection for highquality sleep. The results of this study, suggest that a hybrid pillow with a good supportive core and appropriate fluffiness can maintain comfort and correct cervical spine alignment during sleep.

목적 : 본 연구는 경추 척수손상 장애인이 스마트 홈 기술을 통한 일상생활의 변화를 경험하는 과정을 탐구하여, 이 기술 이 기존의 가정환경수정 프로그램에 어떻게 통합할 수 있을지에 대한 기초자료를 제공하고자 한다. 연구방법 : 연구대상자는 경추 척수손상 장애인 1명으로, 질적 연구 방법 중 사례연구를 통해 스마트 홈 기술 사용 전후의 변화와 경험을 심층적으로 이해하였다. 인터뷰는 2021년 7월 초기 인터뷰 1회, 8월 중간 인터뷰 1회, 12월 스마트 홈 사용 경험 인터뷰 1회를 대면으로 30분~1시간 동안 진행되었다. 자료 분석은 개방 코딩, 범주화, 범주 확인으로 진행되는 반복 적 비교분석법을 사용하였다. 결과 : 자료 분석 결과 ‘스마트 홈 적용 환경’, ‘스마트 홈 사용 경험’, ‘스마트 홈 사용으로 겪은 변화’라는 세 가지 주제가 도출되었다. 이 주제들은 연구 참여자가 경험한 ‘주요 스마트 홈 기술’, ‘적용한 스마트 기기’, ‘스마트 홈에 대한 기대’, ‘주관적 실제’, ‘내적 변화’, ‘독립적인 일상생활’이라는 개념으로 정리하였다. 도출된 개념은 15개의 의미 단위와 51개의 중심의미로 나타났다. 결론 : 본 연구는 스마트 홈 기술이 경추 척수손상 장애인의 일상에 긍정적인 변화를 불러오며, 장애인 삶의 질 향상에 뒷 받침하는 중요한 기초자료를 제공한다. 스마트 홈의 임상 적용 가능성에 대한 새로운 시각을 제공하고,

Intervertebral disc disease is a medical condition in which the disc, a fibrocartilage substance, escapes in the spinal cavity and compresses the spinal cord and it often co-occurs with Chiari-like malformation. A 7-year-old Pomeranian dog was referred for a forelimb ataxia. Disc protrusion at C2 to C3, crowding of the caudal fossa and mild cerebellar herniation into the foramen magnum were confirmed through Computed tomography and magnetic resonance imaging. The patient was hospitalized for two weeks and received electroacupuncture along with other rehabilitation therapies. After 2 weeks of inpatient treatment, there was an improvement in the patient's clinical symptoms.

Background: Smart devices including smart phones have many benefits. However, prolonged used may aggravate cervical pain and postural deformity. Smart devices with appropriate applications (apps) may be useful cost-effective and easy-to-use instruments to relieve cervical pain and improve range of motion (ROM). Objectives: To review recent experimental studies on smart device-based apps on cervical pain and postural ROM improvement. Design: Systemic review study. Methods: Ten articles were selected through bibliographic searches and successive and exclusion procedure of the PubMed, ScienceDirect, and Google Scholar. Out of initial 1,046 articles, 98 articles were selected from abstract review. 33 articles were selected for full article review. Final 10 research articles were selected. Results: Three static ROM feasibility, two active ROM feasibility, four self-management promotion, and one pre/post research study articles were included. Smart device with artificial intelligent (AI) based app were utilized promote adherence to physical activity. Conclusion: Smart device apps steadily showed high feasibility even for research purpose. Studies on AL and machine learning apps showed mixed results for need for wider and precision application.

Background: Pain neuroscience education (PNE) with other therapeutic approaches can reduce pain intensity in patients with Chronic musculoskeletal pain and chronic spine pain by improving quality of life and disability. However, in various clinical trials and reviews, the optimal dose of an intervention combined with PNE is still an area to be studied. Objectives: To investigated the effect of forward head posture (FHP) with chronic neck pain on the PNE combined with cervical and thoracic mobilization. Design: A non-randomized, controlled intervention study. Methods: Thirty-two subjects were allocated to pain neuroscience education combined with cervical and thoracic mobilization group (PCTMG, n=17) and cervical and thoracic mobilization with TENS group (CTMG, n=15). For 6 weeks, the PCTM group applied PNE and cervical and thoracic mobilization and the CTM group applied cervical and thoracic mobilization and TENS. Changes in intervention pre-post pain and kinesiophobia were observed. Results: Results from the study indicated that statistically significant decrease in VAS and TSK-11 in PCTMG. In CTMG, there was a statistically significant decrease in VAS. And in PCTMG, there was a statistically significant decrease in VAS and TSK-11 than in CTMG. Conclusion: Therefore, this study confirmed that PNE combined with cervical thoracic mobilization is an effective intervention compared to ervical thoracic mobilization alone in reducing pain and kinesiophobia in FHP with chronic neck pain.

Background: The craniocervical flexion test (CCFT) was developed for the activation and endurance of deep cervical flexors. However, the muscle thickness and muscle thickness changing ratio of the sternocleidomastoid (SCM) and deep cervical flexor (DCF) muscles in subjects with and without forward head posture (FHP) have not been reported. Objects: To determine the difference in thickness of the SCM and DCF muscles and the difference in the muscle thickness changing ratio between SCM, DCF, and DCF/SCM 20 mmHg and DCF/SCM 30 mmHg between subjects with and without FHP. Methods: Thirty subjects with and without FHP were enrolled. The muscle thickness of the SCM and DCF was measured when maintained at a baseline pressure of 20 mmHg and a maximum pressure of 30 mmHg using a pressure biofeedback unit during the CCFT. Ultrasonography was used to capture images of SCM and DCF muscle thickness during the CCFT, which was calculated using the picture archiving and communication system (PACS). Results: We observed a significant difference within the pressure main effect between SCM and DCF at a baseline pressure of 20 mmHg and a maximum pressure of 30 mmHg (p < 0.05). However, there was no significant difference in the muscle thickness and muscle thickness changing ratio for SCM and DCF during CCFT between subjects with and without FHP. Conclusion: There was no significant difference in the muscle thickness recruitment pattern during CCFT in posture changes between subjects with and without FHP.

Preserving intact genetic material and delivering it to the next generation are the most significant tasks of living organisms. The integrity of DNA sequences is under constant threat from endogenous and exogenous factors. The accumulation of damaged or incompletely-repaired DNA can cause serious problems in cells, including cell death or cancer development. Various DNA damage detection systems and repair mechanisms have evolved at the cellular level. Although the mechanisms of these responses have been extensively studied, the global RNA expression profiles associated with genomic instability are not well-known. To detect global gene expression changes under different DNA damage and hypoxic conditions, we performed RNA-seq after treating human cervical cancer cells with ionizing radiation (IR), hydroxyurea, mitomycin C (MMC), or 1% O2 (hypoxia). Results showed that the expression of 184–1037 genes was altered by each stimulus. We found that the expression of 51 genes changed under IR, MMC, and hypoxia. These findings revealed damage-specific genes that varied differently according to each stimulus and common genes that are universally altered in genetic instability.

Background: Forward head posture leads to resulting in posture instability and changes in spine alignment. To treat this condition, numerous studies have shown the effectiveness of joint mobilization. However, only a few studies have reported on the intervention location of joint mobilization or its effects on heart rate variability. Objectives: To investigated the effects of joint mobilization intervention at the lower cervical spine on pain, head posture, and heart rate variability (HRV) in patients with a forward head posture. Design: A randomized controlled trial. Methods: Twenty patients with forward head postures who met the study inclusion criteria were recruited. A randomization program was used to divide the subjects into experimental and control groups. Each group consisted of ten subjects. The intervention was performed for four weeks, three sessions per week, 15 min per day, and non-simultaneously throughout the 12-week study period. Results: A significant decrease in neck pain was shown in both the experimental and control groups. In contrast, significant changes in craniovertebral angle (CVA), cranial rotation angle (CRA), and HRV were found only in the experimental group. Conclusion: The mobilization of the cervical spine is an effective intervention for improving pain, head posture, and HRV.

Background: Cervical spine mobilization is an effective intervention method to increase cervical range of motion (ROM). However, whether using a sling with cervical spine mobilization can provide a similar positive effect in improving ROM and muscle stiffness as conventional cervical spine mobilization has not yet been proven. Objectives: To investigated the effects of sling with cervical spine lateral mobilization on improving neck ROM and muscle stiffness in healthy subjects. Design: A two-group pre-posttest design. Methods: A total of 20 healthy subjects were allocated to a sling with cervical spine mobilization (SWCM) group (n=10) and a cervical spine mobilization (CM) group (n=10). The mobilization exercise at grade Ⅳ+ amplitude was applied to the left-side and right-side C3-C4 and C4-C5 of each group for three sets. The mobilization exercise was performed for 30 seconds (frequency of two vibrations per second), with a 30-second resting time. The active cervical ROM, muscle tone, and muscle stiffness of the cervical region of each group was measured and compared before and after the intervention. Results: The active cervical ROM of both groups significantly improved after the intervention (p<.05). However, no significant differences in the cervical active ROM, cervical muscle tone, and muscle stiffness were observed between two groups. Conclusion: The application of sling with cervical spine lateral mobilization is an intervention method that can be effectively used to improve the physiological movement of the neck, as well as cervical muscle tone and stiffness.

Background: Forward head posture (FHP) causes various posture imbalances associated with the head and neck. Myofascial release is an effective treatment method used for relaxing muscles and reducing muscle hyperactivity, but no studies have been conducted on suboccipital and neck muscles related to FHP. Objects: The purpose of this study was to investigate the immediate effect of roller massages on the cranio-cervical flexion (CCF) range of motion (ROM) and CCF strength applied to suboccipital and neck muscles in subject with forward head posture. Methods: Twenty-four FHP subjects (male: 13, female: 11) were recruited for this study. All subjects were recruited with a craniovertebral angle (CVA) of 53 degrees or less and a head tilt angle (HTA) of 20.66 degrees or higher. CCF strength was measured using Pressure biofeedback unit (PBU) in the supine posture and CCF ROM was measured using smartphone-based inclinometer. Roller massage (RM) was applied to suboccipital and neck muscles for 2 minutes and CCF ROM and strength were remeasured. Results: These results of this study showed that CCF ROM was a significant difference in CCF ROM before and after RM (p < 0.05). CCF strength also showed a significant difference before and after RM (p < 0.05). Conclusion: RM method might be recommended to increase the immediate ROM and strength of CCF in subjects with forward head posture.

Background: Deep learning related research works on website medical images have been actively conducted in the field of health care, however, articles related to the musculoskeletal system have been introduced insufficiently, deep learning-based studies on classifying orthopedic manual therapy images would also just be entered. Objectives: To create a deep learning model that categorizes cervical mobilization images and establish a web application to find out its clinical utility. Design: Research and development. Methods: Three types of cervical mobilization images (central posteroanterior (CPA) mobilization, unilateral posteroanterior (UPA) mobilization, and anteroposterior (AP) mobilization) were obtained using functions of ‘Download All Images’ and a web crawler. Unnecessary images were filtered from 'Auslogics Duplicate File Finder' to obtain the final 144 data (CPA=62, UPA=46, AP=36). Training classified into 3 classes was conducted in Teachable Machine. The next procedures, the trained model source was uploaded to the web application cloud integrated development environment (https://ide.goorm.io/) and the frame was built. The trained model was tested in three environments: Teachable Machine File Upload (TMFU), Teachable Machine Webcam (TMW), and Web Service webcam (WSW). Results: In three environments (TMFU, TMW, WSW), the accuracy of CPA mobilization images was 81-96%. The accuracy of the UPA mobilization image was 43~94%, and the accuracy deviation was greater than that of CPA. The accuracy of the AP mobilization image was 65-75%, and the deviation was not large compared to the other groups. In the three environments, the average accuracy of CPA was 92%, and the accuracy of UPA and AP was similar up to 70%. Conclusion: This study suggests that training of images of orthopedic manual therapy using machine learning open software is possible, and that web applications made using this training model can be used clinically.

Background: It is reported that the proprioceptive sensation of patients with neck pain is reduced, and neck sensory-motor control training using visual feedback is reported to be effective. Objects: The purpose of this study is to investigate how sensorimotor control training for the cervical spine affects pain, function, and psychosocial status in patients with chronic cervical pain. Methods: The subjects consisted of 36 adults (male: 15, female: 21) who had experienced cervical spine pain for more than 6 weeks. An exercise program composed of cervical stabilization exercise (10 minutes), electrotherapy (10 minutes), manual therapy (10 minutes), and cervical sensorimotor control training (10 minutes) was implemented for both the experimental and the control groups. The cervical range of motion (CROM) and head repositioning accuracy were assessed using a CROM device. In the experimental group, the subjects wore a laser device on the head to provide visual feedback while following pictures in front of their eyes; whereas, in the control group, the subjects had the same training of following pictures without the laser device. Results: There were no statistically significant differences between the two groups in pain, dysfunction, range of motion, or psychosocial status; however, post-test results showed significant decreases after 2 weeks and 4 weeks compared to baseline (p < 0.01), and after 4 weeks compared to after 2 weeks (p < 0.01). The cervical joint position sense differed significantly between the two groups (p < 0.05). Conclusion: In this study, visual feedback enhanced proprioception in the cervical spine, resulting in improved cervical joint position sense. On the other hand, there were no significant effects on pain, dysfunction, range of motion, or psychosocial status.

Background: Forward head posture (FHP) is common postural malalignment. FHP is described relatively extension to upper cervical and lower cervical is relatively flexion. Although several researchers mentioned the lower cervical flexion posture in FHP, most of the studies related to FHP is focused on the deep cervical flexor function. Objects: The purposes of present study is to compare the cervical strength (upper cervical extension [UCE], lower cervical extension [LCE], upper cervical flexion [UCF], lower cervical flexion [LCF]) between individuals with and without FHP. Methods: Fifty-one participants are recruited. Participants who have the craniovertebral angle (CVA) less than 48 degree were classified to the FHP group (n = 24) and the others were included in without FHP group (n = 27). The cervical strength (UCE, LCE, UCF, LCF) were measured using Smart KEMA strength sensor and the strength data was normalized by body weight. All strength measurement conducted at head and neck neutral position in sitting. Independent t-test was used to compare the cervical strength between individuals with and without FHP. Results: The mean value of CVA was greater in without FHP group than with FHP group (p < 0.000). The strength value of UCF (p < 0.002) and LCE (p < 0.001) was significant less in FHP group than without FHP group. But no significant differences were seen in the LCF and UCE strength between two groups. Conclusion: UCF and LCE weakness in FHP group should be considered to evaluate and manage the individuals with FHP.

Background: Adults with forward head posture (FHP) often suffer from thoracic hyperkyphosis and thoracic dysfunction, and including reduction of the craniovertebral angle (CV angle) and tightening of the superficial neck muscles. In order to treat thoracic dysfunction, interventions aimed at improving thoracic mobility are necessary. Objectives: To examine the effects of maitland manual mobilization therapy on the thoracic spine in adults with FHP. Design: Single-blind randomized controlled trial. Methods: Thirty adults with FHP who met the selection criteria were randomized to the thoracic multiple joint mobilization (TMJM; n=15) group and the thoracic general joint mobilization (TGJM; n=15) group. Joint mobilizations were performed for 23 minutes a day for 4 weeks continuously, two times per week. Outcome measures were ImageJ, BTS FREE EMG 1000, neck disability Index (NDI). Results: Although changes in the left sternocleidomastoid muscle activity and NDI scores over time between the two groups differed, other variables were noted only changes observed over time. Muscle activity in the right sternocleidomastoid increased again in the TGJM group post-intervention and 2 weeks after the end of the experiment, but changes in other variables were retained or improved, confirming the lasting effects of thoracic joint mobilization. Conclusion: Thoracic multiple joint mobilization may be recommended as a more effective intervention for adults with FHP.

Background: There is an opinion that improper postures of the head and cervical spine are associated with temporomandibular joint (TMJ) disorders (TMDs). Objects: The aim of this study was to investigate the proportions among the cervical kyphotic angle, physical symptoms including the pain intensity level of the TMJ, and severity of TMD disability in patients diagnosed with TMD. Methods: Sixty-two subjects participated in the study. The evaluation tools included measurements of the cervical kyphotic angle based on the Ishihara index, pressure pain threshold (PPT) on the TMJ, maximal mouth opening (MMO) without pain, current pain intensity level of the TMJ measured using the Quadruple Visual Analogue Scale (QVAS), Korean TMD (KTMD) disability index, KTMD Symptom Frequency/Intensity Scales (SFS/SIS), and Korean Headache Impact Test-6. Correlation analysis was conducted to investigate the correlations between the cervical kyphotic angle and parameters related to TMJ symptoms. Results: Variables that were significantly correlated with the cervical kyphotic angle were the PPT around the TMJ (r = 0.259, p < 0.05), current pain intensity level of the TMJ based on the QVAS (r = –0.601, p< 0.01), and usual pain intensity level based on the SIS (r = –0.379, p < 0.01). The level of TMD functional disability was significantly correlated with the degree of headache (r = 0.551, p < 0.01), level of PPT of the TMJ (r = –0.383, p < 0.01), pain-free MMO (r = –0.515, p < 0.01), pain intensity level of the TMJ based on the QVAS (r = 0.393, p < 0.01), TMD symptom frequency (r = 0.739, p < 0.01), usual pain intensity of the TMJ (r = 0.624, p < 0.01), and most severe pain intensity of the TMJ (r = 0.757, p < 0.01). Conclusion: There is a positive correlation between the cervical kyphotic angle and PPT and a negative correlation between the current and usual pain intensity levels of the TMJ. The cervical kyphotic angle was a predictor of the pain level, tenderness threshold, and intensity of pain in the TMJ.

Background: Mobilization and cranio-cervical flexion exercise has been reported in reducing pain from cervical part and improving its motor function; also, has been represented that alleviate of neck pain and recover of neck muscles improve the normal gait performance. However, few studies have identified the effects of mobilization and exercise on pain and gait parameters with preceding issues. Objective: To examine the effects or changes of pressure pain threshold (PPT) and gait parameters in patients with chronic neck pain. Design: Cross-Sectional Clinical Trials Methods: Twenty patients with the history of neck pain (>3 months) performed the cervical mobilization and cranio-cervical flexion exercise. Gait parameters were assessed with wireless device and collected data were transmitted to the personal computer via Bluetooth. The PPT was measured posteroanterior direction at the prone position and the mean of subsequent three PPT measurements was used for the final analysis. Results: Both cervical central posteroanterior mobilization (CCPAM) (p<.000) and sling-based cranio-cervical flexion exercise (SBCCFE) (p<.000) group showed a significant increase in the PPT and the gait parameters, cadence (p<.023), was significantly increased in the CCPAM group, however slightly increased in the SBCCFE group. The comparison between the CCPAM and the SBCCFE groups after treatment did not show significant differences for the score on the PPT and gait parameters. Conclusions: This study suggests that CCPAM and SBCCFE increase PPT, cadence, and gait speed.

Histiocytic necrotizing lymphadenitis (Kikuchi-Fujimoto disease, KFD) is a benign self-limiting lesion that can self-heal when no severe symptoms are present. KFD resembles tuberculous lymphadenitis and malignant lymphoma. Thus, early differential diagnosis will minimize unnecessary evaluation and treatment. Histological examination of a lymph node biopsy or fine needle aspiration could be a reliable method for KFD diagnosis. This study reports a case of histiocytic necrotizing lymphadenitis of the right cervical lymph node in a 52-year-old female patient. According to the fine needle aspiration biopsy result, the patient was diagnosed with Kikuchi-Fujimoto disease and treated with prednisolone (15 mg/day). After treatment, there was no recurrence or adverse event.

The International Headache Society (IHS) has validated cervicogenic headache (CGH) as a secondary headache type that is hypothesized to originate due to nociception in the cervical area. CGH is a common form of headache and accounts for 15% to 20% of all chronic and recurrent headaches. CGH is commonly treated with manual and exercise therapy. To date, no studies have isolated only one manual intervention in an attempt to determine its effectiveness. In this case study we present a 28-year-old patient with right upper cervical (UC) and occipital pain who responded well to a single manual intervention technique. This technique was applied in isolation for the first three visits and two therapeutic exercises prescribed on the fourth and fifth visit. In total, manual and exercise intervention occurred over 8 visits at which point in time the patient was discharged with no UC motion impairments, an NPRS rating of 0, a NDI and HDI demonstrating a 100% improvement and a 37% improvement in FOTO score. The traction based manual intervention and two therapeutic exercises prescribed for this patient were successful in relieving UC pain and CGH. At six months follow up, the patient was still symptom free.