The effectiveness of a multimodal approach in the treatment of patients with upper crossed syndrome: A randomized controlled trial

Abstract

Objectives: Considering the multitude of contributing factors to upper crossed syndrome (UCS), a multimodal treatment may be an effective therapeutic option. This study aimed to examine the effectiveness of the multimodal approach, including muscle energy technique (MET), cervical and scapulothoracic stabilization exercises, and postural correction training with ergonomic advice, in the treatment of patients with UCS.

Methods: This randomized controlled trial randomly assigned 40 patients with UCS aged 30-55 years to either group A (intervention group, n = 20) who received the multimodal approach or group B (control group, n = 20) who received MET only. The trial evaluated the craniovertebral angle (CVA) and sagittal shoulder angle (SSA) measured by photogrammetry, pain intensity estimated using the visual analog scale (VAS), and functional disability evaluated using the Arabic version of the neck disability index (ANDI) pretreatment and four weeks after intervention.

Results: The within-group analysis demonstrated a substantial decrease in VAS and ANDI and an increase in CVA post-intervention (P < 0.001). Only the multimodal group exhibited a significant change in SSA (P < 0.0001). Between-group differences were noteworthy, favoring the multimodal intervention (P < 0.0001).

Conclusions: A 4-week multimodal approach that comprises MET, cervical and scapulothoracic stabilization exercises, and postural correction training with ergonomic advice has remarkable improvements in CVA, SSA, pain intensity, and functional disability in patients with UCS, highlighting it as a superior choice.

Keywords: Manual therapy; Multimodal approach; Rehabilitation; Upper crossed syndrome.