Comparative Effect of Maitland Mobilization Combined With Kendall Exercises for Pain and Postural Alignment in Adults With Upper Cross Syndrome

NCT07588061 | Recruiting

• 1 other identifier: IIUI/RERC/ADT/2026/04/282
• Study Type: interventional
• Target: 58
• Locations: 1 country
• Sites: 1

Brief Summary

This randomized controlled trial aims to compare the effects of Maitland mobilization combined with Kendall exercises versus Kendall exercises alone on pain and postural alignment in adults with Upper Cross Syndrome (UCS). Upper Cross Syndrome is characterized by muscle imbalance leading to forward head posture, rounded shoulders, and increased thoracic kyphosis. The study will evaluate pain intensity, craniovertebral angle, thoracic kyphosis, and rounded shoulder posture

Conditions

Upper Cross Syndrome

Outcome Measures

Primary Outcomes (4)

• Thoracic Kyphosis Assessed With Flexicurve Ruler

  Thoracic kyphosis will be measured using a flexicurve ruler. The spinous processes of C7 and T12 will be palpated and marked. The flexicurve ruler will mold along the thoracic curvature between these landmarks, and the curve will be transferred onto paper. . Based on previously published literature, thoracic kyphosis is considered 'normal' between 20 and 40°. Where this exceeds 40°, the curvature is described as hyperkyphosis.

  baseline to last week (8 week)

• Forward Head Posture Assessed with Protractor mobile application

  Forward head posture will be assessed by measuring the craniovertebral angle (CVA) using the protractor mobile application. Measuring CVA from a lateral view by drawing a line from the ear tragus to the spinous process of the seventh cervical vertebra and a horizontal reference line through C7. The angle formed between these two lines will represent the craniovertebral angle.A reduced craniovertebral angle indicates increased forward head posture, with values less than 50° commonly used to identify this condition

  baseline to last week (8 week)

• Rounded Shoulder Assessed with Vernier Caliper

  Rounded shoulder posture was assessed using a vernier caliper. Participants were positioned supine on a firm couch with arms relaxed by their sides. The vertical distance between the posterolateral edge of the acromion process and the couch surface was measured using a vernier caliper. Measurements will be taken bilaterally; an acromion-to-couch distance greater than 2.5cm will be considered indicative of rounded shoulder posture.

  baseline to last week (8 week)

• Visual Analogue Scale

  The intensity of the pain will be measured with the help of the Visual Analogue Scale (VAS). The VAS is a 10-cm horizontal line with two opposite endpoints marked with the following words: "no pain" at one end and "worst imaginable pain" at the other. The patient will then mark a point on the line that they feel most accurately reflects their current pain. The distance in centimeters or millimeters between the "no pain" point and the patient's mark will be taken as the measure of the patient's pain.

  baseline to last week

Study Arms (2)

Maitland Mobilization Combined With Kendall Exercises

EXPERIMENTAL

Participants in this group will receive Maitland mobilization techniques applied to the cervical and thoracic spine, combined with Kendall exercises targeting postural correction. Mobilization will be performed by a trained physiotherapist using graded oscillatory techniques. The exercise program will focus on strengthening weak postural muscles and stretching tight musculature associated with upper cross syndrome.

Other: Kendall Exercises combined Maitland Mobilization

Kendall Exercises Alone

ACTIVE COMPARATOR

Participants in this group will receive a Kendall exercise program focusing on postural correction. The program includes strengthening of weak muscles and stretching of tight muscles associated with upper cross syndrome.

Other: Kendall Exercise alone

Interventions

Kendall Exercises combined Maitland Mobilization OTHER

Group A (Experimental) received Kendall exercises combined with Maitland mobilization, including strengthening of deep cervical flexors, lower trapezius, and serratus anterior, along with stretching of upper trapezius, levator scapulae, and pectoralis major/minor. Maitland mobilization was applied to the cervical and upper thoracic spine using central and unilateral PA oscillations for 50-60 seconds per segment at 2-3 oscillations per second, in addition to warm-up (cervical AROM and shoulder mobility exercises) and cool-down (stretching and diaphragmatic breathing).

Maitland Mobilization Combined With Kendall Exercises

Kendall Exercise alone OTHER

Participants in this group will receive a structured Kendall exercise program only, without any manual therapy or mobilization techniques. The intervention will focus on postural correction through strengthening of weakened muscles (deep cervical flexors, scapular retractors) and stretching of tight muscles (pectoralis major/minor, upper trapezius, levator scapulae) associated with upper cross syndrome.

Kendall Exercises Alone

Eligibility Criteria

• Age: 18 Years - 45 Years
• Sex: all
• Healthy Volunteers: No
• Age Groups: Adult (18-64)

You may qualify if:

• Age 18 to 45 years
• Neck and/or upper thoracic pain for a duration of \> 6 weeks
• Pain Severity: VAS \> 5 (Afzal, Noor, Mumtaz, Bashir, \& Saqulain, 2023)
• Pain exacerbated by prolonged postures
• Adults diagnosed with Upper Cross Syndrome
• Diagnostic criteria: Upper Cross Syndrome will be diagnosed when individuals demonstrate: thoracic kyphosis \> 40°, craniovertebral angle \< 50°, and acromion-to-couch distance \> 2.5 cm based on established normative values.

You may not qualify if:

• History of neck or shoulder surgery or trauma
• Inflammatory conditions such as rheumatoid arthritis or gout
• Pregnancy
• Neurological conditions affecting upper limb function, and
• Cardiovascular Problems
• Congenital issues i.e.; torticollis, and scoliosis
• Disc prolapse and other spine issues
• Currently taking any medication or taking physical therapy

Sponsors & Collaborators

• Ibadat International University, Islamabad: lead

Study Sites (1)

Ibadat International University, Islamabad (Iiui)

Peshawar, KPK, 25000, Pakistan

RECRUITING

Related Publications (38)

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  BACKGROUND

MeSH Terms

Conditions

Oculocerebral hypopigmentation syndrome type Preus

Central Study Contacts

Naeem Ullah, DPT, MS-PT MSK

CONTACT

+923308088558; naeemphysio58@gmail.com

Fatima Amjad, DPT, MS-PT Sports, PHD Scholer

CONTACT

+923330940975; Fatima.amjad@uipt.iiui.edu.pk

Study Design

• Study Type: interventional
• Phase: not applicable
• Allocation: RANDOMIZED
• Masking: SINGLE
• Who Masked: OUTCOMES ASSESSOR
• Masking Details: Two-arm parallel group randomized controlled trial
• Purpose: TREATMENT
• Intervention Model: PARALLEL
• Sponsor Type: OTHER
• Responsible Party: SPONSOR

Study Record Dates

• First Submitted: May 2, 2026
• First Posted: May 14, 2026
• Study Start: April 6, 2026
• Primary Completion: June 6, 2026
• Study Completion: June 8, 2026
• Last Updated: May 20, 2026

Record last verified: 2026-05

Data Sharing

• IPD Sharing: Will not share

Locations

PA (1)