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.
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.
Study Type
INTERVENTIONAL
Allocation
RANDOMIZED
Purpose
TREATMENT
Masking
SINGLE
Enrollment
28
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.
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.
Anas Iqbal Physiotherapy and Rehabilitation Centre, Khadija tul Zahra Physiotherapy Centre
Faisalābad, Punjab Province, Pakistan
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
Time frame: 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
Time frame: Baseline and Week 8
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%
Time frame: Baseline and Week 8
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