Forward Head PostureNCT07721389
Comparison Between Dynamic Neuromuscular Stabilization Breathing and Manual Therapy on Forward Head Posture in University Students
A study testing Dynamic neuromuscular stabilisation breathing, Myofascial Release and Convetional Exercises in people with Forward Head Posture, run by Istinye University at 1 site in Turkey (Türkiye).
Trial 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. Read more about this study
- Who is it for?
- Ages 18 to 28 yearsHealthy volunteers can take part
- Conditions the study is for
- Forward Head Posture
- What is being tested?
- Dynamic neuromuscular stabilisation breathing, Myofascial Release and Convetional Exercises
- Could I receive a placebo?
- No, everyone receives an active treatment
- How many people
- 60 participants
- Where
- 1 siteTurkey (Türkiye)
- Study dates
- 16 May 2025to 15 Jul 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 28 years
- All sexes
- Healthy volunteers accepted
- Adult
Who may be able to join
- 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
Who cannot join
- History of cervical spine surgery
- Presence of neurological disorders
- Diagnosis of cervical disc herniation
- Severe musculoskeletal pain (VAS ≥ 7)
Trial locations and contacts
1 site in 1 country. Contact the study team or a site near you to ask about taking part.
Prof.Dr. H. Habibe serap INAL, doctor of physical therapy contact
PT Rami M.osama Ramdoun, Bachelor of physical therapy contact
Turkey (Türkiye)1 site, 1 recruiting
- Recruiting
İstinye University, Fizyoterapi ve Rehabilitasyon Uygulama ve Araştırma Merkezi -İSÜFİZYOTEM
Istanbul, Zeytinburnu, 34010
Dr. Öğr. Üyesi Nurgül Dürüstkan Elbaşı, phd of physical therapy, 0850 283 00 00, sbf@istinye.edu.tr
About this study
Official title: The Effects of Dynamic Neuromuscular Stabilization Breathing and Manual Therapy on Forward Head Posture in University Students: A Randomized Controlled Trial
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:
Read more
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
- Being tested
- Dynamic neuromuscular stabilisation breathing, Myofascial Release, Convetional Exercises
- Keywords
- Forward Head Posture, Dynamic Neuromuscular Stabilization, Myofascial Release, Conventional Therapy, Neck Pain, Cervical Spine
- Medical subject headings
- Neck Pain
What participants receive
What participants receive. In a randomised study each person is assigned to one group by chance.
Dynamic neuromuscular stabilisation breathingOther
Diaphragmatic breathing exercises performed in supine, side-lying, and quadruped positions, 3 sets of 1 minute each.
Myofascial ReleaseOther
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
Convetional ExercisesOther
Standardized exercise protocol including head rotation, neck/upper back extension, swimmer exercise, head retraction with resistance band, and upper trapezius/levator scapulae stretches.
| Study group | Role | What they receive |
|---|---|---|
| dynamic neuromuscular stabilisation breathing | Experimental | Not described Receives: Other: Dynamic neuromuscular stabilisation breathing; Other: Convetional Exercises |
| Myofacial release | Experimental | Not described Receives: Other: Myofascial Release; Other: Convetional Exercises |
| Conventional Therapy | Active comparator | Not described Receives: Other: Convetional Exercises |
What is being measured
The primary outcome is the main question the study is designed to answer.
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.
Measured: 4 weeks, and 8 weeks
Secondary outcomes (1)
Visual Analogue Scale (VAS)
Pain intensity will be assessed using a 10 cm Visual Analogue Scale (VAS), where 0 indicates no pain and 10 indicates worst imaginable pain. Participants will mark their perceived pain level at rest and during activity.
Measured: Baseline, 4 weeks, and 8 weeks
Timeline
From the start of the study to its completion; the mark is today. Estimated dates are the sponsor’s plan.
- First posted23 Jul 2026
- Study start16 May 2025
- Primary completion15 Jul 2026 (estimated)
- Study completion15 Jul 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 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
- Masking
- None (open label)
- Enrolment
- 60 participants (estimated)
Sponsor and investigators
- Lead sponsor
- Istinye University
- Sponsor type
- University, hospital or other
- Responsible party
- Sponsor
- Investigators
- Prof.Dr. Habibe. Serap İnal, doctor of physical therapy, Principal investigator, istinye university, faculty of health sciences , Department of physical therapy and rehabilitation
IDs, dates and publications
- ClinicalTrials.gov ID
- NCT07721389
- Sponsor's protocol ID
- 25 - 26 - 2025
- Status last verified
- Jul 2026
- First submitted
- 29 Dec 2025
- Last updated
- 23 Jul 2026
- Results posted
- No
- Data monitoring committee
- No
- FDA-regulated drug
- No
- FDA-regulated device
- No
- Individual data sharing
- No
Publications
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.
PubMed 21881737Briem 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.
PubMed 19066648Salahzadeh 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.
PubMed 23963268Gulrandhe 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.
PubMed 37601999Fathollahnejad 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.
PubMed 30777064Aggarwal, 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.
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.
PubMed 31586371Ajimsha 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.
PubMed 25603749Alshahrani, 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.
Naz, A., Bashir, M. S., & Noor, R. (2018). Prevalance of forward head posture among university students. Rawal Med J, 43(2), 260-2.
Study at a glance
From the registry record, last updated by the sponsor on 23 Jul 2026. Recruitment status is as the sponsor reported it: confirm with the study team.
- Official title
- The Effects of Dynamic Neuromuscular Stabilization Breathing and Manual Therapy on Forward Head Posture in University Students: A Randomized Controlled Trial
- ClinicalTrials.gov ID
- NCT07721389
- Acronym / sponsor ID
- 25 - 26 - 2025
- Conditions
- Forward Head Posture
- Keywords
- Forward Head Posture, Dynamic Neuromuscular Stabilization, Myofascial Release, Conventional Therapy, Neck Pain, Cervical Spine
- Study type
- Interventional
- Recruitment status
- Recruiting
- Enrolment
- 60 participants (estimated)
- Lead sponsor
- Istinye UniversityUniversity, hospital or other
- Study start
- 16 May 2025 (actual)
- Primary completion
- 15 Jul 2026 (estimated)
- Study completion
- 15 Jul 2026 (estimated)
- First posted
- 23 Jul 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.
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.
Study design
- Primary purpose
- Treatment
- Allocation
- Randomised
- Intervention model
- Parallel groups
- Masking
- None (open label)
- Number of arms
- 3
| Arm | Type | Receives |
|---|---|---|
| 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 |
Who may qualify
- Ages
- 18 to 28 years
- Sex
- All
- Healthy volunteers
- Accepted
- Age groups
- Adult
Key inclusion criteria (4 listed)
- 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
Key exclusion criteria (4 listed)
- History of cervical spine surgery
- Presence of neurological disorders
- Diagnosis of cervical disc herniation
- Severe musculoskeletal pain (VAS ≥ 7)
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 stabilisation breathingDiaphragmatic breathing exercises performed in supine, side-lying, and quadruped positions, 3 sets of 1 minute each. | Other | dynamic neuromuscular stabilisation breathing |
| Myofascial ReleaseManual 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 | Myofacial release |
| Convetional ExercisesStandardized exercise protocol including head rotation, neck/upper back extension, swimmer exercise, head retraction with resistance band, and upper trapezius/levator scapulae stretches. | Other | Conventional Therapy, Myofacial release, dynamic neuromuscular stabilisation breathing |
Primary outcome
Craniovertebral Angle (CVA)
Time frame: 4 weeks, and 8 weeks
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.
1 secondary outcome
Visual Analogue Scale (VAS)
Time frame: Baseline, 4 weeks, and 8 weeks
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 23 Jul 2026.
- Background: PubMed 21881737Okuro 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.
- Background: PubMed 19066648Briem 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.
- Background: PubMed 23963268Salahzadeh 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.
- Background: PubMed 37601999Gulrandhe 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.
- Background: PubMed 30777064Fathollahnejad 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.
- BackgroundAggarwal, 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: PubMed 31586371Karimian 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.
- Background: PubMed 25603749Ajimsha 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.
- BackgroundAlshahrani, 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.
- Results publicationNaz, A., Bashir, M. S., & Noor, R. (2018). Prevalance of forward head posture among university students. Rawal Med J, 43(2), 260-2.
- Individual participant dataSharing planned: No
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Forward Head Posture
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.
Prof.Dr. H. Habibe serap INAL, doctor of physical therapy contact
PT Rami M.osama Ramdoun, Bachelor of physical therapy contact
Prof.Dr. Habibe. Serap İnal, doctor of physical therapy principal investigator
istinye university, faculty of health sciences , Department of physical therapy and rehabilitation
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 stabilisation breathing, Myofascial Release and Convetional Exercises in people with Forward Head Posture, run by Istinye 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 4 inclusion and 4 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: looking for participants now, as of the sponsor's last update on 23 Jul 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?
Contact Prof.Dr. H. Habibe serap INAL, doctor of physical therapy (+905325573354, serap.inal@galata.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: 4 weeks, and 8 weeks). 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 NCT07721389, 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 23 Jul 2026.