Comparison of Proprioceptive Neuromuscular Facilitation and Patient Education in Upper Crossed Syndrome

NCT07773857 | Completed

• 1 other identifier: PNF_Patient_Edu
• Study Type: interventional
• Target: 38
• Locations: 1 country
• Sites: 1

Brief Summary

The aim of this study is to investigate the effects of exercises applied using the Proprioceptive Neuromuscular Facilitation (PNF) technique on pain, joint range of motion, muscle strength, and posture in individuals with Upper Crossed Syndrome, and to compare these effects with patient education. Individuals diagnosed with Upper Crossed Syndrome will be included in the study and allocated into two groups: a PNF-based exercise combined with patient education group and a patient education-only group. In the PNF group, Stabilizing Reversals for scapular anterior elevation-posterior depression and Replication techniques for posterior depression will be applied. In the patient education group, education including postural awareness and exercise will be provided. Assessments will be conducted at two time points, before and after the intervention. Pain level, joint range of motion, muscle strength and endurance, and postural parameters will be analyzed. This study is expected to provide evidence regarding the clinical effectiveness of PNF approaches targeting scapular control in individuals with Upper Crossed Syndrome and to contribute to the management of postural disorders in the field of physiotherapy and rehabilitation.

Conditions

Upper Crossed Syndrome; Forward Head Posture; Rounded Shoulder Posture; Hyperkyphosis; Kyphosis

Keywords

Upper Cross Syndrome; Proprioseptive Neuromuscular Facilitatiton; PNF; Patient Education; Posture

Outcome Measures

Primary Outcomes (1)

• Posture Assesment

  Posture will be assessed using the Posture Screen Mobile (PSM) application (Backbone Software, Inc., USA), a valid and reliable mobile application designed for postural analysis. Participants will be positioned in a static standing posture on a flat surface, with their feet parallel, wearing appropriate clothing that allows visualization of the upper body and lower extremities. Photographs will be taken from the anterior, posterior, and lateral views using a mobile device placed at a standardized distance. During the assessment, the application will automatically identify anatomical reference points (e.g., ears, shoulders, pelvis). Based on these reference points, postural deviations will be calculated and reported by the software. Anterior and posterior postural deviations in the frontal plane and lateral postural deviations in the sagittal plane will be recorded for each participant.

  Baseline and up to 8 weeks

Secondary Outcomes (6)

• Muscle Strength Assessment

  Baseline and up to 8 weeks

• Pain Assessment

  Baseline and up to 8 weeks

• Muscle Endurance

  Baseline and up to 8 weeks

• Muscle Length Tests

  Baseline and up to 8 weeks

• Range of Motion Assessment

  Baseline and up to 8 weeks

Study Arms (2)

Patient Education Group

ACTIVE COMPARATOR

Participants in the patient education group will receive a single face-to-face patient education session at the beginning of the study.

Behavioral: Patient Education

PNF Group

EXPERIMENTAL

In the PNF group, in addition to patient education, Stabilizing Reversals and Replication techniques with scapular patterns will be performed.

Behavioral: Patient Education; Behavioral: PNF

Interventions

Patient Education BEHAVIORAL

Participants in the patient education group will receive a single face-to-face patient education session at the beginning of the study. This education will include information on postural awareness, correct sitting posture, and maintaining proper posture during activities of daily living. In addition, participants will be provided with a prepared educational brochure and will be asked to perform the two postural exercises included in the brochure three days per week for a total duration of four weeks. Participants will be encouraged to integrate the postural principles taught during the education into their daily lives.

PNF Group; Patient Education Group

PNF BEHAVIORAL

In the PNF, trunk correction in the sitting position, approximation, and the application of Stabilizing Reversals in the direction of scapular posterior depression-anterior elevation and Replication techniques toward scapular posterior depression in the side-lying position will be performed. These interventions are planned to be applied three days per week, with a total intervention duration of four weeks.

PNF Group

Eligibility Criteria

• Age: 18 Years+
• Sex: all
• Healthy Volunteers: No
• Age Groups: Adult (18-64), Older Adult (65+)

You may qualify if:

• Age 18 years or older
• Clinically diagnosed with Upper Crossed Syndrome and referred by a specialist physician (e.g., Physical Medicine and Rehabilitation, Orthopedics)
• Upper Crossed Syndrome diagnosis confirmed at baseline based on postural characteristics (e.g., forward head posture, rounded shoulders, thoracic kyphosis etc.)
• Willingness to participate in the study and provision of written informed consent

You may not qualify if:

• History of spinal surgery or spinal fracture
• Presence of structural spinal deformities (e.g., structural kyphosis or scoliosis)
• Presence of neuromuscular diseases affecting the spine or upper quadrant
• Presence of congenital or acquired severe structural spinal anomalies
• Any medical condition that contraindicates participation in exercise programs
• History of severe psychiatric disorders
• History of chronic pain in the cervical or lumbopelvic regions
• History of postural control disorders
• Any condition expected to prevent regular participation or adherence during the study period.

Sponsors & Collaborators

• Atlas University: lead

Study Sites (1)

Istanbul Atlas University, Faculty of Health Sciences, Department of Physiotherapy and Rehabilitation

Istanbul, Istanbul, 34408, Turkey (Türkiye)

Location

MeSH Terms

Conditions

Oculocerebral hypopigmentation syndrome type Preus; Kyphosis

Interventions

Patient Education as Topic

Condition Hierarchy (Ancestors)

Spinal Curvatures; Spinal Diseases; Bone Diseases; Musculoskeletal Diseases

Intervention Hierarchy (Ancestors)

Health Education; Preventive Health Services; Health Services; Health Care Facilities Workforce and Services

Study Design

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

Study Record Dates

• First Submitted: August 14, 2026
• First Posted: August 19, 2026
• Study Start: March 5, 2026
• Primary Completion: June 15, 2026
• Study Completion: July 15, 2026
• Last Updated: August 31, 2026

Record last verified: 2026-01

Locations

TU (1)