Effectiveness of Rib Mobilization Combined With Postural Correction Exercises in Individuals With Upper Crossed Syndrome

This randomized controlled trial aims to evaluate the effectiveness of rib mobilization combined with postural correction exercises in reducing pain, improving cervical posture, and enhancing rib and thoracic mobility among individuals with Upper Crossed Syndrome (UCS). A total of 64 participants aged 20-45 years will be recruited and randomly assigned to two groups: Group A (rib mobilization + postural correction) and Group B (postural correction only). Intervention will be provided for 4-6 weeks, three sessions per week. Outcomes will include pain (VAS), cervical posture (inclinometer), and rib/thoracic mobility (tape measure). Data will be analyzed using SPSS version 26.

Study Overview

• Status: Recruiting
• Conditions: Upper Cross Syndrome
• Intervention / Treatment: Behavioral: Rib Mobilization and Postural Correction Exercises; Other: Postural Correction Exercises Only

Detailed Description

Upper Crossed Syndrome (UCS) is a common musculoskeletal disorder that arises from sustained poor posture, leading to muscular imbalance and functional impairment in the upper body. The syndrome is characterized by forward head posture, increased cervical lordosis, and thoracic kyphosis caused by tightness in the upper trapezius, levator scapulae, and pectoralis muscles, and weakness in the deep cervical flexors, lower trapezius, and serratus anterior. This imbalance not only affects spinal alignment but also restricts rib mobility and thoracic extension, contributing to chronic neck and upper back pain.

Rib mobilization techniques focus on restoring the normal motion of the ribs and thoracic spine, improving chest expansion and flexibility. When combined with postural correction exercises, these interventions may correct alignment, reduce pain, and enhance thoracic mobility. Postural correction exercises aim to stretch overactive muscles and strengthen weakened ones to restore functional balance. Together, these methods are hypothesized to provide superior outcomes compared to postural exercises alone.

Previous studies have demonstrated the efficacy of either rib mobilization or postural correction in isolation. However, limited evidence exists regarding their combined use for UCS. This study seeks to fill this gap by examining the synergistic effects of both interventions on pain relief, postural correction, and thoracic mobility. Findings may contribute to developing an evidence-based rehabilitation protocol for UCS.

• Study Type: Interventional
• Enrollment (Estimated): 64
• Phase: Not Applicable

Contacts and Locations

• Study Contact: Name: Altamash Hussain Khan, DPT; Phone Number: +92 3088805119; Email: altamash.hussain1@icloud.com

Study Locations

• Pakistan
  • Khyber Pakhtunkhwat
    • Chak Six Hundred Twenty-four, Khyber Pakhtunkhwat, Pakistan, 22620
      • Recruiting
      • District Headquater Haripur
      • Contact: Attiq ur Rehman, MS; Phone Number: +923361055533; Email: attiq.rehman@riphah.edu.pk
      • Contact: Altamash Hussain, DPT; Phone Number: +923088805119
      • Principal Investigator: Altamash Hussain, DPT

Participation Criteria

Eligibility Criteria

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

Description

Inclusion Criteria:

• Age between 20 to 45 years
• Forward head posture (craniovertebral angle < 50°)
• Cervical pain or discomfort for ≥4 weeks
• Moderate pain intensity (VAS 3-6)
• Willingness to participate and provide informed consent
• Clinically diagnosed Upper Crossed Syndrome (UCS)
• Meets Asian Fitness Society diagnostic criteria for UCS

Exclusion Criteria:

• History of trauma or surgery to cervical/thoracic spine
• Cervical disc herniation, radiculopathy, or neurological deficits
• Structural deformities (scoliosis, Scheuermann's disease)
• Systemic musculoskeletal disorders (e.g., rheumatoid arthritis)
• Vestibular, balance, or visual disorders
• Recent similar therapy within 3 months
• Pregnancy or contraindication to manual therapy
• Ongoing use of pain medications or muscle relaxants

Study Plan

How is the study designed?

Design Details

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

Number of Arms

2

Arms and Interventions

Participant Group / Arm	Intervention / Treatment
Experimental: Intervention group; Group receiving Rib Mobilization + Postural Correction Exercises	Behavioral: Rib Mobilization and Postural Correction Exercises; Participants will receive Grade I-III rib mobilizations at the costovertebral and costotransverse joints (ribs 2-6) along with thoracic central posterior-anterior mobilizations. In addition, postural correction exercises including scapular retraction, deep neck flexor training, pectoralis stretching, and thoracic extension exercises will be performed. Each session will last 30-40 minutes, three times per week for 4-6 weeks.
Active Comparator: Control group; Group receiving Postural Correction Exercises Only	Other: Postural Correction Exercises Only; Participants will perform only postural correction exercises, including scapular retraction, deep neck flexor training, pectoralis stretching, and thoracic extension exercises. Sessions will last 30-40 minutes, three times per week for 4-6 weeks.

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Pain Intensity	1. Pain Intensity - Measured using the Visual Analog Scale (VAS) ranging from 0 (no pain) to 10 (worst pain).	1 year
Cervical Posture	Cervical Posture - Measured using an inclinometer to determine the craniovertebral angle.	1 year
Rib/Thoracic Mobility	Rib/Thoracic Mobility - Measured using a tape measure and inclinometer to assess rib cage expansion and thoracic extension.	1 year

Collaborators and Investigators

• Sponsor: Riphah International University
• Investigators: Principal Investigator: Attiq Ur Rehman, MS, Riphah International University

Publications and helpful links

General Publications

• Chang MC, Choo YJ, Hong K, Boudier-Reveret M, Yang S. Treatment of Upper Crossed Syndrome: A Narrative Systematic Review. Healthcare (Basel). 2023 Aug 17;11(16):2328. doi: 10.3390/healthcare11162328.
• Arshadi R, Ghasemi GA, Samadi H. Effects of an 8-week selective corrective exercises program on electromyography activity of scapular and neck muscles in persons with upper crossed syndrome: Randomized controlled trial. Phys Ther Sport. 2019 May;37:113-119. doi: 10.1016/j.ptsp.2019.03.008. Epub 2019 Mar 21.
• Sepehri S, Sheikhhoseini R, Piri H, Sayyadi P. The effect of various therapeutic exercises on forward head posture, rounded shoulder, and hyperkyphosis among people with upper crossed syndrome: a systematic review and meta-analysis. BMC Musculoskelet Disord. 2024 Feb 1;25(1):105. doi: 10.1186/s12891-024-07224-4.
• Bayattork M, Skold MB, Sundstrup E, Andersen LL. Exercise interventions to improve postural malalignments in head, neck, and trunk among adolescents, adults, and older people: systematic review of randomized controlled trials. J Exerc Rehabil. 2020 Feb 26;16(1):36-48. doi: 10.12965/jer.2040034.017. eCollection 2020 Feb.

Study record dates

Study Major Dates

• Study Start (Actual): October 16, 2025
• Primary Completion (Estimated): June 28, 2026
• Study Completion (Estimated): June 28, 2026

Study Registration Dates

• First Submitted: April 30, 2026
• First Submitted That Met QC Criteria: April 30, 2026
• First Posted (Actual): May 7, 2026

Study Record Updates

• Last Update Posted (Actual): May 7, 2026
• Last Update Submitted That Met QC Criteria: April 30, 2026
• Last Verified: April 1, 2026

More Information

Terms related to this study

• Additional Relevant MeSH Terms: Oculocerebral hypopigmentation syndrome type Preus
• Other Study ID Numbers: REC/02285 Altamash

Plan for Individual participant data (IPD)

• Plan to Share Individual Participant Data (IPD)?: NO

Drug and device information, study documents

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