Comparison Of The Neck And Scapular Proprioceptive Neuromuscular Facilitation Exercises On Postural Disorders, Scapular Dyskinesia And Round Shoulders in Individuals With Cervical Sagittal Alignment Disorder.
Condition: Forward Head Posture; Sagittal Cervical Malalignment; Rounded Shouler; Scapular Dyskinesis
MeSH terms: Dyskinesias
Study type: Interventional

Summary: 
      In modern society, repetitive and monotonous activities are increasing due to the decrease in
      general physical activity, the development of the information technology industry, and time
      culture flow. Therefore, prolonged exposure to unstable or abnormal posture can trigger a
      chain reaction of poor alignment and imbalance, leading to musculoskeletal diseases such as
      muscle stiffness or repetitive traumatic injury.

      Sagittal cervical malalignment (SCM), and also known as Forward head posture (FHP), is one of
      the poor posture types of the head commonly seen in the sagittal plane. İt is defined as the
      forward shift of the head. As the head moves forward, the center of gravity changes. To
      compensate for this shift in the center of gravity, the upper body slides back and the
      shoulders move forward, the rounded shoulder develops so that the head is placed in front of
      the body.

      SCM can cause many harmful symptoms such as neck pain, shoulder pain, back pain, chronic
      headaches, increased curvature of the spine and scapular dyskinesis, and rounded shoulder.
    

Detailed description: 
      Proper posture is defined as musculoskeletal balance with minimal stress or strain on the
      body. The human body is a multi-joint system with kinetic chains controlled by the central
      nervous system, with a series of joints that interact with muscle activity.

      Prolonged exposure to unstable or abnormal posture can trigger a chain reaction of weak
      alignment and imbalance, leading to musculoskeletal diseases such as muscle stiffness or
      repeated traumatic injury. Sagittal cervical malalignment (SCM), in other words forward head
      posture (FHP), is one of the poor posture types of the head commonly seen in the sagittal
      plane. It is defined as the shift of the center of the head towards the front. As the head
      moves forward, the center of gravity changes. To compensate for this shift in the center of
      gravity, the upper body slides back and the shoulders move forward, the rounded shoulder
      develops so that the head is placed in front of the body.

      SCM of the head is defined as the anterior extension of the head with hyperextension of the
      upper cervical vertebrae (C1-C3) and flexion of the lower cervical vertebrae (C4-C7) and
      hyperlordosis of the cervical curve. It can be caused by a variety of factors, including
      Sleeping in positions with an excessive elevation of the head, prolonged use of the computer,
      and developed back muscle weakness.

      SCM can cause many harmful symptoms such as neck pain, shoulder pain, back pain, chronic
      headaches, increased curvature of the spine and scapular dyskinesia, and rounded shoulder.

      The rounded shoulder is a bent posture in which the scapulae are elevated and the acromion
      protrudes forward compared to the center of gravity of the body. These changes can cause an
      imbalance of the surrounding muscles and eventually pain in the head, temporomandibular
      joints, neck, back, shoulders and arms.

      Scapular dyskinesia is referred to as visible changes in scapular position and movement
      patterns. It produces changes in the kinematics of the glenohumeral and acromioclavicular
      joints and can interfere with the activity of the periscapular muscles and rotator cuffs.7
      Proprioceptive neuromuscular facilitation (PNF) methods focus on functional diagonal movement
      patterns and use cutaneous, visual, and auditory stimulation to improve neuromuscular control
      and function as well as muscle strength, balance, and flexibility. It is used as a
      progressive resistance for functional training in therapeutic exercises, improves joint
      limitations, and strengthens muscles. Scapular and neck PNF patterns are known to increase
      the stability of the head, neck, and scapular muscles.
    

Intervention name(s): Scapular and Neck Proprioceptive Neuromuscular Facilitation exercises; McKenzie and Kendall exercises
Intervention type(s): Other; Other
Intervention description(s): The researcher will perform a total of 12 sessions of scapular and neck pnf exercises for 4 weeks. The participants will apply PNF exercises using rhythmic initiation, rhythmic stabilization and cobination techniques of isotonics. Patterns of anterior elevation, posterior depression, anterior depression, posterior elevation will be used in scapular exercises. Upper cervical flexion, lower cervical flexion, rotation and lateral flexion patterns will be used in neck pnf exercises.; Kendall and Mckenzie exercises will be given to the participants as a home workout. The self-stretch exercise methods are as followed: Placing both hands on the shoulders and pushing out the chest, placing one hand over the shoulder and grasp the elbow of the turned hand, with the other hand over the head and slowly pull it inward, throwback the head until it has reached the fully stretched point, look straight ahead and slowly turn the head horizontally until the maximum value is reached, throwback the head, and turn it until it has reached the fully stretched point, lower the head turn it until it has reached the maximal point. Stretching pectoralis muscle, strengthening shoulder retraction, strengthening the deep cervical flexors, strengthening the deep cervical flexors.
Allocation: Randomized
Intervention model: Parallel Assignment
Masking: Single (Participant)
Primary purpose: Treatment
Keywords: Forward head posture; Proprioceptive Neuromuscular Facilitation; Mckenzie; Kendall