Earticle

The purpose of this study is to compare the difference in the craniovertebral angle (CVA) on the upper trapezius muscle tone and forced vital capacity (FVC) based on the different smartphone usage durations. Twenty healthy students attending a university in South Korea participated in this study. Subjects were randomly aligned to two groups: a 5-minute and 20-minute smartphone usage group, with each group consisting of ten participants. CVA was measured using digital protractor, muscle tone using Myoton, FVC for respiratory function was measured using digital spirometery. Three measurement variables were assessed before and after the experiment. There was a significant reduction in CVA when compared within each group (p<.05), but there was no significant difference when comparing the difference before and after the experiment within groups and between groups (p>.05). Muscle tone in right and left trapezius showed no significant difference within groups and between groups (p>.05). FVC showed significant decrease in the comparisons within each group (p<.05). FVC decreased significantly in the 20-minute smartphone usage group than in the 5-minute usage group (p<.05). Therefore, during 5 and 20-minute smartphone usage, neck angle and FVC decreased. Particularly, 20-minute smartphone usage had a greater impact on FVC compared to 5-minute usage. It is suggested that maintaining proper alignment of the neck and trunk is necessary during smartphone usage.

The study aimed to determine the effect of the thoracic mobility exercise with 8-figure shoulder brace on pain, range of motion (ROM), craniovertebral angle (CVA) in neck pain patients with forward head posture. Following baseline measurements, 22 subjects (n=22) with chronic neck pain were randomized into two groups: the experimental group (n=11), which received thoracic mobility exercise with figure 8 shoulder brace, and the control group (n=11), which only thoracic mobility exercise. Each group participated in the intervention for three times per week, for four weeks. The numeric pain rating scale (NPRS) for pain, ROM and CVA of both groups were recorded at both pre- and post-intervention. Paired t-tests were used to determine significant changes in the post-intervention period compared with pre-intervention, and independent t-tests were used to analyze differences in the dependent variables between the two groups. After the four weeks intervention, both groups experienced significantly decreased NPRS (p<.05) and significantly increased ROM and CVA (p<.05). The experimental group that received the thoracic mobility exercise with figure 8 shoulder brace showed greater improvements in pain, ROM and CVA than those of the control group (p<.05). These results suggest that the thoracic mobility exercise with figure 8 shoulder brace reduces neck pain and enhances ROM and CVA in neck pain patients with forward head posture.

The purpose of this study was to investigate the effects of self-myofascial release of the thoracolumbar fascia (SMR-TLF) using a foam roller, combined with cervical and scapular stabilization exercises, on craniovertebral angle (CVA) and muscle tone (suboccipital muscles, upper trapezius, and erector spinae). Forty participants, with an average age of 22.3 years (SD = 1.59), were enrolled. Forward head posture was defined as a CVA of less than 51 degrees. CVA was measured using Image J, while muscle tone and stiffness on the dominant side were assessed with a Myoton PRO. Participants were randomly assigned to either a stabilization exercise group (control) or a combined stabilization exercise and SMR-TLF group (experimental). Post-intervention measurements followed the same sequence as pre-intervention measurements. A significant decrease in CVA was observed in both groups (p<.05). The Experimental group demonstrated a significant reduction in muscle tone and stiffness of the suboccipital muscles and erector spinae (p<.05). Comparisons between groups revealed a significant difference in erector spinae stiffness only (p<.05). In conclusion, cervical and scapular stabilization exercises effectively improve CVA, and the incorporation of SMR-TLF further reduces muscle tone in the suboccipital muscles and erector spinae.

Background: This study aimed to investigate the effects of stabilization exercises performed after an abdominal drawing-in exercise using pressure biofeedback for 8 weeks on craniovertebral angle, muscle performance, neck pain level and neck disability index in lactating women with neck pain. Methods: Twenty lactating women voluntarily participated and were randomly divided into control group and experimental groups. The control group (n=10) was subjected to abdominal drawing-in exercises before lumbar stabilization exercises, while the experimental group (n=10) was subjected to abdominal drawing-in exercises using pressure biofeedback before lumbar stabilization exercises 50 minutes, thrice weekly for 8 weeks. The craniovertebral angle (CVA), transverse abdominis and deep neck flexor muscle performance, visual analog scale (VAS) score, neck disability index (NDI) were evaluated before and after the intervention. Results: As a result of the study, there was significant difference between each group, and when looking at the differences before and after each group, there was a significant difference in CVA, transverse abdominis and deep neck flexor muscle performance, VAS, NDI in both groups. Conclusion: The above results revealed that selective muscle activation through abdominal drawing-in exercises using pressure biofeedback were effective on CVA, transverse abdominis and deep neck flexor muscle performance, VAS, NDI in lactating women with neck pain.

Background: Forward head posture, present in approximately 60% of individuals with neck pain, is commonly associated with muscular imbalances, including weakness of the deep neck flexors and overactivity of the cervical extensors and superficial neck flexors, which may compromise cervical spine stability. This pilot study compared therapist-guided postural correction (using manual or verbal cues) with self-directed exercise on pain, disability, cervical alignment, and psychosocial outcomes in individuals with neck pain. Methods: Twenty-one participants with neck pain were randomly assigned to one of three groups (n=7, each): manual guidance (MG), verbal guidance (VG), or self-exercise (SE). All participants completed 12 intervention sessions over four weeks (three sessions per week). Outcomes were assessed pre- and post-intervention using the numeric rating scale for pain, the Korean neck disability index, craniovertebral angle for postural assessment, and the 12-Item short form health survey (SF-12) for psychosocial status. Results: All three groups showed significant improvements in pain and functional disability after the intervention (p<.05). However, CVA significantly improved only in the MG and VG groups, both pre- and post-intervention (p<.05). Additionally, the degree of change in these variables differed significantly among the groups (p<.05), with the MG group showing significantly greater improvements than the SE group (p<.05). Conclusion: All interventions were effective in reducing pain and improving physical function. However, therapist-led exercise relieves pain and improves function, and postural correction—particularly with manual guidance—was associated with a greater tendency toward cervical alignment improvement. These results suggest that professional involvement in postural retraining may provide additional benefits for individuals with neck pain.

Background: This study aimed to investigate the effect of mobilization with movement (MWM) applied to the ankle joint, on the craniovertebral angle (CVA), pressure pain threshold, and neck disability index (NDI) in asymptomatic adults with a forward head posture (FHP). Methods: A total of 32 subjects with FHP were assigned to either the MWM group (N=16) or the cranio-cervical flexion exercise (CCFE) group (n=16). The CVA, pressure pain threshold and NDI were measured before and 4 weeks after the intervention. Results: A significant improvement in the CVA was observed in the MWM group (p<.05), whereas no significant changes (p>.05) were observed in the CCFE group. Both groups showed significant differences in the pressure pain threshold and NDI before and after the intervention (p<.05). Conclusion: The results of the study suggest that MWM applied to the ankle joint can effectively improve the CVA, pressure pain threshold, and NDI of adults with a forward head posture. Based on this study, the ankle MWM technique for dorsiflexion can be used as an objective research method for additional studies targeting FHP patients in the future.

Purpose: This study aimed to determine the effects of cervico-thoracic (C-T) mobilization technique and therapeutic exercise on muscle activity, craniovertebral angle (CVA), and neck disability index (NDI) in patients with neck pain. Methods: : A total of 30 patients with neck pain were included and divided into C-T mobilization combined with Pilates group (Experimental group; EG) and thoracic mobilization and self-exercise (Control group; CG) group; each group consisted of 15 patients. The exercises were performed by patients in both groups three times a week, for four weeks. NDI was used to measure functional disability and sEMGﾠwas used to measure muscle activity. Results: The EG participants showed significant improvement in the CVA and NDI after the intervention than the CG (p<.05). While both groups presented after intervention decreased muscle activity(upper trapezius), there were no statistically significant differences between the groups (p>.05). Conclusion: The findings of this study suggest that thoracic mobilization technique combined with Pilates exercise may have beneficial effects on CVA and NDI in patients with neck pain and forward head posture.

Background: Backpacks are one of the most widely used accessories in modern society. However, previous studies have shown that carrying a backpack can cause various musculoskeletal problems. Objectives: To investigate the effects of a body-adhesive backpack on craniovertebral angle, sagittal shoulder angle and the muscle fatigue in the upper extremity. Design: Randomized cross-over design. Methods: For this study, 36 healthy university students participated in this study. The experiment was conducted three times using common backpack, and body-adhesive backpack condition. The angles of the cervical spine and shoulder joints of the subjects were calculated without the backpack. Electrodes were placed at upper trapezius, lower trapezius, rectus abdominis and erector spinae to check for muscle fatigue. Subjects carried a backpack and walked on a treadmill for 15 minutes at 4 km/h. The muscle fatigue signal was also measured while walking. After walking, the craniovertebral and sagittal shoulder angles were measured again while subjects carried backpack. Results: As a result of this study, body-adhesive backpack condition showed significant decrease and significant increase in craniovertebral angle and sagittal shoulder angle than common backpack (P<.05). Body-adhesive backpack condition showed significant decrease in upper trapezius, lower trapezius, erector spinae, and rectus abdominis when compared to a common backpack (P<.05). Conclusion: This study suggests that a body-adhesive backpack is more beneficial in correcting body posture than a common backpack.

PURPOSE: This study examined the relationship between the cervical lordosis angle (CLA) and the craniovertebral angle (CVA) and between CVA and a cross-sectional area (CSA) of the cervical muscles. METHODS: In 17 healthy college students, the CLA was measured using a posterior tangent technique. The CVA was analyzed using photographic images, and the CSA of the cervical muscles, including longus colli, longus capitis, and sternocleidomastoid, was evaluated using computerized tomography. The Pearson's correlation coefficient was used to determine the relationship between these variables and a neck disability index. RESULTS: The CVA correlated with the CLA and with a CSA of longus colli (r = .487, p = .047 and r = .592, p = .012, respectively). The CLA correlated with a CSA of longus colli (r = .578, p = .015). CONCLUSION: This study clarified the relationship between the postural, structural, and muscular changes in the cervical regions. A significant correlation was observed between the CVA and a CSA of the longus colli with the CLA and between the CVA and the CSA of the longus colli. Prescription strengthening exercises for the deep neck flexors for individuals with a forward head posture and reduced cervical lordosis are useful.

전방머리자세는 머리와 목의 잘못된 자세 정렬 중 하나로 비정상적인 관절 위치감각과 고유수용성 감각손상으로 인해 목의 통증과 균형 손상까지 발생시키는 주요 원인으로 알려져 있다. 키네시오 테이핑은 통증관리를 위해 사용되는 임상적인 중재방법으로 통증감소, 혈액순환 촉진, 근육이완을 유도하여 관절 위치 교정 및 근육과 관절에 안정성을 제공하는 효과를 가지고 있다. 이전의 많은 연구에서 키네시오 테이핑을 활용하여 목 통증감소와 목의 정렬에 긍정적인 효과가 있음을 입증하였지만 일부 연구에서는 통증 완화의 효과를 입증하지 못한 부분도 있다. 키네시오 테이핑 적용 후 즉각적인 통증완화 및 정렬 개선에 효과를 보이긴 하지만 적용이후 효과의 지속에 대해서는 증거가 충분하지 않고 임상적으로 더 큰 가치를 보이기 위해서는 키네시오 테이핑의 장점에 대해서 추가적인 연구를 권장하였다. 따라서 본 연구는 앞머리 자세를 가진 사람에서 키네시오 테이핑이 머리 자세의 정렬과 동적 균형 능력에 미치는 영향을 조사하고자 한다.

Forward head posture is one of the most recognized types of poor head and neck alignment. Poor head and neck alignment posture is a major contributor to compromised balance and neck pain, due to abnormal joint position sense and proprioception. Kinesio taping is an intervention method used clinically for the management of pain. Kinesio taping may produce its effects through pain reduction, stimulation of blood circulation, induction of muscle relaxation which provides correction of joint position, and providing stability to the muscles and joints without limiting the range of motion. Many studies have proved that kinesio taping has positive effects on the reduction of pain and improves alignment, on the other hand, some studies have not found. Kinesio taping may provide immediate pain relief and improved alignment following the application, but there is insufficient evidence to support sustained relief beyond that time and they recommended future studies to examine the benefits of kinesio taping as this would have a greater value in clinical practice. Therefore, this study is to investigate the effects of kinesio taping on the alignment of head posture and dynamic balance ability in people with forward head posture.

Background: The importance of postural stabilization and cervical mobilization in subjects with pain from the anterior head posture is drawing more attention. However, studies on head and neck stabilizing intervention after mobilization are lacking. Objective: To examine the effects of Kinesiotaping and posture setting exercise on forward head posture (FHP). Design: Crossover Study Design Methods: The subjects were 17 male and female college students in their 20s with FHP. They were randomized into the Kinesiology taping group (KTG) with 9 subjects and posture stabilizing exercise group (PSEG) with 8 subjects. The intervention was conducted for 4 weeks, and changes in pain, craniovertebral angle (CVA), and proprioception were observed before and after intervention. Results: Pain was significantly reduced in the KTG and PSEG both before and after intervention. CVA and proprioception were significantly increased only in the PSEG. The differences in CVA and proprioception between the two groups were significant. Conclusions: These findings suggest that the application of posture setting exercise could decrease pain, proprioceptive error and increase CVA on FHP.

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.

PURPOSE: Forward head posture (FHP) is a head-on-trunk malalignment that results in musculoskeletal dysfunction and neck pain. To improve forward head posture, both the craniocervical flexion exercise (CCFE) and the visual guide (VG) technique have been used. This study compared the immediate effects of CCFE and VG combined with CCFE on craniovertebral angle (CVA), as well as on the activity of the sternocleidomastoid (SCM) and anterior scalene (AS) muscles during CCFE in subjects with FHP. METHODS: In total, 16 subjects (nine males, seven females) with FHP were recruited using the G-power software. Each subject conducted CCFE and CCFE combined with VG in random order. The CVA was recorded using a digital camera and the ImageJ image analysis software. The EMG data of SCM and AS were measured by surface electromyography. A paired T-test was used to assess differences between the effects of the CCFE and VG combined with CCFE interventions in the same group. RESULTS: The CVA was significantly greater for CCFE combined with the VG than for CCFE alone (p<.05). The activity of the SCM and AS muscles was also significantly greater when the VG was combined with CCFE than during CCFE alone across all craniocervical flexion exercise phases (p<.05). CONCLUSION: Use of the VG technique combined with CCFE improved FHP in subjects with FHP compared to CCFE alone.

이 연구는 앞쪽머리자세를 가진 대학생을 대상으로 바이오피드백을 적용한 목뼈 안정화 운동중재가 뒤통수근육의 긴장도, 깊은목굽힘근 지구력 및 머리뼈 척추각에 어떠한 영향을 미치는지 알아보고자 실시되었다. 연구 대상자는 바이오피드백 목뼈 안정화 운동군(BCSEG) 12명과 대조군(CG) 12명을 선정하였으며, 8주간 주 3회, 50분간 실시하였다. 이 연구 결과 바이오피드백을 적용한 목뼈 안정화 운동 후 뒤통수밑근은 BCSEG에서 경직도와 근 긴장도가 유의하게 감소하였고(p<.01), 깊은목굽힘근은 BCSEG에서 근지구력(p<.01)과 머리 척추각(p<.01) 유의하게 증가하였다. 이상의 결과를 종합해 보면 바이오피드백을 적용한 목뼈 안정화 운동은 뒤통수밑근과 깊은목굽힘근의 근기능 향상시킴으로써 머리 척추각도 개선을 한 것으로 생각된다. 압력 바이오피드백을 적용한 목뼈 안정화 운동은 FHP를 개선을 위한 중재방법으로 제안될 수 있다.

The purpose of this study was to the effects of a cervical stabilization exercise using pressure biofeedback intervention on suboccipital muscle tone, deep neck flexor muscle endurance, and craniovertebral angle in college students with forward head posture. The subjects of the study were selected as BCSEG(n=12) and CG(n=12), and the intervention was performed for 50 minutes, 3 times a week for 8 weeks. The results of the study showed that after biofeedback neck stabilization exercises, the suboccipital muscle significantly decreased in stiffness and muscle tone in the BCSEG(p<.01), and the deep neck flexors significantly increased in muscle endurance(p<.01) and craniovertebral angle(p<.01). The results of the cervical stabilization exercises with biofeedback are thought to improve cranio- vertebral angle by improving muscle function of the suboccipital muscles and deep neck flexors, which cervical stabilization exercises with biofeedback may be suggested as an intervention to improve FHP.

Objective: The purpose of this study was to compare concurrent validity and test-retest reliability based on Craniovertebral angle of 'Angles video goniometer', a smart phone application for convenient range of motion measurement, and 'Image J', an analysis software with high reliability and validity. This was conducted to find out whether 'Angle video goniometer' can be used clinically. Design: Cross-sectional study Methods: Fifty subjects were imaged laterally, and the angle of the head and spine was measured using Image J and the Angles video goniometer, respectively, in a resting posture and a chin in posture. The level of concurrent validity between the two measurement methods and the level of inter-rater reliability and intra-rater reliability were analyzed. Results: For forty participants, the concurrent validity between Image J and Angles video goniometer showed very high validity with ICC of 0.997(0.995~0.999) and 0.994(0.994~0.998), CVME% 0.71~0.72%, SEM% 0.31~0.34, MDC% 0.86~0.94. The test-retest intra-rater reliability showed very high reliability ICC 0.994(0.991~0.996), CVME% 0.71%, SEM% 0.31~0.43, MDC% 0.86~1.19%. The test-retest inter-rater showed very high reliability ICC 0.995(0.992~0.997), CVME% 0.71%, SEM% 0.43~0.59%, MDC% 1.20~1.62% Conclusions: Angles video goniometer', a smartphone application, is a device with very high reliability and validity for craniovertebral angle measurement in healthy adults, and it is a device that can be easily used in clinical practice.

PURPOSE: This study examined the effects of an exercise program for the thoracic spine and scapula rather than the neck, which is the primary site of pain. METHODS: Thirty-two elementary school teachers with a forward head posture (FHP) were assigned randomly to either the experimental group (n = 16) or the control group (n = 16). The experimental group performed scapular stabilization exercise (SSE) and thoracic extension exercise (TEE), and the control group performed cervical self-myofascial release exercise and stretching exercise. The pulmonary functions, pain, craniovertebral angle (CVA), and cervical range of motion (CROM) were measured before the intervention and six weeks after. RESULTS: The within-group comparisons showed that the VAS and CROM (except for extension) in both groups were significantly different before and after the intervention (p < .05). The changes in the maximum inspiratory pressure (MIP), maximum expiratory pressure (MEP), forced vital capacity (FVC), forced expiratory volume at 1 sec (FEV1), and CVA were significant only in the experimental group (p < .05). The between-group comparisons showed a significant difference in the FVC, FEV1, VAS, CVA, and left lateral flexion (p < .05). CONCLUSION: The combination of SSE and TEE in the experimental group was more effective in improving the FHP and breathing ability. Moreover, the experimental group and control combination appeared to be effective in reducing pain and improving the CROM. The combination of SSE and TEE, which are exercises that do not target the cervical spine directly, was effective in improving the posture, respiration, neck pain, and CROM in elementary school teachers with FHP.

Purpose : the purpose of the study was to investigate the effect of craniovertebral angle on bag strap length change method : this study is aimed at twenties healthy adult for 30 persons (male-8, female-22) research participant attach marks on tragus and cervical7 participant did not carry bag in First test. thereafter we take a picture mark point and measure the angle. immediately the second experiment was designed to carry back on participant's iliac crest and to walk freely for five minutes. afterward, we take a picture mark point and measure the angle. last experiment was performed after five minutes break. participants carried back on 10cm below participant's iliac crest and third experiment was performed the same way. results : Increase the length of the bag, craniovertebral angle is reduced and there is a significant difference between the three experiments.(p=.000) conclusion : when hold the back too long, Cervical spine cause temporary head forward posture. so carry on bag short.

PURPOSE: The purpose of this study was to investigate the correlation between craniovertebral angle (CVA) and cardiorespiratory function ($VO_2max$ and $VCO_2max$) in young adults. METHODS: For this study, the students of D college were questioned and 50 members of D college were participated in our research.. Side-view pictures of each subject were taken in standing positions, in order to assess forward head posture (FHP) by measuring the craniovertebral angle. The craniovertebral angle was measured as the angle between a horizontal line at C7 and a line from the tragus of the ear to the spinous process of C7. And $VO_2max$ and $VCO_2max$ were measured by Quark CPET (cosmed co, USA) while the subjects were performed the treadmill running task of a intensity to set with respiratory mask. Subjucts were Then Pearson's correlation coefficient was calculated to estimate the relationship between craniovertebral and cardiorespiratory function ($VO_2max$ and $VCO_2max$) using SPSS for window. RESULTS: There was a significant positive correlation between craniovertebral angle and $VO_2max$ during treadmill running task (r=0.528, p<0.05). And there was a significant positive correlation between craniovertebral angle and $VO_2max$ during treadmill running task (r=0.566, p<0.05). CONCLUSION: Foreward head posture is related to cardiorespiratory function, and it has a negative correlation with cardiorespiratory function.

본 연구의 목적은 40~50대 중년에서 두개척추각(CVA), 나이, BMI와의 상관관계를 알아보는 것이다. 신체 건강한 성인 남녀 40~50대 456명을 대상으로3D 센서를 활용한 자세측정기를 활용하여 전방머리자세를 측정하였다. 연구결과 전체 중년의 CVA는 나이와는 높은 수준의 음의 상관관계가 있고(r=-.937;p<.01), BMI에 대해서는 매우 낮은 수준의 양의 상관관계(r=.056가 있음을 확인하였다. 성별에 따른 연구에서 중년 남성의 CVA는 나이와는 높은 수준의 음의 상관관계가 있었고(r=-.932; p<.01). BMI에 대해서는 매우 낮은 수준의 양의 상관관계(r=.071)가 있었다. 반면 중년 여성의 경우엔 나이에 대해서만 높은수준의 음의 상관관계(r=.940, p<.01)가 나타났고 BMI 에 대해서는 상관관계가 나타나지 않았다. 본 연구는CVA가 남성과 여성 모두에서 연령과 유의 한 음의상관관계를 가지고 있지만, BMI와 낮은 수준의 상관관계를 가지고 있음을 시사한다.

The purpose of this study was to investigate the corelation betwen craniovertebral angle(CVA), age, and body mas index(BMI) in midle-aged people in their 40s and 50s. The forward head posture(FHP) was measured using a posture measuring device using a 3D sensor for 456 healthy men and women. As a result of the study, the midle-aged CVA had a high level of negative corelation with age (r=-.937; p<.01) and a very low level of positve corelation with BMI (r=.071). CVA of midle-aged men had a high negative corelation with age (r=-.932; p<.01) and a very low positve corelation with BMI. There was a corelation (r=.056), whereas, for midle-aged women, there was a high level of negative corelation (r=.939, p<.01) only with age, but had a weak (low level of negative) corelation with BMI. This study sugests that CVA has a significant negative corelation with age in both males and females however, has a weak relationship with BMI.

Nowdays, many people suffer from the neck pain due to forward head posture(FHP) and text neck(TN). To assess the severity of the FHP and TN the craniovertebral angle(CVA) is used in clinincs. However, it is difficult to monitor the neck posture using the CVA in daily life. We propose a new method using the cervical flexion angle(CFA) obtained from a wearable sensor to monitor neck posture in daily life. 15 participants were requested to pose FHP and TN. The CFA from the wearable sensor was compared with the CVA observed from a 3D motion camera system to analyze their correlation. The determination coefficients between CFA and CVA were 0.80 in TN and 0.57 in FHP, and 0.69 in TN and FHP. From the monitoring the neck posture while using laptop computer for 20 minutes, this wearable sensor can estimate the CVA with the mean squared error of 2.1 degree.