Forward Head PostureNCT06947421
The Effect of Different Exercises on Craniovertebral Angle in Individuals With Forward Head Posture
A study testing McKenzie Exercise and Standard Neck Exercise in people with Forward Head Posture, run by Bahçeşehir University at 1 site in Turkey (Türkiye).
Trial summary
Forward head posture (FHP) is a prevalent postural misalignment commonly attributed to prolonged exposure to poor ergonomic conditions and insufficient physical activity. This condition adversely affects craniovertebral angle (CVA), cervical muscle activity, and upper extremity function, ultimately compromising… Read more about this study
- Who is it for?
- Ages 18 to 30 years
- Conditions the study is for
- Forward Head Posture
- What is being tested?
- McKenzie Exercise and Standard Neck Exercise
- Type of treatment
- Lifestyle or therapy programme
- Could I receive a placebo?
- No, everyone receives an active treatment
- How many people
- 44 participants
- Where
- 1 siteTurkey (Türkiye)
- Study dates
- 16 Apr 2025to 16 Dec 2025
- Phase
- Interventional
- Are there results?
- Not yet: the study is under way
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 30 years
- All sexes
- No healthy volunteers
- Adult
Who may be able to join
- Individuals diagnosed with forward head posture, defined by a craniovertebral angle (CVA) of less than 50°, based on established diagnostic criteria
- Age between 18 and 30 years
- Pain intensity greater than 3 on the Visual Analog Scale (VAS)
- Mild to moderate neck disability, indicated by a Neck Disability Index (NDI) score below 15 out of 50
- Voluntary participation with signed informed consent
Who cannot join
- Presence of medical contraindications to exercise
- Regular engagement in structured spinal exercise programs
- History of spinal surgery
- Diagnosis of cancer or other malignant conditions
- Presence of an implanted cardiac pacemaker
- Visual, auditory, or cognitive impairments that would prevent adherence to the exercise protocol
Trial locations and contacts
1 site in 1 country.
About this study
Official title: Effectiveness of McKenzie and Standard Neck Exercises on Craniovertebral Angle, Hand Grip Strength, and Psychosocial Status in Individuals With Forward Head Posture- Randomized Assessor Blinded Clinical Trial
Forward head posture (FHP) is a prevalent postural misalignment commonly attributed to prolonged exposure to poor ergonomic conditions and insufficient physical activity. This condition adversely affects craniovertebral angle (CVA), cervical muscle activity, and upper extremity function, ultimately compromising overall physical health and quality of life. Current literature highlights the corrective effects of McKenzie exercises on postural awareness and cervical alignment, while standard neck exercises are frequently employed to address muscular imbalances and alleviate posture-related pain and functional limitations. However, studies that directly compare these two exercise approaches in individuals with FHP particularly in terms of their short-term effects on craniovertebral angle, hand grip strength, and psychosocial outcomes remain scarce. Accordingly, the present study aims to fill this critical gap by conducting a multidimensional analysis of the immediate effects of McKenzie versus standard neck exercise programs in individuals with FHP, thereby contributing meaningful insights to clinical rehabilitation practices.
Read the detailed description
Forward head posture (FHP) is a common postural misalignment characterized by the anterior positioning of the head relative to the trunk in the sagittal plane. It is frequently associated with poor ergonomic habits, prolonged screen time, heavy backpack use, and lack of physical activity. This postural deviation can lead to upper cervical hyperextension, lower cervical and upper thoracic flexion, increased muscle tension, and long-term dysfunctions in the musculoskeletal, neurological, and vascular systems.
The craniovertebral angle (CVA) is a commonly used and reliable method for evaluating FHP. A CVA less than 50 degrees is considered indicative of forward head posture. Current literature supports the use of exercise interventions to improve CVA and reduce the symptoms associated with postural abnormalities.
The McKenzie method is based on directional preference and repetitive movements, aiming to enhance postural awareness and spinal alignment. Standard neck exercises, frequently used in clinical practice, aim to improve muscular balance, cervical alignment, and reduce neck pain.
Although both exercise methods have shown individual effectiveness in improving posture and function, few studies have directly compared their effects on both structural and functional outcomes. Additionally, hand grip strength and psychosocial factors are often overlooked, despite their importance in evaluating upper extremity function and overall well-being in individuals with FHP.
This randomized, assessor-blinded clinical trial aims to compare the short-term effects of McKenzie exercises and standard neck exercises on craniovertebral angle, hand grip strength, and psychosocial status in individuals with forward head posture. The results will contribute to clinical knowledge regarding effective rehabilitation strategies for postural dysfunctions.
- Conditions
- Forward Head Posture
- Being tested
- McKenzie Exercise, Standard Neck Exercise
- Keywords
- forward head posture, craniovertebral angle, McKenzie, Standard Neck Exercises
What participants receive
What participants receive. In a randomised study each person is assigned to one group by chance.
McKenzie ExerciseBehavioural
Exercises will be performed in seated or supine positions, 15 repetitions per session, twice daily, for a total duration of 6 weeks. The program will begin with physiotherapist-supervised sessions and continue at home with guidance via a digital training manual. Weekly follow-up and progress will be ensured through individual exercise diaries. Participants missing two consecutive days of exercise will be excluded from the study. Includes:
- Cervical retraction in sitting and supine positions
- Cervical rotation to both sides
- Lateral flexion of the neck
- Combined chin rotation toward the shoulder
Standard Neck ExerciseBehavioural
The protocol includes chin tucks, chin drop stretches, scapular retraction with resistance, and both unilateral and bilateral pectoral stretching. Exercises will be performed twice daily, 15 repetitions per session, over a period of 6 weeks. Exercise progression will be adapted biweekly based on participant tolerance. Includes:
- Chin tucks in supine with progressive hold durations
- Chin drop stretch in sitting with optional manual assistance
- Scapular retraction using theraband or weights
- Pectoral muscle stretching using doorway and seated techniques
| Study group | Role | What they receive |
|---|---|---|
| McKenzie Exercise Group (MG) | Experimental | Participants in this group will follow a McKenzie-based cervical exercise program consisting of four specific movements: retraction, rotation, lateral flexion, and combined rotation. Receives: Behavioral: McKenzie Exercise |
| Standard Neck Exercise Group (SG) | Experimental | Participants in this group will follow a standard cervical postural correction program focused on strengthening deep cervical flexors and scapular retractors, and stretching cervical extensors and pectoralis muscles. Receives: Behavioral: Standard Neck Exercise |
What is being measured
The primary outcome is the main question the study is designed to answer.
1.Craniovertebral Angle (CVA)
CVA is used to assess forward head posture. Participants will be asked to stand in a natural and relaxed posture while focusing on a marked point at eye level on the wall. A lateral photograph will be taken using a Iphone 13 camera mounted on a tripod at shoulder height and placed 1.5 meters from the participant. The spinous process of the C7 vertebra and the tragus of the ear will be marked. The angle between the line connecting the tragus to C7 and a horizontal reference line will be calculated using the ImageJ software. The measurement results will be recorded on the evaluation form.
Analysis Metric: Change in CVA (degrees)
Measured: through study completion, an average of 6 months
Secondary outcomes (4)
2.Cognitive Exercise Therapy Approach Scale (BETY)
The BETY scale will be used to assess participants' biopsychosocial status, including emotional state, functionality, fatigue, pain, sleep quality, and social/sexual life. The scale consists of 30 items scored on a 0-4 Likert scale, with a total score range of 0-120. Higher scores indicate greater biopsychosocial impairment.
Analysis Metric: Total score (0-120)
Measured: through study completion, an average of 6 months
3.Hand Grip Strength (HGS)
Grip strength will be measured using a Baseline hydraulic hand dynamometer. Participants will be seated or standing upright with the shoulder in adduction, elbow at 90° flexion, wrist in 0-30° extension and 0-5° ulnar deviation. They will be instructed to squeeze the dynamometer with maximum effort for 3 seconds. The test will be performed three times for each hand (starting with the dominant hand), and the highest value from each will be recorded.
Analysis Metric: Maximum grip strength in kilograms (kg)
Measured: through study completion, an average of 6 months
4.Neck Disability Index (NDI)
The Neck Disability Index is a standardized self-reported questionnaire used to assess the impact of neck pain on daily living activities. This scale evaluates the individual's functional status through self-assessment of neck pain, including domains such as pain intensity, personal care, lifting, reading, headaches, concentration, work, driving, sleeping, and recreational activities. Each section is scored on a scale from 0 ("no pain") to 5 ("the worst pain imaginable"). The scores from each section are summed and expressed as a percentage to determine the overall level of disability. Interpretation categories are as follows: 0-8% = no disability, 10-28% = mild, 30-48% = moderate, 50-64% = severe, and 70-100% = complete disability
Measured: through study completion, an average of 6 months
5. Visual Analog Scale (VAS) for Neck Pain
Cervical pain intensity will be assessed using a 10-cm horizontal VAS. Participants will mark their current level of pain on the line, where 0 indicates "no pain" and 10 indicates "worst imaginable pain." Analysis Metric: Pain score (0-10)
Measured: through study completion, an average of 6 months
Timeline
From the start of the study to its completion; the mark is today. Estimated dates are the sponsor’s plan.
- First posted27 Apr 2025
- Study start16 Apr 2025
- Primary completion16 Oct 2025 (estimated)
- Study completion16 Dec 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
- Parallel groups
- Model description
- a randomized, controlled, assessor-blind, prospective study
- Masking
- Single blind
- Who is masked
- Outcomes assessor
- Enrolment
- 44 participants (estimated)
Sponsor and investigators
- Lead sponsor
- Bahçeşehir University
- Sponsor type
- University, hospital or other
- Responsible party
- Principal investigator, Esra BECENI, Bahçeşehir University
- Investigators
- Pelin Pişirici, PhD, Study director, Bahcesehir University, Faculty of Health Sciences, Department of PhysiotherapyEsra Beceni, PhD Student, Principal investigator, Bahcesehir University, Graduate Education InstituteBüşra Tamgüç, PhD Student, Study chair, Bahcesehir University, Graduate Education InstituteGülay Yalcin, PhD, Study chair, Mudanya University, Faculty of Health Sciences, Department of Physiotherapy
IDs, dates and publications
- ClinicalTrials.gov ID
- NCT06947421
- Sponsor's protocol ID
- E-10840098-202.3.02-2206
- Status last verified
- Apr 2025
- First submitted
- 21 Apr 2025
- Last updated
- 27 Apr 2025
- Results posted
- No
- Data monitoring committee
- No
- FDA-regulated drug
- No
- FDA-regulated device
- No
Study at a glance
From the registry record, last updated by the sponsor on 27 Apr 2025. Recruitment status is as the sponsor reported it: confirm with the study team.
- Official title
- Effectiveness of McKenzie and Standard Neck Exercises on Craniovertebral Angle, Hand Grip Strength, and Psychosocial Status in Individuals With Forward Head Posture- Randomized Assessor Blinded Clinical Trial
- ClinicalTrials.gov ID
- NCT06947421
- Acronym / sponsor ID
- E-10840098-202.3.02-2206
- Conditions
- Forward Head Posture
- Keywords
- forward head posture, craniovertebral angle, McKenzie, Standard Neck Exercises
- Study type
- Interventional
- Recruitment status
- Active, not recruiting
- Enrolment
- 44 participants (estimated)
- Lead sponsor
- Bahçeşehir UniversityUniversity, hospital or other
- Study start
- 16 Apr 2025 (actual)
- Primary completion
- 16 Oct 2025 (estimated)
- Study completion
- 16 Dec 2025 (estimated)
- First posted
- 27 Apr 2025 (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) is a prevalent postural misalignment commonly attributed to prolonged exposure to poor ergonomic conditions and insufficient physical activity. This condition adversely affects craniovertebral angle (CVA), cervical muscle activity, and upper extremity function, ultimately compromising overall physical health and quality of life. Current literature highlights the corrective effects of McKenzie exercises on postural awareness and cervical alignment, while standard neck exercises are frequently employed to address muscular imbalances and alleviate posture-related pain and functional limitations. However, studies that directly compare these two exercise approaches in individuals with FHP particularly in terms of their short-term effects on craniovertebral angle, hand grip strength, and psychosocial outcomes remain scarce. Accordingly, the present study aims to fill this critical gap by conducting a multidimensional analysis of the immediate effects of McKenzie versus standard neck exercise programs in individuals with FHP, thereby contributing meaningful insights to clinical rehabilitation practices.
Detailed description
Forward head posture (FHP) is a common postural misalignment characterized by the anterior positioning of the head relative to the trunk in the sagittal plane. It is frequently associated with poor ergonomic habits, prolonged screen time, heavy backpack use, and lack of physical activity. This postural deviation can lead to upper cervical hyperextension, lower cervical and upper thoracic flexion, increased muscle tension, and long-term dysfunctions in the musculoskeletal, neurological, and vascular systems.
The craniovertebral angle (CVA) is a commonly used and reliable method for evaluating FHP. A CVA less than 50 degrees is considered indicative of forward head posture. Current literature supports the use of exercise interventions to improve CVA and reduce the symptoms associated with postural abnormalities.
The McKenzie method is based on directional preference and repetitive movements, aiming to enhance postural awareness and spinal alignment. Standard neck exercises, frequently used in clinical practice, aim to improve muscular balance, cervical alignment, and reduce neck pain.
Although both exercise methods have shown individual effectiveness in improving posture and function, few studies have directly compared their effects on both structural and functional outcomes. Additionally, hand grip strength and psychosocial factors are often overlooked, despite their importance in evaluating upper extremity function and overall well-being in individuals with FHP.
This randomized, assessor-blinded clinical trial aims to compare the short-term effects of McKenzie exercises and standard neck exercises on craniovertebral angle, hand grip strength, and psychosocial status in individuals with forward head posture. The results will contribute to clinical knowledge regarding effective rehabilitation strategies for postural dysfunctions.
Study design
- Primary purpose
- Treatment
- Allocation
- Randomised
- Intervention model
- Parallel groups
- Masking
- Single blind (outcomes assessor)
- Number of arms
- 2
- Model description
- a randomized, controlled, assessor-blind, prospective study
| Arm | Type | Receives |
|---|---|---|
| McKenzie Exercise Group (MG) | Experimental | Behavioral: McKenzie ExerciseParticipants in this group will follow a McKenzie-based cervical exercise program consisting of four specific movements: retraction, rotation, lateral flexion, and combined rotation. |
| Standard Neck Exercise Group (SG) | Experimental | Behavioral: Standard Neck ExerciseParticipants in this group will follow a standard cervical postural correction program focused on strengthening deep cervical flexors and scapular retractors, and stretching cervical extensors and pectoralis muscles. |
Who may qualify
- Ages
- 18 to 30 years
- Sex
- All
- Healthy volunteers
- Not accepted
- Age groups
- Adult
Key inclusion criteria (5 listed)
- Individuals diagnosed with forward head posture, defined by a craniovertebral angle (CVA) of less than 50°, based on established diagnostic criteria
- Age between 18 and 30 years
- Pain intensity greater than 3 on the Visual Analog Scale (VAS)
- Mild to moderate neck disability, indicated by a Neck Disability Index (NDI) score below 15 out of 50
- Voluntary participation with signed informed consent
Key exclusion criteria (6 listed)
- Presence of medical contraindications to exercise
- Regular engagement in structured spinal exercise programs
- History of spinal surgery
- Diagnosis of cancer or other malignant conditions
- Presence of an implanted cardiac pacemaker
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 |
|---|---|---|
| McKenzie ExerciseExercises will be performed in seated or supine positions, 15 repetitions per session, twice daily, for a total duration of 6 weeks. The program will begin with physiotherapist-supervised sessions and continue at home with guidance via a digital training manual. Weekly follow-up and progress will be ensured through individual exercise diaries. Participants missing two consecutive days of exercise will be excluded from the study. Includes: * Cervical retraction in sitting and supine positions * Cervical rotation to both sides * Lateral flexion of the neck * Combined chin rotation toward the shoulder | Behavioural | McKenzie Exercise Group (MG) |
| Standard Neck ExerciseThe protocol includes chin tucks, chin drop stretches, scapular retraction with resistance, and both unilateral and bilateral pectoral stretching. Exercises will be performed twice daily, 15 repetitions per session, over a period of 6 weeks. Exercise progression will be adapted biweekly based on participant tolerance. Includes: * Chin tucks in supine with progressive hold durations * Chin drop stretch in sitting with optional manual assistance * Scapular retraction using theraband or weights * Pectoral muscle stretching using doorway and seated techniques | Behavioural | Standard Neck Exercise Group (SG) |
Primary outcome
1.Craniovertebral Angle (CVA)
Time frame: through study completion, an average of 6 months
CVA is used to assess forward head posture. Participants will be asked to stand in a natural and relaxed posture while focusing on a marked point at eye level on the wall. A lateral photograph will be taken using a Iphone 13 camera mounted on a tripod at shoulder height and placed 1.5 meters from the participant. The spinous process of the C7 vertebra and the tragus of the ear will be marked. The angle between the line connecting the tragus to C7 and a horizontal reference line will be calculated using the ImageJ software. The measurement results will be recorded on the evaluation form. Analysis Metric: Change in CVA (degrees)
4 secondary outcomes
2.Cognitive Exercise Therapy Approach Scale (BETY)
Time frame: through study completion, an average of 6 months
3.Hand Grip Strength (HGS)
Time frame: through study completion, an average of 6 months
4.Neck Disability Index (NDI)
Time frame: through study completion, an average of 6 months
5. Visual Analog Scale (VAS) for Neck Pain
Time frame: through study completion, an average of 6 months
Results and safety
This study is still under way. Results are not available in the source record yet.
Research links
- Official record on ClinicalTrials.govLast updated by the sponsor 27 Apr 2025.
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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.
Pelin Pişirici, PhD study director
Bahcesehir University, Faculty of Health Sciences, Department of Physiotherapy
Esra Beceni, PhD Student principal investigator
Bahcesehir University, Graduate Education Institute
Büşra Tamgüç, PhD Student study chair
Bahcesehir University, Graduate Education Institute
1 site in 1 country: see every site and its status.
Questions about this trial
What is this clinical trial studying?
A study testing McKenzie Exercise and Standard Neck Exercise in people with Forward Head Posture, run by Bahçeşehir University at 1 site in Turkey (Türkiye).
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 5 inclusion and 6 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: under way, not looking for participants, as of the sponsor's last update on 27 Apr 2025. 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 Turkey (Türkiye). 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?
This study is still under way. Results are not available in the source record yet.
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?
1.Craniovertebral Angle (CVA) (time frame: through study completion, an average of 6 months). It is what the study was designed to measure, not a finding.
Where can I read the original study information?
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 Apr 2025.