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Upper Cross Syndrome (UCS) is characterized by weakening of the neck flexors and rhomboids and stiffness in the pectoralis major, upper trapezius, and levator scapulae. Rhomboids major and minor need to be strengthened in order to enhance scapular stability and regain proper posture. The aim of this study is to determine effect of rhomboids strength training regime on pain, craniovertebral angle and disability among patients with upper crossed syndrome.
This study will be a randomized controlled trial and will be conducted in Haleema Surgical Hospital, Shorkot city. Non-probability convenient sampling will be used to collect the data. Sample size of 38 subjects with age group between 20-45 years will be taken. Data will be collected from the patients having present complaint of upper crossed syndrome pain. Outcome measures will be taken using Numeric pain rating scale (NPRS) for pain, craniovertebral angle, and neck disability index questionnaire for disability. An informed consent will be taken. Subjects will be selected on the basis of inclusion and exclusion criteria and will be equally divided into two groups by computer-generated stratified randomization. The study will be a single-blind assessor. Both the Groups will receive Hot Pack, TENS, posture training and stretching exercises while group A will receive rhomboids strengthening exercises additionally. Outcome measures will be measured at baseline and after 4 weeks. Data analysis will be done by SPSS version 25.
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| Label | Type | Description | Intervention Names |
|---|---|---|---|
| Rhomboids strengthening exercises along with conventional Exercises | Experimental | Rhomboids strengthening exercises:
hot pack for 10 min. Trans-cutaneous Electric Nerve Stimulation (TENS). Stretching chest muscles, pectoralis muscles, levator scapulae muscle, cervical extensor muscles, upper trapezius Posture correction exercises |
|
| Conventional Exercises | Active Comparator |
|
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| Name | Type | Description | Arm Group Labels | Other Names |
|---|---|---|---|---|
| Rhomboids Strengthening Exercise | Other |
Conventional treatment Modalities: Trans-cutaneous Electric Nerve Stimulation (TENS) and Hot pack, postural exercises and stretching exercises |
| Measure | Description | Time Frame |
|---|---|---|
| Numerical Pain Rating Scale (NPRS) | Patient level of pain will be assessed using this scale. This scale ranges from 0 to 10. 0 indicates "no pain" 1-3 indicate "Mild pain" 4-6 indicate "Moderate pain" 7-10 indicate "worst pain". NPRS have shown high test-retest reliability (r = 0.96 and 0.95, respectively) | upto 4 weeks |
| Neck Disability Index (NDI_ | The NDI is a 10-item, 50-point index that evaluates many facets of day-to-day functioning in individuals with neck pain. The NDI evaluates two items pertaining to discretionary daily living activities (personal care, reading), four items pertaining to activities of daily living (lifting, work, driving, and recreation), and four items related subjective symptoms (pain intensity, headache, concentration, and sleeping). The scores are interpreted as follows: 0-4: No disability 5-14: Mild disability 15-24: Moderate disability 25-34: Severe disability 35-50: Complete disability. For the NDI, test-retest reliability was good | upto 4 weeks |
| Craniovertebral Angle | Anatomically speaking, the degree of forward head posture is measured using the craniovertebral angle (CVA), which is a measurement of the head and neck posture. It is the angle created by a horizontal line running from the C7 vertebra and the line joining the tragus of the ear to the vertebra (the seventh cervical vertebra). In order to calculate the craniovertebral angle:
| upto 4 weeks |
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Inclusion Criteria:
Exclusion Criteria:
• Exclusion criteria Patients were excluded if they were diagnosed with the following conditions for ˃6 months
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| Name | Role | Phone | Extension | |
|---|---|---|---|---|
| Samrood Akram, PhD Scholar | Contact | 03324806143 | Samrood.akram@riphah.edu.pk | |
| Bisma Batool, MSPT | Contact | 03347191694 | bismaiftikhar177@gmail.com |
| Name | Affiliation | Role |
|---|---|---|
| Samrood Akram, PhD Scholar | Riphah International University | Principal Investigator |
| Facility | Status | City | State | ZIP | Country | Contacts |
|---|---|---|---|---|---|---|
| Haleema Surgical Hospital | Jhang | Punjab Province | 54000 | Pakistan |
| PubMed Identifier | Type | Citation | Retractions |
|---|---|---|---|
| 31040591 | Background | Mujawar JC, Sagar JH. Prevalence of Upper Cross Syndrome in Laundry Workers. Indian J Occup Environ Med. 2019 Jan-Apr;23(1):54-56. doi: 10.4103/ijoem.IJOEM_169_18. | |
| 38541838 | Background | Jeong GH, Lee BH. Effects of Telerehabilitation Combining Diaphragmatic Breathing Re-Education and Shoulder Stabilization Exercises on Neck Pain, Posture, and Function in Young Adult Men with Upper Crossed Syndrome: A Randomized Controlled Trial. J Clin Med. 2024 Mar 11;13(6):1612. doi: 10.3390/jcm13061612. |
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| ID | Term |
|---|---|
| C537866 | Oculocerebral hypopigmentation syndrome type Preus |
| D010146 | Pain |
| ID | Term |
|---|---|
| D009461 | Neurologic Manifestations |
| D012816 | Signs and Symptoms |
| D013568 | Pathological Conditions, Signs and Symptoms |
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|
| Conventional Exercises | Other | Conventional Treatment
releasing muscles of anterior part of the trunk, neck, shoulder. |
|
| Background | Naseer R, Tauqeer S. Prevalence of upper cross syndrome in different occupations. Pakistan Journal of Physical Therapy (PJPT). 2021:03-7. |
| 32940899 | Background | Huang JF, Meng Z, Zheng XQ, Qin Z, Sun XL, Zhang K, Tian HJ, Wang XB, Gao Z, Li YM, Wu AM. Real-World Evidence in Prescription Medication Use Among U.S. Adults with Neck Pain. Pain Ther. 2020 Dec;9(2):637-655. doi: 10.1007/s40122-020-00193-1. Epub 2020 Sep 17. |
| 34063944 | Background | Chu EC, Butler KR. Resolution of Gastroesophageal Reflux Disease Following Correction for Upper Cross Syndrome-A Case Study and Brief Review. Clin Pract. 2021 May 21;11(2):322-326. doi: 10.3390/clinpract11020045. |
| Background | Kirthika SV, Sudhakar S, Padmanabhan K, Ramanathan K. Impact of upper crossed syndrome on pulmonary function among the recreational male players: A preliminary report. Saudi Journal of Sports Medicine. 2018;18(2):71-4. |
| Background | Gull M, Akbar UU, Asim HM. FREQUENCY OF CHRONIC NECK PAIN IN UPPER CROSS SYNDROME IN FEMALE SCHOOL TEACHERS. Independent Journal of Allied Health Sciences. 2018;1(01):33-8. |
| 37316911 | Background | Firouzjah MH, Firouzjah EMAN, Ebrahimi Z. The effect of a course of selected corrective exercises on posture, scapula-humeral rhythm and performance of adolescent volleyball players with upper cross syndrome. BMC Musculoskelet Disord. 2023 Jun 14;24(1):489. doi: 10.1186/s12891-023-06592-7. |