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

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.

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.