The Effect of Whole Body Vibration on Neck Disability and Proprioception in Patients With Forward Head Posture
Condition: Forward Head Posture
Study type: Interventional

Summary: 
      To investigate if the Whole-body vibration affect cervical function cervical, proprioception,
      pain intensity level and ROM and in subjects with forward head posture?
    

Detailed description: 
      Forward head posture (FHP) is one of the most common types of postural abnormality, and it is
      generally described as an anterior position of the head in relation to the vertical line of
      the body's center of gravity. Many researchers have reported that several factors, including
      headache, neck pain, and musculoskeletal disorders such as temporomandibular disorders or
      rounded shoulders, are related to FHP In forward head posture (FHP) lower cervical vertebrae
      are bent and upper cervical vertebrae are extended, and the weight of the head supported by
      the neck is increased. The bending moment of the head applies pressure on muscles and joints
      around the cervical vertebrae, in addition to active myofascial trigger points of the
      suboccipital muscle which may induce tension type headaches, neck pain and cervical
      headaches, while reducing the mobility of the neck Furthermore, FHP was associated with
      shortening of the upper trapezius, the posterior cervical extensor muscles, the
      sternocleidomastoid muscle and the levator scapulae muscle Recently studies have reported
      impaired proprioception to be one of the results of prolonged FHP. The cervical spine
      proprioceptive system is responsible for head orientation in space and in relation to the
      trunk and it is known for its role in maintaining head and neck stability It was concluded
      that the craniovertebral angle (CVA) is negatively correlated with the disability of patients
      with neck pain. So, patients with small CVA have a greater forward head posture, and the
      greater the forward head posture, the greater the disability.

      Neck pain is a common complaint in the population. It has an episodic occurrence with
      variable recovery between episodes, and it is considered the most persistent musculoskeletal
      pain syndrome. Regarding physical work factors, neck pain was significantly associated with
      holding the neck in a forward bent posture for a prolonged time and making repetitive
      movements Despite claims that FHP may be related to neck pain, existing evidence seems
      controversial, since some previous studies have reported no significant associations between
      neck pain and FHP whereas other studies have reported an association between FHP and neck
      pain. It was showed that adults with neck pain have significantly more FHP than asymptomatic
      adults. Greater FHP has been associated with greater deficits in cervical range of motion,
      particularly neck rotation and flexion. Also, FHP seems to have a negative impact on static
      balance control in asymptomatic adults.

      Corrective exercise is one of the interventional methods that had been suggested for
      treatment of FHP, including stretching, strengthening, and movement control exercises.
      Moreover, there may be advantages in exercising adjacent body segments to the cervical spine,
      such as the thoracic spine, to enhance the effectiveness of exercise training on FHP. Several
      studies have shown that corrective exercise regimes can improve FHP and potentially related
      symptoms. For example, exercise training protocols have resulted in improvement of CVA, head
      tilt, cranial or cervical range of motion neck disability and pain

      Whole-body vibration exercise (WBV) may enhance muscle strength adaptations associated with
      traditional neuromuscular training or rehabilitation. The potentially beneficial effects of
      WBV are caused by the transmission of mechanical, sinusoidal vibrations throughout the body
      via the feet WBV is a neuromuscular training method that has recently been developed. In WBV
      training, the subject stands on a platform that generates vertical sinusoidal vibration at a
      frequency between 35 and 40 Hz. These mechanical stimuli are transmitted to the body where
      they stimulate in turn sensory receptors, most likely muscle spindles. This leads to the
      activation of the alpha-motoneurons and initiates muscle contractions comparable to the
      earlier described "tonic vibration reflex" Whole-body vibration (WBV) has become increasingly
      popular with reports of improved strength, power, movement velocity as well as balance and
      flexibility (Pollock et al., 2010). WBV exercises are performed while standing on a motor
      driven oscillating platform device. The mechanical vibration stimulus applied to the muscles
      and tendons during WBV exercise is characterized by a cyclic transition between eccentric and
      concentric muscle contractions and leads to a neuromuscular response
    

Intervention name(s): Whole body vibration training; Conventional physical treatment
Intervention type(s): Other; Other
Intervention description(s): The participants will be instructed to stand on the vibration platform bare footed and distribute their weight evenly on both feet (fig 3). Next, they will be asked to do a head and neck retraction while looking forward with their knees at 30 degrees of flexion. In order to prevent fatigue in the subject's cervical area due to holding their head and neck in retraction, they will be asked to hold this position for 15 seconds then rest for 5 seconds. Since each set will last 60 second this allowed the subjects to do 3 retractions in each set. In total each subject will perform 15 retractions during the training. The subjects will experience a vertical vibration at a frequency and amplitude of 30 Hz and 4 mm during the sets (Salami et al., 2018).; Posturalcorrectionexercisesintheformofstretchingandstrengthening exercise. Manual stretching exercises as passive stretch to (upper trapezius, levator scapulae, sub occipitalis, scalene, sternocleidomastoid, and pectoralis major muscles), 30 seconds of 3-5 repetitions for each muscle, followed by 30 seconds of rest, as well as isotonic exercises (to strength deep neck flexors and scapular retractor muscles) 3 sets of 12 repetitions each with a 6 second hold in between, with a 1-2-minute rest between sets (Kisner. and Colby 2012).
Allocation: Randomized
Intervention model: Parallel Assignment
Intervention model description: This trail has 2 groups one control and one experimental
Masking: Double (Investigator, Outcomes Assessor)
Primary purpose: Treatment