Clinical Research Directory

Correlation Between Forward Head Posture and Executive Functions in Cervical Radiculopathy

PURPOSE: This study aims to: * Investigate the relationship between Forward Head Posture (FHP), Pain Intensity and executive functions in patients with Cervical Radiculopathy (CR). * Investigate whether the severity of Forward Head Posture (FHP) is correlated with the degree of executive dysfunction in this population. BACKGROUND: Forward head posture (FHP) is a condition characterized by anterior translation of the head, resulting in sagittal plane misalignment of the cervical spine. It has become increasingly common in the digital era due to prolonged screen use and sedentary lifestyles. Previous studies have reported that this altered posture and the associated mechanical load on the cervical spine may be correlated with deficits in executive functions, including attention, processing speed, and working memory in older adults. Executive function refers to higher-order cognitive processes responsible for goal-directed behaviour, such as maintaining and manipulating information in short-term memory and selecting task-relevant information. The prefrontal cortex (PFC) plays a central role in regulating these functions through its extensive neuroanatomical connections with multiple cortical and subcortical brain regions, allowing it to participate in several neural networks involved in cognitive control. Recent evidence suggests that cognitive dysfunction may arise not only from localized lesions within these networks but also from degenerative or functional alterations affecting their integrity. HYPOTHESES: * There will be no significant association between Forward Head Posture (FHP), Pain Intensity and executive functions in patients with Cervical Radiculopathy. * There will be no significant correlation between the severity of Forward Head Posture and the degree of executive dysfunction in this population. RESEARCH QUESTION: Is there an association between Forward Head Posture (FHP), Pain intensity and executive dysfunction in patients with Cervical Radiculopathy (CR)?

Digital Use, 24-Hour Movement Behaviors, and Myofascial Release in University Students With Neck Pain

This study will examine how smartphone use recorded by the phone and daily sleep, sitting, and physical activity are related to neck posture, sensitivity to pressure, and body awareness in university students aged 18 to 30 years. One hundred students will complete seven days of smartphone and activity monitoring and clinical assessments. Among these students, 56 who have nonspecific neck pain for at least three months, average pain of at least 3 out of 10, and forward head posture will be randomly assigned to integrated myofascial release or a light-touch control. Both groups will receive six sessions over two weeks. An assessor who does not know the assigned group will measure outcomes before and after treatment and, where feasible, one month after treatment. The study will investigate whether myofascial release improves neck pain, pressure pain threshold, posture, movement, disability, and awareness.

Relationship of Forward Head Posture With Burnout and Quality of Life

The goal of this observational study is to investigate the relationship of forward head posture with burnout and quality of life in patients with mechanical neck pain. The main questions the study aims to answer are: Is there a significant correlation between the severity of forward head posture (measured by Kinovea software) and psychological burnout (evaluated by the Maslach Burnout Inventory, MBI)? How do different degrees of forward head posture impact pain intensity, pressure pain threshold, cervical proprioception, and cognitive function (assessed via MoCA and the CogniFit application)? comparison groups: Researchers will compare Group 1 (patients with a forward head posture angle from 40 to 45 degrees) to Group 2 (patients with a forward head posture angle from 45 to 50 degrees) to see if varying degrees of forward head posture lead to different levels of physical, cognitive, and psychological impairments. Participants will: Undergo posture assessment using Kinovea software to determine their forward head posture angle and be allocated into their respective study groups. pain intensity and pressure pain threshold measured using the Visual Analogue Scale (VAS) and pressure algometry. Perform a cervical proprioception test using a pointer laser device. Complete cognitive evaluations using the Montreal Cognitive Assessment (MoCA) and the CogniFit digital application. Fill out standardized questionnaire, the Maslach Burnout Inventory (MBI) ,to assess burnout .

Comparative Effects of Pressure and Visual Biofeedback Training on Pain, Disability, Range of Motion Among Patients With Forward Head Posture Correction: A Randomized Controlled Trial

The study will take place at Akbar Niazi Teaching Hospital and AL kauther International hospital, Bhara Kahu, Islamabad with formal permission obtained from the institution. Patients with forward head posture, who meet the inclusion criteria, will be selected and asked for consent. Participants will be randomly assigned to either a pressure bio feedback training group or a visual biofeedback training group using a computer randomizer. Before starting the training, baseline measurements of neck muscle activation and posture will be recorded. Group1will receive pressure bio feedback training using a cuff, while Group 2 will use visual feedback through a mirror or screen to correct posture. An 6 weeks intervention will be implemented, with treatments administered three times per week. Outcome measures will be assessed at baseline and again at the conclusion of the 6 weeks intervention period. The results will be analyzed using the latest version of SPSS (Statistical Package for the Social Sciences).

Effects of a Wearable Device ,Phone App and Exercise on Cervico-thoracic Posture in University Students.

Forward head posture and thoracic kyphosis are among the most common postural problems in university students, driven largely by long hours of screen use and poor sitting habits. Research suggests that nearly two-thirds of university students show measurable forward head posture, and if uncorrected, it is linked to chronic neck pain and long-term musculoskeletal strain. This study compares three approaches to correcting posture over a six-week supervised exercise program: a wearable sensor belt that vibrates in real time when posture slips, a smartphone app that sends scheduled reminders throughout the day, and exercise alone with no reminders. The two technology-assisted groups are prompted to correct their posture throughout daily activities, not just during exercise sessions. The study will show whether real-time or scheduled reminders produce greater improvements in posture, neck pain, and neck function than exercise alone . Helping physical therapists and university health services to identify the most practical strategy for correcting posture in screen-heavy academic environments.

Biofeedback Exercises Versus Mulligan Concept on Pain, Mobility, and Posture in Females With Mechanical Neck Pain

This study compares two physical therapy treatment approaches for females suffering from mechanical neck pain - pain in the neck that comes from the muscles, joints, or soft tissues rather than from nerve damage or disease. Mechanical neck pain is very common and can cause significant pain, stiffness, difficulty moving the head, and problems with daily activities. Fifty adult females aged 18 to 45 years with mechanical neck pain lasting more than 4 weeks will be randomly divided into two equal groups. Group M (25 participants) will receive upper cervical spine manual therapy using the Mulligan mobilization technique, which involves gentle joint movements to restore normal neck joint motion, combined with standard cervical exercises. Group B (25 participants) will receive the same Group M treatment plus biofeedback-guided deep cervical flexor training. This additional exercise uses a pressure sensor placed behind the neck to help the patient learn to activate the deep stabilizing muscles of the neck, which are often weakened in people with neck pain. Both groups will attend 3 treatment sessions per week for 4 consecutive weeks (12 sessions total). Each session lasts approximately 45 minutes. Before each session, all participants receive suboccipital release, myofascial release, and stretching exercises as preparation. The researchers will measure pain intensity, upper cervical flexion range of motion, the flexion-rotation test (which assesses upper neck rotation), the Neck Disability Index (which measures how neck pain affects daily activities), and pressure pain threshold (which measures sensitivity to pressure over neck muscles). All measurements are taken before treatment begins and after the 4-week intervention period. The study aims to determine whether adding biofeedback-guided deep cervical flexor training to the Mulligan manual therapy approach produces greater improvements in pain, neck mobility, disability, and muscle sensitivity compared to the Mulligan approach alone.

Effects of Nordic Pole Walking in Adults With Forward Head Posture

This randomized controlled trial aims to investigate the effects of Nordic pole walking on pain, neck-related disability, pulmonary function, respiratory muscle strength, and postural alignment in adults with forward head posture and neck pain. Participants will be randomly assigned to either a Nordic pole walking group or a general walking group. Both groups will participate in a 6-week walking program, three times per week, with each session lasting 40 minutes. Neck-related disability and pain will be assessed using the Neck Disability Index (NDI) and Visual Analog Scale (VAS). Pulmonary function will be assessed using forced vital capacity (FVC), forced expiratory volume in one second (FEV1), and the FEV1/FVC ratio. Respiratory muscle strength will be evaluated using maximal inspiratory pressure (MIP) and maximal expiratory pressure (MEP), and postural alignment will be assessed using the craniovertebral angle (CVA). Measurements will be performed before and after the 6-week intervention.

Virtual Reality Versus Traditional Exercise on EMG Activity in Postural Malalignment

This study aims to investigate the immediate effects of virtual reality (VR)-based exercise compared with traditional Active free exercise on trapezius muscle activation in adults with and without postural malalignment. Surface electromyography (EMG) will be used to assess upper, middle, and lower trapezius muscle activity during relaxed and corrected postures and during VR and traditional exercise. Demographic data will be collected. The study will also assess posture, trapezius muscle strength, cervical range of motion, Activity level, craniovertebral angle, and neck proprioception. Approximately 40 adults aged 18-35 years will participate in a single study session. The findings may help determine whether VR-based rehabilitation provides an effective and engaging approach for assessing and training postural control and trapezius muscle activation.

Comparison Between Kaltenborn and Mulligan Mobilization in Forward Head Posture

This randomized controlled trial will compare the effectiveness of Kaltenborn mobilization and Mulligan mobilization in individuals with Forward Head Posture. The study will compare their effects in neck pain, craniovertebral angle, cervical range of motion, cervical proprioception, and deep neck flexor endurance after a two-week treatment program.

Comparison of Deep Neck Flexor Strengthening and Motor Learning-Based Neuroplasticity Training for Forward Head Posture

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.

Comparison of Proprioceptive Neuromuscular Facilitation and Patient Education in Upper Crossed Syndrome

The aim of this study is to investigate the effects of exercises applied using the Proprioceptive Neuromuscular Facilitation (PNF) technique on pain, joint range of motion, muscle strength, and posture in individuals with Upper Crossed Syndrome, and to compare these effects with patient education. Individuals diagnosed with Upper Crossed Syndrome will be included in the study and allocated into two groups: a PNF-based exercise combined with patient education group and a patient education-only group. In the PNF group, Stabilizing Reversals for scapular anterior elevation-posterior depression and Replication techniques for posterior depression will be applied. In the patient education group, education including postural awareness and exercise will be provided. Assessments will be conducted at two time points, before and after the intervention. Pain level, joint range of motion, muscle strength and endurance, and postural parameters will be analyzed. This study is expected to provide evidence regarding the clinical effectiveness of PNF approaches targeting scapular control in individuals with Upper Crossed Syndrome and to contribute to the management of postural disorders in the field of physiotherapy and rehabilitation.

Effect of Kinesio Taping Combined With Postural Correction on Improving Tension-Type Headache Among University Students

This study aims to evaluate the effectiveness of combining Kinesio Taping (KT) with postural correction exercises and suboccipital muscle inhibition (SMI) in managing tension-type headaches (TTH) among university students. The intervention's impact on headache intensity, frequency, and functional limitations will be compared with a control group performing postural correction and SMI alone.

Postural Rehabilitation for Visual Dysfunction in Forward Head Posture

This assessor-blinded randomized controlled trial aims to compare the effects of motor control training, sensor-based biofeedback training using a wearable inertial measurement unit, and standardized postural correction exercises on mild visual dysfunction in university students with forward head posture. The trial seeks to establish whether targeted postural rehabilitation can produce measurable improvements in validated visual and sensorimotor outcomes.

Electromyographic Effects of Postural Correction Exercises in Individuals With Forward Head Posture

This study investigates the effects of specific corrective exercises on EMG of masticatory and cervical muscles in individuals with forward head posture. The study's design will be a retrospective, double- blinded, randomized controlled trial. The participants will be randomly allocated to one of two groups: the exercise group and the control group. The training groups will perform a program consisting of two strengthening (deep cervical flexors and shoulder retractors) and two stretchings (cervical extensors and pectoral muscles) exercises. This exercise program will be repeated 4 times per week for 10 weeks, and each session lasted 30 minutes. The pre/post assessment of forward head posture will measure by using craniovertebral angle CVA. While the muscle activity EMG of the masseter, temporalis, splenius, upper trapezius, and SCM will measure pre and post-assessment using a biopic data acquisition system.

Comparative Effects of Stabilization Exercises and Corrective Exercises in Administrative Staff With Upper Cross Syndrome

This study compares two types of rehabilitation strategies' - the stabilization exercises and the corrective exercises - to improve pain, respiratory function, and postural alignment in administrative staff with upper cross syndrome. Participants undertook a six-week intervention program. Random sampling technique was employed and 50 participants were included out of which 4 participants drops out. Randmoization was done via computer generator.The participants were divided into two groups: group A (Stabilization Exercises) and group B (Corrective Exercises). The process of data collection was conducted at MTH, and united hospital and participants will have included according to inclusion criteria. Pain was assessed by using the numeric pain rating. Respiratory function was assessed by using a digital spirometer. Postural alignment i.e., CVA \& SHA was assessed by using kinovea-2D video analysis. Mid thoracic curve was assessed by using Flexi curve rule.This study aims to determine which treatment produces greater improvement, which may help physiotherapists to give more effective evidence based treatment patients with UCS in Pakistan.

Effects of Electrotherapy on Muscle Properties in Forward Head Posture

This randomized controlled trial investigates the acute effects of three electrotherapy modalities (therapeutic ultrasound, interferential current, and TENS) on the mechanical and viscoelastic properties of neck muscles in young adults with forward head posture. Seventy-five participants will be randomly allocated to one of three groups. Muscle stiffness, oscillation frequency, and craniovertebral angle will be assessed before and immediately after a single treatment session.

Comparison Between Dynamic Neuromuscular Stabilization Breathing and Manual Therapy on Forward Head Posture in University Students

Forward Head Posture (FHP) is a common postural dysfunction characterized by the anterior displacement of the head relative to the shoulders, leading to cervical spine misalignment, increased muscle strain, and neck pain. It is highly prevalent in university students (63-66%), largely due to prolonged sedentary behaviors and the use of smartphones, laptops, and tablets in poor ergonomic postures . This randomized controlled trial aims to evaluate the effectiveness of three intervention strategies for managing FHP in university students: Dynamic Neuromuscular Stabilization (DNS) Breathing + Conventional Exercises: DNS breathing will emphasize diaphragmatic activation and postural stabilization, combined with stretching, strengthening, and postural education. Myofascial Release (MFR) + Conventional Exercises: Suboccipital MFR to release fascial tension, combined with the same conventional exercise program. Conventional Exercises Alone (Control Group): A standard rehabilitation protocol of stretching, strengthening, and postural correction. All interventions will be delivered three times per week for six weeks, with each session lasting 45 minutes. Assessments will be conducted at baseline, week 4, and week 6: Craniovertebral Angle (CVA) and Forward Shoulder Angle (FSA) measured using smartphone photographic analysis. Wall Test to assess forward head and rounded shoulder posture. Visual Analog Scale (VAS) to measure subjective pain intensity. SF-36 Health Survey to evaluate quality of life across eight health domains. The study will compare the relative effectiveness of DNS breathing and MFR, each combined with conventional therapy, against conventional therapy alone. Findings are expected to contribute to evidence-based postural rehabilitation, particularly for young adults with sedentary lifestyles.

Comparative Effects of SNAG Vis GONG's Mobilization in Text Neck Syndrome Patients

Text neck syndrome is a common musculoskeletal disorder caused by prolonged smartphone and computer use, resulting in neck pain, forward head posture, and functional disability. Manual therapy techniques, including Sustained Natural Apophyseal Glides (SNAG) and GONG's Mobilization, are frequently used to manage cervical dysfunction. This quasi-experimental pretest-posttest comparative study aimed to compare the effectiveness of SNAG and GONG's Mobilization on pain intensity, craniovertebral angle, and neck disability in individuals with text neck syndrome. Participants divided into 2 groups (Treatment group A and B) were undergo baseline and post-intervention assessments followed a 12-week treatment program

The Effects of Stabilization Exercises and Taping on Cervical Muscle Strength, Endurance, and Function in Women With Forward Head Posture.

This study was conducted to investigate the effects of taping application on cervical muscle strength, endurance, and function in women with forward head posture. A total of 42 women with forward head posture participated in the study. Participants in Exercise group received cervical and scapular stabilization exercises (n = 21), while participants in Taping group received cervical taping in addition to the exercise program (n = 21).The participants' demographic characteristics, the horizontal distance between the earlobe and the acromion process, Neck Disability Index scores, craniovertebral angle measurements, activation and endurance of the deep neck flexor muscles, and endurance of the cervical extensor muscles were evaluated. All assessments were performed at baseline and were repeated after 6 weeks.

An Investigation of the Effect of Smartphone Usage Levels on Cervical Posture, Tongue Pressure, Balance, and Neck Disability in Individuals With Rheumatoid Arthritis and Ankylosing Spondylitis

The purpose of this cross-sectional and comparative study is to investigate the impact of smartphone addiction on the cervical posture, musculoskeletal system, balance, and tongue pressure in individuals diagnosed with Rheumatoid Arthritis (RA) and Ankylosing Spondylitis (AS), and to compare these findings with a healthy control group. Smartphone addiction has become a major contributing factor to postural alterations such as Text Neck Syndrome. This study aims to evaluate and compare the Craniovertebral Angle (CVA), neck extensor muscle strength, Pressure Pain Thresholds (PPT) of the neck and shoulder, Single-Leg Stance (SLS) static balance, and tongue pressure among three distinct groups. A healthy control group will be included as a reference baseline to differentiate the postural and functional deterioration caused by rheumatological diseases from the additional mechanical load imposed by smartphone dependency. To eliminate the misleading effects of acute pain, joint swelling, and severe functional limitations during flare-ups, only patients with stable disease activity (DAS28 \< 3.2 for RA and BASDAI \< 4 for AS) will be enrolled. This approach aims to examine the pure biomechanical relationship between technological dependency and cervical functions, independent of active systemic inflammation.

Relationship Between Forward Head Posture and Sagittal Lumbopelvic Alignment Among Smartphone Users

Forward head posture is a common postural abnormality characterized by anterior positioning of the head in the sagittal plane. This posture may increase biomechanical stress on the cervical spine and may be associated with compensatory changes in spinal and lumbopelvic alignment. This observational study will investigate the relationship between forward head posture and sagittal lumbopelvic alignment among male smartphone users aged 18 to 35 years. Craniovertebral angle will be measured using the APECS mobile application, and sagittal lumbopelvic alignment parameters will be measured using the Spine3D LiDAR system.

Comparative Effects of Blackburn and Egoscue Exercises to Improve CVA 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.

Acute Effects of Instrument-Assisted Soft Tissue Mobilization Added to Postural Corrective Exercises in Young Adults With Forward Head Posture

This study investigated the acute effects of instrument-assisted soft tissue mobilization added to postural corrective exercises in young adults with forward head posture. Participants were randomly allocated to one of three groups: instrument-assisted soft tissue mobilization plus postural corrective exercises, postural corrective exercises only, or control. The primary outcome was craniovertebral angle. Secondary outcomes included cervical joint repositioning error, deep cervical flexor muscle endurance, and scapular muscle endurance. All outcomes were assessed at baseline and 1 hour after the intervention by a blinded outcome assessor.

Effect of Adding Thoracolumbar Fascia Release by IASTM to Conventional Treatment on Craniovertebral Angle in Forward Head Subjects

The Posture Committee of the American Academy of Orthopedic Surgery defines good posture as "that state of muscular and skeletal balance that protects the supporting structures of the body against injury or progressive deformity irrespective of the attitude (erect, lying, squatting, and stooping) in which these structures are working or resting." Under those conditions, the muscles will function most efficiently, and the Thoracic and abdominal organs will be in their optimal places.