Strengthening and Stretching Exercise to Improve Forward Head Posture and Rounded Shoulders

October 26, 2020 updated by: Riphah International University

Effect of Strengthening and Stretching Exercise of Deep Neck Muscles Group to Improve Forward Head Posture and Rounded Shoulders in Normal Healthy Adults

Forward head posture (FHP) and Rounded shoulders (RS) are defined as protrusion of the head and shoulders in the sagittal plane. Forward head posture is defined as the anterior positioning of the cervical spine. Rounded shoulders also called protracted shoulder (PS) is a protrusion of the acromion of the shoulder joint relative to the centerline of gravity of the body, causing stooped posture along with elevation, protraction, and downward rotation of the scapula, and an increased angle between the lower neck bone and upper spine. Many Physical therapy treatment options are available to correct forward head posture and rounded shoulders which focused to correct the muscle imbalance and restore the normal posture of Cervical spine and shoulder. The objective of this study is to compare the outcomes of Strengthening exercise with the outcomes of stretching exercise on the targeted muscle group to correct forward head posture and rounded shoulders. The study will determine effective management plan for correction of forward head posture and rounded shoulders. It will be Experimental Randomized Controlled Trial. 26 Patients will be included through consecutive sampling, with 13 patients in each of 2 groups. Subjects will be equally distributed to two groups with use of dice roll method of randomization. From the two groups, one receiving strengthening exercise treatment and other receiving stretching exercise treatment. Statistical Package for Social Sciences (SPSS) V 25.will be used for Data analysis. Results will be extracted. Conclusion will be made after comparing the pre and post treatment results of both treatment approaches.

Study Overview

Status

Completed

Conditions

Intervention / Treatment

Detailed Description

Forward head posture and Rounded Shoulder are related to muscle imbalance, which disturbs length tension relationship of muscles. Weak and lengthened muscles in Forward head posture and rounded shoulders are deep neck flexors which include longus capitis and longus coli and weak scapular stabilizers and retractors which include Rhomboids and middle, lower trapezius, Teres Minor and Infraspinatus. The overactive and shortened muscles participating in Forward head posture and Rounded shoulders are Deep upper cervical extensors which include longissimus capitis, Splenius Capitis, Cervical Multifidus, Upper Trapezius and Shoulder protractors and elevators which include Pectoralis minor, Pectoralis major and Levator Scapula. Previous researches suggests that weakened postural muscles should be strengthened and shortened muscles should be lengthened in order to improve postural alignment and alleviate Forward head posture and restoring the normal muscle balance between opposing muscle groups (agonists and antagonists). The majority of treatments have focused on the deep neck flexors, as they play a major role in stabilizing the alignment of the cervical spine. Exercise improved the forward head and Rounded Shoulder significantly.

The selection of 50º as a reference angle for forward head posture was guided by previous studies, with the latter reporting 55.02 ± 2.86 as a normal range. As is well known, subjects with forward head posture have a significantly smaller cervical angle when compared with normal subjects. In the present study, the investigators considered 52º as the reference angle based on a previous study which evaluated 310 participants in a standing position and reported 2.6º±15.3 as a normal range, and Brink et al, who evaluated 15 to 17 year-olds and reported a mean shoulder angle value of 51.35º ± 17.2º, and based on the premise that subjects with protracted shoulder have a significantly smaller shoulder angle when compared with normal subjects. Individual will be considered to have rounded shoulder if the angle will be less than 52º.

Study Type

Interventional

Enrollment (Actual)

30

Phase

  • Not Applicable

Contacts and Locations

This section provides the contact details for those conducting the study, and information on where this study is being conducted.

Study Locations

  • Pakistan
      • Lahore, Pakistan, 54000
        • Riphah International University

Participation Criteria

Researchers look for people who fit a certain description, called eligibility criteria. Some examples of these criteria are a person's general health condition or prior treatments.

Eligibility Criteria

Ages Eligible for Study

22 years to 40 years (ADULT)

Accepts Healthy Volunteers

Yes

Genders Eligible for Study

All

Description

Inclusion Criteria:

  1. Individuals having Craniovertebral Angle (CVA) less than 50 degree
  2. Individuals having Shoulder Angle (SA) less than 52 degree.
  3. Those who had not under any regular exercise for last 6 months
  4. Those who use a smart phone or computer for at least 4 hours or more per day on average.

Exclusion Criteria:

  1. Individuals will be excluded if they had visual deficits, diagnosed balance disorders, musculoskeletal pathologies (e.g. history of shoulder surgery, cervical or thoracic fracture, Osteosarcoma, Myeloma), non-ambulatory, displayed functional or structural scoliosis, or had excessive thoracic kyphosis.
  2. Individuals having symptoms of Vertebral Artery Insufficiency.
  3. Individuals not willing to participate or to follow up treatment plan.

Study Plan

This section provides details of the study plan, including how the study is designed and what the study is measuring.

How is the study designed?

Design Details

  • Primary Purpose: TREATMENT
  • Allocation: RANDOMIZED
  • Interventional Model: PARALLEL
  • Masking: SINGLE

Arms and Interventions

Participant Group / Arm
Intervention / Treatment
EXPERIMENTAL: Strengthening exercise treatment
This exercise targets the deep flexor muscles of the upper cervical region the longus capitis and longus colli muscles.
Other: Exercise
Different type of exercises for treatment of Forward Head Posture
ACTIVE_COMPARATOR: Stretching exercise treatment
The subject's forearm is stabilized by a vertical plane before the trunk is rotated in the opposite direction. Therefore the arm on the involved side is externally rotated and abducted to 90.
Other: Exercise
Different type of exercises for treatment of Forward Head Posture

What is the study measuring?

Primary Outcome Measures

Outcome Measure
Measure Description
Time Frame
Craniovertebral angle
Time Frame: 3 Months
The angle between the line from the external auditory meatus to the seventh cervical vertebra and a horizontal line at the level of the seventh cervical vertebra using photogrammetry
3 Months
Scapular Index
Time Frame: 3 Months
Its the ratio of the length of the scapula to its breadth multiplied by 100 and will be measured using Posture Assessment Software
3 Months

Collaborators and Investigators

This is where you will find people and organizations involved with this study.

Sponsor

Riphah International University

Publications and helpful links

The person responsible for entering information about the study voluntarily provides these publications. These may be about anything related to the study.

General Publications

Study record dates

These dates track the progress of study record and summary results submissions to ClinicalTrials.gov. Study records and reported results are reviewed by the National Library of Medicine (NLM) to make sure they meet specific quality control standards before being posted on the public website.

Study Major Dates

Study Start (ACTUAL)

September 1, 2019

Primary Completion (ACTUAL)

February 20, 2020

Study Completion (ACTUAL)

March 1, 2020

Study Registration Dates

First Submitted

December 23, 2019

First Submitted That Met QC Criteria

January 2, 2020

First Posted (ACTUAL)

January 3, 2020

Study Record Updates

Last Update Posted (ACTUAL)

October 27, 2020

Last Update Submitted That Met QC Criteria

October 26, 2020

Last Verified

October 1, 2020

More Information

Terms related to this study

Keywords

Other Study ID Numbers

  • RiphahIU Tehmina Irfan

Plan for Individual participant data (IPD)

Plan to Share Individual Participant Data (IPD)?

NO

Drug and device information, study documents

Studies a U.S. FDA-regulated drug product

No

Studies a U.S. FDA-regulated device product

No

This information was retrieved directly from the website clinicaltrials.gov without any changes. If you have any requests to change, remove or update your study details, please contact register@clinicaltrials.gov. As soon as a change is implemented on clinicaltrials.gov, this will be updated automatically on our website as well.

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