Forward Head PostureEMGNCT06778980
The Effect of Focus Approaches on Neck Region Muscle Activation
A study testing The chin tuck posture in people with Forward Head Posture, run by Gazi University at 1 site in Turkey (Türkiye).
Trial summary
Forward Head Posture (FHP) causes muscle imbalances in the neck and shoulder regions. Various exercises are suggested to correct FHP. During these exercises, internal and external focus techniques are used to enhance motor learning and improve muscle balance. Read more about this study
- Who is it for?
- Ages 18 to 35 yearsHealthy volunteers can take part
- Conditions the study is for
- Forward Head Posture
- What is being tested?
- The chin tuck posture
- Could I receive a placebo?
- No, everyone receives an active treatment
- How many people
- 30 participants
- Where
- 1 siteTurkey (Türkiye)
- Study dates
- 2 Feb 2025to 15 Apr 2025
- Phase
- Interventional
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 18 to 35 years
- All sexes
- Healthy volunteers accepted
- Adult
Who may be able to join
- Aged between 18-35 years,
- Craniovertebral angle (CVA) less than 50 degrees,
- Willing to not participate in any treatment/evaluation during the study,
- Voluntary participation.
Who cannot join
- Experiencing pain in the neck, spine, upper or lower extremities for the past 3 months,
- Body mass index (BMI) greater than 25 kg/m²,
- History of neck injuries or surgeries such as intervertebral disc herniation, spondylosis, radiculopathy, chronic headaches, or whiplash,
- Any visual, auditory, or sensory impairments,
- Temporomandibular joint issues,
- Neurological (e.g., epilepsy), rheumatological, or orthopedic symptoms,
- Any conditions affecting balance and muscle control,
- Cardiopulmonary or systemic diseases that prevent exercise.
Trial locations and contacts
1 site in 1 country. Contact the study team or a site near you to ask about taking part.
Gamze Çobanoğlu Demirkan, Phd contact
Turkey (Türkiye)1 site
Gazi University
Ankara, Turkey, 06490
Seyit Çıtaker, 05336212449, scitaker@gazi.edu.tr
About this study
Official title: Investigation of the Effect of Externally Vs. Internally Focused Techniques on Neck Region Muscle Activation During Postural Correction Exercises in Individuals with Forward Head Posture: Prospective Randomized Crossover Study
Forward Head Posture (FHP) causes muscle imbalances in the neck and shoulder regions. Various exercises are suggested to correct FHP. During these exercises, internal and external focus techniques are used to enhance motor learning and improve muscle balance. However, there are no studies examining how these approaches affect neck muscle activation in individuals with FHP. Therefore, the purpose of this study is to investigate the effects of external and internal focus techniques, aimed at improving cervical alignment during postural correction exercises, on cervical muscle activation in individuals with FHP.
Read the detailed description
Various corrective exercises are suggested in the literature to address Forward Head Posture (FHP). For individuals without musculoskeletal issues, chin-tuck and scapular retraction exercises in a supine position have strong evidence for effectiveness. Scapular stabilization exercises help reduce negative mechanical loads caused by abnormal scapular and cervical spine positions. Additionally, focusing attention on the exercise or target area is used to enhance motor learning and muscle balance, with external focus shown to improve performance in various tasks compared to internal focus.
In clinical practice, it is essential to maintain cervical alignment during scapular retraction exercises for individuals with FHP. To optimize muscle balance during these exercises, instructions often emphasize keeping the chin-tuck position to avoid cervical protraction. Internal and external focus approaches during scapular retraction exercises may help balance the muscle imbalances in individuals with FHP. However, no studies have yet examined the effects of internal and external focus approaches on neck muscle activation in individuals with FHP.
Thirty participants with FHP, defined as having a craniovertebral angle less than 50 degrees, will be included in the study. Participants will perform scapular retraction exercises (bilateral row) with a theraband and T-exercises in a prone position. The exercises will be carried out under three conditions: without guidance (control - no corrective cues for the cervical region), external focus, and internal focus. A laser headband will be used for the external focus condition. Muscle activation of the Upper Trapezius, Middle Trapezius, Lower Trapezius, Serratus Anterior, and Sternocleidomastoid muscles will be measured using the Noraxon MiniDTS system (Noraxon, USA, Inc, Scottsdale, AZ). Muscle activation will be calculated as a percentage of Maximum Voluntary Isometric Contraction (MVIC), and the % MVIC values will be used for analysis. The order of exercises will be randomized.
- Conditions
- Forward Head Posture
- Being tested
- The chin tuck posture
- Keywords
- muscle activation, external focus, internal focus, scapular retraction
What participants receive
What participants receive. In a randomised study each person is assigned to one group by chance.
The chin tuck postureOther
A chin tuck is a posture correction technique where the individual gently tucks their chin towards their chest while keeping the rest of the body straight. This movement helps align the head and neck, reducing forward head posture and improving spinal alignment. After performing the unguided exercises, the patients will be taught the chin tuck position. From this point onward, they will be instructed to maintain the chin tuck position while performing the exercises using both external and internal focus strategies.
| Study group | Role | What they receive |
|---|---|---|
| unguided scapular retraction | No intervention | Participants will be asked to perform the scapular retraction exercise without any corrective cues for the cervical region. |
| unguided prone T exercise | No intervention | Participants will be asked to perform the prone T exercise without any corrective cues for the cervical region. |
| scapular retraction exercise with External focus | Active comparator | For external focus, participants will wear a headband with a laser light positioned on their forehead. The laser will be aligned to shine above and between the eyebrows. A flat wall will be placed in front of them, where the laser light is clearly visible. Participants will be instructed: "Bring your head into a chin tuck position and focus on the point where the laser hits the wall while performing the exercise." Receives: Other: The chin tuck posture |
| scapular retraction exercise with internal focus | Active comparator | Participants will be instructed: "Bring your head into a chin tuck position and focus on keeping your neck in a neutral position while performing the exercise." Receives: Other: The chin tuck posture |
| prone T exercise with external focus | Active comparator | For external focus, participants will wear a headband with a laser light positioned on their forehead. The laser will be aligned to shine above and between the eyebrows. A flat wall will be placed in front of them, where the laser light is clearly visible. Participants will be instructed: "Bring your head into a chin tuck position and focus on the point where the laser hits the wall while performing the exercise." Receives: Other: The chin tuck posture |
| prone T exercise with internal focus | Active comparator | Participants will be instructed: "Bring your head into a chin tuck position and focus on keeping your neck in a neutral position while performing the exercise." Receives: Other: The chin tuck posture |
What is being measured
The primary outcome is the main question the study is designed to answer.
Electromyography (EMG) Measurement on neck muscles
The activation of the Upper Trapezius (UT), Middle Trapezius (MT), Lower Trapezius (LT), Serratus Anterior (SA), and Sternocleidomastoid (SCM) muscles will be measured using the non-invasive surface 8-channel EMG Noraxon MiniDTS system (Noraxon, USA, Inc, Scottsdale, AZ).
Measured: through study completion, an average of 3 months
Craniovertebral Angle Measurement
The craniovertebral angle (CVA) will be measured using the reliable and valid lateral digital photogrammetric method and Kinovea Video Analysis Software. Participants will be filmed laterally from their dominant side (left for left-dominant, right for right-dominant). A phone on a tripod will be placed 1.5 meters away from the participant at shoulder height. Markers will be placed on the tragus and C7 spinous process for accurate measurement, with participants wearing tight shorts and a short-sleeved shirt. They will be instructed to stand with feet shoulder-width apart and face forward. Before photographing, participants will walk in place five times to capture their natural head-body position. Photos will be taken within the first 5 seconds, and the CVA will be measured using Kinovea Video Analysis Software.
Measured: through study completion, an average of 3 months
Timeline
From the start of the study to its completion; the mark is today. Estimated dates are the sponsor’s plan.
- First posted16 Jan 2025
- Study start2 Feb 2025 (estimated)
- Primary completion5 Mar 2025 (estimated)
- Study completion15 Apr 2025 (estimated)
Resources
- Official record on ClinicalTrials.govThe registry entry this page is built from, with its full change history.
- 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
- Crossover
- Masking
- Single blind
- Who is masked
- Outcomes assessor
- Enrolment
- 30 participants (estimated)
Sponsor and investigators
- Lead sponsor
- Gazi University
- Sponsor type
- University, hospital or other
- Responsible party
- Principal investigator, BEYZA YAZGAN DAĞLI, Gazi University
IDs, dates and publications
- ClinicalTrials.gov ID
- NCT06778980
- Sponsor's protocol ID
- BYDTEZ-2024/1
- Other IDs
- Gazi University
- Acronym
- EMG
- Status last verified
- Nov 2024
- First submitted
- 20 Nov 2024
- Last updated
- 16 Jan 2025
- Results posted
- No
- Data monitoring committee
- No
- FDA-regulated drug
- No
- FDA-regulated device
- No
- Individual data sharing
- No