Thoracic Expansion vs DNS Exercises in Forward Head Posture

NCT07238660 | Not Yet Recruiting

• 1 other identifier: MU-FHP-DNS-TE-2025-01
• Study Type: interventional
• Target: 32
• Locations: 1 country
• Sites: 1

Brief Summary

This randomized controlled trial aims to compare the effects of thoracic expansion exercises and Dynamic Neuromuscular Stabilization (DNS) on respiratory function and bilateral trapezius muscle activity in individuals with forward head posture (FHP). A total of 32 participants aged 18-40 years with a craniovertebral angle (CVA) of less than 53° will be randomly assigned to either the DNS group or the thoracic expansion exercise group. Primary outcomes include respiratory function (FEV1, FVC, FEV1/FVC), trapezius muscle activation measured with EMG biofeedback, and craniovertebral angle. Secondary outcomes include thoracic mobility and health-related quality of life assessed using the St. George's Respiratory Questionnaire. Both interventions will be applied for 6 weeks. The study aims to determine which approach provides greater improvement in posture-related respiratory dysfunction and muscle activation.

Conditions

Forward Head Posture

Keywords

craniovertebral angle; respiratory function test; electromyography; Dynamic Neuromuscular Stabilization(DNS); breathing exercises

Outcome Measures

Primary Outcomes (1)

• Craniovertebral Angle (CVA)

  CVA is used to assess forward head posture. Participants will be asked to stand in a natural and relaxed posture while focusing on a marked point at eye level on the wall. A lateral photograph will be taken using a Iphone 13 camera mounted on a tripod at shoulder height and placed 1.5 meters from the participant. The spinous process of the C7 vertebra and the tragus of the ear will be marked. The angle between the line connecting the tragus to C7 and a horizontal reference line will be calculated using the ImageJ software. The measurement results will be recorded on the evaluation form. Analysis Metric: Change in CVA (degrees)

  Baseline and Week 6

Secondary Outcomes (5)

• Trapezius Muscle Activity (Surface EMG Biofeedback, µV)

  Baseline and Week 6

• FEV1 (Forced Expiratory Volume in 1 Second)

  Baseline and Week 6

• FVC (Forced Vital Capacity)

  Baseline and Week 6

• Thoracic Expansion (Chest Mobility, cm)

  Baseline and Week 6

• St. George's Respiratory Questionnaire (SGRQ) Total Score

  Baseline and Week 6

Study Arms (2)

Dynamic Neuromuscular Stabilization Group (DNSG)

EXPERIMENTAL

Developmental DNS patterns (supine 90/90, prone on elbows, quadruped), performed twice daily for 6 weeks.

Behavioral: Dynamic Neuromuscular Stabilization Exercises

Thoracic Expansion Exercise Group (TEG)

EXPERIMENTAL

Upper, middle, and lower lobe-focused thoracic expansion breathing exercises, twice daily for 6 weeks.

Behavioral: Thoracic Expansion Exercise

Interventions

Dynamic Neuromuscular Stabilization Exercises BEHAVIORAL

Participants in the DNS group will perform Dynamic Neuromuscular Stabilization exercises based on developmental kinesiology principles. The program consists of three standardized DNS patterns: Supine 90°/90° Position (4.5-month developmental stage): The participant lies supine with hips and knees flexed to 90°, emphasizing diaphragmatic breathing, rib cage expansion, and neutral spine alignment. Prone on Elbows (4.5-month stage): The participant supports the upper body on elbows while maintaining cervical neutrality and coordinated diaphragmatic breathing. Quadruped Position (9-month developmental stage): The participant maintains a four-point kneeling position with proper spinal stabilization and controlled breathing. All exercises focus on coordinated activation of deep cervical flexors, diaphragm, transversus abdominis, multifidus, and pelvic floor muscles. Participants will perform 2 supervised sessions per week and twice-daily home exercises (10 repetitions × 3 sets) for 6 weeks.

Dynamic Neuromuscular Stabilization Group (DNSG)

Thoracic Expansion Exercise BEHAVIORAL

Participants in the thoracic expansion group will perform a structured breathing exercise program focused on increasing upper, middle, and lower thoracic mobility. The program includes: Upper Lobe Expansion Exercise: Participant places hands over upper thoracic region and performs deep inhalation to expand upper lung fields, followed by slow exhalation. Middle Lobe Expansion Exercise: Hands placed laterally at mid-thoracic level to facilitate expansion of the middle lobes during inhalation. Lower Lobe Expansion Exercise: Hands positioned over the lower rib cage to promote diaphragmatic and lower thoracic expansion. Each exercise is performed for 3 sets of 10 repetitions, twice daily, for 6 weeks. Two supervised sessions per week will ensure correct technique and progression. The exercises aim to improve thoracic mobility, respiratory mechanics, and chest wall expansion.

Thoracic Expansion Exercise Group (TEG)

Eligibility Criteria

• Age: 18 Years - 40 Years
• Sex: all
• Healthy Volunteers: No
• Age Groups: Adult (18-64)

You may qualify if:

• Adults aged 18 to 40 years.
• Craniovertebral angle (CVA \< 53°) indicating forward head posture.
• Able to perform exercise-based interventions.
• Voluntarily agrees to participate and signs the informed consent form.
• No neurological, orthopedic, systemic, or cardiopulmonary conditions that would limit participation.

You may not qualify if:

• Contraindications to exercise (e.g., acute musculoskeletal injury, uncontrolled cardiovascular disease).
• Chronic upper respiratory tract disease that may affect spirometry results. Presence of a cardiac pacemaker.
• Neurological disorders, systemic diseases, or mental impairments that could interfere with exercise cooperation.
• History of orthopedic or musculoskeletal surgery affecting mobility or posture.
• Currently participating in respiratory exercises, spinal stabilization training, or structured exercise programs.
• Engagement in professional sports or intensive physical training that may affect baseline neuromuscular measurements.
• Failure to comply with the exercise program (e.g., missing 3 consecutive days of prescribed exercises).

Sponsors & Collaborators

• Esra BECENI: lead

Study Sites (1)

Mudanya University

Bursa, 16940, Turkey (Türkiye)

Location

Study Officials

• Gülay Yalçın, PhD

  Mudanya University, Faculty of Health Sciences, Department of Physiotherapy

  STUDY DIRECTOR

• Esra Beceni, Lecturer

  Mudanya University Vocational, Physiotherapy Program

  PRINCIPAL INVESTIGATOR

Central Study Contacts

Gülay Yalçın, PhD

CONTACT

+905376342600; gulay.yalcin@mudanya.edu.tr

Esra Beceni, Lecturer

CONTACT

+905387358097; esra.beceni@mudanya.edu.tr

Study Design

• Study Type: interventional
• Phase: not applicable
• Allocation: RANDOMIZED
• Masking: SINGLE
• Who Masked: OUTCOMES ASSESSOR
• Masking Details: Randomization will be done by the sealed envelope method.
• Purpose: TREATMENT
• Intervention Model: PARALLEL
• Sponsor Type: OTHER
• Responsible Party: SPONSOR INVESTIGATOR
• PI Title: lecturer

Model Details: a randomized, controlled, assessor-blind, prospective study

Study Record Dates

• First Submitted: November 16, 2025
• First Posted: November 20, 2025
• Study Start: December 1, 2025
• Primary Completion: January 31, 2026
• Study Completion: February 15, 2026
• Last Updated: November 25, 2025

Record last verified: 2025-11

Locations

TU (1)