MET to Levator Scapulae Versus MET to Anterior Scalene: Comparative Effects on Craniovertebral Angle and Cervical Joint Position in Forward Head Posture.

Abstract

Background: Forward head posture (FHP) results in an accentuated posterior curve in the higher thoracic vertebrae and an accentuated anterior curve in the lower cervical vertebrae. Dysfunction leads to muscle imbalance, where one side of the neck and scapula muscles become weak and the opposite group of muscles become tight. Strategies to correct this imbalance by treating flexibility and improving strength are the need of the hour.

Purpose: The aim of this study is to assess the effectiveness of muscle energy technique (MET) to levator scapulae versus MET to anterior scalene in improving craniovertebral angle (CVA) and joint position sense.

Setting: This study was conducted at the outpatient department of Dr. D. Y. Patil College of Physiotherapy, Pune, India.

Participants: Both males and females aged between 18 and 30 years with a CVA <48° were included.

Research design: This was an experimental study.

Intervention: A comparative experimental study was done on subjects aged between 18 and 30 years with CVA<48°. Group A (n = 15) received MET to levator scapulae muscles with conventional treatment and group B (n = 15) received MET to anterior scalene muscles with conventional treatment for 4 weeks, three sessions per week. The outcome measures assessed were CVA and cervical joint position error, pre- and post-intervention.

Main outcome measures: CVA and cervical joint position sense.

Results: MET to levator scapulae and anterior scalene significantly improved the FHP (p = 0.001 for both the groups) and cervical proprioception (p = 0.001 for both the groups) using the Wilcoxon signed rank test for pre-post comparison. However, on comparison between groups using the Mann-Whitney U test, MET to levator scapulae was better in improving the FHP (p = 0.002). No significant difference was found in the cervical joint position sense between both the groups.

Conclusion: Levator scapulae and anterior scalene flexibility should also be considered in FHP. Applying MET to these two muscles is not only beneficial in realigning the FHP but also in improving the cervical joint position sense.