Effectiveness of Rib Mobilization Combined With Postural Correction Exercises in Individuals With Upper Crossed Syndrome

Upper Crossed Syndrome (UCS) is a common musculoskeletal disorder that arises from sustained poor posture, leading to muscular imbalance and functional impairment in the upper body. The syndrome is characterized by forward head posture, increased cervical lordosis, and thoracic kyphosis caused by tightness in the upper trapezius, levator scapulae, and pectoralis muscles, and weakness in the deep cervical flexors, lower trapezius, and serratus anterior. This imbalance not only affects spinal alignment but also restricts rib mobility and thoracic extension, contributing to chronic neck and upper back pain.

Rib mobilization techniques focus on restoring the normal motion of the ribs and thoracic spine, improving chest expansion and flexibility. When combined with postural correction exercises, these interventions may correct alignment, reduce pain, and enhance thoracic mobility. Postural correction exercises aim to stretch overactive muscles and strengthen weakened ones to restore functional balance. Together, these methods are hypothesized to provide superior outcomes compared to postural exercises alone.

Previous studies have demonstrated the efficacy of either rib mobilization or postural correction in isolation. However, limited evidence exists regarding their combined use for UCS. This study seeks to fill this gap by examining the synergistic effects of both interventions on pain relief, postural correction, and thoracic mobility. Findings may contribute to developing an evidence-based rehabilitation protocol for UCS.

Inclusion criteria

• Age between 20 to 45 years
• Forward head posture (craniovertebral angle < 50°)
• Cervical pain or discomfort for ≥4 weeks
• Moderate pain intensity (VAS 3-6)
• Willingness to participate and provide informed consent
• Clinically diagnosed Upper Crossed Syndrome (UCS)
• Meets Asian Fitness Society diagnostic criteria for UCS

Exclusion criteria

• History of trauma or surgery to cervical/thoracic spine
• Cervical disc herniation, radiculopathy, or neurological deficits
• Structural deformities (scoliosis, Scheuermann's disease)
• Systemic musculoskeletal disorders (e.g., rheumatoid arthritis)
• Vestibular, balance, or visual disorders
• Recent similar therapy within 3 months
• Pregnancy or contraindication to manual therapy
• Ongoing use of pain medications or muscle relaxants