Dynamic Neuromuscular Stabilization Versus Corrective Exercises in Upper Cross Syndrome (DNS/NASM)

Effect of Dynamic Neuromuscular Stabilization Versus Corrective Exercises on Pain, Functional Disability, and Postural Alignment in Upper Crossed Syndrome.

The purpose of the study will be to investigate dynamic neuromuscular stabilization versus National American Academy of Sports Medicine (NASM) corrective exercises on pain, functional disability, cranio-vertebral angle, forward shoulder angle, and thoracic kyphosis in upper cross syndrome.

Study Overview

• Status: Not yet recruiting
• Conditions: Upper Crossed Syndrome; Upper Cross Syndrome; Upper Crossed Syndorme
• Intervention / Treatment: Other: Dynamic neuromuscular stabilization; Other: NASM corrective exercises

Detailed Description

Upper Cross Syndrome (UCS) is a frequent condition that is most commonly encountered in musculoskeletal disorders, showing a typical pattern of imbalance in muscles and neck and shoulder region joint dysfunction. It causes pain in shoulders, upper back, thoracic and cervical spine. It is frequently associated with inadequate posture or forward head position, muscular weakness, and alterations in movement patterns, leading to pain, restricted mobility, and dysfunction in the affected areas of patients suffering from UCS.

Dynamic Neuromuscular Stabilization (DNS) is a developing rehabilitation approach based on reflex locomotion. The idea of reflex locomotion describes particular involuntary motor reactions/movement patterns that occur when firm pressure is applied to specific muscle zones. These movement patterns are standard and referred to as "global patterns". The global pattern generated from the prone position is known as "reflex creeping," whereas the one from the supine or side lying posture is known as "reflex rolling". Furthermore, some motor motions such as gripping, turning, crawling, and eventually walking occur automatically without the need for specific training in normal babies.

The National American Academy of Sports Medicine (NASM) provided a corrective exercise protocol for postural malalignment. It includes 4 steps: inhibition (self-mobilization release technique targeting trigger points), lengthening (stretching techniques for tight muscles), third: activation (strengthening techniques for weak muscles), and integration (retraining all muscles through functionally progressive movements). It was successful in treating UCS.

• Study Type: Interventional
• Enrollment (Estimated): 45
• Phase: Not Applicable

Contacts and Locations

• Study Contact: Name: Passant M Assistant lecturer, MSc; Phone Number: 01004139949; Email: passant.moustafa@cu.edu.eg
• Study Contact Backup: Name: Nesreen F Lecturer, PhD; Phone Number: 01127283925; Email: dr_nesreenfawzy@cu.edu.eg

Study Locations

• Egypt
  • Cairo Governorate
    • Cairo, Cairo Governorate, Egypt, 11432
      • Outpatient clinic at faculty of physical therapy - Cairo University
      • Contact: Passant M Assistant lecturer, MSc; Phone Number: 01004139949; Email: passant.moustafa@cu.edu.eg
      • Contact: Nesreen F Lecturer, PhD; Phone Number: 01127283925; Email: dr_nesreenfawzy@cu.edu.eg

Participation Criteria

Eligibility Criteria

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

Description

Inclusion Criteria:

1. Having non-specfic neck Pain.
2. Patients having a CVA of < 52 .
3. Forward shoulder angle > 52 degrees.

Exclusion Criteria:

• Participants having conditions such as osteoporosis, blood disease, congestive heart disease, cancer, severe skin sensitization, major mental disease, and frozen shoulder, will be excluded from the study. Neck pain has a specific underlying pathology such as fractures, rheumatoid arthritis, osteoporosis, or whiplash injuries as well as neck pain associated with radiculopathy.

Study Plan

How is the study designed?

Design Details

• Primary Purpose: Treatment
• Allocation: Randomized
• Interventional Model: Parallel Assignment
• Masking: None (Open Label)

Number of Arms

3

Arms and Interventions

Participant Group / Arm	Intervention / Treatment
Experimental: Dynamic neuromuscular stabilization; Dynamic neuromuscular stabilization involves precise co-activation of the intrinsic muscles of the spine which forms the Integrated spinal stabilization system (ISSS) and includes cervical flexors and extensors, diaphragm, transversus abdominis, multifidus and pelvic floor. Participants will receive DNS for 6 weeks.	Other: Dynamic neuromuscular stabilization; Dynamic neuromuscular stabilization involves precise co-activation of the intrinsic muscles of the spine which forms the Integrated spinal stabilization system (ISSS) and includes cervical flexors and extensors, diaphragm, transverses abdominis, multifidus and pelvic floor.
Experimental: Corrective exercises; National Academy of sports medicine corrective exercises that involve 4 steps : First: Inhibition for tight muscles Second: Lengthening for tight muscles Third: Activation for weak muscles fourth: Intergration to retrain all muscles through functionally progressive movements using integrated dynamic movements. Participants will receive NASM corrective exercises for 6 weeks.	Other: NASM corrective exercises; It is corrective exercise protocol, which includes four phases, i.e. inhibit, lengthen, activate, and integrate stage
Experimental: Combined Dynamic neuromuscular stabilization and corrective exercises group; Participants will receive both DNS and NASM for 6 weeks.	Other: Dynamic neuromuscular stabilization; Dynamic neuromuscular stabilization involves precise co-activation of the intrinsic muscles of the spine which forms the Integrated spinal stabilization system (ISSS) and includes cervical flexors and extensors, diaphragm, transverses abdominis, multifidus and pelvic floor.; Other: NASM corrective exercises; It is corrective exercise protocol, which includes four phases, i.e. inhibit, lengthen, activate, and integrate stage

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Neck pain intensity	Neck pain intensity will be measured through Numerical pain rating scale. A scale from 0 to 10, with 0 indicating no pain and 10 signifying excruciating pain.	At baseline at the first session and reassessed at the end of six weeks of intervention.

Secondary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Neck disability	The patient will be asked to fill the 10- section of the questionnaire. Higher score indicate higher disability.	At baseline at the first session and after 6 weeks of intervention.
Craniovertebral angle	craniovertebral angle will be measured using Kinovea software to assess forward head posture	At baseline and after 6 weeks of intervention
Forward shoulder angle	Forward shoulder angle will be measured using Kinovea software to assess rounded shoulder posture	At baseline and after 6 weeks of intervention
Thoracic kyphosis angle	Thoracic kyphosis angle will be measured using a bubble inclinometer	At baseline and after 6 weeks of intervention

Collaborators and Investigators

• Sponsor: Cairo University
• Investigators: Principal Investigator: Karima A Hassan, PhD, Cairo University

Study record dates

Study Major Dates

• Study Start (Estimated): November 1, 2026
• Primary Completion (Estimated): February 1, 2027
• Study Completion (Estimated): September 30, 2028

Study Registration Dates

• First Submitted: July 8, 2026
• First Submitted That Met QC Criteria: July 8, 2026
• First Posted (Actual): July 13, 2026

Study Record Updates

• Last Update Posted (Actual): July 13, 2026
• Last Update Submitted That Met QC Criteria: July 8, 2026
• Last Verified: July 1, 2026

More Information

Terms related to this study

• Additional Relevant MeSH Terms: Oculocerebral hypopigmentation syndrome type Preus
• Other Study ID Numbers: P.T.REC/012/006422

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