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in ©IJONS

Vol.15 / Issue 85 / Aug / 2024 International Bimonthly (Print) – Open Access ISSN: 0976 – 0997
RESEARCH ARTICLE

The Effectiveness of Comprehensive Corrective Exercise Program Along

with Janda’s Approach and Lacrosse Ball Massage Technique in the
Improvement of Posture in Subjects with Lower Crossed Syndrome

P. Saranraj1*, S. Raja Durai2, P. Susmitha3, B. Arun4, and G. Sujitha5

1Ph.D Scholar, Department of Physiotherapy, Meenakshi Academy of Higher Education and Research,
Chennai, Tamil Nadu, India and Professor, Nandha college of Physiotherapy, (Affiliated to Tamil Nadu
Dr. MGR Medical University). Erode, Tamil Nadu, India.
2Department of Orthopaedics, Meenakshi Medical College and Hospital and Research Institute (Deemed

to be University), Chennai, Tamil Nadu, India.

3Associate Professor, Department of Cardio Respiratory, Nandha College of Physiotherapy, Erode,

(Affiliated to The Tamil Nadu Dr. M.G.R. Medical University), Chennai, Tamil Nadu, India.
4Physiotherapist, Department of Physiotherapy, Government Headquarters Hospital, Erode, Tamil Nadu,

India.
5MPT Student, Department of Physiotherapy, Nandha College of Physiotherapy, Erode, (Affiliated to The

Tamil Nadu Dr. M.G.R. Medical University), Chennai, Tamil Nadu, India.

Received: 21 Feb 2024 Revised: 03 Mar 2024 Accepted: 26 Jun 2024

*Address for Correspondence

P. Saranraj
Ph.D Scholar,
Department of Physiotherapy,
Meenakshi Academy of Higher Education and Research,
Chennai, Tamil Nadu, India and
Professor, Nandha college of Physiotherapy,
(Affiliated to Tamil Nadu Dr. MGR Medical University).
Erode, Tamil Nadu, India.
Email: [email protected]

This is an Open Access Journal / article distributed under the terms of the Creative Commons Attribution License
(CC BY-NC-ND 3.0) which permits unrestricted use, distribution, and reproduction in any medium, provided the
original work is properly cited. All rights reserved.

ABSTRACT

Lower crossed syndrome is a muscle imbalance caused by the weakening and lengthening of the
posterior Back muscles. This imbalance leads to abnormal posture and joint dysfunction. The study
aimed to find out `the effectiveness of a comprehensive corrective exercise program along with Janda’s
approach and lacrosse ball massage technique in the improvement of posture in subjects with the Lower
crossed syndrome. A experimental study design consisting of 30 patients with Back pain for 1 month.30
patients were included, and the average age was about 20 to 50 years. All the patients underwent pre and
post-test scores of Costo vertebral angle and Lumbo sacral angle. The pre and post-test values were
assessed by smartphone mobile application on protractor in group A and group B. The calculated ‘t’ test
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Vol.15 / Issue 85 / Aug / 2024 International Bimonthly (Print) – Open Access ISSN: 0976 – 0997

Saranraj et al.,

values by the unpaired test in group A & group B is 20.0946 & 17.3618. The calculated ‘ t ’test values were
more in group A than in B. In the present sample, the Comprehensive corrective exercise program along
with Janda’s approach has a positive effect.
Keywords: Smartphone mobile application on the protractor, Janda’s approach exercise, Costovertebral
angle and Lumbo Sacral angle.

INTRODUCTION

According to the World Health Organization, musculoskeletal disorders are one of the main causes of disability in
persons between the ages of 20 and 50, and the most prevalent complaints worldwide are headaches and persistent
Back pain. Muscles, ligaments, joints, peripheral nerve fibres, and supporting blood arteries are all affected by a
variety of inflammatory and pathological conditions together referred to as musculoskeletal disorders [1]. The human
body is prone to several musculoskeletal illnesses, including those that affect the lower limbs, the back, and the
upper extremities. Depending on the kind of condition, the symptoms of upper extremity musculoskeletal disorders
include typically pain, pains, discomfort, numbness, stiffness, and/or weakness[2].Muscular disparity known as
Lower crossed syndrome is frequently brought on by stiffness in the Back area. Distal or Pelvic girdle syndrome is
another name for the Lower crossed syndrome. In addition to postural deviations (Hyperlordotic, increased thoracic
kyphosis), Lower crossed syndrome refers to a specific altered muscle activation pattern (especially in the Back,
trunk, and Pelvic muscles) and altered movement patterns. Vladimir Janda (1923-2002) defined it as an abnormal
posture [3]. The lower crossed syndrome is the result of muscle strength imbalances in the lower segment. These
imbalances can occur when muscles are constantly shortened or lengthened in relation to each other. The lower
crossed syndrome is characterized by specific patterns of muscle weakness and tightness that cross between the
dorsal and the ventral sides of the body. In LCS there is over activity and hence tightness of hip flexors and lumbar
extensors. Along with this there is under activity and weakness of the deep abdominal muscles on the ventral side
and of the gluteus maximus and medius on the dorsal side.[1] The hamstrings are frequently found to be tight in
this syndrome as well. This imbalance results in an anterior tilt of the pelvis, increased flexion of the hips, and a
compensatory hyperlordosis in the lumbar spine [4]. It is a movement system disorder characterised by hyperlordosis
in the Lumbar region. The ailment known as Lower crossed syndrome, which can draw an "X" (a cross) over the
lower body, was given this name because it causes predominantly muscular imbalance, which eventually affects
tonic and phasic muscles. There are a few potential side effects of the Lower crossed syndrome, including
impingement syndrome, deterioration of the body's hard and soft tissues, and Pelvic instability [5].

Dr. Janda claimed that the Lower crossed condition, which she referred to as the issue with the Hyperlordotic,
developed when a slouched sitting position was maintained for an extended length of time. Here, a muscle that has
been overworked in the same direction for an extended amount of time shortens and tightens, an action known as
"adaptive shortening." All antagonists elongate and weaken a condition known as "stretch weakness," as a result of
becoming strained [6]. Dr. Janda observed that these focused regions of stress in the spine correlate to transitional
zones where the morphology of nearby vertebrae changes. This is one of the methods that is mostly applied to people
with Lower crossed syndrome to address their posture alignment. Stretching and strengthening exercises are the key
tools used in this strategy. The main muscles that become tensed in this situation should be stretched for flexibility,
while the weaker muscles should be given strengthening exercises. In the realm of corrective exercises intended to
treat musculoskeletal diseases and avoid subsequent issues like pain and injury, the entire approach is innovative.
Rather than concentrating simply on the area of the body where the problem is, comprehensive corrective exercise
regimens concurrently address muscle activation, movement pattern, and posture throughout the entire body[7].
Stretching involves extending the range of motion in the specific joints to lengthen the contracted muscles and
increase flexibility. It is a manual treatment technique. The ability of a joint to move through its full range of motion
is referred to as flexibility. Flexibility varies from person to person, relies on workouts, and is specific to particular
joints. Additional forms of stretching exercises include proprioceptive neuromuscular facilitation stretching, dynamic

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stretching, ballistic stretching, and static stretching. A crucial technique for extending the range of motion is static
stretching. Static stretching is a sort of stretching exercise that involves applying low force for a prolonged period to
lengthen the muscle. The act of performing a controlled stretch is called dynamic stretching [8]. Specific muscles, such
as the thorocolumbar extensor and Hip flexor should be stretched using specific methods. Muscles are worked by
strengthening exercises or resistance training employing resistance, such as a dumbbell or your body weight. Rachael
Return explained this. Here, Abdominals and Gluteus maximus are the major targets of the strengthening exercise.
Professionals in rehabilitation and fitness frequently utilise self-myofascial release to improve myofascial mobility.
Tools used often for self-myofascial release include foam rollers and different roller massagers. By reducing the
effects of acute muscle soreness, delayed onset muscle soreness, and post-exercise muscle performance, it is possible
that these tools can improve joint range of motion and the healing process. There are various sizes and foam densities
available for foam rollers and roller massage bars [9]. One method of self-myofascial release that makes use of hard
and thick balls is lacrosse ball massage. Additionally, it resembles a tennis ball. By releasing the connective tissue that
might become tight around muscles due to extended sitting, bad posture, or exercise, this ball helps to reduce
discomfort and enhance function in sore muscles.

METHODS

PARTICIPATION
A total of 30 patients were included in this study all subjects provided written informed consent before entering the
study. The patient’s age is between 20 years to 50 years. Inclusion criteria were as follows: The persons were in the
age group of 20-50 years. The usage of handheld devices, reading, working and travelling for > 3 hours, sleeping in a
fetal position and unsupported back chair are the factors, Back pain over one month

STUDY DESIGN
The study design that was used for this study is experimental.

OUTCOME MEASURES
The Costovertebral angle is the angle which is used to measure the posture that was given at any time of day. Lumbo
Sacral angle is the angle which is used to measure the posture that was given at any time of day.

INTERVENTION
15 patients in this group A underwent a comprehensive corrective exercise program along with Janda’s approach for
duration of 30 minutes, and 15 patients in this group B lacrosse ball massage technique for duration of 10 minutes.
This reduces muscle pain and improves posture One method of self-myofascial release that makes use of hard and
thick balls is lacrosse ball massage. Additionally, it resembles a tennis ball. By releasing the connective tissue that
might become tight around muscles due to extended sitting, bad posture, or exercise, this ball helps to reduce
discomfort and enhance function in sore muscles by following the exercises. All these exercises are demonstrated to
the subjects individually under the therapist’s guidance. The following interventions are taught to the patient as a
home programme and the patients are regularly monitored to know the accuracy of results.

Training Program
Group A
Exercises included
Comprehensive corrective exercise program along with Janda’s approach:
1. Pelvic bridging
2. Slight leg Raising
3. Lunges
4. Janda’s approach:
Thoracolumbar extensor Stretch

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Saranraj et al.,

Hip flexor Stretch

Group B
Exercises included
Lacrosse ball massage technique

STATISTICAL ANALYSIS
The data were evaluated by using an unpaired ‘t’ test. The unpaired t-test was used to find out the statistical
significance between post and post-t-test values of Costovertebral angle and Lumbosacral angle.

Data Presentation
Table 1 Data Analysis and Presentation
Data values Costovertebral Angle Lumbosacral Angle
Mean values 24.13 12.73
Standard Deviation 1.64 1.03
The unpaired t test 20.09 17.36
Table value 2.15 2.15
p value 0.0456 0.0425

RESULTS

A protractor is used to measure the Costovertebral angle, which is presented in table 4.1, for the Paired 't' test
analysis for the pre-test and post-test variables. The pre-test and post-test values varied significantly between the two
groups. Group A's "t" value is 44.9941, whereas Group B's "t" value is 20.6148. The Costovertebral angle is measured
using a smart phone mobile application on a protractor for both groups in the unpaired 't' test analysis for the post-
test variables, which are reported in table 4.2. Between the Groups, a sizable variation was evident. Subjects in Group
A outperform those in Group B. The post-test variables for both groups have a 't' value of 20.0946. The Lumbo Sacral
angle is measured using a smart phone mobile application employing the Paired 't' test analysis for the pre-test and
post-test variables, as shown in Table 4.3. Between the two groups, there were substantial differences in the pre-test
and post-test values. The "t" value for Group A is 29.8642, while the "t" value for Group B is 11.4492. The unpaired't'
test analysis for the post-test variables for both groups is displayed in table 4.4. These variables are assessed by smart
phone mobile on protractor for Lumbo Sacral angle. Between the Groups, a sizable variation was evident. Subjects in
Group A outperform those in Group B. The post-test variables for both groups have a 't' value of 17.3618.

DISCUSSION

This study aimed to evaluate the efficacy of a complete corrective exercise programme, Janda's method, and lacrosse
ball massage technique in the treatment of Lower crossed syndrome in patients. The predefined inclusive and
exclusive criteria were met by 30 participants. Ten each were assigned to two groups of subjects. While Group B got a
lacrosse ball massage technique, Group A had a thorough remedial exercise programme coupled with Janda's
method. There was a considerable correction of posture in both Groups' before and after treatment values, which was
validated by the following research. In both groups, the post-test value shows that there was a significant correction
of posture in the comprehensive corrective exercise program along with Janda’s approach compared to the lacrosse
ball massage technique, which was supported by studies as follows. This study examines how Back and pelvic
muscle stretching and strengthening activities affect the corrective posture of the Back in those who have a
hyperlordotic. Yoo claims that by extending the muscles and ligaments of the posterior Back and correcting posture,
it is possible to reduce the pain brought on by pelvic Back syndrome to some extent. He also determined that the
simplest technique was to stretch by pressing the head with a hand. The thorocolumbar extensor and Hip flexor were
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Saranraj et al.,
stretched, while the Abdominals and Gluteal maximus were strengthened, throughout this investigation [6]. The
research conducted by Mahajan R and his colleagues in 2012 on the comparative efficacy of muscle energy technique
and static stretching conducted a study for the treatment of sub-acute mechanical Back pain supports the findings of
our study regarding the effectiveness of muscle energy technique in reducing pain and increasing ROM. This study's
utilization of the Comprehensive Corrective Exercise Program suggests that it has a respectable impact on
reestablishing equilibrium in the pelvic stabilizer muscles. In recent years, there has been a greater focus on studying
how various exercise regimens affect Lower-crossed syndrome. The bulk of the research included both male and
female participants, showing that Back problems can affect people of either sex [8]. Through the Comprehensive
Corrective Exercise Program, the participants steadily improved their ability to perform the activity in various
postures while creating concentric and eccentric contractions. Earlier studies have supported the rationale of exercise
progression (from isometric to dynamic). Our findings revealed an improvement in some muscle activations
throughout all three contraction phases—concentric, isometric, and eccentric—which may have been brought on by
training in all three. An app for smart phones measures the angle [10]. The findings revealed that smart phone
agreements were greater from both sides. These results show that smart phone applications for evaluating cranial
angles have a good level of validity. In a research titled "Smartphone and Universal Goniometer for Measurement of
Elbow Joint Motions: A Comparative Study," Behnam Behnoush and his colleagues utilized a smart phone
application and universal goniometer to measure elbow range of motion (ROM). The findings demonstrated that the
elbow joint supination had the best level of measurement reliability. After eight weeks of corrective exercises, these
therapies are anticipated to improve and minimise UCS symptoms, including postural mal alignment and muscle
imbalance [10]. The results of this study's data analysis show that comprehensive corrective exercise programmes
combined with Janda's method are more effective than lacrosse ball massage in treating people with Lower-crossed
syndrome. The substantial improvement is therefore founded on his idea.
This study found that complete corrective exercise programmes and Janda's method were more effective in reducing
pain and improving posture than lacrosse ball massage.

CONCLUSION

The goal of this study was to determine if an extensive schedule of corrective exercises, Janda's method, and a
massage technique using a lacrosse ball might improve posture in participants with Lower crossing syndrome. The
analysis of the data appears to support the claim that people with nonspecific Back discomfort may improve their
posture by using Janda's method, the Comprehensive Corrective Exercise Program, and the lacrosse ball massage
technique. These workouts help to improve functional abilities while also reducing discomfort. This is evidenced by
the fact that the groups significantly improved, demonstrating the value of the Comprehensive Corrective Exercise
Program, Janda's method, and lacrosse ball massage therapy in increasing posture improvement and pain relief. In
light of this, it can be said that the Comprehensive Corrective Exercise Program, in conjunction with Janda's method
and lacrosse ball massage technique, is very effective in treating a patient with Nonspecific Back Pain and leads to a
significant improvement in functional activities and pain relief. The null hypothesis is not the primary hypothesis in
this investigation.

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