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CompletedNCT06303388Updated Jul 28, 2026

Effects of Bruegger's Exercises Versus Egoscue Exercise on Lower Cross Syndrome

An interventional study of Bruegger,s Exercise and Egoscue Exercise in Lower Cross Syndrome, sponsored by Riphah International University. Completed at 1 site in Pakistan. Open to participants aged 16 Years to 65 Years, including healthy volunteers. Per ClinicalTrials.gov, last updated 2026-07-28.

Sponsored by Riphah International University · Not applicable, Interventional, and Treatment

Phase
Not applicable
Study type
Interventional
Enrollment
34
Allocation
Randomized
Ages
16 Years to 65 Years
Sex
All
01

Study summary

This study aims to find effects of Bruegger's Exercise versus Egoscue exercise on pain and hyperlordosis on patient with lower cross syndrome. This is interventional study which recruits 34 participants ,14 in each group.

Read the detailed description

A randomized control trial will be conducted on patients with lower cross syndrome. A total number of 34 participants will be randomised into two groups with 17 participants in each group. Both groups will receive Hot Packs on the lumbar area for 10 minutes. Group A will receive Conventional Therapy and will follow protocol of Bruegger's Exercise. Group B will follow protocol of the Egoscue exercise. This study aims to decrease pain and hyperlordosis.

Each group will be assessed at baseline which will include pain through NPRS, hyperlordosis through flexicurve ruler and anterior pelvic tilt through pelvic inclinometer. Data from both groups will again be assessed after 4 weeks of intervention.

Protocol of Bruegger's Exercise: Pt. position: Upright sitting on a chair.

  1. Sit with your buttocks at the edge of a chair.
  2. Spread your legs apart slightly.
  3. Turn your toes out slightly.
  4. Rest your weight on your legs/feet \& relax your abdominal muscles.
  5. Tilt your pelvis forward (i.e. arch your lower back) while lifting your chest up
  6. Rotate your arms outward while turning your palms up.
  7. Hold your head high in the air, with a slight arch in the neck.

The patient is to perform this exercise once or twice every 20-30 minutes of prolonged sitting and held in this position for 30-60 seconds. To avoid non-compliance patient will be asked to perform five repetitions of particular exercise with five second hold during their clinical session.

Protocol of Egoscue Exercise The Egoscue group received a total of 10 exercises which includes

  1. Static back alone and with breathing
  2. Abdominal contraction while in the static back position
  3. abductor press
  4. Overhead extension
  5. elbow curls on a wall
  6. Static wall
  7. Upper spinal twist
  8. pelvic tilts
  9. supine groin progressive
  10. Air bench exercises

Week 1: 3 times with 10 s hold time Week 2: 5 times with 10 s hold time Week 3: 15 times with 10 s hold time Week 4: 20 times with 10 s hold time

02

Conditions studied

  • Lower Cross Syndrome

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Keywords

  • Pain
  • Hyperlordosis
  • Anterior pelvic tilt
03

In context

Pain

10,054 studies on the registry are indexed under Pain; 1,649 are open to participants now.

This study's enrollment of 34 is below the median of 66 across 8,493 interventional studies indexed under Pain.

Browse Pain studies →

Lead sponsor

Riphah International University is the lead sponsor of 2,193 studies on the registry; 650 are open to participants now.

Counted across the registry records on this site, refreshed daily.

04

Who can participate

Ages eligible
16 Years to 65 Years
Sexes eligible
All
Accepts healthy volunteers
Yes

Eligibility criteria

Inclusion Criteria: • Females and males aged between 16 to 65 years

  • Participants had to present with low back pain
  • Participants had to meet the criteria for lower crossed syndrome indicating tight hip flexors (Modified Thomas test) and erector spinae (visual assessment through toe touching) together with weak glutei (Prone Hip Extension Co-ordination/Strength Test) and abdominals (Trunk Flexion Co-ordination and Strength Test)and thoracic kyphosis.
  • Angle of anterior pelvic tilt > 10 degrees

Exclusion Criteria: • Participants who would be undergoing other forms of treatment that may interfere with the study, for the duration of the study, including other manipulative and physical therapies specific to back pain.

  • Presence of other conditions that may mimic low back pain, e.g. nerve entrapment.
  • Participants taking any medication that may interfere with the results of this study including, pain medication, anti-inflammatory medication, and muscle relaxants.
  • Surgery on the back, pelvis, or sacrum is indicated or has previously occurred
  • LBP having localised or radiating pain.
  • Practiced any kind of exercise or sports activity during the last 6 months.
05

Study design

Phase
Not applicable
Primary purpose
Treatment
Allocation
Randomized
Intervention model
Parallel assignment
Masking
Single (Participant)
Enrollment
34 participants (actual)

Study arms

  • Experimental
    Egoscue Exercise

    • The Egoscue exercise comprise of 10 exercises which Included 1. Static back alone and with breathing. 2. Abdominal contraction while in the static back position. 3. abductor press 4. overhead extension 5. elbow curls on a wall 6. static wall 7. upper spinal twist 8 pelvic tilts 9.supine groin progressive 10.air bench exercises.

    Other: Egoscue Exercise

  • Active comparator
    Bruegger's Exercise

    steps include in Breugger's Exercise 1. Sit with your buttocks at the edge of a chair. 2. Spread your legs apart slightly. 3. Turn your toes out slightly. 4. Rest your weight on your legs/feet \& relax your abdominal muscles. 5. Tilt your pelvis forward (i.e. arch your lower back) while lifting your chest up 6. Rotate your arms outward while turning your palms up. 7. Hold your head high in the air, with a slight arch in the neck. The patient is to slowly exhale by breathing out through their lips while actively externally rotating their arms and spreading their fingers. The patient is to perform this exercise once or twice every 20-30 minutes of prolonged sitting and held in this position for 30-60 seconds

    Other: Bruegger,s Exercise

Interventions

  • OtherBruegger,s Exercise

    Bruegger's Exercise protocol along with conventional Physiotherapy.

  • OtherEgoscue Exercise

    Egoscue Exercise along with conventional Physiotherapy.

06

What researchers measure

Primary outcomes

  1. Flexicurve Ruler

    The flexicurve ruler (flexible) is commonly used to measure the degree of spinal curvature of the lumbar lordosis in the sagittal plane. The flexible ruler was placed according to the Youdas method, over spinous processes from T12 to S2 vertebrae. The ruler was then cautiously removed from the spine and traced onto a plain piece of white paper. A vertical line was drawn to connect the T12 and S2 landmarks (L line) and together with the maximum width of the lumbar curvature (H line

    Time frame: 12 day

  2. Pelvic Inclinometer

    A pelvic inclinometer was used to measure the anterior/posterior inclination of the pelvis of the subjects. An inclinometer has a 23 Cm length base and two 15 Cm arms in each side that freely move 360 degrees in horizontal plane. The ends of the arms are placed on the bony landmarks.The subject was asked to stand with the feet shoulder width apart. Even pressure was applied to both the arms of the inclinometer at anterior superior iliac spine and posterior superior iliac spine, with a bubble in the center the reading was then measured in degrees.

    Time frame: 12 day

  3. NPRS

    Several pain scales are used clinically to evaluate the severity of musculoskeletal pain, one of which is the Numeric Pain Rating Scale (NPRS-11), which is an eleven-point scale in which the endpoints are the extremes of no pain at all (score of 0) and the worst pain the patient has ever experienced (score of 10).

    Time frame: 12 Day

Secondary outcomes

  1. Modified Thomas Test

    This test was performed with the patient supine and the thighs positioned over the edge of the examining table. The patient was told to grasp the thigh of the untested limb and pull it toward the chest to flatten the back and stabilise the pelvis, preventing an increase in lumbar lordosis. A standard stretch position for the iliopsoas muscle is demonstrated with the hip extended and the leg hanging freely with normal knee flexion. A positive test was indicated if the hip remained flexed against gravity on tested limb. Additionally, if there was also knee extension on the tested limb then further testing was needed to decide between a tight iliopsoas or rectus femoris muscle. This was done by passively extending the knee of the tested limb to neutralize the effect of the rectus femoris and find if there was still no change in hip flexion.

    Time frame: 12 day

  2. Visual Assessment through toe touching

    The patient was seated on the examining table with the pelvis in a vertical position and the legs extended. The patient was asked to actively flex foreword in order to bring the forehead to the knees. The normal functioning of the erector spinae should display an even 'C' shaped curve and a distance of 10cm from the knees to the forehead. There should be also no knee flexion and involve no pelvic tilting. Any deviation from these norms indicates shortness of the erector spinae muscles.

    Time frame: 12 day

  3. Prone Hip Extension Co-ordination Test

    The patient lay prone and raised the tested thigh into extension with the knee held in an extended position. The researcher then palpated the lumbar erector spinae and gluteus maximus muscles. A normal activation sequence was then observed and palpated which involved first the hamstring and gluteus maximus muscles, then the contralateral lumbar erector spinae muscles and lastly the ipsilateral lumbar erector spinae muscles. A positive test result occurred if the lumbar erector spinae contracted before the gluteus maximus muscles did.

    Time frame: 12 day

  4. Trunk Flexion Co-ordination and Strength Test

    The patient lay supine with the arms either behind the neck or forward across the body and knees bent. The researcher then contacted the patient's heels or positioned a hand under the patient's lumbar spine. The patient was then asked to complete a posterior pelvic tilt and raise the trunk up until the scapulae cleared the table. This position was maintained for 2 seconds. The patient then held the pelvic tilt while lowering their back to the table. The patient was then instructed to perform 10 repetitions while holding the last repetition for 30 seconds. A positive test result occurred if the patient could not perform 10 repetitions without the lumbar spine or heels rising off the table.

    Time frame: 12 day

07

Study locations

1 site
  • Pakistan Railway General Hospital
    Rawalpindi, Federal 44000, Pakistan
08

References and documents

Publications

  • Waters T. The effect of Bruegger's exercise on chronic low back pain in association with lower crossed syndrome: University of Johannesburg (South Africa); 2014.
  • Koes BW, van Tulder MW, Thomas S. Diagnosis and treatment of low back pain. BMJ. 2006 Jun 17;332(7555):1430-4. doi: 10.1136/bmj.332.7555.1430. No abstract available. PubMed 16777886 ↗
  • May S, Johnson R. Stabilisation exercises for low back pain: a systematic review. Physiotherapy. 2008;94(3):179-89
  • Nourbakhsh MR, Arabloo AM, Salavati M. The relationship between pelvic cross syndrome and chronic low back pain. Journal of back and musculoskeletal rehabilitation. 2006;19(4):119-28.
  • Kudchadkar GS, Gurudut P, Welling A. Comparative effect of mat pilates and egoscue exercises in asymptomatic individuals with lumbar hyperlordosis: A randomized controlled trial. Indian Journal of Physical Therapy and Research. 2019;1(2):79-88.
  • Sequeira S, Gurudut P, Kage V. Exploring effects of Egoscue versus lumbar stabilisation exercises for lower crossed syndrome on postural stability and hyperlordotic posture correction. Comparative Exercise Physiology. 2023:1-12.
  • Vehrs Z. The Effect of Egoscue Corrective Exercises on Chronic Knee and Hip Pain: Brigham Young University; 2014.
  • Laxmi V R, G N, V S, G M, Gopinath Y, G T. Efficacy of Janda's approach versus bruegger's exercise in pelvic cross syndrome and its impact on quality of life. International Journal of Research in Pharmaceutical Sciences. 2020;11:1701-6.
  • Childs JD, Piva SR, Fritz JM. Responsiveness of the numeric pain rating scale in patients with low back pain. Spine (Phila Pa 1976). 2005 Jun 1;30(11):1331-4. doi: 10.1097/01.brs.0000164099.92112.29. PubMed 15928561 ↗
  • Kahl C, Cleland JA. Visual analogue scale, numeric pain rating scale and the McGill pain Questionnaire: an overview of psychometric properties. Physical therapy reviews. 2005;10(2):123-8.
  • Macintyre NJ, Bennett L, Bonnyman AM, Stratford PW. Optimizing reliability of digital inclinometer and flexicurve ruler measures of spine curvatures in postmenopausal women with osteoporosis of the spine: an illustration of the use of generalizability theory. ISRN Rheumatol. 2011;2011:571698. doi: 10.5402/2011/571698. Epub 2011 Feb 7. PubMed 22482067 ↗
  • Khan N, Nouman M, Iqbal MA, Anwar K, Sajjad AG, Hussain SA. Comparing the Effect of Stretching and Muscle Energy Technique in the Management of Lower Cross Syndrome. Pakistan Journal of Medical & Health Sciences. 2022;16(07):31-

Individual participant data

Plan to share: No

09

Updates

Tracking since Sep 25, 2026
No changes since tracking began. The registry record was last updated on Jul 28, 2026, before this site started recording changes on Sep 25, 2026. Its history is on ClinicalTrials.gov ↗
10

Registry details

Key details

Study ID
NCT06303388
Responsible party
Sponsor
First posted
Mar 12, 2024
Start date
Feb 26, 2024
Primary completion
Jun 5, 2024
Completion
Jun 15, 2024
Last update
Jul 28, 2026

Study contacts

Nadia Ishtiaq, MS
principal investigator · Riphah International University

Oversight

Data monitoring committee
No
FDA-regulated drug
No
FDA-regulated device
No
View the source record on ClinicalTrials.gov ↗

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