Billis E1, Nikolaos K1, Lambrini T1, Zacharias D2, Elias T1
1TEI of Western Greece, Department of Physiotherapy, Patras, Greece, 2General University Hospital 'Attikon', Department of Physiotherapy, Athens, Greece
Background: Forward head posture (FHP), neck mobility, pain and function are factors reported to predispose to chronic neck pain. Various therapeutic exercises have been postulated to improve pain and function in neck pain. In particular, motor control training of the deep cervical musculature and upper quadrant strengthening exercises are recommended for improving overall neck function. However, it is not well established whether such improvements are more effective when a comprehensive motor control-specific program is utilized instead of a more general neck muscles' training program.
Purpose: To investigate the effects of a progressive motor control exercise program of the deep cervical musculature on forward head posture, pain, function and cervical range of movement (ROM) in patients with FHP and neck pain.
Methods: Volunteer adults were recruited from a university campus. Selected subjects had self-reported neck pain and an established FHP (craniocervical angle of less than 55° in sitting according to previously reported criteria). Participants were randomized to one of two intervention groups: motor control or general strengthening exercise (control) group. Motor control group encompassed deep neck flexor and extensor muscle activation and endurance exercises, specific proprioceptive and kinaesthetic exercises. Control group included neck and upper limb general strengthening exercises. Both programs involved 30-minute sessions, 3-times weekly for 8 weeks. Primary outcome included craniocervical angle (CCA) measured in 4 standardised positions; relaxed sitting and standing and upright (corrected) sitting and standing. Secondary outcomes included neck ROM (measured with bubble inclinometer), Neck Disability Index (NDI), Numeric Pain Rating Scale (NPRS) scores, deep neck flexor muscle endurance (utilizing pressure biofeedback device) and five reliable and established motor control tests. Participants were tested at baseline and post-intervention. Time-group interactions for each dependent variable were examined with a two-way mixed ANOVA model.
Results: Fifty one participants with FHP were randomly assigned to a motor control (n=26, 18 females, mean age 20,35±1,2 years) and a general strengthening (control) exercise (n=25, 14 females, mean age 20,84±1,8 years) group. Intra- and inter-tester reliability for all clinical outcomes were satisfactory (ICCs and Kappas between 0,500 to 0,996). There were significant group x time interactions in CCAs measured in standing (relaxed and upright) and sitting upright, NDI and in the 'best' pain intensity across groups (p 0.05), with motor control group demonstrating improvements in all variables. Motor control tests, deep neck flexor endurance, average and worst pain intensity and ROM did not yield any changes across groups over time.
Conclusion(s): Findings provide encouraging data regarding the effects of a progressive and comprehensive motor control exercise program for self-reported neck pain and forward head posture. Such exercise programs seem to benefit neck posture, pain, disability and overall function of adults with FHP. However, specific neck flexors' training was not proven superior to general strengthening on neck ROM, average and worst neck pain intensity and on specific neck motor control tests.
Implications: An 8 weeks' physiotherapy program in the form of specific exercises preferentially delivered in a neuromuscular and proprioceptive-based progressive manner seem to be effective for improving FHP, pain and overall neck function.
Keywords: Forward head posture, neck, motor control exercises
Funding acknowledgements: None
Purpose: To investigate the effects of a progressive motor control exercise program of the deep cervical musculature on forward head posture, pain, function and cervical range of movement (ROM) in patients with FHP and neck pain.
Methods: Volunteer adults were recruited from a university campus. Selected subjects had self-reported neck pain and an established FHP (craniocervical angle of less than 55° in sitting according to previously reported criteria). Participants were randomized to one of two intervention groups: motor control or general strengthening exercise (control) group. Motor control group encompassed deep neck flexor and extensor muscle activation and endurance exercises, specific proprioceptive and kinaesthetic exercises. Control group included neck and upper limb general strengthening exercises. Both programs involved 30-minute sessions, 3-times weekly for 8 weeks. Primary outcome included craniocervical angle (CCA) measured in 4 standardised positions; relaxed sitting and standing and upright (corrected) sitting and standing. Secondary outcomes included neck ROM (measured with bubble inclinometer), Neck Disability Index (NDI), Numeric Pain Rating Scale (NPRS) scores, deep neck flexor muscle endurance (utilizing pressure biofeedback device) and five reliable and established motor control tests. Participants were tested at baseline and post-intervention. Time-group interactions for each dependent variable were examined with a two-way mixed ANOVA model.
Results: Fifty one participants with FHP were randomly assigned to a motor control (n=26, 18 females, mean age 20,35±1,2 years) and a general strengthening (control) exercise (n=25, 14 females, mean age 20,84±1,8 years) group. Intra- and inter-tester reliability for all clinical outcomes were satisfactory (ICCs and Kappas between 0,500 to 0,996). There were significant group x time interactions in CCAs measured in standing (relaxed and upright) and sitting upright, NDI and in the 'best' pain intensity across groups (p 0.05), with motor control group demonstrating improvements in all variables. Motor control tests, deep neck flexor endurance, average and worst pain intensity and ROM did not yield any changes across groups over time.
Conclusion(s): Findings provide encouraging data regarding the effects of a progressive and comprehensive motor control exercise program for self-reported neck pain and forward head posture. Such exercise programs seem to benefit neck posture, pain, disability and overall function of adults with FHP. However, specific neck flexors' training was not proven superior to general strengthening on neck ROM, average and worst neck pain intensity and on specific neck motor control tests.
Implications: An 8 weeks' physiotherapy program in the form of specific exercises preferentially delivered in a neuromuscular and proprioceptive-based progressive manner seem to be effective for improving FHP, pain and overall neck function.
Keywords: Forward head posture, neck, motor control exercises
Funding acknowledgements: None
Topic: Musculoskeletal: spine
Ethics approval required: Yes
Institution: TEI of Western Greece
Ethics committee: School of Health & Caring Professions
Ethics number: 12132/6-4-2018
All authors, affiliations and abstracts have been published as submitted.
