Forward Head Posture
Conditions
Keywords
INIT, Forward Head Posture, Joint Position Error Test
Brief summary
The purpose of the study is to determine the effects of Integrated Neuromuscular Inhibition Technique on Cervical Proprioception in Patients with Forward Head Posture. A randomized control trial was conducted at Riphah International University, Gulberg Green Campus, Islamabad. The sample size was 42 calculated through G-Power. The participants were divided into two interventional groups each having 21 participants. The study duration was six months. Sampling technique applied was Non-probability Purposive sampling for recruitment. Only 18 to 40 years participants with CVA angle less than 50 degree were included in the study. Tools used in this study are Inclinometer, Mobile phone, Labtop, Kinovea Software, NPRS Scale, Laser Beam. Data was collected at Baseline, after 1st session at the end of 2nd week and 4th week. Data analyzed through SPSS version 23.
Detailed description
Forward Head Posture is defined as ≥5 cm in horizontal distance between the tragus of the ear and the posterior angle of acromion in a standing position. The forward head position is characterized by extension of the upper cervical spine (Cl-C3), and flexion of the lower cervical spine (C4-C7), while the cervical curvature is increased. According to study conducted in 2019, Craniovertebral angle is Formed between C7 spinous process and tragus of ear. Forward head posture is present in all age groups, 22-24 years is the mean age group in males with normal CVA about 48.8 degrees, while in females the CVA angle is 47.6 and their mean age is 23-66 years. Normal craniovertebral angle is 49.9 degrees. Joint position sense is a part of proprioception, which affects body posture and stability. It is influenced by muscle spindles, which respond to changes in muscle length and speed. Forward Head Posture (FHP) causes changes in the lengths of neck muscles, leading to poor joint position sense. The integrated neuromuscular inhibition technique is one of the manual therapies that are directed to trigger point treatment; this technique consists of ischemic compression, Strain Counter-Strain, and Muscle Energy Technique. Intermittent ischemic pressure increases blood flow, Strain Counter-Strain decreases muscle tone, and Muscle Energy Technique encourages muscle easing, this leads to improvements in pain, function, and range of motion. A Study in 2019 reported the shortness of Levator scapulae associated with Forward Head Posture leads. In 2020 Khan et al. carried out research which showed tightness of Sternocleidomastoid muscle in patients with Forward Head Posture. A study conducted in 2023 evaluated the effect of dry needling of Upper trapezius muscle in Forward Head Posture and results showed one session of dry needle therapy with stretching exercises could improve Pain and Pressure Threshold, Range of Motion, craniovertebral angle, which improved Forward Head Posture. According to a study conducted in 2020 The craniovertebral angle had a negative correlation with position sensing and individuals with Forward Head Posture had a higher error value when observing cervical position sensing than individual with normal head posture. According to a study of 2018, integrated neuromuscular inhibition technique is effective in improving cervical function by reducing the trigger points on upper trapezius muscle in mechanical neck pain. Mustafa et al. in 2023 found that integrated neuromuscular inhibition technique to a multimodal treatment program (Mulligan (SNAG, NAGS) with isometric exercises) improve neck function.
Interventions
OTHERIntegrated Neuromuscular Inhibition Technique and Posture Corrective Exercises.
INIT will be performed for experimental group and then posture corrective exercises will be performed and for control group only posture corrective exercises will be performed
Sponsors
Riphah International University
Study design
Allocation
RANDOMIZED
Intervention model
PARALLEL
Primary purpose
TREATMENT
Masking
NONE
Intervention model description
Experimental Group: Group A INIT+ Posture Corrective Exercises Control Group: Group B Posture corrective exercise
Eligibility
Sex/Gender
ALL
Age
18 Years to 40 Years
Healthy volunteers
Yes
Inclusion criteria
* Both Male and Female patients * CVA less than 50 degree * Age 18-40 years * Neck pain for more than 3 months * NPRS \> 3 * Decreased Cervical ROMs * Active trigger points in following muscles (Upper Trapezius, Sternocleidomastoid, Levator Scapulae)
Exclusion criteria
* History of cervical or facial trauma or surgery. * Congenital anomalies of spine such as scoliosis. * Systemic arthritis. * Any disorder of Central Nervous System. * Patients with cognitive deficit
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Numeric Pain Rating Scale | 40 minutes session, thrice a week for 4 weeks. | The NPRS is a segmented numeric version of the visual analog scale (VAS) in which a respondent selects a whole number (0-10 integers) that best reflects the intensity of his/her pain. Where 0 means no pain and 10 means worst imaginable pain. NPRS was measured at Baseline, 1st Session, 2nd Week and 4th Week |
| Cranio-vertebral Angle | 40 minutes session, thrice a week for 4 weeks. | For measuring the angle, the reflective markers will be placed on the tragus of the ear and spinous process of the C7. The camera will be positioned on a tripod 50 cm away from the participant. The axis of the lens of the camera was placed at the level of the shoulder. The photos will be taken and the CVA angle will be calculated by Software Kinovea. CVA was measured at Baseline, 1st Session, 2nd Week and 4th Week |
| Cervical Joint Position Error Test | 40 minutes session, thrice a week for 4 weeks. | For measurement of proprioception, Joint Position Error Test is used. The distance/deviation will represent the proprioception deficit (JPE) of each participant. Angle is then calculated by taking arc tan of error distance divided by 90. A meaningful distance of 7.1cm or angle greater than 4.5 degree represents proprioception deficit. JPE Test was measured at Baseline, 1st Session, 2nd Week and 4th Week |
| Cervical Range of Motion | 40 minutes session, thrice a week for 4 weeks. | Cervical ROM will be measured by using an inclinometer for Flexion, Extension, Lateral Flexion and Rotation. The normal Range for Flexion is usually approximately 80º. Normal cervical extension is usually 50°, Value for Lateral Flexion is 45° and for rotation its approximately 80°. Cervical ROM were measured at Baseline, 1st Session, 2nd Week and 4th Week |
Countries
Pakistan
Contacts
Primary ContactImran Amjad, PhD
Outcome results
None listed