Kendall Exercises Versus Proprioceptive Neuromuscular Facilitation Technique in Patients With Upper Cross Syndrome

NCT ID: NCT06770205

Last Updated: 2025-01-13

Basic Information

• Recruitment Status: ACTIVE_NOT_RECRUITING
• Clinical Phase: NA
• Total Enrollment: 58 participants
• Study Classification: INTERVENTIONAL
• Study Start Date: 2024-07-01
• Study Completion Date: 2025-01-31

Brief Summary

Upper Crossed Syndrome (UCS) is a postural disorder characterized by a distinct pattern of muscle imbalances within the musculature of the shoulder girdle and cervico-thoracic region. The use of different corrective exercise approaches enhances and improves muscle balance and motor control thereby reducing postural abnormalities. Therefore, the aim of study will be to compare the effects of Kendall exercises versus proprioceptive neuromuscular facilitation technique on pain, range of motion, disability craniovertebral and thoracic angle in patients with upper cross syndrome.

A Randomized Clinical Trial will be conducted at Riphah Clinic Lahore, Sehat medical complex hospital Lahore through consecutive sampling technique on 52 patients which will be allocated using computer generated sampling (random number table) into Group A and Group B. Group A will be treated with kendall exercises and Group B will be treated with Proprioceptive Neuromuscular Facilitation techniques with the frequency that Stretching exercises will be performed actively for 30 second hold and 3 repetitions. Strengthening exercise will be performed for 10 second hold and 10 repetitions. All Exercises will be performed 3 times per week for total of 4 weeks. Outcome measures will be conducted through pain, range of motion, disability craniovertebral and thoracic angle after 4 weeks. Data will be analyzed during SPSS software version 25.

Detailed Description

Upper Crossed Syndrome (UCS) is a postural disorder characterized by a distinct pattern of muscle imbalances within the musculature of the shoulder girdle and cervico-thoracic region. This syndrome is typified by tightness and over-facilitation of muscles such as the levator scapulae, pectoralis major, and upper trapezius, juxtaposed with the weakness or inhibition of the serratus anterior, deep neck flexors (specifically scalene), middle trapezius, lower trapezius, and rhomboids. Individuals with UCS typically exhibit a forward head posture, rounded upper back (thoracic kyphosis), elevated and protracted shoulders, and scapular winging. Prolonged and repetitive activities, such as manual material handling, especially when performed in inappropriate postures, can exacerbate the symptoms of UCS. A study involving medical students at the University of Lahore highlighted a concerning prevalence of UCS, with 48.7% of the student population reporting neck pain. The use of different corrective exercise approaches enhances and improves muscle balance and motor control thereby reducing postural abnormalities. Therefore, the aim of study will be to compare the effects of Kendall exercises versus proprioceptive neuromuscular facilitation technique on pain, range of motion, disability craniovertebral and thoracic angle in patients with upper cross syndrome.

A Randomized Clinical Trial will be conducted at Riphah Clinic Lahore, Sehat medical complex hospital Lahore through consecutive sampling technique on 52 patients which will be allocated using computer generated sampling (random number table) into Group A and Group B. Group A will be treated with kendall exercises and Group B will be treated with Proprioceptive Neuromuscular Facilitation techniques with the frequency that Stretching exercises will be performed actively for 30 second hold and 3 repetitions. Strengthening exercise will be performed for 10 second hold and 10 repetitions. All Exercises will be performed 3 times per week for total of 4 weeks. Outcome measures will be conducted through pain, range of motion, disability craniovertebral and thoracic angle after 4 weeks. Data will be analyzed during SPSS software version 25. The normality of data will be assessed by Shapiro-Wilk test after which it will be decided either parametric or non-parametric test will be used within a group or between two groups.

Conditions

Upper Extremity Dysfunction

Study Design

• Allocation Method: RANDOMIZED
• Intervention Model: PARALLEL
• Primary Study Purpose: TREATMENT
• Blinding Strategy: DOUBLE

Study Groups

traditional physical therapy

Hot pack and TENS for 10 minutes and massage that will as 3 sessions per week for 4 weeks.

Group Type: ACTIVE_COMPARATOR

traditional physical therapy

Intervention Type: OTHER

hot pack and TENS for 10 minutes and massage that will as 3 sessions per week for 4 weeks.

kendall Exercise Group A

The Kendall exercise group participated in 5 sets of consisting of 12 repetitions of postures, each taking 30 seconds, based on Kendall exercise. The Kendall exercise methods were as follows:

1. Strengthening the deep cervical flexors, lying flat on the back with the chin down and then lifting the head and holding this position for 2-8 seconds to strengthen deep cervical flexors

2. Stretching the cervical extensors, placing both hands on the occipital area in a sitting position followed by a flexed neck posture with the head down to stretch the cervical extensors

3. strengthening shoulder retraction, putting a Thera Band around a secure object and pulling the band back with both hands as far as possible to move the shoulder blades toward each other in a standing position

4. stretching the pectoralis muscle, placing both hands on the occipital area and pulling the elbows back up

Group Type: EXPERIMENTAL

kendall Exercise Group A

Intervention Type: OTHER

The group B will receive Proprioceptive Neuromuscular Facilitation technique for stretching and rhythmic stabilization technique for strengthening. Proprioceptive Neuromuscular Facilitation (PNF) is a stretching technique utilized to improve muscle elasticity and has been shown to have a positive effect on active and passive range of motions. The PNF group performed the intervention for 30 minutes a day, six times a week, a total of 24 times. (13) In this group, two types of PNF techniques were given:

1. first is strengthening technique included rhythmic stabilization that is characterized by alternating isometric contractions against resistance, no motion intended to apply for the weak muscles of upper cross syndrome included deep neck flexors specifically lower trapezius and serratus anterior.

2. Second is stretching technique included contract relax that is resisted isotonic contractions of the restricting muscles (antagonists) followed by relaxation and movement

Interventions

traditional physical therapy

hot pack and TENS for 10 minutes and massage that will as 3 sessions per week for 4 weeks.

Intervention Type: OTHER

kendall Exercise Group A

The group B will receive Proprioceptive Neuromuscular Facilitation technique for stretching and rhythmic stabilization technique for strengthening. Proprioceptive Neuromuscular Facilitation (PNF) is a stretching technique utilized to improve muscle elasticity and has been shown to have a positive effect on active and passive range of motions. The PNF group performed the intervention for 30 minutes a day, six times a week, a total of 24 times. (13) In this group, two types of PNF techniques were given:

1. first is strengthening technique included rhythmic stabilization that is characterized by alternating isometric contractions against resistance, no motion intended to apply for the weak muscles of upper cross syndrome included deep neck flexors specifically lower trapezius and serratus anterior.

2. Second is stretching technique included contract relax that is resisted isotonic contractions of the restricting muscles (antagonists) followed by relaxation and movement

Intervention Type: OTHER

Eligibility Criteria

Inclusion Criteria

• Patients diagnose with upper crossed syndrome.
• To diagnose upper cross syndrome, janda classification or approach will be use. Janda believed that muscle tightness or spasticity is predominant. Often weakness from muscle imbalance results from reciprocal inhibition of the tight antagonist. These patterns lead to postural changes and joint dysfunction and degeneration (23)
• Both genders male and female.
• Participants with constantly or frequently occurring neck-shoulder pain more than 1 month.
• Age between 25 and 50 years (3)
• Pain and restricted range of motion
• NPRS score greater than 3
• Craniovertebral angle < 51 degree. (20)

Exclusion Criteria

• Tumors
• Pregnancy
• Diagnosed psychological disorders
• Surgery
• Cancer and neuropathies past one year
• Rheumatoid arthritis and cervical instability.

• Minimum Eligible Age: 25 Years
• Maximum Eligible Age: 50 Years
• Eligible Sex: ALL
• Accepts Healthy Volunteers: No

Sponsors

Riphah International University

OTHER

Sponsor Role: lead

Responsible Party

Responsibility Role: SPONSOR

Principal Investigators

Amna Shahid, t-DPT

Role: PRINCIPAL_INVESTIGATOR

Riphah International University

Locations

Riphah Rehab Training and Research Center

Lahore, Punjab Province, Pakistan

Countries

Pakistan

Other Identifiers

REC/RCR&AHS/24/0108

Identifier Type: -

Identifier Source: org_study_id