This study is a double-blind, parallel-group randomized controlled trial designed to evaluate the effectiveness of a Comprehensive Corrective Exercise Program (CCEP) with and without Instrument-Assisted Soft Tissue Mobilization (IASTM) in individuals with Upper-Crossed Syndrome (UCS). UCS is a common postural dysfunction characterized by muscular imbalance, including tightness of the upper trapezius, levator scapulae, and pectoral muscles, along with weakness of the deep cervical flexors and scapular stabilizers. This imbalance leads to forward head posture, rounded shoulders, neck pain, reduced cervical mobility, and functional limitations, particularly in individuals exposed to prolonged sedentary activities and poor ergonomic conditions.
A total of 60 participants aged 18-40 years diagnosed with Upper-Crossed Syndrome will be recruited and randomly allocated into two groups. The control group will receive a structured Comprehensive Corrective Exercise Program (CCEP), while the experimental group will receive the same exercise program combined with Instrument-Assisted Soft Tissue Mobilization (IASTM).
Both interventions will be administered three times per week for six weeks under the supervision of a trained physiotherapist. Outcome measures will be assessed at baseline and after completion of the intervention period. Primary outcomes include cervical range of motion, muscle strength assessed by the Deep Neck Flexor endurance test, functional disability measured using the Neck Disability Index, and postural alignment assessed using a plumb line method.
The aim of this study is to determine whether the addition of IASTM to a corrective exercise program results in superior improvements in cervical mobility, muscle strength, functional disability, and postural alignment compared to corrective exercise alone. It is hypothesized that the combined intervention will produce greater clinical improvements in individuals with Upper-Crossed Syndrome.
Age between 18-40 years
Both males and females
Diagnosed with Upper-Crossed Syndrome
Presence of forward head posture and rounded shoulders
History of cervical spine surgery or fracture
Neurological conditions (e.g., radiculopathy, myelopathy)
Systemic musculoskeletal disorders (e.g., rheumatoid arthritis)
Current physiotherapy treatment for neck pain
Parallel
Instrument-Assisted Soft Tissue Mobilization (IASTM) + Comprehensive Corrective Exercise Program (CCEP)
Other interventionThis intervention combines the Comprehensive Corrective Exercise Program (CCEP) with Instrument-Assisted Soft Tissue Mobilization (IASTM). The exercise component is identical to the control group and includes stretching, strengthening, and postural re-education exercises targeting cervical and scapular musculature. IASTM is applied to overactive muscles including upper trapezius, levator scapulae, sternocleidomastoid, and pectoral muscles using specialized instruments with techniques such as scanning, sweeping, J-stroke, and fanning. Each session lasts approximately 20 minutes, administered three times per week for six weeks under physiotherapist supervision.
Comprehensive Corrective Exercise Program (CCEP)
Other interventionThe Comprehensive Corrective Exercise Program (CCEP) is a structured physiotherapy intervention designed to correct muscular imbalance associated with Upper-Crossed Syndrome. It includes stretching of overactive muscles (pectoralis major and minor, upper trapezius, levator scapulae, sternocleidomastoid), strengthening of weak muscles (deep cervical flexors, lower trapezius, rhomboids, serratus anterior), and motor control and postural re-education exercises. Exercises are performed under physiotherapist supervision three times per week for six weeks.
Cervical Range of Motion (CROM)
Cervical range of motion will be measured using a goniometer. Measurements will include flexion, extension, lateral flexion, and rotation.
Muscle Strength (Deep Neck Flexor Endurance Test)
The Deep Neck Flexor Endurance Test (also known as the craniocervical flexion endurance test) measures the duration a participant can hold a chin-tuck position with correct form. Scores range from 0 to 60 seconds, with the test terminated at 60 seconds if the position is maintained that long. Higher scores indicate better deep neck flexor muscle endurance.
Neck Disability (Neck Disability Index)
The Neck Disability Index is a 10-item patient-reported outcome measure assessing functional disability related to neck pain, covering activities such as personal care, lifting, reading, and concentration. Each item is scored 0-5, for a total score range of 0 to 50. Higher scores indicate greater disability.
Postural Alignment
Postural alignment will be assessed using a plumb line method to evaluate forward head posture and rounded shoulder posture.
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