Symmetrical Scapula-pelvis Proprioceptive Neuromuscular Facilitation and Superficial Back Line in Chronic Neck Pain With Hamstring Tightness

March 8, 2026 updated by: Aftab Ahmed Mirza Baig,DPT, MSAPT, University of Karachi
A research study will be conducted at Physiotherapy department of the Sindh Institute of Physical Medicine and Rehabilitation, Karachi, Pakistan. Overall 156 patients with 18-40 years old individuals with neck pain will be eligible and they will be included through non-probability, purposive sampling technique. The written informed consent will be taken from all the patients. They will be divided through Simple random sampling (computer generated software) method into two groups, 78 in each group. Group A (experimental group) will receive PNF Symmetrical Scapula-Pelvis Patterns (PNF-SSPP), group B (control group) will receive sub occipital muscle inhibition technique (SMI) and static stretching (SS) of hamstring muscle. All participants will be assessed using assessment form. Outcome measures will be Pain, disability, disability, neck range of motions, hamstring tightness, head posture, and levator scapulae index. An independent assessor blinded to the treatment will assess all the patients for treatment outcome assessment at baseline, after first session and post treatment. Treatment sessions will be given thrice a week for 6 weeks.

Study Overview

Status

Status

Indicates the current recruitment status or the expanded access status.
Recruiting

Conditions

Conditions

The disease, disorder, syndrome, illness, or injury that is being studied. On ClinicalTrials.gov, conditions may also include other health-related issues, such as lifespan, quality of life, and health risks.

Intervention / Treatment

Intervention / Treatment

A process or action that is the focus of a clinical study. Interventions include drugs, medical devices, procedures, vaccines, and other products that are either investigational or already available. Interventions can also include noninvasive approaches, such as education or modifying diet and exercise.

Detailed Description

A maximum drop-out rate of 20% is expected. The Statistical package for the social sciences (SPSS) 23 version will be used for data analysing. The Mean ± SD will be calculated for quantitative variables like age. The qualitative variables will be shown through calculated frequencies and percentages. The outcome results of the study (decrease pain intensity, improve disability, improve ROM and improve muscle tightness) taken before, after 1st session and after 18th session will be compared and analyzed. The repeated measure of ANOVA will be used as the statistical test. The p-value of 0.05 will be considered as level of significant.

Study Type

Study Type

Describes the nature of a clinical study. Study types include interventional studies (also called clinical trials), observational studies (including patient registries), and expanded access.
Interventional

Enrollment (Estimated)

Enrollment

The number of participants in a clinical study. The "anticipated" enrollment is the target number of participants that the researchers need for the study.
156

Phase

Phase

The stage of a clinical trial studying a drug or biological product, based on definitions developed by the U.S. Food and Drug Administration (FDA). The phase is based on the study's objective, the number of participants, and other characteristics. There are five phases: Early Phase 1 (formerly listed as Phase 0), Phase 1, Phase 2, Phase 3, and Phase 4. Not Applicable is used to describe trials without FDA-defined phases, including trials of devices or behavioral interventions.
  • Not Applicable

Contacts and Locations

This section provides the contact details for those conducting the study, and information on where this study is being conducted.

Study Contact

Study Contact

The name and contact information for the person who can answer enrollment questions for a clinical study. Each location where the study is being conducted may also have a specific contact, who may be better able to answer those questions.

Study Contact Backup

Study Locations

  • Pakistan
    • Sindh
      • Karachi, Sindh, Pakistan, 75300
        • Recruiting
        • Sindh Institute of Physical Medicine and Rehabilitation
        • Contact:

Participation Criteria

Researchers look for people who fit a certain description, called eligibility criteria. Some examples of these criteria are a person's general health condition or prior treatments.

Eligibility Criteria

Eligibility Criteria

The key requirements that people who want to participate in a clinical study must meet or the characteristics they must have. Eligibility criteria consist of both inclusion criteria (which are required for a person to participate in the study) and exclusion criteria (which prevent a person from participating). Types of eligibility criteria include whether a study accepts healthy volunteers, has age or age group requirements, or is limited by sex.

Ages Eligible for Study

  • Adult

Accepts Healthy Volunteers

No

Description

Inclusion Criteria:

  • Individual with both male and female gender
  • Individuals with chronic neck pain (pain for > 3 month) with hamstring tightness

Exclusion Criteria:

  • Any history related to spinal surgery
  • Previous administration of epidural injections
  • Neck pain due to specific pathology
  • Patients with radiculopathy or myelopathy
  • Traumatic spinal cord injury
  • Neck pain associated with progressive neurological deficit or loss of strength

Study Plan

This section provides details of the study plan, including how the study is designed and what the study is measuring.

How is the study designed?

Design Details

  • Primary Purpose: Treatment
  • Allocation: Randomized
  • Interventional Model: Parallel Assignment
  • Masking: Single

Arms and Interventions

Participant Group / Arm

Participant Group / Arm

A group or subgroup of participants in a clinical trial that receives a specific intervention/treatment, or no intervention, according to the trial's protocol.
Intervention / Treatment

Intervention / Treatment

A process or action that is the focus of a clinical study. Interventions include drugs, medical devices, procedures, vaccines, and other products that are either investigational or already available. Interventions can also include noninvasive approaches, such as education or modifying diet and exercise.
Experimental: Symmetrical Scapula-Pelvis Pattern Exercises
This arm will receive PNF Dynamic Reversal of Antagonists using Symmetrical Scapula-Pelvis Patterns
Other: Symmetrical Scapula-Pelvis Patterns Exercises
Symmetrical scapula-pelvis patterns refer to a balanced, aligned posture and movement of the shoulder blades and pelvis which is often a therapeutic goal in physical rehabilitation with proprioceptive neuromuscular facilitation.
Active Comparator: Control Treatment
This arm will receive evidence based treatment, the suboccipital muscle inhibition with static stretching of the hamstrings.
Other: Suboccipital muscle inhibition technique
The Suboccipital Muscle Inhibition technique is a manual therapy method used by practitioners to relieve tension in the suboccipital muscles, which are located at the base of the skull.
Other: Static stretching of hamstring muscle
Static stretching for hamstrings involves holding a position that creates tension in the back of the thigh for 30 seconds.

What is the study measuring?

Primary Outcome Measures

Primary Outcome Measures

In a clinical study's protocol, the planned outcome measure that is the most important for evaluating the effect of an intervention/treatment. Most clinical studies have one primary outcome measure, but some have more than one.
Outcome Measure
Measure Description
Time Frame
Change in pain intensity with visual analogue scale for pain at Day 1
Time Frame: From enrolment to the end of the first treatment session at Day 1.
The Visual Analogue Scale is a 10 cm line used to measure pain intensity, where the patient marks a point on the line to indicate their pain level, with 0 representing "no pain" and 10 representing "pain as bad as it could possibly be". A score is obtained by measuring the distance from the "no pain" end to the patient's mark, which can be done in centimeters (0-10) or millimeters (0-100). Higher scores indicate greater pain intensity, and this score helps healthcare providers assess severity, which can be categorized as mild (1-3), moderate (4-6), or severe (7-10)
From enrolment to the end of the first treatment session at Day 1.
Change in pain intensity with visual analogue scale for pain at 6 weeks
Time Frame: From enrolment to the end of 18 treatment session at 6 weeks
The Visual Analogue Scale (VAS) is a 10 cm line used to measure pain intensity, where the patient marks a point on the line to indicate their pain level, with 0 representing "no pain" and 10 representing "pain as bad as it could possibly be". A score is obtained by measuring the distance from the "no pain" end to the patient's mark, which can be done in centimeters (0-10) or millimeters (0-100). Higher scores indicate greater pain intensity, and this score helps healthcare providers assess severity, which can be categorized as mild (1-3), moderate (4-6), or severe (7-10).
From enrolment to the end of 18 treatment session at 6 weeks
Change in range of motion with goniometry at Day 1
Time Frame: From enrolment to the end of first treatment at Day 1
Goniometry measures the change in range of motion of a joint in degrees by using a goniometer to calculate the joint's angle. The increase in degrees suggests increase in range of motion and decrease suggests decrease in range of motion.
From enrolment to the end of first treatment at Day 1
Change in range of motion with goniometry at 6 weeks
Time Frame: From enrolment to the end of 18 treatment sessions at 6 weeks.
Goniometry measures the change in range of motion of a joint in degrees by using a goniometer to calculate the joint's angle. The increase in degrees suggests increase in range of motion and decrease suggests decrease in range of motion.
From enrolment to the end of 18 treatment sessions at 6 weeks.
Change in neck disability with Neck Disability Index at day 1
Time Frame: From enrolment to the end of first treatment session at Day 1.
A change in the Neck Disability Index score indicates a change in a patient's self-reported neck disability. A higher score means greater disability.The NDI is scored from 0 to 50, or 0% to 100%. A score of 0 indicates no limitation, while a score of 50 represents complete limitation.
From enrolment to the end of first treatment session at Day 1.
Change in neck disability with Neck Disability Index at 6 weeks
Time Frame: From enrolment to the end of 18 treatment sessions at 6 weeks.
A change in the Neck Disability Index score indicates a change in a patient's self-reported neck disability. A higher score means greater disability.The NDI is scored from 0 to 50, or 0% to 100%. A score of 0 indicates no limitation, while a score of 50 represents complete limitation.
From enrolment to the end of 18 treatment sessions at 6 weeks.
Change in hamstring tightness with Sit and Reach (SR) test at Day 1
Time Frame: From enrolment to the end of first treatment session at Day 1.
A low Sit and Reach test score in centimetre indicates tight hamstrings, while a higher score shows better hamstring flexibility. When a person with tight hamstrings performs the Sit and Reach test, the muscles pull the pelvis into a posterior tilt, which limits the ability to reach as far and can cause the lower back to round instead of the spine flexing naturally. As hamstring tightness decreases through stretching, the SR score increases, signifying greater flexibility and improved superficial back line.
From enrolment to the end of first treatment session at Day 1.
Change in hamstring tightness with Sit and Reach (SR) test at 6 weeks
Time Frame: From enrolment to the end of 18 treatment sessions at 6 weeks.
A low Sit and Reach test score in centimetre indicates tight hamstrings, while a higher score shows better hamstring flexibility. When a person with tight hamstrings performs the Sit and Reach test, the muscles pull the pelvis into a posterior tilt, which limits the ability to reach as far and can cause the lower back to round instead of the spine flexing naturally. As hamstring tightness decreases through stretching, the SR score increases, signifying greater flexibility and improved superficial back line.
From enrolment to the end of 18 treatment sessions at 6 weeks.

Secondary Outcome Measures

Secondary Outcome Measures

In a clinical study's protocol, a planned outcome measure that is not as important as the primary outcome measure for evaluating the effect of an intervention but is still of interest. Most clinical studies have more than one secondary outcome measure.
Outcome Measure
Measure Description
Time Frame
Change in head posture with goniometry at Day 1
Time Frame: From enrolment to the end of first treatment session at Day 1
Goniometry can measure changes in forward head posture by using a goniometer to calculate the craniovertebral angle. This involves placing the goniometer's base on the C7 spinous process and the moving arm on the tragus of the ear, with a smaller CVA angle indicating a greater degree of forward head posture and vice versa. Changes are tracked by taking repeated measurements over time to see if the CVA increases (improving posture) or decreases (worsening posture).
From enrolment to the end of first treatment session at Day 1
Change in head posture with goniometry at 6 weeks
Time Frame: From enrolment to the end of 18 treatment sessions at 6 weeks
Goniometry can measure changes in forward head posture by using a goniometer to calculate the craniovertebral angle. This involves placing the goniometer's base on the C7 spinous process and the moving arm on the tragus of the ear, with a smaller CVA angle indicating a greater degree of forward head posture and vice versa. Changes are tracked by taking repeated measurements over time to see if the CVA increases (improving posture) or decreases (worsening posture).
From enrolment to the end of 18 treatment sessions at 6 weeks
Change in levator scapulae index with vernier caliper at Day 1
Time Frame: From enrolment to the end of first treatment session at Day 1
The levator scapulae index is a measurement technique used to assess the relative length of the levator scapulae muscle. It provides a normalized value by comparing the muscle's length to an individual's total body height, which accounts for variations in size between patients. A vernier caliper is the tool used for this measurement due to its accuracy. A normal levator scapulae index range is greater than or equal to 7.44. Decrease in score suggests decrease in muscle length and increase suggests increase in length.
From enrolment to the end of first treatment session at Day 1
Change in levator scapulae index with vernier caliper at 6 weeks
Time Frame: Time Frame: From enrolment to the end of 18 treatment sessions at 6 weeks
The levator scapulae index is a measurement technique used to assess the relative length of the levator scapulae muscle. It provides a normalized value by comparing the muscle's length to an individual's total body height, which accounts for variations in size between patients. A vernier caliper is the tool used for this measurement due to its accuracy. A normal levator scapulae index range is greater than or equal to 7.44. Decrease in score suggests decrease in muscle length and increase suggests increase in length.
Time Frame: From enrolment to the end of 18 treatment sessions at 6 weeks

Collaborators and Investigators

This is where you will find people and organizations involved with this study.

Sponsor

Sponsor

The organization or person who initiates the study and who has authority and control over the study.
University of Karachi

Collaborators

Collaborators

An organization other than the sponsor that provides support for a clinical study. This support may include activities related to funding, design, implementation, data analysis, or reporting.
Sindh Institute of Physical Medicine and Rehabilitation

Investigators

Investigators

A researcher involved in a clinical study. Related terms include site principal investigator, site sub-investigator, study chair, study director, and study principal investigator.
  • Principal Investigator: Aftab Ahmed Mirza Baig, PhD, University of Karach
  • Study Director: Basit Ansari, PhD, University of Karachi

Study record dates

These dates track the progress of study record and summary results submissions to ClinicalTrials.gov. Study records and reported results are reviewed by the National Library of Medicine (NLM) to make sure they meet specific quality control standards before being posted on the public website.

Study Major Dates

Study Start (Actual)

Study Start

The actual date on which the first participant was enrolled in a clinical study. The "anticipated" study start date is the date that the researchers think will be the study start date.
January 16, 2026

Primary Completion (Estimated)

Primary Completion

The date on which the last participant in a clinical study was examined or received an intervention to collect final data for the primary outcome measure. Whether the clinical study ended according to the protocol or was terminated does not affect this date. For clinical studies with more than one primary outcome measure with different completion dates, this term refers to the date on which data collection is completed for all the primary outcome measures. The "anticipated" primary completion date is the date that the researchers think will be the primary completion date for the study.
October 26, 2026

Study Completion (Estimated)

Study Completion

The date on which the last participant in a clinical study was examined or received an intervention/treatment to collect final data for the primary outcome measures, secondary outcome measures, and adverse events (that is, the last participant's last visit). The "anticipated" study completion date is the date that the researchers think will be the study completion date.
November 26, 2026

Study Registration Dates

First Submitted

First Submitted

The date on which the study sponsor or investigator first submitted a study record to ClinicalTrials.gov. There is typically a delay of a few days between the first submitted date and the record's availability on ClinicalTrials.gov (the first posted date).
December 30, 2025

First Submitted That Met QC Criteria

First Submitted That Met QC Criteria

The date on which the study sponsor or investigator first submits a study record that is consistent with National Library of Medicine (NLM) quality control (QC) review criteria. The sponsor or investigator may need to revise and submit a study record one or more times before NLM's QC review criteria are met. It is the responsibility of the sponsor or investigator to ensure that the study record is consistent with the NLM QC review criteria.
December 30, 2025

First Posted (Actual)

First Posted

The date on which the study record was first available on ClinicalTrials.gov after National Library of Medicine (NLM) quality control (QC) review has concluded. There is typically a delay of a few days between the date the study sponsor or investigator submitted the study record and the first posted date.
January 12, 2026

Study Record Updates

Last Update Posted (Actual)

Last Update Posted

The most recent date on which changes to a study record were made available on ClinicalTrials.gov. There may be a delay between when the changes were submitted to ClinicalTrials.gov by the study's sponsor or investigator (the last update submitted date) and the last update posted date.
March 10, 2026

Last Update Submitted That Met QC Criteria

Last Update Submitted That Met QC Criteria

The most recent date on which the study sponsor or investigator submitted changes to a study record that are consistent with National Library of Medicine (NLM) quality control (QC) review criteria. It is the responsibility of the sponsor or investigator to ensure that the study record is consistent with the NLM QC review criteria.
March 8, 2026

Last Verified

Last Verified

The most recent date on which the study sponsor or investigator confirmed the information about a clinical study on ClinicalTrials.gov as accurate and current. If a study with a recruitment status of recruiting; not yet recruiting; or active, not recruiting has not been confirmed within the past 2 years, the study's recruitment status is shown as unknown.
March 1, 2026

More Information

Terms related to this study

Keywords

Additional Relevant MeSH Terms

Other Study ID Numbers

Other Study ID Numbers

Identifiers or ID numbers other than the NCT number that are assigned to a clinical study by the study's sponsor, funders, or others. These numbers may include unique identifiers from other trial registries and National Institutes of Health grant numbers.
  • IBC KU-544/2025

Plan for Individual participant data (IPD)

Plan to Share Individual Participant Data (IPD)?

NO

Drug and device information, study documents

Studies a U.S. FDA-regulated drug product

No

Studies a U.S. FDA-regulated device product

No

This information was retrieved directly from the website clinicaltrials.gov without any changes. If you have any requests to change, remove or update your study details, please contact register@clinicaltrials.gov. As soon as a change is implemented on clinicaltrials.gov, this will be updated automatically on our website as well.

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