Effectiveness of Chin Tuck Versus Scapular Retraction Exercises Combined With Posture Education in Students With Smartphone-Related Forward Head Posture: A Randomized Controlled Trial

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Published: 2026-06-10
DOI: https://doi.org/10.61919/3z7d2063
Keywords:
Forward Head Posture; Chin Tuck Exercise; Scapular Retraction; Posture Education; Smartphone Use; Neck Pain; Neck Disability Index; Randomized Controlled Trial.

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Rabia Pervaiz
Al Razi Institute, Pakistan
Mahwash Zulfiqar Khan
Head of Department, Department of Physical Therapy, Al Razi Institute, Pakistan
Nusrat Qamar
Head of Department, Department of Physical Therapy, Khalid Mehmood Institute of Medical Sciences, Sialkot, Pakistan
Syed Ihtisham Ahmed
Project Director, Al Razi Institute, Pakistan
Syeda Iqra Bukhari
Statistician, Al Razi Institute, Pakistan.

Abstract

Background: Smartphone-related forward head posture is increasingly common among students and may contribute to neck pain, rounded shoulders, neck fatigue, upper-back tightness, and functional disability. Chin tuck and scapular retraction exercises are frequently prescribed with posture education, but comparative evidence regarding their outcome-specific effects remains limited. Objective: To compare the effects of chin tuck exercises versus scapular retraction exercises, both combined with posture education, on pain intensity and neck-related disability among students with smartphone-related forward head posture. Methods: This randomized controlled trial included 126 students aged 18–30 years with smartphone-related forward head posture. Participants were allocated equally to chin tuck plus posture education or scapular retraction plus posture education for eight weeks. Pain intensity was assessed using the Numeric Pain Rating Scale, and disability was assessed using the Neck Disability Index at baseline and after intervention. Group comparisons, within-group changes, Mann–Whitney U tests, and regression analyses were performed. Results: Both groups showed significant pre–post improvements in pain and disability. NPRS improvement was greater in the scapular retraction group than in the chin tuck group, 2.08 ± 0.49 versus 1.84 ± 0.60, p = .016. NDI improvement was greater in the chin tuck group than in the scapular retraction group, 14.40 ± 6.94 versus 7.25 ± 5.18, p < .001. Conclusion: Both interventions improved symptoms and disability, with scapular retraction showing slightly greater pain reduction and chin tuck showing greater disability improvement. Baseline disability imbalance warrants cautious interpretation.

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Vol. 4 No. 11 (2026): Volume 4, Issue 11 (June 2026)

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Articles
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This work is licensed under a Creative Commons Attribution 4.0 International License.

How to Cite

1.
Rabia Pervaiz, Mahwash Zulfiqar Khan, Nusrat Qamar, Syed Ihtisham Ahmed, Syeda Iqra Bukhari. Effectiveness of Chin Tuck Versus Scapular Retraction Exercises Combined With Posture Education in Students With Smartphone-Related Forward Head Posture: A Randomized Controlled Trial. JHWCR [Internet]. 2026 Jun. 10 [cited 2026 Jun. 11];4(11):1-13. Available from: https://www.jhwcr.com/index.php/jhwcr/article/view/1743

References

1. Alghadir AH, Gabr SA, Rizk AA, Alghadir T, Alghadir F, Iqbal A. Smartphone addiction and musculoskeletal associated disorders in university students: biomechanical measures and questionnaire survey analysis. Eur J Med Res. 2025;30(1):274.

2. Rafiyan M, Azadchehr MJ, Fazeli AM, Jalalati N. Examining the prevalence of neck and hand disorders and its relationship with smartphone addiction in medical students. BMC Musculoskelet Disord. 2025;26(1):621.

3. Elvan A, Cevik S, Vatansever K, Erak I. The association between mobile phone usage duration, neck muscle endurance, and neck pain among university students. Sci Rep. 2024;14(1):20116.

4. Maayah MF, Nawasreh ZH, Gaowgzeh RAM, Neamatallah Z, Alfawaz SS, Alabasi UM. Neck pain associated with smartphone usage among university students. PLoS One. 2023;18(6):e0285451.

5. Eitivipart AC, Viriyarojanakul S, Redhead L. Musculoskeletal disorder and pain associated with smartphone use: a systematic review of biomechanical evidence. Hong Kong Physiother J. 2018;38(2):77-90.

6. Namwongsa S, Puntumetakul R, Neubert MS, Boucaut R. Factors associated with neck disorders among university student smartphone users. Work. 2018;61(3):367-378.

7. Kim EY, Kim KJ, Park HR. Comparison of the effects of deep neck flexor strengthening exercises and Mackenzie neck exercises on head forward postures due to the use of smartphones. Indian J Sci Technol. 2015;8(Suppl 7):569-575.

8. Gurudut P, Welling A, Chodankar A. Effect of self-care exercises in forward head posture on craniovertebral angle and craniocervical flexion endurance: a pilot study. Indian J Phys Ther Res. 2020;2(1):25-30.

9. Kang NY, Im SC, Kim K. Effects of a combination of scapular stabilization and thoracic extension exercises for office workers with forward head posture on the craniovertebral angle, respiration, pain, and disability: a randomized-controlled trial. Turk J Phys Med Rehabil. 2021;67(3):291.

10. Kang NY, Kim K. Effects of a combination of scapular stabilization and thoracic extension exercises on respiration, pain, craniovertebral angle and cervical range of motion in elementary school teachers with a forward head posture: a randomized controlled trial. Korean Soc Phys Med. 2022;17(2):29-40.

11. Banadaki FD, Rahimian B, Moraveji F, Varmazyar S. The impact of smartphone use duration and posture on the prevalence of hand pain among college students. BMC Musculoskelet Disord. 2024;25(1):574.

12. Walankar PP, Kemkar M, Govekar A, Dhanwada A. Musculoskeletal pain and risk factors associated with smartphone use in university students. Indian J Occup Environ Med. 2021;25(4):220-224.

13. Hanphitakphong P, Keeratisiroj O, Thawinchai N. Smartphone addiction and its association with upper body musculoskeletal symptoms among university students classified by age and gender. J Phys Ther Sci. 2021;33(5):394-400.

14. Elsiddig AI, Altalhi IA, Althobaiti ME, Alwethainani MT, Alzahrani AM. Prevalence of neck and shoulder pain among Saudi universities’ students who are using smartphones and computers. J Family Med Prim Care. 2022;11(1):194-200.

15. Sirajudeen MS, Alzhrani M, Alanazi A, Alqahtani M, Waly M, Manzar MD, et al. Prevalence of upper limb musculoskeletal disorders and their association with smartphone addiction and smartphone usage among university students in the Kingdom of Saudi Arabia during the COVID-19 pandemic: a cross-sectional study. Healthcare. 2022.

16. Tangmunkongvorakul A, Musumari PM, Tsubohara Y, Ayood P, Srithanaviboonchai K, Techasrivichien T, et al. Factors associated with smartphone addiction: a comparative study between Japanese and Thai high school students. PLoS One. 2020;15(9):e0238459.

17. Khalily MT, Loona MI, Bhatti MM, Ahmad I, Saleem T. Smartphone addiction and its associated factors among students in twin cities of Pakistan. J Pak Med Assoc. 2020;70(8):1357-1362.

18. Alsalameh AM, Harisi MJ, Alduayji MA, Almutham AA, Mahmood FM. Evaluating the relationship between smartphone addiction/overuse and musculoskeletal pain among medical students at Qassim University. J Family Med Prim Care. 2019;8(9):2953-2959.

19. Azizi A, Emamian MH, Hashemi H, Fotouhi A. Smartphone addiction in Iranian schoolchildren: a population-based study. Sci Rep. 2024;14(1):22304.

20. Ay MK, Topuzoğlu A, Altaş ZM. Smartphone addiction and depression among health sciences students during COVID-19 pandemic. BMC Public Health. 2024;24(1):3502.

21. Mokhtarinia HR, Torkamani MH, Farmani O, Biglarian A, Gabel CP. Smartphone addiction in children: patterns of use and musculoskeletal discomfort during the COVID-19 pandemic in Iran. BMC Pediatr. 2022;22(1):681.

22. Kalirathinam D, Manoharlal MA, Mei C, Ling CK, Sheng TWY, Jerome A, et al. Association between the usage of smartphone as the risk factor for the prevalence of upper extremity and neck symptoms among university students: a cross-sectional survey based study. Res J Pharm Technol. 2017;10(4):1184.

23. Kim EY, Kim KJ, Park HR. Comparison of the effects of deep neck flexor strengthening exercises and Mackenzie neck exercises on head forward postures due to the use of smartphones. Indian J Sci Technol. 2015;8(Suppl 7):569-575.

24. Joshi R, Poojary N. The effect of muscle energy technique and posture correction exercises on pain and function in patients with non-specific chronic neck pain having forward head posture: a randomized controlled trial. Int J Ther Massage Bodywork. 2022;15(2):14.

25. Gurudut P, Gauns SV. Effect of kinesio taping on neck flexors and craniovertebral angle in subjects with forward head posture: a randomized controlled trial. Int J Physiother Res. 2016;4(6):1728-1735.

26. Pawaria S, SuDhan DS, Kalra S. Effectiveness of cervical stabilisation exercises on respiratory strength in chronic neck pain patients with forward head posture: a pilot study. J Clin Diagn Res. 2019;13(4):6-9.

27. Yu LJ, Kim TH. The effect of cervical stabilization exercises with thoracic spine extension exercises on forward head posture. Int J Hum Mov Sports Sci. 2021;9(5):852-857.

28. Balthillaya G, Bhat SN, Rao BK. Immediate effects of posture correction taping on pain, cervical range of motion, and scapulothoracic muscle activity in individuals with forward head posture and mechanical neck pain: a randomized controlled trial in India. Asian Spine J. 2025;19(5):698.

29. Shabana AMM, Hanafy AF, Yamany AS, Ashour RS. Effect of core stabilization exercises on cervical sagittal balance parameters in patients with forward head posture: a randomized controlled trial in Egypt. Asian Spine J. 2025;19(1):85.

30. Ali AA, Sheikh N, Chughani V, Hussain A, Rafique M, Ismail M, Khokhar HI. Comparison of effectiveness of isometric and stretching exercise in pain management among the forward head posture patients. Indian J Physiother Occup Ther. 2021;15(2).

31. Sawant SA, Desai MS, Kumar A. Immediate and long-term effect of kinesiotaping on cervical core in forward head posture: one-week follow-up study. Int J Physiother Res. 2017;5(6):2521-2526.

32. Gauns SV, Gurudut PV. A randomized controlled trial to study the effect of gross myofascial release on mechanical neck pain referred to upper limb. Int J Health Sci. 2018;12(5):51.

33. Kage V, Joshi P. Immediate effects of triplanar myofascial release versus suboccipital release in subjects with non-specific neck pain: a clinical trial. Int J Physiother Res. 2017;5(3):2056-2060.

34. Shabbir M, Arshad N, Naz A, Saleem N. Clinical outcomes of Maitland mobilization in patients with myofascial chronic neck pain: a randomized controlled trial. Pak J Med Sci. 2021;37(4):1172.

35. Öcalan MÇ, Ay S, Günaydın EB. Myofascial release therapy in patients with cervical myofascial pain syndrome: a randomized-controlled trial. Turk J Phys Med Rehabil. 2025;71(4):574.

36. Aggarwal A, Gadekar J, Kakodkar P. Role of myofascial release technique on mobility and function in temporomandibular joint disorder patients with neck pain. J Dent Res Rev. 2020;7(1 Suppl):S84-S87.

37. Ramezani E, Arab AM, Nourbakhsh MR. Sub-occipital myofascial release technique in subjects with cervicogenic headache. Pharmacophore. 2017.

38. Wadhokar O, Patil D, Phansopkar P. Efficacy of sub-occipital myofascial release technique on functional disability in temporomandibular dysfunction with neck pain: a randomized control trial.

39. Calvo I, Sunday KL, Macrae P, Humbert IA. Effects of chin-up posture on the sequence of swallowing events. Head Neck. 2017;39(5):947-959.

40. Leigh JH, Oh BM, Seo HG, Lee GJ, Min Y, Kim K, et al. Influence of the chin-down and chin-tuck maneuver on the swallowing kinematics of healthy adults. Dysphagia. 2015;30(1):89-98