Immediate and Prolonged Effects of Breathing Exercises on Pain, Quality of Life & Functional Disability in Patient of Upper Cross Syndrome: A Randomized controlled trial

Main Article Content

Mahnoor Liaqat
Malik Muhammad Atif
Muhammad Imran Nawaz
Tehreem Iqbal
Syeda Khadija Kazmi


Background: The advent of smartphone technology and its increased use, especially during the COVID-19 pandemic, has led to a rise in musculoskeletal disorders, including upper cross syndrome. This condition, characterized by muscle imbalances around the cervical spine and shoulder girdle, results in pain, functional disability, and decreased quality of life. Breathing exercises have been suggested as a therapeutic intervention to address these issues, yet empirical evidence on their effectiveness remains sparse.

Objective: This study aimed to evaluate the immediate and prolonged effects of breathing exercises on pain, functional disability, and quality of life in patients with upper cross syndrome, filling a gap in the literature regarding non-pharmacological interventions for this condition.

Methods: Conducted as a single-blinded randomized controlled trial at Jinnah Memorial Trust Hospital, Gujranwala, Pakistan, this study involved 76 participants with upper cross syndrome, randomized into control (standard physical therapy) and experimental (standard physical therapy plus breathing exercises) groups. Pain was assessed using the Numeric Pain Rating Scale (NPRS), functional disability with the Neck Disability Index (NDI), and quality of life through the SF-36 questionnaire. Assessments were made at baseline, after the first session, and after four weeks. Data analysis was performed using SPSS version 25, employing the Mann-Whitney U Test for between-group comparisons and the Paired Sample T-test for within-group analyses.

Results: The experimental group demonstrated significantly superior improvement compared to the control group in NPRS scores after the first session (p<0.001) and after four weeks (p<0.001), NDI scores (p<0.001 at both intervals), and all eight domains of the SF-36 (p<0.05 for each domain after four weeks), indicating that breathing exercises significantly reduce pain and functional disability while enhancing quality of life.

Conclusion: Breathing exercises are a safe and effective adjunct to standard physical therapy for patients with upper cross syndrome, significantly improving pain management, functional disability, and quality of life. This study underscores the potential of integrating breathing exercises into rehabilitation programs for musculoskeletal disorders related to excessive technology use.

Article Details

How to Cite
Liaqat, M., Atif, M. M., Nawaz, M. I., Amna, Iqbal, T., & Kazmi, S. K. (2024). Immediate and Prolonged Effects of Breathing Exercises on Pain, Quality of Life & Functional Disability in Patient of Upper Cross Syndrome: A Randomized controlled trial. Journal of Health and Rehabilitation Research, 4(1), 1343–1348.
Author Biographies

Mahnoor Liaqat, University of Sargodha Pakistan.

University of Sargodha, Pakistan.

Malik Muhammad Atif, University of Sargodha Pakistan.

Lecturer, Department of Allied Health Sciences, University of Sargodha, Pakistan.

Muhammad Imran Nawaz, Gulab Devi Teaching Hospital Lahore Pakistan.

Senior Lecturer, Gulab Devi Institute of Physiotherapy, Gulab Devi Teaching Hospital Lahore, Pakistan.

Amna, University of Management and Technology Sialkot Pakistan.

Lecturer, University of Management and Technology Sialkot, Pakistan.

Tehreem Iqbal, Superior College Gujranwala Pakistan.

Lecturer, Superior College Gujranwala, Pakistan.

Syeda Khadija Kazmi, University of Management and Technology Sialkot Pakistan.

Lecturer, University of Management and Technology, Sialkot, Pakistan.


Zhu S, Zhuang Y, Lee P, Li JC-M, Wong PW. Leisure and Problem Gaming Behaviors Among Children and Adolescents During School Closures Caused by COVID-19 in Hong Kong: Quantitative Cross-sectional Survey Study. JMIR serious games. 2021;9(2):e26808.

Wong CW, Tsai A, Jonas JB, Ohno-Matsui K, Chen J, Ang M, et al. Digital Screen Time During the COVID-19 Pandemic: Risk for a Further Myopia Boom? American Journal of Ophthalmology. 2021 2021/03/01/;223:333-7.

Moretti A, Menna F, Aulicino M, Paoletta M, Liguori S, Iolascon G. Characterization of home working population during COVID-19 emergency: a cross-sectional analysis. International Journal of Environmental Research and Public Health. 2020;17(17):6284.

Moore MK. Upper crossed syndrome and its relationship to cervicogenic headache. Journal of manipulative and physiological therapeutics. 2004;27(6):414-20.


Roshani S, Mahdavinejad R, Ghanizadehesar N. The effect of a NASM-based training protocol on upper cross syndrome in paraplegia spinalcord injury patients. scientific journal of ilam university of medical sciences. 2018;25(6):73-85.

Ratnovsky A, Elad D, Halpern P. Mechanics of respiratory muscles. Respiratory physiology & neurobiology. 2008;163(1-3):82-9.

Mohan V, Ahmad NB, Tambi NB. Effect of respiratory exercises on neck pain patients: A pilot study. Polish Annals of Medicine. 2016 2016/02/01/;23(1):15-20.

Goodyear MD, Krleza-Jeric K, Lemmens T. The declaration of Helsinki. British Medical Journal Publishing Group; 2007.

Mintken PE, Glynn P, Cleland JA. Psychometric properties of the shortened disabilities of the Arm, Shoulder, and Hand Questionnaire (QuickDASH) and Numeric Pain Rating Scale in patients with shoulder pain. J Shoulder Elbow Surg. 2009;18(6):920-6.

Sterling M, Rebbeck T. The neck disability index (NDI). Australian Journal of Physiotherapy. 2005;51(4):271.

Jenkinson C, Stewart-Brown S, Petersen S, Paice C. Assessment of the SF-36 version 2 in the United Kingdom. Journal of Epidemiology & Community Health. 1999;53(1):46-50.

Mohan V, Ahmad NB, Tambi NB. Effect of respiratory exercises on neck pain patients: A pilot study.

THONGTIPMAK S, BURANRUK O, EUNGPINICHPONG W, KONHARN K. Immediate Effects and Acceptability of an Application-Based Stretching Exercise Incorporating Deep Slow Breathing for Neck Pain Self-management. Healthcare informatics research. 2020:50-60.

Kang J-I, Jeong D-K, Choi H. The effect of feedback respiratory exercise on muscle activity, craniovertebral angle, and neck disability index of the neck flexors of patients with forward head posture. Journal of physical therapy science. 2016;28(9):2477-81.

Radhakrishnan R, Senthil P, Rathnamala D, Gandhi PS. Effectiveness of global posture re-education on pain and improving quality of life in women with chronic neck pain. Int J Phys Educ Sports Health. 2015;1(1):7-9.

Jeong GH, Lee BH. Effects of Telerehabilitation Combining Diaphragmatic Breathing Re-Education and Shoulder Stabilization Exercises on Neck Pain, Posture, and Function in Young Adult Men with Upper Crossed Syndrome: A Randomized Controlled Trial. Journal of Clinical Medicine. 2024 Mar 11;13(6):1612.

Kandil EA, Yamany AA, Alsaka SS, Abd El-Azeim AS. Effect of global postural reeducation on chronic low pain patients with lower cross syndrome. Bulletin of Faculty of Physical Therapy. 2024 Feb 28;29(1):8.

Özlü A, Üstündağ S, Bulut Özkaya D, Menekşeoğlu AK. Effect of Exergame on Pain, Function, and Quality of Life in Shoulder Impingement Syndrome: A Prospective Randomized Controlled Study. Games for Health Journal. 2024 Feb 23.

Zuo C, Zheng Z, Ma X, Wei F, Wang Y, Yin Y, Liu S, Cui X, Ye C. Efficacy of Core Muscle Exercise Combined with Interferential Therapy in Alleviating Chronic Low Back Pain in High-Performance Fighter Pilots: A Randomized Controlled Trial. BMC Public Health. 2024 Dec;24(1):1-2.