Comparison Between Dynamic Neuromuscular Stabilization Breathing and Manual Therapy on Forward Head Posture in University Students
The Effects of Dynamic Neuromuscular Stabilization Breathing and Manual Therapy on Forward Head Posture in University Students: A Randomized Controlled Trial
Forward Head Posture (FHP) is a common postural dysfunction characterized by the anterior displacement of the head relative to the shoulders, leading to cervical spine misalignment, increased muscle strain, and neck pain. It is highly prevalent in university students (63-66%), largely due to prolonged sedentary behaviors and the use of smartphones, laptops, and tablets in poor ergonomic postures .
This randomized controlled trial aims to evaluate the effectiveness of three intervention strategies for managing FHP in university students:
Dynamic Neuromuscular Stabilization (DNS) Breathing + Conventional Exercises: DNS breathing will emphasize diaphragmatic activation and postural stabilization, combined with stretching, strengthening, and postural education.
Myofascial Release (MFR) + Conventional Exercises: Suboccipital MFR to release fascial tension, combined with the same conventional exercise program.
Conventional Exercises Alone (Control Group): A standard rehabilitation protocol of stretching, strengthening, and postural correction.
All interventions will be delivered three times per week for six weeks, with each session lasting 45 minutes.
Assessments will be conducted at baseline, week 4, and week 6:
Craniovertebral Angle (CVA) and Forward Shoulder Angle (FSA) measured using smartphone photographic analysis.
Wall Test to assess forward head and rounded shoulder posture.
Visual Analog Scale (VAS) to measure subjective pain intensity.
SF-36 Health Survey to evaluate quality of life across eight health domains.
The study will compare the relative effectiveness of DNS breathing and MFR, each combined with conventional therapy, against conventional therapy alone. Findings are expected to contribute to evidence-based postural rehabilitation, particularly for young adults with sedentary lifestyles.
Descripción general del estudio
Estado
Condiciones
Intervención / Tratamiento
Tipo de estudio
Inscripción (Estimado)
Fase
- No aplica
Contactos y Ubicaciones
Estudio Contacto
- Nombre: Prof.Dr. H. Habibe serap INAL, doctor of physical therapy
- Número de teléfono: +905325573354
- Correo electrónico: serap.inal@galata.edu.tr
Copia de seguridad de contactos de estudio
- Nombre: PT Rami M.osama Ramdoun, Bachelor of physical therapy
- Número de teléfono: +905344100383
- Correo electrónico: 2333095007@stu.istinye.edu.tr
Ubicaciones de estudio
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Zeytinburnu
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Istanbul, Zeytinburnu, Turquía (Türkiye), 34010
- Reclutamiento
- İstinye University, Fizyoterapi ve Rehabilitasyon Uygulama ve Araştırma Merkezi -İSÜFİZYOTEM
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Contacto:
- Dr. Öğr. Üyesi Nurgül Dürüstkan Elbaşı, phd of physical therapy
- Número de teléfono: 0850 283 00 00
- Correo electrónico: sbf@istinye.edu.tr
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Criterios de participación
Criterio de elegibilidad
Edades elegibles para estudiar
- Adulto
Acepta Voluntarios Saludables
Descripción
Inclusion Criteria:
University student aged 18 to 28 years
Presence of forward head posture confirmed by photogrammetric assessment
Mild to moderate cervical pain (VAS score between 0 and 6)
Voluntary agreement to participate in the study
Exclusion Criteria:
History of cervical spine surgery
Presence of neurological disorders
Diagnosis of cervical disc herniation
Severe musculoskeletal pain (VAS ≥ 7)
Plan de estudios
¿Cómo está diseñado el estudio?
Detalles de diseño
- Propósito principal: Tratamiento
- Asignación: Aleatorizado
- Modelo Intervencionista: Asignación paralela
- Enmascaramiento: Ninguno (etiqueta abierta)
Armas e Intervenciones
Grupo de participantes/brazo |
Intervención / Tratamiento |
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Comparador activo: Terapia convencional
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Standardized exercise protocol including head rotation, neck/upper back extension, swimmer exercise, head retraction with resistance band, and upper trapezius/levator scapulae stretches.
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Experimental: dynamic neuromuscular stabilisation breathing
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Diaphragmatic breathing exercises performed in supine, side-lying, and quadruped positions, 3 sets of 1 minute each.
Standardized exercise protocol including head rotation, neck/upper back extension, swimmer exercise, head retraction with resistance band, and upper trapezius/levator scapulae stretches.
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Experimental: Myofacial release
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Standardized exercise protocol including head rotation, neck/upper back extension, swimmer exercise, head retraction with resistance band, and upper trapezius/levator scapulae stretches.
Manual sustained pressure applied to the suboccipital region, upper trapezius, and levator scapulae, 2-3 minutes per site, to reduce myofascial stiffness and improve tissue extensibility
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¿Qué mide el estudio?
Medidas de resultado primarias
Medida de resultado |
Medida Descripción |
Periodo de tiempo |
|---|---|---|
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Craniovertebral Angle (CVA)
Periodo de tiempo: 4 weeks, and 8 weeks
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The craniovertebral angle (CVA) will be measured using digital photogrammetry to assess the degree of forward head posture.
A marker will be placed on the tragus of the ear and the spinous process of C7, and the angle formed between a horizontal line through C7 and the line connecting C7 to the tragus will be calculated.
Smaller angles indicate a greater degree of forward head posture.
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4 weeks, and 8 weeks
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Medidas de resultado secundarias
Medida de resultado |
Medida Descripción |
Periodo de tiempo |
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Visual Analogue Scale (VAS)
Periodo de tiempo: Baseline, 4 weeks, and 8 weeks
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Pain intensity will be assessed using a 10 cm Visual Analogue Scale (VAS), where 0 indicates no pain and 10 indicates worst imaginable pain.
Participants will mark their perceived pain level at rest and during activity.
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Baseline, 4 weeks, and 8 weeks
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Colaboradores e Investigadores
Patrocinador
Investigadores
- Investigador principal: Prof.Dr. Habibe. Serap İnal, doctor of physical therapy, istinye university, faculty of health sciences , Department of physical therapy and rehabilitation
Publicaciones y enlaces útiles
Publicaciones Generales
- Ajimsha MS, Al-Mudahka NR, Al-Madzhar JA. Effectiveness of myofascial release: systematic review of randomized controlled trials. J Bodyw Mov Ther. 2015 Jan;19(1):102-12. doi: 10.1016/j.jbmt.2014.06.001. Epub 2014 Jun 13.
- Karimian R, Rahnama N, Ghasemi G, Lenjannejadian S. Photogrammetric Analysis of Upper Cross Syndrome among Teachers and the Effects of National Academy of Sports Medicine Exercises with Ergonomic Intervention on the Syndrome. J Res Health Sci. 2019 Jul 3;19(3):e00450.
- Fathollahnejad K, Letafatkar A, Hadadnezhad M. The effect of manual therapy and stabilizing exercises on forward head and rounded shoulder postures: a six-week intervention with a one-month follow-up study. BMC Musculoskelet Disord. 2019 Feb 18;20(1):86. doi: 10.1186/s12891-019-2438-y.
- Salahzadeh Z, Maroufi N, Ahmadi A, Behtash H, Razmjoo A, Gohari M, Parnianpour M. Assessment of forward head posture in females: observational and photogrammetry methods. J Back Musculoskelet Rehabil. 2014;27(2):131-9. doi: 10.3233/BMR-130426.
- Okuro RT, Morcillo AM, Ribeiro MA, Sakano E, Conti PB, Ribeiro JD. Mouth breathing and forward head posture: effects on respiratory biomechanics and exercise capacity in children. J Bras Pneumol. 2011 Jul-Aug;37(4):471-9. doi: 10.1590/s1806-37132011000400009. English, Portuguese.
- Briem K, Huijbregts P, Thorsteinsdottir M. Immediate effects of inhibitive distraction on active range of cervical flexion in patients with neck pain: a pilot study. J Man Manip Ther. 2007;15(2):82-92. doi: 10.1179/106698107790819882.
- Gulrandhe P, Kovela RK, Samal S. Effect of the Dynamic Neuromuscular Stabilization Technique on Functional Capacity in Overweight and Obese Individuals: A Randomized Controlled Trial. Cureus. 2023 Jul 18;15(7):e42076. doi: 10.7759/cureus.42076. eCollection 2023 Jul.
- Aggarwal, A., Nair, A., Palekar, T. J., & Bhamare, D. (2022). Effect of suboccipital release technique in forward head posture: A comparative study. Medical Journal of Dr. DY Patil University, 15(4), 534-537.
- Alshahrani, A., Aly, S. M., Abdrabo, M. S., & Asiri, F. Y. (2018). Impact of smartphone usage on cervical proprioception and balance in healthy adults. Biomed res, 29(12), 2547-2552.
- Naz, A., Bashir, M. S., & Noor, R. (2018). Prevalance of forward head posture among university students. Rawal Med J, 43(2), 260-2.
Fechas de registro del estudio
Fechas importantes del estudio
Inicio del estudio (Actual)
Finalización primaria (Estimado)
Finalización del estudio (Estimado)
Fechas de registro del estudio
Enviado por primera vez
Primero enviado que cumplió con los criterios de control de calidad
Publicado por primera vez (Actual)
Actualizaciones de registros de estudio
Última actualización publicada (Actual)
Última actualización enviada que cumplió con los criterios de control de calidad
Última verificación
Más información
Términos relacionados con este estudio
Palabras clave
Términos MeSH relevantes adicionales
Otros números de identificación del estudio
- 25 - 26 - 2025
Plan de datos de participantes individuales (IPD)
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Información sobre medicamentos y dispositivos, documentos del estudio
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