Manual Massage Versus Foam Rolling within the NASM Corrective Framework: A Trial for Upper Crossed Syndrome Rehabilitation in University Students

Manual Massage Versus Foam Rolling within the NASM Corrective Framework: A Trial for Upper Crossed Syndrome Rehabilitation in University Students | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Article Manual Massage Versus Foam Rolling within the NASM Corrective Framework: A Trial for Upper Crossed Syndrome Rehabilitation in University Students Mohammad Kalantariyan, Mahmoud Sadeghi, Hadi Samadi This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-7308659/v1 This work is licensed under a CC BY 4.0 License Status: Published Journal Publication published 27 Jan, 2026 Read the published version in Scientific Reports → Version 1 posted 16 You are reading this latest preprint version Abstract Background: Upper Crossed Syndrome (UCS) is a prevalent musculoskeletal dysfunction among sedentary young adults, marked by specific patterns of postural misalignment and muscular imbalance. Despite growing reliance on the National Academy of Sports Medicine (NASM) corrective exercise model in conservative management of UCS, a critical gap remains regarding the comparative effectiveness of different myofascial release (MFR) techniques in the foundational “Inhibit” phase. While foam rolling is widely employed for self-MFR, its ability to match the therapeutic depth of manual massage, particularly in accessing deep anterior musculature has yet to be empirically examined in controlled corrective programs. Methods: This quasi-experimental, two-arm parallel-group trial evaluated the differential impact of manual massage versus foam rolling within an 8-week NASM-based corrective exercise protocol among 30 male university students (aged 18–25) with diagnosed UCS. Participants were randomized into a Manual Massage Group (MMG) or a Foam Rolling Group (FRG), both performing identical Lengthen–Activate–Integrate phases. Primary outcome variables included postural parameters consist of Forward Head Angle (FHA), Thoracic Kyphosis Angle (TKA), Rounded Shoulder Angle (RSA), pain intensity, shoulder internal and external range of motion (ROM), upper extremity function, and health-related quality of life. A 2×2 mixed-design ANOVA was conducted to evaluate interaction and main effects (p < 0.05). Results: Both groups demonstrated significant improvements over time (p < 0.001) across all outcome measures. However, the MMG showed significantly greater improvements in RSA (p = 0.031), pain reduction (p = 0.003), shoulder external and internal ROM (p = 0.001 and p = 0.016), and SF-36 physical and mental component scores (p = 0.001). No significant group-by-time interactions were observed for FHA, TKA, or upper extremity function scores. Conclusion: Integrating therapist-delivered manual massage in the Inhibit phase of NASM-based corrective exercise yields superior outcomes in reducing anterior postural deviations, alleviating pain, and enhancing functional mobility and quality of life in UCS populations. These findings support the targeted use of manual MFR in clinical and educational settings where deeper fascial release is warranted. Further research is recommended in diverse populations and long-term follow-ups. Health sciences/Health care Health sciences/Medical research Upper Crossed Syndrome Manual Massage Foam Rolling Corrective Exercise Postural Dysfunction Full Text Additional Declarations No competing interests reported. Cite Share Download PDF Status: Published Journal Publication published 27 Jan, 2026 Read the published version in Scientific Reports → Version 1 posted Editorial decision: Revision requested 02 Dec, 2025 Reviews received at journal 01 Dec, 2025 Reviewers agreed at journal 01 Dec, 2025 Reviews received at journal 30 Nov, 2025 Reviewers agreed at journal 27 Nov, 2025 Reviewers agreed at journal 27 Nov, 2025 Reviewers agreed at journal 27 Nov, 2025 Reviews received at journal 11 Oct, 2025 Reviewers agreed at journal 02 Oct, 2025 Reviewers agreed at journal 02 Oct, 2025 Reviewers agreed at journal 30 Sep, 2025 Reviewers invited by journal 30 Sep, 2025 Editor assigned by journal 30 Sep, 2025 Editor invited by journal 18 Sep, 2025 Submission checks completed at journal 16 Sep, 2025 First submitted to journal 16 Sep, 2025 You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. Our growing team is made up of researchers and industry professionals working together to solve the most critical problems facing scientific publishing. Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-7308659","acceptedTermsAndConditions":true,"allowDirectSubmit":false,"archivedVersions":[],"articleType":"Article","associatedPublications":[],"authors":[{"id":527942368,"identity":"059da0dc-6d19-4229-9ade-1eae9c2e55ad","order_by":0,"name":"Mohammad Kalantariyan","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAA2klEQVRIiWNgGAWjYFACNgaGB2AG8wGoCGMDYS0JDAwSQEYCyVp4DIhzlm4DW+KHhJo7dfyzz3z+XNnGIM/fwNz2AZ8WswNshyUSjj2TkDiXu03ybBuD4YwDjM0z8Gthb5BIAGpjOMO7jbGxjYFxAwNjM16HAbU0/0j4d1hC/gzP449ALfZEaGE7JpHYdljC4AwPgyRQSyJhLYfZ0iwS+w5LbjzDZibZcE4iecZhQlqOtxnf+PDtML/cGebHHxvKbGz729sf49XCwIzKlcAQGQWjYBSMglFABgAAIKZGAlUzMQQAAAAASUVORK5CYII=","orcid":"","institution":"Shahid Rajaee Teacher Training University","correspondingAuthor":true,"prefix":"","firstName":"Mohammad","middleName":"","lastName":"Kalantariyan","suffix":""},{"id":527942369,"identity":"4367b9bf-0d43-4597-acbc-39c2ae1fae6f","order_by":1,"name":"Mahmoud Sadeghi","email":"","orcid":"","institution":"Shahid Rajaee Teacher Training University","correspondingAuthor":false,"prefix":"","firstName":"Mahmoud","middleName":"","lastName":"Sadeghi","suffix":""},{"id":527942370,"identity":"97879f6c-8501-439e-8b2b-80e13ac5ef43","order_by":2,"name":"Hadi Samadi","email":"","orcid":"","institution":"Shahid Rajaee Teacher Training University","correspondingAuthor":false,"prefix":"","firstName":"Hadi","middleName":"","lastName":"Samadi","suffix":""}],"badges":[],"createdAt":"2025-08-06 10:23:14","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-7308659/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-7308659/v1","draftVersion":[],"editorialEvents":[{"content":"https://doi.org/10.1038/s41598-026-35030-6","type":"published","date":"2026-01-27T15:59:31+00:00"}],"editorialNote":"","failedWorkflow":false,"files":[{"id":93396630,"identity":"c9678760-6134-4d52-b7ef-10577c5ad911","added_by":"auto","created_at":"2025-10-13 11:43:13","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":595375,"visible":true,"origin":"","legend":"","description":"","filename":"FinalVersion.WithName.pdf","url":"https://assets-eu.researchsquare.com/files/rs-7308659/v1/5b11f78afccccd49fe97647e.pdf"},{"id":93396629,"identity":"38834b4f-a1b3-47bd-bab1-0f3baa1d4037","added_by":"auto","created_at":"2025-10-13 11:43:13","extension":"json","order_by":1,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":6887,"visible":true,"origin":"","legend":"","description":"","filename":"8d8942cb5f4b4d7e915255876ac7b849.json","url":"https://assets-eu.researchsquare.com/files/rs-7308659/v1/ac7205c99c72e3d9e5736372.json"},{"id":101690920,"identity":"b40762aa-6e84-495e-823c-62bd725c5244","added_by":"auto","created_at":"2026-02-02 16:11:09","extension":"pdf","order_by":1,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":370176,"visible":true,"origin":"","legend":"","description":"","filename":"FinalVersion.WithName.pdf","url":"https://assets-eu.researchsquare.com/files/rs-7308659/v1_covered_5f1b197d-4270-4fa5-8a9c-54425e76a7dc.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"Manual Massage Versus Foam Rolling within the NASM Corrective Framework: A Trial for Upper Crossed Syndrome Rehabilitation in University Students","fulltext":[],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":false,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":true,"isAuthorSuppliedPdf":true,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":true,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"scientific-reports","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"scirep","sideBox":"Learn more about [Scientific Reports](http://www.nature.com/srep/)","snPcode":"","submissionUrl":"","title":"Scientific Reports","twitterHandle":"","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"stoa","reportingPortfolio":"Scientific Reports","inReviewEnabled":true,"inReviewRevisionsEnabled":true},"keywords":"Upper Crossed Syndrome, Manual Massage, Foam Rolling, Corrective Exercise, Postural Dysfunction","lastPublishedDoi":"10.21203/rs.3.rs-7308659/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-7308659/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003e\u003cstrong\u003eBackground:\u003c/strong\u003e Upper Crossed Syndrome (UCS) is a prevalent musculoskeletal dysfunction among sedentary young adults, marked by specific patterns of postural misalignment and muscular imbalance. Despite growing reliance on the National Academy of Sports Medicine (NASM) corrective exercise model in conservative management of UCS, a critical gap remains regarding the comparative effectiveness of different myofascial release (MFR) techniques in the foundational “Inhibit” phase. While foam rolling is widely employed for self-MFR, its ability to match the therapeutic depth of manual massage, particularly in accessing deep anterior musculature has yet to be empirically examined in controlled corrective programs.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eMethods:\u003c/strong\u003e This quasi-experimental, two-arm parallel-group trial evaluated the differential impact of manual massage versus foam rolling within an 8-week NASM-based corrective exercise protocol among 30 male university students (aged 18–25) with diagnosed UCS. Participants were randomized into a Manual Massage Group (MMG) or a Foam Rolling Group (FRG), both performing identical Lengthen–Activate–Integrate phases. Primary outcome variables included postural parameters consist of Forward Head Angle (FHA), Thoracic Kyphosis Angle (TKA), Rounded Shoulder Angle (RSA), pain intensity, shoulder internal and external range of motion (ROM), upper extremity function, and health-related quality of life. A 2×2 mixed-design ANOVA was conducted to evaluate interaction and main effects (p \u0026lt; 0.05).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eResults: \u003c/strong\u003eBoth groups demonstrated significant improvements over time (p \u0026lt; 0.001) across all outcome measures. However, the MMG showed significantly greater improvements in RSA (p = 0.031), pain reduction (p = 0.003), shoulder external and internal ROM (p = 0.001 and p = 0.016), and SF-36 physical and mental component scores (p = 0.001). No significant group-by-time interactions were observed for FHA, TKA, or upper extremity function scores.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConclusion: \u003c/strong\u003eIntegrating therapist-delivered manual massage in the Inhibit phase of NASM-based corrective exercise yields superior outcomes in reducing anterior postural deviations, alleviating pain, and enhancing functional mobility and quality of life in UCS populations. These findings support the targeted use of manual MFR in clinical and educational settings where deeper fascial release is warranted. Further research is recommended in diverse populations and long-term follow-ups.\u003c/p\u003e","manuscriptTitle":"Manual Massage Versus Foam Rolling within the NASM Corrective Framework: A Trial for Upper Crossed Syndrome Rehabilitation in University Students","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-10-13 11:43:09","doi":"10.21203/rs.3.rs-7308659/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"decision","content":"Revision requested","date":"2025-12-02T07:34:11+00:00","index":"","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2025-12-01T07:20:14+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"250861576758926056848083589240456660980","date":"2025-12-01T06:12:27+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2025-11-30T17:43:46+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"192988852461808052464959619745615821389","date":"2025-11-27T10:52:41+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"54141633544763816262564047311824700465","date":"2025-11-27T10:45:52+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"175999079907582420312100963643305403694","date":"2025-11-27T10:13:10+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2025-10-11T04:27:56+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"83659785515446741947811260041662630233","date":"2025-10-03T03:32:23+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"185378138268431033749842065622454236352","date":"2025-10-02T23:15:51+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"44926412398770269753589706094707172232","date":"2025-09-30T15:33:58+00:00","index":"hide","fulltext":""},{"type":"reviewersInvited","content":"","date":"2025-09-30T15:05:01+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2025-09-30T14:59:13+00:00","index":"","fulltext":""},{"type":"editorInvited","content":"","date":"2025-09-18T09:38:15+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2025-09-16T10:40:00+00:00","index":"","fulltext":""},{"type":"submitted","content":"Scientific Reports","date":"2025-09-16T10:38:41+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"scientific-reports","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"scirep","sideBox":"Learn more about [Scientific Reports](http://www.nature.com/srep/)","snPcode":"","submissionUrl":"","title":"Scientific Reports","twitterHandle":"","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"stoa","reportingPortfolio":"Scientific Reports","inReviewEnabled":true,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"b515529f-5d4b-45a4-ad4a-765888be775d","owner":[],"postedDate":"October 13th, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"published-in-journal","subjectAreas":[{"id":56121737,"name":"Health sciences/Health care"},{"id":56121738,"name":"Health sciences/Medical research"}],"tags":[],"updatedAt":"2026-02-02T16:08:06+00:00","versionOfRecord":{"articleIdentity":"rs-7308659","link":"https://doi.org/10.1038/s41598-026-35030-6","journal":{"identity":"scientific-reports","isVorOnly":false,"title":"Scientific Reports"},"publishedOn":"2026-01-27 15:59:31","publishedOnDateReadable":"January 27th, 2026"},"versionCreatedAt":"2025-10-13 11:43:09","video":"","vorDoi":"10.1038/s41598-026-35030-6","vorDoiUrl":"https://doi.org/10.1038/s41598-026-35030-6","workflowStages":[]},"version":"v1","identity":"rs-7308659","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-7308659","identity":"rs-7308659","version":["v1"]},"buildId":"8U1c8b4HqxoKbykW_rLl7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}