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BMC Musculoskeletal Disorders
Published in: BMC Musculoskeletal Disorders 1/2024

Open Access 01-12-2024 | Research

The effect of various therapeutic exercises on forward head posture, rounded shoulder, and hyperkyphosis among people with upper crossed syndrome: a systematic review and meta-analysis

Authors: Simin Sepehri, Rahman Sheikhhoseini, Hashem Piri, Parisa Sayyadi

Published in: BMC Musculoskeletal Disorders | Issue 1/2024

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Abstract

Objectives

This review study aimed to evaluate the impact of therapeutic exercises on Upper-Crossed Syndrome (UCS). The study utilized a systematic review and meta-analysis approach to investigate the effects of various therapeutic exercises on forward head posture, rounded shoulders, and hyperkyphosis associated with upper crossed syndrome.

Methods

The study identified relevant keywords for each independent and dependent variable and conducted a search in scientific databases, including PubMed, Web of Science, Scopus, and Google Scholar, without any time limitations until 12 August 2023. Overall, 4625 articles were found in the selected databases, which were reduced to 1085 after being entered into the EndNote software and removing duplicate data. The full texts of 30 remaining studies were reviewed; ten articles meeting the criteria were included. Additionally, 12 studies from the Google Scholar database were included, resulting in 22 studies. Using Comprehensive meta-analysis software (CMA ver 3), data heterogeneity was measured with I2 and the Q tests. The Funnel Plot and Egger test methods were utilized to determine the possibility of publication bias. The JBI checklist was used to assess the quality of the studies.

Results

The results of the meta-analysis showed that therapeutic exercises were effective in improving forward head, rounded shoulders, and thoracic kyphosis angles (CI 95% = -1.85–1.161, P = 0.001, P = 0.001, CI95%=-1.822–1.15, and P = 0.001, CI 95%= -1.83–1.09, respectively).

Conclusion

Based on the results, it appears that performing therapeutic exercises in the form of strength exercises, stretching, shoulder-based exercises, and incredibly comprehensive exercises that target all muscles may be effective in reducing forward head, rounded shoulders, thoracic kyphosis, and overall UCS.

Level of evidence

1
Appendix
Available only for authorised users
Literature
1.
Harman K, Hubley-Kozey CL, Butler H. Effectiveness of an exercise program to improve forward head posture in normal adults: a randomized, controlled 10-week trial. J Man Manipulative Therapy. 2005;13(3):163–76.CrossRef
2.
Chang MC, Choo YJ, Hong K, Boudier-Revéret M, Yang S. Treatment of upper crossed syndrome: a narrative systematic review. Healthcare. 2023;11(16):2328.CrossRefPubMedPubMedCentral
3.
Nadler SF, Malanga GA, Bartoli LA, Feinberg JH, Prybicien M, Deprince M. Hip muscle imbalance and low back pain in athletes: influence of core strengthening. Med Sci Sports Exerc. 2002;34(1):9–16.CrossRefPubMed
4.
Muscolino J. Upper crossed syndrome. J Australian Traditional-Medicine Soc. 2015;21(2):80.
5.
Lynch SS, Thigpen CA, Mihalik JP, Prentice WE, Padua D. The effects of an exercise intervention on forward head and rounded shoulder postures in elite swimmers. Br J Sports Med. 2010;44(5):376–81.CrossRefPubMed
6.
Salsali M, Sheikhhoseini R, Sayyadi P, Hides JA, Dadfar M, Piri H. Association between physical activity and body posture: a systematic review and meta-analysis. BMC Public Health. 2023;23(1):1670.CrossRefPubMedPubMedCentral
7.
Kendall FP, McCreary EK, Provance PG, Rodgers MM, Romani WA. Muscles: testing and function with posture and pain. Lippincott Williams & Wilkins Baltimore, MD; 2005.
8.
Fatima A, Ashraf HS, Sohail M, Akram S, Khan M, Azam H. Prevalence of upper cross syndrome and associated postural deviations in computer operators. A qualitative study. Asian J Allied Health Sci (AJAHS). 2022;7(3).
9.
Katzman WB, Sellmeyer DE, Stewart AL, Wanek L, Hamel KA. Changes in flexed posture, musculoskeletal impairments, and physical performance after group exercise in community-dwelling older women. Arch Phys Med Rehabil. 2007;88(2):192–9.CrossRefPubMed
10.
Abdolahzadeh 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.
11.
Hajizadeh F, Sedaghati P, Saki F. The effect of comprehensive corrective exercises on posture of Wushu practitioners with upper cross syndrome. J Sport Biomech. 2021;7(1):30–43.CrossRef
12.
Hhajihosseini E, Norasteh A, Shamsi A, Daneshmandi H. The comparison of effect of three programs of strengthening, stretching and comprehensive on upper crossed syndrome. J Res Rehabilitation Sci. 2015;11(1):51–61.
13.
Maarouf A, Norasteh A, Daneshmandi H, Ebrahimi-Atri A. Effect of a corrective exercise program based on scapular stability on upper cross syndrome in wheelchair basketball athletes. Iran J War Public Health. 2020;12(1):19–27.CrossRef
14.
Rautenbach M. The effectiveness of spinal manipulative therapy in conjunction with a stretching program in the treatment of upper crossed syndrome. University of Johannesburg (South Africa); 2012.
15.
Claus AP, Hides JA, Moseley GL, Hodges PW. Thoracic and lumbar posture behaviour in sitting tasks and standing: progressing the biomechanics from observations to measurements. Appl Ergon. 2016;53:161–8.CrossRefPubMed
16.
Bae W-S, Lee H-O, Shin J-W, Lee K-C. The effect of middle and lower trapezius strength exercises and levator scapulae and upper trapezius stretching exercises in upper crossed syndrome. J Phys Therapy Sci. 2016;28(5):1636–9.CrossRef
17.
Seidi F, Bayattork M, Minoonejad H, Andersen LL, Page P. Comprehensive corrective exercise program improves alignment, muscle activation and movement pattern of men with upper crossed syndrome: randomized controlled trial. Sci Rep. 2020;10(1).
18.
Piri H, Hajian M, Mirkarimpour SH, Sheikhhoseini R, Rahimi M. The effect of 12-week corrective exercises on the postural angles of beautician females with upper crossed syndrome: a clinical trial study. Women’s Health Bulletin. 2021;8(2):91–7.
19.
Sheikhhoseini R, Shahrbanian S, Sayyadi P, O’Sullivan K. Effectiveness of therapeutic exercise on forward head posture: a systematic review and meta-analysis. J Manipulative Physiol Ther. 2018;41(6):530–9.CrossRefPubMed
20.
Bansal S, Katzman WB, Giangregorio LM. Exercise for improving age-related hyperkyphotic posture: a systematic review. Arch Phys Med Rehabil. 2014;95(1):129–40.CrossRefPubMed
21.
González-Gálvez N, Gea-García GM, Marcos-Pardo PJ. Effects of exercise programs on kyphosis and lordosis angle: a systematic review and meta-analysis. PLoS ONE. 2019;14(4):e0216180.CrossRefPubMedPubMedCentral
22.
Salamat H, Ghani Zadeh Hesar N, Roshani S, Mohammad Ali Nasasb Firouzjah E. Comparison of the effect of functional corrective exercises and corrective games on upper cross syndrome in 10–13 year-old boys. Sci J Rehabilitation Med. 2020;9(4):19–31.
23.
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.PubMedPubMedCentral
24.
Cheshomi S, Alizadeh MH, Barati AH, Akochakian M. The effect of six weeks corrective exercise on upper-crossed syndrome of overhead athletes. J Appl Exerc Physiol. 2018;14(27):153–66.
25.
Hosseini SM, Rahnama N, Barati AH. Comparing the effects of ten weeks of regular corrective exercise and corrective exercise with whole body vibration apparatus on upper cross syndrome. Stud Sport Med. 2017;8(20):89–106.
26.
Miri H, Shahrokhi H, Dostdar Rozbahani A, Nasirzare F. Comparison of the effect of comprehensive corrective exercises with and without posture training on upper cruciate syndrome in female students. Med J Mashhad. 2022;61(1):344–65.
27.
Javazi F, Sedaghati P, Daneshmandi H. The effect of selected corrective exercises with physioball on the posture of female computer users with upper crossed syndrome. J Sport Biomech. 2019;5(2):112–23.CrossRef
28.
Ahmadi H, Yalfani A, Gandomi F. Effectiveness of eight weeks of corrective exercises in water on postural status of young men with upper crossed syndrome: a randomized controlled clinical trial. Sci J Rehabilitation Med. 2022;11(2):292–305.CrossRef
29.
Sarvari S, Saei SM, Rahimzadeh M, Salehian MH. The effect of an online corrective training intervention on the upper cross syndrome and feelings of fatigue and pain in adolescents. Int J Pediatrics-Mashhad. 2022;10(4):15813–22.
30.
Yaghoubitajani Z, Gheitasi M, Bayattork M, Andersen LL. Corrective exercises administered online vs at the workplace for pain and function in the office workers with upper crossed syndrome: randomized controlled trial. Int Arch Occup Environ Health. 2022;95(8):1703–18.CrossRefPubMedPubMedCentral
31.
Guo Y, Li M, Xie C, Liu X, Chen Y, Yang J et al. Effect of the cervical and thoracic daoyin training on college students with upper crossed syndrome: a randomized controlled trial. 2023.
32.
Park HC, Kim YS, Seok SH, Lee SK. The effect of complex training on the children with all of the deformities including forward head, rounded shoulder posture, and lumbar lordosis. J Exerc Rehabil. 2014;10(3):172–5.CrossRefPubMedPubMedCentral
33.
Firouzjah MH, Firouzjah E, Ebrahimi Z. The effect of a course of selected corrective exercises on posture, scapula-humeral rhythm and performance of adolescent volleyball players with upper cross syndrome. BMC Musculoskelet Disord. 2023;24(1):489.CrossRefPubMedPubMedCentral
34.
Ruivo RM, Carita AI, Pezarat-Correia P. The effects of training and detraining after an 8 month resistance and stretching training program on forward head and protracted shoulder postures in adolescents: randomised controlled study. Man Ther. 2016;21:76–82.CrossRefPubMed
35.
Nitayarak H, Charntaraviroj P. Effects of scapular stabilization exercises on posture and muscle imbalances in women with upper crossed syndrome: a randomized controlled trial. J Back Musculoskelet Rehabil. 2021;34(6):1031–40.CrossRefPubMed
36.
Shalamzari MH, Motaqi M, Ghanjal A. The effects of a corrective exercise on pain and quality of life factors and spinal curvature angles of nurses with kyphosis and forward head position in a military medical center. J Military Med. 2022;23(11).
37.
Ahmadi H, Yalfani A, Gandomi F. Effect of eight weeks of corrective exercises carried out in water on static and semi dynamic balance on students with upper crossed syndrome) Janda approach. Sci J Rehabilitation Med. 2020;9(3):286–96.
38.
Cho J, Lee E, Lee S. Upper cervical and upper thoracic spine mobilization versus deep cervical flexors exercise in individuals with forward head posture: a randomized clinical trial investigating their effectiveness. J Back Musculoskelet Rehabil. 2019;32:595–602.CrossRefPubMed
39.
Mylonas K, Angelopoulos P, Billis E, Tsepis E, Fousekis K. Combining targeted instrument-assisted soft tissue mobilization applications and neuromuscular exercises can correct forward head posture and improve the functionality of patients with mechanical neck pain: a randomized control study. BMC Musculoskelet Disord. 2021;22(1):212.CrossRefPubMedPubMedCentral
40.
Page P, Frank CC, Lardner R. Assessment and treatment of muscle imbalance. (No Title). 2010.
41.
Ranđelović I, Jorgić B, Antić V, Hadžović M. Effects of exercise programs on upper crossed syndrome: a systematic review. Fizičko Vaspitanje i Sport kroz Vekove. 2020;7(2):152–68.CrossRef
42.
Comel JC, Nery RM, Garcia EL, da Silva Bueno C, de Oliveira Silveira E, Zarantonello MM, et al. A comparative study on the recruitment of shoulder stabilizing muscles and types of exercises. J Exerc Rehabilitation. 2018;14(2):219.CrossRef
43.
Weon JH, Oh JS, Cynn HS, Kim YW, Kwon OY, Yi CH. Influence of forward head posture on scapular upward rotators during isometric shoulder flexion. J Bodyw Mov Ther. 2010;14(4):367–74.CrossRefPubMed
Metadata
Title
The effect of various therapeutic exercises on forward head posture, rounded shoulder, and hyperkyphosis among people with upper crossed syndrome: a systematic review and meta-analysis
Authors
Simin Sepehri
Rahman Sheikhhoseini
Hashem Piri
Parisa Sayyadi
Publication date
01-12-2024
Publisher
BioMed Central
Published in
BMC Musculoskeletal Disorders / Issue 1/2024
Electronic ISSN: 1471-2474
DOI
https://doi.org/10.1186/s12891-024-07224-4

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