Upper Cross Syndrome (UCS) is characterized by weakening of the neck flexors and rhomboids and stiffness in the pectoralis major, upper trapezius, and levator scapulae. Rhomboids major and minor need to be strengthened in order to enhance scapular stability and regain proper posture. The aim of this study is to determine effect of rhomboids strength training regime on pain, craniovertebral angle and disability among patients with upper crossed syndrome.
Age group between 20 and 45 years
Both gender male and female
Subject with head neck angle less than 50 degrees(for forward head posture).
Subject with positive JANDAS upper crossed syndrome tests .
• Exclusion criteria Patients were excluded if they were diagnosed with the following conditions for ˃6 months
Tuberculosis, carcinoma, heart disease, and osteoporosis
Neural disorders due to prolapsed intervertebral disc
Any trauma or localized infection in upper back region
Parallel
Rhomboids Strengthening Exercise
Other intervention1. Seated Bent Row in Sitting position,3 sets of the exercise program with 12 repetitions per set, 3 times per week. 2. Bent Over Row in standing position, 3 sets, 12 repetitions, 3 times per week. 3. Lat Pull Down in sitting position with 12 repetitions per set, 3 times per week. 4. Shoulder Horizontal Abduction in lying position with 3 sets of the exercise program with 12 repetitions per set, 3 times per week. 5. Band pull apart performed 4sets, 12 repetitions, and 10 seconds rest for 2 mints, 3 times per week. 6. Prone lateral raise with 3 sets of the exercise program with 12 repetitions per set, 3 times per week. Conventional treatment Modalities: Trans-cutaneous Electric Nerve Stimulation (TENS) and Hot pack, postural exercises and stretching exercises
Conventional Exercises
Other interventionConventional Treatment 1. hot pack for 10 min, 2. Trans-cutaneous Electric Nerve Stimulation (TENS) will be applied, with pulse duration of 250 microseconds at a frequency of 80 Hz for 15 min in the sub occipital region and the trapezius bilaterally. 3. Stretching exercises of tight muscles 2 sets of 15 min. 4. Posture correction exercises: releasing muscles of anterior part of the trunk, neck, shoulder.
Numerical Pain Rating Scale (NPRS)
Patient level of pain will be assessed using this scale. This scale ranges from 0 to 10. 0 indicates "no pain" 1-3 indicate "Mild pain" 4-6 indicate "Moderate pain" 7-10 indicate "worst pain". NPRS have shown high test-retest reliability (r = 0.96 and 0.95, respectively)
Neck Disability Index (NDI_
The NDI is a 10-item, 50-point index that evaluates many facets of day-to-day functioning in individuals with neck pain. The NDI evaluates two items pertaining to discretionary daily living activities (personal care, reading), four items pertaining to activities of daily living (lifting, work, driving, and recreation), and four items related subjective symptoms (pain intensity, headache, concentration, and sleeping). The scores are interpreted as follows: 0-4: No disability 5-14: Mild disability 15-24: Moderate disability 25-34: Severe disability 35-50: Complete disability. For the NDI, test-retest reliability was good
Craniovertebral Angle
Anatomically speaking, the degree of forward head posture is measured using the craniovertebral angle (CVA), which is a measurement of the head and neck posture. It is the angle created by a horizontal line running from the C7 vertebra and the line joining the tragus of the ear to the vertebra (the seventh cervical vertebra). In order to calculate the craniovertebral angle: 1. Indicate the C7 vertebra and the tragus of the ear. 2. Draw an imaginary line that connects the C7 vertebra to the tragus. 3. Sketch a line that extends horizontally from the vertebra C7. 4. Calculate the angle that these two lines form. More than 50 degrees is the normal CVA. Head tilt slightly forward, between 40 and 50 degrees. A somewhat forward head posture, between 30 and 40 degrees. Head Posture Severe Forward when it is less than 30 degrees. CVA is a trustworthy measure of head and neck posture
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