This study aims to investigate the relationship between cervical position sense, core stabilization, and postural balance in university students aged 18-30 years with Upper Crossed Syndrome (UCS). Upper Crossed Syndrome is a common musculoskeletal disorder characterized by muscle imbalance, including weakness of the deep cervical flexors, middle and lower trapezius, rhomboids, and serratus anterior, along with tightness of the upper trapezius, levator scapulae, sternocleidomastoid, and pectoralis major and minor. This condition frequently affects university students due to prolonged sitting, extensive computer use, and poor posture. While previous research has focused on discrete components of UCS such as posture correction or pain management, the combined effects of cervical proprioception, core stability, and postural balance remain poorly understood. A total of 48 participants will be enrolled and divided into two equal groups: 24 students diagnosed with Upper Crossed Syndrome and 24 healthy students as a control group. Assessments include cervical joint position error testing, core stabilization endurance tests (Unilateral Hip Bridge Endurance Test and Sahrmann Five-Level Core Stability Test), static balance evaluation using the Balance Error Scoring System (BESS), and dynamic balance assessment using the Y-Balance Test. Pain intensity will be measured using the Visual Analog Scale (VAS). This study will help identify neuromuscular and sensory mechanisms underlying these parameters and support evidence-based rehabilitation techniques to improve postural alignment, reduce musculoskeletal dysfunction, and enhance overall functional performance in this population.
University students aged 18-30 years.
Diagnosis of Upper Crossed Syndrome (UCS) confirmed by postural assessment.
Forward Head Posture with Craniovertebral Angle (CVA) less than 49 degrees.
Rounded Shoulder Posture greater than 2.5 cm.
History of cervical spine surgery.
Neurological disorders (e.g., stroke, multiple sclerosis, Parkinson's disease).
Acute musculoskeletal injury to the neck, back, or upper extremities within the past 3 months.
Previous traumatic injuries to the neck or back.
The study population consists of university students aged 18-30 years from Istinye University and other universities in Istanbul. Participants will be recruited from various academic disciplines. The target population includes students with Upper Crossed Syndrome (UCS) for the case group and healthy students without UCS for the control group. Recruitment will be conducted through flyers posted across campus buildings, advertisements on student social media platforms, mass emails to all university departments, direct screening in common areas, and an online screening survey for volunteers.
Case-control
Cross-sectional
postural and balance assessment battery
Other interventionA comprehensive assessment battery including cervical joint position error testing, core stabilization endurance tests (Unilateral Hip Bridge Endurance Test and Sahrmann Five-Level Core Stability Test), static balance evaluation using the Balance Error Scoring System (BESS), dynamic balance assessment using the Y-Balance Test, and pain intensity measurement using the Visual Analog Scale (VAS). Total assessment time approximately 25-35 minutes.
Cervical Joint Position Error (JPE)
Measurement of cervical proprioceptive acuity using the Joint Position Error test. Participants actively move their head into extension, left rotation, and right rotation, then attempt to return to the neutral position with eyes closed. The repositioning error is measured in centimeters using a laser pointer mounted on a headband and a target grid positioned at eye level on the wall. Three trials are performed in each movement direction, and the mean repositioning error is calculated. Larger errors indicate impaired cervical position sense.
Core Stabilization Endurance
Evaluation of core muscle endurance and lumbopelvic stability using two tests: (1) Unilateral Hip Bridge Endurance (UHBE) Test: participant lies supine with knees bent, extends one leg, and raises hips into a bridge position. Time maintained without hip sag or body misalignment is recorded in seconds for both sides. (2) Sahrmann Five-Level Core Stability Test: participant in supine with Pressure Biofeedback Unit (PBU) placed under lumbar spine (inflated to 40 mmHg). Participant performs progressively challenging leg movements across five levels while maintaining pressure at 40 mmHg (±10 mmHg). The highest successfully completed level is recorded.
Postural Balance Performance
Evaluation of static and dynamic balance using two tests: (1) Balance Error Scoring System (BESS) for static balance: participant maintains stability in six stances (double-leg, single-leg, and tandem) on firm and foam surfaces while eyes closed. Number of postural deviations or "errors" is counted; higher scores indicate poorer balance. (2) Y-Balance Test for dynamic balance: participant stands on one limb while reaching with contralateral limb in anterior, posteromedial, and posterolateral directions. Reach distances are measured in centimeters, normalized to limb length, and averaged across three trials for each direction.
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