Exercise Program Based on Motor Learning and Forward Head Posture Correction

Deformity Clinical Trial

Official title:

The Efficacy of Exercise Program Based on Motor Learning Principles in Correction of Forward Head Posture

Clinical Trial Details — Status: Completed

Administrative data

• NCT number: NCT03006497
• Other study ID #: PHYSMSC1
• Status: Completed
• Phase: N/A
• Start date: January 2017
• Est. completion date: December 30, 2017

Study information

• Verified date: January 2019
• Source: Technological Education Institute of Sterea Ellada
• Contact: n/a
• Is FDA regulated: No
• Study type: Interventional

Clinical Trial Summary

The aim of this study is to investigate the efficiency of an exercise program based on principles of motor learning in correction of Forward Head Position (FHP) in asymptomatic patients.

Description:

Epidemiological studies have shown that bad posture and poor body control occurs at puberty, with forward head posture (FHP) and rounded shoulders being the most common biomechanical deviations in sagittal plane. The FHP is defined as an anterior displacement of the head with hyperextension of the cervical spine and this is associated with a reduction in the length of the upper portion of the trapezius, posterior portion of the cervical extensor muscles, the sternocleidomastoid and the levator scapulae. FHP can be evaluated by measuring craniovertebral angle (CVA) which is defined as the angle between a horizontal line passing through C7 and a line extending from the tragus of the ear to C7.

CVA, smaller than 50 degrees, constitute a criterion of abnormal posture of cervical spine, suggesting FHP. People with FHP present incomplete balance control, thereby affecting the position of the center of gravity and motor control of the body. The establishment of altered motor control strategies could lead to balance disorders, neck muscle imbalances, chronic neck pain and even respiratory dysfunction.

Despite the efforts of researchers to create effective treatment programs based on strength training and stretching exercises, positive long-term results have been a problem in FHP correction. For this reason, re-education of posture and body alignment, through exercise programs based on motor learning, with cognitive elements (attention, motivation, feedback, reasoning), could be proved a more effective therapeutic strategy.

Recruitment information / eligibility

• Status: Completed
• Enrollment: 52
• Est. completion date: December 30, 2017
• Est. primary completion date: May 2017
• Accepts healthy volunteers: Accepts Healthy Volunteers
• Gender: All
• Age group: 18 Years to 26 Years

Eligibility

Inclusion Criteria:

• Students at Technological Educational Institute of Sterea Ellada,

• Aged 18-26 years old

• Males and females

• Craniocervical angle < 50 degrees (statical Forward Head Posture in standing position)

Exclusion Criteria:

• Injury or surgery in cervical spine

• Accompanying neurologic, musculoskeletal or mental problems

• Any medical administration

• Intense continuous or intermittent neck pain

• BMI >25

• Participation in any rehabilitation or physiotherapy sessions considering neck dysfunction the last 6 months

• Change in physical activities during the research period of 6 weeks

Related Conditions & MeSH terms

• Deformity
• Musculoskeletal Abnormalities

Intervention

Other:
• Exercise program based on motor learning principles
The exercise program will include simple activities exposing volunteers in various environmental conditions with a view to adjust their head posture in such conditions. The progressiveness of exercises will be based on the two-dimensional classification system of Gentile (1987). Furthermore, external attentional focus will be used.

Locations

Country	Name	City	State
n/a

Sponsors (1)

Lead Sponsor	Collaborator
Eleni Kapreli

References & Publications (10)

Christakou A, Zervas Y, Psychountaki M, Stavrou NA. Development and validation of the attention questionnaire of rehabilitated athletes returning to competition. Psychol Health Med. 2012;17(4):499-510. doi: 10.1080/13548506.2011.630402. Epub 2011 Nov 25. — View Citation

Dimitriadis Z, Kapreli E, Strimpakos N, Oldham J. Reliability of the chin tuck neck flexion test for assessing endurance of short neck flexors in healthy individuals. Physiother Theory Pract. 2015 May;31(4):299-302. doi: 10.3109/09593985.2014.1002874. Epub 2015 Jan 14. — View Citation

Dimitriadis Z, Kapreli E, Strimpakos N, Oldham J. Respiratory weakness in patients with chronic neck pain. Man Ther. 2013 Jun;18(3):248-53. doi: 10.1016/j.math.2012.10.014. Epub 2012 Nov 28. — View Citation

Han J, Park S, Kim Y, Choi Y, Lyu H. Effects of forward head posture on forced vital capacity and respiratory muscles activity. J Phys Ther Sci. 2016 Jan;28(1):128-31. doi: 10.1589/jpts.28.128. Epub 2016 Jan 30. — View Citation

Kang JH, Park RY, Lee SJ, Kim JY, Yoon SR, Jung KI. The effect of the forward head posture on postural balance in long time computer based worker. Ann Rehabil Med. 2012 Feb;36(1):98-104. doi: 10.5535/arm.2012.36.1.98. Epub 2012 Feb 29. — View Citation

Kapreli E, Vourazanis E, Strimpakos N. Neck pain causes respiratory dysfunction. Med Hypotheses. 2008;70(5):1009-13. Epub 2007 Oct 23. — View Citation

Rosário JL, Diógenes MS, Mattei R, Leite JR. Can sadness alter posture? J Bodyw Mov Ther. 2013 Jul;17(3):328-31. doi: 10.1016/j.jbmt.2012.12.001. Epub 2012 Dec 23. — View Citation

Ruivo RM, Carita AI, Pezarat-Correia P. The effects of training and detraining after an 8 month resistance and stretching training program on forward head and protracted shoulder postures in adolescents: Randomised controlled study. Man Ther. 2016 Feb;21:76-82. doi: 10.1016/j.math.2015.05.001. Epub 2015 May 13. — View Citation

Silva AG, Johnson MI. Does forward head posture affect postural control in human healthy volunteers? Gait Posture. 2013 Jun;38(2):352-3. doi: 10.1016/j.gaitpost.2012.11.014. Epub 2012 Dec 7. — View Citation

Wulf G, Mercer J, McNevin N, Guadagnoli MA. Reciprocal influences of attentional focus on postural and suprapostural task performance. J Mot Behav. 2004 Jun;36(2):189-99. — View Citation

Outcome

Type	Measure	Description	Time frame	Safety issue
Primary	Change in Static Forward Head Posture (sFHP)	The sFHP will be assessed by calculating the craniovertebral angle through lateral photographs in standing. The craniovertebral angle is the angle between the line extending from the tragus of the ear to the 7th cervical vertebra (C7) spinous process and the horizontal line through C7. The calculation of the angle on the photographs will be carried out using AutoCAD software. A performance curve will be developed using the measurements during the 4 weeks practice and 2 weeks after the end of protocol (retension test).	Change from Baseline sFHP at 4 weeks and Change from Baseline sFHP at 6 weeks
Primary	Change of Dynamic Forward Head Posture (dFHP)	The dFHP will be assessed by calculating the craniovertebral angle through video motion during walking. The craniovertebral angle is the angle between the line extending from the tragus of the ear to the 7th cervical vertebra (C7) spinous process and the horizontal line through C7. The calculation of the angle The calculation of the angle will be carried out using Kinovea and AutoCAD softwares. dFHP will be regarded as a transfer test. Transfer tests are tests involving some novel situation, so that people must adapt the skill they have been practicing to the characteristics of this new situation.	Change from Baseline dFHP t at 4 weeks and Change from Baseline dFHP at 6 weeks
Secondary	Overall self-esteem	Sorensen self-esteem test will be used which has been translated into Greek and has been tested for its reliability and validity.	Baseline; week 4; week 6
Secondary	Mood	A ten point Visual Analogue Scale (VAS) will be used	Baseline; week 4; week 6
Secondary	Overall physical fatigue	A ten point VAS scale will be used	Baseline; week 4; week 6
Secondary	Overall mental fatigue	A ten point VAS scale will be used	Baseline; week 4; week 6
Secondary	Attention-concentration	Attention- concentration questionnaire will be used. It has been developed in Greek language and has been tested for its reliability and validity.	Baseline; week 4; week 6
Secondary	Verbal Comprehension index	The Wechsler Adult Intelligence Scale (WAIS-IV) (similarities) will be used. Participants will be given a number of pairs of words or concepts and have to describe how they are similar.	Baseline
Secondary	Perceptual Organization Index	The WAIS-IV (Matrix Reasoning) will be used. Participants will be given pictures of sets of drawings and have to choose the correct drawing that is missing from each set.	Baseline
Secondary	Change in Deep neck flexors endurance	The first stage of the test allows for the quantification of the performance of craniocervical flexion action, while the second stage examines the isometric endurance of deep neck flexors, during which the participant adopts the crook lying position. The air chamber of a pressure biofeedback device is positioned under the cervical area and the participant is asked to perform a head nod action at five different pressure levels (22, 24, 26, 28 and 30 mmHg). The test is initially performed at a pressure level of 22 mmHg and proceeds to the next pressure level if the participant is able to maintain in the position for 10 seconds on three separate occasions. The Chattanooga stabilizer pressure biofeedback will be used.	Change from Baseline Deep neck flexors endurance at 4 weeks and Change from Baseline Deep neck flexors endurance at 6 weeks
Secondary	Change in Discomfort	The Discomfort will be assessed using a ten point grade VAS scale, where 0 is no pain and 10 worst pain.	Change from Baseline discomfort at 4 weeks and Change from Baseline discomfort at 6 weeks
Secondary	Change in Area of Discomfort	The Discomfort (Head, Neck, Shoulders and upper arms, Middle back, Lower back, Forearms and Wrists/hands areas) will be assessed using a body chart	Change from Baseline discomfort at 4 weeks and Change from Baseline discomfort at 6 weeks
Secondary	Weight	Measurement of weight with scale (kilograms)	Baseline
Secondary	Height	Measurement of height (cm)	Baseline