Search Results (27)

Background/Objectives: A randomized controlled trial (RCT) was designed to test the emerging role of respiratory mechanics as part of physiotherapy in patients with non-specific chronic neck pain (NSCNP). Methods: Ninety patients with NSCNP and symptom duration >3 months were randomly allocated to three intervention groups of equal size, receiving either cervical spine (according to the Mulligan Concept) and diaphragm manual therapy plus breathing reeducation exercises (experimental group—EG1), cervical spine manual therapy plus sham diaphragmatic manual techniques (EG2), or conventional physiotherapy (control group—CG). The treatment period lasted one month (10 sessions) for all groups. The effect on the cervical spine range of motion (CS-ROM) and on the craniovertebral angle (CVA) was examined. Outcomes were collected before treatment (0/12), after treatment (1/12), and three months after the end of treatment (4/12). The main analysis comprised a two-way mixed ANOVA with a repeated measures factor (time) and a between-groups factor (group). Post hoc tests assessed the source of significant interactions detected. The significance level was set at p = 0.05. Results: No significant between-group baseline differences were identified. Increases in CS-ROM and in CVA were registered mainly post-treatment, with improvements maintained at follow-up for CS-ROM. EG1 significantly improved over CG in all movement directions except for flexion and over EG2 for extension only, at 1/12 and 4/12. All groups improved by the same amount for CVA. Conclusions: EG1, which included diaphragm manual therapy and breathing re-education exercises, registered the largest overall improvement over CG (except for flexion and CVA), and for extension over EG2. The interaction between respiratory mechanics and neck mobility may provide new therapeutic and assessment insights of patients with NSCNP. Full article

Objectives: New smartphone-based methods for measuring cervical spine range of motion (CS-ROM) and posture are emerging. The purpose of this study was to assess the reliability and validity of three such methods in patients with non-specific chronic neck pain (NSCNP). Methods: The within-day test–retest reliability of CS-ROM and forward head posture (craniovertebral angle-CVA) was examined in 45 patients with NSCNP. CS-ROM was simultaneously measured with an accelerometer sensor (KFORCE Sens^®) and a mobile phone device (iHandy and Compass apps), testing the accuracy of each and the parallel-forms reliability between the two methods. For construct validity, correlations of CS-ROM with demographics, lifestyle, and other cervical and thoracic spine biomechanically based measures were examined in 90 patients with NSCNP. Male–female differences were also explored. Results: Both methods were reliable, with measurements concurring between the two devices in all six movement directions (intraclass correlation coefficient/ICC = 0.90–0.99, standard error of the measurement/SEM = 0.54–3.09°). Male–female differences were only noted for two CS-ROM measures and CVA. Significant associations were documented: (a) between the six CS-ROM measures (R = 0.22–0.54, p < 0.05), (b) participants’ age with five out of six CS-ROM measures (R = 0.23–0.40, p < 0.05) and CVA (R = 0.21, p < 0.05), (c) CVA with two out of six CS-ROM measures (extension R = 0.29, p = 0.005 and left-side flexion R = 0.21, p < 0.05), body mass (R = −0.39, p < 0.001), body mass index (R = −0.52, p < 0.001), and chest wall expansion (R = 0.24–0.29, p < 0.05). Significantly lower forward head posture was noted in subjects with a high level of physical activity relative to those with a low level of physical activity. Conclusions: The reliability of both CS-ROM methods was excellent. Reductions in CS-ROM and increases in CVA were age-dependent in NSCNP. The significant relationship identified between CVA and CWE possibly signifies interconnections between NSCNP and the biomechanical aspect of dysfunctional breathing. Full article

Objective: The aim of the study was to evaluate the effect of postural stabilization exercises, in addition to cervical stabilization (CS), on the craniovertebral angle (CVA), pain, neck disability index (NDI), and quality of life in people with chronic neck pain. Methods: This study was performed on 60 women with chronic neck pain, aged 20–60 years, who were randomly divided into two groups. Individuals in the first group underwent CS exercises, in addition to scapular and lumbopelvic stabilization (SLPS) exercises, three times a week for 6 weeks. The individuals in the second group underwent only CS exercises for the same period. Moreover, stretching exercises and a 20 min hot pack were applied to the muscles around the neck of all patients. The CVA was measured using photogrammetry. The visual analog scale (VAS) was used to assess pain. The disability level was measured using the NDI. The Turkish version of the 36-Item Short-Form Health Survey (SF-36) was used to assess quality of life. The assessments were conducted before treatment, after treatment, and at the 2-month follow-up. To assess changes over time and between groups, a two-way repeated measures analysis of variance (ANOVA) was conducted. Results: Post-treatment measurements revealed significant differences favoring the SLPS group. The VAS and NDI scores were markedly lower in the SLPS group than in the CS group, both post-treatment (p < 0.001) and at follow-up (p < 0.001). The CVA was significantly greater in the SLPS group at both the post-treatment (p < 0.001) and follow-up (p < 0.001) assessments. However, in all sub-parameters except the SF-36 general health subscale, the SLPS group reported higher scores than the CS group post-treatment and at follow-up. Effect sizes for between-group comparisons ranged from moderate to very large (Cohen’s d = 0.65 to 2.31), and partial eta-squared (η²) values indicated moderate to large effect magnitudes (η² = 0.09 to 0.48), supporting the clinical relevance of the findings. Conclusion: In individuals with neck pain, including SLPS exercises in the treatment program, rather than just exercises for the cervical region, provides more positive results in terms of reducing disability and pain and increasing functionality. Clinical Trial Registration Number: NCT06578481. Full article

Background and Objectives: Forward head posture (FHP) is associated with reduced stability limits, impaired balance performance, and compromised cervical proprioception. This study investigated the effects of capital flexion exercise (CFE) on the craniovertebral angle (CVA), trunk control, balance, and gait in chronic stroke patients with forward head posture. Materials and Methods: Twenty-six subjects were randomly assigned to the CFE group or the control group (n = 13 each). The CFE group underwent a familiarization process and performed CFE for 9 min per session, 3 times a week for 6 weeks, as well as the existing neurodevelopmental treatment (NDT). The control group received only the existing NDT. Results: The CVA, the Korean version of the Postural Assessment Scale for Stroke (K-PASS), the Berg Balance Scale (BBS), and the Timed Up and Go test (TUG) improved after the intervention in the CFE group (p < 0.05). In the control group, CVA and TUG improved after the intervention (p < 0.05). The CVA (d = 1.34, p = 0.002), K-PASS (d = 1.36, p = 0.000), and BBS (d = 1.68, p = 0.000) values of the CFE group showed statistically significant improvement compared to the control group. Although TUG improved in the CFE group, the between-group difference was not statistically significant (d = −0.28, p = 0.467). Conclusions: This study suggests that capital flexion exercises effectively improve craniovertebral angle, trunk control, and balance in chronic stroke patients with forward head posture. Full article

Background: Text neck is a common postural malalignment that significantly affects daily activities. Reliable and user-friendly assessment tools are essential for physiotherapists, and evaluating text neck prevalence in both sitting and standing positions is crucial for effective rehabilitation. This study aimed to compare text neck prevalence between students in practical and non-practical disciplines using multiple assessment methods. Methodology: A total of 82 female students (18–24 years) from Taibah University participated. The practical group included students from the Colleges of Medical Rehabilitation Sciences and Applied Medical Sciences, who engage in hands-on learning. The non-practical group consisted of Business Administration students, whose coursework is primarily theoretical. Text neck was assessed using observational methods, tragus to wall distance (TWD), craniovertebral angle (CVA) via a smartphone application, and PostureCo in both sitting and standing positions. Results: Observational assessment showed text neck prevalence of 95.5% in the non-practical group and 70% in the practical group while sitting, and 91% versus 80% while standing. Based on TWD, prevalence was 48% in non-practical students and 32% in practical students. Using Physiomaster, prevalence was 71% in standing and 54% in sitting for non-practical students, compared to 39% and 14%, respectively, for practical students. Significant differences were found between groups in sitting (p < 0.002) and standing (p < 0.001) using TWD, and in CVA measurements (p < 0.0001). Conclusions: Text neck is more prevalent among non-practical students, while practical students exhibit milder cases. Both sitting and standing assessments are essential for accurate diagnosis and rehabilitation planning. Future studies should analyze the accuracy of various measurement tools to identify the most precise methods for assessing text neck prevalence, taking into consideration both sitting and standing positions. Full article

Background/Objectives: The present study aimed to investigate the relationship between forward head posture (FHP) and the mechanical properties of muscles as well as the influence of FHP on them. Methods: To define participants with FHP, craniovertebral angle (CVA) was measured. All participants were divided into two groups in accordance with their CVA: the experimental group (FHP) consisting of participants with a CVA below 50°, and the control group (CON) consisting of participants with a CVA above 50°. The tone, stiffness, and elasticity of the upper trapezius muscle (UT), the middle trapezius muscle (MT), the lower trapezius muscle (LT), the sternocleidomastoid muscle (SCM), the splenius capitis muscle (SC), the pectoralis major muscle (PM), and the serratus anterior muscle (SA) were measured using MyotonPro (Myoton AS, Tallinn, Estonia). Results: Both tone and stiffness in the UT were statistically significant (p < 0.05). In addition, stiffness in the LT was statistically significant (p < 0.05). No significant differences were found in tone, stiffness, and elasticity of the MT, SCM, SC, PM, and SA muscles (p > 0.05). A significant correlation was found between FHP and both tone and stiffness in the UT (r = −0.731, p = 0.000; r = −0.749, p = 0.000, respectively). No significant correlation was found between FHP and tone, stiffness, and elasticity of the MT, LT, SCM, SC, PM, and SA muscles. Conclusions: Since the UT was the muscle in which changes in mechanical properties were first induced by FHP, an approach targeting UT is necessary as a priority when treating patients with FHP. Full article

The purpose of this study was to compare the effects of a complex shoulder exercise program including respiratory training with those of a similar program including thorax-stabilization exercises on muscle activity and posture in individuals exhibiting scapular internal rotation. The subjects of this study were 32 adults with scapular internal rotation. The exercise group performed the complex shoulder exercise program with respiratory training (EG), while the control group performed the complex shoulder exercise program with thorax-stabilization exercises (CG). After 4 weeks of training, the changes in muscle activity and posture were measured. The differences between the two groups were assessed through comparative analysis using an independent t-test. The paired t-test revealed significant disparities in craniovertebral angle (CVA) and sagittal shoulder angle (SSA) posture between the measurements before and after the programs (p < 0.05). Additionally, the paired t-test indicated notable differences in muscle activity of the upper trapezius (UT), middle trapezius (MT), lower trapezius (LT), and serratus anterior (SA) muscles (p < 0.05). According to the findings, both intervention groups presented significant improvements in cervical and shoulder posture and muscle activity. Consequently, combination of the complex shoulder exercise program with either respiratory training or thorax-stabilization exercises had a favorable impact on posture and muscle activity among individuals exhibiting scapular internal rotation. Full article

The clinical examination of patients with cervical spine pathology includes measures of posture, mobility, strength, and stability. The forward head position as measured by craniovertebral angle (CVA) has been suggested as a risk factor for cervical spine pathology. The purpose of this study was to describe CVA reference values in healthy adults and assess the relationship with age and sex. This prospective cross-sectional observational study measured the CVA in 122 healthy adults using digital analysis of a lateral view photograph. To facilitate this analysis, a marker was placed at the level of the C7 vertebra, with the tragus of the ear visible in the photograph. The CVA was measured using Kinovea 0.8.15 software, where the CVA was calculated using the intersection of a horizontal line with a line joining the spinous process of C7 and the tragus of the ear. Mean CVA values were 48.76° (6.77) across all participants, 50.07° (6.63) for females, and 47.46° (6.71) for males. Linear regression analysis indicated significant relationships with age and with sex. The study established CVA reference values in healthy adults and identified a significant difference in head position between males and females and a 1.6° decrease in CVA per decade of increased age. Full article

Background: Recent studies have found forward head posture (FHP) is associated with altered physiology. There is a lack of research into whether FHP is associated with altered gait parameters when cognitively challenged. Our hypothesis is that individuals with FHP and those without will demonstrate different responses when undergoing dual-task assessment. Methods: Forty-five asymptomatic participants with FHP, defined as a craniovertebral angle (CVA) < 50°, were matched to forty-five participants with normal head posture (NHP) with a CVA > 55°. Participants walked along a 10 m platform under a control condition (no cognitive load) while an optical motion-capture system assessed gait kinematics. Secondly, participants were assessed under a dual-task cognitive load condition to identify the impact on gait kinematics. Results: Under the single-task condition, there were no significant differences for any gait parameter. In the dual-task condition, 12/13 gait parameters were significantly altered for the FHP vs. NHP group (p < 0.01). A calculation of the dual-task cost (DTC) percentage showed significant increases in all gait parameters in participants with FHP (p < 0.02). Correlations between the CVA and gait parameters were not significant for the single-task condition, but all gait parameters were correlated to CVA for the dual-task condition (p < 0.01). The correlation between CVA and DTC for all gait variables was significant (p < 0.04). Conclusions: This study demonstrates that FHP significantly increases the cognitive cost during walking, highlighting the importance of proper postural alignment for maintaining cognitive function under a dual-task condition. Full article

Background/Objectives: This study determined the effects of 60 min or 30 min Pilates program on cervicothoracic alignment, muscular strength, and endurance in university students with upper-crossed syndrome (UCS). Methods: Twenty-six university students with UCS were randomly allocated into 60 min Pilates (60 PG, n = 9), 30 min Pilates (30 PG, n = 9), and control (CG, n = 8) groups. The 60 and 30 PG students participated in the Pilates program, focusing on relaxation, stability, mobility, and strengthening of the cervical, thoracic, and scapular muscles for 60 or 30 min per session, twice a week, for 12 weeks. Cervicothoracic alignment was measured using BodyStyle to determine craniovertebral angle (CVA), forward shoulder angle (FSA), head position angle (HPA), head tilt angle (HTA), and kyphosis angle (KA). We measured the muscular strength and endurance of the shoulder on the dominant side. Results: After the intervention, CVA, HPA, HTA, and KA significantly improved in the 60 and 30 PG (all p < 0.01) but not in the CG (p > 0.05). There were no significant differences between the 60 and 30 PG at 4, 8, and 12 weeks. Shoulder strength differed between shoulder flexion and horizontal abduction (p < 0.01). Shoulder endurance differed between extension, flexion, and horizontal abduction (p < 0.05, p < 0.01, and p < 0.001, respectively). Conclusions: This study confirmed the effectiveness of the Pilates program in improving cervicothoracic sagittal alignment and shoulder muscular function in university students with UCS. Additionally, the effects of participating in 60 and 30 min Pilates programs were found to be equivalent. Therefore, encouraging busy university students to participate in at least 30 min of the Pilates program is important. Full article

Forward head posture (FHP) is a common postural problem experienced by most people. However, its effect on brain activity is still unknown. Accordingly, we aimed to observe changes in brain waves at rest to determine the effect of FHP on the nervous systems. A total of 33 computer users (Male = 17; Female = 16; age = 22.18 ± 1.88) were examined in both FHP and neutral posture. For each session, brain waves were measured for 5 min, and then muscle mechanical properties and cranio-vertebral angle (CVA) were measured. Changes in brain waves between the neutral posture and FHP were prominent in gamma waves. A notable increase was confirmed in the frontal and parietal lobes. That is, eight channels in the frontal lobe and all channels in the parietal lobe showed a significant increase in FHP compared to neutral posture. Additionally, FHP changes were associated with a decrease in CVA (p < 0.001), an increase in levator scapulae tone (Right, p = 0.014; Left, p = 0.001), and an increase in right sternocleidomastoid stiffness (p = 0.002), and a decrease in platysma elasticity (Right, p = 0.039; Left, p = 0.017). The change in CVA was found to have a negative correlation with the gamma activity (P7, p = 0.044; P8, p = 0.004). Therefore, increased gamma wave activity in FHP appears to be related to CVA decrease due to external force that was applied to the nervous system and cervical spine. Full article

Background: Forward head posture (FHP) and altered cervical lordotic curvatures are common spine displacements often associated with neck pain and disability. Two primary categories for determining FHP exist: radiographic and postural measurements. Methods: This study investigated the correlation between the craniovertebral angle (CVA), the radiographically measured C2–C7 sagittal vertical axis (SVA), and cervical lordosis (absolute rotation angle: ARA C2–C7) in a sample of participants with chronic myofascial pain (CMP). In 120 participants, we performed both a postural measurement of the CVA and a lateral cervical radiograph, where the C2–C7 SVA and ARA C2–C7 were measured. A linear-regression R² value to assess the correlation between the CVA, C2–C7 SVA, and ARA C2–C7 was sought. Results: A statistically significant weak linear fit was identified (Spearman’s r = 0.549; R² = 0.30, p < 0.001) between the CVA and C2–C7 SVA, having considerable variation between the two measures. A statistically significant linear fit (very weak) was identified for the lordosis ARA C2–C7 and the CVA: Spearman’s r = 0.524; R² = 0.275; p < 0.001. A value of 50° for the CVA corresponded to a value of 20 mm for the C2–C7 SVA on an X-ray. Conclusion: While the CVA and radiographic C2–C7 SVA are weakly correlated in an individual, they seem to represent different aspects of sagittal cervical balance. The CVA cannot replace radiographically measured cervical lordosis. We recommend that more emphasis be given to radiographic measures of sagittal cervical alignment than the CVA when considering patient interventions. Full article

Background: Forward head posture and rounded shoulder posture are common postural variants found in upper crossed syndrome, which can lead to limited neck mobility, respiratory problems, and other issues. The purpose of this study was to investigate the effects of telerehabilitation, combining diaphragmatic breathing re-education and shoulder stabilization exercises, on young men with upper crossed syndrome during the COVID-19 pandemic over 4 weeks. Methods: The study included 37 participants aged in their 20s and 30s who were randomly divided into two groups. The experimental group received diaphragmatic breathing re-education and shoulder stabilization exercises, while the control group only underwent shoulder stabilization exercises. Both groups were trained three times a week for four weeks using telerehabilitation. The comparison of within-group pre–post differences in the experimental and control groups was conducted using a paired t-test, while the effects of treatment were assessed using repeated-measures analysis of variance. Results: After 4 weeks, both groups showed significant improvements in the pain pressure threshold of the upper trapezius, craniovertebral angle, round shoulder posture, shoulder tilt degree, neck disability index, and closed kinetic chain upper extremity stability test (all p < 0.05). The results showed a significant difference between the Time effect (p adj < 0.05/4) for both sides of PPT, CVA, and STD and both sides of RSP, NDI, and CKCUEST, and an interaction between the Time × Group effects (p adj < 0.05/4) for the Rt. PPT, CVA, and STD. Conclusions: These findings suggest that the telerehabilitation training group, which included diaphragmatic breathing re-education and shoulder stabilization exercises, was more effective in improving Rt. PPT, CVA, and STD in males with UCS. Full article

The purpose of this randomized controlled trial was to evaluate the effectiveness of the Myofascial Release Technique (MRT) along with Cognitive Behavioral Therapy (CBT) on pain, craniovertebral angle (CVA), and neck disability in university students with chronic neck pain and forward head posture. A total of sixty-six eligible participants with chronic neck pain and forward head posture were randomized into the Myofascial Release Therapy (MRT) group (n = 33) and MRT and Cognitive Behavior Therapy (CBT) group (n = 33). Clinical outcomes included neck pain measured using the numerical pain rating scale, neck disability measured through the neck disability index, and forward head posture measured through the cranial vertebral angle. The outcomes were assessed at baseline and the four and eight weeks after the intervention. Both groups showed significant improvement in pain intensity, CVA, and neck disability after the intervention. However, the CBT group demonstrated greater improvements than the MRT group. The difference in outcomes between the groups was statistically significant. Myofascial Release Therapy combined with CBT is an effective treatment method for patients with chronic neck pain and forward head posture. Full article

This study assessed the relationship between head posture displacements and biomechanical parameters during gait and jumping. One hundred male and female students (20 ± 3 yrs) were assessed via the PostureScreen Mobile® app to quantify postural displacements of head rotations and translations including: (1) the cranio-vertebral angle (CVA) (°), (2) anterior head translation (AHT) (cm), (3) lateral head translation in the coronal plane (cm), and (4) lateral head side bending (°). Biomechanical parameters during gait and jumping were measured using the G-Walk sensor. The assessed gait spatiotemporal parameters were cadence (steps/min), speed (m/s), symmetry index, % left and right stride length (% height), and right and left propulsion index. The pelvic movement parameters were (1) tilt symmetry index, (2) tilt left and right range, (3) obliquity symmetry index, (4) obliquity left and right range, (5) rotation symmetry index, and (6) rotation left and right range. The jump parameters measured were (1) flight height (cm), (2) take off force (kN), (3) impact Force (kN), (4) take off speed (m/s), (5) peak speed (m/s), (6) average speed concentric phase (m/s), (7) maximum concentric power (kW), (8) average concentric power (kW) during the counter movement jump (CMJ), and (9) CMJ with arms thrust (CMJAT). At a significance level of p ≤ 0.001, moderate-to-high correlations (0.4 < r < 0.8) were found between CVA, AHT, lateral translation head, and all the gait and jump parameters. Weak correlations (0.2 < r < 0.4) were ascertained for lateral head bending and all the gait and jump parameters except for gait symmetry index and pelvic symmetry index, where moderate correlations were identified (0.4 < r < 0.6). The findings indicate moderate-to-high correlations between specific head posture displacements, such as CVA, lateral head translation and AHT with the various gait and jump parameters. These findings highlight the importance of considering head posture in the assessment and optimization of movement patterns during gait and jumping. Our findings contribute to the existing body of knowledge and may have implications for clinical practice and sports performance training. Further research is warranted to elucidate the underlying mechanisms and establish causality in these relationships, which could potentially lead to the development of targeted interventions for improving movement patterns and preventing injuries. Full article