The effect of manual therapy and stabilizing exercises on forward head and rounded shoulder postures

📍Forward head posture (FHP) is a kind of poor posture associated with increased kyphosis in the thoracic spine and anterior shoulder position. Poor posture is also associated with altered scapula position in terms of kinematic and muscle activities.

🔴In FHP, hyperextension of the upper cervical spine associated with shortening of the upper trapezius, cervical extensor muscles (e.g. Suboccipital, Semispinalis, and splenius), Sternocleidomastoids and the Levator scapulae muscles has been observed. On the other hand, in round shoulder posture (RSP), there is acromion forward displacement in relation to the 7th cervical spinous process and can be measured by the shoulder angle associated with a protracted, anteriorly tilted, internally rotated scapula and the pectoralis minor muscles shortness.

✔Forward head and round-shoulder postures (FHRSP) can result in shoulder pain and dysfunction because of altered scapular kinematics and muscle activity and consequently, placing increased stress on the shoulder. Therefore, FHRSP has to be modified to decrease stress on the shoulder

✔It has been indicated that stabilization exercises (SEs) for the scapula by improving and normalizing muscular activities can improve pain and posture in patients with neck pain and FHP and consequently, the quality of life.

✔On the other hand, manual therapy (MT) is another form of conservative treatment provided by physical therapists, chiropractors, osteopaths and sometimes other healthcare providers. MT can be used as an effective modulation in relieving soft tissue, a range of motion (ROM), and pain, and altering muscle function in musculoskeletal disorders.

🔻Stabilizing Exercises:

◾The neutral posture during daily activities and the exercises should be educated using mirrors putting in the side and the front of the subjects. 

◾The subjects should have the neutral position on the stable and unstable surfaces during the exercises. 

◾The warm up consists of 5–6 min walking. Strengthening exercises progressively performed for three sets, with 10 to 15 repetitions. 

◾The stretching part of the exercises to be done with the purpose of increasing the flexibility of the pectoralis and the cervical neck extensors muscles (pectoralis stretch, chin tuck). 

◾Exercises is approved to be effective on the lengthening of the pectoralis minor, activation of the lower trapezius/middle trapezius, serratus anterior, and improvement of the posture.

🔴Manual interventions

🔻One of the options is manipulation, manipulation could be done for 10 min, three times a week, for six weeks. The aim of manipulation is to increase flexion, extension, and side bending ROMs by checking the passive motion in cervical facet joints. 

🔻The manual therapist hold the occipital region and C6 spinous process with both hands and check the mobility of the C5 and C6 joints. 

🔻This method is used to check the extension ROM restriction of the joint in the cervical spine by holding the C5, C4, and C2 SPs. Then, the therapist apply the manual intervention for extension ROM. 

🔻To increase flexion ROM, the subject is asked to stay in the same supine position as an extension. The C5–6 joints motion is checked to assess the flexion ROM. Then, the manipulation is performed by checking mobility. 

🔻To increase the side bending motions of the cervical joints, the same method is used to analyze the ROM restriction and manual application to be done for side bending motions.

🔖Combined treatment consisting of MT and SEs, performed three times a week over a 6-week period for patients with neck pain, and FHRSP, resulted in pain reduction, and posture and function improvements, with a reduction in cervical and shoulder angles.