PURPOSE: To investigate the effect of cervicothoracic mobilization on Craniovertebral angle (CVA), sagittal shoulder angle (SSA), kyphotic angle and pain intensity level in upper crossed syndrome.

Upper crossed syndrome and its associated neck pain is considered to be the fourth most frequent cause of disability with an annual 30% increase in the rate of prevalence. According to the report on Global burden of diseases (GBD) 2010, neck pain is ranked 21st in terms overall burden of diseases. Musculoskeletal pain in the neck and upper limbs is common; population studies suggest that 6-48% of adults have pain in one of these areas .

Recently, joint mobilization has proven to be effective, and it is now frequently used in clinics .Cervical mobilization combined with thoracic mobilization is recommended as a clinical intervention for neck pain patients with forward head posture ( FHP) rather than cervical mobilization alone. This study has two groups; one will receive cervicothoracic Mobilization + conventional treatment and the second will receive conventional treatment for eight weeks.

Inclusion Criteria:

1. Age between 20-50 years .
2. Participants will included if their CVA less than 48° ( SSA less than 52°) , as above these values are considered normal and thoracic kyphosis (with flexicurve angle more than 45 degrees) .
3. Subjects who have weakness in deep neck flexors, serratus anterior, middle and lower trapezius and rhomboid muscles and tightness in upper trapezius, levator scapulae, scalene, posterior neck and suboccipital muscles, pectoralis major and minor and sternocleidomastoid muscles.
4. Subject complaining of this symptom for more than 3mothes.
5. Marking pain intensity score visual analog scale (VAS) ≥3 in neck and shoulder

Exclusion Criteria:

1. History of surgery or joint diseases of the spine or shoulder.
2. Osteoporosis, or fracture ,cervical instability or any sign those with other contraindications against joint mobilization.
3. Individuals with any cervical condition e.g. radiculopathy, cervical rib, whiplash injury and individuals with any neurological/ condition .
4. History of congenital spinal deformity (congenital scoliosis) .
5. Any malignancy related to soft tissue and joints .
6. Subjects taking analgesics and/or muscle relaxants.
7. pregnancy.
8. Being in weight out of the normal range (18 ≥ BMI ≥ 25).
9. Cognitive impairment and inability to understand the scale.