Effects of Postural Education or Corrective Exercise on Forward Head Posture
NCT ID: NCT05321654
Last Updated: 2022-04-11
Study Results
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Basic Information
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COMPLETED
NA
79 participants
INTERVENTIONAL
2021-08-26
2021-11-04
Brief Summary
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Detailed Description
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Participants were asked to arrive at the lab wearing either a tank top or t-shirt, as well as to have their hair tied back if necessary. Height and weight were measured using a digital scale (Health-o-meter Professional, model 500KL, McCook, IL). Participants were instructed to sit comfortably on a stool with hands resting approximately two-thirds down their thighs with palms supinated and feet flat on the ground with hips and knees at 90 degrees; and to look straight ahead at an opposite wall in the laboratory. A digital camera (Canon Powershot, model SX540, Tokyo, Japan) was mounted and leveled on a tripod (Manfrotto, model 055, Cassola, IT) and placed three meters away from the subject. Two photographs were taken of participant's posture. Immediately after data capture, image files were uploaded into Kinovea video analysis software (version 8.15) for CVA assessment. CVA assessment will be discussed further in outcome measures section.
Seventy-nine participants met inclusion criteria (discussed in detail in future section) and were enrolled in the study. Randomization of participant group assignments was completed by the PI using a block randomization generator. Utilizing a sequence created by the block randomizer, the PI placed participants who met inclusion criteria into one of four groups: postural education (PE; n = 20), self-myofascial release + stretching (SMRS; n = 20), self-myofascial release + stretching + strengthening (SMRSS; n = 19), and control group (CG; n = 20). Details of these groups will be provided in future sections. A hard-copy of the sequence generator report was kept concealed in a manila folder and was only opened by the PI during group delegation.
Intervention duration was 4 weeks. Two weeks into the study, participants in intervention groups completed a mid-study questionnaire to assess intervention compliance. At the end of the study (after the completion of 4 weeks) participants in intervention groups completed a post-study questionnaire to assess intervention compliance. All study participants were asked to return back to the Biomechanics laboratory after the completion of the 4 week intervention period to undergo follow-up posture screening, which followed the same posture assessment procedures as described above.
Declarations of interest: This study was part of the requirements for completion of a Ph.D. dissertation (Concordia University Chicago) by David Titcomb, DPT.
Conflicts of interest: none.
Conditions
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Study Design
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RANDOMIZED
PARALLEL
PREVENTION
NONE
Study Groups
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Posture Education (PE) Group
PE group members received a 20-minute in-person one-on-one standardized educational session by a research team member in the laboratory on the following topics: health risks associated with forward head posture; postural guidelines for using mobile electronic devices, desktop computers, and laptop computers; as well as rest break guidelines. Participants were asked to adhere to the postural guidelines provided in the educational session for the next 4 weeks.
Education for Behavior Modification
Please see arm description for a detailed description of the intervention
Self-Myofascial Release + Stretching (SMRS) Group
This group applied self-myofascial release (SMR) to their thoracic spine with a myofascial roller for 30 sec., then 6 repetitions of myofascial rolling for 90 sec. They applied SMR for 30 sec. to their neck flexors and extensors using their fingertips. They applied SMR to the upper trapezius and pectoralis for 30 sec using a soft tissue mobilization tool. For the first 2 weeks, they performed SMR 3x/wk. During wks. 3 and 4, they progressed SMR to 5 days/wk. Group members also performed stretching to these same muscles after SMR 3 days/wk for the first 2 weeks of the study, progressing to 5 days/wk during weeks 3 and 4.
Corrective Exercise Program
Please see arm description for a detailed description of the intervention
Self-Myofascial Release + Stretching + Strengthening (SMRSS) Group
This group performed the same protocol as SMRS group, as well as include the following strengthening exercises: the supine chin tuck (SCT), upper thoracic-lower cervical extension (UTLCE) using an exercise band that provided 5.5 pounds of resistance, and a single-arm row with trunk rotation (SARTR) using exercise tubing that provided 20 pounds of resistance. The SCT was progressed in 3 phases: Week 1: chin tuck held 2 sec., 5 reps. Week 2: same as week 1, but included us of a towel roll placed under the head. Wks. 3 and 4: chin tuck with head lift 1 in., 2 sec. hold. UTLCE: neck extension with exercise band, held 2 sec. SARTR: single arm row with trunk rotation was performed in a controlled and fluid manner using a self-selected speed. The UTLCE and SARTR were performed with 1 X 10 reps for wks 1-2 and progressed to 2 X10 reps in wks 3-4. Strengthening exercises were performed 3x/wk. for 4 wks.
Corrective Exercise Program
Please see arm description for a detailed description of the intervention
Control Group (CG)
Participants in the CG did not receive an intervention.
No interventions assigned to this group
Interventions
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Education for Behavior Modification
Please see arm description for a detailed description of the intervention
Corrective Exercise Program
Please see arm description for a detailed description of the intervention
Eligibility Criteria
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Inclusion Criteria
* Craniovertebral angle ≤ 53 degrees
* Self-rating of Transtheoretical Model stage of change stage ≥ 3/5
Exclusion Criteria
* Diagnosis of pathology related to the cervical spine, thoracic spine, or upper extremities
* Non-clearance for physical activity based on results of the 2020 PAR-Q+ questionnaire
18 Years
29 Years
ALL
Yes
Sponsors
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National Academy of Sports Medicine
UNKNOWN
Liberty University
OTHER
Responsible Party
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Dr. David Titcomb
Professor of Health Sciences
Principal Investigators
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David A Titcomb, DPT
Role: PRINCIPAL_INVESTIGATOR
Liberty University
Bridget F Melton, EdD
Role: STUDY_CHAIR
Concordia University Chicago
Theresa Miyashita, PhD
Role: STUDY_DIRECTOR
Concordia University Chicago
Helen W Bland, PhD
Role: STUDY_DIRECTOR
Concordia University Chicago
Locations
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Liberty University
Lynchburg, Virginia, United States
Countries
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References
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Abdelhameed AA, Abdel-Aziem AA. Exercise training and postural correction improve upper extremity symptoms among touchscreen smartphone users. Hong Kong Physiother J. 2016 Sep 7;35:37-44. doi: 10.1016/j.hkpj.2016.06.001. eCollection 2016 Dec.
Bayattork M, Seidi F, Minoonejad H, McClure P, Mozafaripoor E. Intra-rater and inter-rater reliability and agreement of the scapular dyskinesis test in young men with forward head and round shoulder posture. J Rehabil. Sci. 2019 Dec 10;6(4):169-173. https://doi.org/10.30476/JRSR.2019.82944.1037
Carter SE, Draijer R, Holder SM, Brown L, Thijssen DHJ, Hopkins ND. Regular walking breaks prevent the decline in cerebral blood flow associated with prolonged sitting. J Appl Physiol (1985). 2018 Sep 1;125(3):790-798. doi: 10.1152/japplphysiol.00310.2018. Epub 2018 Jun 7.
Cuellar JM, Lanman TH. "Text neck": an epidemic of the modern era of cell phones? Spine J. 2017 Jun;17(6):901-902. doi: 10.1016/j.spinee.2017.03.009. Epub 2017 Mar 20. No abstract available.
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Fahmy R. NASM Essentials of corrective exercise training. 2nd ed. Burlington, Massachusetts: Jones & Bartlett Learning; 2022.
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Hansraj KK. Assessment of stresses in the cervical spine caused by posture and position of the head. Surg Technol Int. 2014 Nov;25:277-9.
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Kar G, Hedge A. Effect of workstation configuration on musculoskeletal discomfort, productivity, postural risks, and perceived fatigue in a sit-stand-walk intervention for computer-based work. Appl Ergon. 2021 Jan;90:103211. doi: 10.1016/j.apergo.2020.103211. Epub 2020 Aug 17.
Kim BB, Lee JH, Jeong HJ, Cynn HS. Effects of suboccipital release with craniocervical flexion exercise on craniocervical alignment and extrinsic cervical muscle activity in subjects with forward head posture. J Electromyogr Kinesiol. 2016 Oct;30:31-7. doi: 10.1016/j.jelekin.2016.05.007. Epub 2016 May 24.
Kim SY, Koo SJ. Effect of duration of smartphone use on muscle fatigue and pain caused by forward head posture in adults. J Phys Ther Sci. 2016 Jun;28(6):1669-72. doi: 10.1589/jpts.28.1669. Epub 2016 Jun 28.
Kuroda Y, Sato Y, Ishizaka Y, Yamakado M, Yamaguchi N. Exercise motivation, self-efficacy, and enjoyment as indicators of adult exercise behavior among the transtheoretical model stages. Glob Health Promot. 2012 Mar;19(1):14-22. doi: 10.1177/1757975911423073. Epub 2012 Feb 14.
Lau KT, Cheung KY, Chan KB, Chan MH, Lo KY, Chiu TT. Relationships between sagittal postures of thoracic and cervical spine, presence of neck pain, neck pain severity and disability. Man Ther. 2010 Oct;15(5):457-62. doi: 10.1016/j.math.2010.03.009.
Lee DY, Nam CW, Sung YB, Kim K, Lee HY. Changes in rounded shoulder posture and forward head posture according to exercise methods. J Phys Ther Sci. 2017 Oct;29(10):1824-1827. doi: 10.1589/jpts.29.1824. Epub 2017 Oct 21.
Neupane S, Ali UI, Mathew A. Text neck syndrome-systematic review. Imp. J. Interdiscip. Res. 2017; 3(7): 141-148. http://www.onlinejournal.in
Richards KV, Beales DJ, Smith AJ, O'Sullivan PB, Straker LM. Neck Posture Clusters and Their Association With Biopsychosocial Factors and Neck Pain in Australian Adolescents. Phys Ther. 2016 Oct;96(10):1576-1587. doi: 10.2522/ptj.20150660. Epub 2016 May 12.
Ruivo RM, Pezarat-Correia P, Carita AI. Cervical and shoulder postural assessment of adolescents between 15 and 17 years old and association with upper quadrant pain. Braz J Phys Ther. 2014 Jul-Aug;18(4):364-71. doi: 10.1590/bjpt-rbf.2014.0027. Epub 2014 Jul 18.
Sahu M, Sundari KG, David A. Recent ergonomic interventions and evaluations on laptop, smartphones and desktop computer users. In Arockiarajan A, Duraiselvam M, Raju R, editors. Advances in Industrial Automation and Smart Manufacturing. Singapore: Springer; 2021. p. 207-224. https://doi.org/10.1007/978-981-15-4739-3
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Vate-U-Lan P. Text neck epidemic: a growing problem for smart phone users in Thailand. Int J Comput. Internet Manage. 2015 Sept-Dec;23(3): 551-556.
Warburton DER, Jamnik VK, Bredin SSD, and Gledhill N. The physical activity readiness questionnaire for everyone (PAR-Q+) and electronic physical activity readiness medical examination (ePARmed-X+). Health Fit J of Canada. 2011; 4(2):3-23. https://doi.org/10.14288/hfjc.v4i2.103
Provided Documents
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Document Type: Study Protocol and Statistical Analysis Plan
Document Type: Informed Consent Form
Other Identifiers
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UR2201
Identifier Type: OTHER_GRANT
Identifier Source: secondary_id
IRB-FY20-21-1073
Identifier Type: -
Identifier Source: org_study_id
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