Upper Cross SyndromeNCT07588061
Comparative Effect of Maitland Mobilization Combined With Kendall Exercises for Pain and Postural Alignment in Adults With Upper Cross Syndrome
A study testing Kendall Exercises combined Maitland Mobilization and Kendall Exercise alone in people with Upper Cross Syndrome, run by Ibadat International University, Islamabad at 1 site in Pakistan.
Trial summary
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). Read more about this study
- Who is it for?
- Ages 18 to 45 years
- Conditions the study is for
- Upper Cross Syndrome
- What is being tested?
- Kendall Exercises combined Maitland Mobilization and Kendall Exercise alone
- Could I receive a placebo?
- No, everyone receives an active treatment
- How many people
- 58 participants
- Where
- 1 sitePakistan
- Study dates
- 6 Apr 2026to 8 Jun 2026
- Phase
- Interventional
- Are there results?
- Not yet: the study is under way
Key requirements
Who can take part, as listed by the sponsor. Only the study team can confirm whether you are eligible, so take this list to your doctor.
- Ages 18 to 45 years
- All sexes
- No healthy volunteers
- Adult
Who may be able to join
- 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.
Who cannot join
- 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
Trial locations and contacts
1 site in 1 country. Contact the study team or a site near you to ask about taking part.
Pakistan1 site, 1 recruiting
- Recruiting
Ibadat International University, Islamabad (Iiui)
Peshawar, KPK, 25000
Fatima Amjad, DPT, MS-PT Sports, PHD, +923330940975, Fatima.amjad@uipt.iiui.edu.pk
About this study
Official title: 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
- Conditions
- Upper Cross Syndrome
- Being tested
- Kendall Exercises combined Maitland Mobilization, Kendall Exercise alone
- Medical subject headings
- Oculocerebral hypopigmentation syndrome type Preus
What participants receive
What participants receive. In a randomised study each person is assigned to one group by chance.
Kendall Exercises combined Maitland MobilizationOther
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).
Kendall Exercise aloneOther
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.
| Study group | Role | What they receive |
|---|---|---|
| Maitland Mobilization Combined With Kendall Exercises | Experimental | 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. Receives: Other: Kendall Exercises combined Maitland Mobilization |
| Kendall Exercises Alone | Active comparator | 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. Receives: Other: Kendall Exercise alone |
What is being measured
The primary outcome is the main question the study is designed to answer.
Thoracic Kyphosis Assessed With Flexicurve Ruler
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.
Measured: baseline to last week (8 week)
Forward Head Posture Assessed with Protractor mobile application
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
Measured: baseline to last week (8 week)
Rounded Shoulder Assessed with Vernier Caliper
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.
Measured: baseline to last week (8 week)
Visual Analogue Scale
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.
Measured: baseline to last week
Timeline
From the start of the study to its completion; the mark is today. Estimated dates are the sponsor’s plan.
- First posted14 May 2026
- Study start6 Apr 2026
- Primary completion6 Jun 2026 (estimated)
- Study completion8 Jun 2026 (estimated)
Resources
- Official record on ClinicalTrials.govThe registry entry this page is built from, with its full change history.
- Publications (38)Papers the sponsor has linked to this study.
- Other trials for Upper Cross SyndromeStudies of the same condition, open and under way.
- What the trial phases meanHow a treatment moves from first tests in people to approval.
More details
For doctors and researchers: how the study is designed, who runs it, and its registry IDs.
Study design
- Study type
- Interventional
- Phase
- Phase N/A
- Primary purpose
- Treatment
- Allocation
- Randomised
- Intervention model
- Parallel groups
- Masking
- Single blind
- Who is masked
- Outcomes assessor
- Enrolment
- 58 participants (estimated)
Sponsor and investigators
- Lead sponsor
- Ibadat International University, Islamabad
- Sponsor type
- University, hospital or other
- Responsible party
- Sponsor
IDs, dates and publications
- ClinicalTrials.gov ID
- NCT07588061
- Sponsor's protocol ID
- IIUI/RERC/ADT/2026/04/282
- Status last verified
- May 2026
- First submitted
- 2 May 2026
- Last updated
- 20 May 2026
- Results posted
- No
- Data monitoring committee
- No
- FDA-regulated drug
- No
- FDA-regulated device
- No
- Individual data sharing
- No
Publications
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.
PubMed 34243795van 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.
PubMed 18713477Usman, 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.
PubMed 28559753Singh, 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.
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.
PubMed 38302926Salahzadeh 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.
PubMed 23963268Rodrigues, 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.
PubMed 40640904Reshma, 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.
PubMed 29191286Rahul, 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.
Study at a glance
From the registry record, last updated by the sponsor on 20 May 2026. Recruitment status is as the sponsor reported it: confirm with the study team.
- Official title
- Comparative Effect of Maitland Mobilization Combined With Kendall Exercises on Pain and Postural Alignment in Adults With Upper Cross Syndrome
- ClinicalTrials.gov ID
- NCT07588061
- Acronym / sponsor ID
- IIUI/RERC/ADT/2026/04/282
- Conditions
- Upper Cross Syndrome
- Study type
- Interventional
- Recruitment status
- Recruiting
- Enrolment
- 58 participants (estimated)
- Lead sponsor
- Ibadat International University, IslamabadUniversity, hospital or other
- Study start
- 6 Apr 2026 (actual)
- Primary completion
- 6 Jun 2026 (estimated)
- Study completion
- 8 Jun 2026 (estimated)
- First posted
- 14 May 2026 (actual)
- Results
- Not posted in the source record
Clinical summary
The research question as the sponsor registered it. This describes what the study plans to test, not what it found.
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 design
- Primary purpose
- Treatment
- Allocation
- Randomised
- Intervention model
- Parallel groups
- Masking
- Single blind (outcomes assessor)
- Number of arms
- 2
| Arm | Type | Receives |
|---|---|---|
| Maitland Mobilization Combined With Kendall Exercises | Experimental | Other: Kendall Exercises combined Maitland MobilizationParticipants 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. |
| Kendall Exercises Alone | Active comparator | Other: Kendall Exercise aloneParticipants 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. |
Who may qualify
- Ages
- 18 to 45 years
- Sex
- All
- Healthy volunteers
- Not accepted
- Age groups
- Adult
Key inclusion criteria (6 listed)
- 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
Key exclusion criteria (8 listed)
- 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
Eligibility is decided by the study team after screening; this overview does not establish that a patient qualifies. Full inclusion and exclusion criteria.
Interventions
| Intervention | Type | Arms |
|---|---|---|
| Kendall Exercises combined Maitland MobilizationGroup 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). | Other | Maitland Mobilization Combined With Kendall Exercises |
| Kendall Exercise aloneParticipants 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. | Other | Kendall Exercises Alone |
Primary outcome
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.
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
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.
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.
Results and safety
This study is still under way. Results are not available in the source record yet.
Research links
- Official record on ClinicalTrials.govLast updated by the sponsor 20 May 2026.
- Background: PubMed 34243795Zappala 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.
- Background: PubMed 18713477van 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.
- BackgroundUsman, 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.
- BackgroundSyinta, 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.
- Background: PubMed 28559753Singla 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.
- BackgroundSingh, 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.
- Background: PubMed 38302926Sepehri 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.
- Background: PubMed 23963268Salahzadeh 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.
- BackgroundRodrigues, 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.
- Background: PubMed 40640904Rezaei 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.
- BackgroundReshma, 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.
- Background: PubMed 29191286Raupp 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.
- Individual participant dataSharing planned: No
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Referral and contact
AzTrials does not enrol participants or take referrals. Contact the study team or a site listed below; they decide who can take part.
1 site in 1 country: see every site and its status.
Questions about this trial
What is this clinical trial studying?
A study testing Kendall Exercises combined Maitland Mobilization and Kendall Exercise alone in people with Upper Cross Syndrome, run by Ibadat International University, Islamabad at 1 site in Pakistan.
The full registered description is in the About this study section and the official record.
Who may be eligible to take part?
The sponsor lists 6 inclusion and 8 exclusion criteria. Eligibility is decided by the study team after screening, so read the full criteria and contact a listed site.
Is this clinical trial currently recruiting?
The record says: looking for participants now, as of the sponsor's last update on 20 May 2026. Status can change between updates, so confirm with the study contact before making plans.
Where is the study taking place?
The record lists 1 site in Pakistan. Whether a site is taking part right now should be confirmed with that site. See every site.
What are the possible benefits and risks?
They depend on the study and the treatment, and no study can promise a benefit. The study team explains the known risks during informed consent, before anyone joins; the record itself does not list them.
Are results available for this study?
This study is still under way. Results are not available in the source record yet.
How can a doctor refer a patient or contact the research team?
Contact Naeem Ullah, DPT, MS-PT MSK (+923308088558, naeemphysio58@gmail.com), or a site near the patient. AzTrials does not enrol participants or take referrals.
What does the primary outcome measure?
Thoracic Kyphosis Assessed With Flexicurve Ruler (time frame: baseline to last week (8 week)). The study lists 4 primary outcomes in all. It is what the study was designed to measure, not a finding.
Where can I read the original study information?
On the ClinicalTrials.gov record for NCT07588061, which also lists 38 linked publications.
Does a listing mean the treatment is approved or proven to work?
No. A listing means the study is registered. It does not show that the treatment is safe, works, or is approved by a regulator.
How often is this information updated?
AzTrials copies changed records from ClinicalTrials.gov every night and reloads the whole registry every week. The sponsor last updated this record on 20 May 2026.