Comparative Effect of Maitland Mobilization Combined With Kendall Exercises for Pain and Postural Alignment in Adults With Upper Cross Syndrome
17 de mayo de 2026 actualizado por: 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
Descripción general del estudio
Estado
Reclutamiento
Condiciones
Intervención / Tratamiento
Tipo de estudio
Intervencionista
Inscripción (Estimado)
58
Fase
- No aplica
Contactos y Ubicaciones
Esta sección proporciona los datos de contacto de quienes realizan el estudio e información sobre dónde se lleva a cabo este estudio.
Estudio Contacto
- Nombre: Naeem Ullah, DPT, MS-PT MSK
- Número de teléfono: +923308088558
- Correo electrónico: naeemphysio58@gmail.com
Copia de seguridad de contactos de estudio
- Nombre: Fatima Amjad, DPT, MS-PT Sports, PHD Scholer
- Número de teléfono: +923330940975
- Correo electrónico: Fatima.amjad@uipt.iiui.edu.pk
Ubicaciones de estudio
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KPK
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Peshawar, KPK, Pakistán, 25000
- Reclutamiento
- Ibadat International University, Islamabad (Iiui)
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Contacto:
- Fatima Amjad, DPT, MS-PT Sports, PHD
- Número de teléfono: +923330940975
- Correo electrónico: Fatima.amjad@uipt.iiui.edu.pk
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Criterios de participación
Los investigadores buscan personas que se ajusten a una determinada descripción, denominada criterio de elegibilidad. Algunos ejemplos de estos criterios son el estado de salud general de una persona o tratamientos previos.
Criterio de elegibilidad
Edades elegibles para estudiar
- Adulto
Acepta Voluntarios Saludables
No
Descripción
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
Plan de estudios
Esta sección proporciona detalles del plan de estudio, incluido cómo está diseñado el estudio y qué mide el estudio.
¿Cómo está diseñado el estudio?
Detalles de diseño
- Propósito principal: Tratamiento
- Asignación: Aleatorizado
- Modelo Intervencionista: Asignación paralela
- Enmascaramiento: Único
Armas e Intervenciones
Grupo de participantes/brazo |
Intervención / Tratamiento |
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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.
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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).
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Comparador activo: 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.
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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.
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¿Qué mide el estudio?
Medidas de resultado primarias
Medida de resultado |
Medida Descripción |
Periodo de tiempo |
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Thoracic Kyphosis Assessed With Flexicurve Ruler
Periodo de tiempo: baseline to last week (8 week)
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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.
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baseline to last week (8 week)
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Forward Head Posture Assessed with Protractor mobile application
Periodo de tiempo: baseline to last week (8 week)
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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
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baseline to last week (8 week)
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Rounded Shoulder Assessed with Vernier Caliper
Periodo de tiempo: baseline to last week (8 week)
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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.
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baseline to last week (8 week)
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Visual Analogue Scale
Periodo de tiempo: baseline to last week
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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.
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baseline to last week
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Colaboradores e Investigadores
Aquí es donde encontrará personas y organizaciones involucradas en este estudio.
Patrocinador
Publicaciones y enlaces útiles
La persona responsable de ingresar información sobre el estudio proporciona voluntariamente estas publicaciones. Estos pueden ser sobre cualquier cosa relacionada con el estudio.
Publicaciones Generales
- 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.
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- 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).
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- 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.
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- 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.
Fechas de registro del estudio
Estas fechas rastrean el progreso del registro del estudio y los envíos de resultados resumidos a ClinicalTrials.gov. Los registros del estudio y los resultados informados son revisados por la Biblioteca Nacional de Medicina (NLM) para asegurarse de que cumplan con los estándares de control de calidad específicos antes de publicarlos en el sitio web público.
Fechas importantes del estudio
Inicio del estudio (Actual)
6 de abril de 2026
Finalización primaria (Estimado)
6 de junio de 2026
Finalización del estudio (Estimado)
8 de junio de 2026
Fechas de registro del estudio
Enviado por primera vez
2 de mayo de 2026
Primero enviado que cumplió con los criterios de control de calidad
8 de mayo de 2026
Publicado por primera vez (Actual)
14 de mayo de 2026
Actualizaciones de registros de estudio
Última actualización publicada (Actual)
20 de mayo de 2026
Última actualización enviada que cumplió con los criterios de control de calidad
17 de mayo de 2026
Última verificación
1 de mayo de 2026
Más información
Términos relacionados con este estudio
Términos MeSH relevantes adicionales
Otros números de identificación del estudio
- IIUI/RERC/ADT/2026/04/282
Plan de datos de participantes individuales (IPD)
¿Planea compartir datos de participantes individuales (IPD)?
NO
Información sobre medicamentos y dispositivos, documentos del estudio
Estudia un producto farmacéutico regulado por la FDA de EE. UU.
No
Estudia un producto de dispositivo regulado por la FDA de EE. UU.
No
Esta información se obtuvo directamente del sitio web clinicaltrials.gov sin cambios. Si tiene alguna solicitud para cambiar, eliminar o actualizar los detalles de su estudio, comuníquese con register@clinicaltrials.gov. Tan pronto como se implemente un cambio en clinicaltrials.gov, también se actualizará automáticamente en nuestro sitio web. .