Comprehensive corrective exercise program improves alignment, muscle activation and movement pattern of men with upper crossed syndrome: randomized controlled trial

Foad Seidi, Mohammad Bayattork, Hooman Minoonejad, Lars Louis Andersen, Phil Page, Foad Seidi, Mohammad Bayattork, Hooman Minoonejad, Lars Louis Andersen, Phil Page

Abstract

Upper crossed syndrome (UCS) refers to the altered muscle activations and movement patterns in scapulae along with some abnormal alignment in the upper quarter, which may contribute to the dysfunction of the cervicothoracic and glenohumeral joints. The present study aimed to investigate the effectiveness of a comprehensive corrective exercise program (CCEP) and subsequent detraining on alignment, muscle activation, and movement pattern in men with the UCS. This randomized controlled trial included 24 men. The intervention group conducted CCEP (8 weeks), followed by four weeks of detraining and the control group maintained normal daily activities. Electromyography of selected muscles, scapular dyskinesis test, head, shoulder, and thoracic spine angle were measured at baseline, post-test, and follow-up. There were significant differences for Group x time interaction and also for within-group from pre-test to post-test and follow-up in all outcomes. Also, significant differences were observed in three outcomes at post-test and follow-up between the CCEP and control group in favor of the CCEP. In Conclusion, the present study demonstrates that the CCEP for individuals with UCS is feasible and effective, improving muscle activation imbalance, movement patterns, and alignment. Importantly, these improvements were maintained after four weeks of detraining, suggesting lasting neuromuscular re-training adaptations.

Conflict of interest statement

The authors declare no competing interests.

Figures

Figure 1
Figure 1
The results of MCID in the CCEP group.
Figure 2
Figure 2
Study flowchart.
Figure 3
Figure 3
The initial phase exercises: lay supine on the foam roll in three different arm abduction angles (exercise 1A-C), side-lying external rotation (exercise 2), side-lying forward flexion (exercise 3), standing diagonal flexion (exercise 4), and military press (exercise 5). Improvement phase exercises: side-lying external rotation with dumbbell (exercise 6), side-lying forward flexion with dumbbell (exercise 7), standing diagonal flexion with dumbbell (exercise 8), standing external rotation with Thera-band (exercise 9), standing diagonal flexion with Thera-band (exercise 10), abduction in sitting on a training ball (exercise 11), lying prone V, T, and W exercises (exercise 12), and abduction in standing on the balance board (exercise 13).

References

    1. Yip CH, Chiu TT, Poon AT. The relationship between head posture and severity and disability of patients with neck pain. Man. Ther. 2008;13:148–154. doi: 10.1016/j.math.2006.11.002.
    1. Claus AP, Hides JA, Moseley GL, Hodges PW. Thoracic and lumbar posture behaviour in sitting tasks and standing: Progressing the biomechanics from observations to measurements. Appl. Ergon. 2016;53:161–168. doi: 10.1016/j.apergo.2015.09.006.
    1. Griegel-Morris P, Larson K, Mueller-Klaus K, Oatis CA. Incidence of common postural abnormalities in the cervical, shoulder, and thoracic regions and their association with pain in two age groups of healthy subjects. Phys. Ther. 1992;72:425–431. doi: 10.1093/ptj/72.6.425.
    1. Yoo W-G, Park S-Y. Effects of posture-related auditory cueing (PAC) program on muscles activities and kinematics of the neck and trunk during computer work. Work. 2015;50:187–191. doi: 10.3233/WOR-131738.
    1. Barrett E, O'Keeffe M, O'Sullivan K, Lewis J, McCreesh K. Is thoracic spine posture associated with shoulder pain, range of motion and function? A systematic review. Man. Ther. 2016;26:38–46. doi: 10.1016/j.math.2016.07.008.
    1. Morris CE, Greenman PE, Bullock MI, Basmajian JV, Kobesova A. Vladimir Janda, MD, DSc: tribute to a master of rehabilitation. Spine. 2006;31:1060–1064. doi: 10.1097/01.brs.0000214879.93102.4e.
    1. Page P. Shoulder muscle imbalance and subacromial impingement syndrome in overhead athletes. Int. J. Sports Phys. Ther. 2011;6:51.
    1. Page P. Cervicogenic headaches: an evidence-led approach to clinical management. Int. J. Sports Phys. Ther. 2011;6:254.
    1. Kang J-H, et al. The effect of the forward head posture on postural balance in long time computer based worker. Ann. Rehabil. Med. 2012;36:98–104. doi: 10.5535/arm.2012.36.1.98.
    1. Page P. Sensorimotor training: A “global” approach for balance training. J. Bodywork Mov. Ther. 2006;10:77–84. doi: 10.1016/j.jbmt.2005.04.006.
    1. Sahrmann S, Azevedo DC, Van Dillen L. Diagnosis and treatment of movement system impairment syndromes. Braz. J. Phys. Ther. 2017;21:391–399. doi: 10.1016/j.bjpt.2017.08.001.
    1. Bae WS, Lee HO, Shin JW, Lee KC. The effect of middle and lower trapezius strength exercises and levator scapulae and upper trapezius stretching exercises in upper crossed syndrome. J. Phys. Ther. Sci. 2016;28:1636–1639. doi: 10.1589/jpts.28.1636.
    1. Hodges, P. et al. (JOSPT, Inc. JOSPT, 1033 North Fairfax Street, Suite 304, Alexandria, VA…, 2019).
    1. Hrysomallis C. Effectiveness of strengthening and stretching exercises for the postural correction of abducted scapulae: a review. J. Strength Cond. Res. 2010;24:567–574. doi: 10.1519/JSC.0b013e3181c069d8.
    1. Hrysomallis C, Goodman C. A review of resistance exercise and posture realignment. J. Strength Cond. Res. 2001;15:385–390.
    1. Bayattork M, Sköld MB, Sundstrup E, Andersen LL. Exercise interventions to improve postural malalignments in head, neck, and trunk among adolescents, adults, and older people: systematic review of randomized controlled trials. J. Exerc. Rehabil. 2020;16:36. doi: 10.12965/jer.2040034.017.
    1. Seidi F, Rajabi R, Ebrahimi I, Alizadeh MH, Minoonejad H. The efficiency of corrective exercise interventions on thoracic hyper-kyphosis angle. J. Back Musculoskelet. Rehabil. 2014;27:7–16. doi: 10.3233/BMR-130411.
    1. Bayattork M, Seidi F, Minoonejad H, Andersen LL, Page P. The effectiveness of a comprehensive corrective exercises program and subsequent detraining on alignment, muscle activation, and movement pattern in men with upper crossed syndrome: protocol for a parallel-group randomized controlled trial. Trials. 2020;21:1–10. doi: 10.1186/s13063-020-4159-9.
    1. Ahn AC, Tewari M, Poon C-S, Phillips RS. The limits of reductionism in medicine: could systems biology offer an alternative? PLoS Med. 2006;3:e208. doi: 10.1371/journal.pmed.0030208.
    1. Page P, Frank C, Lardner R. Assessment and treatment of muscle imbalance: the Janda approach. J. Orthop. Spopts Phys. Ther. 2010;41:799–800.
    1. Kibler WB, Sciascia A. Current concepts: scapular dyskinesis. Br. J. Sports Med. 2010;44:300–305. doi: 10.1136/bjsm.2009.058834.
    1. Rajalaxmi V, Paul J, Nithya M, Lekha SC, Likitha B. Effectiveness of three dimensional approach of schroth method and yoga on pulmonary function test and posture in upper crossed syndrome with neck Pain-A double blinded study. Res. J. Pharm. Technol. 2018;11:1835–1839. doi: 10.5958/0974-360X.2018.00341.4.
    1. Kim T-W, et al. Effects of elastic band exercise on subjects with rounded shoulder posture and forward head posture. J. Phys. Ther. Sci. 2016;28:1733–1737. doi: 10.1589/jpts.28.1733.
    1. Lederman E. Neuromuscular Rehabilitation in Manual and Physical Therapies: Principles to Practice. Amsterdam: Elsevier Health Sciences; 2010.
    1. Worsley P, et al. Motor control retraining exercises for shoulder impingement: effects on function, muscle activation, and biomechanics in young adults. J. Shoulder Elbow Surg. 2013;22:e11–e19. doi: 10.1016/j.jse.2012.06.010.
    1. Mottram SL, Woledge RC, Morrissey D. Motion analysis study of a scapular orientation exercise and subjects’ ability to learn the exercise. Man. Ther. 2009;14:13–18. doi: 10.1016/j.math.2007.07.008.
    1. Holtermann A, Mork P, Andersen L, Olsen HB, Søgaard K. The use of EMG biofeedback for learning of selective activation of intra-muscular parts within the serratus anterior muscle: a novel approach for rehabilitation of scapular muscle imbalance. J. Electromyogr. Kinesiol. 2010;20:359–365. doi: 10.1016/j.jelekin.2009.02.009.
    1. Roy J-S, Moffet H, Hébert LJ, Lirette R. Effect of motor control and strengthening exercises on shoulder function in persons with impingement syndrome: a single-subject study design. Man. Ther. 2009;14:180–188. doi: 10.1016/j.math.2008.01.010.
    1. Holtermann A, et al. Selective activation of neuromuscular compartments within the human trapezius muscle. J. Electromyogr. Kinesiol. 2009;19:896–902. doi: 10.1016/j.jelekin.2008.04.016.
    1. On AY, Uludağ B, Taşkiran E, Ertekin C. Differential corticomotor control of a muscle adjacent to a painful joint. Neurorehabil. Neural Repair. 2004;18:127–133. doi: 10.1177/0888439004269030.
    1. Kibler WB, Sciascia AD, Uhl TL, Tambay N, Cunningham T. Electromyographic analysis of specific exercises for scapular control in early phases of shoulder rehabilitation. Am. J. Sports Med. 2008;36:1789–1798. doi: 10.1177/0363546508316281.
    1. Cools AM, et al. Rehabilitation of scapular muscle balance. Am. J. Sports Med. 2007;35:1744–1751. doi: 10.1177/0363546507303560.
    1. Cricchio M, Frazer C. Scapulothoracic and scapulohumeral exercises: a narrative review of electromyographic studies. J. Hand Ther. 2011;24:322–334. doi: 10.1016/j.jht.2011.06.001.
    1. Schory A, Bidinger E, Wolf J, Murray L. A systematic review of the exercises that produce optimal muscle ratios of the scapular stabilizers in normal shoulders. Int. J. Sports Phys. Ther. 2016;11:321.
    1. Cools AM, Witvrouw EE, Declercq GA, Danneels LA, Cambier DC. Scapular muscle recruitment patterns: trapezius muscle latency with and without impingement symptoms. Am. J. Sports Med. 2003;31:542–549. doi: 10.1177/03635465030310041101.
    1. Ben Kibler W. The role of the scapula in athletic shoulder function. Am. J. Sports Med. 1998;26:325–337. doi: 10.1177/03635465980260022801.
    1. Ou H-L, et al. Alterations of scapular kinematics and associated muscle activation specific to symptomatic dyskinesis type after conscious control. Man. Ther. 2016;26:97–103. doi: 10.1016/j.math.2016.07.013.
    1. De Mey K, et al. Conscious correction of scapular orientation in overhead athletes performing selected shoulder rehabilitation exercises: the effect on trapezius muscle activation measured by surface electromyography. J. Orthop. Sports Phys. Ther. 2013;43:3–10. doi: 10.2519/jospt.2013.4283.
    1. Cools AM, et al. Rehabilitation of scapular dyskinesis: from the office worker to the elite overhead athlete. Br. J. Sports. Med. 2013;48:692–697. doi: 10.1136/bjsports-2013-092148.
    1. Hakkinen K. Neuromuscular adaptation during strength training, ageing, detraining, and immobilization. Crit. Rev. Phys. Rehabil. Med. 1994;14:161–198.
    1. Andersen LL, Andersen JL, Magnusson SP, Aagaard P. Neuromuscular adaptations to detraining following resistance training in previously untrained subjects. Eur. J. Appl. Physiol. 2005;93:511–518. doi: 10.1007/s00421-004-1297-9.
    1. Vaughn DW, Brown EW. The influence of an in-home based therapeutic exercise program on thoracic kyphosis angles. J. Back Musculoskelet. Rehabil. 2007;20:155–165. doi: 10.3233/BMR-2007-20404.
    1. Brody LT. Effective therapeutic exercise prescription: the right exercise at the right dose. J. Hand Ther. 2012;25:220–232. doi: 10.1016/j.jht.2011.09.009.
    1. Garber CE, et al. American College of Sports Medicine position stand. Quantity and quality of exercise for developing and maintaining cardiorespiratory, musculoskeletal, and neuromotor fitness in apparently healthy adults: guidance for prescribing exercise. Med. Sci. Sports Exerc. 2011;43:1334–1359. doi: 10.1249/MSS.0b013e318213fefb.
    1. Hermens HJ, Freriks B, Disselhorst-Klug C, Rau G. Development of recommendations for SEMG sensors and sensor placement procedures. J. Electromyogr. Kinesiol. 2000;10:361–374. doi: 10.1016/S1050-6411(00)00027-4.
    1. De Mey K, Danneels L, Cagnie B, Cools AM. Scapular muscle rehabilitation exercises in overhead athletes with impingement symptoms effect of a 6-week training program on muscle recruitment and functional outcome. Am. J. Sports Med. 2012;40:1906–1915. doi: 10.1177/0363546512453297.
    1. McClure P, Tate AR, Kareha S, Irwin D, Zlupko E. A clinical method for identifying scapular dyskinesis, part 1: reliability. J. Athletic Train. 2009;44:160–164. doi: 10.4085/1062-6050-44.2.160.
    1. Kibler WB, et al. Clinical implications of scapular dyskinesis in shoulder injury: the 2013 consensus statement from the ‘Scapular Summit’. Br. J. Sports. Med. 2013;47:877–885. doi: 10.1136/bjsports-2013-092425.
    1. Bayattork M, Seidi F, Minoonejad H, McClure P, Mozafaripoor E. Intra-rater and inter-rater reliability and agreement of the scapular dyskinesis test in young men with forward head and round shoulder posture. J. Rehabil. Sci. Res. 2019;6:169–173.
    1. Gadotti IC, Armijo-Olivo S, Silveira A, Magee D. Reliability of the craniocervical posture assessment: visual and angular measurements using photographs and radiographs. J. Manipulative Physiol. Ther. 2013;36:619–625. doi: 10.1016/j.jmpt.2013.09.002.
    1. Ruivo RM, Pezarat-Correia P, Carita AI. Intrarater and interrater reliability of photographic measurement of upper-body standing posture of adolescents. J. Manipulative Physiol. Ther. 2015;38:74–80. doi: 10.1016/j.jmpt.2014.10.009.
    1. Greendale G, Nili N, Huang M-H, Seeger L, Karlamangla A. The reliability and validity of three non-radiological measures of thoracic kyphosis and their relations to the standing radiological Cobb angle. Osteoporos. Int. 2011;22:1897–1905. doi: 10.1007/s00198-010-1422-z.
    1. Barrett E, McCreesh K, Lewis J. Reliability and validity of non-radiographic methods of thoracic kyphosis measurement: a systematic review. Man. Ther. 2014;19:10–17. doi: 10.1016/j.math.2013.09.003.
    1. Bakeman R. Recommended effect size statistics for repeated measures designs. Behav. Res. Methods. 2005;37:379–384. doi: 10.3758/BF03192707.
    1. Richardson JT. Eta squared and partial eta squared as measures of effect size in educational research. Educ. Res. Rev. 2011;6:135–147. doi: 10.1016/j.edurev.2010.12.001.
    1. Norman GR, Sloan JA, Wyrwich KW. Interpretation of changes in health-related quality of life: the remarkable universality of half a standard deviation. Med. Care. 2003;41:582–592.

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