Literature Review

 A study published in 2020 looked at the effectiveness of ELDOA exercises at the cervical
spine and treating trigger points in the trapezius and levator scapulae on 74 people with
chronic neck discomfort. The findings showed that the ELDOA approach considerably
reduced discomfort, cervical ranges, and neck impairment brought on by trigger points.(Javaid
et al., 2022)
 A research consisting of 44 males and females patients aged 30-40 years, with the diagnosis of
forward head posture also called as text neck syndrome was conducted. The study design was
quasi experimental. All the patients received three sessions per week for 4 weeks after
selection through convenience sampling technique. The assessment was done at baseline, first,
fourth and twelveth post treatment day. The finding revealed that ELDOA exercises were
found to be effective in the correction of forward head posture.(Waqar, Khalid, & Khalid,
2022)
 In 2016 a study was conducted to observe the effect of suboccipital muscle inhibition
technique (SMI) to correct craniocervical posture. A randomized, single blinded clinical study
with a sample of 24 patients that were divided into experimental (n=12) who underwent SMI
and sham group (n=12) who underwent a sham (placebo) intervention was done. The effect
size is large in SMI group.(Rizo et al., 2012)
 Harman-at-al did a research to correct the head\thorax posture of computer
workers. A computer generated random number list supplied by an
investigator with no clinical participation in the experiment was used for
block randomization. The participants were allocated in two groups, group A
received neck isometrics as conventional treatment with strengthening
exercises on deep neck flexors and shoulder muscles and stretching exercises
on pect minor and neck flexors. Group B received only neck isometrics.
Results showed a decrease in cervical angle, pain, anxiety and an
improvement in quality of life for group A (Mylonas et al., 2021)
 All previous studies in which the suboccipital muscle inhibition technique
has been performed on different muscles have shown greater improvement in
comparison to other techniques. However, the suboccipital muscle inhibition
technique and ELDOA have never been compared and performed to cervical
region. Therefore, the current study is designed to compare the effects of
myofascial stretching ELDOA and suboccipital muscle inhibition technique
on pain, muscle length and functional performance in patients with text neck
syndrome
Aims and Objectives

 To see the effect of ELDOA technique on pain and disability in text neck
syndrome patients.
 To see the effect of sub-occipital muscle inhibition technique on pain and
disability in text neck syndrome patients.
 To reduce pain intensity
 To improve range of motion in cervical spine
 To improve functional ability
Hypothesis

 Alternate hypothesis (HA)

ELDOA technique will be more effective to reduce pain and range of cervical
spine in patients with text neck syndrome
 Null hypothesis (HO)
Sub-occipital muscle inhibition technique will be more effective to reduce pain
and range of cervical spine in patients with text neck syndrome
Material and methodology

 Study design: Quasi experimental study

 Sample size: 44(male and female) (Waqar et al., 2022)
 Sampling technique: Convenient sampling
 Duration of study: 6 months
 Setting: Common civilians of Faisalabad.
Selection criteria
 Inclusion criteria
Aged 24 to 40 years
History of chronic neck pain (for at least 3 months)
pain > 30 NRS
Palpable taut bands in skeletal muscles
Reduced ROMs
Willingness and proper understanding of patient to perform test:acromion to wall test >5cm
(Waqar et al., 2022)
 Exclusion criteria
Surgery of spine or any extremity
Cervical osteoporosis
Cervical radiculopathy
Spinal infection
Malignancy of upper extremity or thorax
(Waqar et al., 2022)
Measurement tools

 Numeric Pain Rating Scale.

 Neck disability index.
 Inclinometer.
 Tragus to wall distance test.
 Global Rating of change scale.
 Fear Avoidance Belief Questionnaire.
 Physical Health:SF-36
Data collection procedure
This study will be quasi experimental study. 44 participants will be randomly allocated to group A and
group B which will meet the selection criteria from common civilians of Faisalabad. Participants will
sign a consent form before entering the study. Data will be collected through coin tossing technique.
Group A (n=22) will receive ELDOA and baseline treatment and group B (n=22) will receive sub-
occipital muscle inhibition and baseline treatment, the baseline treatment will include hot pack, TENS,
and neck isometrics. Data will be analyzed by SPSS version – 16

FITT Group A Group B

Frequency 5 times/ week 5 times/ week

Intensity ELDOA: Apply 15 to 20 sec 3-4 ELDOA: Apply 15 to 20 sec 3-4

repsHot pack: 10 min TENS: 15 repsHot pack: 10 min TENS: 15
minIsometrics: 5 min minIsometrics: 5 min

Time 30 min / session 30 min/ session

 Reference
 Javaid, M., Mansha, H., Khalid, M. U., Hassan, M., Kazmi, Y., & Naseer, M. W. (2022). Effects of Eldoa
Technique with Conservative Treatment on Pain Threshold of Active Trigger Points in Upper Trapezius and
Levator Scpulae. Pakistan Journal of Medical & Health Sciences, 16(10), 135-135.
 Mylonas, K., Angelopoulos, P., Billis, E., Tsepis, E., Tsekoura, M., & Fousekis, K. (2021). The effects of
therapeutic exercise in improving forward head posture and functionality in patients with neck pain A
literature update. Archives of Hellenic Medicine/Arheia Ellenikes Iatrikes, 38(5).
 Rizo, A. M. H., Pascual-Vaca, Á. O., Cabello, M. A., Blanco, C. R., Pozo, F. P., & Carrasco, A. L. (2012).
Immediate effects of the suboccipital muscle inhibition technique in craniocervical posture and greater
occipital nerve mechanosensitivity in subjects with a history of orthodontia use: a randomized trial. Journal of
manipulative and physiological therapeutics, 35(6), 446-453.
 Waqar, S., Khalid, M., & Khalid, N. (2022). EFFECTIVENESS OF ELONGATION LONGITUDINAUX
AVEC DECOAPTION OSTEOARTICULAIRE IN CORRECTING FORWARD HEAD POSTURE: soi: 21-
2017/re-trjvol06iss01p284. The Rehabilitation Journal, 6(01), 284-289.