PostureNCT07834177
Comparative Effects of Reverse Natural Apophyseal Glides Versus Sustained Natural Apophyseal Glides in Patients With Upper Cross Syndrome
A study testing Reverse Natural Apophyseal Glides and Sustained Natural Apophyseal Glides in people with Posture, run by Foundation University Islamabad at 1 site in Pakistan.
Trial summary
This study will compare the effectiveness of two manual therapy interventions combined with a standardized conventional physiotherapy protocol in individuals with Upper Cross Syndrome. Participants will be randomly allocated into two groups. Read more about this study
- Who is it for?
- Ages 20 to 40 years
- Conditions the study is for
- Posture
- What is being tested?
- Reverse Natural Apophyseal Glides and Sustained Natural Apophyseal Glides
- Type of treatment
- Surgery or procedure
- Could I receive a placebo?
- No, everyone receives an active treatment
- How many people
- 44 participants
- Where
- 1 sitePakistan
- Study dates
- 11 Feb 2026to 18 Jan 2027
- 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 40 years
- All sexes
- No healthy volunteers
- Adult
Who may be able to join
- Both genders.
- Age 20 to 40 years.
- Patients who had been experiencing chronic neck pain for three months or longer.
- Pain intensity of 3 or more and less than 8 on NPRS.
- Craniovertebral angle less than 48 degrees.
- Thoracic kyphosis angle greater than 40 degrees
- Participants able to understand instructions and provide informed consent.
Who cannot join
- Cervical radiculopathy
- Vertebrobasilar insufficiency
- Patients with a history of spinal surgery
- Any history of trauma or whiplash injury (from the past 6 months to 1 year)
- Diagnosed cases of osteoporosis
- Pregnancy
- Patients with diagnosed systemic diseases.
- Patients with a known medical diagnosis of spinal cord compression.
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
Foundation University College of Physical Therapy
Islamabad, Punjab Province, 44000
Marwa Asim, MS-OMPT, +92 333 5339457, marwa@fui.edu.pk
About this study
This study will compare the effectiveness of two manual therapy interventions combined with a standardized conventional physiotherapy protocol in individuals with Upper Cross Syndrome. Participants will be randomly allocated into two groups. Group A will receive Reverse Natural Apophyseal Glides, while Group B will receive Sustained Natural Apophyseal Glides. Both manual therapy interventions will primarily target the lower cervicaland upper thoracic spine specifically C6 to T2 and will be administered for 3 times a week for 4 weeks. The conventional physiotherapy protocol will be identical for both groups and will include a 10-minute hot pack followed by stretching of the pectoralis, upper trapezius and levator scapulae, each stretching exercise will be performed for 10 repetitions, 3 sets, with a 10 second hold per repetition. The strengthening program will target the deep cervical flexors and scapular stabilizers, including middle trapezius, lower trapezius, serratus anterior and rhomboids. Strengthening exercises will be performed for 10 repetitions, 3 sets, with a 10 second hold per repetition. The manual therapy component will differ between groups, allowing comparison of Reverse Natural Apophyseal Glides and Sustained Natural Apophyseal Glides when used alongside the same conventional intervention. This standardized approach aims to evaluate the comparative effects of the two manual therapy techniques on the postural and functional impairments associated with Upper Cross Syndrome.
Read the detailed description
Upper Cross Syndrome UCS is characterized by a cross pattern of muscular imbalance involving tightness of the upper trapezius, levator scapulae, and pectoral muscles, with weakness of the deep neck flexors, rhomboids, serratus anterior, middle trapezius, and lower trapezius. These imbalances contribute to forward head posture, rounded shoulders, and increased thoracic kyphosis, while also affecting scapulothoracic rhythm and cervical biomechanics. To address these impairments, both groups will receive manual therapy targeting C6 to T2 along with an identical conventional physiotherapy protocol for 4 weeks.Group A will receive Reverse Natural Apophyseal Glides. Participants will sit comfortably while the therapist applies Reverse Natural Apophyseal Glides to the lower cervical and upper thoracic segments C6 to T2. The therapist will apply small amplitude rhythmic oscillations at the end range of the facet joints. On day 1, 3 oscillations will be performed in
1 set. For the remaining days, the dosage will progress to 10 oscillations, 3 sets. Group B will receive Sustained Natural Apophyseal Glides. Participants will sit upright while the therapist stands behind them. The therapist will stabilize the desired spinous process using the medial border of one thumb, reinforced by the pulp of the opposite thumb, with the fingers positioned comfortably around the mandible. The participant will actively perform cervical extension while the therapist maintains a posterior to anterior glide on the selected spinous process toward the participant's eyes throughout the movement. The participant will perform end range overpressure. On day 1, 3 repetitions will be performed in 1 set, progressing to 10 repetitions, 3 sets for the remaining days. For both groups, the conventional protocol will begin with a hot pack applied to the posterior cervical and upper thoracic region for 10 minutes in prone lying. Stretching will include the pectoralis, upper trapezius, and levator scapulae, with each stretch held for 10 seconds for 10 repetitions, 3 sets, with a 5 second interval between repetitions. Strengthening will include deep cervical flexor activation through chin tucks and scapular stabilizers targeting the middle trapezius, lower trapezius, serratus anterior and rhomboids. On day 1-3, supine foam roller exercises performed at three shoulder abduction angles. From days 4-6, side lying external rotation and forward flexion exercises will be performed. From days 7-9, prone V, T, and W exercises will be performed. From days 10-12, standing diagonal flexion and military press exercises will be performed. Each strengthening exercise will be performed for 10 repetitions, 3 sets, with a 10 second hold for each repetition. This progressive protocol will provide increasing postural and scapular stabilization demands while maintaining the same conventional treatment across both groups, allowing the specific effects of Reverse Natural Apophyseal Glides and Sustained Natural Apophyseal Glides to be compared.
- Conditions
- Posture
- Being tested
- Reverse Natural Apophyseal Glides, Sustained Natural Apophyseal Glides
What participants receive
What participants receive. In a randomised study each person is assigned to one group by chance.
Reverse Natural Apophyseal GlidesProcedure or surgery
Participants will receive Reverse Natural Apophyseal Glides to the C6-T2 cervicothoracic region in sitting, using small-amplitude rhythmic oscillations at end-range facet movement. Day 1 will include 1 set of 3 oscillations, progressing to 3 sets of 10 oscillations for the remaining days. Hot pack will target the posterior cervical and upper thoracic region for 10 minutes in prone lying. Pectoralis, upper trapezius, and levator scapulae stretching will be performed with 10 seconds hold, 3 sets of 10 repetitions, with 5-second intervals. Strengthening will include chin tucks, supine foam roller exercises at three abduction angles on day 1-3, side-lying external rotation and forward flexion on days 4-6, prone V, T, W exercises on days 7-9, and standing diagonal flexion and military press on days 10-12.
Sustained Natural Apophyseal GlidesProcedure or surgery
Participants will receive Sustained Natural Apophyseal Glides to the C6-T2 cervicothoracic region in sitting. Therapist will stabilize the spinous process with the thumb while applying a sustained posterior-to-anterior glide toward the eyes during cervical extension with end-range overpressure. Day 1 will include 1 set of 3 repetitions, progressing to 3 sets of 10 repetitions for the remaining days. Hot pack will target the posterior cervical and upper thoracic region for 10 minutes. Pectoralis, upper trapezius, and levator scapulae stretching will involve 10-second holds, 3 sets of 10 repetitions. Strengthening will include chin-tucks, supine foam roller exercises at three abduction angles on day 1-3, side-lying external rotation and forward flexion on days 4-6, prone V, T, W exercises on days 7-9, and standing diagonal flexion and military press on days 10-12.
| Study group | Role | What they receive |
|---|---|---|
| Group A Reverse Natural Apophyseal Glides | Experimental | Not described Receives: Procedure: Reverse Natural Apophyseal Glides |
| Group B Sustained Natural Apophyseal Glides | Active comparator | Not described Receives: Procedure: Sustained Natural Apophyseal Glides |
What is being measured
The primary outcome is the main question the study is designed to answer.
Pain
Numeric Pain Rating Scale scale will be used to measure pain. 0 shows no pain, 1-3 represents mild pain, 4-6 represents moderate pain, and 7-10 represents severe pain..
Measured: Before and at 4 weeks of treatment
Craniovertebral angle
Craniovertebral angle will be assessed using Kinovea 0.8.15 software from lateral photographs by measuring the angle between the horizontal C7 line and a line connecting C7 to ear tragus. Angle less than 48 degrees will indicate forward head posture.
Measured: Before and at 4th week of treatment
Thoracic kyphosis angle
Thoracic kyphosis will be measured using two gravity-dependent inclinometers placed at T1/T2 and T12/L1. Three measurements will be recorded and averaged. Angle greater than 40 degrees will indicate hyper kyphosis.
Measured: Before and at 4th week of treatment
Cervical range of motion
Cervical range of motion will be assessed using the CROM device, comprising three inclinometers positioned in the sagittal, frontal, and horizontal planes to measure cervical movement relative to gravity and the reference position.
Measured: Before and at 4th week of treatment
Neck Disability Index
Neck Disability Index is a self-reported questionnaire that assesses the level of disability and functional impairment caused by neck pain. Total score ranges from 0 to 50. 0-4 indicates no disability, 5-14 indicates mild disability, 15-24 indicates moderate disability, 25-34 indicates severe disability and 35-50 indicates complete disability.
Measured: Before and at 4th week of treatment
Timeline
From the start of the study to its completion; the mark is today. Estimated dates are the sponsor’s plan.
- First posted22 Sep 2026
- Study start11 Feb 2026
- Primary completion18 Dec 2026 (estimated)
- Study completion18 Jan 2027 (estimated)
Resources
- Official record on ClinicalTrials.govThe registry entry this page is built from, with its full change history.
- Other trials for PostureStudies of the same condition, open and under way.
- More trials run by Foundation University IslamabadThe 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
- None (open label)
- Enrolment
- 44 participants (estimated)
Sponsor and investigators
- Lead sponsor
- Foundation University Islamabad
- Sponsor type
- University, hospital or other
- Responsible party
- Sponsor
IDs, dates and publications
- ClinicalTrials.gov ID
- NCT07834177
- Sponsor's protocol ID
- FUI/FUCP/CTR/MSMSK/ArshiaIqbal
- Status last verified
- Sep 2026
- First submitted
- 16 Sep 2026
- Last updated
- 22 Sep 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 22 Sep 2026. Recruitment status is as the sponsor reported it: confirm with the study team.
- Official title
- Comparative Effects of Reverse Natural Apophyseal Glides Versus Sustained Natural Apophyseal Glides in Patients With Upper Cross Syndrome
- ClinicalTrials.gov ID
- NCT07834177
- Acronym / sponsor ID
- FUI/FUCP/CTR/MSMSK/ArshiaIqbal
- Conditions
- Posture
- Study type
- Interventional
- Recruitment status
- Recruiting
- Enrolment
- 44 participants (estimated)
- Lead sponsor
- Foundation University IslamabadUniversity, hospital or other
- Study start
- 11 Feb 2026 (actual)
- Primary completion
- 18 Dec 2026 (estimated)
- Study completion
- 18 Jan 2027 (estimated)
- First posted
- 22 Sep 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 study will compare the effectiveness of two manual therapy interventions combined with a standardized conventional physiotherapy protocol in individuals with Upper Cross Syndrome. Participants will be randomly allocated into two groups. Group A will receive Reverse Natural Apophyseal Glides, while Group B will receive Sustained Natural Apophyseal Glides. Both manual therapy interventions will primarily target the lower cervicaland upper thoracic spine specifically C6 to T2 and will be administered for 3 times a week for 4 weeks. The conventional physiotherapy protocol will be identical for both groups and will include a 10-minute hot pack followed by stretching of the pectoralis, upper trapezius and levator scapulae, each stretching exercise will be performed for 10 repetitions, 3 sets, with a 10 second hold per repetition. The strengthening program will target the deep cervical flexors and scapular stabilizers, including middle trapezius, lower trapezius, serratus anterior and rhomboids. Strengthening exercises will be performed for 10 repetitions, 3 sets, with a 10 second hold per repetition. The manual therapy component will differ between groups, allowing comparison of Reverse Natural Apophyseal Glides and Sustained Natural Apophyseal Glides when used alongside the same conventional intervention. This standardized approach aims to evaluate the comparative effects of the two manual therapy techniques on the postural and functional impairments associated with Upper Cross Syndrome.
Detailed description
Upper Cross Syndrome UCS is characterized by a cross pattern of muscular imbalance involving tightness of the upper trapezius, levator scapulae, and pectoral muscles, with weakness of the deep neck flexors, rhomboids, serratus anterior, middle trapezius, and lower trapezius. These imbalances contribute to forward head posture, rounded shoulders, and increased thoracic kyphosis, while also affecting scapulothoracic rhythm and cervical biomechanics. To address these impairments, both groups will receive manual therapy targeting C6 to T2 along with an identical conventional physiotherapy protocol for 4 weeks.Group A will receive Reverse Natural Apophyseal Glides. Participants will sit comfortably while the therapist applies Reverse Natural Apophyseal Glides to the lower cervical and upper thoracic segments C6 to T2. The therapist will apply small amplitude rhythmic oscillations at the end range of the facet joints. On day 1, 3 oscillations will be performed in
1 set. For the remaining days, the dosage will progress to 10 oscillations, 3 sets. Group B will receive Sustained Natural Apophyseal Glides. Participants will sit upright while the therapist stands behind them. The therapist will stabilize the desired spinous process using the medial border of one thumb, reinforced by the pulp of the opposite thumb, with the fingers positioned comfortably around the mandible. The participant will actively perform cervical extension while the therapist maintains a posterior to anterior glide on the selected spinous process toward the participant's eyes throughout the movement. The participant will perform end range overpressure. On day 1, 3 repetitions will be performed in 1 set, progressing to 10 repetitions, 3 sets for the remaining days. For both groups, the conventional protocol will begin with a hot pack applied to the posterior cervical and upper thoracic region for 10 minutes in prone lying. Stretching will include the pectoralis, upper trapezius, and levator scapulae, with each stretch held for 10 seconds for 10 repetitions, 3 sets, with a 5 second interval between repetitions. Strengthening will include deep cervical flexor activation through chin tucks and scapular stabilizers targeting the middle trapezius, lower trapezius, serratus anterior and rhomboids. On day 1-3, supine foam roller exercises performed at three shoulder abduction angles. From days 4-6, side lying external rotation and forward flexion exercises will be performed. From days 7-9, prone V, T, and W exercises will be performed. From days 10-12, standing diagonal flexion and military press exercises will be performed. Each strengthening exercise will be performed for 10 repetitions, 3 sets, with a 10 second hold for each repetition. This progressive protocol will provide increasing postural and scapular stabilization demands while maintaining the same conventional treatment across both groups, allowing the specific effects of Reverse Natural Apophyseal Glides and Sustained Natural Apophyseal Glides to be compared.
Study design
- Primary purpose
- Treatment
- Allocation
- Randomised
- Intervention model
- Parallel groups
- Masking
- None (open label)
- Number of arms
- 2
| Arm | Type | Receives |
|---|---|---|
| Group A Reverse Natural Apophyseal Glides | Experimental | Procedure: Reverse Natural Apophyseal Glides |
| Group B Sustained Natural Apophyseal Glides | Active comparator | Procedure: Sustained Natural Apophyseal Glides |
Who may qualify
- Ages
- 20 to 40 years
- Sex
- All
- Healthy volunteers
- Not accepted
- Age groups
- Adult
Key inclusion criteria (7 listed)
- Both genders.
- Age 20 to 40 years.
- Patients who had been experiencing chronic neck pain for three months or longer.
- Pain intensity of 3 or more and less than 8 on NPRS.
- Craniovertebral angle less than 48 degrees.
Key exclusion criteria (8 listed)
- Cervical radiculopathy
- Vertebrobasilar insufficiency
- Patients with a history of spinal surgery
- Any history of trauma or whiplash injury (from the past 6 months to 1 year)
- Diagnosed cases of osteoporosis
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 |
|---|---|---|
| Reverse Natural Apophyseal GlidesParticipants will receive Reverse Natural Apophyseal Glides to the C6-T2 cervicothoracic region in sitting, using small-amplitude rhythmic oscillations at end-range facet movement. Day 1 will include 1 set of 3 oscillations, progressing to 3 sets of 10 oscillations for the remaining days. Hot pack will target the posterior cervical and upper thoracic region for 10 minutes in prone lying. Pectoralis, upper trapezius, and levator scapulae stretching will be performed with 10 seconds hold, 3 sets of 10 repetitions, with 5-second intervals. Strengthening will include chin tucks, supine foam roller exercises at three abduction angles on day 1-3, side-lying external rotation and forward flexion on days 4-6, prone V, T, W exercises on days 7-9, and standing diagonal flexion and military press on days 10-12. | Procedure or surgery | Group A Reverse Natural Apophyseal Glides |
| Sustained Natural Apophyseal GlidesParticipants will receive Sustained Natural Apophyseal Glides to the C6-T2 cervicothoracic region in sitting. Therapist will stabilize the spinous process with the thumb while applying a sustained posterior-to-anterior glide toward the eyes during cervical extension with end-range overpressure. Day 1 will include 1 set of 3 repetitions, progressing to 3 sets of 10 repetitions for the remaining days. Hot pack will target the posterior cervical and upper thoracic region for 10 minutes. Pectoralis, upper trapezius, and levator scapulae stretching will involve 10-second holds, 3 sets of 10 repetitions. Strengthening will include chin-tucks, supine foam roller exercises at three abduction angles on day 1-3, side-lying external rotation and forward flexion on days 4-6, prone V, T, W exercises on days 7-9, and standing diagonal flexion and military press on days 10-12. | Procedure or surgery | Group B Sustained Natural Apophyseal Glides |
Primary outcome
Pain
Time frame: Before and at 4 weeks of treatment
Numeric Pain Rating Scale scale will be used to measure pain. 0 shows no pain, 1-3 represents mild pain, 4-6 represents moderate pain, and 7-10 represents severe pain..
Craniovertebral angle
Time frame: Before and at 4th week of treatment
Craniovertebral angle will be assessed using Kinovea 0.8.15 software from lateral photographs by measuring the angle between the horizontal C7 line and a line connecting C7 to ear tragus. Angle less than 48 degrees will indicate forward head posture.
Thoracic kyphosis angle
Time frame: Before and at 4th week of treatment
Thoracic kyphosis will be measured using two gravity-dependent inclinometers placed at T1/T2 and T12/L1. Three measurements will be recorded and averaged. Angle greater than 40 degrees will indicate hyper kyphosis.
Cervical range of motion
Time frame: Before and at 4th week of treatment
Cervical range of motion will be assessed using the CROM device, comprising three inclinometers positioned in the sagittal, frontal, and horizontal planes to measure cervical movement relative to gravity and the reference position.
Neck Disability Index
Time frame: Before and at 4th week of treatment
Neck Disability Index is a self-reported questionnaire that assesses the level of disability and functional impairment caused by neck pain. Total score ranges from 0 to 50. 0-4 indicates no disability, 5-14 indicates mild disability, 15-24 indicates moderate disability, 25-34 indicates severe disability and 35-50 indicates complete disability.
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 22 Sep 2026.
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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 Reverse Natural Apophyseal Glides and Sustained Natural Apophyseal Glides in people with Posture, run by Foundation University Islamabad 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 22 Sep 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 Arshia Iqbal, DPT (+92 332 1514083, arsheeya.iqbal@gmail.com), or a site near the patient. AzTrials does not enrol participants or take referrals.
What does the primary outcome measure?
Pain (time frame: Before and at 4 weeks of treatment). The study lists 5 primary outcomes in all. 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 22 Sep 2026.