# Manual massage versus foam rolling within the NASM corrective framework: a trial for upper crossed syndrome rehabilitation in university students

## TL;DR

This study compares manual massage and foam rolling for treating upper crossed syndrome in university students, finding manual massage more effective for posture and pain.

## Contribution

The study provides empirical evidence comparing manual massage and foam rolling within the NASM framework for upper crossed syndrome rehabilitation.

## Key findings

- Manual massage showed greater improvements in rounded shoulder angle, pain reduction, and shoulder range of motion.
- Manual massage led to better physical and mental quality of life scores compared to foam rolling.
- Both methods improved postural parameters over time, but manual massage had superior outcomes in specific areas.

## Abstract

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. This quasi-experimental, two-arm parallel-group trial evaluated the differential impact of manual massage versus foam rolling within a 12-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 consisting 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). 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. In the present study, integrating therapist-delivered manual massage was associated with greater improvements 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.

The online version contains supplementary material available at 10.1038/s41598-026-35030-6.