• Physical Therapy Korea
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• v.23 no.2
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• pp.57-66
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• 2016

Background: For the treatment of forward head posture (FHP) and forward shoulder posture, methods for strengthening scapular retractors and deep cervical flexors and stretching pectoralis and upper cervical extensors are generally used. No study has yet assessed whether suboccipital release (SR) followed by cranio-cervical flexion exercise (CCFE) (SR-CCFE) will result in a positive change in the shoulders and neck, showing a "downstream" effect. Objects: The purpose of this study was to investigate the immediate effects of SR-CCFE on craniovertebral angle (CVA), shoulder abduction range of motion (ROM), shoulder pain, and muscle activities of upper trapezius (UT), lower trapezius (LT), and serratus anterior (SA) and LT/UT and SA/UT muscle activity ratios during maximal shoulder abduction in subjects with FHP. Methods: In total, 19 subjects (7 males, 12 females) with FHP were recruited. The subject performed the fifth phase of CCFE immediately after receiving SR. CVA, shoulder abduction ROM, shoulder pain, muscle activities of UT, LT, and SA, and LT/UT and SA/UT muscle activity ratios during maximal shoulder abduction were measured immediately after SR-CCFE. A paired t-test and Wilcoxon signed-rank test were used to determine the significance of differences in scores between pre- and post-intervention in the same group. Results: The CVA (p<.001) and shoulder abduction ROM (p<.001) were increased significantly post-versus pre-intervention. Shoulder pain was decreased significantly (p<.001), and LT (p<.05) and SA (p<.05) muscle activities were increased significantly post- versus pre-intervention. The LT/UT muscle activity ratio was increased significantly post- versus pre-intervention (p<.05). However, there was no significant change in UT muscle activity and SA/UT muscle activity ratio between pre- and post-intervention (p>.05). Conclusion: SR-CCFE was an effective intervention to improve FHP and induce downstream effect from the neck to the trunk and shoulders in subjects with FHP.

• Physical Therapy Rehabilitation Science
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• v.5 no.2
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• pp.101-105
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• 2016

Objective: The purpose of this study was to measure the change in pain threshold of levator scapular muscle, carniovertebral angle, and head position angle when applying a head-weight device on healthy adult. Design: Cross-sectional study. Methods: This study was conducted with 21 healthy adult male and female who voluntarily agreed to participate in this study after being informed of the purpose and method of this study. After measuring the cervical angle and pain threshold of levator scapular muscle, subject was instructed to walk for 5 minutes on a treadmill at a speed of less than 5 km/h while wearing after wearing head-weight device of 0.5 kg. Then, cervical spine angle and pain threshold of levator scapula muscle were re-measured. Measurement of cervical spine angle was conducted with photo by using the Bluebeam Revu software and the pain pressure thresholds (PPTs) were measured using an electronic algometer over potential trigger points on the body. Results: The results cervical angle showed a significant change, from $49.62^{\circ}$ to $52.10^{\circ}$ (p<0.05). PPT showed a significant change, from 30.71 to 36.89 (p<0.05). Conclusions: These findings suggest that applying head-weight device has a positive influence on increasing cervical angle and reducing pain when applied as a therapeutic intervention method of forward head posture.

• Journal of the Korean Society of Physical Medicine
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• v.11 no.3
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• pp.65-72
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• 2016

PURPOSE: The purpose of this study is to determine the differences between the muscle activity of cranio-cervical flexion and extension muscles according to the types of tools used through a short-term intervention of cranio-cervical static stabilization exercises using small tools. METHODS: A total of fifteen male and female adults in their 20s who showed forward head posture in the overall body posture measurement system participated in this study. Each subject performed cranio-cervical static stabilization exercises about flexion and extension while using a sling, a foam roller, a TOGU ball, and without tools separately, and the muscle activity of the sternocleidomastoid muscle, scalenus anterior and splenius capitis was measured. Each value was measured for 10 seconds a total of three times. The maximum voluntary isometric contraction value was computed using the average during the middle four seconds. RESULTS: Cranio-cervical flexion exercises using various tool types, the average activity of the sternocleidomastoid and scalenus anterior muscles was significantly higher when applying the TOGU ball (p<.05). According to the results of implementing cranio-cervical flexion exercise using various tools, the maximum muscle activity of the sternocleidomastoid muscle was significantly higher for the TOGU ball (p<.05). CONCLUSION: Based on these results, the provision of an unstable surface using small tools rather than a stable surface is recommended as an exercise scheme for proprioceptive stimulation in a forward head posture. Particularly, we recommend using the TOGU ball for the provision of an unstable surface to increase the muscle activity of the sternocleidomastoid muscle and scalenus anterior.

• Journal of the Korean Society of Radiology
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• v.8 no.2
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• pp.89-96
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• 2014

This paper tries to examine whether the application of joint mobilization to subjects who have the forward head posture due to malalignment in the cervical joint has influence on posture changes and functions in the cervical joint. The subjects were 39 students from G University in Gyeongsangbuk-do. The cervical joint mobilization was applied to 20 subjects and not to 19. The students with a cervical lordosis angle of $21^{\circ}C$ or less, an anterior weight bearing (AWB) of 15mm or greater, and a cervical extension ROM of $70^{\circ}C$ or less in terms of radiography were selected as subjects under their voluntary agreement. The patients actively performed the joint mobilization slowly 8 times per session while therapists continuously applied sustained accessory glide to their painful joints 3 times per week for 4 weeks along with the cervical expansion and flexion in SNAGS among other Mulligan's (1995) techniques. The measurement was carried out in terms of radiographic inspection and neck disability indexes. As a result of the experiment, it turned out that the subjects with the forward head posture had changes in the cervical AWB and ARA, the ranges of expansion and flexion, and the NDI(Neck Disability Index) after the intervention for the experimental group by applying cervical joint mobilization. There were no changes observed in the control group. In conclusion, the application of joint mobilization turned out to have influence on the improvement of cervical joint postures, and craniocervical region functions.

• Physical Therapy Korea
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• v.23 no.3
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• pp.11-20
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• 2016

Background: A forward head posture (FHP) is one of the most common types of poor head posture in patients with neck disorder. A prolonged FHP might increase pressure on the posterior cranio-cervical structure and exhibit reduced performance on a cranio-cervical flexion test (CCFT). CCFT is included to activate deep cervical flexor muscles and inhibit excessive activation of superficial cervical flexor muscles. Therefore, the selective activation of deep cervical flexors is needed for effective exercise for FHP. Objects: The purpose of this study was to compare muscle thickness between longus colli (Lco) and sternocleidomastoid (SCM) using ultrasonography in subjects with FHP depending on head support. Methods: This was a cross-sectional, case-control research design study. The ultrasonographic images of Lco and SCM were taken in 17 subjects with FHP during the 5 phases of the CCFT with and without a head support. Towel was used for supporting head to make the neutral head position in supine. Changes in muscle thickness during the test were calculated to infer muscle activation. Data were analyzed using repeated measures of two-way analysis of variance with the significance level of .05. Results: When subjects performed the CCFT with head support, there was a significant difference in muscle thickness of Lco and SCM (p<.05). According to a post hoc paired t-test, change of thickness of Lco was greater at all phases, and change of thickness of SCM muscle was less at phase 4 and 5 in condition with head support (p<.01) compared to condition without head support (p<.01). Conclusion: The result of this study suggest that applying head support for neutral head position during CCFT could be a useful method for activating Lco muscle without excessive activation of SCM muscle.

• PNF and Movement
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• v.14 no.3
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• pp.185-193
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• 2016

Purpose: The purpose of this study was to investigate the effects of neck patterns in proprioceptive neuromuscular facilitation (PNF) for neck movement and the neck disability index (NDI) among adults with forward head posture. Methods: Thirty-nine subjects were randomly assigned into two groups. Subjects in the proprioceptive neuromuscular facilitation exercise group (PNFG, n = 20) received 20 minutes of PNF neck pattern (flexion-Rt. lateral flexion-Rt. rotation followed by extension-Lt. lateral flexion-Lt. rotation) 3 times weekly for 4 weeks. Outcomes were measured using absolute rotation angle (ARA), anterior weight bearing (AWB), range of flexion and extension motions (RFEM), and neck disability index (NDI) methods before and after the 4-week intervention period. Results: There were significant effects for the PNFG, pre- and post-intervention, in ARA, AWB, RFEM, and NDI. There were significant differences in ARA, AWB, RFEM, and NDI compared with CG. Conclusion: The results of this study suggest the PNF neck pattern could be beneficial for adults with forward head posture.Purpose: This study investigates how abdominal muscular exercise based on proprioceptive neuromuscular facilitation (PNF) can affect chronic low back pain patients in terms of their pulmonary function, pain, and functional disability indexes. Methods: Fourteen target subjects with chronic low back were randomly assigned to the control group (n = 7) that performed abdominal muscle exercises and the experimental group (n = 7) that performed PNF abdominal muscular exercises. The exercises were performed five times a week for six weeks. To check the change in pulmonary function, the forced expiratory volume at one second (FEV1) and visible analogue scale (VAS) were measured to check the pain level. The disability level caused by back pain was measured by the Oswestry Disability Index (ODI). A paired t-test was applied to compare the differences between the groups before and after the intervention, and an independent t-test was used to compare the differences between the groups. The level of statistical significance was set as ${\alpha}=0.05$. Results: Before and after the intervention, the experimental group showed a significant change in FEV1 (p < 0.01), and both the experimental and the control groups showed significant changes in VAS and ODI (p < 0.01). A comparison of the differences between the groups indicated that the experimental group showed more significant changes in FEV1 (p < 0.05). Conclusion: According to the study results, PNF abdominal muscular exercise effectively improved pulmonary function, pain, and functional disability indexes in subjects with chronic back pain. The proposed program can be applied to chronic back pain patients as a useful therapy.

• The korean journal of orthodontics
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• v.14 no.1
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• pp.75-92
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• 1984

This study attempted to analyze the distribution of stress, to examine the bending effect in the mandible according to the pulling directions and determine on which pulling directions are adequate when an orthopedic force was applied to the mandible. An orthopedic force, 500gm, was applied to the gnathion, one point of the chin area, in three directions. The three directions were ; high puli' from gnathion to the center of condyle head, and vertical pull, from gnathion to a parallel line with the posterior border of the ramus, and medium pull, from the gnathion to a parallel line with the lower border of mandible. The distribution of principal stress, bending moment and amount of displacement within the mandible was analyzed by a 3-dimensional finite element method and that of the various portions of mandible were computed and compared according to the pulling directions. The results were as follows : 1. The bending moment of each part of a mandible has been found to be markedly larger in case of vertical pull than in case of either high pull or medium pull. In vertical pull the bending moment turned out to largest at the condyle head and neck portion, the gonial angle portion, the coronoid portion and the ascending ramus portion, respectively, while comparatively large at the cuspid and bicuspid portion and the first molar portion. In case of high pull it was largest at the gonial angle portion and becoming smaller at the coronoid portion, the ascending ramus portion, the condyle head and neck portion, and the cuspid and bicuspid portion, in that order. In case of medium pull, however, the bending moment was largest at the condyle head and neck portion, becoming smaller at the first molar portion, the ascending ramus portion, the coronoid portion, the cuspid and bicuspid portion, and gonial angle portion, in that order. 2. As for the bending effect it was calculated to be mostly oriented downward at the mandibular body and backward at the mandibular ramus in both high pull and vertical pull. In case of medium pull it was oriented upward at the mandibular body and forward at the mandibular ramus. 3. The bending effect also turned out to be mostly oriented outward in case of high pull and medium pull, and inward in vertical pull. 4. At the mandibular body and ramus, the bending effect in the upward-downward direction and that in the forward-backward direction were found to be larger than in the inward-outward direction. 5. If and when we expect any correcting effect on the mandibular protrusion by means of the chin cup appliance, we can say sure as conclusion that high pull and vertical pull are more effective than medium pull.

• Physical Therapy Korea
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• v.25 no.2
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• pp.62-70
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• 2018

Background: The craniocervical flexion (CCF) exercise is one of the effective exercise in correcting forward head posture (FHP). However, some people with FHP achieve CCF with compensatory movements, for example, low cervical flexion using superficial neck flexors such as the sternocleidomastoid (SCM) muscle. No study has yet investigated whether a dual­pres ure biofeedback unit (D-PBU) method to prevent low cervical flexion would be helpful in performing pure CCF movement. Objects: The purpose of this study was to compare the effects of the CCF using D-PBU method and the traditional CCF method on the cross-sectional area (CSA) of the longus colli muscle (LCM) and the activity of SCM muscle in subjects with FHP. Methods: Twenty­four FHP subjects (male: 16, female: 8) were recruited for this study. All subjects performed CCF using two different methods: the traditional CCF method and the CCF using D-PBU method. The CSA of the LCM was measured via ultrasound, and surface electromyography was used to measure SCM muscle activity. Results: The change in CSA of the LCM was significantly larger during the CCF using D-PBU method ($1.28{\pm}.09$) compared with the traditional CCF method ($1.19{\pm}.08$) (p<.05). The SCM muscle activity using the CCF using D-PBU method ($2.01{\pm}1.97$ %MVIC) was significantly lower than when using the traditional CCF method ($2.79{\pm}2.32$ %MVIC) (p<.05). Conclusion: The CCF using D-PBU method can be recommended for increasing LCM activation and decreasing SCM muscle activity during CCF movement in subjects with FHP.

• Journal of the Korean Society of Physical Medicine
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• v.15 no.3
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• pp.29-41
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• 2020

PURPOSE: The aim of this study was to provide evidence for the treatment of Forward Head and Rounded Shoulder Posture (FHRSP) using posture correction exercises by comparing muscle activity and onset time around the neck and shoulder area during an arm elevation task. METHODS: The subjects were divided into FHRSP (21 persons) and non-FHRSP (19 persons) groups to measure muscle activity and onset time of muscle contraction. Wireless surface electromyography was used to assess the muscle activity and onset time of the right and left sternocleidomastoid (SCM), splenius capitis, anterior deltoid, middle deltoid, serratus anterior, upper trapezius, pectoralis major, and infraspinatus during an arm elevation task. After the pre-measurement, the participants performed the postural correction exercises, and then the post-measurement was conducted. RESULTS: After the posture correction exercises, there were significant differences in the muscle activity and onset time of all muscles in the FHRSP group. The results of the comparison of the muscle onset time during an arm elevation task demonstrated that after the postural correction exercises, the muscle onset time was significantly reduced in the right and left SCM and left splenius capitis, but there were no significant changes in the onset time of other muscles. CONCLUSION: The results of this study help us understand the change in muscle activities and muscle contraction onset time in a person with FHRSP when lifting the arm and suggest the relevant basis to apply the posture correction exercise in clinical settings.

• Journal of the Korea Convergence Society
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• v.9 no.12
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• pp.123-128
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• 2018

The aim of this study was to determine the effects of the action observation and visual feedback on the alignment, pain and function of forward head posture(FHP) and round shoulder(RS). A total of 24 participants with FHP and RSP were randomly assigned to general exercise(GE, n=8), action observation(AO, n=8), and visual feedback(VF, n=8). All subjects were exercised three times a week for four weeks. The groups were assessed for craniovertebral angle(CVA), round shoulder posture(RSP), visual analog scale(VAS), and neck disability index(NDI) before and after exercise, There was a significant difference in CVA in the GE, AO and RSP, VAS and NDI were significantly different in all groups. AO was more effective than GE, VF for VAS. The results of this study suggest that action observation may be effective to improve the FHP and RS.