Comparative Feasibility and Implementation of Bruegger’s and Egoscue Exercise Protocols in Lower Cross Syndrome: A Descriptive Study

Abstract

Background: Lower Cross Syndrome (LCS) is a prevalent postural imbalance characterized by weak gluteal and abdominal muscles combined with tight hip flexors and lumbar extensors, leading to anterior pelvic tilt, lumbar hyperlordosis, and functional limitations. Corrective exercise is a cornerstone of LCS management, yet the practical implementation, patient adherence, and clinical feasibility of different exercise protocols remain poorly understood. Bruegger’s and Egoscue exercises are widely used interventions, but comparative data on their clinical application and real-world utility are limited. Objective: The study aimed to compare the clinical implementation and feasibility of Bruegger’s exercise and Egoscue exercise in the management of Lower cross syndrome. Methods: A non-randomized comparative observational study was conducted at the outpatient department of Pakistan Railway General Hospital, Rawalpindi, involving 34 participants (aged 20–50 years) with clinically confirmed LCS. Participants were allocated to either the Bruegger’s group (n = 17) or the Egoscue group (n = 17) and underwent 12 supervised exercise sessions over four weeks. Outcome measures included pain intensity (Numerical Pain Rating Scale, NPRS), lumbar curvature (flexicurve), and pelvic tilt (inclinometer). Feasibility data (compliance, ease of performance, supervision needs) were collected through verbal feedback. Statistical analyses were performed using the Wilcoxon Signed-Rank test and Mann–Whitney U test, with p < 0.05 considered significant. Results: Both interventions significantly reduced pain (Bruegger’s: median NPRS from 6 to 2, Z = -3.703, p < 0.001, r = 0.63; Egoscue: median NPRS from 6 to 3, Z = -3.877, p < 0.001, r = 0.66) and improved lumbar curvature (p < 0.01). Changes in pelvic tilt were not statistically significant. No significant differences were found between groups in therapeutic outcomes (p > 0.05). Bruegger’s protocol demonstrated higher patient adherence (88.2% vs. 76.5%), greater ease of execution, shorter session duration (≈5 min vs. ≈30 min), and lower supervision requirements. Conclusion: Both Bruegger’s and Egoscue exercises are feasible in improving pain and reducing lumbar hyperlordosis in individuals with Lower cross syndrome, with Bruegger’s protocol offering higher compliance and ease of implementation in an outpatient setting.