Effects of suboccipital release with craniocervical flexion exercise on craniocervical alignment and extrinsic cervical muscle activity in subjects with forward head posture.
BACKGROUND
Forward head posture is a head-on-trunk malalignment, which results in musculoskeletal dysfunction and neck pain. To improve forward head posture, both the craniocervical flexion exercise and the suboccipital release technique have been used.


OBJECTIVE
The purpose of this study was to compare the immediate effects of craniocervical flexion exercise and suboccipital release combined with craniocervical flexion exercise on craniovertebral angle, cervical flexion and extension range of motion, and the muscle activities of the sternocleidomastoid, anterior scalene, and splenius capitis during craniocervical flexion exercise in subjects with forward head posture.


METHODS
In total, 19 subjects (7 males, 12 females) with forward head posture were recruited using G-power software. Each subject performed craniocervical flexion exercise and suboccipital release combined with craniocervical flexion exercise in random order. After one intervention was performed, the subject took a 20min wash out period to minimize any carry-over effect between interventions. Craniovertebral angle, cervical flexion and extension range of motion, and the muscle activities of the sternocleidomastoid, anterior scalene, and splenius capitis were measured. A one-way, repeated-measures ANOVA was used to assess differences between the effects of the craniocervical flexion exercise and suboccipital release combined with craniocervical flexion exercise interventions in the same group.


RESULTS
Craniovertebral angle (p<0.05), cervical flexion range of motion (p<0.05), and cervical extension range of motion (p<0.001) were significantly greater after suboccipital release combined with craniocervical flexion exercise compared to craniocervical flexion exercise alone. The muscle activities of the sternocleidomastoid, anterior scalene, and splenius capitis were significantly lower during suboccipital release combined with craniocervical flexion exercise than during craniocervical flexion exercise alone across all craniocervical flexion exercise phases except the first (all p<0.05).


CONCLUSIONS
The addition of suboccipital release to craniocervical flexion exercise provided superior benefits relative to craniocervical flexion exercise alone as an intervention for subjects with forward head posture.
Applied Kinesiology and Ergonomic Technology Laboratory, Department of Physical Therapy, The Graduate School, Yonsei University, South Korea. Electronic address: saminchu@naver.com.
Bo-Been
BB
Kim
Applied Kinesiology and Ergonomic Technology Laboratory, Department of Physical Therapy, The Graduate School, Yonsei University, South Korea. Electronic address: rapa60@naver.com.
Ji-Hyun
JH
Lee
Applied Kinesiology and Ergonomic Technology Laboratory, Department of Physical Therapy, The Graduate School, Yonsei University, South Korea. Electronic address: phyot@naver.com.
Hyo-Jung
HJ
Jeong
Applied Kinesiology and Ergonomic Technology Laboratory, Department of Physical Therapy, The Graduate School, Yonsei University, South Korea. Electronic address: cynn@yonsei.ac.kr.
Heon-Seock
HS
Cynn
D002574:Cervical Vertebrae / Q000502:physiology*; D003430:Cross-Sectional Studies; D015444:Exercise / Q000502:physiology*; D005260:Female; D019416:Head Movements / Q000502:physiology*; D006801:Humans; D008297:Male; D009334:Neck Muscles / Q000502:physiology*; D009777:Occipital Bone / Q000502:physiology; D010865:Pilot Projects; D011187:Posture / Q000502:physiology; D011897:Random Allocation; D016059:Range of Motion, Articular / Q000502:physiology*; D012886:Skull / Q000502:physiology; D055815:Young Adult
Cervical range of motion; Craniocervical flexion exercise; Craniovertebral angle; Forward head posture; Suboccipital release