Earticle

Purpose: The purpose of this study was to determine whether cervical stabilization exercise with visual feedback exercise would improve cervical alignment and mechanical properties of cervical muscles in patients with forward head posture. Methods: Thirty patients with forward head posture were recruited and were randomly divided into three groups: cervical stabilization exercise with visual feedback exercise group (n=10, group Ⅰ), passive stretching group (n=10, group Ⅱ) and control group (n=10, group Ⅲ). After receiving conventional physical therapy, each group additionally received cervical stabilization exercise with visual feedback exercise and passive stretching for 30min, three days per week for four weeks. Their muscle tone (㎐), stiffness (㎐) and craniovertebral angle (°) were analyzed before the intervention. After four weeks of intervention, the above items were re-measured and an intergroup analysis was performed. Results: The comparison and analyses of the changes in muscle tone and post hoc analysis revealed statistically significant intragroup decreases in the suboccipital, upper trapezius and sternocleidomastoid muscles in groups Ⅰand Ⅱ. Furthermore, statistically significant intergroup differences were observed in the suboccipital muscles with a greater change in group Ⅰ than in group Ⅱ and Ⅲ. Furthermore, greater changes in the upper trapezius muscles were observed in group Ⅰ than in groups Ⅱ and Ⅲ. Sternocleidomastoid muscle changes were greater group Ⅰ than in group Ⅱ, Ⅲ. The comparison and analyses of the changes in muscle stiffness and post hoc analysis revealed statistically significant intragroup decreases in the muscles in groups Ⅰ and Ⅱ, upper trapezius muscles in groups Ⅰ, Ⅱ and Ⅲ, and sternocleidomastoid muscles in group Ⅰ. Moreover, statistically significant intergroup differences in the suboccipital muscles with a greater change in group Ⅰ than in group Ⅱ and Ⅲ; upper trapezius muscles with greater changes in group Ⅰ than in groups Ⅱ and Ⅲ, and sternocleidomastoid muscles with a greater change in group Ⅰ than in group Ⅱ and Ⅲ, were observed. The comparison and analyses of the changes in the craniovertebral angle and post hoc analysis revealed statistically significant intragroup changes in groups Ⅰ and Ⅱ, and statistically significant intergroup differences with greater changes in group Ⅰ than in groups Ⅱ and Ⅲ. Conclusion: Cervical stabilization exercise with visual feedback exercise may be suggested as an effective intervention method for functional recovery of patients in the forward head posture.

Purpose: This study aimed to examine the effects of ankle stabilization exercises performed on unstable surfaces on cervical vertebral alignment and postural control in adults with forward head posture (FHP). Methods: Thirty adults with FHP were randomly assigned to either an experimental group (training on an unstable surface) or a control group (training on a stable surface). Participants in both groups performed 20 min of resistance band exercises, focusing on dorsiflexion and plantarflexion. Outcome measures included the craniovertebral angle (CVA), cervical muscle characteristics, and static plantar pressure. Results: The experimental group showed significant improvements in CVA and plantar pressure distribution (p<.05). A significant increase in the tone of the upper trapezius (UTA) muscle was also observed. However, there were no significant changes in other muscle parameters, such as stiffness or decrement. Conclusion: Ankle stabilization exercises on unstable surfaces may be effective in improving cervical alignment and postural stability in individuals with forward head posture.

Purpose: The purpose of this study was to determine whether cervical stabilization exercise with a pressure biofeedback unit would improve cervical alignment, the mechanical properties of cervical muscles, and neck disability in patients with forward head posture. Thirty such patients were recruited and randomly divided into two groups: cervical stabilization exercise with a pressure biofeedback unit (n=15, group Ⅰ) and the controls (n=15, group Ⅱ). After receiving conventional physical therapy, each group underwent cervical stabilization exercise with visual feedback exercise and passive stretching for 30 min, 3 days a week for 4 weeks. Their craniovertebral angle (CVA; °), muscle tone (Hz), stiffness (Hz), and neck disability index were analyzed before the intervention. After 4 weeks of intervention, the aforementioned items were remeasured, and an intergroup analysis was performed. Results: CVA, muscle tone, stiffness, and neck disability increased in group Ⅰ, with a statistically significant difference (p<.001; p<.05). Conclusion: Cervical stabilization exercise with a pressure biofeedback unit may be suggested as an effective intervention method for the functional recovery of patients with forward head posture.

본 연구는 25-45세 여성 경부 통증 환자를 대상으로 깊은 목 굽힘 근 강화 운동과 흉추 가동 운동이 머리 척추각 (CVA), 머리 회전각(CRA), 경추 전만각, 그리고 통증과 깊은 목 굽힘 근의 근력, 근지구력 등에 미치는 영향을 분석하여, 경추의 정렬, 통증 완화, 체형 변화, 근 체력 강화에 영향이 있는가를 규명하는 것이다. 연구 목적 달성을 위하여 통제집단 (CG) 8명, 깊은 목 굽힘 근 강화 운동집단(DG) 8명, 깊은 목 굽힘 근 강화 운동과 흉추가동 운동을 함께한 운동집단(DTG) 8명, 총 24명의 연구 대상을 3개 집단으로 분류하여 실험을 진행하였다. 각 집단은 주 3회 빈도로, 1회 50분간, 8주에 걸쳐서 24회의 운동 프로그램을 진행하였다. 통제집단은 같은 기간에 일반 물리치료(hot pack, tens, ultra sound)를 실시하였다. 통제군과 경부 운동군, 경 흉부 운동군은 실험 전, 후 척추 머리각, 척추 회전각, 경추 전만각, 경부 기능 장애지 수, 통증지수, 뉴욕 주 자세평가 지수, 깊은 목 굽힘 근의 근력 및 근지구력을 측정하였다. 측정한 자료를 통계적으로 분석 한 결과 경부 운동군과 경 흉부 운동군 모두 실험 후 척추 머리각, 척추 회전각, 경추 전만각, 뉴욕 주 자세평가 지수, 깊은 목 굽힘 근의 근력 및 근지구력은 0.1% 수준에서 유의한 변화가 있었다. 또한 세 집단 모두에서 경부 기능 장애지수, 통증 지수에서 0.1% 수준에서 유의한 변화가 있었다.

This study was done at the target of neck pain 25~50 aged women for the purpose of deep neck flexor muscles strength exercise and thoracic mobilization exercise on cervical spine alignment and pain. To attain these purposes, there were investigated the effects on the change cranio vertebral angle, cranio rotation angle, cervical lordosis angle, neck disability index, visual analogue scale, new york state posture rating test scale, maximus deep neck flexor muscle strength, and deep neck flexor muscle endurance. 24 neck pain women patient chosen as experimental subjects. These subjects were classified into 3 groups. In the exercise groups, exercise program was performed for 50 minutes, 3 times a week, for 8 weeks. The angle of cranio vertebral angle, cranio rotation angle, cervical lordosis angle, neck disability index, visual analogue scale, new york state posture rating test scale, maximus deep neck flexor muscle strength, and deep neck flexor muscle endurance were measured before and after the experiment in these groups. results: Both the deep neck flexor exercise group, and deep neck flexor exercise group + thoracic mobilization exercise group had significant change in the level of 0.1% in the angle of cranio vertebral angle, cranio rotation angle, cervical lordosis angle and maximus deep neck flexor muscle strength, in and deep neck flexor muscle endurance, new york state posture rating test scale. There were signficant changes in the level of 1% neck disability index, visual analogue scale in the all groups. In conclusion compared with the control group, both exercise groups, there are significant and positive changes in cervical spine alignment and deep neck flexor muscle strength, endurance.

Purpose: The purpose of this study was to investigate the effects of neck stabilization exercise with PNF for neck alignment, neck disability index, and sitting balance in adults with forward-head posture. Methods: Forty participants were randomly assigned to two groups. Patients in the neck stabilization exercise group (NSG, n = 20) and the proprioceptive neuromuscular facilitation neck pattern exercise group (PNFG, n = 20) were studied 30 minutes a day three times a week for four weeks. Outcomes were measured using cranial vertical angle (CVA), the Korean version of the neck disability index (KNDI), anterior limit of stability (ALOS), and posterior limit of stability (PLOS) before and after the intervention period. Results: There were significant effects in the CVA and the KNDI of both groups pre- and post-intervention. There were significant effects in ALOS and PLOS in the PNFG pre- and post-intervention compared with the NSG. Conclusion: The results of this study suggest that PNF with neck exercise could be beneficial to the static balance of adults with forward-head posture.

Background: The purpose of this study is to investigate the effect of neck and shoulder self-stretching exercise using audiovisual media on neck pain, postural alignment, and joint position error in women with chronic neck pain. Methods: The subjects included 20 women that gave consent to participate in the study voluntarily. They performed the self-stretching exercises using audiovisual media was carried out 20 minutes 5 times a week during 3 weeks. Neck disability index (NDI) and visual analogue scale (VAS) were used to measure the functional disability and pain, A pressure pain threshold was measured using an algometer, and a cervical range of motion (CROM) measurement tool was used to measure the range of motion and error of proprioceptive position sense of the cervical spine. To assess posture alignment, forward head angle (FHA), forward shoulder angle (FSA) were measured using image J software. Results: The neck pain intensity was statistically significantly within group (p<.05). Neck and shoulder functional disability were a statistically significant difference within group (p<.05). Splenius capitis and upper trapezius pressure pain threshold were statistically significant difference in within group (p<.05). The postural alignment was statistically significantly within group (p<.05). The cervical range of motion in neck extension, right and left lateral flexion were statistically significantly within group (p<.05). The joint position error in neck flexion, extension, right and left lateral flexion decreased statistically significantly within group (p<.05). Conclusion: Self-stretching exercise using audiovisual media increased the mobility of the neck, decreased neck pain and joint position error, and improved posture alignment. As a result, there was a positive effect by applying the self-stretching exercise using audiovisual media to people with neck pain. Based on this, it is thought that it can be used as the basis for research related to home training programs for healthy self-management.

Background: The purpose of this study was to determine the effects of cervical extension-traction exercise on cervical alignment, pain, and neck disability in patients with mild turtle syndrome. Methods: Thirty two outpatients with mild turtle neck syndrome were recruited and randomly divided into two groups. Participants in the experimental group was applied cervical extension-traction exercise (CETE, n=16) and in the control group applied cervical stabilization exercise (CSE, n=16) for three times a week for 4 weeks. Results: Cobb angle and Jochumsen depth were CETE showed significant difference within the group post test (p<.05). And the CETE was significantly higher than the CSE. In the pressure pain threshold, both CETE and CSE showed significant differences within post test (p<.05). And the CETE was significantly higher than the CSE. Neck disability index were significant (p<.05) in the CETE post test. There was no significant difference between the two groups. Conclusion: Our results of this study showed that applying cervical extension-traction exercise to patients with mild turtle syndrome improved cervical alignment, pain and neck dysfunction.

Objective: The purpose of this study is to determine the most effective exercise to improve neck alignment and muscle function in university students with forward head posture among neck stabilization exercises (SE), reverse plank exercises (RPE), and neck stabilization exercises combined with reverse plank exercises (SE+RPE). Design: A pre-post intervention study Methods: In this study, 48 university students with a craniovertebral angle of 49 degrees or less were recruited. The selected subjects were randomly assigned to the SE group, the RPE group, and the SE+RPE exercise. The SE+RPE group performed five repetitions of SE and RPE exercises, each with a 30 s hold and 30 s rest. The SE group performed 10 repetitions of SE and the RPE group performed 10 repetitions of RPE, each with a 30 s hold and 30 s rest. To compare before and after the intervention, neck alignment and muscle function were examined. Neck alignment was examined for the craniovertebral angle and range of motion of the neck, and muscle function was examined for the viscoelastic properties of suboccipital and sternocleidomastoid muscles and proprioceptive sensations of neck. Results: There were no significant differences among the three groups (p>0.05), but the SE+RPE group showed significant improvement in neck alignment and muscle function before and after the intervention (p<0.05). Conclusions: The results of this study recommend the selective application of SE+RPE, SE, and RPE depending on the cause of the subject with forward head posture.

Objective : Degenerative changes in the cervical spine are commonly accompanied by cervical kyphosis which can cause neck pain. This study examined the relationship between neck pain and cervical alignment. Methods : A total of 323 female nursing staff from our hospital were enrolled. Sagittal radiographs of the cervical spine, Body Mass Index (BMI), Visual Analogue Scale (VAS) measures of neck and arm pain, Neck Disability Index (NDI) and the Short Form (36) Health Survey (SF-36 scores) were obtained and reviewed retrospectively. Global lordosis (GL) of the cervical spine was measured on radiograph images. Correlations between GL and questionnaire scores were investigated using the following three methods : 1) correlation between GL and questionnaire scores among the entire sample; 2) subgroup analysis of patients with "kyphosis (KYP) : GL scores<0" vs. those with "lordosis (LOR) : GL scores>0" on questionnaire measures; and 3) subgroup analysis of patients with pain vs. those without pain, on GL and questionnaire measures. Results : There was no significant correlation between GL and any questionnaire measure. There was a significant difference between the mean GLs of the KYP and LOR groups, but there were no group differences in BMI, age or any questionnaire measures. There was no difference between the pain (n=92) and pain-free (n=231) groups in age, BMI or GL, but there were differences in neck, and arm pain, and physical function and NDI scores. Conclusions : Our data suggest that kyphotic deformity was not associated with neck pain.

PURPOSE: This study aimed to provide basic clinical data by analyzing the impact of motion observation training and stretching exercises for improving postures on the neck alignment and balance of stroke patients to enable them to accurately recognize the correct exercise method. METHODS: After sampling 20 stroke patients who met the selection criteria, this study randomly assigned 10 people who were administered the stretching exercise with observation training to the experimental group and 10 who received only the stretching exercise intervention to the control group by drawing lots. Next, neck alignment and balance were pre-tested. All interventions were conducted for 30 minutes, 3 times a week for 4 weeks, and when all the interventions were completed after 4 weeks, neck alignment and balance were re-measured in the same way as the pre-test. RESULTS: The comparison of changes in neck alignment and balance within the experimental and control groups showed statistically significant differences in the craniovertebral angle, cranial rotation angle, and balance (p < .05) (p < .01). Between the groups, statistically significant differences were found in the craniovertebral angle, cranial rotation angle, and balance (p < .05) (p < .01). CONCLUSION: A statistically significant difference in neck alignment and balance was observed in the group that underwent stretching exercises combined with observational training and a statistically significant difference was found between the groups. Therefore, it is believed that observation training should be used in clinical practice to improve forward head posture and restore balance in stroke patients.

본 연구는 상부교차증후군(Upper Crossed Syndrome, UCS)을 가진 노인을 대상으로, 8주간의 동적 신경근 안정화(Dynamic Neuromuscular Stabilization, DNS) 운동 프로그램이 자세 정렬, 근두께, 호흡 기능, 그리고 목장애지수(Neck Disability Index, NDI)에 미치는 영향을 분석하였다. 연구에는 하루 8시간 이상 앉아 생활하며 전방머리자세(CVA < 45°) 또는 둥근어깨(바로 누운 자세에서 어깨봉우리–테이블 간 거리 ≥ 70mm)를 가진 65세 이상 노인 13명이 참여하였다. 중재 후 자세정렬 평가에서 머리-척추각(CVA)과 어깨봉우리 높이가 유의하게 개선되었으며(p < .05), 초음파 기반 근두께 측정에서는 배가로근(transversus abdominis, TrA), 횡격막(diaphragm, DIA), 깊은목굽힘근(deep neck flexors, DNF)이 유의하게 증가하였다. 반면, 목빗근(sternocleidomastoid, SCM)과 가슴근육(Pectoral muscle)에서는 감소 경향이 나타났다. 호흡기능(FEV1, FEV1/FVC, PEF)은 증가했지만 통계적으로 유의하지는 않았다(p > .05). 목장애지수(Neck Disability Index, NDI)는 유의하게 감소하였다(p < .05). 이러한 결과는 DNS 운동이 UCS를 가진 노인의 자세 및 신경근 기능 개선에 효과적이며, 일상생활의 기능 향상과 불편감 감소로 삶의 질 향상에 기여할 수 있음을 시사한다.

This study investigated the effects of an 8-week Dynamic Neuromuscular Stabilization (DNS) exercise program on postural alignment, muscle thickness, respiratory function, and neck disability in older adults with Upper Crossed Syndrome (UCS). Thirteen participants aged 65 or older who sat for more than 8 hours per day and exhibited either forward head posture (CVA < 45°) or rounded shoulder posture (acromion-to-table distance ≥ 70 mm) were included. Post-intervention assessments revealed significant improvements in craniovertebral angle and acromion height, indicating better postural alignment (p < .05). Ultrasound measurements showed significant increases in the transverse abdominis (TrA), diaphragm (DIA), and deep neck flexors (DNF), while reductions were observed in the sternocleidomastoid (SCM) and pectoral muscles. Pulmonary function parameters such as FEV1, FEV1/FVC, and PEF increased, though not significantly (p > .05). The Neck Disability Index (NDI) scores significantly decreased following the intervention (p < .05). These findings suggest that DNS is an effective intervention for improving posture and neuromuscular function in older adults with UCS, thereby contributing to reduced discomfort and enhanced daily functional abilities, ultimately improving quality of life.

PURPOSE: This study examined the clinical effects of sling-based shoulder stabilization exercise on pain, postural alignment, cervical range of motion, and functional disability in patients with neck pain accompanied by forward head posture (FHP) and rounded shoulder posture (RSP). METHODS: In this randomized controlled trial, forty patients with neck pain and concomitant FHP and RSP completed the study. All participants received standardized conventional physical therapy, followed by either sling-based or conventional shoulder stabilization exercise, three times per week for four weeks. The outcomes included the pain intensity assessed using the visual analogue scale at rest and during cervical movements, postural alignment, cervical range of motion, and functional disability assessed by the Neck Disability Index. The group-by-time effects were analyzed using repeated-measures analysis of variance. RESULTS: Both groups showed significant improvements in pain intensity, postural alignment, cervical range of motion, and functional disability over time. Compared with the control group, the sling group showed greater reductions in movement-related pain at follow-up, along with greater improvements in the Neck Disability Index scores and right lateral flexion range of motion. CONCLUSION: Both interventions improved the pain, posture, cervical mobility, and disability in patients with neck pain accompanied by FHP and RSP. On the other hand, sling-based exercise provided additional benefits in reducing movement-evoked pain and improving specific cervical movements, indicating its potential value in clinical management.

목 적: 두경부 환자가 입체적 세기변조 회전 방사선치료 시 변화하는 체형과 환자 정열 상태를 조사하고 그에 따라 치료 시 발생하는 선량분포의 변화와 적절한 재 CT 모의치료의 필요성을 평가하고자 한다. 대상 및 방법: 근치적 목적으로 방사선 치료를 시행한 두경부암 89명에 대해 입체적 세기변조 방사선치료계획을 수립하고 치료 기간 동안의 체중을 측정하였다. 그 중 10명의 환자에 대하여 체형변화를 평가하였다. ARIA software(Offline review)를 이용하여 ramus, chin, posterior neck, clavicle 등의 landmark를 지정한 후 skin까지의 거리를 측정하여 차이를 분석하였다. 결 과: 남성 60명을 대상으로 치료시행 $17{\pm}4$회에서 re-CT 모의치료를 시행한 결과 체중 감소율이 $-6.47{\pm}3.5%$로 나타났으며, 여성 29명은 경우는 $17{\pm}5$회에서 체중 감소율이 $-5.73{\pm}2.7%$로 나타났다. 피부위축(Skin shrinkage) 변화를 관찰한 결과 대표 landmark에서의 표준편차는 C1(${\pm}0.44cm$), C3(${\pm}0.83cm$), C5(${\pm}1.35cm$)로서 0.5 kg 감소 당 약 1 mm shrinkage 발생함을 알 수 있었다. 치료 횟수에 따른 피부위축은 1~4 fx (변화 없음), 5~13 fx (-2 mm), 14~22 fx(-4 mm), 23~30 fx(-6 mm)로 나타났다. 결 론: 체형이 약 5 mm 변화하게 되면 중심부 선량은 약 3 % 이상 차이나기 시작하게 되므로 적응증치료에 필요한 CT 모의치료를 추가로 진행하여야만 한다. 또한 적극적으로 lower neck의 CT 모의치료 방법 및 set up 방법에 관하여 연구하고 새로운 고정용구(Immobilization device)의 사용도 검토할 필요가 있다.

Objectives: The purpose of this study was to evaluate the change of body shape and the patient alignment state during image-guided volumetric modulated arc therapy in head and neck cancer patients, Materials and Methods: We performed a image-guided volumetric modulated arc therapy plan for 89 patients with head and neck cancer who underwent curative radiotherapy. Ten of them were evaluated for set up error. The landmarks of the ramus, chin, posterior neck, and clavicle were specified using ARIA software (Offline review), and the positional difference was analyzed. Results: The re-CT simulation therapy was performed in 60 men with $17{\pm}4$ cycles of treatment. The weight loss rate was $-6.47{\pm}3.5%$. 29 women performed re-CT simulation at $17{\pm}5$ cycles As a result, weight loss rate was $-5.73{\pm}2.7%$. The distance from skin to C1, C3, and C5 was measured, and both clavicle levels were observed to measure the skin shrinkage changes. The skin shrinkage standard deviations were C1 (${\pm}0.44cm$), C3 (${\pm}0.83cm$), and C5 (${\pm}1.35cm$), which is about 1 mm shrinkage per 0.5 kg reduction. Skin shrinkage according to the number of treatments was 1 ~ 4 fractions (no change), 5 ~ 13 fractions (-2 mm), 14 ~ 22 fractions (-4 mm) and 23 ~ 30 fractions (-6 mm). Conclusion: When the body shape changes about 5 mm, the central dose starts to differ about 3 % or more. Therefore, the CT simulation treatment for the adaptive therapy should be additionally performed. In addition, it is necessary to actively study the CT simulation therapy method and set up method of the lower neck and to examine the use of a new immobilization device.