Effects of IASTM Along With Comprehensive Corrective Exercise Program in Upper Cross Syndrome.

Effects of Instrument Assisted Soft Tissue Mobilization Technique Along With Comprehensive Corrective Exercise Program in Upper Cross Syndrome.

This study will see the effects of IASTM along with comprehensive corrective exercise program in upper cross syndrome through their effects on pain and cervical ranges as well as postural improvement. Our study targets both male and female population. In the reference study only male population was targeted which did not show effects of both techniques on the female population though females have high stress levels which may alter results.

Study Overview

• Status: Recruiting
• Conditions: Upper Cross Syndrome
• Intervention / Treatment: Other: IASTM and CCEP; Other: Traditional treatment

Detailed Description

The upper cross syndrome involves stiffness of levator scapulae, pectoralis major and upper trapezius muscles and serratus anterior, deep neck flexors, rhomboids, middle and lower trapezius and scalene muscles weakness. Numerous bodily abnormalities such as headache, early deterioration of cervical spine and loss of cervical spine curve can be brought on by this syndrome. This syndrome can also result in thoracic spine abnormality and impaired glenohumeral joint biomechanics. Upper cross syndrome develops abnormality in head, neck and shoulder and develops in upper 1⁄4 of the trunk. The underlying causative agents of Upper cross syndrome are long surgeries, weakness, female gender, disability and poor posture. It was a randomized, controlled trial, conducted among patient with upper cross syndrome with Sample size was 44 by using G- Power software. Group A will be given IASTM with Graston's tool and comprehensive corrective exercise program and Group B will receive only comprehensive corrective exercise program. The protocol will consist of 12 sessions in total with 3 sessions a week 45 minutes / session for both groups. Assessment will be at baseline then after 2 weeks after that 2 weeks home plan for exercises and then after 4 weeks assessment will be done. Only pain will be assessed on alternative days

• Study Type: Interventional
• Enrollment (Estimated): 44
• Phase: Not Applicable

Contacts and Locations

• Study Contact: Name: Rida Alam, MSOMPT; Phone Number: 03359635579; Email: nadia.ishtiaq@riphah.edu.pk

Study Locations

• Pakistan
  • Federal
    • Islamabad, Federal, Pakistan, 44000
      • Recruiting
      • Maroof international Hospital and Railway Hospital

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: Adult
• Accepts Healthy Volunteers: No

Description

Inclusion Criteria:

Age 18-40 years.

• Diagnosed patients with the upper crossed syndrome who have chronic neck
• pain for more than 3 months.
• Having neck pain scoring more than 3 on the Numeric Pain Scale were included
• in this study.
• Any abnormality in the position and rhythm of the scapula, as measured by the Scapular dyskinesis test, having postural changes such as excessive thoracic kyphosis (≥42°), forward head (≥44°) or round shoulder (≥49°) as measured by Flexicurve and photogrammetry.
• Both male and female population will be included

Exclusion Criteria:

The subjects with any previous surgery, any type of Infection Hypersensitive skin Diabetes Mellitus type II Having Traumatic Injury Psychological disorder Manual Therapy contraindication like osteoporosis, infection, Disc- Herniation acute Inflammation, burn scars, closed /non-complicated fractures and open wound.

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: IASTM and CCEP; Instrument Assisted Soft Mobilization Technique; For pectoralis major: Subjects will be asked to lay supine with their thorax front side exposed. In abduction, restriction or adhesions will be located using scanning and gel will be applied. IASTM also address soft tissue restrictions and pain in levator scapulae, suboccipital muscles and sternocleidomastoid muscle. The CCEP will be designed in three phases, including initial, improvement, and maintenance.. The exercises in appropriate muscles in correct alignment during the movement pattern, the protocol focused on improving sustained postures. Exercises in initial phase protocol from 10 s hold x7 to 15 s hold x 10 from roller Exercises in improvement phase protocol from 10 repetition x 5 to 15 repetition x 6 from dumbbell , thera band, swiss ball and balance board	Other: IASTM and CCEP; Instrument Assisted Soft Mobilization Technique (IASTM); For pectoralis major: Subjects will be asked to lay supine with their thorax front side exposed. In abduction, restriction or adhesions will be located using scanning and gel will be applied. IASTM also address soft tissue restrictions and pain in levator scapulae, suboccipital muscles and sternocleidomastoid muscle. The Comprehensive Corrective Exercise Program (CCEP) will be designed in three phases, including initial, improvement, and maintenance.. The exercises in appropriate muscles in correct alignment during the movement pattern, the protocol focused on improving sustained postures. Exercises in initial phase protocol from 10 s hold x7 to 15 s hold x 10 from roller Exercises in improvement phase protocol from 10 repetition x 5 to 15 repetition x 6 from dumbbell , thera band, swiss ball and balance board
Active Comparator: Comprehensive Corrective Exercise Program.Type; The CCEP will be designed in three phases, including initial, improvement, and maintenance. Exercises are progressed in frequency and intensity during these phases, as long as the movements are performed in a good quality. The exercises in appropriate muscles in correct alignment during the movement pattern, the protocol focused on improving sustained postures. This goal was addressed in the improvement phase when necessary tissue adaptations occurred by increasing the load of exercises. In the maintenance phase, the participant continued to do the exercises and maintain the training adaptations for two weeks. The exercises will be the same as the improvement phase without any progression in intensity and frequency. Exercises in initial phase protocol from 10 s hold x7 to 15 s hold x 10 from roller Exercises in improvement phase protocol from 10 repetition x 5 to 15 repetition x 6 from dumbbell , thera band, swiss ball and balance board	Other: Traditional treatment; Hot Pack will be applied at the beginning of the session for 10 minutes. Wall corner stretching exercises, neck isometric exercises and neck stretching exercises will be performed Cold pack will be applied at the end of the session for a few minutes.

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Measure Description	Time Frame
ROM Cervical (Extension)	Changes from baseline,2nd week, 4th week ROM range of motion of cervical extension was taken	4 Week
ROM Cervical (Left Lateral Flexion)	Changes from baseline,2nd week, 4th week ROM range of motion of Cervical Left Lateral Flexion was taken	4 week
ROM Cervical( Right Lateral Flexion)	Changes from baseline,2nd week, 4th week ROM range of motion of Cervical Right Lateral flexion was taken with the help of bubble Inclinometer	4 week
ROM Cervical ( Right Rotation)	Changes from baseline,2nd week, 4th week ROM range of motion of Cervical Right Rotation was taken	4 week
ROM Cervical ( Left Rotation)	Changes from baseline,2nd week, 4th week ROM range of motion of Cervical Left Rotation was taken.	4 week
Range of motion Cervical (Flexion)	Changes from baseline,2nd week, 4th week ROM range of motion of cervical flexion was taken	4 week

Secondary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Numeric Pain Rating Scale (NPRS)	NPRS is used for pain assessment. Pain assessment will be at baseline and in week one on alternative days and then after 2nd, 3rd and 4th weeks pain will be assessed on alternative days.	4 week
Flexicurve Ruler and Photogrammetry for posture	Excessive thoracic kyphosis, forward head or round shoulder as measured by Flexicurve and photogrammetry. For posture correction assessment will be at baseline and then after 2 weeks and then after 4 weeks.	4 week

Collaborators and Investigators

• Sponsor: Riphah International University
• Investigators: Principal Investigator: Nadia Ishtiaq, MSOMPT, Riphah International University Islamabad

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.
• Page P. Cervicogenic headaches: an evidence-led approach to clinical management. Int J Sports Phys Ther. 2011 Sep;6(3):254-66.
• Dehdilani M, Gol MK, Hashemzadeh K. Effects of Stretching Exercises on Upper Crossed Syndrome in Women after a Coronary Artery Bypass Graft. Crescent Journal of Medical & Biological Sciences. 2019 Jul 1;6(3).
• Mahmood T, Afzal MW, Waseem I, Arif MA, Mahmood W. Comparative Effectiveness of Routine Physical Therapy with and without Instrument Assisted Soft Tissue Mobilization for Improving Pain and Disability in Patients with Neck Pain Due to Upper Crossed Syndrome. Annals of Punjab Medical College (APMC). 2022 Mar 31;16(1):45-50.
• Ali S, Ahmad S, Jalal Y, Shah B. Effectiveness of Stretching Exercises Versus Muscle Energy Techniques in the Management of Upper Cross Syndrome: JRCRS. 2017; 5 (1): 12-16. Journal Riphah College of Rehabilitation Sciences. 2017 Mar 10;5(1):12-6.
• El-Hafez HM, Hamdy HA, Takla MK, Ahmed SEB, Genedy AF, Abd El-Azeim ASS. Instrument-assisted soft tissue mobilisation versus stripping massage for upper trapezius myofascial trigger points. J Taibah Univ Med Sci. 2020 Mar 6;15(2):87-93. doi: 10.1016/j.jtumed.2020.01.006. eCollection 2020 Apr.
• Gull M, Akbar UU, Asim HM. FREQUENCY OF CHRONIC NECK PAIN IN UPPER CROSS SYNDROME IN FEMALE SCHOOL TEACHERS. Independent Journal of Allied Health Sciences. 2018;1(01):33-8.

Study record dates

Study Major Dates

• Study Start (Actual): October 30, 2023
• Primary Completion (Estimated): June 30, 2024
• Study Completion (Estimated): June 30, 2024

Study Registration Dates

• First Submitted: March 4, 2024
• First Submitted That Met QC Criteria: March 4, 2024
• First Posted (Actual): March 12, 2024

Study Record Updates

• Last Update Posted (Actual): April 19, 2024
• Last Update Submitted That Met QC Criteria: April 18, 2024
• Last Verified: April 1, 2024

More Information

Terms related to this study

• Keywords: Pain; ROM; Rounded Shoulder; Forward head angle
• Additional Relevant MeSH Terms: Pathologic Processes; Disease; Syndrome
• Other Study ID Numbers: RCRAHS-ISB/REC/MS-PT/01771

Plan for Individual participant data (IPD)

• Plan to Share Individual Participant Data (IPD)?: NO

Drug and device information, study documents

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