J. Phys. Ther. Sci.

Original Article 27: 977–979, 2015

The effect of forward head posture on muscle

activity during neck protraction and retraction

Kyeong-Jin Lee1), Hee-Young Han1), Song-Hee Cheon, PT, PhD1), So-Hyun Park, PT, PhD1),
Min-Sik Yong, PT, PhD1)*
1) Department of Physical Therapy, Youngsan University: 288 Joonam-ro, Yangsan, Kyeongsangnam-
do, Republic of Korea

Abstract. [Purpose] The present study was performed to investigate whether forward head posture (FHP) affects
muscle activity. [Subjects and Methods] Twenty subjects attending Y university in Gyeongsangnam-do, Republic
of Korea. They were divided into two groups according to craniovertebral angle: a control group (n=10) and a FHP
group (n=10). Electromyography electrodes were attached to the upper fibers of the trapezius, middle fibers of the
trapezius, the splenii (splenius capitis and splenius cervicis), and the sternocleidomastoid (SCM) muscle to measure
muscle activity during the neck protraction and retraction. [Results] EMG activities of the middle trapezius, sple-
nii, and SCM muscle showed significant differences between the control group and the FHP group. However, the
EMG activity of the upper trapezius muscle showed no significant difference between the two groups during neck
protraction and retraction. [Conclusion] The results suggest that FHP alters the muscle activity in neck protraction
and retraction.
Key words: Forward head posture, Muscle activity, Electromyography
(This article was submitted Dec. 1, 2014, and was accepted Dec. 25, 2014)

INTRODUCTION load is imposed on the joint and muscle, thereby making the
problems caused by FHP chronic7).
When maintenance of musculoskeletal balance occurs, Recently, the use of computers or smart phones has
the stress and strain on the body are minimized, and this become increasingly common, and their use has made FHP
condition is considered proper posture1, 2). It is well-known more common3). Against this background, it has been sug-
that many factors including vision, the cerebellum and gested that further studies regarding FHP are necessary for
vestibular function have an influence on the maintenance of patients suffering from FHP. The present study investigated
balance3). In particular, Barett et al.4) stated that joint posi- whether there are differences in the muscle activities be-
tion sense plays an important role in the maintenance. Since tween subjects with forward head posture and with normal
the position sense is affected by mechanoreceptors located head posture.
in muscles, muscle-related problem are also considered to be
major factors influencing balance3, 5). SUBJECTS AND METHODS
Forward head posture (FHP) is one of the most common
types of postural abnormality, and it is generally described as Twenty subjects attending Y university in Gyeongsang-
an anterior position of the head in relation to the vertical line nam-do, the Republic of Korea participated in the present
of the body’s center of gravity6, 7). Many researchers have study. They were divided into two groups according to the
reported that several factors, including headache, neck pain, craniovertebral angle: a control group (n=10) and a FHP
and musculoskeletal disorders such as temporomandibular group (n=10) (Table 1). Lateral views of each subjects were
disorders or rounded shoulders, are related to FHP1, 8). In photographed to measure the craniovertebral angle which
addition, FHP leads to lengthening and weakness of the an- was defined as the angle between the horizontal line pass-
terior cervical muscles as well as shortening of the posterior ing through C7 and the line extending from the tragus of
cervical muscles. If imbalances in cervical muscles resulting the external auditory meatus to C7. The base of camera was
from postural misalignment are prolonged, an excessive set at the height of the subjects shoulders. The tragus was
marked, and a pointer as taped to the skin overlying C7 spi-
nous process6, 9). Subjects with an angle less than 53° were
*Corresponding author. Min-Sik Yong (E-mail: peast4ever@ put in the FHP group2, 6, 10). All the subjects were informed
naver.com) of the purpose of the present study and provided their writ-
©2015 The Society of Physical Therapy Science. Published by IPEC Inc. ten informed consent prior to their participation. The present
This is an open-access article distributed under the terms of the Cre- study adhered to the ethical principles of the Declaration of
ative Commons Attribution Non-Commercial No Derivatives (by-nc- Helsinki.
nd) License <http://creativecommons.org/licenses/by-nc-nd/3.0/>. Electromyography activities were collected using a
978 J. Phys. Ther. Sci. Vol. 27, No. 3, 2015

TELEMYO 2400 (Noraxon, USA). A sampling rate of DISCUSSION

1,000 Hz was used for EMG signal acquisition, and the
signals were full-wave rectified. Band pass filtering at Almost everywhere, including homes, schools, and offic-
30–500 Hz was performed using MyoResearch-XP 1.07 es, computers and smart phones are commonly used today.
(Noraxon, USA) software, and the signals were also notch Although this usage is efficient in terms of improvement in
filtered at 60 Hz to remove noise. The values of maximum work productivity, it has also several negative aspects, e.g.
voluntary isometric contractions (MVIC) of each muscle headaches and visual problems, and musculoskeletal disor-
was used to normalize the values of the muscle activities. ders are the most important negative factor resulting from
EMG electrodes were attached to four sites: the upper fibers the regular use of computers and smart phones11, 12).
of the trapezius, the middle fibers of the trapezius, the splenii The present study investigated muscle activities of the
(splenius capitis and splenius cervicis), and the sternocleido- upper trapezius, middle trapezius, splenii, and SCM in ac-
mastoid (SCM) muscle. cordance with head posture. Higher values of activities in all
Statistical anslysis was performed using SPSS for muscles was shown in the control group compared with the
Windows (version 18.0). In order to assess EMG activities FHP group when subjects performed neck protraction and
according to neck protraction and retraction between the retraction. These results implies that FHP is associated with
control group and the FHP group, the independent t-test reduced muscle activity.
was performed. All the measurements were expressed as the FHP, head-on-trunk misalignment, leads to increased lor-
mean±standard deviation and significance was accepted at dosis of the lower cervical spine as well as rounded shoulders
values of p<005. accompanied by increased kyphosis of the thoracic spine.
These musculoskeletal disorders change the balance of the
RESULTS muscles around the neck3, 7). Cesar et al.13) reported that FHP
usually results in shortening of not only the cervical extensor
The EMG activities of the splenii and SCM muscle muscles including the splenii and upper trapezius, but also
showed significant differences between the control group the SCM muscle. In addition, FHP causes weakness of the
and the FHP group during neck protraction (p<0.05) (Table cervical flexor muscles as well as scapular retractors such
2). The EMG activity of middle trapezius muscle showed a as the middle trapezuis. The ability of a muscle to generate
significant difference between the two groups during neck force is influenced by its length. When a muscle is shortened
retraction (p<0.05) (Table 2). However, there was no signifi- or lengthened compared to its resting position, its ability
cant difference in the EMG activity of the upper trapezius to generate force is reduced. In other words, the change in
muscle between the two groups during neck protraction and muscle length affects muscle activity, and this is associated
retraction. with a force-length relationship14, 15).
The results of the present study show that there were sig-
nificant differences in the EMG activities of the splenii and
SCM muscles between the control group and the FHP group
during neck protraction. There was a significant difference
in the EMG activity of the middle trapezius muscle between
Table 1. General characteristics of the subjects the groups during neck retraction. These results suggest that
reduced length of the splenii and SCM muscles as well as in-
Control group FHP group creased length and weakness of the middle trapezuis muscle
Age (years) 20.7±1.3 21±1.4 resulting from FHP affect EMG activity.
Height (cm) 172.0±4.3 173.9±6.3 However, there was no significant difference in the EMG
Weight (kg) 70.0±17.5 67.5±10.5 activity of the upper trapezius muscle between the groups.
Values are expressed as the Mean±SD. Although the upper trapezius is one of the muscles shortened

Table 2. Comparison of EMG activities during neck protraction and retraction

between the control group and the FHP group (Unit: %MVIC)

Muscle Movement Control group FHP group

Protraction 5.93±2.81 3.63±2.24*
SCM
Retraction 4.72±3.00 2.98±1.62
Protraction 10.75±9.41 5.34±3.81*
Splenii
Retraction 10.00±6.78 6.21±4.68
Protraction 5.60±6.57 3.58±3.31
Upper Trapezius
Retraction 4.18±4.09 3.45±3.38
Protraction 14.65±6.76 11.44±3.87
Middle Trapezius
Retraction 15.50±6.97 9.51±4.11*
Values are expressed as the Mean±SD.
*p<0.05
 979

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