Comparative Effect of Maitland Mobilization Combined With Kendall Exercises for Pain and Postural Alignment in Adults With Upper Cross Syndrome

May 17, 2026 updated by: Ibadat International University, Islamabad

Comparative Effect of Maitland Mobilization Combined With Kendall Exercises on Pain and Postural Alignment in Adults With Upper Cross Syndrome

This randomized controlled trial aims to compare the effects of Maitland mobilization combined with Kendall exercises versus Kendall exercises alone on pain and postural alignment in adults with Upper Cross Syndrome (UCS). Upper Cross Syndrome is characterized by muscle imbalance leading to forward head posture, rounded shoulders, and increased thoracic kyphosis. The study will evaluate pain intensity, craniovertebral angle, thoracic kyphosis, and rounded shoulder posture

Study Overview

Status

Recruiting

Conditions

Intervention / Treatment

Study Type

Interventional

Enrollment (Estimated)

58

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 Contact

Study Contact Backup

Study Locations

  • Pakistan
    • KPK
      • Peshawar, KPK, Pakistan, 25000
        • Recruiting
        • Ibadat International University, Islamabad (Iiui)
        • Contact:

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:

  • Age 18 to 45 years
  • Neck and/or upper thoracic pain for a duration of > 6 weeks
  • Pain Severity: VAS > 5 (Afzal, Noor, Mumtaz, Bashir, & Saqulain, 2023)
  • Pain exacerbated by prolonged postures
  • Adults diagnosed with Upper Cross Syndrome
  • Diagnostic criteria: Upper Cross Syndrome will be diagnosed when individuals demonstrate: thoracic kyphosis > 40°, craniovertebral angle < 50°, and acromion-to-couch distance > 2.5 cm based on established normative values.

Exclusion Criteria:

  • History of neck or shoulder surgery or trauma
  • Inflammatory conditions such as rheumatoid arthritis or gout
  • Pregnancy
  • Neurological conditions affecting upper limb function, and
  • Cardiovascular Problems
  • Congenital issues i.e.; torticollis, and scoliosis
  • Disc prolapse and other spine issues
  • Currently taking any medication or taking physical therapy

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: Single

Arms and Interventions

Participant Group / Arm
Intervention / Treatment
Experimental: Maitland Mobilization Combined With Kendall Exercises
Participants in this group will receive Maitland mobilization techniques applied to the cervical and thoracic spine, combined with Kendall exercises targeting postural correction. Mobilization will be performed by a trained physiotherapist using graded oscillatory techniques. The exercise program will focus on strengthening weak postural muscles and stretching tight musculature associated with upper cross syndrome.
Other: Kendall Exercises combined Maitland Mobilization
Group A (Experimental) received Kendall exercises combined with Maitland mobilization, including strengthening of deep cervical flexors, lower trapezius, and serratus anterior, along with stretching of upper trapezius, levator scapulae, and pectoralis major/minor. Maitland mobilization was applied to the cervical and upper thoracic spine using central and unilateral PA oscillations for 50-60 seconds per segment at 2-3 oscillations per second, in addition to warm-up (cervical AROM and shoulder mobility exercises) and cool-down (stretching and diaphragmatic breathing).
Active Comparator: Kendall Exercises Alone
Participants in this group will receive a Kendall exercise program focusing on postural correction. The program includes strengthening of weak muscles and stretching of tight muscles associated with upper cross syndrome.
Other: Kendall Exercise alone
Participants in this group will receive a structured Kendall exercise program only, without any manual therapy or mobilization techniques. The intervention will focus on postural correction through strengthening of weakened muscles (deep cervical flexors, scapular retractors) and stretching of tight muscles (pectoralis major/minor, upper trapezius, levator scapulae) associated with upper cross syndrome.

What is the study measuring?

Primary Outcome Measures

Outcome Measure
Measure Description
Time Frame
Thoracic Kyphosis Assessed With Flexicurve Ruler
Time Frame: baseline to last week (8 week)
Thoracic kyphosis will be measured using a flexicurve ruler. The spinous processes of C7 and T12 will be palpated and marked. The flexicurve ruler will mold along the thoracic curvature between these landmarks, and the curve will be transferred onto paper. . Based on previously published literature, thoracic kyphosis is considered 'normal' between 20 and 40°. Where this exceeds 40°, the curvature is described as hyperkyphosis.
baseline to last week (8 week)
Forward Head Posture Assessed with Protractor mobile application
Time Frame: baseline to last week (8 week)
Forward head posture will be assessed by measuring the craniovertebral angle (CVA) using the protractor mobile application. Measuring CVA from a lateral view by drawing a line from the ear tragus to the spinous process of the seventh cervical vertebra and a horizontal reference line through C7. The angle formed between these two lines will represent the craniovertebral angle.A reduced craniovertebral angle indicates increased forward head posture, with values less than 50° commonly used to identify this condition
baseline to last week (8 week)
Rounded Shoulder Assessed with Vernier Caliper
Time Frame: baseline to last week (8 week)
Rounded shoulder posture was assessed using a vernier caliper. Participants were positioned supine on a firm couch with arms relaxed by their sides. The vertical distance between the posterolateral edge of the acromion process and the couch surface was measured using a vernier caliper. Measurements will be taken bilaterally; an acromion-to-couch distance greater than 2.5cm will be considered indicative of rounded shoulder posture.
baseline to last week (8 week)
Visual Analogue Scale
Time Frame: baseline to last week
The intensity of the pain will be measured with the help of the Visual Analogue Scale (VAS). The VAS is a 10-cm horizontal line with two opposite endpoints marked with the following words: "no pain" at one end and "worst imaginable pain" at the other. The patient will then mark a point on the line that they feel most accurately reflects their current pain. The distance in centimeters or millimeters between the "no pain" point and the patient's mark will be taken as the measure of the patient's pain.
baseline to last week

Collaborators and Investigators

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

Sponsor

Ibadat International University, Islamabad

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

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)

April 6, 2026

Primary Completion (Estimated)

June 6, 2026

Study Completion (Estimated)

June 8, 2026

Study Registration Dates

First Submitted

May 2, 2026

First Submitted That Met QC Criteria

May 8, 2026

First Posted (Actual)

May 14, 2026

Study Record Updates

Last Update Posted (Actual)

May 20, 2026

Last Update Submitted That Met QC Criteria

May 17, 2026

Last Verified

May 1, 2026

More Information

Terms related to this study

Additional Relevant MeSH Terms

Other Study ID Numbers

  • IIUI/RERC/ADT/2026/04/282

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

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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