Upper Cross SyndromeNCT07573553
Effectiveness of Rib Mobilization Combined With Postural Correction Exercises in Individuals With Upper Crossed Syndrome
A study testing Rib Mobilization and Postural Correction Exercises and Postural Correction Exercises Only in people with Upper Cross Syndrome, run by Riphah International University at 1 site in Pakistan.
Trial summary
This randomized controlled trial aims to evaluate the effectiveness of rib mobilization combined with postural correction exercises in reducing pain, improving cervical posture, and enhancing rib and thoracic mobility among individuals with Upper Crossed 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?
- Rib Mobilization and Postural Correction Exercises and Postural Correction Exercises Only
- Type of treatment
- Lifestyle or therapy programme
- Could I receive a placebo?
- No, everyone receives an active treatment
- How many people
- 64 participants
- Where
- 1 sitePakistan
- Study dates
- 16 Oct 2025to 28 Jun 2026
- Phase
- Interventional
- Are there results?
- Not yet: the study is under way
Key requirements
Who can take part, as listed by the sponsor. Only the study team can confirm whether you are eligible, so take this list to your doctor.
- Ages 20 to 45 years
- All sexes
- No healthy volunteers
- Adult
Who may be able to join
- Age between 20 to 45 years
- Forward head posture (craniovertebral angle < 50°)
- Cervical pain or discomfort for ≥4 weeks
- Moderate pain intensity (VAS 3-6)
- Willingness to participate and provide informed consent
- Clinically diagnosed Upper Crossed Syndrome (UCS)
- Meets Asian Fitness Society diagnostic criteria for UCS
Who cannot join
- History of trauma or surgery to cervical/thoracic spine
- Cervical disc herniation, radiculopathy, or neurological deficits
- Structural deformities (scoliosis, Scheuermann's disease)
- Systemic musculoskeletal disorders (e.g., rheumatoid arthritis)
- Vestibular, balance, or visual disorders
- Recent similar therapy within 3 months
- Pregnancy or contraindication to manual therapy
- Ongoing use of pain medications or muscle relaxants
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 Headquater Haripur
Chak Six Hundred Twenty-four, Khyber Pakhtunkhwat, 22620
Attiq ur Rehman, MS, +923361055533, attiq.rehman@riphah.edu.pk
Altamash Hussain, DPT, +923088805119
About this study
This randomized controlled trial aims to evaluate the effectiveness of rib mobilization combined with postural correction exercises in reducing pain, improving cervical posture, and enhancing rib and thoracic mobility among individuals with Upper Crossed Syndrome (UCS). A total of 64 participants aged 20-45 years will be recruited and randomly assigned to two groups: Group A (rib mobilization + postural correction) and Group B (postural correction only). Intervention will be provided for 4-6 weeks, three sessions per week. Outcomes will include pain (VAS), cervical posture (inclinometer), and rib/thoracic mobility (tape measure). Data will be analyzed using SPSS version 26.
Read the detailed description
Upper Crossed Syndrome (UCS) is a common musculoskeletal disorder that arises from sustained poor posture, leading to muscular imbalance and functional impairment in the upper body. The syndrome is characterized by forward head posture, increased cervical lordosis, and thoracic kyphosis caused by tightness in the upper trapezius, levator scapulae, and pectoralis muscles, and weakness in the deep cervical flexors, lower trapezius, and serratus anterior. This imbalance not only affects spinal alignment but also restricts rib mobility and thoracic extension, contributing to chronic neck and upper back pain.
Rib mobilization techniques focus on restoring the normal motion of the ribs and thoracic spine, improving chest expansion and flexibility. When combined with postural correction exercises, these interventions may correct alignment, reduce pain, and enhance thoracic mobility. Postural correction exercises aim to stretch overactive muscles and strengthen weakened ones to restore functional balance. Together, these methods are hypothesized to provide superior outcomes compared to postural exercises alone.
Previous studies have demonstrated the efficacy of either rib mobilization or postural correction in isolation. However, limited evidence exists regarding their combined use for UCS. This study seeks to fill this gap by examining the synergistic effects of both interventions on pain relief, postural correction, and thoracic mobility. Findings may contribute to developing an evidence-based rehabilitation protocol for UCS.
- Conditions
- Upper Cross Syndrome
- Being tested
- Rib Mobilization and Postural Correction Exercises, Postural Correction Exercises Only
- 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.
Rib Mobilization and Postural Correction ExercisesBehavioural
Participants will receive Grade I-III rib mobilizations at the costovertebral and costotransverse joints (ribs 2-6) along with thoracic central posterior-anterior mobilizations. In addition, postural correction exercises including scapular retraction, deep neck flexor training, pectoralis stretching, and thoracic extension exercises will be performed. Each session will last 30-40 minutes, three times per week for 4-6 weeks.
Postural Correction Exercises OnlyOther
Participants will perform only postural correction exercises, including scapular retraction, deep neck flexor training, pectoralis stretching, and thoracic extension exercises. Sessions will last 30-40 minutes, three times per week for 4-6 weeks.
| Study group | Role | What they receive |
|---|---|---|
| Intervention group | Experimental | Group receiving Rib Mobilization + Postural Correction Exercises Receives: Behavioral: Rib Mobilization and Postural Correction Exercises |
| Control group | Active comparator | Group receiving Postural Correction Exercises Only Receives: Other: Postural Correction Exercises Only |
What is being measured
The primary outcome is the main question the study is designed to answer.
Pain Intensity
- Pain Intensity - Measured using the Visual Analog Scale (VAS) ranging from 0 (no pain) to 10 (worst pain).
Measured: 1 year
Cervical Posture
Cervical Posture - Measured using an inclinometer to determine the craniovertebral angle.
Measured: 1 year
Rib/Thoracic Mobility
Rib/Thoracic Mobility - Measured using a tape measure and inclinometer to assess rib cage expansion and thoracic extension.
Measured: 1 year
Timeline
From the start of the study to its completion; the mark is today. Estimated dates are the sponsor’s plan.
- First posted7 May 2026
- Study start16 Oct 2025
- Primary completion28 Jun 2026 (estimated)
- Study completion28 Jun 2026 (estimated)
Resources
- Official record on ClinicalTrials.govThe registry entry this page is built from, with its full change history.
- Publications (4)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
- Single blind
- Who is masked
- Participant
- Enrolment
- 64 participants (estimated)
Sponsor and investigators
- Lead sponsor
- Riphah International University
- Sponsor type
- University, hospital or other
- Responsible party
- Sponsor
- Investigators
- Attiq Ur Rehman, MS, Principal investigator, Riphah International University
IDs, dates and publications
- ClinicalTrials.gov ID
- NCT07573553
- Sponsor's protocol ID
- REC/02285 Altamash
- Status last verified
- Apr 2026
- First submitted
- 30 Apr 2026
- Last updated
- 7 May 2026
- Results posted
- No
- Data monitoring committee
- Yes
- FDA-regulated drug
- No
- FDA-regulated device
- No
- Individual data sharing
- No
Publications
Sepehri S, Sheikhhoseini R, Piri H, Sayyadi P. The effect of various therapeutic exercises on forward head posture, rounded shoulder, and hyperkyphosis among people with upper crossed syndrome: a systematic review and meta-analysis. BMC Musculoskelet Disord. 2024 Feb 1;25(1):105. doi: 10.1186/s12891-024-07224-4.
PubMed 38302926Bayattork M, Skold MB, Sundstrup E, Andersen LL. Exercise interventions to improve postural malalignments in head, neck, and trunk among adolescents, adults, and older people: systematic review of randomized controlled trials. J Exerc Rehabil. 2020 Feb 26;16(1):36-48. doi: 10.12965/jer.2040034.017. eCollection 2020 Feb.
PubMed 32161733Chang 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 37628525Arshadi R, Ghasemi GA, Samadi H. Effects of an 8-week selective corrective exercises program on electromyography activity of scapular and neck muscles in persons with upper crossed syndrome: Randomized controlled trial. Phys Ther Sport. 2019 May;37:113-119. doi: 10.1016/j.ptsp.2019.03.008. Epub 2019 Mar 21.
PubMed 30928841
Study at a glance
From the registry record, last updated by the sponsor on 7 May 2026. Recruitment status is as the sponsor reported it: confirm with the study team.
- Official title
- Effectiveness of Rib Mobilization Combined With Postural Correction Exercises in Individuals With Upper Crossed Syndrome
- ClinicalTrials.gov ID
- NCT07573553
- Acronym / sponsor ID
- REC/02285 Altamash
- Conditions
- Upper Cross Syndrome
- Study type
- Interventional
- Recruitment status
- Recruiting
- Enrolment
- 64 participants (estimated)
- Lead sponsor
- Riphah International UniversityUniversity, hospital or other
- Study start
- 16 Oct 2025 (actual)
- Primary completion
- 28 Jun 2026 (estimated)
- Study completion
- 28 Jun 2026 (estimated)
- First posted
- 7 May 2026 (actual)
- Results
- Not posted in the source record
Clinical summary
The research question as the sponsor registered it. This describes what the study plans to test, not what it found.
This randomized controlled trial aims to evaluate the effectiveness of rib mobilization combined with postural correction exercises in reducing pain, improving cervical posture, and enhancing rib and thoracic mobility among individuals with Upper Crossed Syndrome (UCS). A total of 64 participants aged 20-45 years will be recruited and randomly assigned to two groups: Group A (rib mobilization + postural correction) and Group B (postural correction only). Intervention will be provided for 4-6 weeks, three sessions per week. Outcomes will include pain (VAS), cervical posture (inclinometer), and rib/thoracic mobility (tape measure). Data will be analyzed using SPSS version 26.
Detailed description
Upper Crossed Syndrome (UCS) is a common musculoskeletal disorder that arises from sustained poor posture, leading to muscular imbalance and functional impairment in the upper body. The syndrome is characterized by forward head posture, increased cervical lordosis, and thoracic kyphosis caused by tightness in the upper trapezius, levator scapulae, and pectoralis muscles, and weakness in the deep cervical flexors, lower trapezius, and serratus anterior. This imbalance not only affects spinal alignment but also restricts rib mobility and thoracic extension, contributing to chronic neck and upper back pain.
Rib mobilization techniques focus on restoring the normal motion of the ribs and thoracic spine, improving chest expansion and flexibility. When combined with postural correction exercises, these interventions may correct alignment, reduce pain, and enhance thoracic mobility. Postural correction exercises aim to stretch overactive muscles and strengthen weakened ones to restore functional balance. Together, these methods are hypothesized to provide superior outcomes compared to postural exercises alone.
Previous studies have demonstrated the efficacy of either rib mobilization or postural correction in isolation. However, limited evidence exists regarding their combined use for UCS. This study seeks to fill this gap by examining the synergistic effects of both interventions on pain relief, postural correction, and thoracic mobility. Findings may contribute to developing an evidence-based rehabilitation protocol for UCS.
Study design
- Primary purpose
- Treatment
- Allocation
- Randomised
- Intervention model
- Parallel groups
- Masking
- Single blind (participant)
- Number of arms
- 2
| Arm | Type | Receives |
|---|---|---|
| Intervention group | Experimental | Behavioral: Rib Mobilization and Postural Correction ExercisesGroup receiving Rib Mobilization + Postural Correction Exercises |
| Control group | Active comparator | Other: Postural Correction Exercises OnlyGroup receiving Postural Correction Exercises Only |
Who may qualify
- Ages
- 20 to 45 years
- Sex
- All
- Healthy volunteers
- Not accepted
- Age groups
- Adult
Key inclusion criteria (7 listed)
- Age between 20 to 45 years
- Forward head posture (craniovertebral angle < 50°)
- Cervical pain or discomfort for ≥4 weeks
- Moderate pain intensity (VAS 3-6)
- Willingness to participate and provide informed consent
Key exclusion criteria (8 listed)
- History of trauma or surgery to cervical/thoracic spine
- Cervical disc herniation, radiculopathy, or neurological deficits
- Structural deformities (scoliosis, Scheuermann's disease)
- Systemic musculoskeletal disorders (e.g., rheumatoid arthritis)
- Vestibular, balance, or visual disorders
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 |
|---|---|---|
| Rib Mobilization and Postural Correction ExercisesParticipants will receive Grade I-III rib mobilizations at the costovertebral and costotransverse joints (ribs 2-6) along with thoracic central posterior-anterior mobilizations. In addition, postural correction exercises including scapular retraction, deep neck flexor training, pectoralis stretching, and thoracic extension exercises will be performed. Each session will last 30-40 minutes, three times per week for 4-6 weeks. | Behavioural | Intervention group |
| Postural Correction Exercises OnlyParticipants will perform only postural correction exercises, including scapular retraction, deep neck flexor training, pectoralis stretching, and thoracic extension exercises. Sessions will last 30-40 minutes, three times per week for 4-6 weeks. | Other | Control group |
Primary outcome
Pain Intensity
Time frame: 1 year
1. Pain Intensity - Measured using the Visual Analog Scale (VAS) ranging from 0 (no pain) to 10 (worst pain).
Cervical Posture
Time frame: 1 year
Cervical Posture - Measured using an inclinometer to determine the craniovertebral angle.
Rib/Thoracic Mobility
Time frame: 1 year
Rib/Thoracic Mobility - Measured using a tape measure and inclinometer to assess rib cage expansion and thoracic extension.
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 7 May 2026.
- Background: PubMed 38302926Sepehri S, Sheikhhoseini R, Piri H, Sayyadi P. The effect of various therapeutic exercises on forward head posture, rounded shoulder, and hyperkyphosis among people with upper crossed syndrome: a systematic review and meta-analysis. BMC Musculoskelet Disord. 2024 Feb 1;25(1):105. doi: 10.1186/s12891-024-07224-4.
- Background: PubMed 32161733Bayattork M, Skold MB, Sundstrup E, Andersen LL. Exercise interventions to improve postural malalignments in head, neck, and trunk among adolescents, adults, and older people: systematic review of randomized controlled trials. J Exerc Rehabil. 2020 Feb 26;16(1):36-48. doi: 10.12965/jer.2040034.017. eCollection 2020 Feb.
- 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 30928841Arshadi R, Ghasemi GA, Samadi H. Effects of an 8-week selective corrective exercises program on electromyography activity of scapular and neck muscles in persons with upper crossed syndrome: Randomized controlled trial. Phys Ther Sport. 2019 May;37:113-119. doi: 10.1016/j.ptsp.2019.03.008. Epub 2019 Mar 21.
- 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.
Attiq Ur Rehman, MS 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 Rib Mobilization and Postural Correction Exercises and Postural Correction Exercises Only 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 7 inclusion and 8 exclusion criteria. Eligibility is decided by the study team after screening, so read the full criteria and contact a listed site.
Is this clinical trial currently recruiting?
The record says: looking for participants now, as of the sponsor's last update on 7 May 2026. Status can change between updates, so confirm with the study contact before making plans.
Where is the study taking place?
The record lists 1 site in Pakistan. Whether a site is taking part right now should be confirmed with that site. See every site.
What are the possible benefits and risks?
They depend on the study and the treatment, and no study can promise a benefit. The study team explains the known risks during informed consent, before anyone joins; the record itself does not list them.
Are results available for this study?
This study is still under way. Results are not available in the source record yet.
How can a doctor refer a patient or contact the research team?
Contact Altamash Hussain Khan, DPT (+92 3088805119, altamash.hussain1@icloud.com), or a site near the patient. AzTrials does not enrol participants or take referrals.
What does the primary outcome measure?
Pain Intensity (time frame: 1 year). 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 NCT07573553, which also lists 4 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 7 May 2026.