Journal of

Modern Rehabilitation April 2017, Volume 11, Number 2

Research Paper: Efects of 4 Week Potural Corrective

Exercise on Correcting Forward Head Poture
Zahra Abdollahzade1, Azade Shadmehr2*, Kazem Malmir3, Nataran Ghotbi4

1. MSc. Student, Department of Physical Therapy, School of Rehabilitation, Tehran University of Medical Sciences, Tehran, Iran.
2. Professor, Department of Physical Therapy, School of Rehabilitation, Tehran University of Medical Sciences, Tehran, Iran.
3. Assitant Professor, Department of Physical Therapy, School of Rehabilitation, Tehran University of Medical Sciences, Tehran, Iran.
4. Associate Professor, Department of Physical Therapy, School of Rehabilitation, Tehran University of Medical Sciences, Tehran, Iran.

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Citation: Abdollahzade Z, Shadmehr A, Malmir K, Ghotbi N. Efects of 4 Week Potural Corrective Exercise on Correcting
Forward Head Poture. Journal of Modern Rehabilitation. 2017; 11(2):85-92.
: :

Article info: ABSTRACT

Received: 16 Nov. 2016
Accepted: 23 Feb. 2017 Introduction: This tudy aimed to assess the efects of 4-week potural corrective exercise
program on forward head poture in college-aged females.
Materials and Methods: This is a randomized controlled tudy. Twenty-one female tudents
with craniovertebral angle measured less than or equal to 50 degrees were selected and randomly
assigned to intervention (n=12) or control (n=9) group. Intervention group performed forward
head poture corrective exercises in the form of tretching and trengthening exercises. The
craniovertebral angle, active neck lexion range of motion and trength of lower and middle
trapezius were measured before and after 4 weeks exercise program.
Results: After four weeks, signiicant increases were observed in the intervention group
regarding the means of craniovertebral angle (P=0.0001), active neck lexion range of motion
(P=0.04) and lower trapezius trength (P=0.03), while the mean trength of middle trapezius
Keywords: had not changed signiicantly (P>0.05).
Forward head poture, Conclusion: Four week intervention protocol successfully improved potural alignment
Corrective exercise, related to forward head poture. Thus, corrective exercise program for 4 weeks is efective to
Craniovertebral angle decrease forward head poture.

1. Introduction [4]. According to Sahrman [5, 6], the leat train is im-

F
posed on the musculoskeletal sytem in an ideal poture.
orward Head Poture (FHP) is anterior Normal tresses to the muscles and joints can decrease
positioning of the head relative to the line acute and chronic musculoskeletal pain and discomfort.
of gravity in the sagittal plane [1], which
results from habitual potures adopted The imposed loads on the muscles and joints of the
over time [2]. It is frequently observed cervical spine due to this potural misalignment of the
in individuals working with a computer for prolonged head on the trunk may result in various musculoskel-
periods [3]. FHP has been considered as a “bad” poture etal disorders [7]. FHP has been linked to complaints

* Corresponding Author:
Azade Shadmehr, PhD
Address: Department of Physical Therapy, School of Rehabilitation, Tehran University of Medical Sciences, Tehran, Iran.
Tel: +98 (21) 77528468
E-mail: [email protected]

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of pain in neck and shoulder region [8-11], fatigue and performed by a person who blindly picked up numbers
retricted movement of neck [12, 13], reduced proprio- from sealed envelopes containing numbers. All partici-
ception [14] and temporomandibular joint dysfunction pants were recruited from Augut 2015 to October 2016.
[15, 16]. FHP is also found in asymptomatic people [17- They were briefed about the procedures and signed an
19]. In addition, this poture is associated with weakness inform consent form approved by the Ethics Committee
of deep cervical short lexors and mid-thoracic scapular of our Intitutional Review Board.
retractors (such as middle and lower trapezius) as well as
shortness of the opposing cervical extensors and pecto- Postural alignment assessment
ralis muscles [1, 17, 18, 20].
The mot common way to objectively assess the FHP
For correcting FHP, trengthening and tretching ex- is measuring the CV angle [1, 29-32]. This angle is con-
ercises can be used. This exercise which can address sidered to be a valid and reliable evaluation tool [33]. It
the imbalances of the underlying soft tissues, consits is measured in the sagittal plane formed by intersection
of tretching the cervical and pectoral muscles and of an imagery horizontal line drawn through the spinous
trengthening the deep cervical lexor and shoulder re- process of the C7 and a line drawn from the tragus of
tractor muscles. This management approach has been the ear to the C7 (Figure 1); Yib et al. (2008) reported an
advocated to improve potural alignment [18, 21, 22]. average value of 55.02±2.86 degrees for this angle [28].
Previous tudies have supported improvement of FHP The more anterior position of the head, the smaller value
after such an intervention protocol [23]. However, these of the angle [34].
tudies have considered a long duration (8-32 weeks) of
corrective exercises [2, 23-27]. The present tudy chose For measuring the angle, the relective markers were
a 4-week intervention program, to invetigate if using placed on the tragus of the ear and spinous process of
shorter duration of intervention is efective to have simi- the C7. The participant was asked to tand and main-
lar changes. To the bet of our knowledge, no tudy has tain her usual upright poture with her arms reting at the
yet considered the efects of four weeks exercise training sides, and looking traight ahead. The photos were cap-
on multiple aspects of FHP. tured by a digital camera (Samsung Galaxy S4) from the
dominant side of the upper extremities. The camera was
The present tudy aimed to evaluate the efects of a positioned on a tripod 50 cm away from the participant.
4-week exercise program on musculoskeletal param- The axis of the lens of the camera was placed orthogo-
eters, including Craniovertebral (CV) angle, the trength nal to the sagittal plane of the participant at the level of
of lower and middle trapezius muscles, and active neck the shoulder. The photos were taken repeatedly so that
lexion Range of Motion (ROM) associated with FHP. We the participant was not exactly aware of the actual time
hypothesized that four weeks exercise training is adequate of photography. The CV angle was calculated by image
for improving above measurements in the FHP patients. J; 1.48 (Rasband, USA). If this angle was less than 50
degrees, the subject would be included in the tudy [28].
2. Materials and Methods
Strength assessment
The current tudy used a randomized, controlled trial
design. Thirty female tudents with FHP (20 to 28 years The isometric trength of the lower and middle trape-
old) recruited conveniently from School of Rehabilita- zius muscles of the dominant side was measured by a
tion of TUMS and were evaluated with photogramme- dynamometer (Multi Analyzer, MIE Medical Research
try. They were screened before inclusion by measuring LTD, England). Isometric trength tets performed in
the CV angle. If the angle was less than 50 degrees, the the tandard position as described by Kendall [18]. The
participant would be included [28]. The participants participant was given intructions regarding the teting
who had previous shoulder surgery, scoliosis, cervical or procedure. Before the main tet, participants got famil-
thoracic fracture, and chronic or acute diseases such as iarized with the tet by performing one submaximal and
metabolic, neural or heart disease were excluded. The one maximal isometric contraction. After 2 minutes ret,
participants, who missed the intervention exercises more the participant performed three maximum isometric con-
than one session, were excluded. tractions for each muscle.

Considering these criteria, a total of 21 participants They maintained each maximum contraction for 5 sec-
were included and randomly allocated into intervention onds. Thirty seconds ret was allowed between successive
(n=12) and control group (n=9). Randomization was contractions of each muscle. Also, one minute ret was

Abdollahzade Z, et al. Efects of 4 Week Potural Corrective Exercise on Correcting Forward Head Poture. JMR. 2017; 11(2):85-92.
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formed and the average was considered for analyses.

All measures, including poture alignment, trength and
ROM were assessed for both groups before and four
weeks after intervention.

Intervention protocol

The participants in the intervention group received a

potural corrective exercise program consiting of two
trengthening (deep cervical lexor and shoulder retrac-
tor muscles) and two tretching (pectoral and ternoclei-
domatoid muscles) exercises (Table 1). These exercises
were selected based on the assumption that performing
therapeutic exercise is efective in the correction of the
neck and shoulder potures [24, 26, 36, 37]. The par-
ticipants were given a lit of exercises and descriptions
(with illutration) for each exercise. They were asked
Figure 1. Craniovertebral angle (the angle between horizon- to perform three sets daily, 12 repetitions in each set as
tal and the tragus to C7 line)
trengthening exercises, and two tretching exercises
each held for 30 seconds.
considered between the tets of each muscle. The maxi-
mum value of the recorded forces during three trials was
A 30-second ret was considered between succes-
considered as the measure of trength for each muscle.
sive exercises. The intervention protocol lated for four
Range of motion assessment weeks and was repeated four times per week. Every
session of the intervention program took 20 minutes
The active neck lexion ROM was measured by using on average. Participants in both groups were asked to
a goniometer (Lafayette Gollehon Extendable Goniom- avoid any other intervention that could interfere with the
eter, Model 01135, USA). Goniometry was done by the results. The participants in the intervention group were
technique described by Norkin and White [35]. In this called at the end of each week to check for performing
method, the participant sits on a chair in a usual manner the exercises, supervision and guidance. Participants in
while his or her feet are on the ground. Before the tet, the control group did not receive any intervention for
she was given intructions about the tet and asked to poture correction; however, they were intructed to car-
perform an active neck lexion. Three trials were per-

Table 1. Strengthening and stretching exercises used during four weeks training program

Exercise Descripion

The paricipant is asked to chin tuck in the supine posiion with the head in contact with the loor,
1. Chin tuck keep the head straight and hold it for 6 seconds and relax, then repeat the exercise. This exercise
improves the funcion of deep lexor muscles of the upper cervical region.

This exercise is done in the standing posiion by using a thera-band pulling the shoulders back. The
2. Strengthening shoulder
paricipant is instructed to retract and pinch scapula together without elevaion or extension in the
retractors
shoulders and hold this posiion for 6 seconds and then relax.

The paricipant is posiioned in opimal posture and asked to place let arm behind the body and
3. Stretching of sternocleido- depress the shoulder, tuck chin and slowly draw her right ear to the right shoulder, also is asked to
mastoid muscle rotate her neck upward toward the ceiling unil a slight stretch is felt on the let side; she should hold
this posiion for 30 seconds then relax and repeat it for the opposite side.

The paricipant is asked to stand, hold a piece of wood and place it behind her neck while her
4. Pectoralis stretch scapula is pinched and her elbow is in 90 degrees lexion unil a slight stretch is felt in front of the
chest. She should hold this posiion for 30 seconds and then relax.

Abdollahzade Z, et al. Efects of 4 Week Potural Corrective Exercise on Correcting Forward Head Poture. JMR. 2017; 11(2):85-92
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ry on their regular activities and were called at the end of no signiicant diference between two groups before the
each week to check their activities. intervention for the mean of age, weight, height or CV
angle, as well as trength and neck lex ROM.
Statistical analysis
The results are summarized in Table 3. Accordingly, in
All tatitical analyses were performed by SPSS v.22 the intervention group, paired t tet analysis revealed sig-
(SPSS Inc, Chicago, IL, USA). For each variable, the niicant diferences between pretet to pottet for means
mean and tandard deviation were calculated. Signii- of CV angle (P=0.0001), ROM (P=0.04) and lower trape-
cant level was set at 0.05. The Kolmogorov-Smirnov tet zius trength (P=0.03). However, there was not any sig-
showed the normality of data ditribution. Paired sample niicant change in the mean of middle trapezius trength
t tets were used to compare the means of CV angle, mus- (P>0.05). In the control group, the results of analysis
cle trength and active neck lexion ROM before and four revealed no signiicant change after four weeks for the
weeks after the intervention in each group. Independent mean of CV angle (P=0.16), ROM (P=0.34), lower tra-
sample t tets were used for comparing means of demo- pezius trength (P=0.72) and middle trapezius trength
graphic values and other variables between two groups. (P=0.5). However independent sample t tet showed sig-
niicant change in the means of CV angle, trength and
3. Results ROM between intervention and control groups at pot-
tet. The intervention group presented with an increase
In the present tudy, 12 tudents in the experimental in the means of CV angle (P=0.0001), lower trapezius
group and 9 tudents in the control group were assessed. trength (P=0.01), middle trapezius trength (P=0.007)
Demographic data of both groups are presented in Table
2. The results of the independent sample t tets showed

Table 2. Mean±SD for demographic data, CV angle, as well as strength and lex neck ROM of participants at the beginning of study

Intervenion Group (n=12) Control Group (n=9) P-value

Age (year),mean±SD 23.58±2.6 23.22±1.9 0.73

Weight (Kg), mean±SD 61.6±7.73 60.22±5.4 0.65

Height (cm), mean±SD 165.4±6.99 163.6±5.71 0.53

CV angle (deg), mean±S 46.21±2.93 44.42±2.98 0.18

Lower trapezius (N), mean±SD 17.5±3.35 15.22±8.56 0.30

Middle trapezius (N), mean±SD 17.75±9.48 14.33±3.12 0.07

ROM (deg) 37.25±7.07 38.11±5.48 0.18

Abbreviations: SD: Standard Deviation; CV: Craniovertebral; ROM: Range of Motion

Table 3. Means±SD of study variables in control and intervention group, pretest and posttest

Control Group (n=9) Intervenion Group (n=12)

Pre-test Post-test p-value Pre-test Post-test p-value

CV angle (deg) 44.42±2.98 45.04±2.33 0.16 46.21±2.93 51.12±2.72 0.0001*

ROM (deg) 38.11±5.48 37.88±5.25 0.34 37.25±7.07 43.16±2.4 0.04*

Lower trapezius (N) 15.22±8.56 15.11±8.44 0.72 17.5±3.35 28.83±7.14 0.03*

Middle trapezius (N) 14.33±3.12 14.66±2.59 0.5 17.75±9.48 24.08±9.71 0.07

* P<0.05 is signiicant.

Abbreviations: SD: Standard Deviation; CV: Craniovertebral; ROM: Range of Motion

Abdollahzade Z, et al. Efects of 4 Week Potural Corrective Exercise on Correcting Forward Head Poture. JMR. 2017; 11(2):85-92.
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and ROM (P=0.006) following exercise program com- and tretching exercises during a 32-week period was
pared with control group. beneicial in decreasing FHP in adolescents [23].

4. Discussion Lynch et al. (2012) reported improvement in FHP dur-

ing eight weeks tretching and trengthening program.
The present tudy invetigated whether or not a four- They also reported an increase in the trength of shoulder
week exercise protocol with shorter duration (compar- girdle muscles in both groups (control and intervention
ing with previous exercise programs) can signiicantly groups), but no diferences were observed in the trength
improve FHP. Findings indicated that the intervention measures of the intervention group compared with the
program signiicantly increased CV angle, neck active control group after training. The results of their tudy
lexion ROM and lower trapezius muscle trength. How- may be due to exercise program that was not challenging
ever, there was no signiicant change in middle trapezius enough for highly trained swimmers [24]. In contrat,
muscle trength after training. The results revealed an Wang and Colleagues (1999) reported an increase in the
increase in CV angle for both groups although it was not trength of periscapular muscles after eight weeks exer-
tatitically signiicant in the control group. This trend cise intervention. They incorporated a resitance tubing
may be due to potural awareness. Potural awareness for trengthening program [38].
of the control group was developed because all partici-
pants were acknowledged about FHP. This awareness Resitance tubing was used in the current tudy and the
may have afected the control sytem, so that potural results showed an increase in the trength of the lower
awareness may inluence the habitual potures. There- trapezius after four weeks exercise program in the inter-
fore, the control sytem should be considered in potural vention group. As mentioned, no signiicant change was
re-education programs [2]. observed in the trength of the middle trapezius in the in-
tervention group after four weeks. This was a borderline
FHP is associated with weakness in the deep cervi- measure, so if the sample size was bigger it may show a
cal short lexors and mid-thoracic scapular retractors, diference between the two groups. However, this tudy
and shortness of the cervical extensors and pectoralis has some limitations which can be corrected in future
muscles [17, 18, 20]. FHP can be corrected by retoring tudies. In the present tudy, only college-aged females
the normal muscle balance between agonit and antago- were assessed, so the results cannot be generalized to
nit muscles [23] .In the present tudy, an intervention other age and sex groups. Also, the long-term efects of
protocol as a form of two trengthening (deep cervical the exercise was not determined.
lexors and shoulder retractors) and two tretching (pec-
toral muscles and ternocleidomatoid) exercises was Our indings indicate that a 4-week exercise interven-
designed. The intervention program was performed four tion (performed four times per week) improved potural
times per week for four weeks. In the present tudy, a parameters, including CV angle, active neck lexion
shorter treatment period (compared to previous tudies) ROM and lower trapezius muscle trength in the females
was found to be efective in correction of the FHP. For with FHP. Therefore, a 4-week tretching and trength-
example, Harman et al. (2005) showed that a 10-week ening exercises seems enough for correcting FHP and
exercise program consited of two trengthening (deep improving neck ROM and muscle trength.
cervical lexors and shoulder retractors) and two tretch-
ing (cervical extensors and pectoral muscles) exercises Acknowledgements
can improve potural alignment related to FHP.
This tudy was inancially supported by School of Re-
They measured cervical ROM and reported that ex- habilitation, Tehran University of Medical Sciences as
ercise program can result in signiicant improvement part of a MSc. thesis (Efects of potural corrective exer-
of cervical ROM. One of the exercises that targeted cise on musculoskeletal and neurocognitive parameters
the movement is chin tuck [2]. In the current tudy, we in female with forward head poture).The authors would
achieved similar therapeutic efect; as our results indi- like to thank the volunteers participated in the tudy.
cated that exercise program can improve cervical ROM.
Diab et al. (2012) in two tudies reported that a 10-week Conlict of Interet
tretching and trengthening exercises was successful at
correcting the FHP [25, 26]. Ruivo et al. (2015) demon- The authors declared no conlicts of interet.
trated that targeted exercise program with trengthening

Abdollahzade Z, et al. Efects of 4 Week Potural Corrective Exercise on Correcting Forward Head Poture. JMR. 2017; 11(2):85-92
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References [16] Makofsky HW. The inluence of forward head pos-

ture on dental occlusion. Cranio. 2000; 18(1):30–9. doi:
[1] Braun BL, Amundson LR. Quantitative assessment of head 10.1080/08869634.2000.11746111
and shoulder posture. Archives of Physical Medicine and Re-
habilitation. 1989; 70(4):322-9. PMID: 2930348 [17] Darling DW, Kraus S, Glasheen Wray MB. Relation-
ship of head posture and the rest position of the mandible.
[2] Harman K, Hubley Kozey CL, Butler H. Effectiveness of an The Journal of Prosthetic Dentistry. 1984; 52(1):111–5. doi:
exercise program to improve forward head posture in nor- 10.1016/0022-3913(84)90192-6
mal adults: A randomized, controlled 10-week trial. Journal
of Manual & Manipulative Therapy. 2005; 13(3):163–76. doi: [18] Kendall FP, McCreary EK, Kendall HO. Muscles: Testing
10.1179/106698105790824888 and function. Philadelphia: Lippincott Williams and Wilkins;
1983.
[3] Kim SY, Kim NS, Kim LJ. Effects of cervical sustained
natural apophyseal glide on forward head posture and res- [19] Capuano Pucci D, Rheault W, Aukai J, Bracke M, Day R,
piratory function. Journal of Physical Therapy Science. 2015; Pastrick M. Intratester and intertester reliability of the cervical
27(6):1851–4. doi: 10.1589/jpts.27.1851 range of motion device. Archives of Physical Medicine and
Rehabilitation. 1991; 72(5):338-40. PMID: 2009054
[4] Good M, Stiller C, Zauszniewski JA, Anderson GC, Stanton-
Hicks M, Grass JA. Sensation and distress of pain scales: Reli- [20] McKenzie R. Treat your own neck. New Zealand: Spinal
ability, validity, and sensitivity. Journal of Nursing Measure- Publications; 1983.
ment. 2001; 9(3):219-38. PMID: 11881266
[21] Jull GA, Janda V. Muscles and motor control in low back
[5] Sahrmann SA. Posture and muscle imbalance: Faulty lum- pain: Assessment and Management, Physical Therapy of the
bar-pelvic alignment and associated musculoskeletal pain Low Back. New York: Churchill Livingstone. 1987.
syndromes. Ontario: Orthopaedic Division Review; 1992.
[22] Latham JM, Fraser RD, Moore RJ, Blumbergs PC, Bogduk
[6] Sahrmann S. Diagnosis and treatment of movement impair- N. The pathologic effects of intrathecal betamethasone. Spine.
ment syndromes. Amsterdam: Elsevier Health Sciences; 2002. 1997; 22(14):1558–62. doi: 10.1097/00007632-199707150-00004

[7] Szeto GP, Straker L, Raine S. A ield comparison of neck [23] Ruivo RM, Carita AI, Pezarat Correia P. The effects of train-
and shoulder postures in symptomatic and asymptomatic ing and detraining after an 8 month resistance and stretching
ofice workers. Applied Ergonomics. 2002; 33(1):75–84. doi: training program on forward head and protracted shoulder
10.1016/s0003-6870(01)00043-6 postures in adolescents: Randomised controlled study. Man-
ual Therapy. 2016; 21:76–82. doi: 10.1016/j.math.2015.05.001
[8] Harms Ringdahl K, Schüldt K, Ekholm J. Principles of pre-
vention of neck-and-shoulder pain. Scandinavian Journal of [24] Lynch SS, Thigpen CA, Mihalik JP, Prentice WE, Padua
Rehabilitation Medicine. 1994; 32:87-96. PMID: 3616526 D. The effects of an exercise intervention on forward head
and rounded shoulder postures in elite swimmers. British
[9] Bogduk N. The anatomical basis for spinal pain syndromes. Journal of Sports Medicine. 2010; 44(5):376–81. doi: 10.1136/
Journal of Manipulative and Physiological Therapeutics. bjsm.2009.066837
1995; 18(9):603-5. PMID: 8775022
[25] Diab AA. The role of forward head correction in manage-
[10] Langford ML. Poor posture subjects a worker's body to ment of adolescent idiopathic scoliotic patients: A randomized
muscle imbalance, nerve compression. Occupational Health controlled trial. Clinical Rehabilitation. 2012; 26(12):1123–32.
& Safety (Waco, Tex.). 1994; 63(9):38-40. PMID: 9156441 doi: 10.1177/0269215512447085

[11] Moore PV, Winzeler S, Rosenstein BD. Orthopedic prob- [26] Diab AA, Moustafa IM. The eficacy of forward head cor-
lems of the upper extremities: Assessment and diagnosis. rection on nerve root function and pain in cervical spondylot-
AAOHN Journal. 1997; 45(4):188-203. PMID: 9155269 ic radiculopathy: A randomized trial. Clinical Rehabilitation.
2011; 26(4):351–61. doi: 10.1177/0269215511419536
[12] Baldry P. Myofascial pain and ibromyalgia syndromes:
A clinical guide to diagnosis and management. London: [27] Moustafa IM, Diab AA. The effect of adding forward head
Churchill Livingstone; 2001. posture corrective exercises in the management of lumbosa-
cral radiculopathy: A randomized controlled study. Jour-
[13] Griegel Morris P, Larson K, Mueller Klaus K, Oatis CA. nal of Manipulative and Physiological Therapeutics. 2015;
Incidence of common postural abnormalities in the cervical, 38(3):167–78. doi: 10.1016/j.jmpt.2014.11.009
shoulder, and thoracic regions and their association with pain
in two age groups of healthy subjects. Physical Therapy. 1992; [28] Yip CHT, Chiu TTW, Poon ATK. The relationship between
72(6):425–31. doi: 10.1093/ptj/72.6.425 head posture and severity and disability of patients with neck
pain. Manual Therapy. 2008; 13(2):148–54. doi: 10.1016/j.
[14] Lee MY, Lee HY, Yong MS. Characteristics of cervical posi- math.2006.11.002
tion sense in subjects with forward head posture. Journal of
Physical Therapy Science. 2014; 26(11):1741–3. doi: 10.1589/ [29] Garrett TR, Youdas JW, Madson TJ. Reliability of measur-
jpts.26.1741 ing forward head posture in a clinical setting. Journal of Or-
thopaedic & Sports Physical Therapy. 1993; 17(3):155–60. doi:
[15] Lee WY, Okeson JP, Lindroth J. The relationship between 10.2519/jospt.1993.17.3.155
forward head posture and temporomandibular disorders.
Journal of Orofacial Pain. 1995; 9(2):161-7. PMID: 7488986 [30] Greenield B, Catlin PA, Coats PW, Green E, McDonald
JJ, North C. Posture in patients with shoulder overuse in-
juries and healthy individuals. Journal of Orthopaedic &

Abdollahzade Z, et al. Efects of 4 Week Potural Corrective Exercise on Correcting Forward Head Poture. JMR. 2017; 11(2):85-92.
90
Journal of
Modern Rehabilitation April 2017, Volume 11, Number 2

Sports Physical Therapy. 1995; 21(5):287–95. doi: 10.2519/

jospt.1995.21.5.287

[31] Grimmer K. An investigation of poor cervical resting pos-

ture. Australian Journal of Physiotherapy. 1997; 43(1):7–16.
doi: 10.1016/s0004-9514(14)60398-6

[32] Lewis JS, Green A, Wright C. Subacromial impingement

syndrome: The role of posture and muscle imbalance. Jour-
nal of Shoulder and Elbow Surgery. 2005; 14(4):385–92. doi:
10.1016/j.jse.2004.08.007

[33] Talavera Carbajal MR, Estanol Vidal B, Lopez Lomeli MM,

Garcia Ramos G, Corona V, Plascencia N, et al. Monitoring
dermatomal somatosensory evoked potentials at the ERB
point, the cervical spinal cord and the cerebral cortex in the
diagnosis of cervical radiculopathy. Revista de Neurologia.
2003; 36(10):917-24. PMID: 12766863

[34] Raine S, Twomey LT. Head and shoulder posture vari-

ations in 160 asymptomatic women and men. Archives of
Physical Medicine and Rehabilitation. 1997; 78(11):1215–23.
doi: 10.1016/s0003-9993(97)90335-x

[35] Norkin CC, White DJ. Measurement of joint motion: A

guide to goniometry. Philadelphia: F.A. Davis Company;
2016.

[36] Benedetti M, Berti L, Presti C, Frizziero A, Giannini S. Ef-

fects of an adapted physical activity program in a group of
elderly subjects with lexed posture: clinical and instrumental
assessment. Journal of NeuroEngineering and Rehabilitation.
2008; 5(1):32. doi: 10.1186/1743-0003-5-32

[37] Chiu TT, Ku WY, Lee MH, Sum WK, Wan MP, Wong CY,
Yuen CK. A study on the prevalence of and risk factors for
neck pain among university academic staff in Hong Kong.
Journal of Occupational Rehabilitation. 2002; 12(2):77-91.
PMID: 12014228

[38] Wang CH, McClure P, Pratt NE, Nobilini R. Stretching

and strengthening exercises: Their effect on three dimen-
sional scapular kinematics. Archives of Physical Medicine
and Rehabilitation. 1999; 80(8):923–9. doi: 10.1016/s0003-
9993(99)90084-9

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