Lower Cross Syndrome happens when there is muscular imbalance between weak and tight muscles. The tight muscles are generally the hip flexors and erector spinae, and weak muscles are the abdominals and gluteal muscles. Shortening occurs in the hip flexors while weakening occurs in the abdominals and gluteal muscles.

Group I (Study): will consist of 20 patients with lower cross syndrome and will receive extracorporeal shock wave in addition to conventional physical therapy program. For 12 sessions every other day, each session for 1 hour.

Group II (Control): will consist of 20 patients with lower cross syndrome and will receive sham extracorporeal shock wave in addition to conventional physical therapy program only same as group (I). For 12 sessions every other day, each session for 1 hour.

Inclusion Criteria:

1. Forty-four lower cross syndrome patients from both genders their ages ranged from 30-45 years old.
2. All patients in present study will be ambulant independently.
3. All patients will be medically stable.
4. The body mass index (BMI) will be ranged from 20:25 Kg/m2.

Exclusion Criteria:

1. Patients with musculoskeletal deformities and disorders.
2. Patients with psychiatric disorders or seizures.
3. Patients with visual and auditory impairment or tremors influencing balance.
4. Patients with other neuromuscular disorders.
5. Patients with BMI more than 25 kg/m2.
6. Patients with cognitive impairment.
7. Patients with lower limb or head and brain surgeries.