The Effect of Focus Approaches on Neck Region Muscle Activation

NCT ID: NCT06778980

Last Updated: 2025-01-16

Basic Information

• Recruitment Status: NOT_YET_RECRUITING
• Clinical Phase: NA
• Total Enrollment: 30 participants
• Study Classification: INTERVENTIONAL
• Study Start Date: 2025-02-02
• Study Completion Date: 2025-04-15

Brief Summary

Forward Head Posture (FHP) causes muscle imbalances in the neck and shoulder regions. Various exercises are suggested to correct FHP. During these exercises, internal and external focus techniques are used to enhance motor learning and improve muscle balance. However, there are no studies examining how these approaches affect neck muscle activation in individuals with FHP. Therefore, the purpose of this study is to investigate the effects of external and internal focus techniques, aimed at improving cervical alignment during postural correction exercises, on cervical muscle activation in individuals with FHP.

Detailed Description

Various corrective exercises are suggested in the literature to address Forward Head Posture (FHP). For individuals without musculoskeletal issues, chin-tuck and scapular retraction exercises in a supine position have strong evidence for effectiveness. Scapular stabilization exercises help reduce negative mechanical loads caused by abnormal scapular and cervical spine positions. Additionally, focusing attention on the exercise or target area is used to enhance motor learning and muscle balance, with external focus shown to improve performance in various tasks compared to internal focus.

In clinical practice, it is essential to maintain cervical alignment during scapular retraction exercises for individuals with FHP. To optimize muscle balance during these exercises, instructions often emphasize keeping the chin-tuck position to avoid cervical protraction. Internal and external focus approaches during scapular retraction exercises may help balance the muscle imbalances in individuals with FHP. However, no studies have yet examined the effects of internal and external focus approaches on neck muscle activation in individuals with FHP.

Thirty participants with FHP, defined as having a craniovertebral angle less than 50 degrees, will be included in the study. Participants will perform scapular retraction exercises (bilateral row) with a theraband and T-exercises in a prone position. The exercises will be carried out under three conditions: without guidance (control - no corrective cues for the cervical region), external focus, and internal focus. A laser headband will be used for the external focus condition. Muscle activation of the Upper Trapezius, Middle Trapezius, Lower Trapezius, Serratus Anterior, and Sternocleidomastoid muscles will be measured using the Noraxon MiniDTS system (Noraxon, USA, Inc, Scottsdale, AZ). Muscle activation will be calculated as a percentage of Maximum Voluntary Isometric Contraction (MVIC), and the % MVIC values will be used for analysis. The order of exercises will be randomized.

Conditions

Forward Head Posture

Study Design

• Allocation Method: RANDOMIZED
• Intervention Model: CROSSOVER
• Primary Study Purpose: TREATMENT
• Blinding Strategy: SINGLE

Study Groups

unguided scapular retraction

Participants will be asked to perform the scapular retraction exercise without any corrective cues for the cervical region.

Group Type: NO_INTERVENTION

No interventions assigned to this group

unguided prone T exercise

Participants will be asked to perform the prone T exercise without any corrective cues for the cervical region.

Group Type: NO_INTERVENTION

No interventions assigned to this group

scapular retraction exercise with External focus

For external focus, participants will wear a headband with a laser light positioned on their forehead. The laser will be aligned to shine above and between the eyebrows. A flat wall will be placed in front of them, where the laser light is clearly visible. Participants will be instructed: "Bring your head into a chin tuck position and focus on the point where the laser hits the wall while performing the exercise."

Group Type: ACTIVE_COMPARATOR

The chin tuck posture

Intervention Type: OTHER

A chin tuck is a posture correction technique where the individual gently tucks their chin towards their chest while keeping the rest of the body straight. This movement helps align the head and neck, reducing forward head posture and improving spinal alignment. After performing the unguided exercises, the patients will be taught the chin tuck position. From this point onward, they will be instructed to maintain the chin tuck position while performing the exercises using both external and internal focus strategies.

scapular retraction exercise with internal focus

Participants will be instructed: "Bring your head into a chin tuck position and focus on keeping your neck in a neutral position while performing the exercise."

Group Type: ACTIVE_COMPARATOR

The chin tuck posture

Intervention Type: OTHER

A chin tuck is a posture correction technique where the individual gently tucks their chin towards their chest while keeping the rest of the body straight. This movement helps align the head and neck, reducing forward head posture and improving spinal alignment. After performing the unguided exercises, the patients will be taught the chin tuck position. From this point onward, they will be instructed to maintain the chin tuck position while performing the exercises using both external and internal focus strategies.

prone T exercise with external focus

For external focus, participants will wear a headband with a laser light positioned on their forehead. The laser will be aligned to shine above and between the eyebrows. A flat wall will be placed in front of them, where the laser light is clearly visible. Participants will be instructed: "Bring your head into a chin tuck position and focus on the point where the laser hits the wall while performing the exercise."

Group Type: ACTIVE_COMPARATOR

The chin tuck posture

Intervention Type: OTHER

A chin tuck is a posture correction technique where the individual gently tucks their chin towards their chest while keeping the rest of the body straight. This movement helps align the head and neck, reducing forward head posture and improving spinal alignment. After performing the unguided exercises, the patients will be taught the chin tuck position. From this point onward, they will be instructed to maintain the chin tuck position while performing the exercises using both external and internal focus strategies.

prone T exercise with internal focus

Participants will be instructed: "Bring your head into a chin tuck position and focus on keeping your neck in a neutral position while performing the exercise."

Group Type: ACTIVE_COMPARATOR

The chin tuck posture

Intervention Type: OTHER

A chin tuck is a posture correction technique where the individual gently tucks their chin towards their chest while keeping the rest of the body straight. This movement helps align the head and neck, reducing forward head posture and improving spinal alignment. After performing the unguided exercises, the patients will be taught the chin tuck position. From this point onward, they will be instructed to maintain the chin tuck position while performing the exercises using both external and internal focus strategies.

Interventions

The chin tuck posture

A chin tuck is a posture correction technique where the individual gently tucks their chin towards their chest while keeping the rest of the body straight. This movement helps align the head and neck, reducing forward head posture and improving spinal alignment. After performing the unguided exercises, the patients will be taught the chin tuck position. From this point onward, they will be instructed to maintain the chin tuck position while performing the exercises using both external and internal focus strategies.

Intervention Type: OTHER

Eligibility Criteria

Inclusion Criteria

• Aged between 18-35 years,
• Craniovertebral angle (CVA) less than 50 degrees,
• Willing to not participate in any treatment/evaluation during the study,
• Voluntary participation.

Exclusion Criteria

• Experiencing pain in the neck, spine, upper or lower extremities for the past 3 months,
• Body mass index (BMI) greater than 25 kg/m²,
• History of neck injuries or surgeries such as intervertebral disc herniation, spondylosis, radiculopathy, chronic headaches, or whiplash,
• Any visual, auditory, or sensory impairments,
• Temporomandibular joint issues,
• Neurological (e.g., epilepsy), rheumatological, or orthopedic symptoms,
• Any conditions affecting balance and muscle control,
• Cardiopulmonary or systemic diseases that prevent exercise.

• Minimum Eligible Age: 18 Years
• Maximum Eligible Age: 35 Years
• Eligible Sex: ALL
• Accepts Healthy Volunteers: Yes

Sponsors

Gazi University

OTHER

Sponsor Role: lead

Responsible Party

BEYZA YAZGAN DAĞLI

Research Assistant

Responsibility Role: PRINCIPAL_INVESTIGATOR

Locations

Gazi University

Ankara, Turkey, Turkey (Türkiye)

Countries

Turkey (Türkiye)

Central Contacts

Beyza Yazgan Dagli

Role: CONTACT

beyzayazgan@gazi.edu.tr

05535134631

Gamze Çobanoğlu Demirkan, Phd

Role: CONTACT

fztgamze7@gmail.com

Facility Contacts

Seyit Çıtaker

Role: primary

scitaker@gazi.edu.tr

05336212449

Other Identifiers

Gazi University

Identifier Type: OTHER

Identifier Source: secondary_id

BYDTEZ-2024/1

Identifier Type: -

Identifier Source: org_study_id