This study was conducted to examine the effects of Evjenth-Hamberg stretching of the sternocleidomastoid, upper trapezius, and pectoralis major on the lung function of adults with forward neck posture. The subjects were 20 adult students in P university located in Pohang, Korea, whose degree of head forward displacement measured according to NEW YORK state posture test was mild. The subjects were randomly and equally assigned to the Evjenth- Hamberg Stretching group (EHSG, n=10) and the control group (CG, n=10). Their forced vital capacity (FVC), slow vital capacity (SVC), and maximal voluntary ventilation (MVV) were measured before and after the experiment. In within-group comparison, only the EHSG experienced statistically significant improvement in FVC, forced expiratory volume in the first second (FEV1), and peak expiratory flow (PEE) after the experiment, compared to before the experiment (.05<p). In between-group comparison, the PEE of EHSG was statistically significantly higher than CG (.05<p). Regarding SVC, only the EHSG experienced statistically significant improvement in inspiratory vital capacity after the experiment, compared to before the experiment. With regard to MVV, only the EHSG experienced statistically significant improvement in their tidal volume during maximal voluntary ventilation after the experiment compared to before the experiment. Our results indicated that Evjenth- Hamberg stretching was an effective physical therapy intervention to improve the lung function of adults with FHP by correcting their head forward displacement.

To examine the changes in pain, the severity of the neck disorder, craniovertebral angle, and muscle activity in young adults with forward head posture. 37 “N” University students in their 20s with forward head posture, including both male and female participants. Measurement of pain, NDI (neck disorder index) craniovertebral angle, and muscle activity were taken before and after the 6 week intervention period. The pain was measured using the visual analog scale. The severity of the neck disorder was measured using the NDI The craniovertebral angle was measured by taking a photo. The muscle activity was measured using surface electromyography. Neck posture correction exercises paired with proprioceptive training is the most effective intervention for reducing pain. Both neck posture correction exercises paired with Kinesio taping or proprioceptive training are effective interventions for addressing neck disability, craniocervical angle, and muscle activity. Neck posture correction exercises paired with Kinesio taping or proprioceptive training are more effective at addressing pain, neck disorder, craniocervical angle, and muscle activity than performing the neck posture correction exercises alone.

The purpose of this study was to identify the effect of upper thoracic mobilization on cervical alignment in stroke patients with forward head posture. The subject's of this study were two stroke patients with forward head posture and a cervical curve angle (four-line Cobb's method; FLCM) less than 40°. The intervention, central posterior-anterior (PA) mobilization, was applied to the T1-T4 vertebrae (upper thoracic spine) following the Maitland concept. This mobilization was applied three times per week for four weeks. In the results, the cervical curve angle (FLCM) increased for both subject 1 and 2. However, Jochumsen method score was decreased in subject 1, while it was increased in subject 2. These results demonstrate that upper thoracic mobilization had the positive effect on the cervical curve angle but not on Jochumsen method score. These findings suggest that PA mobilization on the upper thoracic spine could correct cervical curve angle measured by FLMC in stroke patients with FHP.

This study was conducted to examine the effect of joint mobilization on forward head posture and to propose an effective method to improve correct body posture and balance. A total of eight patients from a Maitland-applied group (n=8) received mobilization therapy to increase the mobility of the cervical joint, with Maitland's movement grade III intensity for 30 seconds of treatment and 30 seconds of rest, for ten intervals, three times a week for four weeks. The craniovertebral angle (CVA) changes before and after the intervention with the Maitland technique were measured as 56.85 ± 2.31° before, 63.23 ± 2.23° two weeks after, and 64.98 ± 1.27° four weeks after joint intervention. There were significant CVA changes before and after the Maitland technique (P <.05). The results of this study suggest that the Maitland technique is useful for improving the head vertebral angle in patients with forward head posture

Background: The craniocervical flexion (CCF) exercise is one of the effective exercise in correcting forward head posture (FHP). However, some people with FHP achieve CCF with compensatory movements, for example, low cervical flexion using superficial neck flexors such as the sternocleidomastoid (SCM) muscle. No study has yet investigated whether a dualpressure biofeedback unit (D-PBU) method to prevent low cervical flexion would be helpful in performing pure CCF movement. Objects: The purpose of this study was to compare the effects of the CCF using D-PBU method and the traditional CCF method on the cross-sectional area (CSA) of the longus colli muscle (LCM) and the activity of SCM muscle in subjects with FHP. Methods: Twentyfour FHP subjects (male: 16, female: 8) were recruited for this study. All subjects performed CCF using two different methods: The traditional CCF method and the CCF using D-PBU method. The CSA of the LCM was measured via ultrasound, and surface electromyography was used to measure SCM muscle activity. Results: The change in CSA of the LCM was significantly larger during the CCF using D-PBU method (1.28±.09) compared with the traditional CCF method (1.19±.08) (p<.05). The SCM muscle activity using the CCF using D-PBU method (2.01±1.97 %MVIC) was significantly lower than when using the traditional CCF method (2.79±2.32 %MVIC) (p<.05). Conclusion: The CCF using D-PBU method can be recommended for increasing LCM activation and decreasing SCM muscle activity during CCF movement in subjects with FHP.

The purpose of this study was to investigate the effects of strengthening and stretching exercises on forward head angle and static·dynamic balance ability. 21 adults with the forward head posture were participated in this study. Subjects were randomly assigned to strengthening exercise group I(n=11) and stretching exercise group II (n=10) respectively. Each group were underwent six intervention over the period of 2 weeks, each session lasting 30 minutes. During a preliminary examination, forward head angle and static∙dynamic balance were measured, and a post examination was conducted that involved same procedure as preliminary examination. There were significant differences in forward head angle after exercise in both groups. In the strengthening group, center of gravity total sway distances was significantly changed under all conditions. In the stretching group, center of gravity total sway distances was significantly changed when subjects had their eyes open while standing on an foam surface. There were significant changes in center of gravity sway velocities in the strengthening group under all conditions, and the same was true in the stretching group only when the subjects had their eyes open while standing on an foam surface. In the comparison between groups, eyes closed while standing on a firm surface was significantly different. There was a significant difference in dynamic balance of the stretching group when the subjects tilted their bodies forward, and there was a statistically significant difference between groups under the same condition. The results of this study suggest that forward head posture can be corrected through therapeutic exercise, and muscle strengthening exercise more effective in improving static balance of forward head posture more than stretching exercise.

The purpose of this study was to identify the effects of cervical alignment, pain, and physique to apply proprioceptive neuromuscular facilitation( PNF) techniques in patients with forward head posture (FHP). The subjects of this study were 24 patients diagnosed with FHP. They were randomly divided into two groups: a PNF group(n=12) and a control group(n=12). The intervention was performed a total of 24 times, 30 min a day, six times a week for four weeks. Data on cervical alignment(forward head displacement, FHD), pain(visual analog scale, VAS), and physique(height, weight, and body mass index) were obtained pre- and post-intervention. Two-way repeated measures ANOVA was used to compare the groups and time. For FHD, the VAS, and physique(height and BMI), there was an interaction effect for the groups and time(p<.001, BMI: p<.05) and main effects for time(p<.001, BMI: p<.05). For weight, there were main effects of time(p<.01). For FHD(p<.01) and the VAS(p<.05), there were main effects for the groups. In the PNF group, there were significant improvements in FHD, VAS, and physique. In the control group, there was a significant increase in FHD. The results of this study indicated that PNF intervention using scapular and upper extremity patterns effective in FHP positively. The use of a therapeutic intervention on physique changes may also be effective in improving poor posture and help to better patients’ quality of life.

The purpose of this study was to investigate the effects of occipital bone stimulation by cervical stabilizing exercise on the muscle tone, stiffness, ROM, and cervical lordosis in patient with forward head posture( FHP). This study was a case study of a single patient with forward head posture. This study used a ABA' design, A and A' were the baseline phases and B was the intervention phase. The intervention was occipital bone stimulation by cervical stabilization exercise. It was administered once daily for 7 days. The therapist kept hands together, and placed the two index fingers under the subject's occipital bone. The subject performed the chin-in exercise with a maximum isometric contraction for 20 sec.The exercise was implemented by performing the movements 10 times as a set and repeating the set three times. The muscle tone was not significantly changed after intervention. However, the stiffness was decreased and lasted the effect lasted without intervention. The cervical flexion angle was increased, but the cervical extension angle was not significantly changed after the intervention. The left and right lateral flexion angles were increased and the effect lasted without any intervention. However, the left and right rotation angles were significantly changed after the intervention. Cervical lordosis increased not from 37° to 41° after the intervention. These results suggest that occipital bone stimulation by cervical stabilizing exercise had a positive effect on cervical stiffness, flexion and lateral flexion ROM, and lordosis in a patient with forward head posture.

Background: A forward head posture (FHP) is one of the most common types of poor head posture in patients with neck disorder. A prolonged FHP might increase pressure on the posterior cranio-cervical structure and exhibit reduced performance on a cranio-cervical flexion test (CCFT). CCFT is included to activate deep cervical flexor muscles and inhibit excessive activation of superficial cervical flexor muscles. Therefore, the selective activation of deep cervical flexors is needed for effective exercise for FHP. Objects: The purpose of this study was to compare muscle thickness between longus colli (Lco) and sternocleidomastoid (SCM) using ultrasonography in subjects with FHP depending on head support. Methods: This was a cross-sectional, case-control research design study. The ultrasonographic images of Lco and SCM were taken in 17 subjects with FHP during the 5 phases of the CCFT with and without a head support. Towel was used for supporting head to make the neutral head position in supine. Changes in muscle thickness during the test were calculated to infer muscle activation. Data were analyzed using repeated measures of two-way analysis of variance with the significance level of .05. Results: When subjects performed the CCFT with head support, there was a significant difference in muscle thickness of Lco and SCM (p<.05). According to a post hoc paired t-test, change of thickness of Lco was greater at all phases, and change of thickness of SCM muscle was less at phase 4 and 5 in condition with head support (p<.01) compared to condition without head support (p<.01). Conclusion: The result of this study suggest that applying head support for neutral head position during CCFT could be a useful method for activating Lco muscle without excessive activation of SCM muscle.

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 was to identify the effects of continuous muscle strengthening applied to the antagonist of the sternocleidomatoid, upper trapezius, and pectoralis major, which are the shortened muscles of forward head posture(FHP) subjects, and Evjenth-Hamberg stretching(EHS) applied to the shortened muscles on changes in pressure pain threshold(PPT). Twenty subjects were divided into the continuous antagonist strengthening( CAS) group(n=10) and the EHS group(n=10), and each group performed its respective exercise three times a week for a six week period. The results were as follows: The comparison of changes in PPT within each group before and after the treatment showed a statistically significant difference( p<.05) according to the treatment period and a statistically significant difference according to the treatment period and method(p<.05). While the comparison of the tests of between subjects effects between the groups did not show a statistically significant difference, the CAS group exhibited better effects. The above results suggest that the combined application of CAS and EHS generates better effects on changes in PPT than the single application of EHS. Given that stretching and muscle strengthening exercises even for the short research period of six weeks could change the PPT, continuous exercises and a correct postural habit for a longer period of time are likely to help prevent chronic pain and correct FHP

This study compared the effects of the initial head position (i.e., a HHP versus a relaxed head position) of subjects with and without a FHP on the thickness of the deep and superficial neck flexor muscles during CCF. The study recruited 6 subjects with a FHP and 10 subjects without a FHP. The subjects performed CCF in two different head positions: a HHP, with the head aligned so that the forehead and chin formed a horizontal line, and a relaxed head position (RHP), with the head aligned in a self-selected comfortable position. During the CCF exercise, the thickness of the longus colli (LCo) and the thickness of the sternocleidomastoid (SCM) were recorded using ultrasonography. The thickness of each muscle was measured by Image J software. The statistical analysis was performed with a two-way mixed-model analysis of variance. The thickness of the SCM differed significantly (p<.05) between the subjects with and without FHP. According to a post hoc independent t-test, the change in thickness of the SCM increased significantly during CCF in the subjects with FHP while adopting a HHP compared to that in the subjects without FHP. The change in thickness of the SCM was not significantly different between the two positions in subjects without FHP, and there was no significant change in thickness of the LCo muscle during the CCF exercise according to the initial position in both subjects with and without FHP. The results suggest that CCF should be performed in RHP to minimize contraction of the SCM in subjects with a FHP.

This research was conducted to investigate the effect of continuous antagonistic muscle strengthening exercise and Evjenth-Hamberg stretching on the pulmonary function of university students with abnormal transformation of forward head posture(FHP). The results of study subject to the continuous antagonistic muscle strengthening(CAS) group(n=10) and Evjenth- Hamberg stretching(EHS) group(n=10) that was conducted 3 times a week for 6 weeks are as follow. FVC, IVC, and MVV all were shown to be significant in the pre·post comparison between the CAS group and EHS group(p<.05), and significant difference was shown for MW between the two groups(p<.05) in which the CAS group showed better effect. Based on the results above, it is considered that combining continuous antagonistic muscle strengthening exercise has better effect on pulmonary function compared to application of only Evjenth-Hamberg stretching.

Although the relationship between temporomandibular disorder and forward head posture (FHP) is controversial, it is generally accepted that altered head posture can affect mandible position and masticatory muscles activity. Because suprahyoid (SH) and infrahyoid (IH) muscles are stretched by increased passive tension in FHP, this study investigated their activity during mouth opening in FHP compared to neutral head posture (NHP). Twenty healthy subjects (10 males and 10 females) participated in this study. Head postures were evaluated with a cervical range of motion instrument. Electromyography (EMG) activity of bilateral SH and IH muscles was measured while an open mouth was maintained at each head posture. Paired t-test was used to identify significant differences in normalized EMG activity between head postures. Statistical significance was set at .01. Results showed the normalized EMG activity of SH and IH muscles were significantly lower in FHP compared to NHP. This finding indicates that FHP affects the EMG activity of hyoid muscles when they are stretched.

This study aims to reveal the impact of continuous antagonist strengthening( CAS) and Evjenth-Hamberg stretching(EHS) on the cervical mobility in the university students with abnormal transformation of forward head posture( FHP). Our experiment was conducted 3 times a week for 6 weeks in a total of 20 individuals : continuous antagonist strengthening(CAS) group(n=10) & Evjenth-Hamberg stretching(EHS) group(n=10). In a pre and post comparison, both CAS group and EHS group appeared significantly in mSBI and SBA(p<.05) and the two-group comparison showed a significant difference(p<.05) : CAS group showed better effects. Thus, it is considered that the combined use with continuous antagonist strengthening(CAS) had better effects for cervical mobility than Evjenth-Hamberg stretching(EHS) alone.

Work-related musculoskeletal disorder has been associated with long hours of computer work and prolonged periods of static posture. In clinical settings, postural correction is a common treatment approach for individuals with neck, shoulder, and back pain. This study was designed to identify the effect of Forward Head Posture Correctional Device during computer work. Twelve healthy adults (mean age, 27.4 yrs; mean height, 165.0cm mean weight, 65.8 kg) participated in the study. They had no medical history of neurological or surgical problems with their upper extremity. The subjects were asked to perform Head Forward Posture under the guidance of physical therapists and the measured angles were analyzed using a 3-D motion analysis system. Markers were placed on the C7 spinous process, tragus of the ear and forward head angle was between the line from the tragus to the C7 line and the Y-axis at the C7. The statistical significance of difference between, "without" and "with" correctional device was tested by paired t-test. A level of significance was set at α=.05. In comparison of the computer work between "without" and "with" correctional device, Forward Head Angle was showed significant difference (p<.05). In conclusion, the range of Forward Head Angle was significantly decreased during computer work with the correctional device. Further research is needed to understand the nature of motor control problems in deep muscles in patients with neck, shoulder, and back pain.

The purpose of this study was to determine the intra-rater and inter-rater reliability of various forward head posture measurements. Ten healthy adults (age, 20.4±2.2 yrs; height, 164.0±5.5 ㎝; weight, 58.7±7.3 ㎏) participated in the study. They were free of injury and neurologic deficits in the upper extremities and neck at the time of testing. The subjects were asked to perform head forward posture by under the guidance of physical therapists. Markers were placed on the C7 spinous process, mastoid process, tragus of the ear, outer canthus, and forehead. Measurement 1 for forward head posture assessment was measured as the angle between the horizontal line through C7 and the line connecting the C7 spinous process with the tragus of the ear. Measurement 2 was measured as the angle between the C7 spinous process, the mastoid process and the outer canthus. Measurement 3 was measured as two kinds of angles the HT (head tilt) angle is between the line from the midpoint of forehead to the tragus line and Y-axis at the tragus point. The NF (neck flexion) angle is between the line from the tragus to the C7 line and the Y-axis at the C7. Intra-rater, inter-rater reliability and coefficient of variation was assessed by comparing the measured values from three kinds of measurements of forward head posture. The intra-rater reliability was indicated by intraclass correlation coefficients [ICC(1,1)] and inter-rater reliability was shown by intraclass correlation coefficients [ICC(3,k)]. The results of study were as follows: ICC(1,1) values for intra-rater reliability of three measurements were in the 'excellent' category. ICC(3,k) values for inter-rater reliability of three measurements were also in the 'excellent' category. The coefficient of variation of method 2 had a lower value than method 1 and method 3. This data means that the measured value of method 2 was less scattered. Further research is needed to determine whether the validity of all measurements is revealed in the 'excellent' category.

경추관절의 부정렬로 인한 두부전방자세를 가진 대상자에게 관절가동술을 적용 후 경추관절의 자세변화와 기능에 영향을 미치는지 알아보고자 한다. 대상자들은 경상북도 G대학 학생 39명 중 경부관절가동술그룹 20명, 가동술을 적용하지 않은 그룹 19명을 나누어서 실시하였으며, 대상자들은 방사선 사진 촬영을 한 후 그 중 경추전만각(cervical lordosis angle)이 21°이하이고, 머리의 전방무게부하(anterior weight bearing, AWB)가 15㎜이상이며, 경추 신전 관절가동범위(extension ROM)가 70°이하인 대학생을 선별하여 자발적 동의를 구하였다, Mulligan 기법(1995) 중 SNAGS로 경추 신전과 굴곡 운동을 주당 3회, 4주간 통증이 있는 관절을 치료사가 지속적인 종속활주운동(sustained accessory glide)을 적용하는 동안 환자가 능동적으로 관절운동을 각 회마다 천천히 8회 정도 적용하였다. 측정 방법은 방사선 검사와 경부장애지수를 통해 실시하였다. 실험 결과 두부전방자세 대상자에게 경부관절가동술 적용 후 경부관절가동술군에서 경부의 AWB와 ARA, 굴곡신전범위 변화, NDI에 대한 변화가 있음을 알 수 있었다. 대조군에서는 거의 변화가 없었다. 결론적으로 관절가동술 적용이 경부관절의 자세개선을 향상시키는데 영향을 미친 것으로 나타났고, 또한 두경부의 기능개선에서도 도움이 된 것으로 나타났다.