Muscle Energy Technique of Lower Limb Muscles in Forward Head Posture

Effect Of Muscle Energy Technique Of Lower Limb Superficial Backline Muscles in Patients With Forward Head Posture

The aim of this randomized controlled trial is to find the effect of muscle energy technique of muscles involved in lower limb superficial backline (hamstring and Gastro-soleus) on improving craniovertebral angle and cervical proprioception and minimizing pain among patients with forward head posture

Study Overview

• Status: Recruiting
• Conditions: Forward Head Posture
• Intervention / Treatment: Other: Muscle energy technique; Other: Conventional PT

Detailed Description

Forward head posture (FHP) is a common postural disorder (66%), occurring when the head is anterior to a vertical line passing through the center of gravity. This malalignment causes muscle weakness in deep cervical flexors and shortened opposing cervical extensor muscles. This posture increases lordosis in the lower cervical spine, leading to increased extension over upper, and flexion over the lower cervical spine. Abnormal postures can lead to headaches, myofascial pain syndrome, abnormal scapular movement, temporomandibular disorders, and limited cervical range of motion.

Muscles of the neck, back and lower limb are interconnected through myofascial called superficial backline. Prolonged forward head posture affects muscles and involved in superficial backline. So remote muscle stretching has a same effect on local neck muscles.

Muscle energy technique is a soft tissue technique designed to improve musculoskeletal function through stretching tight muscles and fascia, to reduce pain and improve circulation. MET is characterized by a patient-induced skeletal muscle contraction against physiotherapist resistance in a controlled direction and position. Pathological barrier of a muscle is located through joint positioning which is followed by active muscle contraction by the patient moving away from the resistance followed by relaxation of the muscle. A new pathological barrier is located through passive movement and process is repeated. The rationale for the use of these techniques is to identify the effects of MET of lower limb superficial backline muscles which are interconnected with cervical muscles through myofacial chain, on cervical pain ROM, craniovertebral angle , disability and cervical proprioception.

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

Contacts and Locations

• Study Contact: Name: KINZA ANWAR, MS-OMPT; Phone Number: +92-3239735427; Email: kinza.anwar@riphah.edu.pk

Study Locations

• Pakistan
  • Punjab
    • Islamabad, Punjab, Pakistan
      • Recruiting
      • We Care Physical Therapy Clinic street 13 phase 4A, Ghouri town Islamabad
      • Contact: KINZA ANWAR, MS-OMPT; Phone Number: +92-3239735427; Email: kinza.anwar@riphah.edu.pk
      • Contact: MARIA NAWAZ, MS-OMPT*; Phone Number: +92-3435625466
      • Sub-Investigator: MARIA NAWAZ

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: Adult
• Accepts Healthy Volunteers: No

Description

Inclusion Criteria:

• Age between 20 and 35 years
• Both Genders
• Craniovertebral angle <49.9 degrees
• History of neck pain >3 months
• Patients with hamstring tightness(Inability to achieve greater than 160° of knee extension with hip at 90° of flexion)
• Patients with calf muscle tightness(The Taloche Sign (Maestro) If a patient with a tight gastrocnemius tries to stand on an inclined plane, it is immediately evident that it is impossible for the patient to be stable in this position)

Exclusion Criteria:

• Patient with recent injuries or surgeries in and around the neck region
• Vertigo
• radiating pain in upper limb
• spinal deformities
• malignancy in and around the neck region
• cervical instabilities
• fibromyalgia
• patients with any lower limb or lower back pathology(e.g arthritis)

Study Plan

How is the study designed?

Design Details

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

Number of Arms

2

Arms and Interventions

Participant Group / Arm	Intervention / Treatment
Active Comparator: Muscle Energy Technique of Calf and hamstrings; Muscle Energy Technique of Calf and hamstrings (soft tissue technique)	Other: Muscle energy technique; They would be receiving treatment as follow: Muscle energy technique of hamstring and gastro-soleus. Frequency: 10 reps 3 times/week for 4 consecutive weeks Intensity starting from 20% to 50% resistance across barrier provided by Physical therapist Conventional PT including 1-cervical isometric exercises 2-Transcutaneous Electrical Nerve Stimulation (TENS) for 1o minutes 3-hot pack for 10 minutes 4-Stretching exercise for suboccipitals, sternocleidomastoid 5-gentle stretching of calf and hamstrings.
Other: Conventional PT; Cervical isometric exercises Hot pack	Other: Conventional PT; They would be receiving treatment as follow: Conventional PT including 1-cervical isometric exercises 2-Transcutaneous Electrical Nerve Stimulation (TENS) for 1o minutes 3-hot pack for 10 minutes 4-Stretching exercise for suboccipitals, sternocleidomastoid 5-gentle stretching of calf and hamstrings.

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Neck disability index (NDI)	The NDI is a Patient-completed, condition-specific functional status questionnaire with 10 items including pain, personal care, lifting, reading, headaches, concentration, work, driving, sleeping and recreation. The NDI is composed of 10 items. Each item consists of different statements which describe how much neck pain interferes with certain activity. Patient choses one option which describes his pain most precisely.	4 weeks
Numeric Pain Rating Scale NPRS	The NPRS is a segmented numeric version of the visual analog scale which is used to assess pain. It scores ranges from 0-10, 0 means No pain and 10 means Severe pain. Patient will be asked to verbally report the pain score.	4 weeks

Secondary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Bubble inclinometer	It is an instrument that measures the available range of motion at a joint.	4 weeks
FHP Mobile Application (To measure Craniovertebral angle)	FHP app is a free mobile application that enables measurement of the CV angle for the analysis of cervical posture in the sagittal plane. It was used to measure the CV angle. The protocol involved:(1) Preparation of the location of the camera and the subject; (2) palpation and marking anatomical reference points(3) realization of the photographs.	4 weeks
Cervical Joint Position Error	The patient is sitting 90 cm from the wall, and the starting point (center of target or reference point) of the laser projection is marked. The patient (blindfolded or closed) performs active neck movement and then returns to the starting position as accurately as possible. The final laser position is measured relative to the starting position (distance or angle). The errors are measured after cervical extension and flexion.	4 weeks

Collaborators and Investigators

• Sponsor: Riphah International University
• Investigators: Principal Investigator: KINZA ANWAR, MS-OMPT, RIPHAH INTERNATIONAL UNIVERSITY,ISLAMABAD,PAKISTAN

Study record dates

Study Major Dates

• Study Start (Actual): March 26, 2024
• Primary Completion (Estimated): March 20, 2025
• Study Completion (Estimated): April 20, 2025

Study Registration Dates

• First Submitted: March 17, 2024
• First Submitted That Met QC Criteria: March 17, 2024
• First Posted (Actual): March 22, 2024

Study Record Updates

• Last Update Posted (Actual): April 3, 2024
• Last Update Submitted That Met QC Criteria: April 2, 2024
• Last Verified: April 1, 2024

More Information

Terms related to this study

• Keywords: Conventional physical therapy; Muscle energy technique; Superficial backline MUSCLES
• Other Study ID Numbers: REC/01805 MARIA NAWAZ

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