Comparative Effects of Janda and IASTM on UCS (IASTM UCS)

Effects of Janda's Approach Versus Instrument Assisted Soft Tissue Mobilization on Pain, Fatigue and Posture Among Individuals With Upper Cross Syndrome

Upper Crossed Syndrome (UCS) is a widespread muscle imbalance defined by tightness in the upper trapezius, pectoralis major and minor, and sternocleidomastoid, coupled with weakness in deep neck flexors, lower trapezius, and serratus anterior. It is usually triggered by sustained faulty posture, predominantly in computer users, drivers, or other prolonged forward head and trunk flexion positions, resulting in pain, fatigue, limited ROM and functional limitations.

On a global scale, estimates suggest that UCS affects between 11% and 60% of individuals, spanning various age groups and cultural backgrounds. Individuals who engage in prolonged slouching, such as desk workers, teachers, drivers, IT professionals, students, and laundry workers, demonstrate prevalence rates of approximately 32.4%, 16.2%, 26.4%, 67%, 37.1%, and 28% respectively.

Janda's approach, aims to restore or normalize muscle balance and refine posture by combining stretching of tight and overactive muscles with strengthening of weak and inhibited muscles, in sequence. Instrument-Assisted Soft Tissue Mobilization (IASTM) enhances ROM and alleviates pain by directing myofascial restrictions. As adjuncts, hot packs and transcutaneous electrical nerve stimulation (TENS) are frequently used to reduce discomfort and prepare tissues for further therapeutic interventions.

Although numerous intervention techniques are offered for UCS but limited research has compared Janda's approach and IASTM, especially with respect to their impact on fatigue. Therefore, this study aims to evaluate and compare the effects of these interventions on pain, fatigue, and posture in adults with UCS.

Study Overview

• Status: Completed
• Conditions: Upper Cross Syndrome
• Intervention / Treatment: Other: Janda's Approach; Other: Instrument Assisted Soft Tissue Mobilization (IASTM)

• Study Type: Interventional
• Enrollment (Actual): 60
• Phase: Not Applicable

Contacts and Locations

Study Locations

• Pakistan
  • Punjab Province
    • Lahore, Punjab Province, Pakistan, 54000
      • University of Biological and Applied Sciences, Lahore

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: Adult
• Accepts Healthy Volunteers: No

Description

Inclusion Criteria:

• Participants aged between 19-44 years (Adults), both genders
• Pectoralis major and Upper trapezius tightness, Serratus anterior and Lower trapezius weakness
• Forward Head Posture (developed within 6 weeks or more than 3 months)
• Reported neck, upper back, or shoulder pain or discomfort
• Pain 5 or above on NPRS for at least 3 months
• Fatigue score of 4 or above on Fatigue Severity Scale

Exclusion Criteria:

• Congenital anomalies
• Thoracic Outlet Syndrome
• Inflammatory disorders
• Headache due to any cause (migraine, disc bulge)
• Postural defects (Torticollis, Scoliosis)
• Malignancy
• Fracture of cervical spine and clavicle

Study Plan

How is the study designed?

Design Details

• Primary Purpose: Treatment
• Allocation: Randomized
• Interventional Model: Parallel Assignment
• Masking: Double

Number of Arms

2

Arms and Interventions

Participant Group / Arm	Intervention / Treatment
Experimental: Janda Group; Participants in this arm received Janda's Approach that specifically targets functional muscular imbalance through stretching, strengthening and sensorimotor training.	Other: Janda's Approach; All programs will be performed 3 times per week for 4 weeks. Each session will be of 45 minutes. 15 minutes warm up, 10 minutes cool down with 20 minutes stretching and isometrics along with sensorimotor training. Static stretching will be performed holding the stretch for at least 15 sec. and isometric exercise will be conducted three times in a maximum contraction mode for 3 sec under the supervision of a certified expert. Sensorimotor training includes following tasks chin tuck ins, scapular setting, wall alignment drills, diagonal arm patterns.
Active Comparator: IASTM Group; Participants in this arm received Instrument Assisted Soft Tissue Mobilization through graston tool.	Other: Instrument Assisted Soft Tissue Mobilization (IASTM); It will be performed 3 times per week for 4 weeks. Each treatment session will be of 45 minutes. 15 minutes Warm up and 10 minutes cool down period and 20 mins application of IASTM assisted by gel or oil to make it friction free. Icing will be applied at end of each session to reduce post treatment inflammation.

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Pain Intensity	Pain intensity measured using the Numeric Pain Rating Scale (NPRS), an 11-point scale rating from 0 (no pain) to 10 (worst pain).	Baseline, Post-intervention 2 weeks, Post-intervention 4 weeks
Fatigue	Fatigue assessed using the Fatigue Severity Scale (FSS), a 9-item self-report questionnaire in which each item is scored on a 7-point Likert scale, with higher scores indicating greater fatigue severity.	Baseline, Post-intervention 2 weeks, Post-intervention 4 weeks
Posture	REEDCO Posture Assessment Scale was employed to evaluate postural alignment in individuals with Upper Crossed Syndrome, focusing specifically on the head, shoulder, and upper back regions. These items were selected as they directly correspond to the primary postural deviations associated with the syndrome, namely forward head posture, rounded shoulders, and increased thoracic kyphosis. Scoring was based on established REEDCO criteria, a score of 10 (normal alignment or good posture), a score of 5 (minimal to moderate deviation or fair posture), and a score of 0 (marked or severe deviation or poor posture)	Baseline, Post-intervention 2 weeks, Post-intervention 4 weeks

Collaborators and Investigators

• Sponsor: Lahore University of Biological and Applied Sciences

Study record dates

Study Major Dates

• Study Start (Actual): July 1, 2025
• Primary Completion (Actual): December 30, 2025
• Study Completion (Actual): December 30, 2025

Study Registration Dates

• First Submitted: January 20, 2026
• First Submitted That Met QC Criteria: January 20, 2026
• First Posted (Actual): January 28, 2026

Study Record Updates

• Last Update Posted (Actual): January 28, 2026
• Last Update Submitted That Met QC Criteria: January 20, 2026
• Last Verified: January 1, 2026

More Information

Terms related to this study

• Keywords: Pain; Fatigue; Posture; Janda's Approach; Instrument Assisted Soft Tissue Mobilization (IASTM); Upper Cross Syndrome (UCS)
• Additional Relevant MeSH Terms: Neurologic Manifestations; Pathological Conditions, Signs and Symptoms; Signs and Symptoms; Pain; Fatigue; Oculocerebral hypopigmentation syndrome type Preus
• Other Study ID Numbers: DPT/ERB/36; U1111-1334-3140 (Registry Identifier: WHO Universal Trial Number)

Drug and device information, study documents

• Studies a U.S. FDA-regulated drug product: No
• Studies a U.S. FDA-regulated device product: No