Corrective exercises strongly improve posture but fail to produce consistent clinical or functional benefits in patients with upper crossed syndrome: a systematic review and meta-analysis of randomized controlled trials.

BACKGROUND

Upper Crossed Syndrome (UCS) is a prevalent postural dysfunction involving muscular imbalances and misalignments of the neck, thoracic spine, and shoulder girdle, leading to pain and functional limitation. While corrective exercises (CE) are widely recommended to restore posture and improve musculoskeletal function, their effectiveness across different outcomes remains unclear. This systematic review and meta-analysis evaluated the effects of CE on posture, function, and pain in individuals with UCS.

METHODS

Four databases (PubMed, Web of Science, Scopus, Embase) were searched from inception to November 2025. Eligibility criteria included randomized controlled trials (RCTs) on individuals with UCS evaluating CE versus controls. Data extraction followed the PRISMA 2020 guidelines. Risk of bias was assessed using the RoB 2 tool. Random-effects models were used to calculate standardized mean differences (SMD) with 95% confidence intervals (CI). Heterogeneity (I2), publication bias, and subgroup effects by age and exercise type were evaluated, and evidence certainty was rated using the GRADE approach.

RESULTS

Twenty-eight RCTs (n = 901) were included. CE significantly improved forward head angle (SMD: -1.49; 95% CI: -1.91 to -1.06; p < 0.01) with high heterogeneity (I2 = 79%, p < 0.01), forward shoulders angle (SMD: -1.53; 95% CI: -1.96 to -1.09; p < 0.01) with high heterogeneity (I2 = 78%, p < 0.01), and thoracic hyper-kyphosis angle (SMD: -1.70; 95% CI: -2.27 to -1.12; p < 0.01) with high heterogeneity (I2 = 88%, p < 0.01). However, the effects on muscle activation, function, balance, and pain were inconclusive.

CONCLUSION

CE produces large, significant improvements in postural alignment in individuals with UCS. However, evidence for clinically meaningful benefits in pain, function, and muscle strength remains limited and inconsistent. These findings suggest that while CE effectively addresses biomechanical postural deficits, their translation to symptom relief and functional improvement is uncertain. Future research should establish standardized CE protocols, include long-term follow-up, and employ validated clinical outcome measures to determine whether postural corrections yield sustained clinical benefits.