Forward Head PostureCVANCT07039565
Efficacy of Combined Manual Diaphragm Release Technique and Neck Exercises in Adolescents With Forward Head Posture
A study testing Stretching and strengthening exercises and Diaphragm release technique in people with Forward Head Posture, run by Pharos University in Alexandria at 1 site in Egypt.
Trial summary
Due to the heavy use of smartphones among adolescents the cervical spine destabilizes and moves forward, so do the vital structures (nerves, arteries, veins) within the neck undergo torsion, stretch and compression including the autonomic nervous system nerves (which can cause dysfunction in heart rate, digestion… Read more about this study
- Who is it for?
- Ages 17 to 18 years, men only
- Conditions the study is for
- Forward Head Posture
- What is being tested?
- Stretching and strengthening exercises and Diaphragm release technique
- Could I receive a placebo?
- No, everyone receives an active treatment
- How many people
- 100 participants
- Where
- 1 siteEgypt
- Study dates
- 28 Jun 2025to 30 Sep 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 17 to 18 years
- Men only
- No healthy volunteers
- Child, Adult
Who may be able to join
- Male students their age ranged from 17 to 18 years.
- Has Body Mass Index (BMI) = 5th percentile to less than the 85th percentile.
- has forward head posture
- Studying at any faculty at Pharos University in Alexandria.
- Cooperative and followed the instructions.
Who cannot join
- - Subjects were excluded from the study if the student had visual or hearing defects.
- Overweight, obese or cachexic students.
- Had any neurological disorders.
- Had musculoskeletal problems.
- Had any congenital abnormalities that might affect the study.
Trial locations and contacts
1 site in 1 country.
About this study
Official title: Efficacy of Combined Manual Diaphragm Release Technique and Neck Exercises in Adolescents With Forward Head Posture: a Randomized Controlled Trial
- Due to the heavy use of smartphones among adolescents the cervical spine destabilizes and moves forward, so do the vital structures (nerves, arteries, veins) within the neck undergo torsion, stretch and compression including the autonomic nervous system nerves (which can cause dysfunction in heart rate, digestion, breathing among other symptoms).
- Forward head posture (FHP) puts more compressive strain on the cervical spine's tissues, especially the ligaments and facet joints. Because FHP weakens the respiratory muscles, it has a significant impact on respiratory function. Static balance may be negatively impacted by FHP.
- FHP is effectively treated by a proper and suitable physical therapy program.
Read the detailed description
In the past few years, the number of smart phone users has progressively increased worldwide. With the growing use of smart phones, concerns have also increased about musculoskeletal problems associated with the prolonged use of smart phones.
Concerns have also increased about musculoskeletal problems associated with the prolonged use of smartphones. Recent investigations have shown that smartphone users tend to report pain in the neck, shoulder, and thumb, and the severity of the symptoms as the total time spent using the smartphone increases.
One of the most overspread postural abnormalities is forward head posture (FHP) and it is described as head projection anteriorly in relation to the trunk which appears mainly in sagittal plane. When using a smartphone, people usually flex their neck downwards to stare at the lowered object and maintain the head in a forward position for long periods of time, the maintenance of a head-forward posture decreases cervical lordosis of the lower cervical vertebrae and creates a posterior curve in the upper thoracic vertebrae to maintain balance; this is known as the forward head posture (FHP) that causes shortening of the extensors of the neck and producing chronic neck pain.
The weight supported by the spine dramatically increases when flexing the head forward at varying degrees. An adult head weighs 10-12 pounds in the neutral position. As the head tilts forward, the forces felt by the neck surge to 27 pounds at 15 degrees, 40 pounds at 30 degrees, 49 pounds at 45 degrees, and 60 pounds at 60 degrees. At 90 degrees, the model prediction was not reliable.
- Conditions
- Forward Head Posture
- Being tested
- Stretching and strengthening exercises, Diaphragm release technique
- Keywords
- Manual diaphragm release technique, Postural assessment software (SAPO/PAS), adolescents, Forward head posture, Craniovertebral angle (CVA), Postural deviations
What participants receive
What participants receive. In a randomised study each person is assigned to one group by chance.
Stretching and strengthening exercisesOther
Strengthening exercises were progressively performed for three sets, with 10 to 15 repetitions. The stretching part of the exercises was done with the purpose of increasing the flexibility of the pectoralis and the cervical neck extensors muscles (pectoralis stretch, chin tuck). Exercises have been approved to be effective on the lengthening of the pectoralis minor, activation of the lower trapezius/middle trapezius, serratus anterior, and improvement of the posture
Diaphragm release techniqueOther
the patient will positioned in the supine position. The therapist stand at the head of the patient. The therapist make manual contact bilaterally under the costal cartilages of the lower ribs (7th to 10th ) with hypothenar regions of the hands and last three fingers. During the patient's inspiration, the therapist is gently pulling the points of hands contacts toward the head and slightly laterally, while elevating the ribs simultaneously
| Study group | Role | What they receive |
|---|---|---|
| Experimental group | Experimental | Manual diaphragm release technique and traditional neck exercises Receives: Other: Stretching and strengthening exercises; Other: Diaphragm release technique |
| Control group | Active comparator | Traditional neck exercises Receives: Other: Stretching and strengthening exercises |
What is being measured
The primary outcome is the main question the study is designed to answer.
craniovertebral angle (CVA) Forward head posture
The angle formed by a horizontal line crossing c7 and a line crossing c7 to the tragus of the ear is known as the CVA
Measured: 12 weeks
Vertical head alignment (VHA)
Angle between right tragus, right acromion and vertical.
Measured: 12 weeks
Timeline
From the start of the study to its completion; the mark is today. Estimated dates are the sponsor’s plan.
- First posted26 Jun 2025
- Study start28 Jun 2025
- Primary completion30 Jun 2025
- Study completion30 Sep 2025 (estimated)
Resources
- Official record on ClinicalTrials.govThe registry entry this page is built from, with its full change history.
- Publications (2)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
- Quadruple blind
- Who is masked
- Participant, Care provider, Investigator, Outcomes assessor
- Enrolment
- 100 participants (estimated)
Sponsor and investigators
- Lead sponsor
- Pharos University in Alexandria
- Sponsor type
- University, hospital or other
- Responsible party
- Principal investigator, Amal Youssef Wahba, Pharos University in Alexandria
- Investigators
- Lamiaa said Tolba, LecturerP, Study chair, Pharos University in AlexandriaAmal Youssef Wahba, Lecturer, Principal investigator, Pharos University in Alexandria
IDs, dates and publications
- ClinicalTrials.gov ID
- NCT07039565
- Sponsor's protocol ID
- Treatment of forward head
- Acronym
- CVA
- Status last verified
- Jul 2025
- First submitted
- 9 Jun 2025
- Last updated
- 9 Jul 2025
- Results posted
- No
- Data monitoring committee
- Yes
- FDA-regulated drug
- No
- FDA-regulated device
- No
- Individual data sharing
- Yes: Age, Degree of CVA, smart phone usage (hours/day)
Publications
Lee KJ, Han HY, Cheon SH, Park SH, Yong MS. The effect of forward head posture on muscle activity during neck protraction and retraction. J Phys Ther Sci. 2015 Mar;27(3):977-9. doi: 10.1589/jpts.27.977. Epub 2015 Mar 31.
PubMed 25931773https://www.researchgate.net/publication/379140193_Forward_Head_Posture_and_Its_Effect_on_Muscle_Activation
Study at a glance
From the registry record, last updated by the sponsor on 9 Jul 2025. Recruitment status is as the sponsor reported it: confirm with the study team.
- Official title
- Efficacy of Combined Manual Diaphragm Release Technique and Neck Exercises in Adolescents With Forward Head Posture: a Randomized Controlled Trial
- ClinicalTrials.gov ID
- NCT07039565
- Acronym / sponsor ID
- CVA / Treatment of forward head
- Conditions
- Forward Head Posture
- Keywords
- Manual diaphragm release technique, Postural assessment software (SAPO/PAS), adolescents, Forward head posture, Craniovertebral angle (CVA), Postural deviations
- Study type
- Interventional
- Recruitment status
- Active, not recruiting
- Enrolment
- 100 participants (estimated)
- Lead sponsor
- Pharos University in AlexandriaUniversity, hospital or other
- Study start
- 28 Jun 2025 (actual)
- Primary completion
- 30 Jun 2025 (actual)
- Study completion
- 30 Sep 2025 (estimated)
- First posted
- 26 Jun 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.
- Due to the heavy use of smartphones among adolescents the cervical spine destabilizes and moves forward, so do the vital structures (nerves, arteries, veins) within the neck undergo torsion, stretch and compression including the autonomic nervous system nerves (which can cause dysfunction in heart rate, digestion, breathing among other symptoms).
- Forward head posture (FHP) puts more compressive strain on the cervical spine's tissues, especially the ligaments and facet joints. Because FHP weakens the respiratory muscles, it has a significant impact on respiratory function. Static balance may be negatively impacted by FHP.
- FHP is effectively treated by a proper and suitable physical therapy program.
Detailed description
In the past few years, the number of smart phone users has progressively increased worldwide. With the growing use of smart phones, concerns have also increased about musculoskeletal problems associated with the prolonged use of smart phones.
Concerns have also increased about musculoskeletal problems associated with the prolonged use of smartphones. Recent investigations have shown that smartphone users tend to report pain in the neck, shoulder, and thumb, and the severity of the symptoms as the total time spent using the smartphone increases.
One of the most overspread postural abnormalities is forward head posture (FHP) and it is described as head projection anteriorly in relation to the trunk which appears mainly in sagittal plane. When using a smartphone, people usually flex their neck downwards to stare at the lowered object and maintain the head in a forward position for long periods of time, the maintenance of a head-forward posture decreases cervical lordosis of the lower cervical vertebrae and creates a posterior curve in the upper thoracic vertebrae to maintain balance; this is known as the forward head posture (FHP) that causes shortening of the extensors of the neck and producing chronic neck pain.
The weight supported by the spine dramatically increases when flexing the head forward at varying degrees. An adult head weighs 10-12 pounds in the neutral position. As the head tilts forward, the forces felt by the neck surge to 27 pounds at 15 degrees, 40 pounds at 30 degrees, 49 pounds at 45 degrees, and 60 pounds at 60 degrees. At 90 degrees, the model prediction was not reliable.
Study design
- Primary purpose
- Treatment
- Allocation
- Randomised
- Intervention model
- Parallel groups
- Masking
- Quadruple blind (participant, care provider, investigator, outcomes assessor)
- Number of arms
- 2
| Arm | Type | Receives |
|---|---|---|
| Experimental group | Experimental | Other: Stretching and strengthening exercises, Other: Diaphragm release techniqueManual diaphragm release technique and traditional neck exercises |
| Control group | Active comparator | Other: Stretching and strengthening exercisesTraditional neck exercises |
Who may qualify
- Ages
- 17 to 18 years
- Sex
- Male only
- Healthy volunteers
- Not accepted
- Age groups
- Child, Adult
Key inclusion criteria (5 listed)
- Male students their age ranged from 17 to 18 years.
- Has Body Mass Index (BMI) = 5th percentile to less than the 85th percentile.
- has forward head posture
- Studying at any faculty at Pharos University in Alexandria.
- Cooperative and followed the instructions.
Key exclusion criteria (5 listed)
- - Subjects were excluded from the study if the student had visual or hearing defects.
- Overweight, obese or cachexic students.
- Had any neurological disorders.
- Had musculoskeletal problems.
- Had any congenital abnormalities that might affect the study.
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 |
|---|---|---|
| Stretching and strengthening exercisesStrengthening exercises were progressively performed for three sets, with 10 to 15 repetitions. The stretching part of the exercises was done with the purpose of increasing the flexibility of the pectoralis and the cervical neck extensors muscles (pectoralis stretch, chin tuck). Exercises have been approved to be effective on the lengthening of the pectoralis minor, activation of the lower trapezius/middle trapezius, serratus anterior, and improvement of the posture | Other | Control group, Experimental group |
| Diaphragm release techniquethe patient will positioned in the supine position. The therapist stand at the head of the patient. The therapist make manual contact bilaterally under the costal cartilages of the lower ribs (7th to 10th ) with hypothenar regions of the hands and last three fingers. During the patient's inspiration, the therapist is gently pulling the points of hands contacts toward the head and slightly laterally, while elevating the ribs simultaneously | Other | Experimental group |
Primary outcome
craniovertebral angle (CVA) Forward head posture
Time frame: 12 weeks
The angle formed by a horizontal line crossing c7 and a line crossing c7 to the tragus of the ear is known as the CVA
Vertical head alignment (VHA)
Time frame: 12 weeks
Angle between right tragus, right acromion and vertical.
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 9 Jul 2025.
- Background: PubMed 25931773Lee KJ, Han HY, Cheon SH, Park SH, Yong MS. The effect of forward head posture on muscle activity during neck protraction and retraction. J Phys Ther Sci. 2015 Mar;27(3):977-9. doi: 10.1589/jpts.27.977. Epub 2015 Mar 31.
- Backgroundhttps://www.researchgate.net/publication/379140193_Forward_Head_Posture_and_Its_Effect_on_Muscle_Activation
- Forward head posture (FHP), which is defined as a forward displacement of the head on the cervical spine, is a common postural disorder. It is suggested that this malalignment alters the loads on the spine, affects the length-tension relationship in muscLink provided by the sponsor.
- Individual participant dataSharing planned: Yes. Age, Degree of CVA, smart phone usage (hours/day)
Related trials for Forward Head Posture
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Relationship of Forward Head Posture With Burnout and Quality of Life
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The Association Between Smartphone Overuse and Mechanical Neck Pain Among Galala University Students
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Correlation Between Forward Head Posture and Executive Functions in Cervical Radiculopathy
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Digital Use, 24-Hour Movement Behaviors, and Myofascial Release in University Students With Neck Pain
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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.
Lamiaa said Tolba, LecturerP study chair
Pharos University in Alexandria
Amal Youssef Wahba, Lecturer principal investigator
Pharos University in Alexandria
1 site in 1 country: see every site and its status.
Questions about this trial
What is this clinical trial studying?
A study testing Stretching and strengthening exercises and Diaphragm release technique in people with Forward Head Posture, run by Pharos University in Alexandria at 1 site in Egypt.
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 5 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 9 Jul 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 Egypt. 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?
craniovertebral angle (CVA) Forward head posture (time frame: 12 weeks). 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 NCT07039565, which also lists 2 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 9 Jul 2025.