Comparison of the effects of (Chest-up/Sternal Lift) exercises and Routine exercises on pain, Electromyographic activity and the postural alignment of the head, neck, and thorax in static position and functional task in individuals with Neck Pain Associated with Forward Head Posture

This study aims to compare the effects of Chest‑up / Sternal Lift exercises and routine exercises on pain intensity, electromyographic muscle activity, and postural alignment of the head–neck region and thorax in static posture and during functional activities in individuals with neck pain accompanied by forward head posture.

Randomized clinical trial, single‑blind (outcome assessment), parallel‑group, Phase II, with two active intervention groups on 60 patients. Randomization was performed using the concealed envelope method.

This clinical trial is conducted in the Physiotherapy Laboratory of Tarbiat Modares University. After baseline assessment, participants are randomly allocated to two active intervention groups and receive therapeutic exercises under therapist supervision. Outcome assessment is performed by an independent assessor blinded to group allocation.

Inclusion criteria: Adult individuals with non‑specific neck pain accompanied by forward head posture, able to perform therapeutic exercises, and providing informed consent. Exclusion criteria: history of cervical spine surgery, acute neck trauma or injury, known neurological or musculoskeletal disorders, systemic conditions affecting movement, specific neck pain, or concurrent neck‑related treatments.

Participants are allocated to Chest‑up / Sternal Lift and routine neck exercise groups. Interventions are delivered for 10 sessions (3 sessions per week). In both groups, infrared thermotherapy and TENS are applied before exercises.

Neck pain intensity; electromyographic activity of selected neck and shoulder muscles; head and neck postural alignment (CVA) in static posture and during functional activities

In this study, participants will be randomly allocated to the intervention groups using a simple randomization procedure. After screening for inclusion and exclusion criteria, each eligible participant will be assigned a random number generated by the RAND function in Microsoft Excel. Based on the randomization list, participants will be allocated either to Exercise Group A or Exercise Group B. The randomization sequence will be prepared by an independent researcher who will not be involved in data collection to minimize selection bias. Group assignments will be placed in sealed, opaque, and sequentially numbered envelopes, each containing the group allocation card. Each envelope will be opened only after participant enrollment and in the presence of the intervention supervisor. The unit of randomization will be individual participants, with no stratification or block randomization applied. Allocation concealment will be maintained through the use of sealed and numbered envelopes to ensure blinding of the assessor until the intervention phase begins.

This study is designed as a single-blind randomized controlled trial. Outcome assessments are conducted by an independent assessor (a biomechanical laboratory engineer) who is blinded to group allocation to minimize measurement bias in assessing dependent variables, including craniovertebral angle (CVA), cervical muscle activity measured by surface electromyography (EMG), muscle strength, and the Neck Disability Index (NDI). Participants are aware of the type of intervention they receive, as knowledge of exercise content is essential for safety considerations and the provision of informed consent. To minimize information exchange between groups, intervention sessions are scheduled at different times. Although the principal investigator is aware of group allocation, all collected data are coded before statistical analysis and provided to an independent data analyst who is blinded to group allocation. Statistical analyses are performed using SPSS software to further reduce the risk of bias. Accordingly, this study is classified as a single-blind randomized controlled trial in which both the outcome assessor and the data analyst are blinded, while participants, therapist, and the principal investigator are not blinded due to the nature of exercise therapy interventions.

De-identified individual participant data, study protocol, statistical analysis plan, and data dictionary The individual participant data of this study include baseline demographic information, primary and secondary outcome variables, and measurement results. All data will be shared after complete removal of personal identifiers and will be provided in a fully de-identified format. Complete raw datasets for all primary and secondary outcomes will be available for sharing. In addition, the final study protocol, the pre-specified statistical analysis plan, and the data dictionary will be shared to facilitate proper understanding and reuse of the data.

Access to the data and related documents will begin 6 months after publication of the final study results and will remain available for 5 years following the publication date.

The data and study documents will be made available to researchers affiliated with academic, research, and scientific institutions. Researchers outside academic settings may also be granted access upon submission of a scientifically valid request.

The data will be available exclusively for scientific research purposes, including secondary analyses, systematic reviews, meta-analyses, and comparative studies. Commercial use of the data is not permitted. Applicants must submit a brief research proposal describing the study objectives, planned statistical analyses, and a commitment to maintaining data confidentiality. Any use of the data must appropriately acknowledge the original study.

Requests for access to the data and study documents should be submitted through direct correspondence with the principal investigator. Primary contact method: email communication with the principal investigator. If no response is received, requests may be followed up through the registered postal address of the study.

After submission, the applicant’s research proposal will be reviewed by the principal investigator for scientific and ethical appropriateness. Upon approval, the de-identified data will be provided within 4 weeks. In case of rejection, the reasons will be communicated to the applicant in writing.

All shared data will be fully de-identified, and data sharing will be conducted in accordance with research ethics principles and national data protection regulations.