Effectiveness of Exercise in the Treatment of Upper Cross Syndrome

Upper cross syndrome (UCS) is a common postural deformity characterized by a change in neck, torso and shoulder muscle activity and shoulder movement. UCS results in a shortening of the upper back and chest muscles as well as the muscles which provide movement to the shoulder blade. This is accompanied by weakness of the upper back muscles, shoulder blade stabilizor muscles and deep neck muscles. The resultant muscle imbalance leads to elevation of the shoulders, elongation of the neck and rounding of the back.

The change in posture which occurs in UCS changes the biomechanics of the neck and upper back and can results in neck pain, adverse effects on daily activities and productivity. To date, studies have been done on treatment of elongation of the neck using muscle relaxation techniques and manipulation of the local structures. To date, there is no study which investigates the efficacy of a specific exercise program targeting the muscles affected by UCS. The aim of this study is to investigate the effects of UCS-specific exercises on neck-back pain, cervical posture, disability and quality of life.

Upper cross syndrome (UCS) is a common postural deformity characterised by a change in neck, torso and scapular muscle activity and scapular mobility. UCS results in a shortening of the upper trapezius, pectoralis majör and levator scapula muscles and weakness of the rhomboid, serratus anterior, middle and lower trapezii and deep cervical muscles such as the scalene muscles. The resultant muscle imbalance results in elevation and protraction of the shoulders, protraction of the neck and increase in kyphosis of the thoracic spine.

The change in posture seen in UCS reuslts in a change in the biomechanics of the vertebral bodies, neural arcus, musculature, faset joints, ligaments and discs which in turn can result in pain. Neck pain can negatively affect activities of daily living and function, causing disabiltiy and thus having a detrimental affect quality of life and productivity. Furthermore, studies have shown that UCS is frequently seen occuring in individuals with facet joint degeneration, myofacial pain syndrome and cervical radiculopathy. , In the literature, forward head position is treated craniocervical flexion training, muscle energy techniques, cervical coordination exercises, mobilization, manipulation and stabilization exercises. However, to date, there are no studies which investigate the effect of specific exercises aimed at resolving the muscle imblance which occurs in UCS. The aim of this study is to investigate the effects of UCS-specific exercises on neck-back pain, cervical posture and alignment, disability and quality of life. ,

Eligibility Criteria:
Inclusion Criteria: Male and female patients between the ages of 30-50 years attending the outpatient clinic of our physical medicine and rehabilitation department with neck and back pain with upper cross syndrome on examination.

Exclusion Criteria:

* History of cervical spine trauma or surgery
* Congenital postural deformity
* A history of inflammatory arthritis
* A diagnosis of torticollis, vertigo, pregnancy, vertebrobasilar insufficiency, heart failure, ischaemic heart disease, hypertension.