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Phys. Ther. Korea 2023; 30(4): 261-267
Published online November 20, 2023
https://doi.org/10.12674/ptk.2023.30.4.261
© Korean Research Society of Physical Therapy
Effect of Exercise Intervention on Craniovertebral Angle and Neck Pain in Individuals With Forward Head Posture in South Korea: Literature Review
Gyu-hyun Han1 
, PT, BPT, Chung-hwi Yi2 , PT, PhD, Seo-hyun Kim1 , PT, PhD, Su-bin Kim1 , PT, BPT
1Department of Physical Therapy, The Graduate School, Yonsei University, 2Department of Physical Therapy, College of Software and Digital Healthcare Convergence, Yonsei University, Wonju, Korea
Correspondence to: Chung-hwi Yi
E-mail: pteagle@yonsei.ac.kr
https://orcid.org/0000-0003-2554-8083
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.
Forward head posture (FHP) is a musculoskeletal disorder that causes neck pain. Several exercise interventions have been used in South Korea to improve craniovertebral angle (CVA) and relieve neck pain. There has been no domestic literature review study over the past 5 years that has investigated trends and effects of exercise intervention methods for CVA with neck pain. This domestic literature review aimed to evaluate the trends and effects of exercise interventions on CVA and neck pain in persons with FHP. A review of domestic literature published in Korean or English language between 2018 and 2022 was performed. Literature search was conducted on Google Scholar and Korea Citation Index by using the following keywords: “exercise,” “exercise therapy,” “exercise program,” “forward head posture,” and “neck pain.” Ten studies were included in this review. All of the studies showed positive improvements after intervention programs that included exercises. Notably, four of these studies demonstrated significant differences in results between the experimental and control groups. Among the 10 studies, nine measured visual analogue scale or numerical rating scale scores and reported significant reductions in pain following interventions, including exercise programs. Five of these studies showed significant differences in results between the experimental and control groups. Furthermore, six studies that used neck disability index exhibited a significant decrease in symptoms after implementing intervention programs that included exercise, and significant differences in results were found between the experimental and control groups. This domestic literature review provides consistent evidence to support the application of various exercise intervention programs to improve CVA and relieve neck pain from FHP. Further studies are warranted to review the effects of various exercise interventions on FHP reported not only in domestic but also in international literature.
Keywords: Exercise, Exercise therapy, Musculoskeletal diseases, Posture
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Review Article
Phys. Ther. Korea 2023; 30(4): 261-267
Published online November 20, 2023 https://doi.org/10.12674/ptk.2023.30.4.261
Copyright © Korean Research Society of Physical Therapy.
Effect of Exercise Intervention on Craniovertebral Angle and Neck Pain in Individuals With Forward Head Posture in South Korea: Literature Review
Gyu-hyun Han1 , PT, BPT, Chung-hwi Yi2 , PT, PhD, Seo-hyun Kim1 , PT, PhD, Su-bin Kim1 , PT, BPT
1Department of Physical Therapy, The Graduate School, Yonsei University, 2Department of Physical Therapy, College of Software and Digital Healthcare Convergence, Yonsei University, Wonju, Korea
Correspondence to:Chung-hwi Yi
E-mail: pteagle@yonsei.ac.kr
https://orcid.org/0000-0003-2554-8083
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
Forward head posture (FHP) is a musculoskeletal disorder that causes neck pain. Several exercise interventions have been used in South Korea to improve craniovertebral angle (CVA) and relieve neck pain. There has been no domestic literature review study over the past 5 years that has investigated trends and effects of exercise intervention methods for CVA with neck pain. This domestic literature review aimed to evaluate the trends and effects of exercise interventions on CVA and neck pain in persons with FHP. A review of domestic literature published in Korean or English language between 2018 and 2022 was performed. Literature search was conducted on Google Scholar and Korea Citation Index by using the following keywords: “exercise,” “exercise therapy,” “exercise program,” “forward head posture,” and “neck pain.” Ten studies were included in this review. All of the studies showed positive improvements after intervention programs that included exercises. Notably, four of these studies demonstrated significant differences in results between the experimental and control groups. Among the 10 studies, nine measured visual analogue scale or numerical rating scale scores and reported significant reductions in pain following interventions, including exercise programs. Five of these studies showed significant differences in results between the experimental and control groups. Furthermore, six studies that used neck disability index exhibited a significant decrease in symptoms after implementing intervention programs that included exercise, and significant differences in results were found between the experimental and control groups. This domestic literature review provides consistent evidence to support the application of various exercise intervention programs to improve CVA and relieve neck pain from FHP. Further studies are warranted to review the effects of various exercise interventions on FHP reported not only in domestic but also in international literature.
Keywords: Exercise, Exercise therapy, Musculoskeletal diseases, Posture
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Table 1 . Characteristics of studies selected.
Study (y) Study design Subjects characteristic Intervention description Outcome variable Main outcome Kim and Kang [19] Two-group pretest-posttest design, RCT 32 office workers between 20s and 60s with FHP (CVA < 53°) and neck pain (VAS ≥ 4)
Study group (n = 16)
Control group (n = 16)Study group: Cervical stabilization exercise and stretching exercise. Control group: Cervical self-myofascial release exercise and stretching exercise. Both groups performed exercises for 40 min/d, 3 times/wk for 6 weeks. CVA, VAS, NDI, CROM, respiratory pressure and function The intra-group comparison showed significant differences in VAS and NDI of both groups post-intervention. CVA was significantly improved post-intervention in the study group only. The inter-group comparison showed significant differences in NDI. Kang and Kim [20] Prospective, RCT, two-group pretest-posttest design 32 school teachers with FHP and neck pain (CVA < 53°, VAS ≥ 4)
Study group (n = 16)
Control group (n = 16)Study group: Scapular stabilization exercise and thoracic extension exercise. Control group: Cervical self-myofascial release exercise and stretching exercise. Both groups performed exercises for 40 min/d, 3 times/wk for 6 weeks. VAS, NDI, CVA, CROM, respiratory pressure, pulmonary functions The intra-group comparisons showed that VAS in both groups were significantly different after the intervention. The change in CVA was significant only in the study group. The inter-group comparisons showed a significant difference in VAS, and CVA. Park et al. [24] Two-group pretest-posttest design, RCT 30 patients in 20s and 30s with FHP and neck pain (Cobb’s angle ≤ 35°, NDI ≥ 15)
Study group (n = 15)
Control group (n = 15)Study group: Corrective exercises and TECAR therapy. Control group: Only corrective exercise. Both groups performed intervention for 40 min/d, 3 times/wk for 2 weeks. CVA, NDI, VAS, pressure pain threshold Both groups showed significant differences in CVA, NDI, and VAS. The study group significantly improved compared to the control group in NDI, and VAS, except CVA. Hyun and Choi [17] Pretest-posttest control group design, RCT 17 female adults under 45 with neck pain and FHP (CVA < 50°)
Exercise group (n = 9)
Control group (n = 8)Exercise group: Cervical stabilization exercise and active stretching exercise were conducted 10 min/d, 3 times/wk for 4 weeks. The control group did not participate in the exercise program. CVA, CROM, NDI, NRS There were significant differences between groups after the intervention in CVA, NDI, and NRS. The intra-group comparison showed significant differences in CVA, NDI, and NRS in the exercise group only. Nam et al. [21] Three-group pretest-posttest design, RCT 30 college students in 20s with neck pain and FHP (CVA ≤ 52°)
Group I (n = 10)
Group II (n = 10)
Group III (n = 10)Group I: General physical therapy. Group II: General physical therapy and self-stretching. Group III: General physical therapy and joint mobilization. All groups participated in intervention 3 times/wk for 4 weeks. VAS, CVA, autonomic system function In Group II, VAS and CVA showed significant changes. In comparison between Group I and II was a difference in VAS and CVA. In comparison between Group II and III was a difference in VAS. Kim and Park [23] Three-group pretest-posttest design, RCT 30 college students in 20s with FHP and neck pain (CVA ≤ 50°, 2 ≤ VAS ≤ 5)
Group I (n = 10)
Group II (n = 10)
Group III (n = 10)Group I: Horseback riding simulator exercise. Group II: Sling exercise. Group III: Kendall exercise. All groups performed 3 times/wk for 6 weeks. CVA, VAS Neck pain was reduced significantly after intervention in all three groups. CVA in all groups increased significantly after intervention. Song et al. [16] Two-group pretest-posttest design, RCT 40 adults in 30s and 40s with FHP (31°≤ CVA ≤ 59°) and neck pain
Group I (n = 20)
Group II (n = 20)Group I: Neck stabilization exercise. Group II: PNF neck flexion and extension pattern exercise. Each group conducted 30 min/d, 3 times/wk for 4 weeks. CVA, KNDI, anterior limit of stability, posterior limit of stability There were significant effects in CVA and KNDI of both groups post-intervention. There was a significant difference in KNDI in Group I compared to Group II. Kim and Kang [22] Two-group pretest-posttest design, RCT 26 patients in 40s with FHP and neck pain (CVA ≤ 52°, VAS ≥ 3)
Study group (n = 13)
Control group (n = 13)Study group: PNF cervical stabilization exercise. Control group: Traditional physical therapy. Each group participated in the intervention 3 times/wk for 6 weeks. VAS, CVA, KNDI Both groups showed significant differences in VAS, KNDI, and CVA. The study group showed more significant improvements in pain, CVA, and KNDI than those of the control group. Seo et al. [25] Pretest-posttest control group design, RCT 28 adults in 20s with FHP and neck pain
Exercise group (n = 14)
Control group (n = 14)Only the exercise group participated in the exercise program including 8 types of self-stretching and performed 3 times/wk for 8 weeks. CVA, CRA, VAS, neck tilt angle, neck load After 8 weeks of intervention, there was a significant improvement in CVA and VAS in the exercise group. Park and Jung [18] Two-group pretest-posttest design, RCT 34 subjects in 30s with neck pain and FHP (VAS ≥ 3, CVA < 53°)
Study group (n = 17)
Control group (n = 17)Study group: Exercise program (Thoracic extension and Lower trapezius strengthening exercises) and Dynamic taping. Control group: Exercise program only. The program was conducted for 55 min/d, 3 times/wk for 4 weeks. CVA, CRA, VAS, NDI, SF-12, HIT-6, upper trapezius muscle tone Both groups showed significant differences before and after the intervention in VAS, NDI, and CVA. Moreover, a significant difference in NDI was observed between the two groups. RCT, randomized controlled trial; FHP, forward head posture; CVA, craniovertebral angle; VAS, visual analogue scale; NDI, neck disability index; CROM, cervical range of motion; NRS, numerical rating scale; KNDI, Korean version of neck disability index; CRA, cranial rotation angle; PNF, proprioceptive neuromuscular facilitation; SF-12, short form-12 health survey questionnaire; HIT-6, headache impact test-6; TECAR, transfer electrode capacitative and resistive.