Effects of Cervical Stabilization Exercises With and Without Reverse Natural Apophyseal Glides in Text Neck Syndrome

NCT07646392 | Not Yet Recruiting

• 1 other identifier: REC/RCR&AHS/25/0125 Shomaiza
• Study Type: interventional
• Target: 42
• Locations: 1 country
• Sites: 1

Brief Summary

Text neck syndrome is one such disorder within that group, increasingly affecting individuals worldwide across various age groups. The phenomenon of text neck may occur in individuals who frequently and for prolonged periods adopt a forward-flexed neck and head position while looking at the screens of mobile electronic devices. This posture puts stress on the neck muscles and spine, leading to various symptoms like neck pain, stiffness, and headaches.

Conditions

Text Neck Syndrome

Keywords

Neck pain, disability, Range of motion

Outcome Measures

Primary Outcomes (4)

• 1. Numeric pain rate scale (NPRS)

  Patient level of pain will be assessed using this scale. This scale ranges from 0 to 10. 0 indicates "no pain" and 10 indicates "worst pain" (25). The reliability of NPRS in patient with neck pain has been reported to be 0.76 indicated a moderate level of reliability for NPRS and moderate level of consistency and stability in the scores obtained from the measurement tool

  upto 4 weeks

• 2. Neck Disability index (NDI)

  This questionnaire will be used to assess disability. Each of the ten items in the neck disability assessment is given a score between 0 and 5. Consequently, 50 is the highest possible score. The ten elements include four activities of daily living (lifting, working, driving, and recreation), two discretionary activities of daily living (personal care, reading), and four subjective symptoms (pain intensity, headache, concentration, and sleeping). This index is the most popular and well-researched tool for evaluating patients' self-reported impairment in relation to neck discomfort (27). The intraclass correlation coefficient ICC ( 95% Confidence intervals) for NDI was 0.87(0.66, 0.94), indicating very high reliability and NDI demonstrated an adequate level of absolute reliability(9.3) and internal consistency (Cronbach alpha 0.70), along with possibility, discriminative validity, and acceptable concept validity

  Upto 4 weeks

• 3. Universal Goniometer (UG):

  The Universal Goniometer was used to assess the ranges of motion of cervical flexion, extension, rotation, and lateral flexion. Throughout all range-of-motion tests, subjects sat erect, facing forward, with their arms on their laps and their feet flat on the ground(29). The goniometer application, an excellent correlation (r=0.81, p=0.000), for intra-rater 9(ICC=0.88) and inter-rater reliability (ICC=0.915) were obtained (30).

  Upto 4 weeks

• 4. Craniovertebral Angle:

  Measuring craniovertebral (CV) angle is one of the common objective methods in assessing forward head posture . It is the angle formed by a horizontal line drawn through the spinous process of the seventh cervical (C7) vertebra and a line joining the spinous process of C7 vertebra with the tragus of the ear using kinovvea software 2023 version 1.2. A smaller CVA reflects a greater degree of forward head posture, with angle less than 50 degrees typically considered abnormal

  Upto 4 weeks

Study Arms (2)

Cervical stabilization exercises with reverse NAGs

EXPERIMENTAL

Combining cervical stabilization exercises with Natural Apophyseal Glides (NAGs) is a highly effective, evidence-based approach for treating "text neck syndrome" (forward head posture). Reverse NAGs are gentle, oscillatory manual therapy techniques that, when combined with stabilization exercises, alleviate pain, correct posture, and restore a pain-free range of motion.

Other: Cervical stabilization exercises with reverse NAGs

Cervical stabilization exercises without reverse NAGs

ACTIVE COMPARATOR

Cervical stabilization exercises target the deep neck flexors and upper back muscles to correct forward head posture, reduce strain, and restore the neck's natural alignment.

Other: Cervical stabilization exercises without reverse NAGs

Interventions

Cervical stabilization exercises with reverse NAGs OTHER

1\. Cervical Stabilization Exercises: Chin tuck, Cervical Extension, shoulder Shrugs, shoulder Rolls, scapular Retraction. Reverse NAG A mobilization takes place when you glide the inferior facet up on the superior one. This is achieved by thrusting up along the treatment plane with your bottom hand. You initially press ventrally to secure your thumb and index finger under the chosen segment transverse processes and then glide cranially along the treatment plane. Maintain your ventral pressure or you will slip over the transverse process. Position: Patient is seated. You stand beside patient and cradle his head to your body with forearm. Therapist hand position piston grip for lower cervical spine and for upper thoracic spine will be wide grip. Dosage: The mobilization was applied at C5 to C7 and T1 to T3.

Cervical stabilization exercises with reverse NAGs

Cervical stabilization exercises without reverse NAGs OTHER

1\. Cervical Stabilization Exercises: Chin tuck: In standing position, participant pulls back the chin as if trying to make double chin while keeping the eyes level. This was done for 15 repetitions. Cervical Extension: In standing participant graps the base of neck, with both hands while extending the neck as far as possible. This was done for 15 repetitions. Shoulder Shrugs: In standing position, participant shrugs the shoulders, bringing them up towards the ears. This was done for 15 repetitions. Shoulder Rolls: In standing position, participant rolls the shoulder forward in a circle. Then, rolls shoulder backwards in a circle. Then participant relaxes and repeats the procedure for 15 times. Scapular Retraction: In standing position, participant brings the shoulder blades together in the back; participant then relaxes and repeats the procedure for 15 times.

Cervical stabilization exercises without reverse NAGs

Eligibility Criteria

• Age: 18 Years - 35 Years
• Sex: all
• Healthy Volunteers: No
• Age Groups: Adult (18-64)

You may qualify if:

• Both male and female are taken
• Age between 18-35 years
• Craniovertebral angle less than 50 degree

You may not qualify if:

• Trauma
• Patient undergoes cervical surgery.
• Disc prolapse, herniation, spondylolisthesis
• Osteoporosis
• Torticullis
• Pregnancy
• Psychological Problems
• Cervical radiculopathy

Sponsors & Collaborators

• Riphah International University: lead

Study Sites (1)

Sunrise Medicare Center Faisalabad

Faisalābad, Punjab Province, Pakistan

Location

Related Publications (10)

• lsiwed KT, Alsarwani RM, Alshaikh SA, Howaidi RA, Aljahdali AJ, Bassi MM. The prevalence of text neck syndrome and its association with smartphone use among medical students in Jeddah, Saudi Arabia. Journal of Musculoskeletal Surgery and Research. 2021;5(4):266-72.

  BACKGROUND

• Rashid A, Sahry S, Tabasum H, Farooq M, Ali Z, Younas MW. Prevalence of Text Neck Syndrome and its Association with Forward Head Posture and Aerobic Capacity Among Medical Students. Insights-Journal of Health and Rehabilitation. 2024;2(2 (Health & Allied)):23-8.

  BACKGROUND

• Bhende R, Shinde S, Jain P. Effect of Integrated Postural Training in Individuals with Text Neck Syndrome. Journal of Kinesiology and Exercise Sciences. 2024;34(108):10-9.

  BACKGROUND

• Kaya M, Ucgun H, Denizoglu Kulli H. The effect of proprioceptive neuromuscular facilitation on individuals with text neck syndrome: A randomized controlled study. Medicine (Baltimore). 2024 Jul 26;103(30):e38716. doi: 10.1097/MD.0000000000038716.

  PMID: 39058818 BACKGROUND

• Yüzbaşıoğlu Ü, Ekici E, Aytar A. Pain of Modern Age Text Neck Syndrome: A Traditional Review. İstanbul Gelişim Üniversitesi Sağlık Bilimleri Dergisi. 2024(24):1321-31.

  BACKGROUND

• SAl Miaraj A, Bhat I. Prevalence of Text Neck Syndrome and Its Association with Mobile Phone Usage Among University Academic Staff. Int J Phys Med Rehabil. 2021;9(10).

  BACKGROUND

• Anand B, Sharma P. Association of Hand Performance with Neck Disability in Text Neck Syndrome among College Students. Indian Journal of Physiotherapy and Occupational Therapy. 2020;14(4):13.

  BACKGROUND

• Shah J, Soni K. Effectiveness of pilates along with conventional exercise program and conventional exercise program alone in subjects with text neck syndrome. International Journal of Science and Research (IJSR). 2021;10:1322-6.

  BACKGROUND

• Ahmed HH, Abdelhamid SA, Elhafez HM, Shimaa A, Abd El Azeim S. EFFECT OF TEXT-NECK SYNDROME ON SCAPULAR INDEX AND RESPIRATORY FUNCTIONS IN DIFFERENT AGE GROUPS. 2021

  BACKGROUND

• Piruta J, Kulak W. Physiotherapy in Text Neck Syndrome: A Scoping Review of Current Evidence and Future Directions. J Clin Med. 2025 Feb 19;14(4):1386. doi: 10.3390/jcm14041386.

  PMID: 40004916 BACKGROUND

MeSH Terms

Conditions

Neck Pain

Condition Hierarchy (Ancestors)

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

Study Officials

• Rahat Afzal, MS-OMPT

  Governement Teaching Hospital Shahdara Lahore.

  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 12, 2026
• Study Start: May 30, 2026
• Primary Completion (Estimated): July 30, 2026
• Study Completion (Estimated): August 30, 2026
• Last Updated: June 12, 2026

Record last verified: 2026-06

Locations

PA (1)