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Postural KyphosisKyphosisNCT06835608

Effects of Schroth-Based Exercise on Kyphosis Angle, Muscle Strength, Balance, Pain, and Quality of Life in Hyperkyphosis With Chronic Neck Pain

A study testing Schroth Exercise Group and Postural Exercises Group in people with Postural Kyphosis and Chronic Neck Pain, run by Baskent University at 1 site in Turkey (Türkiye).

Active, not recruiting

Under way, not looking for participants. Everyone needed has enrolled. The study is still running.

Official record
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Trial summary

The normal thoracic kyphosis angle of the spine is 20-40°, however, an angle of more than 40° is referred to as postural kyphosis, increased kyphosis or hyperkyphosis. Although postural kyphosis negatively affects individuals' general health status, physical performance, and quality of life, there is still no… Read more about this study

Who is it for?
Ages 20 to 50 yearsHealthy volunteers can take part
Conditions the study is for
Postural Kyphosis, Chronic Neck Pain
What is being tested?
Schroth Exercise Group and Postural Exercises Group
Could I receive a placebo?
No, everyone receives an active treatment
How many people
52 participants
Where
1 siteTurkey (Türkiye)
Study dates
25 Feb 2025to 23 May 2027
Phase
Interventional
Are there results?
Not yet: the study is under way

Key requirements

Who can take part, as listed by the sponsor. Only the study team can confirm whether you are eligible, so take this list to your doctor.

  • Ages 20 to 50 years
  • All sexes
  • Healthy volunteers accepted
  • Adult

Who may be able to join

  • Thoracic kyphosis angle > 45 degrees,
  • Aged between 20 and 50 years,
  • Have neck pain for more than 3 months,
  • Neck pain visual analogue scale > 3,
  • Not being treated for postural kyphosis in the last 6 months,
  • Has no systemic disease

Who cannot join

  • History of trauma or surgery on spinal joints,
  • Participants with rheumatological and metabolic disorders,
  • Participants with congenital postural deformity and scoliosis

Trial locations and contacts

1 site in 1 country.

Turkey (Türkiye)1 site

  • Baskent University Umitkoy Outpatient Clinic

    Ankara, Çankaya, 06800

Other trials in Turkey (Türkiye)

About this study

Official title: Effects of Schroth-Based Three-Dimensional Exercise Program on Angle of Kyphosis, Muscle Strength, Balance, Pain, and Quality of Life in Patients With Postural Hyperkyphosis With Chronic Neck Pain

The normal thoracic kyphosis angle of the spine is 20-40°, however, an angle of more than 40° is referred to as postural kyphosis, increased kyphosis or hyperkyphosis. Although postural kyphosis negatively affects individuals' general health status, physical performance, and quality of life, there is still no standardized protocol for correcting the thoracic kyphosis angle. Conservative treatment approaches such as postural training and exercises, manual therapy, postural corrective kinesiotaping, and orthotic use have been recommended for managing increased thoracic kyphosis. While numerous studies have demonstrated the effectiveness of three-dimensional exercise programs in the treatment of scoliosis, research examining their impact on kyphosis remains considerably limited.Nevertheless, the potential of these exercises to promote neuromuscular reorganization suggests that they may be similarly effective in individuals with thoracic kyphosis. This randomized controlled trial aims to evaluate the effects of a Schroth-based three-dimensional exercise program on kyphosis angle, trunk muscle strength, balance, pain, and quality of life in individuals with postural hyperkyphosis and chronic neck pain.

Read the detailed description

Increasing thoracic kyphosis, spinal extensor muscle weakness, decreased spinal extension mobility, lumbo-pelvic pain, muscle activation and displacement of the scapula with changing traction angles have been associated with postural changes. It is evident that such alterations in posture have a biomechanical effect on the cervical and lumbar vertebrae. The presence of thoracic dysfunction has been documented in individuals experiencing chronic neck pain. Increases in both the thoracic kyphosis angle and flexor posture have been demonstrated to result in anterior displacement of the central gravity line. Displacement of the body's centre of gravity anteriorly has the potential to exert adverse effects on postural control.The association between postural changes and spinal extensor muscle weakness, increased kyphotic posture, decreased spinal extension mobility, lumbo-pelvic pain, muscle activation and displacement of the scapula with changing traction angles has been demonstrated. These postural changes have been demonstrated to exert a detrimental effect on postural stability, back pain, physical performance and quality of life.

The present study was meticulously designed as a Schroth-based three-dimensional exercise group and a control group, with a duration of eight weeks. The two groups will both undergo a programme comprising 20 sessions of electrotherapy and exercise, to be administered over a period of four weeks. Subsequent to the completion of the fourth week of electrotherapy sessions, the exercise applications will be continued for a further four weeks by the physiotherapist responsible for the study, who will undertake the programme three days per week. The intervention will consist of a series of educational sessions focusing on the development of postural perception, with a particular emphasis on the identification of postural kyphosis and the adoption of optimal posture in daily living. These educational sessions will be administered to both groups. The training programme will be delivered in a practical manner by the physiotherapist. A brochure will be provided to patients, serving as a reference guide for the exercises and considerations.

Being tested
Schroth Exercise Group, Postural Exercises Group
Keywords
postural hyperkyphosis, chronic neck pain

What participants receive

What participants receive. In a randomised study each person is assigned to one group by chance.

  • Schroth Exercise GroupOther

    The study group will receive electrotherapy treatment (hot pack, ultrasound, tens) to the neck area for 30 minutes in each session. After electrotherapy treatment, kyphotic posture correction exercises will be applied with the help of proprioceptive and extroceptive stimuli in the sagittal plane with mirror control and specific corrective breathing. In the exercise program, exercise practices will be performed in specific positions in supine, prone, sitting and standing. The exercise program will be planned for approximately 40 minutes in each session. A total of 20 sessions of electrotherapy and exercise will be performed for 4 weeks. At the end of the 4th week, after the electrotherapy sessions are completed, exercise applications will continue for the other 4 weeks by the physiotherapist who performs the exercise 3 days a week.

  • Postural Exercises GroupOther

    Patients to be included in the control group will receive electrotherapy treatment (ultrasound, tens, hotpack) to the neck area for 30 minutes in each session. After the electrotherapy treatment, posture corrective exercises will be applied. Corrective exercise program for posture will consist of deep neck flexor muscle strengthening exercises, lower and middle trapezius strengthening, neck isometric exercises. All strengthening exercises will be given 3 sets of 10 repetitions per day, each repetition for 10 seconds. Stretching exercises will be given to the shortened upper trapezius and pectoralis major muscles. Stretching exercises will be given 2 sets of 5 repetitions per day, with each repetition lasting 20 seconds. In the first 4 weeks, a total of 20 sessions of electrotherapy and exercise will be performed in corrective exercises for posture. At the end of the 4th week, exercise applications will continue for the other 4 weeks 3 days a week.

Study groups in NCT06835608
Study groupRoleWhat they receive
three-dimensional schroth exercise groupExperimentalSchroth therapy, a three-dimensional exercise therapy program was developed in Germany in the 1920s by Katharina Schroth. The three-dimensional exercise program refers to the sagittal, frontal and horizontal planes. The three- dimensional Schroth exercise training consists of spinal lengthening and positional correction of the cervical, thoracic and lumbar regions in the sagittal plane, special breathing techniques and re-education of the neuromuscular system to improve kyphotic posture.
Receives: Other: Schroth Exercise Group
corrective exercises for postureActive comparatorCorrective exercise program for posture will consist of deep neck flexor muscle strengthening exercises, lower and middle trapezius strengthening, neck isometric exercises.
Receives: Other: Postural Exercises Group

What is being measured

The primary outcome is the main question the study is designed to answer.

  1. Angle of thoracic kyphosis

    The kyphosis angles of the participants will be measured using a flexible ruler and an inclinometer.As stated in the literature, thoracic kyphosis will be measured from C7-T12 spinal processes.Prior to molding the flexicurve ruler to the subject's spine, the C7 and T12 posterior spinous processes were located via palpation.The flexicurve ruler was then molded over the spine midline from C7 to T12. The resulting curve was traced on paper, and the locations of the C7 and T12 processes were labelled. The measurement was performed while the participant stood in a neutral upright posture with feet shoulder-width apart.The flexible ruler will be placed on the marked reference points. It will then be placed on the millimetrically divided paper without distorting its shape. The angular value of the curvature drawn on the paper from the contour of the flexible ruler will then be calculated. Another kyphosis angle will be measured by the same procedure using an inclinometer.

    Measured: Baseline,4th week, 8th week

Secondary outcomes (7)

  1. Trunk Muscle Strength

    In our study, trunk extensor and flexor muscle strengths of participants will be measured with a hand-held dynamometer (Lafayette hand-held dynamometer model 01165 JTech, USA). Trunk extension strength will be measured in a prone position. The dynamometer will be positioned at the T4 level of the subjects, with the measurement being taken perpendicular to the body. Participants will be asked to assume the supine position with their knees straight, in order to measure the strength of their trunk flexor muscles. The dynamometer will be placed at the sternum level, and the measurement will be taken perpendicular to the trunk.Participants will be asked to cross their hands over their chest. In both measurements, participants are instructed to generate an isometric trunk extension force for a duration of two seconds, followed by a maximum isometric hold for five seconds. This measurement is then repeated on three occasions.

    Measured: Baseline,4th week, 8th week

  2. Balance Assessment

    Tetrax posturography device (Tetrax Potable Multiple System, Tetrax Ltd., Ramat Gan, Israel) is a device that allows objective assessment and recording of postural stability and fall risk.The measurements will be conducted in eight different positions: eyes open and closed with the head in a neutral position, eyes open and closed while standing on a foam surface with the head in a neutral position, eyes closed with the head rotated to the right and left, and eyes closed with the neck in full extension and flexion positions. The general stability index (SI) is to be conducted, with the displacement of each case's centre of mass and anterior-posterior weight distribution measurements being the basis on which it is to be assessed.

    Measured: Baseline,4th week, 8th week

  3. Spinal Stabilisation Activity

    The assessment of spinal stabilisation activity will be conducted utilising the Stabiliser Pressure Biofeedback device (PBU; Chattanooga Group-Australia).The pressure biofeedback device is a practical tool commonly used in clinical settings to measure the pressure generated during the activation of the Transversus Abdominis and Multifidus muscles, emphasizing segmental stabilization. The pressure gauge of the device ranges from 0 to 200 mmHg and is connected to an inflation unit (manometer). The measurement will be conducted with the patient in the prone position. The inflation unit of the device will be placed under the patient's umbilicus, positioned above the ASIS (anterior superior iliac spines). Before asking the patient to perform any muscle movement, the device's pressure will be set to 70 mmHg. Participants will be instructed to take a deep breath and gently draw the umbilicus toward the lumbar vertebrae, maintaining this position for 10 seconds

    Measured: Baseline,4th week, 8th week

  4. Visual Analogue Scale (VAS)

    The VAS (Visual Analogue Scale) will be utilised to evaluate the severity of neck pain. The patient will be requested to indicate the intensity of discomfort experienced over the preceding seven days on a 10-centimetre ruler that has been segmented into equal divisions. A score of 0 indicates an absence of pain, while a score of 10 represents the most severe pain. The measurement results will be used to assess the pain intensity.

    Measured: Baseline,4th week, 8th week

  5. Occiput Wall and Tragus Wall Distance

    To determine the anterior tilt of the head, the Tragus-to-Wall Distance will be measured. The participants should stand upright with their heels and back against the wall, maintaining a neutral neck position and closed chin. The distances between the occiput and the wall, as well as the tragus and the wall, will be measured using a tape measure in the sagittal plane. The average of these two measurements will then be calculated and recorded in centimetres.

    Measured: Baseline,4th week, 8th week

  6. Neck Disability Index

    The Neck Disability Index (NDI) is a self-reported questionnaire designed to assess neck pain-related disability. It consists of 10 items addressing daily activities such as personal care, lifting, reading, work, driving, sleeping, recreational activities, pain intensity, concentration, and headache. Each item is scored on a 6-point Likert scale ranging from 0 (no disability) to 5 (complete disability). The total score is calculated by summing the scores of all items and multiplying by two, resulting in a final score ranging from 0 to 100, where higher scores indicate a greater level of disability. In this study, the NDI will be used to evaluate neck-related functional limitations of participants, with scores expressed as a percentage of maximum possible disability.

    Measured: Baseline,4th week, 8th week

  7. Assessment of Quality of Life

    The Scoliosis Research Society-22 (SRS-22) Questionnaire is a widely accepted, simple, and practical tool developed by the Scoliosis Research Society to assess health-related quality of life in individuals with spinal deformities. In this study, the SRS-22 will be used to evaluate the quality of life of participants. The The questionnaire consists of 22 items grouped into five domains: pain, self-image/appearance, function/activity, mental health, and satisfaction with treatment. Each item is scored on a 5-point Likert scale, ranging from 1 (worst outcome) to 5 (best outcome). The total score is calculated by averaging the item scores within each domain or across all items. Higher scores reflect better health-related quality of life.

    Measured: Baseline,4th week, 8th week

Timeline

From the start of the study to its completion; the mark is today. Estimated dates are the sponsor’s plan.

  1. First posted19 Feb 2025
  2. Study start25 Feb 2025
  3. Primary completion23 Sep 2026
  4. Study completion23 May 2027 (estimated)

Resources

More details

For doctors and researchers: how the study is designed, who runs it, and its registry IDs.

Study design
Study type
Interventional
Phase
Phase N/A
Primary purpose
Treatment
Allocation
Randomised
Intervention model
Parallel groups
Model description
The study consists of two groups. Group 1 : exercise group Group 2: Control group
Masking
Single blind
Who is masked
Participant
Enrolment
52 participants (estimated)
IDs, dates and publications
ClinicalTrials.gov ID
NCT06835608
Sponsor's protocol ID
KA24/125
Acronym
Kyphosis
Status last verified
Oct 2026
First submitted
14 Feb 2025
Last updated
5 Oct 2026
Results posted
No
Data monitoring committee
No
FDA-regulated drug
No
FDA-regulated device
No
Individual data sharing
No: There are no plans to share individual participant data (IPD). However, once statistical analyses of all data are completed, aggregated results and summary statistical findings will be made available to researchers. These results will be shared in a de-identified format to ensure participant privacy. Interested researchers can request access to the results by contacting the principal investigator at (bayramtugce91@gmail.com)

Publications

  • Bulut D, Dilek B, Kilinc A, Ellidokuz H, Oncel S. An investigation into the effects of kinesiotaping for posture correction on kyphosis angle, pain, and balance in patients with postmenopausal osteoporosis-associated thoracic kyphosis. Arch Osteoporos. 2019 Aug 13;14(1):89. doi: 10.1007/s11657-019-0634-x.

    PubMed 31410649

  • Alanay A, Cil A, Berk H, Acaroglu RE, Yazici M, Akcali O, Kosay C, Genc Y, Surat A. Reliability and validity of adapted Turkish Version of Scoliosis Research Society-22 (SRS-22) questionnaire. Spine (Phila Pa 1976). 2005 Nov 1;30(21):2464-8. doi: 10.1097/01.brs.0000184366.71761.84.

    PubMed 16261127

  • Telci EA, Karaduman A, Yakut Y, Aras B, Simsek IE, Yagli N. The cultural adaptation, reliability, and validity of neck disability index in patients with neck pain: a Turkish version study. Spine (Phila Pa 1976). 2009 Jul 15;34(16):1732-5. doi: 10.1097/BRS.0b013e3181ac9055.

    PubMed 19770615

  • Crasto CFB, Montes AM, Carvalho P, Carral JMC. Pressure biofeedback unit to assess and train lumbopelvic stability in supine individuals with chronic low back pain. J Phys Ther Sci. 2019 Oct;31(10):755-759. doi: 10.1589/jpts.31.755. Epub 2019 Oct 19.

    PubMed 31645801

  • Akkaya N, Doganlar N, Celik E, Aysse SE, Akkaya S, Gungor HR, Sahin F. TEST-RETEST RELIABILITY OF TETRAX(R) STATIC POSTUROGRAPHY SYSTEM IN YOUNG ADULTS WITH LOW PHYSICAL ACTIVITY LEVEL. Int J Sports Phys Ther. 2015 Nov;10(6):893-900.

    PubMed 26618068

  • De Blaiser C, De Ridder R, Willems T, Danneels L, Roosen P. Reliability and validity of trunk flexor and trunk extensor strength measurements using handheld dynamometry in a healthy athletic population. Phys Ther Sport. 2018 Nov;34:180-186. doi: 10.1016/j.ptsp.2018.10.005. Epub 2018 Oct 12.

    PubMed 30366246

  • Amatachaya P, Wongsa S, Sooknuan T, Thaweewannakij T, Laophosri M, Manimanakorn N, Amatachaya S. Validity and reliability of a thoracic kyphotic assessment tool measuring distance of the seventh cervical vertebra from the wall. Hong Kong Physiother J. 2016 Jul 13;35:30-36. doi: 10.1016/j.hkpj.2016.05.001. eCollection 2016 Dec.

    PubMed 30931031

  • Hunter DJ, Rivett DA, McKiernan S, Weerasekara I, Snodgrass SJ. Is the inclinometer a valid measure of thoracic kyphosis? A cross-sectional study. Braz J Phys Ther. 2018 Jul-Aug;22(4):310-317. doi: 10.1016/j.bjpt.2018.02.005. Epub 2018 Mar 6.

    PubMed 29576490

  • Greendale GA, Nili NS, Huang MH, Seeger L, Karlamangla AS. The reliability and validity of three non-radiological measures of thoracic kyphosis and their relations to the standing radiological Cobb angle. Osteoporos Int. 2011 Jun;22(6):1897-905. doi: 10.1007/s00198-010-1422-z. Epub 2010 Oct 12.

    PubMed 20938766

  • Barrett E, McCreesh K, Lewis J. Intrarater and interrater reliability of the flexicurve index, flexicurve angle, and manual inclinometer for the measurement of thoracic kyphosis. Rehabil Res Pract. 2013;2013:475870. doi: 10.1155/2013/475870. Epub 2013 Dec 12.

    PubMed 24396603

  • Lafage R, Steinberger J, Pesenti S, Assi A, Elysee JC, Iyer S, Lenke LG, Schwab FJ, Kim HJ, Lafage V. Understanding Thoracic Spine Morphology, Shape, and Proportionality. Spine (Phila Pa 1976). 2020 Feb 1;45(3):149-157. doi: 10.1097/BRS.0000000000003227.

    PubMed 31513104

  • Ozdemir Gorgu S, Algun ZC. A randomized controlled study of the effect of functional exercises on postural kyphosis: Schroth-based three-dimensional exercises versus postural corrective exercises. Disabil Rehabil. 2023 Jun;45(12):1992-2002. doi: 10.1080/09638288.2022.2083244. Epub 2022 Jun 12.

    PubMed 35694970

  • Bezalel T, Kalichman L. Improvement of clinical and radiographical presentation of Scheuermann disease after Schroth therapy treatment. J Bodyw Mov Ther. 2015 Apr;19(2):232-7. doi: 10.1016/j.jbmt.2014.04.008. Epub 2014 Apr 18.

    PubMed 25892377

  • Lehnert-Schroth C. Introduction to the Three-dimensional Scoliosis Treatment According to Schroth. Physiother (United Kingdom). 1992;78(11):810-815.

  • Bansal S, Katzman WB, Giangregorio LM. Exercise for improving age-related hyperkyphotic posture: a systematic review. Arch Phys Med Rehabil. 2014 Jan;95(1):129-40. doi: 10.1016/j.apmr.2013.06.022. Epub 2013 Jul 9.

    PubMed 23850611

Questions about this trial

What is this clinical trial studying?

A study testing Schroth Exercise Group and Postural Exercises Group in people with Postural Kyphosis and Chronic Neck Pain, run by Baskent University at 1 site in Turkey (Türkiye).

The full registered description is in the About this study section and the official record.

Who may be eligible to take part?

The sponsor lists 6 inclusion and 3 exclusion criteria. Eligibility is decided by the study team after screening, so read the full criteria and contact a listed site.

Is this clinical trial currently recruiting?

The record says: under way, not looking for participants, as of the sponsor's last update on 5 Oct 2026. Status can change between updates, so confirm with the study contact before making plans.

Where is the study taking place?

The record lists 1 site in Turkey (Türkiye). Whether a site is taking part right now should be confirmed with that site. See every site.

What are the possible benefits and risks?

They depend on the study and the treatment, and no study can promise a benefit. The study team explains the known risks during informed consent, before anyone joins; the record itself does not list them.

Are results available for this study?

This study is still under way. Results are not available in the source record yet.

How can a doctor refer a patient or contact the research team?

The record lists no contact. The official record names the sponsor, who can be asked directly. AzTrials does not enrol participants or take referrals.

What does the primary outcome measure?

Angle of thoracic kyphosis (time frame: Baseline,4th week, 8th week). It is what the study was designed to measure, not a finding.

Where can I read the original study information?

On the ClinicalTrials.gov record for NCT06835608, which also lists 36 linked publications.

Does a listing mean the treatment is approved or proven to work?

No. A listing means the study is registered. It does not show that the treatment is safe, works, or is approved by a regulator.

How often is this information updated?

AzTrials copies changed records from ClinicalTrials.gov every night and reloads the whole registry every week. The sponsor last updated this record on 5 Oct 2026.

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