Acute Effects of Instrument-Assisted Soft Tissue Mobilization Added to Postural Corrective Exercises in Young Adults With Forward Head Posture

This study investigated the acute effects of instrument-assisted soft tissue mobilization added to postural corrective exercises in young adults with forward head posture. Participants were randomly allocated to one of three groups: instrument-assisted soft tissue mobilization plus postural corrective exercises, postural corrective exercises only, or control. The primary outcome was craniovertebral angle. Secondary outcomes included cervical joint repositioning error, deep cervical flexor muscle endurance, and scapular muscle endurance. All outcomes were assessed at baseline and 1 hour after the intervention by a blinded outcome assessor.

Study Overview

• Status: Completed
• Conditions: Forward Head Posture
• Intervention / Treatment: Other: Instrument-Assisted Soft Tissue Mobilization Plus Postural Corrective Exercises; Other: Postural Corrective Exercises

Detailed Description

Forward head posture is a common postural deviation in young adults and may be associated with altered cervicothoracic alignment, impaired cervical proprioception, and reduced cervical and scapular muscle endurance. Postural corrective exercises are commonly used in physiotherapy practice to improve head-neck posture and related neuromuscular control. Instrument-assisted soft tissue mobilization may provide additional acute effects through mechanical stimulation of soft tissues and proprioceptive input.

This single-blind randomized controlled trial evaluated the acute effects of instrument-assisted soft tissue mobilization added to postural corrective exercises in young adults with forward head posture. Eligible participants were randomly allocated in a 1:1:1 ratio to one of three groups: instrument-assisted soft tissue mobilization plus postural corrective exercises, postural corrective exercises only, or control. The control group received no intervention and was assessed at the same time intervals as the intervention groups. Outcome assessments were conducted by a blinded assessor at baseline and 1 hour after the intervention.

The primary outcome was craniovertebral angle, used as an indicator of forward head posture. Secondary outcomes included cervical joint repositioning error, deep cervical flexor muscle endurance, and scapular muscle endurance.

• Study Type: Interventional
• Enrollment (Actual): 45
• Phase: Not Applicable

Contacts and Locations

Study Locations

• Turkey (Türkiye)
  • Izmir, Turkey (Türkiye), 35340
    • Dokuz Eylul University Faculty of Physical Therapy and Rehabilitation

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: Adult
• Accepts Healthy Volunteers: Yes

Description

Inclusion Criteria:

• Individuals aged 18-25 years
• Presence of forward head posture
• Provision of written informed consent

Exclusion Criteria:

• History of any disease or surgical procedure affecting cervical or thoracic posture
• Any health condition preventing completion of the assessments

Study Plan

How is the study designed?

Design Details

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

Number of Arms

3

Arms and Interventions

Participant Group / Arm	Intervention / Treatment
Experimental: Instrument-Assisted Soft Tissue Mobilization Plus Exercise Group; Participants in this group received a single-session postural corrective exercise program and postural education in addition to instrument-assisted soft tissue mobilization applied to the cervicothoracic region.	Other: Instrument-Assisted Soft Tissue Mobilization Plus Postural Corrective Exercises; Participants received a single-session postural corrective exercise program and postural education in addition to instrument-assisted soft tissue mobilization. The exercise program included deep cervical flexor activation using the chin tuck exercise, active cervical range-of-motion exercises, scapular exercises, and pectoral stretching. Instrument-assisted soft tissue mobilization was applied bilaterally to the cervicothoracic region, including the upper and middle trapezius, sternocleidomastoid, levator scapulae, scalene, suboccipital, and cervical erector spinae muscles. The mobilization was applied for approximately 10 minutes using appropriate instruments.
Active Comparator: Exercise Group; Participants in this group received a single-session postural corrective exercise program and postural education.	Other: Postural Corrective Exercises; Participants received a single-session postural corrective exercise program and postural education. The exercise program included deep cervical flexor activation using the chin tuck exercise, active cervical flexion, extension, lateral flexion and rotation exercises, scapular exercises, and pectoral stretching.
No Intervention: Control Group; Participants in this group received no intervention and were assessed at the same time intervals as the intervention groups.

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Craniovertebral Angle	Craniovertebral angle was assessed using digital photographic postural analysis. Markers were placed on the tragus of the ear and the spinous process of C7, and the angle was calculated from a lateral-view photograph. Higher values indicate a more upright head posture.	Baseline and 1 hour after the intervention

Secondary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Cervical Joint Repositioning Error	Cervical joint repositioning error was assessed using a laser pointer system during cervical flexion, extension, right and left rotation, and right and left lateral flexion. Absolute repositioning error was calculated for each movement direction. Lower values indicate better cervical joint position sense.	Baseline and 1 hour after the intervention
Deep Cervical Flexor Muscle Endurance	Deep cervical flexor muscle endurance was assessed using the cervical flexor endurance test. The duration for which the participant could maintain the test position was recorded in seconds. Higher values indicate greater muscle endurance.	Baseline and 1 hour after the intervention
Scapular Muscle Endurance	Scapular muscle endurance was assessed using the scapular muscle endurance test. The duration for which the participant could maintain the required test position and resistance was recorded in seconds. Higher values indicate greater muscle endurance.	Baseline and 1 hour after the intervention

Collaborators and Investigators

• Sponsor: Dokuz Eylul University
• Collaborators: The Scientific and Technological Research Council of Turkey
• Investigators: Study Chair: Nihal Gelecek, Professor, Dokuz Eylul University

Study record dates

Study Major Dates

• Study Start (Actual): May 22, 2024
• Primary Completion (Actual): May 22, 2025
• Study Completion (Actual): June 18, 2025

Study Registration Dates

• First Submitted: May 19, 2026
• First Submitted That Met QC Criteria: May 19, 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 19, 2026
• Last Verified: May 1, 2026

More Information

Terms related to this study

• Keywords: Physiotherapy; Craniovertebral angle; Muscle endurance; Instrument-assisted soft tissue mobilization; Cervical proprioception; Postural corrective exercise
• Other Study ID Numbers: DEU-FTR-IK-04; 19198012327028 (Other Grant/Funding Number: The Scientific and Technological Research Council of Turkey)

Plan for Individual participant data (IPD)

• Plan to Share Individual Participant Data (IPD)?: NO
• IPD Plan Description: Individual participant data will not be shared because participant consent did not include public sharing of individual-level data.

Drug and device information, study documents

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