Forward Head PostureFHP-DNS-TENCT07238660
Thoracic Expansion vs DNS Exercises in Forward Head Posture
A study testing Dynamic Neuromuscular Stabilization Exercises and Thoracic Expansion Exercise in people with Forward Head Posture, run by Esra BECENI at 1 site in Turkey (Türkiye).
Trial summary
This randomized controlled trial aims to compare the effects of thoracic expansion exercises and Dynamic Neuromuscular Stabilization (DNS) on respiratory function and bilateral trapezius muscle activity in individuals with forward head posture (FHP). Read more about this study
- Who is it for?
- Ages 18 to 40 years
- Conditions the study is for
- Forward Head Posture
- What is being tested?
- Dynamic Neuromuscular Stabilization Exercises and Thoracic Expansion Exercise
- Type of treatment
- Lifestyle or therapy programme
- Could I receive a placebo?
- No, everyone receives an active treatment
- How many people
- 32 participants
- Where
- 1 siteTurkey (Türkiye)
- Study dates
- 1 Dec 2025to 15 Feb 2026
- 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 18 to 40 years
- All sexes
- No healthy volunteers
- Adult
Who may be able to join
- Adults aged 18 to 40 years.
- Craniovertebral angle (CVA < 53°) indicating forward head posture.
- Able to perform exercise-based interventions.
- Voluntarily agrees to participate and signs the informed consent form.
- No neurological, orthopedic, systemic, or cardiopulmonary conditions that would limit participation.
Who cannot join
- Contraindications to exercise (e.g., acute musculoskeletal injury, uncontrolled cardiovascular disease).
- Chronic upper respiratory tract disease that may affect spirometry results. Presence of a cardiac pacemaker.
- Neurological disorders, systemic diseases, or mental impairments that could interfere with exercise cooperation.
- History of orthopedic or musculoskeletal surgery affecting mobility or posture.
- Currently participating in respiratory exercises, spinal stabilization training, or structured exercise programs.
- Engagement in professional sports or intensive physical training that may affect baseline neuromuscular measurements.
- Failure to comply with the exercise program (e.g., missing 3 consecutive days of prescribed exercises).
Trial locations and contacts
1 site in 1 country. Contact the study team or a site near you to ask about taking part.
About this study
Official title: A Randomized Controlled Trial Comparing Thoracic Expansion Exercises and Dynamic Neuromuscular Stabilization on Respiratory Function and Bilateral Trapezius Muscle Activity in Individuals With Forward Head Posture
This randomized controlled trial aims to compare the effects of thoracic expansion exercises and Dynamic Neuromuscular Stabilization (DNS) on respiratory function and bilateral trapezius muscle activity in individuals with forward head posture (FHP). A total of 32 participants aged 18-40 years with a craniovertebral angle (CVA) of less than 53° will be randomly assigned to either the DNS group or the thoracic expansion exercise group. Primary outcomes include respiratory function (FEV1, FVC, FEV1/FVC), trapezius muscle activation measured with EMG biofeedback, and craniovertebral angle. Secondary outcomes include thoracic mobility and health-related quality of life assessed using the St. George's Respiratory Questionnaire. Both interventions will be applied for 6 weeks. The study aims to determine which approach provides greater improvement in posture-related respiratory dysfunction and muscle activation.
Read the detailed description
Forward head posture (FHP) is a common postural deviation characterized by reduced craniovertebral angle (CVA), altered cervicothoracic alignment, and compensatory activation of accessory respiratory muscles. Individuals with FHP frequently demonstrate limited thoracic mobility, decreased respiratory efficiency, and increased demand on superficial neck musculature. These biomechanical alterations may negatively influence pulmonary function parameters such as FEV1 and FVC, as well as contribute to elevated electromyographic (EMG) activity in the upper trapezius muscles.
Various therapeutic approaches have been developed to address posture-related respiratory dysfunction. Thoracic expansion breathing exercises aim to enhance chest wall mobility and improve lung expansion across upper, middle, and lower thoracic regions. Dynamic Neuromuscular Stabilization (DNS), based on developmental kinesiology principles, seeks to optimize diaphragmatic function, intra-abdominal pressure regulation, and coordinated activation of deep stabilizing musculature. Although both methods have theoretical benefits for improving respiratory mechanics and postural alignment, comparative evidence regarding their differential effects in individuals with FHP remains limited.
This randomized controlled trial will investigate the immediate and short-term effects of thoracic expansion breathing exercises versus DNS-based stabilization exercises on respiratory function, cervicothoracic posture, and muscle activation patterns. Thirty-two adults aged 18-40 years with a CVA of less than 53° will be enrolled and randomly assigned using an opaque envelope method to one of two intervention groups: the Thoracic Expansion Exercise Group or the Dynamic Neuromuscular Stabilization Group. Each intervention protocol will be implemented over a 6-week period, consisting of twice-weekly supervised sessions complemented by twice-daily home exercise routines.
Outcome assessments will be conducted at baseline and at the end of the 6-week intervention period. These assessments will include: CVA measured by standardized lateral photography and ImageJ analysis; bilateral upper trapezius muscle activity assessed using surface EMG biofeedback; pulmonary function tests (FEV1, FVC, FEV1/FVC) conducted with spirometry; thoracic expansion measured at three levels using a tape-measure chest mobility test; and health-related quality of life evaluated with the St. George's Respiratory Questionnaire (SGRQ). The study protocol was approved by the Istanbul Medipol University Non-Interventional Clinical Research Ethics Committee.
This trial is designed to provide a comparative analysis of two commonly used physiotherapy interventions for FHP, with a focus on their effects on posture-related respiratory mechanics, thoracic mobility, and neuromuscular activation. All findings will be reported separately in the Results section. The present description outlines the scientific rationale, study design, and intervention procedures without duplicating eligibility criteria or outcome measure definitions.
- Conditions
- Forward Head Posture
- Being tested
- Dynamic Neuromuscular Stabilization Exercises, Thoracic Expansion Exercise
- Keywords
- craniovertebral angle, respiratory function test, electromyography, Dynamic Neuromuscular Stabilization(DNS), breathing exercises
What participants receive
What participants receive. In a randomised study each person is assigned to one group by chance.
Dynamic Neuromuscular Stabilization ExercisesBehavioural
Participants in the DNS group will perform Dynamic Neuromuscular Stabilization exercises based on developmental kinesiology principles. The program consists of three standardized DNS patterns:
Supine 90°/90° Position (4.5-month developmental stage): The participant lies supine with hips and knees flexed to 90°, emphasizing diaphragmatic breathing, rib cage expansion, and neutral spine alignment.
Prone on Elbows (4.5-month stage): The participant supports the upper body on elbows while maintaining cervical neutrality and coordinated diaphragmatic breathing.
Quadruped Position (9-month developmental stage): The participant maintains a four-point kneeling position with proper spinal stabilization and controlled breathing.
All exercises focus on coordinated activation of deep cervical flexors, diaphragm, transversus abdominis, multifidus, and pelvic floor muscles.
Participants will perform 2 supervised sessions per week and twice-daily home exercises (10 repetitions × 3 sets) for 6 weeks.
Thoracic Expansion ExerciseBehavioural
Participants in the thoracic expansion group will perform a structured breathing exercise program focused on increasing upper, middle, and lower thoracic mobility. The program includes:
Upper Lobe Expansion Exercise: Participant places hands over upper thoracic region and performs deep inhalation to expand upper lung fields, followed by slow exhalation.
Middle Lobe Expansion Exercise: Hands placed laterally at mid-thoracic level to facilitate expansion of the middle lobes during inhalation.
Lower Lobe Expansion Exercise: Hands positioned over the lower rib cage to promote diaphragmatic and lower thoracic expansion.
Each exercise is performed for 3 sets of 10 repetitions, twice daily, for 6 weeks. Two supervised sessions per week will ensure correct technique and progression. The exercises aim to improve thoracic mobility, respiratory mechanics, and chest wall expansion.
| Study group | Role | What they receive |
|---|---|---|
| Dynamic Neuromuscular Stabilization Group (DNSG) | Experimental | Developmental DNS patterns (supine 90/90, prone on elbows, quadruped), performed twice daily for 6 weeks. Receives: Behavioral: Dynamic Neuromuscular Stabilization Exercises |
| Thoracic Expansion Exercise Group (TEG) | Experimental | Upper, middle, and lower lobe-focused thoracic expansion breathing exercises, twice daily for 6 weeks. Receives: Behavioral: Thoracic Expansion Exercise |
What is being measured
The primary outcome is the main question the study is designed to answer.
Craniovertebral Angle (CVA)
CVA is used to assess forward head posture. Participants will be asked to stand in a natural and relaxed posture while focusing on a marked point at eye level on the wall. A lateral photograph will be taken using a Iphone 13 camera mounted on a tripod at shoulder height and placed 1.5 meters from the participant. The spinous process of the C7 vertebra and the tragus of the ear will be marked. The angle between the line connecting the tragus to C7 and a horizontal reference line will be calculated using the ImageJ software. The measurement results will be recorded on the evaluation form.
Analysis Metric: Change in CVA (degrees)
Measured: Baseline and Week 6
Secondary outcomes (5)
Trapezius Muscle Activity (Surface EMG Biofeedback, µV)
Surface EMG sensors will be placed bilaterally over the upper trapezius muscles. Participants will perform three 5-second isometric contractions, and the mean amplitude (µV) of the signals will be recorded.
Analysis metric: Change from baseline to Week 6 in mean EMG amplitude of bilateral upper trapezius
Measured: Baseline and Week 6
FEV1 (Forced Expiratory Volume in 1 Second)
FEV1 will be recorded using a portable spirometer (BTL-08 Spiro Pro). The highest value of three acceptable forced expiratory maneuvers will be used.
Analysis Metric: Change from baseline to Week 6 (liters)
Measured: Baseline and Week 6
FVC (Forced Vital Capacity)
FVC will be assessed using standard spirometry procedures. Three maximal forced expiratory maneuvers will be performed, and the best value will be recorded.
Analysis Metric:
Change from baseline to Week 6 (liters)
Measured: Baseline and Week 6
Thoracic Expansion (Chest Mobility, cm)
Thoracic expansion will be measured with a tape measure at upper, middle, and lower thoracic levels. The difference between maximum inhalation and exhalation will be used as the thoracic mobility value.
Analysis Metric:
Change from baseline to Week 6 (cm)
Measured: Baseline and Week 6
St. George's Respiratory Questionnaire (SGRQ) Total Score
The SGRQ is a standardized instrument assessing symptoms, activity limitation, and psychosocial impact related to respiratory dysfunction. Scores range from 0 to 100, with higher scores indicating worse health status and greater impairment.
Analysis Metric:
Change from baseline to Week 6 (0-100 score)
Measured: Baseline and Week 6
Timeline
From the start of the study to its completion; the mark is today. Estimated dates are the sponsor’s plan.
- First posted20 Nov 2025
- Study start1 Dec 2025 (estimated)
- Primary completion31 Jan 2026 (estimated)
- Study completion15 Feb 2026 (estimated)
Resources
- Official record on ClinicalTrials.govThe registry entry this page is built from, with its full change history.
- Other trials for Forward Head PostureStudies of the same condition, open and under way.
- What the trial phases meanHow a treatment moves from first tests in people to approval.
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
- a randomized, controlled, assessor-blind, prospective study
- Masking
- Single blind
- Who is masked
- Outcomes assessor
- Enrolment
- 32 participants (estimated)
Sponsor and investigators
- Lead sponsor
- Esra BECENI
- Sponsor type
- University, hospital or other
- Responsible party
- Sponsor-investigator, Esra BECENI, Bahçeşehir University
- Investigators
- Gülay Yalçın, PhD, Study director, Mudanya University, Faculty of Health Sciences, Department of PhysiotherapyEsra Beceni, Lecturer, Principal investigator, Mudanya University Vocational, Physiotherapy Program
IDs, dates and publications
- ClinicalTrials.gov ID
- NCT07238660
- Sponsor's protocol ID
- MU-FHP-DNS-TE-2025-01
- Acronym
- FHP-DNS-TE
- Status last verified
- Nov 2025
- First submitted
- 16 Nov 2025
- Last updated
- 25 Nov 2025
- Results posted
- No
- Data monitoring committee
- No
- FDA-regulated drug
- No
- FDA-regulated device
- No
Study at a glance
From the registry record, last updated by the sponsor on 25 Nov 2025. Recruitment status is as the sponsor reported it: confirm with the study team.
- Official title
- A Randomized Controlled Trial Comparing Thoracic Expansion Exercises and Dynamic Neuromuscular Stabilization on Respiratory Function and Bilateral Trapezius Muscle Activity in Individuals With Forward Head Posture
- ClinicalTrials.gov ID
- NCT07238660
- Acronym / sponsor ID
- FHP-DNS-TE / MU-FHP-DNS-TE-2025-01
- Conditions
- Forward Head Posture
- Keywords
- craniovertebral angle, respiratory function test, electromyography, Dynamic Neuromuscular Stabilization(DNS), breathing exercises
- Study type
- Interventional
- Recruitment status
- Not yet recruiting
- Enrolment
- 32 participants (estimated)
- Lead sponsor
- Esra BECENIUniversity, hospital or other
- Study start
- 1 Dec 2025 (estimated)
- Primary completion
- 31 Jan 2026 (estimated)
- Study completion
- 15 Feb 2026 (estimated)
- First posted
- 20 Nov 2025 (actual)
- Results
- Not posted in the source record
Clinical summary
The research question as the sponsor registered it. This describes what the study plans to test, not what it found.
This randomized controlled trial aims to compare the effects of thoracic expansion exercises and Dynamic Neuromuscular Stabilization (DNS) on respiratory function and bilateral trapezius muscle activity in individuals with forward head posture (FHP). A total of 32 participants aged 18-40 years with a craniovertebral angle (CVA) of less than 53° will be randomly assigned to either the DNS group or the thoracic expansion exercise group. Primary outcomes include respiratory function (FEV1, FVC, FEV1/FVC), trapezius muscle activation measured with EMG biofeedback, and craniovertebral angle. Secondary outcomes include thoracic mobility and health-related quality of life assessed using the St. George's Respiratory Questionnaire. Both interventions will be applied for 6 weeks. The study aims to determine which approach provides greater improvement in posture-related respiratory dysfunction and muscle activation.
Detailed description
Forward head posture (FHP) is a common postural deviation characterized by reduced craniovertebral angle (CVA), altered cervicothoracic alignment, and compensatory activation of accessory respiratory muscles. Individuals with FHP frequently demonstrate limited thoracic mobility, decreased respiratory efficiency, and increased demand on superficial neck musculature. These biomechanical alterations may negatively influence pulmonary function parameters such as FEV1 and FVC, as well as contribute to elevated electromyographic (EMG) activity in the upper trapezius muscles.
Various therapeutic approaches have been developed to address posture-related respiratory dysfunction. Thoracic expansion breathing exercises aim to enhance chest wall mobility and improve lung expansion across upper, middle, and lower thoracic regions. Dynamic Neuromuscular Stabilization (DNS), based on developmental kinesiology principles, seeks to optimize diaphragmatic function, intra-abdominal pressure regulation, and coordinated activation of deep stabilizing musculature. Although both methods have theoretical benefits for improving respiratory mechanics and postural alignment, comparative evidence regarding their differential effects in individuals with FHP remains limited.
This randomized controlled trial will investigate the immediate and short-term effects of thoracic expansion breathing exercises versus DNS-based stabilization exercises on respiratory function, cervicothoracic posture, and muscle activation patterns. Thirty-two adults aged 18-40 years with a CVA of less than 53° will be enrolled and randomly assigned using an opaque envelope method to one of two intervention groups: the Thoracic Expansion Exercise Group or the Dynamic Neuromuscular Stabilization Group. Each intervention protocol will be implemented over a 6-week period, consisting of twice-weekly supervised sessions complemented by twice-daily home exercise routines.
Outcome assessments will be conducted at baseline and at the end of the 6-week intervention period. These assessments will include: CVA measured by standardized lateral photography and ImageJ analysis; bilateral upper trapezius muscle activity assessed using surface EMG biofeedback; pulmonary function tests (FEV1, FVC, FEV1/FVC) conducted with spirometry; thoracic expansion measured at three levels using a tape-measure chest mobility test; and health-related quality of life evaluated with the St. George's Respiratory Questionnaire (SGRQ). The study protocol was approved by the Istanbul Medipol University Non-Interventional Clinical Research Ethics Committee.
This trial is designed to provide a comparative analysis of two commonly used physiotherapy interventions for FHP, with a focus on their effects on posture-related respiratory mechanics, thoracic mobility, and neuromuscular activation. All findings will be reported separately in the Results section. The present description outlines the scientific rationale, study design, and intervention procedures without duplicating eligibility criteria or outcome measure definitions.
Study design
- Primary purpose
- Treatment
- Allocation
- Randomised
- Intervention model
- Parallel groups
- Masking
- Single blind (outcomes assessor)
- Number of arms
- 2
- Model description
- a randomized, controlled, assessor-blind, prospective study
| Arm | Type | Receives |
|---|---|---|
| Dynamic Neuromuscular Stabilization Group (DNSG) | Experimental | Behavioral: Dynamic Neuromuscular Stabilization ExercisesDevelopmental DNS patterns (supine 90/90, prone on elbows, quadruped), performed twice daily for 6 weeks. |
| Thoracic Expansion Exercise Group (TEG) | Experimental | Behavioral: Thoracic Expansion ExerciseUpper, middle, and lower lobe-focused thoracic expansion breathing exercises, twice daily for 6 weeks. |
Who may qualify
- Ages
- 18 to 40 years
- Sex
- All
- Healthy volunteers
- Not accepted
- Age groups
- Adult
Key inclusion criteria (5 listed)
- Adults aged 18 to 40 years.
- Craniovertebral angle (CVA < 53°) indicating forward head posture.
- Able to perform exercise-based interventions.
- Voluntarily agrees to participate and signs the informed consent form.
- No neurological, orthopedic, systemic, or cardiopulmonary conditions that would limit participation.
Key exclusion criteria (7 listed)
- Contraindications to exercise (e.g., acute musculoskeletal injury, uncontrolled cardiovascular disease).
- Chronic upper respiratory tract disease that may affect spirometry results. Presence of a cardiac pacemaker.
- Neurological disorders, systemic diseases, or mental impairments that could interfere with exercise cooperation.
- History of orthopedic or musculoskeletal surgery affecting mobility or posture.
- Currently participating in respiratory exercises, spinal stabilization training, or structured exercise programs.
Eligibility is decided by the study team after screening; this overview does not establish that a patient qualifies. Full inclusion and exclusion criteria.
Interventions
| Intervention | Type | Arms |
|---|---|---|
| Dynamic Neuromuscular Stabilization ExercisesParticipants in the DNS group will perform Dynamic Neuromuscular Stabilization exercises based on developmental kinesiology principles. The program consists of three standardized DNS patterns: Supine 90°/90° Position (4.5-month developmental stage): The participant lies supine with hips and knees flexed to 90°, emphasizing diaphragmatic breathing, rib cage expansion, and neutral spine alignment. Prone on Elbows (4.5-month stage): The participant supports the upper body on elbows while maintaining cervical neutrality and coordinated diaphragmatic breathing. Quadruped Position (9-month developmental stage): The participant maintains a four-point kneeling position with proper spinal stabilization and controlled breathing. All exercises focus on coordinated activation of deep cervical flexors, diaphragm, transversus abdominis, multifidus, and pelvic floor muscles. Participants will perform 2 supervised sessions per week and twice-daily home exercises (10 repetitions × 3 sets) for 6 weeks. | Behavioural | Dynamic Neuromuscular Stabilization Group (DNSG) |
| Thoracic Expansion ExerciseParticipants in the thoracic expansion group will perform a structured breathing exercise program focused on increasing upper, middle, and lower thoracic mobility. The program includes: Upper Lobe Expansion Exercise: Participant places hands over upper thoracic region and performs deep inhalation to expand upper lung fields, followed by slow exhalation. Middle Lobe Expansion Exercise: Hands placed laterally at mid-thoracic level to facilitate expansion of the middle lobes during inhalation. Lower Lobe Expansion Exercise: Hands positioned over the lower rib cage to promote diaphragmatic and lower thoracic expansion. Each exercise is performed for 3 sets of 10 repetitions, twice daily, for 6 weeks. Two supervised sessions per week will ensure correct technique and progression. The exercises aim to improve thoracic mobility, respiratory mechanics, and chest wall expansion. | Behavioural | Thoracic Expansion Exercise Group (TEG) |
Primary outcome
Craniovertebral Angle (CVA)
Time frame: Baseline and Week 6
CVA is used to assess forward head posture. Participants will be asked to stand in a natural and relaxed posture while focusing on a marked point at eye level on the wall. A lateral photograph will be taken using a Iphone 13 camera mounted on a tripod at shoulder height and placed 1.5 meters from the participant. The spinous process of the C7 vertebra and the tragus of the ear will be marked. The angle between the line connecting the tragus to C7 and a horizontal reference line will be calculated using the ImageJ software. The measurement results will be recorded on the evaluation form. Analysis Metric: Change in CVA (degrees)
5 secondary outcomes
Trapezius Muscle Activity (Surface EMG Biofeedback, µV)
Time frame: Baseline and Week 6
FEV1 (Forced Expiratory Volume in 1 Second)
Time frame: Baseline and Week 6
FVC (Forced Vital Capacity)
Time frame: Baseline and Week 6
Thoracic Expansion (Chest Mobility, cm)
Time frame: Baseline and Week 6
St. George's Respiratory Questionnaire (SGRQ) Total Score
Time frame: Baseline and Week 6
Results and safety
This study is still under way. Results are not available in the source record yet.
Research links
- Official record on ClinicalTrials.govLast updated by the sponsor 25 Nov 2025.
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Referral and contact
AzTrials does not enrol participants or take referrals. Contact the study team or a site listed below; they decide who can take part.
Gülay Yalçın, PhD study director
Mudanya University, Faculty of Health Sciences, Department of Physiotherapy
Esra Beceni, Lecturer principal investigator
Mudanya University Vocational, Physiotherapy Program
1 site in 1 country: see every site and its status.
Questions about this trial
What is this clinical trial studying?
A study testing Dynamic Neuromuscular Stabilization Exercises and Thoracic Expansion Exercise in people with Forward Head Posture, run by Esra BECENI 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 5 inclusion and 7 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: opening soon, as of the sponsor's last update on 25 Nov 2025. 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?
Contact Gülay Yalçın, PhD (+905376342600, gulay.yalcin@mudanya.edu.tr), or a site near the patient. AzTrials does not enrol participants or take referrals.
What does the primary outcome measure?
Craniovertebral Angle (CVA) (time frame: Baseline and Week 6). It is what the study was designed to measure, not a finding.
Where can I read the original study information?
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 25 Nov 2025.