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NCT Number: NCT07641959

Effects of Sahrmann's Approach 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.

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Key information

Conditions

Neck Pain Neurologic Manifestations Pain Pathological Conditions, Signs and Symptoms Signs and Symptoms

Age range

20 year–40 year

Sex eligibility

All sexes

Study type

Interventional

Phase

Not applicable

Primary location

University of Lahore Teaching Hospital, Lahore HOD Physio Department

Lahore, Punjab Province, 54000, Pakistan

Location contact

Asim Arif, PhD*

CONTACT

[email protected]

03216597727

About this study

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.

Who can participate

Healthy volunteers accepted: No

Only the study team can determine whether someone qualifies for participation.

Inclusion criteria

  • Adults between 20-40 years, NPRS score 4-6 , positive tests cervical flexion, extension, protraction and retraction and Cervical Nodding Against Wall

Exclusion criteria

Scoliosis, Pregnant females, Any active infection or disese

Treatment and study plan

Sahrmann's Exercises

Other

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 Physiotherapy

Other

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.

Primary outcomes

  1. 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.

  2. 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.

  3. 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.

  4. 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.

  5. 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.

Study contacts

Contact information is provided by the study sponsor or research team.

Samrood Akram, PhD*

CONTACT

[email protected]

03324806143

Sponsors and collaborators

Lead sponsor

Riphah International University

Other

Registry information

Official study title

Effects of Sahrmann's Approach on Pain, Range of Motion, Craniovertebral Angle and Function in Patients With Cervical Extension Syndrome

Important dates

Study start
2026
Primary completion
2026
Study completion
2026
First posted
Jun 11, 2026
Registry last updated
Jun 11, 2026

OpenTrials presents study information sourced from ClinicalTrials.gov. The official registry record should be consulted for the latest information.

View the official ClinicalTrials.gov record (opens in a new tab)

This listing is for discovery and informational purposes only. It is not medical advice, does not guarantee that a study is recruiting, and does not determine eligibility. Contact the study team and a qualified healthcare professional when considering participation.

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