Effect of Maitland Mobilization Combined with Kendall Corrective Exercise on Pain and Postural Alignment of Patients with Upper Cross Syndrome: Pilot Study
DOI:
https://doi.org/10.54536/ajpehs.v4i2.8148Keywords:
Craniovertebral Angle, Kendall Exercises, Maitland Mobilization, Rounded Shoulder, Thoracic Kyphosis, Upper Cross SyndromeAbstract
Upper Cross Syndrome (UCS) is a prevalent postural dysfunction resulting from muscle imbalances that causes forward head posture, rounded shoulders and thoracic kyphosis. Although manual therapy and corrective exercises are frequently performed, studies comparing the two have not been conducted extensively.To determine the feasibility and effectiveness of Maitland mobilizations alongside Kendall exercises in patients with UCS.A pilot single-blinded randomized controlled trial was performed involving 28 subjects (14 in each group). Group A was subjected to Maitland mobilizations alongside Kendall exercises, while Group B underwent only Kendall exercises for four weeks (three sessions/week). Pain, Craniovertebral angle (CVA), thoracic kyphosis and rounded shoulders were measured. Descriptive analysis and preliminary comparisons were made.Feasibility was established based on recruitment, retention rate (100%) and compliance (>90%). Both groups responded well, but group Had better responses. Group A had a higher pain reduction than Group B (-4.66 ± 0.82 versus -2.84 ± 0.75). Group A experienced significant improvement in CVA (+6.6°) than Group B (+2.7°).The combination of Maitland mobilization and Kendall exercises appears more effective than exercises alone in improving pain and postural alignment in UCS. Findings support feasibility and justify larger randomized controlled trials.
Downloads
References
Afzal, H., Noor, R., Mumtaz, N., Bashir, M. S., & Saqulain, G. (2023). Effects of Kendall exercise vs. Gong’s mobilization on pain, range of motion, function, and strength in cases with text neck syndrome. Iranian Rehabilitation Journal, 21(3), 411-420.
Ahmed, Z. M., Ashique, I., Zafar, A., Ali, Z., Zafar, M., & Rasool, A. (2024). Prevalence of thoracic hyperkyphosis posture among female students of allied health institutes and Its association with rounded shoulders: Thoracic Hyperkyphosis and Rounded Shoulders Among Female Students. Journal of Health and Rehabilitation Research, 4(3), 1-4.
Atta, R. M., Yamany, A. A., Ahmed, H. H., Ali, R. R., Zaghloul, H. M. S., & Atta, H. K. (2025). Effect of adding cervicothoracic mobilization to comprehensive corrective exercises on postural alignment and neck functional level in upper crossed syndrome: randomized controlled trial. Fizjoterapia Polska(1).
Bjelkarøy, M. T., Benth, J. Š., Simonsen, T. B., Siddiqui, T. G., Cheng, S., Kristoffersen, E. S., & Lundqvist, C. (2024). Measuring pain intensity in older adults. Can the visual analogue scale and the numeric rating scale be used interchangeably? Progress in Neuro-Psychopharmacology and Biological Psychiatry, 130, 110925.
Chaudhuri, S., Chawla, J. K., & Phadke, V. (2023). Physiotherapeutic interventions for upper cross syndrome: a systematic review and meta-analysis. Cureus, 15(9).
Ganvir, M., & Kadam, S. Effect of Scapular Stabilization Exercises with and without Thoracic Mobilization on Neck Pain and Range of Motion in Upper Cross Syndrome.
Hazar, Z., Karabicak, G. O., & Tiftikci, U. (2015). Reliability of photographic posture analysis of adolescents. Journal of physical therapy science, 27(10), 3123-3126.
Hussain, S., Pereira, F., Sajid, M., Ahmad, I., Saad, S., Iqbal, S., & Rehman, M. (2022). Association between Rounded Shoulder Posture and Pulmonary Capacity among Undergraduate Doctor of Physical Therapy Students. Indian Journal of Physiotherapy & Occupational Therapy, 16(1).
Javed, A., Fatima, U., & Jadoon, I. J. (2022). Prevalence of Upper Cross Syndrome In Medical Students of Women Medical College, Abbottabad, Khyber Pakhtunkhwa, Pakistan. Journal of Women Medical and Dental College, 1(3).
Khawar, A., Khawar, S., Tauqeer, S., Amjad, F., Rubab, H. I., & Wafa, H. S. (2022). Association of upper cross syndrome with prolonged sitting among young adults. Pakistan Biomedical Journal, 370-374.
Mandal, A., & Ganguly, S. (2019). Non-invasive measurement of thoracic kyphosis and lumber lordosis among agricultural workers and corporate professionals (IT) using flexicurve ruler. International Journal of Occupational Safety and Health, 9(2).
Mingels, S. (2020). Spinal Posture as a Trigger for Episodic Headache within a Biopsychosocial context? An explorative study.
Neme, J. R. (2022). Balancing act: muscle imbalance effects on musculoskeletal injuries. Missouri medicine, 119(3), 225.
Outeda, L. R., Cousiño, L. A. J., Carrera, I. d. C., & Caeiro, E. M. L. (2022). Effect of the maitland concept techniques on low back pain: a systematic review. Coluna/Columna, 21(2), e258429.
Pathan, H., Pawar, A., Rao, R., Phansopkar, P., Chitale, N., & Arora, S. P. (2022). A structured exercise program for upper cross syndrome. J Med Pharm Allied Sci, 11(S1), 259-263.
Rahul, S., Anitha, A., Kamalakannan, M., & Ramana, K. (2024). Effectiveness of Kendall Exercise for Forward Head Posture among IT Workers. Indian Journal of Physiotherapy & Occupational Therapy, 18.
Rani, M., & Kaur, J. (2023). Effectiveness of spinal mobilization and postural correction exercises in the management of cervicogenic headache: A randomized controlled trial. Physiotherapy Theory and Practice, 39(7), 1391-1405.
Rezaei, H., Gheitasi, M., & Hosseini, S. M. (2025). Does corrective exercises influence the performance, posture, range of motion and shoulder pain of swimmers with upper crossed syndrome? randomized clinical trial. BMC Sports Science, Medicine and Rehabilitation, 17(1), 193.
Rodrigues, A., Romeiro, C., & Patrizzi, L. (2009). Evaluation of thoracic kyphosis in older adult women with osteoporosis by means of computerized biophotogrammetry. Brazilian Journal of Physical Therapy, 13, 205-209.
Sepehri, S., Sheikhhoseini, R., Piri, H., & Sayyadi, P. (2024). The effect of various therapeutic exercises on forward head posture, rounded shoulder, and hyperkyphosis among people with upper crossed syndrome: a systematic review and meta-analysis. BMC musculoskeletal disorders, 25(1), 105.
Shinwari, N. U., Sikander, M. S., Haider, M., Jan, S. I. U., Hassan, M., & Naz, M. (2024). Work-related musculoskeletal symptoms and their ergonomic risk factors among surgeons of Peshawar. Insights-Journal of Health and Rehabilitation, 2(2), 166-172.
Sikander, M. S., Shinwari, N. U., Shah, J., Atif, M., Jan, S. I. U., & Naz, M. (2024). Prevalence and association of risk factors for plantar fasciitis among nurses in government tertiary care hospitals of Peshawar. Journal of Health and Rehabilitation Research, 4(2), 1623-1628.
Singla, D., Veqar, Z., & Hussain, M. E. (2017). Photogrammetric assessment of upper body posture using postural angles: a literature review. Journal of chiropractic medicine, 16(2), 131-138.
Syinta, A. N., & Komalasari, D. R. (2024). Reliability and Validity of The Visual Analogue Scale in Non-Myogenic Low Back Pain Patients. Academic Physiotherapy Conference Proceeding,
Ullah, N., Atif, M., Amjad, F., Jan, Q., Zafeer, A., & Shah, N. (2026). Effect of Manual Therapy in Correcting Postural Dysfunction in Patients with Upper Crossed Syndrome: A Systematic Review. Journal of Nursing and Allied Health, 4(02), 160-170.
Usman, T., Babur, M. N., Aslam, E., Rashid, M. A. B., Aslam, K., & Azam, A. (2024). Effects of Kendall Exercises vs Gong’s Mobilization on Upper Cross Syndrome: Kendall Exercises vs. Gong’s Mobilization in UCS. Journal of Health and Rehabilitation Research, 4(3), 1-6.
Downloads
Published
Issue
Section
License
Copyright (c) 2026 Naeem Ullah, Fatima Amjad, Qamar Jan, Wagma Wajid, Aamir Niaz, Komal Hameed

This work is licensed under a Creative Commons Attribution 4.0 International License.