Comparative Effects of Reverse Natural Apophyseal Glides Versus Sustained Natural Apophyseal Glides in Patients With Upper Cross Syndrome

NCT07834177 | Recruiting

• 1 other identifier: FUI/FUCP/CTR/MSMSK/ArshiaIqbal
• Study Type: interventional
• Target: 44
• Locations: 1 country
• Sites: 1

Brief Summary

This study will compare the effectiveness of two manual therapy interventions combined with a standardized conventional physiotherapy protocol in individuals with Upper Cross Syndrome. Participants will be randomly allocated into two groups. Group A will receive Reverse Natural Apophyseal Glides, while Group B will receive Sustained Natural Apophyseal Glides. Both manual therapy interventions will primarily target the lower cervicaland upper thoracic spine specifically C6 to T2 and will be administered for 3 times a week for 4 weeks. The conventional physiotherapy protocol will be identical for both groups and will include a 10-minute hot pack followed by stretching of the pectoralis, upper trapezius and levator scapulae, each stretching exercise will be performed for 10 repetitions, 3 sets, with a 10 second hold per repetition. The strengthening program will target the deep cervical flexors and scapular stabilizers, including middle trapezius, lower trapezius, serratus anterior and rhomboids. Strengthening exercises will be performed for 10 repetitions, 3 sets, with a 10 second hold per repetition. The manual therapy component will differ between groups, allowing comparison of Reverse Natural Apophyseal Glides and Sustained Natural Apophyseal Glides when used alongside the same conventional intervention. This standardized approach aims to evaluate the comparative effects of the two manual therapy techniques on the postural and functional impairments associated with Upper Cross Syndrome.

Conditions

Posture

Outcome Measures

Primary Outcomes (5)

• Pain

  Numeric Pain Rating Scale scale will be used to measure pain. 0 shows no pain, 1-3 represents mild pain, 4-6 represents moderate pain, and 7-10 represents severe pain..

  Before and at 4 weeks of treatment

• Craniovertebral angle

  Craniovertebral angle will be assessed using Kinovea 0.8.15 software from lateral photographs by measuring the angle between the horizontal C7 line and a line connecting C7 to ear tragus. Angle less than 48 degrees will indicate forward head posture.

  Before and at 4th week of treatment

• Thoracic kyphosis angle

  Thoracic kyphosis will be measured using two gravity-dependent inclinometers placed at T1/T2 and T12/L1. Three measurements will be recorded and averaged. Angle greater than 40 degrees will indicate hyper kyphosis.

  Before and at 4th week of treatment

• Cervical range of motion

  Cervical range of motion will be assessed using the CROM device, comprising three inclinometers positioned in the sagittal, frontal, and horizontal planes to measure cervical movement relative to gravity and the reference position.

  Before and at 4th week of treatment

• Neck Disability Index

  Neck Disability Index is a self-reported questionnaire that assesses the level of disability and functional impairment caused by neck pain. Total score ranges from 0 to 50. 0-4 indicates no disability, 5-14 indicates mild disability, 15-24 indicates moderate disability, 25-34 indicates severe disability and 35-50 indicates complete disability.

  Before and at 4th week of treatment

Study Arms (2)

Group A Reverse Natural Apophyseal Glides

EXPERIMENTAL

Procedure: Reverse Natural Apophyseal Glides

Group B Sustained Natural Apophyseal Glides

ACTIVE COMPARATOR

Procedure: Sustained Natural Apophyseal Glides

Interventions

Reverse Natural Apophyseal Glides PROCEDURE

Participants will receive Reverse Natural Apophyseal Glides to the C6-T2 cervicothoracic region in sitting, using small-amplitude rhythmic oscillations at end-range facet movement. Day 1 will include 1 set of 3 oscillations, progressing to 3 sets of 10 oscillations for the remaining days. Hot pack will target the posterior cervical and upper thoracic region for 10 minutes in prone lying. Pectoralis, upper trapezius, and levator scapulae stretching will be performed with 10 seconds hold, 3 sets of 10 repetitions, with 5-second intervals. Strengthening will include chin tucks, supine foam roller exercises at three abduction angles on day 1-3, side-lying external rotation and forward flexion on days 4-6, prone V, T, W exercises on days 7-9, and standing diagonal flexion and military press on days 10-12.

Group A Reverse Natural Apophyseal Glides

Sustained Natural Apophyseal Glides PROCEDURE

Participants will receive Sustained Natural Apophyseal Glides to the C6-T2 cervicothoracic region in sitting. Therapist will stabilize the spinous process with the thumb while applying a sustained posterior-to-anterior glide toward the eyes during cervical extension with end-range overpressure. Day 1 will include 1 set of 3 repetitions, progressing to 3 sets of 10 repetitions for the remaining days. Hot pack will target the posterior cervical and upper thoracic region for 10 minutes. Pectoralis, upper trapezius, and levator scapulae stretching will involve 10-second holds, 3 sets of 10 repetitions. Strengthening will include chin-tucks, supine foam roller exercises at three abduction angles on day 1-3, side-lying external rotation and forward flexion on days 4-6, prone V, T, W exercises on days 7-9, and standing diagonal flexion and military press on days 10-12.

Group B Sustained Natural Apophyseal Glides

Eligibility Criteria

• Age: 20 Years - 40 Years
• Sex: all
• Healthy Volunteers: No
• Age Groups: Adult (18-64)

You may qualify if:

• Both genders.
• Age 20 to 40 years.
• Patients who had been experiencing chronic neck pain for three months or longer.
• Pain intensity of 3 or more and less than 8 on NPRS.
• Craniovertebral angle less than 48 degrees.
• Thoracic kyphosis angle greater than 40 degrees
• Participants able to understand instructions and provide informed consent.

You may not qualify if:

• Cervical radiculopathy
• Vertebrobasilar insufficiency
• Patients with a history of spinal surgery
• Any history of trauma or whiplash injury (from the past 6 months to 1 year)
• Diagnosed cases of osteoporosis
• Pregnancy
• Patients with diagnosed systemic diseases.
• Patients with a known medical diagnosis of spinal cord compression.

Sponsors & Collaborators

• Foundation University Islamabad: lead

Study Sites (1)

Foundation University College of Physical Therapy

Islamabad, Punjab Province, 44000, Pakistan

RECRUITING

Central Study Contacts

Arshia Iqbal, DPT

CONTACT

+92 332 1514083; arsheeya.iqbal@gmail.com

Marwa Asim, MS-OMPT

CONTACT

+92 333 5339457; marwa@fui.edu.pk

Study Design

• Study Type: interventional
• Phase: not applicable
• Allocation: RANDOMIZED
• Masking: NONE
• Purpose: TREATMENT
• Intervention Model: PARALLEL
• Sponsor Type: OTHER
• Responsible Party: SPONSOR

Study Record Dates

• First Submitted: September 16, 2026
• First Posted: September 22, 2026
• Study Start: February 11, 2026
• Primary Completion (Estimated): December 18, 2026
• Study Completion (Estimated): January 18, 2027
• Last Updated: September 22, 2026

Record last verified: 2026-09

Locations

PA (1)