European Journal of Biomedical and Pharmaceutical Sciences

COMPARING THE EFFICACY OF VIRTUAL REALITY-BASED BIOFEEDBACK TRAINING VERSUS MANUAL THERAPY ON CRANIOVERTEBRAL ANGLE, CERVICAL PAIN INTENSITY, AND NECK DISABILITY IN PROFESSIONAL ESPORTS PLAYERS WITH TEXT NECK SYNDROME

Dr. Suman (PT), Prof. Dr. M. Riaz Baig Chughtai, Dr. M. Danial Baig Chughtai, Zubda Saleem, Dr. Sana Nawaz, DPT, MSCPPT, *Dr. Hafiza Mubashra, Faima Nisar

ABSTRACT

Background: The rapid global expansion of competitive esports has introduced a distinct occupational musculoskeletal profile among professional players, characterized by prolonged forward-head postures, sustained cervical flexion, and repetitive micro-movements during gameplay. This postural pattern, commonly termed 'text neck syndrome,' is associated with reduced craniovertebral angle (CVA), elevated cervical pain intensity, and functional neck disability. Objective: To compare the efficacy of virtual reality (VR) based biofeedback postural training against conventional manual therapy on CVA, cervical pain intensity, and neck disability index (NDI) in professional esports players diagnosed with text neck syndrome. Methods: In this assessor-blinded, parallel-group randomized controlled trial, 80 professional esports players (mean age 22.4 ± 3.1 years) with a CVA < 48° and NDI > 30% were randomly allocated to a VR Biofeedback Training Group (n = 40) or a Manual Therapy Group (n = 40) using computer-generated block randomization with concealed allocation. Both groups received 18 sessions over 6 weeks (3 sessions/week). Outcome measures — CVA (photogrammetric assessment), cervical pain intensity (Numeric Pain Rating Scale, NPRS), and neck disability (Neck Disability Index, NDI) — were recorded at baseline, 3 weeks, and 6 weeks by a blinded assessor. Results (illustrative/simulated): Both groups demonstrated statistically significant within-group improvement (p < 0.001). Between-group comparison favored the VR Biofeedback Training Group, with a mean CVA improvement of 7.6° versus 3.3° in the Manual Therapy Group (p < 0.001), NPRS reduction of 4.5 points versus 2.8 points (p < 0.001), and NDI reduction of 26.2% versus 16.2% (p < 0.001). Conclusion: VR based biofeedback training produced significantly greater improvements in craniovertebral angle, cervical pain intensity, and neck disability than manual therapy alone in professional esports players with text neck syndrome, suggesting its value as a technology-driven, self-monitored postural correction adjunct within esports athlete-care programs.

Keywords: Text neck syndrome; Virtual reality biofeedback; Manual therapy; Craniovertebral angle; Esports; Neck disability index; Forward head posture; Randomized controlled trial.