Thoracic Expansion vs DNS Exercises in Forward Head Posture
ConditionForward Head Posture
Trial statusNot yet recruiting
Trial phaseNot applicable
Trial typeInterventional
Biological sexAll
Age18-40
SponsorEsra BECENI
About this trial
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.
Eligibility criteria
This trial does not accept healthy volunteersQualifiers
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.
Disqualifiers
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.
Trial design
Design model
Parallel
Treatments tested in this trial
Dynamic Neuromuscular Stabilization Exercises
BehavioralParticipants 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 Exercise
BehavioralParticipants 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.
Treatment groups
32 Participants
are divided into 2 treatment groupsGroup A: Dynamic Neuromuscular Stabilization Group (DNSG)Experimental treatment 1 intervention
Group B: Thoracic Expansion Exercise Group (TEG)Experimental treatment 1 intervention
Trial outcomes
Primary outcomes
1
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)
Time frame
Baseline and Week 6Secondary outcomes
1
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
Time frame
Baseline and Week 62
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)
Time frame
Baseline and Week 63
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)
Time frame
Baseline and Week 64
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)
Time frame
Baseline and Week 6Sponsors and contacts
Click on the lead sponsor to view all of their trials.
Esra BECENI
Lead sponsor
Bahçeşehir University
Sponsor institution
Source ClinicalTrials.gov
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