Forward Head PostureNCT06699888
Effect of Cervicothoracic Junction Manipulation on Craniovertebral Angle and Proprioception in Forward Head Posture
A study testing cervicothoracic manipulation group and forward head correction exercises traditional group in people with Forward Head Posture, run by Riphah International University at 1 site in Pakistan.
Trial summary
The aim of this research is to find out the effect of Cervicothoracic Junction Manipulation on neck Proprioception in individuals with Forward Head Posture. A Randomized controlled trials done at Barki Advance Physiotherapy Center. The sample size was 36. Read more about this study
- Who is it for?
- Ages 18 to 45 years
- Conditions the study is for
- Forward Head Posture
- What is being tested?
- cervicothoracic manipulation group and forward head correction exercises traditional group
- Could I receive a placebo?
- No, everyone receives an active treatment
- How many people
- 36 participants
- Where
- 1 sitePakistan
- Study dates
- 1 Jun 2024to 16 Apr 2025
- 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 45 years
- All sexes
- No healthy volunteers
- Adult
Who may be able to join
- Both male and female patients with age between 18-45 years
- Participants with asymptomatic Forward head posture
- Participants having no active complain of neck pain and muscle stiffness
- Joint position error, an average of >4.5◦ error in rotation or extension directions
- For FHP patient, the Craniovertebral angle should be ≤ 53º
Who cannot join
- Previous history of neck and head trauma
- Vestibular pathologies i.e. vertigo, dizziness
- Musculoskeletal or neurological conditions that could affect Proprioception, cognitive impairment
- History of spinal and thoracic surgeries
Trial locations and contacts
1 site in 1 country.
About this study
The aim of this research is to find out the effect of Cervicothoracic Junction Manipulation on neck Proprioception in individuals with Forward Head Posture. A Randomized controlled trials done at Barki Advance Physiotherapy Center. The sample size was 36. The subjects were divided in two groups, 18 subjects in control group and 16 in experimental (Cervicothoracic Manipulation) group. Study duration is of 6 months after the ethical approval. Sampling technique applied was non probability connivance sampling technique. Only 18-45 years individuals with forward head posture, craniovertebral angle less than 53° degrees and Joint position error, an average of >4.5◦ error in rotation or extension direction were included. Tools used in the study are Craniovertebral Angle (CVA) and Joint Position Error Test (JPE).
Read the detailed description
FHP is greatly linked with multiple musculoskeletal conditions like head and neck dysfunction, myofascial trigger points, temporomandibular dysfunction, poor cervical mobility and functional disability of the cervical and thoracic spines. It also observed in asymptomatic individuals. Muscle spindles, especially in cervical detect muscle length changes and contribute to proprioception. Changes in neck muscles can disrupt proprioceptive function in the cervical spine. Proprioception is vital for joint function, providing stability during activities and informing posture and movement. Decreased balance and positioning errors are common in individuals with neck discomfort, emphasizing the importance of restoring proprioceptive function, particularly in Forward Head Posture (FHP) patients, for maintaining normal neck posture. Abnormalities in the head posture are absolutely harmful for the Head and neck posture. A study investigated the CV angle and joint position error in the cervical region and found a negative correlation between head posture and proprioceptive function, indicating that chronic abnormal head posture (FHP) negatively affects proprioception, body stability, and neck pain. Spinal manipulation uses high velocity and low amplitude thrusts to realign restricted vertebrae, removing restriction in facet joints, and producing mechanical, physiological, and biological effects.
Literature suggest that manipulation has beneficial effects in improving the pain and postural control in spine. The cervicothoracic (CT) junction is the transitional segment between the mobile lordotic cervical and less mobile kyphotic thoracic spines and hence a potential region for stiffness. The cervicothoracic junction, a potential stiffness region, can cause neck, headache, and upper limb pain. Improving its range of motion could reduce the need for compensatory movement, reducing cervical spine tension. According to recent systematic review, cervicothoracic junction level manual therapy in subjects with FHP better improved the muscle recruitment ability than upper-cervical level manual therapy during motor tasks. Upper thoracic spine manipulation has been shown to be more beneficial than thoracic mobilization, cervical mobilization, and standard care for FHP during performing motor task. In 2023 study conducted by Ibrahim et al. find out that FHP influenced Somatosensory Evoked Potentials and Somatosensory Processing in asymptomatic young adults and they reported 1-degree increase in the CVA measurement (indicating better posture) significantly decreased the amplitudes of all the potentials and resulted in a faster, more efficient nerve conduction time
- Conditions
- Forward Head Posture
- Being tested
- cervicothoracic manipulation group, forward head correction exercises traditional group
- Keywords
- Cervicothoracic Manipulation, Craniovertebral Angle, Joint position Error, Proprioception
What participants receive
What participants receive. In a randomised study each person is assigned to one group by chance.
cervicothoracic manipulation groupOther
The participant lay prone with the head firmly into the head piece Palpation of the upper cervico-thoracic segment observed the side of the restriction.
The participants head was rotated to the contralateral side of the restriction. The practitioner's hand contacted the forehead and the other hand's thumb contacted the spinous process of the restricted side.
A low amplitude, high velocity thrust towards the axilla was applied, on the spinous process in PA direction.
Experimental group also received following exercises Chin tuck Strengthening Shoulder Retractors. Stretching SCM Pectoralis Stretch 3 × 10 repetitions, 3 times a week for 2 weeks
forward head correction exercises traditional groupOther
Chin tuck Strengthening Shoulder Retractors. Stretching SCM Pectoralis Stretch 3 × 10 repetitions, 3 times a week for 2 weeks.
| Study group | Role | What they receive |
|---|---|---|
| Cervicothoracic Manipulation group | Experimental | the subject will receive cervicothoracic manipulation and Chin tuck, Strengthening Shoulder Retractors, Stretching SCM, Pectoralis Stretch Receives: Other: cervicothoracic manipulation group |
| forward head correction exercises group | Active comparator | this group receive Chin tuck, Strengthening Shoulder Retractors, Stretching SCM, Pectoralis Stretch Receives: Other: forward head correction exercises traditional group |
What is being measured
The primary outcome is the main question the study is designed to answer.
Craniovertebral Angle
The CV angle was measured for assessment of head posture. All subjects were instructed to stand in a self-selected comfortable upright posture. Then, the skin overlying the spinous process of the seventh cervical vertebra (C7) and tragus of the ear was marked. A lateral view digital photograph of each subject was taken. The CV angle was calculated based on the angle between a horizontal line passing through C7 and a line extending from the tragus of the ear to C7. The x-axis values for the craniovertebral angle were measured prior to movement.
Measured: baseline to 2 weeks
Joint Position Error Test
Proprioceptive accuracy, pertaining to the sense of joint and body movement and position, was evaluated using the Joint Position Error (JPE) Test. The Cervical JPE Test measures the ability of a blindfolded patient to accurately relocate their head position back to a predetermined neutral point after cervical joint movement
Measured: baseline to 2 weeks
Timeline
From the start of the study to its completion; the mark is today. Estimated dates are the sponsor’s plan.
- First posted21 Nov 2024
- Study start1 Jun 2024
- Primary completion25 Feb 2025
- Study completion16 Apr 2025
Resources
- Official record on ClinicalTrials.govThe registry entry this page is built from, with its full change history.
- Other trials for Forward Head PostureStudies of the same condition, open and under way.
- More trials run by Riphah International 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
- Masking
- Double blind
- Who is masked
- Participant, Outcomes assessor
- Enrolment
- 36 participants (actual)
Sponsor and investigators
- Lead sponsor
- Riphah International University
- Sponsor type
- University, hospital or other
- Responsible party
- Sponsor
- Investigators
- Aisha Razzaq, PHD*, Principal investigator, Riphah International University
IDs, dates and publications
- ClinicalTrials.gov ID
- NCT06699888
- Sponsor's protocol ID
- Riphah IU Samiyah Asghar
- Status last verified
- Apr 2025
- First submitted
- 19 Nov 2024
- Last updated
- 18 Apr 2025
- Results posted
- No
- Data monitoring committee
- No
- FDA-regulated drug
- No
- FDA-regulated device
- No
- Individual data sharing
- No
Study at a glance
From the registry record, last updated by the sponsor on 18 Apr 2025. Recruitment status is as the sponsor reported it: confirm with the study team.
- Official title
- Effect of Cervicothoracic Junction Manipulation on Craniovertebral Angle and Proprioception in Forward Head Posture
- ClinicalTrials.gov ID
- NCT06699888
- Acronym / sponsor ID
- Riphah IU Samiyah Asghar
- Conditions
- Forward Head Posture
- Keywords
- Cervicothoracic Manipulation, Craniovertebral Angle, Joint position Error, Proprioception
- Study type
- Interventional
- Recruitment status
- Completed
- Enrolment
- 36 participants (actual)
- Lead sponsor
- Riphah International UniversityUniversity, hospital or other
- Study start
- 1 Jun 2024 (actual)
- Primary completion
- 25 Feb 2025 (actual)
- Study completion
- 16 Apr 2025 (actual)
- First posted
- 21 Nov 2024 (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 aim of this research is to find out the effect of Cervicothoracic Junction Manipulation on neck Proprioception in individuals with Forward Head Posture. A Randomized controlled trials done at Barki Advance Physiotherapy Center. The sample size was 36. The subjects were divided in two groups, 18 subjects in control group and 16 in experimental (Cervicothoracic Manipulation) group. Study duration is of 6 months after the ethical approval. Sampling technique applied was non probability connivance sampling technique. Only 18-45 years individuals with forward head posture, craniovertebral angle less than 53° degrees and Joint position error, an average of >4.5◦ error in rotation or extension direction were included. Tools used in the study are Craniovertebral Angle (CVA) and Joint Position Error Test (JPE).
Detailed description
FHP is greatly linked with multiple musculoskeletal conditions like head and neck dysfunction, myofascial trigger points, temporomandibular dysfunction, poor cervical mobility and functional disability of the cervical and thoracic spines. It also observed in asymptomatic individuals. Muscle spindles, especially in cervical detect muscle length changes and contribute to proprioception. Changes in neck muscles can disrupt proprioceptive function in the cervical spine. Proprioception is vital for joint function, providing stability during activities and informing posture and movement. Decreased balance and positioning errors are common in individuals with neck discomfort, emphasizing the importance of restoring proprioceptive function, particularly in Forward Head Posture (FHP) patients, for maintaining normal neck posture. Abnormalities in the head posture are absolutely harmful for the Head and neck posture. A study investigated the CV angle and joint position error in the cervical region and found a negative correlation between head posture and proprioceptive function, indicating that chronic abnormal head posture (FHP) negatively affects proprioception, body stability, and neck pain. Spinal manipulation uses high velocity and low amplitude thrusts to realign restricted vertebrae, removing restriction in facet joints, and producing mechanical, physiological, and biological effects.
Literature suggest that manipulation has beneficial effects in improving the pain and postural control in spine. The cervicothoracic (CT) junction is the transitional segment between the mobile lordotic cervical and less mobile kyphotic thoracic spines and hence a potential region for stiffness. The cervicothoracic junction, a potential stiffness region, can cause neck, headache, and upper limb pain. Improving its range of motion could reduce the need for compensatory movement, reducing cervical spine tension. According to recent systematic review, cervicothoracic junction level manual therapy in subjects with FHP better improved the muscle recruitment ability than upper-cervical level manual therapy during motor tasks. Upper thoracic spine manipulation has been shown to be more beneficial than thoracic mobilization, cervical mobilization, and standard care for FHP during performing motor task. In 2023 study conducted by Ibrahim et al. find out that FHP influenced Somatosensory Evoked Potentials and Somatosensory Processing in asymptomatic young adults and they reported 1-degree increase in the CVA measurement (indicating better posture) significantly decreased the amplitudes of all the potentials and resulted in a faster, more efficient nerve conduction time
Study design
- Primary purpose
- Treatment
- Allocation
- Randomised
- Intervention model
- Parallel groups
- Masking
- Double blind (participant, outcomes assessor)
- Number of arms
- 2
| Arm | Type | Receives |
|---|---|---|
| Cervicothoracic Manipulation group | Experimental | Other: cervicothoracic manipulation groupthe subject will receive cervicothoracic manipulation and Chin tuck, Strengthening Shoulder Retractors, Stretching SCM, Pectoralis Stretch |
| forward head correction exercises group | Active comparator | Other: forward head correction exercises traditional groupthis group receive Chin tuck, Strengthening Shoulder Retractors, Stretching SCM, Pectoralis Stretch |
Who may qualify
- Ages
- 18 to 45 years
- Sex
- All
- Healthy volunteers
- Not accepted
- Age groups
- Adult
Key inclusion criteria (5 listed)
- Both male and female patients with age between 18-45 years
- Participants with asymptomatic Forward head posture
- Participants having no active complain of neck pain and muscle stiffness
- Joint position error, an average of >4.5◦ error in rotation or extension directions
- For FHP patient, the Craniovertebral angle should be ≤ 53º
Key exclusion criteria (4 listed)
- Previous history of neck and head trauma
- Vestibular pathologies i.e. vertigo, dizziness
- Musculoskeletal or neurological conditions that could affect Proprioception, cognitive impairment
- History of spinal and thoracic surgeries
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 |
|---|---|---|
| cervicothoracic manipulation groupThe participant lay prone with the head firmly into the head piece Palpation of the upper cervico-thoracic segment observed the side of the restriction. The participants head was rotated to the contralateral side of the restriction. The practitioner's hand contacted the forehead and the other hand's thumb contacted the spinous process of the restricted side. A low amplitude, high velocity thrust towards the axilla was applied, on the spinous process in PA direction. Experimental group also received following exercises Chin tuck Strengthening Shoulder Retractors. Stretching SCM Pectoralis Stretch 3 × 10 repetitions, 3 times a week for 2 weeks | Other | Cervicothoracic Manipulation group |
| forward head correction exercises traditional groupChin tuck Strengthening Shoulder Retractors. Stretching SCM Pectoralis Stretch 3 × 10 repetitions, 3 times a week for 2 weeks. | Other | forward head correction exercises group |
Primary outcome
Craniovertebral Angle
Time frame: baseline to 2 weeks
The CV angle was measured for assessment of head posture. All subjects were instructed to stand in a self-selected comfortable upright posture. Then, the skin overlying the spinous process of the seventh cervical vertebra (C7) and tragus of the ear was marked. A lateral view digital photograph of each subject was taken. The CV angle was calculated based on the angle between a horizontal line passing through C7 and a line extending from the tragus of the ear to C7. The x-axis values for the craniovertebral angle were measured prior to movement.
Joint Position Error Test
Time frame: baseline to 2 weeks
Proprioceptive accuracy, pertaining to the sense of joint and body movement and position, was evaluated using the Joint Position Error (JPE) Test. The Cervical JPE Test measures the ability of a blindfolded patient to accurately relocate their head position back to a predetermined neutral point after cervical joint movement
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 18 Apr 2025.
- Individual participant dataSharing planned: No
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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.
Aisha Razzaq, PHD* principal investigator
Riphah International 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 cervicothoracic manipulation group and forward head correction exercises traditional group in people with Forward Head Posture, run by Riphah International University at 1 site in Pakistan.
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 5 inclusion and 4 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 18 Apr 2025. 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 Pakistan. 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?
Craniovertebral Angle (time frame: baseline to 2 weeks). The study lists 2 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 18 Apr 2025.