Neck Exercises for Improving Pelvic Alignment and Low Back Pain (NEPAL)

Effects of a Three-Dimensional Nuchal Exercise Program on Pelvic Alignment and Low Back Pain in Adults

This study aimed to investigate whether a three-dimensional nuchal exercise program is associated with changes in pelvic alignment and low back pain in adults.

Thirty participants with low back pain performed a structured cervical exercise program for four weeks, including horizontal, sagittal, and diagonal movements. Pelvic tilt angle and pain intensity were measured before and after the intervention.

The findings of this study may provide preliminary evidence supporting a potential relationship between cervical movement and pelvic alignment, contributing to the understanding of regional interdependence in musculoskeletal rehabilitation.

Study Overview

• Status: Completed
• Conditions: Low Back Pain; Postural Imbalance; Pelvic Malalignment
• Intervention / Treatment: Behavioral: Three-Dimensional Nuchal Exercise Program

Detailed Description

Low back pain is a common musculoskeletal condition that can lead to functional limitation and reduced quality of life. Traditional rehabilitation approaches often focus on the lumbar and pelvic regions; however, emerging evidence suggests that different body regions may be functionally interconnected.

The concept of regional interdependence proposes that impairments in one anatomical region may contribute to dysfunction in another. The cervical spine plays an important role in postural control due to its rich proprioceptive input and its interaction with visual and vestibular systems. Therefore, cervical movement may influence postural alignment and neuromuscular control throughout the body.

This study was designed as a single-group, pre-post interventional study to explore the effects of a three-dimensional nuchal exercise program on pelvic alignment and pain intensity. Participants with low back pain were instructed to perform a structured exercise program consisting of horizontal rotation, sagittal flexion-extension, and diagonal (star-pattern) cervical movements.

Pelvic alignment was assessed using photographic analysis, and pain intensity was measured using a visual analog scale (VAS). Measurements were conducted before and after the intervention period.

This study is considered a preliminary (pilot) investigation. The results may provide initial evidence for cervico-pelvic interaction and inform the design of future controlled trials.

• Study Type: Interventional
• Enrollment (Actual): 30
• Phase: Not Applicable

Contacts and Locations

Study Locations

• Taiwan
  • Hsinchu, Taiwan, 30015
    • Yuanpei University of Medical Technology

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: Adult
• Accepts Healthy Volunteers: No

Description

Inclusion Criteria:

• Adults aged 30 to 60 years
• Individuals who reported experiencing low back pain within the previous 6 months
• Ability to stand independently and perform exercise tasks
• Willingness to participate and provide written informed consent-

Exclusion Criteria:

• - History of severe head or neck injury
• Previous spinal surgery
• Active infectious disease or uncontrolled malignancy
• Cognitive impairment affecting the ability to follow instructions
• Any condition affecting the ability to stand or walk independently

Study Plan

How is the study designed?

Design Details

• Primary Purpose: Treatment
• Allocation: N/A
• Interventional Model: Single Group Assignment
• Masking: None (Open Label)

Number of Arms

1

Arms and Interventions

Participant Group / Arm	Intervention / Treatment
Experimental: Three-Dimensional Nuchal Exercise Group; Participants performed a structured three-dimensional nuchal exercise program for four weeks. The program included horizontal rotation, sagittal flexion-extension, and diagonal (star-pattern) cervical movements. All participants received the same intervention without a comparison group.	Behavioral: Three-Dimensional Nuchal Exercise Program; A structured cervical exercise program consisting of three components: horizontal rotation, sagittal flexion-extension, and diagonal (star-pattern) movements. Participants performed 20 repetitions for each movement while maintaining an upright posture. The program was performed over a four-week period.

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Pelvic Tilt Angle	Pelvic alignment was assessed by measuring the pelvic tilt angle using digital photographic analysis. The angle was defined as the deviation from horizontal alignment based on anatomical landmarks.	Baseline and after 4 weeks of intervention

Collaborators and Investigators

• Sponsor: Yuanpei University of Medical Technology
• Investigators: Principal Investigator: YU-AN CHEN, PT, PhD, Yuanpei University of Medical Technology

Study record dates

Study Major Dates

• Study Start (Actual): September 1, 2018
• Primary Completion (Actual): December 31, 2018
• Study Completion (Actual): December 31, 2018

Study Registration Dates

• First Submitted: April 30, 2026
• First Submitted That Met QC Criteria: April 30, 2026
• First Posted (Actual): May 7, 2026

Study Record Updates

• Last Update Posted (Actual): May 7, 2026
• Last Update Submitted That Met QC Criteria: April 30, 2026
• Last Verified: April 1, 2026

More Information

Terms related to this study

• Additional Relevant MeSH Terms: Pain; Neurologic Manifestations; Back Pain; Pathological Conditions, Signs and Symptoms; Signs and Symptoms; Low Back Pain
• Other Study ID Numbers: YPUIRB1080223

Drug and device information, study documents

• Studies a U.S. FDA-regulated drug product: No
• Studies a U.S. FDA-regulated device product: No