Journal of the Korean Society of Physical Medicine (대한물리의학회지)

The Korean Society of Physical Medicine (대한물리의학회)
권호 표지
DOI QR코드

DOI QR Code

Effects of Therapeutic Exercise on Posture, Pain and Asymmetric Muscle Activity in a Patient with Forward Head Posture: case report

치료적운동이 전방두부자세 환자의 자세, 통증 및 비대칭적 근육활성에 미치는 영향: 증례보고

  • Yoo, Kyung-Tae (Department of Physical Therapy, Namseoul University) ;
  • Lee, Ho-Seong (Department of Kinesiologic Medical Science, Graduate, Dankook University)
  • 유경태 (남서울대학교 물리치료학과) ;
  • 이호성 (단국대학교 대학원 운동의과학과)
  • Received : 2015.11.29
  • Accepted : 2015.12.24
  • Published : 2016.02.29
Download PDF
⟨ Previous Next ⟩

Abstract

PURPOSE: The purpose of this case report was to determine the effect of therapeutic exercise on posture, pain, and muscle activity in two patients with forward head posture (FHP). METHODS: A-31-year-old male (patient A) and a 19-year-old women (patient B) presented with FHP, neck pain, and headache. The therapeutic exercise program consisted of cervical mobilization, deep cervical flexors strengthening, and cervical extensors stretching, for 40 min/d, 2 d/week, for 8 weeks. Neck pain (VAS), neck disability (NDI), cervical range of motion (CROM), lateral view of cervical spine X-ray (indicating the FHP), and asymmetrical neck and shoulder muscular activity ratio were measured before, after 4 weeks, and after 8 weeks of corrective exercise. RESULTS: VAS and NDI decreased in patients A and B after exercise compared to before the program. CROM increased in patients A and B at flexion, extension, side bending, and rotation after exercise compared to before the program. FHP decreased in patients A and B at distance after exercise compared to before the program. In addition, asymmetrical neck and shoulder muscles activity ratio improved in patients A and B after exercise compared to before the program. CONCLUSION: We demonstrated in a case report that therapeutic exercise increases ROM, decreases pain and disability of neck, FHP, and asymmetry muscle activity ratio in patients with FHP. These finding have clinical implications for therapeutic exercise in patients with FHP.

Keywords

References

  1. Andersen LL, Hansen K, Mortensen OS, et al. Prevalence and anatomical location of muscle tenderness in adults with nonspecific neck/shoulder pain. BMC Musculoskelet Disord. 2011;12:169. https://doi.org/10.1186/1471-2474-12-169
  2. Blangsted AK, Sogaard K, Hansen EA, et al. One-year randomized controlled trial with different physicalactivity programs to reduce musculoskeletal symptoms in the neck and shoulders among office workers. Scand J Work Environ Health. 2008;34(1):55-65. https://doi.org/10.5271/sjweh.1192
  3. Boyle K. Conservative Management for Patients with Sacroiliac Joint Dysfunction. In: Norasteh AA, editor. Low Back Pain. Rijeka, Croatia: InTech; 2012:293-332.
  4. Bronfort G, Evans R, Nelson B. A randomized clinical trial of exercise and spinal manipulation for patients with chronic neck pain. Spine (Phila Pa 1976). 2001;26(7):788-97. https://doi.org/10.1097/00007632-200104010-00020
  5. Chen J, Solinger AB, Poncet JF, et al. Meta-analysis of normative cervical motion. Spine (Phila Pa 1976). 1999;24(15):1571-8. https://doi.org/10.1097/00007632-199908010-00011
  6. Cheng CH., Wang JL., Lin JJ., et al. Position accuracy and electromyographic responses during head reposition in young adults with chronic neck pain. Journal of Electromyography and Kinesiology. 2010;20(5):1014-20. https://doi.org/10.1016/j.jelekin.2009.11.002
  7. Cibulka MT, Strube MJ, Meier D, et al. Symmetrical and asymmetrical hip rotation and its relationship to hip rotator muscle strength. Clin Bio mech (Bristol, Avon). 2010;25:56-62. https://doi.org/10.1016/j.clinbiomech.2009.09.006
  8. Correa EC, Berzin F. Efficacy of physical therapy on cervical muscle activity and on body posture in school-age mouth breathing children. Int J Pediatr Otorhinolaryngol. 2007;71(10):1527-35. https://doi.org/10.1016/j.ijporl.2007.05.031
  9. Diab AA, Moustafa IM. The efficacy of forward head correction on nerve root function and pain in cervical spondylotic radiculopathy: a randomized trial. Clin Rehabil. 2012;26(4):351-61. https://doi.org/10.1177/0269215511419536
  10. Diab AA. The role of forward head correction in management of adolescent idiopathic scoliotic patients: a randomized controlled trial. Clin Rehabil. 2012;26(12):1123-32. https://doi.org/10.1177/0269215512447085
  11. Evans R, Bronfort G, Nelson B, Goldsmith CH. Two-year follow-up of a randomized clinical trial of spinal manipulation and two types of exercise for patients with chronic neck pain. Spine (Phila Pa 1976). 2002;27(21):2383-9. https://doi.org/10.1097/00007632-200211010-00013
  12. Fernandez-de-las-Penas C, Albert-Sanchis JC, Buil M, Benitez JC, Alburquerque-Sendín F. Cross-sectional area of cervical multifidus muscle in females with chronic bilateral neck pain compared to controls. J Orthop Sports Phys Ther. 2008;38(4):175-80. https://doi.org/10.2519/jospt.2008.2598
  13. Fernandez-de-las-Penas C, Downey C, Miangolarra-Page JC. Validity of the lateral gliding test as tool for the diagnosis of intervertebral joint dysfunction in the lower cervical spine. J Manipulative Physiol Ther. 2005;28(8):610-6. https://doi.org/10.1016/j.jmpt.2005.08.014
  14. Ferrario VF, Tartaglia GM, Luraghi FE. The use of surface electromyography as a tool in differentiating temporomandibular disorders from neck disorders. Man Ther. 2007;12(4):372-9. https://doi.org/10.1016/j.math.2006.07.013
  15. Finley MA, Lee RY. Effect of sitting posture on 3-dimensional scapular kinematics measured by skin-mounted electromagnetic tracking sensors. Arch Phys Med Rehabil. 2003;84:563-8. https://doi.org/10.1053/apmr.2003.50087
  16. Ganesh GS, Mohanty P, Pattnaik M. Effectiveness of mobilization therapy and exercises in mechanical neck pain. Physiother Theory Pract. 2015;31(2):99-106. https://doi.org/10.3109/09593985.2014.963904
  17. Gong WT, Lee SY, Lee YM. The Effects of Cervical ROM and Muscle Endurance on Cervical Joint Mobilization of Normal Adults J Korean Soc Phys Med. 2010;5(1):7-13.
  18. Gupta BD, Aggarwal S, Gupta B, et al. 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. J Clin Diagn Res. 2013;7(10):2261-4.
  19. 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. J Manual Manip Ther. 2005;13:163-76. https://doi.org/10.1179/106698105790824888
  20. Hwang BG, Kim GC, Park YK. Effects of Self-stretching Exercise and Upper Thoracic Joint Mobilization on Range of Motion and Pain of the Patients with Chronic Neck Pain. J Korean Soc Phys Med. 2012;7(4):509-14. https://doi.org/10.13066/kspm.2012.7.4.509
  21. Iizuka Y, Iizuka H, Mieda T. Association between neck and shoulder pain, back pain, low back pain and body composition parameters among the Japanese general population. BMC Musculoskelet Disord. 2015;16(1):333. https://doi.org/10.1186/s12891-015-0759-z
  22. Inami S, Shiga T, Tsujino A, et al. Immunohistochemical demonstration of nerve fibers in the synovial fold of the human cervical facet joint. J Orthop Res. 2001;19:593-6. https://doi.org/10.1016/S0736-0266(00)00048-6
  23. Johnston V, Jull G, Souvlis T. Neck movement and muscle activity characteristics in female office workers with neck pain. Spine (Phila Pa 1976). 2008;33(5):555-63 https://doi.org/10.1097/BRS.0b013e3181657d0d
  24. Jull G, Trott P, Potter H, Zito G, Niere K, Shirley D, Emberson J, Marschner I, Richardson C. A randomized controlled trial of exercise and manipulative therapy for cervicogenic headache. Spine (Phila Pa 1976). 2002;27(17):1835-43. https://doi.org/10.1097/00007632-200209010-00004
  25. Jull GA, Falla D, Vicenzino B, et al. The effect of therapeutic exercise on activation of the deep cervical flexor muscles in people with chronic neck pain. Man Ther. 2009;14(6):696-701. https://doi.org/10.1016/j.math.2009.05.004
  26. Kang JH, Park RY, Lee SJ, et al. The effect of the forward head posture on postural balance in long time computer based worker. Ann Rehabil Med. 2012;36:98-104. https://doi.org/10.5535/arm.2012.36.1.98
  27. Kim MH, Yi CH, Kwon OY, et al. Changes in neck muscle electromyography and forward head posture of children when carrying schoolbags. Ergonomics. 2008;51(6):890-901. https://doi.org/10.1080/00140130701852747
  28. Kogawa EM, Calderon PS, Lauris JR. Evaluation of maximal bite force in temporomandibular disorders patients. J Oral Rehabil. 2006;33(8):559-65. https://doi.org/10.1111/j.1365-2842.2006.01619.x
  29. Law EY, Chiu TT. Measurement of cervical range of motion (CROM) by electronic CROM goniometer: a test of reliability and validity. J Back Musculoskelet Rehabil. 2013;26(2):141-8. https://doi.org/10.3233/BMR-2012-00358
  30. Lee B, Lee J, Yang J. The effects of stretching exercise for upper trapezius on the asymmetric rate of bite force. J Phys Ther Sci. 2015;27(7):2159-62. https://doi.org/10.1589/jpts.27.2159
  31. Lee KJ, Roh JS, Choi HS, et al. Effect of Active Intervention after Kaltenborn's Cervical Joint Mobilization on The Cervical Spine Alignment and Muscle Activity in Patients with Forward Head Posture. J Korean Soc Phys Med. 2015;10(2):17-27. https://doi.org/10.13066/kspm.2015.10.2.17
  32. Lee MY., Lee HY., Yong MS. Characteristics of cervical position sense in subjects with forward head posture. J Phys Ther Sci. 2014;26(11):1741-3. https://doi.org/10.1589/jpts.26.1741
  33. Lynch SS, Thigpen CA, Mihalik JP, et al. The effects of an exercise intervention on forward head and rounded shoulder postures in elite swimmers. Internet Br J Sports Med. 2010;44(5):376-81 https://doi.org/10.1136/bjsm.2009.066837
  34. Morningstar MW, Strauchman MN, Weeks DA. Spinal manipulation and anterior headweighting for the correction of forward head posture and cervical hypolordosis: A pilot study. J Chiropr Med. 2003;2(2):51-4. https://doi.org/10.1016/S0899-3467(07)60042-1
  35. Mostamand J, Lotfi H, Safi N. Evaluating the head posture of dentists with no neck pain. J Bodyw Mov Ther. 2013;17(4):430-3. https://doi.org/10.1016/j.jbmt.2012.11.002
  36. Nam SH, Son SM, Kwon JW, et al. The intra- and inter-rater reliabilities of the forward head posture assessment of normal healthy subjects. J Phys Ther Sci. 2013;25:737-9. https://doi.org/10.1589/jpts.25.737
  37. Ning X, Haddad O, Jin S. Influence of asymmetry on the flexion relaxation response of the low back musculature. Clin Biomech (Bristol, Avon). 2011;26(1):35-9. https://doi.org/10.1016/j.clinbiomech.2010.08.012
  38. O' Leary s, Falla D. Specific therapeutic exercise of the neck induces immediate local hypoalgesia. J Pain. 2007;8(11):832-9. https://doi.org/10.1016/j.jpain.2007.05.014
  39. Paris SV. Cervical symptoms of forward head posture. Top Geriatr Rehabil. 1990;5(4):11-20 https://doi.org/10.1097/00013614-199007000-00006
  40. Pearson AM, Ivancic PC, Ito S, et al. Facet joint kinematics and injury mechanisms during simulated whiplash. Spine (Phila Pa 1976). 2004;29:390-7. https://doi.org/10.1097/01.BRS.0000090836.50508.F7
  41. Ries LG, Alves MC, Berzin F. Asymmetric activation of temporalis, masseter, and sternocleidomastoid muscles in temporomandibular disorder patients. Cranio. 2008;26(1):59-64. https://doi.org/10.1179/crn.2008.008
  42. Roddey T, Olson S, Grant S. The effects of pectoralis muscle stretching on the resting position of the scapula in persons with varying degrees of forward head/rounded shoulder posture. J Man Manip Ther. 2002;10:124-8. https://doi.org/10.1179/106698102790819247
  43. Salahzadeh Z, Maroufi N, Ahmadi A, et al. Assessment of forward head posture in females: observational and photogrammetry methods. J Back Musculoskelet Rehabil. 2014;27(2):131-9. https://doi.org/10.3233/BMR-130426
  44. Schroeder H, Siegmund H, Santibanez G. Causes and signs of temporomandibular joint pain and dysfunction:an electromyographical investigation. J Oral Rehabil. 1991;18(4):301-10. https://doi.org/10.1111/j.1365-2842.1991.tb00061.x
  45. SENIAM. European Recommendations for Surface ElectroMyoGraphy, results of the SENIAM project. SENIAM project. Roessingh Research and Development. 1999.
  46. Silva AG, Punt TD, Sharples P, et al. Head posture and neck pain of chronic nontraumatic origin: a comparison between patients and pain-free persons. Arch Phys Med Rehabil. 2009;90:669-74. https://doi.org/10.1016/j.apmr.2008.10.018
  47. Sun A, Yeo H, Kim T, et al. Radiologic Assessment of Forward Head Posture and Its Relation to Myofascial Pain Syndrome. Ann Rehabil Med. 2014;38(6):821-6 https://doi.org/10.5535/arm.2014.38.6.821
  48. Szeto GP, Straker LM, O'Sullivan PB. EMG median frequency changes in the neck-shoulder stabilizers of symptomatic office workers when challenged by different physical stressors. J Electromyogr Kinesiol. 2005;15:544-55. https://doi.org/10.1016/j.jelekin.2005.06.004
  49. Tousignant M, Smeesters C, Breton AM, Breton E, Corriveau H. Criterion validity study of the cervical range of motion (CROM) device for rotational range of motion on healthy adults. J Orthop Sports Phys Ther. 2006;36(4):242-8. https://doi.org/10.2519/jospt.2006.36.4.242
  50. van der Windt DA, Thomas E, Pope DP, et al. Occupational risk factors for shoulder pain: a systematic review. Occup Environ Med. 2000;57(7):433-42. https://doi.org/10.1136/oem.57.7.433
  51. Vernon H, Mior S. The Neck Disability Index: a study of reliability and validity. J Manipulative Physiol Ther. 1991;14(7):409-15.
  52. Wang CH, McClure P, Pratt NE, et al. Stretching and strengthening exercises: their effect on threedimensional scapular kinematics. Arch Phys Med Rehabil 1999;80:923-9 https://doi.org/10.1016/S0003-9993(99)90084-9
  53. Yang NY, Oh JS. Effects of Visual Biofeedback on Movement Patterns of Neck Lateral Bending and Muscle Activation of Sternocleidomastoid during Neck Rotation in Adults with Forward Head Posture. J Korean Soc Phys Med. 2014;9(4): 425-32. https://doi.org/10.13066/kspm.2014.9.4.425
  54. Yoo WG. Comparison of Orbicularis Oculi Muscle Activity during Computer Work with Single and Dual Monitors. J Phys Ther Sci. 2014;26(11):1807-8. https://doi.org/10.1589/jpts.26.1807
  55. Yun KH, Kim K. Effect of CranioCervical Flexion Exercise Using Sling on Thickness of Sternocleidomastoid Muscle and Deep Cervical Flexor Muscle. J Korean Soc Phys Med. 2013;8(2):253-61. https://doi.org/10.13066/kspm.2013.8.2.253

Cited by

  1. 웨어러블 센서 착용이 스마트폰 사용 시 발생하는 전방머리자세의 근활성에 미치는 영향 vol.7, pp.5, 2016, https://doi.org/10.22156/cs4smb.2017.7.5.047
  2. The Importance of Optimal Gaze Direction on Deep Neck Flexor Activation in Chronic Neck Pain vol.8, pp.4, 2016, https://doi.org/10.3390/healthcare8040449