Upper Crossed SyndromeJAM-USCNCT07841639
Comparative Effect of Janda's Approach and Mckenzie Exercises in Patients With Upper Cross Syndrome
A study testing McKenzie Treatment, Janda's Approach and Baseline Treatment in people with Upper Crossed Syndrome, run by Riphah International University at 1 site in Pakistan.
Trial summary
This study was conducted compare the effect Janda's Approach and Mckenzie Excercises in patients with Upper Crossed Syndrome Read more about this study
- Who is it for?
- Ages 20 to 35 years
- Conditions the study is for
- Upper Crossed Syndrome
- What is being tested?
- McKenzie Treatment, Janda's Approach and Baseline Treatment
- Could I receive a placebo?
- No, everyone receives an active treatment
- How many people
- 46 participants
- Where
- 1 sitePakistan
- Study dates
- 1 Oct 2025to 25 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 20 to 35 years
- All sexes
- No healthy volunteers
- Adult
Who may be able to join
- Both male and females
- Age between 20-35 years
- Excessive Forward Head > 46
- Excessive Forward shoulder > 52
- Excessive kyphosis > 42
- Neck pain scores 4-8 on NPRS
- Sedentary or moderately active individuals with prolonged desk/workstation use
- Functional disability ≥10% on the Neck Disability Index
Who cannot join
- Cervical and upper limb fracture history.
- Has vertebrobasilar insufficiency.
- History of surgery to the cervical spine.
- Infections or neoplastic processes of the spine.
- Diagnosed cases of osteoporosis.
- Rheumatoid or other inflammatory arthritis.
- Pregnancy
- Neurological disorder
Trial locations and contacts
1 site in 1 country.
About this study
Official title: Comparative Effect of Janda's Approach and Mckenzie Exercises on Pain Intensity, Craniovertebral Angle and Functional Disability in Patients With Upper Cross Syndrome
This study was conducted compare the effect Janda's Approach and Mckenzie Excercises in patients with Upper Crossed Syndrome
- Conditions
- Upper Crossed Syndrome
- Being tested
- McKenzie Treatment, Janda's Approach, Baseline Treatment
- Keywords
- Upper Cross Syndrome, Janda's Approach, McKenzie Exercises, Craniovertebral Angle, Neck Disability, Forward Head Posture
- 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.
McKenzie TreatmentOther
- Cervical Retraction (Chin Tucks) and Basic Postural Drills: 5-10 reps for, 3-4 times/day.
- Cervical Extension in lying and Thoracic Extension: 10-15 reps for 30-35 minutes.
- Shoulder Retraction, Prone Scapular Squeeze and Wall Angels: 5-10 sec hold, more sets.
- Standing Shoulder Rows (with resistance band) and Neck Isometrics: Functional drills for 40 mins.
- Sitting Posture Drills and Computer Ergonomics Practice: Stimulate workstation posture tasks for 40-45 minutes.
- Full McKenzie Cervical Series and Posture Checklist: Emphasize home program, relapse prevention for 45 minutes.
Janda's ApproachOther
Week 1:
- Chin Tucks (Deep Neck Flexors): 3 sets x 10-12 reps
- Scapular Retraction (Low Resistance):3 sets x 10-12 reps
- Pectoralis Stretch (Doorway Stretch): 30 seconds x 2
- Upper Trapezius Stretch (Lateral Neck Flexion): 30 seconds x 2
- Educate on sitting posture and workstation ergonomics
Week 2:
- Chin Tucks: 3 sets x 12-15 reps
- Prone Y/T/W: 3 sets x 10-12 reps
- Levator Scapulae Stretch: 30 seconds x 2
- Pectoralis Stretch: 30 seconds x 2
- Begin postural correction during daily activities (sitting, standing)
Week 3:
- Chin Tucks: 3 sets x 15 reps
- Prone Y/T/W: 3 sets x 15 reps
- Upper Trapezius Stretch: 45 seconds x 2
- Levator Scapulae Stretch: 45 seconds x 2
- Correct head positioning during tasks like typing or sitting
Week 4:
- Scapular Retraction with Resistance Bands: 3 sets x 10 reps
- Shoulder Retraction: 3 sets x 10-12 reps
- Pectoralis Stretch: 45 seconds x 2
- Upper Trapezius Stretch: 45 seconds x 2
- Focus on functional postural exercises (standing rows)
Baseline TreatmentOther
- Application of a heating pad for muscle relaxation (10 minutes)
- TENS therapy (10 minutes) to alleviate pain
- Range-of-motion exercises for the cervical spine and shoulders to maintain flexibility.
- Stretching exercises targeted the upper trapezius, levator scapulae, and pectoralis muscles
| Study group | Role | What they receive |
|---|---|---|
| Janda's Approach | Active comparator | Not described Receives: Other: Janda's Approach; Other: Baseline Treatment |
| Mckenzie Excercises | Active comparator | Not described Receives: Other: McKenzie Treatment; Other: Baseline Treatment |
What is being measured
The primary outcome is the main question the study is designed to answer.
Numeric Pain Rating Scale
The 11-point Numeric Pain Rating Scale (NPRS) ranged from 0 to 10, with 10 denoting "the highest level of pain imaginable" and 0 denoting "no pain". It was a simple indicator of pain intensity since patients chose the number that most accurately represented their level of pain.
Measured: From enrollment to the end of treatment at 6 weeks.
Neck Disability Index
The Neck Disability Index (NDI) was a standardized, self-administered questionnaire used to evaluate how neck pain affected a person's ability to perform everyday activities. It consisted of 10 items that assessed different aspects of life impacted by neck pain, including pain intensity, personal care, lifting, reading, headaches, concentration, work, driving, sleeping, and recreation. Each item was scored on a scale from 0 to 5, where higher scores indicated greater disability. The total score could range from 0 to 50 and was often converted into a percentage to interpret the level of disability. A score between 0-8% suggested no disability, 10-28% indicated mild disability, 30-48% moderate disability, 50-64% severe disability, and 70% or higher reflected complete disability.
Measured: From enrollment to the end of treatment at 6 weeks
Photogrammetry Method for Craniovertebral Angle
A photogrammetric method was used to evaluate forward head posture (craniovertebral angle), rounded shoulders, and thoracic kyphosis from a lateral view. Key anatomical landmarks-tragus, acromion, C7, and T12-were marked on participants. Individuals stood in a natural posture, barefoot, on a marked board while facing forward. A digital camera, placed 265 cm away, captured three side-view photographs.
The images were analyzed using USC software, which measured:
- Forward head angle: angle between the line from tragus to C7 and the vertical.
- Rounded shoulder angle: angle from acromion to the vertical.
- Kyphosis angle: arc between C7 and T12.
Measured: From enrollment to the end of treatment at 6 weeks
ROM Cervical Spine (Flexion)
Changes in cervical spine flexion ROM at baseline and 6th week of intervention was measured using goniometer.
Measured: From enrollment to the end of treatment at 6 weeks
ROM Cervical Spine (Extension)
Changes in cervical spine extension ROM at baseline and 6th week of intervention was measured using goniometer.
Measured: From enrollment to the end of treatment at 6 weeks
ROM Cervical Spine (Lateral Flexion) Right Side
Changes in cervical spine lateral flexion on right side ROM at baseline and 6th week of intervention was measured using goniometer.
Measured: From enrollment to the end of treatment at 6 weeks
ROM Cervical Spine (Lateral Flexion) Left Side
Changes in cervical spine lateral flexion on left side ROM at baseline and 6th week of intervention was measured using goniometer.
Measured: From enrollment to the end of treatment at 6 weeks
ROM Cervical Spine (Rotation) Right Side
Changes in cervical spine rotation on right side ROM at baseline and 6th week of intervention was measured using goniometer.
Measured: From enrollment to the end of treatment at 6 weeks
ROM Cervical Spine (Rotation) Left Side
Changes in cervical spine rotation on left side ROM at baseline and 6th week of intervention was measured using goniometer.
Measured: From enrollment to the end of treatment at 6 weeks
Timeline
From the start of the study to its completion; the mark is today. Estimated dates are the sponsor’s plan.
- First posted25 Sep 2026
- Study start1 Oct 2025
- Primary completion30 Apr 2026
- Study completion25 Jul 2026
Resources
- Official record on ClinicalTrials.govThe registry entry this page is built from, with its full change history.
- Publications (5)Papers the sponsor has linked to this study.
- Other trials for Upper Crossed 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
- Outcomes assessor
- Enrolment
- 46 participants (actual)
Sponsor and investigators
- Lead sponsor
- Riphah International University
- Sponsor type
- University, hospital or other
- Responsible party
- Sponsor
- Investigators
- Anum Manzoor, MS (OMPT), Principal investigator, Riphah International University
IDs, dates and publications
- ClinicalTrials.gov ID
- NCT07841639
- Sponsor's protocol ID
- REC/RCR & AHS/25/0145
- Acronym
- JAM-USC
- Status last verified
- Sep 2026
- First submitted
- 21 Sep 2026
- Last updated
- 25 Sep 2026
- Results posted
- No
- Data monitoring committee
- 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 36180139Jeong GH, Lee BH. Effects of Telerehabilitation Combining Diaphragmatic Breathing Re-Education and Shoulder Stabilization Exercises on Neck Pain, Posture, and Function in Young Adult Men with Upper Crossed Syndrome: A Randomized Controlled Trial. J Clin Med. 2024 Mar 11;13(6):1612. doi: 10.3390/jcm13061612.
PubMed 38541838Titcomb DA, Melton BF, Miyashita T, Bland HW. The Effects of Postural Education or Corrective Exercise on the Craniovertebral Angle in Young Adults with Forward Head Posture: A Randomized Controlled Trial. Int J Exerc Sci. 2023 Aug 1;16(1):954-973. doi: 10.70252/PYPQ8483. eCollection 2023.
PubMed 37649869Haghighat F, Moradi R, Rezaie M, Yarahmadi N, Ghaffarnejad F. Added value of diaphragm myofascial release on forward head posture and chest expansion in women with symptomatic forward head posture: A randomized controlled trial. J Bodyw Mov Ther. 2025 Dec;45:645-651. doi: 10.1016/j.jbmt.2025.07.015. Epub 2025 Aug 8.
PubMed 41316631Kim Y, Cha Y, Yoon S. Effects of hip extensor exercises on neck disability, cervical alignment, muscle imbalance, and blood flow in forward head posture. Technol Health Care. 2026 Mar;34(2):145-153. doi: 10.1177/09287329251392400. Epub 2025 Nov 11.
PubMed 41217962
Study at a glance
From the registry record, last updated by the sponsor on 25 Sep 2026. Recruitment status is as the sponsor reported it: confirm with the study team.
- Official title
- Comparative Effect of Janda's Approach and Mckenzie Exercises on Pain Intensity, Craniovertebral Angle and Functional Disability in Patients With Upper Cross Syndrome
- ClinicalTrials.gov ID
- NCT07841639
- Acronym / sponsor ID
- JAM-USC / REC/RCR & AHS/25/0145
- Conditions
- Upper Crossed Syndrome
- Keywords
- Upper Cross Syndrome, Janda's Approach, McKenzie Exercises, Craniovertebral Angle, Neck Disability, Forward Head Posture
- Study type
- Interventional
- Recruitment status
- Completed
- Enrolment
- 46 participants (actual)
- Lead sponsor
- Riphah International UniversityUniversity, hospital or other
- Study start
- 1 Oct 2025 (actual)
- Primary completion
- 30 Apr 2026 (actual)
- Study completion
- 25 Jul 2026 (actual)
- First posted
- 25 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 was conducted compare the effect Janda's Approach and Mckenzie Excercises in patients with Upper Crossed Syndrome
Study design
- Primary purpose
- Treatment
- Allocation
- Randomised
- Intervention model
- Parallel groups
- Masking
- Single blind (outcomes assessor)
- Number of arms
- 2
| Arm | Type | Receives |
|---|---|---|
| Janda's Approach | Active comparator | Other: Janda's Approach, Other: Baseline Treatment |
| Mckenzie Excercises | Active comparator | Other: McKenzie Treatment, Other: Baseline Treatment |
Who may qualify
- Ages
- 20 to 35 years
- Sex
- All
- Healthy volunteers
- Not accepted
- Age groups
- Adult
Key inclusion criteria (8 listed)
- Both male and females
- Age between 20-35 years
- Excessive Forward Head > 46
- Excessive Forward shoulder > 52
- Excessive kyphosis > 42
Key exclusion criteria (8 listed)
- Cervical and upper limb fracture history.
- Has vertebrobasilar insufficiency.
- History of surgery to the cervical spine.
- Infections or neoplastic processes of the spine.
- 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 |
|---|---|---|
| McKenzie Treatment* Cervical Retraction (Chin Tucks) and Basic Postural Drills: 5-10 reps for, 3-4 times/day. * Cervical Extension in lying and Thoracic Extension: 10-15 reps for 30-35 minutes. * Shoulder Retraction, Prone Scapular Squeeze and Wall Angels: 5-10 sec hold, more sets. * Standing Shoulder Rows (with resistance band) and Neck Isometrics: Functional drills for 40 mins. * Sitting Posture Drills and Computer Ergonomics Practice: Stimulate workstation posture tasks for 40-45 minutes. * Full McKenzie Cervical Series and Posture Checklist: Emphasize home program, relapse prevention for 45 minutes. | Other | Mckenzie Excercises |
| Janda's ApproachWeek 1: * Chin Tucks (Deep Neck Flexors): 3 sets x 10-12 reps * Scapular Retraction (Low Resistance):3 sets x 10-12 reps * Pectoralis Stretch (Doorway Stretch): 30 seconds x 2 * Upper Trapezius Stretch (Lateral Neck Flexion): 30 seconds x 2 * Educate on sitting posture and workstation ergonomics Week 2: * Chin Tucks: 3 sets x 12-15 reps * Prone Y/T/W: 3 sets x 10-12 reps * Levator Scapulae Stretch: 30 seconds x 2 * Pectoralis Stretch: 30 seconds x 2 * Begin postural correction during daily activities (sitting, standing) Week 3: * Chin Tucks: 3 sets x 15 reps * Prone Y/T/W: 3 sets x 15 reps * Upper Trapezius Stretch: 45 seconds x 2 * Levator Scapulae Stretch: 45 seconds x 2 * Correct head positioning during tasks like typing or sitting Week 4: * Scapular Retraction with Resistance Bands: 3 sets x 10 reps * Shoulder Retraction: 3 sets x 10-12 reps * Pectoralis Stretch: 45 seconds x 2 * Upper Trapezius Stretch: 45 seconds x 2 * Focus on functional postural exercises (standing rows) | Other | Janda's Approach |
| Baseline Treatment* Application of a heating pad for muscle relaxation (10 minutes) * TENS therapy (10 minutes) to alleviate pain * Range-of-motion exercises for the cervical spine and shoulders to maintain flexibility. * Stretching exercises targeted the upper trapezius, levator scapulae, and pectoralis muscles | Other | Janda's Approach, Mckenzie Excercises |
Primary outcome
Numeric Pain Rating Scale
Time frame: From enrollment to the end of treatment at 6 weeks.
The 11-point Numeric Pain Rating Scale (NPRS) ranged from 0 to 10, with 10 denoting "the highest level of pain imaginable" and 0 denoting "no pain". It was a simple indicator of pain intensity since patients chose the number that most accurately represented their level of pain.
Neck Disability Index
Time frame: From enrollment to the end of treatment at 6 weeks
The Neck Disability Index (NDI) was a standardized, self-administered questionnaire used to evaluate how neck pain affected a person's ability to perform everyday activities. It consisted of 10 items that assessed different aspects of life impacted by neck pain, including pain intensity, personal care, lifting, reading, headaches, concentration, work, driving, sleeping, and recreation. Each item was scored on a scale from 0 to 5, where higher scores indicated greater disability. The total score could range from 0 to 50 and was often converted into a percentage to interpret the level of disability. A score between 0-8% suggested no disability, 10-28% indicated mild disability, 30-48% moderate disability, 50-64% severe disability, and 70% or higher reflected complete disability.
Photogrammetry Method for Craniovertebral Angle
Time frame: From enrollment to the end of treatment at 6 weeks
A photogrammetric method was used to evaluate forward head posture (craniovertebral angle), rounded shoulders, and thoracic kyphosis from a lateral view. Key anatomical landmarks-tragus, acromion, C7, and T12-were marked on participants. Individuals stood in a natural posture, barefoot, on a marked board while facing forward. A digital camera, placed 265 cm away, captured three side-view photographs. The images were analyzed using USC software, which measured: * Forward head angle: angle between the line from tragus to C7 and the vertical. * Rounded shoulder angle: angle from acromion to the vertical. * Kyphosis angle: arc between C7 and T12.
ROM Cervical Spine (Flexion)
Time frame: From enrollment to the end of treatment at 6 weeks
Changes in cervical spine flexion ROM at baseline and 6th week of intervention was measured using goniometer.
ROM Cervical Spine (Extension)
Time frame: From enrollment to the end of treatment at 6 weeks
Changes in cervical spine extension ROM at baseline and 6th week of intervention was measured using goniometer.
ROM Cervical Spine (Lateral Flexion) Right Side
Time frame: From enrollment to the end of treatment at 6 weeks
Changes in cervical spine lateral flexion on right side ROM at baseline and 6th week of intervention was measured using goniometer.
ROM Cervical Spine (Lateral Flexion) Left Side
Time frame: From enrollment to the end of treatment at 6 weeks
Changes in cervical spine lateral flexion on left side ROM at baseline and 6th week of intervention was measured using goniometer.
ROM Cervical Spine (Rotation) Right Side
Time frame: From enrollment to the end of treatment at 6 weeks
Changes in cervical spine rotation on right side ROM at baseline and 6th week of intervention was measured using goniometer.
ROM Cervical Spine (Rotation) Left Side
Time frame: From enrollment to the end of treatment at 6 weeks
Changes in cervical spine rotation on left side ROM at baseline and 6th week of intervention was measured using goniometer.
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 25 Sep 2026.
- Background: PubMed 36180139Aneis 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.
- Background: PubMed 38541838Jeong GH, Lee BH. Effects of Telerehabilitation Combining Diaphragmatic Breathing Re-Education and Shoulder Stabilization Exercises on Neck Pain, Posture, and Function in Young Adult Men with Upper Crossed Syndrome: A Randomized Controlled Trial. J Clin Med. 2024 Mar 11;13(6):1612. doi: 10.3390/jcm13061612.
- Background: PubMed 37649869Titcomb DA, Melton BF, Miyashita T, Bland HW. The Effects of Postural Education or Corrective Exercise on the Craniovertebral Angle in Young Adults with Forward Head Posture: A Randomized Controlled Trial. Int J Exerc Sci. 2023 Aug 1;16(1):954-973. doi: 10.70252/PYPQ8483. eCollection 2023.
- Background: PubMed 41316631Haghighat F, Moradi R, Rezaie M, Yarahmadi N, Ghaffarnejad F. Added value of diaphragm myofascial release on forward head posture and chest expansion in women with symptomatic forward head posture: A randomized controlled trial. J Bodyw Mov Ther. 2025 Dec;45:645-651. doi: 10.1016/j.jbmt.2025.07.015. Epub 2025 Aug 8.
- Background: PubMed 41217962Kim Y, Cha Y, Yoon S. Effects of hip extensor exercises on neck disability, cervical alignment, muscle imbalance, and blood flow in forward head posture. Technol Health Care. 2026 Mar;34(2):145-153. doi: 10.1177/09287329251392400. Epub 2025 Nov 11.
- Individual participant dataSharing planned: No
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.
Anum Manzoor, MS (OMPT) 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 McKenzie Treatment, Janda's Approach and Baseline Treatment in people with Upper Crossed 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 8 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: finished, as of the sponsor's last update on 25 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?
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?
Numeric Pain Rating Scale (time frame: From enrollment to the end of treatment at 6 weeks.). The study lists 9 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 NCT07841639, which also lists 5 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 25 Sep 2026.