The Effect of Focus Approaches on Neck Region Muscle Activation (EMG)

January 12, 2025 updated by: BEYZA YAZGAN DAĞLI, Gazi University

Investigation of the Effect of Externally Vs. Internally Focused Techniques on Neck Region Muscle Activation During Postural Correction Exercises in Individuals with Forward Head Posture: Prospective Randomized Crossover Study

Forward Head Posture (FHP) causes muscle imbalances in the neck and shoulder regions. Various exercises are suggested to correct FHP. During these exercises, internal and external focus techniques are used to enhance motor learning and improve muscle balance. However, there are no studies examining how these approaches affect neck muscle activation in individuals with FHP. Therefore, the purpose of this study is to investigate the effects of external and internal focus techniques, aimed at improving cervical alignment during postural correction exercises, on cervical muscle activation in individuals with FHP.

Study Overview

Status

Not yet recruiting

Conditions

Intervention / Treatment

Detailed Description

Various corrective exercises are suggested in the literature to address Forward Head Posture (FHP). For individuals without musculoskeletal issues, chin-tuck and scapular retraction exercises in a supine position have strong evidence for effectiveness. Scapular stabilization exercises help reduce negative mechanical loads caused by abnormal scapular and cervical spine positions. Additionally, focusing attention on the exercise or target area is used to enhance motor learning and muscle balance, with external focus shown to improve performance in various tasks compared to internal focus.

In clinical practice, it is essential to maintain cervical alignment during scapular retraction exercises for individuals with FHP. To optimize muscle balance during these exercises, instructions often emphasize keeping the chin-tuck position to avoid cervical protraction. Internal and external focus approaches during scapular retraction exercises may help balance the muscle imbalances in individuals with FHP. However, no studies have yet examined the effects of internal and external focus approaches on neck muscle activation in individuals with FHP.

Thirty participants with FHP, defined as having a craniovertebral angle less than 50 degrees, will be included in the study. Participants will perform scapular retraction exercises (bilateral row) with a theraband and T-exercises in a prone position. The exercises will be carried out under three conditions: without guidance (control - no corrective cues for the cervical region), external focus, and internal focus. A laser headband will be used for the external focus condition. Muscle activation of the Upper Trapezius, Middle Trapezius, Lower Trapezius, Serratus Anterior, and Sternocleidomastoid muscles will be measured using the Noraxon MiniDTS system (Noraxon, USA, Inc, Scottsdale, AZ). Muscle activation will be calculated as a percentage of Maximum Voluntary Isometric Contraction (MVIC), and the % MVIC values will be used for analysis. The order of exercises will be randomized.

Study Type

Interventional

Enrollment (Estimated)

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 Contact

Study Contact Backup

Study Locations

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

  • Adult

Accepts Healthy Volunteers

Yes

Description

Inclusion Criteria:

  • Aged between 18-35 years,
  • Craniovertebral angle (CVA) less than 50 degrees,
  • Willing to not participate in any treatment/evaluation during the study,
  • Voluntary participation.

Exclusion Criteria:

  • Experiencing pain in the neck, spine, upper or lower extremities for the past 3 months,
  • Body mass index (BMI) greater than 25 kg/m²,
  • History of neck injuries or surgeries such as intervertebral disc herniation, spondylosis, radiculopathy, chronic headaches, or whiplash,
  • Any visual, auditory, or sensory impairments,
  • Temporomandibular joint issues,
  • Neurological (e.g., epilepsy), rheumatological, or orthopedic symptoms,
  • Any conditions affecting balance and muscle control,
  • Cardiopulmonary or systemic diseases that prevent exercise.

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: Crossover Assignment
  • Masking: Single

Arms and Interventions

Participant Group / Arm
Intervention / Treatment
No Intervention: unguided scapular retraction
Participants will be asked to perform the scapular retraction exercise without any corrective cues for the cervical region.
No Intervention: unguided prone T exercise
Participants will be asked to perform the prone T exercise without any corrective cues for the cervical region.
Active Comparator: scapular retraction exercise with External focus
For external focus, participants will wear a headband with a laser light positioned on their forehead. The laser will be aligned to shine above and between the eyebrows. A flat wall will be placed in front of them, where the laser light is clearly visible. Participants will be instructed: "Bring your head into a chin tuck position and focus on the point where the laser hits the wall while performing the exercise."
Other: The chin tuck posture
A chin tuck is a posture correction technique where the individual gently tucks their chin towards their chest while keeping the rest of the body straight. This movement helps align the head and neck, reducing forward head posture and improving spinal alignment. After performing the unguided exercises, the patients will be taught the chin tuck position. From this point onward, they will be instructed to maintain the chin tuck position while performing the exercises using both external and internal focus strategies.
Active Comparator: scapular retraction exercise with internal focus
Participants will be instructed: "Bring your head into a chin tuck position and focus on keeping your neck in a neutral position while performing the exercise."
Other: The chin tuck posture
A chin tuck is a posture correction technique where the individual gently tucks their chin towards their chest while keeping the rest of the body straight. This movement helps align the head and neck, reducing forward head posture and improving spinal alignment. After performing the unguided exercises, the patients will be taught the chin tuck position. From this point onward, they will be instructed to maintain the chin tuck position while performing the exercises using both external and internal focus strategies.
Active Comparator: prone T exercise with external focus
For external focus, participants will wear a headband with a laser light positioned on their forehead. The laser will be aligned to shine above and between the eyebrows. A flat wall will be placed in front of them, where the laser light is clearly visible. Participants will be instructed: "Bring your head into a chin tuck position and focus on the point where the laser hits the wall while performing the exercise."
Other: The chin tuck posture
A chin tuck is a posture correction technique where the individual gently tucks their chin towards their chest while keeping the rest of the body straight. This movement helps align the head and neck, reducing forward head posture and improving spinal alignment. After performing the unguided exercises, the patients will be taught the chin tuck position. From this point onward, they will be instructed to maintain the chin tuck position while performing the exercises using both external and internal focus strategies.
Active Comparator: prone T exercise with internal focus
Participants will be instructed: "Bring your head into a chin tuck position and focus on keeping your neck in a neutral position while performing the exercise."
Other: The chin tuck posture
A chin tuck is a posture correction technique where the individual gently tucks their chin towards their chest while keeping the rest of the body straight. This movement helps align the head and neck, reducing forward head posture and improving spinal alignment. After performing the unguided exercises, the patients will be taught the chin tuck position. From this point onward, they will be instructed to maintain the chin tuck position while performing the exercises using both external and internal focus strategies.

What is the study measuring?

Primary Outcome Measures

Outcome Measure
Measure Description
Time Frame
Electromyography (EMG) Measurement on neck muscles
Time Frame: through study completion, an average of 3 months
The activation of the Upper Trapezius (UT), Middle Trapezius (MT), Lower Trapezius (LT), Serratus Anterior (SA), and Sternocleidomastoid (SCM) muscles will be measured using the non-invasive surface 8-channel EMG Noraxon MiniDTS system (Noraxon, USA, Inc, Scottsdale, AZ).
through study completion, an average of 3 months
Craniovertebral Angle Measurement
Time Frame: through study completion, an average of 3 months
The craniovertebral angle (CVA) will be measured using the reliable and valid lateral digital photogrammetric method and Kinovea Video Analysis Software. Participants will be filmed laterally from their dominant side (left for left-dominant, right for right-dominant). A phone on a tripod will be placed 1.5 meters away from the participant at shoulder height. Markers will be placed on the tragus and C7 spinous process for accurate measurement, with participants wearing tight shorts and a short-sleeved shirt. They will be instructed to stand with feet shoulder-width apart and face forward. Before photographing, participants will walk in place five times to capture their natural head-body position. Photos will be taken within the first 5 seconds, and the CVA will be measured using Kinovea Video Analysis Software.
through study completion, an average of 3 months

Collaborators and Investigators

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

Sponsor

Gazi University

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 (Estimated)

February 2, 2025

Primary Completion (Estimated)

March 5, 2025

Study Completion (Estimated)

April 15, 2025

Study Registration Dates

First Submitted

November 20, 2024

First Submitted That Met QC Criteria

January 12, 2025

First Posted (Actual)

March 25, 2025

Study Record Updates

Last Update Posted (Actual)

March 25, 2025

Last Update Submitted That Met QC Criteria

January 12, 2025

Last Verified

November 1, 2024

More Information

Terms related to this study

Keywords

Other Study ID Numbers

  • BYDTEZ-2024/1
  • Gazi University (Other Identifier: Research Projects Coordination Unit)

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

product manufactured in and exported from the U.S.

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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