Comparative Effects of Global Postural Re-education and NASM-based Corrective Exercises in Patients With Upper Cross Syndrome (UCS)

April 9, 2026 updated by: Rehana Hayat

The goal of this clinical trial is to learn the comparative effects of Global postural re-education (GPR) and National Academy of Sports Medicine (NASM) based corrective exercises in participants with upper cross syndrome (UCS). The main questions it aims to answer:

  • Is there any difference between the effects of GPR and NASM-based corrective exercises in decreasing pain and disability and improving endurance in participants with upper cross syndrome?
  • Is there any difference between the effects of GPR and NASM-based corrective exercises in improving cranio-vertebral angle of participants with upper cross syndrome? Researchers will compare GPR and NASM-based corrective exercises to see if there is difference between the two treatments in decreasing pain, disability and improving endurance and cranio-vertebral angle.

Participants will be:

  • Given treatment 3 times a week for 8 weeks.
  • Assessed before first treatment session (baseline), at 4th week of intervention and at the end of last treatment session (8th week).

Study Overview

Status

Recruiting

Conditions

Intervention / Treatment

Study Type

Interventional

Enrollment (Estimated)

46

Phase

  • Not Applicable

Contacts and Locations

This section provides the contact details for those conducting the study, and information on where this study is being conducted.

Study Locations

  • Pakistan
    • Punjab Province
      • Okāra, Punjab Province, Pakistan, 56300
        • Recruiting
        • District Headquarter Hospital (DHQ) Okara
        • Contact:
        • Contact:
        • Principal Investigator:
          • Rehana Hayat, DPT

Participation Criteria

Researchers look for people who fit a certain description, called eligibility criteria. Some examples of these criteria are a person's general health condition or prior treatments.

Eligibility Criteria

Ages Eligible for Study

  • Adult

Accepts Healthy Volunteers

No

Description

Inclusion Criteria:

  1. Age between 20-45 years
  2. Pain in the upper back and neck region.
  3. Both male and female patients
  4. Rounded shoulders
  5. Craniovertebral angle less than 47 degrees
  6. Willingness to participate

Exclusion Criteria:

  1. History of spinal surgery
  2. Neurological deficits (radiculopathy, myelopathy, disc herniation)
  3. Severe scoliosis or structural deformity
  4. Active cervical spine pathology (spondylosis, stenosis and fracture)

Study Plan

This section provides details of the study plan, including how the study is designed and what the study is measuring.

How is the study designed?

Design Details

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

Arms and Interventions

Participant Group / Arm
Intervention / Treatment
Active Comparator: GPR+ Conventional Treatment
Participants in this arm will receive Global Postural re-education treatment in addition to the routine/conventional evidence based physiotherapy treatment. Participants will be asked to repeat each exercise three times a week for 8 weeks.
Other: Global Postural Re-education

Global Postural Re-education

1st position: Patient will lie in supine, shoulders abducted to 30°, forearms supinated and the pelvis will be kept in a neutral position, while the lumbar spine remain supported. This position is characterized by a progression from flexion to extension of both hips and knees. 2nd position: Patient will remain in supine with their hips at 90° of flexion and perform gradual knee extensions. The participants will remain between 15 & 20 min in each of these two positions. Under the supervision and verbal and/or manual guidance of the physiotherapist performing the intervention, they will perform 5-10s isomet contractions of the antagonist muscles of the muscle chain targeted by each posture. Subjects can also make active adjustments to their position, the physiotherapist can favor with some manual contact, sustained stretching and some joint traction to complete the session, the participants will be requested to maintain an upright posture in standing for 5min

Other Names:
  • GPR
Active Comparator: NASM-based corrective exercises + Conventional Treatment
Participants in this arm will receive NASM-based corrective exercises in addition to the conventional treatment. Participants will be asked to repeat each exercise 10 to 15 times, for 1-2 sets, three times a week for 8 weeks.
Other: NASM-based Corrective exercises

NASM-based Corrective Exercises The four-stage exercise for UCS begins with preventing or reducing excessive muscle contraction (frequent foam wrapping), relaxing these same muscles, which fully eliminates dysfunctional muscles, and finally restores functional mobility.

Step 1: inhibit or self-myofascial release overactive muscles:

It includes the levator scapulae, trapezius (upper fibre), and sternocleidomastoid muscles. Hold pressure will be applied for 30 s on the tender spots.

Step 2: Lengthen/ Static stretch. Upper trapezius Levator scapulae Sternocleidomastoid (SCM) Step 3: Activate/Strengthen. Chin tucks Floor Cobra Step 4: Integrate. Ball combination A routine/conventional evidence based physiotherapy treatment will also be given to both arms.

Other Names:
  • National Academy of Sports Medicine Corrective exercises

What is the study measuring?

Primary Outcome Measures

Outcome Measure
Measure Description
Time Frame
Mean change in endurance from baseline on Progressive iso-inertial lifting evaluation (PILE) test at 4 weeks and 8 weeks
Time Frame: From enrollment (before first treatment session) to the end of treatment at 8 weeks.
Progressive iso-inertial lifting evaluation (PILE) test has been recommended as a functional test to measure muscle endurance and involves lifting weights from waist to shoulder height (30-54 in.). Participants will begin with an 8- pound load and a 13-pound load for females and males respectively. Weight will be subsequently increased at a rate equal to the initial free weight every 20 s. Four lifting movements will actually performed at 20-s intervals. The test end-point will be established when aerobic capacity or neuromuscular fatigue being felt.
From enrollment (before first treatment session) to the end of treatment at 8 weeks.
Mean change in pain score from baseline on Numeric Pain Rating Scale (NPRS) at 4 weeks and 8 weeks
Time Frame: From enrollment (before first treatment session) to the end of treatment at 8 weeks.
The NPRS is an 11-point scale (0, no pain; 10, worst imaginable pain) used to assess the intensity of pain. Participants will be asked to rate their pain from 0 to 10.
From enrollment (before first treatment session) to the end of treatment at 8 weeks.
Mean change in disability score from baseline on Neck Disability Index (NDI) at 4 weeks and 8 weeks
Time Frame: From enrollment (before first treatment session) to the end of treatment at 8 weeks.
The NDI is 10 questions and each question has a possible total score of zero to 5. The total score from all 10 questions is divided by 50, the maximum score possible, with total scores expressed in percentage. Higher percentage scores indicate a worst disability.
From enrollment (before first treatment session) to the end of treatment at 8 weeks.

Secondary Outcome Measures

Outcome Measure
Measure Description
Time Frame
Mean change in the Craniovertebral angle from baseline at 4 weeks and 8 weeks
Time Frame: From enrollment (before first treatment session) to the end of treatment at 8 weeks.
The angle formed between the oblique line connecting right tragus to C7 and the vertical line will be measured as craniovertebral angle. Lesser the angle, more is the forward head posture and upper cross syndrome.
From enrollment (before first treatment session) to the end of treatment at 8 weeks.

Collaborators and Investigators

This is where you will find people and organizations involved with this study.

Sponsor

Rehana Hayat

Publications and helpful links

The person responsible for entering information about the study voluntarily provides these publications. These may be about anything related to the study.

General Publications

Helpful Links

Study record dates

These dates track the progress of study record and summary results submissions to ClinicalTrials.gov. Study records and reported results are reviewed by the National Library of Medicine (NLM) to make sure they meet specific quality control standards before being posted on the public website.

Study Major Dates

Study Start (Actual)

March 5, 2026

Primary Completion (Estimated)

May 10, 2026

Study Completion (Estimated)

May 10, 2026

Study Registration Dates

First Submitted

March 24, 2026

First Submitted That Met QC Criteria

April 9, 2026

First Posted (Actual)

April 14, 2026

Study Record Updates

Last Update Posted (Actual)

April 14, 2026

Last Update Submitted That Met QC Criteria

April 9, 2026

Last Verified

April 1, 2026

More Information

Terms related to this study

Additional Relevant MeSH Terms

Other Study ID Numbers

  • IRB/FAHS/REHAB/10/25/MS/RS3458

Plan for Individual participant data (IPD)

Plan to Share Individual Participant Data (IPD)?

YES

IPD Sharing Time Frame

01-08-2026 to 30-08-2028

IPD Sharing Access Criteria

Data will be available to research journals, editors and reviewers on request through official email.

IPD Sharing Supporting Information Type

  • STUDY_PROTOCOL
  • SAP
  • ICF

Drug and device information, study documents

Studies a U.S. FDA-regulated drug product

No

Studies a U.S. FDA-regulated device product

No

This information was retrieved directly from the website clinicaltrials.gov without any changes. If you have any requests to change, remove or update your study details, please contact register@clinicaltrials.gov. As soon as a change is implemented on clinicaltrials.gov, this will be updated automatically on our website as well.

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