Forward Head Posture (FHP) is a common postural deviation characterized by anterior translation of the head relative to the trunk, which increases load on cervical muscles and joints. This postural change is associated with muscle fatigue, joint compression, and tension in cervical soft tissues, contributing to cervicogenic headache (Al-Mutairi et al., 20242; Koseoglu et al., 2023). The deep cervical flexor (DCF) muscles, especially the longus colli and longus capitis, are key stabilizers of the cervical spine, and weakness or fatigue of these muscles leads to overuse of superficial muscles such as the sternocleidomastoid and anterior scalene, creating an imbalance between deep and superficial systems. Diminished endurance of deep cervical flexors has been linked to forward head posture, impaired motor control, and persistent neck pain (Ismail et al., 2023). Cervical proprioception is crucial for accurate head position sense. Impaired cervical proprioception results in distorted information about head orientation, causing dizziness, incoordinated movement, and neck discomfort, and has been frequently observed in juniors with cervicogenic headache, increasing muscular strain and headache intensity. In the present study, therefore, we aim to investigate the correlation between FHP, cervical endurance, and proprioceptive function in junior students with cervicogenic headache
Sudents from both sexes will participate in this study.
The students' ages will be ranged from 17 to 18 years.
All participants will be referred from neurologists
All participants will be free from any medical disease, visual or hearing problem.
• Patients with a history of cervical spine surgery.
Patients with Whiplash injury..
Patients with any vestibular disorders.
Patients with visual and hearing impairments.
The study will be conducted on fifty-six junior students diagnosed with cervicogenic headache associated with forward head posture. Patients were assigned based on the presence of FHP into two equal groups; Group I (with FHP) and Group II (without FHP). The sample size for this study was calculated using the G\*power program 3.1.9 (G power program version 3.1, Heinrich-Heine-University, Düsseldorf, Germany). The fifty-six junior students diagnosed with cervicogenic headache effect size for the sample size calculation was depending on the previous study (Althubaiti, 2022). Sample size calculation based on t-tests (Means: Wilcoxon-Mann-Whitney test; two groups), Type I error (α) = 0.05, power (1-β error probability) = 0.80, effect size Effect size d = 0.8345487 with a total sample size for 50 participants for 2 independent groups comparison Considering a 15% drop out rate, the appropriate minimum sample size for this study will be 56 patients (28 patients in each group as a minimum
Cohort
Prospective
Not listed
Lateral photography
B. Lateral photographic method: Photography or photogrammetric method will be used to assess FHP. It is a reliable and valid method (Gadotti and Biasotto-Gonzalez,2010). A digital imaging technique will be used to evaluate head and neck posture in the standing position. A digital camera (Canon IXY 12 MP, Japan) will be used to capture images supported on a Magnus PV-3310 photo tripod with 3-way pan and tilt head, was used to capture a photograph. (kuo et al., 2014). Digitized photographs will be analyzed using Kinovea 2024.1.1. This is open access software used to analyze digitized photos and to measure the various head angles (Guzman-Valdivia et al.,2013)
proprioception errors
Cervical Range of Motion device (Lindstorm, Minnesota 651-257-3040) is a type of goniometer designed specifically for cervical spine. It is a valid and reliable method to measure the cervical proprioception functions (Jordean, 2000; Tousignant et al., 2002 and Tousignant et al., 2006). It is composed of three inclinometers strapped to the subject's head and two magnets placed over the subject's shoulders. Each inclinometer measures proprioception error in one plane of movements. One gravity dial meter measures flexion and extension, another gravity dial measures lateral flexion and a compass meter measures rotation with its accuracy reinforced by two magnets Fig.(2) (Reddy et al., 2016).
D. Stabilizer pressure biofeedback:
Chattanooga Stabilizer Pressure Biofeedback Unit. is a valid and reliable method to assess cervical strength and endurance (ICC) 95%. The unit consists of a combined gauge and inflation bulb connected to a pressure cell. Designed by physical therapists, the Stabilizer registers changing pressure in an air-filled pressure cell allowing body movements to be detected during exercise (Lee .20164)
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