Efficacy of Combined Manual Diaphragm Release Technique and Neck Exercises in Adolescents With Forward Head Posture

NCT ID: NCT07039565

Last Updated: 2025-07-09

Basic Information

• Recruitment Status: ACTIVE_NOT_RECRUITING
• Clinical Phase: NA
• Total Enrollment: 100 participants
• Study Classification: INTERVENTIONAL
• Study Start Date: 2025-06-28
• Study Completion Date: 2025-09-30

Brief Summary

• Due to the heavy use of smartphones among adolescents the cervical spine destabilizes and moves forward, so do the vital structures (nerves, arteries, veins) within the neck undergo torsion, stretch and compression including the autonomic nervous system nerves (which can cause dysfunction in heart rate, digestion, breathing among other symptoms).
• Forward head posture (FHP) puts more compressive strain on the cervical spine's tissues, especially the ligaments and facet joints. Because FHP weakens the respiratory muscles, it has a significant impact on respiratory function. Static balance may be negatively impacted by FHP.
• FHP is effectively treated by a proper and suitable physical therapy program.

Detailed Description

In the past few years, the number of smart phone users has progressively increased worldwide. With the growing use of smart phones, concerns have also increased about musculoskeletal problems associated with the prolonged use of smart phones.

Concerns have also increased about musculoskeletal problems associated with the prolonged use of smartphones. Recent investigations have shown that smartphone users tend to report pain in the neck, shoulder, and thumb, and the severity of the symptoms as the total time spent using the smartphone increases.

One of the most overspread postural abnormalities is forward head posture (FHP) and it is described as head projection anteriorly in relation to the trunk which appears mainly in sagittal plane. When using a smartphone, people usually flex their neck downwards to stare at the lowered object and maintain the head in a forward position for long periods of time, the maintenance of a head-forward posture decreases cervical lordosis of the lower cervical vertebrae and creates a posterior curve in the upper thoracic vertebrae to maintain balance; this is known as the forward head posture (FHP) that causes shortening of the extensors of the neck and producing chronic neck pain.

The weight supported by the spine dramatically increases when flexing the head forward at varying degrees. An adult head weighs 10-12 pounds in the neutral position. As the head tilts forward, the forces felt by the neck surge to 27 pounds at 15 degrees, 40 pounds at 30 degrees, 49 pounds at 45 degrees, and 60 pounds at 60 degrees. At 90 degrees, the model prediction was not reliable.

Conditions

Forward Head Posture

Study Design

• Allocation Method: RANDOMIZED
• Intervention Model: PARALLEL
• Primary Study Purpose: TREATMENT
• Blinding Strategy: QUADRUPLE

Study Groups

Experimental group

Manual diaphragm release technique and traditional neck exercises

Group Type: EXPERIMENTAL

Stretching and strengthening exercises

Intervention Type: OTHER

Strengthening exercises were progressively performed for three sets, with 10 to 15 repetitions. The stretching part of the exercises was done with the purpose of increasing the flexibility of the pectoralis and the cervical neck extensors muscles (pectoralis stretch, chin tuck). Exercises have been approved to be effective on the lengthening of the pectoralis minor, activation of the lower trapezius/middle trapezius, serratus anterior, and improvement of the posture

Diaphragm release technique

Intervention Type: OTHER

the patient will positioned in the supine position. The therapist stand at the head of the patient. The therapist make manual contact bilaterally under the costal cartilages of the lower ribs (7th to 10th ) with hypothenar regions of the hands and last three fingers. During the patient's inspiration, the therapist is gently pulling the points of hands contacts toward the head and slightly laterally, while elevating the ribs simultaneously

Control group

Traditional neck exercises

Group Type: ACTIVE_COMPARATOR

Stretching and strengthening exercises

Intervention Type: OTHER

Strengthening exercises were progressively performed for three sets, with 10 to 15 repetitions. The stretching part of the exercises was done with the purpose of increasing the flexibility of the pectoralis and the cervical neck extensors muscles (pectoralis stretch, chin tuck). Exercises have been approved to be effective on the lengthening of the pectoralis minor, activation of the lower trapezius/middle trapezius, serratus anterior, and improvement of the posture

Interventions

Stretching and strengthening exercises

Strengthening exercises were progressively performed for three sets, with 10 to 15 repetitions. The stretching part of the exercises was done with the purpose of increasing the flexibility of the pectoralis and the cervical neck extensors muscles (pectoralis stretch, chin tuck). Exercises have been approved to be effective on the lengthening of the pectoralis minor, activation of the lower trapezius/middle trapezius, serratus anterior, and improvement of the posture

Intervention Type: OTHER

Diaphragm release technique

the patient will positioned in the supine position. The therapist stand at the head of the patient. The therapist make manual contact bilaterally under the costal cartilages of the lower ribs (7th to 10th ) with hypothenar regions of the hands and last three fingers. During the patient's inspiration, the therapist is gently pulling the points of hands contacts toward the head and slightly laterally, while elevating the ribs simultaneously

Intervention Type: OTHER

Eligibility Criteria

Inclusion Criteria

• Male students their age ranged from 17 to 18 years.
• Has Body Mass Index (BMI) = 5th percentile to less than the 85th percentile.

_ has forward head posture

• Studying at any faculty at Pharos University in Alexandria.
• Cooperative and followed the instructions.

Exclusion Criteria

• - Subjects were excluded from the study if the student had visual or hearing defects.
• Overweight, obese or cachexic students.
• Had any neurological disorders.
• Had musculoskeletal problems.
• Had any congenital abnormalities that might affect the study.

• Minimum Eligible Age: 17 Years
• Maximum Eligible Age: 18 Years
• Eligible Sex: MALE
• Accepts Healthy Volunteers: No

Sponsors

Pharos University in Alexandria

OTHER

Sponsor Role: lead

Responsible Party

Amal Youssef Wahba

Lecturer

Responsibility Role: PRINCIPAL_INVESTIGATOR

Principal Investigators

Lamiaa said Tolba, LecturerP

Role: STUDY_CHAIR

Pharos University in Alexandria

Amal Youssef Wahba, Lecturer

Role: PRINCIPAL_INVESTIGATOR

Pharos University in Alexandria

Locations

Pharos University in Alexandria

Alexandria, Egypt, Egypt

Countries

Egypt

References

Lee KJ, Han HY, Cheon SH, Park SH, Yong MS. The effect of forward head posture on muscle activity during neck protraction and retraction. J Phys Ther Sci. 2015 Mar;27(3):977-9. doi: 10.1589/jpts.27.977. Epub 2015 Mar 31.

Reference Type: BACKGROUND

PMID: 25931773 (View on PubMed)

https://www.researchgate.net/publication/379140193_Forward_Head_Posture_and_Its_Effect_on_Muscle_Activation

Reference Type: BACKGROUND

Other Identifiers

Treatment of forward head

Identifier Type: -

Identifier Source: org_study_id