Effect of Neural Mobilization in Upper Cross Syndrome

NCT ID: NCT07017738

Last Updated: 2026-01-09

Basic Information

• Recruitment Status: COMPLETED
• Clinical Phase: NA
• Total Enrollment: 60 participants
• Study Classification: INTERVENTIONAL
• Study Start Date: 2025-06-10
• Study Completion Date: 2025-12-15

Brief Summary

The purpose of this study is to investigate the effect of Neural Mobilization in patients with Upper Cross Syndrome.

Detailed Description

Upper cross syndrome (UCS) is the tightness of the levator scapulae, pectoralis major, and upper trapezius whereas inhibition of serratus anterior, deep neck flexors more specifically scalene, middle trapezius, lower trapezius, and rhomboids. This condition is given its name because a cross can be drawn across the upper body. One arm of the cross indicates the tight muscles and the other arm of the cross indicates the inhibited muscles.

People suffering from UCS present with a forward head posture (FHP), hunching of the thoracic spine (rounded upper back), elevated and protracted shoulders, scapular winging, and decreased mobility of the thoracic spine. Sometimes, manual work can cause musculoskeletal disorders, for example, the workers who do their work in awkward positions repeat the same action throughout their workday.

It was found that UCS causes pain among 24.3% of drivers. Also, 35.9% of office workers suffer from the upper cross syndrome and body posture was the leading cause. Housewives were also suffering from upper cross syndrome. The reason behind this is that during household tasks they don't keep a good posture which causes them pain and other difficulties.

Patients complaining of non-traumatic neck pain tend to keep the forward head posture, when compared to people without pain.

Rounded shoulder has been identified as a leading cause of upper quarter pain. Kyphosis, by both clinical and quantitative assessment, causes diminished function especially in tasks that require mobility.

The effect of neural mobilization in various diseases and conditions includes increasing nerve conduction and functional status, decreasing pain and subjective symptoms.

Accordingly, there are no available studies in the literature investigating the effect of neural mobilization on the upper cross syndrome, therefore this is the purpose of the study.

Conditions

Upper Cross Syndrome

Study Design

• Allocation Method: RANDOMIZED
• Intervention Model: PARALLEL
• Primary Study Purpose: TREATMENT
• Blinding Strategy: SINGLE

Study Groups

Neural mobilization + Corrective exercises

They will receive neural mobilization in addition to corrective exercises for UCS, 3 times per week for 6 weeks.

Group Type: EXPERIMENTAL

Corrective exercises

Intervention Type: OTHER

The corrective exercise program will include various positions: in standing, scapular retraction and arms overhead; in sitting, chin tuck and thoracic extension; in supine, arms in a W shape and horizontal abduction with external rotation; in side-lying, forward flexion starting with arms parallel to the body; and in prone, scapular retraction and depression in a T shape, extension from 90° forward flexion, and horizontal abduction at 90° with external rotation. Exercises will start with three repetitions held for 10 seconds and progress to six repetitions held for 25 seconds, based on overload principles and individual needs. Participants experiencing pain may stop and rest until symptoms subside.

Neural mobilization

Intervention Type: OTHER

Median nerve mobilization will be performed with the patient in a supine position, shoulder abducted to 90°, elbow flexed at 90°, and both wrist and head in a neutral position. The therapist will mobilize the nerve by extending the elbow to 45°, while the patient performs ipsilateral cervical lateral flexion to unload the nervous system.

Corrective exercises

They will receive corrective exercise for UCS, 3 times per week for 6 weeks.

Group Type: ACTIVE_COMPARATOR

Corrective exercises

Intervention Type: OTHER

The corrective exercise program will include various positions: in standing, scapular retraction and arms overhead; in sitting, chin tuck and thoracic extension; in supine, arms in a W shape and horizontal abduction with external rotation; in side-lying, forward flexion starting with arms parallel to the body; and in prone, scapular retraction and depression in a T shape, extension from 90° forward flexion, and horizontal abduction at 90° with external rotation. Exercises will start with three repetitions held for 10 seconds and progress to six repetitions held for 25 seconds, based on overload principles and individual needs. Participants experiencing pain may stop and rest until symptoms subside.

Interventions

Corrective exercises

The corrective exercise program will include various positions: in standing, scapular retraction and arms overhead; in sitting, chin tuck and thoracic extension; in supine, arms in a W shape and horizontal abduction with external rotation; in side-lying, forward flexion starting with arms parallel to the body; and in prone, scapular retraction and depression in a T shape, extension from 90° forward flexion, and horizontal abduction at 90° with external rotation. Exercises will start with three repetitions held for 10 seconds and progress to six repetitions held for 25 seconds, based on overload principles and individual needs. Participants experiencing pain may stop and rest until symptoms subside.

Intervention Type: OTHER

Neural mobilization

Median nerve mobilization will be performed with the patient in a supine position, shoulder abducted to 90°, elbow flexed at 90°, and both wrist and head in a neutral position. The therapist will mobilize the nerve by extending the elbow to 45°, while the patient performs ipsilateral cervical lateral flexion to unload the nervous system.

Intervention Type: OTHER

Eligibility Criteria

Inclusion Criteria

• Age ranged from 20 to 50 years.
• Body Mass Index ≤30 kg/m².
• All participants have a forward head, craniovertebral angle < 50°.
• All participants have round back (kyphosis angle ≥ 42°).
• All participants have rounded shoulders of ≥ 52°.
• The subjects were chosen from both genders based on an assessment of upper cross syndrome by photogrammetric analysis.
• All participants have pain intensity level measured by visual analogue scale (4-8).
• All participants tested positive for upper limb tension test of median nerve.

Exclusion Criteria

• History of trauma or surgery in the cervical region.
• Bone fractures or acute soft tissue injuries.
• Osteoporosis.
• Pregnant women.
• Cancer.
• Neurological conditions affecting cervical and thoracic spine.
• Connective tissue disease: This includes diseases such as osteomyelitis, lupus, and scleroderma.

• Minimum Eligible Age: 20 Years
• Maximum Eligible Age: 50 Years
• Eligible Sex: ALL
• Accepts Healthy Volunteers: No

Sponsors

Cairo University

OTHER

Sponsor Role: lead

Responsible Party

Essam Ahmed Abdelbaky Abdelbaky

Principal Investigator

Responsibility Role: PRINCIPAL_INVESTIGATOR

Principal Investigators

Abeer Abdelrahman, PhD

Role: STUDY_CHAIR

Professor, Cairo university

Locations

Cairo University

Giza, , Egypt

Countries

Egypt

Other Identifiers

P.T.REC/012/005577

Identifier Type: -

Identifier Source: org_study_id