Middle Eastern Journal of Disability Studies

Abstract
Background & Objectives: Upper cross syndrome occurs in the neck and shoulder area. In this syndrome, the upper posterior and anterior muscles of the neck are shortened, and the deep posterior muscles of the spine in the neck region and the lower posterior muscles of the scapula bone, which are mainly phasic muscles, are inhibited. Janda described and argued that the problem of forward head posture in upper crossed syndrome occurs when a hunched sitting position is maintained for a long period. To gain muscle strength and endurance and help maintain the ability to perform normal life activities, neck stabilization exercises are a very common method used in rehabilitating people with neck problems. In addition, shoulder and neck stabilization exercises are an effective way to restore muscle imbalances. The present study compared the effect of four weeks of shoulder and neck stabilization exercises with exercises based on the Janda approach on the electrical activity of selected muscles and the postural alignment in people with upper cross syndrome.
Methods: The current research is quasi–experimental with two training groups. A total of 24 men with upper cross syndrome were selected and placed in 2 training groups based on the Janda approach (12 people) and the shoulder and neck stability training group (12 people). The statistical population of the present study included young men aged 18 to 25 years with upper cross syndrome from students of Shahid Beheshti University in Tehran City, Iran. The inclusion criteria include having an age range of 18 to 25 years, lacking sports experience in the last year, body mass index between 18 and 25 kg/m², male gender, and voluntary consent of the subjects to participate in the research. The exclusion criteria include having more than 2 absences in training sessions, causing pain in any part of the body during exercises so that the person cannot continue the exercise, and the subject's unwillingness to continue participating in the research. In this study, the angle of the forward head and forward shoulder was evaluated by photographic method (Maarouf et al., 2020). Also, the flexible ruler's kyphosis was determined (Maarouf et al., 2020). Besides, in this study, electromyography was used to assess the activity of the upper, middle, and lower trapezius, serratus anterior, and sternocleidomastoid muscles (Falla et al., 2003; Mclean et al., 2005). The percentage of muscle activity (UT, MT, LT, SCM, and SA) was recorded using EMG, and data analysis was done with Matlab software (Falla et al. 2003; Mclean et al. 2005). After skin preparation, the electrodes were placed according to the SENIAM European protocol. Then, the reference electrode for each muscle was connected to the nearest bony site of the muscle. The electrodes' correctness and stability were ensured by simultaneously touching and observing the muscle mass and the isolated contraction of the selected muscles. All data collection was on the dominant side of the subjects (Falla et al. 2003; Mclean et al. 2005); the raw signals collected in the scaption task were stored in the Megawin program. In addition, maximal isolated voluntary contraction (MVIC) was used to normalize and standardize data with root mean square (RMS). The average RMS value of MVIC was multiplied by 100 to obtain the percentage of muscle activity. After evaluating the variables, the subjects of the two groups did the corrective exercise program for 4 weeks (3 sessions per week). After the end of the training period, the evaluations were done again. The Kolmogorov–Smirnov test was used to check the normality of data distribution in the following to investigate the difference between groups; the analysis of covariance was used using SPSS version 26 software, and MATLAB software was also used to convert the raw EMG data. The level of significance in the present study was considered 0.05.
Results: Results of covariance analysis showed that after removing the effect of the pretest of scapula–neck stabilization exercises for the variables of upper trapezius (p=0.020), lower trapezius (p<0.001), forward head (p=0.002), forward shoulder (p=0.027), and kyphosis (p<0.001) performed significantly better than Janda exercises. However, there was no significant difference in the middle trapezius (p=0.065), stratus anterior (p=0.257), and pectoralis major (p=0.126) variables.
Conclusion: According to the study results, the effect of exercises with the Janda approach and scapula and neck stabilization exercises is to improve the activity of selected muscles and reduce the abnormality of the upper cross syndrome. In addition to these findings, more favorable results were obtained following scapula and neck stabilization exercises than with the Janda approach.