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Rev Bras Fisioter. 2010 Jul-Aug;14(4):330-6. Coelho Júnior AN, Gazzola JM, Gabilan YP, Mazzetti
KR, Perracini MR, Ganança FF.

To investigate head and shoulder alignment among patients with unilateral vestibular
hypofunction (UVH), using computerized biophotogrammetry (CB) and to correlate these
measurements with gender, age, duration of clinical evolution, self-perception of intensity of
dizziness and occurrences of falls… The patients with UVH had greater forward and lateral
head deviation angles than did the normal individuals, with a statistically significant
difference… Forward head was associated with the duration of clinical symptoms of the
vestibular disease, age, intensity of dizziness and occurrence of falls.

19) Influence of forward head posture on scapular upward rotators during isometric shoulder
flexion.

J Bodyw Mov Ther. 2010 Oct;14(4):367-74. Weon JH, Oh JS, Cynn HS, Kim YW, Kwon OY, Yi CH.

We assessed the effects of forward head posture in the sitting position on the activity of the
scapular upward rotators during loaded isometric shoulder flexion in the sagittal plane. Healthy
volunteers (n = 21; 11 men, 10 women) with no history of pathology participated in the study.
Subjects were instructed to perform isometric shoulder flexion with the right upper extremity
in both the forward head posture (FHP) and neutral head posture (NHP) while sitting. Surface
electromyography (EMG) was recorded from the upper trapezius, lower trapezius, and serratus
anterior muscles… Significantly increased EMG activity in the upper trapezius and lower
trapezius and significantly decreased EMG activity in the serratus anterior were found during
loaded isometric shoulder flexion with FHP. Thus, FHP may contribute to work-related neck
and shoulder pain during loaded shoulder flexion while sitting. These results suggest that
maintaining NHP is advantageous in reducing sustained upper and lower trapezius activity and
enhancing serratus anterior activity as compared with FHP during loaded shoulder flexion.

20) Head and shoulder posture affect scapular mechanics and muscle activity in overhead
tasks.

J Electromyogr Kinesiol. 2010 Aug;20(4):701-9. Thigpen CA, Padua DA, Michener LA, Guskiewicz
K, Giuliani C, Keener JD, Stergiou N.

Forward head and rounded shoulder posture (FHRSP) is theorized to contribute to alterations in
scapular kinematics and muscle activity leading to the development of shoulder pain. However,
reported differences in scapular kinematics and muscle activity in those with forward head and
rounded shoulder posture are confounded by the presence of shoulder pain. Therefore, the
purpose of this study was to compare scapular kinematics and muscle activity in individuals free
from shoulder pain, with and without FHRSP. Eighty volunteers were classified as having FHRSP
or ideal posture. Scapular kinematics were collected concurrently with muscle activity from the
upper and lower trapezius as well as the serratus anterior muscles during a loaded flexion and
overhead reaching task using an electromagnetic tracking system and surface
electromyography. Separate mixed model analyses of variance were used to compare three-
dimensional scapular kinematics and muscle activity during the ascending phases of both tasks.