Does forward head posture change subacromial space in active or passive arm elevation?

ABSTRACT

Objectives: Forward head posture (FHP) is one of the most common musculoskeletal disorders that appears to affect the shoulder joint through the shared muscles between the head and neck area and the shoulder girdle. The present study compared the acromiohumeral distance between individuals with normal head and neck alignment and those with moderate and severe FHP in active and passive arm elevation.

Methods: Based on the craniovertebral angle, 60 volunteers were selected and equally distributed among three groups, including group one with normal head and neck alignment, group two with moderate FHP and group three with severe FHP. The space between the humeral head and the acromion was measured in 10°, 45° and 60° of active and passive arm elevation as the acromiohumeral distance.

Results: The acromiohumeral distance was only different between the three groups at 45° arm elevation angle, and this difference was significant between groups one and three. In active and passive arm elevation, increased arm elevation angle reduced the subacromial space significantly. Also, in each arm elevation angle, the subacromial space differed significantly between the active and passive arm elevations.

Conclusions: The acromiohumeral distance was significantly lower in the severe FHP group than the group with normal head and neck alignment in the 45° active arm elevation angle, which could be due to the changed tension in tissues between active and passive arm elevation and also the maximum muscle activity in the 45° active arm elevation angle.

KEYWORDS:

• Posture
• cervical vertebrae
• shoulder joint
• ultrasonography

Acknowledgments

The authors wish to express their gratitude to the Neuromuscular Rehabilitation Research Center of Semnan University of Medical Sciences for providing work place and instruments, and finally, the participating patients for their cooperation.

Author contribution

All authors contributed to concept and design of the study and approved the final version.

Disclosure statement

The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Research ethics certificate

This study was in accordance with the ethical principles and the national norms and standards for conducting medical research in Iran (ethic code IR.SEMUMS.REC.1397.132).

Additional information

Funding

This work was supported by the research and technology deputy of Semnan University of Medical Sciences under Grant number: [1453].

Notes on contributors

Behdokht Dehqan

Behdokht Dehqan received her master degree in General Physiotherapy at Semnan University of Medical Sciences in 2019. She has worked as a research assistant for the Neuromuscular Rehabilitation Research Center and clinically across a range of community. This paper reports on work conducted as her Master’s dissertation.

Cyrus Taghizadeh Delkhoush

Cyrus Taghizadeh Delkhoush received his PhD in physical therapy at Iran University of Medical Sciences in 2014. He was a member of the physical therapy department of the rehabilitation faculty at Semnan University of Medical Sciences and Neuromuscular Rehabilitation Research Center since 2014. Cyrus is an assistant professor in the physical therapy, and he is currently conducting research in the area of manual therapies, electro therapies, and biomechanics.

Majid Mirmohammadkhani

Majid Mirmohammadkhani graduated in medicine at the Semnan University of Medical Sciences in 2000, and in 2013, he succeeded in getting his PhD in epidemiology at Tehran University of Medical Sciences. Since then Majid was a member of Community Medicine department at Semnan University of Medical Sciences. He is also a member of the research center for Social Determinants of Health (SDH), and an associated professor in the Epidemiology and Biostatistics.

Fatemeh Ehsani

Fatemeh Ehsani received her PhD in physical therapy at the University of Social Welfare and Rehabilitation Sciences in 2016. She was a member of the physical therapy department of the rehabilitation faculty at Semnan University of Medical Sciences and also a member of the Neuromuscular Rehabilitation Research Center since 2016. Fatemeh is an assistant professor in the physical therapy, and she is currently conducting research in the area of manual therapies, motor control, and neuro-rehabilitation.