Effects of Sahrmann's Approach in Patients With Cervical Extension Syndrome

NCT07641959 | Not Yet Recruiting

• 1 other identifier: REC/RCR & AHS/25/0114 Komal
• Study Type: interventional
• Target: 54
• Locations: 1 country
• Sites: 1

Brief Summary

Cervical Extension Syndrome (CES) is a form of postural dysfunction under the Movement System Impairment (MSI) classification. It has more prevalence among adults due to prolonged poor posture and sedentary lifestyles. This condition involves a forward head position,, increased thoracic curve, and altered movement patterns. This resulting in neck pain and impaired function. The Sahrmann's approach is a biomechanical principle that puts emphasizes on muscle activation, correction of postural impairments, and restoration of movement control through targeted exercises. The objective of the study will be to compare the effects of Sahrmann's Approach on Pain, ROM, craniovertebral angle and function in patients with Cervical Extension Syndrome.

Conditions

Neck Pain

Keywords

pain; range of motion; craniovertebral angle; function

Outcome Measures

Primary Outcomes (5)

• Numerical Pain Rating Scale (NPRS)

  he NPRS is an 11-point self-reported scale used to assess the intensity of neck pain. Participants rate their average pain over the previous 24 hours on a scale from 0 to 10. Scoring: 0 = No pain 1-3 = Mild pain 4-6 = Moderate pain 7-10 = Severe pain Direction of Improvement: Lower scores indicate less pain and improvement.

  upto 4 weeks

• Craniovertebral Angle (CVA) - Forward Head Posture

  Description: The CVA is used to quantify forward head posture. It is measured as the angle formed between: A horizontal line passing through the spinous process of C7. A line connecting C7 to the tragus of the ear. Scoring: Smaller angle = Greater forward head posture. Larger angle = Better head-neck alignment. Typical values: \<48° = Forward head posture ≥50° = More normal alignment Direction of Improvement: Increase in CVA indicates improvement.

  upto 4 weeks

• Neck Disability Index (NDI) - Functional Disability

  Description: The NDI is a self-administered questionnaire consisting of 10 items assessing the impact of neck pain on daily activities.Scoring: Each item scored from 0-5. Total score: 0-50 points Interpretation: 0-4 = No disability 5-14 = Mild disability 15-24 = Moderate disability 25-34 = Severe disability ≥35 = Complete disability Direction of Improvement: Lower scores indicate reduced disability and better function.

  upto 4 weeks

• Cervical Range of Motion (CROM)

  Description: Cervical ROM will be measured in: Flexion Extension Right lateral flexion Left lateral flexion Right rotation Left rotation The participant performs active cervical movements while the examiner records the maximum range in degrees. Units: Degrees (°) Typical Normal Values: Flexion: 45-50° Extension: 60-70° Lateral flexion: 45° Rotation: 70-90° Direction of Improvement: Greater ROM values indicate improvement.

  upto 4 weeks

• Thoracic Kyphosis Angle

  Description: Thoracic kyphosis will be measured in standing using a dual inclinometer technique. One inclinometer is placed over the spinous process of T1-T2 and the second over T12-L1. The difference between the two readings represents the thoracic kyphosis angle. Units: Degrees (°) Interpretation: Increased angle = Greater thoracic kyphosis Reduced angle = Improved thoracic posture Typical values: Approximately 20-40° in healthy adults Direction of Improvement: Reduction toward normal values indicates improvement.

  upto 4 weeks

Study Arms (2)

Sahrmann's exercises

EXPERIMENTAL

Shirley Sahrmann's approach is based on the concept that repetitive movement and sustained postures can create movement impairments, leading to pain and dysfunction. Rather than simply strengthening weak muscles or stretching tight ones, Sahrmann focuses on identifying and correcting faulty movement patterns. Patients will receive Sahrmann's Corrective Exercises for Cervicale Extension Syndrome.

Other: Sahrmann's Exercises

Standard Physical therapy

ACTIVE COMPARATOR

this group will receive conventional physiotherapy. receive muscle stretching of trapezius, pectoralis and levator scapulae. and Active ROM as retractions of scapula and neck

Other: conventional physiotherapy

Interventions

Sahrmann's Exercises OTHER

capital flexion, capital flexion with and without head tilt, Shoulder flexion, Abduction And Lateral Rotation, Cervical Extensors Muscle strengthening along with baseline treatment moist heat pack and TENS.

Sahrmann's exercises

conventional physiotherapy OTHER

this group will receive conventional physiotherapy. receive muscle stretching of trapezius, pectoralis and levator scapulae. and Active ROM as retractions of scapula and neck. along with baseline treatment moist heat pack and TENS.

Standard Physical therapy

Eligibility Criteria

• Age: 20 Years - 40 Years
• Sex: all
• Healthy Volunteers: No
• Age Groups: Adult (18-64)

You may qualify if:

• Adults between 20-40 years, NPRS score 4-6 , positive tests cervical flexion, extension, protraction and retraction and Cervical Nodding Against Wall

You may not qualify if:

• Scoliosis, Pregnant females, Any active infection or disese

Sponsors & Collaborators

• Riphah International University: lead

Study Sites (1)

University of Lahore Teaching Hospital, Lahore HOD Physio Department

Lahore, Punjab Province, 54000, Pakistan

Location

Related Publications (10)

• Sahrmann S. Movement system impairment syndromes of the extremities, cervical and thoracic spines: Elsevier Health Sciences; 2010.

  BACKGROUND

• Shinde SS, Shah DN. Correlation of craniovertebral angle with neck pain in undergraduate students-cross-sectional study. International Journal of Health Sciences and Research. 2022;12:96-101.

  BACKGROUND

• Ogura Y, Dimar JR, Djurasovic M, Carreon LY. Etiology and treatment of cervical kyphosis: state of the art review-a narrative review. J Spine Surg. 2021 Sep;7(3):422-433. doi: 10.21037/jss-21-54.

  PMID: 34734146 BACKGROUND

• Jabbar KM, Gandomi F. The comparison of two corrective exercise approaches for hyperkyphosis and forward head posture: A quasi-experimental study. J Back Musculoskelet Rehabil. 2021;34(4):677-687. doi: 10.3233/BMR-200160.

  PMID: 33896809 BACKGROUND

• Shinde SS, Shah DN. Correlation of craniovertebral angle with neck pain in undergraduate students-crosssectional study. International Journal of Health Sciences and Research. 2022;12:96-101.

  BACKGROUND

• Asadzadeh A, Salahzadeh Z, Samad-Soltani T, Rezaei-Hachesu P. An affordable and immersive virtual reality-based exercise therapy in forward head posture. PLoS One. 2024 Mar 6;19(3):e0297863. doi: 10.1371/journal.pone.0297863. eCollection 2024.

  PMID: 38446782 BACKGROUND

• Lim J-y, Nam S-h, Kim K-d. A Movement-System-Impairment Approach to the Evaluation and Treatment of a Patient Who had Cervical Flexion Syndrome with a Straight Neck: A Case Report. Journal of Musculoskeletal Science and Technology. 2024;8(1):49-56.

  BACKGROUND

• K S, Kanthanathan S, P ALA. Effectiveness of diagnosis and treatment based on movement system impairment in individuals with cervical pain: A randomized controlled trial. J Bodyw Mov Ther. 2024 Apr;38:323-328. doi: 10.1016/j.jbmt.2024.01.024. Epub 2024 Feb 2.

  PMID: 38763576 BACKGROUND

• Caldwell C, Sahrmann S, Van Dillen L. Use of a movement system impairment diagnosis for physical therapy in the management of a patient with shoulder pain. J Orthop Sports Phys Ther. 2007 Sep;37(9):551-63. doi: 10.2519/jospt.2007.2283.

  PMID: 17939614 BACKGROUND

• Yu L-J, Kim T-H. The effect of cervical stabilization exercises with thoracic spine extension exercises on forward head posture. International Journal of Human Movement and Sports Sciences. 2021;9(5):852-7.

  BACKGROUND

MeSH Terms

Conditions

Neck Pain; Pain

Condition Hierarchy (Ancestors)

Neurologic Manifestations; Signs and Symptoms; Pathological Conditions, Signs and Symptoms

Study Officials

• Komal Qayyum, MSPT*

  Riphah International University

  PRINCIPAL INVESTIGATOR

Central Study Contacts

Samrood Akram, PhD*

CONTACT

03324806143; samrood.akram@riphah.edu.pk

Study Design

• Study Type: interventional
• Phase: not applicable
• Allocation: RANDOMIZED
• Masking: SINGLE
• Who Masked: OUTCOMES ASSESSOR
• Purpose: TREATMENT
• Intervention Model: PARALLEL
• Sponsor Type: OTHER
• Responsible Party: SPONSOR

Study Record Dates

• First Submitted: June 8, 2026
• First Posted: June 11, 2026
• Study Start (Estimated): July 1, 2026
• Primary Completion (Estimated): October 1, 2026
• Study Completion (Estimated): November 1, 2026
• Last Updated: June 11, 2026

Record last verified: 2026-06

Data Sharing

• IPD Sharing: Will not share

Locations

PA (1)