This study will compare the effectiveness of two manual therapy interventions combined with a standardized conventional physiotherapy protocol in individuals with Upper Cross Syndrome. Participants will be randomly allocated into two groups. Group A will receive Reverse Natural Apophyseal Glides, while Group B will receive Sustained Natural Apophyseal Glides. Both manual therapy interventions will primarily target the lower cervicaland upper thoracic spine specifically C6 to T2 and will be administered for 3 times a week for 4 weeks. The conventional physiotherapy protocol will be identical for both groups and will include a 10-minute hot pack followed by stretching of the pectoralis, upper trapezius and levator scapulae, each stretching exercise will be performed for 10 repetitions, 3 sets, with a 10 second hold per repetition. The strengthening program will target the deep cervical flexors and scapular stabilizers, including middle trapezius, lower trapezius, serratus anterior and rhomboids. Strengthening exercises will be performed for 10 repetitions, 3 sets, with a 10 second hold per repetition. The manual therapy component will differ between groups, allowing comparison of Reverse Natural Apophyseal Glides and Sustained Natural Apophyseal Glides when used alongside the same conventional intervention. This standardized approach aims to evaluate the comparative effects of the two manual therapy techniques on the postural and functional impairments associated with Upper Cross Syndrome.
Both genders.
Age 20 to 40 years.
Patients who had been experiencing chronic neck pain for three months or longer.
Pain intensity of 3 or more and less than 8 on NPRS.
Cervical radiculopathy
Vertebrobasilar insufficiency
Patients with a history of spinal surgery
Any history of trauma or whiplash injury (from the past 6 months to 1 year)
Parallel
Reverse Natural Apophyseal Glides
Procedure/SurgeryParticipants will receive Reverse Natural Apophyseal Glides to the C6-T2 cervicothoracic region in sitting, using small-amplitude rhythmic oscillations at end-range facet movement. Day 1 will include 1 set of 3 oscillations, progressing to 3 sets of 10 oscillations for the remaining days. Hot pack will target the posterior cervical and upper thoracic region for 10 minutes in prone lying. Pectoralis, upper trapezius, and levator scapulae stretching will be performed with 10 seconds hold, 3 sets of 10 repetitions, with 5-second intervals. Strengthening will include chin tucks, supine foam roller exercises at three abduction angles on day 1-3, side-lying external rotation and forward flexion on days 4-6, prone V, T, W exercises on days 7-9, and standing diagonal flexion and military press on days 10-12.
Sustained Natural Apophyseal Glides
Procedure/SurgeryParticipants will receive Sustained Natural Apophyseal Glides to the C6-T2 cervicothoracic region in sitting. Therapist will stabilize the spinous process with the thumb while applying a sustained posterior-to-anterior glide toward the eyes during cervical extension with end-range overpressure. Day 1 will include 1 set of 3 repetitions, progressing to 3 sets of 10 repetitions for the remaining days. Hot pack will target the posterior cervical and upper thoracic region for 10 minutes. Pectoralis, upper trapezius, and levator scapulae stretching will involve 10-second holds, 3 sets of 10 repetitions. Strengthening will include chin-tucks, supine foam roller exercises at three abduction angles on day 1-3, side-lying external rotation and forward flexion on days 4-6, prone V, T, W exercises on days 7-9, and standing diagonal flexion and military press on days 10-12.
Pain
Numeric Pain Rating Scale scale will be used to measure pain. 0 shows no pain, 1-3 represents mild pain, 4-6 represents moderate pain, and 7-10 represents severe pain..
Craniovertebral angle
Craniovertebral angle will be assessed using Kinovea 0.8.15 software from lateral photographs by measuring the angle between the horizontal C7 line and a line connecting C7 to ear tragus. Angle less than 48 degrees will indicate forward head posture.
Thoracic kyphosis angle
Thoracic kyphosis will be measured using two gravity-dependent inclinometers placed at T1/T2 and T12/L1. Three measurements will be recorded and averaged. Angle greater than 40 degrees will indicate hyper kyphosis.
Cervical range of motion
Cervical range of motion will be assessed using the CROM device, comprising three inclinometers positioned in the sagittal, frontal, and horizontal planes to measure cervical movement relative to gravity and the reference position.
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