Effects of Exercise on Alignment and Muscle Parameters in Forward Head Posture

Study Overview
=================
Brief Summary
-----------------
It is aimed to investigate the effect of corrective exercise program on alignment, muscle activation and biomechanical properties of muscles in medical students with forward head posture.

Detailed Description
-----------------
Forward head posture (FHP) is a common postural abnormality that can be seen in all age groups. It is characterized by the head position being forward relative to the neck in the sagittal plane. The anterior displacement of the head is mainly assessed through examination of the craniovertebral angle (CVA) and a CVA of ˂50° is described as a FHP. Therapeutic exercises have shown to be effective in FHP and related symptoms in many studies. One of the exercise programs applied is the corrective exercise program. Within the scope of this program, deep cervical flexor muscles and shoulder retractors are strengthened, cervical extensors and pectoral muscles are stretched. This exercise protocol has been reported to provide relief in neck pain, improvement in CVA and shoulder angle. However, the number of studies examining the effect of corrective exercise program for the affected muscle groups in FHP on muscle activation parameters is limited, and there is no study examining the effect on the biomechanical properties of the muscles. In this study, it is aimed to investigate the effect of corrective exercise program on alignment, muscle activation and biomechanical properties of muscles in medical students with forward head posture.

Official Title
-----------------
The Effectiveness of Corrective Exercise Program on Alignment, Muscle Activation and Biomechanical Properties in Medical Students With Forward Head Posture

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

Intervention / Treatment
-----------------
* Other: Corrective exercise program


Participation Criteria
=================
Eligibility Criteria
-----------------
Inclusion Criteria: Medical students with a Craniovertebral angle ˂ 50° Exclusion Criteria: History of chronic pain in cervical region Presence of spinal deformity and malalignment Disease, fracture or surgery affecting the spine-shoulder-pelvic region Presence of malignancy BMI outside the normal range Presence of medical condition that prevents participation in physical exercise program Presence of neuromuscular disease Involvement in regular and professional sports activities

Ages Eligible for Study
-----------------
Minimum Age: 20 Years
Maximum Age: 30 Years

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

Accepts Healthy Volunteers
-----------------
Accepts Healthy Volunteers

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

Design Details

Primary Purpose: Other
Allocation: Randomized
Intervention Model: Parallel Assignment
Masking: Single


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Experimental: Corrective Exercise<br>Selective corrective exercise program, 8 weeks | Other: Corrective exercise program<br>* Strengthening exercises for deep cervical flexor muscles and shoulder retractors. Stretching exercises for cervical extensors and pectoral muscles.<br>|
| No Intervention: Control<br>Training for proper posture | |

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

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Craniovertebral angle | The angle between the line connecting the seventh cervical vertebra and the tragus of right ear, and the horizontal line. running in the sagittal place through the C7 process | Day 0 | 
| Craniovertebral angle | The angle between the line connecting the seventh cervical vertebra and the tragus of right ear, and the horizontal line. running in the sagittal place through the C7 process | Week 8 | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Surface electromyography (EMG) amplitude (RMS) | The activity levels of trapezius, sternocleidomastoid and pectoralis muscles will be measured with a wireless EMG system (Delsys, Inc, Boston, MA). The electrodes will be positioned on the belly of the muscle. The signals will be amplified and band-pass filtered (20-450 Hz) before being record digitally at 2000 samples per second, and then the root mean square (RMS) will be calculated. To normalize individual muscle contraction levels, we will use maneuvers of voluntary contractions. | Day 0 | 
| Surface electromyography (EMG) amplitude (RMS) | The activity levels of trapezius, sternocleidomastoid and pectoralis muscles will be measured with a wireless EMG system (Delsys, Inc, Boston, MA). The electrodes will be positioned on the belly of the muscle. The signals will be amplified and band-pass filtered (20-450 Hz) before being record digitally at 2000 samples per second, and then the root mean square (RMS) will be calculated. To normalize individual muscle contraction levels, we will use maneuvers of voluntary contractions. | Week 8 | 
| Myotonometer measures (Muscle tone) | The state of tension and biomechanical properties will be measured with a hand-held device (MyotonPro®, Myoton AS, Tallinn, Estonia). MyotonPro® displays the muscle mechanical properties by analyzing the oscillations of the myofascial tissue in response to the 10 short (15 ms) impulses, at 0.56 Newton (N) force and frequency of 1Hertz (Hz) applied by the probe of the device. The superficial muscles (trapezius, sternocleidomastoid and pectoralis muscle) will be evaluated. The device measures (computes simultaneously) the following parameters: Oscillation frequency (Hz), dynamic stiffness (N/m) and logarithmic decrement. Oscillation Frequency [Hz]: Characterizes the tone (intrinsic tension) of a muscle in its passive or resting state. | Day 0 | 
| Myotonometer measures (Muscle stiffness) | The state of tension and biomechanical properties will be measured with a hand-held device (MyotonPro®, Myoton AS, Tallinn, Estonia). MyotonPro® displays the muscle mechanical properties by analyzing the oscillations of the myofascial tissue in response to the 10 short (15 ms) impulses, at 0.56 N force and frequency of 1Hz applied by the probe of the device. The superficial muscles (trapezius, sternocleidomastoid and pectoralis muscle) will be evaluated. The device measures (computes simultaneously) the following parameters: Oscillation frequency (Hz), dynamic stiffness (N/m) and logarithmic decrement. Dynamic Stiffness [N/m]: Characterises the resistance to a contraction or to an external force that deforms its initial shape. | Day 0 | 
| Myotonometer measures (Muscle elasticity) | The state of tension and biomechanical properties will be measured with a hand-held device (MyotonPro®, Myoton AS, Tallinn, Estonia). MyotonPro® displays the muscle mechanical properties by analyzing the oscillations of the myofascial tissue in response to the 10 short (15 ms) impulses, at 0.56 N force and frequency of 1Hz applied by the probe of the device. The superficial muscles (trapezius, sternocleidomastoid and pectoralis muscle) will be evaluated. The device measures (computes simultaneously) the following parameters: Oscillation frequency (Hz), dynamic stiffness (N/m) and logarithmic decrement. Logarithmic Decrement: Characterises elasticity. | Day 0 | 
| Myotonometer measures (Muscle tone) | The state of tension and biomechanical properties will be measured with a hand-held device (MyotonPro®, Myoton AS, Tallinn, Estonia). MyotonPro® displays the muscle mechanical properties by analyzing the oscillations of the myofascial tissue in response to the 10 short (15 ms) impulses, at 0.56 N force and frequency of 1Hz applied by the probe of the device. The superficial muscles (trapezius, sternocleidomastoid and pectoralis muscle) will be evaluated. The device measures (computes simultaneously) the following parameters: Oscillation frequency (Hz), dynamic stiffness (N/m) and logarithmic decrement. Ossilation Frequency [Hz]: Characterises the tone (intrinsic tension) of a muscle in its passive or resting state. | Week 8 | 
| Myotonometer measures (Muscle stiffness) | The state of tension and biomechanical properties will be measured with a hand-held device (MyotonPro®, Myoton AS, Tallinn, Estonia). MyotonPro® displays the muscle mechanical properties by analyzing the oscillations of the myofascial tissue in response to the 10 short (15 ms) impulses, at 0.56 N force and frequency of 1Hz applied by the probe of the device. The superficial muscles (trapezius, sternocleidomastoid and pectoralis muscle) will be evaluated. The device measures (computes simultaneously) the following parameters: Oscillation frequency (Hz), dynamic stiffness (N/m) and logarithmic decrement. Dynamic Stiffness [N/m]: Characterises the resistance to a contraction or to an external force that deforms its initial shape. | Week 8 | 
| Myotonometer measures (Muscle elasticity) | The state of tension and biomechanical properties will be measured with a hand-held device (MyotonPro®, Myoton AS, Tallinn, Estonia). MyotonPro® displays the muscle mechanical properties by analyzing the oscillations of the myofascial tissue in response to the 10 short (15 ms) impulses, at 0.56 N and frequency of 1Hz applied by the probe of the device. The superficial muscles (trapezius, sternocleidomastoid and pectoralis muscle) will be evaluated. The device measures (computes simultaneously) the following parameters: Oscillation frequency (Hz), dynamic stiffness (N/m) and logarithmic decrement. Logarithmic Decrement: Characterises elasticity. | Week 8 | 

 Terms related to the study
=================
Keywords Provided by Centre Hospitalier Valida
-----------------
Exercise, Craniovertebral angle, Muscle activation, Biomechanical properties, Surface electromyography