Upper Cross SyndromeNCT07528248
Comparative Effects of Global Postural Re-education and NASM-based Corrective Exercises in Patients With Upper Cross Syndrome (UCS)
A study testing Global Postural Re-education and NASM-based Corrective exercises in people with Upper Cross Syndrome, run by Rehana Hayat at 1 site in Pakistan.
Trial summary
The goal of this clinical trial is to learn the comparative effects of Global postural re-education (GPR) and National Academy of Sports Medicine (NASM) based corrective exercises in participants with upper cross syndrome (UCS). Read more about this study
- Who is it for?
- Ages 20 to 45 years
- Conditions the study is for
- Upper Cross Syndrome
- What is being tested?
- Global Postural Re-education and NASM-based Corrective exercises
- Could I receive a placebo?
- No, everyone receives an active treatment
- How many people
- 46 participants
- Where
- 1 sitePakistan
- Study dates
- 5 Mar 2026to 10 May 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 20 to 45 years
- All sexes
- No healthy volunteers
- Adult
Who may be able to join
- Age between 20-45 years
- Pain in the upper back and neck region.
- Both male and female patients
- Rounded shoulders
- Craniovertebral angle less than 47 degrees
- Willingness to participate
Who cannot join
- History of spinal surgery
- Neurological deficits (radiculopathy, myelopathy, disc herniation)
- Severe scoliosis or structural deformity
- Active cervical spine pathology (spondylosis, stenosis and fracture)
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
District Headquarter Hospital (DHQ) Okara
Okāra, Punjab Province, 56300
Sumbal Salik, DPT, 923184552151, sumbalsalik1@gmail.com
Rehana Hayat, DPT, 923024458178, rani_doctor@yahoo.com
About this study
The goal of this clinical trial is to learn the comparative effects of Global postural re-education (GPR) and National Academy of Sports Medicine (NASM) based corrective exercises in participants with upper cross syndrome (UCS). The main questions it aims to answer:
- Is there any difference between the effects of GPR and NASM-based corrective exercises in decreasing pain and disability and improving endurance in participants with upper cross syndrome?
- Is there any difference between the effects of GPR and NASM-based corrective exercises in improving cranio-vertebral angle of participants with upper cross syndrome? Researchers will compare GPR and NASM-based corrective exercises to see if there is difference between the two treatments in decreasing pain, disability and improving endurance and cranio-vertebral angle.
Read more
Participants will be:
- Given treatment 3 times a week for 8 weeks.
- Assessed before first treatment session (baseline), at 4th week of intervention and at the end of last treatment session (8th week).
- Conditions
- Upper Cross Syndrome
- Being tested
- Global Postural Re-education, NASM-based Corrective exercises
- 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.
Global Postural Re-educationOther
Also called GPR
Global Postural Re-education
1st position: Patient will lie in supine, shoulders abducted to 30°, forearms supinated and the pelvis will be kept in a neutral position, while the lumbar spine remain supported. This position is characterized by a progression from flexion to extension of both hips and knees. 2nd position: Patient will remain in supine with their hips at 90° of flexion and perform gradual knee extensions. The participants will remain between 15 \& 20 min in each of these two positions. Under the supervision and verbal and/or manual guidance of the physiotherapist performing the intervention, they will perform 5-10s isomet contractions of the antagonist muscles of the muscle chain targeted by each posture. Subjects can also make active adjustments to their position, the physiotherapist can favor with some manual contact, sustained stretching and some joint traction to complete the session, the participants will be requested to maintain an upright posture in standing for 5min
NASM-based Corrective exercisesOther
Also called National Academy of Sports Medicine Corrective exercises
NASM-based Corrective Exercises The four-stage exercise for UCS begins with preventing or reducing excessive muscle contraction (frequent foam wrapping), relaxing these same muscles, which fully eliminates dysfunctional muscles, and finally restores functional mobility.
Step 1: inhibit or self-myofascial release overactive muscles:
It includes the levator scapulae, trapezius (upper fibre), and sternocleidomastoid muscles. Hold pressure will be applied for 30 s on the tender spots.
Step 2: Lengthen/ Static stretch. Upper trapezius Levator scapulae Sternocleidomastoid (SCM) Step 3: Activate/Strengthen. Chin tucks Floor Cobra Step 4: Integrate. Ball combination A routine/conventional evidence based physiotherapy treatment will also be given to both arms.
| Study group | Role | What they receive |
|---|---|---|
| GPR+ Conventional Treatment | Active comparator | Participants in this arm will receive Global Postural re-education treatment in addition to the routine/conventional evidence based physiotherapy treatment. Participants will be asked to repeat each exercise three times a week for 8 weeks. Receives: Other: Global Postural Re-education |
| NASM-based corrective exercises + Conventional Treatment | Active comparator | Participants in this arm will receive NASM-based corrective exercises in addition to the conventional treatment. Participants will be asked to repeat each exercise 10 to 15 times, for 1-2 sets, three times a week for 8 weeks. Receives: Other: NASM-based Corrective exercises |
What is being measured
The primary outcome is the main question the study is designed to answer.
Mean change in endurance from baseline on Progressive iso-inertial lifting evaluation (PILE) test at 4 weeks and 8 weeks
Progressive iso-inertial lifting evaluation (PILE) test has been recommended as a functional test to measure muscle endurance and involves lifting weights from waist to shoulder height (30-54 in.). Participants will begin with an 8- pound load and a 13-pound load for females and males respectively. Weight will be subsequently increased at a rate equal to the initial free weight every 20 s. Four lifting movements will actually performed at 20-s intervals. The test end-point will be established when aerobic capacity or neuromuscular fatigue being felt.
Measured: From enrollment (before first treatment session) to the end of treatment at 8 weeks.
Mean change in pain score from baseline on Numeric Pain Rating Scale (NPRS) at 4 weeks and 8 weeks
The NPRS is an 11-point scale (0, no pain; 10, worst imaginable pain) used to assess the intensity of pain. Participants will be asked to rate their pain from 0 to 10.
Measured: From enrollment (before first treatment session) to the end of treatment at 8 weeks.
Mean change in disability score from baseline on Neck Disability Index (NDI) at 4 weeks and 8 weeks
The NDI is 10 questions and each question has a possible total score of zero to 5. The total score from all 10 questions is divided by 50, the maximum score possible, with total scores expressed in percentage. Higher percentage scores indicate a worst disability.
Measured: From enrollment (before first treatment session) to the end of treatment at 8 weeks.
Secondary outcomes (1)
Mean change in the Craniovertebral angle from baseline at 4 weeks and 8 weeks
The angle formed between the oblique line connecting right tragus to C7 and the vertical line will be measured as craniovertebral angle. Lesser the angle, more is the forward head posture and upper cross syndrome.
Measured: From enrollment (before first treatment session) to the end of treatment at 8 weeks.
Timeline
From the start of the study to its completion; the mark is today. Estimated dates are the sponsor’s plan.
- First posted14 Apr 2026
- Study start5 Mar 2026
- Primary completion10 May 2026 (estimated)
- Study completion10 May 2026 (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 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
- Triple blind
- Who is masked
- Participant, Care provider, Investigator
- Enrolment
- 46 participants (estimated)
Sponsor and investigators
- Lead sponsor
- Rehana Hayat
- Sponsor type
- University, hospital or other
- Responsible party
- Sponsor-investigator, Rehana Hayat, Superior University
IDs, dates and publications
- ClinicalTrials.gov ID
- NCT07528248
- Sponsor's protocol ID
- IRB/FAHS/REHAB/10/25/MS/RS3458
- Status last verified
- Apr 2026
- First submitted
- 24 Mar 2026
- Last updated
- 14 Apr 2026
- Results posted
- No
- Data monitoring committee
- No
- FDA-regulated drug
- No
- FDA-regulated device
- No
- Individual data sharing
- Yes
Publications
Azam H, Fatima N, Asjad A, Ashraf I, Asif T, Rehman F. Comparative effects of comprehensive corrective exercises versus muscle energy techniques in patients with upper cross syndrome: A randomized controlled trial: corrective exercises vs muscle energy techniques in patients with upper cross syndrome. Pakistan BioMedical Journal. 2022 Jul 31:173-7.
Almasoodi MC, Mahdavinejad R, Ghasmi G. The effect of 8 weeks national academy of sports medicine exercises training on posture, shoulder pain, and functional disability in male with upper cross syndrome. spine (cervicothoracic angle). 2020;21:22.
Abadiyan F, Hadadnezhad M, Khosrokiani Z, Letafatkar A, Akhshik H. Adding a smartphone app to global postural re-education to improve neck pain, posture, quality of life, and endurance in people with nonspecific neck pain: a randomized controlled trial. Trials. 2021 Apr 12;22(1):274. doi: 10.1186/s13063-021-05214-8.
PubMed 33845880Chaudhuri S, Chawla JK, Phadke V. Physiotherapeutic Interventions for Upper Cross Syndrome: A Systematic Review and Meta-Analysis. Cureus. 2023 Sep 18;15(9):e45471. doi: 10.7759/cureus.45471. eCollection 2023 Sep.
PubMed 37859911Chang 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 37628525Gillani SN, Ain Q-, Rehman SU, Masood T. Effects of eccentric muscle energy technique versus static stretching exercises in the management of cervical dysfunction in upper cross syndrome: a randomized control trial. J Pak Med Assoc. 2020 Mar;70(3):394-398. doi: 10.5455/JPMA.300417.
PubMed 32207413Mendes Fernandes T, Mendez-Sanchez R, Puente-Gonzalez AS, Martin-Vallejo FJ, Falla D, Vila-Cha C. A randomized controlled trial on the effects of "Global Postural Re-education" versus neck specific exercise on pain, disability, postural control, and neuromuscular features in women with chronic non-specific neck pain. Eur J Phys Rehabil Med. 2023 Feb;59(1):42-53. doi: 10.23736/S1973-9087.22.07554-2. Epub 2023 Jan 4.
PubMed 36598342Karimian R, Rahnama N, Ghasemi G, Lenjannejadian S. Photogrammetric Analysis of Upper Cross Syndrome among Teachers and the Effects of National Academy of Sports Medicine Exercises with Ergonomic Intervention on the Syndrome. J Res Health Sci. 2019 Jul 3;19(3):e00450.
PubMed 31586371
Study at a glance
From the registry record, last updated by the sponsor on 14 Apr 2026. Recruitment status is as the sponsor reported it: confirm with the study team.
- Official title
- Comparative Effects of Global Postural Re-education and NASM-based Corrective Exercises in Patients With Upper Cross Syndrome (UCS)
- ClinicalTrials.gov ID
- NCT07528248
- Acronym / sponsor ID
- IRB/FAHS/REHAB/10/25/MS/RS3458
- Conditions
- Upper Cross Syndrome
- Study type
- Interventional
- Recruitment status
- Recruiting
- Enrolment
- 46 participants (estimated)
- Lead sponsor
- Rehana HayatUniversity, hospital or other
- Study start
- 5 Mar 2026 (actual)
- Primary completion
- 10 May 2026 (estimated)
- Study completion
- 10 May 2026 (estimated)
- First posted
- 14 Apr 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.
The goal of this clinical trial is to learn the comparative effects of Global postural re-education (GPR) and National Academy of Sports Medicine (NASM) based corrective exercises in participants with upper cross syndrome (UCS). The main questions it aims to answer:
- Is there any difference between the effects of GPR and NASM-based corrective exercises in decreasing pain and disability and improving endurance in participants with upper cross syndrome?
- Is there any difference between the effects of GPR and NASM-based corrective exercises in improving cranio-vertebral angle of participants with upper cross syndrome? Researchers will compare GPR and NASM-based corrective exercises to see if there is difference between the two treatments in decreasing pain, disability and improving endurance and cranio-vertebral angle.
Participants will be:
- Given treatment 3 times a week for 8 weeks.
- Assessed before first treatment session (baseline), at 4th week of intervention and at the end of last treatment session (8th week).
Study design
- Primary purpose
- Treatment
- Allocation
- Randomised
- Intervention model
- Parallel groups
- Masking
- Triple blind (participant, care provider, investigator)
- Number of arms
- 2
| Arm | Type | Receives |
|---|---|---|
| GPR+ Conventional Treatment | Active comparator | Other: Global Postural Re-educationParticipants in this arm will receive Global Postural re-education treatment in addition to the routine/conventional evidence based physiotherapy treatment. Participants will be asked to repeat each exercise three times a week for 8 weeks. |
| NASM-based corrective exercises + Conventional Treatment | Active comparator | Other: NASM-based Corrective exercisesParticipants in this arm will receive NASM-based corrective exercises in addition to the conventional treatment. Participants will be asked to repeat each exercise 10 to 15 times, for 1-2 sets, three times a week for 8 weeks. |
Who may qualify
- Ages
- 20 to 45 years
- Sex
- All
- Healthy volunteers
- Not accepted
- Age groups
- Adult
Key inclusion criteria (6 listed)
- Age between 20-45 years
- Pain in the upper back and neck region.
- Both male and female patients
- Rounded shoulders
- Craniovertebral angle less than 47 degrees
Key exclusion criteria (4 listed)
- History of spinal surgery
- Neurological deficits (radiculopathy, myelopathy, disc herniation)
- Severe scoliosis or structural deformity
- Active cervical spine pathology (spondylosis, stenosis and fracture)
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 |
|---|---|---|
| Global Postural Re-educationAlso: GPRGlobal Postural Re-education 1st position: Patient will lie in supine, shoulders abducted to 30°, forearms supinated and the pelvis will be kept in a neutral position, while the lumbar spine remain supported. This position is characterized by a progression from flexion to extension of both hips and knees. 2nd position: Patient will remain in supine with their hips at 90° of flexion and perform gradual knee extensions. The participants will remain between 15 \& 20 min in each of these two positions. Under the supervision and verbal and/or manual guidance of the physiotherapist performing the intervention, they will perform 5-10s isomet contractions of the antagonist muscles of the muscle chain targeted by each posture. Subjects can also make active adjustments to their position, the physiotherapist can favor with some manual contact, sustained stretching and some joint traction to complete the session, the participants will be requested to maintain an upright posture in standing for 5min | Other | GPR+ Conventional Treatment |
| NASM-based Corrective exercisesAlso: National Academy of Sports Medicine Corrective exercisesNASM-based Corrective Exercises The four-stage exercise for UCS begins with preventing or reducing excessive muscle contraction (frequent foam wrapping), relaxing these same muscles, which fully eliminates dysfunctional muscles, and finally restores functional mobility. Step 1: inhibit or self-myofascial release overactive muscles: It includes the levator scapulae, trapezius (upper fibre), and sternocleidomastoid muscles. Hold pressure will be applied for 30 s on the tender spots. Step 2: Lengthen/ Static stretch. Upper trapezius Levator scapulae Sternocleidomastoid (SCM) Step 3: Activate/Strengthen. Chin tucks Floor Cobra Step 4: Integrate. Ball combination A routine/conventional evidence based physiotherapy treatment will also be given to both arms. | Other | NASM-based corrective exercises + Conventional Treatment |
Primary outcome
Mean change in endurance from baseline on Progressive iso-inertial lifting evaluation (PILE) test at 4 weeks and 8 weeks
Time frame: From enrollment (before first treatment session) to the end of treatment at 8 weeks.
Progressive iso-inertial lifting evaluation (PILE) test has been recommended as a functional test to measure muscle endurance and involves lifting weights from waist to shoulder height (30-54 in.). Participants will begin with an 8- pound load and a 13-pound load for females and males respectively. Weight will be subsequently increased at a rate equal to the initial free weight every 20 s. Four lifting movements will actually performed at 20-s intervals. The test end-point will be established when aerobic capacity or neuromuscular fatigue being felt.
Mean change in pain score from baseline on Numeric Pain Rating Scale (NPRS) at 4 weeks and 8 weeks
Time frame: From enrollment (before first treatment session) to the end of treatment at 8 weeks.
The NPRS is an 11-point scale (0, no pain; 10, worst imaginable pain) used to assess the intensity of pain. Participants will be asked to rate their pain from 0 to 10.
Mean change in disability score from baseline on Neck Disability Index (NDI) at 4 weeks and 8 weeks
Time frame: From enrollment (before first treatment session) to the end of treatment at 8 weeks.
The NDI is 10 questions and each question has a possible total score of zero to 5. The total score from all 10 questions is divided by 50, the maximum score possible, with total scores expressed in percentage. Higher percentage scores indicate a worst disability.
1 secondary outcome
Mean change in the Craniovertebral angle from baseline at 4 weeks and 8 weeks
Time frame: From enrollment (before first treatment session) to the end of treatment at 8 weeks.
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 Apr 2026.
- BackgroundAzam H, Fatima N, Asjad A, Ashraf I, Asif T, Rehman F. Comparative effects of comprehensive corrective exercises versus muscle energy techniques in patients with upper cross syndrome: A randomized controlled trial: corrective exercises vs muscle energy techniques in patients with upper cross syndrome. Pakistan BioMedical Journal. 2022 Jul 31:173-7.
- BackgroundAlmasoodi MC, Mahdavinejad R, Ghasmi G. The effect of 8 weeks national academy of sports medicine exercises training on posture, shoulder pain, and functional disability in male with upper cross syndrome. spine (cervicothoracic angle). 2020;21:22.
- Background: PubMed 33845880Abadiyan F, Hadadnezhad M, Khosrokiani Z, Letafatkar A, Akhshik H. Adding a smartphone app to global postural re-education to improve neck pain, posture, quality of life, and endurance in people with nonspecific neck pain: a randomized controlled trial. Trials. 2021 Apr 12;22(1):274. doi: 10.1186/s13063-021-05214-8.
- Background: PubMed 37859911Chaudhuri S, Chawla JK, Phadke V. Physiotherapeutic Interventions for Upper Cross Syndrome: A Systematic Review and Meta-Analysis. Cureus. 2023 Sep 18;15(9):e45471. doi: 10.7759/cureus.45471. eCollection 2023 Sep.
- 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.
- Background: PubMed 32207413Gillani SN, Ain Q-, Rehman SU, Masood T. Effects of eccentric muscle energy technique versus static stretching exercises in the management of cervical dysfunction in upper cross syndrome: a randomized control trial. J Pak Med Assoc. 2020 Mar;70(3):394-398. doi: 10.5455/JPMA.300417.
- Background: PubMed 36598342Mendes Fernandes T, Mendez-Sanchez R, Puente-Gonzalez AS, Martin-Vallejo FJ, Falla D, Vila-Cha C. A randomized controlled trial on the effects of "Global Postural Re-education" versus neck specific exercise on pain, disability, postural control, and neuromuscular features in women with chronic non-specific neck pain. Eur J Phys Rehabil Med. 2023 Feb;59(1):42-53. doi: 10.23736/S1973-9087.22.07554-2. Epub 2023 Jan 4.
- Background: PubMed 31586371Karimian R, Rahnama N, Ghasemi G, Lenjannejadian S. Photogrammetric Analysis of Upper Cross Syndrome among Teachers and the Effects of National Academy of Sports Medicine Exercises with Ergonomic Intervention on the Syndrome. J Res Health Sci. 2019 Jul 3;19(3):e00450.
- Google Scholar is a search engine for articlesLink provided by the sponsor.
- Related InfoLink provided by the sponsor.
- PEDro is a physiotherapy related research databaseLink provided by the sponsor.
- Individual participant dataSharing planned: Yes
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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 Global Postural Re-education and NASM-based Corrective exercises in people with Upper Cross Syndrome, run by Rehana Hayat 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 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: looking for participants now, as of the sponsor's last update on 14 Apr 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?
Each site lists its own contact: choose the nearest one under Trial locations. AzTrials does not enrol participants or take referrals.
What does the primary outcome measure?
Mean change in endurance from baseline on Progressive iso-inertial lifting evaluation (PILE) test at 4 weeks and 8 weeks (time frame: From enrollment (before first treatment session) to the end of treatment at 8 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 NCT07528248, 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 Apr 2026.