The Effects of Cervical Mobilization Combined with Thoracic Mobilization on Forward Head Posture of Neck Pain Patients

Abstract

Abstract.[Purpose] The purpose of the present study was to examine the effects of cervical mobilization combined with thoracic mobilization on neck pain patients' recovery from forward head posture (FHP). [Subjects] Thirty neck pain patients with FHP were randomly assigned to an experimental group (n=15) and a control group (n=15).[Methods] The experimental group received cervical mobilization combined with thoracic mobilization and the control group received only cervical mobilization. Cranial vertical angle (CVA) and cranial rotation angle (CRA) were measured before and after the experiment.[Results] The experimental group had significantly greater improvements in CVA and CRA than the control group.[Conclusion] Therefore, we recommend cervical mobilization combined with upper thoracic mobilization for the improvement of FHP in neck pain patients.

Mechanism of Action of Spinal Mobilizations

“…42,43 Fifteen studies 20,21,26,28,30,[32][33][34][35][36]38,[40][41][42][43] measured immediate effects of mobilizations; others measured after different periods of time: 24 hours afterward, 22,37 4 days 31 and 1 week, 27 and 2 to 18 weeks (Table 3). [23][24][25]29,39 Mobilizations used were the cervical lateral glide, 20,21,32,34,37,38 central 22,26,28,30,31,33,40-43 or unilateral 35,36 posteroanterior (PA) mobilizations, central anteroposterior mobilizations, 24,39 a cervical sustained natural apophyseal glide, 29 and a combination of passive physiological (e.g., flexion, extension, or retraction) and accessory mobilizations (PA and anteroposterior). 23,25,27 In 10 studies, effects were compared with sham; either maintenance of therapist's hand position without oscillation 24,32,34,35,37,38 Measures that may explain the mechanism of action of mobilizations or the application of detuned laser 29,31 or ultrasound.…”

“…[23][24][25]29,39 Mobilizations used were the cervical lateral glide, 20,21,32,34,37,38 central 22,26,28,30,31,33,40-43 or unilateral 35,36 posteroanterior (PA) mobilizations, central anteroposterior mobilizations, 24,39 a cervical sustained natural apophyseal glide, 29 and a combination of passive physiological (e.g., flexion, extension, or retraction) and accessory mobilizations (PA and anteroposterior). 23,25,27 In 10 studies, effects were compared with sham; either maintenance of therapist's hand position without oscillation 24,32,34,35,37,38 Measures that may explain the mechanism of action of mobilizations or the application of detuned laser 29,31 or ultrasound. 20,21 Others compared effects of mobilizations with self-stretching, 23 peripheral neurodynamic sliders (upper limb passive movements aimed at mobilizing the nerves), 27 thoracic spinal mobilizations, 25 a high-velocity thrust, 30 Thai massage, 26 prone lumbar extension, 28 spinal mobilizations to an asymptomatic location, 36 or supplementary to craniocervical flexor muscle exercises.…”

“…39 The remainder compared mobilizations only with a control condition of lying for the same duration 22,33 or had no comparator. [40][41][42][43] Most participants had neck pain 23,25,[30][31][32]35,36,41,42 or low back pain (LBP). 22,26,28,33,40,43 Three studies' participants had cervicobrachial neurogenic pain.…”

“…39 Symptom duration varied from more than 48 hours 22 to 3 years. 37 Outcomes associated with mechanisms of action were surface electromyography (SEMG), 35 25 substance P concentration, 26 and nociceptive flexion reflex. 32 Studies also assessed outcome measures associated with symptoms; pain at rest, 22,24,26,27,30,31,35,37,39,43 during movement, 22,28,[33][34][35] during the previous 24 hours, 37 during PA force application, 33,43 and during activities of daily living, 22,29 dizziness, 29 range of movement (ROM), 27,29,31,33,34,36,43 disability, 39 global perceived effect, 29 and upper limb function.…”

“…37 Methodological Quality Table 4 summarizes methodological quality assessment. Four studies 22,25,40,41 were classified as having a high risk of bias and four 24,31,34,35 [40][41][42] and was unclear in seven. 22,23,25,27,29,39,43 Ten 20,21,26,29-35 studies demonstrated adequate randomization and allocation concealment procedures.…”