Effect of a Comprehensive Corrective Exercise Program With and Without Instrument-Assisted Soft Tissue Mobilization on Cervical Range of Motion, Muscle Strength, Disability, and Postural Alignment in Individuals With Upper-Crossed Syndrome

NCT07702604 | Not Yet Recruiting DMC

• 1 other identifier: UBAS/ERB/26/04/018
• Study Type: interventional
• Target: 48
• Locations: 1 country
• Sites: 1

Brief Summary

This study is a double-blind, parallel-group randomized controlled trial designed to evaluate the effectiveness of a Comprehensive Corrective Exercise Program (CCEP) with and without Instrument-Assisted Soft Tissue Mobilization (IASTM) in individuals with Upper-Crossed Syndrome (UCS). UCS is a common postural dysfunction characterized by muscular imbalance, including tightness of the upper trapezius, levator scapulae, and pectoral muscles, along with weakness of the deep cervical flexors and scapular stabilizers. This imbalance leads to forward head posture, rounded shoulders, neck pain, reduced cervical mobility, and functional limitations, particularly in individuals exposed to prolonged sedentary activities and poor ergonomic conditions. A total of 60 participants aged 18-40 years diagnosed with Upper-Crossed Syndrome will be recruited and randomly allocated into two groups. The control group will receive a structured Comprehensive Corrective Exercise Program (CCEP), while the experimental group will receive the same exercise program combined with Instrument-Assisted Soft Tissue Mobilization (IASTM). Both interventions will be administered three times per week for six weeks under the supervision of a trained physiotherapist. Outcome measures will be assessed at baseline and after completion of the intervention period. Primary outcomes include cervical range of motion, muscle strength assessed by the Deep Neck Flexor endurance test, functional disability measured using the Neck Disability Index, and postural alignment assessed using a plumb line method. The aim of this study is to determine whether the addition of IASTM to a corrective exercise program results in superior improvements in cervical mobility, muscle strength, functional disability, and postural alignment compared to corrective exercise alone. It is hypothesized that the combined intervention will produce greater clinical improvements in individuals with Upper-Crossed Syndrome.

Conditions

Upper Crossed Syndrome; Postural Dysfunction

Keywords

Upper Crossed Syndrome; Neck Pain; Postural Dysfunction; Corrective Exercises; Instrument-Assisted Soft Tissue Mobilization

Outcome Measures

Primary Outcomes (4)

• Cervical Range of Motion (CROM)

  Cervical range of motion will be measured using a goniometer. Measurements will include flexion, extension, lateral flexion, and rotation.

  Baseline and 6 weeks

• Muscle Strength (Deep Neck Flexor Endurance Test)

  The Deep Neck Flexor Endurance Test (also known as the craniocervical flexion endurance test) measures the duration a participant can hold a chin-tuck position with correct form. Scores range from 0 to 60 seconds, with the test terminated at 60 seconds if the position is maintained that long. Higher scores indicate better deep neck flexor muscle endurance.

  Baseline and 6 weeks

• Neck Disability (Neck Disability Index)

  The Neck Disability Index is a 10-item patient-reported outcome measure assessing functional disability related to neck pain, covering activities such as personal care, lifting, reading, and concentration. Each item is scored 0-5, for a total score range of 0 to 50. Higher scores indicate greater disability.

  Baseline and 6 weeks

• Postural Alignment

  Postural alignment will be assessed using a plumb line method to evaluate forward head posture and rounded shoulder posture.

  Baseline and 6 weeks

Study Arms (2)

CCEP with Instrument-Assisted Soft Tissue Mobilization (IASTM)

EXPERIMENTAL

Participants in this arm will receive the same Comprehensive Corrective Exercise Program (CCEP) as the control group, combined with Instrument-Assisted Soft Tissue Mobilization (IASTM). IASTM will be applied to overactive muscles including upper trapezius, levator scapulae, sternocleidomastoid, and pectoral muscles using standardized techniques (scanning, sweeping, and fanning). Each session will last approximately 20 minutes and will be performed three times per week for six weeks under physiotherapist supervision.

Other: Instrument-Assisted Soft Tissue Mobilization (IASTM) + Comprehensive Corrective Exercise Program (CCEP)

Comprehensive Corrective Exercise Program (CCEP)

ACTIVE COMPARATOR

Participants in this arm will receive a Comprehensive Corrective Exercise Program (CCEP) only. The program includes stretching of overactive muscles (pectoralis major/minor, upper trapezius, levator scapulae, sternocleidomastoid), strengthening of weak muscles (deep cervical flexors, lower trapezius, rhomboids, serratus anterior), and postural re-education and motor control exercises. Sessions will be supervised by a physiotherapist, conducted three times per week for six weeks.

Other: Comprehensive Corrective Exercise Program (CCEP)

Interventions

Instrument-Assisted Soft Tissue Mobilization (IASTM) + Comprehensive Corrective Exercise Program (CCEP) OTHER

This intervention combines the Comprehensive Corrective Exercise Program (CCEP) with Instrument-Assisted Soft Tissue Mobilization (IASTM). The exercise component is identical to the control group and includes stretching, strengthening, and postural re-education exercises targeting cervical and scapular musculature. IASTM is applied to overactive muscles including upper trapezius, levator scapulae, sternocleidomastoid, and pectoral muscles using specialized instruments with techniques such as scanning, sweeping, J-stroke, and fanning. Each session lasts approximately 20 minutes, administered three times per week for six weeks under physiotherapist supervision.

CCEP with Instrument-Assisted Soft Tissue Mobilization (IASTM)

Comprehensive Corrective Exercise Program (CCEP) OTHER

The Comprehensive Corrective Exercise Program (CCEP) is a structured physiotherapy intervention designed to correct muscular imbalance associated with Upper-Crossed Syndrome. It includes stretching of overactive muscles (pectoralis major and minor, upper trapezius, levator scapulae, sternocleidomastoid), strengthening of weak muscles (deep cervical flexors, lower trapezius, rhomboids, serratus anterior), and motor control and postural re-education exercises. Exercises are performed under physiotherapist supervision three times per week for six weeks.

Comprehensive Corrective Exercise Program (CCEP)

Eligibility Criteria

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

You may qualify if:

• Age between 18-40 years
• Both males and females
• Diagnosed with Upper-Crossed Syndrome
• Presence of forward head posture and rounded shoulders
• Chronic neck pain related to postural dysfunction

You may not qualify if:

• History of cervical spine surgery or fracture
• Neurological conditions (e.g., radiculopathy, myelopathy)
• Systemic musculoskeletal disorders (e.g., rheumatoid arthritis)
• Current physiotherapy treatment for neck pain
• Skin conditions preventing IASTM application

Sponsors & Collaborators

• Lahore University of Biological and Applied Sciences: lead

Study Sites (1)

Ghurki Trust Teaching Hospital

Lahore, Punjab Province, 53400, Pakistan

Location

MeSH Terms

Conditions

Oculocerebral hypopigmentation syndrome type Preus; Neck Pain

Condition Hierarchy (Ancestors)

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

Study Officials

• Shoaib Waqas, PhD

  Lahore University of Biological and Applied Sciences

  STUDY CHAIR

Central Study Contacts

Maryam Nadeem, DPT, MSPT

CONTACT

+92 334 4010121; maryamnadeem1321@gmail.com

Aroona Sattar, DPT, MSPT

CONTACT

+92 305 4630138; aroona.sattar@ubas.edu.pk

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 9, 2026
• First Posted: July 14, 2026
• Study Start: July 16, 2026
• Primary Completion (Estimated): October 30, 2026
• Study Completion (Estimated): November 30, 2026
• Last Updated: July 22, 2026

Record last verified: 2026-07

Data Sharing

• IPD Sharing: Will not share

Locations

PA (1)