Journal of Modern Rehabilitation July 2020, Volume 14, Number 3 Research Paper: The Effect of Eight Weeks of Iyengar Yoga With an Emphasis on Spine and Shoulder Exercises on the Upper Cross Syndrome in Middle-aged Women Shilan Sohrabi1 , Mohammad Rahimi2 , Mojtaba Babaei-Mobarakeh3, Hashem Piri4* 1. Department of Physical Education & Sport Sciences, Faculty of Literature, Humanities and Social Sciences, Tehran Science and Research Branch, Islamic Azad University, Tehran, Iran. 2. Corrective Exercises and Sport Injuries, Faculty of Sport Sciences, Shahid Rajaee Teacher Training University, Tehran, Iran. 3. Department of Biomechanics and Sports Injuries, Faculty of Physical Education and Sport Sciences, Kharazmi University, Tehran, Iran. 4. Department of Corrective Exercise & Sports Injuries, Faculty of Physical Education and Sport Sciences, Allameh Tabataba’i University, Tehran, Iran. Use your device to scan and read the article online Citation: Sohrabi Sh, Rahimi M, Babaei-Mobarakeh M, Piri H. The Effect of Eight Weeks of Iyengar Yoga With an Emphasis on Spine and Shoulder Exercises on the Upper Cross Syndrome in Middle-aged Women. Journal of Modern Rehabilitation. 2020; 14(3):159-168. http://dx.doi.org/10.32598/JMR.14.3.3 : http://dx.doi.org/10.32598/JMR.14.3.3 A B S T R A C T Introduction: Upper Crossed Syndrome (UCS) is a combination of forward head, rounded shoulder, and hyperkyphosis deformities. Yoga is a non-competitive physical exercise with the Article info: potential to correct postural imbalances in the human body. Iyengar yoga is a form of Hatha yoga. Received: 21 Feb 2020 Materials and Methods: The purpose of present study was to evaluate the effect of Iyengar Accepted: 28 Apr 2020 yoga with an emphasis on spine and shoulder exercises on the UCS in middle-aged women. In Available Online: 01 Jul 2020 this quasi-experimental applied research, 15 subjects were purposefully recruited out of middle- aged women affected with UCS. The participants performed Iyengar yoga exercises with an emphasis on the spine and shoulder. The photogrammetry method was used to measure UCS. Results: At the end of 8 weeks exercises, there was a significant increase in the cervical (P<0.001) and shoulder angles (P<0.005), and a significant decrease in thoracic flexion angle (P<0.001). Keywords: Conclusion: All relevant coaches and therapists are recommended considering Iyengar yoga Iyengar, Syndrome, Exercise as an alternative for training programs in middle-aged women affected by UCS. 1. Introduction and spine from injuries during activities such as lifting, sitting, and standing [2]. However, a faulty relationship o evaluate the effect of Iyengar yoga with an between various parts of the body with abnormal spinal emphasis on spine and shoulder exercises on curves may impair this balance [3]. In this regard, Vladi- the UCS in middle-aged women. osture is mir Janda recognized three muscle imbalance patterns defined as the appropriate arrangement that accompany with distinctive pain syndromes: the up- T of the body parts [1]. In a balanced per crossed, pelvic crossed, and stratification syndromes structure, local and global muscles ac- [4]. Upper Crossed Syndrome (UCS) is also referred to tivate accordingly to protect the body * Corresponding Author: Hashem Piri, PhD. Address: Department of Corrective Exercise & Sports Injuries, Faculty of Physical Education and Sport Sciences, Allameh Tabataba’i University, Tehran, Iran. Tel: +98 (919) 9033390 E-mail: [email protected] 159 Journal of July 2020, Volume 14, Number 3 Modern Rehabilitation as forward head and rounded shoulder posture, forward malpostures like hyperkyphosis in various populations head posture and protracted shoulders, and proximal or [20]. Iyengar yoga is a form of Hatha yoga with key shoulder girdle crossed syndrome [4-6]. UCS has been aspects of correct alignment of the body and sequences defined as tightness or facilitation of postural muscles, of postures using props such as blocks, belts (rope), and namely, the pectoralis major, pectoralis minor, subscapu- chairs [21]. To the best of our knowledge, the effect of laris, latissimus dorsi, levator scapulae, upper trapezius, Iyengar yoga with an emphasis on spine and shoulder teres major, sternocleidomastoid, upper trapezius, and exercises on UCS has not been studied. Previous studies scalenes, and weakness or inhibition of phasic muscles, have examined the effects of general yoga exercises on namely, the rhomboids, serratus anterior, middle and hamstring flexibility, and discrete abnormalities such as lower trapezius, teres minor, infraspinatus, and the deep hyperkyphosis [22-27]. Also, the effects of different -ex neck flexors [7, 8]. Janda called this syndrome ‘‘upper ercises such as scapular stabilization, strengthening and crossed’’ because when the weakened and tightened mus- stretching, and comprehensive exercises on the discrete cles are joined in the upper body, they form a cross [9]. component of UCS such as FHP, RSP, and kyphosis have been investigated[28-30] . UCS results from muscle imbalances between two types of muscles, namely, postural or tonic and phasic Considering the high prevalence of UCS and its fre- muscles [10]. Predominantly postural or tonic muscles quent complications, there is no evidence about the ef- such as pectoralis major tend to become tight, whereas fectiveness of Iyengar yoga with an emphasis on spine predominantly phasic muscles such as deep-neck flex- and shoulder exercises for the management of UCS. So, ors tend to become weak [11]. People who afflicted with regarding the safety of yoga exercises and the possibility UCS will show particular postural changes, including of doing these exercises by a person alone at home, this Forward Head Posture (FHP), rounded back, elevation study aimed to evaluate the effect of Iyengar yoga with and protraction of the shoulders, winging of the scapula, an emphasis on spine and shoulder exercises on correct- and diminished mobility of the thoracic spine [4, 8]. ing UCS in middle-aged women. FHP and Rounded Shoulder Posture (RSP) as the compo- 2. Materials and Methods nents of UCS are prevalent in people of all ages and with different jobs [6, 12-15]. In an Iranian academic dental In this quasi-experimental applied study, 15 participants staff, the prevalence rates of the FHP and RSP have been were selected, using a convenience sampling method from reported as 85.5%, 68.8%, respectively [14]. The preva- middle-aged women afflicted with UCS, aged between 45 lence of UCS in laundry workers is reported as 28% [11]. and 61 years. Considering α=0.05, the power of 80%, and an effect size of 0.80, the sample size was determined as Many disorders are linked with UCS, including mi- 15 subjects by using G˟Power software [31]. The inclu- graine headaches; chronic headaches; Subacromial im- sion criteria for the participants were having a shoulder pingement; biceps tendinitis; thoracic outlet syndrome; angle less than 52°, a cervical angle less than 50°, and degeneration of the cervical spine; and joint dysfunction a thoracic flexion angle of more than 50° [32, 33]. The at the C1-C2 segment, C4-C5 segment, cervicothoracic participants would be excluded if they had a vertebral joint, and T4-T5 segment [1, 4, 8, 9, 16]. Also, dysfunc- fracture, scoliosis, severe dysplasia, rheumatic disease, tion in the sternoclavicular joint, acromioclavicular joint torticollis, persistent respiratory problems, uncontrolled and thoracic and cervical facet joints have been proposed hypertension, pulmonary disease, cervical spine, and as potential joint dysfunctions in individuals with UCS shoulder instability. They would also be excluded if they [8]. Altered scapular kinematics and muscle activity, missed practice for two consecutive sessions or more. modification in biomechanics and neuromuscular con- All participants were informed about the procedures and trol of the shoulder complex and upper extremity, and signed a consent form before the initiation of the study. reduction in glenohumeral stability are among the other consequences of UCS [1, 4, 5, 17]. UCS-related disor- Yoga exercises are performed three times a week. The ders greatly affect the safety and health status worldwide participants performed general Iyengar yoga 1 day per and it may increase in the near future [18]. week (1 hour each day) (Table 1) and Iyengar yoga home-based training with an emphasis on spine and Yoga is a way of living. It was first introduced by Swami shoulder exercises 2 days (half an hour each day) per Vivekananda in the United States in 1893, and now yoga week (Table 2). They were monitored through phone practice has evolved to target health and beauty [19]. calls, and an exercise checklist was completed by each Yoga has been traditionally used to treat many pains or participant. All exercise sessions began with the moun- Sohrabi Sh, et al. Effect of Yoga on Spine and Shoulder Exercises on the Upper Cross Syndrome. JMR. 2020; 14(3):159-168. 160 Journal of Modern Rehabilitation July 2020, Volume 14, Number 3 Table 1. General Iyengar yoga exercises Number Movement Name Description 1 Tadasana Mountain pose 2 Utkatasana Chair Pose 3 Ardha Uttanasana Standing Half Forward Bend 4 Virabhadrasana I Warrior Pose I 5 Virabhadrasana II Warrior Pose II 6 Vrikshasana Tree Pose 7 Utthita trikonasana Triangle Pose 8 Utthita parśvakonasana Extended Side Angle Pose 9 Parsvottanasana Pyramid Pose 10 Darnikasana Child pose 11 Adho-Mukha Śvanasana Downward-facing dog pose 12 Urdhva-mukha Śvanasana Upward Facing