McKenzie Retraction and Bruegger's Exercises Effects on Forward Head Posture

Study Overview
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Brief Summary
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The aim of the study is to compare effects of McKenzie Retraction exercises and Bruegger's exercise on neck pain, ROM, craniovertebral angle and functional performance on forward head posture among young adults.

Detailed Description
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There are many advantages of technology such as improving work productivity and efficacy; however, using technology for an extended period of time can place a substantial amount of load on the neck musculature leading to musculoskeletal disorder. The most related cause of neck pain is muscle weakness leading to forward head posture due to static abnormal posture used while using electronic devices. The aim of the study is to compare effects of McKenzie Retraction exercises and Bruegger's exercise on neck pain, ROM, craniovertebral angle and functional performance on forward head posture among young adults. A randomized clinical trial will be conducted at Sadiq Hospital, Sargodha. Non-probability convenience sampling will be used, and 36 subjects, age 15-30 years will be randomly allocated into two groups by lottery method after meeting the inclusion criteria. Both groups will receive hot pack for 10-15 minutes, as common treatment. Group A will be treated with McKenzie Retraction Exercises and Group B will be treated with Bruegger's Exercise.5 sessions per week and total20sessions for 4 weeks. The outcome measures will be conducted through NPRS, NDI, photogrammetry and goniometry before and after 4 weeks. Data will be analyzed using SPSS software version 26.

Official Title
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Comparative Effects of McKenzie Retraction and Bruegger's Exercises on Forward Head Posture Among Young Adults

Conditions
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Forward Head Posture

Intervention / Treatment
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* Other: McKenzie Retraction Exercises
* Other: Bruegger's Exercise


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: Both Male and Female age between 15-30 years. Craniovertebral angle < 50. Electronic gadgets >6 hours a day. Neck pain from the previous 3 months. NPRS >3. NDI > 10. Exclusion Criteria: Neck surgery or trauma. Torticollis. Subjects with diagnosed cases of discogenic disease. Subjects with migraine problem.

Ages Eligible for Study
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Minimum Age: 15 Years
Maximum Age: 30 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
Masking: Single


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Experimental: McKenzie Retraction Exercises<br>McKenzie Retraction Exercises along with hot pack. | Other: McKenzie Retraction Exercises<br>* McKenzie Retraction exercises 5 days a week and 10-15 times for active exercises and 5-6 repetitions of clinician assisted exercise for a period of 4 weeks and a rest interval of 2 minutes between exercises.<br>|
| Experimental: Bruegger's Exercise<br>Bruegger's Exercise along with hot pack. | Other: Bruegger's Exercise<br>* Bruegger's Exercise will be started from 10 seconds hold to 30 seconds with 2 seconds increment in every session. Rest time will be 30 seconds, 4 sets 12 times repetition, for duration of 30 mins per session, 5 days a week for a period of 4 weeks.<br>|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Numeric Pain Rating Scale (NPRS) | Changes from Baseline Numeric Pain Rating Scale (NRS-11), which is an eleven-point scale in which the end points are the extremes of no pain at all (score of 0) and the worst pain the patient has ever experienced (score of 10). NPRS-11 pain severity score of 4 is frequently given special significance in this regard, suggesting it as a potential threshold value for pain severity in clinical practice. This scale has high reliability (0.95-0.96). | 4th week. | 
| NECK DISABILITY INDEX (NDI) | Changes from Baseline, In 1991, Howard Vernon developed the Neck Disability Index (NDI).The Neck Disability Index (NDI) was the first tool to measure self-reported disability in patients with neck pain. It is used extensively in literature and its psychometric properties have been well established. It has been translated and cross-culturally adapted to many languages. The index has 10 neck-related functional activities scored on a 0-5 scale for each item and a total raw score of 50. The higher the score, the greater the disability. | 4th week | 
| PHOTOGRAMMETRY | Changes from Baseline, The CVA was assessed using a digital camera. The camera was placed 1.5 m away from the participant's right side to take a lateral photographic view of the participant's head and neck in a seated position. The CVA is the angle between the horizontal line passing the 7th Cervical vertebra (C7) and then the line extending from C7 to the tragus of the ear. The resulting FHP was determined using Image J software. A CVA of less than 50º was defined as FHP. 'Image J', an analysis software with high reliability and validity. | 4th week | 
| UNIVERSAL GONIOMETER (ROM Cervical Spine Flexion) | Changes from Baseline ROM range of motion of cervical spine flexion was taken with help of goniometer. Goniometry, the measurement of joint angles, traditionally performed with a universal goniometer (UG), is a commonly utilized assessment tool in monitoring problems of the musculoskeletal system, as well as the progression of rehabilitation interventions. | 4th week | 
| UNIVERSAL GONIOMETER (ROM Cervical Spine Extension) | Changes from Baseline ROM range of motion of cervical spine flexion was taken with help of goniometer. Goniometry, the measurement of joint angles, traditionally performed with a universal goniometer (UG), is a commonly utilized assessment tool in monitoring problems of the musculoskeletal system, as well as the progression of rehabilitation interventions. | 4th week | 
| UNIVERSAL GONIOMETER (ROM Cervical Spine rotation) | Changes from Baseline ROM range of motion of cervical spine flexion was taken with help of goniometer. Goniometry, the measurement of joint angles, traditionally performed with a universal goniometer (UG), is a commonly utilized assessment tool in monitoring problems of the musculoskeletal system, as well as the progression of rehabilitation interventions. | 4th week | 

 Terms related to the study
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Keywords Provided by Centre Hospitalier Valida
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Young Adult, Bruegger's Exercise, Forward head posture, McKenzie Exercise