Cervical and Non-Cervical Muscle Thickness Changes in Forward Head Posture

NCT07500051 | Completed

• 1 other identifier: AEŞH-BADEK1-2025-012
• Study Type: observational
• Target: 49
• Locations: 1 country
• Sites: 1

Brief Summary

Head-forward posture (FHP) is one of the most common postural disorders and is increasing worldwide. Most studies examining FHP have focused on the relationship between craniovertebral angle (CVA) and cervical muscle thickness. However, FHP is a postural disorder that affects the entire musculoskeletal system, not just the cervical region. It creates a chain of adaptations in the body, generating both local and global effects. The aim of this study is to evaluate the relationship between postural changes triggered by CVA and the thickness of the trapezius, splenius capitis, semispinalis capitis, semispinalis cervicis, multifidus, sternocleidomastoid (SCM), transversus abdominis (TrA), internal oblique (IO), external oblique (EO), gluteus maximus, tibialis anterior, rectus femoris, and gastrocnemius (GK) medial muscles, as measured by ultrasonography (USG), since postural changes triggered by CVA can affect the spine, hips, and lower extremities. If this relationship can be confirmed, this information could be used as a basis for evaluating abnormal posture.

Conditions

Craniovertebral Angle; Posture; Ultrasonography

Keywords

Forward Head Posture; Craniovertebral Angle; Cervical and Non-cervical Muscle Thickness; Ultrasonography

Outcome Measures

Primary Outcomes (7)

• Cervical extensor muscle thickness measurement

  Ultrasonographic imaging of the cervical extensor muscles will be performed at the C4 level using a 7-12 MHz high-frequency linear array probe. Participants will be seated comfortably in a chair with their hands on their thighs. The fourth cervical (C4) vertebral prominence will be identified by palpation. Then, the transducer will be placed horizontally at the level of the C4 vertebral prominence and slowly slid to the right and slightly up and down so that the echogenic vertebral lamina is clearly observed. The thickness of the cervical extensor muscles, including the trapezius, splenius capitis, semispinalis capitis, semispinalis cervicis, and multifidus muscles, will be measured at the C4 level as the widest distance between the anterior and posterior fascia. This measurement will be taken three times, and the average will be recorded in millimeters (mm).

  baseline, at the time of clinical assessment

• Sternocleidomastoid (SCM) muscle thickness measurement

  The SCM muscle has sternal and clavicular heads and five compartments attached to different locations. Because the muscle runs very superficially, it is easy to both palpate and visualize. To locate the SCM muscle, imaging will be performed by positioning a 7-12 MHz high-frequency linear array probe at the C5 and C6 levels in the axial plane, and the average of three measurements will be recorded in millimeters (mm).

  baseline, at the time of clinical assessment

• Abdominal muscle thickness measurement

  A 7-12 MHz high-frequency linear array probe will be used to locate the TrA, IO, and EO muscles. The participant will lie comfortably with their knees bent and hips at a 45° angle during imaging. The ultrasound head will be placed between the anterior superior iliac spine (ASIS) and the lowest rib, approximately 3 cm superomedially to the iliac crest. The TrA muscle is the deepest layer visible on the screen with B-mode ultrasound. EO, IO, and TrA will be imaged sequentially from the outside in. The average of the three thickness measurements will be recorded in millimeters (mm).

  baseline, at the time of clinical assessment

• Gluteus maximus muscle thickness measurement

  The participant will be asked to lie in the prone position with both lower extremities in a neutral position. Ultrasonographic imaging will be performed using a 2-5 MHz convex probe in B-mode. Measurements will be taken within the proximal 30% of the distance between the posterior superior iliac spine (PSIS) and the greater trochanter of the femur, corresponding to the first third of this region. Depth and zoom settings will be adjusted until the left third of the sacrum is no longer visible on the screen. Once the optimal image is displayed, it will be frozen, and the thickness of the gluteus maximus muscle fibers will be measured. The mean of three measurements will be recorded in millimeters (mm).

  baseline, at the time of clinical assessment

• Rectus femoris (RF) muscle thickness measurement

  A 7-12 MHz linear probe will be used to obtain images of the rectus femoris (RF) muscle. With the participant in the supine position, measurements will be taken at the midpoint of the distance between the anterior superior iliac spine (ASIS) and the superior border of the patella. In the axial plane, muscle thickness will be determined as the perpendicular distance between the superficial and deep fascia at the thickest point of the muscle. The mean of three measurements for each muscle will be recorded in millimeters (mm).

  baseline, at the time of clinical assessment

• Gastrocnemius medialis(GC) muscle thickness measurement

  A 7-12 MHz linear probe will be used to obtain images of the medial head of the gastrocnemius (MG) muscle. For imaging the medial gastrocnemius, the participant will lie in the prone position with the ankle in a neutral position. Muscle thickness will be measured at the midpoint of the distance between the fibular head and the medial malleolus. In the axial plane, thickness will be determined as the perpendicular distance between the superficial and deep fascia at the thickest portion of the muscle. The mean of three measurements for each muscle will be recorded in millimeters (mm).

  baseline, at the time of clinical assessment

• Tibialis anterior (TA) muscle thickness measurement

  A 7-12 MHz linear probe will be used to obtain images of the tibialis anterior (TA) muscle. For ultrasonographic imaging, the participant will be in the supine position. Muscle thickness will be measured along the line from the medial aspect of the patella to the lateral malleolus, at one-third of this distance, using a standardized transducer placement. In the axial plane, thickness will be determined as the perpendicular distance between the superficial and deep fascia at the thickest point of the muscle. The mean of three measurements for each muscle will be recorded in millimeters (mm).

  baseline, at the time of clinical assessment

Study Arms (2)

Forward Head Posture(FHP)

A craniovertebral angle(CVA) less than 48 degrees is defined as forward head posture(FHP).

Normal Head Posture(NHP)

A craniovertebral angle(CVA) greater than or equal to 48 degrees is defined as normal head posture(NHP).

Eligibility Criteria

• Age: 18 Years+
• Sex: female
• Healthy Volunteers: Yes
• Age Groups: Adult (18-64), Older Adult (65+)
• Sampling Method: Non-Probability Sample

Study Population

The study population consisted of 49 female participants aged over 18 years. Participants were divided into two groups: 25 individuals diagnosed with forward head posture (FHP) and 24 individuals with normal head posture(NHP). All participants were right-hand dominant. Inclusion and exclusion criteria were applied during recruitment. Individuals with systemic diseases affecting posture, a history of musculoskeletal or neurological disorders, previous relevant surgeries, or conditions that could interfere with participation were excluded from the study. Participation was voluntary.

You may qualify if:

• Age \>18 years
• Female sex
• Right-hand dominance

You may not qualify if:

• Presence of a systemic disease that may cause forward head posture (FHP)
• Presence of osteoarthritis in the ankle, knee, hip, or spine
• History of surgery involving the cervical region, lumbar region, or lower extremities
• Presence of neurological disorders affecting muscles or nerves
• Presence of pain originating from the cervical region
• Presence of radiculopathy
• Presence of mental retardation or neuropsychiatric disorders preventing participation
• Unwillingness to participate
• Pregnancy

Sponsors & Collaborators

• Gaziantep City Hospital: lead

Study Sites (1)

Ankara Etlik City Hospital

Yenimahalle, Ankara, 06170, Turkey (Türkiye)

Location

Study Officials

• Başak MANSIZ KAPLAN, Medical Doctor

  Ankara Etlik City Hospital

  STUDY DIRECTOR

Study Design

• Study Type: observational
• Observational Model: CASE CONTROL
• Time Perspective: PROSPECTIVE
• Sponsor Type: OTHER
• Responsible Party: PRINCIPAL INVESTIGATOR
• PI Title: Consultant

Study Record Dates

• First Submitted: March 20, 2026
• First Posted: March 30, 2026
• Study Start: April 30, 2025
• Primary Completion: September 30, 2025
• Study Completion: October 30, 2025
• Last Updated: March 30, 2026

Record last verified: 2026-03

Data Sharing

• IPD Sharing: Will share
• Shared Documents: STUDY PROTOCOL, SAP, ICF, ANALYTIC CODE
• Time Frame: Data will be available after publication of the study results.
• Access Criteria: De-identified individual participant data and supporting documents will be available to qualified researchers upon reasonable request to the principal investigator. Access will be granted for scientific research purposes after approval of the research proposal. Data will be shared through secure electronic transfer.

Locations

TU (1)