Effects Of Active Release Technique and Active Isolated Stretching on Muscles of Upper Cross Syndrome

ART and AIS on Upper Cross Syndrome


  • Fizza Ali Syed Department of Physiotherapist, Baloch Hospital, Lahore
  • Idrees Ahmed Zahoor Central Park Medical College, Lahore
  • Saira Shabbir Department of Physiotherapist, Riphah International University, Lahore
  • Arif Ali Rana Department of Physical Therapy, Central Park Medical College, Lahore
  • Mubshra Ibrahim Department of Physiotherapist, Riphah International University, Lahore
  • Erum Ghaffar Hijvari University, Lahore




Active release technique (ART), Active Isolated Stretching (AIS), Muscle-length, Upper-cross syndrome (UCS)


Upper cross syndrome is a condition in which there exist a muscle imbalance in upper quadrant, involving weakness of some muscles and tightness of others. In UCS, levator scapulae muscle, upper fibers of trapezius muscle, and pectoralis minor get stiff and shortened from their original length occasionally involving pectoralis major muscle. Objectives: To compare the effect of Active release technique and active isolated stretching on the muscles of upper cross syndrome. Methods: This study was a single blinded randomized clinical trial. Muscle length measurement by Vernier calipers and measuring tape between standard bony landmarks, NDI (neck disability index), Cervical rotation ROM, Cranio-vertebral angle & Numeric Pain Rating Scale (NPRS) tools for screening will be used for data collection. Recorded values were analyzed for any change using SPSS 21.0 version. Results: In ART the mean value of NPRS was 2.21 ± 1.49 and in AIS was 2.31 ± 1.35. For ART group the mean NDI score was 15.12 ± 8.83 and for AIS group was 16.1250 ± 5.3898. The mean of cranio-vertebral angle in AIS group was 47.2125 ± 1.9373 and in ART group was 48.1819 ± 1.6483 which is nearer to normal CV angle. Conclusions: The study concluded that both Active release technique (ART) and Active isolated stretching (AIS) are effective methods of treatment. It was indicated that Active release technique (ART) was helpful in pain relief, improving range, cranio-vertebral angle, muscle length and functional status in subjects with Upper-cross syndrome (UCS). 


Mocke RC. A Comparison of Cervical and Thoracic Manipulation, Kinesio™ Abdominal Core Taping and the Combination of the Two in the Management of Upper Cross Syndrome. University of Johannesburg (South Africa); 2019.

Weiner MT, Oakley PA, Dennis AK, Shapiro DA, Harrison DE. Increasing the cervical and lumbar lordosis is possible despite overt osteoarthritis and spinal stenosis using extension traction to relieve low back and leg pain in a 66-year-old surgical candidate: a CBP® case report. The Journal of Physical Therapy Science. 2018 Nov; 30(11):1364-1369. doi: 10.1589/jpts.30.1364

Chan J, Desai AK, Kazi ZB, Corey K, Austin S, Hobson-Webb LD, Case LE, et al. The emerging phenotype of late-onset Pompe disease: A systematic literature review. Molecular Genetics and Metabolism. 2017 Mar; 120(3):163-172. doi: 10.1016/j.ymgme.2016.12.004

Harris J and Cale L. Promoting active lifestyles in schools. Human Kinetics; 2018 Jan.

Wohl V and Converse D. Medication and massage therapy: Introduction to pharmacology. Elite Continuing Education. 2020.

Duray M, Şimşek Ş, Altuğ F, Cavlak U. Effect of proprioceptive training on balance in patients with chronic neck pain. Agriculture. 2018 Jul; 30(3):130-137. doi: 10.5505/agri.2018.61214

Dhari IF, Anniza M, Faidullah HZ. A study on Relationship between Fatigue and the Myofascial Trigger Point Syndrome (MTP) Experienced by Yogya Handmade Atik Artisans. Industrial Engineering & Management Systems. 2019 Dec; 18(4):667-75. doi: 10.7232/iems.2019.18.4.667

Devendran M. A Comparative study on the Effectiveness of Muscle Energy Techniques and Maitland Mobilization Coupled with Ultrasound in Patients with Periarthritis of the Shoulder Joint (Doctoral dissertation, Cherraan's College of Physiotherapy, Coimbatore). doi: 10.15621/ijphy/2016/v3i5/117451

Sadria G, Hosseini M, Rezasoltani A, Akbarzadeh Bagheban A, Davari A, Seifolahi A. A comparison of the effect of the active release and muscle energy techniques on the latent trigger points of the upper trapezius. Journal of Bodywork and Movement Therapies. 2017 Oct; 21(4):920-925. doi: 10.1016/j.jbmt.2016.10.005

Shuttleworth JP. The Moral and Physical Condition of the Working Classes: Employed in the Cotton Manufacture of Manchester. Routledge. 2019 May. doi: 10.4324/9780429054280-2

Ali S, Ahmad S, Jalal Y, Shah B. Effectiveness of Stretching Exercises Versus Muscle Energy Techniques in the Management of Upper Cross Syndrome. Journal Riphah College of Rehabilitation Sciences. 2017 Mar; 5(1):12-6.

Chan WY. Evaluation and enhancement of thermal and mechanical performance of posture correction girdle for adolescent idiopathic scoliosis (AIS).

Hassan Beygi B. Design and evaluation of orthotic treatment for patients with adolescent idiopathic scoliosis using a purpose-design assessment frame and 3-dimensional clinical ultrasound analysis.

Kwok HC. Development of posture correction tank-top synchronized with biofeedback muscle training for adolescents with early scoliosis. 2017

Borhany T, Shahid E, Siddique WA, Ali H. Musculoskeletal problems in frequent computer and internet users. Journal of Family Medicine and Primary Care. 2018 Apr; 7(2):337-339. doi: 10.4103/jfmpc.jfmpc_326_17

Mohammadipour F, Pourranjbar M, Naderi S, Rafie F. Work-related Musculoskeletal Disorders in Iranian Office Workers: Prevalence and Risk Factors. Journal of Medicine and Life. 2018 Dec; 11(4):328-333. doi: 10.25122/jml-2018-0054

Kamiński M, Łoniewski I, Marlicz W. "Dr. Google, I am in Pain"-Global Internet Searches Associated with Pain: A Retrospective Analysis of Google Trends Data. International Journal of Environmental Research and Public Health. 2020 Feb; 17(3):954. doi: 10.3390/ijerph17030954

Walk D and Poliak-Tunis M. Chronic Pain Management: An Overview of Taxonomy, Conditions Commonly Encountered, and Assessment. Medical Clinics of North America. 2016 Jan; 100(1):1-16. doi: 10.1016/j.mcna.2015.09.005

Al-Hadidi F, Bsisu I, AlRyalat SA, Al-Zu'bi B, Bsisu R, Hamdan M, et al. Association between mobile phone use and neck pain in university students: A cross-sectional study using numeric rating scale for evaluation of neck pain. PLoS One. 2019 May; 14(5):e0217231. doi: 10.1371/journal.pone.0217231

Oliveira AC and Silva AG. Neck muscle endurance and head posture: A comparison between adolescents with and without neck pain. Manual Therapy. 2016 Apr; 22:62-7. doi: 10.1016/j.math.2015.10.002

Lampl C, Thomas H, Tassorelli C, Katsarava Z, Laínez JM, Lantéri-Minet M, et al. Headache, depression and anxiety: associations in the Eurolight project. The Journal of Headache and Pain. 2016; 17:59. doi: 10.1186/s10194-016-0649-2

Mohammadi-Kojidi M, Okhovatian F, Rahimi A, Akbarzade-Baghban A. Effects of Active and Positional Release Techniques on Musculo-Skeletal Disorders: A Review of the Literature. The Scientific Journal of Rehabilitation Medicine. 2016 Dec; 5(4):290-301.

Kamel DM, Hamed NS, Abdel Raoof NA, Tantawy SA. Pulsed magnetic field versus ultrasound in the treatment of postnatal carpal tunnel syndrome: A randomized controlled trial in the women of an Egyptian population. Journal of Advanced Research. 2017 Jan; 8(1):45-53. doi: 10.1016/j.jare.2016.11.001

Kothawale S and Rao K. Effectiveness of positional release technique versus active release technique on hamstrings tightness. International Journal of Physiotherapy and Research. 2018; 6(1):2619-22. doi: 10.16965/ijpr.2017.265

Haik MN, Alburquerque-Sendín F, Moreira RF, Pires ED, Camargo PR. Effectiveness of physical therapy treatment of clearly defined subacromial pain: a systematic review of randomised controlled trials. British Journal of Sports Medicine. 2016 Sep; 50(18):1124-34. doi: 10.1136/bjsports-2015-095771



DOI: 10.54393/pbmj.v5i7.621
Published: 2022-07-31

How to Cite

Ali Syed, F. ., Ahmed Zahoor, I. ., Shabbir, S. ., Ali Rana, A. ., Ibrahim, M. ., & Ghaffar , E. . (2022). Effects Of Active Release Technique and Active Isolated Stretching on Muscles of Upper Cross Syndrome: ART and AIS on Upper Cross Syndrome . Pakistan BioMedical Journal, 5(7), 334–339. https://doi.org/10.54393/pbmj.v5i7.621



Original Article