Comparison of Oculomotor Exercises Versus Suboccipital METs on Visual Fatigue Among FHP

Comparison of Oculomotor Exercises and Muscle Energy Technique on Visual Fatigue Among Patients Having Forward Head Posture

The aim of this research is to compare the effect of Oculomotor Exercises and Muscle energy technique on visual fatigue, proprioception, Craniovertebral angle among patients having Forward head posture.. It will raise awareness about the link between posture and visual health, encouraging early identification of visual symptoms associated with FHP, enhance recovery outcomes, improve functional performance, and promote a holistic treatment approach, ultimately provide benefit to population.

Study Overview

• Status: Completed
• Conditions: Forward Head Posture; Visual Fatigue
• Intervention / Treatment: Other: Oculomotor Exercise along with conventional Therapy; Other: sub-occipital muscle energy technique along with Conventional Therapy

Detailed Description

Studies have shown that integrating eye exercises with neck strengthening exercises has a significant effect in managing symptoms associated with visual disturbances and neck pain. For instance, a study conducted in 2024 to investigate the effect of oculomotor exercises in patients having chronic neck pain. Based on the result, they found that incorporating oculomotor exercises along with conventional exercises into treatment plan can significantly improve gaze stability, proprioception, visual acuity and fatigue in chronic neck pain patients. In 2023 study investigate the effectiveness of manual techniques for the management of FHP. They found that sub-occipital muscle energy technique is effective in improving CVA, cervical range of motion and postural alignment. study conducted in 2023 investigated the comparative effect sub-occipital muscle energy technique vs sub-occipital release in mechanical neck pain and FHP population. They concluded that group receiving MET show significant improvement in CVA, NDI and Cervical ROMs. Another research concluded that Sub-occipital muscle energy technique incorporating with proprioceptive training are effective in improving joint position sense (proprioception) and CVA in FHP population. A study evaluate the effectiveness of eye exercises on computer vision syndrome. They concluded the ocular exercises are effective in reducing visual fatigue symptoms such as eye itching, dryness and headache.

This research is innovative as it explores the interconnected roles of ocular muscles and sub-occipital muscles on visual fatigue, proprioception, and postural imbalances, particularly in FHP patients. As Literature suggest that tightness of suboccipital affect somatosensory input and proprioceptive information crucial for head and eye coordination. Thus, offering a comprehensive view of how FHP and visual fatigue are interconnected. Furthermore, the integration of oculomotor exercises in managing FHP-related visual fatigue is an underexplored as the existing literature primarily focuses on the musculoskeletal consequences of forward head posture and ocular exercises for visual disturbance without exploring the interaction between these factors. This research aimed to bridge the existing gap in literature by providing evidence-based guidance on the effectiveness of METs and oculomotor exercises in the management of visual symptoms associated FHP.

• Study Type: Interventional
• Enrollment (Actual): 44
• Phase: Not Applicable

Contacts and Locations

Study Locations

• Pakistan
  • Islamabad, Pakistan, 44000
    • Capital Diagnostic Center Islamabad
  • Islamabad, Pakistan, 44000
    • Care Plus Medical Center
  • Islamabad, Pakistan, 44000
    • National Institute of Rehabilitation

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: Adult
• Accepts Healthy Volunteers: No

Description

Inclusion Criteria:

• Age 20-50 years
• Both Male and Female
• Diagnosed patients of Forward head posture, Craniovertebral Angle less than 50 degree.
• Patients having Asthenopia survey questionnaire (ASQ-17) score of 13 or higher.

Exclusion Criteria:

• Participant failing to fall in this category would be excluded of the study.
• Pre-existing medical conditions that cause visual issues such as conjunctivitis, cataract, Strabismus anomaly, glaucoma and those undergoing any eye treatment.
• Any previous neck and Eye surgery.
• Cervical conditions such as cervical radiculopathy, non-specific neck pain, and TMJ dysfunction that cause visual disturbances.

Study Plan

How is the study designed?

Design Details

• Primary Purpose: Treatment
• Allocation: Randomized
• Interventional Model: Parallel Assignment
• Masking: Double

Number of Arms

2

Arms and Interventions

Participant Group / Arm	Intervention / Treatment
Experimental: oculomotor exercises along with conventional therapy	Other: Oculomotor Exercise along with conventional Therapy; Oculomotor Exercises: Saccadic eye movement, Smooth pursuit, Adaptation X1, Adaptation X2. Time duration will be 2 minutes for each exercise. conventional therapy: hot pack 20 mins Kendall exercises: Strengthening the deep cervical flexor, Stretching the cervical extensors, Strengthening shoulder retraction, Stretching of the pectoralis major muscle strengthening exercise: 12 repetitions* 3 sets, 2-8 sec hold stretching exercise was: 3 reps* 30 seconds' hold Total duration of treatment would be 4 weeks, 3 days a week with total 12 sessions.
Experimental: sub-occipital muscle energy technique along with Conventional Therapy; Sub-occipital muscle energy technique (PIR) 3 reps * 1 set conventional therapy: Hot pack 20 minutes Kendall exercises were performed as follows: strengthening exercise: 12 repetitions* 3 sets, 2-8 sec hold stretching exercise was: 3 reps* 30 seconds' hold; Strengthening the deep cervical flexors; Stretching the cervical extensors; Strengthening shoulder retraction; Stretching of the pectoralis major muscle	Other: sub-occipital muscle energy technique along with Conventional Therapy; Sub-occipital muscle energy technique (PIR) 3 rep * 1 set with 20 sec hold conventional therapy: hot pack 20 mins Kendall exercises: Strengthening the deep cervical flexor, Stretching the cervical extensors, Strengthening shoulder retraction, Stretching of the pectoralis major muscle strengthening exercise: 12 repetitions* 3 sets, 2-8 sec hold stretching exercise was: 3 reps* 30 seconds' hold Total duration of treatment would be 4 weeks, 3 days a week with total 12 sessions.

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Measure Description	Time Frame
visual fatigue	; Visul fatigue can be assessed by using Asthenopia Survey Questionnaire (ASQ-17). Responses are marked using four-point Likert scale with total score 51. Score range from 0-13 indicates no asthenopia, whereas the score range between 13-51 indicate asthenopia and need medical attention	4 weeks
propioception	cervical proprioception can be assed Cervical Joint Position Error (JPE) Test. Values > 4.5 degree indicate proprioception deficit	4 weeks
Craniovertebral Angle	Craniovertebral Angle can be measured by usng ON PROTRACTOR google App. Craniovertebral angle (CVA) values for individuals with moderate-severe forward head posture ranged from 40.7° to 43.2°, and for those with mild FHP, values ranged from 46.9° to 49.1 FHP. However, angle between 50- 57 degree is consider as normal.	4 weeks

Collaborators and Investigators

• Sponsor: Riphah International University
• Investigators: Principal Investigator: Dr Aneela Zia, ms-ompt, Riphah International University

Study record dates

Study Major Dates

• Study Start (Actual): November 11, 2024
• Primary Completion (Actual): August 28, 2025
• Study Completion (Actual): August 29, 2025

Study Registration Dates

• First Submitted: November 25, 2024
• First Submitted That Met QC Criteria: November 25, 2024
• First Posted (Actual): November 27, 2024

Study Record Updates

• Last Update Posted (Estimated): September 3, 2025
• Last Update Submitted That Met QC Criteria: September 1, 2025
• Last Verified: September 1, 2025

More Information

Terms related to this study

• Keywords: proprioception; forward head posture; Craniovertebral angle; visual fatigue; suboccipital muscles; , oculomotor exercises; muscle energy technique (PIR; VOR(vestibulo- ocular reflex); cervical spine.
• Additional Relevant MeSH Terms: Eye Diseases; Asthenopia
• Other Study ID Numbers: REC/02020 Amna Rashid.

Plan for Individual participant data (IPD)

• Plan to Share Individual Participant Data (IPD)?: NO

Drug and device information, study documents

• Studies a U.S. FDA-regulated drug product: No
• Studies a U.S. FDA-regulated device product: No