Forward Head Posture Corrective Exercises in the Management of Lumbosacral Radiculopathy
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Friday, April 17, 2015 12:00 AM

Lumbosacral radiculopathy associated with disk herniation is one of the most common health-related complaints.  The challenge that clinicians face results from focusing on pathoanatomy as one of the most common etiological factors of back pain, ignoring the significant role of dysfunction.  Abnormal posture is one of the most important etiological factors associated with low back pain.

Studies have reported that many postural reflexes such as the vestibulocollic reflex, cervicocollic reflex, pelvo-ocular reflex, vestibuloocular reflex, cervico-ocular reflex, and cervical somatosensory input are located or occur in the head and neck region.  Given the high incidence of forward head posture, especially in older adults, a correction of this abnormal posture must achieve optimal postural correction in which the spine orients itself according to the normalized reference point.  Although the effect that forward head posture has on the entire nervous system has been reported, there are few controlled studies evaluating the effect of abnormal head posture on lumbar nerve root function. The current evidence to support the role of forward head posture correction in patients with lumbar disk herniation radiculopathy lacks the experimental data to support a cause-and-effect relationship and interventional outcomes. The purpose of this study was to evaluate the immediate and long-term effects of a multimodal program, with the addition of forward head posture correction, on disability, 3-dimensional spinal posture parameters, back and leg pain, and S1 nerve root function of patients with chronic discogenic lumbosacral radiculopathy.

The purpose of this study was to determine the immediate and long-term effects of a multimodal program, with the addition of forward head posture correction, in patients with chronic discogenic lumbosacral radiculopathy.  The addition of forward head posture correction to a functional restoration program seemed to positively affect disability, 3-dimensional spinal posture parameters, back and leg pain, and S1 nerve root function of patients with chronic discogenic lumbosacral radiculopathy.

This randomized controlled trial compared the outcomes of lumbosacral radiculopathy disability, pain, neurophysiological parameters, and 3-dimensional postural measures in a group receiving a forward head correction exercise program and a functional restoration program to a group receiving only a functional restoration program. The comparison between the experimental and standard care groups in the AHT and 3-dimensional posture parameters revealed significant differences at the 2 follow-up points. The results of the lumbar radiculopathy management outcomes such as disability, leg and back pain intensity, and neurophysiological parameters after 10 weeks indicate that the intervention programs succeed. At the 2-year follow-up, the statistically significant changes favoring the outcomes of the experimental group provide objective evidence that biomechanical dysfunction in terms of abnormal head posture and not lumbosacral pathoanatomy alone influences the long-term outcome measures of lumbosacral radiculopathy.

In our study, we found that the experimental group that received forward head posture corrective exercises experienced significant changes in the posture parameters in the sagittal, transverse, and coronal planes. These significant changes may suggest that the cervical spine has an important role in global spinal posture.

The restoration of normal posture may be a direct consequence for restoring the normal afferentation process. On theoretic grounds, it can be assumed that posture is largely maintained by reflexive, involuntary control. These reflexive components for postural control are found in skin and joint receptors, somatic graviceptors, and baroreceptors throughout the body. Because much of the reflexive postural control mechanisms are housed or occur within the head and neck region primarily,  disturbance of neurologic regulation of static upright human posture is possibly associated with forward head posture.

Applying a functional restoration program alone or in conjunction with forward head posture corrective exercises appears to be approximately equal in successfully improving the disability, leg and back pain intensity, and neurophysiological findings after 10 weeks of treatment. At the 2-year follow-up, the results revealed statistically significant changes favoring the outcomes of the experimental group for the previous variables.

At the 2-year follow-up, it may be speculated that the patient improved because of the normal course of the lumbosacral radiculopathy. However, we found no statistically significant changes in the standard care group’s outcomes. In this regard, Haugen et al showed that 44% to 47% of the patients with sciatica who were referred for secondary care had a nonsuccessful outcome at 1 year and 39% to 42% at 2 years. The recurrence of radicular pain is relatively common after nonsurgical treatment of lumbar disc herniation.


Source: http://chiro.org/wordpress/2015/03/10/the-effect-of-adding-forward-head-posture-corrective-exercises-in-the-management-of-lumbosacral-radiculopathy-a-randomized-controlled-study/