Effect of Extracorporeal Shockwave Therapy Before Postural Correction Exercise in Adults With Forward Head Posture

Study Overview
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Brief Summary
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Currently, as digital leisure activities increase, more time is spent at home. According to these social trends, it is necessary to establish a program that can safely and effectively perform exercise at home.Therefore, this study assumed that if the trigger point and tension of the upper trapezius are resolved by applying ESWT before implementing the exercise program, it will have a significant effect on pain, functional aspects, and posture improvement. On this account, investigator would like to study the effect of applying ESWT before conducting the exercise program on the muscle activity ratio, craniovertebral angle, pressure pain threshold, and Neck disability index in adults with FHP.

Detailed Description
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Experimental participants who meet the criteria of the study subjects will be selected, and the experiment will be conducted by coordinating the schedules of the subjects. The experiment will be conducted in an independent space, and the general characteristics of the subjects will be investigated collectively before the experiment. Subjects will take a side photograph from a distance of 265 cm to check the CVA. In addition, the basic value will be obtained by measuring the activity of the UT, MT, LT and SA when the arm is lifted in the direction of the scapula plane, and the pressure pain threshold of the UT Trigger point will be measured using a pain threshold will be measured. In addition, NDI will be self-measured to evaluate neck pain and function. The experiment will be divided into groups that conduct in ESWT and posture correction exercise programs together and groups that conduct only posture correction exercise programs, and the subjects will be randomly assigned to the two groups. After the experiment is completed, the muscle activity, head spine angle, pressure pain threshold, and ranch index measured in advance will be measured again. ESWT: Radial shock waves will be applied to the main muscles with Trigger points, the Upper trapezius and Levator scapulae muscles. This is conducted twice a week, with 1000impulses, 60mJ/m (2), and 5Hz frequency for a total of four weeks. Posture Correction Exercise Program: Muscles such as weakened deep neck flexors, middle trapezius, lower trapezius, and serratus anterior muscles will undergo strengthening exercises, while muscles such as shortened and overactive upper trapezius, Levator scapulae, and sternocleidomastoid muscle will apply relaxation stretching. This will be conducted privately at home by providing exercise leaflets, and will be conducted for a total of four weeks with a 30-minute program three times a week.

Official Title
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Effect of Extracorporeal Shockwave Therapy Before Postural Correction Exercise on EMG Ratio, CVA, PPT, and NDI in Adults With Forward Head Posture

Conditions
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Exercise Program, Neck Pain, Extracorporeal Shock Waves Therapy

Intervention / Treatment
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* Device: Extracorporeal shock waves
* Behavioral: Posture Correction Exercise Program


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: Those with CVA≤53 or less when measuring the Craniovertbral angle through photometric method A person who uses a smartphone or computer for an average of 4 hours or more per day A person who has not exercised regularly in the past six months Exclusion Criteria: A person who is subject to extracorporeal shock wave contraindication A person with a history of fractures or surgery A person who is unable to exercise due to medical conditions

Ages Eligible for Study
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Minimum Age: 18 Years
Maximum Age: 26 Years

Sexes Eligible for Study
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All

Accepts Healthy Volunteers
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Accepts Healthy Volunteers

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: Double


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Experimental: Extracorporeal shock waves therapy[ESWT] + posture corrective exercise programs[PCEP]<br>Before proceeding with the exercise, apply a radial-type Extracorporeal shock waves. This applies to the main muscles with TrP, the upper trapezius and Leavator scapulae muscle. It is conducted twice a week at 1000 impulse, 60 mJ/m (2), and 5 Hz frequencies. In addition, a posture correction exercise program will be conducted along with ESWT. Muscles such as weakened deep neck flexors, middle trapezius muscles, lower trapezius muscles, and serratus anterior muscles will undergo strengthening exercises, while muscles such as shortened and overactive upper trapezius muscle, Leavator scapulae muscle, and sternocleidomastoid muscle will apply relaxation stretching. This will be conducted privately at home by providing exercise leaflets, and will be conducted for a total of four weeks with a 30-minute program three times a week. | Device: Extracorporeal shock waves<br>* Extracorporeal shock waves are non-invasive and simple treatments that are easy to apply to a wide surface and have fewer side effects with low intensity. In addition, there is an advantage of improving blood circulation through an increase in reactive blood flow and creation of new blood vessels.<br>* Other names: ESWT;Behavioral: Posture Correction Exercise Program<br>* The exercise program mainly consists of stretching and muscle strengthening exercises, which have shown improvement effects in terms of head vertebrae and pain. In order to optimize the muscle activity between pairs due to FHP, the selected exercise should focus on providing an appropriate proportion of muscle activity for each other as well as muscle strength.<br>* Other names: PCEP;|
| Active Comparator: posture corrective exercise programs[PCEP]<br>Only posture correction exercise programs are conducted. Muscles such as weakened deep neck flexors, middle trapezius muscles, lower trapezius muscles, and serratus anterior muscles will undergo strengthening exercises, while muscles such as shortened and overactive upper trapezius muscle, Leavator scapulae muscle, and sternocleidomastoid muscle will apply relaxation stretching. This will be conducted privately at home by providing exercise leaflets, and will be conducted for a total of four weeks with a 30-minute program three times a week. | Behavioral: Posture Correction Exercise Program<br>* The exercise program mainly consists of stretching and muscle strengthening exercises, which have shown improvement effects in terms of head vertebrae and pain. In order to optimize the muscle activity between pairs due to FHP, the selected exercise should focus on providing an appropriate proportion of muscle activity for each other as well as muscle strength.<br>* Other names: PCEP;|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Electromyography | It will measure muscle activity when the arm is raised in the direction of the scapula plane. Each muscle measured is an upper trapezius, middle trapezius, lower trapezius, and serratus anterior, and the values obtained are to obtain the muscle activity ratio of each of the upper trapezius/lower trapezius, upper trapezius/middle trapezius, upper trapezius/serratus anterior. | 6weeks | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Photogrammetry(CVA) | To check the angle of the head spine, the subjects' profile will be photographed at a distance of 265 centimeters. We would like to measure the angle of the line connecting the migration and cervical spine 7 spinous process in a vertical line to check the change in the angle of the head that comes out forward. | 6weeks | 
| Pressure pain threshold | It is intended to obtain a quantitative value related to mechanical sensitivity to deep structural pain by applying the metal rod of the pain system vertically to the trigger point area of the upper trapezius. | 6weeks | 
| Neck Disability Index | We would like to check the difference in the degree of pain and the degree of limitation in daily life due to neck pain by evaluating the items of self-management, lifting objects, reading, headache, concentration, work, driving, sleep and leisure activities as scores. | 6weeks | 

 Terms related to the study
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Keywords Provided by Centre Hospitalier Valida
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Forward head posture, Extracorporeal shock waves, Posture Corrective Exercise Program, Trigger point, Upper trapezius, Serratus anterior, Middle trapezius, lower trapezius, Musculoskeletal Pain