Forward Head PostureNCT07337824
Comparison of Deep Neck Flexor Strengthening and Motor Learning-Based Neuroplasticity Training for Forward Head Posture
A study testing Deep neck flexor strengthening and Motor learning based neuroplasticity training in people with Forward Head Posture, run by Riphah International University at 1 site in Pakistan.
Trial summary
The aim of this randomized clinical trial is to compare the effects of deep neck flexor strengthening and motor learning-based neuroplasticity training on craniovertebral angle, deep neck flexor strength, proprioception, and symptom recurrence in individuals with forward head posture (FHP). Read more about this study
- Who is it for?
- Ages 19 to 25 years
- Conditions the study is for
- Forward Head Posture
- What is being tested?
- Deep neck flexor strengthening and Motor learning based neuroplasticity training
- Could I receive a placebo?
- No, everyone receives an active treatment
- How many people
- 74 participants
- Where
- 1 sitePakistan
- Study dates
- 12 Mar 2026to 20 Jan 2027
- 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 19 to 25 years
- All sexes
- No healthy volunteers
- Adult
Who may be able to join
- University students aged 19-25 years
- Both genders
- Forward head posture with craniovertebral angle < 50°
Who cannot join
- History of cervical spine injury or surgery
- Chronic neck pain or recent therapy within six months.
- Diagnosed with neurological, musculoskeletal, or visual disorders affecting posture.
Trial locations and contacts
1 site in 1 country. Contact the study team or a site near you to ask about taking part.
Pakistan1 site, 1 recruiting
- Recruiting
Riphah Postgraduate Lab, Riphah INternational University
Islamabad, Capital, 44120
Aisha Razzaq, PHD*, 03015030784, aisha.razzaq@riphah.edu.pk
Nimra Shahid, MSPT-OMPT*
About this study
The aim of this randomized clinical trial is to compare the effects of deep neck flexor strengthening and motor learning-based neuroplasticity training on craniovertebral angle, deep neck flexor strength, proprioception, and symptom recurrence in individuals with forward head posture (FHP).
The study will be conducted at Riphah International University, Gulberg Green Campus. A total of 74 participants with forward head posture will be recruited using non-probability convenience sampling and randomly allocated into two groups (37 participants per group). Group A will receive deep neck flexor strengthening exercises, while Group B will receive motor learning-based neuroplasticity training. Both groups will undergo three sessions per week for four weeks. Assessments will be performed at baseline, post-intervention, and at one-month follow-up to assess symptom recurrence. Data will be analyzed using SPSS version 27.
Read the detailed description
Forward head posture is a prevalent postural abnormality characterized by anterior translation of the head relative to the cervical spine. It is commonly observed among university students and young adults due to prolonged smartphone use, computer work, and sedentary lifestyles. Persistent FHP leads to muscular imbalance, weakness of the deep neck flexors, altered proprioception, and impaired neuromuscular control, often resulting in neck pain and functional limitations.
Deep neck flexor strengthening targets the longus colli and longus capitis muscles to restore cervical alignment and improve segmental stability. These exercises aim to correct muscular imbalances by enhancing endurance and motor control of the cervical stabilizers.
Motor learning-based neuroplasticity training is an emerging rehabilitation approach that emphasizes sensorimotor integration, task-specific training, and multisensory feedback. This approach facilitates cortical reorganization and re-establishment of disrupted cortico-spinal and cortico-subcortical pathways through repetitive, goal-oriented motor tasks. By integrating visual, auditory, and proprioceptive feedback, neuroplasticity-based training enhances postural awareness, motor planning, and long-term postural correction.
Despite evidence supporting both interventions individually, limited research has directly compared their effectiveness across postural, neuromuscular, and proprioceptive outcomes, particularly with respect to symptom recurrence. This study seeks to address this gap.
Previous studies have demonstrated that deep neck flexor strengthening significantly improves craniovertebral angle, reduces neck pain, and enhances cervical stability in individuals with forward head posture. Cervical stabilization programs have also shown positive effects on proprioception and neck repositioning accuracy.
Recent randomized controlled trials investigating motor learning-based neuroplasticity approaches have reported improvements in postural control, proprioception, and functional movement patterns through experience-dependent cortical plasticity. However, systematic reviews highlight inconsistent evidence regarding the superiority of strengthening exercises over motor learning-based interventions, with limited comparative trials and short-term follow-up.
Furthermore, evidence related to symptom recurrence and long-term sustainability of postural correction remains scarce. Therefore, a direct comparison of these two interventions is warranted.
- Conditions
- Forward Head Posture
- Being tested
- Deep neck flexor strengthening, Motor learning based neuroplasticity training
- Keywords
- Craniovertebral angle, Deep neck flexor strength, Proprioception, Neuroplasticity training, Motor learning
What participants receive
What participants receive. In a randomised study each person is assigned to one group by chance.
Deep neck flexor strengtheningOther
Chin tuck exercises, Isometric cervical flexion using gentle resistance, Prone head lift exercises. Frequency: 3 sessions per week, Duration: 4 weeks (12 sessions total).
Motor learning based neuroplasticity trainingOther
Task-specific postural training using visual (laser), auditory (metronome), and proprioceptive feedback. Progressive balance and coordination exercises under varying environmental conditions. Static and dynamic postural control tasks with intertrial variability. Frequency: 3 sessions per week, Duration: 4 weeks (12 sessions total)
| Study group | Role | What they receive |
|---|---|---|
| Experimental interventional group A (Deep neck flexor strengthening) | Experimental | * Chin tuck exercises
* Isometric cervical flexion using gentle resistance
* Prone head lift exercises Receives: Other: Deep neck flexor strengthening |
| Experimental :interventional group B ( Motor learning based neuroplasticity training) | Experimental | Task specific postural training using proprioceptive feedback, progressive balance and coordination and static and dynamic postural control tasks under different environmental conditions. Receives: Other: Motor learning based neuroplasticity training |
What is being measured
The primary outcome is the main question the study is designed to answer.
Craniovertebral Angle (CVA)
Measured using digital photogrammetry and analyzed with software (e.g., Kinovea) to quantify forward head posture severity.
Measured: Baseline to 4 weeks
Secondary outcomes (3)
Deep Neck Flexor Strength
Assessed using the Deep Neck Flexor Endurance Test. It is performed in the supine line position with the chin hold and head off the couch and ask the patient to hold the position. The time of the hold will be recorded.
Measured: Baseline to 4 weeks
Cervical Proprioception
Measured using the Cervical Joint Repositioning Error Test with laser-guided repositioning.
Measured: Baseline to 4 weeks
Deep Neck Extensor Strength
Assessed using the Deep Neck Extensor Endurance Test. It is performed in the prone line position with the chin hold and head off the couch and ask the patient to hold the position. The time of the hold will be recorded.
Measured: Baseline to 4 weeks
Timeline
From the start of the study to its completion; the mark is today. Estimated dates are the sponsor’s plan.
- First posted13 Jan 2026
- Study start12 Mar 2026
- Primary completion30 Dec 2026 (estimated)
- Study completion20 Jan 2027 (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
- Masking
- Single blind
- Who is masked
- Outcomes assessor
- Enrolment
- 74 participants (estimated)
Sponsor and investigators
- Lead sponsor
- Riphah International University
- Sponsor type
- University, hospital or other
- Responsible party
- Sponsor
- Investigators
- Aisha Razzaq, PHD*, Principal investigator, Riphah International University
IDs, dates and publications
- ClinicalTrials.gov ID
- NCT07337824
- Sponsor's protocol ID
- RiphahIU Nimra Shahid
- Status last verified
- Sep 2026
- First submitted
- 1 Jan 2026
- Last updated
- 9 Sep 2026
- Results posted
- No
- Data monitoring committee
- No
- FDA-regulated drug
- No
- FDA-regulated device
- No
- Individual data sharing
- No