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

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.