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.
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Parallel
Dynamic neuromuscular stabilisation breathing
Other interventionDiaphragmatic breathing exercises performed in supine, side-lying, and quadruped positions, 3 sets of 1 minute each.
Myofascial Release
Other interventionManual sustained pressure applied to the suboccipital region, upper trapezius, and levator scapulae, 2-3 minutes per site, to reduce myofascial stiffness and improve tissue extensibility
Convetional Exercises
Other interventionStandardized exercise protocol including head rotation, neck/upper back extension, swimmer exercise, head retraction with resistance band, and upper trapezius/levator scapulae stretches.
Craniovertebral Angle (CVA)
The craniovertebral angle (CVA) will be measured using digital photogrammetry to assess the degree of forward head posture. A marker will be placed on the tragus of the ear and the spinous process of C7, and the angle formed between a horizontal line through C7 and the line connecting C7 to the tragus will be calculated. Smaller angles indicate a greater degree of forward head posture.
Visual Analogue Scale (VAS)
Pain intensity will be assessed using a 10 cm Visual Analogue Scale (VAS), where 0 indicates no pain and 10 indicates worst imaginable pain. Participants will mark their perceived pain level at rest and during activity.
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