Dallas Chiropractor Best Practices
Research Commentary;

Best Care for Upper Back Pain

A review of

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. https://doi.org/10.3390/healthcare11162328

By Dr. Bryan Stephens

Summarized Review Conclusions

Upper cross syndrome, UCS, has become more prevalent in society with the increased time sitting or looking at devices. As tension continues to build in the anterior chest and posterior neck, weakness builds in the upper back and then the front of the neck as well. This creates a hunched position which adds to many musculoskeletal symptoms such as “headaches, neck pain, chest pain, upper back pain, tingling in the upper arms, or a limited range of motion in the neck or shoulders.”

“The awkward positions put constant pressure on the joints, and degenerative changes in joints progress rapidly when exposed to sustained pressure, causing muscle imbalances and pain”

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. https://doi.org/10.3390/healthcare11162328

“If a muscle imbalance continues and progresses, this may lead to altered movement patterns and joint damage, creating further dysfunction.”

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. https://doi.org/10.3390/healthcare11162328

“Correcting postural muscle imbalances may decrease the mechanical stress on muscles, which can result in a reduction in pain, neck disabilities, and a restricted ROM, and corrective exercises can improve postural deviations in patients with UCS.”

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. https://doi.org/10.3390/healthcare11162328

Introduction to the Research

Upper cross syndrome has become more common through our society as it is brought on by prolonged time in an abnormal posture. Most often, this posture is with the head pulled forward along with shoulders rotated to the front. The reason for this being so common now, this position occurs when people are at a computer, looking at their phone, reading, texting, and driving to name a few things. As time goes on, the front of the neck becomes inhibited while the chest is tightened, along with tension in the back of the neck at the base of the skull along with stretching and weakening of the muscles in the upper back. Over time, this adds to more issues such as neck and back pain along with increased frequency of headaches.

Research Methodology

“The following inclusion criteria were applied for the selection of articles: (1) patients with UCS; (2) patients with neck pain; and (3) a comparison of the effect of therapeutic interventions with controls. The exclusion criteria were as follows: (1) studies that were not related to UCS; (2) reviews; (3) case reports; (4) commentaries; (5) letters; (6) animal studies; and (7) study outcomes that were not reported or insufficient. After reading the titles and abstracts, two independent reviewers (SYY and MCC) excluded articles and assessed the full-text articles to reject those ones not fulfilling the inclusion criteria. Any disagreement was resolved by consensus. The opinion of a third reviewer was put into consideration to resolve the disagreement if necessary.
All data were extracted independently by reviewers (SYY and MCC) using a standard data collection form. Discrepancies were resolved through consensus and discussions with another reviewer (KYH). The following data were collected from each eligible article: (1) the name of the first author, (2) the year of publication, (3) the study design, (4) the number of patients, (5) the duration of treatment, (6) the intervention programs, and (6) the outcome measures.
The methodological quality of randomized controlled trials (RCTs) was assessed using a revised tool for assessing the risk of bias in randomized trials (RoB 2) [10], while the non-RCT was evaluated using a tool for assessing the risk of bias in non-randomized studies of interventions (ROBINS-I) [11]. RoB 2 comprises a total of five evaluation domains: (1) bias arising from the randomization process, (2) bias due to deviations from the intended intervention, (3) bias due to missing outcome data, (4) bias in the measurement of the outcome, and (5) bias in the selection of the reported result. Depending on the degree of the risk of bias within each domain, the evaluations are categorized as “low”, “some concerns”, “high”, or, in cases where there is insufficient information for an assessment, “no information”. On the other hand, ROBINS-I consists of seven domains: (1) bias due to confounding, (2) bias due to the selection of participants, (3) bias in the classification of interventions, (4) bias due to deviations from the intended interventions, (5) bias due to missing data, (6) bias in the measurement of the outcomes, and (7) bias in the selection of the reported result. Each domain is rated as “low”, “moderate”, “serious”, “critical”, or “no information” depending on the level of bias risk. Either RoB 2 or ROBINS-I was used to assess the overall risk of bias for each included study. The overall risk of bias represents the least favorable evaluation across all bias domains.”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. https://doi.org/10.3390/healthcare11162328

Research Findings

“The results of the included studies showed that postural correction exercises and ergonomic interventions improved pain in patients with UCS [2,14,20,21]. This may be related to the mechanism whereby neck pain can be aggravated by prolonged sitting or an incorrect posture; an improper posture can increase the load on the cervical spine and induce muscle imbalances by changing the muscle length [29]. The repetitive mechanical stress on the neural, muscular, and articular tissues of the neck and shoulders can increase the tissue mechanosensitivity and negatively affect the tolerance of the central nervous system, resulting in pain and hyperalgesia [30]. Therefore, education about posture awareness, posture-corrective exercises, and strengthening and endurance exercises can be helpful for maintaining an upright neutral postural position [31]. Studies have reported that treatment programs for UCS were effective at restoring the normal sagittal configuration of the head, neck, and shoulders [2,14,15,20]. Normalizing the cervical spinal curve may also improve shoulder alignment because our body structures are all connected. Thus, sustaining a proper posture may result in an overall decrease in abnormal stresses on tissues, which can lead to a reduction in pain. Corrective exercises help patients to activate and increase the activity of inhibited, weak muscles and reduce the activity of overactive muscles to restore muscle balance and improve neuromuscular control.
Exercise programs, such as stretching exercises and cervical or scapulothoracic stabilization exercises, also improved neck disabilities [16,21]. An abnormal posture of the head and neck can decrease the proprioception of the neck [32]. The loss of proprioception feedback brings negative effects to the head and neck muscle function, reaction time, postural stability, and postural control [33]. Correcting an abnormal head posture seems to improve neck disabilities, as it enhances the proprioception of the neck.”

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. https://doi.org/10.3390/healthcare11162328

Research References

As always with these reviews, these are my takeaways from the article and I encourage you to read the article in its entirety. The references used in this article by the authors of this article are listed here.

Our Message

When you are looking for a Chiropractor near you that you can trust, choose one who will not only get rid of your back pain, neck pain, or headaches but who will also guide you to living a healthier lifestyle to keep you out of pain. Our East Dallas Chiropractors located in Lakewood, near the corner of Mockingbird Ln. and Abrams Rd., are here to teach you that taking care of your mental health and getting the proper nutrients are just as important as the chiropractic adjustment to stay healthy.