Effect of Bruegger's Exercise in Chronic Mechanical Neck Pain With Forward Head Posture

The purpose of the study is to investigate the effect of adding Bruegger's exercises on conventional exercise program in treatment of forward head posture.

Study Overview

• Status: Not yet recruiting
• Conditions: Neck Pain
• Intervention / Treatment: Other: Core stability exercise; Other: Bruegger's training

Detailed Description

Forward head posture, head-on-trunk misalignment, leads to increased lordosis of the lower cervical spine as well as rounded shoulders accompanied by increased kyphosis of the thoracic spine. These musculoskeletal disorders change the balance of the muscles around the neck.

Bruegger's postural relief position is one such self-care exercise that works in order to reverse Forward head posture (FHP) by strengthening the scapular retractors meanwhile stretching the protractors. This exercise helps in aligning the spine in correct position through isometric co-contraction of scapular muscles, thereby improving scapular stabilization. The exercise helped in strengthening the weak deep cervical flexor muscles since it includes isometric contraction of neck muscles through chin tuck.

Although Bruegger's exercises has been widely suggested or advised clinically by the physiotherapists, there is a lack of research-based evidence/data which proves regarding its effect in the correction of FHP. Hence, it was hypothesized that the Bruegger's exercises will show favorable results in the correction of FHP and craniovertebral angle (CVA).

This study may benefit physical therapists by providing a new and easy approach in treating FHP.

• Study Type: Interventional
• Enrollment (Estimated): 24
• Phase: Not Applicable

Contacts and Locations

• Study Contact: Name: Hadeer Morsi, Master; Phone Number: 01157677014; Email: happypt91@gmail.com
• Study Contact Backup: Name: Dina AbdAllah, PHD; Phone Number: 01282742057; Email: drdinasayed_ptW@yahoo.com

Study Locations

• Egypt
  • Cairo, Egypt
    • Hadeer SalahEldin Mahmoud

Participation Criteria

Eligibility Criteria

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

Description

Inclusion Criteria:

• Participant with neck pain and craniovertebral angle value lower than 50°.
• Numeric pain rating score above 3.
• More than 10 on neck disability index.

Exclusion Criteria:

• Arthritis (or other inflammatory diseases).
• Locoregional tumor or metastasis .
• Myopathy .
• Severe psychiatric disorders.
• Previous neck surgery.
• Fibromyalgia.

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
Active Comparator: Core stability exercises; The participants will receive conventional core stability exercise for 12 sessions (3 sessions per week for four weeks).	Other: Core stability exercise; The participants will be treated with conventional core stability exercise; Neck Stability Exercises-Free exercise for cervical spine, Neck isometric exercises (flexion, extension, lateral flexion, rotation), Wall angle exercises for lower trapezius, Chin tuck, Chin tuck into the towel
Experimental: Bruegger's training and core stability exercises; will receive a program of Bruegger's training plus conventional core stability exercise for 4 weeks, 3 sessions per week, total 12 sessions, with about 30:45 minutes per session.	Other: Core stability exercise; The participants will be treated with conventional core stability exercise; Neck Stability Exercises-Free exercise for cervical spine, Neck isometric exercises (flexion, extension, lateral flexion, rotation), Wall angle exercises for lower trapezius, Chin tuck, Chin tuck into the towel; Other: Bruegger's training; Bruegger's Position of external arm rotation, shoulder abduction and retraction of the scapulae . This position with simultaneous head and neck retraction is a strengthening exercise for deep neck flexors and lower scapular stabilizers. The subjects are instructed to place their feet on the floor completely and keep their knee joints 10 ㎝ below the hip joints in 45° of abduction. The subjects sit hitting their ischial tuberosity on the chair and maintained their physiological curvature for the TL spine. Following external rotation of the glenohumeral joints, tension is relaxed with each inhalation, and depression and retraction of the shoulder girdle are performed with each exhalation.

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Assessment of pain intensity	The numerical pain rating scale will be used to assess pain intensity. It is 11-point numeric scale ranges from '0' representing one pain extreme (e.g. "no pain") to '10' representing the other pain extreme (e.g. "pain as bad as you can imagine" or "worst pain imaginable.	4 weeks
Assessment of craniocervical angle (CVA)	The CVA will be evaluated with forward head posture (FHP) application on a Xiaomi® MiA2. Two markers are placed on the ground separated by 1.5 m, where the camera or smart phone and the subject are located. Reference markers are placed on the spinous process of C7 and in the swallow of the subjects' ears, which were identified through palpation. The subject is placed on the floor mark, barefoot and standing, lateral to the evaluator. The application provides the complement to the CVA, thus making further calculation necessary. To determine the CVA, it is necessary to subtract the angle provided by the application from 360°. The presence of FHP will be determined by an angle value lower than 50°, and the absence of FHP if the angle value is greater than or equal to 50°	4 weeks
Assessment of craniocervical flexion endurance	Craniocervical flexion endurance test (CCFE test) will be used. The position of the participant is supine with cervical spine in the neutral position. The PBU is placed between the plinth and the posterior neck just below the occiput. The cuff is then inflated to a baseline of 20 mmHg. The participant was then asked to avoid head lift during CCFE test, thereby reducing the recruitment of superficial flexors. Each participant will be asked to perform the neck flexion movement at five different pressure levels (22, 24, 26, 28, and 30 mmHg) with 10 s hold at each level and 30 s rest between each level. The test is terminated if the subject is not able to hold the position of the neck for 10 s at a specific pressure level or if the maximum level of 30 mmHg is achieved.	4 weeks

Secondary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Assessment of function disability	Arabic version of neck disability index will be used to assess function disability. Questions include activities of daily living, such as personal care, lifting, reading, work, driving, sleeping, recreational activities, pain intensity, concentration, and headache. Each question is measured on a scale from 0(no disability) to 5, and an overall score out of 100 is calculated by adding each item score together and multiply in it by two. A higher NDI score means the greater a patient's perceived disability due to neck pain.	4 weeks

Collaborators and Investigators

• Sponsor: Cairo University
• Investigators: Study Chair: Salwa Abd E-Majeed, Professor, Cairo University

Study record dates

Study Major Dates

• Study Start (Estimated): July 1, 2026
• Primary Completion (Estimated): September 1, 2026
• Study Completion (Estimated): September 16, 2026

Study Registration Dates

• First Submitted: June 21, 2026
• First Submitted That Met QC Criteria: June 21, 2026
• First Posted (Actual): June 25, 2026

Study Record Updates

• Last Update Posted (Actual): June 25, 2026
• Last Update Submitted That Met QC Criteria: June 21, 2026
• Last Verified: June 1, 2026

More Information

Terms related to this study

• Additional Relevant MeSH Terms: Pain; Neurologic Manifestations; Pathological Conditions, Signs and Symptoms; Signs and Symptoms; Neck Pain
• Other Study ID Numbers: P.T.REC/012/004505

Drug and device information, study documents

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