Original Article

PREVALENCE OF UPPER CROSS SYNDROME AND ITS

CONTRIBUTING FACTORS IN WORKING
OPHTHALMOLOGIST OF LAHORE
Faryal Safdar, Dr. Iqra Waseem
University Institute of Physical Therapy, Faculty of Allied Health Sciences,
University of Lahore, Pakistan

Objective: The study's objectives were the

prevalence of upper cross syndrome and its
contributing factors in working ophthalmologists.
Methodology: This was a cross sectional study.
Data was collected from the ophthalmologist with
more than 1 year experience. Sample size was
121 which is calculated by the Epitool calculator.
Participant were made aware to the research
purpose. REEDCO postural assessment scale
used for posture evaluation with neck disability
scale for upper crossed syndrome evaluation.
Age of participants was in between of 30 to
60year. Both male and female ophthalmologist
was participated in this research with more than
1 year experience
Results: Total 121 participants, with mean age
(±39.38), males (51.2%) females (48.8%), work
experience more one years (69.4%). Prevalence
of upper crossed syndrome was 33.1% in
ophthalmologist, with forward head bend 14.9%,
difficulty in neck stability 7.4%, thoracic curve
increases 7.4%, cervical thoracic curve 5.8%.
The independent t-test was found to have
significant association (p<0.005) on posture and
upper crossed syndrome.
Conclusion: It was concluded that upper
crossed syndrome was 33.1% in working
ophthalmologist.
Keywords Upper crossed syndrome,
ophthalmologist,

INTRODUCTION
According to the World Health Organization, the
most common complaints in the world are
headaches and persistent neck pain, and among
individuals between the ages of 20 and 50,
musculoskeletal problems are one of the root
causes of impairment (James et al., 2018). Most of
these conditions are linked with people's
jobs.(Brennan-Olsen et al., 2017; Safiri et al., 2022)
With estimates of the GDP loss from absenteeism
and low productivity as high as 2%, it is well
recognised that the impairment can cause serious
medical concerns and socioeconomic
issues.(Cerezo-Téllez et al., 2016)Numerous
studies have shown that 50% of ophthalmologists
often experience work-related musculoskeletal
disorders (WMSDs) during their first five years of
practice, with musculoskeletal disorders affecting
about 90% of rehabilitation specialists.(Bevan,
2015) This could be explained by the fact that their
line of work entails extended periods of lifting,
standing, sitting, or executing manual procedures in
clinical or academic settings which accounts for the
high prevalence (66%) of lower limb disorders,
particularly in the low back and neck region.(Da
Costa & Vieira, 2010) Musculoskeletal problems at
work are still very prevalent and pose a significant
challenge to therapists(Javed, Fatima, & Jadoon,
2022; Weon et al., 2010). The new phrase, "work-
related musculoskeletal disorders," has less bearing
on the aetiology than the previous terms, which
were more frequently used to refer to repetitive
strain injuries or trauma illnesses(Fatima et al.,
2022). If not treated properly, these illnesses, which
affect the neck, upper limbs, and lower limbs, can
be quite expensive.(Bernard & Putz-Anderson,
1997)
Upper Cross Syndrome (UCS), also known as
cervical cross syndrome, is characterised by an
alternate pattern of weakness and tension in the
Scalene muscles, pectoralis major, levator
scapulae, rhomboids, and deep neck flexors(Sasun,
Jawade, Chitale, & Chitale, 2022), as well as the
upper trapezius and pectoralis major, which is
brought on by bad work habits, poor body
ergonomics, or low self-esteem.(Rajalaxmi, Paul,
Nithya, Lekha, & Likitha, 2018) Instead of merely
involving one muscle, Upper Cross Syndrome is
characterised by muscle imbalance in the skeletal
system activation and inhibition. Muscular
insufficiencies occur if the tonic and phasic muscles
fail to activate simultaneously.(Kim Christensen &
DACRB)
The primary reason for missing work and the second
sustainable source of disability worldwide are work-
related musculoskeletal disorders (MSDs).(Woolf &
Pfleger, 2003) Chronic pain in the lower back is the
most focal reason of include in MSDs. (Shaw,
Bourkiza, Wickham, Mccarthy, & Mckechnie,
2017) In the entire world, occupation is responsible
for % of cases of lower back pain.
ophthalmologists(Mortazvi, Dorosti, & Moharrami,
2020). The musculoskeletal issues of paediatric
ophthalmologists were the primary emphasis; there
was no examination. Ophthalmologists typically
blame neck and back pain on the magnifying loupes
used during surgery.(Epstein et al., 2018)
The goal of this study was to determine the
prevalence of Upper Cross Syndrome (UCS) in
practising ophthalmologists, evaluate the
association between UCS and WRMSD, and
identify potential areas for major ergonomic
advancement.
METHODOLOGY
In this cross-sectional study, data was collected
from the ophthalmologist with more than 1 year
experience. Sample size was 121 which is
calculated by the Epitool calculator. Participant
were made aware to the research purpose.
REEDCO postural assessment scale used for
posture evaluation with neck disability scale for
upper crossed syndrome evaluation. Age of
participants was in between of 30 to 60year. Both
male and female ophthalmologist was participated
in this research with more than 1 year experience.
Both male and female working ophthalmologist
were included in the study. Ophthalmologist
working from beginner to proficient level of
experience were included in the study of age 30 to
60.
The study was conducted at Physiotherapy
department of university of Lahore Teaching
Hospital, Defence Road, Lahore.
Mansoorah hospital, social security hospital, ganga
ram. It included 112 ophthalmologists of Lahore.
Participants having novice level of experience,
 recent trauma of neck and spine, surgery, fracture,
soft tissue malignancy of neck and upper limb and FREUENCY OF UPPER
any congenital deformities of neck were not CROSSED SYNDROME
included in this study.

RESULTS 29%
A sample of 112 of ophthalmologists were included
in the study. According to the work experience of
the participants. Participants with more than 1 year
84(69.4%), with 1 year experience were 28(23.1%), 81%
9(7.4%) participants with less than one year
experience of work. Table-1 shows the frequency of
gender and frequency of work experience of
participants.The REEDCO scale assessment was
used to access participants. Its show that only
15(12.4%) participants with severe disability, YES NO
22(18.2%) participants with moderate disability,
and 83(68.6%) participant with no disability.
According to the NDI assessment in participants.
17(14.0%) with severe disability of neck, However the prevalence of upper crossed syndrome
26(21.5%) with moderate disability, and in working ophthalmologist is 40(33.1%).While
participants with no disability were 78(64.5%). studying the contributing factors of Upper crossed
syndrome in participants. The results show that
18(14.9%) participants with marked forward bend
Variable frequency Percentage head. 9(7.4%) participants with increased thoracic
Gender(male) 62 51 curve, While 7(5.8%) participants with increased
cervical curve. Participants with shoulder bended on
Gender(female) 59 48.8 one side markedly were 8(6.6%). Participants who’s
Less than one year 9 7.4 neck stabilization was difficult markedly were
9(7.4%). Participants with increased spine curve
1 year 28 23.1 were 6(5.0%).The Table no. 2 shows the frequency
of REEDCO assessment, NDI assessment and the
More than 1 year 84 69.4
prevalence of upper crossed syndrome among the
Table 1. Frequency of gender and work experience of participants as well as the factors that contribute to
participants the prevalence of upper crossed syndrome
 Table 2. Frequency of REEDCO and NDI assessment and prevalence of upper crossed syndrome and
frequency of contributing factors

Variable frequency Percentage

REEDCO
No disability 83 68
Moderate disability 22 18
Severe disability 15 12
NDI
No disability 78 64
Moderate disability 26 21
Severe disability 17 14
POSTURE
Forward head 18 14.9
Increased thoracic curve 9 7
Increased cervical curve 7 5.8
Bended shoulder 8 6.6
Difficulty in neck stablilization 9 7.4
Spine curve 6 5.0

f Sig. T Df Std. Error

difference
Equal 141.018 .000 -17.803 119 .072
.
variance
assumed
Equal -13.063 41.564 .098
variance
not
assumed
Table 3. shows the relation between mean
posture and upper crossed syndrome
DISCUSSION The Upper Cross Syndrome (UCS) is an
The findings of this study revealed the prevalence understudied phenomenon despite physiotherapists
of Upper crossed syndrome was 33.1% in working are alleged to have sufficient understanding of
ophthalmologists and screening revealed that correct posture and adequate knowledge of
forward head posture 14.9% , increase thoracic musculoskeletal disorders, they're at high risk of
curve 7.4%, increase cervical curve 5.8%, bended developing Work-Related Musculoskeletal
shoulder, 6.6%, spine curve 5.0% in working Disorders (WMDs). To date, there are several
ophthalmologist. The independent t-test analysis studies reported to ascertain the frequency and
was found to have significant association profile of Work-Related Musculoskeletal Disorders
(p<0.005) on posture and upper crossed syndrome. (WMDs) among Physiotherapist (PTs), however
It was reveled that both female and male gender there's lack of data regarding prevalence of Upper
were more vulnerable to develop the disorder Cross Syndrome (UCS) among Physiotherapist
while bad posture associated with disorders. Upper (PTs) in Pakistan. Therefore, future researches are
cross syndrome apparently seems a simple required to gauge the burden of the musculoskeletal
muscular imbalance but it may impart huge stress disorders to strategize effective prevention and
on economy of country via resulting in frequent management strategies. Moreover, there is no data
loss of work days due to neck pain. available to evaluate the psychological stress, work
If proper steps are not taken at this moment this performance and its relationship with Work
simple syndrome one day may become an endemic Related Musculoskeletal Disorders (WRMDs)
not only in working population and students only especially in healthcare professionals.
but also in people with luxurious life style as they
are the one who are least bothered regarding their
posture (Trinkoff, Le, Geiger‐Brown, Lipscomb, CONCLUSION
& Lang, 2006). Finally it is recom- mended that It was concluded that upper crossed syndrome
some serious steps should be taken to gener- ate prevalence was found to be 33.1% in working
postural awareness in people of all ages especially ophthalmologists. The findings of this investigation
students. shouldn’t be extrapolated because of the limited
Prevalence of Upper Cross syndrome (UCS) has sample size, and additional analysis is advised for
been studied among students as well, a study that future investigations
concluded that medical students who did not give
attention to their postures, prolong duration of
classes and long term time spending on laptops/
personal computer led them to develop Upper
Cross syndrome (UCS) in their future, was found
to be 37.1%22. This condition is not only
prevalent among professional health care workers
but also related in abundance with the labors in
various sectors of the industry. Mujawar, and
Sagar23 have figured out a prevalence of Upper
Cross syndrome (UCS) being 28% in laundry
workers owing to their abnormal posture for long
working hours. The chief complaints were noted
as neck pain presenting with forward head and
neck posture. There is need for more researchers
in work related musculoskeletal disorders to be
studied with respect to profession, age, gender
and the chief complains, psychological issues,
work performance and the limitations this
condition makes for an individual in his/her life.

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