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: 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: 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: 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.

The aim of the present study was to compare the effects of Rolfing and Swedish massage. In total, 105 patients with cervical myofascial pain syndrome were divided into two groups based on the intervention: a 40-min Rolfing session (n = 52) or a 40-min Swedish massage session (n = 53). Pre- and pos-tintervention visual analog scale (VAS) scores for pain, muscle tone (Myoton F), muscle elasticity (Myoton D), and muscle stiffness (Myoton S) were measured to compare treatment effects between the two groups. The results revealed a significant decrease in the VAS score for pain, Myoton F, and Myoton S (p < .05), with no change in Myoton D (p > .05), after the intervention in the Rolfing group. Similar findings were obtained for the Swedish massage group. Intergroup comparison of the degree of improvement after the intervention revealed no significant difference for any variable. The findings suggest that both group indicated a similar decrease in pain, muscle tension, and muscle stiffness after the intervention, with no significant improvement in muscle elasticity.

Background: For the treatment of forward head posture (FHP) and forward shoulder posture, methods for strengthening scapular retractors and deep cervical flexors and stretching pectoralis and upper cervical extensors are generally used. No study has yet assessed whether suboccipital release (SR) followed by cranio-cervical flexion exercise (CCFE) (SR-CCFE) will result in a positive change in the shoulders and neck, showing a “downstream” effect. Objects: The purpose of this study was to investigate the immediate effects of SR-CCFE on craniovertebral angle (CVA), shoulder abduction range of motion (ROM), shoulder pain, and muscle activities of upper trapezius (UT), lower trapezius (LT), and serratus anterior (SA) and LT/UT and SA/UT muscle activity ratios during maximal shoulder abduction in subjects with FHP. Methods: In total, 19 subjects (7 males, 12 females) with FHP were recruited. The subject performed the fifth phase of CCFE immediately after receiving SR. CVA, shoulder abduction ROM, shoulder pain, muscle activities of UT, LT, and SA, and LT/UT and SA/UT muscle activity ratios during maximal shoulder abduction were measured immediately after SR-CCFE. A paired t-test and Wilcoxon signed-rank test were used to determine the significance of differences in scores between pre- and post-intervention in the same group. Results: The CVA (p<.001) and shoulder abduction ROM (p<.001) were increased significantly postversus pre-intervention. Shoulder pain was decreased significantly (p<.001), and LT (p<.05) and SA (p<.05) muscle activities were increased significantly post- versus pre-intervention. The LT/UT muscle activity ratio was increased significantly post- versus pre-intervention (p<.05). However, there was no significant change in UT muscle activity and SA/UT muscle activity ratio between pre- and post-intervention (p˃.05). Conclusion: SR-CCFE was an effective intervention to improve FHP and induce downstream effect from the neck to the trunk and shoulders in subjects with FHP.

The purpose of this study is to investigate effects of Maitland orthopedic manipulative physiotherapy and stretching on pain, cervical range of motion, and muscle tone of adults with forward neck posture. A total 40 subjects were divided into a Maitland OMPT group(n=20) and a stretching group(n=20), performing joint mobilization exercise and stretching three times per week for six weeks. As for changes in pain, statistically significant decrease were found before and after the exercise within group comparison( p<.01), while no statistically significant difference was observed between-group comparison. In changes in cervical range of motion before and after the exercise, the Maitland OMPT group showed statistically significant increase(p<.01) in flexion, (left lateral flexion(p<.05), extension, left rotation, right rotation, and right lateral flexion, while the stretching group showed statistically significant increase(p<.05) in extension(p<.01), left rotation, left lateral flexion, right rotation, and right lateral flexion. However, no significant differences in between group comparison in flexion, extension, right rotation, left rotation, right lateral flexion and left lateral flexion. The results of measuring muscle tone changes showed that the Maitland OMPT group and the stretching group did not show significance in within and between group comparison(p<.05). In conclusion, the Maitland OMPT and stretching were effective on improving pain and range of motion.

This case report describes the effectiveness of cervical corrective exercises in a patient with cervical radiculopathy (CR) who experienced radicular pain, upper limb paresis, and limited functional activity. A 39-year-old male with cervical radiculopathy performed the cervical corrective exercises for reducing pain. Pain intensity, cervical posture, and active range of motion of cervical intersegmental spine motion were measured baseline, after 4 weeks, and after 8 weeks with self-reported questionnaire and radiographs. After 8 weeks of intervention, the patient demonstrated alleviated radicular symptoms, improved neck posture and active range of flexion and extension of the cervical intersegmental spine. Especially in the angle between the cervical vertebra 6 and 7, the angle was changed from -4.69° to 3.30° during resting position after intervention. The present case indicates that the cervical corrective exercises might be a possible treatment to effectively reduce radicular symptoms, improve neck posture, and active cervical intersegmental motion for patient with CR.

The purpose of this study is to provide fundamental clinical data for the treatment plan and rehabilitation of patients with cervical hypolordosis by comparing the cervical headache and muscle activity after cervical stretching exercise and cervical traction, which are generally applied to patients with cervical hypolordosis. The research subjects included 20 patients without gender division who were diagnosed with cervical hypolordosis. After applying cervical stretching exercise and cervical traction for six weeks, cervical headache and the activity of the muscles around the cervical vertebra(upper trapezius muscle, sternocleidomastoid muscle, splenius capitis muscle, and anterior temporal muscle) were investigated and the following results were obtained. In a comparison of the within group intervention effects of the two groups, cervical pain statistically significantly decreased in the cervical stretching exercise group. According to the results of analyzing the change of muscle tension in the upper trapezius muscle, both the cervical traction group and showed a statistically significant within group difference in the left and right side. According to the results of analyzing the change in the muscle tension of the splenius capitis muscle, both groups showed a statistically significant within group difference in the left and right side. In a betweengroup comparison, a statistically significant difference in the right side was observed. These results confirm that cervical vertebra traction and cervical stretching exercise decrease the cervical headache and muscle activity of the upper trapezius muscle and the splenius capitis muscle among patients with cervical hypolordosis.

This study aimed to determine the effect of lower trapezius muscle strengthening exercises on pain, neck disability index (NDI), cervical range of motion (ROM), and lower trapezius muscle strength in patients with unilateral neck pain. Following baseline measurements, the subjects (N=40) with unilateral neck pain were randomized into one of two 5 weeks exercise intervention groups: a experimental group (EG, n1=20) that received strength training of the lower trapezius muscles or a control group (CG, n2=20) that received routine physical therapy program. Each group participated in the intervention for 30 minutes, 3 times a week, for 5 weeks. All participants performed 2 repetitions of each intervention per day. The numeric pain rating scale for pain, NDI, ROM, and lower trapezius strength were recorded both pre- and post-intervention for both groups. Paired t-tests were used to determine significant changes post-intervention compared with pre-intervention and independent t-tests were used to analyze differences in the dependent variables between the 2 groups. After the 5-weeks intervention, both groups experienced significantly decreased pain and disability level (p<.05) and significantly increased cervical flexion, extension, lateral flexion, and rotation ROM (p<.05). The EG that received strength training of the lower trapezius muscles showed greater improvements in pain and functional disability level, cervical rotation, and lower trapezius strength than the CG (p<.05). These results suggest that a lower trapezius strengthening exercises reduce neck pain and neck disability level and enhance cervical ROM and lower trapezius strength level in patients with unilateral neck pain.

The purpose of this study was to investigate the effects of smartphone use on muscle fatigue and tenderness in the cervical erector spinae (CES) and the upper trapezius (UT) and on the cervical range of motion among subjects with and without neck muscle pain. The subjects were 30 smartphone users in their 20 s who -were assigned to either an experimental group with neck muscle pain or a control group without neck muscle pain. Muscle fatigue and tenderness in the CES and the UT as well as the subjects’ cervical range of motion were measured before and after 20-min smartphone sessions in a sitting position. In a between-group comparison of muscle fatigue, the experimental group showed a significantly greater decrease in median frequency in the CES and the right UT after smartphone use (p<.05). Regarding the assessment of muscle tenderness after smartphone use, the experimental group showed a statistically significant decrease in the pressure-pain threshold (PPT) in all muscles (p<.05), whereas the control group showed a significantly decreased PPT in the right CES and the UT (p<.05). The assessment of the cervical range of motion revealed a statistically significant reduction in the cervical flexion-extension and left lateral flexion in the experimental group (p<.05) after smartphone use. However, there was no significant change in the cervical range of motion in the control group (p>.05) after smartphone use. When compared with the control group, the experimental group demonstrated greater changes in cervical extension, lateral flexion, and rotation, except for cervical flexion (p<.05). In conclusion, when smartphone users have pre-existing neck muscle pain, the use of a smartphone further increased muscle fatigue and tenderness in the neck and reduced PPT and the cervical range of motion.

This study compared the stability of the cervical spine according to the presence of neck pain and deep neck flexor performance. Thirty subjects with neck pain, and thirty subjects without neck pain were recruited for this study. The Cranio-cervical flexion (CCF) test was applied using a pressure biofeedback unit to classify the subjects into four subgroups; no cervical pain and good deep neck flexor performance (NG group), no cervical pain and poor deep neck flexor performance (NP group), cervical pain and good deep neck flexor performance (PG group), and cervical pain and poor deep neck flexor performance (PP group). The head sway angle was measured using a three-dimensional motion analysis system. A 3-kg weight was used for external perturbation with the subject sitting in a chair in the resting and erect head positions with voluntary contraction of the deep neck flexors. A one-way analysis of variance (ANOVA) was performed with a Bonferroni post hoc test. The deep neck flexor performance differed significantly among the four groups (p<.05). The NG group had significantly greater deep neck flexor performance than NP and PP groups. The stability of the cervical spine also differed significantly among the four groups in the resting head position (p<.05). The head sway angle was significantly smaller in NG group as compared with the other groups. The PP group had the greatest head sway angle in the resting head position. However, there was no significant difference in the stability of the cervical spine among the groups in the erect head position with voluntary contraction of deep neck flexors (p=.57). The results of this study suggest that the deep neck flexor performance is important for maintaining the stability of cervical spine from external perturbation.

The purpose of this study was to identify the effects of manipulation on the velocity of cerebral blood flow and level of pain in cervicogeinc headache patients. The velocity of cerebral blood flow of 30 cervicogeinc headache patients(male=15, female=15, age=24.00±3.60) and 33 normal subjects(male=15, female=18, age=23.27±3.00) was compared. The 30 cervicogeinc headache patients were divided into suboccipitalis relaxation group, cervical manipulation group, and placebo group, and each were given different interventions. The velocity of cerebral blood flow and pain level was measured before intervention, and 1, 2, 3 weeks after intervention. The velocity of cerebral blood flow was measured with the Transcranial Doppler(TCD), and pain level was measured with visual analog scale(VAS). Blood flow velocity of middle cerebral artery in cervicogeinc headache patients was slower than those in healthy subjects. Physical therapy intervention did not have significant effect on velocity of cerebral blood flow, but slowly decreased at intervention for pain level increased. The suboccipitalis relaxation group and cervical manipulation group showed significant effect in decreasing pain level compared to the placebo group(p＜.05). Directly applied manipulation therapy in the neck area not only has effect on joint of cervical and soft tissue but also on blood vessels and nerves which pass the neck area, and because of those results of manual therapy seems to help recovery.

The conclusions of this study are based on the analysis of clinical observations and treatments of twenty two patients who have received acupucture treatment, physical therapy and herbal medication in the Wonkwang Oriental Hospital from 8st march 2000yr to 11nd Jauary 2001yr. The results were analyzed as follows : Background and Purpose : To evaluate the effect of treatment for cervical pain by using acupucture treatment, physical therapy and herbal medication. Object and Methods : Evaluated the result of oriental medical treatment with cervical pain at Ik-San Oriental medical hospital in affiliation with wonkwang university. Results : 1. In the distribution of treatment periods, the most frequent cases were "one to two week" with 8cases (36.36%). 2. In the analysis of the radiation result, HIVD and Degenerative change respectively were 9 cases (21.96.8%). 3. The effect of treatment by ses & age was as follows : "Exellent" was the most number of 40&50 generation and "Good", "Improved" was the most number of 30&60 generation. 4. The effect of treatment by duration was as follows : 1-2week was the most improved highly. 5. In the distribution of treatment progression : 9cases (40.90%) were "good". 7cases (31.82%) were "excellent". 6cases (27.27%) were "fair". Conclusions : These results shows that the effect of treatment by acupucture treatment, physical therapy and herbal medication is exellent by relaxing contracted muscles, strengthening weakened ligaments and improving inflammatory parts.