PROCEDURE:

Before the experiment, according to the Declaration of Helsinki, the purpose and procedures of the study were fully explained to all subjects, and all subjects subsequently voluntarily agreed to enroll in the present study.

All subjects would be screened keeping in mind the inclusion and exclusion criteria and subjects and those who are appropriate to the study would be chosen.

Written consent form will be signed by subjects who will be included in study.

MEASUREMENT OF CV ANGLE FOR FORWARD HEAD POSTURE

In this study photogrammetry method, a digital imaging technique was used to evaluate the head and neck posture. An iphone 15 pro max has a trio of lenses: wide, ultrawide and telephoto. The main camara has a 48- megapixel sensor, while the other two have a resolution of 12-megapixel   camera was placed at a distance of 1.5 meter from a subject distance and height was adjusted according to the level of the subject’s shoulder, colored body markers was placed on tragus of ears and C7cervical spine of the subjects. The participant was asked to face straight and positioned lateral to the camera.

First, subjects were instructed to sit on a chair in a straight position and ankle, knee and hip joint at 90ºand face forward. The researcher asked the subject to flex and ex­tend the neck for a few times before assuming the sitting resting posture. All participants were instructed, prior to photo capturing, to assume a relaxed resting posture while looking forward at the target with arm rested beside the body. Then, three sagittal plane photos were taken by the digital camera from each side and saved to a personal com­puter for further analysis. Repeated photographs aimed at reducing bias due to subject’s tension during photography capturing as well as to overcome the difference between measurements because of postural swaying [34].

Then the photography was transferred to computer and analyzed using kinovea software. A virtual line was drawn between the midpoint of tragus to C7 spinous process and a horizontal line through the spinous process of C7vertebrae. Subjects having CV angle less than 50Ë™ would be considered as having forward head posture.

MEASUREMENTS OF ROUNDED SHOULDER POSTURE

All the subjects who participated in the experiments were instructed to sit on a chair with, to position their ankle, knee, and hip joint at 90° and to face forward. Photos were taken using smartphones to classify the degrees of the upper crossed syndrome, and the photos were analyzed using Dartfish software (DFKOREA, Korea). The distances between the lateral centre line of the shoulder and the lateral centre line of the ear were measured, and those with the lateral centre line of the shoulder positioned less than 1 cm forward from the lateral centre line of the ear were classified as the normal group, those with the lateral centre line of the shoulder positioned 1–2.5 cm forward from the lateral centre line of the ear were classified as the mild upper crossed syndrome group, and those with the lateral centre line of the shoulder positioned 2.5–5 cm forward from the lateral centre line of the ear were classified as the moderate upper crossed syndrome group [9].

MEASUREMENTS OF CLAVICULAR TILT ANGLE

The subjects Sit straight with neutral forearm and resting hand position at the sides. The examiner marked two landmarks with round stickers at the midpoint of the end of the medial clavicle and the midpoint of the end of the lateral clavicle (Ha et al, 2013). Then, a digital camera captured a photographic image 2 m away from the subject’s frontal side. Clavicular tilt angle was defined as the angle between the             line joining the medial and lateral end of the clavicle and a horizontal line from the medial end of the clavicle (Akel et al, 2008) and was calculated automatically using Image kinovea software.

Modified Neck disability indices (NDI) were used to measure neck pain and functional disability, and consisted of 10 items: degree of pain, daily living, lifting, reading, headache, concentration level, work, driving, sleep and leisure activity, each of which was graded from 0 to 5, to a total of 0–55. 0–4 represented no disability, 5–14, mild disability, 15–24, moderate disability, 25–34, severe disability, and ≥35, complete disability [14].