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IRCT20250801066719N1 IRCT 2025-08-19 The University of Shahid Beheshti comparison the effect of DNS exercise with and without the use of VR on Hyperlordosis with nonspecific chronic low back pain Dynamic neuromuscular exercise(DNS) Comparison of the Effect of six Weeks of Dynamic Neuromuscular Stabilization (DNS) Exercise with and without the Use of Virtual Reality (VR) on pain, Balance, Proprioception, Range of Motion and Lumbar Arch Degree in Middle-aged Women with Hyperlordosis with nonspecific chronic low back pain: A randomized clinical trial 2025-08-25 anticipated 50 Complete https://irct.ir/trial/85314 interventional Randomization: Randomized, Blinding: Not blinded, Placebo: Not used, Assignment: Parallel, Purpose: Treatment, Randomization description: Sequence Generation To keep an equal 1 : 1 : 1 allocation across the three study arms— Group A = DNS exercise only Group B = DNS + virtual-reality (VR) exercise Group C = no-treatment control I first divide the total sample size n into three equal parts (n / 3 per group). Then I prepare n / 3 identical paper slips marked “A”, n / 3 slips marked “B”, and n / 3 slips marked “C.” All slips are folded twice so the label cannot be seen, placed together in a single opaque, non-transparent container, and thoroughly mixed before recruitment begins. For each eligible participant I (or an independent staff member) draw one slip blindly from the container. The letter on the slip immediately determines that participant’s assignment. After a slip is drawn it is removed from the pool and stored separately, so the remaining probabilities stay constant (sampling without replacement). N/A هايپرلوردوزيس همراه با كمردرد مزمن غيراختصاصي. Intervention 1: Intervention group 1: The group receiving dynamic neuromuscular training combined with virtual reality technology. Participants receive Dynamic Neuromuscular Stabilization exercises combined with virtual reality. The program lasts 6 weeks (18 sessions) with 3 sessions per week, and each session is 50 minutes. Training is conducted at the Fitness and Sports Rehabilitation Club, Faculty of Sport Sciences, Shahid Beheshti University. The VR device is the Meta Quest 3 headset and the selected game is Dodgeball, which is used to encourage controlled lumbar flexion. Each session includes 5 minutes of warm-up (light stretching, walking, simple mobility), 20 minutes of DNS, 20 minutes of VR-based training (Dodgeball tasks for balance, weight-shift, reaching, and trunk control), and 5 minutes of cool-down (gentle stretching and walking). DNS content covers diaphragmatic breathing and intra-abdominal pressure (IAP) work performed in developmental positions derived from infant motor patterns, including baby-rock/rolling, prone, side-lying, quadruped, bear position, tripod stance, and modified squat. The auxiliary equipment used during DNS consists of elastic resistance bands, light dumbbells, and a Pilates ball; the chosen VR game (Dodgeball) is selected based on prior literature for this population. Intervention 2: Intervention group 2:The group receiving dynamic neuromuscular training without the use of virtual reality technology. The program lasts 6 weeks (18 sessions) with 3 sessions per week. Each session is 50 minutes. Training is conducted at the Fitness and Sports Rehabilitation Club in the Faculty of Sport Sciences, Shahid Beheshti University. DNS exercises are performed for 40 minutes, with 5 minutes of warm-up at the beginning and 5 minutes of cool-down at the end, consisting of light stretching, walking, and simple mobility drills. The DNS component includes core patterns of diaphragmatic breathing and intra-abdominal pressure (IAP) in developmental positions derived from infant motor patterns, such as baby rock, prone, side-lying, quadruped, bear position, tripod stance, and modified squat. Auxiliary equipment during DNS includes elastic resistance bands, light dumbbells, and a Pilates ball. Intervention 3: Control group: The control group receiving no intervention. Undecided - It is not yet known if there will be a plan to make this available Justification or reason for indecision in sharing IPD is At this stage, a final decision regarding the sharing of Individual Participant Data (IPD) has not been made due to the need for coordination with the research team, ethical considerations, and institutional data sharing policies. A decision will be made after careful review of legal and scientific aspects.
public Niusha Tashakori
Shafi'pour Sports Complex, Opposite Niloufar Alley, North Vafa-Azar Street, East Ferdows Boulevard, Ayatollah Kashani Street, Tehran, Iran
Tehran Iran (Islamic Republic of) 1481855943 +98 21 4409 5051 Nta.1379.nt@gmail.com The University of Shahid Beheshti scientific Niusha Tashakori
Shafi'pour Sports Complex, Opposite Niloufar Alley, North Vafa-Azar Street, East Ferdows Boulevard, Ayatollah Kashani Street, Tehran, Iran
Tehran Iran (Islamic Republic of) 1481855943 +98 21 4409 5051 nta.1379.nt@gmail.com The University of Shahid Beheshti Iran (Islamic Republic of) Women between 30-50 years of age Lumbar lordosis greater than 40 degrees Body-mass index (BMI) between 18.5 and 27 Pain intensity between 3 and 7 on the Visual Analogue Scale (VAS) 30 years 50 years Female history of spinal fractures, surgery, or joint disease Use of orthotic insoles, a cane, antidepressant or narcotic medications, or muscle relaxants within 30 days prior to the study, and no significant visual impairment or motor disorders that would prevent the use of virtual-reality equipment Presence of pathological signs related to the condition, such as heart disease, cancer, tumors, previous surgery, etc. Presence of orthopedic deformities or neurosurgical diseases Presence of disc degeneration or other conditions that could influence the interpretation of the results (e.g., severe fibromyalgia or rheumatoid arthritis in combination with other treatments) Surgery or pregnancy within the past 30 days Use of devices or apparatuses for treating hyper-lordosis Presence of any other postural abnormalities M54.5 Low back pain Treatment - Other Treatment - Other N/A Intervention group 1: The group receiving dynamic neuromuscular training combined with virtual reality technology. Participants receive Dynamic Neuromuscular Stabilization exercises combined with virtual reality. The program lasts 6 weeks (18 sessions) with 3 sessions per week, and each session is 50 minutes. Training is conducted at the Fitness and Sports Rehabilitation Club, Faculty of Sport Sciences, Shahid Beheshti University. The VR device is the Meta Quest 3 headset and the selected game is Dodgeball, which is used to encourage controlled lumbar flexion. Each session includes 5 minutes of warm-up (light stretching, walking, simple mobility), 20 minutes of DNS, 20 minutes of VR-based training (Dodgeball tasks for balance, weight-shift, reaching, and trunk control), and 5 minutes of cool-down (gentle stretching and walking). DNS content covers diaphragmatic breathing and intra-abdominal pressure (IAP) work performed in developmental positions derived from infant motor patterns, including baby-rock/rolling, prone, side-lying, quadruped, bear position, tripod stance, and modified squat. The auxiliary equipment used during DNS consists of elastic resistance bands, light dumbbells, and a Pilates ball; the chosen VR game (Dodgeball) is selected based on prior literature for this population. Intervention group 2:The group receiving dynamic neuromuscular training without the use of virtual reality technology. The program lasts 6 weeks (18 sessions) with 3 sessions per week. Each session is 50 minutes. Training is conducted at the Fitness and Sports Rehabilitation Club in the Faculty of Sport Sciences, Shahid Beheshti University. DNS exercises are performed for 40 minutes, with 5 minutes of warm-up at the beginning and 5 minutes of cool-down at the end, consisting of light stretching, walking, and simple mobility drills. The DNS component includes core patterns of diaphragmatic breathing and intra-abdominal pressure (IAP) in developmental positions derived from infant motor patterns, such as baby rock, prone, side-lying, quadruped, bear position, tripod stance, and modified squat. Auxiliary equipment during DNS includes elastic resistance bands, light dumbbells, and a Pilates ball. Control group: The control group receiving no intervention. Hyperlordosis. Timepoint: Outcome assessments will be conducted at baseline and after the completion of the 6-week intervention period. Method of measurement: Hyperlordosis will be assessed using the Spinal Mouse device. Pain intensity. Timepoint: Outcome assessment will be conducted at baseline and after the completion of the 6-week intervention period. Method of measurement: Pain intensity will be measured using the Visual Analogue. Static balance. Timepoint: Outcome assessment will be conducted at baseline and after the completion of the 6-week intervention period. Method of measurement: static Balance will be assessed using the Biodex Balance System. Dynamic balance. Timepoint: Outcome assessment will be conducted at baseline and after the completion of the 6-week intervention period. Method of measurement: Dynamic Balance will be assessed using the Biodex Balance System. Lumbar proprioception. Timepoint: Outcome assessment will be conducted at baseline and after the completion of the 6-week intervention period. Method of measurement: Lumbar Proprioception will be measured using a goniometer. Range of motion. Timepoint: Outcome assessment will be conducted at baseline and after the completion of the 6-week intervention period. Method of measurement: Range of motion will be measured using the MobeeMed device. shahid Beheshti University Approved 2025-05-24 Ethics committee of Shaid Beheshti University Shahid Shahriari Square, Evin, Tehran, Iran Tehran Tehran Iran (Islamic Republic of)