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Effects of Deep Cervical Flexor Exercise with Visual Guide on Muscle Activity and Craniovertebral Angle in Subjects with Forward Head Posture
J Korean Soc Phys Med 2019;14(2):53-61
Published online May 31, 2019;
© 2019 Journal of The Korean Society of Physical Medicine.

Kuk-kyung Son, PT. · Heon-Seock Cynn, PT, PhD · Ji-Hyun Lee, PT, PhD1 · Dong-Hwan Park, PT, MS · Bo-Been Kim, PT, MS

Department of Physical Therapy, Graduate School, Yonsei University,
1Department of Physical Therapy, Baekseok University
Received March 4, 2019; Revised March 4, 2019; Accepted March 13, 2019.
This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License ( which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.
PURPOSE: Forward head posture (FHP) is a head-on-trunk malalignment that results in musculoskeletal dysfunction and neck pain. To improve forward head posture, both the craniocervical flexion exercise (CCFE) and the visual guide (VG) technique have been used. This study compared the immediate effects of CCFE and VG combined with CCFE on craniovertebral angle (CVA), as well as on the activity of the sternocleidomastoid (SCM) and anterior scalene (AS) muscles during CCFE in subjects with FHP.
METHODS: Intotal, 16 subjects (nine males, seven females) with FHP were recruited using the G-power software. Each subject conducted CCFE and CCFE combined with VG in random order. The CVA was recorded using a digital camera and the ImageJ image analysis software. The EMG data of SCM and AS were measured by surface electromyography. A paired T-test was used to assess differences between the effects of the CCFE and VG combined with CCFE interventions in the same group.
RESULTS: The CVA was significantly greater for CCFE combined with the VG than for CCFE alone (p<.05). The activity of theSCM and AS muscles was also significantly greater when the VG was combined with CCFE than during CCFE alone across all craniocervical flexion exercise phases (p<.05).
CONCLUSION: Use of the VG technique combined with CCFE improved FHP in subjects with FHP compared to CCFE alone.
Keywords : Forward head posture, Craniocervical flexion exercise, Visual guide

May 2019, 14 (2)
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