Comparative Effects of Blackburn and Egoscue Exercises to Improve CVA in Individuals With Forward Head Posture

Official title

Comparative Effects of Blackburn and Egoscue Exercises to Improve Craniovertebral Angle in Individuals With Forward Head Posture

Overview

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.

Detailed description

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.

Interventions

• Other Group A (Blackburn Exercises)
  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 li
• Other Group B (Egoscue Exercises)
  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/s

Primary outcome measures

• Neck Pain [Time frame: Baseline and Week 8th]
• Craniovertebral Angle [Time frame: Baseline and Week 8]

Secondary outcome measures (1)

• Neck Disability Index [Time frame: Baseline and Week 8]

Eligibility criteria

Inclusion criteria

• Age range: 25 to 45 years (Mahmoud et al., 2019).
• Individuals demonstrating a Craniovertebral Angle between 30 and 45 degrees.
• Individuals reporting pain levels classified as moderate to severe on the NPRS.
• Individuals demonstrating moderate to severe disability as measured by the Neck Disability Index.
• Both male and female participants will be considered eligible.

Exclusion criteria

• Individuals currently receiving any physical therapy intervention targeting the neck or shoulder regions.
• Individuals utilizing cervical or lumbar orthotic devices.
• Individuals taking prescribed pain medications.
• Individuals with a formally diagnosed psychological condition.
• Any recent bone fracture.
• Any recently sustained trauma or injury.
• Formally diagnosed neurological signs or symptoms.
• Burns or open wounds.
• Formally diagnosed vestibular pathology.

Criteria are shown verbatim from the registry (in English). Final eligibility is always assessed by the study center.

Healthy volunteers: No

Study design

Allocation

Randomized

Model

Parallel assignment

Masking

Single blind

Primary purpose

Treatment

Study locations

Pakistan · 1 center

• Anas Iqbal Physiotherapy and Rehabilitation Centre, Khadija tul Zahra Physiotherapy Centre — Faisalābad

Publications

• Sheikhhoseini R, Shahrbanian S, Sayyadi P, O'Sullivan K. Effectiveness of Therapeutic Exercise on Forward Head Posture: A Systematic Review and Meta-analysis. J Manipulative Physiol Ther. 2018 Jul-Aug;41(6):530-539. doi: 10.1016/j.jmpt.2018.02.002. Epub 2018 Aug 11. PMID 30107937
• Sadeghi A, Rostami M, Ameri S, Karimi Moghaddam A, Karimi Moghaddam Z, Zeraatchi A. Effectiveness of isometric exercises on disability and pain of cervical spondylosis: a randomized controlled trial. BMC Sports Sci Med Rehabil. 2022 Jun 16;14(1):108. doi: 10.1186/s13102-022-00500-7. PMID 35710510
• Rodriguez-Fernandez AL, Garrido-Santofimia V, Gueita-Rodriguez J, Fernandez-de-Las-Penas C. Effects of burst-type transcutaneous electrical nerve stimulation on cervical range of motion and latent myofascial trigger point pain sensitivity. Arch Phys Med Rehabil. 2011 Sep;92(9):1353-8. doi: 10.1016/j.apmr.2011.04.010. PMID 21878204
• Nilmart P, Sichuai A, Chedang A, Goontharo C, Janjamsai N. Internet-Based Telerehabilitation Versus in-Person Therapeutic Exercises in Young Adult Females With Chronic Neck Pain and Forward Head Posture: Randomized Controlled Trial. JMIR Rehabil Assist Technol. 2025 Jul 25;12:e74979. doi: 10.2196/74979. PMID 40712139
• Mahmoud NF, Hassan KA, Abdelmajeed SF, Moustafa IM, Silva AG. The Relationship Between Forward Head Posture and Neck Pain: a Systematic Review and Meta-Analysis. Curr Rev Musculoskelet Med. 2019 Dec;12(4):562-577. doi: 10.1007/s12178-019-09594-y. PMID 31773477
• Kang JI, Choi HH, Jeong DK, Choi H, Moon YJ, Park JS. Effect of scapular stabilization exercise on neck alignment and muscle activity in patients with forward head posture. J Phys Ther Sci. 2018 Jun;30(6):804-808. doi: 10.1589/jpts.30.804. Epub 2018 Jun 12. PMID 29950768
• Cote R, Vietas C, Kolakowski M, Lombardo K, Prete J, Dashottar A. Inter and Intra-Rater Reliability of Measuring Photometric Craniovertebral Angle Using a Cloud-Based Video Communication Platform. Int J Telerehabil. 2021 Jun 22;13(1):e6346. doi: 10.5195/ijt.2021.6346. eCollection 2021. PMID 34345337

Identifiers

NCT: NCT07622979 · TUF/EIRB/178/26

Primary sources (government registries)

• ClinicalTrials.gov (US NIH)

View this study on ClinicalTrials.gov ↗