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Differences in Distance Perception and Balance in Female Students with and without Upper Crossed Syndrome: A Comparative Study

Document Type : Research Article (s)

Authors

1 Department of Exercise Physiology and Corrective Exercises, Faculty of Sport Sciences, Urmia University, Urmia, Iran

2 Department of Motor Behavior and Sport Management, Faculty of Sports Sciences, Urmia University, Urmia, Iran

Abstract

Background: Upper Crossed Syndrome (UCS), a common postural condition characterized by muscle imbalances, can affect proprioception, balance, and functional abilities. This comparative study aimed to investigate differences in distance perception and dynamic balance between female students with and without UCS.
Method: This field-based descriptive and comparative study was conducted in 2025. A total of 72 female students aged 15–18 years from Ajabshir, East Azerbaijan Province, Iran were screened using a grid-based postural assessment and divided into two groups: with UCS (n=36) and without UCS (n=36). Thoracic kyphosis was measured using the Goniometer-Pro app, while forward head posture and shoulder protraction were evaluated via body profile photography analyzed by Kinovea software. Dynamic balance was assessed using the Y-Balance Test, and distance perception was measured using a blindfolded walking task in which participants walked toward the remembered location of a visually presented target. Data were analyzed using independent t-tests in SPSS version 25, with a significance level of 0.05.
Results: The results indicated no significant differences in distance perception between the two groups (P=0.675, Cohen’s d=- 0.10). However, students with UCS exhibited significantly reduced dynamic balance compared with their peers without UCS (P=0.001, Cohen’s d=5.79), indicating a very large effect size.
Conclusion: These findings suggested that while UCS may not directly affect distance perception in young individuals, it substantially impairs dynamic balance. This highlights the need for targeted interventions to improve postural stability in affected individuals. The long-term effects of UCS on sensory-motor functions in a variety of groups should be further investigated.

Highlights

Narmin Ghani Zadeh Hesar: Google Scholar

Keywords

References
  1. Charles ST, Levine LJ. Managing emotions across adulthood. In Cole M, Hollenstein T, editors. Emotion Regulation. UK: Routledge; 2018. p. 250-271. ##
  2. Firestone C, Scholl BJ. Cognition does not affect perception: Evaluating the evidence for “top-down” effects. Behav Brain Sci. 2016;39:e229. doi: 10.1017/S0140525X15000965. PubMed PMID: 26189677. ##
  3. Muscolino J. Upper crossed syndrome. Journal of the Australian Traditional-Medicine Society. 2015;21(2):80–85. ##
  4. da Costa JT, Baptista JS, Vaz M. Incidence and prevalence of upper-limb work-related musculoskeletal disorders: A systematic review. Work. 2015;51(4):635–44. doi: 10.3233/WOR-152032. PubMed PMID: 26409936. ##
  5. Mubeen I, Malik S, Akhtar W, Iqbal M, Asif M, Arshad A, et al. Prevalence of upper cross syndrome among the medical students of University of Lahore. International Journal of Physiotherapy. 2016;3(3):381–384. doi: 10.15621/ijphy/2016/v3i3/100851. ##
  6. Gu SY, Hwangbo G, Lee JH. Relationship between position sense and reposition errors according to the degree of upper crossed syndrome. J Phys Ther Sci. 2016;28(2):438–41. doi: 10.1589/jpts.28.438. PubMed PMID: 27065528; PubMed Central PMCID: PMC4792986. ##
  7. Warda DG, Nwakibu U, Nourbakhsh A. Neck and Upper Extremity Musculoskeletal Symptoms Secondary to Maladaptive Postures Caused by Cell Phones and Backpacks in School-Aged Children and Adolescents. Healthcare. 2023;11(6):819. doi: 10.3390/healthcare11060819. PubMed PMID: 36981476; PubMed Central PMCID: PMC10048647. ##
  8. Horsburgh A, Summers SJ, Lewis A, Keegan RJ, Flood A. The Relationship Between Pain and Interoception: A Systematic Review and Meta-Analysis. J Pain. 2024;25(7):104476. doi: 10.1016/j.jpain.2024.01.341. PubMed PMID: 38244898. ##
  9. Filbrich L, Alamia A, Verfaille C, Berquin A, Barbier O, Libouton X, et al. Biased visuospatial perception in complex regional pain syndrome. Sci Rep. 2017;7(1):9712. doi: 10.1038/s41598-017-09779-8. PubMed PMID: 28852115; PubMed Central PMCID: PMC5574889. ##
  10. Mousavi-Khatir R, Talebian S, Toosizadeh N, Olyaei GR, Maroufi N. Disturbance of neck proprioception and feed-forward motor control following static neck flexion in healthy young adults. J Electromyogr Kinesiol. 2018;41:160–167. doi: 10.1016/j.jelekin.2018.04.013. PubMed PMID: 29935422. ##
  11. McDaniels-Davidson C, Davis A, Wing D, Macera C, Lindsay S, Schousboe J, et al. Kyphosis and incident falls among community-dwelling older adults. Osteoporos Int. 2018;29(1):163–169. doi: 10.1007/s00198-017-4253-3. PubMed PMID: 29018904. ##
  12. Kim DH, Kim CJ, Son SM. Neck Pain in Adults with Forward Head Posture: Effects of Craniovertebral Angle and Cervical Range of Motion. Osong Public Health Res Perspect. 2018;9(6):309–313. doi: 10.24171/j.phrp.2018.9.6.04. PubMed PMID: 30584494; PubMed Central PMCID: PMC6296804. ##
  13. Fathollahnejad K, Letafatkar A, Hadadnezhad M. The effect of manual therapy and stabilizing exercises on forward head and rounded shoulder postures: a six-week intervention with a one-month follow-up study. BMC Musculoskelet Disord. 2019;20(1):86. doi: 10.1186/s12891-019-2438-y. PubMed PMID: 30777064; PubMed Central PMCID: PMC6379958. ##
  14. Singla D, Veqar Z. Association Between Forward Head, Rounded Shoulders, and Increased Thoracic Kyphosis: A Review of the Literature. J Chiropr Med. 2017;16(3):220–229. doi: 10.1016/j.jcm.2017.03.004. PubMed PMID: 29097952; PubMed Central PMCID: PMC5659804. ##
  15. Salamat H, Ghani Zadeh Hesar N, Roshani S, Mohammad Ali Nasasb Firouzjah E. Comparison of the Effect of Functional Corrective Exercises and Corrective Games on Upper Cross Syndrome in 10-13 Year-Old Boys. J Rehab Med. 2021;9(4):19–31. doi: 10.22037/JRM.2020.113088.2318. Persian. ##
  16. Shahri YFK, Ghani Zadeh Hesar N. Validity and reliability of smartphone-based Goniometer-Pro app for measuring the thoracic kyphosis. Musculoskelet Sci Pract. 2020;49:102216. doi: 10.1016/j.msksp.2020.102216. PubMed PMID: 32861369. ##
  17. Plisky P, Schwartkopf-Phifer K, Huebner B, Garner MB, Bullock G. Systematic Review and Meta-Analysis of the Y-Balance Test Lower Quarter: Reliability, Discriminant Validity, and Predictive Validity. Int J Sports Phys Ther. 2021;16(5):1190-1209. doi: 10.26603/001c.27634. PubMed PMID: 34631241; PubMed Central PMCID: PMC8486397. ##
  18. Picot B, Terrier R, Forestier N, Fourchet F, McKeon PO. The star excursion balance test: an update review and practical guidelines. International Journal of Athletic Therapy and Training. 2021;26(6):285–293. doi: 10.1123/ijatt.2020-0106. ##
  19. Eftekhari A, Dehghanizade J. The Effect of Self-Movement on Distance Perception: An Examination of Perception-Action Coupling. Journal of Sports and Motor Development and Learning. 2022;13(4):443-456. doi: 10.22059/jmlm.2022.333849.1624. Persian. ##
  20. Gaeta L, Brydges CR. An examination of effect sizes and statistical power in speech, language, and hearing research. J Speech Lang Hear Res. 2020;63(5):1572–1580. doi: 10.1044/2020_JSLHR-19-00299. PubMed PMID: 32343919. ##
  21. Brydges CR. Effect Size Guidelines, Sample Size Calculations, and Statistical Power in Gerontology. Innov Aging. 2019;3(4):igz036. doi: 10.1093/geroni/igz036. PubMed PMID: 31528719; PubMed Central PMCID: PMC6736231. ##
  22. Khosravi Z, Mohammad Ali Nasab Firouzjah E, Firouzjah MH. Comparison of balance and proprioception of the shoulder joint in girls with and without upper cross syndrome. BMC Musculoskelet Disord. 2024;25(1):618. doi: 10.1186/s12891-024-07552-5. PubMed PMID: 39095725; PubMed Central PMCID: PMC11295306. ##
  23. Toprak CŞ, Duruöz MT, Gündüz OH. Static and Dynamic Balance Disorders in Patients With Rheumatoid Arthritis and Relationships With Lower Extremity Function and Deformities: A Prospective Controlled Study. Arch Rheumatol. 2018;33(3):328-334. doi: 10.5606/ArchRheumatol.2018.6720. PubMed PMID: 30632523; PubMed Central PMCID: PMC6328213. ##
  24. Melo RS, Cardeira CSF, Rezende DSA, Guimaraes-do-Carmo VJ, Lemos A, de Moura-Filho AG. Effectiveness of the aquatic physical therapy exercises to improve balance, gait, quality of life and reduce fall-related outcomes in healthy community-dwelling older adults: A systematic review and meta-analysis. PLoS One. 2023;18(9):e0291193. doi: 10.1371/journal.pone.0291193. PubMed PMID: 37683025; PubMed Central PMCID: PMC10490910. ##
  25. Koelé MC, Lems WF, Willems HC. The Clinical Relevance of Hyperkyphosis: A Narrative Review. 2020;11:5. doi: 10.3389/fendo.2020.00005. PubMed PMID: 32038498; PubMed Central PMCID: PMC6993454. ##
  26. Noonan AM, Brown SH. Paraspinal muscle pathophysiology associated with low back pain and spine degenerative disorders. JOR spine. 2021;4(3):e1171. doi: 10.1002/jsp2.1171. PubMed PMID: 34611593; PubMed Central PMCID: PMC8479522. ##
  27. Nezhad ZG, Gard SA, Arazpour M. The effects of Hyperkyphosis on Balance and Fall Risk in older adults: A Systematic Review. Gait Posture. 2025;118:154–167. doi: 10.1016/j.gaitpost.2025.02.005. PubMed PMID: 39978050. ##
  28. Roghani T, Zavieh MK, Manshadi FD, King N, Katzman W. Age-related hyperkyphosis: update of its potential causes and clinical impacts—narrative review. Aging Clin Exp Res. 2017;29(4):567–577. doi: 10.1007/s40520-016-0617-3. PubMed PMID: 27538834; PubMed Central PMCID: PMC5316378. ##
  29. Hall CD, Herdman SJ, Whitney SL, Anson ER, Carender WJ, Hoppes CW, et al. Vestibular Rehabilitation for Peripheral Vestibular Hypofunction: An Updated Clinical Practice Guideline From the Academy of Neurologic Physical Therapy of the American Physical Therapy Association. J Neurol Phys Ther. 2022;46(2):118–177. doi: 10.1097/NPT.0000000000000382. PubMed PMID: 34864777; PubMed Central PMCID: PMC8920012. ##
  30. Lin G, Zhao X, Wang W, Wilkinson T. The relationship between forward head posture, postural control and gait: A systematic review. Gait Posture. 2022;98:316–329. doi: 10.1016/j.gaitpost.2022.10.008. PubMed PMID: 36274469. ##
  31. Mahmoud NF, Hassan KA, Abdelmajeed SF, Moustafa IM, Silva AG. The Relationship Between Forward Head Posture and Neck Pain: a Systematic Review and Meta-Analysis. Curr Rev Musculoskelet Med. 2019;12(4):562–577. doi: 10.1007/s12178-019-09594-y. PubMed PMID: 31773477; PubMed Central PMCID: PMC6942109. ##
  32. Lee JH. Effects of forward head posture on static and dynamic balance control. J Phys Ther Sci. 2016;28(1):274–277. doi: 10.1589/jpts.28.274. PubMed PMID: 26957773; PubMed Central PMCID: PMC4756019. ##
  33. Moore RT, Piitz MA, Singh N, Dukelow SP, Cluff T. The independence of impairments in proprioception and visuomotor adaptation after stroke. J Neuroeng Rehabil. 2024;21(1):81. doi: 10.1186/s12984-024-01360-7. PubMed PMID: 38762552; PubMed Central PMCID: PMC11102216. ##
  34. Nuzum ND, Teo WP, Macpherson H, Loughman A, Szymlek-Gay EA, Hendy A. Inhibition, excitation and bilateral transfer following a unilateral complex finger-tapping task in young and older adults. Eur J Neurosci. 2021;54(7):6608–6617. doi: 10.1111/ejn.15467. PubMed PMID: 34535926. ##
  35. Vergallito A, Feroldi S, Pisoni A, Romero Lauro LJ. Inter-Individual Variability in tDCS Effects: A Narrative Review on the Contribution of Stable, Variable, and Contextual Factors. Brain Sci. 2022;12(5):522. doi: 10.3390/brainsci12050522. PubMed PMID: 35624908; PubMed Central PMCID: PMC9139102. ##
  36. Dey A, Billinghurst M, Lindeman RW, Swan JE. A Systematic Review of 10 Years of Augmented Reality Usability Studies: 2005 to 2014. Front Robot AI. 2018;5:37. doi: 10.3389/frobt.2018.00037. PubMed PMID: 33500923; PubMed Central PMCID: PMC7805955. ##
  37. Fooken J, Baltaretu BR, Barany DA, Diaz G, Semrau JA, Singh T, et al. Perceptual-Cognitive Integration for Goal-Directed Action in Naturalistic Environments. J Neurosci. 2023;43(45):7511–7522. doi: 10.1523/JNEUROSCI.1373-23.2023. PubMed PMID: 37940592; PubMed Central PMCID: PMC10634571. ##
  38. Burkitt JJ, Campos JL, Lyons JL. Iterative Spatial Updating During Forward Linear Walking Revealed Using a Continuous Pointing Task. J Mot Behav. 2020;52(2):145-166. doi: 10.1080/00222895.2019.1599807. PubMed PMID: 30982465. ##
  39. Feldstein IT, Kölsch FM, Konrad R. Egocentric Distance Perception: A Comparative Study Investigating Differences Between Real and Virtual Environments. Perception. 2020;49(9):940–967. doi: 10.1177/0301006620951997. PubMed PMID: 33002392. ##
  40. Smyth MM, Mason UC. Use of proprioception in normal and clumsy children. Dev Med Child Neurol. 1998;40(10):672–81. doi: 10.1111/j.1469-8749.1998.tb12327.x. PubMed PMID: 9851236. ##
  41. Weeks HM, Therrien AS, Bastian AJ. The cerebellum contributes to proprioception during motion. J Neurophysiol. 2017;118(2):693–702. doi: 10.1152/jn.00417.2016. PubMed PMID: 28404825; PubMed Central PMCID: PMC5539437. ##
  42. Rinderknecht MD, Lambercy O, Raible V, Büsching I, Sehle A, Liepert J, et al. Reliability, validity, and clinical feasibility of a rapid and objective assessment of post-stroke deficits in hand proprioception. J Neuroeng Rehabil. 2018;15(1):47. doi: 10.1186/s12984-018-0387-6. PubMed PMID: 29880003; PubMed Central PMCID: PMC5991441. ##
  43. Stirling L, Kelty-Stephen D, Fineman R, Jones ML, Daniel Park BK, Reed MP, et al. Static, Dynamic, and Cognitive Fit of Exosystems for the Human Operator. Hum Factors. 2020;62(3):424–440. doi: 10.1177/0018720819896898. PubMed PMID: 32004106. ##
International Journal of School Health
Volume 13, Issue 2 - Serial Number 49
April 2026
Pages 146-155
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