Comparison of the Effects of Dynamic Neuromuscular Stabilization and Thoracic Stabilization Exercises on Thoracic Erector Spinae Muscle Strength Using EMG Biofeedback in Individuals With Kyphosis

Thoracic kyphosis is a frequently observed postural deviation that affects the sagittal alignment of the spine and may lead to alterations in muscular balance, impaired trunk stability, and increased biomechanical stress on the vertebral column. Postural thoracic kyphosis typically results from prolonged sedentary behaviors-such as extended computer and smartphone use-and habitual forward-flexed postures adopted during work or daily activities. Over time, inadequate thoracic extension, weakness of the thoracic erector spinae musculature, and compensatory recruitment of accessory trunk muscles may further contribute to the progression of the deformity. Although postural kyphosis is considered flexible and reversible in early stages, insufficient management may allow gradual transition toward more structural changes.

Conservative physiotherapy interventions represent the primary approach to managing postural thoracic kyphosis. These interventions traditionally include thoracic mobility exercises, strengthening of the spinal extensors, scapular stabilization strategies, and postural retraining. In recent years, neuromuscular re-education methods and biofeedback-supported interventions have become increasingly prominent, reflecting a shift toward approaches that emphasize sensorimotor control and integration of respiratory-postural synergy.

Dynamic Neuromuscular Stabilization (DNS) is a rehabilitation method grounded in developmental kinesiology principles. DNS aims to restore optimal joint stabilization and postural alignment through coordinated activation of the diaphragm, deep spinal stabilizers, and global trunk musculature. By replicating developmental postures, DNS seeks to reintegrate diaphragmatic breathing patterns and promote central stabilization strategies that influence thoracic alignment and motor control.

Thoracic stabilization exercises represent another commonly applied approach and typically include targeted thoracic extension, scapular retraction, and segmental mobilization techniques. These exercises aim to improve local muscle function of the thoracic erector spinae, enhance thoracic mobility, and promote more efficient load transfer across the spine. While both DNS and thoracic stabilization approaches have theoretical and clinical justification, direct comparative evidence regarding their short-term effects on neuromuscular activation and postural correction in adults with thoracic kyphosis remains limited.

This single-center randomized controlled trial will be conducted at Mudanya University and will include 30 adults aged 18 to 40 years with postural thoracic kyphosis confirmed through flexible ruler assessment. Participants will be randomly assigned in a 1:1 ratio to either a Dynamic Neuromuscular Stabilization intervention group or a Thoracic Stabilization Exercise group. Both intervention programs will extend over a 6-week period and will include two supervised sessions per week, complemented by home-based exercises performed twice daily. To ensure adherence, each participant will maintain an exercise diary, and individuals who fail to perform the prescribed exercises for three consecutive days will be withdrawn from the study in accordance with predefined adherence criteria.