Upper Extremity DysfunctionNCT06770205
Kendall Exercises Versus Proprioceptive Neuromuscular Facilitation Technique in Patients With Upper Cross Syndrome
A study testing traditional physical therapy and kendall Exercise Group A in people with Upper Extremity Dysfunction, run by Riphah International University at 1 site in Pakistan.
Trial summary
Upper Crossed Syndrome (UCS) is a postural disorder characterized by a distinct pattern of muscle imbalances within the musculature of the shoulder girdle and cervico-thoracic region. Read more about this study
- Who is it for?
- Ages 25 to 50 years
- Conditions the study is for
- Upper Extremity Dysfunction
- What is being tested?
- traditional physical therapy and kendall Exercise Group A
- Could I receive a placebo?
- No, everyone receives an active treatment
- How many people
- 58 participants
- Where
- 1 sitePakistan
- Study dates
- 1 Jul 2024to Jan 2025
- Phase
- Interventional
- Are there results?
- Not yet: the study is under way
Key requirements
Who can take part, as listed by the sponsor. Only the study team can confirm whether you are eligible, so take this list to your doctor.
- Ages 25 to 50 years
- All sexes
- No healthy volunteers
- Adult
Who may be able to join
- Patients diagnose with upper crossed syndrome.
- To diagnose upper cross syndrome, janda classification or approach will be use. Janda believed that muscle tightness or spasticity is predominant. Often weakness from muscle imbalance results from reciprocal inhibition of the tight antagonist. These patterns lead to postural changes and joint dysfunction and degeneration (23)
- Both genders male and female.
- Participants with constantly or frequently occurring neck-shoulder pain more than 1 month.
- Age between 25 and 50 years (3)
- Pain and restricted range of motion
- NPRS score greater than 3
- Craniovertebral angle < 51 degree. (20)
Who cannot join
- Tumors
- Pregnancy
- Diagnosed psychological disorders
- Surgery
- Cancer and neuropathies past one year
- Rheumatoid arthritis and cervical instability.
Trial locations and contacts
1 site in 1 country.
Pakistan1 site
Riphah Rehab Training and Research Center
Lahore, Punjab Province, 54000
About this study
Official title: Effects of Kendall Exercises Versus Proprioceptive Neuromuscular Facilitation Technique on Pain, Range of Motion, Disability, Craniovertebral and Thoracic Angle in Patients With Upper Cross Syndrome
Upper Crossed Syndrome (UCS) is a postural disorder characterized by a distinct pattern of muscle imbalances within the musculature of the shoulder girdle and cervico-thoracic region. The use of different corrective exercise approaches enhances and improves muscle balance and motor control thereby reducing postural abnormalities. Therefore, the aim of study will be to compare the effects of Kendall exercises versus proprioceptive neuromuscular facilitation technique on pain, range of motion, disability craniovertebral and thoracic angle in patients with upper cross syndrome.
A Randomized Clinical Trial will be conducted at Riphah Clinic Lahore, Sehat medical complex hospital Lahore through consecutive sampling technique on 52 patients which will be allocated using computer generated sampling (random number table) into Group A and Group B. Group A will be treated with kendall exercises and Group B will be treated with Proprioceptive Neuromuscular Facilitation techniques with the frequency that Stretching exercises will be performed actively for 30 second hold and 3 repetitions. Strengthening exercise will be performed for 10 second hold and 10 repetitions. All Exercises will be performed 3 times per week for total of 4 weeks. Outcome measures will be conducted through pain, range of motion, disability craniovertebral and thoracic angle after 4 weeks. Data will be analyzed during SPSS software version 25.
Read the detailed description
Upper Crossed Syndrome (UCS) is a postural disorder characterized by a distinct pattern of muscle imbalances within the musculature of the shoulder girdle and cervico-thoracic region. This syndrome is typified by tightness and over-facilitation of muscles such as the levator scapulae, pectoralis major, and upper trapezius, juxtaposed with the weakness or inhibition of the serratus anterior, deep neck flexors (specifically scalene), middle trapezius, lower trapezius, and rhomboids. Individuals with UCS typically exhibit a forward head posture, rounded upper back (thoracic kyphosis), elevated and protracted shoulders, and scapular winging. Prolonged and repetitive activities, such as manual material handling, especially when performed in inappropriate postures, can exacerbate the symptoms of UCS. A study involving medical students at the University of Lahore highlighted a concerning prevalence of UCS, with 48.7% of the student population reporting neck pain. The use of different corrective exercise approaches enhances and improves muscle balance and motor control thereby reducing postural abnormalities. Therefore, the aim of study will be to compare the effects of Kendall exercises versus proprioceptive neuromuscular facilitation technique on pain, range of motion, disability craniovertebral and thoracic angle in patients with upper cross syndrome.
A Randomized Clinical Trial will be conducted at Riphah Clinic Lahore, Sehat medical complex hospital Lahore through consecutive sampling technique on 52 patients which will be allocated using computer generated sampling (random number table) into Group A and Group B. Group A will be treated with kendall exercises and Group B will be treated with Proprioceptive Neuromuscular Facilitation techniques with the frequency that Stretching exercises will be performed actively for 30 second hold and 3 repetitions. Strengthening exercise will be performed for 10 second hold and 10 repetitions. All Exercises will be performed 3 times per week for total of 4 weeks. Outcome measures will be conducted through pain, range of motion, disability craniovertebral and thoracic angle after 4 weeks. Data will be analyzed during SPSS software version 25. The normality of data will be assessed by Shapiro-Wilk test after which it will be decided either parametric or non-parametric test will be used within a group or between two groups.
- Conditions
- Upper Extremity Dysfunction
- Being tested
- traditional physical therapy, kendall Exercise Group A
- Keywords
- Pain, Disability, Range of Motion, Craniovertebral angle, Thoracic angle.
- Medical subject headings
- Pain
What participants receive
What participants receive. In a randomised study each person is assigned to one group by chance.
traditional physical therapyOther
hot pack and TENS for 10 minutes and massage that will as 3 sessions per week for 4 weeks.
kendall Exercise Group AOther
The group B will receive Proprioceptive Neuromuscular Facilitation technique for stretching and rhythmic stabilization technique for strengthening. Proprioceptive Neuromuscular Facilitation (PNF) is a stretching technique utilized to improve muscle elasticity and has been shown to have a positive effect on active and passive range of motions. The PNF group performed the intervention for 30 minutes a day, six times a week, a total of 24 times. (13) In this group, two types of PNF techniques were given:
- first is strengthening technique included rhythmic stabilization that is characterized by alternating isometric contractions against resistance, no motion intended to apply for the weak muscles of upper cross syndrome included deep neck flexors specifically lower trapezius and serratus anterior.
- Second is stretching technique included contract relax that is resisted isotonic contractions of the restricting muscles (antagonists) followed by relaxation and movement
| Study group | Role | What they receive |
|---|---|---|
| traditional physical therapy | Active comparator | Hot pack and TENS for 10 minutes and massage that will as 3 sessions per week for 4 weeks. Receives: Other: traditional physical therapy |
| kendall Exercise Group A | Experimental | The Kendall exercise group participated in 5 sets of consisting of 12 repetitions of postures, each taking 30 seconds, based on Kendall exercise. The Kendall exercise methods were as follows:
1. Strengthening the deep cervical flexors, lying flat on the back with the chin down and then lifting the head and holding this position for 2-8 seconds to strengthen deep cervical flexors
2. Stretching the cervical extensors, placing both hands on the occipital area in a sitting position followed by a flexed neck posture with the head down to stretch the cervical extensors
3. strengthening shoulder retraction, putting a Thera Band around a secure object and pulling the band back with both hands as far as possible to move the shoulder blades toward each other in a standing position
4. stretching the pectoralis muscle, placing both hands on the occipital area and pulling the elbows back up Receives: Other: kendall Exercise Group A |
What is being measured
The primary outcome is the main question the study is designed to answer.
Numeric pain rate scale
Numeric pain rate scale, Patient level of pain will be assessed using this scale. This scale ranges from 0 to 10. 0 indicates "no pain" and 10 indicate worst pain. The NPRS has a validity of (r=0.79-0.96) and a reliability of 0.86-0.89. (16) It takes less than one minute to complete, and can be understood in any language; i.e. there is no language barrier. It is a valid and reliable scale that measures pain intensity and experience.
Measured: 4th day
Neck Disability index
Neck Disability index (NDI), this questionnaire will be used to assess disability. It comprises of 10 items; 7 related to daily living activities, 2 related to pain and 1 related to concentration. Each item is scored from 0 to 5. Total score is expressed as a percentage, with higher scores related to greater disability.
Measured: 4th day
Secondary outcomes (3)
Range of motion
Universal Goniometer (UG) It will measure range of motion of neck in each direction. (19) Universal goniometer is commonly used as a standard method to evaluate joint range of motion as a part of joint assessment.
Measured: 4th day
Craniovertebral angle
APECS/ J-App, This is software will use to measure craniovertebral angle, Craniovertebral angle is measured by taking 2 lateral photographs of the subject in a relaxed seated position without a back support. Spinous process of C7 and the tragus of ear are marked with a body marker. A horizontal line is drawn passing through C7 making a right angle with the vertical. Then, the angle between the line connecting C7 spinous process with the tragus of the ear and the horizontal line, is measured using Image J Software.
Measured: 4th day
Thoracic angle
Flexicurve method using inclinometer, It will use to measure thoracic kyphosis angle.
Measured: 4th day
Timeline
From the start of the study to its completion; the mark is today. Estimated dates are the sponsor’s plan.
- First posted13 Jan 2025
- Study start1 Jul 2024
- Primary completionJan 2025 (estimated)
- Study completionJan 2025 (estimated)
Resources
- Official record on ClinicalTrials.govThe registry entry this page is built from, with its full change history.
- Other trials for Upper Extremity DysfunctionStudies of the same condition, open and under way.
- More trials run by Riphah International UniversityThe sponsor's other registered studies.
- What the trial phases meanHow a treatment moves from first tests in people to approval.
More details
For doctors and researchers: how the study is designed, who runs it, and its registry IDs.
Study design
- Study type
- Interventional
- Phase
- Phase N/A
- Primary purpose
- Treatment
- Allocation
- Randomised
- Intervention model
- Parallel groups
- Model description
- A Randomized Clinical Trial will be conducted at Riphah Clinic Lahore, Sehat medical complex hospital Lahore through consecutive sampling technique on 52 patients which will be allocated using computer generated sampling (random number table) into Group A and Group B. Group A will be treated with kendall exercises and Group B will be treated with Proprioceptive Neuromuscular Facilitation techniques with the frequency that Stretching exercises will be performed actively for 30 second hold and 3 repetitions. Strengthening exercise will be performed for 10 second hold and 10 repetitions. All Exercises will be performed 3 times per week for total of 4 weeks. Outcome measures will be conducted through pain, range of motion, disability craniovertebral and thoracic angle after 4 weeks. Data will be analyzed during SPSS software version 25. The normality of data will be assessed by Shapiro-Wilk test after which it will be decided either parametric or non-parametric test will be used within a g
- Masking
- Double blind
- Who is masked
- Participant, Investigator
- Enrolment
- 58 participants (estimated)
Sponsor and investigators
- Lead sponsor
- Riphah International University
- Sponsor type
- University, hospital or other
- Responsible party
- Sponsor
- Investigators
- Amna Shahid, t-DPT, Principal investigator, Riphah International University
IDs, dates and publications
- ClinicalTrials.gov ID
- NCT06770205
- Sponsor's protocol ID
- REC/RCR&AHS/24/0108
- Status last verified
- Jan 2025
- First submitted
- 12 Dec 2024
- Last updated
- 13 Jan 2025
- Results posted
- No
- Data monitoring committee
- No
- FDA-regulated drug
- No
- FDA-regulated device
- No
- Individual data sharing
- No
Study at a glance
From the registry record, last updated by the sponsor on 13 Jan 2025. Recruitment status is as the sponsor reported it: confirm with the study team.
- Official title
- Effects of Kendall Exercises Versus Proprioceptive Neuromuscular Facilitation Technique on Pain, Range of Motion, Disability, Craniovertebral and Thoracic Angle in Patients With Upper Cross Syndrome
- ClinicalTrials.gov ID
- NCT06770205
- Acronym / sponsor ID
- REC/RCR&AHS/24/0108
- Conditions
- Upper Extremity Dysfunction
- Keywords
- Pain, Disability, Range of Motion, Craniovertebral angle, Thoracic angle.
- Study type
- Interventional
- Recruitment status
- Active, not recruiting
- Enrolment
- 58 participants (estimated)
- Lead sponsor
- Riphah International UniversityUniversity, hospital or other
- Study start
- 1 Jul 2024 (actual)
- Primary completion
- Jan 2025 (estimated)
- Study completion
- Jan 2025 (estimated)
- First posted
- 13 Jan 2025 (actual)
- Results
- Not posted in the source record
Clinical summary
The research question as the sponsor registered it. This describes what the study plans to test, not what it found.
Upper Crossed Syndrome (UCS) is a postural disorder characterized by a distinct pattern of muscle imbalances within the musculature of the shoulder girdle and cervico-thoracic region. The use of different corrective exercise approaches enhances and improves muscle balance and motor control thereby reducing postural abnormalities. Therefore, the aim of study will be to compare the effects of Kendall exercises versus proprioceptive neuromuscular facilitation technique on pain, range of motion, disability craniovertebral and thoracic angle in patients with upper cross syndrome.
A Randomized Clinical Trial will be conducted at Riphah Clinic Lahore, Sehat medical complex hospital Lahore through consecutive sampling technique on 52 patients which will be allocated using computer generated sampling (random number table) into Group A and Group B. Group A will be treated with kendall exercises and Group B will be treated with Proprioceptive Neuromuscular Facilitation techniques with the frequency that Stretching exercises will be performed actively for 30 second hold and 3 repetitions. Strengthening exercise will be performed for 10 second hold and 10 repetitions. All Exercises will be performed 3 times per week for total of 4 weeks. Outcome measures will be conducted through pain, range of motion, disability craniovertebral and thoracic angle after 4 weeks. Data will be analyzed during SPSS software version 25.
Detailed description
Upper Crossed Syndrome (UCS) is a postural disorder characterized by a distinct pattern of muscle imbalances within the musculature of the shoulder girdle and cervico-thoracic region. This syndrome is typified by tightness and over-facilitation of muscles such as the levator scapulae, pectoralis major, and upper trapezius, juxtaposed with the weakness or inhibition of the serratus anterior, deep neck flexors (specifically scalene), middle trapezius, lower trapezius, and rhomboids. Individuals with UCS typically exhibit a forward head posture, rounded upper back (thoracic kyphosis), elevated and protracted shoulders, and scapular winging. Prolonged and repetitive activities, such as manual material handling, especially when performed in inappropriate postures, can exacerbate the symptoms of UCS. A study involving medical students at the University of Lahore highlighted a concerning prevalence of UCS, with 48.7% of the student population reporting neck pain. The use of different corrective exercise approaches enhances and improves muscle balance and motor control thereby reducing postural abnormalities. Therefore, the aim of study will be to compare the effects of Kendall exercises versus proprioceptive neuromuscular facilitation technique on pain, range of motion, disability craniovertebral and thoracic angle in patients with upper cross syndrome.
A Randomized Clinical Trial will be conducted at Riphah Clinic Lahore, Sehat medical complex hospital Lahore through consecutive sampling technique on 52 patients which will be allocated using computer generated sampling (random number table) into Group A and Group B. Group A will be treated with kendall exercises and Group B will be treated with Proprioceptive Neuromuscular Facilitation techniques with the frequency that Stretching exercises will be performed actively for 30 second hold and 3 repetitions. Strengthening exercise will be performed for 10 second hold and 10 repetitions. All Exercises will be performed 3 times per week for total of 4 weeks. Outcome measures will be conducted through pain, range of motion, disability craniovertebral and thoracic angle after 4 weeks. Data will be analyzed during SPSS software version 25. The normality of data will be assessed by Shapiro-Wilk test after which it will be decided either parametric or non-parametric test will be used within a group or between two groups.
Study design
- Primary purpose
- Treatment
- Allocation
- Randomised
- Intervention model
- Parallel groups
- Masking
- Double blind (participant, investigator)
- Number of arms
- 2
- Model description
- A Randomized Clinical Trial will be conducted at Riphah Clinic Lahore, Sehat medical complex hospital Lahore through consecutive sampling technique on 52 patients which will be allocated using computer generated sampling (random number table) into Group A and Group B. Group A will be treated with kendall exercises and Group B will be treated with Proprioceptive Neuromuscular Facilitation techniques with the frequency that Stretching exercises will be performed actively for 30 second hold and 3 repetitions. Strengthening exercise will be performed for 10 second hold and 10 repetitions. All Exercises will be performed 3 times per week for total of 4 weeks. Outcome measures will be conducted through pain, range of motion, disability craniovertebral and thoracic angle after 4 weeks. Data will be analyzed during SPSS software version 25. The normality of data will be assessed by Shapiro-Wilk test after which it will be decided either parametric or non-parametric test will be used within a g
| Arm | Type | Receives |
|---|---|---|
| traditional physical therapy | Active comparator | Other: traditional physical therapyHot pack and TENS for 10 minutes and massage that will as 3 sessions per week for 4 weeks. |
| kendall Exercise Group A | Experimental | Other: kendall Exercise Group AThe Kendall exercise group participated in 5 sets of consisting of 12 repetitions of postures, each taking 30 seconds, based on Kendall exercise. The Kendall exercise methods were as follows: 1. Strengthening the deep cervical flexors, lying flat on the back with the chin down and then lifting the head and holding this position for 2-8 seconds to strengthen deep cervical flexors 2. Stretching the cervical extensors, placing both hands on the occipital area in a sitting position followed by a flexed neck posture with the head down to stretch the cervical extensors 3. strengthening shoulder retraction, putting a Thera Band around a secure object and pulling the band back with both hands as far as possible to move the shoulder blades toward each other in a standing position 4. stretching the pectoralis muscle, placing both hands on the occipital area and pulling the elbows back up |
Who may qualify
- Ages
- 25 to 50 years
- Sex
- All
- Healthy volunteers
- Not accepted
- Age groups
- Adult
Key inclusion criteria (8 listed)
- Patients diagnose with upper crossed syndrome.
- To diagnose upper cross syndrome, janda classification or approach will be use. Janda believed that muscle tightness or spasticity is predominant. Often weakness from muscle imbalance results from reciprocal inhibition of the tight antagonist. These patterns lead to postural changes and joint dysfunction and degeneration (23)
- Both genders male and female.
- Participants with constantly or frequently occurring neck-shoulder pain more than 1 month.
- Age between 25 and 50 years (3)
Key exclusion criteria (6 listed)
- Tumors
- Pregnancy
- Diagnosed psychological disorders
- Surgery
- Cancer and neuropathies past one year
Eligibility is decided by the study team after screening; this overview does not establish that a patient qualifies. Full inclusion and exclusion criteria.
Interventions
| Intervention | Type | Arms |
|---|---|---|
| traditional physical therapyhot pack and TENS for 10 minutes and massage that will as 3 sessions per week for 4 weeks. | Other | traditional physical therapy |
| kendall Exercise Group AThe group B will receive Proprioceptive Neuromuscular Facilitation technique for stretching and rhythmic stabilization technique for strengthening. Proprioceptive Neuromuscular Facilitation (PNF) is a stretching technique utilized to improve muscle elasticity and has been shown to have a positive effect on active and passive range of motions. The PNF group performed the intervention for 30 minutes a day, six times a week, a total of 24 times. (13) In this group, two types of PNF techniques were given: 1. first is strengthening technique included rhythmic stabilization that is characterized by alternating isometric contractions against resistance, no motion intended to apply for the weak muscles of upper cross syndrome included deep neck flexors specifically lower trapezius and serratus anterior. 2. Second is stretching technique included contract relax that is resisted isotonic contractions of the restricting muscles (antagonists) followed by relaxation and movement | Other | kendall Exercise Group A |
Primary outcome
Numeric pain rate scale
Time frame: 4th day
Numeric pain rate scale, Patient level of pain will be assessed using this scale. This scale ranges from 0 to 10. 0 indicates "no pain" and 10 indicate worst pain. The NPRS has a validity of (r=0.79-0.96) and a reliability of 0.86-0.89. (16) It takes less than one minute to complete, and can be understood in any language; i.e. there is no language barrier. It is a valid and reliable scale that measures pain intensity and experience.
Neck Disability index
Time frame: 4th day
Neck Disability index (NDI), this questionnaire will be used to assess disability. It comprises of 10 items; 7 related to daily living activities, 2 related to pain and 1 related to concentration. Each item is scored from 0 to 5. Total score is expressed as a percentage, with higher scores related to greater disability.
3 secondary outcomes
Range of motion
Time frame: 4th day
Craniovertebral angle
Time frame: 4th day
Thoracic angle
Time frame: 4th day
Results and safety
This study is still under way. Results are not available in the source record yet.
Research links
- Official record on ClinicalTrials.govLast updated by the sponsor 13 Jan 2025.
- Individual participant dataSharing planned: No
Related trials for Upper Extremity Dysfunction
RecruitingPhase 3
A Pivotal Clinical Study to Investigate the Safety and Efficacy of Efimosfermin Compared With Placebo in Adult Participants With Compensated Cirrhosis Due to Metabolic Dysfunction-associated Steatohepatitis (MASH)
Metabolic Dysfunction-associated Steatohepatitis
Recruiting
Wearable Focal Vibration Therapy on Upper Extremity Function of People With Multiple Sclerosis: A Pilot Study
Multiple Sclerosis (MS) - Relapsing-remitting, Upper Extremity Dysfunction
Not yet recruitingObservational study
From Blast Injury to Multicompartment Dysfunction:
Compartment Syndrome, Compartment Syndrome Nontraumatic Lower Extremity
Not yet recruiting
Radiofrequency and Pelvic Floor-Core Exercise for Chronic Low Back Pain in Women With Pelvic Floor Dysfunction
Chronic Low Back Pain, Urinary Incontinence
RecruitingPhase 3
A Study to Learn More About How Safe Finerenone is, When it is Taken for a Longer Time With Standard Treatment, in Children and Young Adults With Heart Failure and Left Ventricular Systolic Dysfunction
Left Ventricular Systolic Dysfunction, Heart Failure (Pediatric)
Referral and contact
AzTrials does not enrol participants or take referrals. Contact the study team or a site listed below; they decide who can take part. This study is not recruiting at the moment.
Amna Shahid, t-DPT principal investigator
Riphah International University
1 site in 1 country: see every site and its status.
Questions about this trial
What is this clinical trial studying?
A study testing traditional physical therapy and kendall Exercise Group A in people with Upper Extremity Dysfunction, run by Riphah International University at 1 site in Pakistan.
The full registered description is in the About this study section and the official record.
Who may be eligible to take part?
The sponsor lists 8 inclusion and 6 exclusion criteria. Eligibility is decided by the study team after screening, so read the full criteria and contact a listed site.
Is this clinical trial currently recruiting?
The record says: under way, not looking for participants, as of the sponsor's last update on 13 Jan 2025. Status can change between updates, so confirm with the study contact before making plans.
Where is the study taking place?
The record lists 1 site in Pakistan. Whether a site is taking part right now should be confirmed with that site. See every site.
What are the possible benefits and risks?
They depend on the study and the treatment, and no study can promise a benefit. The study team explains the known risks during informed consent, before anyone joins; the record itself does not list them.
Are results available for this study?
This study is still under way. Results are not available in the source record yet.
How can a doctor refer a patient or contact the research team?
The record lists no contact. The official record names the sponsor, who can be asked directly. AzTrials does not enrol participants or take referrals.
What does the primary outcome measure?
Numeric pain rate scale (time frame: 4th day). The study lists 2 primary outcomes in all. It is what the study was designed to measure, not a finding.
Where can I read the original study information?
Does a listing mean the treatment is approved or proven to work?
No. A listing means the study is registered. It does not show that the treatment is safe, works, or is approved by a regulator.
How often is this information updated?
AzTrials copies changed records from ClinicalTrials.gov every night and reloads the whole registry every week. The sponsor last updated this record on 13 Jan 2025.