Correlation between head posture and proprioceptive function in the cervical region

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.

Effects of Cervical Mobilization on Balance and Gait Parameters in Individuals With Stroke: A Randomized Controlled Trial

Stroke is a significant health problem that may result in long-term functional deficits. Balance and walking problems are among the most common post-stroke deficits, and they may negatively affect quality of life. Our aim in this study was to investigate the effects of cervical mobilization on balance and gait parameters after stroke. Participants were 24 adults (aged 30-65 years), who scored 24 or above on the Standardized Mini-Mental State Exam (MMSE) and no more than 3 on the Modified Rankin scale. Participants were randomly assigned to either an experimental Bobath therapy and cervical mobilization group (n = 12) or a control group who received Bobath therapy and a sham application (n = 12). Both groups received 60 minutes of Bobath therapy three times a week for four weeks; additionally, the experimental group received 15 minutes of cervical mobilization in each session, while the control group received 15 minutes of spinal sham mobilization each session. Pre and post treatment, we assessed all participants' demographic characteristics, gait parameters, balance parameters, and forward head posture values using a clinical data assessment form, spatiotemporal gait analysis (LEGSystm), portable computerized kinesthetic balance device (SportKAT 550), and craniovertebral angle (CVA), respectively. The groups showed no significant differences in their initial demographic and clinical characteristics (age, sex, stroke duration and disability levels.). In comparing changes on variables of interest, we observed significant experimental versus control group improvements in balance parameters except for their left side balance score (right side, left side, forward, backward and total balance scores were significant at p = .003, p = .089, p < .001, p = .022, p < .001, respectively), gait parameters (stride number, stride length, stride time, stride velocity, cadance at p = .007, p = .019, p = .013, p = .005, p = .001, respectively) and CVA (p < .001). Also, there were findings in favor of the experimental group on the modified timed up and go test on walk out, mid turn, walk back and total times (p = .028, p = .001, p = .016, and p = .001, respectively),but not for sit-to-stand time or stand-to-sit time. Clinicians involved in stroke rehabilitation should assess and treat the cervical region to enhance rehabilitation effectiveness.

Effect of sit-stand workstation position and computer task on head and trunk postural sway and discomfort

Adjustable-height desks may provide musculoskeletal health benefits to offset the effects of prolonged sitting. One mechanism may be increased postural variability, here characterized by head and trunk postural sway. Linear acceleration of the head and trunk were measured while participants used computer workstations in seated and standing positions during keyboard and mouse tasks; secondary measures were discomfort and proprioception (head and neck repositioning error). Median accelerations of the head and trunk were 20-26% lower in mouse tasks compared to keyboard tasks (p < 0.01). There were no significant differences in sway parameters between seated and standing positions. Discomfort and proprioception were correlated; subjects who experienced increased neck discomfort after 1.5 h of computer work had almost twice the head and neck repositioning error. The results suggest that postural sway is more affected by different tasks (keyboard vs. mouse) than by different workstation configurations and that low proprioception acuity may relate to the development of discomfort.

Neck muscle activation in response to eye movement depends on sitting posture and is modified in whiplash associated disorders: Cross-sectional study

BACKGROUND

Activity of specific neck muscles is modulated by eye movement. This activity modulation is exaggerated in people with whiplash associated disorders (WAD), but it is unknown whether it is impacted by sitting posture.

OBJECTIVE

This study investigated; (i) whether activity of cervical muscles differs with spinal posture; (ii) whether the effect of eye gaze direction (horizontal/vertical) on neck muscle activity differs between postures, and (iii) whether these effects differ between individuals with and without WAD.

METHODS

In three seated postures (normal relaxed, head forward, sit tall) electromyography (EMG) was recorded right obliquus capitis inferior (OI), multifidus (MF), splenius capitis (SP) and left sternocleidomastoid (SCM) with fine-wire and surface electrodes in ten healthy controls and nine with WAD. Electro-oculography recorded eye movements.

RESULTS

In controls, EMG was less for extensor muscles in Sit Tall than Head Forward, but higher in SCM. Only SC EMG modulated with eye movement. When WAD participants adopted similar sitting postures several responses were different; compared to Normal Relaxed posture OI EMG was less in Head Forward; MF EMG was less in Sit Tall; and SC was less in Head Forward and Sit Tall. Neck muscles in WAD were generally more sensitive to eye movement, except SC which did not modulate.

CONCLUSIONS

These finding support the hypothesis that neck muscle activity is influenced by spinal posture and eye movement. In WAD, this relationship is distorted and the response to eye movement is increased.

SIGNIFICANCE

These observations have potential implications for clinical management of individuals with WAD.

Treatment of Upper Crossed Syndrome: A Narrative Systematic Review

BACKGROUND AND OBJECTIVES

Upper crossed syndrome (UCS) is a common musculoskeletal condition that is characterized by tightness and weakness of the muscles of the neck, shoulders, and upper back. The aim of this current study is to summarize and provide an overview of the treatment in patients with UCS.

MATERIALS AND METHODS

A MEDLINE (PubMed), Cochrane library, Embase, Scopus, and Web of Science database search was conducted for English-language articles about upper crossed syndrome that were published until 19 January 2023. To identify potentially relevant articles, the following key search phrases were combined: "upper crossed syndrome", "upper cross syndrome", "diagnosis", and "treatment". A total of 233 articles were identified. After reading the titles and abstracts and assessing their eligibility based on the full-text articles, 11 articles were finally included in this review. The risk of bias (RoB) was assessed using RoB-2 and ROBINS-I for the randomized controlled trials (RCTs) and the non-randomized clinical trial (non-RCT), respectively.

RESULTS

Among eleven studies that investigated the effect of treatment programs for UCS, five studies compared the therapeutic effect of exercise programs with controls, whereas six compared different rehabilitative treatment strategies, such as the muscle energy technique, soft-tissue mobilization, and stretching exercises. In addition, regarding the study design, ten studies were RCTs and only one study was a prospective observational study.

CONCLUSIONS

Treatment programs including various types of exercises and techniques to correct an abnormal posture and restore neuromuscular imbalances are effective for decreasing pain and improving neck disabilities and postural deviations in patients with UCS.

Typical Cockpit Ergonomics Influence on Cervical Motor Control in Healthy Young Male Adults

INTRODUCTION: Neck pain and injury are common problems in military high-performance aircraft and helicopter aircrews. A contributing factor may be the reclined sitting position in cockpits. This study aimed to determine the effect of typical cockpit ergonomics on cervical proprioception, assessed by using the cervical joint position error (cJPE).METHODS: A total of 49 healthy male military employees (mean age 19.9 ± 2.2 yr) were examined. Measurements of the cJPE were obtained in the flexion, extension, and rotation directions in an upright and in a 30°-reclined sitting position. Each condition comprised three trials, with an additional 3-kg head load to mimic real world working conditions.RESULTS: A smaller cJPE was noted in the 30°-reclined sitting position (mean cJPE = 3.9 cm) than in the upright sitting position (mean cJPE = 4.6 cm) in the flexion direction. The cJPE decreased significantly in all movement directions across the three trials; for example, in the flexion direction in the 30°-reclined sitting position: Trial 1/2/3 mean cJPE = 5.0/3.8/3.1 cm.CONCLUSION: It seems that a reclined seating position has a positive influence on cJPE. However, the result is weak. In both sitting positions and all three directions, the first tests of the cJPE showed the highest values. Already after one or two further measurement runs, a significantly reduced cJPE was observed. This rapid improvement might indicate that an exercise similar to the cJPE test may improve the pilots' cervical proprioception and possibly reduce the risk of injury or pain.Heggli U, Swanenburg J, Hofstetter L, Häusler M, Schweinhardt P, Bron D. Typical cockpit ergonomics influence on cervical motor control in healthy young male adults. Aerosp Med Hum Perform. 2023; 94(3):107-112.

Assessment of shoulder proprioception in patients with chronic mechanical cervical pain: A comparative study

BACKGROUND

Chronic mechanical cervical pain (CMCP) is a common disabling problem worldwide, interfering with upper extremities function. However studying the impact of CMCP on shoulder proprioception is still lacking.

OBJECTIVE

To investigate the impact of CMCP on shoulder proprioception in young adults compared with normal control (NC) individuals.

METHODS

A comparative study was conducted between two groups; 40 patients with CMCP (mean age 32.28 ± 6.586) and 40 age and sex matched NC (mean age 33.43 ± 9.021). The Biodex isokinetic dynamometer was used to assess shoulder active sense of position at 30∘ external and internal rotations. The absolute angular error was calculated for the dominant and non-dominant shoulders.

RESULTS

The absolute angular error was significantly increased only in the CMCP at both rotation angles for both shoulders, showing a remarkable increase on the dominant shoulder and in the external rotation range compared with NC.

CONCLUSIONS

CMCP can significantly impair shoulder proprioception, particularly on the dominant side and in external rotation range. This could emphasize the careful examination of shoulder proprioception for the early detection of shoulders at risk, to eliminate the possibility of shoulder instability and/or injury in young adults with CMCP.

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.

Effectiveness of clinical Pilates and home exercises in sagittal cervical disorientation: randomized controlled study

Aim: To compare effects of clinical Pilates and home exercises on postural disorders, strength and endurance of deep cervical flexors (DCF), cervical range of motion (CROM), pain intensity and functional disability in sagittal cervical disorientation. Patients & methods: Fourty six patients were included and divided into two groups. Clinical Pilates group performed stabilization based exercise and home exercise group performed conventional exercises. Results: Craniovertebral, head tilt, cervicothoracic angles and strength and endurance of DCF muscles had improvement in favor of clinical Pilates group (p < 0.05). There was no difference between groups in terms of right-left acromial distance, pain intensity, functional disability and CROM parameters (p > 0.05). Conclusion: Clinical Pilates exercises have been found to provide clinically significant improvements in craniovertebral, head tilt, cervicothoracic angles and strength and endurance of DCF muscles. However, in the increase of CROM, decreasing pain severity and functional impairment parameters there was no superiority of both exercise training. Clinical trial registration number: NCT03352921 (Clinicaltrials.gov).

Demonstration of Autonomic Nervous Function and Cervical Sensorimotor Control After Cervical Lordosis Rehabilitation: A Randomized Controlled Trial

CONTEXT

Sagittal-plane cervical spine alignment has emerged as one of the most important clinical outcomes in health care. Nevertheless, the quantity and quality of research on the role that cervical sagittal alignment plays in improving sensorimotor and autonomic nervous functions are limited.

OBJECTIVE

To investigate the immediate and long-term effects of cervical lordosis restoration and correction of anterior head translation (AHT) on pain, disability, autonomic nervous system function, and cervical sensorimotor control in athletes with chronic nonspecific neck pain.

DESIGN

Randomized controlled clinical trial.

SETTING

University research laboratory.

PATIENTS OR OTHER PARTICIPANTS

A total of 110 patients (59 males, 51 females) with chronic nonspecific neck pain and a defined hypolordotic cervical spine and AHT posture.

INTERVENTION(S)

Patients were randomly assigned to the control or intervention group. Both groups received a multimodal program; the intervention group also received Denneroll cervical traction. Treatments were applied 3 times per week for 10 weeks.

MAIN OUTCOME MEASURE(S)

Outcome measures were cervical lordosis from C2 to C7, AHT, neck disability index, pain intensity, smooth pursuit neck torsion test, overall stability index, left and right rotation repositioning accuracy, and amplitude and latency of skin sympathetic response. The measures were assessed 3 times: at baseline, after 10 weeks of treatment, and at 1-year follow-up.

RESULTS

The general linear model with repeated measures indicated group × time effects in favor of the intervention group for the following management outcomes: cervical lordosis, AHT, neck disability index, pain intensity, smooth pursuit neck torsion test, overall stability index, left and right rotation repositioning accuracy, and amplitude and latency of the skin sympathetic response (P values < .001).

CONCLUSIONS

Restoration of cervical sagittal alignment in the athletic population had a direct influence on pain, disability, autonomic nervous system dysfunction, and sensorimotor control. Our results should guide treatment planning for athletes and optimize their recovery time.

Influence of Forward Head Posture on Cervicocephalic Kinesthesia and Electromyographic Activity of Neck Musculature in Asymptomatic Individuals

OBJECTIVE

The purpose of this study was to compare cervicocephalic kinesthesia and electromyographic (EMG) activity of neck muscles-upper trapezius (UT) and sternocleidomastoid (SCM)-between individuals with and without forward head posture (FHP) and to examine the correlation between cervicocephalic kinesthesia and craniovertebral angle (CVA).

METHODS

Twenty-two asymptomatic individuals with FHP and 22 without FHP were recruited for the present study. Craniovertebral angle was measured, and those with CVA ≤53° were assigned to the FHP group, whereas those with CVA >53° were assigned to the control group. Thereafter, cervicocephalic kinesthesia and EMG activity of the neck muscles were assessed. Cervicocephalic kinesthesia was measured using a head repositioning accuracy test for all cervical spine motions. EMG activity of the UT and SCM muscles was recorded at rest and during activity.

RESULTS

Position-sense error values were found to be significantly greater for all directions-ie, flexion, extension, side flexion, and rotation-in participants with FHP than those without (P < .05). EMG activity of the UT and SCM muscles was found to be significantly raised both at rest and during activity in individuals with FHP relative to the non-FHP group (P < .05). Position-sense error values showed a significant inverse correlation with CVA (P < .05).

CONCLUSION

Findings of the present study suggest that cervicocephalic kinesthesia and activation patterns of the neck muscles may be significantly altered in individuals with FHP. Also, cervicocephalic kinesthesia is significantly associated with the severity of FHP.

Psychometric Proprieties of a Mobile Application to Measure the Craniovertebral Angle a Validation and Reliability Study

The aim of this study was to assess the psychometric properties of the mobile application forward head posture in terms of validity, inter- and intra-rater reliability, minimum detectable change, sensitivity, and specificity to measure craniovertebral angle. In total, 44 subjects (mean age 23.30 ± 4.44 years) were evaluated in the standing position with markers on the tragus and cutaneous prominence of seventh cervical vertebra (C7). We had two experienced and trained physiotherapists assess cervical posture using the mobile application forward head posture and photogrammetry. Intraclass correlation coefficients were used to determine validity and reliability. A contingency table was made to determine sensitivity and specificity. Intra-rater reliability of the mobile application forward head posture had an intraclass correlation coefficient of 0.88. The inter-rater reliability generated an intraclass correlation coefficient of 0.83 to 0.89. Criterion validity data were above 0.82. The minimum detectable change was 4.96° for intra-rater and 5.52° for inter-rater reliability. The smartphone application exhibited 94.4% sensitivity and 84.6% specificity. The smartphone application forward head posture is a valid and reliable tool to measure craniovertebral angle in a standing position and, therefore, could be a useful assessment tool in clinical practice.

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.

Is forward head posture relevant to autonomic nervous system function and cervical sensorimotor control? Cross sectional study

BACKGROUND

There is a growing interest concerning the understanding of the sagittal configuration of the cervical spine as a clinical outcome. However, evaluating sensorimotor control and autonomic nervous system for participants with forward head posture (FHP) compared to strictly matched control participants with normal head alignment has not been adequately addressed.

METHODS

Sensorimotor control variables include smooth pursuit neck torsion test(SPNT), Overall stability index (OSI) and left and right rotation repositioning accuracy. Autonomic nervous system function includes amplitude and latency of skin sympathetic response (SSR). We measured these variables in 80 participants with definite forward head posture (Craniovertebral angle less than 50 degrees) and 80 participants with age, gender, and BMI matched normal head alignment (Craniovertebral angle (CVA) more than 50 degrees). Differences in variable measures were examined using the parametric t-test. Pearson correlation was used to evaluate the relationship between FHP, sensorimotor control, and autonomic nervous system function.

RESULTS

The unpaired t-test analysis showed that there were statistically significant differences between the FHP group and control group for all of the sensorimotor measured variables including SPNT, OSI and left and right rotation repositioning accuracy (P < 0.001). Also, there was a significant difference in neurophysiological findings, including SSR amplitude (P = .005), but there was no significant difference for SSR Latency (P = .7). The CVA significantly correlated with all measured variables (P < 0.001).

CONCLUSIONS

Participants with FHP exhibited abnormal sensorimotor control and autonomic nervous system dysfunction compared to those with normal head alignment.

Comparing the Effects of SUREE Programs on People With Scapular Downward Rotation Syndrome: A Randomized Clinical Trial

CONTEXT

Scapular downward rotation syndrome (SDRS) is an impaired alignment that causes shoulder and neck pain. Interventions may lead to the reduction of pain intensity and joint position error (JPE) and improved range of motion (ROM).

OBJECTIVE

To evaluate the effects of 6-week Scapular Upward Rotation and Elevation Exercises (SUREE) with and without visual feedback on pain, ROM, and JPE in people with SDRS.

STUDY DESIGN

Randomized control trial.

SETTING

Institutional practice.

PARTICIPANTS

Forty-two young and active subjects (22.61 [1.80] y; 27 males and 15 females) with unilateral SDRS randomly assigned into 3 groups (2 intervention groups and 1 control group).

INTERVENTIONS

SUREE without and with visual feedback programs.

MAIN OUTCOME MEASURES

Pain, neck-flexion and rotation ROMs, and JPE were measured using visual analog scale (score), double inclinometer method, universal goniometer method (degrees), and a dual digital inclinometer (degrees), respectively, before and after interventions.

RESULTS

The results showed statistically significant changes within the experimental groups in all variables except for the neck rotation ROM in the SUREE intervention without visual feedback (P < .05). However, there were no changes in the control group before and after the interventions in all dependent variables (P < .05). Also, there were no significant differences between both experimental groups concerning all dependent variables except for the rotation ROM (P < .05).

CONCLUSION

The results suggest that the 6-week SUREE with and without visual feedback programs result in decreased neck pain and improved flexion ROM and JPE during active neck motions in subjects with unilateral SDRS. However, the 6-week SUREE with visual feedback may improve the neck rotation ROM in subjects with unilateral SDRS. However, further studies are needed to confirm the results of this study.

Concurrent validity and reliability of a mobile tracking technology to measure angular and linear movements of the neck

The neck can be moved in six degrees of freedom. Current 3D-optoelectronic motion-capture systems capable of measuring these movements are inappropriate for use in clinical practice because they are stationary, expensive and time-consuming. We therefore developed a less complex 3D-tracking technology based on Steam®VR to measure six degrees of freedom in a clinical setting. The aim of this study was to assess the validity and reliability of this system. The developed prototype consists of two infrared-emitting lighthouses and sensors, mounted on the participant's helmet and trunk belt, to detect the orientation of the head and trunk. The system was evaluated by means of an infrared light-reflecting marker tracking system. Twenty healthy participants, equipped with these sensors and markers, performed thirteen neck movement tasks. Linear and angular movements were measured. These tasks were repeated after six to eight days to assess test-retest reliability. Concurrent validity was assessed by the root mean square error, and reliability with generalizability theory. With an average root mean square error between 1.2 and 2.0° in angular and 0.4-0.5 cm in linear movements, the prototype was shown to precisely track these movements. Reliability of the prototype and the reference system was comparable for all tasks. A high contribution of participant's variability to the observed variance was generally detected, with the exception of joint repositioning error and upper cervical flexion. The reliability was task-specific and did not differ between the systems. The prototype system was shown to be valid, although the reliability of the repositioning and upper cervical flexion tests needs to be reconsidered.

Voice Improvement in Patients with Functional Dysphonia Treated with the Proprioceptive-Elastic (PROEL) Method

The objective of the study was to analyze the outcome of the proprioceptive-elastic (PROEL) voice therapy method in patients with functional dysphonia (FD). Fifty-two patients with FD were involved in the study; they were composed of three subgroups of patients with (1) FD without glottal insufficiency (n = 28), (2) FD and glottal insufficiency (n = 9), and (3) FD, glottal insufficiency, and vocal nodules (n = 15). A multidimensional assessment protocol including videolaryngostroboscopy; maximum phonation time; perceptual evaluation of dysphonia with the Grade, Instability, Roughness, Breathiness, Asthenia, and Strain (GIRBAS) scale; and 10-item version of the Voice Handicap Index was conducted before and after 15 sessions of voice therapy. All voice therapy sessions were conducted by the same speech-language pathologist. The comparison between voice assessment before and after voice therapy with the PROEL method in patients with FD, in all the three subgroups, revealed a statistically significant improvement in periodicity and the mucosal wave in the laryngostroboscopy, maximum phonation time, GIRBAS scale scores, and VHI-10. Voice of patients with FD improved after treatment with the PROEL method. Further studies are needed to analyze the efficacy of the PROEL method with randomized double-blind clinical trials using different methods for voice therapy. At present, the PROEL method represents an alternative tool for the speech pathologist to improve voice in patients with FD.