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Upper Cross SyndromeNCT07724574

Kendall Versus Janda's Approach Along With Diaphragmatic Breathing Exercises in Upper Crossed Syndrome

A study testing Kendall exercises and Janda's Approach in people with Upper Cross Syndrome, run by Riphah International University at 1 site in Pakistan.

Recruiting

Looking for participants now. Contact the study team or a site below to ask about taking part.

Sites and contacts
Official record
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Trial summary

Upper Crossed Syndrome (UCS) is a postural imbalance in the upper body characterized by shortened and tight muscles in the front and upper back, while weak muscles in the back and neck are stretched and underactive. Read more about this study

Who is it for?
Ages 30 to 50 years
Conditions the study is for
Upper Cross Syndrome
What is being tested?
Kendall exercises and Janda's Approach
Could I receive a placebo?
No, everyone receives an active treatment
How many people
50 participants
Where
1 sitePakistan
Study dates
20 Jun 2026to 20 Sep 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 30 to 50 years
  • All sexes
  • No healthy volunteers
  • Adult

Who may be able to join

  • Age between 30 to 50 years old Both male and female are included, Craniovertebral angle less than 50°, Rounded shoulders (on photogrammetry)

Who cannot join

  • Cervical trauma or surgery Congenital scoliosis Spasmodic torticollis Any tumor or trauma History of surgical procedures on neck or lower back Disc issues in neck or lower back

Trial locations and contacts

1 site in 1 country. Contact the study team or a site near you to ask about taking part.

Amna Zia, PhD* contact

03244686993

amna.zia@kemu.edu.pk

Samrood Akram, PhD* contact

03324806143

samrood.akram@riphah.edu.pk

Pakistan1 site, 1 recruiting
  • Anwars Polyclinic

    Sialkot, Punjab Province

    Shaban Anwar, MS-OMPT, 0332 8609425, shani_gh85@yahoo.com

    Recruiting

Other trials in Pakistan

About this study

Official title: Comparative Effects of Kendall Versus Janda's Approach Along With Diaphragmatic Breathing Exercises on Pain, Chest Expansion, Cranio Vertebral Angle, and Disability in Upper Crossed Syndrome

Upper Crossed Syndrome (UCS) is a postural imbalance in the upper body characterized by shortened and tight muscles in the front and upper back, while weak muscles in the back and neck are stretched and underactive. This imbalance can lead to forward head posture, rounded shoulders, and increased spinal curves, causing pain, headaches, and reduced range of motion. The study aims to compare the effects of Kendall exercises with Janda's Approach along with Diaphragmatic breathing exercises on pain, chest expansion, craniovertebral angle, and disability in upper crossed syndrome.

Read the detailed description

This randomized clinical trial study will be conducted at Central Hospital and Anwer's Polyclinic, Sialkot. We will include 50 patients (25 in each group) of Upper Crossed Syndrome with an age range of 30-50 years, both male and female will be included. Group A will be provided Kendall Exercises with Diaphragmatic breathing exercises, and Group B will receive Janda's with diaphragmatic breathing exercises. Both interventions will be administered for 45 minutes per session, three times per week, for a total duration of six weeks. Outcome measures will include NPRS for pain, Neck Disability Index for disability, Universal goniometer for cranio vertebral angle, and a measuring tape for thoracic expansion will be used. The collected data will be analyzed in the Statistical Package for the Social Sciences (SPSS) 26.0 version. If the data is normally distributed, then a parametric if not normally distributed than a nonparametric test will be applied.

Being tested
Kendall exercises, Janda's Approach
Keywords
upper crossed syndrome, breathing, disability
Medical subject headings
Oculocerebral hypopigmentation syndrome type Preus, Respiratory Aspiration

What participants receive

What participants receive. In a randomised study each person is assigned to one group by chance.

  • Kendall exercisesOther

    Stretching: Pectoralis, Upper Trapezius, Levator Scapulae (2 sets of 20 sec each) Strengthening: Scapular retractors with Thera band (2 sets of10 reps), Chin tucks (2 sets of 10 reps), Diaphragmatic breathing (4 mins) Strengthening: Add isometric cervical flexors (5 sec hold with 5 reps),, Chin tucks \& scapular retractors (3 sets of 10 reps) Strengthening: Add scapular squeeze (5 sec hold of 5 reps), Emphasize postural control during exercises Strengthening: Functional posture tasks (e.g., seated posture with resistance), Maintain 15 reps of 3 sets

    Anterior (Wall Slides), Deep Neck Flexors - 2 sets of 10 reps Diaphragmatic breathing (4 mins), Neck Flexor Hold: 30 sec × 3 sets Add Dumbbell Shrugs, Table Pushes - 3 sets of 10 reps Add Serratus Anterior Upper Cuts (3 sets of 10 reps) strengthening increased to 12-15 reps per set (all muscle groups). Functional integration: Posture tasks during daily movement

  • Janda's ApproachOther

    Stretching: Levator scapulae, Upper Trapezius, Pectoralis (doorway/towel) - 2 sets × 30 sec each, Strengthening: Middle \& Lower Trapezius, Serratus Anterior (Wall Slides), Deep Neck Flexors - 2 sets × 10 reps, Diaphragmatic breathing (4 mins) Neck Flexor Hold: 30 sec × 3 sets Add Dumbbell Shrugs, Table Pushes 3 sets × 10 reps Add Serratus Anterior Upper Cuts (3 sets × 10 reps) strengthening increased to 12-15 reps per set (all muscle groups). Maintain 3 sets of stretching.

    Functional integration: Posture tasks during daily movement (e.g., reaching, sitting)

Study groups in NCT07724574
Study groupRoleWhat they receive
Kendall exercisesExperimentalKendall exercisesare a set of physical therapy movements designed to correct postural faults like Forward Head Posture (FHP), kyphosis, and rounded shoulders. They focus on correcting muscle imbalances through targeted stretching and strengthening.
Receives: Other: Kendall exercises
Janda's ApproachActive comparatorJanda's approach is a functional rehabilitation method focusing on how the central nervous system controls muscles and movement. It emphasizes correcting muscle imbalances-where some muscles are overly tight and others are weak or inhibited-to alleviate chronic pain
Receives: Other: Janda's Approach

What is being measured

The primary outcome is the main question the study is designed to answer.

  1. NUMERIC PAIN RATE SCALE (NPRS) for pain

    It is a self-reported scale that measures pain intensity on a scale from 0 (no pain) to 10 (worst possible pain). It is widely used in musculoskeletal conditions for monitoring pain levels over time. The NPRS has demonstrated high validity (r = 0.85 with VAS) and excellent test-retest reliability (ICC = 0.92-0.96). The MCID for NPRS is generally considered to be 2 points, indicating a meaningful improvement or worsening in pain perception

    Measured: upto 6 weeks

  2. NECK DISABILITY INDEX (NDI)

    It is a validated questionnaire consisting of 10 items that assess the functional impact of neck pain on daily activities such as personal care, work, driving, and recreation. It is specific to cervical conditions. The NDI has strong content validity, with excellent internal consistency (α = 0.87) and test-retest reliability (ICC = 0.89). The MCID for NDI has been reported to range from 5 to 7 points, representing a clinically important change in neck-related disability

    Measured: upto 6 weeks

  3. UNIVERSAL GONIOMETER for ROM

    It is used to measure the craniovertebral angle (CVA), an objective indicator of forward head posture in individuals. A CVA less than 50° typically indicates abnormal posture. This tool shows good validity and excellent intra-rater reliability (ICC = 0.80-0.98) for cervical spine angle measurements. While an exact MCID for CVA is not firmly established, a change of 3-5 degrees is often considered clinically meaningful in postural correction studies

    Measured: Upto 6 weeks

  4. MEASURING TAPE

    t is a simple and cost-effective tool used to assess chest expansion, which reflects thoracic mobility and respiratory function. The measurement is taken by placing the tape around the chest at the level of the fourth intercostal space during full inhalation and exhalation. It has acceptable criterion validity and demonstrates high intra-rater reliability (ICC = 0.91-0.94), making it suitable for tracking changes in chest mobility during postural or breathing interventions. The MCID for chest expansion is not universally defined, but an increase of 0.5 to 1.0 cm is generally considered clinically relevant in pulmonary and postural rehabilitation contexts

    Measured: Upto 6 weeks

Timeline

From the start of the study to its completion; the mark is today. Estimated dates are the sponsor’s plan.

  1. First posted24 Jul 2026
  2. Study start20 Jun 2026
  3. Primary completion20 Aug 2026 (estimated)
  4. Study completion20 Sep 2026 (estimated)

Resources

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
50 participants (estimated)
IDs, dates and publications
ClinicalTrials.gov ID
NCT07724574
Sponsor's protocol ID
REC/RCR & AHS/25/0134 Kinza
Status last verified
Jul 2026
First submitted
21 Jul 2026
Last updated
24 Jul 2026
Results posted
No
FDA-regulated drug
No
FDA-regulated device
No
Individual data sharing
No

Publications

  • Aneis YM, El-Badrawy NM, El-Ganainy AA, Atta HK. The effectiveness of a multimodal approach in the treatment of patients with upper crossed syndrome: A randomized controlled trial. J Bodyw Mov Ther. 2022 Oct;32:130-136. doi: 10.1016/j.jbmt.2022.05.011. Epub 2022 May 18.

    PubMed 36180139
  • Chang 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 37628525
  • 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 31040591
  • Mubashir M. A cross-sectional survey on prevalence of upper cross syndrome and its correlation to WRMSDS in working physiotherapists. Pakistan Journal of Rehabilitation. 2021;10(1):42-50.

  • Yang S, Boudier-Reveret M, Yi YG, Hong KY, Chang MC. Treatment of Chronic Neck Pain in Patients with Forward Head Posture: A Systematic Narrative Review. Healthcare (Basel). 2023 Sep 22;11(19):2604. doi: 10.3390/healthcare11192604.

    PubMed 37830641
  • Joshi R, Poojary N. The Effect of Muscle Energy Technique and Posture Correction Exercises on Pain and Function in Patients with Non-specific Chronic Neck Pain Having Forward Head Posture-a Randomized Controlled Trail. Int J Ther Massage Bodywork. 2022 Jun 1;15(2):14-21. doi: 10.3822/ijtmb.v15i2.673. eCollection 2022 Jun.

    PubMed 35686175
  • Oakley PA, Moustafa IM, Haas JW, Betz JW, Harrison DE. Two Methods of Forward Head Posture Assessment: Radiography vs. Posture and Their Clinical Comparison. J Clin Med. 2024 Apr 8;13(7):2149. doi: 10.3390/jcm13072149.

    PubMed 38610914
  • Mol N, Abeeshna A, Kumar D. Upper crossed syndrome: trends and recent advances in the physiotherapy treatment a narrative review. J Pharm Res Int. 2021;33(64B):359-67

  • Yu L, Gu Q, Kim T. The effects of cervical stabilization exercises with breathing exercises on respiratory function in subjects with forward head posture. WSEAS Transactions on Systems and Control. 2021;16:486-92.

  • Koo D-J, Park S-C, Park J-Y, Jung J-W, Kwon H-G. Effect of Breathing TechniqueBased Exercises on Alignment and Mechanical Properties of Muscles Related to Upper Cross Syndrome. Journal of the Korean Society of Physical Medicine. 2024;19(4):21-33

Questions about this trial

What is this clinical trial studying?

A study testing Kendall exercises and Janda's Approach 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 1 inclusion and 1 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 24 Jul 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 Amna Zia, PhD* (03244686993, amna.zia@kemu.edu.pk), or a site near the patient. AzTrials does not enrol participants or take referrals.

What does the primary outcome measure?

NUMERIC PAIN RATE SCALE (NPRS) for pain (time frame: upto 6 weeks). The study lists 4 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 NCT07724574, which also lists 10 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 24 Jul 2026.

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