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Upper Cross SyndromeNCT07854119

Kendall Exercises With and Without Positional Release Therapy in Upper Crossed Syndrome

A study testing Kendall Exercises with Positional Release Therapy and Kendall Exercises in people with Upper Cross Syndrome, run by Riphah International University at 2 sites 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 Cross Syndrome (UCS) is a prevalent musculoskeletal disorder characterized by a specific pattern of muscular imbalance and postural dysfunction. This condition arises from prolonged poor posture. Read more about this study

Who is it for?
Ages 20 to 40 years
Conditions the study is for
Upper Cross Syndrome
What is being tested?
Kendall Exercises with Positional Release Therapy and Kendall Exercises
Could I receive a placebo?
No, everyone receives an active treatment
How many people
48 participants
Where
2 sitesPakistan
Study dates
1 Jun 2026to 1 Dec 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 40 years
  • All sexes
  • No healthy volunteers
  • Adult

Who may be able to join

  • Age 20 and 40 years.
  • Both Male and Female.
  • Clinical diagnosis of Upper Crossed Syndrome (Pectoralis major contracture test, Pectoralis minor contracture test, Upper trapezius muscle length test, Lower and Middle trapezius weakness tests will be done).
  • Forward Head Posture (Craniovertebral angle (CVA) ≤ 48°).
  • Numeric Pain Rating Scale (NPRS) score of ≥ 4).
  • Neck pain for more than 4 weeks but less than 6 months NDI.

Who cannot join

  • History of cervical spine trauma, fractures, or surgery
  • Systemic musculoskeletal disorders
  • Spinal Deformities
  • Ongoing physiotherapy or chiropractic treatment
  • Severe scoliosis or spinal deformities

Trial locations and contacts

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

Syed Shakil ur Rehman, PhD Physical Therapy contact

+92 320 786661

shakil.urrehman@riphah.edu.pk

Pakistan2 sites, 2 recruiting
  • Riphah Rehabilitation Clinic

    Lahore, Punjab Province, 54000

    Syed Shakil ur Rehman, PhD, +92 320 7866611, shakil.urrehman@riphah.edu.pk

    Recruiting
  • Riphah International University

    Lahore, 54000

    Recruiting

Other trials in Pakistan

About this study

Official title: Effects of Kendall Exercises With and Without Positional Release Therapy on Pain, Range of Motion, Craniovertebral Angle and Disability in Patients With Upper Crossed Syndrome

Upper Cross Syndrome (UCS) is a prevalent musculoskeletal disorder characterized by a specific pattern of muscular imbalance and postural dysfunction. This condition arises from prolonged poor posture. The resulting imbalance often manifests as visible postural changes, including rounded shoulders, forward head posture, and increased thoracic kyphosis. UCS is characterized by tightness and weakness of the neck, shoulders, and upper back muscles that cross between the dorsal and the ventral sides of the body. Postural abnormalities associated with UCS include a forward head posture (FHP), cervical lordosis, thoracic hyper kyphosis, protracted and elevated shoulders (round shoulders), and scapular winging with increased internal rotation and abduction.

In UCS, neck and chest muscles, such as the sternocleidomastoid (SCM), levator scapulae, Pectoralis major and minor, Scalenes, and Upper Trapezius (UT), are tightened or shortened, whereas muscles of the neck and posterior upper back, such as the Deep Neck Flexors (DNFs), Serratus Anterior (SA), Rhomboids, Middle Trapezius (MT), and Lower Trapezius (LT), are weakened, stretched, and restrained. Opposite-group muscle imbalances in UCS bring postural disturbances, misalignments in the upper limbs, and atlanto-occipital, cervicothoracic, and glenohumeral joint dysfunction. The muscular imbalances may also lead to various musculoskeletal symptoms, such as headaches, neck pain, chest pain, upper back pain, tingling in the upper arms, or a limited range of motion in the neck or shoulders.

Read more

The alteration in scapula muscles in UCS affects the movement of the scapula, which acts as a bridge and provides mobility and stability to the shoulders and neck. A proper posture is necessary for optimal functional performance in daily activities. The awkward positions put constant pressure on the joints, and degenerative changes in joints progress rapidly when exposed to sustained pressure, causing muscle imbalances and pain. If a muscle imbalance continues and progresses, this may lead to altered movement patterns and joint damage, creating further dysfunction.

The main risk factor for developing UCS is maintaining an abnormal posture for a prolonged duration. Some daily activities that involve bad postures are often occupation-related. Repetitive tasks or continuous work for long hours can aggravate postural deviations. For example, patients with improper postures are more prone to musculoskeletal injuries after handling or lifting heavy objects than others with a proper posture. Musculoskeletal pain, most commonly neck pain, may present as the main symptom of UCS. Musculoskeletal pain may increase in relation to standing continuously or improperly sitting for long hours.

Read the detailed description

With the rise in sedentary lifestyles and prolonged use of digital devices, the prevalence of UCS has significantly increased. Individuals with UCS often experience cervical pain, limited range of motion, headaches, and functional impairments. Effective rehabilitation strategies are essential to correct muscle imbalances, reduce pain, and restore mobility. Diagnostic criteria for UCS involve assessing the imbalance of shoulder, neck, and chest muscles, the inward curving of the spine at the neck, and the protrusion of shoulder blades. Management of UCS focuses on correcting abnormal posture, restoring neuromuscular balance, and alleviating pain. Various physiotherapeutic approaches, including manual therapy, stretching, strengthening, and postural training, are employed.

Two commonly used interventions in the management of UCS are Kendall exercises and Positional Release Therapy (PRT). Kendall's exercises are a system of therapeutic movements developed by Florence Peterson Kendall and colleagues, grounded in the principles outlined in their influential textbook Muscles: Testing and Function with Posture and Pain .These exercises are specifically designed to address postural abnormalities by correcting muscle imbalances through targeted stretching and strengthening techniques.

Positional Release Therapy (PRT) is a gentle, passive manual therapy technique developed by Dr. Lawrence Jones in the 1950s. It involves placing the body in a position of comfort often shortening the affected muscle for a sustained period (usually 90 seconds), which helps to reduce muscle spindle activity, relieve pain, and restore normal tissue tone. The technique is believed to facilitate a resetting of the proprioceptive and nociceptive responses in the affected tissues.

This study will help to determine the more effective intervention between Kendall exercises alone and Kendall exercises combined with Positional Release Therapy in individuals with Upper Crossed Syndrome. The findings will assist clinical physiotherapists in developing optimal treatment plans for managing postural dysfunction, pain, and mobility limitations associated with upper crossed syndrome.

Being tested
Kendall Exercises with Positional Release Therapy, Kendall Exercises
Keywords
Upper Cross Syndrome, Kendall exercises, Positional Release Techniques, Craniovertebral angle, Pain, Range of Motion
Medical subject headings
Oculocerebral hypopigmentation syndrome type Preus, Pain

What participants receive

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

  • Kendall Exercises with Positional Release TherapyOther

    Kendall's exercises and the Positional Release Technique (PRT) offer complementary physical therapy approaches for managing Upper Cross Syndrome.

    Kendall's framework, grounded in manual muscle testing and detailed postural analysis, restores alignment by pairing selective strengthening of weak muscles with selective stretching of tight ones. Its protocol incorporates chin tucks, shoulder blade squeezes, scapular depression, chest stretches, wall slides, and thoracic extensions. Exercises are executed in 3-6 sets of 10-15 reps, holding each for 10 seconds to enhance scapular control and correct forward head posture.

    Conversely, PRT-developed by Dr. Lawrence Jones-is an indirect soft-tissue therapy aimed at reducing muscle spasms and hypertonicity without stretching. Clinicians identify tender points and passively position the tissue into a shortened state of ease, holding it for 90 seconds to reset muscle spindle activity before returning to neutral.

  • Kendall ExercisesOther

    Kendall's exercises, derived from the foundational work of Florence and Henry Kendall, provide a targeted physical therapy framework for addressing Upper Cross Syndrome through precise postural analysis and manual muscle testing. The core strategy centers on correcting muscle imbalances by selectively strengthening inhibited, weak muscles while stretching tight, shortened ones to restore proper posture and alignment.

    To counteract forward head posture and scapular dysfunction, the protocol incorporates chin tucks to strengthen deep cervical flexors, prone shoulder blade squeezes for middle trapezius and rhomboids, and scapular depression or retraction for lower and upper trapezius control. Flexibility is restored using doorway stretches for tight pectoralis muscles, along with targeted stretches for the upper trapezius and levator scapulae. Wall slides and foam roller thoracic extension further improve scapular movement and spine mobility. Exercises are routinely performed for 3 to 6

Study groups in NCT07854119
Study groupRoleWhat they receive
Group AExperimentalKendall Exercises with Positional Release Therapy
Receives: Other: Kendall Exercises with Positional Release Therapy
Group BActive comparatorKendall Exercises
Receives: Other: Kendall Exercises

What is being measured

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

  1. Numeric Pian Rating Scale

    Numeric Pain Rating Scale (NPRS). It is a uni-dimensional scale to measure pain intensity, particularly in adults. It is a 10-rating scale and an 11-point numeric scale in the form of a horizontal bar or line. Zero is no pain, and 10 is intolerable/worst pain.

    Measured: Baseline; Week 3; Week 6

  2. Neck Diability Index (NDI)

    This questionnaire will be used to assess disability. It comprises of 10 items; 7 related to daily living activities, 2 related to pain and 1 related to concentration. Each item is scored from 0 to 5. Total score is expressed as a percentage, with higher scores related to greater disability

    Measured: Baseline; Week 3; Week 6

  3. Craniovertebral Angle

    The craniovertebral angle (CVA) is a commonly used clinical indicator for evaluating forward head posture, which is a prominent feature of Upper Crossed Syndrome (UCS). It is measured by drawing a horizontal line through the spinous process of the seventh cervical vertebra (C7) and a second line from C7 to the tragus of the ear. A smaller CVA reflects a greater degree of forward head posture, with angles less than 50 degrees typically considered abnormal

    Measured: Baseline; 3 Week; 6 Week

Timeline

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

  1. First posted2 Oct 2026
  2. Study start1 Jun 2026
  3. Primary completion1 Nov 2026 (estimated)
  4. Study completion1 Dec 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
Double blind
Who is masked
Participant, Outcomes assessor
Enrolment
48 participants (estimated)
IDs, dates and publications
ClinicalTrials.gov ID
NCT07854119
Sponsor's protocol ID
Tania Ziaullah Khan
Status last verified
Sep 2026
First submitted
27 Sep 2026
Last updated
2 Oct 2026
Results posted
No
Data monitoring committee
No
FDA-regulated drug
No
FDA-regulated device
No
Individual data sharing
No

Publications

  • 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
  • Khosravi Z, Mohammad Ali Nasab Firouzjah E, Firouzjah MH. Comparison of balance and proprioception of the shoulder joint in girls with and without upper cross syndrome. BMC Musculoskelet Disord. 2024 Aug 2;25(1):618. doi: 10.1186/s12891-024-07552-5.

    PubMed 39095725
  • Zhang C, Zhang J, Yang G. Association between internet addiction and the risk of upper cross syndrome in Chinese college students: A cross sectional study. Medicine (Baltimore). 2023 Jul 28;102(30):e34273. doi: 10.1097/MD.0000000000034273.

    PubMed 37505162
  • Shaheen A, Kazim H, Eltawil M, Aburukba R. IoT-Based Solution for Detecting and Monitoring Upper Crossed Syndrome. Sensors (Basel). 2023 Dec 26;24(1):135. doi: 10.3390/s24010135.

    PubMed 38202995
  • Firouzjah MH, Firouzjah EMAN, Ebrahimi Z. The effect of a course of selected corrective exercises on posture, scapula-humeral rhythm and performance of adolescent volleyball players with upper cross syndrome. BMC Musculoskelet Disord. 2023 Jun 14;24(1):489. doi: 10.1186/s12891-023-06592-7.

    PubMed 37316911

Questions about this trial

What is this clinical trial studying?

A study testing Kendall Exercises with Positional Release Therapy and Kendall Exercises in people with Upper Cross Syndrome, run by Riphah International University at 2 sites 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 6 inclusion and 5 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 2 Oct 2026. Status can change between updates, so confirm with the study contact before making plans.

Where is the study taking place?

The record lists 2 sites 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 Syed Shakil ur Rehman, PhD Physical Therapy (+92 320 786661, shakil.urrehman@riphah.edu.pk), or a site near the patient. AzTrials does not enrol participants or take referrals.

What does the primary outcome measure?

Numeric Pian Rating Scale (time frame: Baseline; Week 3; Week 6). 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 NCT07854119, 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 2 Oct 2026.

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