To compare the effect of post-isometric relaxation versus positional release technique with therapeutic ultrasound on forward head posture in smartphone users

Abstract

Background: Prolonged smartphone use promotes sustained neck flexion and repetitive muscle loading, predisposing to forward head posture, neck pain and functional disability. Post-isometric relaxation and positional release technique are commonly used approaches for myofascial dysfunction, often combined with therapeutic ultrasound.​ Objective: To compare the effectiveness of post-isometric relaxation versus positional release technique, each combined with therapeutic ultrasound, on pain, pressure pain threshold, neck disability and upper trapezius muscle thickness in smartphone users with forward head posture.​ Methods: Sixty participants aged 18-45 years with FHP and upper trapezius trigger points were randomly allocated into two groups (n=30 each). Group A received PIR with therapeutic ultrasound; Group B received PRT with therapeutic ultrasound, 3 sessions/week for 4 weeks. Outcomes: Numerical Pain Rating Scale (NPRS), pressure pain threshold (PPT) via algometer, Neck Disability Index (NDI), diagnostic ultrasound for muscle thickness. Assessments at baseline and week 4. Paired t-tests/wilcoxon for within-group; independent t-tests/mann-whitney for between-group (p<0.05).​ Results: Both groups improved significantly (p=0.0001 within-group). Group A: NPRS 7.6±0.91 to 2.86±0.66 (↓62.3%); PPT 3.76±0.56 to 8.8±1.01 kg/cm² (↑134.1%); NDI 37.86±6.21 to 18.6±3.90 (↓50.8%); muscle thickness 1.48±0.14 to 0.96±0.09 cm (↓35.1%). Group B showed lesser gains. Between-group: Group A superior (p<0.05 all outcomes).​ Conclusion: Ultrasound with PIR was superior to ultrasound with PRT for pain relief, PPT increase, disability reduction and muscle thickness normalization in smartphone users with FHP.​