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

June 1, 2026 updated by: Maryam Safdar, University of Faisalabad

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

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.

Study Overview

Status

Not yet recruiting

Conditions

Intervention / Treatment

Detailed Description

Forward head posture represents a common cervical spinal deviation characterized by hyperextension of the upper cervical vertebrae combined with hyperflexion of the lower cervical region, ultimately producing excessive lordosis within the cervical spine. As a consequence, affected individuals experience difficulties performing their routine daily functions due to premature muscular fatigue in the neck region, diminished cervical stability, cervicogenic headache, and compromised postural regulation. 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.

Study Type

Interventional

Enrollment (Estimated)

28

Phase

  • Not Applicable

Contacts and Locations

This section provides the contact details for those conducting the study, and information on where this study is being conducted.

Study Contact

Study Contact Backup

Study Locations

  • Pakistan
    • Punjab Province
      • Faisalābad, Punjab Province, Pakistan, 38000
        • Anas Iqbal Physiotherapy and Rehabilitation Centre, Khadija tul Zahra Physiotherapy Centre
        • Contact:
        • Contact:

Participation Criteria

Researchers look for people who fit a certain description, called eligibility criteria. Some examples of these criteria are a person's general health condition or prior treatments.

Eligibility Criteria

Ages Eligible for Study

  • Adult

Accepts Healthy Volunteers

No

Description

Inclusion Criteria:

  • 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.

Exclusion Criteria:

  • 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.

Study Plan

This section provides details of the study plan, including how the study is designed and what the study is measuring.

How is the study designed?

Design Details

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

Arms and Interventions

Participant Group / Arm
Intervention / Treatment
Experimental: Group A (Blackburn exercises)
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)
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.
Active Comparator: Group B (Egoscue exercises)
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)
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.

What is the study measuring?

Primary Outcome Measures

Outcome Measure
Measure Description
Time Frame
Neck Pain
Time Frame: Baseline and Week 8th
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
Time Frame: Baseline and Week 8
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 Outcome Measures

Outcome Measure
Measure Description
Time Frame
Neck Disability Index
Time Frame: Baseline and Week 8
Originally developed in 1991, this instrument remains widely adopted for evaluating disability in individuals with neck pain. It comprises 10 items, each scored on a 6-point scale from 0 to 5, where 0 denotes no disability and 5 represents total disability. Item scores are aggregated to yield a total ranging from 0 to 50. Some investigators opt to multiply the total score by 2, thereby converting it to a percentage-based scale ranging from 0 to 100%
Baseline and Week 8

Collaborators and Investigators

This is where you will find people and organizations involved with this study.

Sponsor

University of Faisalabad

Investigators

  • Study Chair: Dr Muhammad Ateeb, PhD Public Health, The University of Faisalabad

Publications and helpful links

The person responsible for entering information about the study voluntarily provides these publications. These may be about anything related to the study.

General Publications

Study record dates

These dates track the progress of study record and summary results submissions to ClinicalTrials.gov. Study records and reported results are reviewed by the National Library of Medicine (NLM) to make sure they meet specific quality control standards before being posted on the public website.

Study Major Dates

Study Start (Estimated)

May 20, 2026

Primary Completion (Estimated)

September 20, 2026

Study Completion (Estimated)

September 20, 2026

Study Registration Dates

First Submitted

May 13, 2026

First Submitted That Met QC Criteria

June 1, 2026

First Posted (Actual)

June 3, 2026

Study Record Updates

Last Update Posted (Actual)

June 3, 2026

Last Update Submitted That Met QC Criteria

June 1, 2026

Last Verified

June 1, 2026

More Information

Terms related to this study

Keywords

Other Study ID Numbers

  • TUF/EIRB/178/26

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

This information was retrieved directly from the website clinicaltrials.gov without any changes. If you have any requests to change, remove or update your study details, please contact register@clinicaltrials.gov. As soon as a change is implemented on clinicaltrials.gov, this will be updated automatically on our website as well.

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