Comparison Between Dynamic Neuromuscular Stabilization Breathing and Manual Therapy on Forward Head Posture in University Students

Official title

The Effects of Dynamic Neuromuscular Stabilization Breathing and Manual Therapy on Forward Head Posture in University Students: A Randomized Controlled Trial

Overview

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.

Interventions

• Other Dynamic neuromuscular stabilisation breathing
  Diaphragmatic breathing exercises performed in supine, side-lying, and quadruped positions, 3 sets of 1 minute each.
• Other Myofascial Release
  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
• Other Convetional Exercises
  Standardized exercise protocol including head rotation, neck/upper back extension, swimmer exercise, head retraction with resistance band, and upper trapezius/levator scapulae stretches.

Primary outcome measures

• Craniovertebral Angle (CVA) [Time frame: 4 weeks, and 8 weeks]

Secondary outcome measures (1)

• Visual Analogue Scale (VAS) [Time frame: Baseline, 4 weeks, and 8 weeks]

Eligibility criteria

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)

Criteria are shown verbatim from the registry (in English). Final eligibility is always assessed by the study center.

Healthy volunteers: Yes

Study design

Allocation

Randomized

Model

Parallel assignment

Masking

Open label

Primary purpose

Treatment

Study locations

Turkey (Türkiye) · 1 center

• İstinye University, Fizyoterapi ve Rehabilitasyon Uygulama ve Araştırma Merkezi -İSÜFİZYOT — Istanbul

Publications

• 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. PMID 21881737
• 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. PMID 19066648
• 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. PMID 23963268
• 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. PMID 37601999
• 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. PMID 30777064
• 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.
• 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. PMID 31586371
• 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. PMID 25603749

Identifiers

NCT: NCT07721389 · 25 - 26 - 2025

Primary sources (government registries)

• ClinicalTrials.gov (US NIH)

View this study on ClinicalTrials.gov ↗