Proprioceptive Neuromuscular Facilitation Combined With Postural Education in Upper Cross Syndrome

The Effect of Proprioceptive Neuromuscular Facilitation Combined With Postural Education on Pressure Pain Threshold in Upper Back Among Students With Upper Cross Syndrome: an Experimental Study

The aim of this study was to investigate the effectiveness of PNF and conventional neck stretching, combined with a postural education program in improving forward head posture in students with clinical signs and symptoms of UCS. The study included a sample of undergraduate Gulf Medical University students with clinical signs and symptoms of UCS. A total of 24 samples were divided into two groups of 12. Group A received PNF pattern neck stretching and self-resisted neck PNF pattern, whereas Group B received Conventional neck stretches along with isometric strengthening of the neck muscles. Both groups were given a common postural education program. The intervention duration was 5 days per week for 4 weeks.

Study Overview

• Status: Completed
• Conditions: Upper Cross Syndrome
• Intervention / Treatment: Other: Active neck muscle stretching and strengthening exercises; Other: Proprioceptive neuromuscular facilitation with postural education

Detailed Description

Collegiate students are prone to adopt slouched posture and develop muscular imbalance which is considered as a causative factor for the development of UCS. Studies have shown that students in medical universities have a higher risk of developing UCS. Even though PNF is considered to be simple and effective to improve inter and intramuscular coordination, its application to collegiate students with UCS is limited. Application of PNF combined with postural education programs may benefit the students to reduce UCS-associated clinical problems such as reduced forward head posture, pain intensity and improving muscle strength etc. Our current study might open the door of simple and effective management of UCS among collegiate students. Therefore, our study was conducted to find out the effect of PNF and active muscle stretching, both in combination with postural education programs, on forward head posture of the students with upper crossed syndrome.

Objectives:

● To compare the effect of PNF with active muscle stretching, both in combination with postural education programs on forward head posture of students with upper cross syndrome.

• Study Type: Interventional
• Enrollment (Actual): 24
• Phase: Not Applicable

Contacts and Locations

Study Locations

• United Arab Emirates
  • Ajman
    • Al Jurf, Ajman, United Arab Emirates, 4184
      • Gulf Medical University

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: Adult
• Accepts Healthy Volunteers: Yes

Description

Inclusion Criteria:

• Students of Gulf Medical University.
• Both genders.
• Age between 18 - 30 years.
• Presence of clinical signs and symptoms of UCS.
• Presence of FHP with CVA of 49 degrees and below.

Exclusion Criteria:

• Musculoskeletal disorder such as strain, sprain, scoliosis.
• Students participating in any other interventions.
• Nutritional deficiencies.
• Unwilling participate.
• Degenerative joint disorder
• Neurologically unstable individuals

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: Group A: PNF with postural education; PNF neck pattern intervention with a rhythmic initiation technique implemented. This exercise intervention consisted of a two-phase exercise set: stretching the muscles and strengthening them	Other: Proprioceptive neuromuscular facilitation with postural education; Phase 1: Active Rhythmic Initiation The exercise was demonstrated to the students in a seated position, as sitting is considered the functional position for neck motion and stability. Then, the exercises was passively practiced on the students using tactile input. After passive demonstration, students were asked to perform the same exercise actively and verbal commands were used to guide and correct them. Phase 2: Resisted Rhythmic Initiation "Modified" The investigators applied resistance by placing the palm of one hand on the right side of the chin to strengthen the muscles. Then, resisted scapular posterior depression PNF exercise also employed. Also received a comprehensive postural education program to emphasize the importance of proper posture. The program was divided into three sections, which focused on the effects of good and bad posture, as well as practical demonstration.
Active Comparator: Group B: Active neck muscle stretching and strengthening exercises; Active neck muscle stretching and self-isometric strengthening exercises, targeting all cervical muscle groups.	Other: Active neck muscle stretching and strengthening exercises; Phase 1: Active Muscle Stretching In this phase, participants were instructed on performing active muscle stretching exercises for all cervical muscles, including neck flexors, extensors, lateral flexors and neck rotators. Each stretch was held for a period of 25-30 seconds and repeated three times. Phase 2: Self-Isometric Strengthening Participants were provided with a demonstration of self-isometric strengthening exercise for the neck muscles. The exercises involved six movement patterns: cervical flexion, cervical extension, right/left lateral flexion and right/left rotation. For each exercise the participants were required to apply resistance against the direction of movement using their hand without allowing any motion in the neck. Also received a comprehensive postural education program to emphasize the importance of proper posture. The program was divided into three sections, which focused on the effects of good and bad posture, as well as practical demonstration.

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Forward Head Posture	Measured by using a mobile phone app (physio master) and have taken craniovertebral angle, sagittal head tilt, and, head shoulder angle to identify a forward head posture.	Day one before the treatment, Four weeks post treatment.

Secondary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Trigger point tenderness	The manual palpation method was applied to specific muscle groups associated with UCS, including the upper trapezius, rhomboids, levator scapulae, and sternomastoid (STM). The grading scale involved four grades: grade 1, where the patient complains of pain; grade 2, where the patient winces on palpation; grade 3, where the patient withdraws from palpation; and grade 4, where the patient is not allowed to be touched.	Day one before the treatment, Four weeks post treatment.
Cervical spine range of motion	To assess the range of motion (ROM) of the cervical muscle groups, an Acumar single & Dual inclinometer (Lafayette instrument, models ACU001 & ACU002) was utilized. For neck flexion, the inclinometer was placed on the top of the student's head, and the other end of the inclinometer was positioned on the T1 vertebra while the student was seated. The same method was applied for measuring neck extension and left/right lateral flexion. To measure left/right rotation, the participants were asked to be in a supine position, and the inclinometer was placed on the forehead as the main reference point. During each measurement, three trials were conducted, and the mean value of the three trials was calculated to determine the ROM for each specific movement.	Day one before the treatment, Four weeks post treatment.

Collaborators and Investigators

• Sponsor: Gulf Medical University
• Investigators: Study Chair: Ramprasad Muthukrishnan, PhD, Gulf Medical University

Study record dates

Study Major Dates

• Study Start (Actual): February 16, 2023
• Primary Completion (Actual): June 15, 2023
• Study Completion (Actual): July 15, 2023

Study Registration Dates

• First Submitted: September 18, 2024
• First Submitted That Met QC Criteria: September 18, 2024
• First Posted (Actual): September 20, 2024

Study Record Updates

• Last Update Posted (Estimated): November 27, 2024
• Last Update Submitted That Met QC Criteria: November 24, 2024
• Last Verified: November 1, 2024

More Information

Terms related to this study

• Keywords: Neck pain; Upper cross syndrome; Postural correction; Upper back pain; Neuromuscular facilitation
• Additional Relevant MeSH Terms: Pathologic Processes; Disease; Syndrome
• Other Study ID Numbers: IRB/COHS/STD/16/FEB-2023

Plan for Individual participant data (IPD)

• Plan to Share Individual Participant Data (IPD)?: NO
• IPD Plan Description: Data might be shared based on the request

Drug and device information, study documents

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