Comparative Effect of Maitland Mobilization Combined With Kendall Exercises for Pain and Postural Alignment in Adults With Upper Cross Syndrome
17. maj 2026 opdateret af: 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
Studieoversigt
Status
Rekruttering
Betingelser
Intervention / Behandling
Undersøgelsestype
Interventionel
Tilmelding (Anslået)
58
Fase
- Ikke anvendelig
Kontakter og lokationer
Dette afsnit indeholder kontaktoplysninger for dem, der udfører undersøgelsen, og oplysninger om, hvor denne undersøgelse udføres.
Studiekontakt
- Navn: Naeem Ullah, DPT, MS-PT MSK
- Telefonnummer: +923308088558
- E-mail: naeemphysio58@gmail.com
Undersøgelse Kontakt Backup
- Navn: Fatima Amjad, DPT, MS-PT Sports, PHD Scholer
- Telefonnummer: +923330940975
- E-mail: Fatima.amjad@uipt.iiui.edu.pk
Studiesteder
-
-
KPK
-
Peshawar, KPK, Pakistan, 25000
- Rekruttering
- Ibadat International University, Islamabad (Iiui)
-
Kontakt:
- Fatima Amjad, DPT, MS-PT Sports, PHD
- Telefonnummer: +923330940975
- E-mail: Fatima.amjad@uipt.iiui.edu.pk
-
-
Deltagelseskriterier
Forskere leder efter personer, der passer til en bestemt beskrivelse, kaldet berettigelseskriterier. Nogle eksempler på disse kriterier er en persons generelle helbredstilstand eller tidligere behandlinger.
Berettigelseskriterier
Aldre berettiget til at studere
- Voksen
Tager imod sunde frivillige
Ingen
Beskrivelse
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
Studieplan
Dette afsnit indeholder detaljer om studieplanen, herunder hvordan undersøgelsen er designet, og hvad undersøgelsen måler.
Hvordan er undersøgelsen tilrettelagt?
Design detaljer
- Primært formål: Behandling
- Tildeling: Randomiseret
- Interventionel model: Parallel tildeling
- Maskning: Enkelt
Våben og indgreb
Deltagergruppe / Arm |
Intervention / Behandling |
|---|---|
|
Eksperimentel: 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.
|
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).
|
|
Aktiv komparator: 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.
|
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.
|
Hvad måler undersøgelsen?
Primære resultatmål
Resultatmål |
Foranstaltningsbeskrivelse |
Tidsramme |
|---|---|---|
|
Thoracic Kyphosis Assessed With Flexicurve Ruler
Tidsramme: 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
Tidsramme: 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
Tidsramme: 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
Tidsramme: 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
|
Samarbejdspartnere og efterforskere
Det er her, du vil finde personer og organisationer, der er involveret i denne undersøgelse.
Publikationer og nyttige links
Den person, der er ansvarlig for at indtaste oplysninger om undersøgelsen, leverer frivilligt disse publikationer. Disse kan handle om alt relateret til undersøgelsen.
Generelle publikationer
- Ghan GM, Babu VS. Immediate Effect of Cervico-thoracic Mobilization on Deep Neck Flexors Strength in Individuals with Forward Head Posture: A Randomized Controlled Trial. J Man Manip Ther. 2021 Jun;29(3):147-157. doi: 10.1080/10669817.2020.1834321. Epub 2020 Oct 22.
- 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.
- Gallego-Izquierdo T, Arroba-Diaz E, Garcia-Ascoz G, Val-Cano MDA, Pecos-Martin D, Cano-de-la-Cuerda R. Psychometric Proprieties of a Mobile Application to Measure the Craniovertebral Angle a Validation and Reliability Study. Int J Environ Res Public Health. 2020 Sep 8;17(18):6521. doi: 10.3390/ijerph17186521.
- Zappala M, Lightbourne S, Heneghan NR. The relationship between thoracic kyphosis and age, and normative values across age groups: a systematic review of healthy adults. J Orthop Surg Res. 2021 Jul 9;16(1):447. doi: 10.1186/s13018-021-02592-2.
- 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.
- Salahzadeh Z, Maroufi N, Ahmadi A, Behtash H, Razmjoo A, Gohari M, Parnianpour M. Assessment of forward head posture in females: observational and photogrammetry methods. J Back Musculoskelet Rehabil. 2014;27(2):131-9. doi: 10.3233/BMR-130426.
- Chaudhuri S, Chawla JK, Phadke V. Physiotherapeutic Interventions for Upper Cross Syndrome: A Systematic Review and Meta-Analysis. Cureus. 2023 Sep 18;15(9):e45471. doi: 10.7759/cureus.45471. eCollection 2023 Sep.
- van Niekerk SM, Louw Q, Vaughan C, Grimmer-Somers K, Schreve K. Photographic measurement of upper-body sitting posture of high school students: a reliability and validity study. BMC Musculoskelet Disord. 2008 Aug 20;9:113. doi: 10.1186/1471-2474-9-113.
- Usman, T., Babur, M. N., Aslam, E., Rashid, M. A. B., Aslam, K., & Azam, A. (2024). Effects of Kendall Exercises vs Gong's Mobilization on Upper Cross Syndrome: Kendall Exercises vs. Gong's Mobilization in UCS. Journal of Health and Rehabilitation Research, 4(3), 1-6.
- Syinta, A. N., & Komalasari, D. R. (2024). Reliability and Validity of The Visual Analogue Scale in Non-Myogenic Low Back Pain Patients. Paper presented at the Academic Physiotherapy Conference Proceeding.
- Singla D, Veqar Z, Hussain ME. Photogrammetric Assessment of Upper Body Posture Using Postural Angles: A Literature Review. J Chiropr Med. 2017 Jun;16(2):131-138. doi: 10.1016/j.jcm.2017.01.005. Epub 2017 Mar 18.
- Singh, N., Kumar, P., & Parasher, R. K. Inter-tester and Intra-tester Reliability of Physical Examination Test Used to Measure Positional Faults of the Shoulder Girdle in Healthy Individuals. International Journal of Health Sciences, 6(S7), 3771-3780.
- Rodrigues, A., Romeiro, C., & Patrizzi, L. (2009). Evaluation of thoracic kyphosis in older adult women with osteoporosis by means of computerized biophotogrammetry. Brazilian Journal of Physical Therapy, 13, 205-209.
- Rezaei H, Gheitasi M, Hosseini SM. Does corrective exercises influence the performance, posture, range of motion and shoulder pain of swimmers with upper crossed syndrome? randomized clinical trial. BMC Sports Sci Med Rehabil. 2025 Jul 10;17(1):193. doi: 10.1186/s13102-025-01200-8.
- Reshma, S. M., Chinnakalai, T., SuHAiL, M., al-Hussinan, N., & Pillai, P. (2020). Reliability of the flexible ruler in measuring lumbar lordosis among children. J Clin Diagn Res, 14, YCO1-YCP4.
- Raupp EG, Candotti CT, Marchetti BV, Vieira A, Medeiros FS, Loss JF. The Validity and Reproducibility of the Flexicurve in the Evaluation of Cervical Spine Lordosis. J Manipulative Physiol Ther. 2017 Sep;40(7):501-510. doi: 10.1016/j.jmpt.2017.06.010.
- Rahul, S., Anitha, A., Kamalakannan, M., & Ramana, K. (2024). Effectiveness of Kendall Exercise for Forward Head Posture among IT Workers. Indian Journal of Physiotherapy & Occupational Therapy, 18.
- Pathan, H., Pawar, A., Rao, R., Phansopkar, P., Chitale, N., & Arora, S. P. (2022). A structured exercise program for upper cross syndrome. J Med Pharm Allied Sci, 11(S1), 259-263.
- Outeda, L. R., Cousiño, L. A. J., Carrera, I. d. C., & Caeiro, E. M. L. (2022). Effect of the maitland concept techniques on low back pain: a systematic review. Coluna/Columna, 21(2), e258429.
- Neme JR. Balancing Act: Muscle Imbalance Effects on Musculoskeletal Injuries. Mo Med. 2022 May-Jun;119(3):225-228.
- Mol, N., Abeeshna, A., & Kumar, D. (2021). Upper crossed syndrome: trends and recent advances in the physiotherapy treatment a narrative review. J Pharm Res Int, 33(64B), 359-367.
- Mingels, S. (2020). Spinal Posture as a Trigger for Episodic Headache within a Biopsychosocial context? An explorative study.
- Maricot A, Lathouwers E, Verschueren J, De Pauw K, Meeusen R, Roelands B, Tassignon B. Test-retest, intra- and inter-rater reliability of the reactive balance test in patients with chronic ankle instability. Front Neurol. 2024 Feb 16;15:1320043. doi: 10.3389/fneur.2024.1320043. eCollection 2024.
- Mandal, A., & Ganguly, S. (2019). Non-invasive measurement of thoracic kyphosis and lumber lordosis among agricultural workers and corporate professionals (IT) using flexicurve ruler. International Journal of Occupational Safety and Health, 9(2).
- Khawar, A., Khawar, S., Tauqeer, S., Amjad, F., Rubab, H. I., & Wafa, H. S. (2022). Association of upper cross syndrome with prolonged sitting among young adults. Pakistan Biomedical Journal, 370-374.
- Karbalaeimahdi M, Minoonejad H, Mousavi SH, Rajabi R. Photogrammetry-based smartphone applications for spinal posture assessment: a systematic review and meta-analysis. Sci Rep. 2025 Dec 15;16(1):2885. doi: 10.1038/s41598-025-32708-1.
- Javed, A., Fatima, U., & Jadoon, I. J. (2022). Prevalence of Upper Cross Syndrome In Medical Students of Women Medical College, Abbottabad, Khyber Pakhtunkhwa, Pakistan. Journal of Women Medical and Dental College, 1(3).
- Hussain, S., Pereira, F., Sajid, M., Ahmad, I., Saad, S., Iqbal, S., & Rehman, M. (2022). Association between Rounded Shoulder Posture and Pulmonary Capacity among Undergraduate Doctor of Physical Therapy Students. Indian Journal of Physiotherapy & Occupational Therapy, 16(1).
- Ganvir, M., & Kadam, S. Effect of Scapular Stabilization Exercises with and without Thoracic Mobilization on Neck Pain and Range of Motion in Upper Cross Syndrome.
- Bjelkaroy MT, Benth JS, Simonsen TB, Siddiqui TG, Cheng S, Kristoffersen ES, Lundqvist C. Measuring pain intensity in older adults. Can the visual analogue scale and the numeric rating scale be used interchangeably? Prog Neuropsychopharmacol Biol Psychiatry. 2024 Mar 2;130:110925. doi: 10.1016/j.pnpbp.2023.110925. Epub 2023 Dec 22.
- Brambilla L, Maronese CA, Bortoluzzi P, Barberi F, Tourlaki A. Mucosal Kaposi's sarcoma in HIV-negative patients: a large case series from a single, tertiary referral center in Italy. Int J Dermatol. 2021 Sep;60(9):1120-1125. doi: 10.1111/ijd.15557. Epub 2021 Apr 8.
- Hariadi RF, Winfree E, Yurke B. Determining hydrodynamic forces in bursting bubbles using DNA nanotube mechanics. Proc Natl Acad Sci U S A. 2015 Nov 10;112(45):E6086-95. doi: 10.1073/pnas.1424673112. Epub 2015 Oct 26.
- Studer G, Graetz KW, Glanzmann C. Outcome in recurrent head neck cancer treated with salvage-IMRT. Radiat Oncol. 2008 Dec 17;3:43. doi: 10.1186/1748-717X-3-43.
- Zhang C, Gao J, Wang O, Georgel P, Yang R, Davis J, Frahm JM, Pollefeys M. Personal photograph enhancement using internet photo collections. IEEE Trans Vis Comput Graph. 2014 Feb;20(2):262-75. doi: 10.1109/TVCG.2013.77.
- Shah DS, Middleton C, Gurdezi S, Horwitz MD, Kedgley AE. The effects of wrist motion and hand orientation on muscle forces: A physiologic wrist simulator study. J Biomech. 2017 Jul 26;60:232-237. doi: 10.1016/j.jbiomech.2017.06.017. Epub 2017 Jun 21.
- Patel TR, Fricano S, Waqas M, Tso M, Dmytriw AA, Mokin M, Kolega J, Tomaszewski J, Levy EI, Davies JM, Snyder KV, Siddiqui AH, Tutino VM. Increased Perviousness on CT for Acute Ischemic Stroke is Associated with Fibrin/Platelet-Rich Clots. AJNR Am J Neuroradiol. 2021 Jan;42(1):57-64. doi: 10.3174/ajnr.A6866. Epub 2020 Nov 26.
- Ahmed, Z. M., Ashique, I., Zafar, A., Ali, Z., Zafar, M., & Rasool, A. (2024). Prevalence of Thoracic Hyperkyphosis Posture among Female Students of Allied Health Institutes and Its Association With Rounded Shoulders: Thoracic Hyperkyphosis and Rounded Shoulders Among Female Students. Journal of Health and Rehabilitation Research, 4(3), 1-4.
- Afzal, H., Noor, R., Mumtaz, N., Bashir, M. S., & Saqulain, G. (2023). Effects of Kendall exercise vs. Gong's mobilization on pain, range of motion, function, and strength in cases with text neck syndrome. Iranian Rehabilitation Journal, 21(3), 411-420.
Datoer for undersøgelser
Disse datoer sporer fremskridtene for indsendelser af undersøgelsesrekord og resumeresultater til ClinicalTrials.gov. Studieregistreringer og rapporterede resultater gennemgås af National Library of Medicine (NLM) for at sikre, at de opfylder specifikke kvalitetskontrolstandarder, før de offentliggøres på den offentlige hjemmeside.
Studer store datoer
Studiestart (Faktiske)
6. april 2026
Primær færdiggørelse (Anslået)
6. juni 2026
Studieafslutning (Anslået)
8. juni 2026
Datoer for studieregistrering
Først indsendt
2. maj 2026
Først indsendt, der opfyldte QC-kriterier
8. maj 2026
Først opslået (Faktiske)
14. maj 2026
Opdateringer af undersøgelsesjournaler
Sidste opdatering sendt (Faktiske)
20. maj 2026
Sidste opdatering indsendt, der opfyldte kvalitetskontrolkriterier
17. maj 2026
Sidst verificeret
1. maj 2026
Mere information
Begreber relateret til denne undersøgelse
Yderligere relevante MeSH-vilkår
Andre undersøgelses-id-numre
- IIUI/RERC/ADT/2026/04/282
Plan for individuelle deltagerdata (IPD)
Planlægger du at dele individuelle deltagerdata (IPD)?
INGEN
Lægemiddel- og udstyrsoplysninger, undersøgelsesdokumenter
Studerer et amerikansk FDA-reguleret lægemiddelprodukt
Ingen
Studerer et amerikansk FDA-reguleret enhedsprodukt
Ingen
Disse oplysninger blev hentet direkte fra webstedet clinicaltrials.gov uden ændringer. Hvis du har nogen anmodninger om at ændre, fjerne eller opdatere dine undersøgelsesoplysninger, bedes du kontakte register@clinicaltrials.gov. Så snart en ændring er implementeret på clinicaltrials.gov, vil denne også blive opdateret automatisk på vores hjemmeside .