Efficacy of Adding Scapular Stabilization Exercises to Postural Correctional Exercises on on Forward Head Posture

Study Overview
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Brief Summary
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The aim of this study is to investigate efficacy of adding Scapular Stabilization Exercises to postural correctional exercises on Endurance of cervical flexor and extensor muscles on Asymptomatic forward head posture.

Detailed Description
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Forward head posture (FHP) is the most common deviation from ideal head posture and is characterized by the head projecting forward into the sagittal plane such that it is anterior to the trunk. Individuals with neck pain frequently demonstrate FHP, when compared to age-matched controls. Asymmetric posture is a chronic stressor and the origin of most noxious stimuli that could alleviate 70-90 % of chronic pain. It is reported that FHP is a common postural abnormality, with a conservative estimate being 66 % of the patient population. It causes vertebral displacement patterns, abnormal stresses, and strain on the spinal cord. FHP has adverse mechanical tension on neural and vascular elements. It is theorized that when muscle performance is impaired, the balance between the stabilizers on the posterior aspect of the neck and the DNFs will be disrupted, resulting in loss of proper alignment and posture, which is then likely to contribute to cervical Impairment (loss of range of motion, or decreased strength including, but not limited to, the sternocleidomastoid (SCM), trapezius, and deep neck flexor (DNF) muscles endurance of the neck musculature. Assessment of DNF muscle performance properties is arguably important given the relationship between DNF muscle torque and endurance deficits and patient complaints of head and neck pain. sixty subjects with forward head posture assigned randomly to three groups. experimental group 1 will receive scapular stabilization plus postural correction exercise and advice, experimental group 2 will receive postural correction exercise plus advice and finally control group will receive advice.

Official Title
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Efficacy of Adding Scapular Stabilization Exercises to Postural Correctional Exercises on Endurance of Cervical Flexor and Extensor Muscles on Asymptomatic Forward Head Posture; Randomized Controlled Trial

Conditions
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Forward Head Posture

Intervention / Treatment
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* Other: scapular stabilization exercise
* Other: postural correction exercise
* Other: advice


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: If asymptomatic subjects with CVA equal or less than 50. shoulder flexion at least 130 degrees or more, they involved in this research. Exclusion Criteria: If they had a history of cervical spine sur¬gery Cervical spondylosis Cervical or shoulder neurological movement disorder, Temporo-mandibular surgery, Pathologic trauma.

Ages Eligible for Study
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Minimum Age: 20 Years
Maximum Age: 35 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: scapular stabilization and postural correction exercise
Masking: Double


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Experimental: scapular stabilization exercise<br>the subjects will receive scapular stabilization exercise + postural correction exercise and advice three times per week for 10 weeks | Other: scapular stabilization exercise<br>* In the supine position, the subject will instruct to take a deep breath to relax the body. In croock-lying position, the subject will raise his dominant arm to 90° shoulder flexion with full elbow extension and scapular protraction. In the quadruped position, the subject lifts up his arms alternatively with shoulder abduction and 120 ° flexion. In a sitting position with 90° knee flexion on a stool or bed without back support, the subject held a pair of dumbbells (2 kg) in each hand and laterally lifted them up while maintaining the height of scapulae below 80°. Each stage will instruct to be held for 10 seconds before returning to the starting position and three laps of 10 repetitions with a 30-second break in between will perform. In the sitting position, a mirror will place in front of the patient. The subject will instruct to check and correct his posture by him<br>|
| Experimental: postural correction exercise<br>the subjects will receive postural correction exercise and advice three times per week for 10 weeks | Other: scapular stabilization exercise<br>* In the supine position, the subject will instruct to take a deep breath to relax the body. In croock-lying position, the subject will raise his dominant arm to 90° shoulder flexion with full elbow extension and scapular protraction. In the quadruped position, the subject lifts up his arms alternatively with shoulder abduction and 120 ° flexion. In a sitting position with 90° knee flexion on a stool or bed without back support, the subject held a pair of dumbbells (2 kg) in each hand and laterally lifted them up while maintaining the height of scapulae below 80°. Each stage will instruct to be held for 10 seconds before returning to the starting position and three laps of 10 repetitions with a 30-second break in between will perform. In the sitting position, a mirror will place in front of the patient. The subject will instruct to check and correct his posture by him<br>Other: postural correction exercise<br>* The program consisted of two strengthening (deep cervical flexors and scapular retractors) and two stretchings: cervical extensors (sub-occipital muscles) and pectoral muscles). The program was based on a program by Harman and Kendall.<br>|
| Active Comparator: advice<br>the subjects will receive advice three times per week for 10 weeks | Other: scapular stabilization exercise<br>* In the supine position, the subject will instruct to take a deep breath to relax the body. In croock-lying position, the subject will raise his dominant arm to 90° shoulder flexion with full elbow extension and scapular protraction. In the quadruped position, the subject lifts up his arms alternatively with shoulder abduction and 120 ° flexion. In a sitting position with 90° knee flexion on a stool or bed without back support, the subject held a pair of dumbbells (2 kg) in each hand and laterally lifted them up while maintaining the height of scapulae below 80°. Each stage will instruct to be held for 10 seconds before returning to the starting position and three laps of 10 repetitions with a 30-second break in between will perform. In the sitting position, a mirror will place in front of the patient. The subject will instruct to check and correct his posture by him<br>Other: postural correction exercise<br>* The program consisted of two strengthening (deep cervical flexors and scapular retractors) and two stretchings: cervical extensors (sub-occipital muscles) and pectoral muscles). The program was based on a program by Harman and Kendall.<br>Other: advice<br>* all subjects will be instructed to maintain normal alignment of the cervical vertebry<br>|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| craniovertebral angle | craniovertebral angle will be measured by objective software. | up to ten weeks | 
| cervical range of motion | cervical range of motion will be assessed by CROM. cervical flexion, extension, side bending and rotation will be assessed | up to ten weeks | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| flexion endurance | flexion endurance test by stop watch will be used for assessment the endurance of cervical flexor | up to ten weeks | 
| extension endurance | extension endurance test by stop watch will be used for assessment the endurance of extensor muscles | up to ten weeks | 
| muscle activity during rest and activity | electromyography will be used for measuring the activity of upper trapezius and sternocleidomastoid muscle at rest and during activity | up to ten weeks | 

 Terms related to the study
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Keywords Provided by Centre Hospitalier Valida
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scapular stabilization exercise, postural correction exercises, forward head posture