Upper Crossed SyndromeNCT07064031
Effects of Post Isometric Relaxation and Janda's Approach in Patient With Shoudler Girdle Crossed Syndrome
A study testing Neck Isometrics , TENS and Hot pack in people with Upper Crossed Syndrome, run by Riphah International University at 1 site in Pakistan.
Trial summary
Shoulder girdle crossed syndrome referred as upper crossed syndrome. In this syndrome, tightness of the upper trapezius and levator scapula on the dorsal side crosses with tightness of the pectoralis major and minor. Read more about this study
- Who is it for?
- Ages 18 to 50 years
- Conditions the study is for
- Upper Crossed Syndrome
- What is being tested?
- Neck Isometrics , TENS and Hot pack
- Could I receive a placebo?
- No, everyone receives an active treatment
- How many people
- 54 participants
- Where
- 1 sitePakistan
- Study dates
- Jul 2025to Oct 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 50 years
- All sexes
- No healthy volunteers
- Adult
Who may be able to join
- Age group between 18 and 50 years (defined as pain in the area of the neck could be provoked by mechanical characteristics, including sustained neck postures, cervical movement, or manual palpation of the cervical musculature)
Who cannot join
- Cervical radiculopathy
- History of whiplash injury
- History of cervical and thoracic spine surgery
- Neck pain associated with vertigo
Trial locations and contacts
1 site in 1 country. Contact the study team or a site near you to ask about taking part.
About this study
Official title: Effects of Post Isometric Relaxation and Janda's Approach on Pain, Muscle Endurance and Disability in Patient With Shoudler Girdle Crossed Syndrome
Shoulder girdle crossed syndrome referred as upper crossed syndrome. In this syndrome, 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, lower trapezius and Rhomboids. Janda Approach treatment involves steps i.e Normalize the Periphery, Restore Muscle Balance, Increase afferent input to facilitate reflexive stabilization and increase endurance in muscles.
Read the detailed description
This study will be a randomized controlled trial and will be conducted in Riphah Rehabilitation Clinic Lahore. Non-probability convenient sampling will be used to collect the data. Sample size of 54 subjects with age group between 18-50 years will be taken. Data will be collected from the patients having present complaint of neck pain. Outcome measures will be taken using Numeric pain rating scale (NPRS) for pain, Neck disability index (NDI) for disability and Muscle Endurance tests for neck flexors, extensors and lateral flexors, 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 random number generator table. Both the Groups will receive Janda treatment as standard physical therapy, while Group A will receive janda's Technique and Muscle Energy Technique. In Janda technique weak muscles will be Strengthened and Tight muscles will be stretched. While group B is control group and receive only Janda Technique. 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
- Neck Isometrics , TENS and Hot pack
- Keywords
- Muscle strength, Muscle Endurance, pain, posture
- 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.
Neck Isometrics , TENS and Hot packOther
Hot apck and TENS applied for 10min each. Using the same amount of light pressure, gently push your head into your hand as you did before. This time, allow the head to move slowly toward the shoulder against the pressure of the hand. This too can be repeated on the opposite side, forwards, backward, and into left and right rotation
| Study group | Role | What they receive |
|---|---|---|
| Post isometric relaxation | Experimental | This Group Will Receive Post isometric relaxation and Janda . PIR will be perform on upper trapezius and pectorals major muscle. In Janda technique weak muscles will be Strengthened and Tight muscles will be stretched. Receives: Other: Neck Isometrics , TENS and Hot pack |
| Janda Technique | Active comparator | This group is control group and receive only Janda Technique as mentioned weak muscles i.e. serratus Anterior and Rhomboids are strengthened by isometric contraction of these muscles. Stretching of tight muscles i.e. upper trapezius and Pectoralis major muscle. Receives: Other: Neck Isometrics , TENS and Hot pack |
What is being measured
The primary outcome is the main question the study is designed to answer.
Numerical Pain Rating Scale (NPRS)
The Numeric Pain Rating Scale (NPRS) is perhaps the most frequently applied scale used to quantify pain intensity in the clinical setting. It is an 11-point numeric scale, ranging from 0 indicating no pain to 10 indicating worst pain imaginable
Measured: upto 4 weeks
Neck Disability Index (NDI)
The Neck Disability Index (NDI) is a validated 10-item-questionnaire for the assessment of neck pain. The items of the questionnaire assess deficits in physical and social functioning as well as pain and everyday activities.
Measured: upto 4 weeks
Endurance Tests
Endurance Tests:
Research by Parazza et al 2014 found the following results when looking at neck endurance strength in flexion and extension:
Neck flexion: 44 seconds and Neck extension: 261 seconds
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 posted14 Jul 2025
- Study startJul 2025 (estimated)
- Primary completionSep 2025 (estimated)
- Study completionOct 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
- 54 participants (estimated)
Sponsor and investigators
- Lead sponsor
- Riphah International University
- Sponsor type
- University, hospital or other
- Responsible party
- Sponsor
- Investigators
- Samrood Akram, PhD*, Principal investigator, Riphah International University
IDs, dates and publications
- ClinicalTrials.gov ID
- NCT07064031
- Sponsor's protocol ID
- REC/RCR &AHS/24/0144 Muqaddas
- Status last verified
- Jul 2025
- First submitted
- 3 Jul 2025
- Last updated
- 14 Jul 2025
- Results posted
- No
- Data monitoring committee
- No
- FDA-regulated drug
- No
- FDA-regulated device
- No
- Individual data sharing
- No
Publications
Mubeen I, Malik S, Akhtar W, Iqbal M, Asif M, Arshad A, et al. Prevalence of upper cross syndrome among the medical students of University of Lahore. International journal of Physiotherapy. 2016;3(3):381-4.
Dhage P, Anap D. Prevalence of an "Upper Crossed Syndrome in Physiotherapy College Students"-A Cross-Sectional Study. VIMS Health Science Journal. 2019;6(1):10-3.
Kage V, Putti B. Effectiveness of stretching and strengthening exercises (Janda's approach) in subjects with postural backache: A randomized controlled trial. Int J Physiother Res. 2015;3(6):1301-6.
Bae WS, Lee HO, Shin JW, Lee KC. The effect of middle and lower trapezius strength exercises and levator scapulae and upper trapezius stretching exercises in upper crossed syndrome. J Phys Ther Sci. 2016 May;28(5):1636-9. doi: 10.1589/jpts.28.1636. Epub 2016 May 31.
PubMed 27313388Guanche C, Knatt T, Solomonow M, Lu Y, Baratta R. The synergistic action of the capsule and the shoulder muscles. Am J Sports Med. 1995 May-Jun;23(3):301-6. doi: 10.1177/036354659502300308.
PubMed 7661256Umphred D, Byl N, Lazaro R, Roller M. Interventions for neurological disabilities. Neurological rehabilitation. 2001;4:56-134.
Sherrington C. On reciprocal innervation of antagonistic muscles. Proc R Soc London B. 1905;76:161-269.
El Laithy MH, Fouda KZ. Effect of post isometric relaxation technique in the treatment of mechanical neck pain. Physical Therapy and Rehabilitation. 2018;5(1):20.
Study at a glance
From the registry record, last updated by the sponsor on 14 Jul 2025. Recruitment status is as the sponsor reported it: confirm with the study team.
- Official title
- Effects of Post Isometric Relaxation and Janda's Approach on Pain, Muscle Endurance and Disability in Patient With Shoudler Girdle Crossed Syndrome
- ClinicalTrials.gov ID
- NCT07064031
- Acronym / sponsor ID
- REC/RCR &AHS/24/0144 Muqaddas
- Conditions
- Upper Crossed Syndrome
- Keywords
- Muscle strength, Muscle Endurance, pain, posture
- Study type
- Interventional
- Recruitment status
- Not yet recruiting
- Enrolment
- 54 participants (estimated)
- Lead sponsor
- Riphah International UniversityUniversity, hospital or other
- Study start
- Jul 2025 (estimated)
- Primary completion
- Sep 2025 (estimated)
- Study completion
- Oct 2025 (estimated)
- First posted
- 14 Jul 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.
Shoulder girdle crossed syndrome referred as upper crossed syndrome. In this syndrome, 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, lower trapezius and Rhomboids. Janda Approach treatment involves steps i.e Normalize the Periphery, Restore Muscle Balance, Increase afferent input to facilitate reflexive stabilization and increase endurance in muscles.
Detailed description
This study will be a randomized controlled trial and will be conducted in Riphah Rehabilitation Clinic Lahore. Non-probability convenient sampling will be used to collect the data. Sample size of 54 subjects with age group between 18-50 years will be taken. Data will be collected from the patients having present complaint of neck pain. Outcome measures will be taken using Numeric pain rating scale (NPRS) for pain, Neck disability index (NDI) for disability and Muscle Endurance tests for neck flexors, extensors and lateral flexors, 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 random number generator table. Both the Groups will receive Janda treatment as standard physical therapy, while Group A will receive janda's Technique and Muscle Energy Technique. In Janda technique weak muscles will be Strengthened and Tight muscles will be stretched. While group B is control group and receive only Janda Technique. 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 |
|---|---|---|
| Post isometric relaxation | Experimental | Other: Neck Isometrics , TENS and Hot packThis Group Will Receive Post isometric relaxation and Janda . PIR will be perform on upper trapezius and pectorals major muscle. In Janda technique weak muscles will be Strengthened and Tight muscles will be stretched. |
| Janda Technique | Active comparator | Other: Neck Isometrics , TENS and Hot packThis group is control group and receive only Janda Technique as mentioned weak muscles i.e. serratus Anterior and Rhomboids are strengthened by isometric contraction of these muscles. Stretching of tight muscles i.e. upper trapezius and Pectoralis major muscle. |
Who may qualify
- Ages
- 18 to 50 years
- Sex
- All
- Healthy volunteers
- Not accepted
- Age groups
- Adult
Key inclusion criteria (1 listed)
- Age group between 18 and 50 years (defined as pain in the area of the neck could be provoked by mechanical characteristics, including sustained neck postures, cervical movement, or manual palpation of the cervical musculature)
Key exclusion criteria (4 listed)
- Cervical radiculopathy
- History of whiplash injury
- History of cervical and thoracic spine surgery
- Neck pain associated with vertigo
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 |
|---|---|---|
| Neck Isometrics , TENS and Hot packHot apck and TENS applied for 10min each. Using the same amount of light pressure, gently push your head into your hand as you did before. This time, allow the head to move slowly toward the shoulder against the pressure of the hand. This too can be repeated on the opposite side, forwards, backward, and into left and right rotation | Other | Janda Technique, Post isometric relaxation |
Primary outcome
Numerical Pain Rating Scale (NPRS)
Time frame: upto 4 weeks
The Numeric Pain Rating Scale (NPRS) is perhaps the most frequently applied scale used to quantify pain intensity in the clinical setting. It is an 11-point numeric scale, ranging from 0 indicating no pain to 10 indicating worst pain imaginable
Neck Disability Index (NDI)
Time frame: upto 4 weeks
The Neck Disability Index (NDI) is a validated 10-item-questionnaire for the assessment of neck pain. The items of the questionnaire assess deficits in physical and social functioning as well as pain and everyday activities.
Endurance Tests
Time frame: upto 4 weeks
Endurance Tests: Research by Parazza et al 2014 found the following results when looking at neck endurance strength in flexion and extension: Neck flexion: 44 seconds and Neck extension: 261 seconds
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 14 Jul 2025.
- BackgroundMubeen I, Malik S, Akhtar W, Iqbal M, Asif M, Arshad A, et al. Prevalence of upper cross syndrome among the medical students of University of Lahore. International journal of Physiotherapy. 2016;3(3):381-4.
- BackgroundDhage P, Anap D. Prevalence of an "Upper Crossed Syndrome in Physiotherapy College Students"-A Cross-Sectional Study. VIMS Health Science Journal. 2019;6(1):10-3.
- BackgroundKage V, Putti B. Effectiveness of stretching and strengthening exercises (Janda's approach) in subjects with postural backache: A randomized controlled trial. Int J Physiother Res. 2015;3(6):1301-6.
- Background: PubMed 27313388Bae WS, Lee HO, Shin JW, Lee KC. The effect of middle and lower trapezius strength exercises and levator scapulae and upper trapezius stretching exercises in upper crossed syndrome. J Phys Ther Sci. 2016 May;28(5):1636-9. doi: 10.1589/jpts.28.1636. Epub 2016 May 31.
- Background: PubMed 7661256Guanche C, Knatt T, Solomonow M, Lu Y, Baratta R. The synergistic action of the capsule and the shoulder muscles. Am J Sports Med. 1995 May-Jun;23(3):301-6. doi: 10.1177/036354659502300308.
- BackgroundUmphred D, Byl N, Lazaro R, Roller M. Interventions for neurological disabilities. Neurological rehabilitation. 2001;4:56-134.
- BackgroundSherrington C. On reciprocal innervation of antagonistic muscles. Proc R Soc London B. 1905;76:161-269.
- BackgroundEl Laithy MH, Fouda KZ. Effect of post isometric relaxation technique in the treatment of mechanical neck pain. Physical Therapy and Rehabilitation. 2018;5(1):20.
- 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* 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 Neck Isometrics , TENS and Hot pack 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 1 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 14 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.com), 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 NCT07064031, 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 14 Jul 2025.