A Comparison of Two Forward Head Posture Corrective Approaches in Elderly with Chronic Non-Specific Neck Pain: A Randomized Controlled Study
Abstract
:1. Introduction
2. Materials and Methods
2.1. Participants
2.2. Randomization
2.3. Interventions
Denneroll™ Cervical Traction Orthotic (DCTO)
- (1)
- In the upper cervical area (C2-C4). This position allows for upper cervical segment extension bending while providing minor anterior head translation (AHT). This placement site was assigned to two participants.
- (2)
- In the mid-cervical area (C4-C6). This position allows for mid-upper cervical extension bending while causing a significant posterior head translation. This placement location was assigned to 8 participants.
- (3)
- Upper thoracic/lower cervical (C6-T1) area. This position allows for lower to intermediate cervical segment extension bending while causing substantial posterior head translation. This placement location was assigned to 23 participants.
2.4. Mirror Image Exercises
- (1)
- Maximum anterior head translation (+TzH) Anterior head translation generates a cervical spine coupling pattern that results in lordosis of the upper cervical spine and kyphosis (curve reversal) of the lower cervical spine.
- (2)
- While maintaining +TzH, maximum head extension (−RxH). Maintaining anterior head translation permits the upper cervical spine to keep its lordosis, while maximal head extension allows the lower cervical spine to progress toward a healthy lordotic curvature.
- (3)
- While maintaining the −RxH, a posterior head translation (−TzH) with a slight inferior compression down the long axis of the spine (−TyH) is initiated. The posterior head translation with compression from this position allows for the head to return to a normal postural position while maintaining the induced cervical lordosis from the previous movements.
2.5. The Standardized Exercise Based FHP Correction Group (Standard Group)
- Chin tucks were performed while lying supine with the head in touch with the floor, which progressed to lifting the head off the floor in a tucked posture and holding it for varied periods of time (this was to progress by two-second holds starting at two seconds, i.e., 2, 4, 6, and 8 s. During the session, patients completed five chin tuck repetitions and five to seven sets of five chin tucks with a 1-min rest between each set. Figure 4 presents this exercise.
- Chin drop while sitting to stretch cervical extensors (the progression of this exercise was to drop the chin with hand assistance). The patients were instructed to flex the neck until a good stretch was felt at the base of the head and top of the neck. The patient held the final position for 5 s. This chin drop exercise was repeated a total of 10 times, or as tolerated. A modification of the chin tuck that further emphasizes strengthening of the deep neck flexor muscles is to apply resistance with a hand placed under the tucked chin and apply light downward pressure into the hand, or by adding manual resistance to the forehead using the 5-s hold time approach. Figure 5 demonstrates this exercise maneuver.
- Pulling the shoulders back using a theraband while standing to strengthen the shoulder retractors. The patient was instructed to squeeze their scapulae together tightly for at least 6 s without elevating or extending their shoulder. The initial progression step was to use weights to do shoulder retraction from a prone posture. The second stage involved the use of elastic resistance and weights. Each progression was carried out by the participants for two weeks. At the consultation, they were moved to the second progression if they could complete three sets of 12 repetitions, with 2 min of rest in between, accurately for appropriate strengthening. Figure 6 demonstrates this exercise maneuver.
- Every two weeks, participants alternated between unilateral and bilateral pectoralis stretches. The patient was seated comfortably with their hand behind their head for bilateral pectoralis stretching. From this posture, the patient’s elbow was pushed up and out to the limit of its possible range. The arm at the affected location was shifted into abduction and external rotation for unilateral stretching. The end position was maintained for 20–30 s and repeated 3–5 times. For unilateral stretching, the patients were directed to bring their hands up such that their forearms and elbows rested on the side of the doorway. The elbow and shoulder should be at a 90-degree angle. The patient was encouraged to move his or her body toward the opposite side away from the doorway until a stretch was felt anteriorly between the chest and shoulder. Each stretch was performed with slow, steady movements without any bouncing. The same process was repeated on the opposite side. This posture was maintained for 20–30 s and repeated 3–5 times. Two sets of 3–5 repetitions of unilateral self-stretching with a 1-min rest were performed for each patient. Figure 7 shows this exercise maneuver.
2.6. Outcome Measures
2.6.1. Craniovertebral Angle
2.6.2. Berg Balance Scale
2.6.3. Numeric Pain Rating Scale
2.6.4. Cervicocephalic Kinesthetic Sensibility
2.7. Sample Size Determination
2.8. Data Analysis
3. Results
Group Outcomes
4. Discussion
4.1. Sagittal Cervical Alignment
4.2. Balance, Pain, Cervicocephalic Kinesthetic Sensibility and ROM
4.3. Limitations
4.4. Conclusions
Supplementary Materials
Author Contributions
Funding
Institutional Review Board Statement
Informed Consent Statement
Data Availability Statement
Conflicts of Interest
References
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Demographic Information | CBP Group (n = 33) | Standard Group (n = 33) | p Value |
---|---|---|---|
Age (y) | 63.5 ± 3 | 65 ± 4.2 | 0.09 |
Weight (kg) | 66 ± 10 | 60 ± 19 | 0.1 |
Sex, Marital status | |||
Male | 22 (67%) | 20 (60%) | 0.3 |
Female | 11 (33%) | 13 (40%) | |
Single | 1 (3%) | 2 (7%) | |
Married | 22 (67%) | 20 (60%) | |
Separated, divorced, or widowed | 10 (30%) | 11 (33%) | |
Pain duration (%) [Mean ± SD] | |||
< 1 y | 1 (3%) | 3 (10%) | 0.1 |
1–2 y | 21 (67%) | 20 (60%) | |
>2 y | 10 (30%) | 10 (30%) | |
Smoking history | |||
Light smoker | 8 (24%) | 7 (21%) | 0.2 |
Heavy smoker | 0 | 1 | |
Non-Smoker | 25 (76%) | 26 (79%) |
Baseline | 6-Weeks | 3-Month Follow-Up | p-Value | ||||
---|---|---|---|---|---|---|---|
G | T | G vs. T | |||||
CVA | CBP G | 41.4 ± 2.6 | 54.9 ± 3.2 | 54 ± 2.6 | <0.001 * F = 76 Partial Eta squared = 0.5 | <0.001 * F = 248 Partial Eta squared= 0.8 | <0.001 * F = 131 Partial Eta squared = 0.7 |
Standard G | 42.7 ± 3.2 | 45 ± 2.4 | 45.6 ± 5.9 | ||||
p-Value 95% C.I. | 0.08 [−2.7, 0.2] | <0.001 * [8.7, 11.1] | <0.001 * [6.1, 10.7] | ||||
Pain intensity | CBP G | 4.7 ± 0.8 | 1.1 ± 0.7 | 0.5 ± 0.8 | <0.001 * F = 209 Partial Eta squared = 0.7 | <0.001 * F = 244 Partial Eta squared = 0.8 | <0.001 * F = 54 Partial Eta squared = 0.6 |
Standard G | 5.3 ± 1.5 | 2.9 ± 1.2 | 4.3 ± 1 | ||||
p-Value 95% C.I. | 0.08 [−1.19, 0.008] | <0.001 * [−2.2, −1.2] | <0.001 * [−4.2, −3.2] |
Baseline | 6-Weeks | 3-Month Follow-Up | p-Value | ||||
---|---|---|---|---|---|---|---|
G | T | G vs. T | |||||
Berg Balance Score | CBP G | 43 ± 2.1 | 48.1 ± 3 | 48.2 ± 3.2 | <0.001 * F = 28.3 Partial Eta squared =0.3 | <0.001 * F = 91.3 Partial Eta squared = 0.6 | <0.001 * F = 29.2 Partial Eta squared = 0.7 |
Standard G | 42.3± 2.2 | 44.6 ± 1.7 | 43.8 ± 2.1 | ||||
p-Value C.I. | 0.2 [−0.49, 1.7] | 0.48 [2.2, 4.7] | <0.001 * [2.9, 5.5] | ||||
HRA Right | CBP G | 3.4 ± 0.6 | 2.1 ± 0.9 | 0.3 ± 0.5 | <0.001 * F = 43 Partial Eta squared = 0.5 | <0.001 * F = 193 Partial Eta squared = 0.8 | <0.001 * F = 183 Partial Eta squared = 0.8 |
Standard G | 3 ± 0.9 | 2.2 ± 1.1 | 2.7 ± 1 | ||||
p-Value C.I. | 0.06 [0.023, −0.77] | 0.6 [−0.3, 0.2] | <0.001 * [−2.5, −2.1] | ||||
HRA Left | CBP G | 3.8 ± 1.4 | 2.2 ± 1.4 | .4 ± 1.1 | <0.001* F = 20.3 Partial Eta squared = 0.2 | <0.001* F = 184 Partial Eta squared = 0.8 | <0.001* F = 208 Partial Eta squared = 0.8 |
Standard G | 3.2 ± 0.9 | 2.5 ± 1.6 | 2.9 ± 1.2 | ||||
p-Value C.I. | 0.07 [0.02, −1.1] | 0.3 [−0.6, 0.07] | <0.001 * [−2.8, −2.1] |
Baseline | 6-Weeks | 3-Month Follow-Up | p-Value | ||||
---|---|---|---|---|---|---|---|
G | T | G vs. T | |||||
CROM lateral flexion right | CBP G | 36.9 ± 2.8 | 42.4 ± 2 | 42.1 ± 2.2 | <0.001 * F = 44.2 Partial Eta squared = 0.5 | <0.001 * F = 132 Partial Eta squared = 0.6 | <0.001 * F = 44.9 Partial Eta squared = 0.5 |
Standard G | 37.2 ± 2 | 40.6 ± 3 | 37.4 ± 3.8 | ||||
p-Value C.I. | 0.5 [−0.9, 1.3] | <0.008 * [0.5, 3.1] | <0.001 * [3.6, 5.7] | ||||
CROM lateral flexion left | CBP G | 37.5 ± 2.3 | 42.6 ± 1.8 | 42.2 ± 2.6 | <0.001 * F = 23 Partial Eta squared = 0.3 | <0.001 * F = 104 Partial ETA squared = 0.7 | <0.001 * F = 40 Partial Eta squared = 0.5 |
Standard G | 37.1 ± 2.7 | 40.1 ± 2.6 | 37.8 ± 2.5 | ||||
p-Value C.I. | 0.4 [−0.6, 1.4] | <0.001 * [0.8, 3.1] | <0.001 * [3.3, 5.4] | ||||
CROM rotation right | CBP G | 61.1 ± 5.3 | 71.40 ± 2.3 | 70.8 ± 4 | <0.001 * F = 24 Partial Eta squared = 0.2 | <0.001 * F = 150 Partial Eta squared = 0.8 | <0.001 * F = 72 Partial Eta squared = 0.7 |
Standard G | 62.3 ± 5.6 | 63.6 ± 4.8 | 62 ± 6.1 | ||||
p-Value C.I. | 0.1 [−2.8, 2.5] | <0.001 * [5.8, 9.6] | <0.001 * [6.4, 11.2] | ||||
CROM rotation left | CBP G | 62.15 ± 4.5 | 70.7 ± 3.9 | 70 ± 5.7 | <0.001 * F = 24.6 Partial Eta squared = 0.3 | F = 73 Partial Eta squared = 0.7 | F = 46 Partial Eta squared = 0.6 |
Standard G | 60.9 ± 6.4 | 63.4 ± 4.5 | 61.2 ± 6.7 | ||||
p-Value C.I. | 0.3 [−1.4, 4.2] | <0.001 * [5.2, 9.1] | <0.001 * [6, 11.4] |
Correlation between Variables | ∆ CVA CBP Group r (p Value) n = 33 | ∆ CVA Standard Group r (p Value) n = 33 |
---|---|---|
∆Pain intensity | −0.7 (<0.001) | −0.67 (<0.001) |
∆Berg Balance Score | 0.64 (<0.001) | 0.49 (<0.001) |
∆ Head repositioning accuracy (Right) | −0.69 (<0.001) | −0.71 (<0.001) |
∆ Head repositioning accuracy (Left) | −0.72 (<0.001) | −0.72 (<0.001) |
∆ CROM lateral flexion Right | 0.49 (<0.001) | 0.61 (<0.001) |
∆ CROM lateral flexion Left | 0.57 (<0.001) | 0.52 (<0.001) |
∆ CROM rotation right | 0.49 (<0.001) | 0.61 (<0.001) |
∆ CROM rotation left | 0.57 (<0.001) | 0.52 (<0.001) |
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Suwaidi, A.S.A.; Moustafa, I.M.; Kim, M.; Oakley, P.A.; Harrison, D.E. A Comparison of Two Forward Head Posture Corrective Approaches in Elderly with Chronic Non-Specific Neck Pain: A Randomized Controlled Study. J. Clin. Med. 2023, 12, 542. https://doi.org/10.3390/jcm12020542
Suwaidi ASA, Moustafa IM, Kim M, Oakley PA, Harrison DE. A Comparison of Two Forward Head Posture Corrective Approaches in Elderly with Chronic Non-Specific Neck Pain: A Randomized Controlled Study. Journal of Clinical Medicine. 2023; 12(2):542. https://doi.org/10.3390/jcm12020542
Chicago/Turabian StyleSuwaidi, Aisha Salim Al, Ibrahim M. Moustafa, Meeyoung Kim, Paul A. Oakley, and Deed E. Harrison. 2023. "A Comparison of Two Forward Head Posture Corrective Approaches in Elderly with Chronic Non-Specific Neck Pain: A Randomized Controlled Study" Journal of Clinical Medicine 12, no. 2: 542. https://doi.org/10.3390/jcm12020542