Kendall Versus Janda's Approach Along With Diaphragmatic Breathing Exercises in Upper Crossed Syndrome

Official title

Comparative Effects of Kendall Versus Janda's Approach Along With Diaphragmatic Breathing Exercises on Pain, Chest Expansion, Cranio Vertebral Angle, and Disability in Upper Crossed Syndrome

Overview

Upper Crossed Syndrome (UCS) is a postural imbalance in the upper body characterized by shortened and tight muscles in the front and upper back, while weak muscles in the back and neck are stretched and underactive. This imbalance can lead to forward head posture, rounded shoulders, and increased spinal curves, causing pain, headaches, and reduced range of motion. The study aims to compare the effects of Kendall exercises with Janda's Approach along with Diaphragmatic breathing exercises on pain, chest expansion, craniovertebral angle, and disability in upper crossed syndrome.

Detailed description

This randomized clinical trial study will be conducted at Central Hospital and Anwer's Polyclinic, Sialkot. We will include 50 patients (25 in each group) of Upper Crossed Syndrome with an age range of 30-50 years, both male and female will be included. Group A will be provided Kendall Exercises with Diaphragmatic breathing exercises, and Group B will receive Janda's with diaphragmatic breathing exercises. Both interventions will be administered for 45 minutes per session, three times per week, for a total duration of six weeks. Outcome measures will include NPRS for pain, Neck Disability Index for disability, Universal goniometer for cranio vertebral angle, and a measuring tape for thoracic expansion will be used. The collected data will be analyzed in the Statistical Package for the Social Sciences (SPSS) 26.0 version. If the data is normally distributed, then a parametric if not normally distributed than a nonparametric test will be applied.

Interventions

• Other Kendall exercises
  Stretching: Pectoralis, Upper Trapezius, Levator Scapulae (2 sets of 20 sec each) Strengthening: Scapular retractors with Thera band (2 sets of10 reps), Chin tucks (2 sets of 10 reps), Diaphragmatic breathing (4 mins) Strengthening: Add isometric cervical flexors (5 sec hold with 5 reps),, Chin tucks \& scapular retractors (3 sets of 10 reps) Strengthening: Add scapular squeeze (5 sec hold of 5 reps), Emphasize postural control during exercises Strengthening: Functional posture tasks (e.g., seat
• Other Janda's Approach
  Stretching: Levator scapulae, Upper Trapezius, Pectoralis (doorway/towel) - 2 sets × 30 sec each, Strengthening: Middle \& Lower Trapezius, Serratus Anterior (Wall Slides), Deep Neck Flexors - 2 sets × 10 reps, Diaphragmatic breathing (4 mins) Neck Flexor Hold: 30 sec × 3 sets Add Dumbbell Shrugs, Table Pushes 3 sets × 10 reps Add Serratus Anterior Upper Cuts (3 sets × 10 reps) strengthening increased to 12-15 reps per set (all muscle groups). Maintain 3 sets of stretching. Functional integrati

Primary outcome measures

• NUMERIC PAIN RATE SCALE (NPRS) for pain [Time frame: upto 6 weeks]
• NECK DISABILITY INDEX (NDI) [Time frame: upto 6 weeks]
• UNIVERSAL GONIOMETER for ROM [Time frame: Upto 6 weeks]
• MEASURING TAPE [Time frame: Upto 6 weeks]

Eligibility criteria

Inclusion criteria

Age between 30 to 50 years old Both male and female are included, Craniovertebral angle less than 50°, Rounded shoulders (on photogrammetry)

Exclusion criteria

• Cervical trauma or surgery Congenital scoliosis Spasmodic torticollis Any tumor or trauma History of surgical procedures on neck or lower back Disc issues in neck or lower back

Criteria are shown verbatim from the registry (in English). Final eligibility is always assessed by the study center.

Healthy volunteers: No

Study design

Allocation

Randomized

Model

Parallel assignment

Masking

Single blind

Primary purpose

Treatment

Study locations

Pakistan · 1 center

• Anwars Polyclinic — Sialkot

Publications

• Aneis YM, El-Badrawy NM, El-Ganainy AA, Atta HK. The effectiveness of a multimodal approach in the treatment of patients with upper crossed syndrome: A randomized controlled trial. J Bodyw Mov Ther. 2022 Oct;32:130-136. doi: 10.1016/j.jbmt.2022.05.011. Epub 2022 May 18. PMID 36180139
• Chang MC, Choo YJ, Hong K, Boudier-Reveret M, Yang S. Treatment of Upper Crossed Syndrome: A Narrative Systematic Review. Healthcare (Basel). 2023 Aug 17;11(16):2328. doi: 10.3390/healthcare11162328. PMID 37628525
• Mujawar JC, Sagar JH. Prevalence of Upper Cross Syndrome in Laundry Workers. Indian J Occup Environ Med. 2019 Jan-Apr;23(1):54-56. doi: 10.4103/ijoem.IJOEM_169_18. PMID 31040591
• Mubashir M. A cross-sectional survey on prevalence of upper cross syndrome and its correlation to WRMSDS in working physiotherapists. Pakistan Journal of Rehabilitation. 2021;10(1):42-50.
• Yang S, Boudier-Reveret M, Yi YG, Hong KY, Chang MC. Treatment of Chronic Neck Pain in Patients with Forward Head Posture: A Systematic Narrative Review. Healthcare (Basel). 2023 Sep 22;11(19):2604. doi: 10.3390/healthcare11192604. PMID 37830641
• Joshi R, Poojary N. The Effect of Muscle Energy Technique and Posture Correction Exercises on Pain and Function in Patients with Non-specific Chronic Neck Pain Having Forward Head Posture-a Randomized Controlled Trail. Int J Ther Massage Bodywork. 2022 Jun 1;15(2):14-21. doi: 10.3822/ijtmb.v15i2.673. eCollection 2022 Jun. PMID 35686175
• Oakley PA, Moustafa IM, Haas JW, Betz JW, Harrison DE. Two Methods of Forward Head Posture Assessment: Radiography vs. Posture and Their Clinical Comparison. J Clin Med. 2024 Apr 8;13(7):2149. doi: 10.3390/jcm13072149. PMID 38610914
• Mol N, Abeeshna A, Kumar D. Upper crossed syndrome: trends and recent advances in the physiotherapy treatment a narrative review. J Pharm Res Int. 2021;33(64B):359-67

Identifiers

NCT: NCT07724574 · REC/RCR & AHS/25/0134 Kinza

Primary sources (government registries)

• ClinicalTrials.gov (US NIH)

View this study on ClinicalTrials.gov ↗