Different Methods of Forward Head Posture Correction

Study Overview
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Brief Summary
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The goal of the study is to compare various methods of correcting forward head posture in elderly subjects. In particular, we will contrast two methods: the conventional program, which aims to restore muscle balance, and the Chiropractic BioPhysics (CBP) rehabilitation program, which relies on stretching the viscous and plastic elements of the longitudinal ligament and intervertebral disc in addition to effectively stretching the soft tissue throughout the entire body.

Detailed Description
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Forward head posture has been shown to be a common postural displacement, with a conservative estimate being 66% of the whole population. It is generally believed that this abnormal posture is associated with the development and persistence of many disorders. There are many strategies to treat forward head posture; the commonly used is traditional exercise program, which aims to restore muscle balance by stretching the short muscles and strengthening the weak ones. The second treatment method is Chiropractic BioPhysics (CBP) rehabilitation program which depend on stretching of the viscous and plastic elements of the longitudinal ligament and intervertebral disc, in addition to effectively stretching the soft tissue through the entire neck area in the direction of the normal head and neck postures as seen with Denneroll traction in addition to mirror image exercise. Up to our knowledge, there is no available studies evaluating the difference between the two forward head correcting methods regarding the amount of head posture correction and the impact of different correction methods on balance. Most important, in the majority of the previous studies which investigated the efficacy of the different posture correction techniques, the subjects were young people. Therefore, the results might not be applicable to all age groups, particularly to the elderly, due to age-related musculoskeletal and physiological changes. Accordingly, the aim of this study is to compare between traditional exercise program and chiropractic biophysics approach in elderly subject .

Official Title
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Different Methods of Forward Head Posture Correction: Does it Matter? A Randomized Controlled Study

Conditions
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Forward Head Posture

Intervention / Treatment
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* Other: Posture corrective exercises
* Other: Denneroll extension traction


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: craniovertebral angle (CVA) is less than 50° Exclusion Criteria: any signs or symptoms of medical red flags were present: tumor, fracture, rheumatoid arthritis, severe osteoporosis, and prolonged steroid use. Subjects with previous spine surgery Neurological diseases Vascular disorders

Ages Eligible for Study
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Minimum Age: 60 Years
Maximum Age: 70 Years

Sexes Eligible for Study
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All

Accepts Healthy Volunteers
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No

Study Plan
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How is the study designed?
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Design Details

Primary Purpose: Treatment
Allocation: Randomized
Intervention Model: Parallel Assignment
Interventional Model Description: A prospective, double blinded, parallel-group, randomized clinical trial was conducted at one of our university's research departments,
Masking: Single


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Active Comparator: Traditional exercise<br>The exercise group will receive a posture corrective exercise program in the form of two strengthening(deep cervical flexors and shoulder retractors)and two stretching (cervical extensors and pectoral muscles) exercises. The exercise program will be done according to Harman et al.'s protocol and based on Kendall et al.'s approach. | Other: Posture corrective exercises<br>* The exercises are of two types strengthening exercises and starching exercise ,). The strengthening exercises are to be done for 15 repetitions in 2 sets, Progression will be by increasing to 3 sets and adding 1 Kilogram of resistance in dumbbells exercises, the targeted muscles are teres minor, infraspinatus, medial and lower trapezius, rhomboids, and cervical flexor muscles. On the other hand, stretching exercises are to be hold for 30 seconds for 2 sets then progressed to 3 sets, the targeted muscles are pectoralis minor, sternocleidomastoid and levator scapulae.<br>|
| Experimental: Denneroll extension traction<br>Denneroll extension traction. Participants in the intervention group will receive the Denneroll cervical orthotic . In the current study, Denneroll cervical traction will be used to restore the normal cervical alignment. . We will follow previously published protocols and procedures for application of this orthotic. The Denneroll orthotic will be performed in the physiotherapy clinic setting. The participants will be instructed to lie supine on the floor, in a straightened position, with their arms gently folded across their stomach. | Other: Denneroll extension traction<br>* The participants will be instructed to lie supine and keep their legs extended. Based on the apex of each participant's cervical curvature on the initial radiograph, the therapist will position the apex of the denneroll in one of two regions (mid cervical placement or lower cervical placement). The duration of the traction session will start at 2-3 min and increased 1 min per session until reaching the goal of 20 min, the traction will repeated three times per week for 6 weeks<br>|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| The change in craniovertebral angle | The craniovertebral angle will be measured by taking a lateral photograph. The participants will be asked to sit on a chair as usual and a lateral photograph will be taken. Adhesive markers will be fixed on the tragus of the ear and the spinous processes of the seventh cervical vertebra. The head forward angle will be measured as an angle between a line drawn from the tragus of the ear to the seventh cervical vertebra and horizontal line | will be measured at two intervals ;pre-treatment and immediately after treatment | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| The change in pain intensity | Measurement of pain will be performed by using a visual analogue scale (VAS). The subjects will be asked about the perception of pain using a 10-cm line with 0 (no pain) on one end and 10 (worst pain) on the other. subjects will be asked to place a mark along the line to denote their level of pain | will be measured at two intervals ;pre-treatment and immediately after treatment | 
| The change in Neck Disability Index | The Neck Disability Index , consisting of 10 items related to daily living activities. | will be measured at two intervals ;pre-treatment and immediately after treatment | 
| Changes in Cervical joint position sense testing | Assessment of head repositioning accuracy with a cervical range of motion (CROM) device will be done according to existing investigations . Participants will be placed in upright neutral seated posture on a stool with no back rest with their feet touching the ground; where their perceived natural head position was determined and used as the reference neutral point. The CROM device will be positioned to 0, 0, 0 for x, y, and z rotational displacements. With their eyes closed, participants will be asked to remember their NHP as the starting posture, andthen actively rotate their head 30° to the left about the vertical y-axis and then reposition their head back the natural head position | will be measured at two intervals ;pre-treatment and immediately after treatment | 

 Terms related to the study
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Keywords Provided by Centre Hospitalier Valida
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Forward head posture, Elderly, Randomized controlled trial