Original article The effects of training and detraining after an 8 month resistance and stretching training program on forward head and protracted shoulder postures in adolescents: Randomised controlled study R.M. Ruivo a, * , A.I. Carita b, 2 , P. Pezarat-Correia b, 1 a Faculdade de Motricidade Humana, Universidade de Lisboa, Lisboa, Portugal b CIPER, Faculdade de Motricidade Humana, Universidade de Lisboa, Estrada da Costa, 1499-002, Cruz Quebrada, Dafundo, Portugal article info Article history: Received 10 September 2014 Received in revised form 12 January 2015 Accepted 1 May 2015 Keywords: Detraining Neck Posture Rehabilitation abstract Purpose: This study aimed to evaluate the effects of a 32-week resistance and stretching training pro- gram applied in Physical Education classes on forward head posture and protracted shoulder posture of Portuguese adolescents (15e17 years old). The detraining effects after a 16-week period were also measured. Methods: This prospective, randomized and controlled study was conducted in two secondary schools in Portugal. One hundred and thirty adolescents with forward head and protracted shoulder posture were randomly assigned to a control or experimental group. The sagittal head, cervical and shoulder angle were measured before and after a 32-week time intervention period. The control group (n ¼ 46) did only the Physical Education classes whereas the exercise group (n ¼ 42) received a posture corrective exercise programme in addition to Physical Education classes. A 16 week detraining period followed the 32-week. Results: Significant increase were observed in the cervical and shoulder angle in the experimental group following the 32 week-intervention period. After the 16-week detraining period no significant differ- ences were observed in the three postural angles in the intervention group. Conclusions: The exercise intervention was successful at decreasing forward head and protracted shoulder in adolescents. Detraining period was not sufficient to reduce the overall training effects. This study supports the postural training and rehabilitation performed during Physical Education classes, with the aim of preventing and managing upper quadrant musculoskeletal pain. ClinicalTrials.gov Identifier: NCT02190331. © 2015 Elsevier Ltd. All rights reserved. 1. Introduction Posture can be defined as the relative position of different body parts in space (Hu, 1997) and it is an essential element of normal balance (Pausi c et al., 2010) and an important health indicator (McEvoy et al., 2005 Jan). Epidemiological studies have shown that bad posture is commonplace in adolescence (Cho, 2008 Mar), with the forward head posture (FHP) and protracted shoulder (PS) being cited as two of the most common postural deviations in adolescents in school age (Detsch et al., 2007 Apr; Van Niekerk et al., 2008 Jan; Ruivo et al., 2014). Concurrently high prevalence of neck and shoulder pain is also common in adolescents (Straker et al., 2011 Jun). FHP is a forward head with cervical spine hyperextension and it is associated with shortening of the upper trapezius, the posterior cervical extensor muscles (suboccipital, semispinalis and splenni), sternocleidomastoideus and the levator scapulae muscles (Lynch et al., 2010 Apr). A PS is a forward displacement of the acromion with reference to the 7th cervical spinous process and can be measured by the shoulder angle. It is frequently associated with a protracted, ante- rior tilted and internally rotated scapula and with a tightness of the pectoralis minor muscle (Wang et al., 1999). * Corresponding author. Avenida Fernando Pessoa, lote 3.20.01, Bloco B, 4 A, 1990-102 Lisbon, Portugal. Tel.: þ351 919996559; fax: þ351 217507001. E-mail addresses: rodrigo.ruivo@netcabo.pt (R.M. Ruivo), acarita@fmh.ulisboa.pt (A.I. Carita), ppezarat@fmh.ulisboa.pt (P. Pezarat-Correia). 1 Rua Eug enio dos Santos, 15, 12  A, 2780-105 Oeiras, Portugal. Tel.: þ351 966206400; fax: þ351 214149236. 2 Estrada da Costa, Cruz Quebrada, 1499-002, Portugal. Tel.: þ351 918793259. Contents lists available at ScienceDirect Manual Therapy journal homepage: www.elsevier.com/math http://dx.doi.org/10.1016/j.math.2015.05.001 1356-689X/© 2015 Elsevier Ltd. All rights reserved. Manual Therapy xxx (2015) 1e7 Please cite this article in press as: Ruivo RM, et al., The effects of training and detraining after an 8 month resistance and stretching training program on forward head and protracted shoulder postures in adolescents: Randomised controlled study, Manual Therapy (2015), http:// dx.doi.org/10.1016/j.math.2015.05.001