Effect of Adding Thoracolumbar Fascia Release by IASTM to Conventional Treatment on Craniovertebral Angle in Forward Head Subjects (IASTM)

Influence of Thoracolumbar Fascial Release by Instrument Assisted Soft Tissue Moblization on Craniovertebral Angle in Forward Head Posture

The Posture Committee of the American Academy of Orthopedic Surgery defines good posture as "that state of muscular and skeletal balance that protects the supporting structures of the body against injury or progressive deformity irrespective of the attitude (erect, lying, squatting, and stooping) in which these structures are working or resting." Under those conditions, the muscles will function most efficiently, and the Thoracic and abdominal organs will be in their optimal places.

Study Overview

• Status: Recruiting
• Conditions: Forward Head Posture
• Intervention / Treatment: Device: Instrument assisted soft tissue moblization

Detailed Description

The FHP is expected to have a major impact on respiratory function by weakening the accessory respiratory muscles. Persistent FHP weakens the muscles involved in breathing, leading to a decline in respiratory function. Also, it was suggested that FHP is quite common in undergraduate students and has significant effect on level of stress.

A vital component of the myofascial girdle envelops the lower torso, thoracolumbar fascia, participates in posture, load transfer, and breathing. The deep muscles at the back of the spine and the muscles in the abdomen are covered by the TLF. The latissimus dorsi, gluteus maximus, and other muscles in the area are related to a few muscles that engage in the movement of the proximal limbs, and the TLF functions as a force-transmitting structure.

When the upper extremities are impacted, the thoracolumbar fascia release (TLFR) technique should be considered, however, there has not been much research that uses TLFR for the upper extremities. The TLF works together by connecting with the deep core muscles. The medium and posterior parts of the TLF form the transversus abdominis, and the deep lamina is associated with the lumbar spinous processes .

The deep posterior layer continues cranially by merging with the splenius cervicis fascia. Therefore, TLF plays a role in Cervical region mobility. The TLFR increased bilateral sternocleidomastoid muscle resistance and decreased head-forward posture angle in the short term in young women with head-forward posture .

Another novel technique that is quickly gaining traction is IASTM, which allows physicians to treat patients with soft tissue dysfunction in a non-invasive manner. By remodeling connective tissue, resorbing excess fibrosis, recruiting fibroblasts, and inducing collagen repair and regeneration, IASTM mobilizes connective tissue and myofascial adhesions using specially designed instruments. The use of IASTM is recommended to improve the range of motions in healthy individuals, reduce pain in patients with musculoskeletal injuries.

However, there is a gap of empirical data establishing the effect of adding TLF release by IASTM to conventional treatment protocol of FHP on CVA, Cervical ROM, Cervical proprioception and stress level.

Therefore, this study sought to determine the effect of adding TLFR to conventional treatment protocol of FHP to improve CVA, Cervical ROM, Cervical proprioception and stress level.

• Study Type: Interventional
• Enrollment (Estimated): 30
• Phase: Not Applicable

Contacts and Locations

• Study Contact: Name: Mariam M Abdallah, Assistant lecturer; Phone Number: +201221337723; Email: mariam.youssef@cu.edu.eg
• Study Contact Backup: Name: Aya M Mohamed, Lecturer; Phone Number: +201066925459; Email: aya_mahmoud_mohamed@cu.edu.eg

Study Locations

• Egypt
  • Giza Governorate
    • Giza, Giza Governorate, Egypt, 12611
      • Recruiting
      • Faculty of physical therapy
      • Principal Investigator: Ragia M kamel, professor
      • Sub-Investigator: Mary K Nassif, Assistant professor
      • Sub-Investigator: Aya M Mohamed, lecturer

Participation Criteria

Eligibility Criteria

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

Description

Inclusion Criteria:

• Forward head posture subjects with CVA of < 52
• Subject's age ranged from 18-30 years old, with Body Mass Index (BMI) less than 30Kg/m2.

• Pain-free subjects for over 3 months, No PT intervention. Exclusion Criteria;

  1. Osteoporotic disorder.
  2. Any history of congenital deformities of the Cervical and Thoracic region.
  3. Recent injuries or fractures.
  4. Any inflammatory joint disorder.
  5. Malignancy.
  6. Vascular disorders.
  7. Neurological or psychiatric disorders.
  8. Any respiratory disease, presence of open wound/s, or history of surgery in the past 6 months.

Study Plan

How is the study designed?

Design Details

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

Number of Arms

2

Arms and Interventions

Participant Group / Arm	Intervention / Treatment
Other: control group; Control group (conventional treatment protocol): The control group will receive firstly, Kendall exercises; every strengthening exercise will be repeated for 12 repetitions and done for 3 sets and each stretching exercise will be held for 30 seconds and repeated 3 times. Then, participants will receive IASTM application on cervical muscles as follows: IASTM for upper fibers of trapezius, levator scapulae muscles and scalnae.	Device: Instrument assisted soft tissue moblization; Instrument-assisted soft tissue mobilization (IASTM) is a special instrument with beveled edges to assist the clinician in the evaluation and mobilization of soft tissue. Instruments are used in a multi directional stroking fashion applied to the skin at 30°-60° angles to detect soft tissue irregularities via the undulation of the tools. It has been purported to enhance proliferation of extracellular matrix fibro blasts, improve ion transport, and decrease cell matrix adhesions; Other Names: IASTM
Experimental: experimental group; participants will receive same protocol as control group (IASTM on cervical muscles and Kendel exercises) in addition to Thoraco lumber fascia release using IASTM tool	Device: Instrument assisted soft tissue moblization; Instrument-assisted soft tissue mobilization (IASTM) is a special instrument with beveled edges to assist the clinician in the evaluation and mobilization of soft tissue. Instruments are used in a multi directional stroking fashion applied to the skin at 30°-60° angles to detect soft tissue irregularities via the undulation of the tools. It has been purported to enhance proliferation of extracellular matrix fibro blasts, improve ion transport, and decrease cell matrix adhesions; Other Names: IASTM

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Craniovertebral angle(CVA)	Craniovertebral angle (CVA) is a line drawn from the tragus of the ear to the C7 vertebra intersects a horizontal line. It is used to measure the value of FHP, and the greater the value of this angle, the more forward the head is positioned on the neck. A vast variety of names exist for this angle, such as sagittal C7-tragus angle, sagittal plane head alignment, neck inclination angle, Cervical angle, head protrusion angle, head position, FHP, forward head position, and head anteriorization in relation to Cervical vertebra	measurement at Day 1 then after 1 month

Secondary Outcome Measures

Outcome Measure	Measure Description	Time Frame
cervical range of motion	flexion ,extension,sidebending ,rotation	measurement at Day 1 then after 1 month
cervical proprioception	flexion, extension,sidebending,rotation	measurement at Day 1 then after 1 month
Cohen perceived stress scale	Arabic version for stress scale	measurement at Day 1 then after 1 month

Collaborators and Investigators

• Sponsor: Cairo University

Study record dates

Study Major Dates

• Study Start (Actual): March 4, 2026
• Primary Completion (Estimated): December 18, 2026
• Study Completion (Estimated): January 18, 2027

Study Registration Dates

• First Submitted: May 1, 2026
• First Submitted That Met QC Criteria: May 18, 2026
• First Posted (Actual): May 26, 2026

Study Record Updates

• Last Update Posted (Actual): May 26, 2026
• Last Update Submitted That Met QC Criteria: May 18, 2026
• Last Verified: February 1, 2026

More Information

Terms related to this study

• Keywords: FHP
• Other Study ID Numbers: Faculty of Physical Therapy CU

Plan for Individual participant data (IPD)

• Plan to Share Individual Participant Data (IPD)?: UNDECIDED

Drug and device information, study documents

• Studies a U.S. FDA-regulated drug product: No
• Studies a U.S. FDA-regulated device product: No
• product manufactured in and exported from the U.S.: No