Title: Effect of forward head posture on postural stabilization measured by postural somatooscillography. Objectives: The aim of this thesis was to assess the influence of the forward head posture on the overall ability of postural stabilization using postural somatooscillography method. Methods: This thesis was prepared using analytical - comparative study. It compared two groups of fifteen subjects using the challenge test "3 steps - standing on one leg" in standart conditions. The measurement was recorded to the Microswing 6.0 and collected data was evaluated by Posturomed Commander. Results: The research did not achieve clear results at all, but in the overall assessment, we could say, that people with forward head posture have different, maybe slightly worse ability of postural stabilization. Keywords: postural stability, forward head posture, Posturomed, cervical spine

Backpacks are used by more than 90% of schoolchildren worldwide and over 40 million students in the United States on a regular basis. The carriage of loaded backpacks is associated with kinematic and physiological changes, as well as complaints of neck and back pain. Since a history of backpain in childhood is the strongest predictor of having musculoskeletal discomfort and back pain as an adult, development of back pain due to backpack use is of prognostic concern. The purpose of this dissertation was to examine the effects of backpack weights (up to 20% body weight (BW)) on children’s posture, subjective complaints of pain and perceived exertion, and walking endurance. A secondary goal was to examine the data to identify and recommend a weight limit for backpacks carried by elementary school children based on the results. In Chapter 2, we performed a preliminary study designed to examine the effects of loaded backpacks on forward head posture in school children. The results of this study found that forward head posture increased with both backpack weight and condition. The greatest differences were noted at the 15% and 20%BW backpack loads with initial loading, but after 6 minutes of walking the forward head posture was similar for all backpack loads. In Chapter 3, we conducted a study to evaluate multiple postural angles and the subjective complaints of pain and perceived exertion/fatigue in children to determine the effects of both the weight and time spent carrying loaded backpacks up to 20%BW. Subjects showed significant changes in all measures including the Six Minute Walk Test (6MWT), OMNI Walk/Run Scale of perceived exertion/fatigue and subjective complaints of pain, as well as the postural angles of Craniovertebral Angle, Forward Trunk Lean, and Pelvic Tilt. Subjects demonstrated immediate and significant changes in forward head posture, forward trunk lean, and pelvic tilt while wearing backpacks weighing 10%, 15% and 20%BW, but the 10%BW backpack resulted in the least amount of change. This study also found that these postural angles changed additionally after walking 6 minutes while carrying the loaded backpacks. Subjects also demonstrated decreased 6MWT distances and increased reports of perceived exertion and pain after carrying backpacks weighing 10%, 15% and 20%BW. In Chapter 4, we discussed the clinical implications of this research. It was determined that backpack loads weighing 10%, 15% and 20%BW of a child’s body weight result in immediate changes in posture, which continue to increase after walking six minutes with the loaded backpack. The backpack loads significantly impacted the children’s walking endurance as well as their reports of perceived exertion/fatigue and regional pain. This study found that of the loads tested, the 10%BW resulted in the least amount of change in all outcome measures. However, the 10%BW load was not innocuous, as it still created significant changes in posture and subjective complaints. Backpack weight limit guidelines need to be written to protect children from carrying backpacks weighing more than 10% body weight.

Purpose: 1, to determine effect of education and exercise on neck pain, disability, cervical posture and muscle function in office workers with sub-clinical neck symptoms; 2, to determine differences in forward head posture in preferred and standardized posture, and 3, to explore the influence of time on work posture in a sub-group of office workers. Subjects: Sixty-six office workers with sub-clinical neck symptoms who utilize computers at least 4 hours per day participated. A sub-group of 27 were videotaped to assess posture over a workday. Methods: Videotaping was performed 15 minutes of the first and last hour of the workday for analysis of the craniovertebral angle. Cervical posture using the CROM was measured on all subjects in standardized and preferred positioning of the trunk and lower extremities. Subjects were randomly assigned to one of three groups: education only (EOG), education and exercise (EEG), or control (CG). Pre and post-test measurements of pain (Visual Analog Scale), disability (NeckDisability Index), forward head posture (FHP), and deep cervical flexor muscle function (Craniocervical Flexion Test and Short Neck Flexor Endurance Test) were assessed for change within group as well as differences between groups over the 8 week period. Results: No difference was found for FHP over 8 hours in the subgroup. FHP was greater in preferred position compared to standardized by 7.59 mm (95% CI 6.27-8.92, p<.001). Median and mean scores improved for all 3 groups on pain and disability with greater improvement in intervention groups. FHP was unchanged/slightly worse in the CG and EOG, and improved in the EEG. Muscle function improved for the EEG. Statistical significance was not found for change scores between groups. Posttest scores were statistically significant for the NDI between EEG (20.45) and the CG (34.47), p=.042, and between the EEG and the EOG (34.59), p=.023 using Kruskall Wallis with adjusted significance for pairwise comparisons. Discussion/Conclusions: Posture over the workday did not change, differences were found based on preferred and standardized positions. Exercise and education intervention for those with sub-clinical neck symptoms show promise but did not demonstrate significance improvement over controls in this study.

Objective: A scoping review was employed to consolidate what is currently being studied and reported on concerning interactions with smartphone devices and correlated negative health-outcomes, specifically within the college student population. We are specifically concerned with this population due to the unique demands of technology use coupled with free time use of smartphone devices. Information such as study focus, study design, and summarized results are be provided within this compilation of available data. Results: The existing data findings are heavily skewed in favor of a positive correlation between smartphone use and negative health-outcomes. Sampling 17,069 total participants across 41 studies, which utilized 36 various tools and scales in at least 4 different study designs, only 2 articles found a lack of correlative evidence for negative health-outcomes within this population. Designs were commonly cross-sectional, which can only assign correlation and not causation. The top scales utilized were the Neck Disability Index (NDI), the Nordic Musculoskeletal Questionnaire (NMQ), and the Smartphone Addiction Scale (SAS-SV). Conclusions: Due to the variable nature of Smartphone use and lack of gold standard tools to clearly define, measure, and intervene in this area of study, goals to create and apply such standards are imperative in securing a high level of understanding to contribute towards an improved Health-Related Quality of Life for this population. Correlative findings are currently what has been found to be available. There is a critical lack of temporality within available work as a result. Causative findings are required to fully grasp and rectify the problems surrounding smartphone overuse. Note that the oldest article included was published in 2014 with a slow increase in volume of work leading into 2024, which is a positive trend in concern but is still not enough to fully understand the scope of risks involved.

Bakgrund Muskuloskeletala besvär i nacke och skuldra är vanligt förekommande arbetsrelaterade sjukdomar bland bildskärmsarbetare. Detta orsakar individuellt lidande med stora kostnader för samhället i storleksordningen 0.5% till 2% av ett lands BNP, men även för företag som utöver ökade omkostnader även riskerar sämre produktion och kvalitet. Det finns en oro att bildskärmsarbetande med progressiva glasögon arbetar med en ökad huvudextension och huvudprotraktion sk ”gamnacke”. Få jämförande studier har dock gjorts på HE respektive FHP vid användandet av progressiva glasögon, och ännu färre med subjekten i deras naturliga arbetsmiljö. Syfte – I denna studie undersöktes om det, i subjektens egen arbetsmiljö, föreligger ett samband mellan begreppet gamnacke och bildskärmsarbete vid användandet av progressiva glasögon avseende faktorerna FHP och HE jämfört med bildskärmsarbete utan progressiva glasögon. Subjekt –Datainsamlingen har skett på sju stycken olika företag i storstockholmsområdet under tidsperioden Mars-April 2017. Testgruppen bestod av 3 män och 7 kvinnor med en medelålder på 57,80 år (±8,18). Tid som de använt progressiva glasögon var 5,85 år (±5,59). kontrollgruppen bestod av 4 män och 6 kvinnor med en medelålder på 55,90 år (±3,60). Metod – Subjekten fotograferades med en smartphonekamera i ett stativ med horisontellt vattenpass, sittande vid sina skrivbord framför sina egna bildskärmar. Tre fotografier togs under 5 minuters tid på respektive subjekt. Subjekten var inte varse om exakt vid vilken tidpunkt fotografierna togs. En mobilapplikation användes för att ta ut vinklar för HE och FHP. Medelvärdena användes sedan för vidare analys med ett two-independent-sample test. Resultat – Testgruppens medelvärde för huvudets protraktion, TFHP var 42,20° (±7,15°). Testgruppens vinkel för mätning av huvudets extension, THE, hade medelvärdet 17,73° (±5,55°). Kontrollgruppens medelvärde för huvudets protraktion, KFHP var 40,87° (±7,53°). Kontrollgruppens medelvärde av huvudets extension, KHE var 11,53° (±7,42°). Korrelationen mellan progressiva glasögon och FHP var inte statistisk signifikant (p = 0,739), detta gällde även för korrelationen mellan progressiva glasögon och HE (p = 0,063). Konklusion – Resultatet av studien visade inget statistiskt signifikant samband gällande att bildskärmsarbetande i subjektetens naturliga arbetsmiljö med fullprogressiva glasögon hade en högre grad FHP eller HE än bildskärmsarbetande utan fullprogressiva glasögon i förhållande till lodlinjen respektive horisontallinjen, däremot sågs en tendens till en högre grad av HE hos gruppen med fullprogressiva glasögon i förhållande till horisontallinjen (p=0,063). / Introduction – Musculoskeletal disorders of the neck and shoulders are common occupational diseases among VDU operators. This causes individual suffering with high costs for society at around 0.5% to 2% of a countries GDP, as well as for companies, that besides high costs also risk a poorer production and quality. There is a concern that VDU operators with progressive lenses have an increased head extension and Forward head posture. However, Few comparative studies have been made on head extension and Forward head posture on subjects with progressive lenses and even fewer with subjects in their natural working environment. Aim – In this study, the aim was to, in the subjects own natural working environment, investigate whether there is a connection between the concept of poor posture in regards of FHP and HE, and VDU operators in the use of progressive lenses, compared to VDU operators without progressive lenses. Materials – The data was collected from seven different companies in the Greater Stockholm area during the period March-April 2017. The test group consisted of 3 men and 7 women with an average age of 57.80 years (± 8.18). The time spent using progressive lenses was 5.85 years (± 5.59). The control group consisted of 4 men and 6 women with an average age of 55.90 years (± 3.60). Method - The subjects were photographed with a smartphone on a leveled tripod, sitting at their own desks in front of their own monitors. Three photos were taken within 5 minutes on each subject. The subjects did not know exactly when the photographs were taken. A mobile application was used to extract angles for HE and FHP measurements. The mean values were then used for further analysis with a two-independent sample test. Results – The test group's mean head protrusion, TFHP was 42.20° (±7.15°). The test group's angle for measuring the head extension, THE, had an average of 17.73° (±5.55°). The control group's mean head protrusion, KFHP was 40.87° (±7.53°). The control group's mean of the head extension, KHE was 11.53° (±7.42°). The correlation between progressive lenses and FHP was not significant (p = 0.739), nor was the correlation between progressive lenses and HE significant (p = 0.063). Conclusion – The results of the study showed no statistically significant correlation that VDU operators in the subject's natural working environment with progressive lenses have a higher degree of FHP or HE than VDU operators without progressive lenses in relation to the vertical- and horizontal line respectively. On the other hand, they had a trend towards a higher HE than VDU operators without progressive lenses with a p-value of 0.063.

Dissertation submitted in partial compliance with the requirements for a Master's Degree in Technology: Chiropractic, Durban University of Technology, 2010. / Forward head posture (FHP) is a common postural abnormality, often associated with myofascial trigger points which can result in head and neck pain. The craniovertebral (CV) angle lies between a horizontal line running through C7 spinous process and a line connecting C7 spinous process to the tragus of the ear. The smaller the angle the greater the FHP. Cervical musculoskeletal abnormalities have often been linked to headache types, most especially episodic tension-type headache (ETTH) and cervicogenic headaches (CGH). Objectives: To determine whether an association exists between FHP, distance of the external auditory meatus (EAM) from the plumbline and cervical range of motion and the presentation of ETTH and CGH. Method: This was a quantitative comparative study (n=60) comparing three equal groups, one with ETTH, CGH and healthy controls. The FHP of the Subjects FHP was assessed by measuring the CV angle. A lateral digital photograph was taken to assess the distance of the external auditory meatus from the plumbline. Lastly, cervical range of motion was measured. The two symptomatic groups also received a headache diary for a fourteen day period monitoring frequency, intensity and duration of their headaches. Result: The two symptomatic groups had a smaller CV angle and a greater distance from the plumbline (p<0.05) than the asymptomatic group. The asymptomatic group had a significantly greater flexion (p=0.009), extension (p=0.038) and left rotation (p=0.018) range of motion than the two symptomatic groups. The CGH group had a significant positive correlation between the distance of the EAM from the plumbline and the intensity of headaches. The ETTH group had a significant positive correlation between the right craniovertebral angle and the mean duration of headaches. Conclusion: Therefore, it can be concluded that patients presenting with ETTH and/or CGH may have associated postural abnormalities that may act as a trigger or a contributory factor to the presenting headache. / Durban University of Technology

Dissertation submitted in partial compliance with the requirements for a Master's Degree in Technology: Chiropractic, Durban University of Technology, 2010. / Forward head posture (FHP) is a common postural abnormality, often associated with myofascial trigger points which can result in head and neck pain. The craniovertebral (CV) angle lies between a horizontal line running through C7 spinous process and a line connecting C7 spinous process to the tragus of the ear. The smaller the angle the greater the FHP. Cervical musculoskeletal abnormalities have often been linked to headache types, most especially episodic tension-type headache (ETTH) and cervicogenic headaches (CGH). Objectives: To determine whether an association exists between FHP, distance of the external auditory meatus (EAM) from the plumbline and cervical range of motion and the presentation of ETTH and CGH. Method: This was a quantitative comparative study (n=60) comparing three equal groups, one with ETTH, CGH and healthy controls. The FHP of the Subjects FHP was assessed by measuring the CV angle. A lateral digital photograph was taken to assess the distance of the external auditory meatus from the plumbline. Lastly, cervical range of motion was measured. The two symptomatic groups also received a headache diary for a fourteen day period monitoring frequency, intensity and duration of their headaches. Result: The two symptomatic groups had a smaller CV angle and a greater distance from the plumbline (p<0.05) than the asymptomatic group. The asymptomatic group had a significantly greater flexion (p=0.009), extension (p=0.038) and left rotation (p=0.018) range of motion than the two symptomatic groups. The CGH group had a significant positive correlation between the distance of the EAM from the plumbline and the intensity of headaches. The ETTH group had a significant positive correlation between the right craniovertebral angle and the mean duration of headaches. Conclusion: Therefore, it can be concluded that patients presenting with ETTH and/or CGH may have associated postural abnormalities that may act as a trigger or a contributory factor to the presenting headache. / Durban University of Technology / M

Stillasittande arbete och medföljande dålig hållning har kommit att bli ett stort problem i samhället. Framskjutet huvud, så kallad FHP (Forward Head Posture), är ett vanligt exempel på dålig hållning som har starka kopplingar till nacksmärta. Produkten FixaSpine är ett smarthalsband vars funktion är att komma till rätta med problemen genom att påminna användaren att räta upp sin hållning. Då produkten i dagsläget är i prototypstadiet behöver en stor mängd testning göras för att utveckla sensorteknologi och mjukvara. För att kunna testa prototyper på ett kontrollerat sätt uppstår behovet av en testanordning. Olika grad av FHP och hopsjunken rygg behöver kunna återskapas och det behöver kunna ske upprepade gånger med precision. Testanordningen bör även kunna utföra en störningsrörelse som Fixaspine ska kunna ignorera. Arbetets syfte är att möjliggöra en systematiserad testning och utveckling av FixaSpines sensorteknologi och funktionalitet, genom att ta fram en mekanisk testanordning som kan simulera dåliga hållningar samt en störningsrörelse. Genom att kartlägga olika positioner och rörelsemönster vid dålig hållning tas ett underlag fram för en mekanisk testanordning. Koncept utarbetas, beräkningar för drivning och motorer utförs, och slutligen görs konstruktion och detaljutveckling. Den resulterande testanordningen kan inta positioner som efterliknar olika grad av framskjutet huvud, som mest motsvarande en hög grad av FHP (CVA 22°). Den kan även efterlikna olika grad av hopsjunken rygg som motsvarar en rotation av bröst korgen på mer än 15°. Anordningen kan lutas framåt mer än 30° för att utföra en störningsrörelse. Dessutom kan den åstadkomma en kombination av ovan positioner och rörelser. Anordningen drivs av linjära ställdon som kan programmeras efter behov. Genom att använda testanordningen som utvecklingsredskap kan felvariabler och brus som testning på människor annars medför undvikas. På så vis underlättar testanordningen utvecklingen av FixaSpine och bidrar i förlängningen till minskad nacksmärta. / The prevalence of poor posture as a consequence of sedentary work has become a major issue in today’s society. A common example of poor posture is the so-called Forward Head Posture (FHP), which has strong associations with neck pain. FixaSpine is a smart necklace attempting to correct these problems by reminding its users to improve their posture when necessary. As the product is currently in the prototyping stage, thorough testing has to be conducted so that its software and sensor technology can be further developed. However, testing prototypes in a controlled manner has proven difficult. Hence, there is a need for a test apparatus able to simulate poor posture repeatedly and with precision. This device should be able to achieve various degrees of FHP and hunched back. Furthermore, it should also be able to perform a disruptive movement that Fixaspine ought to ignore.  The purpose of the project is to facilitate the systematized testing and development of FixaSpine’s sensor technology and functionality, by developing a mechanical test device. By analyzing lateral photographs of poor postures, positions and movement patterns are mapped, and the prerequisites for a mechanical test device determined. Concepts are drawn up, calculations for motor loads are carried out, and the final design and mechanical construction developed.  The resulting test device can simulate positions with varying degrees of Forward Head Posture. It is capable of achieving a high degree of FHP (CVA 22°). The device can simulate different degrees of hunched back equivalent to a thorax rotation of more than 15°. In addition, the device can be tilted forward more than 30°, performing a disruptive movement. Furthermore, it can perform a combination of these positions and movements. The device is powered by linear actuators that can be programmed as needed. Using it as a development tool minimizes error variables and noise otherwise prevalent when testing on humans. Subsequently, this test device is able to facilitate the development of FixaSpine and ultimately contribute to reducing neck pain.