Effect of Cervicothoracic Mobilization on Upper Crossed Syndrome

PURPOSE: To investigate the effect of cervicothoracic mobilization on Craniovertebral angle (CVA), sagittal shoulder angle (SSA), kyphotic angle and pain intensity level in upper crossed syndrome.

Study Overview

• Status: Not yet recruiting
• Conditions: Upper Crossed Syndrome
• Intervention / Treatment: Other: cervicothoracic mobilization; Other: CCE

Detailed Description

Upper crossed syndrome and its associated neck pain is considered to be the fourth most frequent cause of disability with an annual 30% increase in the rate of prevalence. According to the report on Global burden of diseases (GBD) 2010, neck pain is ranked 21st in terms overall burden of diseases. Musculoskeletal pain in the neck and upper limbs is common; population studies suggest that 6-48% of adults have pain in one of these areas .

Recently, joint mobilization has proven to be effective, and it is now frequently used in clinics .Cervical mobilization combined with thoracic mobilization is recommended as a clinical intervention for neck pain patients with forward head posture ( FHP) rather than cervical mobilization alone. This study has two groups; one will receive cervicothoracic Mobilization + conventional treatment and the second will receive conventional treatment for eight weeks.

• Study Type: Interventional
• Enrollment (Anticipated): 60
• Phase: Not Applicable

Contacts and Locations

• Study Contact: Name: Reem M El-kaffas, ass lecturer; Phone Number: 01124434473; Email: reem_elqaffas@yahoo.com
• Study Contact Backup: Name: Abeer Yamany, professor; Phone Number: 01006899872; Email: abeer.yamany@pt.cu.edu.eg

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: 18 years to 48 years (Adult)
• Accepts Healthy Volunteers: No

Description

Inclusion Criteria:

1. Age between 20-50 years .
2. Participants will included if their CVA less than 48° ( SSA less than 52°) , as above these values are considered normal and thoracic kyphosis (with flexicurve angle more than 45 degrees) .
3. Subjects who have weakness in deep neck flexors, serratus anterior, middle and lower trapezius and rhomboid muscles and tightness in upper trapezius, levator scapulae, scalene, posterior neck and suboccipital muscles, pectoralis major and minor and sternocleidomastoid muscles.
4. Subject complaining of this symptom for more than 3mothes.
5. Marking pain intensity score visual analog scale (VAS) ≥3 in neck and shoulder

Exclusion Criteria:

1. History of surgery or joint diseases of the spine or shoulder.
2. Osteoporosis, or fracture ,cervical instability or any sign those with other contraindications against joint mobilization.
3. Individuals with any cervical condition e.g. radiculopathy, cervical rib, whiplash injury and individuals with any neurological/ condition .
4. History of congenital spinal deformity (congenital scoliosis) .
5. Any malignancy related to soft tissue and joints .
6. Subjects taking analgesics and/or muscle relaxants.
7. pregnancy.
8. Being in weight out of the normal range (18 ≥ BMI ≥ 25).
9. Cognitive impairment and inability to understand the scale.

Study Plan

How is the study designed?

Design Details

• Primary Purpose: Treatment
• Allocation: Randomized
• Interventional Model: Parallel Assignment
• Masking: Single

Number of Arms

2

Arms and Interventions

Participant Group / Arm	Intervention / Treatment
Experimental: cervicothoracic mobilization; This group will receive cervicothoracic mobilization with comprehensive corrective exercise	Other: cervicothoracic mobilization; Each participant in study group will receive cervicothoracic mobilization (central PA and transverse Grade III or grade IV) with comprehensive corrective exercise. The duration will eight weeks three sessions per week.; Other: CCE; Each participant will receive comprehensive corrective exercise include three phases: Initial phase -Improvement phase and Maintenance phase. The initial phase exercises progress in frequency and intensity during this phase, as long as participants are able to demonstrate good quality movement. The initial phase duration is 2 weeks and the exercises will be performed for seven sets of 10-s hold . Improvement phase exercises are progressed by considering individual characteristics of each participant and by observing the overload principle and the progression in the number of repetitions of each set during the 4 weeks of the improvement phase. The exercises will be performed from five sets of ten repetitions to six sets of 15 repetitions . Maintenance phase exercises:The exercises are the same as in the improvement phase without any progression in intensity and frequency. The maintenance phase duration is 2 weeks
Active Comparator: control group: comprehensive corrective exercise (CCE).; This group will receive traditional treatment comprehensive corrective exercise (CCE).	Other: CCE; Each participant will receive comprehensive corrective exercise include three phases: Initial phase -Improvement phase and Maintenance phase. The initial phase exercises progress in frequency and intensity during this phase, as long as participants are able to demonstrate good quality movement. The initial phase duration is 2 weeks and the exercises will be performed for seven sets of 10-s hold . Improvement phase exercises are progressed by considering individual characteristics of each participant and by observing the overload principle and the progression in the number of repetitions of each set during the 4 weeks of the improvement phase. The exercises will be performed from five sets of ten repetitions to six sets of 15 repetitions . Maintenance phase exercises:The exercises are the same as in the improvement phase without any progression in intensity and frequency. The maintenance phase duration is 2 weeks

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Measure Description	Time Frame
change in Craniovertebral angle (CVA) .	Craniovertebral angle (CVA) will be measured using Computerized photogrammetry is utilized markers, Digital camera and Kinovea software.	before treatment,and after eight weeks of treatment.
change in Sagittal shoulder angle (SSA).	Sagittal shoulder angle (SSA) will be measured using Computerized photogrammetry is utilized markers, Digital camera and Kinovea software.	before treatment,and after eight weeks of treatment.
change in thoracic kyphosis angle.	thoracic kyphosis angle will be measured using the flexicurve ruler	before treatment,and after eight weeks of treatment.
change in pain level	pain severity will be measured using visual analogue scale Each participant will be asked to put a mark on a 10-cm horizontal line that is marked with 'zero' at one end to indicate no pain and marked with'10' at the other end to indicate maximum pain.	before treatment,and after eight weeks of treatment.

Collaborators and Investigators

• Sponsor: Cairo University
• Investigators: Study Chair: Abeer Yamany, professor, Professor of physical therapy, Cairo University

Publications and helpful links

General Publications

• Seidi F, Bayattork M, Minoonejad H, Andersen LL, Page P. Comprehensive corrective exercise program improves alignment, muscle activation and movement pattern of men with upper crossed syndrome: randomized controlled trial. Sci Rep. 2020 Nov 26;10(1):20688. doi: 10.1038/s41598-020-77571-4.

Study record dates

Study Major Dates

• Study Start (Anticipated): April 1, 2023
• Primary Completion (Anticipated): August 1, 2023
• Study Completion (Anticipated): September 1, 2023

Study Registration Dates

• First Submitted: December 16, 2022
• First Submitted That Met QC Criteria: December 16, 2022
• First Posted (Actual): December 27, 2022

Study Record Updates

• Last Update Posted (Actual): April 11, 2023
• Last Update Submitted That Met QC Criteria: April 8, 2023
• Last Verified: April 1, 2023

More Information

Terms related to this study

• Keywords: Mobilization; Forward head posture; Rounded Shoulders; Thoracic kyphosis; UCS
• Additional Relevant MeSH Terms: Pathologic Processes; Disease; Syndrome
• Other Study ID Numbers: P.T.REC/012/003840

Drug and device information, study documents

• Studies a U.S. FDA-regulated drug product: No
• Studies a U.S. FDA-regulated device product: No