SYNOPSIS

FREQUENCY OF FORWARD HEAD POSTURE AMONG

TAILORS

BAQAI INSTITUTE OF PHYSICAL THERAPY AND REHABILITATION

MEDICINE
BAQAI MEDICAL UNIVERSITY

Student’s Names
ZUNAIRA ASLAM
MEHRAN SHAH
SHERAZ MASHWANI
ASAD ALI
SANAM MAGSI

Academic Supervisor
Dr Ariba Sohail Ahmed
 ABSTRACT

INTRODUCTION/BACKGROUND

Forward head posture is protrusion of the head more than a normal position. Due to forward head
posture many normal activities become hindered. Sitting in a fixed position not moving or sitting
putting the head hyperextended for too long doing activities in a hyperextended position.
Forward head posture in tailors is due to sitting and expending more time on their sewing
machine which causes many posture-related abnormalities and shortening of back muscles cause
musculoskeletal abnormalities. Tailors should improve their ergonomics use proper tools and
chairs which can be adjustable and have a backrest position.

OBJECTIVE

The objective of the study is to find the frequency of forward head posture among tailors using
tragus to wall test.

MATERIAL AND METHODS

The self-made questionnaire will be used by which 288 participants will be selected based on
inclusion and exclusion criteria the research will be conducted around the industrial areas and
private tailors. The tragus to wall test will be used to measure forward head posture.

RESULTS

It concludes that sitting long hours on the sewing machine with protruded head develops forward
head posture among tailors. it reduce their working capacity and can lead to other health issues
like headache, MSK pain awareness about posture and ergonomics is essential, which can
improve their health working functionality it concludes that long sitting can lead to formation of
forward head posture by developing slouched posture it is essential to tell them to reduce the
distance between tailor and the sewing machine which can improve working capability.

KEYWORDS

Forward head, tailors, kyphosis, rounded shoulder, slouched posture.

 1. INTRODUCTION

1.1 BACKGROUND

1.1.1 Introduction to Forward Head Posture

Forward head posture is a poor habitual neck posture that often co-exists with upper
crossed syndrome in upper crossed syndrome there will be tightness of the upper
trapezius and levator scapula on the dorsal side crosses with pectoralis major and minor
weakness of the deep cervical flexors ventrally crosses with weakness of the middle
and lower trapezius which creates a pattern of imbalance known as joint dysfunction,
particularly at the atlantooccipital and glenohumeral joint. [1]
The head form the total 6 % of the body weight and have a link with cervical region
and other body joints many people tend to work in putting head in forward posture or in
hyperflexed position which tend to cause fatigue and strain in neck muscle which
ultimately effect surrounding areas like shoulder region thoracic region and lumber
region however maintaining forward head posture of a head decreases cervical lordosis
of lower cervical vertebrae which enables posterior curve in the upper thoracic
vertebrae to create balance protraction and retraction movement also takes place along
with flexion and extension in saggital plane extension of upper cervical spine and
flexion of lower cervical spine lead to protraction movement while flexion of upper
cervical spine and flexion of lower cervical spine leads to retraction movement if the
cervical spine is put under prolonged protracted position for longer period of can lead
to forward head posture which is thought to be deviation from normal posture studies
shows that the amount of cervical lordosis was found to correlate with the degree of
thoracic kyphosis while thoracic spine is less mobile and more stable as compared to
cervical region increase cervical lordosis can lead to exaggerated thoracic kyphosis
failure of the head to align with vertical axis of the body can lead to malalignments like
rounded shoulder and increased thoracic kyphosis which compensate for the altered line
of gravity which leads to further impairments combination of all this posture deviations
lead to slouched posture moreover forward head posture affects 66% of people between
 the ages of 20 and 30 and it is more common in women (24.1) than in men (9.1%)
forward head posture influences the range of cervical spine the grater the angle of
forwards head the less movement the cervical spine can make. [2]
While it is found that the forward head posture has caused expansion of the upper
thorax and contraction of the lower thorax and these morphological changes cause a
decrease in respiratory function. [3]

1.1.2 Epidemiology
The prevalence of neck pain, in general, is very high which is about 86.8%,
Occupational posture sitting in a forward or backward position for a long duration
slouched or relaxed sitting, and faulty sitting while using electronic devices or doing
work. Poor ergonomics alignment sleeping with the head elevated too high poor posture
maintain for longer period of time causes postural instability [1]

1.1.3 Causes
Forward head posture is caused by multiple numbers of reasons, mainly it includes
Slouching, sleeping with the head raised, carrying a heavy backpack or purse, driving
with a hunched back, Sewing, Reading while in bed, Whiplash or other injuries to the
spine, and Weakness in the muscle of the upper back and arthritis and bone
degeneration [4]

1.1.4 Risk Factors

Precisely people are more prone to FHP, those who are older age, Female gender, Ex-
smokers, High job demand, and Low social or work support. [4]
Psychological factors such aschange of mood, emotion nd feeling of a person can also
affect the body posture. [5]

1.1.5 Clinical Findings

Clinically, patients with a forward head posture will decrease the cervical spine range
and suffer from Tension headaches, Early disc degeneration and osteophyte formation
Temporomandibular joint pain, and inflammation. and decrease in vital capacity and
 range of motion of shoulder and arm, Possible protrusion of nucleus pulposus and arm,
and temporomandibular joint symptoms, the muscles of mastication may have
increased tension (Pterygoid, Masseter, temporalis muscles) [1]

1.1.6 Assessment
When it comes to clinical assessment of FHP, it is done through observation of the
position of the head relative to the reference anatomical landmarks and radiographic
techniques can be used to measure postural angles, but it is not always practical and the
craniovertebral angle is one of the most reliable methods and common angles for
evaluating the FHP. It examines head status relative to the seventh cervical vertebrae. [1]

1.1.7 Treatment
Exercises and stretches The NASM suggests several techniques that strengthen and
lengthen muscles including chin tucks Stand with the upper back against the wall with
the feet shoulder-width apart tuck the chin in and hold for a few seconds return to the
starting position and repeat a number of times. [1]
This can help stretch the muscle in the upper neck supine chin tucks to do this a person
needs to lie down on the floor facing up they then need to repeat for regular chin tucks
and chest stretch The United Kingdom’s National Health Service (NHS) provides the
following instruction stand upright with feet shoulder-width apart bring the shoulders
back and down ensuring that the elbow is straight and that there is no arch in the low
back.4 and for postural alignment cervical traction scapular retraction balance training
and for joint mobility cervical traction thoracic manual technique and exercises and to
reduce spasm myofascial release ischemic compression positional release techniques to
relieve tension headache and to improve ergonomics it is advice to use correct number
of pillows [1]

1.2 RESEARCH QUESTIONS

 What will be the frequency of forward head posture in tailors?
 How does forward head posture develop in tailors?
 What will be the association between forward head posture and the tragus-to-wall test?
1.3 PROBLEM STATEMENT
The purpose of the study is to find the frequency of forward head posture among tailors.

1.4 RATIONALE OF THE STUDY

The significance of the study is to find the frequency of forward head posture among tailors

1.5 OBJECTIVE OF THE STUDY

The objective of the study is to find the frequency of forward head posture among tailors by
using tragus to wall test.

1.6 HYPOTHESIS
Ho = There will be no frequency of forward head posture among tailors.
Ha = There will be the frequency of forward head posture among tailors.

1.7 OPERATIONAL DEFINITIONS

1.7.1 Forward Head Posture

Forward head posture is defined as when the cervical spine is held in a protracted
position for a longer period of time leading to alteration in head posture causing poor
posture known as FHP. [2]

1.7.2 Slouched Posture

Slouched posture is defined as the combination of all posture deviations is known as
slouched posture [2]

1.7.3 Rounded Shoulder

A rounded shoulder is defined as when the acromion process is present more anteriorly
compared with mastoid processes can lead to forward shoulder posture or rounded
shoulder [2]
1.7.4 Kyphosis
Kyphosis is an exaggerated forward rounding of the upper back [6]

2. LITERATURE REVIEW
A study is conducted in Feb (2022) by Bhalchandra B.B and Kulkarni S on the relationship
between addiction to smartphone usage and protracted shoulder forward head posture and
thoracic kyphosis in college student’s ethical approval taken 40 samples aged 18-25 selected and
assessed by using nomophobia questionnaire tragus to wall test and scapular index p-value is
found to be 0.7527 and the relationship between smartphone usage and posture is not significant.
[2]

The study is conducted in 2020 by Singh S Kausha K et al on the prevalence of forward head
posture and its impact on the activity of daily living among students of adesh university it is a
cross-sectional study of 188 are assessed by using a demographic questionnaire cervical angle is
measure by photography and analyzed by using web plot digitizer software 67% are aware of the
forward head while 58.5% are not only computer and smartphone showed significant association
with forward head posture. [9]

The study is conducted in 2020 by Ashok K et al on the prevalence of forward head posture in
electronic gamers it’s a cross-sectional study 160 participants are selected 72 males and 88
females and the angle is measured by photogrammetry and analyzed by web plot digitizer 97
participants has forward head (60.63) % and it depends upon timing who spend long hours on
their electronic games have a higher risk of forward head posture. [10]

The study is conducted in FEB 2019 by Nitin A W Rajesh M S by Nitin A W Rajesh S M on the
incidence of forward head posture and associated problems in desktop users the methodology
used mb ruler tripod stand ecg vacuum cup mobile camera ihandy mobile app goniometer visual
analogue scale the study concludes that there is no relation between forward head posture pain
and range of motion of the cervical spine. [11]

The study is conducted in 2015 by Sara N L et al on the correlation between forward head
posture and neck pain in Iranian office workers in which 46 subjects without neck pain and 55
with neck pain are examined using a photographic method thoracic and cervical posture are
measure high thoracic and craniovertebral angles these angles are positively correlated with neck
pain only in working position (p<0.05) in forward-looking position there is no significance
between the 2 groups (p>0.05) it concludes that office workers has a defective posture [13]
3. MATERIALS & METHODS
3.1 RESEARCH DESIGN
An observational cross-sectional study.

3.2 STUDY SETTING

 Garment factories.
 Tailor’s shops.

3.3 STUDY DURATION

Four months after the approval of the synopsis.

3.4 SAMPLE SIZE

The sample size will be 288.

3.5 SAMPLING TECHNIQUES

Non-probability Purposive Sampling.

3.6 SELECTION CRITERIA

3.6.1 Inclusion Criteria

 Professional or amateur tailors
 Tailors who are currently or have worked in the tailoring industry for a
minimum of 2 year. [13]
 Age 18 – 40 years. [11]
 Working hours >4 hours. [4]
 positive tragus to wall test. [2]

3.6.2 Exclusion Criteria

 History of neck or spinal injuries or surgeries and chronic pain and neurological
conditions. [2]
  Any medical condition that affects the neck or spine such as scoliosis or
arthritis. [11]
 Pain that is radiating to upper neck shoulder are excluded. [13]
 Negative tragus to wall test. [2]

3.7 DATA COLLECTION PROCEDURE

Data is collected on the basis of inclusion and exclusion criteria tailors who are willing to
participate in the study are added moreover 300 questionnaires will be filled out by the
participants which consisted of 23 questions both males and females will be included aged
18 to 45 were selected and also provided a consent form prior to filling of questionnaire
tragus to wall test is used to determine the forward head posture it is told to stand upright as
tall as possible with both heels sacrum and back against the wall while putting head in a
neutral position then a scale is used from tragus of the ear to the wall and then the value is
noted normal value from the tragus to wall is nine and a half centimetres so the participants
are divided into three groups according to severity including mild (between 10 to 12)
moderate ( less than 15 ) severe ( 15 to 19 ) in centimetres.

3.8 ETHICAL CONSIDERATIONS

The consent form will be filled out by the participants in order to maintain the privacy of
the subject because it is essential not to disclose anyone’s data without their permission and
it is mandatory for medical research and other purposes in medical field.

3.9 MATERIALS
3.9.1 Tragus-to-Wall Test
Tragus to wall test is assessed by asking the subject to stand with heels and buttocks
against the wall knee extended and chin drawn in the horizontal distance between the
tragus and a wall is measured by measuring tape or retracted scale [2]

3.9.2 BMI
 BMI is a statistical index using a person's weight and height to provide an estimate of
body fat in males and females of any age. It is calculated by taking a person's weight,
in kilograms, divided by their height, in meters squared, or BMI = weight (in kg)/
height^2 (in m^2). The number generated from this equation is then the individual's
BMI number. Asian and South Asian population: overweight - BMI between 23 and
24.9 kg/m^2; obesity - BMI greater than 25 kg/m [16]

3.9.3 Visual Analogue Scale

It is often used in epidemiologic and clinical research to measure the intensity or
frequency of various symptoms. For example, the amount of pain that a patient feels
ranges across a continuum from none to an extreme amount of pain and it can be
used as a simple, valid, and effective to assess disease control [17]

3.10 DATA ANALYSIS PROCEDURE

Data will be analyzed through the SPSS version 25.

3.11 STUDY TIMELINE

S.NO WORKING STEPS TIME (MONTHS)
1 2 3 4 5 6 7 8 9
1. Synopsis writing & approval
4. Data collection
5. Data processing
6. Thesis writing

3.12 BUDGET
The total budget for the whole study is estimated to be 15,000/-.
 4. EXPECTED RESULTS

The expected result can be conclude as tailors who spend more time on sewing machine without
having breaks and awareness about ergonomics and risk factor which causes forward head
posture the prevalence of forward head posture can be equally in male and female who spend
long time on sweing machine with faulty posture or in a bad ergonomics condition. It concludes
that spending long hours sitting on the working machines can lead to formation of forward head
posture. And can impact the health and well being of person by developing musculoskeletal pain
headache and stiff neck. It can lead to blurry vision which can create posture related
abnormalities like forward head posture and kyphosis and long term complication can include
reducing lung capacity of a tailor. It is important to develop strategy and intervention which
improve ergonomics body function and posture related abnormalities by telling the tailor to take
break between the work. Reduce the distance between you and with your sewing machine.
Increase the light of that area. Improve the ventilation by opening the windows of that area
where you are sitting can develop healthy changes in your working environment .

5. REFERENCES
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 6. APPENDICES

6.1 Consent form (English, Urdu).

6.2 Questionnaire (English, Urdu).
6.3 IRB letter from the university.