• Journal of Oral Medicine and Pain
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• 제20권2호
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• pp.361-376
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• 1995

The purpose of this study was to investigate the relationship between the head and neck postre and the cervical curvature, especially in forward head postrue(FHP). Sixty patients with craniomandibular disorders and thirty dental students without any signs and symptoms of craniomandibular disordres participated in this study as patient groups and sa control group, respectively. The author evaluated the head and neck posture of all subjects by plumb line and CROM( Cervical Ragne of Motion), and had taken cephaograph in natural head position. On the cephalograph the angle of cervical inclination formed by true horizntal plane and 4th cervical vertebra(C4) and the radius of cervical curvature from C1 to C5 were measured. A specially designed ruler was used for measuring cervical curvature. Occlusal contac number and force with T-scan system, electromygraphic activity of cervical muscles with Bio-EMG, and distance of freeway space with Bio-ECN were recorded, respectively. The collected data were processed by SAS/STAT progrm. The obtained results were as follows : 1. In subjects with longer radius which was less cervical curvature, head positioned more anteriorly than subjects with smaller radius, and they showed slightly straight cervical vertebra. 2. Between the patients and the control group, there were no differences in cervical curvature, in forward head position by plumb line and in CROM. But the patient group had a greater cervical inclination than the control group had. 3. There were positive correlation between cervical curvature and forward head position by plumbline,between forward head position y plumb line and that by CROM in patient group. The cervical inclination, however, had negative correlation with cervical curvature, and with forward head postion by plumb line, respectively. 4. In case of showing more cervical curvature and more forward head position by plumb line the head position was defined as forward head posture. In patient group, subjects without forward head posture showed greater posterior teeth contact force than subjects with forward head posture, but in control group, there were no difference between the two subjects. 5. There were higher electromyographic activity in almost all muscles and smaller freeway space in induced forward head posture than those in natural head position in subjects without forward head posture. In conclusion, head position of patients with craniomandibular disorders were not more anterior than that of normal control person, but they had tendency to head extension. From the result of this study, forward head posture could be defined as posterior rotation of upper cervical segment with a straight lower cercial segment due to loss of normal lordosis.

• Journal of Oral Medicine and Pain
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• 제24권2호
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• pp.189-206
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• 1999

This study was performed to investigate the factors affecting muscle activity and cephalometric variables according to change of head postures. For this study, 150 patients with temporomandibular disorders and 80 dental students without any signs and symptoms of temporomandibular disorders were selected as the patients group and as the normal group, respectively. Head position to body-midline in frontal plane and upper quarter posture to body plumb line in sagittal plane were observed clinically and electromyographic(EMG) activity of anterior temporalis, masseter, sternocleidomastoideus, and trapezius on clenching were recorded with $BioEMG^{(R)}$ in four head postures, which were natural head posture(NHP), forward head posture(FHP), $20^{\circ}$ upward head posture(UHP), and $20^{\circ}$ downward head posture(DHP). Cephaloradiographs were also taken in the same head postures as in EMG taking, but that was taken only in NHP for the patient group. Cephalometric variables measured were SN angle, CVT angle, atlas inclination angle, occlusal plane angle, Me-C2 angle, pharyngeal width, occiput~axis distance, area of pharyngeal space, and cervical curvature. The data were analyzed by SAS statistical program. The results of this study were as follows : 1. Between the patient and the normal group, there were significant difference in distance from plumb line to acromion, eye-tragus angle, electromyographic activity of the four muscles, and cephalometric variables of linear measurement. 2. There was no consistent pattern of correlation between upper quarter posture, EMG activity and cephalometric variables in any case without relation to cervical curvature and head position in frontal plane. 3. Sternocleidomastoid muscle only showed variation of electromyographic activty with changes of head postures, but all the muscles did show correlation with head postures. 4. All the cephalometric variables measured in this study showed difference of mean value by head posture, and CVT angle, pharyngeal width, occiput-atlas distance, and area of pharyngeal space showed correlation between these variables with change from NHP to FHP, and from NHP to UHP.

• 한국전문물리치료학회지
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• 제22권4호
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• pp.44-50
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• 2015

This study compared the effects of the initial head position (i.e., a HHP versus a relaxed head position) of subjects with and without a FHP on the thickness of the deep and superficial neck flexor muscles during CCF. The study recruited 6 subjects with a FHP and 10 subjects without a FHP. The subjects performed CCF in two different head positions: a HHP, with the head aligned so that the forehead and chin formed a horizontal line, and a relaxed head position (RHP), with the head aligned in a self-selected comfortable position. During the CCF exercise, the thickness of the longus colli (LCo) and the thickness of the sternocleidomastoid (SCM) were recorded using ultrasonography. The thickness of each muscle was measured by Image J software. The statistical analysis was performed with a two-way mixed-model analysis of variance. The thickness of the SCM differed significantly (p<.05) between the subjects with and without FHP. According to a post $h^{\circ}C$ independent t-test, the change in thickness of the SCM increased significantly during CCF in the subjects with FHP while adopting a HHP compared to that in the subjects without FHP. The change in thickness of the SCM was not significantly different between the two positions in subjects without FHP, and there was no significant change in thickness of the LCo muscle during the CCF exercise according to the initial position in both subjects with and without FHP. The results suggest that CCF should be performed in RHP to minimize contraction of the SCM in subjects with a FHP.

• 한국산학기술학회논문지
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• 제20권12호
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• pp.645-651
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• 2019

본 연구는 전방머리자세와 턱관절 장애 및 정량적 턱관절의 체성감각의 상관관계를 알아보고자 연구를 진행하였다. 본 연구는 대상자 선정요구를 충족한 62명의 대상자(22.15±2.56세)을 대상으로 전방머리자세에 대한 중재 후 전방머리 자세 변화에 따른 턱관절 기능 및 체성감각의 상관관계를 분석하였다. 전방머리자세에 대한 중재는 바이오피드백 훈련을 실시하였으며, 주 3회 총 4주간 총 12회 진행되었다. 전방머리자세를 평가하기 위하여 머리-척추각을 검사하였으며, 턱관절 기능은 입 벌림과 좌, 우측 치우침을 검사 하였고, 체성감각의 변화를 확인하기 위하여 진동역치감각을 측정하였다. 연구결과 머리 척추각의 변화에 따른 턱관절 기능(p<0.001) 및 체성감각(p<0.001)의 변화는 모두 유의한 상관관계를 보였다. 연구 결과 전방머리자세와 턱관절 기능 및 체성감각에 유의한 상관관계를 보였으며, 본 연구를 기반으로 턱관절 장애로 고통 받고 있는 환자들에게 턱관절 치료에 새로운 패러다임을 제공 할 수 있을 것이며, 향후 턱관절의 치료에 대한 기초 자료로 제공 될 수 있을 것이다.

• Journal of Oral Medicine and Pain
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• 제25권2호
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• pp.173-189
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• 2000

The purpose of this study was to evaluate the effect of specific head positions on the mandibular rotational torque movements in maximum mouth opening, protrusion and lateral excursion. Thirty dental students without any sign or symptom of temporomandibular disorders(TMDs) were included as a control group and 90 patients with TMDs were selected and examined by routine diagnostic procedure for TMDs including radiographs and were classified into 3 subgroups : disc displacement with reduction, disc displacement without reduction, and degenerative joint disease. Mandibular rotational torque movements were observed in four head postures: upright head posture(NHP), upward head posture(UHP), downward head posture(DHP), and forward head posture(FHP). For UHP, the head was inclined 30 degrees upward: for DHP, the head was inclined 30 degrees downward: for FHP, the head was positioned 4cm forward. These positions were adjusted with the use of cervical range-of-motion instrumentation(CROM, Performance Attainment Inc., St. Paul, U.S.A.). Mandibular rotational torque movements were monitored with the Rotate program of BioPAK system (Bioresearch Inc., WI, U.S.A.). The rotational torque movements in frontal and horizontal plane during mandibular border movement were recorded with two parameters: frontal rotational torque angle and horizontal rotational torque angle. The data obtained was analyzed by the SAS/Stat program. The obtained results were as follows : 1. The control group showed significantly larger mandibular rotational angles in UHP than those in DHP and FHP during maximum mouth opening in both frontal and horizontal planes. Disc displacement with reduction group showed significantly larger mandibular rotational angles in DHP and FHP than those in NHP during lateral excursion to the affected and non-affected sides in both frontal and horizontal planes(p<0.05). 2. Disc displacement without reduction group showed significantly larger mandibular rotational angles in FHP than those in any other head postures during maximum mouth opening as well as lateral excursion to the affected and non-affected sides in both frontal and horizontal planes. Degenerative joint disease group showed significantly larger mandibular rotational angles in FHP than those in any other head postures during maximum mouth opening, protrusion and lateral excursion in both frontal and horizontal planes(p<0.05). 3. In NHP, mandibular rotational angle of the control group was significantly larger than that of any other patient subgroups. Mandibular rotational angle of disc displacement with reduction group was significantly larger than that of disc displacement without reduction group during maximum mouth opening in the frontal plane. Mandibular rotational angle of disc displacement without reduction group was significantly larger than that of disc displacement with reduction group or degenerative joint disease group during maximum mouth opening in the horizontal plane(p<0.05). 4. In NHP, mandibular rotational angles of disc displacement without reduction group were significantly larger than those of the control group or disc displacement with reduction group during lateral excursion to the affected side in both frontal and horizontal planes. Mandibular rotational angle of disc displacement without reduction group was significantly smaller than that of the control group during lateral excursion to the non-affected side in frontal plane. Mandibular rotational angle of disc displacement without reduction group was significantly larger than that of disc displacement with reduction group during lateral excursion to the non-affected side in the horizontal plane(p<0.05). 5. In NHP, mandibular rotational angle of the control group was significantly smaller than that of disc displacement with reduction group or disc displacement without reduction group during protrusion in the frontal plane. Mandibular rotational angle of disc displacement without reduction group was significantly larger than that of the disc displacement with reduction group or degenerative joint disease group during protrusion in the horizontal plane. Mandibular rotational angle of the control group was significantly smaller than that of disc displacement without reduction group or degenerative joint disease group during protrusion in the horizontal plane(p<0.05). 6. In NHP, disc displacement without reduction group and degenerative joint disease group showed significantly larger mandibular rotational angles during lateral excursion to the affected side than during lateral excursion to the non-affected side in both frontal and horizontal planes(p<0.05). The findings indicate that changes in head posture can influence mandibular rotational torque movements. The more advanced state is a progressive stage of TMDs, the more influenced by FHP are mandibular rotational torque movements of the patients with TMDs.

• 대한물리치료과학회지
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• 제25권1호
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• pp.44-51
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• 2018

Background: In this paper, the relationship between the Cranio-Vertebral Angle (CVA) and the vital capacity in each position is reviewed, and the vital capacity in the position is studied. Methods: This study targeted 20 non-smoking female students of U university, which is located in Gyeongju-si. To review the Forward Head Posture (FHP) of each subject, CVA was measured, and FVC, FEV1, and FEF (25-75%) were measured and analyzed using a spirometer. Subjects were ordered to exhale three times with ease and then inhale up to their total lung capacity. After then, they were requested to exhale longer than six seconds. Then the inspiration and expiration were repeated. The measurement was executed in three positions, including supine, prone, and sitting. In each position the measurement was repeated twice, and a one-minute break was given between each cycle, so it was measured six times in total. SPSS 14.0 for Windows was used to analyze the data. The subjects' general properties were analyzed using descriptive statistics, and the correlation between the angle and the respiration variable result in each position was analyzed. The result of the respiration variable in each position was analyzed using the one-way ANOVA, and then a Scheffe post-hoc comparison was executed. Results: According to the analysis result of the correlation between the angle and respiration variable in each position, the sitting position and FEF (25-75%) showed a positive correlation (P<0.05). The respiration variable in each position showed a significant difference in FVC (p<0.05), and the Scheffe post-hoc comparison differed in prone and sitting positions. Conclusion: To increase the FVC of FHP patients, different exercises for each position can be applied, and the result of this study can be utilized as background data for further research.

• PNF and Movement
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• 제20권3호
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• pp.371-381
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• 2022

Purpose: Forward head posture (FHP) is known to cause pain, limit range of motion, and reduce quality of life. Joint mobilization is commonly used to correct FHP. However, no study has compared cervical, thoracic, and combined cervical and thoracic joint mobilization for FHP. The aim of this study was to investigate and compare the effects of each mobilization technique on range of motion in the sagittal plane and pain in patients with FHP. Methods: Forty-five patients were recruited and randomly divided into three groups: the mobilization group (CM; n = 15), the cervical and thoracic mobilization group (CTM; n = 15), and the thoracic mobilization group (TM; n = 15). Each intervention was performed in sets of three and repeated six times. Range of motion and pain were assessed pre- and post-intervention. The cervical range of motion was evaluated using a goniometer, and pain was evaluated using a visual analogue scale and pain thresholds of the suboccipital and upper trapezius muscles. Results: All groups showed an increase in range of motion post-intervention, but the increase in the CTM group was significantly greater than in the CM and TM groups (p < 0.05). Pain measured using the visual analogue scale decreased in all groups, but the decreases in the CM and CTM groups were significantly greater than in the TM group (p < 0.05). The pain thresholds of the suboccipital and upper trapezius muscles increased in all groups, but the increase in the CTM group was significantly greater than in the CM and TM groups (p < 0.05). Conclusion: Overall, our findings suggest that CTM may be more effective than CM or TM for improving cervical range of motion in the sagittal plane and pain in patients with FHP.

• PNF and Movement
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• 제22권1호
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• pp.1-11
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• 2024

Purpose: The prevalent use of mobile devices may contribute to musculoskeletal disorders, such as forward head posture (FHP), among users. The measurement of the craniovertebral angle (CVA) using photographic images is frequently employed in assessing FHP. Although manual CVA measurement using photographic images is reliable in clinical settings, computer programs or mobile applications to support tele-physical therapy are not yet fully developed. Therefore, in the current study, we propose an automatic method for extracting CVA from photographic images of FHP subjects to facilitate tele-physical therapy. Methods: To develop the automatic CVA measuring computer program, photographic images were obtained from 10 FHP participants. The location information obtained from the markers attached to the tragus and the spinous process of the seventh cervical vertebra were used as coordinates. Using these coordinates, straight line 1 was generated by connecting the seventh spinous process of the cervical vertebra and the tragus, while straight line 2 was drawn parallel to the coordinate obtained from the seventh spinous process of the cervical vertebra. The arc tangent function was used to calculate the angle between the two straight lines. The automatic CVA measurement computer program utilizing photographic images was developed using MATLAB (ver. 2016b). Results: The results showed that the automatic CVA measurement computer program demonstrated stable repeatability and high accuracy. Conclusion: The proposed approach was able to automatically estimate the CVA using photographic images. The developed computer program can potentially be used for easier and more reliable clinical assessment of FHP.

• The Journal of Korean Physical Therapy
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• 제26권5호
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• pp.358-364
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• 2014

Purpose: Flexed posture commonly increases with age in older women and is characterized by an excessive curvature in the thoracic spine (kyphosis), forward head posture, and decline in height. This study was conducted in order to determine the relationship between flexed posture, physical performance, and psychosocial factors in community dwelling elderly women in Korea. Methods: Fifty-two subjects with thoracic kyphosis of $40^{\circ}C$ or greater participated in this study. Flexed posture was measured using kyphosis angle (KA), forward head posture (FHP), and round shoulder (RS), and physical performance was evaluated using the short physical performance battery (SPPB), grip strength, and static and dynamic balance. Psychosocial factors were measured using depression and the quality of life (QOL). All data were analyzed using SPSS 18.0 software for windows. Results: KA showed significant correlation with SPPB score (r=-0.447) and dynamic balance (r=0.426) (p<0.05) depression (r=0.405) and QOL (r=-0.464) but not with grip strength and static balance in elderly individuals. FHP and RS showed significant correlation with SPPB score (r=0.002, r=-0341) and dynamic balance (r=-0.278, r=0.346) (p<0.05) but not with psychosocial factors. Conclusion: These findings suggest that flexed posture provides meaningful information about physical performance and psychosocial factors in elderly women. Our data suggest that the flexed posture may need to be addressed as part of the health management process for elderly women.

• 국제물리치료학회지
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• 제7권2호
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• pp.989-993
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• 2016

The purpose of this study was to investigate the effects of occipital bone stimulation by cervical stabilizing exercise on the muscle tone, stiffness, ROM, and cervical lordosis in patient with forward head posture(FHP). This study was a case study of a single patient with forward head posture. This study used a ABA' design, A and A' were the baseline phases and B was the intervention phase. The intervention was occipital bone stimulation by cervical stabilization exercise. It was administered once daily for 7 days. The therapist kept hands together, and placed the two index fingers under the subject's occipital bone. The subject performed the chin-in exercise with a maximum isometric contraction for 20 sec.The exercise was implemented by performing the movements 10 times as a set and repeating the set three times. The muscle tone was not significantly changed after intervention. However, the stiffness was decreased and lasted the effect lasted without intervention. The cervical flexion angle was increased, but the cervical extension angle was not significantly changed after the intervention. The left and right lateral flexion angles were increased and the effect lasted without any intervention. However, the left and right rotation angles were significantly changed after the intervention. Cervical lordosis increased not from $37^{\circ}$ to $41^{\circ}$ after the intervention. These results suggest that occipital bone stimulation by cervical stabilizing exercise had a positive effect on cervical stiffness, flexion and lateral flexion ROM, and lordosis in a patient with forward head posture.