Comparative Effects of Kendall and Feldenkrais Exercise in Upper Crossed Syndrome

Riphah International University72 enrolled

Overview

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.

Study Type

INTERVENTIONAL

Allocation

RANDOMIZED

Purpose

TREATMENT

Masking

SINGLE

Enrollment

Conditions

Upper Crossed Syndrome

Interventions

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

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

Eligibility

Sex: ALLMin age: 20 YearsMax age: 50 Years

Medical Language ↔ Plain English

Inclusion Criteria: * Male subjects between 20-50 years * Female subjects between 20-50 years * Cranio-vertebral angle less than 50 degrees * Subjects who had been experiencing neck pain for more than 3 months * Slouched sitting for more than four hours per day * Usage of handheld devices while reading, working, and travelling * Pain intensity score between 4 to 10 on NPRS * NDI\>10 scores between 10 and 34 * Tight pectoralis major muscle Exclusion Criteria: * Surgeries of the cervical spine within past 1 year * Surgeries or fracture to the shoulder joint * Cervical instability * Cervical Radiculopathy * Neurological disorders such as cervical spondylosis, spondylolisthesis, disc prolapse and rheumatic disease

Outcomes

Primary Outcomes

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)

Time frame: 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)