Comparative Effects of Suboccipital Muscle Inhibition vs Instrument Assisted Soft Tissue Mobilization in Forward Head Posture

Summary

Forward Head Posture (FHP) is a prevalent postural dysfunction characterized by anterior displacement of the head relative to the shoulder line. It is often linked to musculoskeletal pain, restricted cervical mobility, and altered muscle activation patterns. The condition manifests with shortening of the upper trapezius, suboccipital muscles, semispinalis, splenius capitis, Sternocleidomastoid (SCM), and levator scapulae. Concurrently, there is weakness or inhibition in the deep cervical flexors, resulting in an imbalance between the cervical flexor and extensor muscle groups. These muscular imbalances contribute to dysfunctional cervical movement patterns, altered proprioception, and increased joint loading, particularly at the atlanto-occipital and cervico-thoracic junctions. The objective of this randomized controlled trial is to compare the effectiveness of Sub-Occipital Muscle Inhibition (SMI) and Instrument Assisted Soft Tissue Mobilization (IASTM) in improving postural alignment, reducing pain, and enhancing cervical range of motion in individuals with Forward Head Posture. It will address a common postural and musculoskeletal problem that affects a large portion of the population which will contribute to a more effective management approach for Forward Head Posture and will guide clinicians in selecting targeted, evidence-based therapies for their patients with FHP. As there is a lack of comparative studies assessing their relative effectiveness specifically for FHP, it will contribute novel data to the field of physiotherapy and rehabilitation science. A total of 38 participants with FHP will be randomly assigned into two equal groups (n=19). Group A will receive conventional physiotherapy along with Sub-Occipital Muscle Inhibition, while Group B will receive conventional physiotherapy combined with Instrument Assisted Soft Tissue Mobilization. Both groups will undergo 18 treatment sessions over six weeks, administered on alternate days. Both interventions are expected to show positive outcomes in improving FHP; however, the study aims to determine which technique is more effective. The results will help clinicians understand which manual therapy methods work best. This can make it easier for them to choose the right treatment for Forward Head Posture. Using proven techniques can improve patient comfort and recovery. In the end, it will help to provide advance approach and more personalised care for the patients.

Conditions

• Forward Head Posture
• Occipital Muscle Inhibition Technique

Interventions

PROCEDURE

suboccipital muscle inhibition

Group A will receive total 18 sessions in 6 weeks (3 sessions per week on alternate days). Each session will begin with application of a hot pack to the posterior cervical area (upper cervical spine) for 10 minutes while the patient lies in a relaxed prone position.Following thermotherapy, Group A will undergo sub occipital muscle inhibition. The subjects will be placed in the supine position, with their eyes closed; the evaluator will sit at the head of an adjustable table and placed both palms under the subjects' head, contacting the evaluator's index, middle, and ring fingertips of both hands with the metacarpophalangeal joints in 90◦ flexion between the spinous process of the second cervical vertebra and the occipital condyles. Thereafter, painless and constant pressure will be exerted upward and toward the evaluator the pressure will be maintained for 2 minutes until tissue relaxation of the suboccipital region has been achieved.

PROCEDURE

Instrument assisted soft tissue mobilization

Group B will receive total 18 sessions in 6 weeks (3 sessions per week on alternate days). Each session will begin with application of a hot pack to the posterior cervical area (upper cervical spine) for 10 minutes while the patient lies in a relaxed prone position. Following thermotherapy, Group B will undergo IASTM. Firstly explain the procedure, Position the patient comfortably to expose the target area. Apply emollient (e.g., massage cream or lubricant) to reduce friction. The technique will be delivered in unidirectional for 3- 5 minutes per muscle group, with controlled pressure and specific strokes (e.g., sweeping, fanning, strumming) adjusted according to patient tolerance (3 sessions/week).Then a structured stretching protocol will be implemented to address tight musculature in Forward Head Posture (FHP). The targeted muscles include the pectoralis major, levator scapulae, sternocleidomastoid, and upper trapezius.

Sponsors & Collaborators

• Foundation University Islamabad

  lead OTHER

Principal Investigators

• Iqra Shafiq, DPT · Foundation University Islamabad

Study Design

Allocation

RANDOMIZED

Purpose

TREATMENT

Masking

NONE

Model

PARALLEL

Eligibility

Min Age

18 Years

Max Age

40 Years

Sex

ALL

Healthy Volunteers

No

Timeline & Regulatory

Start

2026-05-13

Primary Completion

2026-07-01

Completion

2026-07-15

Countries

• Pakistan

Study Locations