Strengthening and Stretching Exercise to Improve Forward Head Posture and Rounded Shoulders
Condition: Forward Head Posture
Study type: Interventional

Summary: 
      Forward head posture (FHP) and Rounded shoulders (RS) are defined as protrusion of the head
      and shoulders in the sagittal plane. Forward head posture is defined as the anterior
      positioning of the cervical spine. Rounded shoulders also called protracted shoulder (PS) is
      a protrusion of the acromion of the shoulder joint relative to the centerline of gravity of
      the body, causing stooped posture along with elevation, protraction, and downward rotation of
      the scapula, and an increased angle between the lower neck bone and upper spine. Many
      Physical therapy treatment options are available to correct forward head posture and rounded
      shoulders which focused to correct the muscle imbalance and restore the normal posture of
      Cervical spine and shoulder. The objective of this study is to compare the outcomes of
      Strengthening exercise with the outcomes of stretching exercise on the targeted muscle group
      to correct forward head posture and rounded shoulders. The study will determine effective
      management plan for correction of forward head posture and rounded shoulders. It will be
      Experimental Randomized Controlled Trial. 26 Patients will be included through consecutive
      sampling, with 13 patients in each of 2 groups. Subjects will be equally distributed to two
      groups with use of dice roll method of randomization. From the two groups, one receiving
      strengthening exercise treatment and other receiving stretching exercise treatment.
      Statistical Package for Social Sciences (SPSS) V 25.will be used for Data analysis. Results
      will be extracted. Conclusion will be made after comparing the pre and post treatment results
      of both treatment approaches.
    

Detailed description: 
      Forward head posture and Rounded Shoulder are related to muscle imbalance, which disturbs
      length tension relationship of muscles. Weak and lengthened muscles in Forward head posture
      and rounded shoulders are deep neck flexors which include longus capitis and longus coli and
      weak scapular stabilizers and retractors which include Rhomboids and middle, lower trapezius,
      Teres Minor and Infraspinatus. The overactive and shortened muscles participating in Forward
      head posture and Rounded shoulders are Deep upper cervical extensors which include
      longissimus capitis, Splenius Capitis, Cervical Multifidus, Upper Trapezius and Shoulder
      protractors and elevators which include Pectoralis minor, Pectoralis major and Levator
      Scapula. Previous researches suggests that weakened postural muscles should be strengthened
      and shortened muscles should be lengthened in order to improve postural alignment and
      alleviate Forward head posture and restoring the normal muscle balance between opposing
      muscle groups (agonists and antagonists). The majority of treatments have focused on the deep
      neck flexors, as they play a major role in stabilizing the alignment of the cervical spine.
      Exercise improved the forward head and Rounded Shoulder significantly.

      The selection of 50º as a reference angle for forward head posture was guided by previous
      studies, with the latter reporting 55.02 ± 2.86 as a normal range. As is well known, subjects
      with forward head posture have a significantly smaller cervical angle when compared with
      normal subjects. In the present study, the investigators considered 52º as the reference
      angle based on a previous study which evaluated 310 participants in a standing position and
      reported 2.6º±15.3 as a normal range, and Brink et al, who evaluated 15 to 17 year-olds and
      reported a mean shoulder angle value of 51.35º ± 17.2º, and based on the premise that
      subjects with protracted shoulder have a significantly smaller shoulder angle when compared
      with normal subjects. Individual will be considered to have rounded shoulder if the angle
      will be less than 52º.
    

Intervention name(s): Exercise
Intervention type(s): Other
Intervention description(s): Different type of exercises for treatment of Forward Head Posture
Allocation: Randomized
Intervention model: Parallel Assignment
Masking: Single (Outcomes Assessor)
Primary purpose: Treatment
Keywords: Forward Head; Rounded Shoulder; Neck Pain