Forward Head PostureNCT05642130
Effect of Muscle Energy Technique on Craniovertebral and Shoulder Angles in Forward Head Posture
A study testing exersice program (Muscle energy technique) and exersice program (stretching and strengthening exercises ) In addition to postural advices in people with Forward Head Posture, run by Cairo University at 1 site in Egypt.
Trial summary
The study will be determine how muscle energy strategy for the upper trapezius and sternocleidomastoid muscles affects the craniovertebral angle and shoulder angle. Read more about this study
- Who is it for?
- Ages 18 to 23 yearsHealthy volunteers can take part
- Conditions the study is for
- Forward Head Posture
- What is being tested?
- exersice program (Muscle energy technique) and exersice program (stretching and strengthening exercises ) In addition to postural advices
- Could I receive a placebo?
- Yes, some participants may receive a placebo
- How many people
- 60 participants
- Where
- 1 siteEgypt
- Study dates
- 22 Mar 2021to 8 Jan 2023
- Phase
- Interventional
- 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 to 23 years
- All sexes
- Healthy volunteers accepted
- Adult
Who may be able to join
- Both sex will be included with age ranged between (18-23) years old
- subject with CVA less than 50°
- subject with shoulder angle less than 52.28°.
- Subjects without neck or shoulder pain or recent shoulder fracture.
- Body mass index between (18-31) Kg/m2
- They will understand and follow instructions included in the test.
Who cannot join
- Neck pain
- Shoulder pain
- Recent shoulder fracture
- Athlete
- Cervical disc
- Radiculopathy
Show all 9Show fewer
- Subjects had symptoms of vertigo, dizziness.
- Subjects had visual or auditory problems.
- Subjects had an autoimmune disease or systemic disease
Trial locations and contacts
1 site in 1 country.
About this study
The study will be determine how muscle energy strategy for the upper trapezius and sternocleidomastoid muscles affects the craniovertebral angle and shoulder angle.
Read the detailed description
Participants in group (A) received PIR for upper trapezius and sternocleidomastoid muscles. the therapist moved the subject's head into the position that put each muscle in stretch, once resistance/ barrier was felt, that position was held and subjects were asked to isometrically contract the target muscle with 20% of maximal contraction for 5 sec against mild resistance from the therapist, relax for 5 sec followed by passive stretch until reaching a new barrier for 30 sec, 3 repetitions for each muscle, 3sessions /week over a period of 4 weeks . In addition to the program designed for control group.
The treatment protocol was designed based on the assumption that the targeted muscles are the most shortened muscles in FHP.
PIR for upper trapezius The patient sat on a stool in an erect position. The therapist stood behind the patient with one hand on the patient's ipsilateral shoulder for stabilization, while the other was on the side of the patient's head. The patient's head was moved to flexion, lateral bending to the opposite side and rotation to the same side of the stretched muscle. The ipsilateral hand pushed the shoulder inferiorly to lengthen the muscle until the restrictive barrier was met, then we asked the patients to raise the shoulder against the hand isometrically then gently stretch the muscle until meeting a new barrier.
PIR for upper trapezius PIR for Sternocleidomastoid The patient sat on a stool in an erect position. The therapist stood behind the patient with her forearm on the patient's ipsilateral shoulder for stabilization, while the hands surrounded the patient's head. The head moved into lateral flexion away from the side of the involvement, rotation to the side of involvement, extension of the lower cervical spine and flexion of upper cervical spine to meet the restrictive barrier. The patient was instructed to push forward against the therapist's hand isometrically, and then gently stretch the muscle until meeting a new barrier.
Group (B) Participants in group (B) received static stretching exercise for upper trapezius and sternocleidomastoid .
Repetitions: 3times/day, 3days/week over a period of 4 weeks, in addition to strengthening exercises of deep cervical flexors and scapular retractor muscles, 3sets of 12 repetitions with 6 sec hold. In addition to postural advices Strengthening of deep cervical flexor muscles Each participant was instructed to sit with his arms relaxed at the side. The area above the lip and under the nose was lightly touched and the patient was asked to tuck his head down and in. The correct movement of tucking the chin in and straightening the spine were verbally reinforced. From sitting position, the patient was asked to tuck chin so that ears were in line with the tip of shoulders.
Strengthening of the scapular retractor muscles The participant sat on a chair without back support. The movement of the medial border of the scapula was gently resisted and the subject pinch them together "retraction". The subject was asked to imagine "holding a quarter between both the shoulder blades". Instructing each subject not to extend the shoulders or elevate the scapulae. The participant then stranded with his hands grasped together behind the lower back (this activity cause scapular adduction). The patient is instructed to adduct scapula and to hold the adducted position with both arms lowered downwards.
Postural education
- Postural advice They were advised that they should not sleep on a foam rubber pillow; should use a chair with proper back support and an arm rest of an appropriate height to provide elbow support while working at a keyboard and computer; should avoid leaning forward toward the screen of a computer or on a desk while writing for a prolonged period; and should avoid prolonged conversation on a telephone while holding the receiver by tilting the neck. Furthermore, the participants were advised to relieve muscle tension after every 20-30 minutes of work by getting up; stretching the arm, shoulder, neck, and back muscles; and walking to turn off the buzzer and reset the timer. They should either avoid prolonged carrying of a bag on any one side of the shoulder or balance the hanging weight of the bag on both sides of the shoulder.
- Conditions
- Forward Head Posture
- Being tested
- exersice program (Muscle energy technique), exersice program (stretching and strengthening exercises ) In addition to postural advices
What participants receive
What participants receive. In a randomised study each person is assigned to one group by chance.
exersice program (Muscle energy technique)Other
Also called post isometricrelaxation for upper trapezius and sternocleidomastoid muscles
Post isometric relaxation for upper trapezius and sternocleidomastoid muscles. the therapist moved the subject's head into the position that put each muscle in stretch, once resistance/ barrier was felt, that position was held and subjects were asked to isometrically contract the target muscle with 20% of maximal contraction for 5 sec against mild resistance from the therapist, relax for 5 sec followed by passive stretch until reaching a new barrier for 30 sec, 3 repetitions for each muscle, 3sessions /week over a period of 4 weeks, In addition to the program designed for control group
exersice program (stretching and strengthening exercises ) In addition to postural advicesOther
Also called traditional tretment
static stretching exercise for upper trapezius and sternocleidomastoid . Repetitions: 3times/day, 3days/week over a period of 4 weeks, in addition to strengthening exercises of deep cervical flexors and scapular retractor muscles, 3sets of 12 repetitions with 6 sec hold. In addition to postural advices
| Study group | Role | What they receive |
|---|---|---|
| treatment group | Experimental | (30) thirty patients with forward head received PIR for upper trapezius and sternocleidomastoid muscles. the therapist moved the subject's head into the position that put each muscle in stretch, once resistance/ barrier was felt, that position was held and subjects were asked to isometrically contract the target muscle with 20% of maximal contraction for 5 sec against mild resistance from the therapist, relax for 5 sec followed by passive stretch until reaching a new barrier for 30 sec, 3 repetitions for each muscle, 3sessions /week over a period of 4 weeks In addition to the program designed for control group. Receives: Other: exersice program (Muscle energy technique); Other: exersice program (stretching and strengthening exercises ) In addition to postural advices |
| control group | Sham comparator | (30) thirty patients with forward head received static stretching exercise for upper trapezius and sternocleidomastoid .
Repetitions: 3times/day, 3days/week over a period of 4 weeks, in addition to strengthening exercises of deep cervical flexors and scapular retractor muscles 3sets of 12 repetitions with 6 sec hold. In addition to postural advices Receives: Other: exersice program (stretching and strengthening exercises ) In addition to postural advices |
What is being measured
The primary outcome is the main question the study is designed to answer.
craniovertebral angle
(CVA): It is the angle formed between a horizontal line through the spinous process of C7 and a line from the tragus of the ear It is a measure of forward head posture
Measured: one month
shoulder angle
(SA) : is formed at a line between the center of the humerus and spinous process of C7 and the horizontal line through the center of the humerus. It is a measure of rounded shoulder posture.
Measured: one month
Pressure Pain Threshold
the point at which a non-painful pressure stimulus turns into a painful pressure sensation Subjects' pressure pain thresholds (PPTs) were assessed using a Commander algometer
Measured: one month
Timeline
From the start of the study to its completion; the mark is today. Estimated dates are the sponsor’s plan.
- First posted8 Dec 2022
- Study start22 Mar 2021
- Primary completion3 Nov 2022
- Study completion8 Jan 2023
Resources
- Official record on ClinicalTrials.govThe registry entry this page is built from, with its full change history.
- Publications (5)Papers the sponsor has linked to this study.
- Other trials for Forward Head PostureStudies of the same condition, open and under way.
- More trials run by Cairo UniversityThe sponsor's other registered studies.
- 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
- randomized controlled trial
- Masking
- Single blind
- Who is masked
- Participant
- Enrolment
- 60 participants (actual)
Sponsor and investigators
- Lead sponsor
- Cairo University
- Sponsor type
- University, hospital or other
- Responsible party
- Principal investigator, Heba saeid Mohamed Ahmed Elfaky, Cairo University
- Investigators
- Heba Elfaki, MSc, Principal investigator, Assist. lecture faculty of physical therapy Cairo university
IDs, dates and publications
- ClinicalTrials.gov ID
- NCT05642130
- Sponsor's protocol ID
- P.T.REC/012/003845
- Status last verified
- Nov 2022
- First submitted
- 9 Nov 2022
- Last updated
- 31 Mar 2026
- Results posted
- No
- Data monitoring committee
- Yes
- FDA-regulated drug
- No
- FDA-regulated device
- No
Publications
Andersen LL, Kjaer M, Andersen CH, Hansen PB, Zebis MK, Hansen K, Sjogaard G. Muscle activation during selected strength exercises in women with chronic neck muscle pain. Phys Ther. 2008 Jun;88(6):703-11. doi: 10.2522/ptj.20070304. Epub 2008 Mar 13.
PubMed 18339796Diab AA, Moustafa IM. The efficacy of forward head correction on nerve root function and pain in cervical spondylotic radiculopathy: a randomized trial. Clin Rehabil. 2012 Apr;26(4):351-61. doi: 10.1177/0269215511419536. Epub 2011 Sep 21.
PubMed 21937526Farrar JT, Young JP Jr, LaMoreaux L, Werth JL, Poole MR. Clinical importance of changes in chronic pain intensity measured on an 11-point numerical pain rating scale. Pain. 2001 Nov;94(2):149-158. doi: 10.1016/S0304-3959(01)00349-9.
PubMed 11690728Falla D, Jull G, Russell T, Vicenzino B, Hodges P. Effect of neck exercise on sitting posture in patients with chronic neck pain. Phys Ther. 2007 Apr;87(4):408-17. doi: 10.2522/ptj.20060009. Epub 2007 Mar 6.
PubMed 17341512Grimmer-Somers K, Milanese S, Louw Q. Measurement of cervical posture in the sagittal plane. J Manipulative Physiol Ther. 2008 Sep;31(7):509-17. doi: 10.1016/j.jmpt.2008.08.005.
PubMed 18804001
Study at a glance
From the registry record, last updated by the sponsor on 31 Mar 2026. Recruitment status is as the sponsor reported it: confirm with the study team.
- Official title
- Effect of Muscle Energy Technique on Craniovertebral and Shoulder Angles in Forward Head Posture
- ClinicalTrials.gov ID
- NCT05642130
- Acronym / sponsor ID
- P.T.REC/012/003845
- Conditions
- Forward Head Posture
- Study type
- Interventional
- Recruitment status
- Completed
- Enrolment
- 60 participants (actual)
- Lead sponsor
- Cairo UniversityUniversity, hospital or other
- Study start
- 22 Mar 2021 (actual)
- Primary completion
- 3 Nov 2022 (actual)
- Study completion
- 8 Jan 2023 (actual)
- First posted
- 8 Dec 2022 (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.
The study will be determine how muscle energy strategy for the upper trapezius and sternocleidomastoid muscles affects the craniovertebral angle and shoulder angle.
Detailed description
Participants in group (A) received PIR for upper trapezius and sternocleidomastoid muscles. the therapist moved the subject's head into the position that put each muscle in stretch, once resistance/ barrier was felt, that position was held and subjects were asked to isometrically contract the target muscle with 20% of maximal contraction for 5 sec against mild resistance from the therapist, relax for 5 sec followed by passive stretch until reaching a new barrier for 30 sec, 3 repetitions for each muscle, 3sessions /week over a period of 4 weeks . In addition to the program designed for control group.
The treatment protocol was designed based on the assumption that the targeted muscles are the most shortened muscles in FHP.
PIR for upper trapezius The patient sat on a stool in an erect position. The therapist stood behind the patient with one hand on the patient's ipsilateral shoulder for stabilization, while the other was on the side of the patient's head. The patient's head was moved to flexion, lateral bending to the opposite side and rotation to the same side of the stretched muscle. The ipsilateral hand pushed the shoulder inferiorly to lengthen the muscle until the restrictive barrier was met, then we asked the patients to raise the shoulder against the hand isometrically then gently stretch the muscle until meeting a new barrier.
PIR for upper trapezius PIR for Sternocleidomastoid The patient sat on a stool in an erect position. The therapist stood behind the patient with her forearm on the patient's ipsilateral shoulder for stabilization, while the hands surrounded the patient's head. The head moved into lateral flexion away from the side of the involvement, rotation to the side of involvement, extension of the lower cervical spine and flexion of upper cervical spine to meet the restrictive barrier. The patient was instructed to push forward against the therapist's hand isometrically, and then gently stretch the muscle until meeting a new barrier.
Group (B) Participants in group (B) received static stretching exercise for upper trapezius and sternocleidomastoid .
Repetitions: 3times/day, 3days/week over a period of 4 weeks, in addition to strengthening exercises of deep cervical flexors and scapular retractor muscles, 3sets of 12 repetitions with 6 sec hold. In addition to postural advices Strengthening of deep cervical flexor muscles Each participant was instructed to sit with his arms relaxed at the side. The area above the lip and under the nose was lightly touched and the patient was asked to tuck his head down and in. The correct movement of tucking the chin in and straightening the spine were verbally reinforced. From sitting position, the patient was asked to tuck chin so that ears were in line with the tip of shoulders.
Strengthening of the scapular retractor muscles The participant sat on a chair without back support. The movement of the medial border of the scapula was gently resisted and the subject pinch them together "retraction". The subject was asked to imagine "holding a quarter between both the shoulder blades". Instructing each subject not to extend the shoulders or elevate the scapulae. The participant then stranded with his hands grasped together behind the lower back (this activity cause scapular adduction). The patient is instructed to adduct scapula and to hold the adducted position with both arms lowered downwards.
Postural education
- Postural advice They were advised that they should not sleep on a foam rubber pillow; should use a chair with proper back support and an arm rest of an appropriate height to provide elbow support while working at a keyboard and computer; should avoid leaning forward toward the screen of a computer or on a desk while writing for a prolonged period; and should avoid prolonged conversation on a telephone while holding the receiver by tilting the neck. Furthermore, the participants were advised to relieve muscle tension after every 20-30 minutes of work by getting up; stretching the arm, shoulder, neck, and back muscles; and walking to turn off the buzzer and reset the timer. They should either avoid prolonged carrying of a bag on any one side of the shoulder or balance the hanging weight of the bag on both sides of the shoulder.
Study design
- Primary purpose
- Treatment
- Allocation
- Randomised
- Intervention model
- Parallel groups
- Masking
- Single blind (participant)
- Number of arms
- 2
- Model description
- randomized controlled trial
| Arm | Type | Receives |
|---|---|---|
| treatment group | Experimental | Other: exersice program (Muscle energy technique), Other: exersice program (stretching and strengthening exercises ) In addition to postural advices(30) thirty patients with forward head received PIR for upper trapezius and sternocleidomastoid muscles. the therapist moved the subject's head into the position that put each muscle in stretch, once resistance/ barrier was felt, that position was held and subjects were asked to isometrically contract the target muscle with 20% of maximal contraction for 5 sec against mild resistance from the therapist, relax for 5 sec followed by passive stretch until reaching a new barrier for 30 sec, 3 repetitions for each muscle, 3sessions /week over a period of 4 weeks In addition to the program designed for control group. |
| control group | Sham comparator | Other: exersice program (stretching and strengthening exercises ) In addition to postural advices(30) thirty patients with forward head received static stretching exercise for upper trapezius and sternocleidomastoid . Repetitions: 3times/day, 3days/week over a period of 4 weeks, in addition to strengthening exercises of deep cervical flexors and scapular retractor muscles 3sets of 12 repetitions with 6 sec hold. In addition to postural advices |
Who may qualify
- Ages
- 18 to 23 years
- Sex
- All
- Healthy volunteers
- Accepted
- Age groups
- Adult
Key inclusion criteria (6 listed)
- Both sex will be included with age ranged between (18-23) years old
- subject with CVA less than 50°
- subject with shoulder angle less than 52.28°.
- Subjects without neck or shoulder pain or recent shoulder fracture.
- Body mass index between (18-31) Kg/m2
Key exclusion criteria (9 listed)
- Neck pain
- Shoulder pain
- Recent shoulder fracture
- Athlete
- Cervical disc
Eligibility is decided by the study team after screening; this overview does not establish that a patient qualifies. Full inclusion and exclusion criteria.
Interventions
| Intervention | Type | Arms |
|---|---|---|
| exersice program (Muscle energy technique)Also: post isometricrelaxation for upper trapezius and sternocleidomastoid musclesPost isometric relaxation for upper trapezius and sternocleidomastoid muscles. the therapist moved the subject's head into the position that put each muscle in stretch, once resistance/ barrier was felt, that position was held and subjects were asked to isometrically contract the target muscle with 20% of maximal contraction for 5 sec against mild resistance from the therapist, relax for 5 sec followed by passive stretch until reaching a new barrier for 30 sec, 3 repetitions for each muscle, 3sessions /week over a period of 4 weeks, In addition to the program designed for control group | Other | treatment group |
| exersice program (stretching and strengthening exercises ) In addition to postural advicesAlso: traditional tretmentstatic stretching exercise for upper trapezius and sternocleidomastoid . Repetitions: 3times/day, 3days/week over a period of 4 weeks, in addition to strengthening exercises of deep cervical flexors and scapular retractor muscles, 3sets of 12 repetitions with 6 sec hold. In addition to postural advices | Other | control group, treatment group |
Primary outcome
craniovertebral angle
Time frame: one month
(CVA): It is the angle formed between a horizontal line through the spinous process of C7 and a line from the tragus of the ear It is a measure of forward head posture
shoulder angle
Time frame: one month
(SA) : is formed at a line between the center of the humerus and spinous process of C7 and the horizontal line through the center of the humerus. It is a measure of rounded shoulder posture.
Pressure Pain Threshold
Time frame: one month
the point at which a non-painful pressure stimulus turns into a painful pressure sensation Subjects' pressure pain thresholds (PPTs) were assessed using a Commander algometer
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 31 Mar 2026.
- Background: PubMed 18339796Andersen LL, Kjaer M, Andersen CH, Hansen PB, Zebis MK, Hansen K, Sjogaard G. Muscle activation during selected strength exercises in women with chronic neck muscle pain. Phys Ther. 2008 Jun;88(6):703-11. doi: 10.2522/ptj.20070304. Epub 2008 Mar 13.
- Background: PubMed 21937526Diab AA, Moustafa IM. The efficacy of forward head correction on nerve root function and pain in cervical spondylotic radiculopathy: a randomized trial. Clin Rehabil. 2012 Apr;26(4):351-61. doi: 10.1177/0269215511419536. Epub 2011 Sep 21.
- Background: PubMed 11690728Farrar JT, Young JP Jr, LaMoreaux L, Werth JL, Poole MR. Clinical importance of changes in chronic pain intensity measured on an 11-point numerical pain rating scale. Pain. 2001 Nov;94(2):149-158. doi: 10.1016/S0304-3959(01)00349-9.
- Background: PubMed 17341512Falla D, Jull G, Russell T, Vicenzino B, Hodges P. Effect of neck exercise on sitting posture in patients with chronic neck pain. Phys Ther. 2007 Apr;87(4):408-17. doi: 10.2522/ptj.20060009. Epub 2007 Mar 6.
- Background: PubMed 18804001Grimmer-Somers K, Milanese S, Louw Q. Measurement of cervical posture in the sagittal plane. J Manipulative Physiol Ther. 2008 Sep;31(7):509-17. doi: 10.1016/j.jmpt.2008.08.005.
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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.
Heba Elfaki, MSc principal investigator
Assist. lecture faculty of physical therapy Cairo university
1 site in 1 country: see every site and its status.
Questions about this trial
What is this clinical trial studying?
A study testing exersice program (Muscle energy technique) and exersice program (stretching and strengthening exercises ) In addition to postural advices in people with Forward Head Posture, run by Cairo University at 1 site in Egypt.
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 6 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 31 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 Egypt. 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. Some participants in this study may receive a placebo. 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?
craniovertebral angle (time frame: one month). The study lists 3 primary outcomes in all. It is what the study was designed to measure, not a finding.
Where can I read the original study information?
On the ClinicalTrials.gov record for NCT05642130, which also lists 5 linked publications.
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 31 Mar 2026.