Argyrou S1,2, Dimitriadis Z1, Strimpakos N1,3, Kanellopoulos A1, Poulis I1, Kapreli E1
1Technological Educational Institute (TEI) of Sterea Ellada, Physiotherapy, Lamia, Greece, 2European University of Cyprus, Physiotherapy, Nicosia, Cyprus, 3University of Manchester, Manchester, United Kingdom

Background: Epidemiological studies have shown forward head posture (FHP) and rounded shoulders being the most common biomechanical deviations in sagittal plane (Schwanke et al. 2016). People with FHP develop incomplete orthostatic control with balance issues (Johnson and Silva 2013). Adopting unhealthy motor control leads to chronic musculoskeletal syndromes (Lynch et al. 2010) with pain in the cervical spine (CS), even respiratory dysfunction (Kapreli et al. 2008). Despite the efforts to create effective treatment programmes based on muscular strength training and stretching exercises to correct posture, there is failure of positive long-term results in correction and maintenance (Falla et al. 2007; Lynch et al. 2010).

Purpose: The aim of the current study was to investigate the efficiency of an exercise program based on principles of motor learning with cognitive elements (attention, motivation, feedback, reasoning and video gaming) in correction of FHP in asymptomatic patients.

Methods: 149 students from TEI of Sterea Ellada were recruited, aged 18-25 years. Volunteers found to have cranial-vertical angle (CVA) 50o were randomly divided into two groups, the intervention group IG (n=26) and the control group CG (n =26). The primary outcome measures were:
1) Static FHP (CV in standing by photographs) and
2) Dynamic FHP (CVA through video motion analysis during walking).
The secondary outcome measures were:
1) Overall self-esteem (Sorensen self-esteem test),
2) Mood (VAS scale),
3) Overall physical fatigue (VAS scale),
4) Overall mental fatigue (VAS scale),
5) Attention -concentration (Attention-concentration questionnaire),
6) Deep neck flexors endurance (Chattanooga stabilizer pressure biofeedback) and
7) Discomfort (VAS scale).
The treatment protocol for the IG lasted 4 weeks/3 sessions per week, for a total of 12 sessions of 30-45 minutes each. At the end of the programme, a transfer measurement was carried out. Furthermore, 2 weeks after the end of the programme, a retention measurement was performed. Two-way Anova was used to detect differences between groups before, immediately after and after the retention period, whereas significance level was set at P 0.05. The study was conducted using SPPS statistical software for Microsoft Windows, release 19.0 (Professional Statistic, Chicago, IL, USA) ( Identifier: NCT03006497).

Results: Significant increase were observed in both measures of the CVA (Static, p=0,000 and Dynamic p=0,010), in the IG following the 4 week-intervention period. After the 2-week detraining period significand differences were observed also in the both measures of the CVA (Static, p=0,000 and Dynamic p=0,010). Additionally, there was an increase in deep neck flexors endurance (p=0,000), remaining during the detraining period (p=0,000), although intervention did not include strength exercises in IG. Finally, subjects with FHP were able to transfer motor ability trained on static position task to a similar dynamically untrained task such as walking.

Conclusion(s): The exercise intervention was successful at decreasing FHP in subjects, sustaining the results for a 2-week period. This study supports the effectiveness of postural training by a programme based on motor learning principles.

Implications: New rehabilitation strategies based on motor control and motor learning could be introduced into physiotherapy practice to increase effectiveness.

Keywords: Craniovertebral angle, forward head posture, motor learning

Funding acknowledgements: The study was unfunded

Topic: Musculoskeletal: spine; Robotics & technology

Ethics approval required: Yes
Institution: Technological Educational Institution of Sterea Ellada, Lamia, Greece
Ethics committee: Ethics Committee of Physiotherapy Department
Ethics number: 118/02-10-2008

All authors, affiliations and abstracts have been published as submitted.

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