Comparison Of The Neck And Scapular Proprioceptive Neuromuscular Facilitation Exercises On Postural Disorders, Scapular Dyskinesia And Round Shoulders in Individuals With Cervical Sagittal Alignment Disorder.
Primary Purpose
Forward Head Posture, Sagittal Cervical Malalignment, Rounded Shouler
Status
Completed
Phase
Not Applicable
Locations
Cyprus
Study Type
Interventional
Intervention
Scapular and Neck Proprioceptive Neuromuscular Facilitation exercises
McKenzie and Kendall exercises
Sponsored by
About this trial
This is an interventional treatment trial for Forward Head Posture focused on measuring Forward head posture, Proprioceptive Neuromuscular Facilitation, Mckenzie, Kendall
Eligibility Criteria
Inclusion Criteria:
- Those with a Kraviovertebral angle below 50o.
- Healthy individuals who have not had an upper extremity injury in the last 6 months.
- Has 3 or more pain in VAS for at least 3 months
Exclusion Criteria:
- Have received any physiotherapy program in the last 6 months due to neck pain or back pain.
- With structural scoliosis
- Have a history of fracture in the cervical vertebrae
- Have any rheumatic disease affecting the neck
- Having had a cervical spine surgery
- Spinal cord compression from a tumor or other cause
- Those with neurological deficits
Sites / Locations
- Eastern Mediterranean University
Arms of the Study
Arm 1
Arm 2
Arm Type
Experimental
Experimental
Arm Label
Scapular and Neck Proprioceptive Neuromuscular Facilitation Group
Control Group
Arm Description
Participants in the intervention group will be applied neck and scapular Proprioceptive Neuromuscular Facilitation exercises lasting 40 minutes for 3 sessions a week for 4 weeks.
McKenzie and Kendall exercises will be given to the participants in the control group. Exercises will be done 3 sessions a week over a 4-week period.
Outcomes
Primary Outcome Measures
Craniovertebral Angel Evaluation
The anatomical points of the participant's ipsilateral tragus and C7 spinous process will be marked. The angle between the line connecting the C7 spinous process and the tragus point and the horizontal line drawn from C7 gives the craniovertebral angle. Individuals with a CVA angle of less than 50 degrees are individuals with cervical sagittal alignment. A camera will be placed at a distance of 1 meter and the camera lens will be at the C7 level, fınally the lateral photos of the patients will be taken. Angle calculations will be made using the triangular screen ruler computer program of Markus Bader- MB Software Solutions.
Secondary Outcome Measures
Neck Pain assessment
Neck pain intensity will be objectively evaluated with the Visual Analogue Scale. The patient will be asked to mark the severity of the pain felt on the line drawn with a 10 cm ruler such as 0 = "no pain" 10 = "very severe pain".
The International Physical Activity Questionnaire (IPAQ)- Short Form
This short-form consists of 7 questions and provides information about sitting, walking, moderately vigorous activities, and time spent on vigorous activities. In the IPAQ short form evaluation, the energy required for the activities will be calculated with the MET-minute score.
Neck disailty index (NDİ)
It is a questionnaire consisting of 10 topics investigating how neck pain affects the daily life of the patient. These headings evaluate the severity of pain, personal care, carrying, reading, headache, concentration, work-life, driving, sleep and recreation. Each section is scored between 0 and 5. The total score of NDİ is calculated over 100. According to the BDI score; 0-8% no disability, 10-28% mild disability, 30-48% moderate disability, 50% 68 severe disability, 68% over full disability.
Active Cervical Range of Motion
Active cervical range of motion is measured with goniometer application (G-pro© ), which was proven to be valid by Pourahmadi in 2018. For measuring flexion and extension, the testing position of the iPhone was placed just beside the external auditory meatus, and one axis of the app was aligned with the imaginary line between the base of the nostril and the external auditory meatus. Active lateral flexion range of motion was measured in the sitting position. The center of the app was placed over the C7 spinous process and one axis of the app was aligned with the occipital protuberance. Finally, active craniocervical rotation in sitting, this movement was evaluated in the supine position the center of the app was positioned at the center of the head and one axis was aligned with the nose.
Evaluation of Postural Problems
In the study, the photography method will be used in measuring the tilt angle, the frontal tilt angle of the head, and the rounded shoulder angle. The determined anatomical points will be marked, the lateral and anterior photographs of the patients will be taken with a digital camera. Angular calculations will be made using the triangular screen ruler computer program of Markuz Bader- MB Software Solutions.
Head tilt, will be calculated by finding the angle between the line drawn between the endpoint of the eye from the tragus point and the horizontal line drawn from the tragus line.
Frontal tilt angle is the angle formed between the line joining the lower edges of each ear and the horizontal line Rounded shoulder, is calculated by finding the angle between the line joining the C7 spinous process and the acromion midpoint, and the horizontal line drawn from the midpoint of C7.
Lateral Scapular Slide Test
Each subject was instructed to actively achieve the first test position both arms at the sides in glenohumeral joint neutral, second position subject actively placed both hands on the ipsilateral hips and place the humerus in medial rotation at 45° of abduction in the coronal plane and third position subject actively extended both elbows, placed the upper extremities in a position of maximum medial rotation at 90° of abduction in the coronal plane. When the test position will be obtained the inferior angle of the scapula and the adjacent spinous process of the reference vertebra in the same horizontal plane will be identified through palpation and measured with a digital caliper bilaterally.
The Craniocervical Flexion Test
The test is performed with the patient in supine crook lying with the neck in a neutral position such that the line of the face is horizontal and a line bisecting the neck longitudinally is horizontal to the testing surface. The uninflated pressure sensor is placed behind the neck so that it abuts the occiput and is inflated to a stable baseline pressure of 20 mm Hg, a standard pressure sufficient to fill the space between the testing surface and the neck but not push the neck into a lordosis. The device provides feedback and direction to the patient to perform the required five stages of the test. The patient is instructed that the test is not one of strength but rather one of precision. The movement is performed gently and slowly as a head-nodding action (as if saying "yes").
Full Information
NCT ID
NCT04865926
First Posted
April 27, 2021
Last Updated
April 28, 2022
Sponsor
Eastern Mediterranean University
1. Study Identification
Unique Protocol Identification Number
NCT04865926
Brief Title
Comparison Of The Neck And Scapular Proprioceptive Neuromuscular Facilitation Exercises On Postural Disorders, Scapular Dyskinesia And Round Shoulders in Individuals With Cervical Sagittal Alignment Disorder.
Official Title
Comparison Of The Neck And Scapular Proprioceptive Neuromuscular Facilitation Exercises On Postural Disorders, Scapular Dyskinesia And Round Shoulders in Individuals With Cervical Sagittal Alignment Disorder.
Study Type
Interventional
2. Study Status
Record Verification Date
April 2022
Overall Recruitment Status
Completed
Study Start Date
March 22, 2021 (Actual)
Primary Completion Date
January 30, 2022 (Actual)
Study Completion Date
January 30, 2022 (Actual)
3. Sponsor/Collaborators
Responsible Party, by Official Title
Sponsor
Name of the Sponsor
Eastern Mediterranean University
4. Oversight
Studies a U.S. FDA-regulated Drug Product
No
Studies a U.S. FDA-regulated Device Product
No
5. Study Description
Brief Summary
In modern society, repetitive and monotonous activities are increasing due to the decrease in general physical activity, the development of the information technology industry, and time culture flow. Therefore, prolonged exposure to unstable or abnormal posture can trigger a chain reaction of poor alignment and imbalance, leading to musculoskeletal diseases such as muscle stiffness or repetitive traumatic injury.
Sagittal cervical malalignment (SCM), and also known as Forward head posture (FHP), is one of the poor posture types of the head commonly seen in the sagittal plane. İt is defined as the forward shift of the head. As the head moves forward, the center of gravity changes. To compensate for this shift in the center of gravity, the upper body slides back and the shoulders move forward, the rounded shoulder develops so that the head is placed in front of the body.
SCM can cause many harmful symptoms such as neck pain, shoulder pain, back pain, chronic headaches, increased curvature of the spine and scapular dyskinesis, and rounded shoulder.
Detailed Description
Proper posture is defined as musculoskeletal balance with minimal stress or strain on the body. The human body is a multi-joint system with kinetic chains controlled by the central nervous system, with a series of joints that interact with muscle activity.
Prolonged exposure to unstable or abnormal posture can trigger a chain reaction of weak alignment and imbalance, leading to musculoskeletal diseases such as muscle stiffness or repeated traumatic injury. Sagittal cervical malalignment (SCM), in other words forward head posture (FHP), is one of the poor posture types of the head commonly seen in the sagittal plane. It is defined as the shift of the center of the head towards the front. As the head moves forward, the center of gravity changes. To compensate for this shift in the center of gravity, the upper body slides back and the shoulders move forward, the rounded shoulder develops so that the head is placed in front of the body.
SCM of the head is defined as the anterior extension of the head with hyperextension of the upper cervical vertebrae (C1-C3) and flexion of the lower cervical vertebrae (C4-C7) and hyperlordosis of the cervical curve. It can be caused by a variety of factors, including Sleeping in positions with an excessive elevation of the head, prolonged use of the computer, and developed back muscle weakness.
SCM can cause many harmful symptoms such as neck pain, shoulder pain, back pain, chronic headaches, increased curvature of the spine and scapular dyskinesia, and rounded shoulder.
The rounded shoulder is a bent posture in which the scapulae are elevated and the acromion protrudes forward compared to the center of gravity of the body. These changes can cause an imbalance of the surrounding muscles and eventually pain in the head, temporomandibular joints, neck, back, shoulders and arms.
Scapular dyskinesia is referred to as visible changes in scapular position and movement patterns. It produces changes in the kinematics of the glenohumeral and acromioclavicular joints and can interfere with the activity of the periscapular muscles and rotator cuffs.7 Proprioceptive neuromuscular facilitation (PNF) methods focus on functional diagonal movement patterns and use cutaneous, visual, and auditory stimulation to improve neuromuscular control and function as well as muscle strength, balance, and flexibility. It is used as a progressive resistance for functional training in therapeutic exercises, improves joint limitations, and strengthens muscles. Scapular and neck PNF patterns are known to increase the stability of the head, neck, and scapular muscles.
6. Conditions and Keywords
Primary Disease or Condition Being Studied in the Trial, or the Focus of the Study
Forward Head Posture, Sagittal Cervical Malalignment, Rounded Shouler, Scapular Dyskinesis
Keywords
Forward head posture, Proprioceptive Neuromuscular Facilitation, Mckenzie, Kendall
7. Study Design
Primary Purpose
Treatment
Study Phase
Not Applicable
Interventional Study Model
Parallel Assignment
Masking
Participant
Allocation
Randomized
Enrollment
29 (Actual)
8. Arms, Groups, and Interventions
Arm Title
Scapular and Neck Proprioceptive Neuromuscular Facilitation Group
Arm Type
Experimental
Arm Description
Participants in the intervention group will be applied neck and scapular Proprioceptive Neuromuscular Facilitation exercises lasting 40 minutes for 3 sessions a week for 4 weeks.
Arm Title
Control Group
Arm Type
Experimental
Arm Description
McKenzie and Kendall exercises will be given to the participants in the control group. Exercises will be done 3 sessions a week over a 4-week period.
Intervention Type
Other
Intervention Name(s)
Scapular and Neck Proprioceptive Neuromuscular Facilitation exercises
Intervention Description
The researcher will perform a total of 12 sessions of scapular and neck pnf exercises for 4 weeks. The participants will apply PNF exercises using rhythmic initiation, rhythmic stabilization and cobination techniques of isotonics. Patterns of anterior elevation, posterior depression, anterior depression, posterior elevation will be used in scapular exercises. Upper cervical flexion, lower cervical flexion, rotation and lateral flexion patterns will be used in neck pnf exercises.
Intervention Type
Other
Intervention Name(s)
McKenzie and Kendall exercises
Intervention Description
Kendall and Mckenzie exercises will be given to the participants as a home workout. The self-stretch exercise methods are as followed: Placing both hands on the shoulders and pushing out the chest, placing one hand over the shoulder and grasp the elbow of the turned hand, with the other hand over the head and slowly pull it inward, throwback the head until it has reached the fully stretched point, look straight ahead and slowly turn the head horizontally until the maximum value is reached, throwback the head, and turn it until it has reached the fully stretched point, lower the head turn it until it has reached the maximal point. Stretching pectoralis muscle, strengthening shoulder retraction, strengthening the deep cervical flexors, strengthening the deep cervical flexors.
Primary Outcome Measure Information:
Title
Craniovertebral Angel Evaluation
Description
The anatomical points of the participant's ipsilateral tragus and C7 spinous process will be marked. The angle between the line connecting the C7 spinous process and the tragus point and the horizontal line drawn from C7 gives the craniovertebral angle. Individuals with a CVA angle of less than 50 degrees are individuals with cervical sagittal alignment. A camera will be placed at a distance of 1 meter and the camera lens will be at the C7 level, fınally the lateral photos of the patients will be taken. Angle calculations will be made using the triangular screen ruler computer program of Markus Bader- MB Software Solutions.
Time Frame
5 minutes
Secondary Outcome Measure Information:
Title
Neck Pain assessment
Description
Neck pain intensity will be objectively evaluated with the Visual Analogue Scale. The patient will be asked to mark the severity of the pain felt on the line drawn with a 10 cm ruler such as 0 = "no pain" 10 = "very severe pain".
Time Frame
1 minute
Title
The International Physical Activity Questionnaire (IPAQ)- Short Form
Description
This short-form consists of 7 questions and provides information about sitting, walking, moderately vigorous activities, and time spent on vigorous activities. In the IPAQ short form evaluation, the energy required for the activities will be calculated with the MET-minute score.
Time Frame
3 minutes
Title
Neck disailty index (NDİ)
Description
It is a questionnaire consisting of 10 topics investigating how neck pain affects the daily life of the patient. These headings evaluate the severity of pain, personal care, carrying, reading, headache, concentration, work-life, driving, sleep and recreation. Each section is scored between 0 and 5. The total score of NDİ is calculated over 100. According to the BDI score; 0-8% no disability, 10-28% mild disability, 30-48% moderate disability, 50% 68 severe disability, 68% over full disability.
Time Frame
3 minutes
Title
Active Cervical Range of Motion
Description
Active cervical range of motion is measured with goniometer application (G-pro© ), which was proven to be valid by Pourahmadi in 2018. For measuring flexion and extension, the testing position of the iPhone was placed just beside the external auditory meatus, and one axis of the app was aligned with the imaginary line between the base of the nostril and the external auditory meatus. Active lateral flexion range of motion was measured in the sitting position. The center of the app was placed over the C7 spinous process and one axis of the app was aligned with the occipital protuberance. Finally, active craniocervical rotation in sitting, this movement was evaluated in the supine position the center of the app was positioned at the center of the head and one axis was aligned with the nose.
Time Frame
10 minutes
Title
Evaluation of Postural Problems
Description
In the study, the photography method will be used in measuring the tilt angle, the frontal tilt angle of the head, and the rounded shoulder angle. The determined anatomical points will be marked, the lateral and anterior photographs of the patients will be taken with a digital camera. Angular calculations will be made using the triangular screen ruler computer program of Markuz Bader- MB Software Solutions.
Head tilt, will be calculated by finding the angle between the line drawn between the endpoint of the eye from the tragus point and the horizontal line drawn from the tragus line.
Frontal tilt angle is the angle formed between the line joining the lower edges of each ear and the horizontal line Rounded shoulder, is calculated by finding the angle between the line joining the C7 spinous process and the acromion midpoint, and the horizontal line drawn from the midpoint of C7.
Time Frame
5 minutes
Title
Lateral Scapular Slide Test
Description
Each subject was instructed to actively achieve the first test position both arms at the sides in glenohumeral joint neutral, second position subject actively placed both hands on the ipsilateral hips and place the humerus in medial rotation at 45° of abduction in the coronal plane and third position subject actively extended both elbows, placed the upper extremities in a position of maximum medial rotation at 90° of abduction in the coronal plane. When the test position will be obtained the inferior angle of the scapula and the adjacent spinous process of the reference vertebra in the same horizontal plane will be identified through palpation and measured with a digital caliper bilaterally.
Time Frame
10 minutes
Title
The Craniocervical Flexion Test
Description
The test is performed with the patient in supine crook lying with the neck in a neutral position such that the line of the face is horizontal and a line bisecting the neck longitudinally is horizontal to the testing surface. The uninflated pressure sensor is placed behind the neck so that it abuts the occiput and is inflated to a stable baseline pressure of 20 mm Hg, a standard pressure sufficient to fill the space between the testing surface and the neck but not push the neck into a lordosis. The device provides feedback and direction to the patient to perform the required five stages of the test. The patient is instructed that the test is not one of strength but rather one of precision. The movement is performed gently and slowly as a head-nodding action (as if saying "yes").
Time Frame
10 minutes
10. Eligibility
Sex
All
Minimum Age & Unit of Time
18 Years
Maximum Age & Unit of Time
65 Years
Accepts Healthy Volunteers
Accepts Healthy Volunteers
Eligibility Criteria
Inclusion Criteria:
Those with a Kraviovertebral angle below 50o.
Healthy individuals who have not had an upper extremity injury in the last 6 months.
Has 3 or more pain in VAS for at least 3 months
Exclusion Criteria:
Have received any physiotherapy program in the last 6 months due to neck pain or back pain.
With structural scoliosis
Have a history of fracture in the cervical vertebrae
Have any rheumatic disease affecting the neck
Having had a cervical spine surgery
Spinal cord compression from a tumor or other cause
Those with neurological deficits
Facility Information:
Facility Name
Eastern Mediterranean University
City
Famagusta
ZIP/Postal Code
99450
Country
Cyprus
12. IPD Sharing Statement
Learn more about this trial
Comparison Of The Neck And Scapular Proprioceptive Neuromuscular Facilitation Exercises On Postural Disorders, Scapular Dyskinesia And Round Shoulders in Individuals With Cervical Sagittal Alignment Disorder.
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