Upper Crossed Syndrome (UCS) is a postural imbalance in the upper body characterized by shortened and tight muscles in the front and upper back, while weak muscles in the back and neck are stretched and underactive. This imbalance can lead to forward head posture, rounded shoulders, and increased spinal curves, causing pain, headaches, and reduced range of motion. The study aims to compare the effects of Kendall exercises with Janda's Approach along with Diaphragmatic breathing exercises on pain, chest expansion, craniovertebral angle, and disability in upper crossed syndrome.
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Cervical trauma or surgery Congenital scoliosis Spasmodic torticollis Any tumor or trauma History of surgical procedures on neck or lower back Disc issues in neck or lower back
Parallel
Kendall exercises
Other interventionStretching: Pectoralis, Upper Trapezius, Levator Scapulae (2 sets of 20 sec each) Strengthening: Scapular retractors with Thera band (2 sets of10 reps), Chin tucks (2 sets of 10 reps), Diaphragmatic breathing (4 mins) Strengthening: Add isometric cervical flexors (5 sec hold with 5 reps),, Chin tucks \& scapular retractors (3 sets of 10 reps) Strengthening: Add scapular squeeze (5 sec hold of 5 reps), Emphasize postural control during exercises Strengthening: Functional posture tasks (e.g., seated posture with resistance), Maintain 15 reps of 3 sets Anterior (Wall Slides), Deep Neck Flexors - 2 sets of 10 reps Diaphragmatic breathing (4 mins), Neck Flexor Hold: 30 sec × 3 sets Add Dumbbell Shrugs, Table Pushes - 3 sets of 10 reps Add Serratus Anterior Upper Cuts (3 sets of 10 reps) strengthening increased to 12-15 reps per set (all muscle groups). Functional integration: Posture tasks during daily movement
Janda's Approach
Other interventionStretching: Levator scapulae, Upper Trapezius, Pectoralis (doorway/towel) - 2 sets × 30 sec each, Strengthening: Middle \& Lower Trapezius, Serratus Anterior (Wall Slides), Deep Neck Flexors - 2 sets × 10 reps, Diaphragmatic breathing (4 mins) Neck Flexor Hold: 30 sec × 3 sets Add Dumbbell Shrugs, Table Pushes 3 sets × 10 reps Add Serratus Anterior Upper Cuts (3 sets × 10 reps) strengthening increased to 12-15 reps per set (all muscle groups). Maintain 3 sets of stretching. Functional integration: Posture tasks during daily movement (e.g., reaching, sitting)
NUMERIC PAIN RATE SCALE (NPRS) for pain
It is a self-reported scale that measures pain intensity on a scale from 0 (no pain) to 10 (worst possible pain). It is widely used in musculoskeletal conditions for monitoring pain levels over time. The NPRS has demonstrated high validity (r = 0.85 with VAS) and excellent test-retest reliability (ICC = 0.92-0.96). The MCID for NPRS is generally considered to be 2 points, indicating a meaningful improvement or worsening in pain perception
NECK DISABILITY INDEX (NDI)
It is a validated questionnaire consisting of 10 items that assess the functional impact of neck pain on daily activities such as personal care, work, driving, and recreation. It is specific to cervical conditions. The NDI has strong content validity, with excellent internal consistency (α = 0.87) and test-retest reliability (ICC = 0.89). The MCID for NDI has been reported to range from 5 to 7 points, representing a clinically important change in neck-related disability
UNIVERSAL GONIOMETER for ROM
It is used to measure the craniovertebral angle (CVA), an objective indicator of forward head posture in individuals. A CVA less than 50° typically indicates abnormal posture. This tool shows good validity and excellent intra-rater reliability (ICC = 0.80-0.98) for cervical spine angle measurements. While an exact MCID for CVA is not firmly established, a change of 3-5 degrees is often considered clinically meaningful in postural correction studies
MEASURING TAPE
t is a simple and cost-effective tool used to assess chest expansion, which reflects thoracic mobility and respiratory function. The measurement is taken by placing the tape around the chest at the level of the fourth intercostal space during full inhalation and exhalation. It has acceptable criterion validity and demonstrates high intra-rater reliability (ICC = 0.91-0.94), making it suitable for tracking changes in chest mobility during postural or breathing interventions. The MCID for chest expansion is not universally defined, but an increase of 0.5 to 1.0 cm is generally considered clinically relevant in pulmonary and postural rehabilitation contexts
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