Effect of Deep Neck Flexor Activation on Upper Trapezius Muscle Tightness in Individuals with Forward Head Posture: A Randomized Controlled Trial
Article Sidebar
Main Article Content
Abstract
Background: Forward head posture is associated with impaired deep cervical flexor function, altered cervical muscle recruitment, neck pain, and disability. Evidence regarding the specific effect of deep cervical flexor activation on upper trapezius tightness remains limited. Objective: To determine the effect of a structured deep cervical flexor activation programme on upper trapezius tightness and secondary cervical outcomes in individuals with forward head posture. Methods: This parallel-group randomized controlled trial included 70 participants allocated to deep cervical flexor activation or general postural education groups, with 35 participants per group. Outcomes assessed at baseline and postintervention included upper trapezius tightness, craniovertebral angle, deep cervical flexor endurance, Numeric Pain Rating Scale score, and Neck Disability Index score. Between-group effects were estimated from differences in change scores with 95% confidence intervals. Results: Compared with the control group, the intervention group demonstrated greater reductions in upper trapezius tightness (mean difference, −1.55; 95% CI, −1.92 to −1.18; p<0.001; d=1.99), pain (−2.15; 95% CI, −2.56 to −1.74; p<0.001), and disability (−14.50 percentage points; 95% CI, −16.06 to −12.94; p<0.001). Craniovertebral angle increased by an additional 3.00° and deep cervical flexor endurance by 8.30 seconds. Improvements in endurance were negatively correlated with changes in upper trapezius tightness in the intervention group (r=−0.68; p<0.001). Conclusion: Deep cervical flexor activation was associated with greater short-term improvements in upper trapezius tightness, cervical posture, muscle endurance, pain, and disability than postural education alone
Article Details
Issue
Section
This work is licensed under a Creative Commons Attribution 4.0 International License.
How to Cite
References
1. Sikka I, Chawla C, Seth S, Alghadir AH, Khan M. Effects of deep cervical flexor training on forward head posture, neck pain, and functional status in adolescents using computer regularly. Biomed Res Int. 2020;2020:8327565. doi:10.1155/2020/8327565.
2. Iqbal ZA, Alghadir AH, Anwer S. Efficacy of deep cervical flexor muscle training on neck pain, functional disability, and muscle endurance in school teachers: a clinical trial. Biomed Res Int. 2021;2021:7190808. doi:10.1155/2021/7190808.
3. Khosrokiani Z, Letafatkar A, Gladin A. Lumbar motor control training as a complementary treatment for chronic neck pain: a randomized controlled trial. Clin Rehabil. 2022;36(1):99–112. doi:10.1177/02692155211038099.
4. 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;30:31–37. doi:10.1016/j.jelekin.2016.05.007.
5. Nishikawa Y, Watanabe K, Chihara T, Sakamoto J, Komatsuzaki T, Kawano K, et al. Influence of forward head posture on muscle activation pattern of the trapezius pars descendens muscle in young adults. Sci Rep. 2022;12:19484. doi:10.1038/s41598-022-24095-8.
6. Alowa Z, Elsayed W. The impact of forward head posture on the electromyographic activity of the spinal muscles. J Taibah Univ Med Sci. 2021;16(2):224–230. doi:10.1016/j.jtumed.2020.10.021.
7. Watthanasuwakul M, Hanphitakphong P, Poomsalood S. Efficacy of ultrasound therapy with neck retraction exercises versus ultrasound therapy with deep cervical flexor training for excessive screen time users: a pilot randomized controlled study. J Phys Ther Sci. 2024;36(5):303–307. doi:10.1589/jpts.36.303.
8. Altmis Kacar H, Ozkul C, Baran A, Guclu-Gunduz A. Effects of cervical stabilization training in patients with headache: a single-blinded randomized controlled trial. Eur J Pain. 2024;28(4):633–648. doi:10.1002/ejp.2208.
9. Sepehri S, Sheikhhoseini R, Piri H, Sayyadi P. The effect of various therapeutic exercises on forward head posture, rounded shoulder, and hyperkyphosis among people with upper crossed syndrome: a systematic review and meta-analysis. BMC Musculoskelet Disord. 2024;25:105. doi:10.1186/s12891-024-07224-4.
10. Sarıyıldız A, Deniz V, Başaran S. Effectiveness of corrective exercise program on alignment, muscle activation and biomechanical properties in forward head posture: a randomized controlled trial. Cukurova Med J. 2024;49(4):1082–1092. doi:10.17826/cumj.1583556.
11. Park SK, Yang DJ, Kim JH, Kang DH, Park SH, Yoon JH. Effects of cervical stretching and craniocervical flexion exercises on cervical muscle characteristics and posture of patients with cervicogenic headache. J Phys Ther Sci. 2017;29(10):1836–1840. doi:10.1589/jpts.29.1836.
12. Müller-Thyssen-Uriarte J, Lucha-López MO, Hidalgo-García C, Sánchez-Rodríguez R, Vicente-Pina L, Ferrández-Laliena L, et al. Electromyographic activity of cervical muscles in patients with neck pain and changes after dry needling: a narrative review. J Clin Med. 2024;13(23):7288. doi:10.3390/jcm13237288.
13. Alghadir AH, Iqbal ZA. Effect of deep cervical flexor muscle training using pressure biofeedback on pain and forward head posture in school teachers with neck pain: an observational study. Biomed Res Int. 2021;2021:5588580. doi:10.1155/2021/5588580.