Background: Muscle imbalance is functional pathology in which strength along with length of muscle is altered. This is observed by Janda which creates abnormal joint function. Shoulder girdle crossed syndrome which has corelation with FHP and rounded shoulders. Chronic postural stress is cause of this in various occupations especially in desktop workers. In these workers muscle weakness and dysfunctional tone in musculature is seen which leads to neck pain. Pressure Biofeedback training and Swiss ball is beneficial on the local stabilizers which works at low loading maximal contractions. Stabilization of cervical spine by training the deep neck cervical flexors and neck extensors one can reduce the risk of further complications. We are focusing on deep neck flexor endurance test and isometric exercises in upper crossed syndrome.

Methodology: In this study 50 subjects both males and females with the mean age of 32.64±5.54 in Group A [pressure biofeedback training]and 32.44±5.24 Group B [isometric exercise with Swiss ball] with upper crossed syndrome were selected according to Janda’s criteria using randomisation and were allocated into two groups (15 subjects in each group) using chit method. In Group A, pressure biofeedback training along with conventional exercises were given and in Group B isometric exercise with swiss ball along with conventional exercises were given. The intervention were given 3 days/week for 4 weeks. Treatment duration 20-30 min for each group. Muscular endurance (hold time), cervical ROM and functional disability were documented of each subject before and after the intervention.

Results: Muscular endurance (Hold time in seconds), Cervical ROM and NDI scores were improved significantly (p<0.0001) after 4 weeks in both groups. Comparison of mean differences of muscular endurance(p=0.001), cervical flexion(p=0.0016), extension (p=0.005), right side flexion(p=0.023), left side flexion(p=0.005), right side rotation(p=0.193), left side rotation (p=0.090), NDI score(p=0.0001) in between the groups after 4 weeks. The muscular endurance, Cervical ROM (except rotations) and NDI score improved significantly in pressure biofeedback training and isometric exercises with swiss ball group.

Conclusion: The study concluded that pressure biofeedback training was more effective than isometric exercise with swiss ball in improving muscular endurance (hold time), cervical ROM (flexion, extension, side flexions) and reducing functional disability. Whereas both are equally effective in improving cervical rotations in both the groups in upper crossed syndrome after 4 weeks.