Abstract
Objective: This study aimed to To systematically review randomized controlled trials (RCTs) investigating the effect of manual therapy, alone or in combination with exercise, on postural correction, pain, and functional outcomes in individuals with FHP or UCS.
Study Design: A Systematic Review was conducted.
Place and duration of study: A systematic search was conducted in PubMed, Cochrane Library, and PEDro for RCTs published between 2018 and 2025.
Material and Methods: A systematic search was conducted in PubMed, Cochrane Library, and PEDro for RCTs published between 2018 and 2025. Studies were included if they examined manual therapy interventions targeting postural dysfunction in FHP/UCS populations. Data on participants, interventions, comparators, outcomes, and results were extracted. Methodological quality was assessed using the PEDro scale, and risk of bias was evaluated using the Cochrane RoB tool.
Results: Twelve RCTs, including 22–66 participants aged 18–45 years, were included. Interventions involved cervicothoracic mobilization, myofascial release, soft tissue manipulation, and combined posture correction programs, often integrated with exercise. Outcomes included craniovertebral angle (CVA), scapular position, neck pain, and functional disability. Most studies reported short-term improvements in postural alignment, pain reduction, and functional performance. Methodological quality was moderate (PEDro scores 6-7/10), and risk of bias was mainly due to lack of participant and therapist blinding
Conclusion: Manual therapy, alone or with exercise, appears effective in improving postural dysfunction and related symptoms in FHP/UCS, although evidence is limited by heterogeneity, small sample sizes, and short-term follow-up. Future high-quality RCTs with standardized protocols and long-term outcomes are warranted.
Keywords: Manual therapy, Forward head posture, Upper Crossed Syndrome, Postural dysfunction, Randomized controlled trial
References
1. Hanif A, Ahmad A, Arslan SAU, Asghar M, Zaheer A, Shafiq H. Effects of muscle energy techniques versus corrective exercise programme on pain, range of motion and function in patients with upper cross syndrome: a randomised clinical trial. Physiotherapy Quarterly. 2024;32(2):76-83.
2. Shivangi BS, Koley S. Digital habits and postural impact: a study on prevalence of forward head posture among collegiate smartphone users. Int J Health Sci Res. 2024;14:265-71.
3. Sepehri S, Sheikhhoseini R, Piri H, Sayyadi P. 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. 2024;25(1):105.
4. Yaghoubitajani Z, Gheitasi M, Bayattork M, Andersen LL. Online supervised versus workplace corrective exercises for upper crossed syndrome: a protocol for a randomized controlled trial. Trials. 2021;22(1):907.
5. Seidi F, Bayattork M, Minoonejad H, Andersen LL, Page P. Comprehensive corrective exercise program improves alignment, muscle activation and movement pattern of men with upper crossed syndrome: randomized controlled trial. Scientific Reports. 2020;10(1):20688.
6. Gera C, Lamba S, Pawalia A, Panihar U. Efficacy of various exercises in the management of upper crossed syndrome. Comparative Exercise Physiology. 2023;19(3):207-14.
7. Rezaei H, Gheitasi M, Hosseini SM. 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. 2025;17(1):193.
8. Chang MC, Choo YJ, Hong K, Boudier-Reveret M, Yang S, editors. Treatment of upper crossed syndrome: a narrative systematic review. Healthcare; 2023: MDPI.
9. Chang MC, Choo YJ, Hong K, Boudier-Reveret M, Yang S, editors. Treatment of upper crossed syndrome: a narrative systematic review. Healthcare; 2023: MDPI.
10. Aneis YM, El-Badrawy NM, El-Ganainy A-EA, Atta HK. The effectiveness of a multimodal approach in the treatment of patients with upper crossed syndrome: A randomized controlled trial. Journal of Bodywork and Movement Therapies. 2022;32:130-6.
11. Janczarzyk D, Kurowski P. Comparison of the effect of two methods of ischemic compression of trigger points on the change of pain threshold and electromyographic parameters of the trapezius muscle. Physiother Rev. 2020;24:15-21.
12. Anwar S, Zahid J, Alexe CI, Ghazi A, Mareș G, Sheraz Z, et al. Effects of myofascial release technique along with cognitive behavior therapy in university students with chronic neck pain and forward head posture: a randomized clinical trial. Behavioral Sciences. 2024;14(3):205.
13. Elsayed WH, Alowa ZA. Impact of forward head posture correction on craniovertebral angle, neck disability, and spinal electromyography: A randomized controlled trial. Journal of Back and Musculoskeletal Rehabilitation. 2025;38(1):83-92.
14. Ghan GM, Babu VS. Immediate effect of cervico-thoracic mobilization on deep neck flexors strength in individuals with forward head posture: A randomized controlled trial. Journal of Manual & Manipulative Therapy. 2021;29(3):147-57.
15. Kim S-Y, An C-M, Cha Y-S, Kim D-H. Effects of sling-based manual therapy on cervicothoracic junction in patients with neck pain and forward head posture: A randomized clinical trial. Journal of Bodywork and Movement Therapies. 2021;27:447-54.
16. Elgendy MH, Ghaffar MAA, Sabbahi SAE, Abutaleb EES, Elsayed SEB. Efficacy of head postural correction program on craniovertebral angle, scapular position, and dominant hand grip strength in forward head posture subjects: A randomized controlled trial. Physiotherapy Research International. 2024;29(3):e2093.
17. Cabrera-Martos I, Rodríguez-Torres J, López-López L, Prados-Roman E, Granados-Santiago M, Valenza MC. Effects of an active intervention based on myofascial release and neurodynamics in patients with chronic neck pain: a randomized controlled trial. Physiotherapy theory and practice. 2022;38(9):1145-52.
18. Reema Joshi M, Nishita Poojary B. The Effect of Muscle Energy Technique and Posture Correction Exercises on Pain and Function in Patients with Non-specific Chronic Neck Pain Having Forward Head Posture—a Randomized Controlled Trail. International Journal of Therapeutic Massage & Bodywork. 2022;15(2):14-21.
19. Abraham B. Video game visions of climate futures: ARMA 3 and implications for games and persuasion. Games and Culture. 2018;13(1):71-91.
20. Buttagat V, Kluayhomthong S, Areeudomwong P. Effects of the combination of traditional Thai massage, scapular stabilization exercise, and chest mobilization in subjects with forward head posture: a single-blinded randomized clinical trial. Chiropractic & manual therapies. 2023;31(1):31.
21. Panihar U, Joshi S. Enhancing respiratory functions and cervical proprioception with myofascial release and feedback respiratory training in forward head posture: a pilot randomized controlled trial. Journal of Nature and Science of Medicine. 2024;7(4):276-83.
22. Kim D-H, Kim S-Y. Comparison of immediate effects of sling-based manual therapy on specific spine levels in subjects with neck pain and forward head posture: a randomized clinical trial. Disability and rehabilitation. 2020;42(19):2735-42.
23. Kaur S, Chatterjee S, Goyal M, Popli A, Goyal K, Saha M, et al. Physiotherapeutic approaches in upper cross syndrome: A systematic review of systematic reviews. Journal of Bodywork and Movement Therapies. 2025;42:756-62.
24. Heneghan NR, Pup C, Koulidis K, Rushton A. Thoracic adverse events following spinal manipulative therapy: a systematic review and narrative synthesis. Journal of Manual & Manipulative Therapy. 2020;28(5):275-86.
This work is licensed under a Creative Commons Attribution-ShareAlike 4.0 International License.
Copyright (c) 2026 Journal of Nursing and Allied Health