Immediate Effect of Chin Tuck Exercises on Craniovertebral Angle and Shoulder Angle Among Collegiates with Forward Head Posture

Forward head posture (FHP) is the forward movement of the head that is caused by improper postural awareness and often results in muscular imbalance that causes pain. The forward head posture is found to be influenced by Craniovertebral Angle (CV) and shoulder angle (SA) that in turn causes rounded shoulder. These biomechanical changes prove to be a hindrance in maintaining neutral head posture and affects the structural integrity. A sample size of 43 were taken according to the selection criteria and the FHP was assessed through plumb line. Double tape was used as markers at tragus of the ear, C7 vertebrae and acromion process. Photos were taken and analyzed using AUTOCAD 2017 software and the results were obtained. A positive association found between the pre and post test results for CV angle with P=0.0001(P<0.05) and no significant association between the pre and posttest for SA with P=0.2 (P>0.05). The craniovertebral angle can be altered with the chin tuck exercises but has no effect on the shoulder angle, hence having no influence over the rounded shoulders but has some effect over the forward head posture.

Vojta Approach Affects Neck Stability and Static Balance in Sitting Position of Children With Hypotonia

Purpose: In this study, the effect of the Vojta approach on neck stability and static balance in children with hypotonia was studied.Methods: Seventeen children with hypotonia were randomly divided into the Vojta approach group (n=9) and the general physical therapy group (n=8). Each group was applied intervention for 30 minutes per session, 3 times a week, for a total of 4 weeks. Ultrasonography was used to measure deep neck flexor muscle thickness, craniovertebral angle (CVA) to measure neck alignment along the spine segment, and Balancia software program to measure static balance.Results: In the Vojta approach group, the deep neck flexor muscle thickness was significantly increased (P<0.05), and the CVA was significantly improved (P<0.05). In addition, path area among static balance was significantly improved (P<0.05).Conclusions: The Vojta approach can be suggested as an effective intervention method for improving neck stability and static balance in children with hypotonia.

Effect of Stretching and Strengthening Protocol on Forward Flexed Posture in Post-Menopausal Women

Background: Forward flexed posture is one of the most common structural change which occurs during menopause due to osteoporosis. Stretching and strengthening of cervical and thoracic spine muscles helps to alter the postural changes and maintain COG. This study thus, aims to see the effectiveness of the structured exercise protocol in post-menopausal women. Aims and Objective: To study the effectiveness of supervised and non-supervised stretching and strengthening protocol in post-menopausal women with forward posture. Materials and Methods: A total 40post-menopausal women with forward head posture were selected on the basis of selection criteria. They were randomly allocated in two groups A) Supervised Group= 20, B) Unsupervised Group=20 each. Forward flexed posture was assessed using Occiput to Wall Test and Craniovertebral Angle. Treatment was explained to both the groups. The pre and post measurements of the participants were recorded. Results: Statistical analysis was performed using the unpaired t test. Occiput to wall test and craniovertebral angle were used as the outcome measures for determining the effect of stretching and strengthening on forward neck posture. Comparing the pre-intervention and post-intervention values of occiput to wall test, a significant difference was seen following administration of protocol (p<0.0001). For craniovertebral angle, a significant difference was seen between pre-intervention and post-intervention values (p<0.0001). Also, it was seen that there was a significantly higher difference in the values of craniovertebral angle and occiput to wall test values in the supervised groups as compared to the unsupervised group. Conclusion: The current study demonstrated the effect of stretching and strengthening exercise in improving postural kyphosis in post-menopausal women. In addition, all variables of interest showed statistically significant post-treatment improvements in supervised group than unsupervised group.

Prevalence of forward neck posture and influence of smartphones in physiotherapy students

Introduction and Aim: InAsia, the prevalence of forward neck posture is 66%. Forward neck posture is the anterior positioning of cervical spine. This posture is sometimes called as “scholar’s neck. Forward neck posture can lead to musculoskeletal disorders such as injuries in muscles, tendons, and peripheral vessels, vascular vessels caused by repetitive or continuous use of certain body part. In forward neck posture, the sternocleidomastoid muscle and trapezius are largely responsible for turning and nodding the head. When the head moves front, the spine follows, pulling the shoulder blades forward as well.They make contact with the upper ribs and begin to drag it forward with them.Therefore, this study aims to quantify forward neck posture in prolonged smart phone users. Methodology:An observational study was done in smartphone using student population comparing the control group students with forward neck posture studentsfor the duration of 3weeks. This study has included 100 students with forward neck posturewho were recruited fromDr. MGR Educational & Research Institute. Goniometer, Craniovertebral angle and Plumb line were used as the outcome measure. Results:The findings of this research exhibit there is a statistically significant changes inforward neck posture studentscompared with control group and the mean difference is 14.97 in two groups students. Conclusion:The present study concluded that 3 weeks after assessing the students. Forward neck posture students found to have decreased craniovertebral angle and range of motion compared to normal neck posture students and also found that forward neck posture students spent 5-6 hours using smart phones per day.

Effects of a combination of scapular stabilization and thoracic extension exercises for office workers with forward head posture on the craniovertebral angle, respiration, pain, and disability: A randomized-controlled trial

Objectives: This study aims to investigate how exercise programs not directly applied to the cervical spine affect office workers with forward head posture (FHP). Patients and methods: Between March 2018 and June 2018, a total of 32 office workers with FHP (13 males, 19 females; mean age 36.63 years; range, 23 to 57 years) were randomized either to experimental (n=16) or control groups (n=16). Scapular stabilization and thoracic extension exercises were applied to the experimental group and cervical stabilization and stretching exercises to the control group. The results of the pre-intervention and after six weeks measurement of the craniovertebral angle (CVA), respiration, pain, and disability were compared and analyzed. Results: For intra-group comparison, both groups showed significant differences (p<0.05) in CVA, forced expiratory volume at 1 sec (FEV1), Visual Analog Scale (VAS), and neck disability index at pre- and post-intervention, while only the experimental group showed a significant difference (p<0.05) in maximum inspiratory pressure, maximum expiratory pressure, and forced vital capacity. For inter-group comparison, a significant difference (p<0.05) between FEV1 and VAS was observed. Conclusion: The combination of scapular stabilization and thoracic extension exercises, not directly applied to the cervical spine, has an effect on improving the posture, respiration, neck pain, and disability in office workers with FHP.

Immediate Effects of Diaphragmatic Breathing with Cervical Spine Mobilization on the Pulmonary Function and Craniovertebral Angle in Patients with Chronic Stroke

Background and Objectives: Patients with stroke have a forward neck posture due to neurological damage and often have impaired pulmonary function. This study investigated the effect of diaphragmatic breathing with cervical mobilization to improve pulmonary function cervical alignments. Materials and Methods: This study used a one-group pre-test–post-test design including 20 patients with stroke. Two types of cervical joint mobilization techniques, consisting of left and right lateral glide mobilization and posterior–anterior mobilization, were utilized. During joint mobilization, the patients performed diaphragmatic breathing. The measurements were performed immediately after the intervention. Pulmonary function was evaluated using a spirometer to measure the forced expiratory volume in 1 s (FEV1), forced vital capacity (FVC), and peak expiratory flow (PEF). The craniovertebral angle (CVA) was measured using lateral photographs. Results: After diaphragm breathing with cervical joint mobilization, subjects had significantly increased FEV1, FVC, PEF and CVA. Conclusion: Diaphragm breathing with cervical joint mobilization are possible interventions to increase pulmonary function and improve the craniovertebral angle in patients with stroke. However, a complete conclusion can be reached only after a follow-up study has been conducted with a comparison of more subjects and controls.

Correlation Between Craniovertebral Angle and Thickness of Longus Colli in Women with and Without Forward Head Posture

Background: Forward head posture (FHP) of the craniocervical region is one of the most common poor postures. The craniovertebral angle (CVA) is one of the most common methods to evaluate this posture. The longus colli (LCo) muscle is an important muscle to control head posture. Objectives: This study aimed to evaluate the relationship between CVA and thickness of LCo in women with FHP. Methods: This case-control research included 35 women with FHP and a control group. Sagittal view photography of the cervical spine was used for measurement of CVA. An ultrasonography device measured the thickness of the LCo. Correlation between CVA and thickness of LCo was determined using correlation coefficient in both groups. Results: Our findings showed a non-significant correlation between the CVA and thickness of LCo in case and control groups. Conclusions: According to the results of this study, there was no significant correlation between a lower CVA and smaller thickness of LCo.

Inter and Intra-Rater Reliability of Measuring Photometric Craniovertebral Angle Using a Cloud-Based Video Communication Platform

Objective: Due to social distancing guidelines during the Coronavirus (COVID-19) pandemic, most providers and patients have wanted to avoid close contact. This makes physical therapy (PT) assessments difficult because of the lack of empirical evidence about the reliability of various clinical measurements performed in a virtual environment. One such procedure is the photometric measurement of craniovertebral (CV) angle. Craniovertebral angle measurement is usually performed in an outpatient setting and is defined as the acute angle formed between a straight line connecting the spinous process of C7 to the tragus of the ear, and the horizontal line passing through the spinous process of the C7. Although the photometric measurement of CV angles is considered both valid and reliable in the clinics, no empirical evidence exists about the CV angle measurement reliability when performed in a virtual environment. Thus, the purpose of this study was to assess the inter- and intra-rater reliability of photometric CV angle measurement using a cloud-based video communication platform. Number of Subjects: 66 subjects (57 females). Methods: All measurements were performed by two final year PT students who had completed the musculoskeletal part of the curriculum and were blinded to each other’s measurements. Each subject was photographed in two postures over a HIPAA-compliant video-based telehealth platform: (1) normal/ relaxed posture and (2) ideal posture (posture the subject considered good). Student researcher 1 measured the CV angle in both the relaxed posture and ideal posture, while student researcher 2 measured the CV angle only in the relaxed posture. Each subject's CV angle measurement was performed three times on three separate days and the means were used for further analysis. The shape of the CV angle frequency distribution was assessed using kurtosis and skewness values. Rater reliability was assessed using intraclass correlation coefficients (ICC), and interpreted based on the guidelines provided by Portney and Watkins (2009). Results: The CV angles were normally distributed in both relaxed and ideal postures. The mean and standard deviation (SD) of relaxed posture was 50.7o ± 6.3o with kurtosis and skewness of 0.67 and -0.74 respectively. The mean and SD of ideal posture was 55.5o ± 5.4o, with kurtosis and skewness of 0.1 and -0.54 respectively. The ICC for inter-rater reliability in the relaxed posture was 0.88 and the ICC for intra-rater reliability for relaxed posture was 0.91. Conclusion: Craniovertebral angles were normally distributed in the sample. An acceptable level of inter- and intra-rater reliability can be attained when measuring CV angle using a cloud-based video communication platform.

Correlation between craniovertebral angle in the sagittal plane and angles and indices measured in the frontal plane at the moment of inducing forward head posture

BACKGROUND: Forward head posture (FHP) is the most common malposition in the head and neck area. With the growing use of digital devices, the prevalence of FHP may be expected to increase dramatically. Thus far, FHP has been evaluated only in the sagittal plane. OBJECTIVE: The objective of this study was to measure angles and indices from anatomical landmarks in the frontal plane and determine the possible correlations between these variables and craniovertebral angle (CVA) as an index of FHP in the sagittal plane. METHODS: Fifty eight healthy individuals (29 men, 29 women) between 18 and 40 years old participated in this cross-sectional study. Participants were evaluated with an 8-camera motion analysis system. After markers were placed on predetermined landmarks, the participants were asked to maintain their head and neck in the neutral position for 5 seconds. Then participants induced FHP by flexing and lowering their head. The correlation between CVA and a set of angles and indices was calculated at the moment of FHP induction. RESULTS: A moderate correlation was observed between 3-D CVA and the angle formed between the sternum and both tragi for the whole sample and separately in both sexes. A moderate negative correlation was observed between 3-D CVA and height, weight, and BMI in women. A moderate negative correlation was observed between 3-D CVA and height, weight, BMI, and hours on digital devices in men. CONCLUSIONS: Changes in CVA in the sagittal plane can be predicted from changes in the angle formed between the midpoint of the sternum and the left and right tragi in the frontal plane.