Additional Effects of Maitland Mobilization With Mckenzie Exercises on Kinesiophobia and Range of Motion in Upper Cross Syndrome

Upper cross syndrome is a postural condition that is characterized by muscle imbalance in neck region. It is described as a pattern of crossed tightness in trapezius, levator scapulae and pectoralis major and minor with crossed weakness in neck flexors,rhomboids,serratus anterior weakness due to poor working habits and inappropriate ergonomics. It has multiple treatment options and manual therapy is on of them. Maitland mobilizations are widely used for upper cross syndrome. However limited literature is available on the additional effects of Maitland mobilizations with Mckenzie exercises in upper cross syndrome.

Upper cross syndrome is a postural condition that is experinced by 32.43% in desk workers. It is one of the most prevelant leading cause of neck pain and musculoskeletal conditions that has a major impact on a person life by effecting activities of daily living.Neck pain ranked 21st among Global burden of diseses and fourth highest overall for all disabilities. Prevelance of neck pain in Pakistan is 62%. Neck pain has a strong positive correlation with kinesiophobia. Kinesiophobia is a strong predictor of pain intensity,proprioception and functional performance. Patients with upper cross syndrome presents with forward head posture, protracted and elongated shoulders,khyphosis of thoracic spine,winging of scapula and decreased thoracic spine mobility. Upper cross syndrome occurs due to poor faulty posture, extensive use of mobile,laptops,watching T.V,driving and all the other activities that encourages this postural stance.

This study will be a Randomized Control Trial conducted in rehab opd of Fauji Foundation hospital. Both genders with age 18-45 years who had diagnosed with upper cross syndrome will be recruited into two groups using non probability purposive sampling technique. Sample size has been calculated by using open epi sample calculator and it is calculated to be 28. Patients with primary neck pain complain referred to rehab opd of FFH and local physiotherapy clinics of Rawalpindi/Islamabad will be recruited according to the eligibility criteria. Participants will be briefed regarding study objectives, study procedures, risks and benefits of treatment, voluntarily participation and right to withdraw. After taking informed consent,basic demographics, baseline assessment, participants will be randomly allocated into the two groups using sealed enveloped method. Group A(controlled group) will be recieving moist heat therapy(15 minutes hot pack) and Mckenzie exercise(5 reps x 2 sets in week 1 then progressed to 10 reps x 3 sets in week 2) . While group B will be given Maitland mobilization (Central glidewith grade i and ii mobilizations in week 1 and then progressed to grade iii and iv in week 2) with Mckenzie exercises along with moist heat therapy. Before and after the intoduction of intervention kinesiophobia,range of motion and pain will be assessed before and after the treatment.Frequency: thrice biweekly for 2 weeks for a total of 6 treatment sessions.

Eligibility Criteria:
Inclusion Criteria:

* Age group:18-45 years with diagnosed upper cross syndrome
* Both males and females
* Neck pain with a score between 4-8 in NPRS
* Able to provide informed consent and understand therapists instruction

Exclusion Criteria:

* History of Cervical or upper limb fracture
* Vertibrobasilar insufficiency
* Cervical spine surgery
* Spinal infections and tumors
* Osteoporosis
* Metabolic disorders
* Rheumatiod Arthritis
* Inflammatory Arthritis