Effectiveness of Ankle Stretching and Strengthening Exercises to Improve Rounded Shoulder Posture: A Pilot Study

Abstract

Introduction: Incorrect posture habits and reduced physical activity can predispose individuals to various changes in the muscular and skeletal structures. Rounded Shoulder Posture (RSP) is one such clinical manifestation that deforms the normal relationship of various structures. Different treatment protocols have been devised for correcting RSP; however, postural changes in the musculoskeletal system can also be addressed by focusing on muscular imbalances elsewhere in the biomechanical kinetic chain. Aim: To analyse and investigate the efficacy of ankle muscle stretching and strengthening exercises in enhancing the correction of RSP in young adults. Materials and Methods: The present pilot study was conducted at Amity Institute of Physiotherapy in Noida, Uttar Pradesh, and Prime Hospital and Ortho Centre in Faridabad, Haryana, India, from January 2021 to July 2021. A total of 30 young adults with RSP were randomly allocated into two groups of 15 each. Group 1 (control group) received six weeks of conventional exercises consisting of scapular stabilisation and stretching of the pectoralis minor muscle. Group 2 (experimental group) received ankle plantar flexor stretching and ankle dorsiflexor strengthening in addition to the conventional exercises, three times per week for six weeks, with each session lasting between 30 to 45 minutes. RSP and ankle Dorsi-Flexion (DF) were assessed using the posterior Acromion to Table Distance (ATD) in a supine lying position and a universal goniometer, respectively, pre-intervention and post-intervention for the dominant and non-dominant sides. For statistical analysis, after determining the normality of the data, either a Paired-test or Wilcoxon rank sum test was used to compare the data within each group. Further, either a two-sample Independent t-test or WilcoxonMann-Whitney U test was used to find statistical differences between the two groups at a 5% level of significance. Results: The subjects had an average age of 24.8±4.07 years and a Body Mass Index (BMI) of 24.10±4.39 kg/m2 , with 11 male and 19 female participants (p-value=0.70), with the right side being the dominant side for all. At baseline, there was no significant difference in the variables between the two groups (p-value>0.05). After the six-week intervention, a significant difference was found in the ATD (dominant pre: 6.17±1.02, dominant post: 3.47±1.05, p-value<0.0001; non-dominant pre: 6.07±1.05, non-dominant post: 3.32±0.92, MD=-2.75; p-value<0.0001) and DF (dominant pre: 16.23±1.37, dominant post: 19.27±1.33, MD=3.03; non-dominant pre: 15.67±1.05, non-dominant post: 19.53±0.74, MD=3.87; p-value<0.0001) in the experimental group. However, the control group revealed a significant difference only for ATD (dominant pre: 6.51±0.89, dominant post: 4.47±0.84, MD=-2.05; non-dominant pre: 6.23±1.00, non-dominant post: 4.41±0.90, MD=-1.82; p-value<0.0001). Additionally, when compared to the control group, the experimental group showed statistically significant results for ATD and DF (p-value<0.05). Conclusion: The incorporation of ankle muscle strengthening and stretching exercises was found to be more effective compared to the conventional treatment used for correcting RSP.