Effect of Posture and Breathing Exercises in Forward Head Posture

Effects of Posture Exercises With and Without Breathing Exercises in Forward Head Posture

This study aims to compare the effects of postural exercises with and without breathing exercises in the subjects having forward head posture.

Study Overview

• Status: Recruiting
• Conditions: Forward Head Posture
• Intervention / Treatment: Other: postural exercises with breathing exercises; Other: postural exercises

Detailed Description

Forward head posture (FHP) is a prevalent postural deviation that can occur in individuals of various age groups, spanning from childhood to old age. It manifests as an anterior positioning of the head in relation to the neck in the sagittal plane. . FHP is commonly associated with the excessive extension of the upper cervical spine (C1-C3) and flexion of the lower cervical spine (C4-C7). A common method to diagnose forward head posture is by measuring craniovertebral angle i.e. if CVA<49 than FHP is positive. In many cases faulty postures are linked with different musculoskeletal conditions as well as breathing difficulties. Forward head posture specifically impairs the mobility and functionality of the diaphragm, resulting in inefficient contraction of abdominal muscles and reduced lung capacity. A randomized clinical trial will be conducted so that we can rule out proper treatment protocol for forward head posture.

For this randomized clinical trial, 36 participants having forward head posture will be recruited from Sehat medical complex and shalamar hospitals Lahore by nonprobability convenient sampling. Participants will divide in two groups A and B by randomization. Group A will be given both exercise regimes of postural exercises and breathing exercises while group B will be given with only postural exercise protocol. Pain, ROM and craniovertebral angle will be assessment before the treatment start, after 5 weeks and at the end of treatment after 10 weeks. After the collection of data in 8 months, Statistical analysis using SPSS version 21, will be done to summarize the results.

• Study Type: Interventional
• Enrollment (Estimated): 36
• Phase: Not Applicable

Contacts and Locations

• Study Contact: Name: imran amjad, PhD; Phone Number: 03324390125; Email: imran.amjad@ripha.edu.pk

Study Locations

• Pakistan
  • Punjab
    • Lahore, Punjab, Pakistan, 54000
      • Recruiting
      • Sehat Medical Complex
      • Contact: waseem javed, phD; Phone Number: 03457881133; Email: wasim800@hotmail.com
    • Lahore, Punjab, Pakistan, 54000
      • Recruiting
      • Shalamar Hospital
      • Contact: usman sarwar, FCPS; Phone Number: 03004280554; Email: onlyawan@yahoo.com
      • Contact: usman sarwar, FCPS; Phone Number: 03326099065; Email: onlyawan@yahoo.com

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: Adult
• Accepts Healthy Volunteers: Yes

Description

Inclusion Criteria:

• Individuals with 20 to 35 years of age, both male and female
• Individuals with CVA <49.

Exclusion Criteria:

• History of Surgery of thorax or spine or both.
• Traumatic neck injury.
• Acute or chronic neuro-muscular pain.
• Clinical deformity present in thoracic cage or spine

Study Plan

How is the study designed?

Design Details

• Primary Purpose: Treatment
• Allocation: Randomized
• Interventional Model: Parallel Assignment
• Masking: Double

Number of Arms

2

Arms and Interventions

Participant Group / Arm	Intervention / Treatment
Experimental: postural exercises with breathing exercises; The postural exercise program consisted of two strengthening and stretching exercises. The exercises involved chin tucks in, shoulder retraction , and unilateral and bilateral pectoralis stretches alternating each 2-week period. 36 Participants were instructed to complete 3 sets of 12 repetitions of the strengthening exercises and 3 stretching exercises held for 30 seconds each. For the breathing exercises in experimental group, breathing program includes respiratory muscle training, relaxation techniques, breathing techniques, e.g., deep breathing, hand controlled abdominal/diaphragmatic breathing, aimed stretching and strengthening exercises are combined with each other. Deep breathing, controlled diaphragmatic breathing, slow relaxed exhalation with pursed lips technique, direct apnoea exercises and segmental breathing techniques. exercise protocol will be continued for 10 weeks with and initial, after 5 weeks and final assessment of pain and CVA.	Other: postural exercises with breathing exercises; The postural exercise program consisted the exercises i.e chin tucks in, a chin drop in sitting, shoulder retraction. Participants were instructed to complete 3sets of 12repetitions of these exercises. This program was to be repeated 4times per week. They also returned for a consultation every 2weeks to be checked for exercise technique and progression, if appropriate. Progress to the next exercise level was indicated if the participant could complete 12repetitions, 3times easily with correct form. For the breathing exercises in experimental group, breathing program includes respiratory muscle training, relaxation techniques, breathing techniques, e.g., deep breathing, hand controlled diaphragmatic breathing, relaxation technique, deep breathing, controlled diaphragmatic breathing, slow relaxed exhalation with pursed lips technique, and segmental breathing techniques. exercise protocol will be continued for 6 weeks with and initial, after 3weeks and final assessment of pain and CVA.
Experimental: postural exercises without breathing exercises; In this study forward head posture will be defined as CVA<49°, which was diagnosed by photogrammetry method. The postural exercise program consisted of two strengthening and stretching exercises. The exercises involved (a) chin tucks in (c) shoulder retraction , and (d) unilateral and bilateral pectoralis stretches alternating each 2-week period. 36 Participants were instructed to complete 3 sets of 12 repetitions of the strengthening exercises and 3 stretching exercises held for 30 seconds each. This program was to be repeated 4 times per week. They also returned for a consultation every 2 weeks to be checked for exercise technique and progression, if appropriate. Progress to the next exercise level was indicated if the participant could complete 12 repetitions, 3 times easily with correct form.	Other: postural exercises; In this study forward head posture will be defined as CVA<49°, which was diagnosed by photogrammetry method. The postural exercise program consisted of two strengthening (deep cervical flexors and shoulder retractors) and two stretching (cervical extensors and pectoral muscles) exercises based on Kendall et al's approach. The exercises involved; chin tucks ins; a chin drop in sitting; shoulder retraction; unilateral and bilateral pectoralis stretches Participants were instructed to complete 3 sets of 12 repetitions of the strengthening exercises and 3 stretching exercises held for 30 seconds each. This program was to be repeated 4 times per week. They also returned for a consultation every 2 weeks to be checked for exercise technique and progression, if appropriate. Progress to the next exercise level was indicated if the participant could complete 12 repetitions, 3 times easily with correct form

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Measure Description	Time Frame
photogrammetry for CVA and cervical range of motion(ROM) (image j)	CVA, can be measured using the lateral photo exposing C7 and the ear. The participants will maintain the natural head posture through the measurement method of self balance posture.It is the angle made by the line that connects the seventh cervical spine with the tragus and the horizontal line of 7th cervical spine in the standing position. A CVA is of ,49 is characterized as Forward head posture. image j is an image processing and analysis program that can read both image file formats and raw formats. it has been introduces as a reliable assessment tool used to measure cervical angle in several studies on forward head posture.	6 weeks

Secondary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Numeric pain rating scale (NPRS):	The NPRS is a subjective pain rating scale using an 11 point scale from 0 to 10, where 0 means "no pain" and 10 means "intolerable pain". Participants select the whole number that best represent their level of pain. The reliability is>0.95 with ICC value 0.86-0.95	6 weeks
Goniometer	Goniometer is an objective tool to measure range of motion of different joints of body. it has good reliability (r = .70)	6 weeks

Collaborators and Investigators

• Sponsor: Riphah International University
• Investigators: Principal Investigator: Ali Raza, MS, Riphah International University; Principal Investigator: izzah ijaz, Riphah International University

Study record dates

Study Major Dates

• Study Start (Actual): May 10, 2023
• Primary Completion (Estimated): January 10, 2024
• Study Completion (Estimated): January 10, 2024

Study Registration Dates

• First Submitted: December 26, 2023
• First Submitted That Met QC Criteria: December 26, 2023
• First Posted (Actual): January 9, 2024

Study Record Updates

• Last Update Posted (Actual): January 9, 2024
• Last Update Submitted That Met QC Criteria: December 26, 2023
• Last Verified: December 1, 2023

More Information

Terms related to this study

• Keywords: breathing exercises
• Additional Relevant MeSH Terms: Pathologic Processes; Respiratory Tract Diseases; Respiration Disorders; Respiratory Aspiration
• Other Study ID Numbers: REC/RCR &AHS/23/0169

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