Research Paper: Effects of 4 Week Postural Corrective Exercise on Correcting Forward Head Posture
Introduction: This study aimed to assess the effects of 4-week postural corrective exercise program on forward head posture in college-aged females.
Materials and Methods: This is a randomized controlled study. Twenty-one female students with craniovertebral angle measured less than or equal to 50 degrees were selected and randomly assigned to intervention (n=12) or control (n=9) group. Intervention group performed forward head posture corrective exercises in the form of stretching and strengthening exercises. The craniovertebral angle, active neck flexion range of motion and strength of lower and middle trapezius were measured before and after 4 weeks exercise program.
Results: After four weeks, significant increases were observed in the intervention group regarding the means of craniovertebral angle (P=0.0001), active neck flexion range of motion (P=0.04) and lower trapezius strength (P=0.03), while the mean strength of middle trapezius had not changed significantly (P>0.05).
Conclusion: Four week intervention protocol successfully improved postural alignment related to forward head posture. Thus, corrective exercise program for 4 weeks is effective to decrease forward head posture.
Braun BL, Amundson LR. Quantitative assessment of head and shoulder posture. Archives of Physical Medicine and Rehabilitation. 1989; 70(4):322-9. PMID: 2930348
Harman K, Hubley Kozey CL, Butler H. Effectiveness of an exercise program to improve forward head posture in normal adults: A randomized, controlled 10-week trial. Journal of Manual & Manipulative Therapy. 2005; 13(3):163–76. doi: 10.1179/106698105790824888
Kim SY, Kim NS, Kim LJ. Effects of cervical sustained natural apophyseal glide on forward head posture and respiratory function. Journal of Physical Therapy Science. 2015; 27(6):1851–4. doi: 10.1589/jpts.27.1851
Good M, Stiller C, Zauszniewski JA, Anderson GC, Stanton-Hicks M, Grass JA. Sensation and distress of pain scales: Reliability, validity, and sensitivity. Journal of Nursing Measurement. 2001; 9(3):219-38. PMID: 11881266
Sahrmann SA. Posture and muscle imbalance: Faulty lumbar-pelvic alignment and associated musculoskeletal pain syndromes. Ontario: Orthopaedic Division Review; 1992.
Sahrmann S. Diagnosis and treatment of movement impairment syndromes. Amsterdam: Elsevier Health Sciences; 2002.
Szeto GP, Straker L, Raine S. A field comparison of neck and shoulder postures in symptomatic and asymptomatic office workers. Applied Ergonomics. 2002; 33(1):75–84. doi: 10.1016/s0003-6870(01)00043-6
Harms Ringdahl K, Schüldt K, Ekholm J. Principles of prevention of neck-and-shoulder pain. Scandinavian Journal of Rehabilitation Medicine. 1994; 32:87-96. PMID: 3616526
Bogduk N. The anatomical basis for spinal pain syndromes. Journal of Manipulative and Physiological Therapeutics. 1995; 18(9):603-5. PMID: 8775022
Langford ML. Poor posture subjects a worker's body to muscle imbalance, nerve compression. Occupational Health & Safety (Waco, Tex.). 1994; 63(9):38-40. PMID: 9156441
Moore PV, Winzeler S, Rosenstein BD. Orthopedic problems of the upper extremities: Assessment and diagnosis. AAOHN Journal. 1997; 45(4):188-203. PMID: 9155269
Baldry P. Myofascial pain and fibromyalgia syndromes: A clinical guide to diagnosis and management. London: Churchill Livingstone; 2001.
Griegel Morris P, Larson K, Mueller Klaus K, Oatis CA. Incidence of common postural abnormalities in the cervical, shoulder, and thoracic regions and their association with pain in two age groups of healthy subjects. Physical Therapy. 1992; 72(6):425–31. doi: 10.1093/ptj/72.6.425
Lee MY, Lee HY, Yong MS. Characteristics of cervical position sense in subjects with forward head posture. Journal of Physical Therapy Science. 2014; 26(11):1741–3. doi: 10.1589/jpts.26.1741
Lee WY, Okeson JP, Lindroth J. The relationship between forward head posture and temporomandibular disorders. Journal of Orofacial Pain. 1995; 9(2):161-7. PMID: 7488986
Makofsky HW. The influence of forward head posture on dental occlusion. Cranio. 2000; 18(1):30–9. doi: 10.1080/08869634.2000.11746111
Darling DW, Kraus S, Glasheen Wray MB. Relationship of head posture and the rest position of the mandible. The Journal of Prosthetic Dentistry. 1984; 52(1):111–5. doi: 10.1016/0022-3913(84)90192-6
Kendall FP, McCreary EK, Kendall HO. Muscles: Testing and function. Philadelphia: Lippincott Williams and Wilkins; 1983.
Capuano Pucci D, Rheault W, Aukai J, Bracke M, Day R, Pastrick M. Intratester and intertester reliability of the cervical range of motion device. Archives of Physical Medicine and Rehabilitation. 1991; 72(5):338-40. PMID: 2009054
McKenzie R. Treat your own neck. New Zealand: Spinal Publications; 1983.
Jull GA, Janda V. Muscles and motor control in low back pain: Assessment and Management, Physical Therapy of the Low Back. New York: Churchill Livingstone. 1987.
Latham JM, Fraser RD, Moore RJ, Blumbergs PC, Bogduk N. The pathologic effects of intrathecal betamethasone. Spine. 1997; 22(14):1558–62. doi: 10.1097/00007632-199707150-00004
Ruivo RM, Carita AI, Pezarat Correia P. The effects of training and detraining after an 8 month resistance and stretching training program on forward head and protracted shoulder postures in adolescents: Randomised controlled study. Manual Therapy. 2016; 21:76–82. doi: 10.1016/j.math.2015.05.001
Lynch SS, Thigpen CA, Mihalik JP, Prentice WE, Padua D. The effects of an exercise intervention on forward head and rounded shoulder postures in elite swimmers. British Journal of Sports Medicine. 2010; 44(5):376–81. doi: 10.1136/bjsm.2009.066837
Diab AA. The role of forward head correction in management of adolescent idiopathic scoliotic patients: A randomized controlled trial. Clinical Rehabilitation. 2012; 26(12):1123–32. doi: 10.1177/0269215512447085
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):351–61. doi: 10.1177/0269215511419536
Moustafa IM, Diab AA. The effect of adding forward head posture corrective exercises in the management of lumbosacral radiculopathy: A randomized controlled study. Journal of Manipulative and Physiological Therapeutics. 2015; 38(3):167–78. doi: 10.1016/j.jmpt.2014.11.009
Yip CHT, Chiu TTW, Poon ATK. The relationship between head posture and severity and disability of patients with neck pain. Manual Therapy. 2008; 13(2):148–54. doi: 10.1016/j.math.2006.11.002
Garrett TR, Youdas JW, Madson TJ. Reliability of measuring forward head posture in a clinical setting. Journal of Orthopaedic & Sports Physical Therapy. 1993; 17(3):155–60. doi: 10.2519/jospt.1918.104.22.168
Greenfield B, Catlin PA, Coats PW, Green E, McDonald JJ, North C. Posture in patients with shoulder overuse injuries and healthy individuals. Journal of Orthopaedic & Sports Physical Therapy. 1995; 21(5):287–95. doi: 10.2519/jospt.1922.214.171.1247
Grimmer K. An investigation of poor cervical resting posture. Australian Journal of Physiotherapy. 1997; 43(1):7–16. doi: 10.1016/s0004-9514(14)60398-6
Lewis JS, Green A, Wright C. Subacromial impingement syndrome: The role of posture and muscle imbalance. Journal of Shoulder and Elbow Surgery. 2005; 14(4):385–92. doi: 10.1016/j.jse.2004.08.007
Talavera Carbajal MR, Estanol Vidal B, Lopez Lomeli MM, Garcia Ramos G, Corona V, Plascencia N, et al. Monitoring dermatomal somatosensory evoked potentials at the ERB point, the cervical spinal cord and the cerebral cortex in the diagnosis of cervical radiculopathy. Revista de Neurologia. 2003; 36(10):917-24. PMID: 12766863
Raine S, Twomey LT. Head and shoulder posture variations in 160 asymptomatic women and men. Archives of Physical Medicine and Rehabilitation. 1997; 78(11):1215–23. doi: 10.1016/s0003-9993(97)90335-x
Norkin CC, White DJ. Measurement of joint motion: A guide to goniometry. Philadelphia: F.A. Davis Company; 2016.
Benedetti M, Berti L, Presti C, Frizziero A, Giannini S. Effects of an adapted physical activity program in a group of elderly subjects with flexed posture: clinical and instrumental assessment. Journal of NeuroEngineering and Rehabilitation. 2008; 5(1):32. doi: 10.1186/1743-0003-5-32
Chiu TT, Ku WY, Lee MH, Sum WK, Wan MP, Wong CY, Yuen CK. A study on the prevalence of and risk factors for neck pain among university academic staff in Hong Kong. Journal of Occupational Rehabilitation. 2002; 12(2):77-91. PMID: 12014228
Wang CH, McClure P, Pratt NE, Nobilini R. Stretching and strengthening exercises: Their effect on three dimensional scapular kinematics. Archives of Physical Medicine and Rehabilitation. 1999; 80(8):923–9. doi: 10.1016/s0003-9993(99)90084-9