Effects of Sahrmann's Versus Janda Approach in Lower Crossed Syndrome Patients

NCT07642271 | Not Yet Recruiting

• 1 other identifier: REC/RCR&AHS/25/0113 Rahila
• Study Type: interventional
• Target: 54
• Locations: 1 country
• Sites: 1

Brief Summary

Muscular imbalance due to prolonged sitting or standing posture leads to a condition lower cross syndrome(LCS) or lumbopelvic syndrome. Several stretching and strengthening regimens are used to treat cross pattern of muscular tightness and weakness in LCS. This study aims to compare the effects of Sahrmann's versus Janda's approach on pain, pelvic tilt and lumbar lordosis in lower crossed syndrome patients.

Conditions

Lower Cross Syndrome

Keywords

pain; pelvic tilt

Outcome Measures

Primary Outcomes (3)

• Numeric pain rate scale (NPRS) for pain

  The Numeric Pain Rating Scale (NRS) is an 11-point, standardized assessment tool used to measure subjective pain intensity. Ranging from 0 ("no pain") to 10 ("the worst pain imaginable"), it provides healthcare providers with a quick and reliable method to evaluate pain severity, track symptom changes, and measure treatment effectiveness

  upto 4 weeks

• Flexible Ruler for lumbar Lordosis (degree)

  To measure lumbar lordosis using a flexible ruler (flexicurve), mold it to the curvature of your spine from T12 to S2. Trace the curve onto paper to find the curve's length (\\(L\\)) and the maximum perpendicular height (\\(H\\)). Calculate the angle in degrees using the equation: \\(\\theta = 4 \\times \\arctan(2H/L)\\).

  upto 4 weeks

• I Handy Level for Pelvic tilt(degree)

  The examiner performed the process three times, and during those three trials, the best view was acquired, the normal average anterior pelvic tilt angle is 9.6±3.5 and 11.7±3.8° in males and females, respectively

  upto 4 weeks

Study Arms (2)

Sahrmann's approach

EXPERIMENTAL

Dr. Shirley Sahrmann's approach-rooted in her concept of Movement System Impairment (MSI) Syndromes-takes a functional, movement-based approach to postural dysfunctions like lower crossed syndrome (LCS). Rather than treating LCS strictly as a static structural cross-syndrome, her model emphasizes analyzing how the body moves in daily life

Other: Sahrmann's approach

Janda Approach

ACTIVE COMPARATOR

The Janda approach to Lower Crossed Syndrome (LCS) corrects muscle imbalances caused by prolonged sitting or poor posture. It targets an alternating "cross" of tight and weak muscles-specifically tight hip flexors/lower back muscles and weak glutes/abdominals-to relieve low back pain and restore proper pelvic alignment.

Other: Jandas approach

Interventions

Jandas approach OTHER

1.50 to 70 degrees of trunk flexion 2.Pelvis tilting 3.One leg standing 4.Quadreped position (forward and backward movement) 5. Quadruped position (raising opposite arm and leg) 6. pelvic bridging 7.One leg bridge 8.Side Plank 9.Abdominal bracing 10. Knee active bending 90 degrees 11. Half Crunch

Janda Approach

Sahrmann's approach OTHER

1. single knee to chest and double knee to chest 2. Rectus femoris stretching 3. kneeling psoas stretch 4. piriformis stretch in pigeon pose 5. lying piriformis stretch 6. Sit and reach stretch 1.Clamshell (side lying) strengthening of gluteus medius 2.Hip abduction gluteus medius strengthening 3.Extension of femur 4.isometric abdominal contraction(top to floor) 5. abdominal contraction(cat exercise)

Sahrmann's approach

Eligibility Criteria

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

You may qualify if:

• Gender (both)
• Age (18 to 40)
• Participants who fulfilled the criteria of lower cross syndrome

You may not qualify if:

• Any serious pathology i.e. Neoplasm
• Any history of trauma
• Spinal malalignment i.e. Scoliosis
• Receiving any other form of Physical therapy treatment

Sponsors & Collaborators

• Riphah International University: lead

Study Sites (1)

Rasheed Hospital

Lahore, Punjab Province, 54000, Pakistan

Location

Related Publications (9)

• Kandil EA, Yamany AAER, Alsaka SSD, Abd El-Azeim AS. Effect of global postural reeducation on chronic low pain patients with lower cross syndrome. Bulletin of Faculty of Physical Therapy. 2024;29(1):8.

  BACKGROUND

• Sugavanam T, Sannasi R, Anand PA, Ashwin Javia P. Postural asymmetry in low back pain - a systematic review and meta-analysis of observational studies. Disabil Rehabil. 2025 Apr;47(7):1659-1676. doi: 10.1080/09638288.2024.2385070. Epub 2024 Aug 21.

  PMID: 39166267 BACKGROUND

• Nourbakhsh MR, Arabloo AM, Salavati M. The relationship between pelvic cross syndrome and chronic low back pain. Journal of Back and Musculoskeletal Rehabilitation. 2006;19(4):119-28.

  BACKGROUND

• Pradeep S, Heggannavar A, Metgud S. Effect of Sciatic Nerve Neurodynamic Sustained Natural Apophyseal Glides on Individuals with Pelvic Crossed Syndrome: A Randomized Controlled Trial. Indian Journal of Physical Therapy and Research. 2020;2(1):35-40.

  BACKGROUND

• Puagprakong P, Earde P, Kooncumchoo P, editors. Lumbo-Pelvic-Hip Angle Changes During Upright and Free Style Sitting in Office Workers with Lower Crossed Syndrome. Human Interaction, Emerging Technologies and Future Applications IV; 2021 2021//; Cham: Springer International Publishing.

  BACKGROUND

• Childs JD, Piva SR, Fritz JM. Responsiveness of the numeric pain rating scale in patients with low back pain. Spine (Phila Pa 1976). 2005 Jun 1;30(11):1331-4. doi: 10.1097/01.brs.0000164099.92112.29.

  PMID: 15928561 BACKGROUND

• Seidi F, Rajabi R, Ts E, Sj M. Iranian Flexible ruler Reliability and Validity in Lumbar Lordosis Measurement. World Journal of Sport Sciences. 2009;2:95-9.

  BACKGROUND

• Lewandrowski KU, Elfar JC, Li ZM, Burkhardt BW, Lorio MP, Winkler PA, Oertel JM, Telfeian AE, Dowling A, Vargas RAA, Ramina R, Abraham I, Assefi M, Yang H, Zhang X, Ramirez Leon JF, Fiorelli RKA, Pereira MG, de Carvalho PST, Defino H, Moyano J, Lim KT, Kim HS, Montemurro N, Yeung A, Novellino P. The Changing Environment in Postgraduate Education in Orthopedic Surgery and Neurosurgery and Its Impact on Technology-Driven Targeted Interventional and Surgical Pain Management: Perspectives from Europe, Latin America, Asia, and The United States. J Pers Med. 2023 May 18;13(5):852. doi: 10.3390/jpm13050852.

  PMID: 37241022 BACKGROUND

• Luna, A., Casertano, L., Timmerberg, J., O'Neil, M., Machowsky, J., Leu, C.-S., . . . Agrawal, S. (2021). Artificial intelligence application versus physical therapist for squat evaluation: a randomized controlled trial. Scientific Reports, 11(1), 18109. doi:10.1038/s41598-021-97343-y Mahmoud, H., Aljaldi, F., El-Fiky, A., Battecha, K., Thabet, A., Alayat, M., . . . Ibrahim, A. (2023). Artificial Intelligence machine learning and conventional physical therapy for upper limb outcome in patients with stroke: a systematic review and meta-analysis. Eur Rev Med Pharmacol Sci, 27(11), 4812-4827. doi:10.26355/eurrev_202306_32598

  BACKGROUND

MeSH Terms

Conditions

Pain

Condition Hierarchy (Ancestors)

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

Study Officials

• Samrood Akram, PhD*

  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: May 30, 2026
• Primary Completion (Estimated): July 30, 2026
• Study Completion (Estimated): August 30, 2026
• Last Updated: June 11, 2026

Record last verified: 2026-06

Data Sharing

• IPD Sharing: Will not share

Locations

PA (1)