Neck PainNCT07641959
Effects of Sahrmann's Approach in Patients With Cervical Extension Syndrome
A study testing Sahrmann's Exercises and conventional physiotherapy in people with Neck Pain, run by Riphah International University at 1 site in Pakistan.
Trial summary
Cervical Extension Syndrome (CES) is a form of postural dysfunction under the Movement System Impairment (MSI) classification. It has more prevalence among adults due to prolonged poor posture and sedentary lifestyles. Read more about this study
- Who is it for?
- Ages 20 to 40 years
- Conditions the study is for
- Neck Pain
- What is being tested?
- Sahrmann's Exercises and conventional physiotherapy
- Could I receive a placebo?
- No, everyone receives an active treatment
- How many people
- 54 participants
- Where
- 1 sitePakistan
- Study dates
- 1 Jul 2026to 1 Nov 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 20 to 40 years
- All sexes
- No healthy volunteers
- Adult
Who may be able to join
- Adults between 20-40 years, NPRS score 4-6 , positive tests cervical flexion, extension, protraction and retraction and Cervical Nodding Against Wall
Who cannot join
- Scoliosis, Pregnant females, Any active infection or disese
Trial locations and contacts
1 site in 1 country. Contact the study team or a site near you to ask about taking part.
Pakistan1 site
University of Lahore Teaching Hospital, Lahore HOD Physio Department
Lahore, Punjab Province, 54000
Asim Arif, PhD*, 03216597727, asimarif@uipt.uol.edu.pk
About this study
Official title: Effects of Sahrmann's Approach on Pain, Range of Motion, Craniovertebral Angle and Function in Patients With Cervical Extension Syndrome
Cervical Extension Syndrome (CES) is a form of postural dysfunction under the Movement System Impairment (MSI) classification. It has more prevalence among adults due to prolonged poor posture and sedentary lifestyles. This condition involves a forward head position,, increased thoracic curve, and altered movement patterns. This resulting in neck pain and impaired function. The Sahrmann's approach is a biomechanical principle that puts emphasizes on muscle activation, correction of postural impairments, and restoration of movement control through targeted exercises. The objective of the study will be to compare the effects of Sahrmann's Approach on Pain, ROM, craniovertebral angle and function in patients with Cervical Extension Syndrome.
Read the detailed description
This randomized controlled trial will investigate the effects of Sahrmann's corrective exercises on pain, range of motion, craniovertebral angle, thoracic curve and function in individuals with CFS. Total sample size 54 is calculated by GPower and participants aged 20-40 years will be recruited from Femwell Physio Clinic, Sir Ganga Ram Hospital and University of Lahore Teaching Hospital Lahore using non- probability consecutive sampling. Subjects will be randomly assigned to either Group A (conventional physiotherapy) or Group B (Sahrmann's approach) through sealed opaque envelopes. Group A will follow a standard treatment, while Group B will perform Sahrmann's corrective exercises for cervical extension syndrome. Numeric Pain Rating Scale (NPRS) for pain, Universal Goniometer (UG) for craniovertebral angle, Inclinometer for thoracic kyphosis and cervical range of motion and Neck Disability Index (NDI) for function will be assessed at baseline and after 6 weeks. Data will be analyzed using SPSS v25 to determine the comparative effects of both interventions.
- Conditions
- Neck Pain
- Being tested
- Sahrmann's Exercises, conventional physiotherapy
- Keywords
- pain, range of motion, craniovertebral angle, function
- Medical subject headings
- Neck Pain, Pain
What participants receive
What participants receive. In a randomised study each person is assigned to one group by chance.
Sahrmann's ExercisesOther
capital flexion, capital flexion with and without head tilt, Shoulder flexion, Abduction And Lateral Rotation, Cervical Extensors Muscle strengthening along with baseline treatment moist heat pack and TENS.
conventional physiotherapyOther
this group will receive conventional physiotherapy. receive muscle stretching of trapezius, pectoralis and levator scapulae. and Active ROM as retractions of scapula and neck. along with baseline treatment moist heat pack and TENS.
| Study group | Role | What they receive |
|---|---|---|
| Sahrmann's exercises | Experimental | Shirley Sahrmann's approach is based on the concept that repetitive movement and sustained postures can create movement impairments, leading to pain and dysfunction. Rather than simply strengthening weak muscles or stretching tight ones, Sahrmann focuses on identifying and correcting faulty movement patterns.
Patients will receive Sahrmann's Corrective Exercises for Cervicale Extension Syndrome. Receives: Other: Sahrmann's Exercises |
| Standard Physical therapy | Active comparator | this group will receive conventional physiotherapy. receive muscle stretching of trapezius, pectoralis and levator scapulae. and Active ROM as retractions of scapula and neck Receives: Other: conventional physiotherapy |
What is being measured
The primary outcome is the main question the study is designed to answer.
Numerical Pain Rating Scale (NPRS)
he NPRS is an 11-point self-reported scale used to assess the intensity of neck pain. Participants rate their average pain over the previous 24 hours on a scale from 0 to 10.
Scoring:
0 = No pain 1-3 = Mild pain 4-6 = Moderate pain 7-10 = Severe pain
Direction of Improvement:
Lower scores indicate less pain and improvement.
Measured: upto 4 weeks
Craniovertebral Angle (CVA) - Forward Head Posture
Description:
The CVA is used to quantify forward head posture. It is measured as the angle formed between:
A horizontal line passing through the spinous process of C7. A line connecting C7 to the tragus of the ear.
Scoring:
Smaller angle = Greater forward head posture. Larger angle = Better head-neck alignment.
Typical values:
<48° = Forward head posture
≥50° = More normal alignment
Direction of Improvement:
Increase in CVA indicates improvement.
Measured: upto 4 weeks
Neck Disability Index (NDI) - Functional Disability
Description:
The NDI is a self-administered questionnaire consisting of 10 items assessing the impact of neck pain on daily activities.Scoring:
Each item scored from 0-5.
Total score:
0-50 points
Interpretation:
0-4 = No disability 5-14 = Mild disability 15-24 = Moderate disability 25-34 = Severe disability
≥35 = Complete disability
Direction of Improvement:
Lower scores indicate reduced disability and better function.
Measured: upto 4 weeks
Cervical Range of Motion (CROM)
Description:
Cervical ROM will be measured in:
Flexion Extension Right lateral flexion Left lateral flexion Right rotation Left rotation
The participant performs active cervical movements while the examiner records the maximum range in degrees.
Units:
Degrees (°)
Typical Normal Values:
Flexion: 45-50° Extension: 60-70° Lateral flexion: 45° Rotation: 70-90°
Direction of Improvement:
Greater ROM values indicate improvement.
Measured: upto 4 weeks
Thoracic Kyphosis Angle
Description:
Thoracic kyphosis will be measured in standing using a dual inclinometer technique. One inclinometer is placed over the spinous process of T1-T2 and the second over T12-L1. The difference between the two readings represents the thoracic kyphosis angle.
Units:
Degrees (°)
Interpretation:
Increased angle = Greater thoracic kyphosis Reduced angle = Improved thoracic posture
Typical values:
Approximately 20-40° in healthy adults
Direction of Improvement:
Reduction toward normal values indicates improvement.
Measured: upto 4 weeks
Timeline
From the start of the study to its completion; the mark is today. Estimated dates are the sponsor’s plan.
- First posted11 Jun 2026
- Study start1 Jul 2026 (estimated)
- Primary completion1 Oct 2026 (estimated)
- Study completion1 Nov 2026 (estimated)
Resources
- Official record on ClinicalTrials.govThe registry entry this page is built from, with its full change history.
- Publications (10)Papers the sponsor has linked to this study.
- Other trials for Neck PainStudies of the same condition, open and under way.
- More trials run by Riphah International UniversityThe sponsor's other registered studies.
- 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
- Masking
- Single blind
- Who is masked
- Outcomes assessor
- Enrolment
- 54 participants (estimated)
Sponsor and investigators
- Lead sponsor
- Riphah International University
- Sponsor type
- University, hospital or other
- Responsible party
- Sponsor
- Investigators
- Komal Qayyum, MSPT*, Principal investigator, Riphah International University
IDs, dates and publications
- ClinicalTrials.gov ID
- NCT07641959
- Sponsor's protocol ID
- REC/RCR & AHS/25/0114 Komal
- Status last verified
- Jun 2026
- First submitted
- 8 Jun 2026
- Last updated
- 11 Jun 2026
- Results posted
- No
- FDA-regulated drug
- No
- FDA-regulated device
- No
- Individual data sharing
- No
Publications
Sahrmann S. Movement system impairment syndromes of the extremities, cervical and thoracic spines: Elsevier Health Sciences; 2010.
Shinde SS, Shah DN. Correlation of craniovertebral angle with neck pain in undergraduate students-cross-sectional study. International Journal of Health Sciences and Research. 2022;12:96-101.
Ogura Y, Dimar JR, Djurasovic M, Carreon LY. Etiology and treatment of cervical kyphosis: state of the art review-a narrative review. J Spine Surg. 2021 Sep;7(3):422-433. doi: 10.21037/jss-21-54.
PubMed 34734146Jabbar KM, Gandomi F. The comparison of two corrective exercise approaches for hyperkyphosis and forward head posture: A quasi-experimental study. J Back Musculoskelet Rehabil. 2021;34(4):677-687. doi: 10.3233/BMR-200160.
PubMed 33896809Shinde SS, Shah DN. Correlation of craniovertebral angle with neck pain in undergraduate students-crosssectional study. International Journal of Health Sciences and Research. 2022;12:96-101.
Asadzadeh A, Salahzadeh Z, Samad-Soltani T, Rezaei-Hachesu P. An affordable and immersive virtual reality-based exercise therapy in forward head posture. PLoS One. 2024 Mar 6;19(3):e0297863. doi: 10.1371/journal.pone.0297863. eCollection 2024.
PubMed 38446782Lim J-y, Nam S-h, Kim K-d. A Movement-System-Impairment Approach to the Evaluation and Treatment of a Patient Who had Cervical Flexion Syndrome with a Straight Neck: A Case Report. Journal of Musculoskeletal Science and Technology. 2024;8(1):49-56.
K S, Kanthanathan S, P ALA. Effectiveness of diagnosis and treatment based on movement system impairment in individuals with cervical pain: A randomized controlled trial. J Bodyw Mov Ther. 2024 Apr;38:323-328. doi: 10.1016/j.jbmt.2024.01.024. Epub 2024 Feb 2.
PubMed 38763576Caldwell C, Sahrmann S, Van Dillen L. Use of a movement system impairment diagnosis for physical therapy in the management of a patient with shoulder pain. J Orthop Sports Phys Ther. 2007 Sep;37(9):551-63. doi: 10.2519/jospt.2007.2283.
PubMed 17939614Yu L-J, Kim T-H. The effect of cervical stabilization exercises with thoracic spine extension exercises on forward head posture. International Journal of Human Movement and Sports Sciences. 2021;9(5):852-7.
Study at a glance
From the registry record, last updated by the sponsor on 11 Jun 2026. Recruitment status is as the sponsor reported it: confirm with the study team.
- Official title
- Effects of Sahrmann's Approach on Pain, Range of Motion, Craniovertebral Angle and Function in Patients With Cervical Extension Syndrome
- ClinicalTrials.gov ID
- NCT07641959
- Acronym / sponsor ID
- REC/RCR & AHS/25/0114 Komal
- Conditions
- Neck Pain
- Keywords
- pain, range of motion, craniovertebral angle, function
- Study type
- Interventional
- Recruitment status
- Not yet recruiting
- Enrolment
- 54 participants (estimated)
- Lead sponsor
- Riphah International UniversityUniversity, hospital or other
- Study start
- 1 Jul 2026 (estimated)
- Primary completion
- 1 Oct 2026 (estimated)
- Study completion
- 1 Nov 2026 (estimated)
- First posted
- 11 Jun 2026 (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.
Cervical Extension Syndrome (CES) is a form of postural dysfunction under the Movement System Impairment (MSI) classification. It has more prevalence among adults due to prolonged poor posture and sedentary lifestyles. This condition involves a forward head position,, increased thoracic curve, and altered movement patterns. This resulting in neck pain and impaired function. The Sahrmann's approach is a biomechanical principle that puts emphasizes on muscle activation, correction of postural impairments, and restoration of movement control through targeted exercises. The objective of the study will be to compare the effects of Sahrmann's Approach on Pain, ROM, craniovertebral angle and function in patients with Cervical Extension Syndrome.
Detailed description
This randomized controlled trial will investigate the effects of Sahrmann's corrective exercises on pain, range of motion, craniovertebral angle, thoracic curve and function in individuals with CFS. Total sample size 54 is calculated by GPower and participants aged 20-40 years will be recruited from Femwell Physio Clinic, Sir Ganga Ram Hospital and University of Lahore Teaching Hospital Lahore using non- probability consecutive sampling. Subjects will be randomly assigned to either Group A (conventional physiotherapy) or Group B (Sahrmann's approach) through sealed opaque envelopes. Group A will follow a standard treatment, while Group B will perform Sahrmann's corrective exercises for cervical extension syndrome. Numeric Pain Rating Scale (NPRS) for pain, Universal Goniometer (UG) for craniovertebral angle, Inclinometer for thoracic kyphosis and cervical range of motion and Neck Disability Index (NDI) for function will be assessed at baseline and after 6 weeks. Data will be analyzed using SPSS v25 to determine the comparative effects of both interventions.
Study design
- Primary purpose
- Treatment
- Allocation
- Randomised
- Intervention model
- Parallel groups
- Masking
- Single blind (outcomes assessor)
- Number of arms
- 2
| Arm | Type | Receives |
|---|---|---|
| Sahrmann's exercises | Experimental | Other: Sahrmann's ExercisesShirley Sahrmann's approach is based on the concept that repetitive movement and sustained postures can create movement impairments, leading to pain and dysfunction. Rather than simply strengthening weak muscles or stretching tight ones, Sahrmann focuses on identifying and correcting faulty movement patterns. Patients will receive Sahrmann's Corrective Exercises for Cervicale Extension Syndrome. |
| Standard Physical therapy | Active comparator | Other: conventional physiotherapythis group will receive conventional physiotherapy. receive muscle stretching of trapezius, pectoralis and levator scapulae. and Active ROM as retractions of scapula and neck |
Who may qualify
- Ages
- 20 to 40 years
- Sex
- All
- Healthy volunteers
- Not accepted
- Age groups
- Adult
Key inclusion criteria (1 listed)
- Adults between 20-40 years, NPRS score 4-6 , positive tests cervical flexion, extension, protraction and retraction and Cervical Nodding Against Wall
Key exclusion criteria (1 listed)
- Scoliosis, Pregnant females, Any active infection or disese
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 |
|---|---|---|
| Sahrmann's Exercisescapital flexion, capital flexion with and without head tilt, Shoulder flexion, Abduction And Lateral Rotation, Cervical Extensors Muscle strengthening along with baseline treatment moist heat pack and TENS. | Other | Sahrmann's exercises |
| conventional physiotherapythis group will receive conventional physiotherapy. receive muscle stretching of trapezius, pectoralis and levator scapulae. and Active ROM as retractions of scapula and neck. along with baseline treatment moist heat pack and TENS. | Other | Standard Physical therapy |
Primary outcome
Numerical Pain Rating Scale (NPRS)
Time frame: upto 4 weeks
he NPRS is an 11-point self-reported scale used to assess the intensity of neck pain. Participants rate their average pain over the previous 24 hours on a scale from 0 to 10. Scoring: 0 = No pain 1-3 = Mild pain 4-6 = Moderate pain 7-10 = Severe pain Direction of Improvement: Lower scores indicate less pain and improvement.
Craniovertebral Angle (CVA) - Forward Head Posture
Time frame: upto 4 weeks
Description: The CVA is used to quantify forward head posture. It is measured as the angle formed between: A horizontal line passing through the spinous process of C7. A line connecting C7 to the tragus of the ear. Scoring: Smaller angle = Greater forward head posture. Larger angle = Better head-neck alignment. Typical values: <48° = Forward head posture ≥50° = More normal alignment Direction of Improvement: Increase in CVA indicates improvement.
Neck Disability Index (NDI) - Functional Disability
Time frame: upto 4 weeks
Description: The NDI is a self-administered questionnaire consisting of 10 items assessing the impact of neck pain on daily activities.Scoring: Each item scored from 0-5. Total score: 0-50 points Interpretation: 0-4 = No disability 5-14 = Mild disability 15-24 = Moderate disability 25-34 = Severe disability ≥35 = Complete disability Direction of Improvement: Lower scores indicate reduced disability and better function.
Cervical Range of Motion (CROM)
Time frame: upto 4 weeks
Description: Cervical ROM will be measured in: Flexion Extension Right lateral flexion Left lateral flexion Right rotation Left rotation The participant performs active cervical movements while the examiner records the maximum range in degrees. Units: Degrees (°) Typical Normal Values: Flexion: 45-50° Extension: 60-70° Lateral flexion: 45° Rotation: 70-90° Direction of Improvement: Greater ROM values indicate improvement.
Thoracic Kyphosis Angle
Time frame: upto 4 weeks
Description: Thoracic kyphosis will be measured in standing using a dual inclinometer technique. One inclinometer is placed over the spinous process of T1-T2 and the second over T12-L1. The difference between the two readings represents the thoracic kyphosis angle. Units: Degrees (°) Interpretation: Increased angle = Greater thoracic kyphosis Reduced angle = Improved thoracic posture Typical values: Approximately 20-40° in healthy adults Direction of Improvement: Reduction toward normal values indicates improvement.
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 11 Jun 2026.
- BackgroundSahrmann S. Movement system impairment syndromes of the extremities, cervical and thoracic spines: Elsevier Health Sciences; 2010.
- BackgroundShinde SS, Shah DN. Correlation of craniovertebral angle with neck pain in undergraduate students-cross-sectional study. International Journal of Health Sciences and Research. 2022;12:96-101.
- Background: PubMed 34734146Ogura Y, Dimar JR, Djurasovic M, Carreon LY. Etiology and treatment of cervical kyphosis: state of the art review-a narrative review. J Spine Surg. 2021 Sep;7(3):422-433. doi: 10.21037/jss-21-54.
- Background: PubMed 33896809Jabbar KM, Gandomi F. The comparison of two corrective exercise approaches for hyperkyphosis and forward head posture: A quasi-experimental study. J Back Musculoskelet Rehabil. 2021;34(4):677-687. doi: 10.3233/BMR-200160.
- BackgroundShinde SS, Shah DN. Correlation of craniovertebral angle with neck pain in undergraduate students-crosssectional study. International Journal of Health Sciences and Research. 2022;12:96-101.
- Background: PubMed 38446782Asadzadeh A, Salahzadeh Z, Samad-Soltani T, Rezaei-Hachesu P. An affordable and immersive virtual reality-based exercise therapy in forward head posture. PLoS One. 2024 Mar 6;19(3):e0297863. doi: 10.1371/journal.pone.0297863. eCollection 2024.
- BackgroundLim J-y, Nam S-h, Kim K-d. A Movement-System-Impairment Approach to the Evaluation and Treatment of a Patient Who had Cervical Flexion Syndrome with a Straight Neck: A Case Report. Journal of Musculoskeletal Science and Technology. 2024;8(1):49-56.
- Background: PubMed 38763576K S, Kanthanathan S, P ALA. Effectiveness of diagnosis and treatment based on movement system impairment in individuals with cervical pain: A randomized controlled trial. J Bodyw Mov Ther. 2024 Apr;38:323-328. doi: 10.1016/j.jbmt.2024.01.024. Epub 2024 Feb 2.
- Background: PubMed 17939614Caldwell C, Sahrmann S, Van Dillen L. Use of a movement system impairment diagnosis for physical therapy in the management of a patient with shoulder pain. J Orthop Sports Phys Ther. 2007 Sep;37(9):551-63. doi: 10.2519/jospt.2007.2283.
- BackgroundYu L-J, Kim T-H. The effect of cervical stabilization exercises with thoracic spine extension exercises on forward head posture. International Journal of Human Movement and Sports Sciences. 2021;9(5):852-7.
- Individual participant dataSharing planned: No
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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.
Komal Qayyum, MSPT* principal investigator
Riphah International University
1 site in 1 country: see every site and its status.
Questions about this trial
What is this clinical trial studying?
A study testing Sahrmann's Exercises and conventional physiotherapy in people with Neck Pain, run by Riphah International University at 1 site in Pakistan.
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 1 inclusion and 1 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 11 Jun 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 Pakistan. 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 Samrood Akram, PhD* (03324806143, samrood.akram@riphah.edu.pk), or a site near the patient. AzTrials does not enrol participants or take referrals.
What does the primary outcome measure?
Numerical Pain Rating Scale (NPRS) (time frame: upto 4 weeks). The study lists 5 primary outcomes in all. 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 NCT07641959, which also lists 10 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 11 Jun 2026.