Craniovertebral AngleNCT07500051
Cervical and Non-Cervical Muscle Thickness Changes in Forward Head Posture
An observational study of Craniovertebral Angle and Posture, run by Gaziantep City Hospital at 1 site in Turkey (Türkiye).
Trial summary
Head-forward posture (FHP) is one of the most common postural disorders and is increasing worldwide. Most studies examining FHP have focused on the relationship between craniovertebral angle (CVA) and cervical muscle thickness. Read more about this study
- Who is it for?
- Ages 18 years and older, women onlyHealthy volunteers can take part
- Conditions the study is for
- Craniovertebral Angle, Posture, Ultrasonography
- How many people
- 49 participants
- Where
- 1 siteTurkey (Türkiye)
- Study dates
- 30 Apr 2025to 30 Oct 2025
- Phase
- Observational
- 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 18 years and older
- Women only
- Healthy volunteers accepted
- Adult, Older adult
Study population: The study population consisted of 49 female participants aged over 18 years. Participants were divided into two groups: 25 individuals diagnosed with forward head posture (FHP) and 24 individuals with normal head posture(NHP). All participants were right-hand dominant. Inclusion and exclusion criteria were applied during recruitment. Individuals with systemic diseases affecting posture, a history of musculoskeletal or neurological disorders, previous relevant surgeries, or conditions that could interfere with participation were excluded from the study. Participation was voluntary.
Who may be able to join
- Age >18 years
- Female sex
- Right-hand dominance
Who cannot join
- Presence of a systemic disease that may cause forward head posture (FHP)
- Presence of osteoarthritis in the ankle, knee, hip, or spine
- History of surgery involving the cervical region, lumbar region, or lower extremities
- Presence of neurological disorders affecting muscles or nerves
- Presence of pain originating from the cervical region
- Presence of radiculopathy
Show all 9Show fewer
- Presence of mental retardation or neuropsychiatric disorders preventing participation
- Unwillingness to participate
- Pregnancy
Trial locations and contacts
1 site in 1 country.
Turkey (Türkiye)1 site
Ankara Etlik City Hospital
Yenimahalle, Ankara, 06170
About this study
Official title: Assessment of Muscle Thickness in Cervical and Non-Cervical Muscles in the Presence of Forward Head Posture (FHP)
Head-forward posture (FHP) is one of the most common postural disorders and is increasing worldwide. Most studies examining FHP have focused on the relationship between craniovertebral angle (CVA) and cervical muscle thickness. However, FHP is a postural disorder that affects the entire musculoskeletal system, not just the cervical region. It creates a chain of adaptations in the body, generating both local and global effects. The aim of this study is to evaluate the relationship between postural changes triggered by CVA and the thickness of the trapezius, splenius capitis, semispinalis capitis, semispinalis cervicis, multifidus, sternocleidomastoid (SCM), transversus abdominis (TrA), internal oblique (IO), external oblique (EO), gluteus maximus, tibialis anterior, rectus femoris, and gastrocnemius (GK) medial muscles, as measured by ultrasonography (USG), since postural changes triggered by CVA can affect the spine, hips, and lower extremities. If this relationship can be confirmed, this information could be used as a basis for evaluating abnormal posture.
Read the detailed description
Head-forward posture (FHP) is one of the most common postural disorders and is increasing worldwide. Most studies examining FHP have focused on the relationship between craniovertebral angle (CVA) and cervical muscle thickness. However, FHP is a postural disorder that affects the entire musculoskeletal system, not just the cervical region. It creates a chain of adaptations in the body, generating both local and global effects. The aim of this study is to evaluate the relationship between postural changes triggered by CVA and the thickness of the trapezius, splenius capitis, semispinalis capitis, semispinalis cervicis, multifidus, sternocleidomastoid (SCM), transversus abdominis (TrA), internal oblique (IO), external oblique (EO), gluteus maximus, tibialis anterior, rectus femoris, and gastrocnemius (GK) medial muscles, as measured by ultrasonography (USG), since postural changes triggered by CVA can affect the spine, hips, and lower extremities. If this relationship can be confirmed, this information could be used as a basis for evaluating abnormal posture.
The sample size calculation was based on a similar study previously conducted by Kyung Woo Kang et al., which recorded the ultrasound appearance of the TrA, IO, and EO muscles obtained with head-forward posture and reduced CVA. Adequacy in the strength analysis, based on abdominal muscle measurements using G*Power 3.0.10a, was calculated with a minimum of 21 volunteers in each group, with a 5% type 1 error and 99% power. Considering losses, it was planned to recruit 23 patients in each group.
Participants included in the study will be divided into two groups. The first group will consist of 23 female volunteers diagnosed with forward head posture (FHP), while the second group will include 23 female volunteers with normal posture who do not meet any of the exclusion criteria.
For both groups, postural assessment and ultrasonographic evaluation of muscle thickness will be performed on the same day they receive their clinical diagnosis, in a manner that does not interfere with their treatment. No interventional procedure will be applied.
To determine the presence of forward head posture (FHP), the craniovertebral angle (CVA) measurement method will be used in this study for postural assessment. For CVA measurement, participants will be instructed to stand in a comfortable position with their arms relaxed at their sides. The spinous process of C7 will be identified by palpation and marked. Subsequently, participants will be asked to perform head flexion and extension movements 3-4 times to obtain a self-balanced head position. A digital camera will be positioned 1.5 meters from the participant at shoulder level, and lateral digital images of the head, neck, and shoulders will be captured for further analysis. The angle formed between the line connecting the spinous process of C7 to the tragus of the ear and a horizontal line passing through C7 will be defined as the CVA. A CVA of less than 48° will be considered indicative of forward head posture.Based on a previous study, only female participants with right-hand dominance will be included, as no difference is expected between the right and left sides of the spine in healthy individuals. Therefore, only right-sided muscle thickness will be measured, and the obtained data will be analyzed.
Demographic data of the participants, cervical range of motion measurements, Visual Analog Scale (VAS) scores, and Neck Disability Index (NDI) scores will be recorded. Muscle thickness measurements obtained by ultrasonography (USG) will be recorded in millimeters (mm).
To minimize inter-operator variability, clinical assessments, ultrasonographic (USG) measurements, and statistical analyses will be performed by different researchers. For all muscles, the average of three thickness measurements will be used for statistical analysis.
Ultrasonographic imaging of the posterior neck muscles will be performed at the C4 level using a 7-12 MHz high-frequency linear array probe. Participants will be seated comfortably with their hands resting on their thighs during the procedure. The spinous process of the fourth cervical vertebra (C4) will be identified by palpation. The transducer will then be placed horizontally at the level of the C4 spinous process and moved slowly to the right, and slightly upward and downward, until the echogenic vertebral lamina is clearly visualized. Muscle thickness of the posterior cervical muscles-including the trapezius, splenius capitis, semispinalis capitis, semispinalis cervicis, and multifidus-will be measured at the C4 level as the greatest distance between the anterior and posterior fascia. Measurements will be taken three times, and the mean value will be recorded.
The sternocleidomastoid (SCM) muscle consists of sternal and clavicular heads and five compartments with different attachments. Due to its superficial location, it is easy to palpate and visualize. To identify the SCM muscle, imaging will be performed using a 7-12 MHz high-frequency linear array probe positioned in the axial plane at the C5 and C6 levels. The mean of three measurements will be recorded.
For imaging the transversus abdominis (TrA), internal oblique (IO), and external oblique (EO) muscles, a 7-12 MHz high-frequency linear array probe will be used. Participants will lie in a comfortable position with their knees flexed and hips at approximately 45°. The transducer will be placed between the anterior superior iliac spine (ASIS) and the lowest rib, approximately 3 cm superomedial to the iliac crest. Using B-mode ultrasonography, the deepest muscle layer visible on the screen will be identified as the TrA. From superficial to deep, EO, IO, and TrA will be visualized sequentially. The average of three thickness measurements will be used for statistical analysis.
Participants will be asked to lie in the prone position with both lower extremities in a neutral position. Ultrasonographic imaging will be performed using a 2-5 MHz convex probe in B-mode. Measurements will be taken within the proximal 30% of the distance between the posterior superior iliac spine (PSIS) and the greater trochanter of the femur, specifically within the first third of this region. Depth and zoom settings will be adjusted until the image of the left third of the sacrum is no longer visible. Once the optimal image is obtained, it will be frozen, and the thickness of the gluteus maximus muscle fibers will be measured. The mean of three measurements will be used for statistical analysis.
A 7-12 MHz linear probe will be used to obtain images of the rectus femoris (RF), tibialis anterior (TA), and medial head of the gastrocnemius (MG) muscles.
For rectus femoris imaging, the participant will be in the supine position. Measurements will be taken at the midpoint between the anterior superior iliac spine (ASIS) and the superior border of the patella. In the axial plane, muscle thickness will be determined as the perpendicular distance between the superficial and deep fascia at the thickest portion of the muscle. The mean of three measurements will be recorded.
For imaging of the medial gastrocnemius, the participant will lie in the prone position with the ankle in a neutral position. Muscle thickness will be measured at the midpoint between the fibular head and the medial malleolus. In the axial plane, thickness will be determined as the perpendicular distance between the superficial and deep fascia at the thickest region. The mean of three measurements will be recorded.
For tibialis anterior imaging, the participant will be in the supine position. Muscle thickness will be measured at one-third of the distance along the line extending from the medial aspect of the patella to the lateral malleolus, using a standardized transducer placement. In the axial plane, thickness will be determined as the perpendicular distance between the superficial and deep fascia at the thickest portion of the muscle. The mean of three measurements will be recorded.
- Conditions
- Craniovertebral Angle, Posture, Ultrasonography
- Keywords
- Forward Head Posture, Craniovertebral Angle, Cervical and Non-cervical Muscle Thickness, Ultrasonography
What participants receive
What participants receive. In a randomised study each person is assigned to one group by chance.
| Study group | Role | What they receive |
|---|---|---|
| Forward Head Posture(FHP) | A craniovertebral angle(CVA) less than 48 degrees is defined as forward head posture(FHP). | |
| Normal Head Posture(NHP) | A craniovertebral angle(CVA) greater than or equal to 48 degrees is defined as normal head posture(NHP). |
What is being measured
The primary outcome is the main question the study is designed to answer.
Cervical extensor muscle thickness measurement
Ultrasonographic imaging of the cervical extensor muscles will be performed at the C4 level using a 7-12 MHz high-frequency linear array probe. Participants will be seated comfortably in a chair with their hands on their thighs. The fourth cervical (C4) vertebral prominence will be identified by palpation. Then, the transducer will be placed horizontally at the level of the C4 vertebral prominence and slowly slid to the right and slightly up and down so that the echogenic vertebral lamina is clearly observed. The thickness of the cervical extensor muscles, including the trapezius, splenius capitis, semispinalis capitis, semispinalis cervicis, and multifidus muscles, will be measured at the C4 level as the widest distance between the anterior and posterior fascia. This measurement will be taken three times, and the average will be recorded in millimeters (mm).
Measured: baseline, at the time of clinical assessment
Sternocleidomastoid (SCM) muscle thickness measurement
The SCM muscle has sternal and clavicular heads and five compartments attached to different locations. Because the muscle runs very superficially, it is easy to both palpate and visualize. To locate the SCM muscle, imaging will be performed by positioning a 7-12 MHz high-frequency linear array probe at the C5 and C6 levels in the axial plane, and the average of three measurements will be recorded in millimeters (mm).
Measured: baseline, at the time of clinical assessment
Abdominal muscle thickness measurement
A 7-12 MHz high-frequency linear array probe will be used to locate the TrA, IO, and EO muscles. The participant will lie comfortably with their knees bent and hips at a 45° angle during imaging. The ultrasound head will be placed between the anterior superior iliac spine (ASIS) and the lowest rib, approximately 3 cm superomedially to the iliac crest. The TrA muscle is the deepest layer visible on the screen with B-mode ultrasound. EO, IO, and TrA will be imaged sequentially from the outside in. The average of the three thickness measurements will be recorded in millimeters (mm).
Measured: baseline, at the time of clinical assessment
Gluteus maximus muscle thickness measurement
The participant will be asked to lie in the prone position with both lower extremities in a neutral position. Ultrasonographic imaging will be performed using a 2-5 MHz convex probe in B-mode. Measurements will be taken within the proximal 30% of the distance between the posterior superior iliac spine (PSIS) and the greater trochanter of the femur, corresponding to the first third of this region. Depth and zoom settings will be adjusted until the left third of the sacrum is no longer visible on the screen. Once the optimal image is displayed, it will be frozen, and the thickness of the gluteus maximus muscle fibers will be measured. The mean of three measurements will be recorded in millimeters (mm).
Measured: baseline, at the time of clinical assessment
Rectus femoris (RF) muscle thickness measurement
A 7-12 MHz linear probe will be used to obtain images of the rectus femoris (RF) muscle. With the participant in the supine position, measurements will be taken at the midpoint of the distance between the anterior superior iliac spine (ASIS) and the superior border of the patella. In the axial plane, muscle thickness will be determined as the perpendicular distance between the superficial and deep fascia at the thickest point of the muscle. The mean of three measurements for each muscle will be recorded in millimeters (mm).
Measured: baseline, at the time of clinical assessment
Gastrocnemius medialis(GC) muscle thickness measurement
A 7-12 MHz linear probe will be used to obtain images of the medial head of the gastrocnemius (MG) muscle. For imaging the medial gastrocnemius, the participant will lie in the prone position with the ankle in a neutral position. Muscle thickness will be measured at the midpoint of the distance between the fibular head and the medial malleolus. In the axial plane, thickness will be determined as the perpendicular distance between the superficial and deep fascia at the thickest portion of the muscle. The mean of three measurements for each muscle will be recorded in millimeters (mm).
Measured: baseline, at the time of clinical assessment
Tibialis anterior (TA) muscle thickness measurement
A 7-12 MHz linear probe will be used to obtain images of the tibialis anterior (TA) muscle. For ultrasonographic imaging, the participant will be in the supine position. Muscle thickness will be measured along the line from the medial aspect of the patella to the lateral malleolus, at one-third of this distance, using a standardized transducer placement. In the axial plane, thickness will be determined as the perpendicular distance between the superficial and deep fascia at the thickest point of the muscle. The mean of three measurements for each muscle will be recorded in millimeters (mm).
Measured: baseline, at the time of clinical assessment
Timeline
From the start of the study to its completion; the mark is today. Estimated dates are the sponsor’s plan.
- First posted30 Mar 2026
- Study start30 Apr 2025
- Primary completion30 Sep 2025
- Study completion30 Oct 2025
Resources
- Official record on ClinicalTrials.govThe registry entry this page is built from, with its full change history.
- Other trials for Craniovertebral AngleStudies 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
- Observational
- Observational model
- Case-control
- Time perspective
- Prospective
- Enrolment
- 49 participants (actual)
Sponsor and investigators
- Lead sponsor
- Gaziantep City Hospital
- Sponsor type
- University, hospital or other
- Responsible party
- Principal investigator, Merve Önoğul Özmen, Gaziantep City Hospital
- Investigators
- Başak MANSIZ KAPLAN, Medical Doctor, Study director, Ankara Etlik City Hospital
IDs, dates and publications
- ClinicalTrials.gov ID
- NCT07500051
- Sponsor's protocol ID
- AEŞH-BADEK1-2025-012
- Status last verified
- Mar 2026
- First submitted
- 20 Mar 2026
- Last updated
- 30 Mar 2026
- Results posted
- No
- Data monitoring committee
- No
- FDA-regulated drug
- No
- FDA-regulated device
- No
- Individual data sharing
- Yes: De-identified individual participant data will be shared, including demographic characteristics (age), group allocation (FHP and control), craniovertebral angle (CVA) measurements, and ultrasonographic muscle thickness measurements (trapezius, splenius capitis, semispinalis capitis, semispinalis cervicis, multifidus, sternocleidomastoid, transversus abdominis, internal oblique, external oblique, gluteus maximus, rectus femoris, tibialis anterior, and medial gastrocnemius). All data will be anonymized to ensure participant confidentiality.
Study at a glance
From the registry record, last updated by the sponsor on 30 Mar 2026. Recruitment status is as the sponsor reported it: confirm with the study team.
- Official title
- Assessment of Muscle Thickness in Cervical and Non-Cervical Muscles in the Presence of Forward Head Posture (FHP)
- ClinicalTrials.gov ID
- NCT07500051
- Acronym / sponsor ID
- AEŞH-BADEK1-2025-012
- Conditions
- Craniovertebral Angle, Posture, Ultrasonography
- Keywords
- Forward Head Posture, Craniovertebral Angle, Cervical and Non-cervical Muscle Thickness, Ultrasonography
- Study type
- Observational
- Recruitment status
- Completed
- Enrolment
- 49 participants (actual)
- Lead sponsor
- Gaziantep City HospitalUniversity, hospital or other
- Study start
- 30 Apr 2025 (actual)
- Primary completion
- 30 Sep 2025 (actual)
- Study completion
- 30 Oct 2025 (actual)
- First posted
- 30 Mar 2026 (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.
Head-forward posture (FHP) is one of the most common postural disorders and is increasing worldwide. Most studies examining FHP have focused on the relationship between craniovertebral angle (CVA) and cervical muscle thickness. However, FHP is a postural disorder that affects the entire musculoskeletal system, not just the cervical region. It creates a chain of adaptations in the body, generating both local and global effects. The aim of this study is to evaluate the relationship between postural changes triggered by CVA and the thickness of the trapezius, splenius capitis, semispinalis capitis, semispinalis cervicis, multifidus, sternocleidomastoid (SCM), transversus abdominis (TrA), internal oblique (IO), external oblique (EO), gluteus maximus, tibialis anterior, rectus femoris, and gastrocnemius (GK) medial muscles, as measured by ultrasonography (USG), since postural changes triggered by CVA can affect the spine, hips, and lower extremities. If this relationship can be confirmed, this information could be used as a basis for evaluating abnormal posture.
Detailed description
Head-forward posture (FHP) is one of the most common postural disorders and is increasing worldwide. Most studies examining FHP have focused on the relationship between craniovertebral angle (CVA) and cervical muscle thickness. However, FHP is a postural disorder that affects the entire musculoskeletal system, not just the cervical region. It creates a chain of adaptations in the body, generating both local and global effects. The aim of this study is to evaluate the relationship between postural changes triggered by CVA and the thickness of the trapezius, splenius capitis, semispinalis capitis, semispinalis cervicis, multifidus, sternocleidomastoid (SCM), transversus abdominis (TrA), internal oblique (IO), external oblique (EO), gluteus maximus, tibialis anterior, rectus femoris, and gastrocnemius (GK) medial muscles, as measured by ultrasonography (USG), since postural changes triggered by CVA can affect the spine, hips, and lower extremities. If this relationship can be confirmed, this information could be used as a basis for evaluating abnormal posture.
The sample size calculation was based on a similar study previously conducted by Kyung Woo Kang et al., which recorded the ultrasound appearance of the TrA, IO, and EO muscles obtained with head-forward posture and reduced CVA. Adequacy in the strength analysis, based on abdominal muscle measurements using G*Power 3.0.10a, was calculated with a minimum of 21 volunteers in each group, with a 5% type 1 error and 99% power. Considering losses, it was planned to recruit 23 patients in each group.
Participants included in the study will be divided into two groups. The first group will consist of 23 female volunteers diagnosed with forward head posture (FHP), while the second group will include 23 female volunteers with normal posture who do not meet any of the exclusion criteria.
For both groups, postural assessment and ultrasonographic evaluation of muscle thickness will be performed on the same day they receive their clinical diagnosis, in a manner that does not interfere with their treatment. No interventional procedure will be applied.
To determine the presence of forward head posture (FHP), the craniovertebral angle (CVA) measurement method will be used in this study for postural assessment. For CVA measurement, participants will be instructed to stand in a comfortable position with their arms relaxed at their sides. The spinous process of C7 will be identified by palpation and marked. Subsequently, participants will be asked to perform head flexion and extension movements 3-4 times to obtain a self-balanced head position. A digital camera will be positioned 1.5 meters from the participant at shoulder level, and lateral digital images of the head, neck, and shoulders will be captured for further analysis. The angle formed between the line connecting the spinous process of C7 to the tragus of the ear and a horizontal line passing through C7 will be defined as the CVA. A CVA of less than 48° will be considered indicative of forward head posture.Based on a previous study, only female participants with right-hand dominance will be included, as no difference is expected between the right and left sides of the spine in healthy individuals. Therefore, only right-sided muscle thickness will be measured, and the obtained data will be analyzed.
Demographic data of the participants, cervical range of motion measurements, Visual Analog Scale (VAS) scores, and Neck Disability Index (NDI) scores will be recorded. Muscle thickness measurements obtained by ultrasonography (USG) will be recorded in millimeters (mm).
To minimize inter-operator variability, clinical assessments, ultrasonographic (USG) measurements, and statistical analyses will be performed by different researchers. For all muscles, the average of three thickness measurements will be used for statistical analysis.
Ultrasonographic imaging of the posterior neck muscles will be performed at the C4 level using a 7-12 MHz high-frequency linear array probe. Participants will be seated comfortably with their hands resting on their thighs during the procedure. The spinous process of the fourth cervical vertebra (C4) will be identified by palpation. The transducer will then be placed horizontally at the level of the C4 spinous process and moved slowly to the right, and slightly upward and downward, until the echogenic vertebral lamina is clearly visualized. Muscle thickness of the posterior cervical muscles-including the trapezius, splenius capitis, semispinalis capitis, semispinalis cervicis, and multifidus-will be measured at the C4 level as the greatest distance between the anterior and posterior fascia. Measurements will be taken three times, and the mean value will be recorded.
The sternocleidomastoid (SCM) muscle consists of sternal and clavicular heads and five compartments with different attachments. Due to its superficial location, it is easy to palpate and visualize. To identify the SCM muscle, imaging will be performed using a 7-12 MHz high-frequency linear array probe positioned in the axial plane at the C5 and C6 levels. The mean of three measurements will be recorded.
For imaging the transversus abdominis (TrA), internal oblique (IO), and external oblique (EO) muscles, a 7-12 MHz high-frequency linear array probe will be used. Participants will lie in a comfortable position with their knees flexed and hips at approximately 45°. The transducer will be placed between the anterior superior iliac spine (ASIS) and the lowest rib, approximately 3 cm superomedial to the iliac crest. Using B-mode ultrasonography, the deepest muscle layer visible on the screen will be identified as the TrA. From superficial to deep, EO, IO, and TrA will be visualized sequentially. The average of three thickness measurements will be used for statistical analysis.
Participants will be asked to lie in the prone position with both lower extremities in a neutral position. Ultrasonographic imaging will be performed using a 2-5 MHz convex probe in B-mode. Measurements will be taken within the proximal 30% of the distance between the posterior superior iliac spine (PSIS) and the greater trochanter of the femur, specifically within the first third of this region. Depth and zoom settings will be adjusted until the image of the left third of the sacrum is no longer visible. Once the optimal image is obtained, it will be frozen, and the thickness of the gluteus maximus muscle fibers will be measured. The mean of three measurements will be used for statistical analysis.
A 7-12 MHz linear probe will be used to obtain images of the rectus femoris (RF), tibialis anterior (TA), and medial head of the gastrocnemius (MG) muscles.
For rectus femoris imaging, the participant will be in the supine position. Measurements will be taken at the midpoint between the anterior superior iliac spine (ASIS) and the superior border of the patella. In the axial plane, muscle thickness will be determined as the perpendicular distance between the superficial and deep fascia at the thickest portion of the muscle. The mean of three measurements will be recorded.
For imaging of the medial gastrocnemius, the participant will lie in the prone position with the ankle in a neutral position. Muscle thickness will be measured at the midpoint between the fibular head and the medial malleolus. In the axial plane, thickness will be determined as the perpendicular distance between the superficial and deep fascia at the thickest region. The mean of three measurements will be recorded.
For tibialis anterior imaging, the participant will be in the supine position. Muscle thickness will be measured at one-third of the distance along the line extending from the medial aspect of the patella to the lateral malleolus, using a standardized transducer placement. In the axial plane, thickness will be determined as the perpendicular distance between the superficial and deep fascia at the thickest portion of the muscle. The mean of three measurements will be recorded.
Study design
- Observational model
- Case-control
- Time perspective
- Prospective
- Number of arms
- 2
| Arm | Type | Receives |
|---|---|---|
| Forward Head Posture(FHP) | – | –A craniovertebral angle(CVA) less than 48 degrees is defined as forward head posture(FHP). |
| Normal Head Posture(NHP) | – | –A craniovertebral angle(CVA) greater than or equal to 48 degrees is defined as normal head posture(NHP). |
Who may qualify
- Ages
- 18 years and older
- Sex
- Female only
- Healthy volunteers
- Accepted
- Age groups
- Adult, Older adult
- Study population
- The study population consisted of 49 female participants aged over 18 years. Participants were divided into two groups: 25 individuals diagnosed with forward head posture (FHP) and 24 individuals with normal head posture(NHP). All participants were right-hand dominant. Inclusion and exclusion criteria were applied during recruitment. Individuals with systemic diseases affecting posture, a history of musculoskeletal or neurological disorders, previous relevant surgeries, or conditions that could interfere with participation were excluded from the study. Participation was voluntary.
Key inclusion criteria (3 listed)
- Age >18 years
- Female sex
- Right-hand dominance
Key exclusion criteria (9 listed)
- Presence of a systemic disease that may cause forward head posture (FHP)
- Presence of osteoarthritis in the ankle, knee, hip, or spine
- History of surgery involving the cervical region, lumbar region, or lower extremities
- Presence of neurological disorders affecting muscles or nerves
- Presence of pain originating from the cervical region
Eligibility is decided by the study team after screening; this overview does not establish that a patient qualifies. Full inclusion and exclusion criteria.
Primary outcome
Cervical extensor muscle thickness measurement
Time frame: baseline, at the time of clinical assessment
Ultrasonographic imaging of the cervical extensor muscles will be performed at the C4 level using a 7-12 MHz high-frequency linear array probe. Participants will be seated comfortably in a chair with their hands on their thighs. The fourth cervical (C4) vertebral prominence will be identified by palpation. Then, the transducer will be placed horizontally at the level of the C4 vertebral prominence and slowly slid to the right and slightly up and down so that the echogenic vertebral lamina is clearly observed. The thickness of the cervical extensor muscles, including the trapezius, splenius capitis, semispinalis capitis, semispinalis cervicis, and multifidus muscles, will be measured at the C4 level as the widest distance between the anterior and posterior fascia. This measurement will be taken three times, and the average will be recorded in millimeters (mm).
Sternocleidomastoid (SCM) muscle thickness measurement
Time frame: baseline, at the time of clinical assessment
The SCM muscle has sternal and clavicular heads and five compartments attached to different locations. Because the muscle runs very superficially, it is easy to both palpate and visualize. To locate the SCM muscle, imaging will be performed by positioning a 7-12 MHz high-frequency linear array probe at the C5 and C6 levels in the axial plane, and the average of three measurements will be recorded in millimeters (mm).
Abdominal muscle thickness measurement
Time frame: baseline, at the time of clinical assessment
A 7-12 MHz high-frequency linear array probe will be used to locate the TrA, IO, and EO muscles. The participant will lie comfortably with their knees bent and hips at a 45° angle during imaging. The ultrasound head will be placed between the anterior superior iliac spine (ASIS) and the lowest rib, approximately 3 cm superomedially to the iliac crest. The TrA muscle is the deepest layer visible on the screen with B-mode ultrasound. EO, IO, and TrA will be imaged sequentially from the outside in. The average of the three thickness measurements will be recorded in millimeters (mm).
Gluteus maximus muscle thickness measurement
Time frame: baseline, at the time of clinical assessment
The participant will be asked to lie in the prone position with both lower extremities in a neutral position. Ultrasonographic imaging will be performed using a 2-5 MHz convex probe in B-mode. Measurements will be taken within the proximal 30% of the distance between the posterior superior iliac spine (PSIS) and the greater trochanter of the femur, corresponding to the first third of this region. Depth and zoom settings will be adjusted until the left third of the sacrum is no longer visible on the screen. Once the optimal image is displayed, it will be frozen, and the thickness of the gluteus maximus muscle fibers will be measured. The mean of three measurements will be recorded in millimeters (mm).
Rectus femoris (RF) muscle thickness measurement
Time frame: baseline, at the time of clinical assessment
A 7-12 MHz linear probe will be used to obtain images of the rectus femoris (RF) muscle. With the participant in the supine position, measurements will be taken at the midpoint of the distance between the anterior superior iliac spine (ASIS) and the superior border of the patella. In the axial plane, muscle thickness will be determined as the perpendicular distance between the superficial and deep fascia at the thickest point of the muscle. The mean of three measurements for each muscle will be recorded in millimeters (mm).
Gastrocnemius medialis(GC) muscle thickness measurement
Time frame: baseline, at the time of clinical assessment
A 7-12 MHz linear probe will be used to obtain images of the medial head of the gastrocnemius (MG) muscle. For imaging the medial gastrocnemius, the participant will lie in the prone position with the ankle in a neutral position. Muscle thickness will be measured at the midpoint of the distance between the fibular head and the medial malleolus. In the axial plane, thickness will be determined as the perpendicular distance between the superficial and deep fascia at the thickest portion of the muscle. The mean of three measurements for each muscle will be recorded in millimeters (mm).
Tibialis anterior (TA) muscle thickness measurement
Time frame: baseline, at the time of clinical assessment
A 7-12 MHz linear probe will be used to obtain images of the tibialis anterior (TA) muscle. For ultrasonographic imaging, the participant will be in the supine position. Muscle thickness will be measured along the line from the medial aspect of the patella to the lateral malleolus, at one-third of this distance, using a standardized transducer placement. In the axial plane, thickness will be determined as the perpendicular distance between the superficial and deep fascia at the thickest point of the muscle. The mean of three measurements for each muscle will be recorded in millimeters (mm).
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 30 Mar 2026.
- Individual participant dataSharing planned: Yes. De-identified individual participant data will be shared, including demographic characteristics (age), group allocation (FHP and control), craniovertebral angle (CVA) measurements, and ultrasonographic muscle thickness measurements (trapezius, splenius capitis, semispinalis capitis, semispinalis cervicis, multifidus, sternocleidomastoid, transversus abdominis, internal oblique, external oblique, gluteus maximus, rectus femoris, tibialis anterior, and medial gastrocnemius). All data will be anonymized to ensure participant confidentiality.
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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.
Başak MANSIZ KAPLAN, Medical Doctor study director
Ankara Etlik City Hospital
1 site in 1 country: see every site and its status.
Questions about this trial
What is this clinical trial studying?
An observational study of Craniovertebral Angle and Posture, run by Gaziantep City Hospital 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 3 inclusion and 9 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 30 Mar 2026. 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?
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?
Cervical extensor muscle thickness measurement (time frame: baseline, at the time of clinical assessment). The study lists 7 primary outcomes in all. 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 30 Mar 2026; AzTrials last refreshed its copy on 30 Oct 2026.