the head and neck posture of an individual can influence soft - tissue relationships in the 
 cervical and shoulder region1 , 2 .
a common concern in the modern workplace is upper extremity 
 disorders arising from overhead work , which is associated with neck and shoulder disorders 
 and pain3 .
long - term overhead working 
 postures result in strain and fatigue of the shoulder muscles because arm elevation is 
 associated with shoulder muscle fatigue4 , 5 .
previous studies have focused on risk 
 factor analysis and the development of therapeutic exercises for overhead work - related 
 disorders rather than prevention6 , 7 .
some studies have been performed on 
 postural ergonomic interventions including working techniques for overhead work6 , 7 . 

however , we found that few studies have focused on protective ergonomic devices for overhead 
 workers .
therefore , this study investigated a new neck support tying ( nst ) method that used 
 a thera - band for the prevention of neck and shoulder pain in workers performing overhead 
 work .
the new nst method supports the neck during hyperextension and prevents excessive 
 upward rotation of the scapula during overhead work .
the purpose of the present study was to 
 investigate the effect of this nst method on cervical rom and shoulder pain after overhead 
 work .
the subjects were divided into two groups as follows : a control group consisting of 7 males 
 without nst , and a nst group consisting of 7 males with nst .
the initial cervical rom and 
 initial ppts of the ut and mt were not significantly different between the two groups .
the 
 initial values of cervical flexion , extension , and right and left lateral flexion in the 
 control group were 63.44.2 , 72.86.0 , 53.92.9 , and 51.35.6 degrees , respectively .
the 
 initial values for cervical flexion , extension , and right and left lateral flexion in the 
 nst group were 62.35.1 , 72.53.9 , 53.33.0 , and 52.22.4 degrees , respectively .
all 
 participants gave their informed , written consent according to the protocol approved by the 
 human ethics committee of the yonsei university faculty of health science .
this study 
 examined a new nst method that uses a thera - band for the prevention of neck and shoulder 
 pain in workers performing overhead work . for the nst method
, we used the grey thera - band 
 ( 60  cm length ) which was applied as follows .
the midpoint of the thera - band supported the 
 posterior aspect of the neck , and both ends of the thera - band were passed under both 
 axillae , and tied behind the back .
the nst provided support for neck hyperextension and 
 prevented excessive upward scapular rotation during overhead work .
cervical flexion , 
 extension , and right and left lateral flexion were measured with a cervical range of motion 
 ( crom ) instrument ( performance attainment associates , st .
a dolorimeter pressure algometer ( fabrication enterprises , white plains , 
 ny , usa ) was used to measure the pressure pain threshold ( ppt ) of the right side upper 
 trapezius ( ut ) and the lower trapezius ( lt ) muscles .
a 1-cm rubber plate 
 delivers pressure from the probe to the body , and the pressure is read from a needle gauge . 

all subjects performed one 
 trial of overhead work with their arms over their heads for 15  min .
the overhead work was 
 performed at a height of 25  cm above each subject 's head .
differences in cervical rom and ppt between the nst and control groups 
 after the overhead work were tested with the independent t - test using the spss statistical 
 package ( version 18.0 ; spss , chicago , il , usa ) .
the cervical flexion , extension , and lateral flexion angles of the nst group were 
 significantly larger than those of the control group ( p < 0.05 ) .
the cervical flexion , 
 extension , and right and left lateral flexion of control group were 50.48.2 , 64.711.3 , 
 41.77.9 , 43.29.2 degrees , respectively .
the cervical flexion , extension , and right and 
 left lateral flexion of nst group were 61.511.2 , 69.46.9 , 48.75.6 , 49.86.7 degrees , 
 respectively .
the ppt of ut of the nst group ( 7.21.8 lb ) was significantly higher than 
 those of the control group ( 6.32.0 lb ) ( p < 0.05 ) .
the ppt of mt of the nst group 
 ( 5.81.4 lb ) was significantly higher than those of the control group ( 5.01.2 lb ) ( p < 
 0.05 ) .
repeated and sustained working with elevated arms is known to lead to neck and shoulder 
 pain8 .
this study proposed a new neck 
 support tying method using thera - band and investigated its effect on cervical rom and 
 shoulder pain after overhead work .
reductions in rom have implications for the safety and 
 efficiency of functional activities , and lead to a loss of corrective or protective 
 reactions1 , 9 .
rom losses can occur from inactivity and structural changes of the 
 tissues in the cervical spine , and result in an increase in connective - tissue density , 
 shortening of collagen tissue , and muscle fibrosis1 , 
 9 . in this study , the cervical flexion , 
 extension , and lateral flexion angles of the nst group
shoulder forward flexion with scapular upward rotation requires the activation of the upper 
 trapezius , and overstretches the middle trapezius through scapular protraction3 , 5 , 7 .
the ppts of the ut and mt were 
 significantly lower in the nst group than those of the control group .
these results indicate 
 that the nst supported the neck and prevented excessive scapular elevation and upward 
 rotation during overhead work .
the thera - band , which provides varied resistance through the 
 range of movement , has been used for rehabilitation in combination with therapeutic 
 exercise10 .
it is light and portable , 
 has low resistance , and can be adjusted to accommodate various situations11 .
the nst method prevented rom reduction 
 and pain in the cervical and shoulder regions .
the nst method can be easily and simply 
 applied using a thera - band and is also inexpensive .
we suggest that industrial workers could 
 use the nst method when performing overhead work .
   [ purpose ] this study proposed a new neck support tying ( nst ) method using thera - band for 
 the prevention of neck and shoulder pain in workers doing overhead work . 
 the purpose of 
 this study was to investigate the effect of the new nst method using thera - band on 
 cervical rom and shoulder pain after overhead work . 
 [ subjects ] fourteen male subjects were 
 recruited . 
 [ methods ] this study measured the cervical rom and pressure pain threshold 
 ( ppt ) of the upper and middle trapezius ( ut and mt ) muscles after the control and nst 
 groups had performed overhead work . 
 [ results ] the cervical flexion , extension , and lateral 
 flexion angles of the nst group were significantly larger than those of the control group . 
 
 the ppts of ut and mt of the nst group were significantly higher than those of the control 
 group [ conclusion ] the nst prevented rom reduction and pain in the cervical and shoulder 
 regions . 