Effect of Specific Postural Corrective Exercises on EMG Activity in Patients With Forward Head Posture

Forward Head Posture Clinical Trial

Official title:

Effect of Specific Postural Corrective Exercises on EMG Activity of Masticatory and Cervical Muscles in Patients With Forward Head Posture

Clinical Trial Details — Status: Recruiting

Administrative data

• NCT number: NCT05895708
• Other study ID #: Forward Head Posture
• Status: Recruiting
• Phase: N/A
• Start date: June 15, 2023
• Est. completion date: September 20, 2023

Study information

• Verified date: June 2023
• Source: Beirut Arab University
• Contact: Ahmed M .elsayed, PhD
• Phone: 00201027943622
• Email: ahmed.elmelhat[@]cu.edu.eg
• Is FDA regulated: No
• Study type: Interventional

Clinical Trial Summary

This study investigates the effects of specific corrective exercises on EMG of masticatory and cervical muscles in patients with forward head posture. The study's design will be a prospective, double- blinded, randomized controlled trial. The participants will be randomly allocated to one of two groups: the exercise group and the control group. The training groups will perform a program consisting of two strengthening (deep cervical flexors and shoulder retractors) and two stretchings (cervical extensors and pectoral muscles) exercises. This exercise program will be repeated 4 times per week for 10 weeks, and each session lasted 30 minutes.

The pre/post assessment of forward head posture will measure by using craniovertebral angle CVA. While the muscle activity EMG of the masseter, temporalis, splenius, upper trapezius, and SCM will measure pre and post-assessment using a biopic data acquisition system. There will be a high significance increase (p-value 0.000) between the pre-and-post CVA between the training groups and the control. And there will be a significant decrease in EMG of the masseter, temporalis, splenius, upper trapezius, and SCM across exercise groups compared to the control. As per the results and analysis, specific postural corrective exercises effectively decrease the EMG of masticatory and cervical muscles in patients with forward head postures.

Description:

Forward head posture (FHD) is a common habitual faulty posture exists in the surrounding that can alter the resting position of the mandible and may affect the masticatory muscle activity.

The aim of this study is to investigate the effect of postural correction on masticatory and cervical muscle activity and mandibular opening in forward-head posture patients.

Materials and Methods:

• Cranio-vertebral angle measurement CVA

• EMG activity of masseter, temporalis, splenius, upper trapezius and SCM

BAU - Institutional Review Board (Form H-II) | BEIRUT ARAB UNIVERSITY

-Electrodes will be placed on the muscle belly parallel to the direction of muscle fibers. The distance between the two electrodes was 2 cm. The subjects will be instructed to complete maximum voluntary contraction (MVC) of clenching the teeth for 3 s and repeating twice. The average of the two trials of MVC will be used for further analysis. The subjects will be seated comfortably in a chair (---cm height).

Recruitment information / eligibility

• Status: Recruiting
• Enrollment: 50
• Est. completion date: September 20, 2023
• Est. primary completion date: September 20, 2023
• Accepts healthy volunteers: Accepts Healthy Volunteers
• Gender: All
• Age group: 18 Years to 40 Years

Eligibility

Inclusion Criteria:

• Men and women

• Age between 18-40

• Patient with forward head posture, CVA less than 48-50.

• Patient suffer from temporomandibular joint disorder

• No other treatment, such as medication, physical therapy, and joint injection, in the past 2 weeks

Exclusion Criteria:

• Previous history of TMG subluxation or dislocation that may interfere with the opening of the mouth

• Neck pain which may affect the head and neck posture;

• Head or neck trauma

• Class II or III malocclusion

• Posture disorder caused by abnormal curvature of spine; rheumatic disease; haemorrhagic disease, etc.; and

• Lateral deviation of mandible

Related Conditions & MeSH terms

• Forward Head Posture

Intervention

Other:
• Specific strengthening and stretching exercise
The program consisted of two strengthening (deep cervical flexors and shoulder retractors) and two stretching (cervical extensors and pectoral muscles) exercises based on Harman and Mostafa et al's approach. This exercise program will be repeated 4 times per week for 10 weeks, and each session lasted for 30 minutes.
• General Exercise
The program will consist of regular general postural exercises such as postural awareness exercises as well as general strengthening exercises such as range of motion exercises for the upper quadrant. The program will also be repeated 4 times per week for 10 weeks, with each session lasting 30 minutes

Locations

Country	Name	City	State
Lebanon	Physical therapy outpatient clinic	Beirut

Sponsors (1)

Lead Sponsor	Collaborator
Beirut Arab University

Country where clinical trial is conducted

Lebanon, 

References & Publications (6)

Kim SD. Effects of yoga exercises for headaches: a systematic review of randomized controlled trials. J Phys Ther Sci. 2015 Jul;27(7):2377-80. doi: 10.1589/jpts.27.2377. Epub 2015 Jul 22. — View Citation

Lee KJ, Han HY, Cheon SH, Park SH, Yong MS. The effect of forward head posture on muscle activity during neck protraction and retraction. J Phys Ther Sci. 2015 Mar;27(3):977-9. doi: 10.1589/jpts.27.977. Epub 2015 Mar 31. — View Citation

Lee SM, Lee CH, O'Sullivan D, Jung JH, Park JJ. Clinical effectiveness of a Pilates treatment for forward head posture. J Phys Ther Sci. 2016 Jul;28(7):2009-13. doi: 10.1589/jpts.28.2009. Epub 2016 Jul 29. — View Citation

Quek J, Pua YH, Clark RA, Bryant AL. Effects of thoracic kyphosis and forward head posture on cervical range of motion in older adults. Man Ther. 2013 Feb;18(1):65-71. doi: 10.1016/j.math.2012.07.005. Epub 2012 Sep 5. — View Citation

Shaghayegh Fard B, Ahmadi A, Maroufi N, Sarrafzadeh J. Evaluation of forward head posture in sitting and standing positions. Eur Spine J. 2016 Nov;25(11):3577-3582. doi: 10.1007/s00586-015-4254-x. Epub 2015 Oct 17. Erratum In: Eur Spine J. 2021 Oct;30(10):3135. — View Citation

Zabihhosseinian M, Holmes MW, Ferguson B, Murphy B. Neck muscle fatigue alters the cervical flexion relaxation ratio in sub-clinical neck pain patients. Clin Biomech (Bristol, Avon). 2015 Jun;30(5):397-404. doi: 10.1016/j.clinbiomech.2015.03.020. Epub 2015 Mar 27. — View Citation

Outcome

Type	Measure	Description	Time frame	Safety issue
Other	craniovertebral angle	Forward head posture will be assess by the craniovertebral angle, one of the most reliable tool for evaluating the FHP.; The examiner takes 2 lateral photographs of the subject in standing position, according to Shaghayegh fard et al.; A digital camera will be positioned on a tripod at a distance of 0.8m from the subject at shoulder height. Two land mark will be taken, the spinous process of C7 and the tragus of ear. A horizontal line will be drawn passing through C7 making a right angle with the vertical. Then, the angle between the line connecting C7 spinous process with the tragus of the ear and the horizontal line.	12 weeks
Primary	EMG activity	Electrodes will be placed on the muscle belly parallel to the direction of muscle fibers. The distance between the two electrodes was 2 cm.; The subjects will be instructed to complete maximum voluntary contraction (MVC) of clenching the teeth for a period of 3 s and repeated twice. The average of the two trials of MVC will be used for further analysis. The subjects will be seated comfortably in a chair (---cm height).	12 weeks