Upper Crossed Syndrome and Its Relationship to Cervicogenic Headache

Dry needling in the management of chronic tension-type headache associated with levator scapulae syndrome: A case report

Key Clinical Message

The use of DN to the muscular trigger points and distal periosteal enthesis of the levator scapulae may be a useful adjunct intervention within a multi-modal plan of care for the management of work-related chronic tension-type headaches associated with LSS.

Abstract

Chronic tension-type headaches (CTTH) have a lifetime prevalence of 42% and account for more lost workdays than migraine headaches. Dry needling (DN) is being increasingly used by physical therapists in the management of CTTH; however, to date, the supporting evidence is limited. The purpose of this case report was to describe how three sessions of DN targeting myofascial trigger points in the levator scapulae (LS) muscle and its distal enthesis was used to treat a 63-year-old male patient who presented with work-related CTTH associated with levator scapulae syndrome (LSS). The patient was treated for five visits over the course of 2 months. At discharge and 6-month follow-up, the patient reported full resolution of symptoms. Self-report outcomes included the numeric pain rating scale and the Neck Disability Index. The use of DN to the LS muscle and its distal enthesis may be a valuable addition to a multi-modal plan of care in the treatment of work-related CTTH associated with LSS.

The effects of an 8-week selective corrective exercises program on the worker's productivity with the upper crossed syndrome - a randomized controlled trial

BACKGROUND

The purpose of this study was to investigate the effectiveness of a corrective exercise program on workers' productivity with Upper Crossed Syndrome (UCS).

METHODS

We used Randomized Controlled Trial (RCT) with parallel groups, double-blind, randomized. The participants were workers recruited at a company of Markazi Province that 23 persons in test group and 25 in control group participated. Before and after the intervention, work productivity and activity impairment was measured by the WPAI-GH questionnaire. In addition, angles of FH and RS were measured by Goniometer, and kyphosis angle was measured by a flexible ruler. The exercise program consisted of stretching, strengthening, and stabilization exercises, conducted three times a week for eight weeks. The primary outcome was work productivity and activity impairment, and the secondary outcomes were FH, RS, and KY. All primary and secondary outcomes were measured before the interventions, one week after intervention.

RESULTS

Results revealed significant differences for KY (MD = 3.84, 95% CI: 0.75,6.94, p = 0.017), RS (MD = -1.83, 95% CI: -2.88, -0.88, p = 0.001), and FH (MD = 3.01, 95% CI: 1.98,4.04, p = 0.001) before and after the intervention. In addition, within-group differences showed a significant difference in work time missed (MD = -2.60, CI: -4.84, -0.37, p = 0.003**), and overall work productivity loss (MD = -2.02, CI: -3.78, -0.26, p = 0.013**) in exercise group. However, there were no significant effects on impairment at work and activity.

CONCLUSIONS

Since significant differences were detected in a selective exercise program on productivity, a continuous exercise program for more than 8-week could be effective in managing productivity and increasing practical working hours.

A multi-dimensional assessment of internet gaming disorder in children and adolescents: A case-control study

BACKGROUND

Internet gaming disorder (IGD) leads to social disturbances and isolation, neglect of daily responsibilities, behavioral disorders, and physical impairments.

OBJECTIVE

This study aimed to investigate the effect of IGD on spine biomechanics, range of motion in the neck and low back, and lung functions and respiratory muscle strength in children and adolescents.

METHODS

Sixty-four children and adolescents with IGD (Group I) and 41 healthy controls (Group II) were included in the study. The outcomes were assessed with the Visual Analogue Scale (VAS), Internet Addiction Scale, active range of motion (AROM) in the neck and lumbar spine, posture and spinal alignment, lung function tests, and respiratory muscle strength.

RESULTS

There is a significant difference in pain intensity at rest, during activity, and daily sitting time between groups (p < 0.05). Craniovertebral angle, shoulder asymmetry, thoracic kyphosis angle, cervical extension and rotation, and right lumbar rotation significantly decreased in Group I than in Group II (p < 0.05). Besides, the PEF, FEF 25-75%, and respiratory muscle strength were lower in Group I than in Group II (p < 0.05). With a multiple linear regression model, MEP, FEV1, and weekly time spent playing online games were significant predictors of internet addiction intensity (R2 = 0.28; p = 0.02, p = 0.01, and p < 0.001, respectively).

CONCLUSION

Postural misalignment and increased sedentary time cause physical health deterioration and negatively affect lung functions in children and adolescents with IGD. Consequently, considering both psychological and physical health is necessary to assess the problematic nature of internet gaming. A comprehensive assessment and multidisciplinary team approach is essential to managing the IGD.

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 various exercises in the management of upper crossed syndrome

Upper crossed syndrome (UCS) is characterised by distortion or imbalances of various muscles that put tension on the nearby tendons, bones, and joints leads to muscle weakness, tiredness, sore shoulder blades, headache and limitation of movements. The rationale of the present study was to evaluate the efficacy of various exercises (McKenzie and TheraBand exercises) on posture, pain and strength in patients suffering with upper crossed syndrome. The participants were randomly allocated into two groups: Group 1 (McKenzie group, n=15) and Group 2 (exercise group, n=15). Outcome measures were pain and disability using SPADI questionnaire and muscle strength using manual muscle testing. Group I received McKenzie exercises for 3 weeks, 5 sessions per week, whereas Group II received TheraBand exercises for 3 weeks, 5 sessions per week. Data analysis was done by using paired t-test for within group comparison and unrelated t-test to evaluate the between group differences in each outcome variable. The results indicated a statistically significant improvement in pre-/post values of pain & disability in the McKenzie group (t=7.60 and P=0.0001), and in the exercise group (t=8.25 and P=0.0001). Results also suggested a statistically significant improvement in the strength of serratus anterior (t=4.52 and P=0.0001), cervical flexors (t=4.12 and P=0.001), and rhomboids (t=4.14 and P=0.001) in the McKenzie group and strength of serratus anterior (t=5.17 and P=0.0001), cervical flexors (t=4.18 and P=0.001), rhomboids (t=4.18 and P=0.001) in the exercise group. Results indicated that the exercise group showed better improvement as compared to McKenzie group in terms of pain and disability. Results also stated that both groups were equally effective in improving muscle strength.

Eye problems and musculoskeletal pain in Pokémon Go players

Individuals benefit from Pokémon Go (PG) gaming because this mobile augmented reality geolocation video game provides an attractive opportunity to increase physical activity outdoors and socialize. However, based on gaming and electronic media studies, intense involvement with PG is likely related to adverse phenomena, such as arm pain or eye-related problems. We aimed to test how PG use (problematic vs. non-problematic gaming and gaming time) is related to physical symptoms (pain in three body regions and computer vision syndrome). To dissect game-specific effects, we controlled for general problematic smartphone use, phubbing, and electronic media usage. PG players (N = 455) completed an online survey. We found that PG players with problematic game use reported more pain and vision problems. Problematic PG use was a better predictor of physical symptoms than PG gaming time and variables related to electronic media use. Problematic PG use and problematic smartphone use were correlated but independent predictors of physical symptoms. We conclude that the type of participation rather than the time spent playing predicts poorer physical health among PG players.

The effectiveness of Sustained Natural Apophyseal Glide on Flexion Rotation Test, pain intensity, and functionality in subjects with Cervicogenic Headache: A Systematic Review of Randomized Trials

OBJECTIVE

To determine the effect of sustained natural apophyseal glide (SNAG) on Flexion Rotation Test, pain intensity, and functionality in subjects with Cervicogenic Headache (CH).

METHODS

The research was conducted on five computerized databases PubMed/Medline, Web of Science, PEDro, Lilacs, and Cochrane Library (CENTRAL), using the keywords combination: (sustained natural apophyseal glide OR SNAG OR joint mobilization OR Mulligan) AND (cervicogenic headache) according to PRISMA guidelines. The methodological quality of the included studies was analyzed using the Physiotherapy Evidence Database (PEDro) scale.

RESULTS

Eight articles fulfilled the eligibility criteria and were included in the review. The selected studies had a methodological quality of 6.6/10 on the PEDro scale and included a total of 357 participants. The SNAG significantly improved pain, Flexion Rotation Test and reduced functional symptoms.

CONCLUSION

The available evidence suggests that SNAG may be a relevant intervention for CH.

Effects of visual input on changes in the bioelectrical activity of the cervical and masticatory muscles in myopic subjects

The study aimed to analyze the changes within the bioelectrical activity of the cervical spine and masticatory muscles during the change of visual stimulus—open and closed eyes test. After applying the inclusion criteria, 50 subjects were included in the study, with visual impairment ranging from −0.5 to −5.75 Diopters. Four muscle pairs were analyzed: the anterior part of the temporalis muscle (TA), the superficial part of the masseter muscle (MM), the anterior belly of the digastric muscle (DA), and the middle part of the sternocleidomastoid muscle (SCM) belly during rest, teeth clenching, teeth clenching on dental cotton rollers, and active mouth opening. Statistical analysis showed a significant decrease in the bioelectrical activity during teeth clenching of all analyzed muscles during the closed eyes test. Significant decreases of electromyographic values were also observed during resting activity within TA muscles, during teeth clenching with dental cotton rollers within SCM and DA muscles, and during active mouth opening within the right masseter. Changing the visual stimulus from open eyes to closed eyes in people with myopia affects the bioelectrical activity of the masticatory and cervical spine muscles.

Assessment of the head, cervical spine, thoracic spine and shoulder girdle postures in people with and without chronic headache

Background/Aims

Cervical dysfunction is one of the common symptoms of chronic headaches. This study was conducted to assess the posture of the head, cervical and thoracic spine and the shoulder girdle in people with and without cervicogenic and migraine headaches.

Methods

The postural angles of the head, cervical and thoracic spine and the shoulder girdle in frontal and sagittal planes, as well as thoracic spine curvature, were measured on 90 people who were split into three groups: 20 people with cervicogenic headache, 20 people with migraine and 50 people as the control group.

Results

There were significant differences among the three groups in the craniovertebral angle, coronal head tilt angle and scapular upward rotation angle (P<0.05). There was no relationship between postural angles.

Conclusions

The results of this study revealed that forward head posture was evident in people with cervicogenic and migraine headache. Decreased scapular upward rotation seen in the migraine headache group highlights the importance of shoulder girdle-related dysfunctions in people with chronic headaches.

Effectiveness of spinal mobilization and postural correction exercises in the management of cervicogenic headache: A randomized controlled trial

OBJECTIVE

The study aims to assess the effect of spinal mobilization and postural correction exercises in patients suffering from cervicogenic headache.

METHODS

A randomized controlled trial was conducted with 72 patients. Patients were randomly allocated into three groups: spinal mobilization (n = 24), postural correction exercises (n = 24), and control group (n = 24). The primary outcome measure was headache impact test-6, and secondary outcomes were headache intensity, neck pain intensity, and neck pain-related disability measured at baseline, postintervention, and follow-up period.

RESULT

Comparison of baseline data (at 0 weeks) among groups showed a statistically nonsignificant difference. There was statistically significant improvement at postintervention (immediately after fourth week) in postural correction exercises group [headache disability: 14.95 ± 7.91 (p < .001); headache intensity: 2.58 ± 1.24 (p < .001); neck disability: 27.66 ± 18.71 (p < .001); neck pain: 1.91 ± 1.44 (p < .001)] and spinal mobilization group [headache disability: 13.83 ± 6.21 (p < .001); headache intensity: 2.29 ± 1.23 (p < .001); neck disability: 23.39 ± 19.51 (p < .001); neck pain: 1.72 ± 0.84 (p < .001)] as compared to the control group. The result of within-group analysis suggests that there was a statistically significant improvement in postintervention (immediately after fourth week) and follow-up (immediately after eighth week) scores as compared to baseline (at 0 weeks) scores for all outcomes in postural correction exercises [headache disability (p < .001), headache intensity (p < .001), neck disability (p < .001), neck pain (p < 0 .001)] as well as in spinal mobilization group [headache disability (p < .001), headache intensity (p < .001), neck disability (p < .001), neck pain (p < .001 for pre versus post; p = .001 for pre versus follow-up)]. There was a statistically nonsignificant difference between postintervention and follow-up scores of all the outcomes in the postural correction exercise and spinal mobilization group, which indicates that improvement in these groups was maintained during the follow-up period.

CONCLUSION

Spinal mobilization and postural correction exercises are effective in the management of cervicogenic headache.

The Organ of Vision and the Stomatognathic System-Review of Association Studies and Evidence-Based Discussion

The stomatognathic system is a functional complex of tissues and organs located within the oral and craniofacial cavities. The craniofacial anatomical factors and the biomechanics of the temporomandibular joints affect many systems throughout the body, including the organ of vision. However, few scientific reports have shown a relationship between the organ of vision and the stomatognathic system. The purpose of this review is to provide an overview of connections along neural, muscle-fascial, and biochemical pathways between the organ of vision and the stomatognathic system. Based on the literature presented in this review, the connections between the organ of vision and the stomatognathic system seem undeniable. Understanding the anatomical, physiological, and biochemical interrelationships may allow to explain the interactions between the mentioned systems. According to the current knowledge, it is not possible to indicate the main linking pathway; presumably, it may be a combination of several presented pathways. The awareness of this relationship among dentists, ophthalmologists, physiotherapists, and optometrists should increase for the better diagnosis and treatment of patients.

Myofascial Treatment for Microcirculation in Patients with Postural Neck and Shoulder Pain

Vascular impairment is a crucial factor associated with chronic muscle pain, but relevant research from the microcirculatory aspect is lacking. Here, we investigated the differences in neck muscle microcirculation detected through laser-doppler flowmetry (LDF) and cervical biomechanics by a videofluoroscopic image in asymptomatic participants and patients with postural neck and shoulder pain. To understand the mechanism behind the effect of myofascial treatment, transverse friction massage (TFM) was applied and the immediate effects of muscular intervention on microcirculation were monitored. In total, 16 asymptomatic participants and 22 patients (mean age = 26.3 ± 2.4 and 25.4 ± 3.2 years, respectively) were recruited. Their neck muscle microcirculation and spinal image sequence were assessed. The differences in the baseline blood flow between the asymptomatic and patient groups were nonsignificant. However, the standard deviations in the measurements of the upper trapezius muscle in the patients were significantly larger (p < 0.05). Regarding the TFM-induced responses of skin microcirculation, the blood flow ratio was significantly higher in the patients than in the asymptomatic participants (p < 0.05). In conclusion, postintervention hyperemia determined through noninvasive LDF may be an indicator for the understanding of the mechanism underlying massage therapies and the design of interventions for postural pain.

The Influence of Visual Input on Electromyographic Patterns of Masticatory and Cervical Spine Muscles in Subjects with Myopia

This study aimed to analyze the change of visual input on electromyographic patterns of masticatory and cervical spine muscles in subjects with myopia. After applying the inclusion criteria, 50 subjects (18 males and 32 females) with myopia ranging from −0.5 to −5.75 Diopters (D), were included in the study. Four muscle pairs were analyzed: the anterior part of the temporalis muscle (TA), the superficial part of the masseter muscle (MM), the anterior belly of the digastric muscle (DA), and the middle part of the sternocleidomastoid muscle belly (SCM) during resting and functional activity. Statistical analysis showed a significant decrease within functional indices (FCI) for the sternocleidomastoid muscle (FCI SCM R, FCI SCM L, FCI SCM total) during clenching in the intercuspal position with eyes closed compared to eyes open. During maximum mouth opening, a statistically significant increase of functional opening index for the left temporalis muscle (FOI TA L) was observed. Within the activity index (AcI), there was a statistically significant decrease during clenching on dental cotton rollers with eyes closed compared to eyes open.

Resolution of Gastroesophageal Reflux Disease Following Correction for Upper Cross Syndrome-A Case Study and Brief Review

Upper cross syndrome (UCS) is a condition caused from prolonged poor posture manifesting as thoracic hyperkyphosis with forward head and shoulder postures. It has been associated with several other secondary conditions, causing pain and discomfort to those with the condition. This is a case report of a 35-year-old female presenting to clinic with a sharp pain in the neck, upper back, and sternum area for 4 weeks and gastroesophageal reflux disease (GERD). She had been working at home for several months after the shelter at home order was issued. Following evaluation and corrective treatment with cervical adjustment and soft tissue massage, the patient's posture improved and reported full pain resolution. Her symptoms of GERD concurrently resolved as well. She continued to receive chiropractic adjustment two times per month for correcting spinal misalignment. Full restoration of posture was attained on the full spine radiographs at 9 months follow-up. The patient remained symptom-free at 12 months follow-up. Manipulative and preventive therapies aimed at treating and preventing UCS should be more widely adopted to prevent secondary conditions.

Comparison of cervical muscle activity and spinal curvatures in the sitting position with 3 different sloping seats

Lumbar and pelvic alignment may have a huge impact on the posture of the spine and other parts. The aim of this study were to compare the spinal curvature of the cervical, thoracic, and lumbar spine and the muscle activity of the cervical erector spinae muscle, upper trapezius muscle, and thoracic erector spinae muscle when sitting at 3 different sloped, seating surfaces. A 10° wedge was used as the seating surface and we compared a forward sloping seat surface, a flat seating surface, and a rear sloping seat surface, in that order. Twenty healthy officers were recruited for this study. The subjects sat on the seat of 3 different slopes and watched a total of 3 videos, 10 minutes each. The rest time was 10 minutes. Subjects were photographed while viewing videos and muscle activity was measured. There were significant differences in cervical, thoracic, lumbar curvatures, and muscle activity in the 3 different sitting positions according to seat tilt (P < .05). Among the 3 slopes, the forward slope decreased forward head posture and cervical erector spinae muscle activity (P < .05). The activity of the cervical erector spinae muscle was 2.67% with a forward sloping seat, 5.45% with a flat sloping seat, and 6.77% with a rear sloping seat, revealing a significant difference (P < .05). This suggests that a forward sloping seat surface was effective in maintaining a neutral alignment of the spine, and this decreased the cervical spine erector muscle activity. Based on this result, equipment and chair development to incline seats forward may improve posture and health, and prevent chronic pain.

Upper cervical and upper thoracic spine mobilization versus deep cervical flexors exercise in individuals with forward head posture: A randomized clinical trial investigating their effectiveness

BACKGROUND

Although commonly utilized treatments, no study has directly compared the effectiveness of joint mobilization and stabilization exercise in individuals with forward head posture (FHP).

OBJECTIVE

This study aimed to investigate the effects of upper cervical and upper thoracic spine mobilization versus deep cervical flexors exercise (DCFE) in individuals with FHP.

METHODS

Thirty-one participants with FHP were randomized into the mobilization (n= 15) or exercise (n= 16) group. The treatment period was 4 weeks with follow-up assessment at 4 weeks and 6 weeks after the initial examination. Outcomes assessed included the craniovertebral angle (CVA), numeric pain rating scale (NPRS), respiratory function, and the global rating of change (GRC).

RESULTS

Participants in the mobilization group demonstrated significant improvements (p< 0.05) in CVA, NPRS, and respiratory function, as compared to those in the exercise group. In addition, 9 of 15 (60%) participants in the mobilization group, as compared to 4 of 16 participants (25%) in the exercise group, had a GRC score of +4 or higher.

CONCLUSIONS

The combination of upper cervical and upper thoracic spine mobilization indicated better overall short-term outcomes in CVA, NPRS, respiratory function, and GRC compared with DCFE in individuals with FHP.

The Healthy e-Elderly People Assessment (HEPA) application

Purpose

The purpose of this paper is to evaluate health effects and determine the factors associated with health effects from smartphone and tablet use among the elderly in Thailand.

Design/methodology/approach

This study was a cross-sectional descriptive study. The participants comprised 490 elderly people. A self-administered questionnaire was used for data collection via the Healthy e-Elderly People Assessment mobile application in the Android operating system by Google which consists of five parts of a questionnaire. The variables were analyzed using SPSS such as frequency, percentage, mean and binary logistic regression.

Findings

Altogether, the participants were 223 males and 267 females; mean age=64.9±5.4. The average time spent using a mobile device was 2.8±1.9 h/day. Participants recorded that after use of either device, 59.0 percent experienced eye pain, 52.7 percent experienced dim eyes, 30.2 percent experienced tiredness, and 28.0 percent experienced moodiness. Socially, 26.8 percent recorded changes in social interaction. Periods of time using devices, time consumed in device usage (hours/day), the type of application, and the difference in times of use, place of usage and time spent in rest breaks from smartphone or tablet usage were significantly associated with health effects (p<0.05).

Originality/value

The elderly users may be at risk of several health effects from smartphone and tablet use. The potential gap in knowledge conceals some of the risk factors for the current health effects. Practical intervention to reduce health effects from the use of smartphones and tablets should be considered.

Effects of Kinesio taping and exercise on forward head posture

BACKGROUND

Little is known about the effects of Kinesio taping and therapeutic exercise on correcting forward head posture.

OBJECTIVE

To compare Kinesio taping versus therapeutic exercise for forward head posture on static posture, dynamic mobility and functional outcomes.

METHODS

Sixty subjects (31 women, 29 men) with forward head postures participated in this study. They were randomly assigned to either one of the three groups: (1) exercise group (n = 20), (2) taping group (n = 20), and (3) control groups (n = 20). The horizontal forward displacement (HFD) between ear lobe and acromion process, upper cervical and lower cervical angle (UCA, LCA), active range of motion (AROM) of cervical spine, and neck disability index (NDI) were measured before and after a 5-week intervention, and a 2-week follow-up. Data were analyzed by means of a mixed design repeated-measures ANOVA.

RESULTS

Both taping and exercise groups showed significant improvements in HFD compared with the control group at post-treatment and follow-up. Compared with the control group, the exercise group exhibited significant improvements in the LCA and the side bending AROM at post-treatment.

CONCLUSIONS

Both Kinesio taping and therapeutic exercise improve forward head posture after intervention and a 2-week follow-up. The effectiveness of therapeutic exercise is better than taping.

Effect of interferential current therapy on forward head posture

[Purpose] The purpose of this study was to examine the effects of interferential current therapy on the shoulder muscles of subjects with forward head posture. [Subjects and Methods] Thirty volunteers (15 forward head posture, 15 control) participated in this study. Interferential current therapy treatment was conducted for 10 min, three times per week, for 3 weeks on both the upper trapezius and levator scapulae. Subjects were measured anterior both acromion distance and posterior both acromial distance using a ruler, and the forward head posture angle using an electronic application. [Results] Both groups showed significant increases in anterior acromial distance, and decreases in posterior acromial distance and forward head posture angle. [Conclusion] Subjects were concluded that electrical therapy could improve structural alignment; therefore, the implementation of interferential current therapy is expected to be effective for the treatment of forward head posture.

Effects of work surface and task difficulty on neck-shoulder posture and trapezius activity during a simulated mouse task

OBJECTIVES

The purpose of this study is to evaluate the influence of the work surface and task difficulty on the head, upper back and upper arm postures and activity of the descending trapezius during a simulated mouse task.

METHODS

Healthy female university students (N = 15) were evaluated. The work surface was positioned at elbow height (EH) and above elbow height (AEH) and the task difficulty was set at low (LD) and high (HD) levels. The postures were recorded by inclinometers. Trapezius activity was normalized by the maximum voluntary isometric contraction (MVIC).

RESULTS

Significantly higher head flexion was found at EH compared to the AEH condition, with an average difference of 2°-5° at the same difficulty level. The HD task significantly increased head (3°-6°) and upper back flexion (6°-7°) at the same table height. For upper arm elevation and trapezius activation, the AEH condition presented higher upper arm elevation (about 6°-8°) and trapezius activity (0.8-1.4% of MVIC), regardless of the difficulty level of the task.

CONCLUSIONS

Head posture was influenced by the table height and task difficulty; the upper back posture by high difficulty; and upper arm posture and trapezius activity were only influenced by table height.

Early Intervention and Nonpharmacological Therapy of Myopia in Young Adults

Myopia is a condition of the eye where parallel rays focus in front of, instead of on, the retina, which results in excessive refractive power of the cornea or the lens or eyeball elongation. Studies carried out in recent years show that the etiology of myopia is complex with genetic and environmental factors playing a role. Refraction defects decrease the quality of vision, while progressing myopia can lead to partial loss of vision, which can be particularly dramatic in young adults. Therefore, it is so crucial to take appropriate actions aimed at preventing myopia progression. This is a review of nonpharmacological therapeutic possibilities of refraction defect prevention in young adults, with special regard to myofascial therapy, osteopathy, and massage of acupuncture points surrounding the eye.

Musculoskeletal dysfunction in migraine patients

Objective The aim of this project was to evaluate the prevalence and pattern of musculoskeletal dysfunctions in migraine patients using a rigorous methodological approach and validating an international consensus cluster of headache assessment tests. Methods A physiotherapist, blinded towards the diagnosis, examined 138 migraine patients (frequent episodic and chronic), recruited at a specialised headache clinic, and 73 age and gender matched healthy controls following a standardised protocol. Eleven tests, previously identified in an international consensus procedure, were used to evaluate cervical and thoracic musculoskeletal dysfunctions. Results Primary analyses indicated statistically significant differences across groups for the total number of trigger points, flexion-rotation test, thoracic screening, manual joint testing of the upper cervical spine, cranio-cervical flexion test, and reproduction and resolution. Ninety three percent of the assessed patients had at least three musculoskeletal dysfunctions. Post-hoc tests showed significant differences between episodic or chronic migraine patients and healthy controls, but not between migraine groups. Conclusions A standardised set of six physical examination tests showed a high prevalence of musculoskeletal dysfunctions in migraine patients. These dysfunctions support a reciprocal interaction between the trigeminal and the cervical systems as a trait symptom in migraine.

Comparison of Spinal Angles in a Typing Task on a Laptop and a Desktop Computer: A Preliminary Study

OBJECTIVE

This study's objective was to discover whether a difference exists in four postural angles while performing a typing task on a laptop and a desktop computer.

METHOD

Twenty healthy participants performed a 5-min typing task on each computer.

RESULTS

Statistically significant differences for all angles were found when comparing sitting at the desktop computer with sitting at the laptop. Neck angle (p < .0005), head tilt (p < .0005), and lumbar lordosis (p = .018) were significantly higher when using the laptop. The greatest posterior pelvic tilt was associated with the desktop (p = .018).

CONCLUSION

A desktop appears to be more appropriate for the cervical and lumbar regions; however, using a laptop may be more suitable for pelvic tilt.

Neck kinematics and sternocleidomastoid muscle activation during neck rotation in subjects with forward head posture

[Purpose] The present study investigated differences in the kinematics of the neck and activation of the sternocleidomastoid (SCM) muscle during neck rotation between subjects with and without forward head posture (FHP). [Subjects and Methods] Twenty-eight subjects participated in the study (14 with FHP, 14 without FHP). Subjects performed neck rotation in two directions, left and right. The kinematics of rotation-lateral flexion movement patterns were recorded using motion analysis. Activity in the bilateral SCM muscles was measured using surface electromyography. Differences in neck kinematics and activation of SCM between the groups were analyzed by independent t-tests. [Results] Maintaining FHP increased the rotation-lateral flexion ratio significantly in both directions. The FHP group had significantly faster onset time for lateral flexion movement in both directions during neck rotation. Regarding the electromyography of the SCM muscles during neck rotation in both directions, the activity values of subjects with FHP were greater than those of subjects without FHP for the contralateral SCM muscles. [Conclusion] FHP can induce changes in movement in the frontal plane and SCM muscle activation during neck rotation. Thus, clinicians should consider movement in the frontal plane as well as in the sagittal plane when assessing and treating patients with forward head posture.

Effects of stabilization exercises with a Swiss ball on neck-shoulder pain and mobility of adults with prolonged exposure to VDTs

[Purpose] This study compared the effects on neck-shoulder pain and mobility of strengthening exercises for the neck flexors and scapular retractors performed on a Swiss ball and a mat. [Subjects] Twenty student volunteers were the subjects. [Methods] The students were randomly assigned to two groups: Mat group (n=10), and Swiss ball group (n=10). At pre-test, post-test, and 1-week follow-up pain was assessed using the visual analogue scale (VAS), the pain pressure threshold (PPT) of the shoulder was measured with an algometer, and neck mobility was measured with a Zebris. [Results] The data analysis revealed that there was a significant decrease in pain and significant increase in neck flexion in both groups, and the Swiss ball group showed better results. [Conclusion] Strengthening the neck flexors and scapular retractors for stabilization of the neck using exercises on a Swiss ball was more effective at reducing the pain and stabilizing the neck than mat exercises.

An investigation of cervical spinal posture in cervicogenic headache

BACKGROUND

Cervicogenic headache (CGH) is defined as headache symptoms originating from the cervical spine. Cervical dysfunction from abnormal posture has been proposed to aggravate or cause CGH, but there are conflicting reports as to whether there is an association between posture and CGH.

OBJECTIVE

The purpose of this study was to evaluate differences in cervical spinal posture, measured on radiographs, between patients with probable CGH and asymptomatic control participants.

DESIGN

A single-blinded comparative measurement design was used.

METHODS

Differences in postural variables from radiographs between participants with CGH (n=30) and age- and sex-matched asymptomatic control participants (n=30) were determined using paired t tests or the nonparametric equivalent. Postural variables were general cervical lordosis (GCL, Cobb angle C2-C7), upper cervical lordosis (UCL, sagittal alignment C2 compared with C3-C4), and C2 spinous process horizontal deviation. Logistic regression determined postural variables, increasing the likelihood of CGH.

RESULTS

There were no significant differences in posture between the CGH and control groups. The mean GCL was 10.97 degrees (SD=7.50) for the CGH group and 7.17 degrees (SD=5.69) for the control group. The mean UCL was 11.86 degrees (SD=6.46) for the CGH group and 9.44 degrees (SD=4.28) for the control group. The mean C2 spinous process horizontal deviation was 3.00 mm (SD=1.66) for the CGH group and 2.86 mm (SD=2.04) for the control group. However, there was a significant association between greater GCL and an increased likelihood of having CGH (odds ratio=1.08; 95% confidence interval=1.001, 1.191).

LIMITATIONS

The findings are limited to an association between GCL and posture, as cause and effect cannot be determined.

CONCLUSIONS

The association between greater GCL and increased likelihood of having CGH suggests that GCL might be considered in the treatment of patients with CGH. However, as the data do not support posture as a cause of CGH, it is unknown whether addressing posture would reduce CGH.

Characteristics of cervical position sense in subjects with forward head posture

[Purpose] The purpose of this study was to investigate the effect of forward head posture (FHP) on proprioception by determining the cervical position-reposition error. [Subjects and Methods] A sample population was divided into two groups in accordance with the craniovertebral angle: the FHP group and the control group. We measured the craniovertebral angle, which is defined as the angle between a horizontal line passing through C7 and a line extending from the tragus of the ear to C7. The error value of the cervical position sense after cervical flexion, extension, and rotation was evaluated using the head repositioning accuracy test. [Results] There were significant differences in the error value of the joint position sense (cervical flexion, extension, and rotation) between the FHP and control groups. In addition, there was an inverse correlation between the craniovertebral angle and error value of the joint position sense. [Conclusion] FHP is associated with reduced proprioception. This result implies that the change in the muscle length caused by FHP decreases the joint position sense. Also, proprioception becomes worse as FHP becomes more severe.

Comparison of upper cervical flexion and cervical flexion angle of computer workers with upper trapezius and levator scapular pain

[Purpose] In this study, we compared upper cervical flexion and cervical flexion angle of computer workers with upper trapezius and levator scapular pain. [Subject] Eight male computer workers with upper trapezius muscle pain and eight others with levator scapular muscle pain participated. [Methods] Each subject was assessed in terms of upper cervical flexion angle and total cervical flexion angles using a cervical range of motion instrument after one hour of computer work. [Results] The upper cervical flexion angle of the group with levator scapular pain was significantly lower than that of the group with upper trapezius pain after computer work. The total cervical flexion angle of the group with upper trapezius pain was significantly lower than that of the group with levator scapular pain after computer work. [Conclusion] For selective and effective intervention for neck pain, therapists should evaluate upper and lower cervical motion individually.

Therapeutic options for cervicogenic headache

The term cervicogenic headache (CeH) describes a syndrome originating from the cervical spine. There are a variety of therapeutic approaches used for the management of CeH, but scientific evidence of their effectiveness is scarce. No medication drug has proven to be effective. The evidence for greater occipital nerve blocks, cervical nerve blockades, facet joint injections and surgical procedures is limited. Several physical therapy interventions are proposed for CeH, with spinal manipulation and soft tissue interventions being the most commonly used. However, the lack of solid evidence of positive effects and risks of serious complications for spinal manipulation should be considered in favor of other physical therapy interventions associated with less risk. The inconsistent results in the literature can be related to the fact that maybe not all therapeutic interventions are appropriate for all patients with CeH or maybe not all patients with CeH will benefit from particular interventions.

Comparison of Shoulder Muscles Activation for Shoulder Abduction between Forward Shoulder Posture and Asymptomatic Persons

[Purpose] This study investigated the differences in shoulder muscles activities during shoulder abduction between a forward shoulder posture group and asymptomatic group. [Subjects] Seven males with forward shoulder posture (FHS) and seven asymptomatic males were recruited. [Methods] We measured the upper and middle trapezius (UT and MT), serratus anterior (SA), and clavicle portion of the pectoralis major (cPM) in the right side during shoulder abduction. [Results] The activities of the UT and cPM in the FHS group were significantly more increased when compared with the asymptomatic group. The activities of the MT and SA in the FHS group were significantly more decreased when compared with the asymptomatic group. [Conclusion] We suggest that forward shoulder posture may become a potential risk factor evoking the various shoulder disorders.

The effect of the forward head posture on postural balance in long time computer based worker

Objective

To estimate the effects of a relatively protruded head and neck posture on postural balance, in computer based worker.

Method

Thirty participants, who work with computers for over 6 hrs per day (Group I), and thirty participants, who rarely work with computers (Group II), were enrolled. The head and neck posture was measured by estimating angles A and B. A being the angle between the tragus of the ear, the lateral canthus of the eye, and horizontal line and B the angle between the C7 spinous process, the tragus of the ear, and the horizontal line. The severity of head protrusion with neck extension was assessed by the subtraction of angle A from angle B. We also measured the center of gravity (COG) and postural balance by using computerized dynamic posturography to determine the effect of computer-based work on postural balance.

Results

Results indicated that group I had a relatively more protruded head with extensive neck posture (angle B-A of group I and group II, 28.2±8.3, 32.9±6.0; p<.05). The COG of group I tended more toward the anterior than that of group II. Postural imbalance and impaired ability to regulate movement in forward and backward direction were also found.

Conclusion

The results of this study suggest that forward head postures during computer-based work may contribute to some disturbance in the balance of healthy adults. These results could be applied to education programs regarding correct postures when working at a computer for extended periods of time.

The efficacy of forward head correction on nerve root function and pain in cervical spondylotic radiculopathy: a randomized trial

Objective: To investigate the effect of forward head posture correction on pain and nerve root function in cases of cervical spondylotic radiculopathy.

Design: A randomized controlled study with six months follow-up.

Setting: University research laboratory.

Subjects: Ninety-six patients with unilateral lower cervical spondylotic radiculopathy (C5–C6 and C6–C7) and craniovertebral angle measured less than or equal to 50° were randomly assigned to an exercise or a control group.

Interventions: The control group ( n = 48) received ultrasound and infrared radiation, whereas the exercise group ( n = 48) received a posture corrective exercise programme in addition to ultrasound and infrared radiation.

Main outcome measures: The peak-to-peak amplitude of dermatomal somatosensory evoked potentials, craniovertebral angle, visual analogue scale were measured for all patients at three intervals (before treatment, after 10 weeks of treatment, and at follow-up of six months).

Results: There was a significant difference between groups adjusted to baseline value of outcome at 10 weeks post-treatment for craniovertebral angle, pain, C6 and C7 peak-to-peak amplitude of dermatomal somatosensory evoked potentials P = 0.000, 0.01, 0.000, 0.001 respectively and at follow-up for all previous variables ( P = 0.000).

Conclusion: Forward head posture correction using a posture corrective exercise programme in addition to ultrasound and infrared radiation decreased pain and craniovertebral angle and increased the peak-to-peak amplitude of dermatomal somatosensory evoked potentials for C6 and C7 in cases of lower cervical spondylotic radiculopathy.

Chiropractic care of a 6-year-old girl with neck pain; headaches; hand, leg, and foot pain; and other nonmusculoskeletal symptoms

OBJECTIVE

The purpose of this case report is to describe the response to chiropractic care of a pediatric patient with complaints of neck pain; headaches; and hand, leg, and foot pain after head trauma and the reports of changes in the patient's history of chronic fatigue, vomiting, and coughing.

CLINICAL FEATURES

A 6-year-old girl was pushed into a playground slide, hitting her head and resulting in acute complaints of her "neck and brain hurting" and hand, foot, and occasional leg pain. In addition, the patient had a several-year history of unexplained fatigue, vomiting, and coughing spells. She had a neck pain disability index of 17.8%; left lateral and rotational head tilt; cervical antalgic lean; loss of cervical range of motion; anterior cervical translation; and spasm, tenderness, trigger points, and edema along the cervical and thoracic spine.

INTERVENTION AND OUTCOME

The patient was cared for using Activator Methods protocol. After the fifth treatment, all the patient's symptoms dissipated, with a complete return to normal activity and spinal stability after 9 treatments. At 19 weeks, her spine continued to be asymptomatic; and her neck disability index was 0%.

CONCLUSION

This case demonstrated that the Activator Method of chiropractic care had a beneficial effect for this pediatric patient.

Effectiveness of interferential current therapy in the management of musculoskeletal pain: a systematic review and meta-analysis

BACKGROUND

Interferential current (IFC) is a common electrotherapeutic modality used to treat pain. Although IFC is widely used, the available information regarding its clinical efficacy is debatable.

PURPOSE

The aim of this systematic review and meta-analysis was to analyze the available information regarding the efficacy of IFC in the management of musculoskeletal pain.

DATA SOURCES

Randomized controlled trials were obtained through a computerized search of bibliographic databases (ie, CINAHL, Cochrane Library, EMBASE, MEDLINE, PEDro, Scopus, and Web of Science) from 1950 to February 8, 2010.

DATA EXTRACTION

Two independent reviewers screened the abstracts found in the databases. Methodological quality was assessed using a compilation of items included in different scales related to rehabilitation research. The mean difference, with 95% confidence interval, was used to quantify the pooled effect. A chi-square test for heterogeneity was performed.

DATA SYNTHESIS

A total of 2,235 articles were found. Twenty studies fulfilled the inclusion criteria. Seven articles assessed the use of IFC on joint pain; 9 articles evaluated the use of IFC on muscle pain; 3 articles evaluated its use on soft tissue shoulder pain; and 1 article examined its use on postoperative pain. Three of the 20 studies were considered to be of high methodological quality, 14 studies were considered to be of moderate methodological quality, and 3 studies were considered to be of poor methodological quality. Fourteen studies were included in the meta-analysis.

CONCLUSION

Interferential current as a supplement to another intervention seems to be more effective for reducing pain than a control treatment at discharge and more effective than a placebo treatment at the 3-month follow-up. However, it is unknown whether the analgesic effect of IFC is superior to that of the concomitant interventions. Interferential current alone was not significantly better than placebo or other therapy at discharge or follow-up. Results must be considered with caution due to the low number of studies that used IFC alone. In addition, the heterogeneity across studies and methodological limitations prevent conclusive statements regarding analgesic efficacy.

Effects of the height of ball-backrest on head and shoulder posture and trunk muscle activity in VDT workers

This study was designed to elucidate the effects of a ball-backrest at different heights on the head and shoulder posture and neck and trunk muscles of visual display terminal (VDT) workers who adopted a forward head posture when working at a VDT. Twenty-three VDT workers with forward head posture performed the keyboard typing work at a VDT without and with a ball-backrest at the L3, T10, and T4 levels. Surface electromyograms were recorded from the neck, shoulder, and trunk muscles, and the forward head angle and forward shoulder angle were analyzed using a 3-D motion analysis system. The significance of differences for the ball-backrest at different heights was tested by repeated one-way ANOVA, with the significance cutoff set at p=0.05. The mean forward head angle and forward shoulder angle decreased in the order of no backrest, T10-level ball-backrest, T4-level ball-backrest. Compared with not using a backrest, the activity of midcervical muscles was significantly lower and that of the lower trapezius was significantly higher when using a T4-level ball-backrest, and the activity of the internal oblique abdominal muscle was significantly higher when using a T10-level ball-backrest. We suggested that using T4 and T10-level ball-backrests would produce similar effects to active exercise, such as ball exercise for trunk stabilization, and that a ball-backrest would prevent kinematics changes. Therefore, the height of the backrest must be determined on the basis of the characteristics of work-related musculoskeletal disorders when applying a ball-backrest to VDT workers with such disorders.

Changes in neck muscle electromyography and forward head posture of children when carrying schoolbags

This study tested the effects of three alternative types of backpack on head posture and neck muscle electromyography (EMG) in children. Four loading conditions were tested: no pack; a backpack; a double pack; a modified double pack (designed with a backpack and a front pack weighing 10% and 5% of body weight, respectively). Dependent variables were neck muscle activity, forward head angle and forward head distance (the perpendicular distance from C7 to a vertical line through the tragus of the ear). Fifteen children were asked to walk at a speed of 0.8 m/s on a treadmill. The EMG activity of upper trapezius, sternocleidomastoid and midcervical paraspinals muscles and the forward head angle and forward head distance were all significantly higher when carrying a backpack than for the other conditions. When carrying a double pack, there was a backward head posture characterised by an increased negative forward head angle, decreased forward head distance, increased sternocleidomastoid EMG signal and decreased midcervical paraspinals EMG signal, compared to carrying no pack. When carrying a modified double pack, the forward head angle and forward head distance decreased when compared to carrying a backpack. These findings indicate that the modified double pack minimises postural deviation.