Effects of Forward Head Posture on Pulmonary Function in Smokers

This study aims to investigate the relationship between forward head posture (FHP) and respiratory dysfunctions in patients with chronic neck pain. Between June 2014 and November 2016 , a total of 99 patients (11 males, 88 females; mean age 54.1±9 years; range, 38 to 75 years) with chronic neck pain were evaluated for head posture by cervical lateral radiograph measuring the anterior head translation distance (FHPmm) and C7 vertebrae position (C7°). We examined the chest expansion by subtracting chest circumference from the level of xiphoid during maximal inspiration and expiration. Pain severity and neck disability were assessed using the Visual Analog Scale (VAS) and modified Neck Disability Index (MNDI), respectively. The respiratory functions were evaluated using spirometry tests, lung volumes, and maximal inspiratory and expiratory pressures (Pimax and Pemax, respectively). There was a negative correlation between the FHPmm with Pemax% (rho: -0.314; p=0.005). A negative correlation was also observed between C7° and Pemax, Pemax%, forced expiratory volume in one sec (FEV1)/forced vital capacity (FVC)%, forced expiratory flow (FEF)25-75%, and FEF75% (rho:-0.245, -0.349, -0.218, -0.214, and -0.259 respectively; p=0.028, 0.002, 0.035, 0.040, and 0.012, respectively). There was a positive correlation between neck disability and VAS scores (rho: 0.424; p<0.001), while there was a negative correlation between neck disability and chest expansion, maximum voluntary ventilation (rho: -0.201 and -0.217, respectively; p=0.049 and 0.046, respectively). Based on our study results, FHP is associated with expiratory muscle weakness in chronic neck pain patients. To evaluate respiratory dysfunction, chest expansion tests may be useful, although these tests are not specific to muscle weakness. Interventions about FHP and neck pain should focus on the effects of respiratory muscle training.

Background:Forward Head Posture (FHP) is a common musculoskeletal deviation increasingly observed in computer users due to prolonged screen exposure and poor ergonomic practices. It can significantly affect cervical alignment and respiratory mechanics, leading to impaired pulmonary function. Prolonged sedentary behavior combined with inadequate postural awareness is believed to play a pivotal role in the development and progression of FHP among digital device users. Despite growing concern, limited evidence exists focusing on the occupational impact of FHP on respiratory health. Objective:To determine the prevalence of Forward Head Posture among computer workers and to evaluate its association with changes in respiratory function. Methods:A cross-sectional study was conducted among 80 computer workers aged 25–35 years, recruited from the IT departments of Madinah Teaching Hospital, Interloop Administration Unit, and The University of Faisalabad. Participants with musculoskeletal, neurological, or respiratory conditions were excluded. Craniovertebral angle (CVA) was assessed using lateral-view digital photography and analyzed via ImageJ software. FHP was defined as CVA &lt;48°. Respiratory function was measured using a calibrated digital spirometer, recording Forced Vital Capacity (FVC), Forced Expiratory Volume in 1 Second (FEV1), FEV1/FVC ratio, and Peak Expiratory Flow (PEF). Statistical analysis was performed using SPSS version 20, with chi-square tests applied; p&lt;0.05 was considered statistically significant. Results:The prevalence of FHP was 83.8% (n=67). Participants with FHP showed significantly reduced respiratory parameters: mean FEV1 = 3.150 ± 1.056 L, FVC = 3.20 ± 0.998 L, FEV1/FVC ratio = 1.45 ± 0.840, and PEF = 3.625 ± 0.718 L/sec. A significant association was found between FHP and all spirometric measures: FEV1 (p=0.014), FVC (p=0.042), FEV1/FVC (p=0.021), and PEF (p=0.026). Conclusion:Forward Head Posture is highly prevalent among computer workers and is significantly associated with decreased pulmonary function. Early ergonomic interventions and postural correction strategies are essential to reduce long-term respiratory compromise in occupational settings.

ObjectivesThe study sought to examine the effects of Forward Head Posture (FHP) on neck pain, cervical mobility, and proprioception in drivers. Additionally, it aimed to ascertain if the influence of FHP varied between car and bike drivers. MethodsEmploying a comparative cross-sectional approach, 100 drivers (50 car drivers and 50 bike users) aged 18–65, each reporting a minimum of 10 h of driving weekly, were studied. Participants were categorized based on the presence or absence of FHP. Assessment tools encompassed Surgimap for FHP detection, the Visual Analogue Scale (VAS) for pain intensity, the Cervical Range of Motion (CROM) for mobility, and the Joint Position Error Test (JPET) for proprioception. Results60% of participants manifested FHP. At 70%, car drivers had a notably higher prevalence of FHP than bike drivers at 50%. Marked cervical mobility and proprioception differences were observed between drivers with and without FHP. Car drivers with FHP recorded an average pain score of 6.8 ± 1.2 on the VAS, significantly higher than the 3.1 ± 0.8 reported by those without FHP. Bike drivers with FHP reported elevated pain scores (5.9 ± 1.1) compared to those without FHP (3.4 ± 0.7). ConclusionThe findings underscore the significant repercussions of FHP on neck pain intensity, cervical mobility, and proprioception in drivers. Notably, vehicle type emerges as a critical factor, with car drivers displaying a heightened vulnerability compared to bike riders. This research emphasizes the importance of tailored interventions, informed driver education, and vehicle-specific ergonomic modifications to foster better postural health among drivers.

BackgroundNeck pain is a common condition across various populations, with a substantial impact on daily life and quality of life. Forward head posture is frequently observed in individuals with neck pain and is closely associated with lifestyle factors. This study aimed to examine the relationship between lifestyle factors and forward head posture in young adults with neck pain and determine the optimal cutoff value for assessing the risk of forward head posture.MethodsIn total, 200 men and women aged 35–44 years with persistent or recurrent neck pain with a numeric rating scale score of ≥ 3 in the previous week were included in the study. The participants’ sex, age, medical history, anthropometric parameters, posture- and activity-related lifestyle, pain, radiographs, and the craniovertebral angle were obtained. The associations between lifestyle factors and forward head posture were analyzed using logistic regression. The cutoff values for risk prediction were analyzed using receiver operating characteristic curves. The impact of lifestyle factors on changes in craniovertebral angle at the 6-month follow-up was analyzed using multiple linear regression and analysis of covariance.ResultsAfter adjusting for covariates, there were significant differences in lying time (odds ratio = 3.342, 95% confidence interval = 1.607–6.952) and physical activity level index (odds ratio = 0.404, 95% confidence interval = 0.210–0.775) between the forward and non-forward head posture groups. The cutoff values for detecting forward head posture were 6.50 h of lying time and a physical activity level score of 2.88. At the 6-month follow-up, the craniovertebral angle was closer to the diagnosis of forward head posture, with increasing lying time and lower physical activity level score; however, the association was not statistically significant.ConclusionsThe findings indicate that lying time and physical activity level scores are important lifestyle-related predictors of forward head posture. Thus, lying time and physical activity level should be addressed to predict and prevent forward head posture.

Chronic neck pain is one of the most common musculoskeletal pain conditions experienced by many people during their lives. Although patients with neck pain are managed predominantly as musculoskeletal patients, there are indications that they also have poor pulmonary function. The aim of this study was to examine whether patients with chronic neck pain have spirometric abnormalities and whether neck pain problems and psychological states are associated with these abnormalities. Forty-five participants with chronic neck pain and 45 well-matched healthy controls were recruited. Spirometry was used to assess participants' pulmonary function. Neck muscle strength, endurance of deep neck flexors, cervical range of motion, forward head posture, psychological states, disability, and pain intensity were also evaluated. The results showed that patients with chronic neck pain yielded significantly reduced vital capacity, FVC, expiratory reserve volume, and maximum voluntary ventilation (P < .05), but peak expiratory flow, FEV1, and FEV1/FVC ratio were not affected (P > .05). Strength of neck muscles, pain intensity, and kinesiophobia were found to be significantly correlated (r > 0.3, P < .05) with respiratory function. Patients with chronic neck pain do not have optimal pulmonary function. Cervical spine muscle dysfunction in parallel with pain intensity and kinesiophobia are factors that are associated mainly with this respiratory dysfunction.

Forward head posture (FHP) is a common postural problem experienced by most people. However, its effect on brain activity is still unknown. Accordingly, we aimed to observe changes in brain waves at rest to determine the effect of FHP on the nervous systems. A total of 33 computer users (Male = 17; Female = 16; age = 22.18 ± 1.88) were examined in both FHP and neutral posture. For each session, brain waves were measured for 5 min, and then muscle mechanical properties and cranio-vertebral angle (CVA) were measured. Changes in brain waves between the neutral posture and FHP were prominent in gamma waves. A notable increase was confirmed in the frontal and parietal lobes. That is, eight channels in the frontal lobe and all channels in the parietal lobe showed a significant increase in FHP compared to neutral posture. Additionally, FHP changes were associated with a decrease in CVA (p < 0.001), an increase in levator scapulae tone (Right, p = 0.014; Left, p = 0.001), and an increase in right sternocleidomastoid stiffness (p = 0.002), and a decrease in platysma elasticity (Right, p = 0.039; Left, p = 0.017). The change in CVA was found to have a negative correlation with the gamma activity (P7, p = 0.044; P8, p = 0.004). Therefore, increased gamma wave activity in FHP appears to be related to CVA decrease due to external force that was applied to the nervous system and cervical spine.

Forward Head Posture (FHP) results in spine malalignment, muscle imbalance and cervical proprioception sensory input impairment. Subjective description of FHP is interpreted differently by clinicians and therefore the FHP is classified as slight, moderate and sever. This study aimed to evaluate balance disorder in individuals with severe forward head posture (FHP). Twenty individuals with severe FHP and 20 controls were enrolled. Dynamic postural stability was assessed in all participants using the Biodex Balance System (BBS) in semi dynamic position with eye open/eye closed conditions. Based on the findings, dynamic postural stability in the sagittal plane was different between the groups (P<0.05). It can be concluded that impairment of dynamic postural stability occurs in individuals with severe FHP. The findings suggest that clinicians take into account the importance of dynamic postural stability assessment in FHP subjects and consider the application of intervention programs for improvement of the dynamic balance.

Objective To study the percentage of the measured values of the main pulmonary ventilation function parameters in their predicted values based on Zapletal equation among healthy children aged 5-14 years in Kunming, China, and to provide a basis for accurate judgment of pulmonary ventilation function in clinical practice. Methods A total of 702 healthy children aged 5-14 years (352 boys and 350 girls) from Kunming were enrolled. The Jaeger spirometer was used to measure the nine indices:forced vital capacity (FVC), forced expiratory volume in one second (FEV1), ratio of forced expiratory volume in one second to forced vital capacity (FEV1/FVC), maximal mid-expiratory flow (MMEF), forced expiratory flow at 25% of forced vital capacity (FEF25), forced expiratory flow at 50% of forced vital capacity (FEF50), forced expiratory flow at 75% of forced vital capacity (FEF75), peak expiratory flow (PEF), and maximal voluntary ventilation (MVV). The values obtained from the Zapletal equation of predicted values provided by the spirometer were used as the predicted values of children, and the percentage of measured values in predicted values was calculated. Results In the 702 children, the percentages of the measured values of the main pulmonary ventilation function parameters PEF, FVC, FEV1, FEV1/FVC, and MVV in their predicted values fluctuated from 102% to 114%, 94% to 108%, 98% to 113%, 98% to 107%, and 141% to 183% respectively. As for the main airway velocity parameters, the percentages of the measured values of FEF25, FEF50, FEF75, and MMEF in their predicted values fluctuated from 98% to 116%, 85% to 102%, 71% to 98%, and 83% to 100% respectively. The percentages of the measured values of PEF, FVC, FEV1, FEV1/FVC, MVV, FEF25, FEF50, FEF75, and MMEF in their predicted values had the lower limits of normal of 88.2%, 88.4%, 92.0%, 94.4%, 118.5%, 82.9%, 70.0%, 62.1%, and 70.1% respectively. Conclusions There are differences between pulmonary ventilation function parameter levels and normal values provided by Zapletal equation in healthy children aged 5-14 years in Kunming. As for the pulmonary ventilation function parameters of PEF, FVC, FEV, FEV1/FVC, MVV, FEF25, FEF50, FEF75, and MMEF in these children, the lower limits of normal of measured values in predicted values may be determined as 88.2%, 88.4%, 92.0%, 94.4%, 118.5%, 82.9%, 70.0%, 62.1%, and 70.1% respectively.

背景与目的肺癌是世界范围内发病率和死亡率最高的恶性肿瘤之一，手术仍然是早期非小细胞肺癌的首选治疗方法。本研究的目的是探讨术后极早期肺功能的恢复情况，并比较肺癌胸腔镜肺叶切除、胸腔镜肺段切除与开胸肺叶切除术后对肺功能影响。方法选取中国医学科学院肿瘤医院胸外科2015年9月-2016年2月间手术的肺癌患者，按术式不同分为胸腔镜肺段切除术组、胸腔镜肺叶切除术组、开胸肺叶切除术组，分别于术前、术后第3天和术后3个月检查测试肺功能。统计分析采用SPSS 20.0版本，应用单因素方差分析，比较组间差异。结果① 在术后第3天，对比胸腔镜肺叶切除术、胸腔镜肺段切除术、开胸肺叶切除术，三组患者的肺功能，用力肺活量（forced vital capacity, FVC）、FVC占预计值的百分比（FVC%）、一秒用力呼气容积（forced expiratory volume in one second, FEV1）、FEV1占预计值的百分比（FEV1%）、最大呼气流速峰值（peak expiratory?ow, PEF）、每分钟最大通气量（maximal voluntary ventilation, MVV）、肺一氧化碳弥散因子（transfer factor for carbon monoxide of lung, TLCO）、TLCO占预计值的百分比（TLCO%），组间差异具有统计学意义（P值分别为0.033、0.042、0.029、0.045、0.039、0.021、0.018、0.024）。②在术后3个月，对比胸腔镜肺叶切除术、胸腔镜肺段切除术、开胸肺叶切除术，三组患者的肺功能，组间比较发现FVC、FVC%、FEV1、FEV1%、PEF、MVV、TLCO、TLCO%差异显著（P值分别为0.019、0.024、0.044、0.021、0.037、0.029、0.045、0.017）。结论肺癌胸腔镜肺叶切除、胸腔镜肺段切除与开胸肺叶切除术后在术后极早期（术后第3天）与术后3个月，肺功能的恢复情况均为胸腔镜肺段切除优于胸腔镜肺叶切除，胸腔镜肺叶切除优于开胸肺叶切除。

Background: Forward head posture is one of the most prevalent abnormal postures in patients with neck disorders. The aim of this study was to evaluate the effects of forward head posture on gait ground reaction force characteristics in children. Methods: Twelve children with forward head posture (age: 11.8±1.3 years) and sixteen healthy control children (age: 11.7±1.4 years) volunteered to participate in this study. Each participant was asked to walk 10 m in six trials with self-selected speed. The ground reaction force was measured by two Kistler Force Platforms at a frequency of 1000 Hz. MANOVA test ((version 16, SPSS Inc, Chicago, Il)) was used for between group comparisons. Results: In the non-dominant limb, the medio-lateral ground reaction force during push off phasein the forward head group was greater than that in the healthy group by 22.1% (P=0.049). In the dominant limb, time to peak for vertical ground reaction force during heel contact(by 13.7%; P=0.015) and push off(by 14.2%; P=0.004), mediolateral ground reaction force during heel contact (by 46.0%; P=0.006) and push off (by 15.1%; P=0.039) in the forward head group were significantly lower than those in the healthy group. Vertical loading, peak positive and negative free moment, and impulses in all axes were similar in the healthy and the forward head groups (P>0.05). Conclusion: Overall, the results reveal that gait ground reaction force components (especially time to peak for ground reaction forces) in forward head children may have clinical importance for the improvement of walking mechanics of these individuals. Rehabilitation protocols should be designed to increase time to reach peak ground reaction forces and decrease medio-lateral ground reaction force in forward head children during walking.

Stroke often results in significant respiratory dysfunction in patients. Respiratory muscle training (RMT) has been proposed as a rehabilitative intervention to address these challenges, but its effectiveness compared to routine training remains debated. This systematic review and meta-analysis aim to evaluate the effects of RMT on exercise tolerance, muscle strength, and pulmonary function in post-stroke patients. To systematically assess the efficacy of RMT in improving exercise tolerance, respiratory muscle strength, and pulmonary function in patients recovering from a stroke, and to evaluate whether RMT offers a significant advantage over routine training modalities in enhancing these critical health outcomes in the post-stroke population. Following the Preferred Reporting Items for Systematic reviews and Meta-Analyses guidelines, a comprehensive search across PubMed, Embase, Web of Science, and the Cochrane Library was conducted on October 19, 2023, without temporal restrictions. Studies were selected based on the predefined inclusion and exclusion criteria focusing on various forms of RMT, control groups, and outcome measures [including forced expiratory volume in the first second (FEV1), forced vital capacity (FVC), maximal voluntary ventilation (MVV), peak expiratory flow (PEF), maximal inspiratory pressure (MIP), maximal expiratory pressure (MEP), and 6-min walking test (6MWT)]. Only randomized controlled trials (RCTs) were included. Data extraction and quality assessment were conducted independently by two reviewers using the Cochrane Collaboration's risk of bias tool. Statistical analyses, including those using the fixed-effect and random-effects models, sensitivity analysis, and publication bias assessment, were performed using Review Manager software. A total of 15 RCTs were included. Results indicated significant improvements in MIP (12.51 cmH2O increase), MEP (6.24 cmH2O increase), and various pulmonary function parameters (including FEV1, FVC, MVV, and PEF). A substantial increase in 6MWT distance (22.26 meters) was also noted. However, the heterogeneity among studies was variable, and no significant publication bias was detected. RMT significantly enhances walking ability, respiratory muscle strength (MIP and MEP), and key pulmonary function parameters (FEV1, FVC, MVV, and PEF) in post-stroke patients. These findings support the incorporation of RMT into post-stroke rehabilitative protocols.

Background: Forward head posture is considered a deviation because the position of the head varies from that reference line. Frequent use of computers and mobile phones promote rounded shoulders and humped upper back and therefore resulting in forward head posture and neck pain. Objective: To assess the association between forward head posture and neck pain in office workers. Methods: This is a cross-sectional study in which about 88 office workers with age between 20 to 50 years, having neck pain and those who were actively working in their offices in front of personal computers and laptops were included in this study. Participants who has any neurological conditions and those who had neck pain or faulty posture due to any recent accident, trauma or injury were excluded from this study. A mixture of standardized and self-modified structured questionnaires was given to office workers with neck pain. They were inquired about the intensity of their neck pain, and their work concentration levels and were assessed whether they adopted a forward head posture to do their daily visual tasks at work. The posture was evaluated using the postural assessment checklist form and REEDCO postural assessment form. For qualitative variables percentages and frequency were calculated whereas for descriptive analysis, means and standard deviations were calculated for quantitative variables. Results: Out of 88 office workers with neck pain 46(52.27%) office workers had a severely forward head posture, 35(39.77%) had a moderately forward head posture and only 7 (7.95%) had a normal forward head posture. The results of this study suggest that neck pain might be a cause and risk factor of abnormal forward head posture among office workers or faulty forward head posture might be a cause or risk factor for the pain in the neck. Conclusion: It concludes that neck pain among office workers and forward head posture is associated with each other. Neck pain among office workers might be a cause and risk factor of forward head posture in office workers or adopting forward head posture might be a risk factor leading to neck pain.

Purpose: This study aimed to determine the correlation between body mass index (BMI), forward head posture, and respiratory function factors of college students in their 20s. Methods: Twenty-five adults in their 20s were recruited, and their forward head posture, BMI, and respiratory function were evaluated. The mean and standard deviation of the measured values for each variable were calculated, and Pearson’s correlation was used to determine the relationship between BMI, forward head posture, and respiratory function. Results: CVA showed a significant correlation with forced vital capacity (FVC) and forced expiratory volume in 1 s (FEV1), and FHD showed a significant correlation with FEV1/FVC (p&lt;.05). BMI showed a significant correlation with FVC and FEV1 (p&lt;.05). Conclusion: Head posture and BMI were correlated with respiratory function in adults in their 20 s. Therefore, posture and BMI management is necessary to improve respiratory function.

ABSTRACTBackground:The simultaneous effect of physical activity (PA) and smoking on pulmonary function in young people remains unclear.Propose:The aim of this study was to determine the influence of smoking and PA on pulmonary function in young university students in Cáceres, Spain.Methods:A sample of 120 young nursing students was studied (60 smokers and 60 nonsmokers). All subjects underwent spirometry with a COPD-6 portable device, and their level of PA was quantified using the International Physical Activity Questionnaire. The influence of PA and smoking on pulmonary function was determined by comparing hypotheses.Results:Significant differences were observed between smokers and nonsmokers in terms of percent forced expiratory volume in 1 second, percent forced expiratory volume in 6 seconds, lung age, and the difference between lung age and chronological age (LA–CA) in those who practiced mild PA. In the subjects who performed moderate and vigorous PA, these differences were not noted. In the intragroup analysis, significant differences were observed in smokers in terms of percent forced expiratory volume in 1 second, percent forced expiratory volume in 6 seconds, lung age, and LA–CA; however, in the control group, differences were only observed in terms of lung age and LA–CA. These findings were confirmed in the multivariate analysis.Conclusions/Implications for Practice:Our findings confirmed a deterioration in pulmonary function in smokers who did not perform moderate or vigorous PA. The level of PA performed was positively related to pulmonary function in smokers, whereas in nonsmokers, improvements were only significant in LA–CA.

Objective To explore the clinical and electrophysiological features and pulmonary function of 8 Chinese patients with Kennedy's disease (KD) and to enhance the understanding for the disease. Methods Eight patients with KD, admitted to out hospital from July 2010 to December 2013 and confirmed by gene examination, were chosen in our study; their clinical and electrophysiological features, and laboratory characteristics and pulmonary function were compared with those in the healthy volunteers. Results The average age of onset in the 8 patients was (45.13±17.47) years, and the average age of diagnosis was (55.63±12.11) years. The most common complaint was leg weakness. All patients presented hemifacial spasm, tongue muscle atrophy and fibrillation, amyotrophy and gynaecomastia; creatine kinase level was elevated and endocrine disorder appeared in different degrees. The electromyogram characteristics included widespread neurogenic changes accompanied with/without sensory or motor conduction abnormalities. The forced vital capacity, forced expiratory volume in first second, maximal voluntary ventilation and peak expiratory flow rate were significantly lower, and the residual volume in the KD patients was statistically higher than that in the healthy volunteers (P<0.05). Respiratory muscle strength (maximum inspiratory pressure and maximum expiratory pressure) decreased in the KD patients. Conclusion KD is a degenerative disease with slow clinical progression which has its own characteristics of inheritance pattern and natural course; the age of onset, repeat number of CAG sequences, pulmonary function and respiratory muscle strength may be valuable for illness evaluation. Key words: Kennedy's disease; Electromyography; Pulmonary function