The impact of forward head posture on the electromyographic activity of the spinal muscles

Zaenab Alowa, Walaa Elsayed, Zaenab Alowa, Walaa Elsayed

Abstract

Objective: This study aims to examine the electromyographic activity of the regional spinal muscle between patients with forward head posture (FHP) and those with a normal cranio-vertebral (CV) angle.

Methods: We recruited 60 adult women aged between 18 and 29 years from a single institution. The CV angle was measured in the sagittal plane, which helped us to assign the participants in the FHP group (n = 30) with a large CV angle (53.1 ± 2.3) and the control group (n = 30) with a normal CV angle (43.0 ± 3.6). The surface electromyography (EMG) was used to measure the magnitude of normalised muscle activity of eight spinal muscles (cervical, lumbar, and thoracic levels) while standing and performing a specific manual handling task.

Results: The CV angle was significantly lower in the FHP group than in the control group (p = .001). The cervical erector spinae (CES) muscle activity was significantly increased in the FHP group compared to that in the control group. The right and left CES of those in the FHP group exhibited 73% and 87%, respectively, higher normalised muscle activity than those in the control group while performing the manual handling task (p = .001). No significant difference was detected for the thoracic or lumbar segment muscles between groups.

Conclusion: Our results indicate that greater neck muscle demands result from anterior head translation in FHP. This effect is a counterbalance to the reduced CV angle and to support the neck. The increased activity of the neck muscles in FHP could demand more support from the neck muscles and might increase the risk of spinal injuries. Management of FHP is essential to avoid overloading the spinal muscles.

Keywords: Cranio-vertebral angle; Electromyography; Head posture; Musculoskeletal; Spinal muscles.

© 2020 The Authors.

Figures

Figure 1
Figure 1
Measurement of Craniovertebral angle.
Figure 2
Figure 2
Surface EMG electrodes placement sites in spinal muscles.
Figure 3
Figure 3
Setup of the experimental task used by the participants for measuring spinal muscles activation.

References

    1. Nordin M., Frankel V.H. 4th ed. Wolters Kluwer Health/Lippincott Williams & Wilkins; Philadelphia: 2012. Basic biomechanics of the musculoskeletal system.
    1. Shaghayegh B., Ahmadi A., Sarrafzadeh J. Evaluation of forward head posture in sitting and standing positions. Eur Spine J. 2016;25(11):3577–3582. doi: 10.1007/s00586-015-4254-x. Epub 2015 Oct 17. PMID: 26476717.
    1. Lee K.J., Han H.Y., Cheon S.H., Park S.H., Yong M.S. Effect of forward head posture on muscle activity during neck protraction and retraction. J Phys Ther Sci. 2015;27(3):977–979.
    1. Patwardhan A.G., Havey R.M., Khayatzadeh S., Muriuki M.G., Voronov L.I., Carandang G. Postural consequences of cervical sagittal imbalance: a novel laboratory model. Spine. 2015;40(11):783–792.
    1. Lee M.Y., Lee H.Y., Yong M.S. Characteristics of cervical position sense in subjects with forward head posture. J Phys Ther Sci. 2014;26(11):1741–1743.
    1. Silva A.G., Johnson M.I. Does forward head posture affect postural control in human healthy volunteers? Gait Posture. 2013;38(2):352–353.
    1. Edmondston S.J., Chan H.Y., Chi Wing Ngai G., Warren M.L.R., Williams J.M., Glennon S. Postural neck pain: an investigation of habitual sitting posture, perception of ‘good’ posture and cervicothoracic kinaesthesia. Man Ther. 2007;12(4):363–371.
    1. Gaffney B.M., Maluf K.S., Curran-Everett D., Davidson B.S. Associations between cervical and scapular posture and the spatial distribution of trapezius muscle activity. J Electromyogr Kinesiol. 2014;24(4):542–549.
    1. PearsaIi D.J., Reid J.G. Line of gravity relative to upright vertebral posture. Clin BioMech. 1992;7(2):80–86.
    1. Ruivo R.M., Carita A.I., Pezarat-Correia P. The effects of training and detraining after an 8 month resistance and stretching training program on forward head and protracted shoulder postures in adolescents: randomised controlled study. Man Ther. 2016;21:76–82.
    1. Lynch S.S., Thigpen C.A., Mihalik J.P., Prentice W.E., Padua D. The effects of an exercise intervention on forward head and rounded shoulder postures in elite swimmers. Br J Sports Med. 2010;44(5):376–381.
    1. Caneiro J.P., O'Sullivan P., Burnett A., Barach A., O'Neil D., Tveit O. The influence of different sitting postures on head/neck posture and muscle activity. Man Ther. 2010;15(1):54–60.
    1. Zabihhosseinian M., Holmes M.W.R., Ferguson B., Murphy B. Neck muscle fatigue alters the cervical flexion relaxation ratio in sub-clinical neck pain patients. Clin BioMech. 2015;30(5):397–404.
    1. Lee T.H., Lee J.H., Lee Y.S., Kim M.K., Kim S.G. Changes in the activity of the muscles surrounding the neck according to the angles of movement of the neck in adults in their 20s. J Phys Ther Sci. 2015;27(3):973–975.
    1. Malmström E.-M., Olsson J., Baldetorp J., Fransson P.-A. A slouched body posture decreases arm mobility and changes muscle recruitment in the neck and shoulder region. Eur J Appl Physiol. 2015;115(12):2491–2503.
    1. Tsang S.M.H., Szeto G.P.Y., Lee R.Y.W. Altered spinal kinematics and muscle recruitment pattern of the cervical and thoracic spine in people with chronic neck pain during functional task. J Electromyogr Kinesiol. 2014;24(1):104–113.
    1. Faul F., Erdfelder E., Lang A.G., Buchner A. G∗Power 3: a flexible statistical power analysis program for the social, behavioral, and biomedical sciences. Behav Res Methods. 2007;39(2):175–191.
    1. Jordan A., Mehlsen J., Bulow P.M., Ostergaard K., Danneskiold-Samsoe B. Maximal isometric strength of the cervical musculature in 100 healthy volunteers. Spine. 1999;24(13):1343–1348. (Phila Pa 1976)
    1. Salo P.K., Ylinen J.J., Malkia E.A., Kautiainen H., Hakkinen A.H. Isometric strength of the cervical flexor, extensor, and rotator muscles in 220 healthy females aged 20 to 59 years. J Orthop Sports Phys Ther. 2006;36(7):495–502.
    1. Salahzadeh Z., Maroufi N., Ahmadi A., Behtash H., Razmjoo A., Gohari M. Assessment of forward head posture in females: observational and photogrammetry methods. J Back Musculoskelet Rehabil. 2014;27(2):131–139.
    1. Diab A.A., Moustafa I.M. The efficacy of forward head correction on nerve root function and pain in cervical spondylotic radiculopathy: a randomized trial. Clin Rehabil. 2012;26(4):351–361.
    1. Ruivo R.M., Pezarat-Correia P., Carita A.I. Effects of a resistance and stretching training program on forward head and protracted shoulder posture in adolescents. J Manipulative Physiol Therapeut. 2017;40(1):1–10.
    1. Farrag A.T., Elsayed W.H., El-Sayyad M.M., Marras W.S. Weight knowledge and weight magnitude: impact on lumbosacral loading. Ergonomics. 2015;58(2):227–234.
    1. Han T.S., Oh M.K., Kim S.M., Yang H.J., Lee B.S., Park S.Y. Relationship between neck length, sleep, and cardiovascular risk factors. Korean J Fam Med. 2015;36(1):10–21.
    1. Sabharwal S., Kumar A. Methods for assessing leg length discrepancy. Clin Orthop Relat Res. 2008;466(12):2910–2922.
    1. Lason G., Peeters L., Vandenberghe K., Byttebier G., Comhaire F. Reassessing the accuracy and reproducibility of Diers formetric measurements in healthy volunteers. Int J Osteopath Med. 2015;18(4):247–254.
    1. Elsayed W., Farrag A., Muaidi Q., Almulhim N. Relationship between sagittal spinal curves geometry and isokinetic trunk muscle strength in adults. Eur Spine J. 2018;27(8):2014–2022.
    1. Shin S., Yoon D.M., Yoon K.B. Identification of the correct cervical level by palpation of spinous processes. Anesth Analg. 2011;112(5):1232–1235.
    1. Oliveira A.C., Silva A.G. Neck muscle endurance and head posture: a comparison between adolescents with and without neck pain. Man Ther. 2016;22:62–67.
    1. Scholtes V.A., Dallmeijer A.J., Knol D.L., Speth L.A., Maathuis C.G., Jongerius P.H. The combined effect of lower-limb multilevel botulinum toxin type a and comprehensive rehabilitation on mobility in children with cerebral palsy: a randomized clinical trial. Arch Phys Med Rehabil. 2006;87(12):1551–1558.
    1. Hashemirad F., Talebian S., Hatef B., Kahlaee A.H. The relationship between flexibility and EMG activity pattern of the erector spinae muscles during trunk flexion–extension. J Electromyogr Kinesiol. 2009;19(5):746–753.
    1. Kuo Y.-L., Wang P.-S., Ko P.-Y., Huang K.-Y., Tsai Y.-J. Immediate effects of real-time postural biofeedback on spinal posture, muscle activity, and perceived pain severity in adults with neck pain. Gait Posture. 2019;67:187–193.

Source: PubMed

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