Effects of Sprinter and Skater on Text Neck Syndromes

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Background: Digital technology has become a vital part of daily life, changing the way people work, communicate and relax and resulting in unprecedented levels of screen time for all generations. Handheld smart devices, such as smartphones, tablets and computers, have become an essential part of the professional, academic and social lives. But with this technological improvement there has been a significant increase in technology-related musculoskeletal disorders. Neck pain, particularly, is one of the biggest causes of disability globally, especially among young adults and people who work in an office environment performing prolonged sitting postures .The cervical structures may be affected by mechanical stress caused by the prolonged flexed position held while using a smartphone and computer, also known as Text Neck Syndrome (TNS), and there may be a shift in neuromuscular control. New epidemiological evidence in recent years reveals that over 4 hours of digital device use has a detrimental effect on the prevalence of FHP, cervical discomfort, and cervical functional capacity among people. This was reflective of the fact that there has been a change in human behaviors in the digital age from acute injury to chronic postural dysfunction.

Objectives: To evaluate the effect of the combination of synergy exercises (sprinting and skater) on the intensity of pain, muscle activation and posture in people suffering from Text Neck Syndrome (TNS). Secondary objectives include determining which technique shows significantly greater improvement and providing evidence-based recommendations for physiotherapy practice in Pakistan.

Methodology Research type The study design for this research was randomized clinical trials. Study population People of both genders aged 25-45 years with Text neck syndrome Study setting Habib Bank of Pakistan, National Bank of Pakistan, Meezan bank Duration of study Study was completed after the approval of synopsis within 4 months. Sample technique Consecutive sampling technique were used for sampling. Sample size The sample size of 50 participants (25 per group) were included calculated by using G power app.

Allocation and randomization Randomization was carried out using a computer generated random number generator to ensure unbiased group allocation. At the start of the study, a sequence of random number was generated and used to assign participants to either Group A or Group B. As participants were enrolled, they were allocated to groups according to this predefined sequence, ensuring that each participant had an equal chance of being placed in either group.

Intervention Group A : Coordinated Locomotor Training (CLT) The CLT protocol was based on Janda's tonic phasic muscle theory, aimed to restore reciprocal muscle activation patterns and postural balance Duration: 8 weeks Frequency: 3 sessions per week Session Length: 40 minutes Table 1 : Session Phases Phase Repetitions / Sets Description Warm-up Hot pack: 10 minutesChin tuck: 2 sets × 10 reps (10 sec hold)Scapular retraction: 2 sets × 10 reps An electric hot pack was applied for approximately 10 minutes prior to intervention to enhance tissue extensibility and circulation. This was followed by chin tuck exercises for deep neck flexor activation and scapular retraction exercises to promote postural muscle engagement.

Main CLT Phase 2 sets × 10 repetitions per side Alternating Sprinter and Skater synergy exercises performed in supine, sitting, and standing positions to activate deep neck flexors, rhomboids, and serratus anterior while inhibiting upper trapezius and pectoralis major/minor.

Integration Phase 2 sets × 10 repetitions Sequential Sprinter → Skater → Sprinter movement patterns to improve interlimb coordination and neuromuscular control.

Relaxation / Cool Down 5 breathing cycles Gentle breathing and relaxation exercises to reduce muscle tension and promote recovery.

Participants also perform brief home based micro sessions (5-8 minutes) during work hours to maintain postural endurance.

Group B: control group: The control group was received a structured program of conventional physiotherapy exercises focusing on improving neck stability, activating postural muscles, and reducing muscle tightness. Conventional protocols sued "deep cervical flexor training, scapular strengthening, and stretching exercises" that significantly improve pain, posture, and functional outcomes in individuals with neck pain and forward head posture.

Intervention Parameters

• Duration: 8 weeks
• Frequency: 3 sessions per week
• Session Length: 40 minutes Table 2: Session Phases for Control Group Phase Repetitions / Sets Description Warm-up Hot pack: 10 minutesChin tuck: 2 sets × 10 reps (10 sec hold)Scapular retraction: 2 sets × 10 reps An electric hot pack was applied for approximately 10 minutes prior to intervention to enhance tissue extensibility and circulation. This was followed by chin tuck exercises for deep neck flexor activation and scapular retraction exercises to promote postural muscle engagement.

Cervical Stabilization Exercises 2 sets × 10reps (10 sec hold) Deep neck flexor exercises (chin tuck in supine and sitting positions) to improve cervical stability and correct forward head posture.

Scapular Strengthening 2 sets × 10 reps Scapular retraction and prone horizontal abduction exercises targeting middle and lower trapezius and rhomboids to improve postural control.

Stretching Exercises 2 sets× 10 reps per muscle (20 sec hold) Static stretching of upper trapezius, levator scapulae, and pectoralis muscles in sitting to reduce muscle tightness and improve flexibility.

Relaxation / Cool Down 5 breathing cycles Gentle breathing and relaxation exercises to reduce muscle tension and promote recovery.

Inclusion criteria

• Participants who meeted the following criteria, eligible for inclusion in the study:

• Age between 25 and 45 years (both male and female participants).
• Diagnosed with Clinical signs of Text Neck Syndrome (TNS)
• Forward head posture (measured using craniovertebral angle (CVA)).
• Rounded shoulders and scapular elevation (measured via postural assessment)
• History of at least 4 - 6 hours of computer or mobile device use daily for 6 months or more
• Numeric Pain Rating Scale (NPRS) score between 3 and 6 (indicating moderate pain)
• Craniovertebral Angle of less than 50°, indicating significant postural deviation
• Willingness to provide informed consent and participate in the intervention protocol for 8 weeks.
• Participants must be able to commit to completing the 8 week intervention, including in person sessions and home exercises.

Exclusion criteria

Participants were excluded from the study if they meet any of the following criteria

• Previous surgery, history of cervical or shoulder surgery, or any major trauma to the neck or shoulder region
• Reported neurological or vestibular disorders, any condition affecting posture or balance, such as neurological disorders, vestibular impairments, or dizziness (e.g., vertigo, balance dysfunction)
• Reported congenital spinal deformities, diagnosis of congenital spinal deformities such as scoliosis, torticollis, or kyphosis that could interfere with postural assessment or training
• Participation in other rehabilitation programs current participation in another rehabilitation program focused on posture correction, neck pain, or musculoskeletal disorders during the study period
• Female participants who are pregnant or have medical contraindications to moderate physical exercise
• Individuals with serious cardiovascular, musculoskeletal, or neurological diseases that might contraindicate participation in moderate physical activity (e.g., uncontrolled diabetes, severe heart disease, or cancer)
• Individuals with a pain level greater than 6 on the NPRS or those with significant functional disability in the neck and upper back, which might impede their participation in the intervention.