Smartphone Application with Global Postural Re-education in Patients with Upper Cross Syndrome

The Effect of Integrating a Smartphone Application with Global Postural Re-education on Cervical Proprioception in Patients with Upper Cross Syndrome

Design:

Randomized Controlled Trial.

Participants:

The sample size will be determined using G power analysis.

Procedures:

Patients of both sexes (men and women) suffering from cervical pain caused by Upper Cross Syndrome (UCS) will be randomly selected from El Amal Clinic in Fayoum. They will be randomly assigned into three groups:

Group A: Participants will undergo experimental interventions for approximately 50 minutes a day, 4 days a week, for an 8-week period. Exercises will be assisted and reminded by a smartphone app at predetermined times.

Group B: Participants will undergo the same experimental interventions for approximately 50 minutes a day, 4 days a week, for an 8-week period, without app assistance. The exercises include:

Exercise 1: The lying posture with leg extension progression, aimed to stretch the anterior muscle chain (diaphragm, pectoralis minor, scalene, sternocleidomastoid, intercostalis, iliopsoas, arm, forearm, and hand flexors).

Exercise 2: The lying posture with flexion of the thighs, intended to stretch the posterior chain (upper trapezius, levator scapulae, suboccipital, erector spinae, gluteus maximus, ischiotibial, triceps surae, and foot intrinsic muscles).

Control Group: Participants will perform an evidence-based physiotherapy program for approximately 50 minutes a day, 4 days a week, for an 8-week period. This program includes:

Postural correction in daily activities, neck education, and exercise therapy focused on issues such as spine anatomy, physiology, biomechanics, common causes of neck pain, the load tolerance model, nociceptive pain processing, self-care, and ergonomic suggestions for daily activities (e.g., standing, sitting, lifting).

Conventional physical therapy, including strengthening exercises for deep neck flexors, rhomboids, lower trapezius, and serratus anterior (2 sets of 10 repetitions per day) and stretching exercises for pectoralis muscles (20-second hold, 5 repetitions).

Inclusion criteria

Office workers using a computer for at least 4 hours per day.

Aged between 28 and 48 years.

Neck pain scored between 3 and 8 cm on a Visual Analog Scale (VAS) (0 indicating no pain and 10 indicating unbearable pain).

Chronic nonspecific neck pain lasting more than 3 months.

Willingness and ability to safely participate in an exercise program without cognitive impairments.

Specific postural changes seen in UCS, including forward head posture, increased cervical lordosis and thoracic kyphosis, elevated and protracted shoulders, and scapular rotation, abduction, or winging.

Exclusion criteria

Specific causes of neck pain (e.g., systemic, rheumatic, or neuromuscular diseases), central or peripheral neurological signs, cognitive impairments, spinal surgery, or physiotherapy treatments in the 6 months prior to baseline assessment.

Participants missing at least three consecutive or four non-consecutive sessions.

Instrumentation:

For Assessment:

Visual Analog Scale (VAS) to assess cervical pain.

CROM device to assess cervical range of motion (ROM) and cervical proprioception.

Neck Disability Index (NDI) to assess neck function.

For Treatment:

Smartphone app called "Kyphosis and Rounded Back" .

Global Postural Re-education.

Traditional evidence-based physiotherapy.

Inclusion criteria

office workers(using a computer at least 4 h),

• aged between 28 and 48years,
• NP between 3 and 8 cm on a visual analog scale(VAS) (from 0 indicating no pain at all to 10 indicating unbearable pain),
• Chronic non specific neck pain lasting for more than 3 months (Fathollahnejad et al., 2019).

Exclusion criteria

• • Specific causes of NP (e.g., systemic, rheumatic, neuromuscular diseases), central or peripheral neurological signs, cognitive impairment, spinal surgery, or physical therapy treatments in the last 6 months prior to the baseline assessment.

• Participants would be also excluded if they missed at least three consecutive or four non consecutive sessions (Fathollahnejad et al., 2019).