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NCT Number: NCT07588061

Comparative Effect of Maitland Mobilization Combined With Kendall Exercises for Pain and Postural Alignment in Adults With Upper Cross Syndrome

This randomized controlled trial aims to compare the effects of Maitland mobilization combined with Kendall exercises versus Kendall exercises alone on pain and postural alignment in adults with Upper Cross Syndrome (UCS). Upper Cross Syndrome is characterized by muscle imbalance leading to forward head posture, rounded shoulders, and increased thoracic kyphosis. The study will evaluate pain intensity, craniovertebral angle, thoracic kyphosis, and rounded shoulder posture

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Key information

Conditions

Upper Cross Syndrome Oculocerebral hypopigmentation syndrome type Preus

Age range

18 year–45 year

Sex eligibility

All sexes

Study type

Interventional

Phase

Not applicable

Primary location

Ibadat International University, Islamabad (Iiui)

Peshawar, KPK, 25000, Pakistan

Location status: Recruiting

Location contact

Fatima Amjad, DPT, MS-PT Sports, PHD

CONTACT

[email protected]

+923330940975

Who can participate

Healthy volunteers accepted: No

Only the study team can determine whether someone qualifies for participation.

Inclusion criteria

  • Age 18 to 45 years
  • Neck and/or upper thoracic pain for a duration of > 6 weeks
  • Pain Severity: VAS > 5 (Afzal, Noor, Mumtaz, Bashir, & Saqulain, 2023)
  • Pain exacerbated by prolonged postures
  • Adults diagnosed with Upper Cross Syndrome
  • Diagnostic criteria: Upper Cross Syndrome will be diagnosed when individuals demonstrate: thoracic kyphosis > 40°, craniovertebral angle < 50°, and acromion-to-couch distance > 2.5 cm based on established normative values.

Exclusion criteria

  • History of neck or shoulder surgery or trauma
  • Inflammatory conditions such as rheumatoid arthritis or gout
  • Pregnancy
  • Neurological conditions affecting upper limb function, and
  • Cardiovascular Problems
  • Congenital issues i.e.; torticollis, and scoliosis
  • Disc prolapse and other spine issues
  • Currently taking any medication or taking physical therapy

Treatment and study plan

Kendall Exercises combined Maitland Mobilization

Other

Group A (Experimental) received Kendall exercises combined with Maitland mobilization, including strengthening of deep cervical flexors, lower trapezius, and serratus anterior, along with stretching of upper trapezius, levator scapulae, and pectoralis major/minor. Maitland mobilization was applied to the cervical and upper thoracic spine using central and unilateral PA oscillations for 50-60 seconds per segment at 2-3 oscillations per second, in addition to warm-up (cervical AROM and shoulder mobility exercises) and cool-down (stretching and diaphragmatic breathing).

Kendall Exercise alone

Other

Participants in this group will receive a structured Kendall exercise program only, without any manual therapy or mobilization techniques. The intervention will focus on postural correction through strengthening of weakened muscles (deep cervical flexors, scapular retractors) and stretching of tight muscles (pectoralis major/minor, upper trapezius, levator scapulae) associated with upper cross syndrome.

Primary outcomes

  1. Thoracic Kyphosis Assessed With Flexicurve Ruler

    Time frame: baseline to last week (8 week)

    Thoracic kyphosis will be measured using a flexicurve ruler. The spinous processes of C7 and T12 will be palpated and marked. The flexicurve ruler will mold along the thoracic curvature between these landmarks, and the curve will be transferred onto paper. . Based on previously published literature, thoracic kyphosis is considered 'normal' between 20 and 40°. Where this exceeds 40°, the curvature is described as hyperkyphosis.

  2. Forward Head Posture Assessed with Protractor mobile application

    Time frame: baseline to last week (8 week)

    Forward head posture will be assessed by measuring the craniovertebral angle (CVA) using the protractor mobile application. Measuring CVA from a lateral view by drawing a line from the ear tragus to the spinous process of the seventh cervical vertebra and a horizontal reference line through C7. The angle formed between these two lines will represent the craniovertebral angle.A reduced craniovertebral angle indicates increased forward head posture, with values less than 50° commonly used to identify this condition

  3. Rounded Shoulder Assessed with Vernier Caliper

    Time frame: baseline to last week (8 week)

    Rounded shoulder posture was assessed using a vernier caliper. Participants were positioned supine on a firm couch with arms relaxed by their sides. The vertical distance between the posterolateral edge of the acromion process and the couch surface was measured using a vernier caliper. Measurements will be taken bilaterally; an acromion-to-couch distance greater than 2.5cm will be considered indicative of rounded shoulder posture.

  4. Visual Analogue Scale

    Time frame: baseline to last week

    The intensity of the pain will be measured with the help of the Visual Analogue Scale (VAS). The VAS is a 10-cm horizontal line with two opposite endpoints marked with the following words: "no pain" at one end and "worst imaginable pain" at the other. The patient will then mark a point on the line that they feel most accurately reflects their current pain. The distance in centimeters or millimeters between the "no pain" point and the patient's mark will be taken as the measure of the patient's pain.

Study contacts

Contact information is provided by the study sponsor or research team.

Fatima Amjad, DPT, MS-PT Sports, PHD Scholer

CONTACT

[email protected]

+923330940975

Naeem Ullah, DPT, MS-PT MSK

CONTACT

[email protected]

+923308088558

Sponsors and collaborators

Lead sponsor

Ibadat International University, Islamabad

Other

Registry information

Official study title

Comparative Effect of Maitland Mobilization Combined With Kendall Exercises on Pain and Postural Alignment in Adults With Upper Cross Syndrome

Important dates

Study start
2026
Primary completion
2026
Study completion
2026
First posted
May 14, 2026
Registry last updated
May 20, 2026

OpenTrials presents study information sourced from ClinicalTrials.gov. The official registry record should be consulted for the latest information.

View the official ClinicalTrials.gov record (opens in a new tab)

This listing is for discovery and informational purposes only. It is not medical advice, does not guarantee that a study is recruiting, and does not determine eligibility. Contact the study team and a qualified healthcare professional when considering participation.

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