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.

Background: Round shoulder posture, results from excessive flexed posture of the thorax, is defined as a position of scapular protraction, anterior tipping, and downward rotation. However, previous studies have focused on only passive position of the thorax during scapular posterior tilting (SPT) and have not reported on SPT combined with correction of flexed posture. Objects: The aim of this study was to compare effects of SPT and SPT with prone trunk extension (SPT + PTE) on activities of the lower trapezius, serratus anterior, and thoracic erector spinae and degree of posture in subjects with round shoulder and flexed posture. Methods: Fifteen subjects with round shoulder and flexed posture were recruited. The caliper was used to measure the degree of round shoulder and flexed posture. Electromyography was performed to collect data of muscle activities. Paired t-test was used to compare two exercise (α=.05). Results: When SPT + PTE was applied, the degree of round shoulder posture (p=.001) and flexed posture (p=.039) significantly decreased compared with that when SPT was applied. The lower trapezius activity significantly increased in the SPT + PTE condition compared with that in the SPT condition (p=.026). There were no significant differences in serratus anterior activity between SPT + PTE and SPT. The thoracic erector spinae activity significantly increased in the SPT + PTE condition compared with that in the SPT condition (p=.014). Conclusion: SPT + PTE might be one of the effective methods to enhance activities of lower trapezius and thoracic erector spinae, and to reduce round shoulder posture and flexed posture in subjects with round shoulder and flexed posture.

본 연구는 스탠스 자세와 운동면의 차이가 어깨돌림동작 시 활동근의 %MVIC를 비교분석하여 어깨강화운동을 위한 기초자료를 제공하는데 목적이 있다. 남성 8명을 무선배정하여 두발지지 자세, 한발지지 자세, 런지자세와 이마면, 수평면, 시상면에서 회전동작을 10회씩 수행하였다. 수행 중 가시위근, 가시아래근, 작은원근, 앞세모근, 배곧은근, 척수세움근, 큰가슴근, 넓은등근의 근활성도를 측정하였다. SPSS 22.0 통계프로그램을 사용하여 반복측정 일원분산분석(repeted one-way ANOVA)을 실시하였다. 첫째, 이마면에서 바깥돌림 동작 시 척추세움근은 두발지지 자세와 한발지지 자세보다 런지자세에서 높게 나타났고 안쪽돌림 동작 시 가시위근은 두발지지 자세보다 한발지지 자세, 한발지지 자세보다 런지자세에서 높게 나타났다. 둘째, 수평면에서 바깥돌림 동작 시 앞세모근은 두발지지 자세보다 한발지지 자세과 런지자세에서 높게 나타났고 안쪽돌림 동작 시 가시아래근은 두발지지 자세와 한발지지 자세보다 런지자세에서 높게 나타났으며, 큰가슴근에서는 한발지지 자세보다 두발지지 자세, 한발지지 자세보다 런지자세가 높게 나타났다. 셋째, 시상면 바깥돌림 동작 시 배곧은근은 두발지지 자세보다 한발지지 자세와 런지자세에서 유의하게 높게 나타났다. 안쪽돌림 동작 시 가시위근은 두발지지 자세보다 한발지지 자세와 런지자세에서 높게 나타났고 가시아래근은 두발지지 자세와 한발지지 자세보다 런지자 세에서 높게 나타났다. 배곧은근에서 두발지지 자세와 런지자세보다 한발지지 자세에서 높게 나타났고 척추세움근은 한발지지 자세보다 두발지지 자세와 런지자세에서 높게 나타났다. 결론적으로 스탠스와 어깨의 운동면의 차이가 어깨위팔관절의 돌림운동 시 활동근들의 근활성도에 미치는 영향은 스탠스자세와 운동면에 따라서 다른 양상이 나타났으며, 이를 어깨 강화 운동프로그램에 적용한다면 보다 긍정적 효과를 기대할 수 있는 운동프로그램이 될 것으로 생각 된다.

Background: High string instrument (violin, viola) players are at high risk for developing musculoskeletal problems. In particular, a higher prevalence of shoulder problems has been reported. However, evidence of the effectiveness of therapeutic exercise for musicians with this condition is lacking until now. Objects: This case series study investigated the effect of a specific exercise program on shoulder pain, dysfunction, and posture of professional orchestral high string musicians. Methods: Five professional orchestral high string players with shoulder pain participated in this study. A six-week specific exercise program focus on scapular stability for shoulder pain consisted of scapular muscle exercise. Physical examinations for pain and dysfunction, posture were performed, were identified among all subjects before starting the exercise program. Results: The results revealed that shoulder pain decreased by 67.86% and the effect of pain on instrument play decreased by 63.33%. The shoulder pain and disability Index and the performing arts module-quick disability of the arm, shoulder and hand scale decreased by 71.72% and 51.61% respectively. The exercise program improved function and posture. Conclusion: A specific exercise program for high string players was effective in managing shoulder pain. This case series is intended to provide empirical data on the effectiveness of an exercise program aimed at assessing the effect of exercise on pain, dysfunction, and posture of professional orchestra musicians associated with specific instrument groups.

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

The purpose of this study was to examine the immediate effect of neck stabilization exercise and Swiss ball exercise on the recovery from the fatigue of neck muscles induced. The turtleneck posture was set artificially by using Smartphone with healthy adults. Repetitively measured ANOVA was executed to examine the changes in the muscle fatigue of sternocleidomastoid, upper trapezius, and splenius capitis among three-time intervals (at the time of general resting, work and after intervention) in the three intervention groups (neck stabilization exercise group, Swiss ball exercise group, and ordinary rest group). There were no significant differences in the changes of fatigue of sternocleidomastoid muscle among all three intervention groups at the time of general resting, work and after intervention (p>.05). Although there was no significant difference in the changes in the fatigue of upper trapezius and splenius capitis muscles between the intervention groups at the time of general resting and work (p>.05), there was the significant difference between the three intervention groups at the time of work and after intervention (p>.05). This study suggest that Swiss ball exercise is more effective in reducing the muscular fatigue of the neck and shoulder at a turtleneck posture than neck stabilization exercise.

Postural instability can increase the likelihood of hazardous slip and fall accidents in workplaces. The present study intended to extend understanding of the effect of abnormal neck posture on postural control during quiet standing. The effect of body fatigue on the postural control was also of primary concern. Twelve healthy undergraduate students volunteered to participate in the experiment. Standing on a force platform with the neck neutral, flexed, extended, or rotated, subjects’ center of pressures (COP) were measured under the two levels of body fatigue. For the fatigue condition, Subjects exercised in a treadmill to meet the predetermined level of body fatigue. Analyzing the position coordinates of COPs, the length of postural sway path was assessed in both medio-lateral (ML) axis and anterior-posterior (AP) axis. Results showed that, in AP direction, neck extension or rotation significantly increased the sway length as compared with neck neutral. Neck extension led to greater sway length compared to neck rotation. Neck flexion did not differ from neck neutral. The sway length in the AP direction also became significantly larger as the body fatigue accumulated after treadmill exercise. In ML direction, as compared to neutral posture, the neck extension, flexion, or rotation did not significantly affect the length of postural sway path. However, the sway length seemed to increase marginally with the neck extended during the fatigued condition. This study demonstrates that abnormal neck posture may interfere with postural control during standing. The ability to maintain postural stability decreases significantly with the neck extended or rotated. Body fatigue leads to postural instability further.

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.

Background: Sitting posture influences movements of scapulothoracic and glenohumeral joints and changes the shoulder muscle activities. The development and maintenance of correct sitting posture is important for the fundamental treatment of shoulder pain during rehabilitation. Objects: The purpose of this study was to investigate the effects of the sitting postures and the shoulder movements on shoulder muscle activities for both male and female. Methods: Twenty-eight subjects without shoulder-related diseases participated in this experiment. The subjects had randomly adopted three different sitting postures (upright posture, preferred posture, maximum slouched posture) and shoulder flexion angles in scapular plane (30˚, 90˚, 120˚). Surface electrodes were collected from upper trapezius (UT), anterior deltoid (AD), and posterior deltoid (PD) and the active shoulder range of motion was measured in each sitting posture and shoulder flexion angle. Results: The active range of motions of the shoulder external rotation and the flexion in the scapular plane decreased from the upright posture to the maximum slouched posture (p<.05, mixed-effect linear regression with random intercept, Tukey post-hoc analysis). All muscles showed the highest EMG activities at 120˚ shoulder flexion with the maximum slouched posture and did not show the gender differences. Conclusion: Increased shoulder muscle activities may become the potential risk factor for the shoulder impairment and pain if people continuously maintain the maximum slouched posture. Therefore, an upright position is necessary during shoulder exercises, as well as in activities of daily living, including motions involving lifting the arms.

The purpose of this study was to identify the effects of shoulder stabilization exercises and stretching on shoulder height and muscle activity in young adults with rounded shoulder posture. The subjects were young adults with rounded shoulder posture, and divided into two groups: shoulder stabilization exercises and stretching exercises. The shoulder stabilization exercise group performed Thera band exercises and stretching exercises. The stretching exercise group performed stretching exercises. The groups performed the exercises for 40min, three times a week for four weeks. Shoulder height was measure by Vanier calipers and muscle activity was measured by electromyography. Shoulder height was significantly decreased in both groups after intervention, however there was no difference between groups. There was a significant difference in muscle activity between the two groups after the intervention, however there was no difference between the groups. This study suggests that shoulder stabilization exercise and stretching affect shoulder height and muscle activity.

Background: Scapular posterior tilt (SPT) is important in the prevention of abnormal scapular movement and pain during elevation of the arm. However, previous studies have overlooked increased upper trapezius (UT) muscle activity interrupting the normal force couple of scapular motion and compensation of levator scapulae (LS) muscle activated simultaneously with UT during SPT exercise. Objects: The purpose of this study was to compare the effects of modified SPT with depression exercise versus SPT exercise on serratus anterior (SA), lower trapezius (LT), UT, and LS muscle activities and the clavicular tilt angle, in subjects with rounded shoulder posture (RSP) and myofascial pain in the UT muscle region. Methods: Eighteen subjects with RSP were recruited and randomly allocated to 2 groups; 9 in the SPT group and 9 in the SPT with depression group. All subjects met the specific RSP criteria and had myofascial pain of UT region. Depending on the allocated group, subjects performed the assigned SPT exercise and EMG data were recorded during the each exercise. Clavicular tilt angle was defined as the angle between the line joining the medial and lateral end of the clavicle and a horizontal line. Results: The SA muscle activity was significantly greater in SPT with depression than with SPT exercise (p<.05). The UT, LS muscle activity and the clavicular tilt angle was significantly lower in SPT with depression than with SPT exercise (p<.05). Conclusion: These findings were insightful because the potential risk of pain from overactivation of the UT and LS was considered, in contrast with SPT exercise. SPT with depression exercise can be implemented as an effective method to facilitate scapular muscle activity for stability and to prevent myofascial pain in the neck and shoulder.

Background:Rounded shoulder posture (RSP), a postural abnormality, might cause shoulder pain and pathologic conditions. Although most previous research has investigated RSP focusing on the proximal structures of the shoulder, such as the scapula and pectoralis muscles, the relationship between RSP and anterior distal structures of the upper extremity, such as the biceps brachii muscle and elbow joint, is not clearly understood.Objects:This study aimed to investigate the correlations between RSP and the biceps brachii length, elbow joint angle (EJA), pectoralis minor length, general pectoralis major length, humeral head anterior translation (HHAT), glenohumeral internal rotation (IR), external rotation (ER), and horizontal adduction (HAD).Methods:Twelve subjects with RSP (6 male, 6 female) were recruited. All subjects fulfilled the RSP criteria indicated by a distance ≥2.5 cm from the posterior aspect of the acromion to the table in the supine position. The examiner measured each of the following parameters twice: RSP, biceps brachii length, EJA, pectoralis minor length, pectoralis major length, HHAT, glenohumeral IR, ER, and HAD. Pearson’s correlation coefficient(r) was used to assess the correlation between RSP and all the variables.Results:There was a significant moderate positive correlation between RSP and biceps brachii length (r=.55, p=.032), moderate negative correlation between RSP and pectoralis minor length (r=-.62, p=.015), and moderate positive correlation between RSP and HHAT (r=.53, p=.038).Conclusion:The biceps brachii length, pectoralis minor length, and HHAT could be used to evaluate patients with RSP. Better understanding of the correlation between these factors and RSP could help in the development of effective methods to treat patients with this condition in clinical management.

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: Recently, there has been an emphasis on the use of interventions with biofeedback information for the maintenance or correction of posture. Objects: This study assessed the change of trunk posture and trunk muscle activation when people exhibiting postural kyphosis performed visual display terminal work with or without a contact feedback device (CFD). Methods: Eighteen right-handed individuals were recruited. Thoracic angle and right thoracic erector spinae (TES) muscle amplitude were analyzed. There were two sessions in these experiments. The control session involved 16 minutes of typing without a CFD, and the CFD session involved 16 minutes of typing with a CFD. The visual analog scale score was analyzed with a paired t-test, and the kinematic and electromyography data were analyzed through two-way repeated analysis of variance. Results: The paired t-tests revealed that subjects had significantly less pain after the CFD sessions than after the control sessions (p<.05). Significant main effects by session and by time were observed in the thoracic kyphosis angle (p<.05). There was a significant session×time interaction for TES amplitude (p<.05), along with significant main effects by session and by time (p<.05). Conclusion: The CFD caused people with postural kyphosis to straighten and to activate their TES continuously, even though they were habituated to bend their bodies forward. Therefore, the CFD was a beneficial treatment tool

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.