Muscle Energy Technique of Lower Limb Muscles in Forward Head Posture

Effect Of Muscle Energy Technique Of Lower Limb Superficial Backline Muscles in Patients With Forward Head Posture

The aim of this randomized controlled trial is to find the effect of muscle energy technique of muscles involved in lower limb superficial backline (hamstring and Gastro-soleus) on improving craniovertebral angle and cervical proprioception and minimizing pain among patients with forward head posture

Forward head posture (FHP) is a common postural disorder (66%), occurring when the head is anterior to a vertical line passing through the center of gravity. This malalignment causes muscle weakness in deep cervical flexors and shortened opposing cervical extensor muscles. This posture increases lordosis in the lower cervical spine, leading to increased extension over upper, and flexion over the lower cervical spine. Abnormal postures can lead to headaches, myofascial pain syndrome, abnormal scapular movement, temporomandibular disorders, and limited cervical range of motion.

Muscles of the neck, back and lower limb are interconnected through myofascial called superficial backline. Prolonged forward head posture affects muscles and involved in superficial backline. So remote muscle stretching has a same effect on local neck muscles.

Muscle energy technique is a soft tissue technique designed to improve musculoskeletal function through stretching tight muscles and fascia, to reduce pain and improve circulation. MET is characterized by a patient-induced skeletal muscle contraction against physiotherapist resistance in a controlled direction and position. Pathological barrier of a muscle is located through joint positioning which is followed by active muscle contraction by the patient moving away from the resistance followed by relaxation of the muscle. A new pathological barrier is located through passive movement and process is repeated. The rationale for the use of these techniques is to identify the effects of MET of lower limb superficial backline muscles which are interconnected with cervical muscles through myofacial chain, on cervical pain ROM, craniovertebral angle , disability and cervical proprioception.

Inclusion Criteria:

• Age between 20 and 35 years
• Both Genders
• Craniovertebral angle <49.9 degrees
• History of neck pain >3 months
• Patients with hamstring tightness(Inability to achieve greater than 160° of knee extension with hip at 90° of flexion)
• Patients with calf muscle tightness(The Taloche Sign (Maestro) If a patient with a tight gastrocnemius tries to stand on an inclined plane, it is immediately evident that it is impossible for the patient to be stable in this position)

Exclusion Criteria:

• Patient with recent injuries or surgeries in and around the neck region
• Vertigo
• radiating pain in upper limb
• spinal deformities
• malignancy in and around the neck region
• cervical instabilities
• fibromyalgia
• patients with any lower limb or lower back pathology(e.g arthritis)