Upper Crossed SyndromeNCT07773857
Comparison of Proprioceptive Neuromuscular Facilitation and Patient Education in Upper Crossed Syndrome
A study testing Patient Education and PNF in people with Upper Crossed Syndrome and Forward Head Posture, run by Atlas University at 1 site in Turkey (Türkiye).
Trial summary
The aim of this study is to investigate the effects of exercises applied using the Proprioceptive Neuromuscular Facilitation (PNF) technique on pain, joint range of motion, muscle strength, and posture in individuals with Upper Crossed Syndrome, and to compare these effects with patient education. Read more about this study
- Who is it for?
- Ages 18 years and older
- Conditions the study is for
- Upper Crossed Syndrome, Forward Head Posture, Rounded Shoulder Posture
- What is being tested?
- Patient Education and PNF
- Type of treatment
- Lifestyle or therapy programme
- Could I receive a placebo?
- No, everyone receives an active treatment
- How many people
- 38 participants
- Where
- 1 siteTurkey (Türkiye)
- Study dates
- 5 Mar 2026to 15 Jul 2026
- Phase
- Interventional
- Are there results?
- None posted in the registry
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 years and older
- All sexes
- No healthy volunteers
- Adult, Older adult
Who may be able to join
- Age 18 years or older
- Clinically diagnosed with Upper Crossed Syndrome and referred by a specialist physician (e.g., Physical Medicine and Rehabilitation, Orthopedics)
- Upper Crossed Syndrome diagnosis confirmed at baseline based on postural characteristics (e.g., forward head posture, rounded shoulders, thoracic kyphosis etc.)
- Willingness to participate in the study and provision of written informed consent
Who cannot join
- History of spinal surgery or spinal fracture
- Presence of structural spinal deformities (e.g., structural kyphosis or scoliosis)
- Presence of neuromuscular diseases affecting the spine or upper quadrant
- Presence of congenital or acquired severe structural spinal anomalies
- Any medical condition that contraindicates participation in exercise programs
- History of severe psychiatric disorders
Show all 9Show fewer
- History of chronic pain in the cervical or lumbopelvic regions
- History of postural control disorders
- Any condition expected to prevent regular participation or adherence during the study period.
Trial locations and contacts
1 site in 1 country.
Turkey (Türkiye)1 site
Istanbul Atlas University, Faculty of Health Sciences, Department of Physiotherapy and Rehabilitation
Istanbul, Istanbul, 34408
About this study
Official title: Investigation and Comparison of the Effects of a Proprioceptive Neuromuscular Facilitation Technique and Patient Education on Pain, Range of Motion, Muscle Strength, and Posture in Individuals With Upper Crossed Syndrome
The aim of this study is to investigate the effects of exercises applied using the Proprioceptive Neuromuscular Facilitation (PNF) technique on pain, joint range of motion, muscle strength, and posture in individuals with Upper Crossed Syndrome, and to compare these effects with patient education. Individuals diagnosed with Upper Crossed Syndrome will be included in the study and allocated into two groups: a PNF-based exercise combined with patient education group and a patient education-only group.
In the PNF group, Stabilizing Reversals for scapular anterior elevation-posterior depression and Replication techniques for posterior depression will be applied. In the patient education group, education including postural awareness and exercise will be provided. Assessments will be conducted at two time points, before and after the intervention. Pain level, joint range of motion, muscle strength and endurance, and postural parameters will be analyzed.
This study is expected to provide evidence regarding the clinical effectiveness of PNF approaches targeting scapular control in individuals with Upper Crossed Syndrome and to contribute to the management of postural disorders in the field of physiotherapy and rehabilitation.
- Conditions
- Upper Crossed Syndrome, Forward Head Posture, Rounded Shoulder Posture, Hyperkyphosis, Kyphosis
- Being tested
- Patient Education, PNF
- Keywords
- Upper Cross Syndrome, Proprioseptive Neuromuscular Facilitatiton, PNF, Patient Education, Posture
- Medical subject headings
- Oculocerebral hypopigmentation syndrome type Preus, Kyphosis
What participants receive
What participants receive. In a randomised study each person is assigned to one group by chance.
Patient EducationBehavioural
Participants in the patient education group will receive a single face-to-face patient education session at the beginning of the study. This education will include information on postural awareness, correct sitting posture, and maintaining proper posture during activities of daily living. In addition, participants will be provided with a prepared educational brochure and will be asked to perform the two postural exercises included in the brochure three days per week for a total duration of four weeks. Participants will be encouraged to integrate the postural principles taught during the education into their daily lives.
PNFBehavioural
In the PNF, trunk correction in the sitting position, approximation, and the application of Stabilizing Reversals in the direction of scapular posterior depression-anterior elevation and Replication techniques toward scapular posterior depression in the side-lying position will be performed. These interventions are planned to be applied three days per week, with a total intervention duration of four weeks.
| Study group | Role | What they receive |
|---|---|---|
| Patient Education Group | Active comparator | Participants in the patient education group will receive a single face-to-face patient education session at the beginning of the study. Receives: Behavioral: Patient Education |
| PNF Group | Experimental | In the PNF group, in addition to patient education, Stabilizing Reversals and Replication techniques with scapular patterns will be performed. Receives: Behavioral: Patient Education; Behavioral: PNF |
What is being measured
The primary outcome is the main question the study is designed to answer.
Posture Assesment
Posture will be assessed using the Posture Screen Mobile (PSM) application (Backbone Software, Inc., USA), a valid and reliable mobile application designed for postural analysis. Participants will be positioned in a static standing posture on a flat surface, with their feet parallel, wearing appropriate clothing that allows visualization of the upper body and lower extremities. Photographs will be taken from the anterior, posterior, and lateral views using a mobile device placed at a standardized distance.
During the assessment, the application will automatically identify anatomical reference points (e.g., ears, shoulders, pelvis). Based on these reference points, postural deviations will be calculated and reported by the software. Anterior and posterior postural deviations in the frontal plane and lateral postural deviations in the sagittal plane will be recorded for each participant.
Measured: Baseline and up to 8 weeks
Secondary outcomes (6)
Muscle Strength Assessment
Muscle strength of the thoracic back extensor muscles and abdominal muscles (upper, lower, and oblique abdominal muscles) will be assessed before and after the intervention using manual muscle testing performed by the same physiotherapist (Scoring 0-5).
Upper abdominal muscle strength will be evaluated in the supine position using graded trunk flexion tasks with varying arm positions as resistance. Lower abdominal muscle strength will be assessed in the supine position by recording the ability to maintain lumbopelvic stability while the lower extremities are slowly lowered from 90° hip flexion. Oblique abdominal muscle strength will be evaluated through trunk flexion combined with rotation, with scoring based on movement quality and scapular clearance criteria.
Measured: Baseline and up to 8 weeks
Pain Assessment
The level of back pain will be assessed using the Visual Analog Scale (VAS). The VAS consists of a 10-cm horizontal line, with the endpoints labeled "no pain" and "unbearable pain." Participants will be asked to mark the point on the scale that best represents the intensity of their pain. Pain intensity will be determined by measuring the distance in centimeters from the "no pain" anchor to the participant's mark.
Measured: Baseline and up to 8 weeks
Muscle Endurance
Muscle endurance of the thoracic and lumbar back extensor muscles and the abdominal muscles (upper, lower, and oblique abdominal muscles) will be assessed. Endurance of the thoracic and lumbar back extensors will be evaluated using the Biering-Sorensen Test, a valid and reliable method for assessing isometric endurance of spinal extensor muscles. The duration for which the test position can be maintained will be recorded in seconds.
Abdominal muscle endurance will be assessed by recording the holding time (in seconds) at the final position of the highest achievable manual muscle test score. Upper abdominal muscle endurance will be evaluated using the Bench Trunk Curl Test, oblique abdominal muscle endurance will be measured using the Flexion-Rotation Trunk Endurance Test, and lower abdominal muscle endurance will be assessed by recording the duration for which an isometric position requiring lumbopelvic stability can be maintained.
Measured: Baseline and up to 8 weeks
Muscle Length Tests
Muscle length tests will be performed for the following muscle groups.
Pectoralis Major (sternal and clavicular portions):
Muscle length will be assessed in the supine position by measuring the distance between the lateral epicondyle of the humerus and the examination table on both sides. The upper limb will be positioned in shoulder external rotation with standardized abduction angles (135° for the sternal portion and 90° for the clavicular portion) and elbow extension. The measured distance will be recorded as an indicator of muscle tightness.
Pectoralis Minor:
Muscle length will be evaluated in the supine position by measuring the distance between the acromion and the examination table bilaterally. Greater distances will indicate increased muscle tightness.
Hamstring Muscles:
Hamstring muscle length will be assessed bilaterally using the straight leg raise test in the supine position. Hip flexion range of motion will be measured with a universal goniometer and recorded in degree
Measured: Baseline and up to 8 weeks
Range of Motion Assessment
Trunk range of motion, including flexion, extension, lateral flexion, and rotation, will be assessed using a goniometric method. Measurements will be recorded in degrees using Saehan steel goniometers.
Trunk flexion and extension will be measured in the standing position, with the goniometer aligned to anatomical landmarks of the lumbosacral region. Trunk lateral flexion will be assessed in standing, with the goniometer positioned to follow the spinal alignment. Trunk rotation will also be measured in the standing position, and the angle achieved during rotation will be recorded in degrees.
Measured: Baseline and up to 8 weeks
Flexibility Tests
Trunk flexion flexibility will be assessed using the sit-and-reach test. Participants will be seated on a firm surface with the knees extended and instructed to reach forward toward their feet without bending the knees. The distance reached will be measured in centimeters using a measuring tape.
Trunk extension, lateral flexion, and rotation flexibility will be assessed in the standing position. The distances achieved in the respective movement directions will be measured in centimeters using a measuring tape and recorded.
Measured: Baseline and up to 8 weeks
Timeline
From the start of the study to its completion; the mark is today. Estimated dates are the sponsor’s plan.
- First posted19 Aug 2026
- Study start5 Mar 2026
- Primary completion15 Jun 2026
- Study completion15 Jul 2026
Resources
- Official record on ClinicalTrials.govThe registry entry this page is built from, with its full change history.
- Other trials for Upper Crossed 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, Investigator, Outcomes assessor
- Enrolment
- 38 participants (actual)
Sponsor and investigators
- Lead sponsor
- Atlas University
- Sponsor type
- University, hospital or other
- Responsible party
- Sponsor
IDs, dates and publications
- ClinicalTrials.gov ID
- NCT07773857
- Sponsor's protocol ID
- PNF_Patient_Edu
- Status last verified
- Jan 2026
- First submitted
- 14 Aug 2026
- Last updated
- 31 Aug 2026
- Results posted
- No
- Data monitoring committee
- No
- FDA-regulated drug
- No
- FDA-regulated device
- No
Study at a glance
From the registry record, last updated by the sponsor on 31 Aug 2026. Recruitment status is as the sponsor reported it: confirm with the study team.
- Official title
- Investigation and Comparison of the Effects of a Proprioceptive Neuromuscular Facilitation Technique and Patient Education on Pain, Range of Motion, Muscle Strength, and Posture in Individuals With Upper Crossed Syndrome
- ClinicalTrials.gov ID
- NCT07773857
- Acronym / sponsor ID
- PNF_Patient_Edu
- Conditions
- Upper Crossed Syndrome, Forward Head Posture, Rounded Shoulder Posture, Hyperkyphosis, Kyphosis
- Keywords
- Upper Cross Syndrome, Proprioseptive Neuromuscular Facilitatiton, PNF, Patient Education, Posture
- Study type
- Interventional
- Recruitment status
- Completed
- Enrolment
- 38 participants (actual)
- Lead sponsor
- Atlas UniversityUniversity, hospital or other
- Study start
- 5 Mar 2026 (actual)
- Primary completion
- 15 Jun 2026 (actual)
- Study completion
- 15 Jul 2026 (actual)
- First posted
- 19 Aug 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 aim of this study is to investigate the effects of exercises applied using the Proprioceptive Neuromuscular Facilitation (PNF) technique on pain, joint range of motion, muscle strength, and posture in individuals with Upper Crossed Syndrome, and to compare these effects with patient education. Individuals diagnosed with Upper Crossed Syndrome will be included in the study and allocated into two groups: a PNF-based exercise combined with patient education group and a patient education-only group.
In the PNF group, Stabilizing Reversals for scapular anterior elevation-posterior depression and Replication techniques for posterior depression will be applied. In the patient education group, education including postural awareness and exercise will be provided. Assessments will be conducted at two time points, before and after the intervention. Pain level, joint range of motion, muscle strength and endurance, and postural parameters will be analyzed.
This study is expected to provide evidence regarding the clinical effectiveness of PNF approaches targeting scapular control in individuals with Upper Crossed Syndrome and to contribute to the management of postural disorders in the field of physiotherapy and rehabilitation.
Study design
- Primary purpose
- Treatment
- Allocation
- Randomised
- Intervention model
- Parallel groups
- Masking
- Triple blind (participant, investigator, outcomes assessor)
- Number of arms
- 2
| Arm | Type | Receives |
|---|---|---|
| Patient Education Group | Active comparator | Behavioral: Patient EducationParticipants in the patient education group will receive a single face-to-face patient education session at the beginning of the study. |
| PNF Group | Experimental | Behavioral: Patient Education, Behavioral: PNFIn the PNF group, in addition to patient education, Stabilizing Reversals and Replication techniques with scapular patterns will be performed. |
Who may qualify
- Ages
- 18 years and older
- Sex
- All
- Healthy volunteers
- Not accepted
- Age groups
- Adult, Older adult
Key inclusion criteria (4 listed)
- Age 18 years or older
- Clinically diagnosed with Upper Crossed Syndrome and referred by a specialist physician (e.g., Physical Medicine and Rehabilitation, Orthopedics)
- Upper Crossed Syndrome diagnosis confirmed at baseline based on postural characteristics (e.g., forward head posture, rounded shoulders, thoracic kyphosis etc.)
- Willingness to participate in the study and provision of written informed consent
Key exclusion criteria (9 listed)
- History of spinal surgery or spinal fracture
- Presence of structural spinal deformities (e.g., structural kyphosis or scoliosis)
- Presence of neuromuscular diseases affecting the spine or upper quadrant
- Presence of congenital or acquired severe structural spinal anomalies
- Any medical condition that contraindicates participation in exercise programs
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 |
|---|---|---|
| Patient EducationParticipants in the patient education group will receive a single face-to-face patient education session at the beginning of the study. This education will include information on postural awareness, correct sitting posture, and maintaining proper posture during activities of daily living. In addition, participants will be provided with a prepared educational brochure and will be asked to perform the two postural exercises included in the brochure three days per week for a total duration of four weeks. Participants will be encouraged to integrate the postural principles taught during the education into their daily lives. | Behavioural | PNF Group, Patient Education Group |
| PNFIn the PNF, trunk correction in the sitting position, approximation, and the application of Stabilizing Reversals in the direction of scapular posterior depression-anterior elevation and Replication techniques toward scapular posterior depression in the side-lying position will be performed. These interventions are planned to be applied three days per week, with a total intervention duration of four weeks. | Behavioural | PNF Group |
Primary outcome
Posture Assesment
Time frame: Baseline and up to 8 weeks
Posture will be assessed using the Posture Screen Mobile (PSM) application (Backbone Software, Inc., USA), a valid and reliable mobile application designed for postural analysis. Participants will be positioned in a static standing posture on a flat surface, with their feet parallel, wearing appropriate clothing that allows visualization of the upper body and lower extremities. Photographs will be taken from the anterior, posterior, and lateral views using a mobile device placed at a standardized distance. During the assessment, the application will automatically identify anatomical reference points (e.g., ears, shoulders, pelvis). Based on these reference points, postural deviations will be calculated and reported by the software. Anterior and posterior postural deviations in the frontal plane and lateral postural deviations in the sagittal plane will be recorded for each participant.
6 secondary outcomes
Muscle Strength Assessment
Time frame: Baseline and up to 8 weeks
Pain Assessment
Time frame: Baseline and up to 8 weeks
Muscle Endurance
Time frame: Baseline and up to 8 weeks
Muscle Length Tests
Time frame: Baseline and up to 8 weeks
Range of Motion Assessment
Time frame: Baseline and up to 8 weeks
Flexibility Tests
Time frame: Baseline and up to 8 weeks
Results and safety
The study is completed, but results are not available in the source record. That does not mean the treatment did or did not work.
Research links
- Official record on ClinicalTrials.govLast updated by the sponsor 31 Aug 2026.
Related trials for Upper Crossed Syndrome
Not yet recruitingObservational study
Functional Impact of Psychological Symptoms in Patients With Superior Semicircular Canal Dehiscence Syndrome (SSCD): a National Cross-sectional Study
Superior Semicircular Canal Dehiscence
Recruiting
Effect of Kendall Versus McKenzie Exercises in Patients With Upper Crossed Syndrome
Upper Crossed Syndrome
Not yet recruitingPhase 3
Effect of Botulinum Toxin on Resting Tremor of the Refractory Upper Limb in Parkinsonians
PARKINSON DISEASE (Disorder)
RecruitingObservational study
The Association Between Smartphone Overuse and Mechanical Neck Pain Among Galala University Students
Mechanical Neck Pain, Forward Head Posture (FHP)
Recruiting
Beyond Osteopathic Therapy: Functional Performance Following the Addition of Ujjayi Pranayama in College Students With Upper Cross Syndrome
Upper Cross Syndrome, Spinal Alignment
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. This study is not recruiting at the moment.
The record lists no contact. Use the official record to reach the sponsor.
1 site in 1 country: see every site and its status.
Questions about this trial
What is this clinical trial studying?
A study testing Patient Education and PNF in people with Upper Crossed Syndrome and Forward Head Posture, run by Atlas University at 1 site in Turkey (Türkiye).
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 9 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: finished, as of the sponsor's last update on 31 Aug 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 Turkey (Türkiye). 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?
The study is completed, but results are not available in the source record. That does not mean the treatment did or did not work.
How can a doctor refer a patient or contact the research team?
The record lists no contact. The official record names the sponsor, who can be asked directly. AzTrials does not enrol participants or take referrals.
What does the primary outcome measure?
Posture Assesment (time frame: Baseline and up to 8 weeks). It is what the study was designed to measure, not a finding.
Where can I read the original study information?
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 31 Aug 2026.