Effects of MET and Biofeedback Strengthening With and Without Kinesiotaping in Upper Crossed Syndrome

NCT07079319 | Not Yet Recruiting

• 1 other identifier: REC/RCR & AHS/24/0165- Rabia
• Study Type: interventional
• Target: 58
• Locations: 1 country
• Sites: 1

Brief Summary

This randomised controlled trial will aim to evaluate the combined effects of Muscle Energy Technique (MET) and biofeedback strengthening, with and without Kinesiotaping (KT), on pain, posture, deep neck flexor strength, and functional status in individuals with Upper Crossed Syndrome (UCS). A total of 58 participants aged 18-40 years will be randomly allocated into two groups. Group A will receive MET and biofeedback strengthening, while Group B will receive the same intervention with the addition of KT. Treatments will be administered three times per week over a four-week period. Outcome measures will include the Numeric Pain Rating Scale (NPRS), Neck Disability Index (NDI), craniovertebral angle (CVA), rounded shoulder posture (RSP), and cranio-cervical flexion test (CCFT) using a pressure biofeedback unit. It is hypothesised that the addition of KT will result in greater improvements in pain reduction and postural correction compared to MET and biofeedback alone.

Conditions

Neck Pain

Keywords

Upper Crossed Syndrome; Biofeedback Strengthening; Kinesiotaping; Muscle Energy Technique; Muscle Performance

Outcome Measures

Primary Outcomes (5)

• Numeric Pain Rating Scale - NPRS

  Pain intensity will be measured using the Numeric Pain Rating Scale (NPRS), a validated 11-point scale ranging from 0 (no pain) to 10 (worst imaginable pain). Participants will self-report their pain levels at baseline and after 4 weeks of intervention.

  Baseline and 4 weeks post-intervention

• Craniovertebral Angle (CVA)

  Cervical posture will be assessed using the craniovertebral angle (CVA), measured with a universal goniometer. A greater angle indicates improved head posture. Measurements will be taken at baseline and after 4 weeks of intervention.

  Baseline and 4 weeks post-intervention

• Rounded Shoulder Posture (RSP) Rounded Shoulder Posture (RSP) Rounded Shoulder Posture (RSP)

  Rounded shoulder posture will be evaluated by measuring the distance from the posterior acromion to the plinth in a supine position using a measuring tape. A decrease in distance reflects improved shoulder alignment.

  Baseline and 4 weeks post-intervention

• Deep Neck Flexor Strength (CCFT Score)

  Deep neck flexor strength will be measured using the Craniocervical Flexion Test (CCFT) with a pressure biofeedback unit (PBU). Pressure will be increased in 2 mmHg increments from 20 mmHg to 30 mmHg. The maximum pressure level held for 10 seconds without superficial muscle compensation will be recorded.

  Baseline and 4 weeks post-intervention

• Neck Disability Index - NDI

  The Neck Disability Index (NDI) will be used to evaluate functional disability related to neck pain. It includes 10 sections rated 0-5, with higher scores indicating greater disability. Scores will be recorded at baseline and 4 weeks.

  Baseline and 4 weeks post-intervention

Study Arms (2)

MET + Biofeedback Strengthening + Kinesiotaping

EXPERIMENTAL

Participants in this group will receive the same treatment protocol as Arm 1 (MET and biofeedback strengthening), with the addition of Kinesiotaping (KT) applied across the shoulder girdle. KT will be applied with 50-70% stretch from the anterior acromion to the opposite scapula, 3 times per week for 4 weeks. The tape will be worn for 14-16 hours per application. Standard physiotherapy (heat, ultrasound, neck isometrics, and stretching) will also be administered as part of the protocol.

Other: MET + Biofeedback Strengthening + Kinesiotaping

MET + Biofeedback Strengthening

ACTIVE COMPARATOR

Participants in this group will receive Muscle Energy Technique (MET) for the upper trapezius, levator scapulae, pectoralis major, and pectoralis minor using post-isometric relaxation technique. Additionally, they will perform biofeedback-based cranio-cervical flexion exercises using a pressure biofeedback unit (PBU). The intervention will be administered 3 times per week for 4 weeks, with a total of 12 sessions. Standard physiotherapy (heat application, ultrasound, neck isometrics, and stretching exercises) will also be provided.

Other: MET + Biofeedback Strengthening

Interventions

MET + Biofeedback Strengthening + Kinesiotaping OTHER

Participants in this group will receive the same treatment protocol as Arm 1 (MET and biofeedback strengthening), with the addition of Kinesiotaping (KT) applied across the shoulder girdle. KT will be applied with 50-70% stretch from the anterior acromion to the opposite scapula, 3 times per week for 4 weeks. The tape will be worn for 14-16 hours per application. Standard physiotherapy (heat, ultrasound, neck isometrics, and stretching) will also be administered as part of the protocol.

MET + Biofeedback Strengthening + Kinesiotaping

MET + Biofeedback Strengthening OTHER

Participants in this group will receive Muscle Energy Technique (MET) for the upper trapezius, levator scapulae, pectoralis major, and pectoralis minor using post-isometric relaxation technique. Additionally, they will perform biofeedback-based cranio-cervical flexion exercises using a pressure biofeedback unit (PBU). The intervention will be administered 3 times per week for 4 weeks, with a total of 12 sessions. Standard physiotherapy (heat application, ultrasound, neck isometrics, and stretching exercises) will also be provided.

MET + Biofeedback Strengthening

Eligibility Criteria

• Age: 18 Years - 40 Years
• Sex: all
• Healthy Volunteers: No
• Age Groups: Adult (18-64)

You may qualify if:

• Age group between 18-40 years
• Both males and females
• NPRS score \<7 for more than 2 months
• NDI score between 15-34
• Forward neck posture (confirmed by craniovertebral angle \<48-50° measured by goniometer)
• Rounded shoulders posture (confirmed by supine lying test; if the distance between posterior aspect of acromion and plinth is \>1 inch or 2.5 cm)
• Reduced deep neck flexors strength (confirmed by cranio-cervical flexion test (CCFT))

You may not qualify if:

• Age less than 18 or more than 40
• Recent trauma and/or hyper-flexibility
• History of cervical surgery in the last year
• History of infection (local or systemic), any dermatological condition tumor, chemotherapy, radiotherapy
• History of cervical fracture in the last year
• Radiating pain
• Positive upper limb tension tests

Sponsors & Collaborators

• Riphah International University: lead

Study Sites (1)

Horizon Hospital

Lahore, Punjab Province, 54000, Pakistan

Location

Related Publications (5)

• Dr. Samarjeet Kittad DPC. Prevalence Of Upper Cross Syndrome In Students Studying For Competitive Exams Using Pressure Biofeedback. International Journal of Creative Research Thoughts (IJCRT). June 2023;11(6):g668-g78.

  BACKGROUND

• Thacker D, Jameson J, Baker J, Divine J, Unfried A. Management of upper cross syndrome through the use of active release technique and prescribed exercises. Logan College of Chiropractic. 2011.

  BACKGROUND

• Ashfaq R, Riaz H. Effect of Pressure biofeedback training on deep cervical flexors endurance in patients with mechanical neck pain: A randomized controlled trial. Pak J Med Sci. 2021 Mar-Apr;37(2):550-555. doi: 10.12669/pjms.37.2.2343.

  PMID: 33679948 BACKGROUND

• Lwin NN, Myint T, Oo WM, San HH, Tun MT. EFFICACY ON PRESSURE-BIOFEEDBACK GUIDED CRANIOCERVICAL FLEXION EXERCISE IN NECK PAIN: A RANDOMIZED CONTROLLED TRIAL. Journal of Musculoskeletal Research.0(0):2150013.

  BACKGROUND

• A Rayjade TY, R Chintamani, N Joshi. Comparative effectiveness of Kinesio taping and Ift in upper cross syndrome-A randomized clinical trial. Indian Journal of Forensic Medicine & Toxicology. 2020;14(3):127-32.

  BACKGROUND

MeSH Terms

Conditions

Neck Pain; Oculocerebral hypopigmentation syndrome type Preus

Condition Hierarchy (Ancestors)

Pain; Neurologic Manifestations; Signs and Symptoms; Pathological Conditions, Signs and Symptoms

Study Officials

• Amna Zia, Phd Scholar

  Riphah International University/ Mayo Hospital, Lahore

  PRINCIPAL INVESTIGATOR

• Rabia Afzal, MSc Student

  Riphah International University

  PRINCIPAL INVESTIGATOR

Central Study Contacts

Samrood Akram, Phd Scholar

CONTACT

03324806143; samood.akram@riphah.edu.pk

Amna Zia, Phd Scholar

CONTACT

03244686993; amna_zia_17@live.com

Study Design

• Study Type: interventional
• Phase: not applicable
• Allocation: RANDOMIZED
• Masking: DOUBLE
• Who Masked: PARTICIPANT, OUTCOMES ASSESSOR
• Purpose: TREATMENT
• Intervention Model: PARALLEL
• Sponsor Type: OTHER
• Responsible Party: SPONSOR

Study Record Dates

• First Submitted: July 14, 2025
• First Posted: July 23, 2025
• Study Start: July 1, 2025
• Primary Completion: November 15, 2025
• Study Completion: November 30, 2025
• Last Updated: July 23, 2025

Record last verified: 2025-07

Data Sharing

• IPD Sharing: Will not share

Locations

PA (1)