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Upper Cross Syndrome (UCS) is a prevalent musculoskeletal disorder characterized by muscular imbalances and postural dysfunction. Kendall Method and Feldenkrais Method are physiotherapy exercise programs aimed at reducing pain and improving cervical position sense, CV angle and function. This study compares their effects on pain, CV angle, cervical position sense, and disability in individuals with upper cross syndrome. This will be a randomized Controlled trial conducted on 72 participants. Data will be collected from Sikander Medical Complex, Gujranwala by using non-probability convenience sampling technique. Adults aged 20 to 50 years with upper cross syndrome, confirmed by Craniovertebral Angle less than 50 degrees and experiencing symptoms for more than four weeks, will be included in this study. Individuals with cervical spondylosis, spondylolisthesis, disc prolapse, trauma-related cervical injuries, or a history of shoulder surgery will be excluded. Group A will receive Kendall Method along with conservative physiotherapy, while Group B will receive Feldenkrais Method combined with conservative physiotherapy. Each session will last 30 minutes-40 minutes for the primary intervention and 15-20 minutes for conventional therapy-administered three times per week for five weeks. Pre- and post-treatment evaluations will include the Numeric Pain Rating Scale (NPRS), CV angle (measured via Image J), Cervical position Sense (assessed via HRE) and functional disability (measured via NDI). Data will be analyzed using SPSS version 27.0.
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| Label | Type | Description | Intervention Names |
|---|---|---|---|
| Kendall Exercise Method (KM) | Experimental |
| |
| Feldenkrais Exercise Method (FM) | Active Comparator |
|
| Name | Type | Description | Arm Group Labels | Other Names |
|---|---|---|---|---|
| Kendall Exercise Method (KM) | Other | Strengthening of deep cervical flexors Procedure: Positioning supine with the chin tucked in and lifting the head for 2 to 8 s. Stretching of cervical extensors Procedure: Maintaining a sitting posture, with hands on the occipital region, and flexed spine while moving head downwards to stretch cervical extensors. Strengthening of retractors Procedure: Maintaining an upright posture, keep the resistance band circling with strong support and stretching it with the upper limbs of both sides so that there is full retraction of the scapula |
| Measure | Description | Time Frame |
|---|---|---|
| Neck pain and diability index | The NDI is used to measure functional impairment and pain because to its high reliability and validity. A higher NDI score indicates a more severe impairment; the ten parts of the NDI are rated from zero to fifty. With a maximum score of 50, each item may be assessed on a scale from 0 (no disability) to 5 (total impairment). The maximum possible score for each part is 5. If the first statement is marked as true, the section score is 0, and if the final statement is recorded as true, the score is 5. No neck impairment is considered to exist with a score of 0 4, mild disability from 5-14, moderate disability from 15-24, severe disability from 25-34, and full disability from scores over 34(11). The Neck Disability Index exhibited excellent reliability (ICC = 0.92; [95 % CI: 0.46-0.97]).(27) | 6th week |
| Head Repositioning Error Test | The Arc tangent of the distance between the reference and target points divided by the distance between reference point and the laser pointer was considered as HRE.This method was first described by Revel et al. Each participant performed three trials. The average amount of three HRE was used for data analysis. No discomfort or complication was reported by participants after HRE test. The CVA and HRE were measured by two different physiotherapists.(29) | 6th week |
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Inclusion Criteria:
Exclusion Criteria:
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| Name | Role | Phone | Extension | |
|---|---|---|---|---|
| Rabiya Noor, phd | Contact | 03344355660 | Rabiya.Noor@riphah.edu.pk | |
| Iqbal Tariq, phd | Contact | 03338236752 | Iqbal.tariq@riphah.edu.pk |
| Name | Affiliation | Role |
|---|---|---|
| Aiman Hameed, MSPT(CP) | Riphah International University | Principal Investigator |
| Facility | Status | City | State | ZIP | Country | Contacts |
|---|---|---|---|---|---|---|
| Rabiya Noor | Recruiting | Lahore | Punjab Province | 54000 | Pakistan |
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| ID | Term |
|---|---|
| C537866 | Oculocerebral hypopigmentation syndrome type Preus |
| D019547 | Neck Pain |
| D018908 | Muscle Weakness |
| ID | Term |
|---|---|
| D010146 | Pain |
| D009461 | Neurologic Manifestations |
| D012816 | Signs and Symptoms |
| D013568 | Pathological Conditions, Signs and Symptoms |
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| Feldenkrais Exercise Method (FM) | Other | Shoulder 1 minute (2) Relaxation (2) Lift and lower one shoulder slowly Key Focus Focus on small range of motion and awareness Neck Rolls head from one side to the other gently 1 minute Reduce tension, no strain, smooth motion Ear-to-Shoulder (Static) Lower ear to shoulder, return to center 1 minute Observe full-body involvement Ear-to-Shoulder with Shoulder Lift Alternate ear-to-shoulder and shoulder-to-ear 1 minute Gentle coordination of ]head and shoulder Upper Body Rotation (Step 1) Sit forward on chair; rotate upper body right slightly 6-10 Reps Relaxed turning, observe visual range Eyes Fixed with Body Rotation Fix eyes forward, turn upper body right 6-10 Reps Notice effect of eye fixation on motion |
|
| D009135 | Muscular Diseases |
| D009140 | Musculoskeletal Diseases |
| D020879 | Neuromuscular Manifestations |
| D009422 | Nervous System Diseases |
| D010335 | Pathologic Processes |