This study aimed to investigate whether a three-dimensional nuchal exercise program is associated with changes in pelvic alignment and low back pain in adults.

Thirty participants with low back pain performed a structured cervical exercise program for four weeks, including horizontal, sagittal, and diagonal movements. Pelvic tilt angle and pain intensity were measured before and after the intervention.

The findings of this study may provide preliminary evidence supporting a potential relationship between cervical movement and pelvic alignment, contributing to the understanding of regional interdependence in musculoskeletal rehabilitation.

Low back pain is a common musculoskeletal condition that can lead to functional limitation and reduced quality of life. Traditional rehabilitation approaches often focus on the lumbar and pelvic regions; however, emerging evidence suggests that different body regions may be functionally interconnected.

The concept of regional interdependence proposes that impairments in one anatomical region may contribute to dysfunction in another. The cervical spine plays an important role in postural control due to its rich proprioceptive input and its interaction with visual and vestibular systems. Therefore, cervical movement may influence postural alignment and neuromuscular control throughout the body.

This study was designed as a single-group, pre-post interventional study to explore the effects of a three-dimensional nuchal exercise program on pelvic alignment and pain intensity. Participants with low back pain were instructed to perform a structured exercise program consisting of horizontal rotation, sagittal flexion-extension, and diagonal (star-pattern) cervical movements.

Pelvic alignment was assessed using photographic analysis, and pain intensity was measured using a visual analog scale (VAS). Measurements were conducted before and after the intervention period.

This study is considered a preliminary (pilot) investigation. The results may provide initial evidence for cervico-pelvic interaction and inform the design of future controlled trials.

Inclusion Criteria:

• Adults aged 30 to 60 years
• Individuals who reported experiencing low back pain within the previous 6 months
• Ability to stand independently and perform exercise tasks
• Willingness to participate and provide written informed consent-

Exclusion Criteria:

• - History of severe head or neck injury
• Previous spinal surgery
• Active infectious disease or uncontrolled malignancy
• Cognitive impairment affecting the ability to follow instructions
• Any condition affecting the ability to stand or walk independently

This was an open-label study with no blinding of participants or investigators.