An interventional study of Bio feedback training and conventional exercise program in Upper Extremity Problem, Muscle Weakness and Postural Kyphosis, sponsored by Riphah International University. Completed at 1 site in Pakistan. Open to participants aged 25 Years to 45 Years. Per ClinicalTrials.gov, last updated 2026-09-10.
Sponsored by Riphah International University · Not applicable, Interventional, and Treatment
This randomized controlled trial investigates the effects of biofeedback-guided training versus conventional therapy on muscle strength and postural alignment in patients with Upper Cross Syndrome. The study includes adults aged 25-45 years meeting diagnostic criteria for UCS, such as weak deep cervical flexors, restricted cervical ROM, forward head posture, increased thoracic kyphosis, and chronic neck pain >3 months. Participants are divided into two groups: Group A biofeedback training and Group B conventional therapy, receiving 12 sessions over 4 weeks ,3sessions/week. Assessments are conducted at baseline, post-1st session, and weekly intervals using standardized measures.The study aims to compare the efficacy of biofeedback-guided training in improving strength and posture in UCS patients.
Prolonged sitting and repetitive movements, common in desk jobs, poor ergonomics, and sedentary lifestyles, can lead to poor posture, discomfort, pain, and muscle or joint disability. A frequent result of poor posture is Upper Cross Syndrome, characterized by imbalances between upper body muscle groups. In Upper Cross Syndrome, overactive muscles like the pectoralis major, upper trapezius, and levator scapulae become tight, while the deep neck flexors, middle and lower trapezius, serratus anterior, and rhomboids weaken, disrupting movement patterns and increasing injury risk. Dr. Janda's 1988 model categorized muscles into postural (tonic) muscles, prone to tightness, and phasic muscles, prone to weakness. Upper cross Syndrome commonly causes neck, shoulder, and upper back pain, along with discomfort in the shoulder blades and neck stiffness.
Upper Cross Syndrome symptoms include neck, shoulder, and upper back pain, and can lead to forward head posture , increased thoracic kyphosis, and loss of cervical lordosis. Forward head posture, seen in 60% of individuals aged 20 to 50, causes neck strain, reduced mobility, and pain. With the rise of technology use, Upper cross syndrome has become more prevalent. Individuals often lean forward to view screens, exacerbating posture-related issues. Studies show Upper cross syndrome prevalence in IT professionals (67%), students (37.1%) and laundry workers (28%). Prevalence across different groups ranges from 11% to 60%. This condition leads to pain, discomfort, and reduced quality of life, prompting the need for effective treatment.
Effective manual therapy techniques for treating Upper Cross Syndrome aim to alleviate muscle tension, improve mobility, and correct postural imbalances. These include joint mobilization and manipulation, which restore normal motion and reduce pain, and soft tissue mobilization techniques like myofascial release and trigger point therapy that target tight muscles to enhance blood flow and reduce tension. Active Release Techniques identify and release muscle adhesions through specific movements and therapist-applied pressure, while transverse massage uses friction across muscle fibers to break down adhesions and promote healing. Post-Isometric Relaxation helps enhance flexibility and reduce tightness by contracting and stretching muscles, and neuro-mobilization addresses nerve entrapments commonly associated with Upper cross syndrome to alleviate pain.
A growing body of research has explored the effectiveness of various interventions for managing Upper cross syndrome, including manual therapy, and biofeedback-guided strength training. Karthi et al. found that motor control training of deep neck flexors using pressure biofeedback significantly reduced pain and disability, highlighting the efficacy of biofeedback in improving muscle activation and posture. Similarly, Ashfaq et al. demonstrated that cranio-cervical flexion training with biofeedback enhanced muscular endurance and reduced neck pain more effectively than conventional methods. These findings align with the clinical utility of biofeedback in correcting postural imbalances, a key feature of UCS. In addition, ART, which targets muscle adhesions and soft tissue dysfunction, has shown promise in improving range of motion and alleviating pain in UCS patients (Kang et al., 2016).Manual therapy techniques like joint mobilization and soft tissue manipulation are also effective in restoring normal movement patterns and reducing discomfort. Gumuscu et al. further supported these findings by showing that combining conventional program i.e. stabilization exercises with stretching and strengthening improved posture and respiratory function in office workers with forward head posture, suggesting that integrated approaches could enhance outcomes in Upper cross syndrome management.
Strength training has been widely used to correct Upper cross syndrome by targeting weak muscle groups, particularly DCFs. Studies have shown that resistance exercises can significantly improve posture and reduce associated pain by enhancing muscle endurance and correcting imbalances. However, conventional strength training lacks real-time feedback mechanisms, not providing neuromuscular control, potentially leading to compensatory movements and suboptimal outcomes.
601 studies on the registry are indexed under Muscle Weakness; 99 are open to participants now.
This study's enrollment of 56 is above the median of 46 across 444 interventional studies indexed under Muscle Weakness.
Browse Muscle Weakness studies →Riphah International University is the lead sponsor of 2,133 studies on the registry; 633 are open to participants now.
Counted across the registry records on this site, refreshed daily.
Adults aged 25-45 years with both genders.
Exclusion Criteria:
History of recent neck surgery or injury.
Biofeedback-Guided Strength Training: Hot Pack: Applied for 10 minutes, mild warmth sensation to relax muscles and prepare for exercise. 1\. BPU (Biofeedback Pressure Unit): performed at 5 pressure levels (22, 24, 26, 28, 30 mmHg). Each level involves a 10-second hold, with 30 seconds rest between levels. Targeted muscles: * Deep Cervical Flexors (Capitus Longus, Capitus Colli). * Rhomboids * Trapezius Total duration (BPU): 20 minutes/session, performed 3 times/week.
Other: Bio feedback training
Conventional Therapy: Hot Pack: Applied for 10 minutes, mild warmth sensation to relax muscles and prepare for exercise. EXERCISE PROGRAM: * 1\. Supine: Neck curl with Chin Tucks (Deep Cervical Flexors Capitus Longus, Capitus Colli): 10 reps/session, holding each for 5 seconds. * 2\. Sitting: Chin tuck with Head pushing against palm. * 3\. Chin Up (Middle and Lower Trapezius): 10 reps/session, holding each for 5 seconds. * 4\. Scapular Squeezes (Rhomboids): 2-3 sets of 10 reps/session, holding each for 5 seconds * 5\. Doorway Pectoral Stretch (pect major) 2-3 reps, 30 sec hold (36) Total duration: 20 minutes/session, performed 3 times/week.
Other: conventional exercise program
Hot Pack: Applied for 10 minutes, mild warmth sensation to relax muscles and prepare for exercise. 1\. BPU (Biofeedback Pressure Unit): performed at 5 pressure levels (22, 24, 26, 28, 30 mmHg). Each level involves a 10-second hold, with 30 seconds rest between levels. Targeted muscles: * Deep Cervical Flexors (Capitus Longus, Capitus Colli). * Rhomboids * Trapezius Total duration (BPU): 20 minutes/session, performed 3 times/week.
Hot Pack: Applied for 10 minutes, mild warmth sensation to relax muscles and prepare for exercise. EXERCISE PROGRAM: * 1\. Supine: Neck curl with Chin Tucks (Deep Cervical Flexors Capitus Longus, Capitus Colli): 10 reps/session, holding each for 5 seconds. * 2\. Sitting: Chin tuck with Head pushing against palm. * 3\. Chin Up (Middle and Lower Trapezius): 10 reps/session, holding each for 5 seconds. * 4\. Scapular Squeezes (Rhomboids): 2-3 sets of 10 reps/session, holding each for 5 seconds• 5. Doorway Pectoral Stretch (pect major) 2-3 reps, 30 sec hold (36)Total duration: 20 minutes/session, performed 3 times/week.
cranio-cervical flexion test
craniocervical flexion test to measure strength and endurance of Deep cervical flexors. it ranges from 20 mm of hg to 30 mm of Hg based on increased strength
Time frame: baseline to 4th week
NPRS
Pain is measured through NPRS scale. it has 11 level points from 0-10. where 0 indicate no pain and 10 indicate un-bearable pain
Time frame: total of 5 measurements taken at baseline, at the end of 1st, 2nd , 3rd and 4th week
NECK DISABILITY INDEX
neck disability is measured through NDI. it has score from 0-50. where 0 indicate low disability and 50 indicate total disability
Time frame: total of 5 measurements taken at baseline, at the end of 1st, 2nd , 3rd and 4th week
cervical Flexion
A goniometer is a reliable and valid tool for assessing joint angles. cervical flexion is mesaured when the chin tries to touch the chest. it ranges from o-40 degrees.
Time frame: baseline to 4th week
cervical Extension
A goniometer is a reliable and valid tool for assessing joint angles. cervical extension is mesaured when the person tries to look up to the roof as max as he/she can go. it ranges from 0-70 degrees.
Time frame: baseline to 4th week
cervical Rt rotation
A goniometer is a reliable and valid tool for assessing joint angles. cervical Rt rotation is measured when the person face tries to look to the right
Time frame: baseline to 4th week
cervical Lt rotation
A goniometer is a reliable and valid tool for assessing joint angles. cervical Lt rotation is measured when the person face tries to look to the left. it ranges from 0-45 degrees
Time frame: baseline to 4th week
cervical Lt flexion
A goniometer is a reliable and valid tool for assessing joint angles. cervical Lt flexion is measured when the lt ear tries to touch to the shoulder
Time frame: baseline to 4th week
cervical Rt flexion
A goniometer is a reliable and valid tool for assessing joint angles. cervical Rt flexion is measured when the Rt ear tries to touch to the shoulder.
Time frame: baseline to 4th week
Plan to share: No
No publications or documents are linked to this record.
This study is completed, as verified in Sep 2026. You cannot join it, but the record below documents what was studied.
Get an email when the registry record changes — status, dates, results — or when someone posts here.
Sign in to followQuestions and observations about this study, from anyone following it. Not medical advice, and not a channel to the study team — their contact details are on the registry record.
Sign in to join the discussion. Reading takes no account; posting does. You choose a display name, and a pseudonym is the default.
Nothing here yet. If you are running this trial, taking part in it, or weighing whether to, this is the place to say so.
Riphah International University