Effects of forward head posture on static and dynamic balance control

Altered body balance and plantar pressure distribution in young adults with forward head posture

Background

Forward head posture (FHP), a common postural issue, affects balance and may be linked to altered muscle activity and cervical spine alignment. This study investigated the impact of FHP on static balance and plantar pressure distribution in adults. We hypothesized that FHP would be associated with poorer balance and altered pressure distribution.

Methods

This case-control study investigated the impact of FHP on static balance and plantar pressure distribution in adults (n = 52). Participants were categorized based on craniovertebral angle (CVA), into FHP (CVA <47°) and control (CVA ≥47°) groups. Static balance was assessed using a NeuroCom® Balance Manager System, evaluating parameters like center of gravity sway and directional control. Plantar pressure distribution was measured with an Emed Pedobarography system during walking, analyzing maximum force, peak pressure, and contact area.

Results

Participants with FHP showed poorer balance with eyes closed on foam compared to the control group. Additionally, the FHP group exhibited lower total maximum force and altered force distribution in both feet during walking. Correlations suggested that higher CVA degrees were associated with decreased balance and altered plantar pressure distribution. Despite, linear regression analyses revealed no significant predictive relationships between CVA and specific balance measures, it showed significant associations with several plantar pressure distribution parameters, including total maximum force exerted on both feet, maximum force on the forefoot, and peak pressure on the hindfoot.

Conclusion

These findings suggest that FHP may influence balance and plantar pressure distribution, with a potentially stronger effect on plantar pressure than balance parameters.

Investigating the relationship between sagittal spinal curvature and fall incidence and fall risk among elderly nursing home residents

Designing appropriate diagnostic and treatment methods to reduce fall risk and improve quality of life, as well as reduce the cost of care in elderlies. Our findings have potential for early diagnosis of those with a high probability of falling based on fairly simple clinical measures of hyperkyphosis, forward head, and lordosis.

INTRODUCTION

Poor balance is an underlying cause of falling in the elderly, for which a change in the natural curvature of the spine plays a major role. Little is known about the relationship between spinal curvatures and fall incidence in this population. We primarily aimed to investigate the relationship between sagittal plane spinal curvatures and fall incidence over 1 year among nursing facility residents. Secondarily, we aim to determine associations of sagittal plane spinal curvatures with participants' perception of fall risk and balance capability.

METHODS

Participants (100 residents mean age 70.17 ± 6.01 years) underwent standing measures of sagittal plane spinal curvatures (flexible ruler technique) and forward displacement of the head relative to the cervical spine. The Tinetti Performance Oriented Mobility Assessment (POMA) and Fall Efficacy Scale assessed participants' perception of balance and fear of falling. Incident falls were self-reported monthly and tracked across 1 year. Spearman's correlations and logistic regression evaluated associations between fall incidence and spinal curvature. Predictive performance of spinal curvature and fall risk was determined by the corresponding ROC for defining a cut-off for variables of spinal curvature and fall risk indicators.

RESULTS

Predictive performance of spinal curvature and fall risk factors indicated 84% and 77% of participants were correctly classified using models of kyphosis and head angle, respectively.

CONCLUSIONS

Our study adds new data on spinal curvatures and incident falls among nursing facility residents. Efforts are needed to intervene to counter progression of spinal curvatures and improve fall prevention practices.

Comparison of balance and proprioception of the shoulder joint in girls with and without upper cross syndrome

INTRODUCTION

Upper cross syndrome is one of the most common disorders of the upper part of body, often associated with abnormalities of forward head, forward shoulders, elevated and protracted of scapula, and increased thoracic kyphosis. Conducting research on upper cross syndrome, especially in girls, is of highly significant, considering this issue and lack of examination of complications and consequences of this syndrome; therefore, this study aims to compare the balance and proprioception of the shoulder joint in girls with and without upper cross syndrome.Method The statistical population included two groups of 10-12-year-old female students, i.e., healthy and those with upper cross syndrome in the city of Khalkhal in Iran in 2022-2023. A total of 60 girl children were included in this study. The subjects were screened using a checker board and after quantitative evaluations of posture, they were assigned into two groups: healthy group (No. 30) and the one suffering from upper cross syndrome (No. 30). Forward head and forward shoulder angle were assessed using photography and kinovea software, kyphosis angle using Goniometer-pro app, static and dynamic balance using BESS and Y tests, also proprioception at angles of 45- and 80-degrees external rotation of the shoulder joint through photography and kinovea software. Data were analyzed through independent t-test in SPSS software version 26 at the significance level of 0.05.Results Healthy girls were in a better position in all variables of static balance (1.14 95% CI: [0.96, 1.70], p = 0.001), dynamic balance (0.81, 95% CI: [0.73,1.24], p = 0.001), proprioception of external rotation of shoulder joint at 45- (0.78, 95% CI: [0.64, 1.14], p = 0.001) and 80-degrees (0.89, 95% CI: [0.59, 1.34], p = 0.001) angles than those with upper cross syndrome.Conclusion It can be concluded that upper cross syndrome causes a decrease in balance and proprioception of the shoulder joint in female students; therefore, along with correcting the abnormalities, special attention should be paid to strengthening and improving these components. It is recommended for rehabilitation professionals to apply exercise training programs to improve the balance and proprioception and correct of the upper cross syndrome: that the strengthening of these components prevents musculoskeletal disorders.Implications for clinical practice• It is recommended for rehabilitation professionals to apply exercise training programs to improve the balance and proprioception of individual with upper cross syndrome.• It is recommended for rehabilitation professionals to apply exercise training programs to correct of the upper cross syndrome in order to prevents musculoskeletal disorders.

Forward head posture associated with reduced cardiorespiratory fitness in psychotic disorders compared to autism spectrum disorder and healthy controls

Individuals with psychotic disorders often lead sedentary lives, heightening the risk of developing forward head posture. Forward head posture affects upper cervical vertebrae, raising the likelihood of daily discomforts like skeletal misalignment, neck pain, and reduced cardiorespiratory fitness. Improving cardiorespiratory fitness in psychotic disorders is relevant, given its proven benefits in enhancing physical and mental health. This study investigates forward head posture by measuring craniovertebral angles in psychotic disorders and the relationship with reduced cardiorespiratory fitness. To determine whether forward head posture is specific to psychotic disorders, we also included individuals with autism spectrum disorder and healthy controls. Among 85 participants (32 psychotic disorders, 26 autism spectrum disorder, 27 healthy controls), photogrammetric quantification revealed a significantly lower mean craniocervical angle in psychotic disorders compared to autism spectrum disorder (p =  < 0.02) and the healthy control group (p =  < 0.01). Reduced craniovertebral angle is related to diminished cardiorespiratory fitness in psychosis (R2 = 0.45, p =  < 0.01) but not in other control groups. This study found reduced craniovertebral angles, indicating forward head posture in psychotic disorders. Moreover, this relates to diminished cardiorespiratory fitness. Further research is needed to examine the underlying causes and to investigate whether this can be reversed through physical therapy.

Analysis of posture and balance impairments in individuals with chronic nonspecific neck pain-an observational study

Background

Neck pain is one of the most burdensome chronic musculoskeletal problems globally. Impaired proprioception is associated with Chronic Nonspecific neck pain as the structures of the cervical spine are crucial for proprioception and balance. There is a paucity of literature examining objective measures of balance and postural sway in patients with Nonspecific neck pain.

Methods

This study was observational and consisted of 126 samples (63 cases and 63 controls who were recruited using convenience sampling. The demographics of the samples were collected and the postural and balance impairment was assessed using Biodex Balance SD. Mean, Median, and SD were obtained and the inferential analysis was done using the Whitney U Test and the level of significance was accepted at p < 0.05.

Results

The subjects with neck pain showed had a lower static stability index, static sway index, static stability index- forward backward and static sway index lateral scores than the normal counterparts. There are significant differences in the overall static stability index, (p < 0.001). There was a significant difference in static sway index(p = 0.003), and static stability index lateral (p = 0.004). There was no significant difference for static sway index forward and backward (p = 0.550) and lateral sway index (p = 0.711).

Conclusion

Subjects with neck pain showed had a lower static stability index, static sway index, static stability index- forward backward and static sway index lateral scores than the normal counterparts and there was a significant difference between the static sway and static stability index in forward and backward directions as well as in lateral direction. These findings may help to assess the specific balance parameters and address the underlying causes of balance issues in patients with neck pain and also provide a comprehensive care to the patients.

Clinical Trial Registration

The trial was registered with CTRI India with registration number: CTRI/2022/07/044222.

Two Methods of Forward Head Posture Assessment: Radiography vs. Posture and Their Clinical Comparison

Background: Forward head posture (FHP) and altered cervical lordotic curvatures are common spine displacements often associated with neck pain and disability. Two primary categories for determining FHP exist: radiographic and postural measurements. Methods: This study investigated the correlation between the craniovertebral angle (CVA), the radiographically measured C2-C7 sagittal vertical axis (SVA), and cervical lordosis (absolute rotation angle: ARA C2-C7) in a sample of participants with chronic myofascial pain (CMP). In 120 participants, we performed both a postural measurement of the CVA and a lateral cervical radiograph, where the C2-C7 SVA and ARA C2-C7 were measured. A linear-regression R2 value to assess the correlation between the CVA, C2-C7 SVA, and ARA C2-C7 was sought. Results: A statistically significant weak linear fit was identified (Spearman's r = 0.549; R2 = 0.30, p < 0.001) between the CVA and C2-C7 SVA, having considerable variation between the two measures. A statistically significant linear fit (very weak) was identified for the lordosis ARA C2-C7 and the CVA: Spearman's r = 0.524; R2 = 0.275; p < 0.001. A value of 50° for the CVA corresponded to a value of 20 mm for the C2-C7 SVA on an X-ray. Conclusion: While the CVA and radiographic C2-C7 SVA are weakly correlated in an individual, they seem to represent different aspects of sagittal cervical balance. The CVA cannot replace radiographically measured cervical lordosis. We recommend that more emphasis be given to radiographic measures of sagittal cervical alignment than the CVA when considering patient interventions.

Effectiveness of Tailor-Made Physiotherapy Protocol in Smartphone-Addicted Individuals With Text Neck Syndrome and Short Message Service (SMS) Thumb

Background Smartphone usage has led to an increase in text neck syndrome (TNS) and short message service (SMS) thumb, causing neck, shoulder, and thumb pain, affecting daily activities. Limited treatment options are available for these conditions, and early intervention is crucial to prevent chronic pain and musculoskeletal issues. This study sought to determine the impact of a personalized physiotherapy treatment plan on alleviating TNS and SMS thumb in individuals who demonstrate excessive smartphone usage. Method The study utilized a single-group, pre- and post-study design with a sample size of 54 smartphone-addicted individuals. The intervention involved a personalized physiotherapy protocol for three weeks, and data was collected using a visual analog scale (VAS), Neck Disability Index (NDI), Smartphone Addiction Scale (SAS), Cornell Hand Discomfort Questionnaire (CHDQ), and range of motion (ROM). Results Descriptive statistics showed a significant reduction in mean scores from pre- to post-rehabilitation, indicating the potential effectiveness of the treatment. Hypothesis testing revealed significant improvements in VAS, NDI, and CHDQ scores post-rehabilitation, with a p-value of <0.05. Correlation analysis demonstrated moderate to strong correlations between pre- and post-rehabilitation scores for VAS, NDI, and CHDQ, with age showing minimal influence on treatment outcomes. Conclusion The findings emphasize the efficacy of personalized interventions in addressing smartphone-related musculoskeletal disorders and underscore the need for further research to optimize treatment protocols and long-term outcomes.

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.

Are Rotations and Translations of Head Posture Related to Gait and Jump Parameters?

This study assessed the relationship between head posture displacements and biomechanical parameters during gait and jumping. One hundred male and female students (20 ± 3 yrs) were assessed via the PostureScreen Mobile® app to quantify postural displacements of head rotations and translations including: (1) the cranio-vertebral angle (CVA) (°), (2) anterior head translation (AHT) (cm), (3) lateral head translation in the coronal plane (cm), and (4) lateral head side bending (°). Biomechanical parameters during gait and jumping were measured using the G-Walk sensor. The assessed gait spatiotemporal parameters were cadence (steps/min), speed (m/s), symmetry index, % left and right stride length (% height), and right and left propulsion index. The pelvic movement parameters were (1) tilt symmetry index, (2) tilt left and right range, (3) obliquity symmetry index, (4) obliquity left and right range, (5) rotation symmetry index, and (6) rotation left and right range. The jump parameters measured were (1) flight height (cm), (2) take off force (kN), (3) impact Force (kN), (4) take off speed (m/s), (5) peak speed (m/s), (6) average speed concentric phase (m/s), (7) maximum concentric power (kW), (8) average concentric power (kW) during the counter movement jump (CMJ), and (9) CMJ with arms thrust (CMJAT). At a significance level of p ≤ 0.001, moderate-to-high correlations (0.4 < r < 0.8) were found between CVA, AHT, lateral translation head, and all the gait and jump parameters. Weak correlations (0.2 < r < 0.4) were ascertained for lateral head bending and all the gait and jump parameters except for gait symmetry index and pelvic symmetry index, where moderate correlations were identified (0.4 < r < 0.6). The findings indicate moderate-to-high correlations between specific head posture displacements, such as CVA, lateral head translation and AHT with the various gait and jump parameters. These findings highlight the importance of considering head posture in the assessment and optimization of movement patterns during gait and jumping. Our findings contribute to the existing body of knowledge and may have implications for clinical practice and sports performance training. Further research is warranted to elucidate the underlying mechanisms and establish causality in these relationships, which could potentially lead to the development of targeted interventions for improving movement patterns and preventing injuries.

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.

Scapular dyskinesis and loss of cervical lordosis in myofascial pain syndrome and its effects on pain and posture disorders

Objectives

This study aimed to evaluate scapular dyskinesia and loss of cervical lordosis in myofascial pain syndrome and its effects on pain and posture disorders.

Patients and methods

In this cross-sectional study, 101 individuals (74 females, 27 males; mean age: 44.3±8.8 years; range, 25 to 60 years) with chronic neck pain were recruited between January 2021 and February 2021. Demographic and clinical data of the patients were recorded. Visual Analog Scale (VAS), posture evaluation form, the scapular dyskinesia test, the lateral scapular shift test, and Cobb's methods for cervical angle measurements were used in the evaluation of the patients.

Results

In the study population, 52.25% of patients had loss of cervical lordosis, and 44.5% of patients had scapular dyskinesia. It was observed that the VAS activity score was significantly higher in individuals with loss of cervical lordosis, all VAS scores and pain duration were significantly higher in individuals with scapular dyskinesia (p<0.05). Shoulder elevation, rounded shoulder, forward head posture, and kyphosis were significantly higher in patients with scapular dyskinesia, while thoracic kyphosis was significantly higher in patients with both scapular dyskinesia and loss of cervical lordosis (p<0.05). The presence of trigger points was found to be significantly higher in patients with scapular dyskinesia and in patients with both scapular dyskinesia and loss of cervical lordosis (p<0.05).

Conclusion

In patients with chronic neck pain diagnosed with myofascial pain syndrome, the presence of loss of cervical lordosis and scapular dyskinesia have negative effects on pain and posture.

Sensory Organization and Postural Control Strategies in Individuals With Mild and Moderate-to-Severe Forward Head Posture: A Comparative Study

OBJECTIVE

This study aimed to compare sensory organization test and postural control strategies between individuals with mild and moderate-to-severe forward head posture (FHP).

METHODS

A sensory organization test (SOT) was performed in 6 conditions using computerized dynamic posturography, to assess postural control. Equilibrium scores representing overall balance, strategy analysis to assess ankle vs hip strategy dominance, and sensory analysis (Somatosensory, visual, vestibular, visual preference ratio) as an indicator of the use of sensory systems were obtained.

RESULTS

Our results revealed a significant difference between the 2 groups in terms of equilibrium score (P < .05) and strategy scores (P < .05) in conditions of 4 to 6 of the SOT. The results of sensory analysis of SOT showed visual and vestibular ratios were significantly different between the 2 study groups (P < .05), but somatosensory and visual preference ratios were not significantly different between these 2 groups (P > .05).

CONCLUSION

Individuals with moderate-to-severe FHP swayed more in comparison with mild FHP ones in conditions with the Sway-referenced platform of the SOT. They tended to rely on the hip strategy more than the ankle strategy excessively when sensory difficulty increased. Overall, it can be concluded that individuals with moderate-to-severe FHP are more likely to have postural deficits.

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.

Assessment on Practicing Correct Body Posture and Determinant Analyses in a Large Population of a Metropolitan Area

An incorrect posture can generate stress of the spine and can be the cause of musculoskeletal disorders. Considering the extensive use of the computer, which worsens posture disorders, among workers, is important to analyze the phenomenon in order to reduce his impact on industry. The aim of this study is to assess determinants regarding posture in a large population of a metropolitan area. A total of 1177 questionnaires was analyzed. The majority of sample showed good knowledge and attitude regarding correct posture; most of the sample, 70.4% was aware of the definition of posture and 68.7% feel that not enough attention is paid at posture at workplace. Despite the good predisposition, only 2.8% of the sample consult a specialist for posture. The multiple linear regression analysis shows that those who have higher knowledge and best attitudes will consequently have good behaviors in maintaining a correct posture. Furthermore, age and education resulted main drivers of correct posture in any model considered. The results enlighten the necessity of conducting further studies to analyze attitudes of the general population and suggest improving educational and training programs to the enrichment of knowledge and to correct posture behaviors.

A Comparison of Two Forward Head Posture Corrective Approaches in Elderly with Chronic Non-Specific Neck Pain: A Randomized Controlled Study

Forward head posture (FHP) is a common postural displacement that is significantly associated with neck pain, with higher risks of having neck pain in female and older populations. This study investigated the effect of two different forward head posture (FHP) interventions in elderly participants with poor posture and non-specific neck pain. Sixty-six elderly participants with a craniovertebral angle (CVA) < 50° were randomized into either a Chiropractic Biophyics® (CBP®) or a standardized exercise based FHP correction group (Standard Group). Both groups were treated for 18 sessions over a 6-week period. A 3-month post-treatment follow-up was also assessed with no further interventions. The CBP group received a mirror image® exercise and a Denneroll™ cervical traction orthotic (DCTO); the standard group performed a protocol of commonly used stretching and strengthening exercises for the neck. Both groups received 30 min of their respective interventions per session. The primary outcome was the CVA, with secondary outcomes including pain intensity, Berg balance score (BBS), head repositioning accuracy (HRA), and cervical range of motion (CROM). After 18 sessions (6 weeks later), the CBP group had statistically significant improvement in the CVA (p < 0.001), whereas the standard group did not. In contrast, both groups showed improved functional measurements on the BBS and HRA as well as improved pain intensity. However, at the 3-month follow-up (with no further treatment), there were statistically significant differences favoring the CBP group for all outcomes (p < 0.001). The differences in the between group outcomes at the 3-month follow-up indicated that the improved outcomes were maintained in the CBP group, while the standard group experienced regression of the initially improved outcomes at 6 weeks. It is suggested that the improvement in the postural CVA (in the CBP group but not in the standard group) is the driver of superior and maintained pain and functional outcomes.

The influence of curricular physical activities on the values of body balance indices in university students

The investigation analyzes the effect of specific motor structures on the indicators of the static and dynamic balance of the students of Dunărea de Jos University in Galați (99 boys aged = 20.29 years, body weight = 84.17 kg, height = 180.08 cm, respectively 96 girls aged = 20.09 years, mass bodyweight = 60.88 kg, height = 164.73 cm. The members of the tested group have no concerns related to performance sports or physical activities as a lifestyle. The application of the experi-mental program was made during the 28 weeks of the academic year 2018-2019, with 3 distinct moments: T1 / initial at the beginning of the 1st semester, T2 / intermediate before the winter break, T3 / final at the end of the academic year. The battery of tests included 7 tests: One leg standing test with eyes closed (sec), Stork test (sec), Flamingo test (number of attempts), Bass test (points), Functional reach test (cm), Walk and turn field sobriety test (errors) and Fukuda test (degrees). The results of the Anova parametric test with repeated measurements revealed statis-tically significant values of F associated with critical thresholds (p <0.05), and the values of Parti-al eta squared (Ƞ2p) indicate strong influences of the proposed program on test performance in most cases, both at the level of the whole group and also for each gender. It should be noted that the performance improvements are greater in the first part of the study (differences between ini-tial and intermediate tests, with p <0.05), compared to those in semester 2 (differences between intermediate and final tests), which can be explained by the adaptation to the planned and ap-plied stimuli, so modifying or changing their dosage is necessary in order to have a better chan-ce of improving the results. Significant differences are confirmed for most tests of both genders (p <0.05), with exceptions being the Walk and turn field sobriety test for boys (at the level of the difference between intermediate and final testing) and the Fukuda test for both genders (for dif-ferences between initial and intermediate testing). However, the results should be viewed with caution, the low level of physical training and sedentary behavior of most students providing the premises for such progress, even with a single weekly physical activity. Keywords: students, balance, postural stability, physical exercise, progress, motor skills

Influence of forward head posture on muscle activation pattern of the trapezius pars descendens muscle in young adults

Forward head posture (FHP) is a serious problem causing head and neck disability, but the characteristics of muscle activity during long-term postural maintenance are unclear. This study aimed to investigate a comparison of electromyography (EMG) activation properties and subjective fatigue between young adults with and without habitual FHP. In this study, we examined the changes in the spatial and temporal distribution patterns of muscle activity using high-density surface EMG (HD-SEMG) in addition to mean frequency, a conventional measure of muscle fatigue. Nineteen male participants were included in the study (FHP group (n = 9; age = 22.3 ± 1.5 years) and normal group (n = 10; age = 22.5 ± 1.4 years)). Participants held three head positions (e.g., forward, backward, and neutral positions) for a total of 30 min each, and the EMG activity of the trapezius pars descendens muscle during posture maintenance was measured by HD-SEMG. The root mean square (RMS), the modified entropy, and the correlation coefficient were calculated. Additionally, the visual analogue scale (VAS) was evaluated to assess subjective fatigue. The RMS, VAS, modified entropy, and correlation coefficients were significantly higher in the FHP group than in the normal group (p < 0.001). With increasing postural maintenance time, the modified entropy and correlation coefficient values significantly decreased, and the mean frequency and VAS values significantly increased (p < 0.001). Furthermore, the forward position had significantly higher RMS, correlation coefficient, modified entropy, and VAS values than in the neutral position (p < 0.001). The HD-SEMG potential distribution patterns in the FHP group showed less heterogeneity and greater muscle activity in the entire muscle and subjective fatigue than those in the normal group. Excess muscle activity even in the neutral/comfortable position in the FHP group could potentially be a mechanism of neuromuscular conditions in this population.

Effects of Feedback-Supported Online Training during the Coronavirus Lockdown on Posture in Children and Adolescents

(1) Background. The coronavirus pandemic had a serious impact on the everyday life of children and young people with sometimes drastic effects on daily physical activity time that could have led to posture imbalances. The aim of the study was to examine whether a six-week, feedback-supported online training programme could improve posture parameters in young soccer players. (2) Methods. Data of 170 adolescent soccer players (age 15.6 ± 1.6 years) were analyzed. A total of 86 soccer players of a youth academy participated in an online training program that included eight exercises twice per week for 45 min (Zoom group). The participants’ exercise execution could be monitored and corrected via smartphone or laptop camera. Before and after the training intervention, participants’ posture was assessed using photographic analysis. The changes of relevant posture parameters (perpendicular positions of ear, shoulder and hips, pelvic tilt, trunk tilt and sacral angle) were statistically tested by robust mixed ANOVA using trimmed means. Postural parameters were also assessed post hoc at 8-week intervals in a control group of 84 participants of the same age. (3) Results. We found a statistically significant interaction (p < 0.05) between time and group for trunk tilt, head and shoulder protrusion and for hip anteversion in the Zoom group. No changes were found for these parameters in the control group. For pelvic tilt no significant changes were found. (4) Conclusions. Feedback-based online training with two 45 min sessions per week can improve postural parameters in adolescent soccer players over a period of six weeks.

Effect of Forward Head Posture on Dynamic Balance Based on the Biodex Balance System

Forward Head Posture (FHP) results in spine malalignment, muscle imbalance and cervical proprioception sensory input impairment. Subjective description of FHP is interpreted differently by clinicians and therefore the FHP is classified as slight, moderate and sever. This study aimed to evaluate balance disorder in individuals with severe forward head posture (FHP). Twenty individuals with severe FHP and 20 controls were enrolled. Dynamic postural stability was assessed in all participants using the Biodex Balance System (BBS) in semi dynamic position with eye open/eye closed conditions. Based on the findings, dynamic postural stability in the sagittal plane was different between the groups (P<0.05). It can be concluded that impairment of dynamic postural stability occurs in individuals with severe FHP. The findings suggest that clinicians take into account the importance of dynamic postural stability assessment in FHP subjects and consider the application of intervention programs for improvement of the dynamic balance.

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.

Evaluation of the Relationship Between Head Posture, Mandibular Movements and Emotional Tension

Introduction: The head, due to its structure and assigned functions, is a unique part of our body. In a number of studies, an association has been confirmed between the base of the head, the cervical spine, and temporomandibular joint disorders. Research objective: The aim of the study was to evaluate the correlation of spatial head position, temporomandibular joint mobility and emotional tension. Material and methods: The study comprised32 participants, aged 20 to 30 years. The position of the head in the sagittal and frontal planes was evaluated via the photogrammetric method. The mobility of the temporomandibular joints was assessed by measurements made with a ruler. Electrodermal activity was measured with the "Bitalino 3DP by BEEVERYCREATIVE" device, and stress intensity assessment was estimated using the PSS-10 scale. Results: A significant (p<0.01) linear correlation was found between electrodermal activity (EDA Min) and the values of angles describing head tilt (FHT1 and HTA). Higher EDA values are associated with higher angle values. No significant correlations (p>0.05) were found between mandibular mobility and EDA scores, or between mandibular mobility measurements and head position. Conclusions: The study revealed a relationship between head positioning and electrodermal EDA activity.

Text Neck Syndrome: Disentangling a New Epidemic

The aim of this report is to provide a brief review of the predisposing factors for Text Neck Syndrome, along with diagnostic and therapeutic approaches in young and adult populations. Text neck pain is a worldwide public health problem, largely reported nowadays. Currently, data have shown that the erroneous use of personal computers and cell phones might be correlated with the development of various clinical symptoms that are defined as "text neck syndrome". Modified radical changes in everyday life may ameliorate the powerful forces on the cervical spine that can lead to cervical degeneration, along with other developmental, medical, psychological, and social complications that are attributed to text neck syndrome. CONCLUSION: New technologies and the potentially harmful addiction to cell phones and computers while reading or texting are inducing an epidemic of text neck syndrome. By focusing on postural correction, both pain alleviation and a better quality of life can be achieved for the patient. The predisposing factors and therapeutic approaches for this syndrome that affects public health remain to be further elucidated.

Analysis of the Ability to Tolerate Body Balance Disturbance in Relation to Selected Changes in the Sagittal Plane of the Spine in Early School-Age Children

The study aimed to estimate the ability to tolerate body balance disturbance in relation to selected changes in the sagittal plane of the spine in early school-age children. The study involved 189 children with an average age of 8.3 ± 0.7 years (aged 7−10). The tests included an interview, clinical examination (measurement of body weight and height, assessment of the course of the spinous processes of the thoracic and lumbar vertebrae, assessment of the location of selected anatomical landmarks of the torso), and a physical examination in which the shape of the spine surface was examined with the use of the photogrammetric method and the moiré effect projection. Body balance disturbance tolerance skills (BBDTS) were measured with the rotational test (RT). In the rotational test, the results of body balance disturbance tolerance skills show a slight but statistically significant correlation with the bodyweight of the examined children (Rs = 0.35, p < 0.001). This relationship was also statistically significant in the groups by gender. Among the measured indicators of the curvature of the spine in the sagittal plane, the correlation with the RT test result was mostly related to the α angle and the value was Rs = 0.15 (p = 0.04). In the group of girls, this correlation was stronger and amounted to Rs = 0.26 (p = 0.015). Among other measured correlations, the dependence of variables such as the bodyweight of the subjects and the α angle was shown. In conclusion, increasing lumbar lordosis results in the deterioration of balance disturbance tolerance skills. As body weight increases, body balance disturbance tolerance skills decrease.

Immediate effects of thoracic manipulation on cervical joint position sense in individuals with mechanical neck pain: A randomized controlled trial

BACKGROUND

Performing thoracic manipulations for neck pain can result in immediate improvements in neck function.

OBJECTIVE

The aim of this study was to investigate the immediate effects of thoracic manipulation on cervical joint position sense and cervical range of motion in individuals with chronic mechanical neck pain.

METHODS

Eighty male volunteers between 18-25 years and having chronic or recurrent neck or shoulder pain of at least 3 months duration with or without arm pain were randomized into two groups: Thoracic Manipulation Group (TMG:50) and Control Group (CG:30), with a pretest-posttest experimental design. The TMG was treated with thoracic extension manipulation while the CG received no intervention. Cervical joint position error and cervical range of motion of the individuals were assessed at baseline and 5 minutes later.

RESULTS

There was no difference in demographic variables such as age (p= 0.764), Body Mass Index (p= 0.917) and Neck Pain Disability Scale (NPDS) scores (p= 0.436) at baseline outcomes between TMG and CGs. Joint position error outcomes between the two groups following intervention were similar in all directions at 30 and 50 degrees. Differences in range of motion following intervention in neck flexion (p< 0.001) and right rotation (p= 0.004) were higher in TMG compared to CG.

CONCLUSIONS

A single session of thoracic manipulation seems to be inefficient on joint position sense in individuals with mild mechanical neck pain. However, thoracic manipulation might be an effective option to increase flexion and rotation of the cervical region as an adjunctive to treatment.

Clinical outcomes of maitland mobilization in patients with Myofascial Chronic Neck Pain: A randomized controlled trial

Background and Objective

Myofascial neck pain is a common musculoskeletal problem caused by presence of trigger points and local and referred pain patterns. Chronic neck pain is responsible for the involvement of joints, ligaments, fascia and connective tissue as well. The objective of this study was to assess the effect of Maitland mobilization in patients with myofascial chronic neck pain.

Methods

In this randomized, placebo treatment-controlled trial, 30 patients consecutively aged 25-45 years meeting inclusion criteria were isolated into two groups. The study group was treated with Maitland mobilization consistently for eight weeks while the control group got placebo treatment for a similar timeframe. Visual analog Scale (VAS), Neck disability index (NDI) and cervical range of motion (ROM) questionnaire was filled by patients before, intermediate and after the intervention to evaluate the severity of pain, functional ability and range of motion.

Results

Following eight weeks of treatment, when compared the post treatment effects of both groups, the significance value for VAS was 0.008, for NDI p=0.030, for Flexion p=0.573, for extension p=0.001, for right rotation p<0.001, for left rotation p=0.002, for right and left side bending p<0.001.

Conclusion

The study concluded that Maitland mobilization grades (I-IV) are effective in reducing pain and improving functional level of NDI scale and the ranges of cervical spine in patients with myofascial chronic neck pain.

Does forward head posture change subacromial space in active or passive arm elevation?

Objectives: Forward head posture (FHP) is one of the most common musculoskeletal disorders that appears to affect the shoulder joint through the shared muscles between the head and neck area and the shoulder girdle. The present study compared the acromiohumeral distance between individuals with normal head and neck alignment and those with moderate and severe FHP in active and passive arm elevation.Methods: Based on the craniovertebral angle, 60 volunteers were selected and equally distributed among three groups, including group one with normal head and neck alignment, group two with moderate FHP and group three with severe FHP. The space between the humeral head and the acromion was measured in 10°, 45° and 60° of active and passive arm elevation as the acromiohumeral distance.Results: The acromiohumeral distance was only different between the three groups at 45° arm elevation angle, and this difference was significant between groups one and three. In active and passive arm elevation, increased arm elevation angle reduced the subacromial space significantly. Also, in each arm elevation angle, the subacromial space differed significantly between the active and passive arm elevations.Conclusions: The acromiohumeral distance was significantly lower in the severe FHP group than the group with normal head and neck alignment in the 45° active arm elevation angle, which could be due to the changed tension in tissues between active and passive arm elevation and also the maximum muscle activity in the 45° active arm elevation angle.

The effect of a postural exercise program on muscle power in Italian high school students

[Purpose] The present study aimed to investigate the effect of an innovative postural program (the Canali Postural Method, CPM) on muscle power in Italian high school students. It is note that deficits in posture control may, in long term, generate posture weakness as early as childhood and adolescence. Postural programs based on stretching and strengthening exercises can remove these deficits and can be framed in general physical or sport activities. [Participants and Methods] Thirty-four students completed a 8-week postural program. The intervention, consisting of stretching and muscle activation exercises, was integrated in physical education lessons. For the evaluation of the effect of CPM program, we have used the countermovement jump (CMJ), a simple and versatile test that measures muscle power. [Results] The CPM program resulted in significantly increased vertical jump height of the students. The average difference between Initial and Final CMJ was 2.1 cm. [Conclusion] This finding indicates the benefic effect of this new postural program on physical performance in the youth. Further randomized control trials should be conducted to evaluate CPM long-term implications in the prevention of posture weaknesses and its inclusion in the regular school curriculum.

Head Posture and Postural Balance in Community-Dwelling Older Adults Who Use Dentures

Background and objectives: Tooth loss and consequent denture use and impaired posture and postural balance are more prevalent in older adults than in the young ones. The aim of this cross-sectional study was to identify the association between denture use, head posture, postural balance, and neck muscle strength (NMS). Materials and methods: We included 107 participants (56 in the non-denture use group and 51 in the denture use group) and measured their NMS, forward head posture, and postural balance. Forward head posture was measured using the craniocervical angle (CRA). Postural balance was assessed using a timed up-and-go test (TUG) and postural sway. An independent t-test was used to analyze the differences between the groups; Pearson correlation analysis was used to analyze the correlation of period of denture use, head posture, and postural balance. Results: We found that the denture use group had lower NMS, smaller CRA, longer TUG, and longer postural sway length than the non-denture use group. Duration of denture use was significantly correlated with TUG. Conclusions: Our findings reveal that denture use does not help with NMS, forward head maintain NMS, head posture, and postural balance in older adults.

Neuromuscular performance of balance and posture control in childhood and adolescence

This study examined a potential age-dependency of both posture and stability (balance) control in children and adolescents in a healthy population. Body posture with open and closed eyes was examined for a total of 456 test persons (age 6.7–17.6 years. Posture parameters (posture index, upper body tilt, trunk tilt) were assessed in the sagittal plane. Additionally, the oscillation of the center of pressure with open and closed eyes was additionally analyzed in a sub-sample of 318 subjects.

Absolute values of stability control parameters changed significantly during childhood and adolescence for both boys (p = 0.005) and girls (p = 0.01). Relative changes of stability and posture parameters when closing the eyes did not change (p > 0.05) and were independent of age, gender or sports activity in healthy children and adolescents.

The shifting of the body segments towards each other, as a result of the loss of visual information, does not seem to be primarily responsible for the increase in COP fluctuation. This is a further indication that stability control and posture control are complex interdependent mechanisms whose interaction is not yet fully understood.

Effect of forward head and rounded shoulder posture on hand grip strength in asymptomatic young adults: a cross-sectional study

Background

Forward head and rounded shoulder posture (FHRSP) is a common clinical postural misalignment. It leads to flexion posture of the spine which increases the amount of tension on the nerve roots, which inversely affects muscle strength and function of the upper extremity. So, this study was conducted to examine the effect of FHRSP on hand grip strength in asymptomatic young adults and to explore the relationship between the craniovertebral angle (CVA) and hand grip strength.

Results

There was no significant difference in hand grip strength between the groups (p = 0.812). There was no correlation between the CVA and right and left hand grip of the normal group (p = 0.840, 0.816 respectively), rounded shoulder posture (RSP) group (p = 0.523, 0.650 respectively), and FHRSP group (p = 0.855, 0.736 respectively). Regarding the right and left hand grip strength, there was no significant difference between the groups (p = 0.798, 0.826 respectively). The right hand grip strength was significantly higher than the left hand for all groups (p = 0.001).

Conclusion

This study displayed that hand grip strength was not affected by FHRSP nor RSP in asymptomatic young adults. Moreover, the degree of the CVA was not associated with an inverse effect on hand grip strength.

A temporary forward head posture decreases function of cervical proprioception

Increased use of smartphones can cause abnormal alignment of head and neck, resulting in forward head posture (FHP). This can lead to change in the structures and function of the cervical vertebrae. The purpose of this study was to determine the impact on deep neck flexor muscles, proprioception, vestibular function, and balance of subjects with induced FHP by using smartphone. Twenty-two healthy persons were randomly divided into two groups. The FHP group maintained a craniovertebral angle (CVA) of <49° and a normal head posture group maintained a CVA of >50° watching the smartphone for 40 min. We measured the area of the longus colli and longus capitis muscles, cervical joint position sense, Romberg test, subjective visual vertical test, and subjective visual horizontal test. There was no significant difference in the deep neck flexor muscles, vestibular function, and static balance between the groups. However, there was a significant difference in the cervical proprioception (P<0.05). Proprioception may be considered to be the most influential factor in induced FHP by smartphone viewing.

The comparison of acromiohumeral distance and scapular dyskinesis prevalence in females with and without rounded shoulder posture

Background: Altered scapular kinematics in individuals with rounded shoulder posture (RSP) may affect acromiohumeral distance (AHD). The purpose of this study was to compare AHD and scapular dyskinesis prevalence in individuals with and without RSP. Methods: A total of 44 women (RSP, n=21; control, n=23) participated in the study. RSP was assessed by measuring acromion to table distance (ATD) in supine position and forward shoulder angle (FSA) using a camera and the AutoCAD software from the lateral side. According to these measurements, ATD more than 2.6 cm and FSA equal or more than 52° were considered as RSP. AHD was measured via ultrasonography with the arm at rest and 90 º of active elevation in scapular plane (scaption). Also, scapular dyskinesis was assessed by Uhl yes/no rating system. Independent and paired t tests were used to compare AHD between and within groups' comparisons, respectively. Chi-square test was used to compare the scapular dyskinesis prevalence in individuals with or without RSP. The data were analyzed using the SPSS statistical software version 17. Significance level was set at 0.05 Results: There were no statistically significant differences in participants' AHD in rest position (dominant side, p=0.187, nondominant side, p=0.144) and 90° scaption (dominant side, p=0.144, nondominant side, p=0.182) in each side between the 2 groups. Also, the results of chi-square test showed that there were not any significant differences in the prevalence of scapular dyskinesis during shoulder flexion (dominant side, p=0.653, nondominant side, p=0.541) and shoulder abduction (dominant side, p=0.141, nondominant side, p=0.277) in individuals with and without rounded shoulder postures. Conclusion: According to our results, RSD cannot lead to reduced AHD and higher prevalence of scapular dyskinesis.

The Relationship Between Forward Head Posture and Neck Pain: a Systematic Review and Meta-Analysis

PURPOSE OF REVIEW

Forward head posture (FHP) is the most common cervical postural fault in the sagittal plane that is found with different severity levels in almost all populations. Despite claims that FHP may be related to neck pain, this relation seems to be controversial. Thus, our purpose is to determine whether FHP differs between asymptomatic subjects and those with neck pain and to investigate if there is a relationship between head posture and neck pain.

RECENT FINDINGS

A total of 15 cross-sectional studies were eligible for inclusion for this systematic review and meta-analysis. Ten studies compared FHP between a group of asymptomatic participants and a group of participants with neck pain and an overall mean difference (MD) of 4.84 (95% CI = 0.14, 9.54), indicating a significant between-group difference, contrary to adolescent (MD = - 1.05; 95% CI = - 4.23, 2.12). Eight studies showed significant negative correlations between FHP and neck pain intensity (r = - 0.55; 95% CI = - 0.69, - 0.36) as well as disability (r = - 0.42; 95% CI = - 0.54, - 0.28) in adults and older adults, while in adolescents, only lifetime prevalence and doctor visits due to neck pain were significant predictors for FHP. This systematic review found that age played an important role as a confounding factor in the relation between FHP and neck pain. Also, the results showed that adults with neck pain show increased FHP when compared to asymptomatic adults and that FHP is significantly correlated with neck pain measures in adults and older adults. No association was found between FHP and most of neck pain measures in adolescents.

Orofacial muscles activity in children with swallowing dysfunction and removable functional appliances

Swallowing dysfunction is a frequent disorder among children and refers to an altered tongue posture and abnormal tongue movement during swallowing. Removable functional appliance is one of the treatments applied by dentistry to correct this disorder. The aim of this study was to evaluate any differences on orofacial muscles activity in children with swallowing dysfunction with and without removable functional appliances. 68 children were eligible for the study and divided into the orthodontic group (OG) and the no-orthodontic group (NO-OG). Both groups performed a dental occlusion-class evaluation, a swallowing function test and a myoscan analysis in order to measure perioral forces (i.e. tongue extension force, lip pressure, masseter contraction force). Our results showed a significant difference (P=0.02) between OG and NO-OG for the tongue extension force, whereas no significant differences (P>0.05) were found for the other parameters. Our findings suggest that children with swallowing dysfunction and removable functional appliance show orofacial muscles activity within the range of reference values (except for the lip pressure). However, we hypothesize that orthodontic treatment can achieve more effective results with integration of myofunctional therapy.

The effect of cervical spine subtypes on center of pressure parameters in a large asymptomatic young adult population

BACKGROUND

Recent research highlighted that non-lordotic subtypes are common within an asymptomatic population of young adults. The potential mechanisms responsible for the decreased postural control witnessed in healthy participants exhibiting non-lordotic cervical alignment are unclear.

RESEARCH QUESTION

Therefore, the aim of this study is to compare and contrast asymptomatic radiographically derived sagittal cervical alignment subtypes with Center of Pressure (CoP) parameters.

METHODS

In this cross-sectional study strict asymptomatic inclusion criteria were met by 150 of the original 182 volunteers. All radiographs were assessed using a multi-method subtype system with participants classified into lordotic and non-lordotic groups. Participants performed 90s narrow stance trials with their eyes closed whilst standing on both a firm surface (FS) and compliant surface (CS) (3 trials per surface). CoP parameters were recorded from a force platform sampling at 100 Hz. Nonparametric statistical tests were conducted to assess differences between groups for each surface type and to determine differences in CoP parameters between FS and CS types.

RESULTS

Significant differences were found between groups on both surfaces for the anterior to posterior range (FS: p = 0.013; CS: p = 0.023), total excursion (FS: p = 0.029; CS: p = 0.005) and mean velocity of total excursion (FS: p = 0.032; CS: p = 0.004).

SIGNIFICANCE

Our data suggest that sagittal plane cervical alignment is a measure capable of distinguishing between the postural control of asymptomatic lordotic and non-lordotic young adult participants on both surfaces types. Furthermore, decreased postural control is present in asymptomatic participants across all non-lordotic subtypes and is not isolated exclusively to those with forward head posture. Consequently, future research endeavours should investigate the clinical significance of these non-lordotic findings in relation to both the potential for early cervical osseous degeneration and the transitional stages of non-specific pain sufferers from previously asymptomatic young adults.

Targeted Athletic Training Improves the Neuromuscular Performance in Terms of Body Posture From Adolescence to Adulthood - Long-Term Study Over 6 Years

Poor posture in childhood and adolescence is held responsible for the occurrence of associated disorders in adult age. This study aimed to verify whether body posture in adolescence can be enhanced through the improvement of neuromuscular performance, attained by means of targeted strength, stretch, and body perception training, and whether any such improvement might also transition into adulthood. From a total of 84 volunteers, the posture development of 67 adolescents was checked annually between the age of 14 and 20 based on index values in three posture situations. 28 adolescents exercised twice a week for about 2 h up to the age of 18, 24 adolescents exercised continually up to the age of 20. Both groups practiced other additional sports for about 1.8 h/week. Fifteen persons served as a non-exercising control group, practicing optional sports of about 1.8 h/week until the age of 18, after that for 0.9 h/week. Group allocation was not random, but depended on the participants’ choice. A linear mixed model was used to analyze the development of posture indexes among the groups and over time and the possible influence of anthropometric parameters (weight, size), of optional athletic activity and of sedentary behavior. The post hoc pairwise comparison was performed applying the Scheffé test. The significance level was set at 0.05. The group that exercised continually (TR20) exhibited a significant posture parameter improvement in all posture situations from the 2nd year of exercising on. The group that terminated their training when reaching adulthood (TR18) retained some improvements, such as conscious straightening of the body posture. In other posture situations (habitual, closed eyes), their posture results declined again from age 18. The effect sizes determined were between η² = 0.12 and η² = 0.19 and represent moderate to strong effects. The control group did not exhibit any differences. Anthropometric parameters, additional athletic activities and sedentary behavior did not influence the posture parameters significantly. An additional athletic training of 2 h per week including elements for improved body perception seems to have the potential to improve body posture in symptom free male adolescents and young adults.

The effects of shoulder stabilization exercises and pectoralis minor stretching on balance and maximal shoulder muscle strength of healthy young adults with round shoulder posture

[Purpose] The purpose of this study was to analyze the effects of pectoralis minor stretching and shoulder strengthening with an elastic band on balance and maximal shoulder muscle strength in young adults with rounded shoulder posture. [Subjects and Methods] Nineteen subjects with rounded shoulder posture were randomly divided into 2 groups: a shoulder stabilization exercise group and a stretching exercise group. The groups performed each exercise for 40 minutes, 3 times a week, for 4 weeks. Static balance (eyes open and closed), dynamic balance (the limits of stability in 4 directions) and shoulder muscle strength in 5 directions were measure before and after the exercises. [Results] The stretching exercise demonstrated a significant difference between the pre- and post-exercise in the static balance with eyes closed and extension and horizontal abduction strength while the stabilization exercise demonstrated significant difference in the left and right directions between the pre- and post-exercise of the dynamic balance and flexion strength. The stabilization exercise demonstrated significant differences shown in the flexion between the pre- and post-test. [Conclusion] The shoulder stabilization and stretching exercises improved the static balance, dynamic balance, and muscle strength.

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

Objective

The purpose of this review was to explore the association between forward head posture, rounded shoulders, and increased thoracic kyphosis.

Methods

The PubMed, ERIC, and Cochrane databases were searched using the key words posture, head, shoulder, forward scapular posture, and thoracic kyphosis through December 2016.

Results

Our initial search yielded 6840 research studies, 6769 of which were excluded because they either were duplicates or did not satisfy the inclusion criteria. After the abstracts of the remaining studies were read, 15 were assessed for eligibility, and only 4 papers were included in the present review. Cervical lordosis values were found to be significantly associated with thoracic kyphosis values. Also, there were significant correlations between rounded shoulders and increased thoracic kyphosis.

Conclusion

Forward head posture, rounded shoulders, and increased thoracic kyphosis can exist alone or in any combination.

Interrelationship between postural balance and body posture in children and adolescents

[Purpose] This study examined possible interrelationships between postural sway and posture parameters in children and adolescents with a particular focus on posture weakness. [Subjects and Methods] 308 healthy children and adolescents (124 girls, 184 boys, aged 12.3 ± 2.5 years) participated in the study. Posture parameters (posture index, head protrusion, trunk inclination) were determined based on posture photos in the sagittal plane. Postural sway was measured during 20 seconds on a force plate. The Pearson’s product-moment correlation coefficients between the anthropometric and posture parameters and the sway path length (SPL) were calculated, as well as the coefficient of determination R². [Results] There is a weak but significant correlation between age or body mass index of the test subjects and the SPL. There is no statistically significant correlation between posture parameters and the SPL. Children and adolescents with posture weakness do not exhibit a changed SPL. [Conclusion] Therefore, therapy of poor posture must be considered separately from therapeutic measures for the improvement of balance skills.

Should high-power posing be integrated in physical therapy?

[Purpose] Postural assessment and correction is a common approach in patient management to decrease symptoms and improve function for patients. The purpose of this study was to determine the effects of high-power posing on muscle strength and pain threshold. [Subjects and Methods] Thirty-one subjects, 16 females and 15 males, mean age 28.9 (SD 10.8) years old, were recruited through a convenience sampling on the university campus. The research design was a randomized controlled trial. In the experimental group, the subjects were instructed to stand in a high-power posture. In the control group, the subjects were instructed to stand in a low-power posture. Grip strength and pain threshold measurements were conducted before and after the postural intervention. [Results] The grip strength changed by −3.4 (−3.7, 0.3) % and 1.7 (−3.6, 5.3) % for the experimental and control groups, respectively. The pain threshold changed by 0.6 (−9.9, 10.4) % and 15.1 (−9.3, 24.4) % for the experimental and control groups, respectively. However, both changes were not significant as all the 95% CIs included 0. [Conclusions] The data did not show significant benefits of high-power posing in increasing grip strength and pain threshold compared to low-power posing.

Effect of maitland mobilization in cervical and thoracic spine and therapeutic exercise on functional impairment in individuals with chronic neck pain

[Purpose] This study evaluated joint mobilization and therapeutic exercise applied to the cervical spine and upper thoracic spine for functional impairment caused by chronic neck pain. [Subjects and Methods] Eighteen study subjects were randomly assigned to two groups of nine people each. Therapeutic exercise only was applied to the cervical and upper thoracic spine for Group I, while both therapeutic exercise and joint mobilization were applied to Group II. The visual analog scale, neck disability index, active cervical range of motion, static balance capacity, and muscle tone were assessed with a pre-test. The intervention was carried out for 60 minutes a day, three times a week, for two weeks for each group, followed by a post-test using the same protocol as the pre-test. [Results] The visual analog scale, neck disability index, and active cervical range of motion improved significantly in both groups. Group II improved significantly more on right lateral flexion and rightward rotation. Muscle tone improved significantly in the upper trapezius in both groups. [Conclusion] The joint mobilization and therapeutic exercise for functional impairments caused by chronic neck pain had a significant effect on several types of functional impairment.

The effects of shoe heel height and gait velocity on position sense of the knee joint and balance

[Purpose] The aim of this study was to examine the effects of increased heel height and gait velocity on balance control and knee joint position sense. [Subjects and Methods] Forty healthy adults were randomly allocated to 4 groups: low-heel, low-speed group (3 cm, 2 km/h), low-heel, high-speed group (3 cm, 4 km/h), high-heel, low-speed group (9 cm, 2 km/h), high-heel, and high-speed group (9 cm, 4 km/h), with 10 subjects per group. Static and dynamic balance was evaluated using the I-Balance system and knee joint position sense using a goniometer. Measurements were compared using a pre- and posttest design. [Results] Increasing heel height and gait velocity decreased knee joint position sense and significantly increased the amplitude of body sway under conditions of static and dynamic balance, with highest sway amplitude induced by the high-heel, high-speed condition. [Conclusion] Increased walking speed in high heels produced significant negative effects on knee joint sense and balance control.