Comparative Effects of Reverse Natural Apophyseal Glides Versus Sustained Natural Apophyseal Glides in Patients With Upper Cross Syndrome

Description

This study will compare the effectiveness of two manual therapy interventions combined with a standardized conventional physiotherapy protocol in individuals with Upper Cross Syndrome. Participants will be randomly allocated into two groups. Group A will receive Reverse Natural Apophyseal Glides, while Group B will receive Sustained Natural Apophyseal Glides. Both manual therapy interventions will primarily target the lower cervicaland upper thoracic spine specifically C6 to T2 and will be administered for 3 times a week for 4 weeks. The conventional physiotherapy protocol will be identical for both groups and will include a 10-minute hot pack followed by stretching of the pectoralis, upper trapezius and levator scapulae, each stretching exercise will be performed for 10 repetitions, 3 sets, with a 10 second hold per repetition. The strengthening program will target the deep cervical flexors and scapular stabilizers, including middle trapezius, lower trapezius, serratus anterior and rhomboids. Strengthening exercises will be performed for 10 repetitions, 3 sets, with a 10 second hold per repetition. The manual therapy component will differ between groups, allowing comparison of Reverse Natural Apophyseal Glides and Sustained Natural Apophyseal Glides when used alongside the same conventional intervention. This standardized approach aims to evaluate the comparative effects of the two manual therapy techniques on the postural and functional impairments associated with Upper Cross Syndrome.

Interventions

• Reverse Natural Apophyseal Glides (Procedure)
  Participants will receive Reverse Natural Apophyseal Glides to the C6-T2 cervicothoracic region in sitting, using small-amplitude rhythmic oscillations at end-range facet movement. Day 1 will include 1 set of 3 oscillations, progressing to 3 sets of 10 oscillations for the remaining days. Hot pack will target the posterior cervical and upper thoracic region for 10 minutes in prone lying. Pectoralis, upper trapezius, and levator scapulae stretching will be performed with 10 seconds hold, 3 sets of 10 repetitions, with 5-second intervals. Strengthening will include chin tucks, supine foam roller exercises at three abduction angles on day 1-3, side-lying external rotation and forward flexion on days 4-6, prone V, T, W exercises on days 7-9, and standing diagonal flexion and military press on days 10-12.
• Sustained Natural Apophyseal Glides (Procedure)
  Participants will receive Sustained Natural Apophyseal Glides to the C6-T2 cervicothoracic region in sitting. Therapist will stabilize the spinous process with the thumb while applying a sustained posterior-to-anterior glide toward the eyes during cervical extension with end-range overpressure. Day 1 will include 1 set of 3 repetitions, progressing to 3 sets of 10 repetitions for the remaining days. Hot pack will target the posterior cervical and upper thoracic region for 10 minutes. Pectoralis, upper trapezius, and levator scapulae stretching will involve 10-second holds, 3 sets of 10 repetitions. Strengthening will include chin-tucks, supine foam roller exercises at three abduction angles on day 1-3, side-lying external rotation and forward flexion on days 4-6, prone V, T, W exercises on days 7-9, and standing diagonal flexion and military press on days 10-12.

Eligibility criteria

Conditions

Locations

• Foundation University College of Physical Therapy — Islamabad, Punjab Province, Pakistan