Association Between Forward Head, Rounded Shoulders, and Increased Thoracic Kyphosis: A Review of the Literature

Cognitive Load and Dual-Task Performance in Individuals with and without Forward Head Posture

Background: Recent studies have found forward head posture (FHP) is associated with altered physiology. There is a lack of research into whether FHP is associated with altered gait parameters when cognitively challenged. Our hypothesis is that individuals with FHP and those without will demonstrate different responses when undergoing dual-task assessment. Methods: Forty-five asymptomatic participants with FHP, defined as a craniovertebral angle (CVA) < 50°, were matched to forty-five participants with normal head posture (NHP) with a CVA > 55°. Participants walked along a 10 m platform under a control condition (no cognitive load) while an optical motion-capture system assessed gait kinematics. Secondly, participants were assessed under a dual-task cognitive load condition to identify the impact on gait kinematics. Results: Under the single-task condition, there were no significant differences for any gait parameter. In the dual-task condition, 12/13 gait parameters were significantly altered for the FHP vs. NHP group (p < 0.01). A calculation of the dual-task cost (DTC) percentage showed significant increases in all gait parameters in participants with FHP (p < 0.02). Correlations between the CVA and gait parameters were not significant for the single-task condition, but all gait parameters were correlated to CVA for the dual-task condition (p < 0.01). The correlation between CVA and DTC for all gait variables was significant (p < 0.04). Conclusions: This study demonstrates that FHP significantly increases the cognitive cost during walking, highlighting the importance of proper postural alignment for maintaining cognitive function under a dual-task condition.

The impact of scapular posture and sagittal spine alignment on motion and functional outcomes following reverse total shoulder arthroplasty: a scoping review

Background

Reverse total shoulder arthroplasty (RTSA) has evolved beyond its initial indication for elderly patients with rotator cuff arthropathy and is now performed in younger patients for various shoulder pathologies. This surgical procedure has recently gained popularity and has been shown to result in similar functional improvements and complication rates compared to anatomical total shoulder arthroplasty. Scapular posture and sagittal spine alignment (SSPA) have recently emerged as factors potentially influencing RTSA outcomes. This scoping review aimed to assess the existing body of evidence on this topic.

Methods

A systematic search was conducted on MEDLINE, Embase, and CENTRAL databases to evaluate the impact of scapular posture and SSPA on RTSA outcomes.

Results

A total of 6 studies (616 shoulders) were included in this review. Scapular posture was found to influence RTSA outcomes, with studies reporting correlations between scapular posture with postoperative range of motion and functional scores. Suboptimal scapular posture, particularly type C (kyphotic posture with protracted scapulae), appeared to be associated with reduced external rotation. However, findings among the included studies regarding SSPA were varied. Some studies suggested that SSPA, notably thoracic kyphosis, might impact RTSA outcomes by influencing scapular posture, while others did not find a clear relationship.

Conclusion

Scapular posture was implicated as a potential factor affecting RTSA outcomes; however, the role of SSPA remains inconclusive. There is currently a lack of high-quality evidence in the literature to draw definitive conclusions regarding the impact of scapular posture and SSPA on RTSA outcomes. More research is warranted to investigate these relationships more comprehensively.

Efficacy of head postural correction program on craniovertebral angle, scapular position, and dominant hand grip strength in forward head posture subjects: A randomized controlled trial

OBJECTIVE

Forward head posture (FHP) is a common postural disorder that alters shoulder function. This study examined the efficacy of a corrective program involving postural correction exercises (PCEs), scapular stabilization exercises (SSEs), and kinesiotaping (KT) on improving craniovertebral angle (CVA), scapular position, and dominant hand grip strength (HGS) in individuals with FHP.

METHODS

Sixty subjects (8 males and 52 females, 18-40 years old) were randomly allocated into four equal groups: Group A: received PCEs only, Group B: received PCEs and SSEs, Group C: received PCEs and KT, Group D: received PCEs, SSEs and KT. All subjects received treatment for 4 weeks (4 times/week) and postural advice. Outcome measures included cranio-vertebral angle (CVA), scapular position using Lateral Scapular Slide Test and dominant HGS using a CAMRY dynamometer that were assessed at baseline and 4 weeks post intervention.

RESULTS

Comparing all groups post training revealed that there were statistically significant increases (p < 0.05) in all measured variables (CVA, scapular position and dominant HGS) in favor of group (D).

CONCLUSION

Combination of PCEs, SSEs and KT interventions has achieved the best gains in terms of CVA, dominant HGS and regaining optimal scapular position in FHP subjects.

Effect of scapular posterior tilting exercise on scapular muscle activities in men and women with a rounded shoulder posture

Round-shoulder posture (RSP) is a common postural condition, characterized by protraction, downward rotation, anterior tilting and internal rotation of the scapula. RSP can lead to shoulder dysfunction. Different methods have been proposed for rehabilitating and correcting the altered posture in RSP including stretching, strengthening exercises, and shoulder brace or taping. However, the findings are controversial and studies are ongoing to develop more effective method. The present study is aimed at investigating the effects of scapular posterior tilting (SPT) exercise in different support positions on scapular muscle activities in men and women with RSP. In a prospective observational clinical study, we assessed demographic, basic clinical parameters and study variables of the subjects with RSP (n = 20) (men/women = 9/11) attending Daegu University in Gyeongsan, South Korea. To do so, we compared electromyographic (EMG) activities of lower trapezius and serratus anterior muscles between men and women with RSP during SPT exercise on four different support surfaces to determine any difference in the EMG activities. The results revealed that women showed significant differences in EMG activities in the lower and left upper trapezius and serratus anterior muscles, while men showed significant differences in EMG activity only in the lower trapezius muscle during SPT exercise on four different surfaces (P < 0.05). The post-hoc analysis revealed significantly greater EMG activity values in the lower trapezius and serratus anterior muscles during SPT exercise on the upper body unstable surface and whole-body unstable surface (p < 0.05). Independent t-tests after the Bonferroni correction showed no significant differences in muscle activities between men and women on the four different surfaces (p > 0.0125).

Eight-week exercise intervention improves shoulder pain and body posture of wheelchair athletes with spinal cord injury

BACKGROUND

Wheelchair athletes, as a group of elite athletes who participate in high-level sports activities, are constantly exposed to musculoskeletal injuries and disorders due to their frequent use of wheelchairs and overworked upper limbs. In this study, we investigated the effect of elastic band exercises on the extent of athletes' forward head angle, kyphosis, rounded shoulder, and pain scores.

METHODS

Twenty-six male and female wheelchair athletes with spinal cord injuries (age: 27.11±6.67), active in table tennis, basketball and pétanque, were selected and randomly divided into either a control or training group. The Wheelchair User's Shoulder Pain Index (WUSPI) questionnaire was used to investigate the level of shoulder pain. A sagittal view photogrammetry method was used to measure the forward head angle and round shoulder angle, and a flexible ruler was used to measure the thoracic kyphosis angle. For our statistical analysis, a covariance test (ANCOVA) and independent and dependent T tests were used.

RESULTS

After eight weeks of training, there was a significant decrease in the angle of the forward head tilt, kyphosis, round shoulder, and pain questionnaire scores in the training group (P<0.05).

CONCLUSIONS

Changes in the forward head angle, rounded shoulder and kyphosis angle, and pain scores show the desirable effect of resistance training with an elastic band. Therefore, this exercise program is recommended for wheelchair athletes with spinal cord injuries.

Effect of thoracolumbosacral braces on running ground reaction force components in male individuals with kyphosis

BACKGROUND & AIMS

Braces are one of the methods for kyphosis treatment, but they can relocate the center of gravity of the trunk, affecting the ground reaction force (GRF) during running. Therefore, this study aimed to investigate the effects of two types of thoracolumbosacral braces on running GRF components in individuals with kyphosis.

MATERIALS & METHODS

Participants were 15 males diagnosed with kyphosis who volunteered in this quasi-experimental study. Each subject performed the barefoot running trials on the force plate with one simple brace, with a sensor brace, and without the brace condition. The ground reaction forces components were calculated in the stance phase. Statistical analysis was done with repeated measures test with a significant level of 0.05.

RESULTS

Peak medial ground reaction force when running with a sensor brace was lower than running with a simple brace (p = 0.017). Free moments were similar during three running conditions (p > 0.05).

CONCLUSION

Lower maximum medial ground reaction force while using a sensor brace may possibly demonstrate the beneficial effects of a sensor brace in individuals with kyphosis.

Scapular motion during shoulder joint extension movement

A few reports on scapular motion during shoulder joint extension exist. Understanding the normal motion of shoulder joint extension may be useful in evaluating and treating patients with diminished or minimal shoulder joint extension. Therefore, this study aimed to identify scapular motion during shoulder joint extension movement in a sitting position. Shoulder joint extension movement in the sitting position were measured in 22 healthy adults (age, 25.8 ± 2.7 years). Shoulder joint extension, scapular upward rotation, anterior tilt, external rotation angles, and the acromion position were investigated using a three-dimensional motion analyzer. The difference from each value of 10° to 50° shoulder joint extension to each value of 0° shoulder joint extension were checked. The results were compared using multiple comparison method. In most participants, the scapula tilted posteriorly up to 30° of the shoulder joint extension and anteriorly after 30°. Scapular upward and external rotation continued to increase with shoulder extension. Furthermore, the acromion was displaced upward and backward. Thus, scapular posterior tilt is necessary for shoulder joint extension during the initial movement, followed by anterior tilt. The acromion may have been displaced posteriorly because of clavicular retraction, causing the scapula to tilt posteriorly. After 30° of shoulder joint extension, the scapular anterior tilt may have prevailed over the scapular posterior tilt.

Examining accuracy of and determining the best cutoff point for photographic-based postural angles to discriminate between slight and moderate-to-severe forward head posture

PURPOSE

To evaluate the accuracy of and determine the best cutoff point for craniovertebral angle (CVA) and forward shoulder angle (FSA) in discriminating between two groups of individuals with different severities of forward head posture (FHP).

METHODS

A sample of 90 subjects aged 20-50 who had different severities of FHP was recruited. Participants were categorized into two groups based on observational method, namely individuals with slight FHP and those with moderate-to-severe FHP. The CVA and FSA were assessed using the photographic device. The accuracy of these measures was determined by calculation of sensitivity, specificity, area under the receiver operating characteristic curve, likelihood ratio (LR), and predictive value (PV).

RESULTS

Our results show that CVA has high sensitivity (0.93) and acceptable area under the curve (0.88) in discriminating between the two groups of FHP (P < .01), but FSA cannot discriminate between the two groups of FHP (P = .06). The LR and PV results show that the CVA has a low negative LR (0.13) and a large negative PV (0.93). The best cutoff point for CVA was determined at 45.5 degrees.

CONCLUSION

Overall, the results of the present study showed that CVA has a good accuracy in discriminating between two groups of individuals with slight and moderate-to-severe FHP. It can be valuable in correctly identifying the slight FHP and screening the moderate and severe grades of the FHP. Researchers and clinicians can also use the optimal cutoff point for the CVA obtained in this study to accurately quantify and classify the severity of the FHP.

An investigation of the reproducibility of a self-selected natural feet position when standing: Implications for the assessment of upright standing posture

BACKGROUND

Photogrammetry is often used to evaluate standing static postural alignment. Patients are often instructed to self-select a natural feet position but it's unclear whether this position can be consistently replicated across repeated assessments.

OBJECTIVE

To determine whether people can replicate a self-selected natural feet position in upright standing across three sessions on different days.

DESIGN

Between days test-retest reliability.

SETTING

University laboratory.

METHODS

Three variables - Base of Support (BoS), Foot Width (FW), Feet Opening Angle (FOA) - were measured from foot tracings of 150 participants (18-30 years) using established procedures. BoS data were assessed for systematic bias (Analysis of Variance), and absolute (Coefficient of Variation - CV%) and relative (Intraclass Correlation Coefficient - ICC) reliability.

RESULTS

There was systematic bias in the BoS data across the three testing sessions. The CV% for the BoS data was 15.2%. The ICC (95% CI) for the BoS data was 0.84 (0.79-0.87). There were moderate-large correlations between the BoS and both FOA and FW respectively within each session.

CONCLUSION

If clinicians want to allow patients to use their self-selected natural feet position for repeated photogrammetric assessment of their static postural alignment it would be better to standardise the position of the feet, for example, by creating a tracing of a patient's self-selected natural feet position.

Identification of prevalence of musculoskeletal disorders and various risk factors in dentists

Purpose

The awkward and repetitive movements lead to tissue straining, potentially leading to painful musculoskeletal disorders (MSDs). MSDs in dentists result in work inefficiency and a reduction in work hours. A survey was conducted to assess the prevalence of MSDs amongst the dental population of interest.

Methods

Customized individual detail questionnaires, Standard Nordic Musculoskeletal questionnaires, and Level of Pain estimation using the Likert Scale were used to deduce the various responsible risk factors for the occurrence of MSDs in dentists. Inferential statistical analysis was done to identify the prevalence and severity of the MSDs. The Chi-Square test (95 % confidence interval) was used to identify and compare the association of risk factors involved in MSDs with the occurrence of the Effect of MSDs, the presence of MSDs, and the severity of the MSDs.

Results

The results of the study deduced that the dentists followed the sedentary work practices. The dentists experienced maximum discomfort in the neck region, which was accompanied by the discomfort experienced in the lower back, hands and wrists, making the upper extremity being more susceptible to the MSDs. Gender risk factors the, the prevalence of MSDs in the dentist's upper back, and the severity of pain in the upper back region showed a significant association level.

Conclusion

The wrist posture, the prevalence of MSDs and the severity of pain in the dentists' neck, shoulder and upper back showed a significant association level.

Effect of taping on posture of thoracic region in patients with thoracic kyphosis using acceleration

BACKGROUND

In the working environment of modern society, a poor sitting posture for a prolonged time may lead to abnormal spinal alignment such as thoracic kyphosis (TK).

OBJECTIVE

This study aimed to evaluate the efficacy of taping for posture correction of patients with TK, providing theoretical and empirical guidance for clinicians attempting to rectify TK posture.

METHODS

The study included 15 subjects aged 30-60 years, all with a TK angle of ⩾ 40∘. Subjects were required to ascend and descend a set of three steps (a low step, high step, and second low step) under three different conditions: without tape assistance, with taping assistance using 20% elongation, and with taping assistance using 40% elongation. A triaxial accelerometer was employed to measure and compare the anterior-posterior (AP), vertical (VT), and medial-lateral (MIL) movements of the thoracic vertebrae in the different conditions.

RESULTS

There were no significant differences in the MIL (P= 0.903) or AP (P= 0.114) movements between the no tape assistance and 20% elongation taping conditions. However, a significant difference was found in the VT movement (P= 0.017). Comparing the no assistance condition to the 40% elongation taping condition, no significant changes were noted in the MIL movement (P= 0.650), but significant differences were detected in both the VT (P= 0.003) and AP movements (P= 0.016). No significant differences were found in any of the three measurements between 20% and 40% elongation taping.

CONCLUSION

Taping serves as an effective method for immediately improving kyphotic posture. It corrects the position of the scapula and cervicothoracic line and exerts passive retraction on the relevant muscles, thus mitigating trunk imbalance.

Efficacy of scapulothoracic exercises on proprioception and postural stability in cranio-cervico-mandibular malalignment: A randomized, double-blind, controlled trial

BACKGROUND

Cranio-cervico-mandibular (CCM) malalignment is associated with forward head posture (FHP) and temporomandibular joint (TMJ) disorders and affects masticatory muscles.

OBJECTIVE

This randomized, double-blind controlled trial aimed to compare the efficacy of scapula-thoracic (ST) exercises on temporomandibular and cervical joint position sense and postural stability in individuals with CCM malalignment.

METHODS

Fourty-nine participants with CCM malalignment were randomly assigned to the ST exercise group (STEG, n= 24) or the control group (CG, n= 25). STEG included progressive strengthening, proprioceptive, and stabilization exercises. All participants were assessed before treatment, at the end of the 8th week treatment period and at the 12th week post-treatment follow-up. Cranio-vertebral angle measurement, Fonseca's Questionnaire, Helkimo Clinical Dysfunction Index, TMJ position test, cervical joint position error test and postural stability assessment were used.

RESULTS

The TMJ and cervical joint position sense, total sway degree, area gap percentage, sway velocity and antero-posterior body sway results showed significant improvement in the STEG compared to the CG (p< 0.05), however medio-lateral body sway did not differ between groups (p> 0.05).

CONCLUSIONS

Postural stability, TMJ and cervical joint position sense appear to be affected in individuals with CCM malalignment. Our results showed that an exercise program including ST stabilization, proprioception and strengthening of the scapular muscles may be effective in the management of CCM malalignment and will allow clinicians to plan holistic treatment.

IoT-Based Solution for Detecting and Monitoring Upper Crossed Syndrome

A sedentary lifestyle has caused adults to spend more than 6 h seated, which has led to inactivity and spinal issues. This context underscores the growing sedentary behavior, exemplified by extended sitting hours among adults and university students. Such inactivity triggers various health problems and spinal disorders, notably Upper Crossed Syndrome (UCS) and its association with thoracic kyphosis, which can cause severe spinal curvature and related complications. Traditional detection involves clinical assessments and corrective exercises; however, this work proposes a multi-layered system for a back brace to detect, monitor, and potentially prevent the main signs of UCS. Building and using a framework that detects and monitors signs of UCS has facilitated patient-doctor interaction, automated the detection process for improved patient-physician coordination, and helped improve patients' spines over time. The smart wearable brace includes inertial measurement unit (IMU) sensors targeting hunched-back postures. The IMU sensors capture postural readings, which are then used for classification. Multiple classifiers were used where the long short-term memory (LSTM) model had the highest accuracy of 99.3%. Using the classifier helped detect and monitor UCS over time. Integrating the wearable device with a mobile interface enables real-time data visualization and immediate feedback for users to correct and mitigate UCS-related issues.

Effectiveness of Telerehabilitation for Correcting Posture in Elderly with Thoracic Kyphosis in Urban Thailand

Introduction

Thoracic kyphosis (TK) is an abnormal thoracic spine. Telerehabilitation and conventional physical therapy were compared for correct posture in the thoracic angle, forward head posture, back muscle strength, and cost-effectiveness.

Method

Twenty-two Thai women 60 years of age and over, with thoracic angles over 45 degrees, participated in this study. Participants were randomly allocated into a telerehabilitation group (TG) or a control group (CG). TG and CG underwent a thoracic corrective exercise program for 1 hour each session, three times per week for 8 weeks.

Result

Thoracic angle, forward head posture, and back muscle strength improved (P < .05) in both groups. Furthermore, cost-effectiveness showed the cost of intervention in TG lower than CG, approximately 133.78 US$.

Conclusion

Our study showed no difference in telepractice program efficacy and effectiveness compared to in-person treatment in the clinic. Thus, telerehabilitation may be an alternative treatment for the elderly who cannot travel to the hospital.

Ideal Injection Points for Botulinum Neurotoxin for Pectoralis Minor Syndrome: A Cadaveric Study

Pectoralis Minor Syndrome (PMS) causes significant discomfort due to the compression of the neurovascular bundle within the retropectoralis minor space. Botulinum neurotoxin (BoNT) injections have emerged as a potential treatment method; however, their effectiveness depends on accurately locating the injection site. In this study, we aimed to identify optimal BoNT injection sites for PMS treatment. We used twenty-nine embalmed and eight non-embalmed human cadavers to determine the origin and intramuscular arborization of the pectoralis minor muscle (Pm) via manual dissection and Sihler's nerve staining techniques. Our findings showed the Pm's origin near an oblique line through the suprasternal notch, with most neural arborization within the proximal three-fourths of the Pm. Blind dye injections validated these results, effectively targeting the primary neural arborized area of the Pm at the oblique line's intersection with the second and third ribs. We propose BoNT injections at the arborized region within the Pm's proximal three-fourths, or the C region, for PMS treatment. These findings guide clinicians towards safer, more effective BoNT injections.

Treatment of Chronic Neck Pain in Patients with Forward Head Posture: A Systematic Narrative Review

(1) Background: Forward head posture (FHP) is one of the most common cervical postural deviations and is characterized by head protrusion or forward head placement in relation to the shoulder in the sagittal plane. Patients with FHP often experience neck pain and disability. The aim of this study was to investigate whether treatment programs are effective in the management of neck pain in patients with FHP. (2) Methods: A MEDLINE (PubMed), Embase, Cochrane Library, and Scopus database search was conducted for English language articles on patients with chronic neck pain and FHP published until 12 April 2023. To identify potentially relevant articles, the following key search phrases were combined: 'forward head posture' and 'pain'. After searching, 2516 potentially relevant articles were identified. After reading the titles and abstracts and assessing their eligibility based on full-text articles, 16 articles were included in this review. (3) Results: Among the 16 studies that investigated the efficacy of treatment programs for managing chronic pain in patients with FHP, 11 investigated the effect of exercise programs, and 5 investigated the effect of manual therapy. Patients reported significant improvement in pain and disability after receiving treatment programs such as corrective postural exercises and special manual therapy techniques. (4) Conclusions: Various treatment programs, including postural corrective exercises and manual therapy, are beneficial for improving pain and disability in patients with FHP.

Prompt Impact of Muscle Energy Technique on Pectoralis Muscle Tightness in Computer Users: A Quasi-Experimental Study

Tightness of the pectoralis minor muscle has been a common characteristic of abnormal posture. Prolonged inappropriate posture while using computers/laptops results in musculoskeletal problems, mainly in the upper limb. This study aims to see how the muscular energy technique affected pectoralis minor tightness in computer users right away. This study included 65 individuals aged 20-40 years following the inclusion/exclusion criteria. Participants received muscle energy technique for the pectoralis minor muscle. Pre- and post-assessment included the evaluation of pectoralis minor length, round shoulder posture (RSP), and forward head posture (FHP). We used the Kolmogorov-Smirnov test to assess the normality of data, as this study included > 50 participants. Data analysis was conducted using a paired t-test for within-group analysis. The outcome measures demonstrated significant improvement (p < 0.001). In conclusion, the muscle energy technique is effective in reducing muscle tightness, improving RSP and reducing FHP.

Effectiveness of McKenzie approach and segmental spinal stabilization exercises on neck pain in individuals with cervical postural syndrome: An experimental study

BACKGROUND

This study "Effectiveness of Mckenzie approach and segmental spinal stabilization exercises on neck pain in individuals with cervical postural syndrome: an experimental study" was conducted to study and find the effectiveness of Mckenzie approach and segmental spinal stabilization exercises on reduction of pain, correction of rounded shoulder, and disability. Pain, disability, and rounded shoulders are the major limiting factors as it affects the quality of life and reduces efficiency and social participation.

MATERIALS AND METHODS

The study was conducted among 120 individuals with cervical postural syndrome, and fulfilling the inclusion and exclusion criteria was included. The outcome measures were Visual Analogue Scale (VAS), Neck Disability Index (NDI), and Vernier caliper to evaluate pain, functional disability, and rounded shoulder, respectively. Subjects were randomly divided into two groups, Group A and Group B, by using SPSS software. Interventional training was given for 6 weeks to the patients. Group A subjects were given spinal stabilization exercises. Group B subjects were given Mckenzie approach. The statistical analysis was performed using SPSS; pre-test and post-test were used to calculate the results, followed by data presentation and analysis.

RESULT

The result showed that at the end of the 6 weeks on comparison between pre- and post-intervention of Group A and Group B, both the techniques were effective, but group B was significantly effective than Group A.

CONCLUSION

It was noted that McKenzie approach and segmental spinal stabilization exercises were effective on neck pain in individuals with cervical postural syndrome, but on comparing both techniques, Mckenzie protocol is more beneficial than segmental spinal stabilization exercises. The study accepts the alternate hypothesis that there is significant effect of McKenzie approach and segmental spinal stabilization exercises on neck pain in individuals with cervical postural syndrome.

Sagittal Spinal Alignment in People with Chronic Spinal Cord Injury and Normal Individual: A Comparison Study Using 3D Ultrasound Imaging

The aim of this study was to compare the sagittal spinal alignment of people with chronic spinal cord injury (SCI) with normal individuals and to determine whether transcutaneous electrical spinal cord stimulation (TSCS) could cause a change in the thoracic kyphosis (TK) and lumbar lordosis (LL) to re-establish normal sagittal spinal alignment. A case series study was conducted, wherein twelve individuals with SCI and ten neurologically intact subjects were scanned using 3D ultrasonography. In addition, three people with SCI having complete tetraplegia participated further to receive a 12-week treatment (TSCS with task-specific rehabilitation) after evaluation of sagittal spinal profile. Pre- and post-assessments were conducted to evaluate the differences in sagittal spinal alignment. The results showed that the TK and LL values for a person with SCI in a dependent seated posture were greater than those of normal subjects for: standing (by TK: 6.8° ± 1.6°; LL: 21.2° ± 1.9°), sitting straight (by TK: 10.0° ± 4.0°; LL: 1.7° ± 2.6°), and relaxed sitting (by TK: 3.9° ± 0.3°; LL: 7.7° ± 1.4°), respectively, indicating an increased risk for spinal deformity. In addition, TK decreased by 10.3° ± 2.3° after the TSCS treatment, showing a reversible change. These results suggest that the TSCS treatment could be used to restore normal sagittal spinal alignment for individuals with chronic SCI.

Significance of Lower Body Postures in Chair Design

OBJECTIVE

This study examined a system-level perspective to investigate the changes in the whole trunk and head postures while sitting with various lower extremity postures.

BACKGROUND

Sitting biomechanics has focused mainly on the lumbar region only, whereas the anatomy literature has suggested various links from the head and lower extremity.

METHOD

Seventeen male participants were seated in six lower extremity postures, and the trunk kinematics and muscle activity measures were captured for 5 s.

RESULTS

Changes in the trunk-thigh angle and the knee angle affected the trunk and head postures and muscle recruitment patterns significantly, indicating significant interactions between the lower extremity and trunk while sitting. Specifically, the larger trunk-thigh angle (T135°) showed more neutral lumbar lordosis (4.0° on average), smaller pelvic flexion (1.8°), smaller head flexion (3.3°), and a less rounded shoulder (1.7°) than the smaller one (T90°). The smaller knee angle (K45°) revealed a more neutral lumbar lordosis (6.9°), smaller pelvic flexion (9.2°), smaller head flexion (2.6°), and less rounded shoulder (2.4°) than the larger condition (K180°). The more neutral posture suggested by the kinematic measures confirmed significantly less muscular recruitment in the trunk extensors, except for a significant antagonistic co-contraction.

CONCLUSION

The lower and upper back postures were more neutral, and back muscle recruitment was lower with a larger trunk-thigh angle and a smaller knee angle, but at the cost of antagonistic co-contraction.

APPLICATION

The costs and benefits of each lower extremity posture can be used to design an ergonomic chair and develop an improved sitting strategy.

Remission of Dowager's hump by manipulative correction of spinal alignment: a case report

Dowager's hump is described as excessive kyphotic curvature in the thoracic spine with a Cobb angle of more than 40 degrees. This case report presents a 61 years old female office clerk who experienced headaches and neck pain for 3 years that extended into her right shoulder and upper chest. She consulted her primary care physician two months before seeing the chiropractor when the neck pain worsened. A diagnosis of cervicalgia related to osteoarthritis was made based on cervical and thoracic X-ray findings. The patient received non-steroid anti-inflammatory drugs (celecoxib and etoricoxib) and stretching exercises at home. At the onset of chiropractic care, radiographs showed loss of cervical lordosis, narrowing at the C4-5, C5-C6, and C6-7 intervertebral disc space with marginal osteophytes. Based on these findings, a working diagnosis of cervicogenic headache was established. After treatment for 9 months, the patient showed improvement in symptoms and function from cervical curve radiographic change and dextro-convexity of the thoracic spine. Avoiding forward head flexion and maintaining correct posture in daily activities will be key mechanisms to prevent the reoccurrence of Dowager's hump. The improvement of symptoms following chiropractic therapy has been shown to correlate with radiographic markers of spinal realignment.

Short term effect of spinal mobilization with movement (MWM) on pulmonary functions in nonsmokers with thoracic hyperkyphosis: a randomized single-blinded controlled trial

OBJECTIVES

To investigate the effect of mobilization with movement (MWM) on pulmonary functions in subjects with thoracic hyperkyphosis.

METHODS

This randomized single-blinded controlled trial included a sample of 50 subjects (age 18 - 25 years old) with thoracic hyperkyphosis. Subjects were randomly allocated into two groups; the Real MWM group (n = 25) which received thoracic MWM plus standard postural correction exercises, and the Sham MWM group (n = 25) which received sham MWM plus standard postural correction exercises. Digital X-ray and handheld spirometer were used to measure selected pulmonary function tests (FVC, FEV1/FVC ratio, MVV) respectively.

RESULTS

Within-group comparisons demonstrated a statistically significant improvement in all outcome measures in both groups. The between-group comparisons demonstrated significant improvement in the MWM compared to the Sham group regarding the value of FVC, FEV1/FVC ratio, and MVV (P < .05).

CONCLUSION

In young adults with thoracic hyperkyphosis, MWM plus postural exercise produces better improvements in FVC, FEV1, FEV1/FVC, and MVV compared to sham MWM plus postural exercise.

Neck and Upper Extremity Musculoskeletal Symptoms Secondary to Maladaptive Postures Caused by Cell Phones and Backpacks in School-Aged Children and Adolescents

Technology is an essential part of our lives. Nowadays, it is almost impossible to leave the house without a cell phone. Despite the wide range of benefits of cell phones and handheld electronic devices, this evolution of technology has not come without a price. The pandemic of cell phone use among children and young adolescents has led to the emergence of a set of musculoskeletal (MSK) symptoms that have not been seen before in this age group. These symptoms can range from neck and shoulder discomfort to pain, peripheral neurological symptoms of the upper extremity, and long-term complications such as disk prolapse and degenerative disk disease of the cervical spine. This clinical presentation is known as “text neck syndrome.” In addition to MSK symptoms, text neck syndrome could also include eye and ear symptoms, psychological problems, peripheral neurological symptoms, and poor academic performance. Multiple mechanisms have been discussed by which cell phone use causes MSK symptoms. Maladaptive postures, a decrease in physical activity leading to obesity, and the direct effect of electromagnetic radiation are some of the mechanisms by which long-term use of cell phones leads to the clinical presentation of text neck syndrome and its long-term consequences. The purpose of this article is to review the literature, discuss the epidemiology of cell phone use and MSK symptoms associated with its use in children and adolescents, describe its clinical presentation, explain the pathophysiology behind it, and provide preventative guidelines that can be used by this age group to allow for the continued use of these electronics without harmful effects on their posture and long-term health.

Reliability and validity of the Turkish version of the Kyphosis specific spinal appearance questionnaire in adolescents with moderate hyperkyphosis

BACKGROUND

Hyperkyphosis cause poor posture, self-image, clinical or cosmetic deformity and well-being. Therefore, it is important to evaluate patients' perception of appearance in the rehabilitation process of individuals with hyperkyphosis. Recently Kyphosis Specific Spinal Appearance Questionnaire (KSAQ) has been developed for the assessment of appearance in hyperkyphosis patients.

OBJECTIVE

To test validity and reliability of the Turkish version of the KSAQ.

METHODS

Sixty-two patients with hyperkyphosis (curve above 50º), ranging in age between 12 and 22 years, was included in this study. Turkish translation/back-translation of the KSAQ was done by an expert committee. Internal consistency was analyzed using Cronbach's alpha. Validity was assessed by correlating the KSAQ with the Scoliosis Research Society-22 (SRS-22) Questionnaire. Its reliability was assessed using the test-retest method with two-week interval (Pearson's correlation coefficient) on 44 of these patients.

RESULTS

Mean kyphosis angle was 60º ± 8.9º. KSAQ total scores showed excellent internal consistency (Cronbach's α = 0.944) and test-retest reliability (ICC = 0.890). Moderate to strong associations were found between KSAQ total score, each item scores and self-image domain of SRS-22 (r -0.299 to -0.730, p < 0.05). KSAQ total score had moderate correlation with SRS-22 total score (r 0.423, p 0.001). Overall, the KSAQ scale showed good validity.

CONCLUSION

The Turkish version of the KSAQ is a reliable and valid patient reported outcome measure of kyphosis-specific aspects of appearance in patients with moderate hyperkyphosis.

Prevalence of scapular dyskinesis in office workers with neck and scapular pain

Objectives. This study aimed to investigate the presence of scapular dyskinesis (SD) in office workers with neck and scapular complaints. The postural malalignment and related muscle adaptations were also explored. Methods. SD and its subtypes were determined. Postural deviations and the length of commonly reported muscle tightness were evaluated. Results. Among 99 participants, 90% of them had SD. Considering both sides or 198 scapula, 90.4% were identified as having painful scapula and 19% as having painless scapula. There was a difference in the proportion of SD on painful (93%) and painless (69%) sides. Postural deviations including rounded shoulder (100%), forward head (43.3%) and thoracic hyperkyphosis (54.5%) were prevalent. Persons with type III SD had a higher percentage of forward head than other types. There was also tightness of the pectoralis minor (100%), levator scapulae (93.0%) and upper trapezius (98.3%) muscles without different proportions among types of SD. The greatest proportion of persons with SD had tightness of the levator scapulae. Conclusions. There was a high prevalence of SD among office workers with neck and scapular complaints. SD was also associated with abnormal posture and muscle tightness. The proper management of SD and working posture is warranted.

Reference Values for Sagittal Clinical Posture Assessment in People Aged 10 to 69 Years

Poor posture is a well-known problem in all age groups and can lead to back pain, which in turn can result in high socio-economic costs. Regular assessment of posture can therefore help to identify postural deficits at an early stage in order to take preventive measures and can therefore be an important tool for promoting public health. We measured the posture of 1127 symptom-free subjects aged 10 to 69 years using stereophotogrammetry and determined the sagittal posture parameters flèche cervicale (FC), flèche lombaire (FL), and kyphosis index (KI) as well as the values standardized to the trunk height (FC%, FL%, KI%). FC, FC%, KI, and KI% showed an increase with age in men but not in women, and a difference between the sexes. FL remained largely constant with age, although FL% had significantly greater values in women than men. Postural parameters correlated only moderately or weakly with body mass index. Reference values were determined for different age groups and for both sexes. Since the parameters analyzed can also be determined by simple and non-instrumental methods in medical office, they are suitable for performing preventive checks in daily medical or therapeutic practice.

A Prospective Study of 73 Patients to Compare Forward Head Angle, Forward Shoulder Angle, Maximal Inspiratory Pressure, and Self-Reported Breathing-Related Symptoms Before and After Open-Heart Surgery

BACKGROUND Patients who undergo open-heart surgery often experience widespread musculoskeletal and pulmonary complications. These can interfere with their functioning, resulting in soft tissue changes, worsening postural changes, and poor respiratory performance. Therefore, the prospective study aimed to compare forward head angle (FHA) and forward shoulder angle (FSA), maximal inspiratory pressure (MIP), and self-reported breathing dysfunction before and after open-heart surgery. MATERIAL AND METHODS In a prospective observational study of 106 patients, men and women scheduled for open-heart surgery were enrolled. Prior to surgery and before discharge from the hospital, all patients were required to assess FHA and FSA using 2-dimensional motion analysis software, MIP using a respiratory pressure meter, and breathing dysfunction using the 25-item Self Evaluation of Breathing Questionnaire (SEBQ). Paired t test was used to compare differences between before and after surgery. To evaluate associations, logistic regression analysis was performed. RESULTS Of the 106 patients recruited, 73 completed the study. FHA (-Δ6.55±4.77, P.

Effects of modified long stick exercise on hyperkyphosis, muscle imbalance and balance control in elderly community-dwelling women with hyperkyphosis

BACKGROUND

Hyperkyphosis is a condition often seen in older women. This condition causes muscle imbalance in the upper back of the body and impacts balance control. Long stick exercise (LSE) is an exercise programme for the elderly that improves muscle strength and balance control.

OBJECTIVE

This research was designed to investigate the effects of a modified LSE on hyperkyphosis, muscle imbalance and balance control in elderly community-dwelling women with hyperkyphosis.

METHODS

Twenty-eight elderly women with hyperkyphosis were divided into experimental and control groups. The experimental group was assigned to practice the modified LSE programme 30-40 minutes/day, 3 days/week, for 12 weeks. Hyperkyphosis, pectoralis minor length, muscle strength, functional reach test (FRT) and timed up and go test (TUG) were obtained at baseline, after 6 weeks and after 12 weeks of exercise.

RESULTS

The experimental group demonstrated improved hyperkyphosis, pectoralis minor length, muscle strength, FRT, and TUG after 12 weeks of training. Moreover, the experimental group exhibited significantly greater improvements in all outcomes than the control group (p< 0.05).

CONCLUSION

The modified LSE programme is an alternative exercise that is easy and low-impact for improving hyperkyphosis, muscle imbalance, and balance control in elderly community-dwelling women with hyperkyphosis.

Effects of an 8-week multimodal program on thoracic posture, glenohumeral range of motion and serve performance in competitive young tennis players

Introduction

Intensive tennis practice is known to generate sport-specific adaptations at the shoulder region and influence the sagittal spinal curvature. However, increased thoracic kyphosis decreases the shoulder functional capacity, which could limit tennis performance. Therefore, the aim of this study was to investigate the effects of an 8-week multimodal program on thoracic posture, glenohumeral range of motion, and serve performance in competitive young tennis players.

Methods

Eighteen male and four female players (age: 16.0 ± 2.4 years, height: 170.7 ± 11.0 cm; mass: 62.1 ± 11.5 kg; International Tennis Number: 3-4) performed their regular training during 8 weeks, which was used as a reference period, and implemented a multimodal program including stretching, strengthening, and myofascial release exercises, four times per week during 8 additional weeks, which corresponded to the intervention period. The thoracic curvature angle and mobility, the biacromial and interscapular distances, the glenohumeral range of motion and the tennis serve performance were assessed three times, i.e., before and after the regular training and after the 8-week multimodal program.

Results

The results showed that the 8-week regular training had no significant effects on thoracic curvature angle [effect size (ES) = 0.02-0.36, p = 0.06-0.46] and mobility (ES = 0.05-0.26, p = 0.13-0.42), biacromial (ES = 0.05, p = 0.18) and interscapular distances (ES = 0.03, p = 0.45), ranges of motion in glenohumeral internal (ES = 0.04, p = 0.43) and external rotation (ES = 0.43, p = 0.06), and tennis serve accuracy (ES = 0.33, p = 0.07) and velocity (ES = 0.09, p = 0.35). The 8-week multimodal program increased moderately the thoracic mobility (ES = 0.55, p = 0.01), moderately to strongly the serve accuracy and velocity (ES = 0.65, p = 0.003, for both), strongly decreased the interscapular distance (ES = 1.02, p < 0.001), and strongly increased the range of motion in glenohumeral internal (ES = 0.90, p < 0.001) and external rotation (ES = 1.49, p < 0.001).

Discussion

These findings indicated that an 8-week multimodal program, including spine and glenohumeral mobility and shoulder girdle strength exercises, performed four times per week during 8 weeks, is moderately relevant to rectify the sagittal thoracic curvature in competitive tennis players, while such a program may help regain the range of motion in glenohumeral rotation without tennis serve performance impairment.

The Effect of a Comprehensive Corrective Exercise Program on Kyphosis Angle and Balance in Kyphotic Adolescents

This study aimed to investigate the effects of a comprehensive corrective exercise program on the kyphosis angle and balance in kyphotic adolescents. A total of 62 male adolescents (between the ages of 10 and 18, mean BMI 21.7 kg/m2) with a thoracic kyphosis (TK) angle of ≥ 50° were divided into three groups using the simple randomization method: CCEP (comprehensive corrective exercise program), TEP (thoracic exercise program) and control group. The CCEP program consisted of corrective exercises plus postural perception training (PPT). Exercise programs were applied for 40−50 min, 3 days a week for 12 weeks. The kyphosis angle was measured using a flexible ruler, and balance was assessed using the Romberg index obtained from pedobarography. After training, a highly significant reduction in the kyphosis angle was observed in the CCEP and TEP groups (p < 0.001). Comparison among the groups showed a greater reduction in the kyphosis angle in the CCEP group (p < 0.020). Postural perception improved in the CCEP group versus other groups (p < 0.001). Improvement of the Romberg index (balance) was found only in the CCEP group upon within-group comparison (p < 0.001), with no difference among the groups (p > 0.05). The use of postural perception in combination with corrective exercise programs for thoracic kyphosis represents a comprehensive approach, and PPT can increase the effectiveness of the intervention.

Immediate Effects of the Reverse Plank Exercise on Muscle Thickness and Postural Angle in Individuals with the Forward Shoulder Posture

The forward shoulder posture (FSP) results from shoulders being pulled forward by shortened anterior shoulder girdle muscles. The objective of this study was to investigate the short-term effectiveness of the reverse plank exercise on parascapular muscle thickness and forward shoulder angle (FSA) in patients with FSP. Participants were divided into the FSP and non-FSP (NFSP) groups based on the observed angle between the horizontal line of the C7 spinous process and the acromion process. All participants performed a total of five sets of reverse plank exercises at 30 s per set. FSA and muscle thickness of the pectoralis major (PM), serratus anterior (SA), upper trapezius (UT), and lower trapezius (LT) were measured before and after the reverse plank exercise. The muscle thicknesses of the SA and LT, and the FSA, were significantly increased after exercise in the FSP group (p < 0.05). Muscle thickness of the PM and UT significantly decreased after the exercise. In the NFSP group, muscle thickness of the LT was significantly increased, and muscle thickness of the PM and UT were significantly reduced after exercise (p < 0.05). Upon using between-group analysis, there were significant differences between the FSA, SA, UT, and LT groups (p < 0.05). The reverse plank exercise has the short-term benefit of correcting and preventing FSP by increasing SA and LT thickness while decreasing PM and UT thickness. We believe that the reverse plank exercise significantly improved the ability to prevent FSP in FSP-related muscles and was beneficial in achieving optimal postural alignment.

Effects of Artificially Induced Breast Augmentation on the Electromyographic Activity of Neck and Trunk Muscles during Common Daily Movements

A female breast can be a potential source of musculoskeletal problems, especially if it is disproportionately large. The purpose of the present study was to examine the effect of artificially induced breast volume on the EMG activity of neck and trunk musculature during common everyday movements. The EMG activity of the sternocleidomastoid (SCM), the upper trapezius (UT), and the thoracic and lumbar erector spinae (TES, LES) were recorded during 45° trunk inclination from the upright standing and sitting postures (TIST45°, TISI45°) as well as during stand-to-sit and sit-to-stand (STSI, SIST) in 24 healthy females with minimal and ideal breast volume (M-NBV, I-NBV). All movements were performed before and after increasing M-NBV and I-NBV by 1.5-, 3.0-, 4.5-, and 6-times using silicone-gel implants. Significantly higher EMG activity for TES and LES were found at 6.0- and ≥4.5-times increase the I-NBV, respectively, compared to smaller breast volumes during TIST45°. EMG activity of UT was higher, and TES was lower in M-NBV females compared to I-NBV females in all movements but were significantly different only during SIST. The female breast can affect the activity of neck and trunk muscles only when its volume increases above a certain limit, potentially contributing to muscle dysfunction.

Impact of adding scapular stabilization to postural correctional exercises on symptomatic forward head posture: a randomized controlled trial

BACKGROUND

One of the most overspread postural abnormalities is forward head posture (FHP) and it is described as head projection anteriorly in relation to the trunk which appears mainly in sagittal plane. Scapular stabilization exercise (SSE) is capable of restoring each of thoracic cage and head neutral optimum position by neck and shoulder muscles interactions and through controlling scapular position and movement.

AIM

This study was conducted to investigate the impact of adding scapular stabilization (SSE) to postural correctional exercises (PCE) on symptomatic FHP.

DESIGN

The pre-post single-masking (assessor) randomized experimental trial.

SETTING

Participants with postural dysfunction in form of FHP admitted to outer clinic of the Faculty of Physical Therapy.

POPULATION

Sixty participants (20 to 35 years) with symptomatic FHP and recruited from outer clinic at faculty of physical therapy.

METHODS

Participants were allocated randomly by opaque sealed envelope to two groups who are referred from an orthopedist: Group "A" received SSE and postural correction exercises, whereas Group "B" received only postural correctional exercises; treatments were performed three times/week for 10 weeks. The craniovertebral angle, pressure pain threshold, cervical flexor and extensor muscles endurance, Arabic neck disability index, upper trapezius and sternocleidomastoid muscle root mean square during rest and activity were used to evaluate the patients' pretreatment and post-treatment.

RESULTS

Within group analysis for sixty participants reported statistical significant difference between baseline and post-treatment as P value <0.05 with more refinement in stabilization exercise group.

CONCLUSIONS

Adding SSEs to PCEs is more effective method than PCEs seldom for the management of FHP patients.

CLINICAL REHABILITATION IMPACT

Both scapular stabilization and postural correction exercise increase craniovertebral angle and pressure pain threshold (PPT) and decrease muscle activity and disability. Scapular stabilization alone increase craniovertebral angle and PPT and decrease muscle activity and disability more than postural correction exercise. In addition of statistical significant difference in all variables but there were clinical change in disability only.

The relationship between forward head posture, postural control and gait: A systematic review

BACKGROUND

Forward head posture (FHP) is a common postural deviation. An increasing number of studies have reported that people with FHP present with impaired postural control and gait; however, there is conflicting evidence. A systematic review focusing on these relationships has been unavailable to date.

RESEARCH QUESTION

Is there a relationship between FHP, postural control and gait?

METHODS

This systematic review was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) statement (PROSPERO ID: CRD42021231908). Web of Science, PubMed, Scopus, and CINAHL Plus (via EBSCO) were systematically searched, and a manual search was performed using the reference lists of included studies. Eligible studies included observational studies addressing the relationship between FHP, postural control and/or gait. Quality assessment was conducted using the Joanna Briggs Institute Critical Appraisal Checklist for Cross-Sectional Studies.

RESULTS

Nineteen studies were selected for this review. Consistent evidence supported that people with FHP had significant alterations in limits of stability (n = 3), performance-based balance (n = 3), and cervical proprioception (n = 4). Controversial evidence existed for a relationship of FHP with static balance (n = 4) and postural stability control (n = 4). Limited evidence existed to support an alteration in gait and vestibular function. Three studies on induced FHP consistently identified no reduced postural control.

SIGNIFICANCE

Current evidence supports an association between FHP and a detrimental alteration in limits of stability, performance-based balance, and cervical proprioception. Instead of simply indicating impaired overall balance, the findings of this review indicate that a reduction in specific aspects of the postural control requires to be clarified in clinical evaluation for individuals with FHP, which would facilitate the planning and application of appropriate interventions to prevent dysfunctions and disability.

Current Status of the Diagnosis and Management of Osteoporosis

Osteoporosis has been defined as the silent disease of the 21st century, becoming a public health risk due to its severity, chronicity and progression and affecting mainly postmenopausal women and older adults. Osteoporosis is characterized by an imbalance between bone resorption and bone production. It is diagnosed through different methods such as bone densitometry and dual X-rays. The treatment of this pathology focuses on different aspects. On the one hand, pharmacological treatments are characterized by the use of anti-resorptive drugs, as well as emerging regenerative medicine treatments such as cell therapies and the use of bioactive hydrogels. On the other hand, non-pharmacological treatments are associated with lifestyle habits that should be incorporated, such as physical activity, diet and the cessation of harmful habits such as a high consumption of alcohol or smoking. This review seeks to provide an overview of the theoretical basis in relation to bone biology, the existing methods for diagnosis and the treatments of osteoporosis, including the development of new strategies.

Evaluating Differences Between Participants With Various Forward Head Posture With and Without Postural Neck Pain Using Craniovertebral Angle and Forward Shoulder Angle

OBJECTIVE

The purpose of this study was to investigate differences between individuals with various forward head posture (FHP) severities with and without postural neck pain using craniovertebral angle and forward shoulder angle.

METHOD

Ninety participants age 20 to 50 years were categorized into the following 4 groups based on observational method and presence or absence of postural neck pain: (1) slight FHP group without pain, (2) slight FHP group with pain, (3) moderate-to-severe FHP group without pain, and (4) moderate-to-severe FHP group with pain. A digital imaging technique was used to measure the craniovertebral angle and forward shoulder angle in a standing position.

RESULTS

A 1-way analysis of variance test showed a significant difference for craniovertebral angle in the 4 groups (F = 22.04, P < .001). Tukey's test showed the difference in this variable was significant between slight FHP groups (with or without pain) and moderate-to-severe FHP groups (with or without pain) (P < .001). Although overall F indicated a significant difference (F = 4.11, P < .009) of the forward shoulder angle in 4 groups, Tukey's test revealed this was only significantly different in 2 groups: slight FHP with pain and moderate-to-severe FHP with pain (P = .005).

CONCLUSION

The craniovertebral angle in the 2 groups of moderate-to-severe FHP was significantly smaller than that in the 2 groups of slight FHP. However, the forward shoulder angle in the group of moderate-to-severe FHP with pain was only significantly smaller than that in slight FHP with pain. The results showed that including pain as a factor of categorization did not lead to a significant difference between various groups regarding craniovertebral angle and forward shoulder angle.

The effect of upper limb lymphedema in posture of patients after breast cancer surgery

BACKGROUND

Upper limb lymphedema is one of the complications following breast cancer-related surgery. It is a fact that there are alterations in posture of the trunk following surgery, however, there is not much data on whether upper limb lymphedema has any effect on body posture.

OBJECTIVES

The main purpose of the study was to investigate the effect of upper limb lymphedema in the trunk posture and spine mobility of patients following breast cancer surgery.

METHODS

Twenty-seven women with lymphedema and 29 women without lymphedema with mastectomy or breast-conserving surgery participated in the study. Posture was evaluated by the New York Posture Rating Chart and spinal stability and thoracic mobility were evaluated by the Spinal Mouse device.

RESULTS

Posture and spine posture scores were significantly higher in the without lymphedema group (p= 0.004; 0.041; respectively). There was a significant difference between the groups in terms of lateral (p< 0.001) and posterior (p< 0.001) view of shoulders, spine (p= 0.027), upper (p< 0.001) and lower back (p= 0.009), and trunk postures (p= 0.001).

CONCLUSIONS

Body posture and spine are more affected due to upper limb lymphedema following breast cancer surgery. Alterations of posture mainly occur on shoulders, spine, upper and lower back, and trunk, but not on head and neck postures.

Effect of improved thoracic kyphosis on forward shoulder posture after mobilization in individuals with thoracic hyperkyphosis

BACKGROUND

Thoracic hyperkyphosis structurally alters the position of the scapula to cause forward shoulder posture. However, the effect of improved thoracic hyperkyphosis on forward shoulder posture is unclear. The objective of this study was to determine the effect of eight weeks of thoracic mobilization on improving thoracic hyperkyphosis and forward shoulder posture and determine the cutoff change ratio in kyphosis for improving forward shoulder posture using the decision tree method.

METHOD

This study included 19 participants with thoracic hyperkyphosis who underwent thoracic mobilization for eight weeks. Forward shoulder posture (acromion-to-the-wall index) and thoracic kyphosis were measured before and after thoracic mobilization.

FINDINGS

The intervention significantly improved thoracic kyphosis and forward shoulder posture. The cutoff change ratio in kyphosis for improving forward shoulder posture was >13.79%. In the subgroup analysis of participants with a change ratio of kyphosis >13.79% (seven cases), all patients showed improved forward shoulder posture. In contrast, in the subgroup with a change ratio of kyphosis ≤13.79% (12 cases), eight cases showed improved forward shoulder posture, while four cases showed no improvement.

INTERPRETATION

Thoracic mobilization can be recommended in shoulder rehabilitation programs to improve forward shoulder posture to manage and prevent scapular malalignment in individuals with thoracic hyperkyphosis. We suggest that a high probability of improvement in forward shoulder posture can be expected when kyphosis is improved by >13.79%.

Development of a Cranial Suture Traction Therapy Program for Facial Asymmetry Correction Using the New Delphi Technique

Background and Objectives: We aimed to develop a cranial suture traction therapy program, a non-surgical therapeutic method for facial asymmetry correction. Materials and Methods: Six experts, including rehabilitation medicine specialists, oriental medical doctors, dentistry specialists, five experts, including Master’s or doctoral degree holders in skin care and cosmetology with more than 10 years of experience in the field, 4 experts including educators in the field of skin care, a total of 15 people participated in the validation of the development of the cranial suture traction therapy program in stages 1 to 3. Open questions were used in the primary survey. In the second survey, the results of the first survey were summarized and the degree of agreement regarding the questions in each category was presented. In the third survey, the degree of agreement for each item in the questionnaire was analyzed statistically. Results: Most of the questions attained a certain level of consensus by the experts (average of ≥ 4.0). The difference between the mean values was the highest for the third survey at 0.33 and was the lowest between the second and third surveys at 0.47. The results regarding the perceived degree of importance for each point of the evaluation in both the second and third stages of the cranial suture traction therapy program were verified using the content validity ratio. The ratio for the 13 evaluation points was within the range of 0.40−1.00; thus, the Delphi program for cranial suture traction therapy verified that the content was valid. Conclusions: As most questions attained a certain level of consensus by the experts, it can be concluded that these questions are suitable, relevant, and important. The commercialization of the cranial suture traction treatment program will contribute to the correction and prevention of facial dislocations or asymmetry, and the developed treatment will be referred to as cranial suture traction therapy (CSTT).

The impact of breast support garments on fit, support and posture of larger breasted women

Due to current measurement, sizing and fitting approaches, poor bra fit is prevalent amongst larger breasted women. The impact of improving bra fit hasn't yet been explored. This pre-clinical study aimed to explore immediate and short-term biomechanical responses to changing breast support garment. Asymptomatic participants (n=24) performed a static standing task, drop jumps and seated typing whilst kinematic data from the breasts and spine were recorded. Three breast support conditions were assessed: Usual, professionally fitted bra in the immediate term (PFB), and the same professionally fitted bra after four weeks wear (PFB₂₈). Bra fit assessments were included for both bras. All participants failed the bra fit assessment when wearing the Usual bra and 67% (n=16) failed when wearing the PFB. Less bra fit issues were present in the PFB, resulting in immediate biomechanical changes relating to breast support and spinal posture, yet nothing in the short term (PFB₂₈). This research sets the foundations for future work to investigate whether the implementation of better fitting breast support garments can influence musculoskeletal pain amongst larger breasted women, whilst attributing potential improvement of symptoms, objective measures of breast support and spinal posture.

Establishing minimal clinically important difference for effectiveness of corrective exercises on craniovertebral and shoulder angles among students with forward head posture: a clinical trial study

BACKGROUND

Previous studies have addressed the effects of different exercises and modalities on forward head posture (FHP), but the minimal clinically important difference (MCID) of the effect of exercises on FHP remains unclear. Therefore, this study aimed to investigate the effects of selective corrective exercises (SCEs) on the craniovertebral angle (CVA) and shoulder angle (SA) in students with FHP and to establish MCID for these angles.

METHODS

In this randomized clinical trial study, a total of 103 second-grade male students with FHP were enrolled. Participants were randomly assigned to experimental and control groups. CVA and SA of participants were measured before and after the 8-week selective corrective exercise program (including strengthening and stretching exercises). The photogrammetric method was used to measure CVA and SA. MCID value was calculated for CVA and SA using the distribution method.

RESULTS

The results showed that there was a significant difference between the experimental and control groups in terms of CVA (F = 89.04, P = 0.005, Effect size = 0.47) and SA (F = 18.83, P = 0.005, Effect size = 0.16). After eight weeks of selective corrective exercises, the MCID values of CVA and SA were 1.40° and 1.34°, respectively.

CONCLUSION

This study revealed that the selective corrective exercises might lead to postural correction of students having FHP problem. Results further indicated that a corrective exercise program would be considered beneficial if it increased CVA and SA values at least 1.40 and 1.34 degrees, respectively.

Corrective exercises administered online vs at the workplace for pain and function in the office workers with upper crossed syndrome: randomized controlled trial

Objective

To evaluate the effects of online-supervised versus workplace corrective exercises on neck–shoulder pain (NSP), sick leave, posture, workability, and muscular activity among office workers with the upper crossed syndrome (UCS).

Methods

We performed a parallel-group randomized control trial at Shahid Beheshti University, Tehran, Iran, assigning 36 office workers to online-supervised, workplace, and control groups (mean (SD) age 38.91 ± 3.87, 38.58 ± 7.34, 37.00 ± 8.12). Inclusion criteria were alignment alteration (forward head (≥ 45°), rounding shoulder (≥ 52°), rounding back (≥ 42°), and pain intensity ≥ 3 in neck and shoulder. The two intervention groups performed 8-week exercise program, while the control group continued usual activities. Primary (NSP and sick leave) and secondary outcomes [postural angles, workability, and muscular activity were measured by VAS, outcome evaluation questionnaire (OEQ), photogrammetry, workability index, and EMG, respectively, at the baseline and an 8-week follow-up].

Results

ANCOVA results revealed improvements for the online-supervised group versus control for NSP (P = 0.007), postural angles (P = 0.000, P = 0.001, P = 0.005), workability (P = 0.048, P = 0.042), and upper trapezius activation (P = 0.024, P = 0.016), respectively. Using paired t tests, both intervention groups improved from baseline to follow-up for NSP (P = 0.000, P = 0.002), forward head posture (P = 0.000, P = 0.000), round shoulders (P = 0.001, P = 0.031), and round back (P = 0.034, P = 0.008), respectively. Related parameters of workability (P = 0.041, P = 0.038), upper trapezius (P = 0.005, P = 0.005, P = 0.022), and serratus anterior (P = 0.020, P = 0.015) changed only in the online-supervised group.

Conclusion

Online-supervised corrective exercise seems to improve a range of parameters related to work performance. These findings are highly applicable in light of the ongoing COVID pandemic; many workers have to work from home.

Effect of Rounded and Hunched Shoulder Postures on Myotonometric Measurements of Upper Body Muscles in Sedentary Workers

Background: Shoulder pain is prominent among sedentary employees who make motions of the upper limbs on a regular basis. Rounded shoulder posture (RSP) and hunched shoulder posture (HSP) are the most common clinical postural misalignments. These causes the spine to bend and raise tension on the nerve roots, which has a negative impact on upper-extremity muscular strength and function. Therefore, this study was carried out to investigate the effect of RSP and HSP on the mechanical parameters of the upper body muscles in clinically asymptomatic sedentary workers. Methods: Twenty office workers with RSP, 20 with HSP, and 20 with normal shoulder posture (NSP) were matched for age, BMI, and type of job. Volunteers were split into groups based on photometric shoulder angle measurements. Mechanical properties such as muscle tone, stiffness, and elasticity of the upper trapezius, middle trapezius, posterior deltoid, and pectoralis major were assessed in sedentary postures. Results: The study revealed a significant decrease in muscle tone for the pectoralis major and a significant increase in muscle stiffness for the poster deltoid in both RSP and HSP as compared to NSP. Specifically, muscle tone decreased from 20.1 ± 4.0 to 12.4 ± 3.1 Hz (38.3%), (p ≤ 0.001) in RSP and from 20.1 ± 4.0 to 14.0 ± 4.8 Hz (30.3%), (p ≤ 0.001) in HSP. Muscle stiffness increased from 309.9 ± 70.7 to 348.15 ± 68.7 N/m (11%), (p ≤ 0.001) in RSP and from 309.9 ± 70.7 to 441.7 ± 45.9 N/m (29.8%), (p ≤ 0.001) in HSP. Conclusions: RSP and HSP have an impact on the tone, stiffness, and elasticity of upper body muscles in healthy asymptomatic sedentary workers. These postures, on a regular basis, may affect physical health and decrease workers’ productivity. In addition, it is recommended for sedentary workers to take regular breaks and attend training that could help improve their physical health.

Effects of smartphone screen viewing duration and body position on head and neck posture in elementary school children

BACKGROUND

Electronic media have become integral parts of modern life, in which prolonged screen viewing time (SVT) by children is nearly unavoidable. Prolonged use of smartphones could lead to musculoskeletal problems.

OBJECTIVES

To investigate the effect of SVT on head and neck posture during and after using smartphones for various periods of time in either standing or sitting postures.

METHODS

This observational study included 34 male children aged 5-12 years who were assigned to one of two groups based on average smartphone use duration per day: group A comprised 18 children averaging > 4 hours per day (h/day) of smartphone use, and group B comprised 16 children with < 4 h/day of smartphone use. The children's postures were photographed in standing and sitting positions while using a smartphone and 30 min after ceasing smartphone use. The head flexion, neck flexion, gaze, and craniocervical angles were measured using the software program Kinovea.

RESULTS

Significant increases were found in head flexion, neck flexion, and gaze angles. Furthermore, both groups saw a significant decrease in craniocervical angle when sitting compared to when standing, both during and 30 min after smartphone use. The head flexion, neck flexion, and gaze angles of group A were significantly higher than those of group B, and the craniocervical angle of group A was significantly lower than that of group B in both postures (p< 0.05).

CONCLUSION

SVT is associated with increased neck and head flexion posture in children, especially in a sitting position.

Decreasing thoracic hyperkyphosis - Which treatments are most effective? A systematic literature review and meta-analysis

BACKGROUND

A variety of treatments aim to reduce thoracic hyperkyphosis in adults, thereby improving posture and reducing possible complications.

OBJECTIVE

To investigate the effectiveness of treatments to reduce thoracic hyperkyphosis.

DESIGN

Systematic review and meta-analysis.

METHODS

MEDLINE, EMBASE, CINAHL, and CENTRAL were searched from inception to March 2021. Two authors independently selected randomised controlled trials assessing the effectiveness of treatments to reduce thoracic hyperkyphosis in adults. Raw data on mean change in thoracic kyphosis were extracted and standardised mean differences (SMD) calculated. Meta-analysis was performed on studies homogenous for study population and intervention. Strength of evidence was assessed using GRADE.

RESULTS

Twenty-eight studies were included, with five meta-analyses performed. Low to moderate-quality evidence found structured exercise programs of three-months duration or less effective in reducing thoracic hyperkyphosis in younger (SMD -2.8; 95%CI -4.3 to -1.3) and older populations (SMD -0.3; 95%CI -0.6 to 0.0). Low-quality evidence found bracing for three months or more effective in older participants (SMD -1.0, 95%CI -1.3 to -0.7). A single study demonstrated the effectiveness of multimodal care in younger participants. The available evidence suggests multimodal care, structured exercise programs over three months duration, and taping in older adults, and biofeedback and muscle stimulation in younger adults, are ineffective in reducing thoracic hyperkyphosis.

CONCLUSION

Low to moderate-quality evidence indicates that structured exercise programs are effective to reduce thoracic hyperkyphosis. Low-quality evidence indicates that bracing is effective to reduce thoracic hyperkphosis in older adults.

Effects of scapular stabilization exercises on posture and muscle imbalances in women with upper crossed syndrome: A randomized controlled trial

BACKGROUND

Scapular stabilization exercises can improve forward shoulder posture in young women. However, the effects of optimal exercise protocols on neck and shoulder postures, scapular muscle imbalance and thoracic kyphosis are still unclear.

OBJECTIVES

To investigate the effects of scapular stabilization exercises on neck and shoulder postures, scapular muscle imbalance and thoracic kyphosis in young women with upper crossed syndrome.

METHODS

Thirty-nine women aged 18-25 years with upper crossed syndrome were recruited. Participants were randomly allocated intotwo groups. The exercise group performed scapular stabilization exercises using elastic bands at 10 repetitions/set, 3 sets/day, and 3 days/week for 4 weeks. The control group did not perform any exercises during the experimental period. The cervical and shoulder angles were evaluated using the Kinovea program. A caliper, handheld dynamometer and flexi ruler were used to evaluate the length of the pectoralis minor, strength of the scapular stabilizer muscles and degree of the mid-thoracic curve, respectively.

RESULTS

The exercise group showed significant differences (p< 0.05) in the increase in cervical and shoulder angle, length of the pectoralis minor, and strength of the scapular muscles, except in the degree of mid-thoracic curve compared to the control group.

CONCLUSION

This study indicated that scapular stabilization exercises can improve forward head and shoulder posture, increase the flexibility of the pectoralis minor and strengthen the scapular muscles.

Text neck: An adverse postural phenomenon

BACKGROUND

The excessive use of hand-held mobile devices (HHMD) leads to a postural phenomenon known as text neck.

OBJECTIVE

The aim of this paper is to discuss the anatomical, biomechanical and muscle activation changes within the cervical and thoracic regions associated with the sustained, forward, flexed neck posture, observed with excessive usage of hand-held mobile devices. Additionally, this paper examines the relationship of gender, as well as the effects of carrying backpack loads by youth, on this forward, flexed neck posture.

METHODS

Multiple aspects of the text neck position that occur when an individual uses a HHMD are described.

RESULTS

Prolonged use of hand-held mobile devices results in adverse anatomical and biomechanical changes in the cervical and thoracic spine, muscular imbalances, and postural compensations, all of which contribute to muscular overuse and fatigue resulting in pain.

CONCLUSIONS

Physical therapists must educate their patients about proper posture while using hand-held mobile devices. Proper posture includes: holding the device close to eye level, using the device while standing or sitting and holding the device with a line of sight perpendicular to the surface of the device, using a larger screen, and texting with both hands. Also, because children are using hand held mobile devices at younger ages, parents and teachers must be educated about the dangers of prolonged use of hand-held devices.

The association of reactive balance control and spinal curvature under lumbar muscle fatigue

Background

Although low back fatigue is an important intervening factor for physical functioning among sedentary people, little is known about its possible significance in relation to the spinal posture and compensatory postural responses to unpredictable stimuli. This study investigates the effect of lumbar muscle fatigue on spinal curvature and reactive balance control in response to externally induced perturbations.

Methods

A group of 38 young sedentary individuals underwent a perturbation-based balance test by applying a 2 kg load release. Sagittal spinal curvature and pelvic tilt was measured in both a normal and Matthiass standing posture both with and without a hand-held 2 kg load, and before and after the Sørensen fatigue test.

Results

Both the peak anterior and peak posterior center of pressure (CoP) displacements and the corresponding time to peak anterior and peak posterior CoP displacements significantly increased after the Sørensen fatigue test (all at p < 0.001). A lumbar muscle fatigue led to a decrease of the lumbar lordosis in the Matthiass posture while holding a 2 kg load in front of the body when compared to pre-fatigue conditions both without a load (p = 0.011, d = 0.35) and with a 2 kg load (p = 0.000, d = 0.51). Also the sacral inclination in the Matthiass posture with a 2 kg additional load significantly decreased under fatigue when compared to all postures in pre-fatigue conditions (p = 0.01, d = 0.48). Contrary to pre-fatigue conditions, variables of the perturbation-based balance test were closely associated with those of lumbar curvature while standing in the Matthiass posture with a 2 kg additional load after the Sørensen fatigue test (r values in range from −0.520 to −0.631, all at p < 0.05).

Conclusion

These findings indicate that lumbar muscle fatigue causes changes in the lumbar spinal curvature and this is functionally relevant in explaining the impaired ability to maintain balance after externally induced perturbations. This emphasizes the importance for assessing both spinal posture and reactive balance control under fatigue in order to reveal their interrelations in young sedentary adults and predict any significant deterioration in later years.