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CTRI Number  CTRI/2025/07/090807 [Registered on: 14/07/2025] Trial Registered Prospectively
Last Modified On: 12/07/2025
Post Graduate Thesis  Yes 
Type of Trial  Interventional 
Type of Study   Physiotherapy (Not Including YOGA) 
Study Design  Randomized, Parallel Group Trial 
Public Title of Study   Improving Neck Posture and Reducing Pain Using Muscle Feedback Training 
Scientific Title of Study   Effect of Electromyography Biofeedback Training to Deep Neck Flexor in Mechanical Neck Pain Patients with Forward Head Posture  
Trial Acronym  NIL 
Secondary IDs if Any  
Secondary ID  Identifier 
NIL  NIL 
 
Details of Principal Investigator or overall Trial Coordinator (multi-center study)  
Name  Rabia Aziz 
Designation  Student 
Affiliation  Jamia Hamdard 
Address  Room number 522, Department of Physiotherapy, School of Nursing Sciences and Allied Health, Jamia Hamdard, New Delhi

South
DELHI
110062
India 
Phone  9213136786  
Fax    
Email  rabiaaziz_sch@jamiahamdard.ac.in  
 
Details of Contact Person
Scientific Query  
Name  Irshad Ahmad 
Designation  Assistant Professor 
Affiliation  Manav Rachna International Institute of Research and Studies 
Address  Research Lab, Department of Physiotherapy, Faculty of Allied Health Sciences, Manav Rachna International Institute of Research and Studies, Faridabad, Haryana

Faridabad
HARYANA
121004
India 
Phone  8178071369  
Fax    
Email  kkut84440@gmail.com  
 
Details of Contact Person
Public Query  
Name  Irshad Ahmad 
Designation  Assistant Professor 
Affiliation  Manav Rachna International Institute of Research and Studies 
Address  Research Lab, Department of Physiotherapy, Faculty of Allied Health Sciences, Manav Rachna International Institute of Research and Studies, Faridabad, Haryana

Faridabad
HARYANA
121004
India 
Phone  8178071369  
Fax    
Email  kkut84440@gmail.com  
 
Source of Monetary or Material Support  
Research Laboratory, Department of Physiotehrapy, facult of Allied Hea;th Sciences, Manav Rachna International Institute of Research and Studies, sector-43, Delhi Surajkund Road, Faridabad, Haryana, 121004 
 
Primary Sponsor  
Name  Manav Rachna International Institute of Research and Studies 
Address  Manav Rachna International Institute of Research and Studies, sector 43, Delhi Surajkund Road, Faridabad, Haryana, 121004 
Type of Sponsor  Research institution 
 
Details of Secondary Sponsor  
Name  Address 
NIL  NIL 
 
Countries of Recruitment     India  
Sites of Study  
No of Sites = 1  
Name of Principal Investigator  Name of Site  Site Address  Phone/Fax/Email 
Dr Irshad Ahmad  Manav Rachna International Institute of Research and Studies  Research Laboratory, Department of Physiotherapy,Faculty of Allied Health Sciences, Manav Rachna International Institute of Research and StudiesSector-43, Faridabad, Delhi Surajkund road, Haryana 121004
Faridabad
HARYANA 		 8178071369

kkut84440@gmail.com 
 
Details of Ethics Committee  
No of Ethics Committees= 1  
Name of Committee  Approval Status 
Manav Rachna International Institute of Research and Studies Ethical Committee  Approved 
 
Regulatory Clearance Status from DCGI  
Status 
Not Applicable 
 
Health Condition / Problems Studied  
Health Type  Condition 
Patients  (1) ICD-10 Condition: Z682||Body mass index (BMI) 20-29, adult,  
 
Intervention / Comparator Agent  
Type  Name  Details 
Comparator Agent  Conventional DCF Training Without Biofeedback  Exercise Type: Deep cervical flexor training using chin tuck maneuver Position: Same as experimental group (sitting upright without back support) Instructions: Participants are instructed to perform chin tuck exercises with verbal cues only. No feedback device is provided; focus is on patient effort and therapist guidance. Monitoring: Verbal and tactile cues are used by the therapist to correct technique. No EMG electrodes or visual/auditory feedback is used. Repetitions: 10 repetitions per session Hold Time: 15 seconds per repetition Rest Between Reps: 10 seconds Frequency: 1 session per day for 14 consecutive days Supervision: Exercises performed under therapist supervision to ensure consistency and avoid compensatory movements. 
Intervention  EMG Biofeedback-Assisted DCF Training  Exercise Type: Deep cervical flexor training via chin tuck maneuver Position: Sitting upright on a stool with back unsupported, feet flat on floor Instructions: The participant is instructed to gently draw the chin inward (like making a double chin) without cervical flexion or shoulder movement. Emphasis is placed on isolating deep neck flexor activation without activating the sternocleidomastoid or superficial muscles. EMG Biofeedback Setup: Device: Portable EMG biofeedback unit with visual display and auditory signal Electrode Placement: Longus colli: Over anterior neck, medial to sternocleidomastoid Upper trapezius: Over midpoint between acromion and C7 (for monitoring compensatory overuse) The screen provides real-time graphical feedback showing DCF activity and alerts when upper trapezius activity increases. Repetitions: 10 repetitions per session Hold Time: 15 seconds per repetition Rest Between Reps: 10 seconds Frequency: 1 session per day for 14 consecutive days Supervision: Exercises were performed under therapist supervision during sessions to ensure proper electrode placement and technique adherence. 
 
Inclusion Criteria  
Age From  20.00 Year(s)
Age To  50.00 Year(s)
Gender  Both 
Details  aged 20 to 50 years with mechanical neck pain and CVA more than 50 degrees were recruited 
 
ExclusionCriteria 
Details  Psychiatric disorder, Metabolic disorder, Hormonal disorder 
 
Method of Generating Random Sequence   Computer generated randomization 
Method of Concealment   Case Record Numbers 
Blinding/Masking   Participant and Outcome Assessor Blinded 
Primary Outcome  
Outcome  TimePoints 
CVA (using digital photography and goniometry), VAS for pain, NDI for functional disability, and cervical active range of motion (AROM)   Baseline, after 2 weeks, After 4 weeks  
 
Secondary Outcome  
Outcome  TimePoints 
Quality of life (SF-12)  At baseline, after week 2, after week 4 
 
Target Sample Size   Total Sample Size="40"
Sample Size from India="40" 
Final Enrollment numbers achieved (Total)= "Applicable only for Completed/Terminated trials"
Final Enrollment numbers achieved (India)="Applicable only for Completed/Terminated trials" 
Phase of Trial   N/A 
Date of First Enrollment (India)   30/07/2025 
Date of Study Completion (India) Applicable only for Completed/Terminated trials 
Date of First Enrollment (Global)  Date Missing 
Date of Study Completion (Global) Applicable only for Completed/Terminated trials 
Estimated Duration of Trial   Years="0"
Months="6"
Days="0" 
Recruitment Status of Trial (Global)   Not Applicable 
Recruitment Status of Trial (India)  Open to Recruitment 
Publication Details   N/A 
Individual Participant Data (IPD) Sharing Statement

Will individual participant data (IPD) be shared publicly (including data dictionaries)?  

Response - YES
  1. What data in particular will be shared?
    Response - Individual participant data that underlie the results reported in this article, after de-identification (text, tables, figures, and appendices).

  2. What additional supporting information will be shared?
    Response -  Study Protocol
    Response -  Statistical Analysis Plan
    Response - Informed Consent Form
    Response - Clinical Study Report

  3. Who will be able to view these files?
    Response - Researchers who provide a methodologically sound proposal.

  4. For what types of analyses will this data be available?
    Response - Any purpose.

  5. By what mechanism will data be made available?
    Response - Proposals should be directed to [kkut84440@gmail.com].

  6. For how long will this data be available start date provided 12-12-2025 and end date provided 12-01-2026?
    Response - Beginning 3 months and ending 5 years following article publication.

  7. Any URL or additional information regarding plan/policy for sharing IPD? 
    Additional Information - NIL
Brief Summary  


Effect of Electromyography Biofeedback Training to Deep Neck Flexor in Mechanical Neck Pain Patients with Forward Head Posture – A Prospective Interventional Study

Background & Rationale:
Mechanical neck pain and forward head posture (FHP) are increasingly common among individuals with sedentary lifestyles, especially those engaged in prolonged screen-based activities. FHP alters cervical spine mechanics, weakens deep cervical flexors (DCF), and leads to muscle imbalances and chronic pain. While chin tuck exercises are standard in rehabilitation, many patients struggle with proprioceptive awareness, limiting the effectiveness of conventional training. Electromyography (EMG) biofeedback offers real-time visual and auditory cues to enhance muscle activation and motor control, potentially improving postural correction and reducing symptoms.

Objective:
To assess the clinical efficacy of EMG biofeedback-assisted Deep Cervical Flexors (DCF) training versus conventional Deep Cervical Flexion exercises in individuals with mechanical neck pain and FHP.

Methodology:
Patients aged 20–50 years with diagnosed mechanical neck pain and CVA <50° will be recruited and randomly allocated to either an EMG biofeedback group or a control group. Both groups will perform identical DCF exercises daily for four weeks. Outcome measures will include Craniovertebral Angle (CVA), Visual Analog Scale (VAS) for pain, Neck Disability Index (NDI), and cervical Active Range of Motion (AROM), assessed pre and post-intervention.

Clinical Significance:
This study aims to generate evidence for the integration of EMG biofeedback into routine physiotherapy practice. If proven effective, it can offer a low-risk, accessible, and efficient intervention to improve posture, alleviate pain, and restore function in patients with cervical dysfunctions, particularly FHP. Findings from this study may inform future guidelines on cervical rehabilitation protocols.

 
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