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Phys. Ther. Korea 2023; 30(3): 184-193
Published online August 20, 2023
https://doi.org/10.12674/ptk.2023.30.3.184
© Korean Research Society of Physical Therapy
Comparing the Effects of Manual and Self-exercise Therapy for Improving Forward Head Posture
Gyeongseop Sim1 
, PT, MSc, Donghoon Kim2 , PT, PhD, Hyeseon Jeon3 , PT, PhD
1Department of Health, Exercise and Rehabilitation, Yeoju Institute of Technology, Yeoju, 2Department of Physical Therapy, Ansan University, Ansan, 3Department of Physical Therapy, College of Health Sciences, Yonsei University, Wonju, Korea
Correspondence to: Hyeseon Jeon
E-mail: hyeseonj@yonsei.ac.kr
https://orcid.org/0000-0003-3986-2030
This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/4.0) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.
Background: Studies investigating the immediate effects of a single intervention to correct forward head posture are rare. Objects: This study aimed to compare the changes in treatment effects in patients with forward head posture and neck pain after manual and self-exercise therapy over a 1-hour period.
Methods: Twenty-eight participants were randomly divided into manual and self-exercise therapy groups. Following the initial evaluation, manual or self-exercise therapy was applied to each group for 30 minutes each in the prone, supine, and sitting positions. The variables measured were the craniovertebral angle (CVA), stress level, pain level, and sternocleidomastoid (SCM) stiffness. After the intervention, re-evaluation was conducted immediately, 30 minutes later, and 1 hour later. Two-way analysis of variance (ANOVA) was used to compare the maintenance of treatment effects between the two groups.
Results: Based on the two-way mixed ANOVA variance, there was no interaction between the groups and time for all variables, and no main effects were found between the groups. However, a significant effect of time was observed (p < 0.05). Post hoc tests using Bonferroni's correction revealed that in both groups, the CVA, pain, and stress showed significant improvements immediately after the intervention compared with before the intervention, and these treatment effects were maintained for up to 1 hour after the treatment (p < 0.0083) in the manual therapy group. However, the stress level was maintained until 30 minutes later (p < 0.0083) in the self-exercise group. There was no significant decrease in right SCM stiffness before and after the intervention; however, left SCM stiffness significantly decreased after the self-exercise intervention (p < 0.0083).
Conclusion: Both manual and self-exercise therapy for 30 minutes were effective in reducing forward head posture related to the CVA, pain, and stress levels. These effects persisted for at least 30 minutes.
Keywords: Cervical vertebrae, Exercise movement techniques, Muscle stretching exercises, Muscle tonus, Neck pain, Stress
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Original Article
Phys. Ther. Korea 2023; 30(3): 184-193
Published online August 20, 2023 https://doi.org/10.12674/ptk.2023.30.3.184
Copyright © Korean Research Society of Physical Therapy.
Comparing the Effects of Manual and Self-exercise Therapy for Improving Forward Head Posture
Gyeongseop Sim1 , PT, MSc, Donghoon Kim2 , PT, PhD, Hyeseon Jeon3 , PT, PhD
1Department of Health, Exercise and Rehabilitation, Yeoju Institute of Technology, Yeoju, 2Department of Physical Therapy, Ansan University, Ansan, 3Department of Physical Therapy, College of Health Sciences, Yonsei University, Wonju, Korea
Correspondence to:Hyeseon Jeon
E-mail: hyeseonj@yonsei.ac.kr
https://orcid.org/0000-0003-3986-2030
This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/4.0) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.
Abstract
Background: Studies investigating the immediate effects of a single intervention to correct forward head posture are rare. Objects: This study aimed to compare the changes in treatment effects in patients with forward head posture and neck pain after manual and self-exercise therapy over a 1-hour period.
Methods: Twenty-eight participants were randomly divided into manual and self-exercise therapy groups. Following the initial evaluation, manual or self-exercise therapy was applied to each group for 30 minutes each in the prone, supine, and sitting positions. The variables measured were the craniovertebral angle (CVA), stress level, pain level, and sternocleidomastoid (SCM) stiffness. After the intervention, re-evaluation was conducted immediately, 30 minutes later, and 1 hour later. Two-way analysis of variance (ANOVA) was used to compare the maintenance of treatment effects between the two groups.
Results: Based on the two-way mixed ANOVA variance, there was no interaction between the groups and time for all variables, and no main effects were found between the groups. However, a significant effect of time was observed (p < 0.05). Post hoc tests using Bonferroni's correction revealed that in both groups, the CVA, pain, and stress showed significant improvements immediately after the intervention compared with before the intervention, and these treatment effects were maintained for up to 1 hour after the treatment (p < 0.0083) in the manual therapy group. However, the stress level was maintained until 30 minutes later (p < 0.0083) in the self-exercise group. There was no significant decrease in right SCM stiffness before and after the intervention; however, left SCM stiffness significantly decreased after the self-exercise intervention (p < 0.0083).
Conclusion: Both manual and self-exercise therapy for 30 minutes were effective in reducing forward head posture related to the CVA, pain, and stress levels. These effects persisted for at least 30 minutes.
Keywords: Cervical vertebrae, Exercise movement techniques, Muscle stretching exercises, Muscle tonus, Neck pain, Stress
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Table 1 . Pre-intervention between-group comparisons (N = 28).
Variable MT group (n = 14) SE group (n = 14) p-value Sex (male/female) 8/6 9/5 0.699a Age (y) 28.43 ± 6.11 26.64 ± 6.07 0.445b Height (cm) 167.79 ± 6.31 169.79 ± 5.71 0.388 Weight (kg) 65.36 ± 12.02 68.29 ± 13.15 0.544 BMI (kg/m2) 23.12 ± 3.44 23.58 ± 3.81 0.742 CVA (°) 47.00 ± 2.04 45.71 ± 2.61 0.159 Stress 6.07 ± 1.33 5.36 ± 2.10 0.293 Pain 3.57 ± 0.51 3.64 ± 0.50 0.712 Left SCM stiffness (N/m) 191.00 ± 10.18 190.21 ± 12.37 0.856 Right SCM stiffness (N/m) 203.50 ± 15.57 194.79 ± 12.83 0.119 Values are presented as number only or mean ± standard deviation. MT, manual therapy; SE, self-exercise therapy; BMI, body mass index; CVA, craniovertebral angle; SCM, sternocleidomastoid. achi-squared test, bindependent t-test..
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Table 2 . Comparison of variables pre- and post-test (N = 28).
Variable MT group (n = 14) SE group (n = 14) Effect p-value Pre-test Post-test After 30 min After 1 h Pre-test Post-test After 30 min After 1 h CVA (°) 47.00 ± 2.04 58.64 ± 3.56 55.93 ± 3.22 55.79 ± 3.17 45.71 ± 2.61 57.50 ± 3.18 54.43 ± 3.84 54.21 ± 3.85 Time < 0.001* Group 0.201 Time × Group 0.974 Stress 6.07 ± 1.33 3.14 ± 1.70 3.29 ± 1.64 3.71 ± 1.44 5.36 ± 2.10 2.43 ± 1.99 2.64 ± 1.82 3.36 ± 1.45 Time < 0.001* Group 0.325 Time × Group 0.433 Pain 3.57 ± 0.51 1.07 ± 0.83 1.36 ± 0.84 1.50 ± 0.65 3.64 ± 0.50 1.21 ± 0.89 1.57 ± 0.51 1.79 ± 0.43 Time 0.004* Group 0.324 Time × Group 0.898 Left SCM
stiffness
(N/m)191.00 ± 10.18 177.36 ± 11.72 182.29 ± 12.74 183.50 ± 11.95 190.21 ± 12.37 175.36 ± 8.13 180.00 ± 9.00 181.29 ± 8.59 Time < 0.001* Group 0.642 Time × Group 0.860 Right SCM
stiffness
(N/m)203.50 ± 15.57 189.00 ± 13.54 194.57 ± 15.94 195.64 ± 15.23 194.79 ± 12.83 181.21 ± 10.76 185.14 ± 12.11 186.36 ± 11.50 Time < 0.001* Group 0.090 Time × Group 0.792 Two-way mixed ANOVA test. Values are presented as mean ± standard deviation. ANOVA, analysis of variance; MT, manual therapy; SE, self-exercise therapy; CVA, craniovertebral angle; SCM, sternocleidomastoid. *p < 0.05..