Effects of MET and Biofeedback Strengthening With and Without Kinesiotaping in Upper Crossed Syndrome

Combined Effects of Muscle Energy Technique and Biofeedback Strengthening With and Without Kinesio Taping on Pain, Muscle Performance and Functional Status in Patients With Upper Crossed Syndrome

This randomised controlled trial will aim to evaluate the combined effects of Muscle Energy Technique (MET) and biofeedback strengthening, with and without Kinesiotaping (KT), on pain, posture, deep neck flexor strength, and functional status in individuals with Upper Crossed Syndrome (UCS). A total of 58 participants aged 18-40 years will be randomly allocated into two groups. Group A will receive MET and biofeedback strengthening, while Group B will receive the same intervention with the addition of KT. Treatments will be administered three times per week over a four-week period. Outcome measures will include the Numeric Pain Rating Scale (NPRS), Neck Disability Index (NDI), craniovertebral angle (CVA), rounded shoulder posture (RSP), and cranio-cervical flexion test (CCFT) using a pressure biofeedback unit. It is hypothesised that the addition of KT will result in greater improvements in pain reduction and postural correction compared to MET and biofeedback alone.

This study will be a single-blinded, two-arm randomized controlled trial designed to evaluate the effects of combining Muscle Energy Technique (MET) and biofeedback-based strengthening exercises, with and without Kinesiotaping (KT), on pain intensity, postural correction, muscle performance, and functional status in individuals diagnosed with Upper Crossed Syndrome (UCS). UCS is a common postural dysfunction resulting from muscle imbalances in the upper quadrant, often associated with forward head posture, rounded shoulders, and neck pain, particularly in individuals with sedentary lifestyles.

A total of 58 participants between the ages of 18 and 40 years will be recruited through non-probability consecutive sampling from Horizon Hospital, Lahore. Participants who meet the inclusion criteria will be randomly assigned into two groups using computer-generated randomisation. Group A will receive MET and biofeedback strengthening via cranio-cervical flexion exercises. Group B will receive the same interventions with the addition of Kinesiotaping applied to the shoulder girdle. Interventions will be administered three times per week for a duration of four weeks, for a total of 12 sessions. Both groups will receive standard physiotherapy care, including heat application, therapeutic ultrasound, neck isometric exercises, and stretches for superficial neck muscles.

The primary outcomes will include pain measured by the Numeric Pain Rating Scale (NPRS), disability assessed using the Neck Disability Index (NDI), and postural parameters including craniovertebral angle (CVA) and rounded shoulder posture (RSP) assessed with a goniometer and measuring tape respectively. Deep neck flexor strength will be measured using the cranio-cervical flexion test (CCFT) with a pressure biofeedback unit (PBU).

Statistical analysis will be conducted using SPSS v25.0. The normality of the data will be assessed via the Kolmogorov-Smirnov test. Non-parametric tests (Wilcoxon signed-rank test and Mann-Whitney U test) will be used to evaluate within-group and between-group differences, respectively. The level of significance will be set at p < 0.05.

It is hypothesised that the group receiving MET and biofeedback strengthening with Kinesiotaping will demonstrate greater improvements in pain relief, postural alignment, deep neck flexor strength, and functional status compared to the group receiving MET and biofeedback strengthening alone.

This study aims to contribute to the growing evidence for multimodal physiotherapy interventions in the management of UCS and provide clinical guidance for the use of kinesiotaping as an adjunctive treatment in postural correction.

Inclusion Criteria:

• Age group between 18-40 years
• Both males and females
• NPRS score <7 for more than 2 months
• NDI score between 15-34
• Forward neck posture (confirmed by craniovertebral angle <48-50° measured by goniometer)
• Rounded shoulders posture (confirmed by supine lying test; if the distance between posterior aspect of acromion and plinth is >1 inch or 2.5 cm)
• Reduced deep neck flexors strength (confirmed by cranio-cervical flexion test (CCFT))

Exclusion Criteria:

• Age less than 18 or more than 40
• Recent trauma and/or hyper-flexibility
• History of cervical surgery in the last year
• History of infection (local or systemic), any dermatological condition tumor, chemotherapy, radiotherapy
• History of cervical fracture in the last year
• Radiating pain
• Positive upper limb tension tests