RAJIV GANDHIUNIVERSITY OF HEALTH SCIENCES,

KARNATAKA, BANGALORE
PROFORMA FOR REGISTRATION OF SUBJECT FOR
DISSERTATION

1. Name of the Candidate MS.AISHWARYA DILIP SANGHAVI

VIKAS COLLEGE OF
And Address
PHYSIOTHERAPY, MANGALORE
(in block letters):

2. Name of the Institute : VIKAS COLLEGE OF

PHYSIOTHERAPY, MANGALORE

3. Course of study and subject : MASTER OF PHYSIOTHERAPY (MPT)

2 YEARS DEGREE COURSE

PHYSIOTHERAPY IN
MUSCULOSKELETAL DISORDERS
AND SPORTS PHYSIOTHERAPY

4. Date of Admission to Course:

TO COMPARE THE EFFECTIVENESS OF

5. Title of the topic:
MYOFASCIAL RELEASE(MFR) WITH
ELASTIC BAND EXERCISE AND PNF
STRETCHING WITH ELASTIC BAND
EXERCISE IN ROUNDED SHOULDER

6. Brief Resume of the Intended Work:

6.1) Introduction and need of the study

younger age group people suffer from various musculoskeletal disorders due to poor posture.
rounded shoulder is the commonest reason for poor posture which constitutes various abnormal
structural anomalies of shoulder complex. it may be due to prolong study hours, repetitive work,
sedentary lifestyle, long term use of smart phone exposes the individual to disorders caused by
maintaining the same posture for long period of time. poor posture may aggravate the pain and
soft tissue damage .so, it is necessary to treat the rounded shoulder in younger people. till the
date, no study has been done to find out the effectiveness of myofascial release-elastic band
exercise and pnf stretch –elastic band exercise. therefore, our purpose of the study is to compare
the effectiveness of myofascial release with elastic band exercise and pnf stretching with elastic
band exercise in rounded shoulder.
poor posture is common during adolescence which involves your body to stand, sit, walk in an
improper way and lie in a position where the greater strain is placed on the supporting muscle
and ligament. because of poor posture concomitant shortening and lengthening occurs which
leads to muscular imbalance and thus, increases strain on muscle and ligament. rounded shoulder
is the commonest reason for poor posture.
out of all musculoskeletal injuries, rounded shoulder constitutes 73% of all musculoskeletal
problems. rounded shoulder is the protrusion of acromion of shoulder joint along with elevation,
protraction and downward rotation of the scapula. many of us are sitting at a desk so many hours
a day, uses a smart phone which reveal the individual to cumulative trauma disorder caused by
maintaining a bad posture for prolong period of time.
due to improper posture, individuals with rounded shoulder leads to stooped posture which
ultimately leads to muscular imbalance. rounded shoulder causes tightness of anterior muscular
such a pectoralis minor muscle and weakness and elongation of back muscle such as serratus
anterior and lower trapezius muscle.
to confirm rounded shoulder, the forward shoulder angle is measure as well as length of
pectoralis minor muscle is measured as it is the main muscle which is shortened due to muscular
imbalance. the forward shoulder angle is the angle measured between the vertical line that
crosses c7 process and the line that passes through c7 and acromion .angle greater than 52
degrees is considered as rounded shoulder posture.
different treatment approaches can be used for rounded shoulder like strengthening of
lengthening muscles such as scapular stabilizer and stretching of shortened muscle such as
pectoral muscles. varieties of stretching and strengthening can be used for therapeutic purpose.
stretching enhances elasticity of soft tissues, thereby increases the flexibility of the structures
which have been shortened due to decreased mobility.
there are various types of techniques which includes flexibility of the tissues like mfr,soft tissue
mobilization, different types of stretching techniques such as passive stretching, self-stretches,pnf
stretching which can be applied to lengthen the shortened muscles.whereas,the strengthening
techniques are scapular stabilization exercises, elastic band exercises, manual therapy ,structured
exercise programme etc.
in this study, effectiveness of mfr with elastic band exercises and effectiveness of pnf stretch
with elastic bad exercises is used to correct the rounded shoulder. a myofascial release is hands
on soft tissue technique in which sustained pressure is applied into restricted barrier which result
in decrease muscle stiffness and increases range of motion.
the advance form of stretching protocol is pnf stretching which can be applied to any tightened
muscles to lengthen. there are different types of pnf stretches such as hold relax, contract relax,
agonist contract techniques. however, there is no consensus on whether one pnf is better than
other type of pnf. the other technique used in this study is, an elastic band exercise which is
applied to strengthen the elongated muscles. elastic band exercises consists of 1)lateral pull down
2)shoulder external rotation 3) shoulder horizontal abduction exercises 4)seated bend row
exercise 5) shoulder abduction exercise 6)shoulder flexion exercise 7)shoulder external rotation .
to our knowledge, there is no study which compared the effectiveness of mfr with elastic band
exercise and pnf stretch with elastic band exercises on individual having rounded shoulder
posture. thus, the authors of the study stated that although, many researches were done on
different treatment approaches .but till the date, no study was yet done on comparing the
effectiveness of this approaches.

HYPOTHESIS
ALTERNATIVEHYPOTHESIS (H0):
There will be significant difference in effectiveness of myofascial release(mfr) with elastic band
exercise and pnf stretching with elastic band exercise in rounded shoulder

NULL HYPOTHESIS (H1):

There is no significant difference in effectiveness of myofascial release(mfr) with elastic band
exercise and pnf stretching with elastic band exercise in rounded shoulder

6.2 REVIEW OF LITERATURE

1. Kaur P, jayaraman G.To compare the effectiveness of Myofascial release (MFR) with
strengthening and stretching with strengthening to improve the rounded shoulder posture .Indian
journal of physiotherapy and occupational therapy 2019 Apr 1:13(2)30 students were
participated in this study. Participants were assigned into 2 groups: Group A was given
(MFR with strengthening) and Group B was given (stretching with strengthening)for 10
days in 2 weeks. Showed that there is significant improvement in muscle length and
rounded shoulder angle. And suggested that MFR with strengthening is more effective than
stretching with strengthening in improving rounded shoulder.
2. Pathak GM, Chotai, K, Patil,S and Rayjade A.,2020.Effectivenesss of structured exercise
programme verses elastic band exercise on individuals with rounded shoulder. Indian journal of
forensic medicine and toxicology.2020 Apr 1; 14(2) conducted a study to find out the
effectiveness of structured exercise programme and elastic band on rounded shoulder.32
sample were collected and randomly divided into 2 groups with 16 individuals in each
group. According to study, structured exercise programme and elastic band are both
equally effective in improving rounded shoulder.
3. Kakararaparthi VN, Alahmari K, Ahmed I.A Study to compare the efficacy of static
stretching and PNF stretching on forward Shoulder posture.Majmaah journal of health sciences,
2016; 4 (1), pp.1-13.conducted a study to find a effectiveness of static an PNF stretching
techniques.30 people were selected for the study and randomly divided into 2 groups.
Although, during first 2 weeks there was no much improvement but from third week
onwards PNF showed marked improvement than static stretching.

4. Laudner KG,Wenig M,Selkow,,N.M,,Williams ,j and post E,,2015.Forward shoulder

posture in collegiate swimmers: a comparative analysis of muscle energy techniques. Journal of
athletic training,2015 NOV ;50(11):1133-1139conducted a study to find out the effect of
MET on pectoralis minor of asymptomatic female swimmers provided improvement in
PML and forward scapular position compared with control group. The result indicated
that 6 weeks of MET treatment applied to pectoralis minor is improved.

5. Fathollahanejad K,Letafatkar A,Hadadnezhad M.The effect of manual therapy and

stabilizing exercises on forward head and round shoulder postures: a six week intervention with
a one month follow –up study.BMC musculoskeletal disorders .2019 Dec ,20 (1):1-8.this
study conducted to evaluate the effect of 6 weeks combined manual therapy and stabilizing
exercises on rounded shoulder.60 women were included in this study .Group A received
MT and group 2 received SE. there found the significant improvement in both
groups .However, in group 1-there was improvement in pain and function compared to
group 2 .

6.3) OBJECTIVES OF STUDY

AIM
To compare the effectiveness of Myofascial release (MFR) with elastic band exercise and
PNF stretching with elastic band exercise in rounded shoulder.
 OBJECTIVES

• To investigate the effectiveness of MFR with Elastic band exercise.

• To investigate the effectiveness of PNF stretching with elastic band exercise.
• To compare the effectiveness of MFR with elastic band exercise and PNF with
elastic band exercise.

7. MATERIALS AND METHODS:

MATERIALS AND METHODOLOGY

 Type of study: Quasi Experimental study

 Study design: Comparative study
 Sampling method: Random sampling method
 Sample size:20
Formula

N = Size of sample
n= size of sample
P0=Expected rate of rounded shoulder in MFR with elastic band exercise
population.(write value)
P1=Expected rate of rounded shoulder in PNF with elastic band exercise population.
Z1-𝛼=standard normal variation at 90% IC= 1.64
Z1-𝛽=power of test value at 80% power =0.84

1. Consent form.

2. Data collection sheet.

3. Elastic band

4. Pen or pencil.
 5. Plain paper

INCLUSION CRITERIA:
i) Both Male and female subjects were taken.

ii) Subjects having age group between 18-25 years with rounded shoulder posture.

iii) Subjects willing to participate.

iv) Rounded shoulder angle greater than 52 degrees included

EXCLUSION CRITERIA:
i) subjects with any history of cervical spine and shoulder injuries.
ii)Shoulder instability
iii) Presence of impingement syndrome, thoracic outlet syndrome.
iv) Recent Fractures related to shoulder.
v) Recent surgeries in upper limb.

TECHNIQUE OF APPLICATION:

Methodology:

An approval for the study will be obtained from the protocol committee and the institutional
ethical committee of KIMSDU
Individuals will be selected .The procedure will be explained and written informed consent will
be taken from those willing to participate.
Demographic information of the subjects will be taken. Individuals will be explained about the
purpose of the study. Also, they will be informing about the procedure.
The participants were divided into two groups (Group A and Group B) Forward shoulder angle
and pectoralis minor length assessment will be taken before and after treatment respectively with
the help of outcome measures.

• GROUP A : MFR (3 repetitions in set with 30 sec hold,5 sessions per week)

Elastic band exercise (15 repetitions of 3 set,5 sessions per week)

• GROUP B
 • :PNF STRETCH(5 times stretch bilaterally,5 session s per week)

Elastic band exercise (15 repetitions of 3 set,5 sessions per week)

The effect of exercises of the group was noted with the help of outcome measures. The
experimental results were statistically analysed. The significant difference between the two
groups was investigated with the unpaired t test and within the group with paired t test.

Pre-assessment

Group A Group B

Myofascial release with elastic band for 2 weeks PNF stretch with elastic band

for 2 weeks

Post assessment

Statiscal analysis

STUDY DURATION:

 Approximately 1year.
OUTCOME MEASURES:
1) MEASUREMENT OF FORWARD SHOULDER ANGLE-
Using the forward shoulder angle, we can measure the Rounded shoulder.
Forward shoulder angle is measured between the vertical line that crosses C7 spinous
process and the line that passes through C7 spinous process and acromion .Before
measuring the angle; first the markers were placed over the acromion process and C7
spinous process. Then, the subjects were asked to stand at 40 cm distance in front of
backdrop, bent forward three times, reached overhead three times and then stood to look
straight ahead in their resting position. A camera will be placed 3.5 m from the wall. Angle
was measured using image processing software (i.e. Adope Photoshop) by respective angles
between the centers of markers.
The angle equal or greater than 52 degrees is considered as ROUNDED
SHOULDER POSTURE.
2) MEASUREMENT OF PECTORALIS MINOR LENGTH-
The participant was instructed to stand in normal, relax posture. We have to
palpate the medial-inferior angle of coracoid process of scapulae and just lateral to sterno
costal junction of the inferior aspect of the fourth rib. After palpating, measure the distance
between these measurements with a tape. Three measurements were taken, and then the
average is divided by the participant’s height and multiplied by 100 to calculate pectoralis
minor length.
3)MANUAL MUSCLE TESTING OF RHOMBOID AND TRAPEZIUS MUSCLE-
The participant was instructed to lie prone, head turned to non-test-side. Test
side arm should be at 90-degree abduction and elbow in 90-degree flexion. Therapist should
stand at test side and palpate the shoulder adductor muscles. Ask the participant to
perform the scapular adduction “lift tip of elbow towards ceiling’’. the examiner will apply
resistance over distal humerus in the direction opposite to scapular adduction.

STATISTICAL ANALYSIS:

 The collected information will be summarized by using, mean, standard deviation

(Descriptive statistics).
 Analyze will be done by using t-test.
 The p value <0.05 will be considered significant.
 RESEARCH QUESTION:
Is there any significant differences in effectiveness of Myofascial release (MFR) with elastic
band exercise and PNF stretching with elastic band exercise in rounded shoulder.

7.3 Does the study require any investigations or interventions to be conducted

on Patients or other humans or animals? If so, please describe briefly.
yes

7.4 Has ethical clearance been obtained from your institutions in case of

Yes

List of References:
8.
Kaur P,jayaraman G.To compare the effectiveness of Myofascial release (MFR) with
strengthening and stretching with strengthening to improve the rounded shoulder
posture .Indian journal of physiotherapy and occupational therapy 2019 Apr 1:13(2)

Pathak GM, Chotai, K, Patil,S and Rayjade A.,2020.Effectivenesss of structured exercise

programme verses elastic band exercise on individuals with rounded shoulder. Indian
journal of forensic medicine and toxicology.2020 Apr 1;14(2)

Kakararaparthi VN,Alahmari K,Ahmed I.A Study to compare the efficacy of static

stretching and PNF stretching on forward Shoulder posture.Majmaah journal of health
sciences,2016;4 (1),pp.1-13.

Laudner KG, Wenig M, Selkow, N.M, Williams, j and post E,, 2015.Forward shoulder
posture in collegiate swimmers: a comparative analysis of muscle energy techniques.
Journal of athletic training, 2015 NOV; 50(11):1133-1139.

Fathollahanejad K,Letafatkar A,Hadadnezhad M.The effect of manual therapy and

stabilizing exercises on forward head and round shoulder postures:a six week intervention
with a one month follow –up study.BMC musculoskeletal disorders .2019 Dec ,20 (1):1-8.