Effect of Neural Mobilization in Upper Cross Syndrome

Upper cross syndrome (UCS) is the tightness of the levator scapulae, pectoralis major, and upper trapezius whereas inhibition of serratus anterior, deep neck flexors more specifically scalene, middle trapezius, lower trapezius, and rhomboids. This condition is given its name because a cross can be drawn across the upper body. One arm of the cross indicates the tight muscles and the other arm of the cross indicates the inhibited muscles.

People suffering from UCS present with a forward head posture (FHP), hunching of the thoracic spine (rounded upper back), elevated and protracted shoulders, scapular winging, and decreased mobility of the thoracic spine. Sometimes, manual work can cause musculoskeletal disorders, for example, the workers who do their work in awkward positions repeat the same action throughout their workday.

It was found that UCS causes pain among 24.3% of drivers. Also, 35.9% of office workers suffer from the upper cross syndrome and body posture was the leading cause. Housewives were also suffering from upper cross syndrome. The reason behind this is that during household tasks they don't keep a good posture which causes them pain and other difficulties.

Patients complaining of non-traumatic neck pain tend to keep the forward head posture, when compared to people without pain.

Rounded shoulder has been identified as a leading cause of upper quarter pain. Kyphosis, by both clinical and quantitative assessment, causes diminished function especially in tasks that require mobility.

The effect of neural mobilization in various diseases and conditions includes increasing nerve conduction and functional status, decreasing pain and subjective symptoms.

Accordingly, there are no available studies in the literature investigating the effect of neural mobilization on the upper cross syndrome, therefore this is the purpose of the study.

Inclusion criteria

• Age ranged from 20 to 50 years.
• Body Mass Index ≤30 kg/m².
• All participants have a forward head, craniovertebral angle < 50°.
• All participants have round back (kyphosis angle ≥ 42°).
• All participants have rounded shoulders of ≥ 52°.
• The subjects were chosen from both genders based on an assessment of upper cross syndrome by photogrammetric analysis.
• All participants have pain intensity level measured by visual analogue scale (4-8).
• All participants tested positive for upper limb tension test of median nerve.

Exclusion criteria

• History of trauma or surgery in the cervical region.
• Bone fractures or acute soft tissue injuries.
• Osteoporosis.
• Pregnant women.
• Cancer.
• Neurological conditions affecting cervical and thoracic spine.
• Connective tissue disease: This includes diseases such as osteomyelitis, lupus, and scleroderma.