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

NCT07622979 | Not Yet Recruiting

• 1 other identifier: TUF/EIRB/178/26
• Study Type: interventional
• Target: 28
• Locations: 1 country
• Sites: 1

Brief Summary

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.

Conditions

Forward Head Posture

Keywords

Forward Head Posture; Blackburn Exercise; Egoscue Exercise; Craniovertebral Angle

Outcome Measures

Primary Outcomes (2)

• Neck Pain

  The NPRS consists of an 11-point measurement scale with values ranging from 0, representing complete absence of pain, to 10, representing the most intense pain conceivable. It is a highly valid and reliable instrument for assessing pain intensity and permits precise patient-reported responses

  Baseline and Week 8th

• Craniovertebral Angle

  The CVA represents an acute angle formed between a horizontal reference line passing through the spinous process of the seventh cervical vertebra and a line connecting the midpoint of the tragus of the ear to the spinous process of the seventh cervical vertebra. This tool is recognized as a valid instrument for quantifying the degree of forward head posture

  Baseline and Week 8

Secondary Outcomes (1)

• Neck Disability Index

  Baseline and Week 8

Study Arms (2)

Group A (Blackburn exercises)

EXPERIMENTAL

The protocol includes prone shoulder exercises to improve scapular stability and posture. Prone horizontal abduction (neutral) is performed by lifting arms laterally from a prone position until parallel to the floor. In full external rotation, thumbs are turned upward to increase rotator cuff activation. Prone horizontal scaption is done \~30° anterior to abduction, while its external rotation variant enhances posterior shoulder activation. Prone horizontal external rotation is performed with shoulders abducted 90° and elbows flexed 90°, rotating forearms upward. Prone horizontal extension involves lifting arms backward in line with the trunk. Exercises are performed 3 times/week, 10 reps with 5-second hold. After 5 days, progression increases hold to 10 seconds per repetition. Baseline care includes hot pack application to neck and shoulders for 15 minutes, and TENS in burst mode (200 µs pulse width, 100 Hz carrier, 2 Hz burst) for 10 minutes and also Cervical isometric exercises

Other: Group A (Blackburn Exercises)

Group B (Egoscue exercises)

ACTIVE COMPARATOR

Egoscue exercises will be performed 3 times/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 and apart with head stable), upper floor spinal twist (side lying trunk rotation with knees bent), cats and dogs (quadruped alternating spinal flexion/extension), and arm circles (standing, arms at shoulder level with scapular retraction and controlled rotations). Baseline care includes hot pack application to neck and shoulders for 15 minutes, and TENS in burst mode (200 µs pulse width, 100 Hz carrier, 2 Hz burst) for 10 minutes. Cervical isometric exercises are also included for strengthening and postural stability.

Other: Group B (Egoscue Exercises)

Interventions

Group A (Blackburn Exercises) OTHER

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 lifts arms backward in line with trunk. Exercises are done 3×/week, 10 reps with 5-second hold, progressing to 10-second hold after 5 days. Baseline care includes hot pack for 15 min, TENS (200 µs, 100 Hz, 2 Hz burst) for 10 min, and cervical isometrics for stability and pain control.

Group A (Blackburn exercises)

Group B (Egoscue Exercises) OTHER

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/shoulder for 15 minutes, and TENS in burst mode (200 µs, 100 Hz carrier, 2 Hz burst) for 10 minutes before sessions. Cervical isometric exercises are also included to improve strength and postural stability.

Group B (Egoscue exercises)

Eligibility Criteria

• Age: 25 Years - 45 Years
• Sex: all
• Healthy Volunteers: No
• Age Groups: Adult (18-64)

You may qualify if:

• 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.

You may not qualify if:

• 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.

Sponsors & Collaborators

• University of Faisalabad: lead

Study Sites (1)

Anas Iqbal Physiotherapy and Rehabilitation Centre, Khadija tul Zahra Physiotherapy Centre

Faisalābad, Punjab Province, 38000, Pakistan

Location

Related Publications (7)

• 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 BACKGROUND

• 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 BACKGROUND

• 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 BACKGROUND

• 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 BACKGROUND

• 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 BACKGROUND

• 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 BACKGROUND

• 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 BACKGROUND

Study Officials

• Dr Muhammad Ateeb, PhD Public Health

  The University of Faisalabad

  STUDY CHAIR

Central Study Contacts

Maryam Safdar Dr, MS PT (MSK)

CONTACT

+923217978088; maryamsafdar.DPT@tuf.edu.pk

Dr Muhammad Ateeb, PhD Public Health

CONTACT

+92-3357333383; mateeb.oric@tuf.edu.pk

Study Design

• Study Type: interventional
• Phase: not applicable
• Allocation: RANDOMIZED
• Masking: SINGLE
• Who Masked: PARTICIPANT
• Masking Details: This study will be a single-blinded randomized clinical trial in which only the participants will be blinded to group allocation. The therapist delivering the interventions will be aware of group assignment due to the nature of the treatment. Outcome assessment will be conducted without participant knowledge of their group to minimize bias.
• Purpose: TREATMENT
• Intervention Model: PARALLEL
• Sponsor Type: OTHER
• Responsible Party: PRINCIPAL INVESTIGATOR
• PI Title: Assistant Professor

Model Details: The study will follow a parallel randomized clinical trial (RCT) on subjects with forward head posture (FHP). Participants of both sexes will be included if CVA is 30°-45°, NDI shows moderate to severe disability, and NPRS indicates moderate to severe pain. Individuals with recent trauma, fractures, or orthotic use will be excluded. Written and verbal consent will be obtained. A total of 28 participants will be randomly allocated into two groups (n=14 each). Group A will receive Blackburn exercises, and Group B will receive Egoscue method exercises. Both groups will also receive TENS, hot pack therapy, and cervical isometrics as baseline care. The intervention will last 8 weeks (24 sessions, 3/week). Outcomes include pain (NPRS), CVA, and disability (NDI), assessed at baseline and post-intervention. Data will be analyzed using SPSS v23.

Study Record Dates

• First Submitted: May 13, 2026
• First Posted: June 3, 2026
• Study Start: May 20, 2026
• Primary Completion (Estimated): September 20, 2026
• Study Completion (Estimated): September 20, 2026
• Last Updated: June 3, 2026

Record last verified: 2026-06

Data Sharing

• IPD Sharing: Will not share

Locations

PA (1)