Unsupervised machine learning for clustering forward head posture, protraction and retraction movement patterns based on craniocervical angle data in individuals with nonspecific neck pain.

OBJECTIVES: The traditional understanding of craniocervical alignment emphasizes specific anatomical landmarks. However, recent research has challenged the reliance on forward head posture as the primary diagnostic criterion for neck pain. An advanced relationship exists between neck pain and craniocervical alignment, which requires a deeper exploration of diverse postures and movement patterns using advanced techniques, such as clustering analysis. We aimed to explore the complex relationship between craniocervical alignment, and neck pain and to categorize alignment patterns in individuals with nonspecific neck pain using the K-means algorithm. METHODS: This study included 229 office workers with nonspecific neck pain who applied unsupervised machine learning techniques. The craniocervical angles (CCA) during rest, protraction, and retraction were measured using two-dimensional video analysis, and neck pain severity was assessed using the Northwick Park Neck Pain Questionnaire (NPQ). CCA during sitting upright in a comfortable position was assessed to evaluate the resting CCA. The average of midpoints between repeated protraction and retraction measures was considered as the midpoint CCA. The K-means algorithm helped categorize participants into alignment clusters based on age, sex and CCA data. RESULTS: We found no significant correlation between NPQ scores and CCA data, challenging the traditional understanding of neck pain and alignment. We observed a significant difference in age (F = 140.14, p < 0.001), NPQ total score (F = 115.83, p < 0.001), resting CCA (F = 79.22, p < 0.001), CCA during protraction (F = 33.98, p < 0.001), CCA during retraction (F = 40.40, p < 0.001), and midpoint CCA (F = 66.92, p < 0.001) among the three clusters and healthy controls. Cluster 1 was characterized by the lowest resting and midpoint CCA, and CCA during pro- and -retraction, indicating a significant forward head posture and a pattern of retraction restriction. Cluster 2, the oldest group, showed CCA measurements similar to healthy controls, yet reported the highest NPQ scores. Cluster 3 exhibited the highest CCA during protraction and retraction, suggesting a limitation in protraction movement. DISCUSSION: Analyzing 229 office workers, three distinct alignment patterns were identified, each with unique postural characteristics; therefore, treatments addressing posture should be individualized and not generalized across the population.

Efficacy of ultrasound therapy with neck retraction exercises vs. ultrasound therapy with deep cervical flexor training for excessive screen time users: a pilot randomized controlled study.

[Purpose] To compare the effectiveness of ultrasound therapy in combination with neck retraction exercises and deep cervical flexor training on pain, forward head posture, and deep cervical flexor muscle strength in excessive screen time users. [Participants and Methods] This 4-week intervention study included 36 participants with forward head posture, categorized into three groups: 1) ultrasound therapy with neck retraction exercises 2) ultrasound therapy with deep cervical flexor training, and 3) a control group. The outcomes were pain, forward head posture, and strength of the deep cervical flexor muscles. [Results] The strength of the deep cervical flexor muscles exhibited a notable increase, indicating a relatively higher mean value in the first intervention group. Upon follow-up, significant changes in all outcomes were observed between the first intervention group and the control group. Also, significant differences were revealed in the deep cervical flexor muscles between the second intervention group and the control group. [Conclusion] Ultrasound therapy with neck retraction exercises could have a more positive effect on pain, forward head posture, and strength of the deep cervical flexor muscles in comparison to ultrasound therapy with deep cervical flexor training for excessive screen time users.

Head posture mediates the association of cognition with hand grip and pinch strength in older adults: an examination using structural equation modeling.

BACKGROUND: The association of cognition with hand grip and pinch strength has been well-recognized in older adults. The authors sought to explore: (1) associations among forward head posture (FHP), cognition, and hand grip and pinch strength in older adults; and (2) the mediator role of FHP in these pathways using structural equation modeling (SEM). METHODS: This cross-sectional study included 88 older adults (70.5% male; mean age = 68.75±3.87 years). Cognition was assessed by the Mini-Mental State Examination (MMSE), head posture by the Craniovertebral Angle (CVA) obtained from photographic analysis, hand grip strength by a handheld dynamometer, and pinch strength by a pinch meter. Using the two SEMs, a potential mediator role of the CVA was investigated. While the MMSE was addressed as an independent variable in both models, hand grip and pinch strength were addressed as dependent variables in model 1 and model 2, respectively. RESULTS: The correlations between the CVA and MMSE (r = 0.310), hand grip strength (r = 0.370), and pinch strength (r = 0.274 to 0.292) were statistically significant (p < 0.001). In addition, significant associations were found between the MMSE and hand grip and pinch strength, ranging from 0.307 to 0.380 (p < 0.001). The mediation analysis showed that the standardized total (ß = 0.41, p < 0.001) and indirect (mediated) effects (ß = 0.12, p = 0.008) of the MMSE on hand grip strength were significant in model (1) The results were similar for model (2) The standardized total (ß = 0.39, p = 0.001) and indirect effects (ß = 0.10, p = 0.026) of the MMSE on pinch strength were significant. As a partial mediator in both models, the CVA explained 29% and 26% of the total effect in models 1 and 2, respectively. CONCLUSIONS: The CVA was associated with the MMSE, hand grip strength, and pinch strength, and CVA partially mediates the association of the MMSE with grip and pinch strength in older adults, indicating that cognition had an effect on grip and pinch strength through an indirect path via head posture. This finding reveals that evaluating head posture and providing corrective therapeutic interventions as needed may be beneficial in reducing the negative impact of decreased cognition on motor functions in older adults.

Body landmarks and genetic algorithm-based approach for non-contact detection of head forward posture among Chinese adolescents: revitalizing machine learning in medicine.

Addressing the current complexities, costs, and adherence issues in the detection of forward head posture (FHP), our study conducted an exhaustive epidemiologic investigation, incorporating a comprehensive posture screening process for each participant in China. This research introduces an avant-garde, machine learning-based non-contact method for the accurate discernment of FHP. Our approach elevates detection accuracy by leveraging body landmarks identified from human images, followed by the application of a genetic algorithm for precise feature identification and posture estimation. Observational data corroborates the superior efficacy of the Extra Tree Classifier technique in FHP detection, attaining an accuracy of 82.4%, a specificity of 85.5%, and a positive predictive value of 90.2%. Our model affords a rapid, effective solution for FHP identification, spotlighting the transformative potential of the convergence of feature point recognition and genetic algorithms in non-contact posture detection. The expansive potential and paramount importance of these applications in this niche field are therefore underscored.

A Multidisciplinary Approach to Swallowing Rehabilitation in Patients with Forward Head Posture.

(1) Background and Objectives: The forward head posture (FHP) is characterized by increased extensions of upper cervical vertebrae and flexion of the lower cervical vertebrae and upper thoracic regions, associated with muscle shortening. The compressive loading on the tissues in the cervical spine negatively impacts suprahyoid and infrahyoid muscles and generates increased tension of the masticatory muscles. The tongue has relations with the suprahyoid and the infrahyoid muscles. The pattern of swallowing evolves gradually from birth to the age of four. If this developmental transition does not occur, the result is persistent infantile or atypical swallowing-an orofacial myofunctional disorder with the tongue in improper position during swallowing, causing strain and stress on the jaw, face, head and neck. In FHP, muscles crucial to swallowing are biomechanically misaligned. The lengthening of the suprahyoid muscles necessitates stronger contractions to achieve proper hyolaryngeal movement during swallowing. This study assesses the added benefits of physiotherapy to the traditional myofunctional swallowing rehabilitation for patients with FHP. The underlying hypothesis is that without addressing FHP, swallowing rehabilitation remains challenged and potentially incomplete. (2) Materials and Methods: A total of 61 participants (12-26 years) meeting the inclusion criteria (FHP and atypical swallowing) were divided into two similar groups. Group A attended one orofacial myofunctional therapy (OMT) and one physiotherapy session per week, group B only one OMT session per week, for 20 weeks. Exclusion criteria were as follows: ankyloglossia, neurological impairment affecting tongue and swallowing, cervical osteoarticular pathology, other previous or ongoing treatments for FHP and atypical swallowing. (3) Results: There is a significant improvement in terms of movement and use of the orofacial structures (tongue, lips, cheeks), as well as in breathing and swallowing in both groups. Group A achieved better outcomes as the CVA angle was directly addressed by manual therapy and GPR techniques. (4) Conclusions: The combined therapy proved to be more effective than single OMT therapy.

Observing the effect of physical activity on forward head posture and rounded shoulder posture in young healthy adults.

[Purpose] This study aimed to examine the effects of physical activity on forward head and rounded shoulder postures in healthy young adults. [Participants and Methods] We recruited 20 healthy young adults engaged in high levels of physical activity and 20 healthy young adults engaged in low levels of physical activity. Both groups completed the International Physical Activity Questionnaire (IPAQ) to assess their physical activity levels. The scapular index (SI) was calculated to assess rounded shoulder posture, whereas the craniovertebral angle (CVA) was calculated to assess forward head posture. Differences in SI and CVA between the two groups were examined. [Results] There was a significant difference in the SI between the two groups, with the low physical activity group exhibiting a lower SI than the high physical activity group. However, there was no significant difference in the CVA between the two groups. [Conclusion] Our study showed that low physical activity levels in healthy young adults could negatively affect shoulder posture but not head posture. Therefore, regularly monitoring rounded shoulder posture in individuals with low physical activity levels is recommended for health considerations.

The treatment and rationale for the correction of a cervical kyphosis spinal deformity in a cervical asymptomatic young female: a Chiropractic BioPhysics® case report with follow-up.

[Purpose] To present a case demonstrating dramatic restoration of the cervical lordosis and reduction of forward head posture by use of Chiropractic BioPhysics® (CBP®) technique. [Participant and Methods] A 24-year-old cervical asymptomatic female presented with poor craniocervical posture. Radiography revealed forward head posture and an exaggerated cervical kyphosis. [Results] The patient received CBP care including mirror image® cervical extension exercises, cervical extension traction and spinal manipulative therapy. After 36 treatments over 17-weeks, repeat radiography demonstrated a dramatic improvement of an alteration of the cervical kyphosis to a lordosis and a reduction of forward head posture. Subsequent treatment increased the lordosis further. Long-term follow-up at 3.5 years showed some loss of original correction, however, a maintenance of the global lordosis. [Conclusion] This case demonstrates that non-surgical reversal of a cervical kyphosis to a lordosis is possible in a short time using CBP cervical extension protocols. It is logical if the kyphosis had not been corrected, over time, osteoarthritis and various craniovertebral symptoms would have evolved as the literature indicates. The diagnosis of gross spinal deformity, we argue, requires its correction prior to the onset of symptoms and permanent degenerative changes.

Alleviation of shoulder injury related to vaccine administration (SIRVA) pain and disability following COVID-19 vaccine with chiropractic biophysics® (CBP®) methods: a case report and long-term follow-up with global implications.

[Purpose] To present the dramatic improvement in posture, radiographic parameters and the alleviation of neck and severe shoulder pain related to shoulder injury associated with vaccine administration (SIRVA) after a COVID-19 injection with a shoulder mobility and posture rehabilitation program. [Participant and Methods] A middle-aged male presented complaining of severe left shoulder pain evolving since receiving a COVID-19 vaccination. The pain was severe and throbbed into the neck. Posture analysis showed a chronic stooped posture with forward head posture and thoracic hyperkyphosis. Treatment included 42 sessions of Chiropractic Biophysics® technique and a shoulder rehabilitation program using three-dimensional vibration. [Results] At 4-months, the patient reported no neck or shoulder pain. There was a 60% decrease in neck disability. The forward head decreased 34 mm, thoracic hyperkyphosis decreased 13°, and T1-T12 forward lean decreased 73 mm, among other radiographic parameters. Re-assessment after 26-months showed maintenance of the treatment induced posture/x-ray corrections and shoulder pain relief. [Conclusion] This case demonstrates immediate and long-term improvement in a patient suffering from COVID-19 vaccine SIRVA, concomitant with neck pain and disability as well as significant radiographic postural/spinal deformity. These conditions all improved and were maintained at a 2 year follow-up without further treatment.

Comparison of The Effectiveness of Exercise Therapy and Electroacupuncture in Patients with Forward Head Abnormalities and Myofascial Pain Syndrome: A Randomized Clinical Trial.

Background: Forward Head Posture (FHP), which refers to the head being more forward than the shoulder, is one of the most common postural defects of all ages. Therefore, in this study, we aimed to compare the effectiveness of exercise therapy and electroacupuncture in patients with FHP and myofascial pain syndrome (MPS). Methods: The present study was an open-label randomized clinical trial. A total of 61 patients with FHP and MPS who were referred to the physical medicine clinic of Besat Hospital between 2020 and 2021 were analyzed. Patients in one group were treated with electroacupuncture, and another one was treated with exercise therapy. The primary outcomes were FHP angles (CVA, CA, and shoulder angle), pain intensity (VAS), and quality of life (SF-12). Paired t-test was used to compare the results obtained in the pre-test and post-test. To detect differences over time, the analysis of variance models was used to repeat the observations. If the p-test result is less than the test significance level of 0.05, the null hypothesis is not confirmed. Results: The rate of final CVA and increase in CVA in the exercise therapy group were significantly higher than in the electroacupuncture group (P < 0.001). The average shoulder angle in the exercise therapy group increased from 47.1° ± 3.0° to 51.9° ± 3.3° (P < 0.001) and in the electroacupuncture group from 47.9° ± 3.1° to 51.0° ± 2.8° (P < 0.001). A significant difference was observed between the two groups in terms of pain intensity changes during the study. Conclusion: Overall, the results of this study showed that both exercise therapy and electroacupuncture significantly improved patients' posture, reduced pain intensity, and increased quality of life in FHP patients with MPS; But exercise therapy was more effective in improving FHP angles and electroacupuncture was more successful in reducing patients' pain intensity.

Instrumental assessment of physiotherapy and onabolulinumtoxin-A on cervical and headache parameters in chronic migraine.

INTRODUCTION: The purpose of the present study is to compare the effect of the physiotherapy to onabolulinumtoxin-A, and their combination, in relation to cervical and headache parameters in patients with chronic migraine. METHODS: This is an observational cohort study conducted by a headache center and a physiotherapy degree course on 30 patients with chronic migraine. The patients were distributed in three groups of treatments for three months: onabolulinumtoxin-A only, physiotherapy only, and onabolulinumtoxin-A plus physiotherapy. The patients were evaluated, before and after each treatment, using the following: the postural assessment software SAPO for the forward head posture; the CROM goniometer for the cervical range of motion; the Migraine Disability Assessment Score for headache parameters. RESULTS: After 3 months of each treatment, the scores obtained for the headache-related disability and the frequency of migraine decreased significantly for all groups, but the pain intensity scores changed significantly only in the onabolulinumtoxin-A (p = 0.01) and in the onabolulinumtoxin-A plus physiotherapy groups (p = 0.007). On the other hand, the forward head posture was reduced significantly in the physiotherapy (p = 0.002) and in the onabolulinumtoxin-A plus physiotherapy groups (p = 0.003). The cervical range of motion increased significantly in certain directions in the physiotherapy group and in the onabolulinumtoxin-A plus physiotherapy groups. CONCLUSIONS: The physiotherapy improved the cervical parameters. The onabolulinumtoxin-A decreased pain intensity. As a consequence, it can be said that the combined treatment was more useful than a mono-therapy alone. From our results, it can be concluded that onabolulinumtoxin-A plus physiotherapy could be a good option in the management of chronic migraine.

Lumbar motor control training as a complementary treatment for chronic neck pain: A randomized controlled trial.

OBJECTIVE: We investigated whether adding lumbar motor control training with a pressure biofeedback unit improves outcomes of a conservative deep cervical flexor motor control program on neck pain, neck disability, deep cervical flexor endurance, and health status in middle-aged patients with chronic neck pain and forward head posture after eight weeks of interventions. DESIGN: Randomized controlled trial. SETTING: Outpatient setting. SUBJECTS AND INTERVENTIONS: A total of 113 males and females (mean age 39 ± 5 years) with chronic neck pain were randomized to three treatment groups, group 1 (n = 38) combined deep cervical flexor motor-control training and lumbar motor control exercise, group 2 (n = 37) deep cervical flexor motor control training alone, and group 3 (n = 38) passive treatment and education. MAIN OUTCOME MEASURES: Pain, neck disability, deep cervical flexor muscular endurance, and health status. RESULTS: There were significant improvements in the combination group compared with the deep cervical flexor motor-control group alone (d = 2.03, 95% confidence interval (CI): -2.8 to -1.27, P = 0.021) for pain (d = -0.99, 95% CI = -1.75 to -0.23, P = 0.023), disability (d = 1.92, 95% CI = 0.86 to 2.98, P = 0.001), deep cervical flexor endurance, and (d = -2.75, 95% CI = -8.81 to -1.68, P = 0.037) for health status favoring the combination group. There were significant between-group differences favoring both active groups versus the passive control in all out comes. CONCLUSION: The addition of Lumbar motor control training as a complementary treatment may enhance effectiveness of deep cervical flexor motor control training on neck pain, neck disability, and deep cervical flexor endurance in patients with chronic moderate neck pain and forward head posture.

Sensorimotor integration, cervical sensorimotor control, and cost of cognitive-motor dual tasking: Are there differences in patients with chronic whiplash-associated disorders and chronic idiopathic neck pain compared to healthy controls?

PURPOSE: The current investigation aimed to compare the sensorimotor integration, sensorimotor control, and cost of cognitive-motor dual task during walking, in persons with chronic WAD as compared to matched chronic idiopathic neck pain and normal healthy controls. METHODS: A cross-sectional, case control design comparing 30 participants in each of two study groups (chronic WAD and chronic idiopathic neck pain) to a matched control group was conducted. Measurements included: (1) the cranio-vertebral angle (CVA), (2) left and right rotation head repositioning accuracy (HRA), (3) frontal N30 amplitudes to assess sensorimotor integration, (4) dual cognitive gait cost (DCGC). RESULTS: A statistically significant difference for the CVA was found between groups: WAD 36.8° ± 3.4, chronic pain 44.5° ± 1.5, and controls 47.1° ± 4; p < 0.05. MANOVA revealed significant group differences for the N30 amplitude (p < 0.05), where the WAD group had the greatest amplitude. Statistically significant differences among the three groups were found for HRA left and right where the WAD group had the greatest error, (p < 0.05). Post hoc tests revealed that the WAD group had the highest dual-task cost during walking, (p < 0.05). Significant linear correlations between the CVA and N30 amplitude, HRA, and DCGC were identified in all 3 groups, (p < 0.05). CONCLUSIONS: Compared to both a matched control group and chronic neck pain group, whiplash-injured persons have greater forward head posture, greater error in sensorimotor control, and an altered ability to perform a motor task with a simultaneous cognitive task.

Changes in deep neck muscle length from the neutral to forward head posture. A cadaveric study using Thiel cadavers.

Forward head posture (FHP) is one of the most common postural deviations. Deep neck muscle imbalance of individuals with FHP is of primary concern in clinical rehabilitation. However, there is scarce quantitative research on changes in deep neck muscle length with the head moving forward. This study aimed to investigate changes in deep neck muscle length with different severity levels of FHP. Six Thiel-embalmed cadavers (four males and two females) were dissected, and 16 deep neck muscles in each cadaver were modeled by a MicroScribe 3D Digitizer in the neutral head posture, slight FHP, and severe FHP. The craniovertebral angle was used to evaluate the degrees of FHP. Quantitative length change of the deep neck muscles was analyzed using Rhinoceros 3D. In slight FHP significant changes in length occurred in four muscles: two shortened (upper semispinalis capitis, rectus capitis posterior minor) and two lengthened (longus capitis, splenius cervicis). In severe FHP all occipital extensors were significantly shortened (10.6 ± 6.4%), except for obliquus capitis superior, and all cervical extensors were significantly lengthened (4.8 ± 3.4%), while longus capitis (occipital flexor) and the superior oblique part of the longus colli (cervical flexor) were lengthened by 8.8 ± 3.8% and 4.2 ± 3.1%, respectively. No significant length change was observed for the axial rotator. This study presents an alternate anatomical insight into the clinical rehabilitation of FHP. Six muscles appear to be important in restoring optimal head posture, with improvements in FHP being related to interventions associated with the occipital and cervical extensors.

Alterations in kinematics of temporomandibular joint associated with chronic neck pain.

BACKGROUND: Temporomandibular disorder (TMD) is an umbrella term for pain and dysfunction of the temporomandibular joint (TMJ) and its associated structures. Patients with TMD show changes in TMJ kinematics and masticatory muscle activation. TMD is commonly comorbid with non-specific chronic neck pain (NCNP), which may be one of the risk factors for TMD. OBJECTIVES: This study aimed to investigate whether patients with NCNP have altered TMJ kinematics and masticatory muscle activity. METHODS: This was a cross-sectional exploratory study including 19 healthy participants and 20 patients with NCNP but without TMD symptoms. TMJ kinematics was measured during mouth opening and closing, jaw protrusion and jaw lateral deviation. Surface electromyography was used to record the muscle activity of the anterior temporalis, masseter, sternocleidomastoid and upper trapezius while clenching. Furthermore, cervical posture, cervical range of motion (ROM) and pressure-pain threshold of the neck and masticatory muscles were measured. RESULTS: Compared with the healthy group, the NCNP group showed significantly reduced upper cervical rotation ROM (p = .041) and increased condylar path length (p = .02), condylar translation (opening p = .034, closing p = .011) and mechanical pain sensitivity of the upper trapezius (p = .018). Increased condylar translation was significantly correlated with reduced upper cervical mobility and poor cervical posture (r = -0.322 to -0.397; p = .012-.046). CONCLUSION: Increased condylar translation and path length in patients with NCNP may indicate poor control of TMJ articular movement, which may result from neck pain or may be a compensation for limited neck mobility. Evaluation of excessive TMJ translation may be considered in patients with NCNP.

Suboccipital Muscles, Forward Head Posture, and Cervicogenic Dizziness.

Dizziness or vertigo can be caused by dysfunction of the vestibular or non-vestibular systems. The diagnosis, treatment, and mechanism of dizziness or vertigo caused by vestibular dysfunction have been described in detail. However, dizziness by the non-vestibular system, especially cervicogenic dizziness, is not well known. This paper explained the cervicogenic dizziness caused by abnormal sensory input with references to several studies. Among head and neck muscles, suboccipital muscles act as stabilizers and controllers of the head. Structural and functional changes of the suboccipital muscles can induce dizziness. Especially, myodural bridges and activation of trigger point stimulated by abnormal head posture may be associated with cervicogenic dizziness.

Structural rehabilitation of the cervical lordosis and forward head posture: a selective review of Chiropractic BioPhysics® case reports.

[Purpose] To characterize the case report evidence of Chiropractic BioPhysics® (CBP®) technique methods applied to increase cervical lordosis and improve forward head posture. [Methods] The CBP Non-profit website as well as PubMed and Index to Chiropractic literature were searched for case reports/series documenting the increase of cervical lordosis and improvement of forward head posture in the treatment of various craniocervical spinal disorders by CBP technique methods. [Results] Sixty patients were reported in 41 unique manuscripts detailing the improvement in cervical spine alignment by CBP technique methods. On average, there was a 14° improvement in cervical lordosis and a 12 mm reduction in forward head position after 40 treatments over 16 weeks with a 5-point reduction in pain rating scores. Thirty-eight percent of cases included follow-up showing only slight loss of lordosis, but maintenance of pain and disability improvements after an average of 1.5 treatments per month for 1.8 years. [Conclusion] An abundance of reports document improvement in craniocervical and other ailments by CBP methods that increase cervical lordosis. Routine radiographic imaging of the spine is recommended as it is safe and the only current practical method of screening for critical biomechanical biomarkers of sagittal spine alignment.

Combining targeted instrument-assisted soft tissue mobilization applications and neuromuscular exercises can correct forward head posture and improve the functionality of patients with mechanical neck pain: a randomized control study.

BACKGROUND: The purpose of this study was to evaluate the short- and intermediate-term effects of the combined application of instrument-assisted soft tissue mobilization (IASTM) techniques and neuromuscular exercises of the cervical and thoracic area on the improvement of the functionality of patients with mechanical neck pain and accompanying forward head posture (FHP). METHODS: Twenty patients with neck pain and FHP were randomized and received eight treatment sessions of either targeted IASTM in combination with neuromuscular exercises (Group A) or a classical massage and the same set of exercises (Group B). The cervical vertebral angle (CVA), cervical range of motion (ROM) and strength, pain (visual analogue scale-VAS), and neck disability index (NDI) were measured throughout the treatment period and in the two- and four-week post-treatment periods. RESULTS: The combined application of IASTM and neuromuscular exercises contributed to a significantly greater improvement in CVA (Group A: + 7,2 deg vs Group B: + 1,1 deg) and NDI (Group A:-25,2 vs Group B:-5,8) than massage and the application of the same exercises. Both interventions improved cervical ROM and strength in the short term. Pain was also significantly improved in both groups in both the short (Group A VAS: - 5,97 vs Group B VAS: - 3,1) and intermediate term (Group A VAS:-5,5 vs Group B:-1,5). CONCLUSIONS: Combining IASTM and exercises for the cervical and thoracic area can induce positive postural adaptations and improve the functional status of neck pain patients. TRIAL REGISTRATION: ISRCTN, ISRCTN54231174 . Registered 19 March 2020 - Retrospectively registered.

Effects of smartphone addiction on children's lung function.

BACKGROUND: With an increase in smartphone usage, constant neck flexion can lead to improper posture, which may impact on lung function. Therefore, the purpose of this study was to examine and compare the craniovertebral angle (CVA) and lung function between addicted and non-addicted boys and girls aged between 8-13 years who use smartphones for long periods of time. METHODS: A cross-sectional study was conducted on 24 boys and 26 girls (mean age 10.5 ± 1.6 years and body mass index 18.6 ± 3.0 kg/m2) . Participants were assigned to two groups based on their scores on the Smartphone Addiction Scale-Short Version (SAS-SV) for Adolescents: addicted group (score > 32, n = 32) and non-addicted group (score ≤ 32, n = 18). The outcome variables were CVA, forced vital capacity (FVC), forced expiratory volume in 1 second (FEV1), peak expiratory flow (PEF), maximal voluntary ventilation (MVV), maximum inspiratory pressures (PImax), and maximum expiratory pressures (PEmax). RESULTS: There was a significant difference in mean CVA between addicted and non-addicted boys (49.4 ± 6.7 vs 55.5 ± 7.6, η2  = 0.9, P = 0.03) and girls (47.3 ± 6.3 vs 52.9 ± 6.1, η2  = 0.9, P = 0.02). Mean FVC, FEV1, and FEV6 were significantly lower in addicted versus non-addicted boys (P = 0.04, P = 0.05, and P = 0.02, respectively). PImax was significantly less in addicted compared to non-addicted girls (55.2 ± 16.4 vs 65.3 ± 13.8, η2  = 0.7, P = 0.05). CONCLUSION: Our findings showed that children addicted to smartphones (when using the SAS-SV as an indicator for addiction) revealed lower CVA and lung function results. Therefore, education on proper posture while holding smartphones is essential to the children's postural and lung function status.

The effect of indirect vision skills on head and shoulder posture amongst Korean dental hygienists.

OBJECTIVES: This study aimed to investigate the effects of indirect vision skills on head and shoulder posture in dental hygienists. MATERIALS AND METHODS: This cross-sectional study included a total of 100 female clinical dental hygienists. It evaluated musculoskeletal symptoms of the neck, shoulders and back, head and shoulder posture (craniovertebral angle [CVA] and sagittal shoulder posture angle [SSPA]). Indirect vision skills were assessed using the O'Connor tweezer test under indirect vision with a mirror. To analyse factors associated with the CVA and SSPA, an independent t test, one-way ANOVA, and multiple linear regression analysis were conducted, respectively. RESULTS: The body region in which the greatest number of symptoms of work-related musculoskeletal disorders was recognised was the neck (89.0%). In the multiple linear regression model, which adjusted for other factors associated with musculoskeletal disorders, dental hygienists with poor indirect vision skills showed relatively small SSPA value (P < .05). However, indirect vision skills were not associated with the CVA value. CONCLUSIONS: Good indirect vision skills contribute to the prevention of rounded shoulders in dental hygienists. Therefore, where possible, dental hygienists should perform clinical procedures using indirect vision with a dental mirror to maintain a balanced posture and reduce flexion of the back or the neck. A dental hygiene curriculum should include training to improve clinical skills, as well as education regarding dental ergonomics and a monitoring system to determine whether ergonomic principles are well observed.

Effects of eccentric muscle energy technique versus static stretching exercises in the management of cervical dysfunction in upper cross syndrome: a randomized control trial.

OBJECTIVE: To compare the effects of eccentric muscle energy technique versus static stretching exercises combined with cervical segmental mobilisation in the management of upper cross syndrome in patients having neck pain. METHODS: The randomised controlled trial was conducted at the Khan Kinetic Treatment Canada Orthopaedic and Rehabilitation Centre, Rawalpindi, Pakistan, from August 2017 to January 2018, and comprised patients of upper cross syndrome who were randomized into two equal groups using lottery method. Patients in Group-A were treated with eccentric muscle energy technique with cervical segmental mobilisation, while those in Group-B received static stretching exercises with cervical segmental mobilisation. Two sessions per week for 3 weeks were given to each patient who were analysed by measuring tragus-to-wall distance, visual analogue scale and neck disability index. Cervical passive range of motion was measured using inclinometer. Data was recorded at baseline and after 3 weeks of treatment. Data was analysed using SPSS 21. RESULTS: Of the 40 subjects, 20(50%) each were in the two groups. In Group-A mean age was 42.75±11.13 years. In Group-B, it was 40.50±9.14 years. Eccentric muscle energy technique and static stretching technique both showed significant results (p<0.05) for within group analysis, but comparison across groups showed non-significant results (p>0.05 each) on all parameters. CONCLUSIONS: Both the techniques used were found to be equally effective in decreasing pain, improving cervical range of motion and reducing neck disability.