The Effect of Through-Range Versus Shortened-Length Exercise Training on Upper Quarter Posture Among Students With Forward Head Posture: A Randomized Clinical Trial
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Abstract
Introduction: The purpose of this study was to investigate the effects of shortened-length versus through-range exercise training on upper quarter posture in primary school students with Forward Head Posture (FHP).
Materials and Methods: Sixty pain-free participants with FHP were randomly allocated to one of three groups; shortened-length training (n=20), through-range training (n=20), and no-treatment control group (n=20). The shortened-length and through-range groups participated in training programs 3 times per week for 8 weeks. Upper quarter postures, including Craniovertebral Angle (CVA), Shoulder Angle (SA), Cranial Angle (CA), and thoracic kyphosis were measured by photogrammetry before and after the training. The confidence level was set at 95% (P<0.05).
Results: After training, both exercise groups showed significant changes in CVA (P=0.001), SA (P=0.001), CA (P=0.001), and thoracic kyphosis (P=0.001) compared to the control group. Besides, CVA changed more in the shortened-length exercise group compared to the through-range exercise group (P=0.003) (effect size =0.446).
Conclusion: Both through-range and shortened-length exercises altered upper quarter alignment. The shortened-length training resulted in a more significant change in CVA. These changes were small, and more studies are needed to investigate the effects of such training programs among people with pain.
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9. Sabatucci A, Raffaeli F, Mastrovincenzo M, Luchetta A, Giannone A, Ciavarella D. Breathing pattern and head posture: Changes in craniocervical angles. Minerva Stomatologica. 2015; 64(2):59-74. [PMID]
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11. Shih HS, Chen SS, Cheng SC, Chang HW, Wu PR, Yang JS, et al. Effects of Kinesio taping and exercise on forward head posture. Journal of Back and Musculoskeletal Rehabilitation. 2017; 30(4):725-33. [DOI:10.3233/BMR-150346] [PMID]
12. Gong W. The effects of cervical joint manipulation, based on passive motion analysis, on cervical lordosis, forward head posture, and cervical ROM in university students with abnormal posture of the cervical spine. Journal of Physical Therapy Science. 2015; 27(5):1609-11. [DOI:10.1589/jpts.27.1609] [PMID] [PMCID]
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15. Ruivo RM, Pezarat-Correia P, Carita AI. Effects of a resistance and stretching training program on forward head and protracted shoulder posture in adolescents. Journal of Manipulative and Physiological Therapeutics. 2017; 40(1):1-10. [DOI:10.1016/j.jmpt.2016.10.005] [PMID]
16. Seidi F, Rajabi R, Ebrahimi I, Alizadeh MH, Minoonejad H. The efficiency of corrective exercise interventions on thoracic hyper-kyphosis angle. Journal of Back and Musculoskeletal Rehabilitation. 2014; 27(1):7-16. [DOI:10.3233/BMR-130411] [PMID]
17. Lee SM, Lee CH, O’Sullivan D, Jung JH, Park JJ. Clinical effectiveness of a Pilates treatment for forward head posture. Journal of Physical Therapy Science. 2016; 28(7):2009-13. [DOI:10.1589/jpts.28.2009] [PMID] [PMCID]
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19. Sheikhhoseini R, Shahrbanian Sh, Sayyadi P, O’Sullivan K. Effectiveness of therapeutic exercise on forward head posture: A systematic review and meta-analysis. Journal of Manipulative and Physiological Therapeutics. 2018; 41(6):530-9. [DOI:10.1016/j.jmpt.2018.02.002] [PMID]
20. Lieber RL. Skeletal muscle structure, function & plasticity: The physiological basis of rehabilitation. 3rd ed. Philadelphia: Lippincott Williams & Wilkins; 2009.
21. Kendall FP, McCreary EK, Provance PG. Muscles: Testing and function with posture and pain. Philadelphia: Lippincott Williams & Wilkins; 2005.
22. Faul F, Erdfelder E, Lang AG, Buchner A. G*Power 3: A flexible statistical power analysis program for the social, behavioral, and biomedical sciences. Behavior Research Methods. 2007; 39(2):175-91. [DOI:10.3758/BF03193146] [PMID]
23. Ruivo RM, Carita AI, Pezarat-Correia P. The effects of training and detraining after an 8 month resistance and stretching training program on forward head and protracted shoulder postures in adolescents: Randomised controlled study. Manual Therapy. 2016; 21:76-82. [DOI:10.1016/j.math.2015.05.001] [PMID]
24. Diab AA. The role of forward head correction in management of adolescent idiopathic scoliotic patients: A randomized controlled trial. Clinical Rehabilitation. 2012; 26(12):1123-32. [DOI:10.1177/0269215512447085] [PMID]
25. McRoberts LB, Cloud RM, Black CM. Evaluation of the New York posture rating chart for assessing changes in postural alignment in a garment study. Clothing and Textiles Research Journal. 2013; 31(2):81-96. [DOI:10.1177/0887302X13480558]
26. Page P. Current concepts in muscle stretching for exercise and rehabilitation. International Journal of Sports Physical Therapy. 2012; 7(1):109-19. [PMID] [PMCID]
27. Brzycki M. Strength testing-predicting a one-rep max from reps-to-fatigue. Journal of Physical Education, Recreation & Dance. 1993; 64(1):88-90. [DOI:10.1080/07303084.1993.10606684]
28. de Oliveira TS, Candotti CT, La Torre M, Pelinson PPT, Furlanetto TS, Kutchak FM, et al. Validity and reproducibility of the measurements obtained using the flexicurve instrument to evaluate the angles of thoracic and lumbar curvatures of the spine in the sagittal plane. Rehabilitation Research and Practice. 2012; 2012:186156. [DOI:10.1155/2012/186156] [PMID] [PMCID]
29. Sullivan GM, Feinn R. Using effect size-or why the P value is not enough. Journal of Graduate Medical Education. 2012; 4(3):279-82. [DOI:10.4300/JGME-D-12-00156.1] [PMID] [PMCID]
30. Shavandi N, Shahrjerdi Sh, Heidarpor R, Sheikh Hoseini R. [The effect of 7 weeks corrective exercise on thoracic kyphosis in hyper-kyphotic students (Persian)]. Journal of Shahrekord University of Medical Sciences. 2011; 13(4):42-50.
31. Kim JY, Kwag KI. Clinical effects of deep cervical flexor muscle activation in patients with chronic neck pain. Journal of Physical Therapy Science. 2016; 28(1):269-73. [DOI:10.1589/jpts.28.269] [PMID] [PMCID]
32. Kong YS, Kim YM, Shim JM. The effect of modified cervical exercise on smartphone users with forward head posture. Journal of Physical Therapy Science. 2017; 29(2):328-31. [DOI:10.1589/jpts.29.328] [PMID] [PMCID]
33. Clark M, Lucett S, Sutton BG, National Academy of Sports Medicine. NASM essentials of corrective exercise training. Burlington. MA: Jones & Bartlett Learning; 2014.
34. Sahrmann Sh. Movement system impairment syndromes of the extremities, cervical and thoracic spines. St. Louis: Mosby; 2010.
35. Kisner C, Colby LA. Therapeutic exercise: Foundations and techniques. 6th ed. Philadelphia: F.A. Davis; 2012.
36. Dobbins M, DeCorby K, Robeson P, Husson H, Tirilis D. School-based physical activity programs for promoting physical activity and fitness in children and adolescents aged 6-18. Cochrane Database of Systematic Reviews. 2009; (1):CD007651. [DOI:10.1002/14651858.CD007651]
37. Janssen I, LeBlanc AG. Systematic review of the health benefits of physical activity and fitness in school-aged children and youth. International Journal of Behavioral Nutrition and Physical Activity. 2010; 7:40. [DOI:10.1186/1479-5868-7-40] [PMID] [PMCID]
38. Hodges P, Smeets R. Interaction between pain, movement and physical activity: Short-term benefits, long-term consequences, and targets for treatment. The Clinical Journal of Pain. 2015; 31(2):97-107. [DOI:10.1097/AJP.0000000000000098] [PMID]
2. Harrison BC, Hart JM. Reactive neuromuscular training in low-back pain rehabilitation: Part one. Athletic Training and Sports Health Care. 2010; 2(6):253-4. [DOI:10.3928/19425864-20101229-02]
3. Singla D, Veqar Z. Association between forward head, rounded shoulders, and increased thoracic kyphosis: A review of the literature. Journal of Chiropractic Medicine. 2017; 16(3):220-9. [DOI:10.1016/j.jcm.2017.03.004] [PMID] [PMCID]
4. Panagiotopoulou G, Christoulas K, Papanckolaou A, Mandroukas K. Classroom furniture dimensions and anthropometric measures in primary school. Applied Ergonomics. 2004; 35(2):121-8. [DOI:10.1016/j.apergo.2003.11.002] [PMID]
5. Jeffries LJ, Milanese SF, Grimmer-Somers KA. Epidemiology of adolescent spinal pain: A systematic overview of the research literature. Spine. 2007; 32(23):2630-7. [DOI:10.1097/BRS.0b013e318158d70b] [PMID]
6. Ståhl M, Kautiainen H, El-Metwally A, Häkkinen A, Ylinen J, Salminen JJ, et al. Non-specific neck pain in schoolchildren: Prognosis and risk factors for occurrence and persistence. A 4-year follow-up study. Pain. 2008; 137(2):316-22. [DOI:10.1016/j.pain.2007.09.012] [PMID]
7. Goodarzi F, Rahnama L, Karimi N, Baghi R, Jaberzadeh S. The effects of forward head posture on neck extensor muscle thickness: An ultrasonographic study. Journal of Manipulative and Physiological Therapeutics. 2018; 41(1):34-41. [DOI:10.1016/j.jmpt.2017.07.012] [PMID]
8. Oliveira AC, Silva AG. Neck muscle endurance and head posture: A comparison between adolescents with and without neck pain. Manual Therapy. 2016; 22:62-7. [DOI:10.1016/j.math.2015.10.002] [PMID]
9. Sabatucci A, Raffaeli F, Mastrovincenzo M, Luchetta A, Giannone A, Ciavarella D. Breathing pattern and head posture: Changes in craniocervical angles. Minerva Stomatologica. 2015; 64(2):59-74. [PMID]
10. Kim MS, Cha YJ, Choi JD. Correlation between forward head posture, respiratory functions, and respiratory accessory muscles in young adults. Journal of Back and Musculoskeletal Rehabilitation. 2017; 30(4):711-5. [DOI:10.3233/BMR-140253] [PMID]
11. Shih HS, Chen SS, Cheng SC, Chang HW, Wu PR, Yang JS, et al. Effects of Kinesio taping and exercise on forward head posture. Journal of Back and Musculoskeletal Rehabilitation. 2017; 30(4):725-33. [DOI:10.3233/BMR-150346] [PMID]
12. Gong W. The effects of cervical joint manipulation, based on passive motion analysis, on cervical lordosis, forward head posture, and cervical ROM in university students with abnormal posture of the cervical spine. Journal of Physical Therapy Science. 2015; 27(5):1609-11. [DOI:10.1589/jpts.27.1609] [PMID] [PMCID]
13. Diab AA, Moustafa IM. The efficacy of forward head correction on nerve root function and pain in cervical spondylotic radiculopathy: A randomized trial. Clinical Rehabilitation. 2011; 26(4):351-61. [DOI:10.1177/0269215511419536] [PMID]
14. Cho J, Lee E, Lee S. Upper thoracic spine mobilization and mobility exercise versus upper cervical spine mobilization and stabilization exercise in individuals with forward head posture: A randomized clinical trial. BMC Musculoskeletal Disorders. 2017; 18:525. [DOI:10.1186/s12891-017-1889-2] [PMID] [PMCID]
15. Ruivo RM, Pezarat-Correia P, Carita AI. Effects of a resistance and stretching training program on forward head and protracted shoulder posture in adolescents. Journal of Manipulative and Physiological Therapeutics. 2017; 40(1):1-10. [DOI:10.1016/j.jmpt.2016.10.005] [PMID]
16. Seidi F, Rajabi R, Ebrahimi I, Alizadeh MH, Minoonejad H. The efficiency of corrective exercise interventions on thoracic hyper-kyphosis angle. Journal of Back and Musculoskeletal Rehabilitation. 2014; 27(1):7-16. [DOI:10.3233/BMR-130411] [PMID]
17. Lee SM, Lee CH, O’Sullivan D, Jung JH, Park JJ. Clinical effectiveness of a Pilates treatment for forward head posture. Journal of Physical Therapy Science. 2016; 28(7):2009-13. [DOI:10.1589/jpts.28.2009] [PMID] [PMCID]
18. Mulet M, Decker KL, Look JO, Lenton PA, Schiffman EL. A randomized clinical trial assessing the efficacy of adding 6 x 6 exercises to self-care for the treatment of masticatory myofascial pain. Journal of Orofacial Pain. 2007; 21(4):318-28. [PMID]
19. Sheikhhoseini R, Shahrbanian Sh, Sayyadi P, O’Sullivan K. Effectiveness of therapeutic exercise on forward head posture: A systematic review and meta-analysis. Journal of Manipulative and Physiological Therapeutics. 2018; 41(6):530-9. [DOI:10.1016/j.jmpt.2018.02.002] [PMID]
20. Lieber RL. Skeletal muscle structure, function & plasticity: The physiological basis of rehabilitation. 3rd ed. Philadelphia: Lippincott Williams & Wilkins; 2009.
21. Kendall FP, McCreary EK, Provance PG. Muscles: Testing and function with posture and pain. Philadelphia: Lippincott Williams & Wilkins; 2005.
22. Faul F, Erdfelder E, Lang AG, Buchner A. G*Power 3: A flexible statistical power analysis program for the social, behavioral, and biomedical sciences. Behavior Research Methods. 2007; 39(2):175-91. [DOI:10.3758/BF03193146] [PMID]
23. Ruivo RM, Carita AI, Pezarat-Correia P. The effects of training and detraining after an 8 month resistance and stretching training program on forward head and protracted shoulder postures in adolescents: Randomised controlled study. Manual Therapy. 2016; 21:76-82. [DOI:10.1016/j.math.2015.05.001] [PMID]
24. Diab AA. The role of forward head correction in management of adolescent idiopathic scoliotic patients: A randomized controlled trial. Clinical Rehabilitation. 2012; 26(12):1123-32. [DOI:10.1177/0269215512447085] [PMID]
25. McRoberts LB, Cloud RM, Black CM. Evaluation of the New York posture rating chart for assessing changes in postural alignment in a garment study. Clothing and Textiles Research Journal. 2013; 31(2):81-96. [DOI:10.1177/0887302X13480558]
26. Page P. Current concepts in muscle stretching for exercise and rehabilitation. International Journal of Sports Physical Therapy. 2012; 7(1):109-19. [PMID] [PMCID]
27. Brzycki M. Strength testing-predicting a one-rep max from reps-to-fatigue. Journal of Physical Education, Recreation & Dance. 1993; 64(1):88-90. [DOI:10.1080/07303084.1993.10606684]
28. de Oliveira TS, Candotti CT, La Torre M, Pelinson PPT, Furlanetto TS, Kutchak FM, et al. Validity and reproducibility of the measurements obtained using the flexicurve instrument to evaluate the angles of thoracic and lumbar curvatures of the spine in the sagittal plane. Rehabilitation Research and Practice. 2012; 2012:186156. [DOI:10.1155/2012/186156] [PMID] [PMCID]
29. Sullivan GM, Feinn R. Using effect size-or why the P value is not enough. Journal of Graduate Medical Education. 2012; 4(3):279-82. [DOI:10.4300/JGME-D-12-00156.1] [PMID] [PMCID]
30. Shavandi N, Shahrjerdi Sh, Heidarpor R, Sheikh Hoseini R. [The effect of 7 weeks corrective exercise on thoracic kyphosis in hyper-kyphotic students (Persian)]. Journal of Shahrekord University of Medical Sciences. 2011; 13(4):42-50.
31. Kim JY, Kwag KI. Clinical effects of deep cervical flexor muscle activation in patients with chronic neck pain. Journal of Physical Therapy Science. 2016; 28(1):269-73. [DOI:10.1589/jpts.28.269] [PMID] [PMCID]
32. Kong YS, Kim YM, Shim JM. The effect of modified cervical exercise on smartphone users with forward head posture. Journal of Physical Therapy Science. 2017; 29(2):328-31. [DOI:10.1589/jpts.29.328] [PMID] [PMCID]
33. Clark M, Lucett S, Sutton BG, National Academy of Sports Medicine. NASM essentials of corrective exercise training. Burlington. MA: Jones & Bartlett Learning; 2014.
34. Sahrmann Sh. Movement system impairment syndromes of the extremities, cervical and thoracic spines. St. Louis: Mosby; 2010.
35. Kisner C, Colby LA. Therapeutic exercise: Foundations and techniques. 6th ed. Philadelphia: F.A. Davis; 2012.
36. Dobbins M, DeCorby K, Robeson P, Husson H, Tirilis D. School-based physical activity programs for promoting physical activity and fitness in children and adolescents aged 6-18. Cochrane Database of Systematic Reviews. 2009; (1):CD007651. [DOI:10.1002/14651858.CD007651]
37. Janssen I, LeBlanc AG. Systematic review of the health benefits of physical activity and fitness in school-aged children and youth. International Journal of Behavioral Nutrition and Physical Activity. 2010; 7:40. [DOI:10.1186/1479-5868-7-40] [PMID] [PMCID]
38. Hodges P, Smeets R. Interaction between pain, movement and physical activity: Short-term benefits, long-term consequences, and targets for treatment. The Clinical Journal of Pain. 2015; 31(2):97-107. [DOI:10.1097/AJP.0000000000000098] [PMID]
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| Issue | Vol 13 No 1 (2019) | |
| Section | Research Article(s) | |
| Keywords | ||
| Exercise therapy Posture Head Kyphosis Shoulder | ||
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How to Cite
1.
Sayyadi P, Sheikhhoseini R, O’Sullivan K, Balouchi R. The Effect of Through-Range Versus Shortened-Length Exercise Training on Upper Quarter Posture Among Students With Forward Head Posture: A Randomized Clinical Trial. jmr. 2019;13(1):49-58.
