ArticlePDF Available

Abstract and Figures

Background: Upper cross syndrome is becoming more prevalent in today’s population. The syndrome is expressed as a postural disorder presenting with over active pectoralis musculature and upper trapezius musculature. Also there is inhibition of lower and middle trapezius musculature, which results in winging of scapula, elevated and abducted scapula. This scapulardyskinesia there by resulted inrounding of shoulders. The syndrome is often associated with bad posture in routine life oroccupation of a person.The purpose of the study is to determine the prevalence of upper cross syndrome in medical students of Lahore. Methods: A convenience sample of 384 medical students was selected from university of Lahore, based on inclusion and exclusion criteria. Medical students of age between 17 to 2 years with sound physical and mental state were included. Students with any trauma, recent injury, recent fracture or surgery and any serious underlying pathology that may interfere with mobility of upper limb were excluded from the study. The research was a cross sectional observational study and self-administered questionnaires were circulated among participants and the data was analyzed using SPSS version 21. Reed-co scale was used to analyze the proper alignment of head, neck and shoulder; where as wall push test was used to assess the abnormal protrusion of scapula. Results: The study have revealed that48.7% population of the students haveneck pain;and the results have concluded that high prevalence of upper cross syndrome in medical students of university of Lahore and a 66.8% of population was found to have poor studying posture. Conclusion: In this study relation between upper cross syndrome and bad posture were seen and it was found that the individuals suffering with upper cross syndrome were somehow related to bad posture or indulge in activities which make individual to adopt a posture of high physiologic cost there by leading to muscular imbalance that will yield upper cross syndrome and prevalence of upper cross syndrome in medical students of University of Lahore was found to be 37.1%.
Content may be subject to copyright.
Int J Physiother 2016; 3(3)
Page | 381
ORIGINAL ARTICLE
IJPHY
ABSTRACT
Background: Upper cross syndrome is becoming more prevalent in today’s population. e syndrome is expressed as a postural
disorder presenting with over active pectoralis musculature and upper trapezius musculature. Also there is inhibition of lower and
middle trapezius musculature, which results in winging of scapula, elevated and abducted scapula. is scapulardyskinesia there by
resulted inrounding of shoulders. e syndrome is oen associated with bad posture in routine life oroccupation of a person.e
purpose of the study is to determine the prevalence of upper cross syndrome in medical students of Lahore.
Methods: A convenience sample of 384 medical students was selected from university of Lahore, based on inclusion and exclusion
criteria. Medical students of age between 17 to 2 years with sound physical and mental state were included. Students with any
trauma, recent injury, recent fracture or surgery and any serious underlying pathology that may interfere with mobility of upper
limb were excluded from the study. e research was a cross sectional observational study and self-administered questionnaires
were circulated among participants and the data was analyzed using SPSS version 21. Reed-co scale was used to analyze the proper
alignment of head, neck and shoulder; where as wall push test was used to assess the abnormal protrusion of scapula.
Results: e study have revealed that48.7% population of the students haveneck pain;and the results have concluded that high
prevalence of upper cross syndrome in medical students of university of Lahore and a 66.8% of population was found to have poor
studying posture.
Conclusion: In this study relation between upper cross syndrome and bad posture were seen and it was found that the individuals
suering with upper cross syndrome were somehow related to bad posture or indulge in activities which make individual to adopt
a posture of high physiologic cost there by leading to muscular imbalance that will yield upper cross syndrome and prevalence of
upper cross syndrome in medical students of University of Lahore was found to be 37.1%.
Keywords: Mid-Pectoral Fascial Lesion, Upper cross syndrome, Torsional upper cross syndrome, over inhibition, over facilitation,
oracic kyphosis, Winging of scapula.
Received 13th February 2016, revised 03rd April 2016, accepted 06th April 2016
www.ijphy.org
CORRESPONDING AUTHOR
Int J Physiother. Vol 3(3), 381-384, June (2016) ISSN: 2348 - 8336
PREVALENCE OF UPPER CROSS SYNDROME AMONG THE
MEDICAL STUDENTS OF UNIVERSITY OF LAHORE
*1Iqra Mubeen
²Salman Malik Komboh
³Waseem Akhtar
⁴Junaid Gondal
⁵Muneeb Iqbal
⁶Asif Wattoo
⁷Adil Arshad
⁸Sobia Zia
*1Iqra Mubeen
Research officer,
Multan Institute of health sciences,
Multan, Pakistan.
²Principal Multan Institute of health sciences, Multan,
Pakistan
³Head of Department, Doctors Hospital, Lahore, Pakistan
⁴Consultant Physiotherapist, School of Physiotherapy,
King Edward medical University, Lahore , Pakistan
⁵Assistant Professor ,University of Veterinary and Animal
Sciences, Lahore, Pakistan
⁶Lecturer, Multan Institute of health sciences, Multan,
Pakistan
⁷Physical Therapist, School of Physiotherapy, King Ed-
ward medical University, Lahor, Pakistan
⁸Physical Therapist, School of physiotherapy, King Ed-
ward medical University, Lahor, Pakistan
is article is licensed under a Creative Commons Attribution-Non Commercial 4.0 International License.
Attribution-NonCommercial-ShareAlike 4.0 International (CC BY-NC-SA 4.0)
Int J Physiother 2016; 3(3)
Page | 382
INTRODUCTION
Upper cross syndrome (UCS) is the tightness, over-facil-
itation ,over-excitation of the levatorscapulae, pectoralis
major and upper trapezius whereas weakness,inhibition,
suppression of serratus anterior, deep neck exors more
specically scalene, middle trapezius, lower trapezius and
rhomboids [1]. e syndrome mainly arises as a result of
muscular imbalance that usually develops between tonic
and phasic muscles, tonic muscles are the muscles that
most of the time become tight i.e. over facilitated whereas
phasic muscles are the muscles of lower activation i.e. they
are more towards developing inhibition[2,3].
Poor posture cause stress on cervico-cranial and cervi-
co-thoracic junction. Stability of scapulae is reduced due
to the altered angle of glenoid fossa and as a result all the
movement patterns of upper limb are changed [4].
People usually sit with position of head in dierent man-
ners. It depends on various factors which includes muscu-
loskeletal structures, body changes regarding age, cultural
customs, motor performances and occupation [5]. Because
of poor sitting posturethe patients may develop forward
head posture along with rounded shoulders due to in-
creased kyphosis in thoracic region. is kind of posture
is related to altered scapular positions, muscular activities
and body kinematics. ese changes gradually increase
muscular tension, impart stress on neck and shoulders
which results in pain, loss of function, numbness, and dif-
ferent neuromuscular symptoms in the upper body [6].
While sitting, forward head position includes exion of
lower cervical region, extension of upper cervical region,
and rounded shoulders, which in average reduces the
length of muscle bers, resulting in extensor torque around
the joints of upper cervical region. is abnormal state re-
sults in musculoskeletal abnormalities which includes de-
creased scapular upward rotation, greater internal rotation
and anterior tilt, resulting in diculty to maintain upright
sitting posture [7,8].Antagonistic muscular imbalances, in
upper cross syndrome give rise to postural disturbance [9].
Previously it was thought that fascial tissue has only ana-
tomical compartment and binding role but recently it has
been ruled out that fascial tissue plays major role in senso-
ry and kinetic chain along with transfer of load. Aer the
realization of its importance, the term mid-pectoral fascial
lesions was introduced by authors to describe myofascial
disorders [10].e purpose of the study is to nd the prev-
alence of upper cross syndrome in medical studentsof uni-
versity of Lahorewho adopted poor sitting postures.
MATERIALS AND METHODS
A cross sectional survey was conducted in University of
Lahore and a convenience sample of 384 medical students
was gathered with the age group of 17-25. Self-adminis-
tered questionnaires were circulated in order to diagnose
winging of scapula, Patients were asked to push the wall
and any abnormal protrusion of scapula was noticed. A di-
agnostic criterion was ruled out and people having neck
pain radiating or non-radiating longer than 2 months, with
diculty in neck stabilization, presence of any of follow-
ing i.e. abnormal cervical or thoracic curve, forward head,
winging of scapula, along with frequent headaches and a
combined score of less than 10 on reed-co scale (for region
of head, shoulder and spine) were considered as positive
for upper cross syndrome. SPSS version 21 was used to an-
alyze the data.
RESULTS
Out of 65.1% male and 34.95% female, 48.7% of the pop-
ulation reported about neck pain while the 51.3% pop-
ulation had no neck pain. However, 48.4% population
mentioned that pain radiates but 51.6% reported that pain
does not radiate.25.8% population mentioned that they are
experiencing pain since 2 months, 24.7% were those who
were experiencing this pain since last 3 months, 7.6% pop-
ulation had pain since last 6months and 30.5% population
was suering with chronic pain experiencing longer than
6 months.53.1% of total population had no neck or upper
back stiness whereas 46.1% population had neck or upper
back stiness. 52.1% of students found it dicult to stabi-
lize their neck whenever they were to sit for long duration,
whereas 47.9% population didnt nd it dicult to stabilize
their neck (Table 1). When students were asked whether
their pain aggravates with work or not 55.5% reported that
their pain aggravates with work although 44.5% said that
pain does not aggravate with work.7% reported that iso-
metric exercise oen serves as a relieving factor for neck
pain and 9.4% population was in the favor of steam pack.
7.8% was nding relief by mobility exercise and a same g-
ure found relief through massage, 10.7% felt relief due to
rest, 22.1% felt relived simply by laying down, 13.3% pre-
ferred stretching and 21.9% didnt nd any factor to relieve
their pain in time of need. 33.6% population was busy in
reading most of the time, 24.2% was indulge in working
with computer, 18.8% was involved in activities which
needs looking down and remaining 23.3% performedac-
tivities which involved the use of upper limb. Majority of
students i.e. 43.1% reported that they study while lying
down on their stomach, 33.1% accounted for studying in
sitting upright with straight back, however 23.7% popula-
tion mentioned that they study with their back exed hav-
ing book in their lap.14.6% population had forward head,
5.5% were with increased thoracic curve, 10.4% had ele-
vated shoulders and a same gure felt it dicult to stabilize
their neck. 2.9% reported headache and 1.6% population
was having winging of scapula which they were not aware
of, meanwhile 24% population had no such diculty or
abnormality (Table 2) None of the participants was found
to be diagnosed of upper cross syndrome. Proper position
of head shoulder and spine were analyzed by using reed-
co scale. is scale comprised of three grades 10, 5 and
0 namely good, fair and poor respectively. For section of
head 17.44% population was in grade 0, 35.41% popula-
tion was in grade 5, and 47.13% population was in grade 10
(Figure-1). For section of shoulder only 3.1% population
was in grade 0, 35.9% population fell under grade 5, where-
as 60.9% population was in grade 1, (Figure-2). In section
Int J Physiother 2016; 3(3)
Page | 383
of spine the results were as follows; only 1.3% population
was in grade 0, 25.8%was in grade 5, and 72.9% population
was in grade 10 (Figure-3).
Frequency Percent Valid
Percent
Cumulative
Percent
NO
YES
Tota l
184 47.9 47.9 47.9
200 52.1 52.1 100.0
384 100.0 100.0
Table 1: Frequency of diculty in neck stabilization.
Abnormality Frequency Percent Valid
Percent
Cumulative
Percent
Forward head
Increased thoracic
curve
Increased cervical
curve
Elevated/forward
bended shoulders
Headache
Diculty in neck
stabilization
No abnormality
Winging of scapula
Tot a l
56 14.6 14.6 14.6
118 30.7 30.7 45.3
21 5.5 5.5 50.8
40 10.4 10.4 61.2
11 2.9 2.9 64.1
40 10.4 10.4 74.5
92 24.0 24.0 98.4
6 1.6 1.6 100.0
384 100.0 100.0
Table 2: Frequency of abnormalities presented as a symp-
tom of upper cross syndrome
Figure 1: Percentage of Reedco scale readingsin head
region.
Figure 2: Percentage of Reedco scale readings in shoulder
region
Figure 3: Percentage of Reedco scale readings in spine
region
DISCUSSION
Upper cross syndrome apparently seems a simple muscu-
lar imbalance but it may impart huge stress on economy
of country via resulting in frequent loss of work days due
to neck pain [11,12]. AndréKlussmanet at al in 2008 con-
ducted study on musculoskeletal symptoms of the up-
per extremities and the neck a cross-sectional study
on prevalence and symptom-predicting factors at
visual display terminal (VDT) workstations and he
concluded with regard to musculoskeletal symptoms,
preventive measures should focus on neck and shoulder
disorders. As derived from this study, work organization
plays an important role, especially when ergonomic mea-
sures are largely implemented [13]. In this study it was
found that only 33.1% population had normal studying
posture, whereas 66.8% population had poor studying
posture and out of which 43.1% studied while laying down
on their stomach and 23.7% studied while having book in
their lap with exed back.
Derek Ret at al did study in 2004 in order to nd out prev-
alence of musculoskeletal disorders (MSD) among rural
Australian nursing students and compare the results with
other international studies and found that MSD is more
frequent among rural Australian nursing students, when
compared to their counterparts around the world. eir
high rate of MSD is also comparable to that reported by
hospital nurses in other countries [14]. In this study the
prevalence of upper cross syndrome in students was found
to be 37.1%. Situation apparently does not seem surpris-
ing but may become a devastating condition if le ignored
[15]. Relation between upper cross syndrome and bad
posture was also seen and it was found that the individ-
uals suering with upper cross syndrome were somehow
related to bad posture or indulge in activities which make
individual to adopt a poor posture there by leading to mus-
cular imbalance that will yield upper cross syndrome [16].
If proper steps are not taken at this moment this simple
syndrome one day may become an endemic not only in
working population and students only but also in people
with luxurious life style as they are the one who are least
Int J Physiother 2016; 3(3)
Page | 384
bothered regarding their posture [17]. Finally it is recom-
mended that some serious steps should be taken to gener-
ate postural awareness in people of all ages especially stu-
dents [18].
CONCLUSION
It has been concluded that most of the medical student
exposed to the risk of adopting poor postures which can
lead to upper cross syndromes in future. e results of this
study suggesting the importance of postural awareness
among medical students.
REFERENCES
[1] Muscolino, J. Upper crossed syndrome.Journal of the
Australian Traditional-Medicine Society.2015; 21(2),
80-85.
[2] Yoo WG, Yi CH, Kim MH. Eects of a ball-backrest
chair on the muscles associated with upper crossed syn-
drome when working at a VDT. Work. 2007;29(3):239-
44.
[3] Phillip Page, Clare Frank, Robert Lardner. Assessment
and Treatment of Muscle Imbalance eBook.2010.
[4] SD Bagg. Electromyographic study of the scapular ro-
tators during arm abduction in the scapular plane.Am
J Phys Med. 1986 Jun;65(3):111-24
[5] Johnson G, Bogduk N, Nowitzke A, House D. Anato-
my and actions of the trapezius muscle. Clin Biomech
(Bristol, Avon). 1994 Jan;9(1):44-50.
[6] Janda, V., Muscle strength in relation to muscle length,
pain, and muscle imbalance, in Muscle Strength
(International Perspectives in Physical erapy)
Harms-Ringdahl, Editor 1993, Churchill Livingstone:
Edinburgh. p. 83–91
[7] Kang JH, Park RY, Lee SJ, Kim JY, Yoon SR, Jung KI.
e eect of the forward head posture on postural bal-
ance in long time computer based worker. Ann Rehabil
Med. 2012 Feb;36(1):98-104
[8] Phil Page. Shoulder muscle imbalance and subacromi-
al impingement syndrome in overhead athletes. Int J
Sports Phys er. 2011 Mar; 6(1): 51–58.
[9] Weon JH, Oh JS, Cynn HS, Kim YW, Kwon OY, Yi CH.
Inuence of forward head posture on scapular upward
rotators during isometric shoulder exion. J Bodyw
Mov er. 2010 Oct;14(4):367-74.
[10] Eirik Garnas. Upper Crossed Syndrome: e Person-
al Trainer’s Guide. http://www.theptdc.com/2014/07/
upper-crossed-syndrome/
[11] Christensen K. Manual muscle testing and postural
imbalance. Dynamic Chiropractic 2000; 15: 2.
[12] Morris CE, Bonnen D, Darville C. e Torsional
Upper Crossed Syndrome: A multi-planar update to
Janda’s model, with a case series introduction of the
mid-pectoral fascial lesion as an associated etiological
factor. J Bodyw Mov er. 2015 Oct;19(4):681-9.
[13] Klussmann et al. Musculoskeletal symptoms of
the upper extremities and the neck: A cross-sec-
tional study on prevalence and symptom-pre-
dicting factors at visual display terminal (VDT)
workstations. BMC Musculoskelet Disord. 2008
Jun 27;9:96.
[14] Derek R. Smith, Peter A. Leggat. Musculoskeletal dis-
orders among rural Australian nursing students. Aus-
tralian Journal of Rural Health. 2004;12(6):241-245.
[15] Valli J. Chiropractic management of a 46-year-old
type 1 diabetic patient with upper crossed syndrome
and adhesive capsulitis. J Chiropr Med. 2004 Au-
tumn;3(4):138-44.
[16] Moore MK. Upper crossed syndrome and its relation-
ship to cervicogenic headache. J Manipulative Physiol
er. 2004 Jul-Aug;27(6):414-20.
[17] Kwon, JW, son SM, Lee NK. Changes in upper extrim-
ity muscle activities due to head position in subjects
with a forward head posture and rounded sholders. J
Phys er Sci.2015; 27(6): 1739-1742.
[18] Steinmetz A, Seidel W, Muche B. Impairment of pos-
tural stabilization systems in musicians with play-
ing-related musculoskeletal disorders. J Manipulative
Physiol er. 2010;33(8):603-11.
Citation
Mubeen, I., Komboh, S. M., Akhtar, W., Gondal, J., Iqbal, M., Wattoo, A., Arshad, A., & Zia, S. (2016). PREVALENCE
OF UPPER CROSS SYNDROME AMONG THE MEDICAL STUDENTS OF UNIVERSITY OF LAHORE. Interna-
tional Journal of Physiotherapy, 3(3), 381-384.
... The cross muscles that will form the mechanics of the postural musculoskeletal is under the effect of foot pressures, except for the upper-lower part. Knee-tendon disorder separated from the lumbopelvic hip complex is posterior tibial and medial stress syndromes (16), the syndrome seen on the tenderness of upper limb compartment muscles is an upper cross syndrome (17). Conclusion, general populations studies different showing on postural deviation as postural musculature syndrome for example, head and ankle plumbline (Table 1). ...
... Deformities and pains in the knee tendon structure are seen in the iliotibial band in cases of abnormal deviation of pelvic asymmetric and inclination changes, unilateral muscle elongation, and muscle shortness of overloads (16). In athletes, shortening and looseness in the lower extremity joint muscles as shoulder, pelvic, lumbar region in severe potential energy loss it causes the known core region or lumbopelvic-hip complex (17,18). Anterior knee pain patella femoral syndrome volleyball and basketball etc. ...
Article
Full-text available
Postural musculature functioning emphasises the importance of dynamic actions in multiple motion stresses and the mechanical deficiencies of movement modelling. Human posture is a result of the distortion of space in different increments in static and dynamic conditions. Postural dysfunctions are caused by muscle tightness related to myofascicular stiffness. Herein, this traditional review explains the heat-and pain-induced syndromes, general mechanical deficiencies in muscle performance, and hypertrophy. Postural analysis shows the connection of motion system to biomechanics and kinesiology. Mechanical syndromes are caused by complex crossovers in the postural skeleton. Complex postural muscles confirm isometric modelling for limb fixation according to the location of compartment. However, different movement patterns in individualised exercises are inadequate and require further comparisons. Therefore, kinematic data regarding mechanical syndromes are limited. Moreover, this study shows how muscular performance should be involved in postural exercises. Postural muscle strength is the conditioning of the muscles in different working principles. Postural muscle dysfunctions should be analysed to compare atrophic characteristics. Current approaches present that postural analyses should be individualised to examine atrophic shortening and elongation because individuals have varied resistance and motion performance. This study aimed to explain development of mechanical syndromes to evaluate the indexes before postural exercises. These mechanical syndromes are presented in view of the longitudinal body kinesiology involved in comprehensive exercises.
... As a result, dentists are more prone to developing problems and upper cross syndrome. According to a text review of musculoskeletal problems among dental professionals, the incidence rate of general musculoskeletal pain among dentists stretches between 64% to 93%, with the most widely stated location of pain being the back with 36.3% to 60.1% and the neck being 19.8% to 85% [5]. ...
... The result of current study in lines with the previous studies conducted in Ahmednagar, India, and Lahore, Pakistan by DR. Pooja Dhage, et al. and Iqra Muneeb, et al. respectively [13,14] also reported higher prevalence among students, while the study conducted in Lahore Pakistan by Sana Shahid, et al. reported low prevalence of UCS among students [15]. It is a highly prevalent work-related musculoskeletal disorder among other The Signifi cant reason for the upper cross syndrome is the persistent postural stress to the upper limb which necessitates contraction and shortening of certain muscles while causing lengthening and inhibition of other muscles [1]. the upper cross syndrome occurs due to persistent static posture and repetitive work which leads to metabolic, biomechanical, and muscular problems. ...
Article
Objective: To assess the prevalence of upper crossed syndrome among students of Doctor of Physical Therapy (DPT) and Bachelors of Eastern Medicine and Surgery (BEMS) at university of Balochistan Quetta, Pakistan. Background: Upper cross syndrome is characterized as a pattern of tightness or over facilitation of chronically contracted and shortened muscles on one side and weakness or inhibition of chronically lengthened muscles on other side due to the muscle imbalance leading to postural abnormalities including, forward head posture, shoulder protraction, winging of scapula. These changes, in turn, lead to overstress of the cervical cranio-cervical junction, cervical and thoracic spine and shoulders, which can cause neck and/or jaw pain, headaches, and shoulder problems. The purpose of this study was to figure out the number of students of DPT and BEMS suffering from upper crossed syndrome at university of Balochistan Quetta, Pakistan. Methodology: A descriptive cross-sectional study was conducted. A self-constructed questionnaire having two parts, the first part comprised of demographics data while second part comprised of 18 questions and consent form was filled by 340 students both males and females from DPT and BEMS department. The Data was analyzed by Statistical Package for Social Sciences (SPSS) version 16. Results: The study participants had a mean age of ±21.85, most of them were, from 22-25 years n=182 (53.5%) age group, males n=178 (52.4%) and from 3rd semester n=107 (31.5%). The prevalence of upper cross syndrome in the current study was 45.0%. Conclusion: The study concludes that upper cross syndrome has high prevalence in the students of DPT and BEMS in faculty of pharmacy and health sciences, at university of Balochistan Quetta, Pakistan.
... Similarly, the study among university students reported FHP among 63.96% of participants was correlated with RSP (3). Another study among medical students had reported that the presence of the FHP and RSP could lead to the upper cross syndrome, which associated with the flexion of the lower cervical region and extension of the upper cervical region cause FHP, while the RSP is associated with alteration of the scapular position (20). In general, the upper cross syndrome alters the normal musculoskeletal structural stability, muscular activities or body kinematic which results in loss of function, numbness, pain, and other neuromuscular symptoms in the upper body, these changes would eventually accelerate the presence of muscular tension and impact the stress over the shoulders and neck region. ...
Article
Full-text available
Objective. Playing-related musculoskeletal disorders (PRMSD) are a common problem for the pianist. The poor upper body ergonomics influences the natural positioning of the neck and shoulders, which involves forward head posture (FHP) and rounded shoulder posture (RSP). This misaligned position could produce a sensation of pain over the upper body, which affects the piano player and computer users with similar ergonomic posture. Recently, photogrammetry methods are commonly applied in a clinical setting to assess posture. The goal of this research is to compare the upper body playing-related musculoskeletal disorders between the piano and the non-piano players by applying photogrammetry. Materials and Methods. This causal-comparative study includes 70 participants with 35 piano and 35 non-piano players. The participant’s FHP was assessed using a digitized photo to record the Craniovertebral angle (CVA) with the support of Kinovea software. Besides, digital Vernier Calliper used to assess the scapular index on the RSP and Neck disability indices (NDI) used to measure neck pain and functional disability of the participants. Results. The findings showed piano players have a higher NDI, lower CVA, and RSP when compared with the non-piano players at a statistically significant level of p-value <0.05. Conclusion. The obtained results conclude piano players are highly prone to the risk of developing PRMSD in the upper body.
... It is most common among young population and among professional such as musicians and dentists. The prevalence in dentists 3,4 and musicians are 57% and 37.1%, respectively. ...
... In today's population, the upper crossed syndrome is found to be a highly prevalent one among all the age group. A study in the University of Lahore reports that 37.1% of students in the college presents with the upper crossed syndrome 1 . The upper crossed syndrome is a most common postural dysfunction in the musculature of the shoulder girdle /cerviothoracic region, which creates joint dysfunction, particularly at the atlantooccipital joint, cerviothoraic joint C 4 -C 5 segment, glenohumeral joint and T 4 -T 5 segment 2 . ...
Article
Aim: The aim of the study is to find the efficacy of the Schroth Method and Yoga in improving the postural alignment and pulmonary function in subjects with upper cross syndrome.Background of the study: In today's population, the upper crossed syndrome is a highly prevalent one, among the people who work at desks and computers, laptops or who sit for a majority of the day and continuously exhibit poor posture. It presents with a muscle imbalance between the tonic and phasic muscles and also interrupts the breathing pattern due to the involvement of accessory respiratory muscles. Due to the postural misalignment of head on trunk it is associated with pain in the neck and shoulder. When any attempts to correct this malaligned posture, towards an ideal posture using a combination of strengthening, stretching and feedback training in a three dimensional approach-Schroth method represent a significant component in improving the posture, mobility, balance and also corrective breathing. Methodology: It is an experimental study comparing the Schroth Method and yoga in individuals with upper cross syndrome, conducted in ACS Medical College And Hospital for the duration of 3 months. The study included 30 subjects based on the inclusion criteria. Both male and female subjects between the age group 17-22 years with forward head posture, rounded shoulder, neck pain and those who were observed with abnormal pattern in Janda cervical flexion test, were included in the study. Subjects with trauma, recent injury or surgery, any serious underlying pathology that influence the mobility of upper limb were excluded from the study. The Janda flexion test and accurate posture assessment software, peak expiratory flow rate were used in pre and post-test measurement. Result: Both the groups (A and B) showed significant difference in the post-test mean values, but group-A (schroth method) showed a better significant difference in post-test than group-B (yoga) at ***p<0.001.
Article
To determine the frequency of upper cross syndrome and its association with prolonged sitting postures and to determine the functional status of upper extremity affected by prolong sitting among young population. METHODS: It was an analytical cross sectional study, conducted in Fatima Memorial College of Medicine and dentistry, Lahore from 18 October, 2017 to 30 January, 2018. Reed co postural assessment scale score was used for the postural assessment, upper limb functional index (ULFI) was used to inquire about the participant current upper extremity functional status in a variety of activities. RESULTS: Out of 165 participants who had 6 to 8 of sitting 15.75% had moderate level of difficulty and out of 150 participants who had 8 to 10 hours of sitting 26.66% had moderate level of difficulty, so significant association was found between sitting hours and upper extremity functional status with p=0.00. Postural analysis of head position, neck position, and upper back has also showed that there is significant association with p value =.000 (< 0.05) between sitting hours and postural changes, as increasing sitting hours cause increased postural changes. CONCLUSION: In the light of these results, it is concluded that prolonged sitting hours are associated with upper cross syndrome and change in upper extremity functional status, so certain strategies could be suggested for the workstations or the individuals, involves in prolong sitting.
Article
Full-text available
Background: Forward head posture (FHP) is one of the most common postural deviations that are usually associated with disability. This posture impairs proper biomechanical loading and, in the long run, may result in cervical spondylosis. Individuals with FHP always presents with pain and persistence of neck discomfort. Active vibration exercises using the Body-blade can produce muscle contractions by stimulation of the muscle spindles. The goal of this study was to compare between the effect of Body-blade exercises and the traditional treatment on cranio-vertebral angle (CVA) and neck pain in individuals with FHP.
Article
Objective Upper Crossed Syndrome (UCS) is a type of musculoskeletal system involvement that results in shortening of anterior muscles and weakening of posterior muscles. The aim of this study was to examine the effect of selected corrective exercises with physioball on the postural status of female computer users with UCS. Methods This quasi-experimental study was conducted on 24 female students with UCS who were selected using a purposive sampling method. The subjects were randomly divided into two groups of exercise (n=12) and control (n=12). The exercise group performed exercises for 6 weeks. Photogrammetry method was used to measure the angle of the forward head and round shoulder. A flexible ruler was used to measure the angle of kyphosis, and tape measure was used to measure the chest expansion. These measurements were performed before and after intervention. The collected data were analyzed using paired t-test and ANOVA at the significance level of P<0.05. Results There was a significant difference in mean values of kyphosis (P=0.001), round shoulder (P=0.001), forward head (P=0.002) and chest expansion (P=0.003) before and after exercise. Conclusion Improvement in forward head, round shoulder and thoracic kyphosis angles and chest expansion showed the effectiveness of applied exercise program. Therefore, it is recommended to use this exercise program in computer users with UCS.
Article
Full-text available
[Purpose] This study investigated upper-extremity muscle activities in natural, ideal, and corrected head positions. [Subjects and Methods] Forty subjects with a forward head posture and rounded shoulder were recruited and randomly assigned to the natural head position group (n = 13), ideal head position group (n = 14), or corrected head position group (n = 13). Muscle activities were measured using a four-channel surface electromyography system at the sternocleidomastoideus, upper and lower trapezius, and serratus anterior muscles on the right side during an overhead reaching task. [Results] The muscle activities of the upper trapezius and serratus anterior differed significantly among head positions. Post hoc tests revealed significant differences between natural and ideal head positions, and natural and ideal head positions for both the upper trapezius and serratus anterior. [Conclusion] Recovery of normal upper trapezius and serratus anterior muscle functions plays an important role in correcting forward head posture and rounded shoulders.
Article
Full-text available
To estimate the effects of a relatively protruded head and neck posture on postural balance, in computer based worker. Thirty participants, who work with computers for over 6 hrs per day (Group I), and thirty participants, who rarely work with computers (Group II), were enrolled. The head and neck posture was measured by estimating angles A and B. A being the angle between the tragus of the ear, the lateral canthus of the eye, and horizontal line and B the angle between the C7 spinous process, the tragus of the ear, and the horizontal line. The severity of head protrusion with neck extension was assessed by the subtraction of angle A from angle B. We also measured the center of gravity (COG) and postural balance by using computerized dynamic posturography to determine the effect of computer-based work on postural balance. Results indicated that group I had a relatively more protruded head with extensive neck posture (angle B-A of group I and group II, 28.2±8.3, 32.9±6.0; p<.05). The COG of group I tended more toward the anterior than that of group II. Postural imbalance and impaired ability to regulate movement in forward and backward direction were also found. The results of this study suggest that forward head postures during computer-based work may contribute to some disturbance in the balance of healthy adults. These results could be applied to education programs regarding correct postures when working at a computer for extended periods of time.
Article
Full-text available
Subacromial impingement is a frequent and painful condition among athletes, particularly those involved in overhead sports such as baseball and swimming. There are generally two types of subacromial impingement: structural and functional. While structural impingement is caused by a physical loss of area in the subacromial space due to bony growth or inflammation, functional impingement is a relative loss of subacromial space secondary to altered scapulohumeral mechanics resulting from glenohumeral instability and muscle imbalance. The purpose of this review is to describe the role of muscle imbalance in subacromial impingement in order to guide sports physical therapy evaluation and interventions.
Article
Full-text available
Recent research demonstrates the importance of postural stabilization systems (PSS) in back pain. The purpose of this study was to examine the frequency of PSS disturbances in musicians experiencing playing-related musculoskeletal disorders (PRMDs). Analysis for the presence of impaired PSS (lumbopelvic and scapular stabilizing system dysfunction, upper crossed syndrome) in 84 musicians. Analysis of clinical examination data revealed dysfunctions of the PSS to be present in 78 (93%) of these subjects. Eighty-five percent were found to have impairments of scapular, 71% impairments of lumbopelvic stabilization system, and 57% were found to have upper crossed syndrome. Subgroup analysis (upper strings, lower strings, wind and keyboard instruments) showed significantly more impairment of the lumbopelvic stabilization system for upper and lower strings (P = .008), whereas similar rates for disturbances of scapular stabilizers and upper crossed syndrome were seen across subgroups. Furthermore, significant sex differences with a higher frequency of scapular stabilizers (P = .014) and upper crossed syndrome (P < .001) in women were present. This study suggests that insufficiencies of the postural stabilization systems play an important role in the manifestation of musculoskeletal pain and PRMD in musicians. Although there are no prospective research data concerning PSS in musicians, the present authors' empirical observations and clinical experience support the notion that the clinical course and therapeutic outcomes of PRMD bear relationship to the function of the stabilization systems. We therefore argue for a greater emphasis on the examination and training of the postural systems in the integrated prevention, treatment, and rehabilitation of musicians.
Article
The Upper Crossed Syndrome (UCS) was presented by Janda to introduce neuromotor aspects of upper body muscle imbalances, describing sagittal plane postural asymmetries as barriers to recovery from chronic locomotor system pain syndromes. The UCS describes muscle imbalances of key antagonists causing forward postures of the head and shoulders and associated changes in the spinal curves -particularly an increased thoracic kyphosis - as well as changed function in the shoulder girdle. The role of fascial tissue has gained remarkable interest over the past decade, previously emphasizing its anatomic compartmental and binding role, while more recently emphasizing load transfer, sensory and kinetic chain function. The authors introduce the Mid-Pectoral Fascial Lesion (MPFL) as a myofascial disorder, describing 11 ipsilateral chest wall cases. While managing these cases, the authors encountered and subsequently designated the Torsional Upper Crossed Syndrome (TUCS) as a multi-planar addition to Janda's classic sagittal plane model.This article integrates published updates regarding the role of posture and fascia with the effects of chest wall trauma and a newly described associated postural syndrome as illustrated with this case series. An effective therapeutic approach to release the MPFL is then briefly described.
Article
Dissection studies revealed the fascicular anatomy of the trapezius. Its occipital and nuchal fibres passed downwards but mainly transversely to insert into the clavicle. Fibres from C7 and T1 passed transversely to reach the acromion and spine of the scapula. Its thoracic fibres converged to the deltoid tubercle of the scapula. Volumetric studies demonstrated that the fibres from C7, T1, and the lower half of ligamentum nuchae were the largest. The essentially transverse orientation of the upper and middle fibres of trapezius precludes any action as elevators of the scapula as commonly depicted. Rather the action of these fibres is to draw the scapula and clavicle backwards or to raise the scapula by rotating the clavicle about the sternoclavicular joint. By balancing moments the trapezius relieves the cervical spine of compression loads.
Article
SUMMARY: We assessed the effects of forward head posture in the sitting position on the activity of the scapular upward rotators during loaded isometric shoulder flexion in the sagittal plane. Healthy volunteers (n = 21; 11 men, 10 women) with no history of pathology participated in the study. Subjects were instructed to perform isometric shoulder flexion with the right upper extremity in both the forward head posture (FHP) and neutral head posture (NHP) while sitting. Surface electromyography (EMG) was recorded from the upper trapezius, lower trapezius, and serratus anterior muscles. Dependent variables were examined by 2 (posture)×3 (muscle) repeated measures analysis of variance. Significantly increased EMG activity in the upper trapezius and lower trapezius and significantly decreased EMG activity in the serratus anterior were found during loaded isometric shoulder flexion with FHP. Thus, FHP may contribute to work-related neck and shoulder pain during loaded shoulder flexion while sitting. These results suggest that maintaining NHP is advantageous in reducing sustained upper and lower trapezius activity and enhancing serratus anterior activity as compared with FHP during loaded shoulder flexion.
Article
To discuss the treatment of a patient with type 1 diabetes presenting with chronic neck and shoulder pain by using chiropractic manipulation and an active rehabilitation program with emphasis on correcting postural imbalances. A 46-year-old insulin dependant (type1) diabetic female presented with neck and right shoulder pain of 6 to 8 months duration. Her history included similar left-sided complaints 2 years prior at which time she underwent 3 months of rehabilitation at a local medical center, which improved her condition. Over time her pain resolved but the residuals of restricted left shoulder range of motion remained. The patient had postural changes consisting of forward head posture, rounded shoulders and internally rotated arms. Treatment included spinal manipulation, ultrasound and active rehabilitation consisting of at home exercises initially and followed with in office low-tech rehabilitation. Rehabilitation was primarily aimed at improving postural abnormalities, muscle imbalances and abnormal movement patterns. The patient improved with this course of treatment. Chiropractic care including active rehabilitation may be helpful in treating diabetic patients suffering from chronic neck and shoulder problems.