Effects of Muscle Energy Technique Versus Cervical and Scapulothoracic Stabilization Exercises in Upper Crossed Syndrome

Overview

This study will be a randomized clinical trial and will be conducted in Younus Hospital, Tehsil headquarters hospital Daska, and Riphah Rehabilitation Clinic Lahore. Non-probability consecutive sampling will be used to collect the data. A sample size of 40 subjects with an age group between 18-65 years will be taken. Data will be collected from the patients having present complaints of Neck pain associated with upper cross syndrome. Outcome measures will be taken using the Numeric Rating Pain Scale (NRPS) for pain and the Neck disability index (NDI) for neck functional health and craniovertebral angle for posture. An informed consent will be taken. Subjects will be selected based on inclusion and exclusion criteria and will be equally divided into two groups by a random number generator table. Both Groups will receive Moist Hot Pack, Cervical segmental mobilizations, and Free Neck Exercises (AROMs), while Group A will receive Muscle energy technique(eccentric muscle energy technique for the cervical spine with Mets for upper trapezius, Suboccipitalis and pectoralis muscle), and Group B will receive cervical and scapulothoracic stabilization exercises(axial elongation exercise, craniocervical flexion, cervical extension and Cervico-scapulothoracic stabilization exercises). Outcome measures will be measured at baseline and after 4 weeks. Data analysis will be done by SPSS version 25.

Neck pain is one of the most commonly occurring musculoskeletal disorders if left untreated can lead to severe complications. Cervical spine and soft tissue disorders e.g. muscles, ligaments, discs, facet joints, etc. are major causes of neck pain while neck pain caused by postural abnormality is termed as upper cross syndrome. Upper crossed syndrome (UCS) characterizes a prevalent postural dysfunction involving dysfunctional tone in the musculature of the neck, shoulders, and upper back that cross between the dorsal and the ventral sides of the body. This condition is given its name because an "X," in other words a cross, can be drawn across the upper body. One arm of the cross indicates the muscles that are typically tight/overly facilitated and the other arm of the cross indicates the muscles that are typically weak/overly inhibited. There are two types of muscles present in our body - the postural muscles such as pectoralis major, upper trapezius, and sternocleidomastoid, and other phasic muscles such as deep-neck flexors, and lower trapezius. In Upper Cross Syndrome (UCS) there is tightness of the upper trapezius and levator scapula on the dorsal side crosses with tightness of the pectoralis major and minor. Weakness of the deep cervical flexors, ventrally, crosses with weakness of the middle and lower trapezius. This pattern of imbalance creates joint dysfunction, particularly at the Atlanto-occipital joint, C4-C5 segment, cervicothoracic joint, glen humeral joint, and T4-T5 segment. Specific postural changes are seen in UCS, including forward head posture, increased cervical Lordosis and thoracic kyphosis, elevated and protracted shoulders, and rotation or abduction and winging of the scapulae. The main risk factor for developing UCS is maintaining an abnormal posture for a prolonged duration. Some daily activities that involve bad postures are often occupation-related. Repetitive tasks or continuous work for long hours can aggravate postural deviations. Because of increased work stress and a sedentary lifestyle, society is becoming more flexion-addicted attitude. In which people tend to frequently stoop forward. This is seen in office workers and students who tend to sit at a desk for prolonged periods, slouching forward to see the computer screen. Therefore, once muscle dysfunction starts, traditional muscle imbalance trends and altered posture follow. Head, neck structures can set limits on head's range of motion (ROM) and cause discomfort to the neck, mid-back muscle spasm/tightness, and decreased range of motion. Understanding of which intervention yields better outcomes for pain relief, reduction in disability, and improvement in craniovertebral angle is crucial for optimizing treatment strategies for upper crossed syndrome patients. This study seeks to provide evidence-based guidance to clinicians regarding the most effective therapeutic approach. Considering the high prevalence of Upper Cross syndrome in the modern world, this study aims to check the effects of METs versus cervical and scapula-thoracic stabilization exercises on pain, disability and craniovertebral angle in patients with Upper Cross syndrome.