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.

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