The Impact of Forward Head Posture on Neck and Ankle Joint Position Sense: A Cross-Sectional Study.

BACKGROUND: Forward head posture (FHP) decreases the neck position sense and creates tension in the neck muscles, which inversely affects the mechanics of the distal joints through body myofascia. Thus, this study investigated the effects of FHP on neck and ankle joint position sense, and conducted a comparison between the joint position sense of the right and left ankle. METHODS: Fifty-seven subjects were assigned according to the craniovertebral angle (CVA) into the FHP group (CVA <49°; n = 27) or the control group (CVA >49°; n = 30). Head and ankle joint repositioning accuracy was measured by using a cervical range-of-motion device and an isokinetic dynamometer, respectively. RESULTS: There was a significant increase in the joint position error (JPE) of the cervical flexion, extension, and right and left side bending motions of the FHP group compared to the control group (P < .05). There were significant increases in the JPE of the right and left ankle dorsiflexion and plantarflexion of the FHP group compared to the healthy group (P < .05). Moreover, the JPE of the right ankle dorsiflexion and plantarflexion of the FHP group were significantly higher than the left ankle (P < .05). CONCLUSIONS: The FHP decreases the position sense of cervical flexion, extension, and right and left side bending motions, and the plantarflexion and dorsiflexion of both ankle joints, especially the right ankle joint.

Combined use of cervical headache snag and cervical snag half rotation techniques in the treatment of cervicogenic headache.

[Purpose] Cervicogenic headache is a major problem in patients with upper cervical dysfunction. However, its physical therapy management is a topic of debate. This study aims to determine the effect of C1-C2 Mulligan sustained natural apophyseal glide mobilizations on cervicogenic headache and associated dizziness. [Participants and Methods] This study included 48 patients with cervicogenic headache, who were randomly assigned to three equal groups: Group A (Headache SNAG), group B (C1-C2 SNAG rotation), and group C (combined). Neck Disability Index was used to examine neck pain intensity and cervicogenic headache symptoms. The 6-item Headache Impact Test scale was used to examine headache severity and its adverse effects on social life and functions. Flexion-Rotation Test was used to assess rotation range of motion at the level of C1-C2 and confirmed by a cervical range of motion device. Dizziness Handicap Inventory scale was used to evaluate dizziness. The evaluation was done pre- and post-treatment and compared between the groups. [Results] Group C showed significant improvement in all variables compared with groups A and B. [Conclusion] Sustained natural apophyseal glide mobilizations used in the study were effective in reducing cervicogenic headache and dizziness in all groups with a greater improvement in the combined group. The use of cervical SNAG mobilizations is encouraged as a noninvasive intervention depending on the therapist's assessment, findings, and clinical reasoning.