Efficacy of Adding Pilates to Postural Correction Exercise on Nerve Root Function and Electromyography Activity in Symptomatic Forward Head Posture: Randomized Controlled Trial

Study Overview
=================
Brief Summary
-----------------
to investigate the Efficacy of adding Pilates to postural correction exercise on nerve root function and electromyography activity in symptomatic forward head posture: Randomized Controlled Trial

Detailed Description
-----------------
Forward head posture (FHP) is nowadays the most common postural problem. In FHP, the head protrudes forward from the sagittal plane and appears to be positioned in front of the body, and this condition is considered the most common postural deformity. The prevalence of anterior head translation in neck pain patients was found to be 37%, out of which 58% were females and 42%were males. FHP is among the most common abnormal postures in upper quarter. 85% of patients with myofascial pain syndrome have FHP. Even more alarming is how frequently these problems are seen in younger populations since it's suggested that problems at a young age may lead to more serious consequences later in life. Pilate's method is a physical fitness system that was developed during the First World War in the early 20th century by Joseph Hubertus Pilates. Direction Control and Range Control exercises are two key types of specific exercises that should be used when specific uncontrolled movements are found. Pilates is a mind-body exercise that focuses on strength, core stability, flexibility, muscle control, posture and breathing. Exercises can be mat-based or involve use of specialized equipment. Six major components of Pilates as: Centering, Concentration, Control, Precision, Flow and Breathing. pilates exercise and postural correction play a major role in restoring the normal posture in patients with forward head posture so this trial will be conducted to investigate efficacy of adding Pilates to postural correction exercise on nerve root function and electromyography activity in symptomatic forward head posture.

Official Title
-----------------
Efficacy of Adding Pilates to Postural Correction Exercise on Nerve Root Function and Electromyography Activity in Symptomatic Forward Head Posture: Randomized Controlled Trial

Conditions
-----------------
Forward Head Posture

Intervention / Treatment
-----------------
* Other: Pilates and postural correction exercise
* Other: Pilates exercises
* Other: postural correction exercises


Participation Criteria
=================
Eligibility Criteria
-----------------
Inclusion Criteria: Ages from 20-45 years old with symptomatic forward head posture will be included in this study Participants have FHP if CVA ≤ 50 Non- athletes Normal body mass index (BMI) (18- 24.9). (BMI = body mass in kg divided by subject height in meters). Exclusion Criteria: any spinal problems Temporomandibular disease Participants with experience in pilates and who will not be sedentary were excluded from the study Previous surgery in the neck and shoulder neurological symptoms of the upper extremities during screening tests (e.g., Spurling test and upper limb tension tests) red flags suggesting of cancer, infection, vascular insufficiency Cervical radiculopathy or mylopathy

Ages Eligible for Study
-----------------
Minimum Age: 20 Years
Maximum Age: 45 Years

Sexes Eligible for Study
-----------------
All

Accepts Healthy Volunteers
-----------------
No

Study Plan
=================
How is the study designed?
-----------------

Design Details

Primary Purpose: Treatment
Allocation: Randomized
Intervention Model: Parallel Assignment
Interventional Model Description: this trial has three groups; one experimental and two groups control.
Masking: Double


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Experimental: Pilates and postural correction exercise<br>pilates and postural correction exercise will be received three times a week for 10 weeks | Other: Pilates and postural correction exercise<br>* ten exercises will be performed: Hip Twist Level 1 Double leg stretch Level 1 Double leg stretch Level 2 One leg stretch Level 1 Clam Level 1 Scissors Level 1 Arm openings Level 1 Breast stroke prep Level 1t Hip Twist Level 1. Breast stroke prep Level 2 as for level 1 postural correction exercise 1-Strengthening deep cervical flexors 2-Stretching cervical extensors 3- Strengthen shoulder retractors 4-Unilateral and bilateral pectoralis stretch<br>|
| Active Comparator: Pilates exercises<br>pilates exercise will be received three times a week for 10 weeks | Other: Pilates exercises<br>* ten exercises will be performed: Hip Twist Level 1 Double leg stretch Level 1 Double leg stretch Level 2 One leg stretch Level 1 Clam Level 1 Scissors Level 1 Arm openings Level 1 Breast stroke prep Level 1t Hip Twist Level 1. Breast stroke prep Level 2 as for level 1<br>|
| Active Comparator: postural correction exercises<br>postural corrections exercise will be received three times a week for 10 weeks | Other: postural correction exercises<br>* postural correction exercise in the form of : Strengthening deep cervical flexors through chin tucks, Stretching cervical extensors through a chin drop Strengthen shoulder retractors Unilateral and bilateral pectoralis stretch alternating each two-week period.<br>|

What is the study measuring?
-----------------
Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| nerve root function | nerve root function in the form of somatosensory evoked potential will be measure by electromyograph. | up to ten weeks | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| pain intensity | pain intensity will be measure by visual analogue scale. | up to ten weeks | 
| neck disability | neck disability will be measure by Arabic neck disability index | up to ten weeks | 
| flexion and extension endurance test | the endurance will be measured by stop watch | up to ten weeks | 
| muscle amplitude | electromyography will be used to measure the muscle amplitude in the form of root mean square | up to ten weeks | 
| craniovertebral angle | craniovertebrel angle will be measured by surgimap program | up to ten weeks | 

 Terms related to the study
=================
Keywords Provided by Centre Hospitalier Valida
-----------------
forward head psture, Pilates exercise, postural correction exercise, nerve root function