EFFICACY OF POSTURAL CORRECTION PROGRAMS ON CRANIOVERTEBRAL ANGLE, DISABILITY, AND MUSCLE ACTIVATION IN FORWARD HEAD POSTURE: A RANDOMIZED CONTROLLED TRIAL

W. Elsayed¹, Z. Alowa²

Background: Forward head posture (FHP) is a common malalignment affecting the cervicothoracic segments of the spine. This deviation commonly causes pain, disability, muscle imbalance in the neck or scapular muscles, or alterations to other spinal regions that compensate for the distorted cervical alignment. Management of FHP includes postural correction exercise involving cervicothoracic region. Association of cervical posture with lumbopelvic kinematics was previously reported. Studies suggested adding lumbopelvic protocol would change sagittal cervical alignment. There is no consensus on the superiority of adding lumbopelvic to cervicothoracic program versus cervicothoracic program solely.  

Purpose: To compare the efficacy of FHP correction using cervicothoracic combined with lumbopelvic program versus cervicothoracic rehabilitation program alone.  Efficacy of programs was tested in terms of craniovertebral (CV) angle correction, neck disability index (NDI), and spinal muscles electromyography (EMG) activation.

Methods: A parallel-group randomized controlled trial design was implemented. Participants with FHP were randomly assigned to receive four weeks (12 sessions) of postural correction program applying either cervicothoracic correction program (control group), or cervicothoracic plus lumbopelvic correction program (experimental group). The primary outcomes were change in CV angle measured from standing posture with a 2-D photogrammetry method, and NDI. The secondary outcome was regional spinal muscles activation examined while holding a five kg box at elbow level. Normalized EMG data (%MVC) were collected from Cervical erector spinae (CES), Upper trapezius (UT), Thoracic erector spinae (TES), and Lumbar erector spinae (LES) bilaterally. Outcome measures were tested at baseline and after completion of the program at week four.

Results: Thirty females with FHP (Age: 19.5 ± 2.4 years, and BMI: 21.5 ± 2.1) were recruited and randomly assigned to either control (n=15) or experimental group (n=15). All subjects were available for testing after treatment. There was a significant improvement across time for CV angle, and NDI for both groups (p=0.000 ,p=0.002). However, between-group comparison was not statistically significant.  The corrected CV angle for control group and experimental group post intervention changed by (8.3%, p=0.000 and 12.4%, p=0.000) respectively. The NDI improved only for experimental group p=0.005. With regards to muscle activation, A reduction of %MVC was observed overtime for both groups for Rt CES (p =0.006), Lt CES (p =0.001), Rt TES (p =0.03), and Lt LES (p =0.03) post exercises. No significant difference were found for the between-group comparison of spinal muscle activation (p>0.05).

Conclusion(s): Management of FHP using cervio-thoarcic, or cervico-thoracic plus lumbo-pelvic protocol could improve the sagittal CV posture, and decrease spinal muscles activation. Adding lumbopelvic program to cervicothoracic protocol was more effective on improving NDI than cervicothoracic program alone.

Implications: Incorporating lumbopelvic to cervicothoracic protocol was more effective at reducing short-term neck pain and disability than cervicothoracic protocol alone. Both programs were considered equivalent on correcting CV angle, and decreasing spinal muscles demand in adults’ females with FHP. Incorporated program may be clinically beneficial and could be added to rehabilitation protocol of FHP if the short-term improvement of neck pain and disability is targeted, but further research on the long-term effect is needed.

Funding, acknowledgements: The work was unfunded

Keywords: Forward Head Posture, Posture Correction, Neck Disability Index

Topic: Musculoskeletal: spine

Did this work require ethics approval? Yes

Institution: Imam Abdulrahman Bin Faisal University

Committee: IRB of Imam Abdulrahman Bin Faisal University

Ethics number: IRB-PGS-2016-03-144