Validity and Reliability of an Artificial Intelligence-Based Posture Estimation Software for Measuring Cervical and Lower-Limb Alignment Versus Radiographic Imaging.

Assessment of forward head posture in individuals with and without chronic neck pain: A cross-sectional study.

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.

BackgroundNeck pain is a common musculoskeletal disorder, often linked to forward head posture (FHP). Studies have shown that exercise interventions can improve pain, craniovertebral angle (CVA), range of motion, and function in individuals with FHP. While telerehabilitation exercise has proven effective for other musculoskeletal conditions, its effectiveness in addressing neck pain and FHP is still being investigated.ObjectiveThis study aimed to evaluate and compare the effectiveness of an internet-based telerehabilitation therapeutic exercise program with an in-person supervised program in improving clinical outcomes among young adult females with chronic nonspecific neck pain and FHP. The study hypothesized that there would be no significant differences in outcomes between the 2 groups.MethodsA randomized controlled trial was conducted with 50 participants experiencing chronic neck pain and FHP, recruited through public announcement and voluntary sign-up. Participants were randomly assigned to either a telerehabilitation group or an in-person supervision group. Both groups completed the same 6-week, physiotherapist-supervised therapeutic exercise program, delivered via Zoom (Zoom Video Communications) or in the physiotherapy department laboratory, respectively. Outcome assessments were conducted face-to-face by blinded assessors at baseline, after 4 and 6 weeks of intervention, and at a 2-week follow-up. Outcome measures included pain intensity (assessed using the Visual Analog Scale [VAS]), CVA, neck disability (assessed using the Neck Disability Index [NDI]), and cervical range of motion (CROM). Adherence was monitored using attendance logs.ResultsOf the 50 participants, 48 completed the intervention with 1 dropout from each group. Adherence among completers was 100 percent in both groups. All 50 participants were included in the analysis using the intention-to-treat principle. No differences in effectiveness were found between the telerehabilitation and in-person groups, as no significant interaction effect between group and time was observed across all outcome measures including VAS, CVA, NDI, and CROM (P values ranged .07-.61). However, improvements were observed in all outcomes across time, including a 2.2‐ to 4.1-cm reduction in VAS, 5°-8.8° increase in CVA, 3.3‐ to 7.1-point reduction in NDI (P<.001 for all), and 3.5°-22.7° increase in CROM (P<.001 to P=.04).ConclusionsBoth telerehabilitation and in-person supervision were similarly effective in improving pain, posture, neck disability, and CROM in young adult females with chronic neck pain and FHP. These findings suggest that telerehabilitation may be a feasible and accessible alternative to conventional in-person therapeutic exercise programs for managing chronic neck pain with FHP.

BackgroundForward head posture (FHP) is a common disorder worsened by prolonged use of electronic devices, causing increased neck load and musculoskeletal issues. While McKenzie neck exercises (MNE) are widely used to address FHP, the potential benefits of hip extensor exercises (HEE) remain underexplored.ObjectiveThis study aims to compare the effects of MNE and HEE on neck disability index (NDI), craniovertebral angle (CVA), cranial rotation angle (CRA), and the thickness of the LC muscle and carotid artery (CA) in individuals with FHP.MethodsTwenty participants with FHP were randomly assigned to either the MNE or HEE group, undergoing their respective exercises for 20 min per session, three times a week for two weeks. Pre- and post-intervention assessments included NDI questionnaire, CVA, CRA measurements, and ultrasonographic evaluation of LC muscle and CA thickness.ResultsBoth MNE and HEE groups showed significant improvements in NDI, CVA, CRA, and LC muscle thickness post-intervention (P < 0.05), with no significant group differences (P > 0.05). CA thickness increased in both groups, though not significantly.ConclusionsBoth MNE and HEE effectively improved symptoms and alignment associated with forward head posture. These findings suggest that hip extensor exercises may be a beneficial approach to mitigating FHP, similar to MNE.

Introduction: Forward head posture is the most common misalignment of the neck. It can lead to headaches, unusual neck pain, and stiffness in muscles. Posture corrective exercises were used to correct this misalignment hence improving the quality of life of the patient. Aim: To identify the effect of postural corrective exercises in forward head posture. Materials and Methods: The articles included were randomised controlled trials and systematic reviews. The databases included were Google Scholar and PubMed. The systematic reviews were taken from 2015-2023. Researchers have used the English language. The studies included were about posture corrective exercises that were used to correct forward head posture. Data were extracted from the proportion of clients in various systematic reviews and randomised controlled trials. Results: Several studies show that postural corrective exercises were effective in correcting forward head posture and improving the craniovertebral angle. These exercises help to improve posture, muscle strength and fl exibility. Conclusion: Forward head posture can be due to poor sitting posture, low height sitting or long hours of use of a laptop. Posture corrective exercises were benefi cial for improving forward head posture and decreasing the craniovertebral angle, which decreases neck pain and enhances the quality of life of patients.Keywords: Forward head posture, exercises, posture, cranio vertebral angle (CVA).

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 is common among office workers who sit for long periods of time and is one of the main causes of neck pain. This study aimed to assess the effects of utilizing a standing desk on the craniovertebral angle, muscle fatigue, work performance, and discomfort in individuals with forward head posture. Twenty-four participants meeting the inclusion criteria were randomly assigned to either a traditional desk group (n = 12) or a standing desk group (n = 12). Each group engaged in 30 min of computer typing. To evaluate the impact of posture change using a standing desk, pre- and post-experiment discomfort surveys were conducted, and the craniovertebral angle and muscle fatigue were measured throughout the experiment. Work performance was assessed post-experiment based on the work completed by the participants. Intra-group analysis of the craniovertebral angle showed a significant decrease in the traditional desk group (p < 0.05) and a significant increase in the standing desk group (p < 0.05). When comparing the craniovertebral angle between the two groups, a significant difference was observed (p < 0.05). Additionally, significant differences in muscle fatigue, particularly in the levator scapulae muscles, were observed between the two groups (p < 0.05). The traditional desk group reported increased discomfort in the neck and shoulders (p < 0.05). These findings suggest that utilizing a standing desk can positively impact posture, reduce muscle fatigue, and alleviate discomfort in individuals with forward head posture, potentially serving as an intervention to prevent musculoskeletal disorders.

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.

BackgroundPrevious studies have addressed the effects of different exercises and modalities on forward head posture (FHP), but the minimal clinically important difference (MCID) of the effect of exercises on FHP remains unclear. Therefore, this study aimed to investigate the effects of selective corrective exercises (SCEs) on the craniovertebral angle (CVA) and shoulder angle (SA) in students with FHP and to establish MCID for these angles.MethodsIn this randomized clinical trial study, a total of 103 second-grade male students with FHP were enrolled. Participants were randomly assigned to experimental and control groups. CVA and SA of participants were measured before and after the 8-week selective corrective exercise program (including strengthening and stretching exercises). The photogrammetric method was used to measure CVA and SA. MCID value was calculated for CVA and SA using the distribution method.ResultsThe results showed that there was a significant difference between the experimental and control groups in terms of CVA (F = 89.04, P = 0.005, Effect size = 0.47) and SA (F = 18.83, P = 0.005, Effect size = 0.16). After eight weeks of selective corrective exercises, the MCID values of CVA and SA were 1.40° and 1.34°, respectively.ConclusionThis study revealed that the selective corrective exercises might lead to postural correction of students having FHP problem. Results further indicated that a corrective exercise program would be considered beneficial if it increased CVA and SA values at least 1.40 and 1.34 degrees, respectively.

Background: The alignment of the neck and shoulder is important in people with forward head posture. However, previous studies have mainly conducted fragmentary studies on the neck and shoulders, and studies on the combined movement of the neck and shoulders are incomplete. Objective: To investigate the effects of 6 week dynamic exercise program using Thera-band on craniovertebral angle (CVA) in adults with forward head posture. Design: Quasi-experimental study. Methods: The study was conducted on 24 adults with forward head posture and experimented with neck and shoulder exercises and divided them into groups of neck exercises, shoulder exercises, and neck and shoulder exercises to measure CVA values before and after the experiment. The neck exercise program included flexion and extension muscles of the neck and shoulder exercises included dynamic exercise of the upper extremities such as the trapezius muscles and serratus anterior muscle. The CVA results were measured using PA200. Results: Following the interventions, neck exercise group showed significant improvement in CVA (P .05). However, both groups showed some positive results. Significant differences were seen in the comparisons between the three groups (P<.05), and the results of the posthoc test showed significant differences in neck exercise group and shoulder exercise, neck exercise and combine exercise group. Conclusion: This study suggested that the Thera-band neck exercise is beneficial for foward head posture patients and is expected to be used in clinical trials.

Background: For the treatment of forward head posture (FHP) and forward shoulder posture, methods for strengthening scapular retractors and deep cervical flexors and stretching pectoralis and upper cervical extensors are generally used. No study has yet assessed whether suboccipital release (SR) followed by cranio-cervical flexion exercise (CCFE) (SR-CCFE) will result in a positive change in the shoulders and neck, showing a “downstream” effect. Objects: The purpose of this study was to investigate the immediate effects of SR-CCFE on craniovertebral angle (CVA), shoulder abduction range of motion (ROM), shoulder pain, and muscle activities of upper trapezius (UT), lower trapezius (LT), and serratus anterior (SA) and LT/UT and SA/UT muscle activity ratios during maximal shoulder abduction in subjects with FHP. Methods: In total, 19 subjects (7 males, 12 females) with FHP were recruited. The subject performed the fifth phase of CCFE immediately after receiving SR. CVA, shoulder abduction ROM, shoulder pain, muscle activities of UT, LT, and SA, and LT/UT and SA/UT muscle activity ratios during maximal shoulder abduction were measured immediately after SR-CCFE. A paired t-test and Wilcoxon signed-rank test were used to determine the significance of differences in scores between pre- and post-intervention in the same group. Results: The CVA (p<.001) and shoulder abduction ROM (p<.001) were increased significantly postversus pre-intervention. Shoulder pain was decreased significantly (p<.001), and LT (p<.05) and SA (p<.05) muscle activities were increased significantly post- versus pre-intervention. The LT/UT muscle activity ratio was increased significantly post- versus pre-intervention (p<.05). However, there was no significant change in UT muscle activity and SA/UT muscle activity ratio between pre- and post-intervention (p..05). Conclusion: SR-CCFE was an effective intervention to improve FHP and induce downstream effect from the neck to the trunk and shoulders in subjects with FHP.

Introduction: One of the most common poor postures in the head and neck region is the forward head posture (FHP). It seems that improper posture for a long period of time causes abnormal physiological load on the neck. Thus, the result can be neck pain (NP). The aim of this study was to compare the relationship between intensity of FHP and a history as well as intensity of NP plus disability in the cervical region. Material and Methods: A total of 32 female students with FHP and history of mild NP participated in this study. The craniovertebral angle (CVA) was measured by taking photos via a digital camera in standing and sitting positions. Intensity of pain was investigated using the Visual Analog Scale (VAS) and the severity of disability was tested with Neck Disability Index (NDI). Results: The Pearson's correlation coefficient was used to investigate the association between the CVA, VAS, NDI, and duration of neck pain. There was a significant positive relationship between the CVA in standing and sitting positions along with a negative correlation between CVA in both standing and sitting positions and the intensity as well as history of NP and severity of disability. Conclusion: Proper postural habits can contribute to prevention of NP. Also, postural correction training in subjects with FHP and NP, in addition to pain decrement methods, can help to reduce pain and disability in these subjects.Keywords: Forward Head, Head Posture, Neck Pain, Neck Disability Index

The purpose of this study was to examine the effects of standing versus sitting body position on the craniovertebral angle (CVA) in young adults without pathology; and to investigate whether mean differences between positional CVA measures in subjects with severe forward head posture (FHP) are distinct from age-matched controls with normal head posture. Ninety-eight young adults (68 women, 30 men) without pathology (OVERALL; n = 98) volunteered for the study; those with CVA > 53° were also included in a normal posture group (NORM; n = 14); those with CVA < 45° were also included in a severe FHP group (SEV; n = 15). CVA assessments were conducted in standing and sitting. Mean difference comparison of change in mean CVA between conditions revealed significantly (p < 0.05) higher CVA values in standing condition (OVERALL: 50.0 ± 5.2°; NORM: 56.6 ± 2.7°; SEV: 41.2 ± 3.2°) compared to sitting condition (OVERALL: 47.8 ± 5.7°; NORM: 55.9 ± 2.8°; SEV: 39.0 ± 4.0°). Mean difference comparison of between-group change in mean CVA between conditions revealed greater CVA change (p < 0.05) in the SEV group (2.2 ± 2.1°) versus the NORM group (0.8 ± 1.2°). Sitting CVA values may be lower (indicating greater FHP) than standing CVA values in young adults. Differences between standing and sitting CVA measures may be greater in young adults with severe FHP compared to peers with normal head posture. Study findings support standing as a standardized body position for CVA assessment in young adults without pathology.

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.

Introduction: Forward head posture (FHP) is one of the most common positional deviations. Frequent users often exhibit incorrect posture because of the rising popularity of media devices, such as smartphones and computers. This posture leads to changes in muscle activity in cervical flexion and extension. It is defined by hyperextension of the upper cervical vertebrae and forward translation of the cervical vertebrae. This study evaluates the effect of dry needles as a new method in the upper trapezius muscle on the neck’s angles and range of motion (ROM) in individuals with FHP Materials and Methods: In this quasi-experimental interventional study, 18 women with FHP underwent a dry needle session. The photogrammetry of the cranio-vertebral angle measured the degree of FHP. Visual analog scale (VAS), pain pressure threshold (PPT), cranio-vertebral angle (CVA) and cranio-horizontal angles (CHA), ROM, scapular index (SI), and forward shoulder translation (FST) were assessed before and after the intervention. Results: The results demonstrated that after the intervention, right and left PPT, flexion, and proper neck rotation, right and left SI, CVA, and CHA were significantly improved (P&lt;0.05). Conclusion: The results showed that one session of dry needling with stretching exercises intervention could improve PPT, ROM, SI, CVA, and CHA and consequently improve FHP.