Effect of therapeutic exercise on functional disability and quality of life in patients with forward head posture and neck pain: a meta-analysis / 中国康复理论与实践

ObjectiveTo systematically analyze the effect of therapeutic exercise on neck function and quality of life in patients with neck pain and forward head posture. MethodsRandomized controlled trials about the effects of exercise training on forward head posture and neck pain were searched from PubMed, Web of science, Embase, Medline, Science Direct, EBSCO, Springlink, CNKI, VIP, and Wanfang Data from database establishment to April, 2022. The literature was screened by two researchers independently. Cochrane bias risk assessment tool and Physiotherapy Evidence Database Scale were used to evaluate the quality of the included articles. Revman 5.4 software was used for meta-analysis. ResultsA total of 416 patients from eleven literatures were included. Level 1a evidence indicated scapula stability training could effectively improve cranial vertebral angle (MD = 3.62, 95%CI 2.41 to 4.83, P < 0.001), and relieve pain (MD = 1.32, 95%CI 0.18 to 2.46, P = 0.02). Level 1b evidence indicated scapula stability training could reduce functional disability (MD = -0.92, 95%CI -1.11 to -0.74, P < 0.001). Level 1b evidence indicated deep cervical flexor training could improve cranial vertebral angle (MD = -0.83, 95%CI -1.56 to -0.10, P = 0.03), relieve pain (MD = 0.93, 95%CI 0.54 to 1.32, P < 0.001), and improve neck functional disability (MD = 2.17, 95%CI 1.39 to 2.95, P < 0.001). ConclusionScapula stability training and deep cervical flexor training can effectively improve cranial vertebral angle, relieve neck pain, and improve neck function.

Efeito da manipulação visceral na postura da cabeça para frente em sujeitos com dor pescoço crônica não específica - um estudo piloto / Effect of visceral manipulation on forward head posture in subjects with chronic non-specific neck pain ­ a pilot study

INTRODUÇÃO: A postura anterior da cabeça é considerada o desequilíbrio postural musculoesquelético mais comum, causando protrusão da cabeça anterior ao tronco. Os órgãos internos são interconectados e fixados posteriormente à coluna por meio das membranas de suporte. A tensão nessas membranas de suporte pode ainda causar restrições mecânicas, afetando a mobilidade do órgão visceral e a estrutura musculoesquelética associada em um mecanismo de mão dupla. OBJETIVO: Explorar o efeito da manipulação visceral específica de órgão na postura, incapacidade, força e dor em indivíduos com dor cervical crônica inespecífica. De acordo com a hipótese deste estudo, a manipulação visceral tem como objetivo explorar o efeito da manipulação da fáscia específica do órgão na postura, incapacidade, força e dor em indivíduos com dor cervical crônica inespecífica. MATERIAL E MÉTODO: cinco indivíduos com dor cervical inespecífica crônica com postura anterior da cabeça foram recrutados usando o método de amostragem de conveniência. Este estudo foi conduzido em um departamento de Fisioterapia de um hospital multi-especializado reconhecido, Mohali. Os indivíduos foram encaminhados após o diagnóstico de dor cervical crônica dos departamentos. Uma única sessão de manipulação visceral placebo foi administrada na primeira semana, seguida de uma única sessão de manipulação visceral da cúpula pleural e ligamentos pericárdicos na segunda semana. Aplicação móvel de tela de postura (postura), unidade de biofeedback de pressão (ativação muscular), Índice de Incapacidade Pescoço e Escalas Visuais Analógicas foram utilizados para medir os resultados pré e pós. RESULTADO: a comparação entre os grupos do desfecho mostrou diferença estatisticamente significativa na EAV (p = 0,001), aplicação da triagem postural (p = 0,02) e NDI (p = 0,07). Não foram observadas mudanças significativas no desfecho força. CONCLUSÃO: Sessão única de manipulação visceral da cúpula pleural e ligamentos pericárdicos pode se beneficiar na melhora da postura anterior da cabeça, incapacidade cervical e redução da dor.

INTRODUCTION: Forward head posture is considered to be the most common musculoskeletal postural imbalance causing protrusion of head anterior to trunk. Internal organs are interconnected and attached posteriorly to the spine through the support membranes. Tension in these support membranes may further cause mechanical restrictions, thereby affecting the mobility of the visceral organ and associated musculoskeletal structure in a two-way mechanism. OBJECTIVE: To explore the effect of organ-specific visceral manipulation on posture, disability, strength, and pain in subjects with chronic non-specific neck pain. According to this study hypothesis visceral manipulation aim to explore the effect of organ-specific fascia manipulation on posture, disability, strength, and pain in subjects with chronic non-specific neck pain. MATERIAL AND METHOD: Five subjects with chronic non-specific neck pain with forwarding head posture were recruited using a convenience sampling method. This study was conducted in a Physiotherapy department of a recognized multispecialty hospital, Mohali. Subjects were referred after diagnosis from chronic neck pain from the departments. A single session of placebo visceral manipulation was administered in the first week, followed by a single session of visceral manipulation of the pleural dome and pericardial ligaments in the second week. Posture screen mobile application (posture), Pressure biofeedback unit (muscular activation), Neck Disability Index, and Visual Analog Scales were used to measure the pre and post outcomes. RESULT: Between-group comparison of the outcome showed a statistically significant difference in the VAS (p=0.001), Posture screening application (p=0.02), and NDI (p=0.07). No significant changes were observed in the strength outcome. CONCLUSION: Single session of visceral manipulation for the pleural dome and pericardial ligaments may benefit in improving the forward head posture, neck disability and reducing the pain.

Efecto del entrenamiento de fuerza con característica socializadora y lúdica sobre la depresión en adultos mayores con anteposición de cabeza y cuello / Effect of strength training with socializing and playful characteristics on depression in older adults with forward head posture

RESUMEN Objetivo: El propósito de este estudio fue evaluar el efecto de un entrenamiento de fuerza con característica socializadora y lúdica sobre la depresión en adultos mayores con anteposición de cabeza y cuello de la ciudad de Talca (Chile). Material y métodos: Este estudio longitudinal se realizó en Club del Adulto Mayor de la ciudad de Talca. Participaron 132 sujetos que se dividieron en tres grupos de 44: dos grupos experimentales y un grupo control. A un grupo experimental se aplicó entrenamiento de fuerza convencional para la anteposición de cabeza y cuello; al otro grupo experimental se le realizó entrenamiento de fuerza con característica socializadora y lúdica; al grupo control se le realizó una evaluación inicial y final. Se aplicaron 2 sesiones semanales durante 4 meses a ambos grupos experimentales. Todos los participantes cumplieron los criterios de inclusión y exclusión: adultos mayores > 60 años, ángulo craneovertebral < 50 grados, índice de masa corporal con sobrepeso y obesidad tipo 1, sin patologías de columna vertebral. Resultados: Hubo cambios estadísticamente significativos en el grupo que recibió entrenamiento de fuerza con característica socializadora y lúdica sobre la disminución de la depresión (P < 0.05), y se obtiene un promedio de 3.6 puntos de disminución de la escala de depresión posterior a los 4 meses de entrenamiento. Conclusión: El entrenamiento de fuerza con característica socializadora y lúdica fue efectivo en un 72 % en la disminución de la depresión en los adultos mayores con anteposición de cabeza y cuello de la ciudad de Talca.

ABSTRACT Objective: The purpose of the study was to evaluate the effect of strength training with a socializing and playful characteristic on depression in older adults with forward head posture in the city of Talca (Chile). Material and methods: This longitudinal study was carried out in the Senior Adult Club of the city of Talca. 132 subjects participated, which were divided into three groups of 44: two experimental groups and one control group. Conventional strength training for forward head posture was applied to one experimental group, the other experimental group underwent strength training with socializing and playful characteristics, the control group underwent an initial and final evaluation. Two weekly sessions were carried out for 4 months in both experimental groups. All the participants fulfilled the inclusion and exclusion criteria: older adults > 60 years, craniovertebral angle < 50 degrees, body mass index with overweight and type 1 obesity, without spinal pathologies. Results: There were statistically significant changes in the group that received strength training with a socializing and playful characteristic on the decrease in depression (P <0.05), obtaining an average of 3.6 points of decrease in the depression scale after 4 months of training. Conclusion: Strength training with a socializing and playful characteristic was 72 % effective in reducing depression in older adults with forward head posture in the city of Talca.

The Effects Of Smartphone Addiction On Childrens Cervical Posture And Range Of Motion

Background: This study examined the effects of smartphones addiction on cervical posture, and compared the cervical range of motion (ROM) between addicted and non-addicted boys and girls 8 to 13 years of age. Methods: Twenty-four boys and 26 girls were assigned to 2 groups; addicted group (score > 32, n=32) and non-addicted group (score ≤ to 32, n=18). Craniovertebral Angle (CVA) was assessed using side view photographs, forward head posture (FHP) was measured using ImageJ 64 software, and cervical ROM in each direction was measured using a cervical (CROM) device. Results: A forward multiple regression showed that addiction score and body mass index (BMI) were significant predictors of CVA (R2 =0.31, p<0.001). Twenty-three percent of the variability in CVA was related to addiction score. A forward logistic regression showed that addiction to smartphone use and BMI were significant predictors of having FHP, and participants who were addicted were more than four times as likely to have FHP than those who were not: Odds Ratio (OR) with 95 % confidence interval (CI)=4.5 (1.2, 10.7), p= 0.03. A significant reduction was found in mean cervical angle in addicted versus non-addicted boys (49.4±6.7 vs. 55.5±7.6,η2=0.5, p=0.03) and girls (47.3±6.3 vs. 52.9±6.1,η2=0.9, p=0.02). A significantly more limited cervical ROM found in most neck movements in addicted participants with FHP compared to participants without FHP. Conclusion: Children who are addicted to smartphones may develop faulty habitual posture due to constant neck flexion downward, which may place them at high risk of spine abnormalities.

Comparison of Vital Capacity and Balance between Elderly Women and Young Women with Forward Head Postures According to the Use of Figure-8 brace

PURPOSE: To improve pulmonary function and decrease in balance ability with increasing forward head position and vertebral curvature, we applied Figure-8 brace to confirm the immediate effect on vital capacity and balance and to see if it is applicable. METHODS: A total of 34 elderly women aged 65 or older and young women in their 20s with FHP were screened to measure vital capacity, measuring the forced expiratory volume in 1 second (FEV1) and forced vital capacity (FVC), and measuring the foot pressure to see the change in balance. For statistical analysis, the difference between pre and post values was compared using pared t-test. RESULTS: As a result of vital capacity measurements, there was no significant difference between FEV1 and FVC for women over 65 years old (p>0.05). Young women in their 20s had no significant difference in FEV1 (p>0.05), and FVC had significant differences (p<0.05). In measuring foot pressure to measure balance, both women aged 65 and above and young women in their 20s had a significant decrease in anterior foot pressure, and a significant increase in posterior foot pressure (p<0.05). CONCLUSION: The results of this study did not positively affect the vital capacity of elderly women with FHP. However, the significant increase in vital capacity of young women in their 20s suggests that contraction of the abdominal muscle is necessary during forced expiration. Therefore, it is believed that proper application and therapeutic interventions should be combined when applying Figure-8 brace.

The Effect of Postural Correction and Visual Feedback on Muscle Activity and Head Position Change During Overhead Arm Lift Test in Subjects with Forward Head Posture

PURPOSE: This study aimed to investigate the immediate effects of posture correction and real-time visual feedback using a video display on muscle activity and change of head position during overhead arm lift test in individuals with forward head posture. METHODS: Fifteen subjects with forward head posture and fifteen normal subjects who volunteered were included in this study. During both groups performed the overhead arm lift test, the muscle activity of the upper trapezius, serratus anterior, sternocleidomastoid, and lower trapezius muscle were measured using electromyography, and head position change was measured using photographs. Then, forward head posture group was asked to perform overhead arm lift test again after posture correction and real-time visual feedback using a video display respectively. One-way analysis of variance (ANOVA) was used to analyze four conditions: pre-test, posture correction, real-time visual feedback, and the control group. RESULTS: The upper trapezius and lower trapezius muscle activity significantly decreased posture correction, real-time visual feedback, and control group than pre-test of forward head posture group (p<0.05). The sternocleidomastoid muscle significantly decreased real-time visual feedback and control group than pre-test of forward head posture group. Head position change significantly decreased three conditions than pre-test of forward head posture group and real-time visual feedback and control group significantly decreased than posture correction. CONCLUSION: This study recommend for maintaining cervical stability during the overhead arm lift test, postural control using real-time visual feedback is more effective in subjects with forward head posture.

The Effect of Visual Feedback of Head Angles With Using a Mobile Posture-Aware System on Craniocervical Angle and Neck and Shoulder Muscles Fatigue During Watching the Smartphone

PURPOSE: To find the effect of visual feedback of head angle with using a mobile posture-aware system on craniocervical angle and neck and shoulder muscles fatigue for preventing or decreasing the forward head posture. METHODS: Twenty-four healthy young adults in Chungbuk to participate in this study. The subjects started to watch a movie clip for 10 minutes with visual feedback in 0°, 30°, and 60° of head angles. During the task, surface electromyography (EMG) was used to collect data from the upper trapezius (UT), sternocleidomasetoid muscle (SCM), cervical erecter spinae (CES) during watching the smartphone. Craniocervical angles were measured using a sagittal-view photograph of the subject in a sitting posture. A one-way repeated analysis of variance with a significant level of 0.05 used for statistical analysis. RESULTS: Craniocervical angle with 0° visual feedback was significantly greater than 30°and 60°. Craniocervical angle with 30° visual feedback was significantly greater than 60°. In addition, MDF of UT muscles in 0° and 30° of visual feedback was significantly greater than 60°. CONCLUSION: We concluded that 0° visual feedback of head angle with using a mobile posture-aware system would be beneficial to prevent or decrease forward head posture during watching a smartphone. We also could recommend using of 30° visual feedback in case of caring UT muscle fatigue primarily.

The Effect of Forward Head Posture and Tension Type Headache on Neck Movement: For Office Worker

PURPOSE: This study examined the effects of the forward head posture and tension type headache on neck movement among office workers. METHODS: The subjects were 6 male and 21 female patients composed of a forward head posture group, forward head posture group with a tension type headache and a normal group. Each group consisted of 2 males and 7 females. The cranio-vertebral angle of the head and the angle of motion of the neck were measured. SPSS 23.0 was used for data analysis and one-way ANOVA was performed for the mean comparison of the neck movements in the three groups. RESULTS: The participants had a limitation in the movement of all necks between the forward head posture group and forward head posture with tension type headache group compared to the normal subjects. The forward head posture with tension headache group had limited neck extension and lateral bending compared to the forward head posture group. CONCLUSION: Office workers have limitations in the movement of the neck when they are accompanied by forward head posture and tension headache. In particular, when accompanied with a tension headache, there is a restriction on the neck extension and side bending. This study is expected to provide basic data for the relief of tension headache and the treatment of forward head posture in office workers.

Effect of Scapular Brace on the Pulmonary Function and Foot Pressure of Elderly Women with Forward Head Posture

PURPOSE: Changes in the curvature of the vertebral columns of elderly women with increasing age causes various side effects and disorders. Therefore, this study was conducted to evaluate the effectiveness of the 8-figure scapular brace to improve pulmonary function and balance ability based on lung capacity and foot pressure by increasing the vertebral curvature. METHODS: Seventeen elderly women with a forward head posture were selected. Women were asked to wear the 8-figure scapular brace and the forced expiratory volume in 1 second (FEV1) and forced vital capacity (FVC) were measured, as were changes in foot pressure. Measurements were conducted three times each and the mean values were used for subsequent analyses. For static evaluation, we used the paired t-test to identify differences between pre and post values. RESULTS: There was no significant difference in FEV1 and FVC before and after use of the brace (p>0.05); however, there was a significant decrease in forefoot pressure and an increase in rearfoot pressure following application of the brace (p < 0.05). CONCLUSION: Application of the 8-figure scapular brace to correct vertebral curvature in elderly women influenced pressure distribution change from immediate effect body arrange of cervical and thoracic. However, wearing the 8-figure scapular brace may interfere with expansion of the chest and therefore respiratory muscle activity. Accordingly, it is necessary to apply appropriate treatment when wearing a scapular brace and to allow a sufficient intervention period while also providing therapeutic interventions such as posture correction or respiration training.

To study correlation between neck pain and cranio-vertebral angle in young adults

Introduction: Neck pain is a common disorder. Poor posture might result in muscular imbalance that causes a faulty relationship among various body parts. Forward head posture is one of the most common cervical abnormalities that predispose individuals toward pathological conditions, such as headache, neck pain, and temporomandibular disorders. Aim: The aim of the study was to find the relationship between CV angle and neck pain. Materials and method: 50 patients were evaluated and included in the study. They were evaluated for pain using Numerical Pain Rating Scale (NPRS) and the forward head posture was assessed by measuring CV angle. The total duration of the study was 6 months. Analysis was done using SPSS Version 20. Results: Spearman’s correlation test was used to find correlation between CV angle and neck pain and the r value was found to be -0.731 with the level of significance 0.01. Conclusion: A moderate to good negative correlation was found between CV angle and neck pain.

Effect of Self-Postural Control with Visual Feedback in the Foot Pressures in the Subject with Forward Head Posture

PURPOSE: The purpose of this study was to investigate the effect of self-postural control on foot pressure in subjects with forward head posture. METHODS: Forty-two healthy adults were recruited in this study. Participants were divided into two groups: The forward-head postural (FHP) group (craniovertebral angle0.05). CONCLUSION: We suggest that cervical posture control using visual feedback has a positive effect on the distribution of foot pressure in subjects with forward head posture.

Correlation of non-traumatic neck pain with cervical angle and shoulder retractor power in adult clerical population.

Background: A forward head posture (or chin poking) is perhaps the most common abnormality associated with NP and is commonly defined as the protrusion of the head in the sagittal plane so that the head is placed anterior to the trunk. Forward head posture can occur because of an anterior translation of the head, lower cervical flexion, or both, and it is claimed to be associated with an increase in upper-cervical extension. It is suggested that forward head posture leads to an increase in the compressive forces on the cervical apophyseal joints and posterior part of the vertebra and to changes in connective tissue length and strength (because of stretching of the anterior structures of the neck and shortening of the posterior muscles) resulting in pain. The objective of the study was to correlate neck pain with cervical angle and shoulder retractor power in non-traumatic neck pain patients. Methods: 50 clerical workers having non traumatic neck pain were included. Neck pain was measured on VAS, cervical angle was measured using photometric method and shoulder retractor power was measured. Results: VAS showed moderate positive correlation with cervical angles (0.63 and 0.72) and moderate negative correlation with shoulder retractor power (-0.59 and -0.71). A moderate positive correlation of craniocervical angle to VAS seen (0.66) whereas there was negative correlation with shoulder retractors I and II (-0.59 and -0.61) A positive correlation was seen between VAS and craniocervical angle but is moderately negative with shoulder retractors I (Rhomboids) and II (Middle trapezius) (0.78, 0.04, -0.69 and -0.64). Conclusion: A moderate increase in cranio vertebral & craniocervical angle showed plausible weakness in lower Trapezius and rhomboids among clerks` having Non-traumatic neck pain.

Cabeza hacia adelante: una mirada desde la biomecánica y sus implicaciones sobre el movimiento corporal humano / Forward head: a biomechanical perspective and its implications for the human body movement

Las condiciones ergonómicas de mobiliario y de equipos, como también la postura incorrecta al estar en posición sedente, de pie o cargando algún peso pueden generar dolores o complicaciones osteomusculares. Dentro de estas, la cabeza hacia adelante es una alteración común detectada en la evaluación postural realizada por los fisioterapeutas. Esta suele asociarse a cambios mecánicos del cuello y columna vertebral, los cuales alteran la funcionalidad de los individuos, causándole discapacidad pues compromete el movimiento de hombros, la movilidad de la articulación temporomandibular, la mecánica respiratoria, desarrollando imbalances musculares, mareos, disfunción vestibular, aumenta el riesgo de fracturas y se asocia con procesos dolorosos como la cervicalgia, dorsalgia y lumbalgia. Por tanto el siguiente artículo tiene por objetivo revisar la fisiopatogénia de la cabeza hacia adelante, desde una perspectiva biomecánica, analizando las implicaciones de esta alteración postural sobre el movimiento corporal humano, proporcionando así herramientas de análisis para el abordaje fisioterapéutico.

The ergonomics of furniture and equipment, as well as improper posture when in a sitting position, standing or carrying some weight can cause pain or musculoskeletal complications. Within these, the forward head is a common alteration detected in the postural assessment by physiotherapists. This is often associated with mechanical changes of the neck and spine, which alters the functionality of individuals, causing disability movement as committed shoulders, temporomandibular joint mobility, respiratory mechanics, developing muscle imbalances, dizziness, vestibular dysfunction, increases the risk of fractures and is associated with painful conditions such as neck pain, dorsal pain and back pain. So the following article is intended to review the pathophysiology of forward head, from a biomechanical perspective, analyzing the implications of this postural change on human body movement, providing analysis tools for addressing physiotherapy.

Forward Head Posture: Relationship between Spinal Alignment Indicies and Myoelectrical Activities of the Paraspinal Muscles

OBJECTIVE: We evaluated the effects of forward head posture on the myoelectrical activities of the paraspinal muscles. METHOD: 15 healthy persons who were pain-free and didn't have the history of neuromuscular disease were participated in this study. Measurements were taken in three different sitting positions (relaxed, erect and forward head posture) with staring forward and arms hanging at the side. Paraspinal myoelectrical activities were measured by surface electrodes in paracervical, paralumbar, sternocleidomastoid (SCM) and levator scapular (LS) muscles. Simultaneously whole spine lateral X-ray including skull was taken. We measured cranio-cervical spinal alignment indicies (craniovertical, craniocervical, cervicohorizontal and upper cervical angles) introduced by Huggare and Gonzalez, lower cervical angle, lumbar lordosis angle and myoelectrical activity of each muscle in three different sitting positions. RESULTS: The analysis of relationship between lumbar lordosis and cranio-cervical spinal alignment index showed significant results. The more the lumbar lordosis increased, the head forward displacement decreased. But, the myoelectrical activities of paraspinal muscles were not influenced by the posture. CONCLUSION: Maintaining lumbar lordosis is very important to correct forward head posture and research for the distraction force loaded to soft tissue of the neck in forward head posture is needed.