Forward Head Posture
Conditions
Keywords
forward head posture , thoracic kyphosis , Craniovertebral angle , Posture Correction , Neck Disability , University Students
Brief summary
Forward head posture and thoracic kyphosis are among the most common postural problems in university students, driven largely by long hours of screen use and poor sitting habits. Research suggests that nearly two-thirds of university students show measurable forward head posture, and if uncorrected, it is linked to chronic neck pain and long-term musculoskeletal strain. This study compares three approaches to correcting posture over a six-week supervised exercise program: a wearable sensor belt that vibrates in real time when posture slips, a smartphone app that sends scheduled reminders throughout the day, and exercise alone with no reminders. The two technology-assisted groups are prompted to correct their posture throughout daily activities, not just during exercise sessions. The study will show whether real-time or scheduled reminders produce greater improvements in posture, neck pain, and neck function than exercise alone . Helping physical therapists and university health services to identify the most practical strategy for correcting posture in screen-heavy academic environments.
Detailed description
Forward head posture(FHP) and thoracic kyphosis are increasingly prevalent among university students due to sustained flexed-neck postures during smartphone use, laptop-based study, and prolonged sitting. Chronic FHP alters the normal cervical lordotic curve, increases mechanical loading on cervical spine structures, and has been associated with muscular imbalance, cervicogenic pain , and headache. Conventional postural correction exercise programs are well established, but adherence to postural correction outside of supervised sessions remains a key limitation. Students are typically unaware of their posture lapsing during daily activities such as studying, phone use and prolonged sitting and correction cues are usually absent outside the clinical or exercise setting. Technology-assisted feedback systems have emerged as a potential solution to this adherence gap. Wearable biofeedback devices provide immediate, real-time correction cues when a threshold postural deviation is detected, theoretically reinforcing correct postural habits through continuous behavioral conditioning. App-based reminder systems, offers a scheduled, intermittent prompts rather than continuous monitoring , it is more practical and scalable given lower cost and no specialized hardware requirement. This three arm, parallel group randomized controlled trial is designed to generate comparative evidence on the relative effectiveness of continuous biofeedback, scheduled reminders, and conventional exercise therapy alone, in order to inform evidence-based, resource-appropriate postural correction strategies for university and academic health settings. The results of this trial are intended to directly inform clinical decision-making for physiotherapists and university wellness programs considering adoption of wearable or app-based postural correction tools. Should either technology-assisted approach demonstrate superiority over conventional exercise alone, this would support integration of low-cost, scalable postural feedback technology into standard student musculoskeletal health programs. Conversely, if outcomes are comparable across groups, this would support conventional supervised exercise as a sufficient, lower-cost first-line approach, without the added expense or complexity of technology-assisted feedback devices. University students represent a population with high daily screen-time exposure and sedentary study behavior, making them broadly representative of the wider demographic at risk for posture-related cervical musculoskeletal strain seen in academic and early-career professional environments. Evidence generated from this population is expected to have relevance beyond the immediate study setting, informing postural health strategies applicable to similarly screen-intensive occupational and educational contexts.
Interventions
A wearable belt worn around the cervicothoracic region that detects postural deviation in real time and provide vibratory feedback to prompt immediate self-correction , used in conjunction with standardized exercise program.
A smartphone application that delivers scheduled reminders prompting participants to self-check and correct their posture throughout the day, used in conjunction with the standardized exercise program
A structured , supervised exercise program targeting cervicothoracic postural muscles , delivered without any wearable device or app based reminder
Sponsors
Study design
Intervention model description
Participants will be randomly allocated in a 1:1:1 to one of the three parallel groups: wearable biofeedback device plus exercise , App based reminder plus exercise and Conventional Exercise group. Each group will receive its assigned intervention independently over a six week period and than a follow up after 12 weeks, with no crossover between groups.
Eligibility
Inclusion criteria
1. University students aged 18-30 years enrolled in a degree program at Riphah International University. 2. Daily sitting duration ≥ 5 hours (academic and/or device-related activities). 3. Presence of at least one observable postural deviation confirmed at baseline assessment: forward head posture (CVA \< 50°), rounded shoulders (protracted shoulder distance in supine line), or thoracic kyphosis (\> 40° via digital inclinometer). 4. Smartphone ownership and basic digital literacy
Exclusion criteria
1. History of spinal surgery, vertebral fracture, or major cervical/thoracic trauma within the past 12 months. 2. Diagnosed neurological disorders affecting posture or motor control (e.g., Parkinson's disease, stroke, cervical dystonia). 3. Structural spinal deformities requiring active medical or surgical management (e.g., scoliosis Cobb angle \> 20°, Scheuermann's kyphosis). 4. Current participation in physiotherapy, chiropractic treatment, or another structured posture correction program. 5. Cardiovascular or pulmonary conditions contraindicating moderate-intensity exercise (e.g., uncontrolled hypertension, severe asthma). 6. Skin conditions, open wounds, or allergies precluding safe use of the posture correction belt.
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Change in Craniovertebral angle | baseline ,Mid treatment (4th week) , Post intervention (6th week) and follow up (12th week) | Degree of forward head posture measured via photogrammetry app, Calculated as angle between a horizontal line through C7 and a line to tragus of the ear. Normal CVA is greater than 50 degrees. |
| Thoracic Kyphosis Angle | At Baseline , Mid treatment Intervention (4th week) , Post intervention (6th week) and follow up at 12 week | Degree of thoracic spinal curvature (T1 - T12) measured using a digital inclinometer. Normal range 20 degree to 45 degree |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Change in Neck Disability Index Score | At Baseline , Mid intervention (4th week) , Post Intervention (6th week ) and follow up at 12th week | 10 item self report questionnaire assessing functional disability related neck pain . Score converted to percentage ,higher score means greater disability. Excellent test re test reliability ,ICC score of 0.91 |
| Change in Neck and Upper Back Pain Intensity | At Baseline , Mid intervention (4th week) , Post Intervention (6th week) and follow up at 12 week. | Subjective pain intensity rated on NPRS ,an 11-point scale (0 = no pain, 10 = worst pain imaginable).The test retest reliability range from 0.67 - 0.96 |
| Change in Shoulder Protraction Distance | At Baseline , Mid intervention (4th week) , Post Intervention (6th week) and follow up at 12 week. | Horizontal distance from the posterolateral acromion to a table surface, measured with participant supine (Table Top Test). Distance greater than 2.6 cm indicates protracted shoulder posture. |
| Change in Postural Awareness Scale Score. | At Baseline , Mid intervention (4th week) , Post Intervention (6th week) and follow up at 12 week | 12-item validated self-report questionnaire assessing postural awareness and body perception, scored 12-60. Higher scores indicate better awareness. The test retest reliability value (ICC) is 0.75-0.83 |
| Change in Deep Neck Flexor Muscle Endurance | At Baseline , Mid intervention (4th week) , Post Intervention (6th week) and follow up at 12 week | Endurance capacity of deep cervical flexor muscles (longus colli, longus capitis), measured in seconds using the Deep Neck Flexor Endurance Test. With good Intra rater Reliability (ICC= 0.81 - 0.94) |
Countries
Pakistan
Contacts
Riphah International University, Islamabad