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

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: Recruiting
• Conditions: Neck Pain; Chronic Neck Pain; Hamstring Muscle Tightness
• Intervention / Treatment: Other: Symmetrical Scapula-Pelvis Patterns Exercises; Other: Suboccipital muscle inhibition technique; Other: Static stretching of hamstring muscle

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: Interventional
• Enrollment (Estimated): 156
• Phase: Not Applicable

Contacts and Locations

• Study Contact: Name: Aftab Ahmed Mirza Baig, PhD; Phone Number: +923002739920; Email: ab.dptrm@gmail.com
• Study Contact Backup: Name: Basit Ansari, PhD; Phone Number: +923222279221; Email: basitansari@hotmail.com

Study Locations

• Pakistan
  • Sindh
    • Karachi, Sindh, Pakistan, 75300
      • Recruiting
      • Sindh Institute of Physical Medicine and Rehabilitation
      • Contact: Faizan Siddiqui, MSAPT; Phone Number: +923350352016; Email: fs.dptrm@gmail.com

Participation Criteria

Eligibility Criteria

• 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

How is the study designed?

Design Details

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

Number of Arms

2

Arms and Interventions

Participant Group / Arm	Intervention / Treatment
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

Outcome Measure	Measure Description	Time Frame
Change in pain intensity with visual analogue scale for pain 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	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	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	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	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	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	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	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

Outcome Measure	Measure Description	Time Frame
Change in head posture with goniometry 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	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	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	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

• Sponsor: University of Karachi
• Collaborators: Sindh Institute of Physical Medicine and Rehabilitation
• Investigators: Principal Investigator: Aftab Ahmed Mirza Baig, PhD, University of Karach; Study Director: Basit Ansari, PhD, University of Karachi

Study record dates

Study Major Dates

• Study Start (Actual): January 16, 2026
• Primary Completion (Estimated): October 26, 2026
• Study Completion (Estimated): November 26, 2026

Study Registration Dates

• First Submitted: December 30, 2025
• First Submitted That Met QC Criteria: December 30, 2025
• First Posted (Actual): January 12, 2026

Study Record Updates

• Last Update Posted (Actual): March 10, 2026
• Last Update Submitted That Met QC Criteria: March 8, 2026
• Last Verified: March 1, 2026

More Information

Terms related to this study

• Keywords: Exercise; PNF; Muscle Inhibition; Muscle Stretching; neck ache
• Additional Relevant MeSH Terms: Pain; Neurologic Manifestations; Pathological Conditions, Signs and Symptoms; Behavior; Signs and Symptoms; Neck Pain; Motor Activity
• Other Study ID 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