The Posture Committee of the American Academy of Orthopedic Surgery defines good posture as "that state of muscular and skeletal balance that protects the supporting structures of the body against injury or progressive deformity irrespective of the attitude (erect, lying, squatting, and stooping) in which these structures are working or resting." Under those conditions, the muscles will function most efficiently, and the Thoracic and abdominal organs will be in their optimal places.

The FHP is expected to have a major impact on respiratory function by weakening the accessory respiratory muscles. Persistent FHP weakens the muscles involved in breathing, leading to a decline in respiratory function. Also, it was suggested that FHP is quite common in undergraduate students and has significant effect on level of stress.

A vital component of the myofascial girdle envelops the lower torso, thoracolumbar fascia, participates in posture, load transfer, and breathing. The deep muscles at the back of the spine and the muscles in the abdomen are covered by the TLF. The latissimus dorsi, gluteus maximus, and other muscles in the area are related to a few muscles that engage in the movement of the proximal limbs, and the TLF functions as a force-transmitting structure.

When the upper extremities are impacted, the thoracolumbar fascia release (TLFR) technique should be considered, however, there has not been much research that uses TLFR for the upper extremities. The TLF works together by connecting with the deep core muscles. The medium and posterior parts of the TLF form the transversus abdominis, and the deep lamina is associated with the lumbar spinous processes .

The deep posterior layer continues cranially by merging with the splenius cervicis fascia. Therefore, TLF plays a role in Cervical region mobility. The TLFR increased bilateral sternocleidomastoid muscle resistance and decreased head-forward posture angle in the short term in young women with head-forward posture .

Another novel technique that is quickly gaining traction is IASTM, which allows physicians to treat patients with soft tissue dysfunction in a non-invasive manner. By remodeling connective tissue, resorbing excess fibrosis, recruiting fibroblasts, and inducing collagen repair and regeneration, IASTM mobilizes connective tissue and myofascial adhesions using specially designed instruments. The use of IASTM is recommended to improve the range of motions in healthy individuals, reduce pain in patients with musculoskeletal injuries.

However, there is a gap of empirical data establishing the effect of adding TLF release by IASTM to conventional treatment protocol of FHP on CVA, Cervical ROM, Cervical proprioception and stress level.

Therefore, this study sought to determine the effect of adding TLFR to conventional treatment protocol of FHP to improve CVA, Cervical ROM, Cervical proprioception and stress level.

Inclusion Criteria:

• Forward head posture subjects with CVA of < 52

• Subject's age ranged from 18-30 years old, with Body Mass Index (BMI) less than 30Kg/m2.

• Pain-free subjects for over 3 months, No PT intervention. Exclusion Criteria;

  1. Osteoporotic disorder.
  2. Any history of congenital deformities of the Cervical and Thoracic region.
  3. Recent injuries or fractures.
  4. Any inflammatory joint disorder.
  5. Malignancy.
  6. Vascular disorders.
  7. Neurological or psychiatric disorders.
  8. Any respiratory disease, presence of open wound/s, or history of surgery in the past 6 months.