Forward Head PostureNCT04216862
Strengthening and Stretching Exercise to Improve Forward Head Posture and Rounded Shoulders
A study testing Exercise in people with Forward Head Posture, run by Riphah International University at 1 site in Pakistan.
Trial summary
Forward head posture (FHP) and Rounded shoulders (RS) are defined as protrusion of the head and shoulders in the sagittal plane. Forward head posture is defined as the anterior positioning of the cervical spine. Read more about this study
- Who is it for?
- Ages 22 to 40 yearsHealthy volunteers can take part
- Conditions the study is for
- Forward Head Posture
- What is being tested?
- Exercise
- Could I receive a placebo?
- No, everyone receives an active treatment
- How many people
- 30 participants
- Where
- 1 sitePakistan
- Study dates
- 1 Sep 2019to 1 Mar 2020
- Phase
- Interventional
- Are there results?
- None posted in the registry
Key requirements
Who can take part, as listed by the sponsor. Only the study team can confirm whether you are eligible, so take this list to your doctor.
- Ages 22 to 40 years
- All sexes
- Healthy volunteers accepted
- Adult
Who may be able to join
- Individuals having Craniovertebral Angle (CVA) less than 50 degree
- Individuals having Shoulder Angle (SA) less than 52 degree.
- Those who had not under any regular exercise for last 6 months
- Those who use a smart phone or computer for at least 4 hours or more per day on average.
Who cannot join
- Individuals will be excluded if they had visual deficits, diagnosed balance disorders, musculoskeletal pathologies (e.g. history of shoulder surgery, cervical or thoracic fracture, Osteosarcoma, Myeloma), non-ambulatory, displayed functional or structural scoliosis, or had excessive thoracic kyphosis.
- Individuals having symptoms of Vertebral Artery Insufficiency.
- Individuals not willing to participate or to follow up treatment plan.
Trial locations and contacts
1 site in 1 country.
About this study
Official title: Effect of Strengthening and Stretching Exercise of Deep Neck Muscles Group to Improve Forward Head Posture and Rounded Shoulders in Normal Healthy Adults
Forward head posture (FHP) and Rounded shoulders (RS) are defined as protrusion of the head and shoulders in the sagittal plane. Forward head posture is defined as the anterior positioning of the cervical spine. Rounded shoulders also called protracted shoulder (PS) is a protrusion of the acromion of the shoulder joint relative to the centerline of gravity of the body, causing stooped posture along with elevation, protraction, and downward rotation of the scapula, and an increased angle between the lower neck bone and upper spine. Many Physical therapy treatment options are available to correct forward head posture and rounded shoulders which focused to correct the muscle imbalance and restore the normal posture of Cervical spine and shoulder. The objective of this study is to compare the outcomes of Strengthening exercise with the outcomes of stretching exercise on the targeted muscle group to correct forward head posture and rounded shoulders. The study will determine effective management plan for correction of forward head posture and rounded shoulders. It will be Experimental Randomized Controlled Trial. 26 Patients will be included through consecutive sampling, with 13 patients in each of 2 groups. Subjects will be equally distributed to two groups with use of dice roll method of randomization. From the two groups, one receiving strengthening exercise treatment and other receiving stretching exercise treatment. Statistical Package for Social Sciences (SPSS) V 25.will be used for Data analysis. Results will be extracted. Conclusion will be made after comparing the pre and post treatment results of both treatment approaches.
Read the detailed description
Forward head posture and Rounded Shoulder are related to muscle imbalance, which disturbs length tension relationship of muscles. Weak and lengthened muscles in Forward head posture and rounded shoulders are deep neck flexors which include longus capitis and longus coli and weak scapular stabilizers and retractors which include Rhomboids and middle, lower trapezius, Teres Minor and Infraspinatus. The overactive and shortened muscles participating in Forward head posture and Rounded shoulders are Deep upper cervical extensors which include longissimus capitis, Splenius Capitis, Cervical Multifidus, Upper Trapezius and Shoulder protractors and elevators which include Pectoralis minor, Pectoralis major and Levator Scapula. Previous researches suggests that weakened postural muscles should be strengthened and shortened muscles should be lengthened in order to improve postural alignment and alleviate Forward head posture and restoring the normal muscle balance between opposing muscle groups (agonists and antagonists). The majority of treatments have focused on the deep neck flexors, as they play a major role in stabilizing the alignment of the cervical spine. Exercise improved the forward head and Rounded Shoulder significantly.
The selection of 50º as a reference angle for forward head posture was guided by previous studies, with the latter reporting 55.02 ± 2.86 as a normal range. As is well known, subjects with forward head posture have a significantly smaller cervical angle when compared with normal subjects. In the present study, the investigators considered 52º as the reference angle based on a previous study which evaluated 310 participants in a standing position and reported 2.6º±15.3 as a normal range, and Brink et al, who evaluated 15 to 17 year-olds and reported a mean shoulder angle value of 51.35º ± 17.2º, and based on the premise that subjects with protracted shoulder have a significantly smaller shoulder angle when compared with normal subjects. Individual will be considered to have rounded shoulder if the angle will be less than 52º.
- Conditions
- Forward Head Posture
- Being tested
- Exercise
- Keywords
- Forward Head, Rounded Shoulder, Neck Pain
- Medical subject headings
- Neck Pain
What participants receive
What participants receive. In a randomised study each person is assigned to one group by chance.
ExerciseOther
Different type of exercises for treatment of Forward Head Posture
| Study group | Role | What they receive |
|---|---|---|
| Strengthening exercise treatment | Experimental | This exercise targets the deep flexor muscles of the upper cervical region the longus capitis and longus colli muscles. Receives: Other: Exercise |
| Stretching exercise treatment | Active comparator | The subject's forearm is stabilized by a vertical plane before the trunk is rotated in the opposite direction. Therefore the arm on the involved side is externally rotated and abducted to 90. Receives: Other: Exercise |
What is being measured
The primary outcome is the main question the study is designed to answer.
Craniovertebral angle
The angle between the line from the external auditory meatus to the seventh cervical vertebra and a horizontal line at the level of the seventh cervical vertebra using photogrammetry
Measured: 3 Months
Scapular Index
Its the ratio of the length of the scapula to its breadth multiplied by 100 and will be measured using Posture Assessment Software
Measured: 3 Months
Timeline
From the start of the study to its completion; the mark is today. Estimated dates are the sponsor’s plan.
- First posted3 Jan 2020
- Study start1 Sep 2019
- Primary completion20 Feb 2020
- Study completion1 Mar 2020
Resources
- Official record on ClinicalTrials.govThe registry entry this page is built from, with its full change history.
- Publications (5)Papers the sponsor has linked to this study.
- Other trials for Forward Head PostureStudies of the same condition, open and under way.
- What the trial phases meanHow a treatment moves from first tests in people to approval.
More details
For doctors and researchers: how the study is designed, who runs it, and its registry IDs.
Study design
- Study type
- Interventional
- Phase
- Phase N/A
- Primary purpose
- Treatment
- Allocation
- Randomised
- Intervention model
- Parallel groups
- Masking
- Single blind
- Who is masked
- Outcomes assessor
- Enrolment
- 30 participants (actual)
Sponsor and investigators
- Lead sponsor
- Riphah International University
- Sponsor type
- University, hospital or other
- Responsible party
- Sponsor
- Investigators
- Danish Hassan, PhD*, Principal investigator, Riphah International University
IDs, dates and publications
- ClinicalTrials.gov ID
- NCT04216862
- Sponsor's protocol ID
- RiphahIU Tehmina Irfan
- Status last verified
- Oct 2020
- First submitted
- 23 Dec 2019
- Last updated
- 27 Oct 2020
- Results posted
- No
- Data monitoring committee
- No
- FDA-regulated drug
- No
- FDA-regulated device
- No
- Individual data sharing
- No
Publications
Lynch SS, Thigpen CA, Mihalik JP, Prentice WE, Padua D. The effects of an exercise intervention on forward head and rounded shoulder postures in elite swimmers. Br J Sports Med. 2010 Apr;44(5):376-81. doi: 10.1136/bjsm.2009.066837.
PubMed 20371564Lee MH, Park SJ, Kim JS. Effects of neck exercise on high-school students' neck-shoulder posture. J Phys Ther Sci. 2013 May;25(5):571-4. doi: 10.1589/jpts.25.571. Epub 2013 Jun 29.
PubMed 24259804Lee DY, Nam CW, Sung YB, Kim K, Lee HY. Changes in rounded shoulder posture and forward head posture according to exercise methods. J Phys Ther Sci. 2017 Oct;29(10):1824-1827. doi: 10.1589/jpts.29.1824. Epub 2017 Oct 21.
PubMed 29184298Diab AA, Moustafa IM. The efficacy of forward head correction on nerve root function and pain in cervical spondylotic radiculopathy: a randomized trial. Clin Rehabil. 2012 Apr;26(4):351-61. doi: 10.1177/0269215511419536. Epub 2011 Sep 21.
PubMed 21937526Falla D, Jull G, O'Leary S, Dall'Alba P. Further evaluation of an EMG technique for assessment of the deep cervical flexor muscles. J Electromyogr Kinesiol. 2006 Dec;16(6):621-8. doi: 10.1016/j.jelekin.2005.10.003. Epub 2005 Dec 15.
PubMed 16359872
Study at a glance
From the registry record, last updated by the sponsor on 27 Oct 2020. Recruitment status is as the sponsor reported it: confirm with the study team.
- Official title
- Effect of Strengthening and Stretching Exercise of Deep Neck Muscles Group to Improve Forward Head Posture and Rounded Shoulders in Normal Healthy Adults
- ClinicalTrials.gov ID
- NCT04216862
- Acronym / sponsor ID
- RiphahIU Tehmina Irfan
- Conditions
- Forward Head Posture
- Keywords
- Forward Head, Rounded Shoulder, Neck Pain
- Study type
- Interventional
- Recruitment status
- Completed
- Enrolment
- 30 participants (actual)
- Lead sponsor
- Riphah International UniversityUniversity, hospital or other
- Study start
- 1 Sep 2019 (actual)
- Primary completion
- 20 Feb 2020 (actual)
- Study completion
- 1 Mar 2020 (actual)
- First posted
- 3 Jan 2020 (actual)
- Results
- Not posted in the source record
Clinical summary
The research question as the sponsor registered it. This describes what the study plans to test, not what it found.
Forward head posture (FHP) and Rounded shoulders (RS) are defined as protrusion of the head and shoulders in the sagittal plane. Forward head posture is defined as the anterior positioning of the cervical spine. Rounded shoulders also called protracted shoulder (PS) is a protrusion of the acromion of the shoulder joint relative to the centerline of gravity of the body, causing stooped posture along with elevation, protraction, and downward rotation of the scapula, and an increased angle between the lower neck bone and upper spine. Many Physical therapy treatment options are available to correct forward head posture and rounded shoulders which focused to correct the muscle imbalance and restore the normal posture of Cervical spine and shoulder. The objective of this study is to compare the outcomes of Strengthening exercise with the outcomes of stretching exercise on the targeted muscle group to correct forward head posture and rounded shoulders. The study will determine effective management plan for correction of forward head posture and rounded shoulders. It will be Experimental Randomized Controlled Trial. 26 Patients will be included through consecutive sampling, with 13 patients in each of 2 groups. Subjects will be equally distributed to two groups with use of dice roll method of randomization. From the two groups, one receiving strengthening exercise treatment and other receiving stretching exercise treatment. Statistical Package for Social Sciences (SPSS) V 25.will be used for Data analysis. Results will be extracted. Conclusion will be made after comparing the pre and post treatment results of both treatment approaches.
Detailed description
Forward head posture and Rounded Shoulder are related to muscle imbalance, which disturbs length tension relationship of muscles. Weak and lengthened muscles in Forward head posture and rounded shoulders are deep neck flexors which include longus capitis and longus coli and weak scapular stabilizers and retractors which include Rhomboids and middle, lower trapezius, Teres Minor and Infraspinatus. The overactive and shortened muscles participating in Forward head posture and Rounded shoulders are Deep upper cervical extensors which include longissimus capitis, Splenius Capitis, Cervical Multifidus, Upper Trapezius and Shoulder protractors and elevators which include Pectoralis minor, Pectoralis major and Levator Scapula. Previous researches suggests that weakened postural muscles should be strengthened and shortened muscles should be lengthened in order to improve postural alignment and alleviate Forward head posture and restoring the normal muscle balance between opposing muscle groups (agonists and antagonists). The majority of treatments have focused on the deep neck flexors, as they play a major role in stabilizing the alignment of the cervical spine. Exercise improved the forward head and Rounded Shoulder significantly.
The selection of 50º as a reference angle for forward head posture was guided by previous studies, with the latter reporting 55.02 ± 2.86 as a normal range. As is well known, subjects with forward head posture have a significantly smaller cervical angle when compared with normal subjects. In the present study, the investigators considered 52º as the reference angle based on a previous study which evaluated 310 participants in a standing position and reported 2.6º±15.3 as a normal range, and Brink et al, who evaluated 15 to 17 year-olds and reported a mean shoulder angle value of 51.35º ± 17.2º, and based on the premise that subjects with protracted shoulder have a significantly smaller shoulder angle when compared with normal subjects. Individual will be considered to have rounded shoulder if the angle will be less than 52º.
Study design
- Primary purpose
- Treatment
- Allocation
- Randomised
- Intervention model
- Parallel groups
- Masking
- Single blind (outcomes assessor)
- Number of arms
- 2
| Arm | Type | Receives |
|---|---|---|
| Strengthening exercise treatment | Experimental | Other: ExerciseThis exercise targets the deep flexor muscles of the upper cervical region the longus capitis and longus colli muscles. |
| Stretching exercise treatment | Active comparator | Other: ExerciseThe subject's forearm is stabilized by a vertical plane before the trunk is rotated in the opposite direction. Therefore the arm on the involved side is externally rotated and abducted to 90. |
Who may qualify
- Ages
- 22 to 40 years
- Sex
- All
- Healthy volunteers
- Accepted
- Age groups
- Adult
Key inclusion criteria (4 listed)
- Individuals having Craniovertebral Angle (CVA) less than 50 degree
- Individuals having Shoulder Angle (SA) less than 52 degree.
- Those who had not under any regular exercise for last 6 months
- Those who use a smart phone or computer for at least 4 hours or more per day on average.
Key exclusion criteria (3 listed)
- Individuals will be excluded if they had visual deficits, diagnosed balance disorders, musculoskeletal pathologies (e.g. history of shoulder surgery, cervical or thoracic fracture, Osteosarcoma, Myeloma), non-ambulatory, displayed functional or structural scoliosis, or had excessive thoracic kyphosis.
- Individuals having symptoms of Vertebral Artery Insufficiency.
- Individuals not willing to participate or to follow up treatment plan.
Eligibility is decided by the study team after screening; this overview does not establish that a patient qualifies. Full inclusion and exclusion criteria.
Interventions
| Intervention | Type | Arms |
|---|---|---|
| ExerciseDifferent type of exercises for treatment of Forward Head Posture | Other | Strengthening exercise treatment, Stretching exercise treatment |
Primary outcome
Craniovertebral angle
Time frame: 3 Months
The angle between the line from the external auditory meatus to the seventh cervical vertebra and a horizontal line at the level of the seventh cervical vertebra using photogrammetry
Scapular Index
Time frame: 3 Months
Its the ratio of the length of the scapula to its breadth multiplied by 100 and will be measured using Posture Assessment Software
Results and safety
The study is completed, but results are not available in the source record. That does not mean the treatment did or did not work.
Research links
- Official record on ClinicalTrials.govLast updated by the sponsor 27 Oct 2020.
- Background: PubMed 20371564Lynch SS, Thigpen CA, Mihalik JP, Prentice WE, Padua D. The effects of an exercise intervention on forward head and rounded shoulder postures in elite swimmers. Br J Sports Med. 2010 Apr;44(5):376-81. doi: 10.1136/bjsm.2009.066837.
- Background: PubMed 24259804Lee MH, Park SJ, Kim JS. Effects of neck exercise on high-school students' neck-shoulder posture. J Phys Ther Sci. 2013 May;25(5):571-4. doi: 10.1589/jpts.25.571. Epub 2013 Jun 29.
- Background: PubMed 29184298Lee DY, Nam CW, Sung YB, Kim K, Lee HY. Changes in rounded shoulder posture and forward head posture according to exercise methods. J Phys Ther Sci. 2017 Oct;29(10):1824-1827. doi: 10.1589/jpts.29.1824. Epub 2017 Oct 21.
- Background: PubMed 21937526Diab AA, Moustafa IM. The efficacy of forward head correction on nerve root function and pain in cervical spondylotic radiculopathy: a randomized trial. Clin Rehabil. 2012 Apr;26(4):351-61. doi: 10.1177/0269215511419536. Epub 2011 Sep 21.
- Background: PubMed 16359872Falla D, Jull G, O'Leary S, Dall'Alba P. Further evaluation of an EMG technique for assessment of the deep cervical flexor muscles. J Electromyogr Kinesiol. 2006 Dec;16(6):621-8. doi: 10.1016/j.jelekin.2005.10.003. Epub 2005 Dec 15.
- Individual participant dataSharing planned: No
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Forward Head Posture
Referral and contact
AzTrials does not enrol participants or take referrals. Contact the study team or a site listed below; they decide who can take part. This study is not recruiting at the moment.
Danish Hassan, PhD* principal investigator
Riphah International University
1 site in 1 country: see every site and its status.
Questions about this trial
What is this clinical trial studying?
A study testing Exercise in people with Forward Head Posture, run by Riphah International University at 1 site in Pakistan.
The full registered description is in the About this study section and the official record.
Who may be eligible to take part?
The sponsor lists 4 inclusion and 3 exclusion criteria. Eligibility is decided by the study team after screening, so read the full criteria and contact a listed site.
Is this clinical trial currently recruiting?
The record says: finished, as of the sponsor's last update on 27 Oct 2020. Status can change between updates, so confirm with the study contact before making plans.
Where is the study taking place?
The record lists 1 site in Pakistan. Whether a site is taking part right now should be confirmed with that site. See every site.
What are the possible benefits and risks?
They depend on the study and the treatment, and no study can promise a benefit. The study team explains the known risks during informed consent, before anyone joins; the record itself does not list them.
Are results available for this study?
The study is completed, but results are not available in the source record. That does not mean the treatment did or did not work.
How can a doctor refer a patient or contact the research team?
The record lists no contact. The official record names the sponsor, who can be asked directly. AzTrials does not enrol participants or take referrals.
What does the primary outcome measure?
Craniovertebral angle (time frame: 3 Months). The study lists 2 primary outcomes in all. It is what the study was designed to measure, not a finding.
Where can I read the original study information?
On the ClinicalTrials.gov record for NCT04216862, which also lists 5 linked publications.
Does a listing mean the treatment is approved or proven to work?
No. A listing means the study is registered. It does not show that the treatment is safe, works, or is approved by a regulator.
How often is this information updated?
AzTrials copies changed records from ClinicalTrials.gov every night and reloads the whole registry every week. The sponsor last updated this record on 27 Oct 2020.