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

NCT07721389 | Recruiting

• 1 other identifier: 25 - 26 - 2025
• Study Type: interventional
• Target: 60
• Locations: 1 country
• Sites: 1

Brief Summary

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.

Conditions

Forward Head Posture

Keywords

Forward Head Posture, Dynamic Neuromuscular Stabilization, Myofascial Release, Conventional Therapy, Neck Pain, Cervical Spine

Outcome Measures

Primary Outcomes (1)

• Craniovertebral Angle (CVA)

  The craniovertebral angle (CVA) will be measured using digital photogrammetry to assess the degree of forward head posture. A marker will be placed on the tragus of the ear and the spinous process of C7, and the angle formed between a horizontal line through C7 and the line connecting C7 to the tragus will be calculated. Smaller angles indicate a greater degree of forward head posture.

  4 weeks, and 8 weeks

Secondary Outcomes (1)

• Visual Analogue Scale (VAS)

  Baseline, 4 weeks, and 8 weeks

Study Arms (3)

dynamic neuromuscular stabilisation breathing

EXPERIMENTAL

Other: Dynamic neuromuscular stabilisation breathing; Other: Convetional Exercises

Myofacial release

EXPERIMENTAL

Other: Myofascial Release; Other: Convetional Exercises

Conventional Therapy

ACTIVE COMPARATOR

Other: Convetional Exercises

Interventions

Convetional Exercises OTHER

Standardized exercise protocol including head rotation, neck/upper back extension, swimmer exercise, head retraction with resistance band, and upper trapezius/levator scapulae stretches.

Conventional Therapy; Myofacial release; dynamic neuromuscular stabilisation breathing

Myofascial Release OTHER

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

Myofacial release

Dynamic neuromuscular stabilisation breathing OTHER

Diaphragmatic breathing exercises performed in supine, side-lying, and quadruped positions, 3 sets of 1 minute each.

dynamic neuromuscular stabilisation breathing

Eligibility Criteria

• Age: 18 Years - 28 Years
• Sex: all
• Healthy Volunteers: Yes
• Age Groups: Adult (18-64)

You may qualify if:

• 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

You may not qualify if:

• History of cervical spine surgery
• Presence of neurological disorders
• Diagnosis of cervical disc herniation
• Severe musculoskeletal pain (VAS ≥ 7)

Sponsors & Collaborators

• Istinye University: lead

Study Sites (1)

İstinye University, Fizyoterapi ve Rehabilitasyon Uygulama ve Araştırma Merkezi -İSÜFİZYOTEM

Istanbul, Zeytinburnu, 34010, Turkey (Türkiye)

RECRUITING

Related Publications (10)

• 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 BACKGROUND

• 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 BACKGROUND

• 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 BACKGROUND

• 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 BACKGROUND

• 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 BACKGROUND

• 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.

  BACKGROUND

• 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 BACKGROUND

• 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 BACKGROUND

• Alshahrani, A., Aly, S. M., Abdrabo, M. S., & Asiri, F. Y. (2018). Impact of smartphone usage on cervical proprioception and balance in healthy adults. Biomed res, 29(12), 2547-2552.

  BACKGROUND

• Naz, A., Bashir, M. S., & Noor, R. (2018). Prevalance of forward head posture among university students. Rawal Med J, 43(2), 260-2.

  RESULT

MeSH Terms

Conditions

Neck Pain

Interventions

Myofascial Release Therapy

Condition Hierarchy (Ancestors)

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

Intervention Hierarchy (Ancestors)

Massage; Therapy, Soft Tissue; Musculoskeletal Manipulations; Complementary Therapies; Therapeutics; Physical Therapy Modalities; Rehabilitation

Study Officials

• Prof.Dr. Habibe. Serap İnal, doctor of physical therapy

  istinye university, faculty of health sciences , Department of physical therapy and rehabilitation

  PRINCIPAL INVESTIGATOR

Central Study Contacts

Prof.Dr. H. Habibe serap INAL, doctor of physical therapy

CONTACT

+905325573354; serap.inal@galata.edu.tr

PT Rami M.osama Ramdoun, Bachelor of physical therapy

CONTACT

+905344100383; 2333095007@stu.istinye.edu.tr

Study Design

• Study Type: interventional
• Phase: not applicable
• Allocation: RANDOMIZED
• Masking: NONE
• Purpose: TREATMENT
• Intervention Model: PARALLEL
• Sponsor Type: OTHER
• Responsible Party: SPONSOR

Study Record Dates

• First Submitted: December 29, 2025
• First Posted: July 23, 2026
• Study Start: May 16, 2025
• Primary Completion: July 15, 2026
• Study Completion: July 15, 2026
• Last Updated: July 23, 2026

Record last verified: 2026-07

Data Sharing

• IPD Sharing: Will not share

Locations

TU (1)