Concentric Versus Eccentric Muscle Energy Technique on Upper Cross Syndrome

Study Overview
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Brief Summary
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This project was a Randomized control trial conducted to check the effects of eccentric and concentric muscle energy techniques on patients with upper cross syndrome so that we can have best treatment option for patients with upper cross syndrome, duration was of 6months,convenient sampling was done, subject following eligibility criteria from Mansoura hospital female physiotherapy department, Lahore were randomly allocated in two groups via lottery method, baseline assessment was done, Group A participants were given conservative treatment along with eccentric muscle energy technique and Group B participants were given conservative treatment along with concentric muscle energy technique than on 1st,3rdand 6th week post intervention assessment was done via neck disability index, Numeric rating scale, inches tape method,3 sessions per week were given, data was analyzed by using SPSS version 26.

Detailed Description
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In Upper cross syndrome upper trapezius, pectoralis major, and levator scapulae become tight and rhomboids , serratus anterior, middle and lower trapezius, and deep neck flexors, including scalene becomes weak. The postural muscles have tendency to become tight while the phasic muscles have tendency to become weak and inhibited. Thus typical pattern of altered posture and muscular imbalance occurs whenever dysfunction of muscle start. mainly muscular imbalance between weak and tonic muscles leads toward this upper cross syndrome. Soft tissue and cervical spine disorders are found out to be the major contributor in neck pain but when postural abnormality becomes the reason behind neck ache than this is categorized as Upper cross syndrome due to this imbalance in muscles our body has to suffer from severe consequences.rounded shoulder posture is a result of protracted girdle of shoulder due to muscular imbalances between agonist and antagonist muscles resulting in extreme pain and exaggerated cervical curvature.Imbalanced stress on cervical vertebrae is responsible in creating extra pull on neck and head similarly change in normal posture is responsible in overloading, weakening or tightening of cervical area. Characteristics of patient presenting with UCS will have forward head posture, kyphosis ,hunch of thoracic spine (rounded shoulder),winged scapulae, protracted and elevated shoulder and reduced thoracic spine mobility. UCS with the passage of time can detoriate persons physical fitness and health ,it is not only responsible for changes in posture of upper back i.e hypokyphosis over time, but it is also responsible for inducing respiratory problems including asthma. It also cause neck back shoulder and chest wall pain, this pain can be caused by muscular imbalance leading to overuse and fatigue of muscle because of movement dysfunction of back and neck.when muscles become fatigued they start generating more amount of inflammatory chemicals resulting in becoming more sore and increased spasticity. With the passage of time biomechanical and postural changing will induce osteoarthritis in upper thoracic and lower cervical spine in early ages. Functional Shoulder impingement syndrome is also considered to be another complication of Upper cross syndrome. Therefore it is necessary to correctly diagnose and treat this condition before its complication starts worsening.

Official Title
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Effects of Concentric Versus Eccentric Muscle Energy Technique on Pain, Muscle Length and Function in Upper Cross Syndrome

Conditions
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Neck Syndrome

Intervention / Treatment
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* Other: Eccentric Muscle Energy Technique
* Other: Concentric muscle energy technique


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: 6 month chronic neck pain upper cross syndrome: Clinical picture (Postural Changes): Forward head posture Increased cervical lordosis and thoracic kyphosis Elevated and protracted shoulders (Rounded shoulders) A hunched upper back Rotation or abduction and winging of the scapula Test: Janda test: Patient supine tries to elevate the head from the couch. Normally the lordosis will disappear and the chin will touch the sternum. Otherwise pathological picture shows that the head is lifted with the very tense neck muscles Exclusion Criteria: Patients having any serious trauma on neck i.e. whiplash injury Spinal fracture Cervicogenic headache History of systemic disease RA, SLE, TUMOR psychiatric disorder Any Red flag

Ages Eligible for Study
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Minimum Age: 25 Years
Maximum Age: 40 Years

Sexes Eligible for Study
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Female

Accepts Healthy Volunteers
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No

Study Plan
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How is the study designed?
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Design Details

Primary Purpose: Treatment
Allocation: Randomized
Intervention Model: Parallel Assignment
Interventional Model Description: Parallel Assignment
Masking: None (Open Label)


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Experimental: Eccentric Muscle Energy Technique<br>conventional physical therapy Along with eccentric muscle energy technique | Other: Eccentric Muscle Energy Technique<br>* Conventional Treatment given to both groups (Hot pack for 15 minutes, Mobilization, AROM Exercises 10 sets x 3days in a week) Reciprocal inhibition of target muscle (i.e. levator scapulae ,pectoralis major, upper trapezius) causing relaxation, patient force is minimal towards maximal therapist force, 5-7 repetition for 2-4seconds 3 days in a week up to 6 weeks. Muscle is taken from shortened to lengthened position.<br>|
| Experimental: concentric muscle energy technique<br>Conventional physical therapy along with concentric muscle energy technique | Other: Concentric muscle energy technique<br>* Group B: Concentric Muscle Energy Technique: (Autogenic inhibition of target muscle (i.e. levator scapulae ,pectoralis major, upper trapezius) patient force is greater than therapist force, 5-7repitition for 3-4seconds)Muscle is taken from lengthened to shortened position. On eligible participants baseline assessment was done,3 session were given 3days per week, post intervention assessment was taken at 1st 3rd and 6th week<br>|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Neck disability index | 10-item questionnaire that measures a patient's self-reported neck pain related disability. A higher NDI score means the greater a patient's perceived disability due to neck pain. 10 item score from 0-5.maximum score is 50. 0 to 4(0-8%)=no disability 5 to14(19-28%)=mild 15 to24(30-48%)=moderate 25 to 34 (50-64%)=severe Above 34(70-80%)=complete. 10-item questionnaire that measures a patient's self-reported neck pain related disability. A higher NDI score means the greater a patient's perceived disability due to neck pain. 10 item score from 0-5.maximum score is 50. 0 to 4(0-8%)=no disability 5 to14(19-28%)=mild 15 to24(30-48%)=moderate 25 to 34 (50-64%)=severe Above 34(70-80%)=complete | 6th Week | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| NPRS | Changes from base Line Numeric Pain rating scale is a scale for pain starting from 0-10. where 0 indicate no pain and 10 indicate severe pain | 6th Week | 

 Terms related to the study
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Keywords Provided by Centre Hospitalier Valida
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upper cross syndrome,, MET,, NDI,, NPRS