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NCT Number: NCT04603716

Concentric Versus Eccentric Muscle Energy Technique on Upper Cross Syndrome

This project was a Randomized control trial conducted to check the effects of eccentric and concentric muscle energy techniques on patients with upper cross syndrome so that we can have best treatment option for patients with upper cross syndrome, duration was of 6months,convenient sampling was done, subject following eligibility criteria from Mansoura hospital female physiotherapy department, Lahore were randomly allocated in two groups via lottery method, baseline assessment was done, Group A participants were given conservative treatment along with eccentric muscle energy technique and Group B participants were given conservative treatment along with concentric muscle energy technique than on 1st,3rdand 6th week post intervention assessment was done via neck disability index, Numeric rating scale, inches tape method,3 sessions per week were given, data was analyzed by using SPSS version 26.

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Key information

Conditions

Neck Syndrome Oculocerebral hypopigmentation syndrome type Preus

Age range

25 year–40 year

Sex eligibility

Female

Study type

Interventional

Phase

Not applicable

Primary location

Mansoora hospital, Lahore

Lahore, Punjab Province, Pakistan

About this study

In Upper cross syndrome upper trapezius, pectoralis major, and levator scapulae become tight and rhomboids , serratus anterior, middle and lower trapezius, and deep neck flexors, including scalene becomes weak. The postural muscles have tendency to become tight while the phasic muscles have tendency to become weak and inhibited. Thus typical pattern of altered posture and muscular imbalance occurs whenever dysfunction of muscle start. mainly muscular imbalance between weak and tonic muscles leads toward this upper cross syndrome. Soft tissue and cervical spine disorders are found out to be the major contributor in neck pain but when postural abnormality becomes the reason behind neck ache than this is categorized as Upper cross syndrome due to this imbalance in muscles our body has to suffer from severe consequences.rounded shoulder posture is a result of protracted girdle of shoulder due to muscular imbalances between agonist and antagonist muscles resulting in extreme pain and exaggerated cervical curvature.Imbalanced stress on cervical vertebrae is responsible in creating extra pull on neck and head similarly change in normal posture is responsible in overloading, weakening or tightening of cervical area. Characteristics of patient presenting with UCS will have forward head posture, kyphosis ,hunch of thoracic spine (rounded shoulder),winged scapulae, protracted and elevated shoulder and reduced thoracic spine mobility. UCS with the passage of time can detoriate persons physical fitness and health ,it is not only responsible for changes in posture of upper back i.e hypokyphosis over time, but it is also responsible for inducing respiratory problems including asthma. It also cause neck back shoulder and chest wall pain, this pain can be caused by muscular imbalance leading to overuse and fatigue of muscle because of movement dysfunction of back and neck.when muscles become fatigued they start generating more amount of inflammatory chemicals resulting in becoming more sore and increased spasticity. With the passage of time biomechanical and postural changing will induce osteoarthritis in upper thoracic and lower cervical spine in early ages. Functional Shoulder impingement syndrome is also considered to be another complication of Upper cross syndrome. Therefore it is necessary to correctly diagnose and treat this condition before its complication starts worsening.

Who can participate

Healthy volunteers accepted: No

Only the study team can determine whether someone qualifies for participation.

Inclusion criteria

  • 6 month chronic neck pain
  • upper cross syndrome:
  • Clinical picture (Postural Changes):
  • Forward head posture
  • Increased cervical lordosis and thoracic kyphosis
  • Elevated and protracted shoulders (Rounded shoulders)
  • A hunched upper back
  • Rotation or abduction and winging of the scapula
  • Test: Janda test: Patient supine tries to elevate the head from the couch. Normally the lordosis will disappear and the chin will touch the sternum. Otherwise pathological picture shows that the head is lifted with the very tense neck muscles

Exclusion criteria

  • Patients having any serious trauma on neck i.e. whiplash injury
  • Spinal fracture
  • Cervicogenic headache
  • History of systemic disease RA, SLE, TUMOR
  • psychiatric disorder
  • Any Red flag

Treatment and study plan

Eccentric Muscle Energy Technique

Other

Conventional Treatment given to both groups (Hot pack for 15 minutes, Mobilization, AROM Exercises 10 sets x 3days in a week)

Reciprocal inhibition of target muscle (i.e. levator scapulae ,pectoralis major, upper trapezius) causing relaxation, patient force is minimal towards maximal therapist force, 5-7 repetition for 2-4seconds 3 days in a week up to 6 weeks.

Muscle is taken from shortened to lengthened position.

Concentric muscle energy technique

Other

Group B: Concentric Muscle Energy Technique: (Autogenic inhibition of target muscle (i.e. levator scapulae ,pectoralis major, upper trapezius) patient force is greater than therapist force, 5-7repitition for 3-4seconds)Muscle is taken from lengthened to shortened position.

On eligible participants baseline assessment was done,3 session were given 3days per week, post intervention assessment was taken at 1st 3rd and 6th week

Primary outcomes

  1. Neck disability index

    Time frame: 6th Week

    10-item questionnaire that measures a patient's self-reported neck pain related disability. A higher NDI score means the greater a patient's perceived disability due to neck pain. 10 item score from 0-5.maximum score is 50.

    • 0 to 4(0-8%)=no disability
    • 5 to14(19-28%)=mild
    • 15 to24(30-48%)=moderate
    • 25 to 34 (50-64%)=severe
    • Above 34(70-80%)=complete.

    10-item questionnaire that measures a patient's self-reported neck pain related disability. A higher NDI score means the greater a patient's perceived disability due to neck pain. 10 item score from 0-5.maximum score is 50.

    • 0 to 4(0-8%)=no disability
    • 5 to14(19-28%)=mild
    • 15 to24(30-48%)=moderate
    • 25 to 34 (50-64%)=severe
    • Above 34(70-80%)=complete

Secondary outcomes

  1. NPRS

    Time frame: 6th Week

    Changes from base Line Numeric Pain rating scale is a scale for pain starting from 0-10. where 0 indicate no pain and 10 indicate severe pain

Other outcomes

  1. Inches Tape method

    Time frame: 6th Week

    Two bony landmarks were selected to measure the length of pectoralis major, upper trapezius, levator scapulae with the help of inches tape ,idea was taken from the Joint range of motion and muscle length testing-E-book by NB Reese,WD Bandy - 2016 - Elsevier Health Sciences

Sponsors and collaborators

Lead sponsor

Riphah International University

Other

Registry information

Official study title

Effects of Concentric Versus Eccentric Muscle Energy Technique on Pain, Muscle Length and Function in Upper Cross Syndrome

Important dates

Study start
2019
Primary completion
2020
Study completion
2020
First posted
Oct 27, 2020
Registry last updated
Oct 27, 2020

OpenTrials presents study information sourced from ClinicalTrials.gov. The official registry record should be consulted for the latest information.

View the official ClinicalTrials.gov record (opens in a new tab)

This listing is for discovery and informational purposes only. It is not medical advice, does not guarantee that a study is recruiting, and does not determine eligibility. Contact the study team and a qualified healthcare professional when considering participation.

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