Effects of Cervical Stabilization Exercises With and Without Reverse Natural Apophyseal Glides in Text Neck Syndrome

June 8, 2026 updated by: Riphah International University

Effects of Cervical Stabilization Exercises With and Without Reverse Natural Apophyseal Glides on Pain, Range of Motion and Disability Among Patients With Text Neck Syndrome

Text neck syndrome is one such disorder within that group, increasingly affecting individuals worldwide across various age groups. The phenomenon of text neck may occur in individuals who frequently and for prolonged periods adopt a forward-flexed neck and head position while looking at the screens of mobile electronic devices. This posture puts stress on the neck muscles and spine, leading to various symptoms like neck pain, stiffness, and headaches.

Study Overview

Status

Not yet recruiting

Conditions

Intervention / Treatment

Detailed Description

The single blinded randomized clinical trial will be conducted at Shafqat Polyclinic and Sunrise Medicare Hospital Faisalabad. A total of 42 participants ( 21 in each group) with text neck syndrome will be recruited through non probability convenient sampling technique on which patients will be randomized through computer generated software into Group A and Group B. Group A will receive cervical stabilization exercises and reverse NAGs mobilization. Cervical stabilization exercises will be performed as 15 repetitions with 10 seconds of contraction and 5 seconds of relaxation. The mobilizations will be repeated 10 times per set, 2 to 3 oscillations per second for a total of 3 sets per treatment. Group B will receive only cervical stabilization exercises. Each exercise will be performed as 15 repetitions with 10 seconds of contraction and 5 seconds of relaxation per treatment. Each session will be last for 40 to 45min and three sessions per week will be performed.. Outcome measure will be conducted through pain (NPRS), disability (NDI) and range of motion (Universal Goniometer) at baseline and after six weeks treatment. Data will be analyzed using SPSS software version 27. After assessing normality of data by Shapiro-wilk test, it will be decided either parametric or non-parametric test will be used within group or between groups.

Study Type

Interventional

Enrollment (Estimated)

42

Phase

  • 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 Locations

  • Pakistan
    • Punjab Province
      • Faisalābad, Punjab Province, Pakistan

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

Ages Eligible for Study

  • Adult

Accepts Healthy Volunteers

No

Description

Inclusion Criteria:

  • • Both male and female are taken

    • Age between 18-35 years
    • Craniovertebral angle less than 50 degree

Exclusion Criteria:

  • • Trauma

    • Patient undergoes cervical surgery.
    • Disc prolapse, herniation, spondylolisthesis
    • Osteoporosis
    • Torticullis
    • Pregnancy
    • Psychological Problems
    • Cervical radiculopathy

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
Intervention / Treatment
Experimental: Cervical stabilization exercises with reverse NAGs
Combining cervical stabilization exercises with Natural Apophyseal Glides (NAGs) is a highly effective, evidence-based approach for treating "text neck syndrome" (forward head posture). Reverse NAGs are gentle, oscillatory manual therapy techniques that, when combined with stabilization exercises, alleviate pain, correct posture, and restore a pain-free range of motion.
Other: Cervical stabilization exercises with reverse NAGs

1. Cervical Stabilization Exercises: Chin tuck, Cervical Extension, shoulder Shrugs, shoulder Rolls, scapular Retraction.

Reverse NAG A mobilization takes place when you glide the inferior facet up on the superior one. This is achieved by thrusting up along the treatment plane with your bottom hand. You initially press ventrally to secure your thumb and index finger under the chosen segment transverse processes and then glide cranially along the treatment plane. Maintain your ventral pressure or you will slip over the transverse process.

Position: Patient is seated. You stand beside patient and cradle his head to your body with forearm. Therapist hand position piston grip for lower cervical spine and for upper thoracic spine will be wide grip.

Dosage: The mobilization was applied at C5 to C7 and T1 to T3.
Active Comparator: Cervical stabilization exercises without reverse NAGs
Cervical stabilization exercises target the deep neck flexors and upper back muscles to correct forward head posture, reduce strain, and restore the neck's natural alignment.
Other: Cervical stabilization exercises without reverse NAGs

1. Cervical Stabilization Exercises: Chin tuck: In standing position, participant pulls back the chin as if trying to make double chin while keeping the eyes level. This was done for 15 repetitions.

Cervical Extension: In standing participant graps the base of neck, with both hands while extending the neck as far as possible. This was done for 15 repetitions.

Shoulder Shrugs: In standing position, participant shrugs the shoulders, bringing them up towards the ears. This was done for 15 repetitions.

Shoulder Rolls: In standing position, participant rolls the shoulder forward in a circle. Then, rolls shoulder backwards in a circle. Then participant relaxes and repeats the procedure for 15 times.

Scapular Retraction: In standing position, participant brings the shoulder blades together in the back; participant then relaxes and repeats the procedure for 15 times.

What is the study measuring?

Primary Outcome Measures

Outcome Measure
Measure Description
Time Frame
1. Numeric pain rate scale (NPRS)
Time Frame: upto 4 weeks
Patient level of pain will be assessed using this scale. This scale ranges from 0 to 10. 0 indicates "no pain" and 10 indicates "worst pain" (25). The reliability of NPRS in patient with neck pain has been reported to be 0.76 indicated a moderate level of reliability for NPRS and moderate level of consistency and stability in the scores obtained from the measurement tool
upto 4 weeks
2. Neck Disability index (NDI)
Time Frame: Upto 4 weeks
This questionnaire will be used to assess disability. Each of the ten items in the neck disability assessment is given a score between 0 and 5. Consequently, 50 is the highest possible score. The ten elements include four activities of daily living (lifting, working, driving, and recreation), two discretionary activities of daily living (personal care, reading), and four subjective symptoms (pain intensity, headache, concentration, and sleeping). This index is the most popular and well-researched tool for evaluating patients' self-reported impairment in relation to neck discomfort (27). The intraclass correlation coefficient ICC ( 95% Confidence intervals) for NDI was 0.87(0.66, 0.94), indicating very high reliability and NDI demonstrated an adequate level of absolute reliability(9.3) and internal consistency (Cronbach alpha 0.70), along with possibility, discriminative validity, and acceptable concept validity
Upto 4 weeks
3. Universal Goniometer (UG):
Time Frame: Upto 4 weeks
The Universal Goniometer was used to assess the ranges of motion of cervical flexion, extension, rotation, and lateral flexion. Throughout all range-of-motion tests, subjects sat erect, facing forward, with their arms on their laps and their feet flat on the ground(29). The goniometer application, an excellent correlation (r=0.81, p=0.000), for intra-rater 9(ICC=0.88) and inter-rater reliability (ICC=0.915) were obtained (30).
Upto 4 weeks
4. Craniovertebral Angle:
Time Frame: Upto 4 weeks
Measuring craniovertebral (CV) angle is one of the common objective methods in assessing forward head posture . It is the angle formed by a horizontal line drawn through the spinous process of the seventh cervical (C7) vertebra and a line joining the spinous process of C7 vertebra with the tragus of the ear using kinovvea software 2023 version 1.2. A smaller CVA reflects a greater degree of forward head posture, with angle less than 50 degrees typically considered abnormal
Upto 4 weeks

Collaborators and Investigators

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

Sponsor

Riphah International University

Investigators

  • Principal Investigator: Rahat Afzal, MS-OMPT, Governement Teaching Hospital Shahdara Lahore.

Publications and helpful links

The person responsible for entering information about the study voluntarily provides these publications. These may be about anything related to the study.

General Publications

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 (Estimated)

May 30, 2026

Primary Completion (Estimated)

July 30, 2026

Study Completion (Estimated)

August 30, 2026

Study Registration Dates

First Submitted

June 8, 2026

First Submitted That Met QC Criteria

June 8, 2026

First Posted (Actual)

June 12, 2026

Study Record Updates

Last Update Posted (Actual)

June 12, 2026

Last Update Submitted That Met QC Criteria

June 8, 2026

Last Verified

June 1, 2026

More Information

Terms related to this study

Keywords

Additional Relevant MeSH Terms

Other Study ID Numbers

  • REC/RCR&AHS/25/0125 Shomaiza

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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