Table 1.
Characteristics of the included studies.
| # | First Author | Year | Study Design | No. of Patients (Active/Control) | Duration of Intervention | Intervention Program | Outcome Parameters | Results |
|---|---|---|---|---|---|---|---|---|
| 1 | Yoo et al. [19] | 2007 | POS | 20 (cross-over) | N/A | A ball backrest vs. general-purpose backrest | EMG activity | The EMG activity of muscles such as the SA and MT increased and that of the UT decreased when sitting in a ball-backrest chair compared to sitting in a chair with a general-purpose backrest. |
| 2 | Bae et al. [13] | 2016 | RCT | 30 (exercise vs. control, 15:15) | 4 weeks, 3 sessions/wk (total of 12 sessions) | Middle and lower trapezius strengthening, and levator scapulae and upper trapezius stretching exercises | Changes in body temperature (using a digital infrared thermographic imaging device) | The results showed that there was a significant difference in posterior neck temperature in the experimental group after the exercise program when compared to the control group. |
| 3 | Arshadi et al. [12] | 2019 | RCT | 30 (exercise vs. control, 15:15) | 8 weeks, 3 sessions/wk (50 min, total of 24 sessions) | Stretching, strengthening, and stabilization exercises | EMG activity | The baseline EMG activity of the SA increased while the UT and SCM activity decreased. In addition, the UT/SA and UT/LT ratios decreased. Eight-week corrective exercises can balance muscle activities and can be used to manage upper-quadrant musculoskeletal disorders in UCS. |
| 4 | Karimian et al. [14] | 2019 | RCT | 23 teachers (exercise vs. control, 12:11) | 12 weeks, 3 sessions/wk (45 min, total of 36 sessions) | Exercises (self-myofascial release, stretching, and strengthening) with an ergonomic training intervention | Head forward angle, kyphosis angle, and round shoulder angle using a UCS software (https://www.cisco.com/) application | Patients who performed exercises showed a significant decrease in forward head posture, shoulder angles, and hyperkyphosis. The exercises had positive effects on reducing the forward head angle, the rounded shoulder angle, and the kyphosis angle. |
| 5 | Seidi et al. [2] | 2020 | RCT | 24 (exercise vs. control, 12:12) | 8 weeks, 3 sessions/wk (1 h, total of 24 sessions) | Comprehensive corrective exercise program | EMG activity, scapular dyskinesis test, and head/shoulder/thoracic kyphosis angle | Corrective exercises for UCS were effective at improving misalignments, muscle activation imbalances, and movement patterns. |
| 6 | Gillani et al. [16] | 2020 | RCT | 40 (eccentric MET vs. static stretching exercises) | 3 weeks, 2 sessions/wk (total of 6 sessions) | Eccentric MET vs. static stretching exercises; both with cervical segmental mobilization, TENS, and IR | Tragus-to-wall distance, VAS, NDI, and cervical passive range of motion | Both groups showed significant improvements, but a comparison across groups showed non-significant results. Both techniques were equally effective for managing pain, the cervical range of motion, and disabilities. |
| 7 | Nitayarak et al. [15] | 2021 | RCT | 40 (exercise vs. control, 20:20) | 4 weeks, 3 sessions/wk (total of 12 sessions) | Scapular stabilization exercises | The cervical and shoulder angles (using the Kinovea program), the length of the pectoralis minor (caliper), the strength of the scapular stabilizer muscles (handheld dynamometer), and the degree of the mid-thoracic curve (flexi ruler) | The subjects in the exercise group showed a significant increase in the cervical and shoulder angles, the length of the pectoralis minor, and the strength of the scapular muscles, although the degree of the mid-thoracic curve did not show any change compared to the control group. |
| 8 | Mahmood et al. [17] | 2021 | RCT | 60 (physical therapy with soft-tissue mobilization vs. physical therapy, 30:30) | 4 weeks, 2 sessions/wk (total of 8 sessions) | Instrument-assisted soft-tissue mobilization (15–20 min) and routine physical therapy | The inclinometer and numeric pain rating scale (NRS) | Patients who received soft-tissue mobilization with physical therapy showed a significant improvement in pain reduction and neck range of motion compared to the controls. Soft-tissue mobilization in combination with stretching exercises was useful for managing neck pain in UCS. |
| 9 | Aneis et al. [21] | 2022 | RCT | 40 (multimodal vs. MET only, 20:20) | 4 weeks, 3 sessions/wk (total of 12 sessions) | Postural correction training, MET, cervical stabilization exercises, and scapulothoracic stabilization exercises | Photogrammetry (CVA and SSA), VAS, and NDI | A decrease in VAS and NDI and an increase in CVA were observed post-intervention. Only the multimodal group showed a significant change in SSA, and between-group differences favored the multimodal intervention. |
| 10 | Sasun et al. [18] | 2022 | RCT | 80 (myofascial rollers vs. post-isometric relaxation, 40:40) | 4 weeks, 4 sessions/wk (20 min, total of 16 sessions) | Myofascial rollers and hot packs vs. post-isometric relaxation and hot packs | Numerical pain rating scale (NRS) and a postural assessment | To improve pain and postural deviation, myofascial rollers were more effective than the post-isometric relaxation technique. |
| 11 | Yaghoubitajani et al. [20] | 2022 | RCT | 36 (home vs. workplace vs. control, 12:12:12) | 8 weeks, 3 sessions/wk (50–60 min, total of 12 sessions) | Online-supervised vs. workplace corrective exercises involving strengthening of cervical and scapular muscles | VAS, outcome evaluation questionnaire, postural angles using photogrammetry, workability index questionnaire, and surface EMG | The online-supervised group reported more improvements in neck–shoulder pain, postural angles, workability, and upper trapezius activation than the controls. Both intervention groups reported improvements in neck–shoulder pain, forward head posture, round shoulders, and round back. |
Abbreviations: CVA, craniovertebral angle; IR, infrared; EMG, electromyography; NDI, neck disability index; NA, not applicable; UT, upper trapezius; MET, muscle energy technique; MT, middle trapezius; NRS, numerical pain rating scale; LT, lower trapezius; RCT, randomized controlled trial; POS, prospective observational study; SA, serratus anterior; SCM, sternocleidomastoid; SSA, sagittal shoulder angle; TENS, transcutaneous electrical nerve stimulation; VAS, visual analog scale.