Change of Craniovertebral Angle and Scapula Alignment in Adults with Forward Head Posture by Shoulder and Abdominal Stabilization Exercise

어깨 안정화운동과 복부 안정화 운동에 의한 전방머리자세 성인의 머리척추각도와 어깨뼈 정렬 변화

  • Kim, Jae-Hyun (Department of Physical Therapy, Graduate School, Catholic University of Pusan) ;
  • Rhee, Min-Hyung (Department of Rehabilitation Medicine, Pusan National University Hospital)
  • 김재현 (부산가톨릭대학교 일반대학원 물리치료학과) ;
  • 이민형 (부산대학교병원 재활의학팀)
  • Received : 2021.08.01
  • Accepted : 2021.08.13
  • Published : 2021.08.31


Purpose: This study aimed to adjust the craniovertebral angle and shoulder alignment through shoulder and abdominal stabilization exercises in adults with a forward head posture. Methods: The study participants were 29 adults with a forward head posture, and they were randomly divided into the following groups: 14 participants in a combined exercise group that used shoulder and abdominal stabilization exercises and 15 participants in a shoulder exercise group that used just shoulder stabilization exercises. The participants performed the stabilization exercises for 30 minutes per day, three times a week for five weeks. Results: There were significant differences in the craniovertebral angle after intervention in the shoulder stabilization exercise group (p < 0.05). There were significant differences in the craniovertebral angle and location of the right root of the spine and both inferior angles before and after intervention in the shoulder and abdominal stabilization exercise group (p < 0.05). There was a significant difference in the location of the right root of the spine and the left inferior angle between the groups at the post-test (p < 0.05), and there was a larger change in the shoulder and abdominal stabilization exercise group. Conclusion: There was a significant difference in the craniovertebral angle and a partially significant difference in shoulder alignment before and after intervention in both groups.



  1. Ahn SH, Yang JH, Lee SK, et al. Effect of chin tuck exercises on various postures and muscle activity of the neck and shoulder. PNF and Movement. 2020;18(3): 403-414.
  2. Barry CM, Kestell G, Gillan M, et al. Sensory nerve fibers containing calcitonin gene-related peptide in gastrocnemius, latissimus dorsi and erector spinae muscles and thoracolumbar fascia in mice. Neuroscience. 2015;219:106-117.
  3. Diab AA, Moustafa IM. The efficacy of forward head correction on nerve root function and pain in cervical spondylotic radiculopathy: a randomized trial. Clinical Rehabilitation. 2011;26(4):351-361.
  4. Fard BS, Ahmadi A, Maroufi N, et al. Evaluation of forward head posture in sitting and standing positions. European Spine Journal. 2016;25(11):3577-3582.
  5. Greig AM, Straker LM, Briggs AM. Cervical erector spinae and upper trapezius muscle activity in children using different information technologies. Physiotherapy. 2005;91(2):119-126.
  6. IJspeert J, Kerstens HCJW, Janssen RMJ, et al. Validity and reliability of serratus anterior hand held dynamometry. BMC Musculoskeletal Disorders. 2019;20(1):360.
  7. Janwantanakul P, Sitthipornvorakul E, Paksaichol A. Risk factors for the onset of nonspecific low back pain in office works: a systematic review of prospective cohort studies. Journal of Manipulative and Physiological Therapeutics. 2012;35(7):568-577.
  8. Kaur N, Bhanot K, Brody LT, et al. Effects of lower extremity and trunk muscles recruitment on serratus anterior muscle activation in healthy male adults. The International Journal of Sports Physical Therapy. 2014;9(7):924-937.
  9. Kang KW, Kang DW, Kwon GY, et al. The impact of head repositioning accuracy and proprioception on cervical stabilization exercise in healthy adults. Physical Therapy Rehabilitation Science. 2015;4 (1): 49-54.
  10. Khan A, Khan Z, Bhati P, et al. Influence of forward head posture on cervicocephalic kinesthesia and electromyographic activity of neck musculature in asymptomatic individuals. Journal of Chiropractic Medicine. 2020;19(4):230-240.
  11. Khayatzadeh S, Kalmanson OA, Schuit D, et al. Cervical spine muscle-tendon unit length differences between neutral and forward head postures: biomechanical study using human cadaveric specimens. Physical Therapy. 2017;97(7):756-766.
  12. Kim BB, Lee JH, Jeong HJ, et al. Can suboccipital release followed by cranio -cervical flexion exercise improve shoulder range of motion, pain, and muscle activity of scapular upward rotators in subjects with forward head posture? Physical Therapy Korea. 2016a;23 (2):57-66.
  13. Kim BB, Lee JH, Jeong HJ, et al. Effects of suboccipital release with craniocervical flexion exercise on craniocervical alignment and extrinsic cervical muscle activity in subjects with forward head posture. Journal of Electromyography and Kinesiology. 2016b; 30:31-37.
  14. Kim BY, Kang SM, Kang JH, et al. 2020 Korean society for the study of obesity guidelines for the management of obesity in Korea. Seoul. Journal of Obesity & Metabolic Syndrome. 2020.
  15. Kim HW, Yun SJ, Ha SM. A reliability study of tape and photography measurement techniques for scapular position. Physical Therapy Korea. 2013;20(3):74-80.
  16. Kim JH, Yoon HB, Park JH, et al. Comparative effect of modified shrug exercises with and without trunk stabilization exercise on scapular upward rotator EMG and thickness in subjects with scapular downward rotation syndrome. Physical Therapy Korea. 2017;24(4):60-67.
  17. Kim MH. The effect of traditional Korean breathing exercises on body composition basic fitness and stress hormone levels in the elderly women. Korea Sport Research. 2007;18(5):91-102.
  18. Kim SH, Park DJ. Effects of diagonal shoulder training in a closed kinematic chain for secondary impingement syndrome: a case study. Journal of Physical Therapy Science. 2015;27(6):2019-2020.
  19. Kim SY, Koo SJ. Effect of duration of smartphone use on muscle fatigue and pain caused by forward head posture in adults. Journal of Physical Therapy Science. 2016;28(6):1669-1672.
  20. Ko KH. A study on correlational relationship between percent body fat (%BF) and body mass index (BMI). Korea Sport Research. 2005;16(5):619-626.
  21. Kocur P, Wilski M, Goliwas M, et al. Influence of forward head posture on myotonometric measurements of superficial neck muscle tone, elasticity, and stiffness in asymptomatic individuals with sedentary jobs. Journal of Manipulative and Physiological Therapeutics. 2019;42(3):195-202.
  22. Kudo S, Mastuda Y, Yanai T, et al. Contribution of upper trunk rotation to hand forward-backward movement and propulsion in front crawl strokes. Human Movement Science. 2019;66:467-476.
  23. Lee JJ. Differential effects of abdominal drawing-in maneuver, abdominal bracing, and dynamic neuromuscular stabilization on core stability and motor control in adults with core instability. Yonsei University. Dissertation of Master's Degree. 2014.
  24. Madokoro S, Yokogawa M, Miaki H. Effect of the abdominal draw-in maneuver and bracing on abdominal muscle thickness and the associated subjective difficulty in healthy individuals. Healthcare. 2020;8(4):496.
  25. Neumann DA, Camargo PR. Kinesiologic considerations for targeting activation of scapulothoracic muscles - part 1: serratus anterior. Brazilian Journal of Physical Therapy. 2019;23(6):459-466.
  26. Park DJ, Lee HO. The intramuscular activation of scapular stabilizing muscles during push-up plus and PNF exercises in a quadruped position. Journal of Physical Therapy Science. 2013a;25(4):371-374.
  27. Park DJ, Lee SK. What is a suitable pressure for the abdominal drawing-in maneuver in the supine position using a pressure biofeedback unit? Journal of the Physical Therapy Science. 2013b;25(5):527-530.
  28. Park SK, Kim YN, Jung EY, et al. Abdominal draw in maneuver with shoulder isometric contractions on abdominal muscles thickness in healthy person. Physical Therapy Korea. 2013;20(2):38-45.
  29. Park SK, Park JM, Lee JH. Effects of a push-up plus exercise program on scapular position and muscle activity in individuals with rounded shoulder posture. The Journal Korean Society of Physical Therapy. 2010;22(5):1-8.
  30. Sheikhhoseini R, Shahrbanian S, Sayyadi P, et al. Effectiveness of therapeutic exercise on forward head posture: a systematic review and meta-analysis. Journal of Manipulative and Physiological Therapeutics. 2018;41(6):530-539.
  31. Shiravi S, Letafatkar A, Bertozzi L, et al. Efficacy of abdominal control feedback and scapula stabilization exercises in participants with forward head, round shoulder postures and neck movement impairment. Sports Health. 2019;11(3):272-279.
  32. Singla D, Veqar Z. Association between forward head, rounded shoulders, and increased thoracic kyphosis: a review of the literature. Journal of Chiropractic Medicine. 2017;16(3):220-229.
  33. Sobush DC, Simoneau GG, Dietz KE, et al. The lennie test for measuring scapular position in healthy young adult females: a reliability and validity study. The Journal of Orthopaedic and Sports Physical Therapy. 1996;23(1):39-50.
  34. Song GB, Kim JJ, Kim KR, et al. The effects of neck stabilization exercise and proprioceptive neuromuscular facilitation on neck alignment, NDI, and static balance in adults with forward-head posture in a sitting position. PNF and Movement. 2020;18(1):11-22.
  35. Toro ASV, Cools AMJ, Oliveira ASD. Instruction and feedback for conscious contraction of the abdominal muscles increase the scapular muscles activation during shoulder exercises. Manual Therapy. 2016;25:11-18.
  36. Weon JH, Oh JS, Cynn HS, et al. Influence of forward head posture on scapular upward rotators during isometric shoulder flexion. Journal of Bodywork & Movement Therapies. 2010;14(4):367-374.
  37. Wong KK, Chai HM, Chen YJ, et al. Mechanical deformation of posterior thoracolumbar fascia after myofascial release in healthy men: a study of dynamic ultrasound imaging. Musculoskeletal Science and Practice. 2017;27:124-130.