Effects of Combined Cervical Stabilization and Stretching Exercises on Craniovertebral Angle, Respiration, Disability, and Range of Motion in Office Workers with Forward Head Posture : A Randomized Control Trial

다국어 초록 (Multilingual Abstract)

Purpose : The purpose of this study was to investigate the effects of combined cervical stabilization exercise (CSE) and stretching exercise (SE) on office workers with forward head posture (FHP).
Methods : A total of 32 office workers with forward head posture were randomly assigned to experimental (n=16) and control (n=16) groups. The experimental group underwent combined CSE and SE, and the control group underwent cervical self-myofascial release and SE. Both groups performed exercises for 40 min per day, thrice per week for a total of 6 weeks. Craniovertebral angle (CVA), respiration, disability, and joint range of motion (ROM) before and 6 weeks after intervention were measured and compared.
Results : There was no significant between-group difference in the general characteristics (p>.05). The intra-group comparison showed significant differences in the visual analog scale (VAS) and neck disability index (NDI) of both groups post-intervention (p<.05). CVA and forced expiratory volume in 1 seconds (FEV1) were significantly improved post-intervention in the experimental group only (p<.05). In the experimental group, all ROM variables were significantly improved post-intervention. In contrast, in the control group, all ROM variables improved significantly post-intervention, except for extension (p<.05). The inter-group comparison showed significant differences in NDI, left lateral flexion, right lateral flexion, and left rotation between the two groups (p<.05).
Conclusion : The combination of CSE and SE, which stabilizes the cervical spine, had positive effects on cranial rotation angle, respiration, disability, and joint ROM in office workers with forward head posture. Therefore, the combination of the two exercises may be an effective option to reduce symptoms and prevent postural problems in office workers with FHP.

참고문헌 (Reference)

1 이명희 ; 주민, "젊은 성인에서 두개척추각과 호흡순환기능의 상관관계 분석" 대한물리의학회 9 (9): 107-113, 2014

2 김기철 ; 황보필녀, "앞쪽머리자세가 있는 만성 목통증 환자에게 압력 바이오피드백 장비를 이용한 목안정화운동 적용이 목통증과 앞쪽머리자세, 음향학적 특성 변화에 미치는 효과" 대한물리의학회 14 (14): 121-129, 2019

3 Cho JC, "Upper thoracic spine mobilization and mobility exercise versus upper cervical spine mobilization and stabilization exercise in individuals with forward head posture : a randomized clinical trial" 18 (18): 525-, 2017

4 Diab AA, "The efficacy of forward head correction on nerve root function and pain in cervical spondylotic radiculopathy: a randomized trial" 26 (26): 351-361, 2012

5 Jang JW, "The effects of sling exercise and Mckenzie exercise on forward head posture" Graduate School of Sahmyook University 2017

6 Choi SY, "The effects of cervical traction, cranial rhythmic impulse, and Mckenzie exercise on headache and cervical muscle stiffness in episodic tension-type headache patients" 28 (28): 837-843, 2016

7 Lim JS, "The effects of cervical stabilization exercise on pain, NDI, and ROM with chronic neck pain patient" Graduate school of Konyang University 2015

8 Jull GA, "The effect of therapeutic exercise on activation of the deep cervical flexor muscles in people with chronic neck pain" 14 (14): 696-701, 2009

9 Ludvigsson ML, "The effect of neck-specific exercise with, or without a behavioral approach, on pain, disability, and self-efficacy in chronic whiplash-associated disorders : a randomized clinical trial" 31 (31): 294-303, 2015

10 Lee KJ, "The effect of forward head posture on muscle activity during neck protraction and retraction" 27 (27): 977-979, 2015

11 Dimitriadis Z, "Respiratory weakness in patients with chronic neck pain" 18 (18): 248-253, 2013

12 선안 ; 여한결 ; 김태욱 ; 현정근 ; 김정윤, "Radiologic Assessment of Forward Head Posture and Its Relation to Myofascial Pain Syndrome" 대한재활의학회 38 (38): 821-826, 2014

13 Genebra CVDS, "Prevalence and factors associated with neck pain : a population-based study" 21 (21): 274-280, 2017

14 Johnson J, "Postural correction" Human Kinetics Publishers 3-52, 2015

15 Patwardhan AG, "Postural consequences of cervical sagittal imbalance : a novel laboratory model" 40 (40): 783-792, 2015

16 Kim MH, "Myofascial pain syndrome in the elderly and self-exercise : a single-blind, randomized, controlled trial" 22 (22): 244-251, 2016

17 Clarkson HM, "Musculoskeletal assessment: joint range of motion and manual muscle strength" Lippincott Williams & Wilkins 34-42, 2000

18 Alpayci M, "Isometric exercise for the cervical extensors can help restore physiological lordosis and reduce neck pain : a randomized controlled trial" 96 (96): 621-626, 2017

19 Rizo AMH, "Immediate effects of the suboccipital muscle inhibition technique in craniocervical posture and greater occipital nerve mechanosensitivity in subjects with a history of orthodontia use : a randomized trial" 35 (35): 446-453, 2012

20 Nezamuddin M, "Efficacy of pressure-biofeedback guided deep cervical flexor training on neck pain and muscle performance in visual display terminal operators" 16 (16): 1350011-, 2013

21 Nezamuddin M, "Efficacy of pressure biofeedback guided deep cervical flexor training on forward head posture in visual display terminal operators" 7 (7): 141-146, 2013

22 Abdel-aziem AA, "Efficacy of deep neck flexor exercise for neck pain : a randomized controlled study" 62 (62): 107-115, 2016

23 Iqbal ZA, "Efficacy of deep cervical flexor muscle training on neck pain, functional disability, and muscle endurance in school teachers : a clinical trial" 2021

24 Quek J, "Effects of thoracic kyphosis and forward head posture on cervical range of motion in older adults" 18 (18): 65-71, 2013

25 Cho JH, "Effects of the shock wave therapy based on stretching exercises on muscle tone and neck range of motion of upper trapezius and sternocleidomastoid in people with forward head posture" 9 (9): 695-699, 2018

26 Noh HJ, "Effects of neck stabilization exercises on neck and shoulder muscle activation in adults with forward head posture" 7 (7): 492-, 2013

27 Akodu AK, "Effects of neck stabilization exercise on pain, disability, craniovertebral angle and psychological status in patient with non-specific chronic neck pain" 6 (6): 10-15, 2018

28 Lee MH, "Effects of neck exercise on high-school students’ neck–shoulder posture" 25 (25): 571-574, 2013

29 Gillani SN, "Effects of eccentric muscle energy technique versus static stretching exercises in the management of cervical dysfunction in upper cross syndrome : a randomized control trial" 70 (70): 394-398, 2020

30 Sikka I, "Effects of deep cervical flexor training on forward head posture, neck pain, and functional status in adolescents using computer regularly" 2020

31 Park SK, "Effects of cervical stretching and cranio-cervical flexion exercises on cervical muscle characteristics and posture of patients with cervicogenic headache" 29 (29): 1836-1840, 2017

32 Ruivo RM, "Effects of a resistance and stretching training program on forward head and protracted shoulder posture in adolescents" 40 (40): 1-10, 2017

33 Kim JY, "Effects of McKenzie exercise, kinesio taping, and myofascial release on the forward head posture" 30 (30): 1103-1107, 2018

34 Pawaria S, "Effectiveness of cervical stabilisation exercises on respiratory strength in chronic neck pain patients with forward head posture-a pilot study" 13 (13): 6-9, 2019

35 Suvarnnato T, "Effect of specific deep cervical muscle exercises on functional disability, pain intensity, craniovertebral angle, and neck-muscle strength in chronic mechanical neck pain : a randomized controlled trial" 12 : 915-925, 2019

36 Kang JI, "Effect of scapular stabilization exercise on neck alignment and muscle activity in patients with forward head posture" 30 (30): 804-808, 2018

37 Koseki T, "Effect of forward head posture on thoracic shape and respiratory function" 31 (31): 63-68, 2019

38 Melam GR, "Effect of different positions on FVC and FEV1 measurements of asthmatic patients" 26 (26): 591-593, 2014

39 Gupta BD, "Effect of deep cervical flexor training vs. conventional isometric training on forward head posture, pain, neck disability index in dentists suffering from chronic neck pain" 7 (7): 2261-2264, 2013

40 Iqbal ZA, "Effect of deep cervical flexor muscles training using pressure biofeedback on pain and disability of school teachers with neck pain" 25 (25): 657-661, 2013

41 Nam CW, "Effect of cervical stabilization exercises on the respiratory function of stroke patients" 88 : 196-199, 2015

42 Kang DY, "Deep cervical flexor training with a pressure biofeedback unit is an effective method for maintaining neck mobility and muscular endurance in college students with forward head posture" 27 (27): 3207-3210, 2015

43 Kim EK, "Correlation between rounded shoulder posture, neck disability indices, and degree of forward head posture" 28 (28): 2929-2932, 2016

44 Lee MY, "Characteristics of cervical position sense in subjects with forward head posture" 26 (26): 1741-1743, 2014

45 Lakens D, "Calculating and reporting effect sizes to facilitate cumulative science : a pmractical primer for t-tests and ANOVAs" 863 : 2013

46 Szczygieł E, "Biomechanical influences on head posture and the respiratory movements of the chest" 17 (17): 143-148, 2015

47 Giggins OM, "Biofeedback in rehabilitation" 10 (10): 1-11, 2013

48 Salahzadeh Z, "Assessment of forward head posture in females : observational and photogrammetry methods" 27 (27): 131-139, 2014

49 Rasmussen GHF, "Absolute and relative reliability of pain sensitivity and functional outcomes of the affected shoulder among women with pain after breast cancer treatment" 15 (15): e0234118-, 2020

50 Jun IS, "A comparison of the deep cervical flexor muscle thicknesses in subjects with and without neck pain during craniocervical flexion exercises" 25 (25): 1373-1375, 2013