Upper Cross SyndromeNCT07025993
Effects of Muscle Energy Technique Versus Cervical and Scapulothoracic Stabilization Exercises in Upper Crossed Syndrome
A study testing Muscle Energy Technique and Eccentric muscle energy technique in people with Upper Cross Syndrome, run by Riphah International University at 1 site in Pakistan.
Trial summary
This study will be a randomized clinical trial and will be conducted in Younus Hospital, Tehsil headquarters hospital Daska, and Riphah Rehabilitation Clinic Lahore. Non-probability consecutive sampling will be used to collect the data. A sample size of 40 subjects with an age group between 18-65 years will be taken. Read more about this study
- Who is it for?
- Ages 18 to 65 years
- Conditions the study is for
- Upper Cross Syndrome
- What is being tested?
- Muscle Energy Technique and Eccentric muscle energy technique
- Could I receive a placebo?
- No, everyone receives an active treatment
- How many people
- 34 participants
- Where
- 1 sitePakistan
- Study dates
- 1 Mar 2025to 30 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 18 to 65 years
- All sexes
- No healthy volunteers
- Adult, Older adult
Who may be able to join
- Both gender diagnosed with upper crossed syndrome
- Patient having neck pain of 4 to 12 weeks
- Pain reported on NRPS score ˃6/10 in the neck region
- Subjects agree to sign the written consent form.
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 neck region
- Upper motor neuron disease, cervical stenosis, and metabolic diseases in bone and joint
- Hyper flexibility
Show all 10Show fewer
- Open sores
- Ongoing radiotherapy, chemotherapy, steroid therapy, or anticoagulants
- Psychiatric diseases such as phobia/obsession and depression
- Allergy to hot pack
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
Riphah Rehabilitation Clinic
Lahore, Punjab Province, 54000
Syed Shakil ur Rehman, PhD, +92 320 7866611, shakil.urrehman@riphah.edu.pk
About this study
Official title: Effects of Muscle Energy Technique Versus Cervical and Scapulothoracic Stabilization Exercises on Pain, Disability and Craniovertebral Angle in Patients With Upper Crossed Syndrome
This study will be a randomized clinical trial and will be conducted in Younus Hospital, Tehsil headquarters hospital Daska, and Riphah Rehabilitation Clinic Lahore. Non-probability consecutive sampling will be used to collect the data. A sample size of 40 subjects with an age group between 18-65 years will be taken. Data will be collected from the patients having present complaints of Neck pain associated with upper cross syndrome. Outcome measures will be taken using the Numeric Rating Pain Scale (NRPS) for pain and the Neck disability index (NDI) for neck functional health and craniovertebral angle for posture. An informed consent will be taken. Subjects will be selected based on inclusion and exclusion criteria and will be equally divided into two groups by a random number generator table. Both Groups will receive Moist Hot Pack, Cervical segmental mobilizations, and Free Neck Exercises (AROMs), while Group A will receive Muscle energy technique(eccentric muscle energy technique for the cervical spine with Mets for upper trapezius, Suboccipitalis and pectoralis muscle), and Group B will receive cervical and scapulothoracic stabilization exercises(axial elongation exercise, craniocervical flexion, cervical extension and Cervico-scapulothoracic stabilization exercises). Outcome measures will be measured at baseline and after 4 weeks. Data analysis will be done by SPSS version 25.
Read the detailed description
Neck pain is one of the most commonly occurring musculoskeletal disorders if left untreated can lead to severe complications. Cervical spine and soft tissue disorders e.g. muscles, ligaments, discs, facet joints, etc. are major causes of neck pain while neck pain caused by postural abnormality is termed as upper cross syndrome. Upper crossed syndrome (UCS) characterizes a prevalent postural dysfunction involving dysfunctional tone in the musculature of the neck, shoulders, and upper back that cross between the dorsal and the ventral sides of the body. This condition is given its name because an "X," in other words a cross, can be drawn across the upper body. One arm of the cross indicates the muscles that are typically tight/overly facilitated and the other arm of the cross indicates the muscles that are typically weak/overly inhibited. There are two types of muscles present in our body - the postural muscles such as pectoralis major, upper trapezius, and sternocleidomastoid, and other phasic muscles such as deep-neck flexors, and lower trapezius. In Upper Cross Syndrome (UCS) there is tightness of the upper trapezius and levator scapula on the dorsal side crosses with tightness of the pectoralis major and minor. Weakness of the deep cervical flexors, ventrally, crosses with weakness of the middle and lower trapezius. This pattern of imbalance creates joint dysfunction, particularly at the Atlanto-occipital joint, C4-C5 segment, cervicothoracic joint, glen humeral joint, and T4-T5 segment. Specific postural changes are seen in UCS, including forward head posture, increased cervical Lordosis and thoracic kyphosis, elevated and protracted shoulders, and rotation or abduction and winging of the scapulae. The main risk factor for developing UCS is maintaining an abnormal posture for a prolonged duration. Some daily activities that involve bad postures are often occupation-related. Repetitive tasks or continuous work for long hours can aggravate postural deviations. Because of increased work stress and a sedentary lifestyle, society is becoming more flexion-addicted attitude. In which people tend to frequently stoop forward. This is seen in office workers and students who tend to sit at a desk for prolonged periods, slouching forward to see the computer screen. Therefore, once muscle dysfunction starts, traditional muscle imbalance trends and altered posture follow. Head, neck structures can set limits on head's range of motion (ROM) and cause discomfort to the neck, mid-back muscle spasm/tightness, and decreased range of motion.
Understanding of which intervention yields better outcomes for pain relief, reduction in disability, and improvement in craniovertebral angle is crucial for optimizing treatment strategies for upper crossed syndrome patients. This study seeks to provide evidence-based guidance to clinicians regarding the most effective therapeutic approach. Considering the high prevalence of Upper Cross syndrome in the modern world, this study aims to check the effects of METs versus cervical and scapula-thoracic stabilization exercises on pain, disability and craniovertebral angle in patients with Upper Cross syndrome.
- Conditions
- Upper Cross Syndrome
- Being tested
- Muscle Energy Technique, Eccentric muscle energy technique
- Keywords
- Posture, Neck Pain, Upper Cross Syndrome, Exercise
- Medical subject headings
- Oculocerebral hypopigmentation syndrome type Preus, Neck Pain, Motor Activity
What participants receive
What participants receive. In a randomised study each person is assigned to one group by chance.
Muscle Energy TechniqueOther
Eccentric muscle energy technique was applied to subjects' cervical spine. The cervical spine will brought to the barrier of motion in each plane i.e. flexion/extension, lateral bending and rotation. Then subjects will asked to push their heads into the direction opposite that of the barrier. The therapist provided isometric resistance for 3- 5 seconds, after which the subjects relaxed their muscles completely and the therapist applied stretch.
Eccentric muscle energy techniqueOther
Eccentric muscle energy technique was applied to subjects' cervical spine. The cervical spine will brought to the barrier of motion in each plane i.e. flexion/extension, lateral bending and rotation. Then subjects will asked to push their heads into the direction opposite that of the barrier. The therapist provided isometric resistance for 3- 5 seconds, after which the subjects relaxed their muscles completely and the therapist applied stretch. Three to five repetitions will performed.
| Study group | Role | What they receive |
|---|---|---|
| Group A | Active comparator | Not described Receives: Other: Muscle Energy Technique |
| Group B | Experimental | Not described Receives: Other: Eccentric muscle energy technique |
What is being measured
The primary outcome is the main question the study is designed to answer.
Numeric Rating Pain Scale (NRPS)
The patient's level of pain will be assessed using this scale. This scale ranges from 0 to 10. 0 indicates "no pain" and 10 indicates "worst pain".
Measured: Baseline, 4th Week
Neck disability index (NDI)
The Neck Disability Index (NDI) is a 10-item questionnaire that measures a patient's self-reported neck pain-related disability
Measured: Baseline, 4th Week
Craniovertebral angle (CVA)
The craniovertebral angle is identified as the intersection of a horizontal line passing through the C7 spinous process and a line joining the midpoint of the tragus of the ear to the skin overlying the C7 spinous process
Measured: Baseline, 4th Week
Timeline
From the start of the study to its completion; the mark is today. Estimated dates are the sponsor’s plan.
- First posted18 Jun 2025
- Study start1 Mar 2025
- Primary completion30 Aug 2025 (estimated)
- Study completion30 Sep 2025 (estimated)
Resources
- Official record on ClinicalTrials.govThe registry entry this page is built from, with its full change history.
- Publications (3)Papers the sponsor has linked to this study.
- Other trials for Upper Cross 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
- Double blind
- Who is masked
- Participant, Outcomes assessor
- Enrolment
- 34 participants (estimated)
Sponsor and investigators
- Lead sponsor
- Riphah International University
- Sponsor type
- University, hospital or other
- Responsible party
- Sponsor
- Investigators
- Danish Hassan, PhD, Principal investigator, Riphah International University
IDs, dates and publications
- ClinicalTrials.gov ID
- NCT07025993
- Sponsor's protocol ID
- Jaazba- REC/RCR&AHS 24/0137
- Status last verified
- Jun 2025
- First submitted
- 11 Jun 2025
- Last updated
- 18 Jun 2025
- Results posted
- No
- Data monitoring committee
- Yes
- 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 31040591Chang 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.
PubMed 37628525Ali S, Ahmad S, Jalal Y, Shah B. Effectiveness of Stretching Exercises Versus Muscle Energy Techniques in the Management of Upper Cross Syndrome: JRCRS. 2017; 5 (1): 12-16. Journal Riphah College of Rehabilitation Sciences. 2017;5(1):12-6
Study at a glance
From the registry record, last updated by the sponsor on 18 Jun 2025. Recruitment status is as the sponsor reported it: confirm with the study team.
- Official title
- Effects of Muscle Energy Technique Versus Cervical and Scapulothoracic Stabilization Exercises on Pain, Disability and Craniovertebral Angle in Patients With Upper Crossed Syndrome
- ClinicalTrials.gov ID
- NCT07025993
- Acronym / sponsor ID
- Jaazba- REC/RCR&AHS 24/0137
- Conditions
- Upper Cross Syndrome
- Keywords
- Posture, Neck Pain, Upper Cross Syndrome, Exercise
- Study type
- Interventional
- Recruitment status
- Recruiting
- Enrolment
- 34 participants (estimated)
- Lead sponsor
- Riphah International UniversityUniversity, hospital or other
- Study start
- 1 Mar 2025 (actual)
- Primary completion
- 30 Aug 2025 (estimated)
- Study completion
- 30 Sep 2025 (estimated)
- First posted
- 18 Jun 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.
This study will be a randomized clinical trial and will be conducted in Younus Hospital, Tehsil headquarters hospital Daska, and Riphah Rehabilitation Clinic Lahore. Non-probability consecutive sampling will be used to collect the data. A sample size of 40 subjects with an age group between 18-65 years will be taken. Data will be collected from the patients having present complaints of Neck pain associated with upper cross syndrome. Outcome measures will be taken using the Numeric Rating Pain Scale (NRPS) for pain and the Neck disability index (NDI) for neck functional health and craniovertebral angle for posture. An informed consent will be taken. Subjects will be selected based on inclusion and exclusion criteria and will be equally divided into two groups by a random number generator table. Both Groups will receive Moist Hot Pack, Cervical segmental mobilizations, and Free Neck Exercises (AROMs), while Group A will receive Muscle energy technique(eccentric muscle energy technique for the cervical spine with Mets for upper trapezius, Suboccipitalis and pectoralis muscle), and Group B will receive cervical and scapulothoracic stabilization exercises(axial elongation exercise, craniocervical flexion, cervical extension and Cervico-scapulothoracic stabilization exercises). Outcome measures will be measured at baseline and after 4 weeks. Data analysis will be done by SPSS version 25.
Detailed description
Neck pain is one of the most commonly occurring musculoskeletal disorders if left untreated can lead to severe complications. Cervical spine and soft tissue disorders e.g. muscles, ligaments, discs, facet joints, etc. are major causes of neck pain while neck pain caused by postural abnormality is termed as upper cross syndrome. Upper crossed syndrome (UCS) characterizes a prevalent postural dysfunction involving dysfunctional tone in the musculature of the neck, shoulders, and upper back that cross between the dorsal and the ventral sides of the body. This condition is given its name because an "X," in other words a cross, can be drawn across the upper body. One arm of the cross indicates the muscles that are typically tight/overly facilitated and the other arm of the cross indicates the muscles that are typically weak/overly inhibited. There are two types of muscles present in our body - the postural muscles such as pectoralis major, upper trapezius, and sternocleidomastoid, and other phasic muscles such as deep-neck flexors, and lower trapezius. In Upper Cross Syndrome (UCS) there is tightness of the upper trapezius and levator scapula on the dorsal side crosses with tightness of the pectoralis major and minor. Weakness of the deep cervical flexors, ventrally, crosses with weakness of the middle and lower trapezius. This pattern of imbalance creates joint dysfunction, particularly at the Atlanto-occipital joint, C4-C5 segment, cervicothoracic joint, glen humeral joint, and T4-T5 segment. Specific postural changes are seen in UCS, including forward head posture, increased cervical Lordosis and thoracic kyphosis, elevated and protracted shoulders, and rotation or abduction and winging of the scapulae. The main risk factor for developing UCS is maintaining an abnormal posture for a prolonged duration. Some daily activities that involve bad postures are often occupation-related. Repetitive tasks or continuous work for long hours can aggravate postural deviations. Because of increased work stress and a sedentary lifestyle, society is becoming more flexion-addicted attitude. In which people tend to frequently stoop forward. This is seen in office workers and students who tend to sit at a desk for prolonged periods, slouching forward to see the computer screen. Therefore, once muscle dysfunction starts, traditional muscle imbalance trends and altered posture follow. Head, neck structures can set limits on head's range of motion (ROM) and cause discomfort to the neck, mid-back muscle spasm/tightness, and decreased range of motion.
Understanding of which intervention yields better outcomes for pain relief, reduction in disability, and improvement in craniovertebral angle is crucial for optimizing treatment strategies for upper crossed syndrome patients. This study seeks to provide evidence-based guidance to clinicians regarding the most effective therapeutic approach. Considering the high prevalence of Upper Cross syndrome in the modern world, this study aims to check the effects of METs versus cervical and scapula-thoracic stabilization exercises on pain, disability and craniovertebral angle in patients with Upper Cross syndrome.
Study design
- Primary purpose
- Treatment
- Allocation
- Randomised
- Intervention model
- Parallel groups
- Masking
- Double blind (participant, outcomes assessor)
- Number of arms
- 2
| Arm | Type | Receives |
|---|---|---|
| Group A | Active comparator | Other: Muscle Energy Technique |
| Group B | Experimental | Other: Eccentric muscle energy technique |
Who may qualify
- Ages
- 18 to 65 years
- Sex
- All
- Healthy volunteers
- Not accepted
- Age groups
- Adult, Older adult
Key inclusion criteria (4 listed)
- Both gender diagnosed with upper crossed syndrome
- Patient having neck pain of 4 to 12 weeks
- Pain reported on NRPS score ˃6/10 in the neck region
- Subjects agree to sign the written consent form.
Key exclusion criteria (10 listed)
- 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 neck region
- Upper motor neuron disease, cervical stenosis, and metabolic diseases in bone and joint
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 |
|---|---|---|
| Muscle Energy TechniqueEccentric muscle energy technique was applied to subjects' cervical spine. The cervical spine will brought to the barrier of motion in each plane i.e. flexion/extension, lateral bending and rotation. Then subjects will asked to push their heads into the direction opposite that of the barrier. The therapist provided isometric resistance for 3- 5 seconds, after which the subjects relaxed their muscles completely and the therapist applied stretch. | Other | Group A |
| Eccentric muscle energy techniqueEccentric muscle energy technique was applied to subjects' cervical spine. The cervical spine will brought to the barrier of motion in each plane i.e. flexion/extension, lateral bending and rotation. Then subjects will asked to push their heads into the direction opposite that of the barrier. The therapist provided isometric resistance for 3- 5 seconds, after which the subjects relaxed their muscles completely and the therapist applied stretch. Three to five repetitions will performed. | Other | Group B |
Primary outcome
Numeric Rating Pain Scale (NRPS)
Time frame: Baseline, 4th Week
The patient's level of pain will be assessed using this scale. This scale ranges from 0 to 10. 0 indicates "no pain" and 10 indicates "worst pain".
Neck disability index (NDI)
Time frame: Baseline, 4th Week
The Neck Disability Index (NDI) is a 10-item questionnaire that measures a patient's self-reported neck pain-related disability
Craniovertebral angle (CVA)
Time frame: Baseline, 4th Week
The craniovertebral angle is identified as the intersection of a horizontal line passing through the C7 spinous process and a line joining the midpoint of the tragus of the ear to the skin overlying the C7 spinous process
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 18 Jun 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 37628525Chang 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.
- BackgroundAli S, Ahmad S, Jalal Y, Shah B. Effectiveness of Stretching Exercises Versus Muscle Energy Techniques in the Management of Upper Cross Syndrome: JRCRS. 2017; 5 (1): 12-16. Journal Riphah College of Rehabilitation Sciences. 2017;5(1):12-6
- 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.
Danish Hassan, PhD 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 Muscle Energy Technique and Eccentric muscle energy technique in people with Upper Cross 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 4 inclusion and 10 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 18 Jun 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 Syed Shakil ur Rehman, PhD (+92 345 7946009, shakil.urrehman@riphah.edu.pk), or a site near the patient. AzTrials does not enrol participants or take referrals.
What does the primary outcome measure?
Numeric Rating Pain Scale (NRPS) (time frame: Baseline, 4th Week). 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 NCT07025993, which also lists 3 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 18 Jun 2025; AzTrials last refreshed its copy on 7 Nov 2026.