Abstract
BackgroundAlthough upper cervical and upper thoracic spine mobilization plus therapeutic exercises are common interventions for the management of forward head posture (FHP), no study has directly compared the effectiveness of cervical spine mobilization and stabilization exercise with that of thoracic spine mobilization and mobility exercise in individuals with FHP.MethodsThirty-two participants with FHP were randomized into the cervical group or the thoracic group. The treatment period was 4 weeks, with follow-up assessment at 4 and 6 weeks after the initial examination. Outcome measures including the craniovertebral angle (CVA), cervical range of motion, numeric pain rating scale (NPRS), pressure pain threshold, neck disability index (NDI), and global rating of change (GRC) were collected. Data were examined with a two-way repeated-measures analysis of variance (group × time).ResultsParticipants in the thoracic group demonstrated significant improvements (p < .05) in CVA, cervical extension, NPRS, and NDI at the 6-week follow-up compared with those in the cervical group. In addition, 11 of 15 (68.8%) participants in the thoracic group compared with 8 of 16 participants (50%) in the cervical group showed a GRC score of +4 or higher at the 4-week follow-up.ConclusionsThe combination of upper thoracic spine mobilization and mobility exercise demonstrated better overall short-term outcomes in CVA (standing position), cervical extension, NPRS, NDI, and GRC compared with upper cervical spine mobilization and stabilization exercise in individuals with FHP.Trial registrationKCT0002307, April 11, 2017 (retrospectively registered).
Highlights
Upper cervical and upper thoracic spine mobilization plus therapeutic exercises are common interventions for the management of forward head posture (FHP), no study has directly compared the effectiveness of cervical spine mobilization and stabilization exercise with that of thoracic spine mobilization and mobility exercise in individuals with FHP
Previous studies reported that 60% of patients with neck and shoulder pain presented with FHP [14], and FHP caused asymmetric muscle activation in the spine, restricted functional activity, and caused spine deviation and lateral inclination of the pelvis [15,16,17]
The active cervical extension showed a significant group-by-time interaction (F2,29 = 3.882, p = .026, ηp2 = .115), with the thoracic group indicating significantly (t29 = 2.54, p = .016) better improvement in active cervical extension (7.5°; 95% confidence intervals (CI): 3.7, 11.3) over time than those in the cervical group (1.3°; 95% CI: -4.0, 6.6)
Summary
Upper cervical and upper thoracic spine mobilization plus therapeutic exercises are common interventions for the management of forward head posture (FHP), no study has directly compared the effectiveness of cervical spine mobilization and stabilization exercise with that of thoracic spine mobilization and mobility exercise in individuals with FHP. Previous studies reported that 60% of patients with neck and shoulder pain presented with FHP [14], and FHP caused asymmetric muscle activation in the spine (which is an important indicator of neck pain), restricted functional activity, and caused spine deviation and lateral inclination of the pelvis [15,16,17]. Dysfunction of the lower cervical spine and articular disc lesions can be causes of pain in the upper thoracic spine, and dysfunction of the upper thoracic spine restricts the movement of the cervical spine and causes pain [21, 22]. Some studies report that neck pain and range of motion were improved by applying manual therapy on the upper thoracic spine and on the cervical spine of patients with neck pain, improving their movement [24, 25]
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