Cross-Sectional Study on Correlation between Forward Head Posture

and weight of school bags in school going children.

Research Proposal

STUDENT NAME: Abhishek Sharma

ROLL NUMBER: 16/FAS/BPT/003

COURSE NAME: Bachelor of Physiotherapy

DEPARTMENT: Physiotherapy

GUIDE: Dr. Shobhit Saxena

DATE OF SUBMISSION: 14/10/19

SIGNATURE :
Introduction:-

Forward head posture is an epidemic in today’s life . Not only in adults but in
children also due to factors like increased use of smartphones , use of heavy school
bags because of carrying school supplies . The schools in India have no facility of
separate lockers to keep the heavy school supplies like the heavy books, practical
files , some notebooks etc.
This study aims at finding the relationship between the weight of the school bag and
forward head posture , is weight of the school bag is an aggravating factor of
increased forward head posture and resulting in neck stiffness and pain ? Lastly
quantifying the postural changes of head and cervical on using heavy bags by school
going children so that some preventive strategies against this problem should be given
and to increase awareness to the parents about this problem which children are facing.
Parisa Nejati et all 2015;28(2).

The overall lifetime prevalence of neck pain due to forwad head posture
among school children in developed countries ranges from 16 to 86% and in
developed countries these figures are higher , ranging from 46.3 to 88.8%.

Ethiopia is one of the fastest developing countries in Africa. There is a

sustained increase in the no. of both public and private schools and the
educational system is evolving. The expanding school syllabus has resulted in
children having to carry more school supplies , while many Ethiopian schools still
have low resources facilities lacking to offer student lockers and transport
coverage to and from schools.
The literature searching revealed that the burden of neck pain due to forward
head posture among school children have not been established or explored in Ethiopia.
Manayesh Delele et all (2018) 19: 276

Literature Review:-
1. Parisa Nejati et all 2015;28(2) done a survey in Iranian population especially the office
employees who works on computer and dentist. The survey is done about relation between
neck pain and forward head posture by measuring Craniovertebral angles and High thoracic
angle. Total hundred and one subjects are taken from Iranian University of Medical Science
(all the working employees and the dentists). The research says that the High thoracic angle
and Craniovertebral angle are positively correlated with the presence of neck pain only in
working position. This research does not explain the changes in CV angle and its effects on
forward head posture in children.

2. Yip CHT et all 2008;13(2):148-54 done a cross-sectional to investigate the relationship

between head posture with pain and disability in patients with neck pain. In this research 62
subjects with neck pain and 52 subjects without neck pain are taken. The sampling is
convenient. The forward head posture is measured by craniovertebral angle by using the
Head Posture Spinal Curvature Instrument (HPSCI). The neck pain disability and severity is
assessed by Chinese version of Northwick Park Neck Pain Questionnaire (NPQ) and
Numeric Pain Rating Scale (NPRS). The research says that there was a significant difference
in the CV angle between subjects with and without neck pain but CV angle is negatively
correlated with Northwick park Neck Pain Questionnaire and Numeric Pain Rating Scale.

3. Silva AG et all 2009; 90 done a Single-Blind( assessor ) cross-sectional study in which a

comparison is done between patients with non-traumatic neck pain and pain free individuals.
Here standing head posture is checked in both the types of subjects and a comparison is
established. A total 96 subjects are taken out of which 80 are selected because they do not
meet the inclusion criteria decided for this research. The patients included in this study must
have neck pain as their main complaint since 6 months. Three angles are measured ; the angle
between C7, the tragus of ear, and the horizontal; the angle between the tragus of ear, the eye
, and the horizontal; and the angle between the inferior margins of the left and right ear and
the horizontal were calculated through the digitalization of video images. The research says
that the neck pain patients were found to have a significantly smaller angle between C7 , the
tragus, and the horizontal, resulting in a more forward head posture than the pain-free
participants.

4. Christine T. San Agustin et all 2003;15(3):30-3 done a survey to quantify the postural
changes, particularly the head on neck angle or craniovertebral angle (CVA), when carrying a
1-strapped or 2-strapped backpack or bag with male and female university students. In this
research, total 48 students are taken from Northeastern University. CV angle with backpack
and without backpack is measured . It is found that the students with heavy bags are having
increased forward head posture and may lead to neck pain. This research does not explain the
neck posture changes in school children , it is done on college students.

5. Pausic J et all 2005;28(6):386-92 done a cross- sectional study done for the purpose of
examining the reliability of a photographic method for assessment of standing posture among
elementary school children. Total 226 students are taken for the research of age between 10-
13 years old. The study shows a satisfactory interitem reliability of a photographic method
for the assessment of standing posture among elementary school children.

6. Manayesh Delele et all (2018) 19: 276 done a survey done on Ethiopian school children
to know the prevalence of musculoskeletal pain in elementary school children. The subject
are taken randomly from 6 different elementary schools. The sample size is around 723
subjects. The researcher collected data consists of physical measurements including height,
weight, and school bag weight and a structured questionnaire on musculoskeletal pain is
given to know the prevalence. The research explains that the prevalence of self-reported
musculoskeletal pain is around 62% among school going children. The common regions of
pain reported are shoulder, neck, and lower leg/knee.

Research hypothesis:-

Alternate hypothesis: There is a statistical significant association between

Forward Head Posture and Weight of the bag in school going children.

Null hypothesis: There is no statistical significant association between

Forward Head Posture and Weight of the bag in school going children.

Aims and Objectives:-

1. To study the effect of heavy bag on neck posture.

2. To study the prevalence of forward head posture in school going children.

Methodology:-

Study design: Correlational study design

Type of study: Cross- sectional study.

Sample size: The total sample size of the subjects is 100.

Sampling: It is a Convenience sampling

Study duration: It is a One time study.

Inclusion criteria:

Students of age between 11-16 years are taken [6th -11th class]

Exclusive criteria:
Students not under the age between 11-16 years are excluded

Variables:

1. Craniovertebral angle

2. Weight of the bag

Instrumentation:-
The instruments used in this research are:-

1. Cannon camera
2. A tripod stand
3. Reflecting dots
4. Weighing machine
5. MB ruler software

Procedure:-

The subjects were included according to the criteria of inclusion and exclusion
protocol. The detailed procedure was explained to the subject with
confidentiality was assured. The consent was signed from parents/ teacher
according to the interest of the subject. The craniovertebral angle and the weight
of the bags are used for the data collection.

The Craniovertebral angle of each subject is calculated, and the angle is seen
less than 50 degrees, subjects were took in the FHP group. The most used
technique for the evaluation of forward head posture is photography methods
which include the steps of taking a picture of the right lateral view of the
subject. The base of the camera was set at according to the subject. The tragus
of ear and C7 spinous process is marked by reflecting dot . Then calculated
craniovertebral angle that is defined from the angle mid of a horizontal line
passing from C7 and from the tragus of the ear the line is extended.
Pictures of the subjects right lateral view was taken using a digital camera(
Cannon, model) placed and fixed 1 meter away from the subjects on the tripod
stand. The angle measurements were carried out using MB ruler Software tool.
At last weight of the bag is measured using weighing scale.

References:-

1. Fejer R, Kyvik KO, Hartvigsen J. The prevalence of neck pain in the world Population:
Asystemic critical review of the literature. Eur Spine J. 2006;15(6): 834-48, https://
dx.doi.org/10.1007/s00586-004-0864-

2. Eltayeb SM , Staal JB , Hassan AA , Awad SS, de Bie RA. Complaints of the arm ,
neck and shoulder, among computer office works in Sudan : A prevalence Study with
validation of an Arabic risk factors Questionnaire. Environ Health . 2008; 7:33-8, https://
dx.doi.org/10.1186/1476-069X-7-33

3. Pargali N, Jowkar N, Prevalence of Musculoskeletal pain among Dentists in Shiraz,

Southern Iran . Int J occup Environ Med. 2010; 1(2):69-74

4. Kang JH, Park RY, Lee SJ, Kim JY, Yoon SR, Jung KI. The effect of Forward head
posture on postural balance in long time computer based worker. Ann Rehabil Med. 2012;
36(1): 98-104, , https:// dx.doi.org/10.5535/arm.2012.36.1.98.

5. Yip CHT , Chiu TTW, Poon ATK. The relationship between head posture and severity
and disability of patients with neck pain. Man Ther. 2008;13(2):148-54, https://
dx.doi.org/10.1016/j.math.2016.11.002

6. Silva AG, Punt TD, Sharples P, Vilas – Boas JP, Jhonson MI. Head posture and neck pain
of chronic non- traumatic origin : A comparison between patients and pain free persons. Arch
Phys med. Rehabil. 2009;90 (4) : 669-74, , https:// dx.doi.org/10.1016/j.apmr.2008.10.018

7. Agustin CTS , Wilmarth MA, Raymond J, Hiliard TS. The amount and variation of
craniovertebral angle changes in college – aged students using one-strapped and two-
strapped backpacks and bags. Orthop Pract. 2003;15(3):30-3
8. Cho CY. Survey of faulty postures and associated factors among chineese adolescents. J
Manipulative Physiotherapy. 2008;31(3)224-9, , https://
dx.doi.org/10.1016/j.jmpt.2008.02.003

9. Pausic J, Pedisic Z, Dizdar D. Reliability of a photographic method for assessing standing

posture of elementary school students . J Manipulative Physiotherapy . 2010;33(6):425-31, ,
https:// dx.doi.org/10.1016/j.jmpt.2010.06.002

10. Dunk NM, Lalonde J, Callaghan JP. Implications of the use of postural analysis as a
clinical diagnostic tool: Reliability of quantifying upright standing spinal postures from
photographic images. J Manipulative Physiotherapy. 2005;28(6): 386-92, , https://
dx.doi.org/10.1016/j.jmpt.2005..6.006

11. Ferreira EAG , Duarte M, Maldonado EP, Burke TN, Marques AP. Postural
Assessment Software (PAS?SAPO): Validation and reliability . Clinics. (Sao Paulo)
2010;65(7):675-81, , https:// dx.doi.org/10.1590/S1807-59322010000700005

12. Cagnie B, Danneels L , van Tiggelen D, de Loose V , Cambier D . Individual and work
related risk factors for neck pain among office workers: A cross sectional study. Eur Spine
J. 2007;16(5):679-86, , https:// dx.doi.org/10.1007/s00586-006-0269-7.

13. Mostamand J , Lotfi H, Safi N. Evaluating the head posture of dentists with no neck
pain. J Bodywork Mov Ther. 2013;17(4):430-3, , https://
dx.doi.org/10.1016/j.jbmt.2012.11.002
 Consent Form

Title:
CROSS - SECTIONAL STUDY ON CORRELATION BETWEEN FORWARD HEAD
POSTURE AND WEIGHT OF SCHOOL BAGS IN SCHOOL GOING CHILDREN.

Invitation to participate:

You are invited to participate in this study which is being done as a part of fulfillment towards the
B.P.T Degree course in Manav Rachna International Institute of Research and Studies, Faridabad ,
Haryana.

Introduction:

The research study is being undertaken to measure Craniovertebral angle and weight of the school
bag among school children.

About the procedure:

Subjects fulfilling the Inclusive criteria would be enrolled in the study. You would be explained
the procedure in detail.

Benefits of Participation:

Every subject who is fulfilling the inclusive criteria will get the free physiotherapy consultation for
neck and free home exercise protocol.

Risk of participation:

As such there is no risk involved; as there is no medication, no drug being used. At the most the risk
could be of muscle fatigue and soreness. So you are advised to report to the physiotherapist if the
frequency is more than comfortable

Right to withdrawl:
The subject has the right to withdraw from this research study at any point of time whenever they
want.

Confidentiality:

All the information regarding the subject would be kept private and shared between me and my
research guide Dr. Shobhit Saxena (PT) and will not be shared with any person who is not a part of
the study. We also request you to let us use the data and photograph for presentation and
publication purpose.

Declaration:

I, …………………………………………… willingly agree to engage in this study , I have been

informed and acquainted to my satisfaction about the process, risk and benefits of the study. I
reserve my right to draw out from the program at any point of time. I understand that the
participation is voluntary and refusal to participate will have no penalty, loss or benefits to
whichever I am entitled . I understand that no compensation is being offered or is available for my
participation and I have the contact address of Mr. Abhishek Sharma , if I requirenfor any further
clarification.

………………………………

Signature

Mobile no. …………………

Contact address:-

Abhishek Sharma

Mobile no. 9205812262

Email Id- as936719@gmail.com

BPT – 8th Semester

Manav Rachna International Institute of Research and Studies