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

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

Interventions

OTHER

Dynamic neuromuscular stabilisation breathing

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

OTHER

Myofascial Release

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

OTHER

Convetional Exercises

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

Sponsors & Collaborators

• Istinye University

  lead OTHER

Principal Investigators

• Prof.Dr. Habibe. Serap İnal, doctor of physical therapy · istinye university, faculty of health sciences , Department of physical therapy and rehabilitation

Study Design

Allocation

RANDOMIZED

Purpose

TREATMENT

Masking

NONE

Model

PARALLEL

Eligibility

Min Age

18 Years

Max Age

28 Years

Sex

ALL

Healthy Volunteers

Yes

Timeline & Regulatory

Start

2025-05-16

Primary Completion

2026-07-15

Completion

2026-07-15

Countries

• Turkey (Türkiye)

Study Locations