Upper Crossed SyndromeNCT06996002
Effects of Rhomboids Strength Training Regime Among Patients With Upper Crossed Syndrome
A study testing Rhomboids Strengthening Exercise and Conventional Exercises in people with Upper Crossed Syndrome, run by Riphah International University at 1 site in Pakistan.
Trial summary
Upper Cross Syndrome (UCS) is characterized by weakening of the neck flexors and rhomboids and stiffness in the pectoralis major, upper trapezius, and levator scapulae. Rhomboids major and minor need to be strengthened in order to enhance scapular stability and regain proper posture. Read more about this study
- Who is it for?
- Ages 20 to 45 years
- Conditions the study is for
- Upper Crossed Syndrome
- What is being tested?
- Rhomboids Strengthening Exercise and Conventional Exercises
- Could I receive a placebo?
- No, everyone receives an active treatment
- How many people
- 38 participants
- Where
- 1 sitePakistan
- Study dates
- Jul 2025to 20 Sep 2025
- 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 20 to 45 years
- All sexes
- No healthy volunteers
- Adult
Who may be able to join
- Age group between 20 and 45 years
- Both gender male and female
- Subject with head neck angle less than 50 degrees(for forward head posture).
- Subject with positive JANDAS upper crossed syndrome tests .
- Population with occupation tailor, computer users and students.
Who cannot join
- • Exclusion criteria Patients were excluded if they were diagnosed with the following conditions for ˃6 months
- Tuberculosis, carcinoma, heart disease, and osteoporosis
- Neural disorders due to prolapsed intervertebral disc
- Any trauma or localized infection in upper back region
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
Haleema Surgical Hospital
Jhang, Punjab Province, 54000
Tariq bin Amir, MSPT, 03006387257, dr.tariqbinameer@gmail.com
About this study
Official title: Effects of Rhomboids Strength Training Regime on Pain, Craniovertebral Angle and Disability Among Patients With Upper Crossed Syndrome
Upper Cross Syndrome (UCS) is characterized by weakening of the neck flexors and rhomboids and stiffness in the pectoralis major, upper trapezius, and levator scapulae. Rhomboids major and minor need to be strengthened in order to enhance scapular stability and regain proper posture. The aim of this study is to determine effect of rhomboids strength training regime on pain, craniovertebral angle and disability among patients with upper crossed syndrome.
Read the detailed description
This study will be a randomized controlled trial and will be conducted in Haleema Surgical Hospital, Shorkot city. Non-probability convenient sampling will be used to collect the data. Sample size of 38 subjects with age group between 20-45 years will be taken. Data will be collected from the patients having present complaint of upper crossed syndrome pain. Outcome measures will be taken using Numeric pain rating scale (NPRS) for pain, craniovertebral angle, and neck disability index questionnaire for disability. An informed consent will be taken. Subjects will be selected on the basis of inclusion and exclusion criteria and will be equally divided into two groups by computer-generated stratified randomization. The study will be a single-blind assessor. Both the Groups will receive Hot Pack, TENS, posture training and stretching exercises while group A will receive rhomboids strengthening exercises additionally. Outcome measures will be measured at baseline and after 4 weeks. Data analysis will be done by SPSS version 25.
- Conditions
- Upper Crossed Syndrome
- Being tested
- Rhomboids Strengthening Exercise, Conventional Exercises
- Keywords
- Craniovertebral Angle, Pain, Disability
- Medical subject headings
- Oculocerebral hypopigmentation syndrome type Preus, Pain
What participants receive
What participants receive. In a randomised study each person is assigned to one group by chance.
Rhomboids Strengthening ExerciseOther
- Seated Bent Row in Sitting position,3 sets of the exercise program with 12 repetitions per set, 3 times per week.
- Bent Over Row in standing position, 3 sets, 12 repetitions, 3 times per week.
- Lat Pull Down in sitting position with 12 repetitions per set, 3 times per week.
- Shoulder Horizontal Abduction in lying position with 3 sets of the exercise program with 12 repetitions per set, 3 times per week.
- Band pull apart performed 4sets, 12 repetitions, and 10 seconds rest for 2 mints, 3 times per week.
- Prone lateral raise with 3 sets of the exercise program with 12 repetitions per set, 3 times per week.
Conventional treatment Modalities:
Trans-cutaneous Electric Nerve Stimulation (TENS) and Hot pack, postural exercises and stretching exercises
Conventional ExercisesOther
Conventional Treatment
- hot pack for 10 min,
- Trans-cutaneous Electric Nerve Stimulation (TENS) will be applied, with pulse duration of 250 microseconds at a frequency of 80 Hz for 15 min in the sub occipital region and the trapezius bilaterally.
- Stretching exercises of tight muscles 2 sets of 15 min.
- Posture correction exercises: releasing muscles of anterior part of the trunk, neck, shoulder.
| Study group | Role | What they receive |
|---|---|---|
| Rhomboids strengthening exercises along with conventional Exercises | Experimental | Rhomboids strengthening exercises:
1. Seated Bent Row
2. Bent Over Row
3. Lat Pull Down
4. Shoulder Horizontal Abduction
5. Band pull apart
6. Prone lateral raise
hot pack for 10 min. Trans-cutaneous Electric Nerve Stimulation (TENS). Stretching chest muscles, pectoralis muscles, levator scapulae muscle, cervical extensor muscles, upper trapezius Posture correction exercises Receives: Other: Rhomboids Strengthening Exercise; Other: Conventional Exercises |
| Conventional Exercises | Active comparator | * Both groups will receive hot pack for 10 min.
* Trans-cutaneous Electric Nerve Stimulation (TENS). Stretching chest muscles, pectoralis muscles, levator scapulae muscle, cervical extensor muscles, upper trapezius
* Posture correction exercises Receives: Other: Conventional Exercises |
What is being measured
The primary outcome is the main question the study is designed to answer.
Numerical Pain Rating Scale (NPRS)
Patient level of pain will be assessed using this scale. This scale ranges from 0 to 10.
0 indicates "no pain" 1-3 indicate "Mild pain" 4-6 indicate "Moderate pain" 7-10 indicate "worst pain". NPRS have shown high test-retest reliability (r = 0.96 and 0.95, respectively)
Measured: upto 4 weeks
Neck Disability Index (NDI_
The NDI is a 10-item, 50-point index that evaluates many facets of day-to-day functioning in individuals with neck pain. The NDI evaluates two items pertaining to discretionary daily living activities (personal care, reading), four items pertaining to activities of daily living (lifting, work, driving, and recreation), and four items related subjective symptoms (pain intensity, headache, concentration, and sleeping). The scores are interpreted as follows:
0-4: No disability 5-14: Mild disability 15-24: Moderate disability 25-34: Severe disability 35-50: Complete disability. For the NDI, test-retest reliability was good
Measured: upto 4 weeks
Craniovertebral Angle
Anatomically speaking, the degree of forward head posture is measured using the craniovertebral angle (CVA), which is a measurement of the head and neck posture. It is the angle created by a horizontal line running from the C7 vertebra and the line joining the tragus of the ear to the vertebra (the seventh cervical vertebra).
In order to calculate the craniovertebral angle:
- Indicate the C7 vertebra and the tragus of the ear.
- Draw an imaginary line that connects the C7 vertebra to the tragus.
- Sketch a line that extends horizontally from the vertebra C7.
- Calculate the angle that these two lines form. More than 50 degrees is the normal CVA. Head tilt slightly forward, between 40 and 50 degrees. A somewhat forward head posture, between 30 and 40 degrees. Head Posture Severe Forward when it is less than 30 degrees. CVA is a trustworthy measure of head and neck posture
Measured: upto 4 weeks
Timeline
From the start of the study to its completion; the mark is today. Estimated dates are the sponsor’s plan.
- First posted30 May 2025
- Study startJul 2025 (estimated)
- Primary completion20 Aug 2025 (estimated)
- Study completion20 Sep 2025 (estimated)
Resources
- Official record on ClinicalTrials.govThe registry entry this page is built from, with its full change history.
- Publications (8)Papers the sponsor has linked to this study.
- Other trials for Upper Crossed SyndromeStudies of the same condition, open and under way.
- More trials run by Riphah International UniversityThe sponsor's other registered studies.
- 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
- 38 participants (estimated)
Sponsor and investigators
- Lead sponsor
- Riphah International University
- Sponsor type
- University, hospital or other
- Responsible party
- Sponsor
- Investigators
- Samrood Akram, PhD Scholar, Principal investigator, Riphah International University
IDs, dates and publications
- ClinicalTrials.gov ID
- NCT06996002
- Sponsor's protocol ID
- REC/RCR &AHS/24/0145 Bisma
- Status last verified
- Jul 2025
- First submitted
- 21 May 2025
- Last updated
- 4 Jul 2025
- Results posted
- No
- Data monitoring committee
- No
- FDA-regulated drug
- No
- FDA-regulated device
- No
- Individual data sharing
- No
Publications
Mujawar JC, Sagar JH. Prevalence of Upper Cross Syndrome in Laundry Workers. Indian J Occup Environ Med. 2019 Jan-Apr;23(1):54-56. doi: 10.4103/ijoem.IJOEM_169_18.
PubMed 31040591Jeong GH, Lee BH. Effects of Telerehabilitation Combining Diaphragmatic Breathing Re-Education and Shoulder Stabilization Exercises on Neck Pain, Posture, and Function in Young Adult Men with Upper Crossed Syndrome: A Randomized Controlled Trial. J Clin Med. 2024 Mar 11;13(6):1612. doi: 10.3390/jcm13061612.
PubMed 38541838Naseer R, Tauqeer S. Prevalence of upper cross syndrome in different occupations. Pakistan Journal of Physical Therapy (PJPT). 2021:03-7.
Huang JF, Meng Z, Zheng XQ, Qin Z, Sun XL, Zhang K, Tian HJ, Wang XB, Gao Z, Li YM, Wu AM. Real-World Evidence in Prescription Medication Use Among U.S. Adults with Neck Pain. Pain Ther. 2020 Dec;9(2):637-655. doi: 10.1007/s40122-020-00193-1. Epub 2020 Sep 17.
PubMed 32940899Chu EC, Butler KR. Resolution of Gastroesophageal Reflux Disease Following Correction for Upper Cross Syndrome-A Case Study and Brief Review. Clin Pract. 2021 May 21;11(2):322-326. doi: 10.3390/clinpract11020045.
PubMed 34063944Kirthika SV, Sudhakar S, Padmanabhan K, Ramanathan K. Impact of upper crossed syndrome on pulmonary function among the recreational male players: A preliminary report. Saudi Journal of Sports Medicine. 2018;18(2):71-4.
Gull M, Akbar UU, Asim HM. FREQUENCY OF CHRONIC NECK PAIN IN UPPER CROSS SYNDROME IN FEMALE SCHOOL TEACHERS. Independent Journal of Allied Health Sciences. 2018;1(01):33-8.
Firouzjah MH, Firouzjah EMAN, Ebrahimi Z. The effect of a course of selected corrective exercises on posture, scapula-humeral rhythm and performance of adolescent volleyball players with upper cross syndrome. BMC Musculoskelet Disord. 2023 Jun 14;24(1):489. doi: 10.1186/s12891-023-06592-7.
PubMed 37316911
Study at a glance
From the registry record, last updated by the sponsor on 4 Jul 2025. Recruitment status is as the sponsor reported it: confirm with the study team.
- Official title
- Effects of Rhomboids Strength Training Regime on Pain, Craniovertebral Angle and Disability Among Patients With Upper Crossed Syndrome
- ClinicalTrials.gov ID
- NCT06996002
- Acronym / sponsor ID
- REC/RCR &AHS/24/0145 Bisma
- Conditions
- Upper Crossed Syndrome
- Keywords
- Craniovertebral Angle, Pain, Disability
- Study type
- Interventional
- Recruitment status
- Not yet recruiting
- Enrolment
- 38 participants (estimated)
- Lead sponsor
- Riphah International UniversityUniversity, hospital or other
- Study start
- Jul 2025 (estimated)
- Primary completion
- 20 Aug 2025 (estimated)
- Study completion
- 20 Sep 2025 (estimated)
- First posted
- 30 May 2025 (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.
Upper Cross Syndrome (UCS) is characterized by weakening of the neck flexors and rhomboids and stiffness in the pectoralis major, upper trapezius, and levator scapulae. Rhomboids major and minor need to be strengthened in order to enhance scapular stability and regain proper posture. The aim of this study is to determine effect of rhomboids strength training regime on pain, craniovertebral angle and disability among patients with upper crossed syndrome.
Detailed description
This study will be a randomized controlled trial and will be conducted in Haleema Surgical Hospital, Shorkot city. Non-probability convenient sampling will be used to collect the data. Sample size of 38 subjects with age group between 20-45 years will be taken. Data will be collected from the patients having present complaint of upper crossed syndrome pain. Outcome measures will be taken using Numeric pain rating scale (NPRS) for pain, craniovertebral angle, and neck disability index questionnaire for disability. An informed consent will be taken. Subjects will be selected on the basis of inclusion and exclusion criteria and will be equally divided into two groups by computer-generated stratified randomization. The study will be a single-blind assessor. Both the Groups will receive Hot Pack, TENS, posture training and stretching exercises while group A will receive rhomboids strengthening exercises additionally. Outcome measures will be measured at baseline and after 4 weeks. Data analysis will be done by SPSS version 25.
Study design
- Primary purpose
- Treatment
- Allocation
- Randomised
- Intervention model
- Parallel groups
- Masking
- Single blind (outcomes assessor)
- Number of arms
- 2
| Arm | Type | Receives |
|---|---|---|
| Rhomboids strengthening exercises along with conventional Exercises | Experimental | Other: Rhomboids Strengthening Exercise, Other: Conventional ExercisesRhomboids strengthening exercises: 1. Seated Bent Row 2. Bent Over Row 3. Lat Pull Down 4. Shoulder Horizontal Abduction 5. Band pull apart 6. Prone lateral raise hot pack for 10 min. Trans-cutaneous Electric Nerve Stimulation (TENS). Stretching chest muscles, pectoralis muscles, levator scapulae muscle, cervical extensor muscles, upper trapezius Posture correction exercises |
| Conventional Exercises | Active comparator | Other: Conventional Exercises* Both groups will receive hot pack for 10 min. * Trans-cutaneous Electric Nerve Stimulation (TENS). Stretching chest muscles, pectoralis muscles, levator scapulae muscle, cervical extensor muscles, upper trapezius * Posture correction exercises |
Who may qualify
- Ages
- 20 to 45 years
- Sex
- All
- Healthy volunteers
- Not accepted
- Age groups
- Adult
Key inclusion criteria (5 listed)
- Age group between 20 and 45 years
- Both gender male and female
- Subject with head neck angle less than 50 degrees(for forward head posture).
- Subject with positive JANDAS upper crossed syndrome tests .
- Population with occupation tailor, computer users and students.
Key exclusion criteria (4 listed)
- • Exclusion criteria Patients were excluded if they were diagnosed with the following conditions for ˃6 months
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 |
|---|---|---|
| Rhomboids Strengthening Exercise1. Seated Bent Row in Sitting position,3 sets of the exercise program with 12 repetitions per set, 3 times per week. 2. Bent Over Row in standing position, 3 sets, 12 repetitions, 3 times per week. 3. Lat Pull Down in sitting position with 12 repetitions per set, 3 times per week. 4. Shoulder Horizontal Abduction in lying position with 3 sets of the exercise program with 12 repetitions per set, 3 times per week. 5. Band pull apart performed 4sets, 12 repetitions, and 10 seconds rest for 2 mints, 3 times per week. 6. Prone lateral raise with 3 sets of the exercise program with 12 repetitions per set, 3 times per week. Conventional treatment Modalities: Trans-cutaneous Electric Nerve Stimulation (TENS) and Hot pack, postural exercises and stretching exercises | Other | Rhomboids strengthening exercises along with conventional Exercises |
| Conventional ExercisesConventional Treatment 1. hot pack for 10 min, 2. Trans-cutaneous Electric Nerve Stimulation (TENS) will be applied, with pulse duration of 250 microseconds at a frequency of 80 Hz for 15 min in the sub occipital region and the trapezius bilaterally. 3. Stretching exercises of tight muscles 2 sets of 15 min. 4. Posture correction exercises: releasing muscles of anterior part of the trunk, neck, shoulder. | Other | Conventional Exercises, Rhomboids strengthening exercises along with conventional Exercises |
Primary outcome
Numerical Pain Rating Scale (NPRS)
Time frame: upto 4 weeks
Patient level of pain will be assessed using this scale. This scale ranges from 0 to 10. 0 indicates "no pain" 1-3 indicate "Mild pain" 4-6 indicate "Moderate pain" 7-10 indicate "worst pain". NPRS have shown high test-retest reliability (r = 0.96 and 0.95, respectively)
Neck Disability Index (NDI_
Time frame: upto 4 weeks
The NDI is a 10-item, 50-point index that evaluates many facets of day-to-day functioning in individuals with neck pain. The NDI evaluates two items pertaining to discretionary daily living activities (personal care, reading), four items pertaining to activities of daily living (lifting, work, driving, and recreation), and four items related subjective symptoms (pain intensity, headache, concentration, and sleeping). The scores are interpreted as follows: 0-4: No disability 5-14: Mild disability 15-24: Moderate disability 25-34: Severe disability 35-50: Complete disability. For the NDI, test-retest reliability was good
Craniovertebral Angle
Time frame: upto 4 weeks
Anatomically speaking, the degree of forward head posture is measured using the craniovertebral angle (CVA), which is a measurement of the head and neck posture. It is the angle created by a horizontal line running from the C7 vertebra and the line joining the tragus of the ear to the vertebra (the seventh cervical vertebra). In order to calculate the craniovertebral angle: 1. Indicate the C7 vertebra and the tragus of the ear. 2. Draw an imaginary line that connects the C7 vertebra to the tragus. 3. Sketch a line that extends horizontally from the vertebra C7. 4. Calculate the angle that these two lines form. More than 50 degrees is the normal CVA. Head tilt slightly forward, between 40 and 50 degrees. A somewhat forward head posture, between 30 and 40 degrees. Head Posture Severe Forward when it is less than 30 degrees. CVA is a trustworthy measure of head and neck posture
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 4 Jul 2025.
- Background: PubMed 31040591Mujawar JC, Sagar JH. Prevalence of Upper Cross Syndrome in Laundry Workers. Indian J Occup Environ Med. 2019 Jan-Apr;23(1):54-56. doi: 10.4103/ijoem.IJOEM_169_18.
- Background: PubMed 38541838Jeong GH, Lee BH. Effects of Telerehabilitation Combining Diaphragmatic Breathing Re-Education and Shoulder Stabilization Exercises on Neck Pain, Posture, and Function in Young Adult Men with Upper Crossed Syndrome: A Randomized Controlled Trial. J Clin Med. 2024 Mar 11;13(6):1612. doi: 10.3390/jcm13061612.
- BackgroundNaseer R, Tauqeer S. Prevalence of upper cross syndrome in different occupations. Pakistan Journal of Physical Therapy (PJPT). 2021:03-7.
- Background: PubMed 32940899Huang JF, Meng Z, Zheng XQ, Qin Z, Sun XL, Zhang K, Tian HJ, Wang XB, Gao Z, Li YM, Wu AM. Real-World Evidence in Prescription Medication Use Among U.S. Adults with Neck Pain. Pain Ther. 2020 Dec;9(2):637-655. doi: 10.1007/s40122-020-00193-1. Epub 2020 Sep 17.
- Background: PubMed 34063944Chu EC, Butler KR. Resolution of Gastroesophageal Reflux Disease Following Correction for Upper Cross Syndrome-A Case Study and Brief Review. Clin Pract. 2021 May 21;11(2):322-326. doi: 10.3390/clinpract11020045.
- BackgroundKirthika SV, Sudhakar S, Padmanabhan K, Ramanathan K. Impact of upper crossed syndrome on pulmonary function among the recreational male players: A preliminary report. Saudi Journal of Sports Medicine. 2018;18(2):71-4.
- BackgroundGull M, Akbar UU, Asim HM. FREQUENCY OF CHRONIC NECK PAIN IN UPPER CROSS SYNDROME IN FEMALE SCHOOL TEACHERS. Independent Journal of Allied Health Sciences. 2018;1(01):33-8.
- Background: PubMed 37316911Firouzjah MH, Firouzjah EMAN, Ebrahimi Z. The effect of a course of selected corrective exercises on posture, scapula-humeral rhythm and performance of adolescent volleyball players with upper cross syndrome. BMC Musculoskelet Disord. 2023 Jun 14;24(1):489. doi: 10.1186/s12891-023-06592-7.
- 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.
Samrood Akram, PhD Scholar principal investigator
Riphah International University
1 site in 1 country: see every site and its status.
Questions about this trial
What is this clinical trial studying?
A study testing Rhomboids Strengthening Exercise and Conventional Exercises in people with Upper Crossed Syndrome, run by Riphah International University 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 5 inclusion and 4 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: opening soon, as of the sponsor's last update on 4 Jul 2025. 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 Samrood Akram, PhD Scholar (03324806143, Samrood.akram@riphah.edu.pk), or a site near the patient. AzTrials does not enrol participants or take referrals.
What does the primary outcome measure?
Numerical Pain Rating Scale (NPRS) (time frame: upto 4 weeks). The study lists 3 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 NCT06996002, which also lists 8 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 4 Jul 2025; AzTrials last refreshed its copy on 7 Nov 2026.