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.
University students aged 19-25 years
Both genders
Forward head posture with craniovertebral angle < 50°
History of cervical spine injury or surgery
Chronic neck pain or recent therapy within six months.
Diagnosed with neurological, musculoskeletal, or visual disorders affecting posture.
Parallel
Deep neck flexor strengthening
Other interventionChin tuck exercises, Isometric cervical flexion using gentle resistance, Prone head lift exercises. Frequency: 3 sessions per week, Duration: 4 weeks (12 sessions total).
Motor learning based neuroplasticity training
Other interventionTask-specific postural training using visual (laser), auditory (metronome), and proprioceptive feedback. Progressive balance and coordination exercises under varying environmental conditions. Static and dynamic postural control tasks with intertrial variability. Frequency: 3 sessions per week, Duration: 4 weeks (12 sessions total)
Craniovertebral Angle (CVA)
Measured using digital photogrammetry and analyzed with software (e.g., Kinovea) to quantify forward head posture severity.
Deep Neck Flexor Strength
Assessed using the Deep Neck Flexor Endurance Test. It is performed in the supine line position with the chin hold and head off the couch and ask the patient to hold the position. The time of the hold will be recorded.
Cervical Proprioception
Measured using the Cervical Joint Repositioning Error Test with laser-guided repositioning.
Deep Neck Extensor Strength
Assessed using the Deep Neck Extensor Endurance Test. It is performed in the prone line position with the chin hold and head off the couch and ask the patient to hold the position. The time of the hold will be recorded.
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