Effects of muscle energy techniques versus corrective exercise programme on pain, range of motion and function in patients with upper cross syndrome: a randomised clinical trial
More details
Hide details
University Institute of Physical Therapy, University of Lahore, Lahore, Pakistan
Submission date: 2022-05-14
Acceptance date: 2023-03-20
Publication date: 2024-06-21
Physiother Quart. 2024;32(2):76-83
Upper crossed syndrome (UCS) is a common musculoskeletal issue that includes the dysfunctional tone of the muscles in the shoulder girdle or cervicothoracic region. The objective of the current study is to compare the effects of muscle energy techniques with the National Academy of Sports Medicine-based exercise protocol on pain, range of motion, and disability in patients with UCS.

It was a single-blinded randomised clinical trial carried out in the Physiotherapy Department of the University of Lahore Teaching Hospital, Pakistan. Fifty patients with upper cross syndrome aged between 20 to 35 years were randomly allocated into two groups: group A (routine physical therapy combined with muscle energy techniques) and group B (routine physical therapy combined with the National Academy of Sports Medicine-based exercise protocol) for three sessions per week for total 8 weeks. Data were collected at baseline, 4th, 8th, and 12th week for assessing the long-term effects of the treatment protocol as well. The Visual Analogue Scale, Neck Disability Index, and an inclinometer were used to measure the pain, disability, and range of motion of the cervical region, respectively. The data was analysed using SPSS version 23.0 (IBM, New York, USA).

Out of 50 participants, 30 were male and 20 were female. The mean age of all the participants in experimental group A was 29.76 ± 2.89 and that in experimental group B was 30.56 ± 2.48. At the 4th, 8th, and 12th week, pain and disability were significantly (p-value < 0.05) reduced and cervical range of motion was significantly (p-value < 0.05) improved within both groups. After 8 weeks of treatment, a significant between-group difference was seen in favour of group A in terms of cervical range of motions (flexion, extension, rotation, and side bending) with p-values of less than 0.05 and in favour of group B in terms of pain (p-value 0.03) and disability (p-value 0.04) was seen. These differences were maintained at the 12th week follow-up as well.

This study concluded that both NASM (National Academy of Sports Medicine-based exercise protocol) and METs (muscle energy techniques) are effective treatment options for people with upper cross syndrome. It was also concluded that METs are more effective in improving Range of motion (ROM), while the NASM-based exercise protocol is more effective in improving symptoms of pain and neck-related disability.

Daneshmandi H, Harati J, Fahim Poor S. Bodybuilding links to upper crossed syndrome. Phys Activ Rev. 2017;5:124–31; doi: 10.16926/par.2017.05.17.
Shahid S, Tanveer F, Dustgir A. Prevalence and risk factors for the development of upper-crossed syndrome (UCS) among DPT students of University of Lahore. 2016;0–98; doi: 10.21275/NOV163371.
Kim YS, Park HK, Park MC. Research the effects of thoracic and lumbar support fixtures on forward head posture during visual display terminal work. J Korean Soc Phys Med. 2016;11(3):41–7; doi: 10.13066/kspm.2016.11.3.41.
Verma SL, Shaikh J, Mahato RK, Sheth MS. Prevalence of forward head posture among 12–16 year old school going students: a cross sectional study. App Med Res. 2018;4(2):18–21; doi: 10.5455/amr.20180805064752.
Mubeen I, Malik S, Akhtar W, Iqbal M, Asif M, Arshad A, Zia S, Khalid S. Prevalence of upper cross syndrome among the medical students of University of Lahore. Int J Physiother. 2016;3(3):381–4; doi: 10.15621/ijphy/2016/v3i3/100851.
Dhage P, Anap D. Prevalence of an “Upper Crossed Syndrome in Physiotherapy College Students”: a cross-sectional study. VIMS Health Sci J. 2019;6(1):10–3.
Mubashir M. A cross-sectional survey on prevalence of upper cross syndrome and its correlation to WRMSDs in working physiotherapists. Pak J Rehabil. 2021;10(1):42–50; doi; 10.36283/pjr.zu.10.1/008.
Rana AA, Ahmad A, Gillani SA, Idrees MQ, Awan I. Effects of conventional physical therapy with and without muscle energy techniques for treatment of upper cross syndrome. Rawal Med J. 2020;45(1):127–32.
Ylinen J, Takala E-P, Nykänen M, Häkkinen A, Mälkiä E, Pohjolainen T, Karppi S-L, Kautiainen H, Airaksinen O. Active neck muscle training in the treatment of chronic neck pain in women: a randomized controlled trial. JAMA. 2003;289(19):2509–16; doi: 10.1001/jama.289.19.2509.
Quek J, Pua Y-H, Clark RA, Bryant AL. Effects of thoracic kyphosis and forward head posture on cervical range of motion in older adults. Manual Ther. 2013;18(1):65–71; doi: 10.1016/j.math.2012.07.005.
Sohrabi S, Rahimi M, Babaei-Mobarakeh M, Piri H. The effect of eight weeks of Iyengar yoga with an emphasis on spine and shoulder exercises on the upper cross syndrome in middle-aged women. J Modern Rehabil. 2020;14(3):159–68; doi: 10.18502/jmr.v14i3.7714.
Karimian R, Rahnama N, Ghasemi G, Lenjannejadian S. Photogrammetric analysis of upper cross syndrome among teachers and the effects of national academy of sports medicine exercises with ergonomic intervention on the syndrome. J Res Health Sci. 2019;19(3):e00450.
Vaidya A, Babu VS, Mungikar S, Dobhal S. Comparison between muscle energy technique and Mulligan’s mobilization with movement in patients with anterior innominate iliosacral dysfunction. Int J Health Sci Res. 2019;1(9):76–84.
Nugraha MHS, Antari N, Saraswati N. The efficacy of muscle energy technique in individuals with mechanical neck pain: a systematic review. Sport Fitness J. 2020;8(2):91–8; doi: 10.24843/spj.2020.v08.i02.p12.
Gillani S, Rehman S, Masood T. Effects of eccentric muscle energy technique versus static stretching exercises in the management of cervical dysfunction in upper cross syndrome: a randomized control trial. J Pak Med Assoc. 2020;70(3):394–8; doi: 10.5455/JPMA.300417.
Chaitow L, Crenshaw K. Muscle Energy Techniques. Elsevier Health Sciences; 2006; doi: 10.1016/j.math.2007.05.006.
Mahajan R, Kataria C, Bansal K. Comparative effectiveness of muscle energy technique and static stretching for treatment of subacute mechanical neck pain. Int J Health Rehabil Sci. 2012;1(1):16–21; doi: 10.5455/ijhrs.00000004.
Gamrot S. Comparison of the effects of muscle energy technique and positional release of latent trigger points of the sternocleidomastoid muscle on changes in pain threshold and bioelectrical activity of the trapezius muscle. Physiother Rev. 26(3):49–59; doi: 10.5114/phr.2022.119745.
Almasoodi MCI, Mahdavinejad R, Ghasmi G. The effect of 8 weeks national academy of sports medicine exercises training on posture, shoulder pain, and functional disability in male with upper cross syndrome. Psychol Educ J. 2021;58(2):6741–52; doi: 10.17762/pae.v58i2.3212.
Arshadi R, Ghasemi GA, Samadi H. Effects of an 8-week selective corrective exercises program on electromyography activity of scapular and neck muscles in persons with upper crossed syndrome: randomized controlled trial. Phys Ther Sport. 2019;37:113–9; doi: 10.1016/j.ptsp.2019.03.008.
Abdolahzad M, Daneshmandi H. The effect of an 8-week NASM corrective exercise program on upper crossed syndrome. J Sport Biomech. 2019;5(3):156–67; doi: 10.32598/biomechanics.5.3.3.
Phadke A, Bedekar N, Shyam A, Sancheti P. Effect of muscle energy technique and static stretching on pain and functional disability in patients with mechanical neck pain: a randomized controlled trial. Hong Kong Physiother J. 2016;35:5–11; doi: 10.1016/j.hkpj.2015.12.002.
Waxenbaum JA, Scafidi JM, Lu M. Physiology, Muscle Energy. StatPearls. Available from: https://www.ncbi.nlm.nih.gov/b....
Tilak M, Isaac SA, Fletcher J, Vasanthan LT, Subbaiah RS, Babu A, Bhide R, Tharion G. Mirror therapy and transcutaneous electrical nerve stimulation for management of phantom limb pain in amputees: a single blinded randomized controlled trial. Physioth Res Int. 2016;21(2):109–115; doi: 10.1002/pri.1626.
ChaSA, Law EH, Shaw JW, Pickard AS. A comparison of self-rated health using EQ-5D VAS in the United States in 2002 and 2017. Qual Life Res. 2019;28(11):3065–9; doi: 10.1007/s11136-019-02249-y.
Gillani SN, Qurat-Ul-Ain RS, Masood T. Effects of eccentric muscle energy technique versus static stretching exercises in the management of cervical dysfunction in upper cross syndrome: a randomized control trial. J Pak Med Assoc. 2020;70(3):394–8; doi: 10.5455/JPMA.300417.
Tudini FT, Myers BJ, Bohannon RW. Forward flexed posture: reliability and determinants of tragus-to-wall measurement. Physiother Theory Pract. 2022;38(4):579–86; doi: 10.1080/09593985.2020.1771801.
Dash SS, Karthiga R. Effect of stretching and strengthening of cervical muscles on neck mobility of lower cervical facet syndrome – a single system design. Indian J Physiother Occup Ther. 2019;13(1):144–8; doi: 10.5958/0973-5674.2019.00029.7.
Pathan H, Pawar A, Rao R, Phansopkar P, Chitale N, Arora SP. A structured exercise program for upper cross syndrome. J Med Pharm Allied Sci. 2022;11(S1):259–63; doi: 10.55522/jmpas.V11S1.1258.
Amjad F, Azeem MT, Daula SA, Ijaz B. Effectiveness of Mckenzie traction and exercises on neck pain secondary to upper crossed syndrome. J Health Med Nurs. 2020;74:74–7; doi: 10.7176\JHMN\74-07.
El Laithy MH, Fouda KZ. Effect of post isometric relaxation technique in the treatment of mechanical neck pain. Phys Ther Rehabil. 2018;5(1):20; doi: 10.7243\2055-2386-5-20.
Ali S, Ahmad S, Jalal Y, Shah B. Effectiveness of stretching exercises versus muscle energy techniques in the management of upper cross syndrome. J Riphah Coll Rehabil Sci. 2017;5(1):12–16.
Vaseghnia A, Shadmehr A, Moghadam BA, Olyaei G, Hadian MR, Khazaeipour Z. Effects of muscle energy technique on daily activities and lumbar stiffness in women with sacroiliac joint dysfunction: a randomized controlled clinical trial study. J Modern Rehabil. 2019;13(1):23–30; doi: 10.32598/JMR.13.1.23.
Tom AA, Rajkumar E, John R, George AJ. Determinants of quality of life in individuals with chronic low back pain: a systematic review. Health PsycholBehav Med. 2022;10(1):124–44; doi: 10.1080/21642850.2021.2022487.
Jabbar KM, Gandomi F. The effects of national academy of sports medicine and sahrmann training on foot pressure distribution in flexed posture students. Iranian Rehabil J. 2021;19(1):99–110; doi: 10.32598/irj.19.1.1319.1.
Journals System - logo
Scroll to top