Forward Head PostureNCT07622979
Comparative Effects of Blackburn and Egoscue Exercises to Improve CVA in Individuals With Forward Head Posture
A study testing Group A (Blackburn Exercises) and Group B (Egoscue Exercises) in people with Forward Head Posture, run by University of Faisalabad at 1 site in Pakistan.
Trial summary
The trial aims to evaluate and compare the therapeutic outcomes of Blackburn and Egoscue exercise interventions in managing forward head posture. The study will be conducted as a Randomized Clinical Trial enrolling subjects diagnosed with forward head posture. Read more about this study
- Who is it for?
- Ages 25 to 45 years
- Conditions the study is for
- Forward Head Posture
- What is being tested?
- Group A (Blackburn Exercises) and Group B (Egoscue Exercises)
- Could I receive a placebo?
- No, everyone receives an active treatment
- How many people
- 28 participants
- Where
- 1 sitePakistan
- Study dates
- 20 May 2026to 20 Sep 2026
- 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 25 to 45 years
- All sexes
- No healthy volunteers
- Adult
Who may be able to join
- Age range: 25 to 45 years (Mahmoud et al., 2019).
- Individuals demonstrating a Craniovertebral Angle between 30 and 45 degrees.
- Individuals reporting pain levels classified as moderate to severe on the NPRS.
- Individuals demonstrating moderate to severe disability as measured by the Neck Disability Index.
- Both male and female participants will be considered eligible.
Who cannot join
- Individuals currently receiving any physical therapy intervention targeting the neck or shoulder regions.
- Individuals utilizing cervical or lumbar orthotic devices.
- Individuals taking prescribed pain medications.
- Individuals with a formally diagnosed psychological condition.
- Any recent bone fracture.
- Any recently sustained trauma or injury.
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- Formally diagnosed neurological signs or symptoms.
- Burns or open wounds.
- Formally diagnosed vestibular pathology.
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
Anas Iqbal Physiotherapy and Rehabilitation Centre, Khadija tul Zahra Physiotherapy Centre
Faisalābad, Punjab Province, 38000
Maryam Safdar, MS PT (MSK), +92-3217978088, maryamsafdar.DPT@tuf.edu.pk
Dr Muhammad Ateeb, Phd Public Health, +92-3357333383, ateeb.oric@tuf.edu.pk
About this study
Official title: Comparative Effects of Blackburn and Egoscue Exercises to Improve Craniovertebral Angle in Individuals With Forward Head Posture
The trial aims to evaluate and compare the therapeutic outcomes of Blackburn and Egoscue exercise interventions in managing forward head posture. The study will be conducted as a Randomized Clinical Trial enrolling subjects diagnosed with forward head posture. Participants of both sexes will be eligible provided they present with a Craniovertebral Angle (CVA) ranging between 30 and 45 degrees, a Neck Disability Index (NDI) score indicating moderate to severe impairment, and pain levels rated as moderate to severe on the Numeric Pain Rating Scale (NPRS). Individuals currently wearing orthotic devices or having a history of recent trauma or fractures will be ineligible for participation. Written as well as verbal informed consent shall be obtained from each participant prior to enrollment. A total of 28 subjects will be distributed across 2 groups, each comprising 14 individuals, with allocation performed through randomization. Group A will undertake Blackburn exercise protocols while Group B will follow Egoscue method exercises. Transcutaneous Electrical Nerve Stimulation (TENS), isometric exercises, and thermotherapy via hot pack will serve as baseline interventions for both cohorts alongside cervical isometrics. The complete intervention protocol will span 24 sessions administered across 3 sessions weekly on alternate days. The principal outcomes assessed will include pain severity, craniovertebral alignment, and functional disability. Assessment instruments will comprise the Craniovertebral Angle measurement, Neck Disability Index, and Numeric Pain Rating Scale. Baseline measurements will be recorded at the start, pain will be documented before and after every treatment session, whereas forward head posture assessment and neck disability evaluations will be conducted both at baseline and upon completion of the 8-week protocol. Statistical processing of data will utilize SPSS version 23.
Read the detailed description
Forward head posture represents a common cervical spinal deviation characterized by hyperextension of the upper cervical vertebrae combined with hyperflexion of the lower cervical region, ultimately producing excessive lordosis within the cervical spine. As a consequence, affected individuals experience difficulties performing their routine daily functions due to premature muscular fatigue in the neck region, diminished cervical stability, cervicogenic headache, and compromised postural regulation. The trial aims to evaluate and compare the therapeutic outcomes of Blackburn and Egoscue exercise interventions in managing forward head posture.The study will be conducted as a Randomized Clinical Trial enrolling subjects diagnosed with forward head posture. Participants of both sexes will be eligible provided they present with a Craniovertebral Angle (CVA) ranging between 30 and 45 degrees, a Neck Disability Index (NDI) score indicating moderate to severe impairment, and pain levels rated as moderate to severe on the Numeric Pain Rating Scale (NPRS). Individuals currently wearing orthotic devices or having a history of recent trauma or fractures will be ineligible for participation. Written as well as verbal informed consent shall be obtained from each participant prior to enrollment. A total of 28 subjects will be distributed across 2 groups, each comprising 14 individuals, with allocation performed through randomization. Group A will undertake Blackburn exercise protocols while Group B will follow Egoscue method exercises. Transcutaneous Electrical Nerve Stimulation (TENS), isometric exercises, and thermotherapy via hot pack will serve as baseline interventions for both cohorts alongside cervical isometrics. The complete intervention protocol will span 24 sessions administered across 3 sessions weekly on alternate days. The principal outcomes assessed will include pain severity, craniovertebral alignment, and functional disability. Assessment instruments will comprise the Craniovertebral Angle measurement, Neck Disability Index, and Numeric Pain Rating Scale. Baseline measurements will be recorded at the start, pain will be documented before and after every treatment session, whereas forward head posture assessment and neck disability evaluations will be conducted both at baseline and upon completion of the 8-week protocol. Statistical processing of data will utilize SPSS version 23.
- Conditions
- Forward Head Posture
- Being tested
- Group A (Blackburn Exercises), Group B (Egoscue Exercises)
- Keywords
- Forward Head Posture, Blackburn Exercise, Egoscue Exercise, Craniovertebral Angle
What participants receive
What participants receive. In a randomised study each person is assigned to one group by chance.
Group A (Blackburn Exercises)Other
Prone exercises include horizontal abduction (neutral) where arms are lifted sideways from a prone position until parallel to floor, and in full external rotation with thumbs up for greater rotator cuff activation. Prone horizontal scaption is performed ~30° anterior to abduction, with its external rotation variant enhancing posterior shoulder control. Prone horizontal external rotation is done at 90° shoulder abduction with elbow flexion, rotating forearms upward. Prone horizontal extension lifts arms backward in line with trunk. Exercises are done 3×/week, 10 reps with 5-second hold, progressing to 10-second hold after 5 days. Baseline care includes hot pack for 15 min, TENS (200 µs, 100 Hz, 2 Hz burst) for 10 min, and cervical isometrics for stability and pain control.
Group B (Egoscue Exercises)Other
Egoscue exercises will be performed 3×/week with 10 repetitions and a 5-second hold, progressing after 5 days to a 10-second hold. Exercises include static back (supine with legs supported at 90°), elbow curls (hands at temples, elbows moving together/apart with head stable), upper floor spinal twist (side-lying trunk rotation), cats and dogs (quadruped spinal flexion/extension), and arm circles (standing with scapular control and arm rotations). Baseline care includes hot pack applied to neck/shoulder for 15 minutes, and TENS in burst mode (200 µs, 100 Hz carrier, 2 Hz burst) for 10 minutes before sessions. Cervical isometric exercises are also included to improve strength and postural stability.
| Study group | Role | What they receive |
|---|---|---|
| Group A (Blackburn exercises) | Experimental | The protocol includes prone shoulder exercises to improve scapular stability and posture. Prone horizontal abduction (neutral) is performed by lifting arms laterally from a prone position until parallel to the floor. In full external rotation, thumbs are turned upward to increase rotator cuff activation. Prone horizontal scaption is done ~30° anterior to abduction, while its external rotation variant enhances posterior shoulder activation. Prone horizontal external rotation is performed with shoulders abducted 90° and elbows flexed 90°, rotating forearms upward. Prone horizontal extension involves lifting arms backward in line with the trunk. Exercises are performed 3 times/week, 10 reps with 5-second hold. After 5 days, progression increases hold to 10 seconds per repetition. Baseline care includes hot pack application to neck and shoulders for 15 minutes, and TENS in burst mode (200 µs pulse width, 100 Hz carrier, 2 Hz burst) for 10 minutes and also Cervical isometric exercises Receives: Other: Group A (Blackburn Exercises) |
| Group B (Egoscue exercises) | Active comparator | Egoscue exercises will be performed 3 times/week with 10 repetitions and a 5-second hold, progressing after 5 days to a 10-second hold. Exercises include static back (supine with legs supported at 90°), elbow curls (hands at temples, elbows moving together and apart with head stable), upper floor spinal twist (side lying trunk rotation with knees bent), cats and dogs (quadruped alternating spinal flexion/extension), and arm circles (standing, arms at shoulder level with scapular retraction and controlled rotations). Baseline care includes hot pack application to neck and shoulders for 15 minutes, and TENS in burst mode (200 µs pulse width, 100 Hz carrier, 2 Hz burst) for 10 minutes. Cervical isometric exercises are also included for strengthening and postural stability. Receives: Other: Group B (Egoscue Exercises) |
What is being measured
The primary outcome is the main question the study is designed to answer.
Neck Pain
The NPRS consists of an 11-point measurement scale with values ranging from 0, representing complete absence of pain, to 10, representing the most intense pain conceivable. It is a highly valid and reliable instrument for assessing pain intensity and permits precise patient-reported responses
Measured: Baseline and Week 8th
Craniovertebral Angle
The CVA represents an acute angle formed between a horizontal reference line passing through the spinous process of the seventh cervical vertebra and a line connecting the midpoint of the tragus of the ear to the spinous process of the seventh cervical vertebra. This tool is recognized as a valid instrument for quantifying the degree of forward head posture
Measured: Baseline and Week 8
Secondary outcomes (1)
Neck Disability Index
Originally developed in 1991, this instrument remains widely adopted for evaluating disability in individuals with neck pain. It comprises 10 items, each scored on a 6-point scale from 0 to 5, where 0 denotes no disability and 5 represents total disability. Item scores are aggregated to yield a total ranging from 0 to 50. Some investigators opt to multiply the total score by 2, thereby converting it to a percentage-based scale ranging from 0 to 100%
Measured: Baseline and Week 8
Timeline
From the start of the study to its completion; the mark is today. Estimated dates are the sponsor’s plan.
- First posted3 Jun 2026
- Study start20 May 2026 (estimated)
- Primary completion20 Sep 2026 (estimated)
- Study completion20 Sep 2026 (estimated)
Resources
- Official record on ClinicalTrials.govThe registry entry this page is built from, with its full change history.
- Publications (7)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
- Model description
- The study will follow a parallel randomized clinical trial (RCT) on subjects with forward head posture (FHP). Participants of both sexes will be included if CVA is 30°-45°, NDI shows moderate to severe disability, and NPRS indicates moderate to severe pain. Individuals with recent trauma, fractures, or orthotic use will be excluded. Written and verbal consent will be obtained. A total of 28 participants will be randomly allocated into two groups (n=14 each). Group A will receive Blackburn exercises, and Group B will receive Egoscue method exercises. Both groups will also receive TENS, hot pack therapy, and cervical isometrics as baseline care. The intervention will last 8 weeks (24 sessions, 3/week). Outcomes include pain (NPRS), CVA, and disability (NDI), assessed at baseline and post-intervention. Data will be analyzed using SPSS v23.
- Masking
- Single blind
- Who is masked
- Participant
- Enrolment
- 28 participants (estimated)
Sponsor and investigators
- Lead sponsor
- University of Faisalabad
- Sponsor type
- University, hospital or other
- Responsible party
- Principal investigator, Maryam Safdar, University of Faisalabad
- Investigators
- Dr Muhammad Ateeb, PhD Public Health, Study chair, The University of Faisalabad
IDs, dates and publications
- ClinicalTrials.gov ID
- NCT07622979
- Sponsor's protocol ID
- TUF/EIRB/178/26
- Status last verified
- Jun 2026
- First submitted
- 13 May 2026
- Last updated
- 3 Jun 2026
- Results posted
- No
- Data monitoring committee
- No
- FDA-regulated drug
- No
- FDA-regulated device
- No
- Individual data sharing
- No
Publications
Sheikhhoseini R, Shahrbanian S, Sayyadi P, O'Sullivan K. Effectiveness of Therapeutic Exercise on Forward Head Posture: A Systematic Review and Meta-analysis. J Manipulative Physiol Ther. 2018 Jul-Aug;41(6):530-539. doi: 10.1016/j.jmpt.2018.02.002. Epub 2018 Aug 11.
PubMed 30107937Sadeghi A, Rostami M, Ameri S, Karimi Moghaddam A, Karimi Moghaddam Z, Zeraatchi A. Effectiveness of isometric exercises on disability and pain of cervical spondylosis: a randomized controlled trial. BMC Sports Sci Med Rehabil. 2022 Jun 16;14(1):108. doi: 10.1186/s13102-022-00500-7.
PubMed 35710510Rodriguez-Fernandez AL, Garrido-Santofimia V, Gueita-Rodriguez J, Fernandez-de-Las-Penas C. Effects of burst-type transcutaneous electrical nerve stimulation on cervical range of motion and latent myofascial trigger point pain sensitivity. Arch Phys Med Rehabil. 2011 Sep;92(9):1353-8. doi: 10.1016/j.apmr.2011.04.010.
PubMed 21878204Nilmart P, Sichuai A, Chedang A, Goontharo C, Janjamsai N. Internet-Based Telerehabilitation Versus in-Person Therapeutic Exercises in Young Adult Females With Chronic Neck Pain and Forward Head Posture: Randomized Controlled Trial. JMIR Rehabil Assist Technol. 2025 Jul 25;12:e74979. doi: 10.2196/74979.
PubMed 40712139Mahmoud NF, Hassan KA, Abdelmajeed SF, Moustafa IM, Silva AG. The Relationship Between Forward Head Posture and Neck Pain: a Systematic Review and Meta-Analysis. Curr Rev Musculoskelet Med. 2019 Dec;12(4):562-577. doi: 10.1007/s12178-019-09594-y.
PubMed 31773477Kang JI, Choi HH, Jeong DK, Choi H, Moon YJ, Park JS. Effect of scapular stabilization exercise on neck alignment and muscle activity in patients with forward head posture. J Phys Ther Sci. 2018 Jun;30(6):804-808. doi: 10.1589/jpts.30.804. Epub 2018 Jun 12.
PubMed 29950768Cote R, Vietas C, Kolakowski M, Lombardo K, Prete J, Dashottar A. Inter and Intra-Rater Reliability of Measuring Photometric Craniovertebral Angle Using a Cloud-Based Video Communication Platform. Int J Telerehabil. 2021 Jun 22;13(1):e6346. doi: 10.5195/ijt.2021.6346. eCollection 2021.
PubMed 34345337