Cho J, Lee E, Lee S Upper thoracic spine mobilization and mobility exercise versus upper cervical spine mobilization and stabilization exercise in individuals with forward head posture: a randomized clinical trial. BMC Musculoskelet Disord. 2017 Dec 12;18(1):525. doi: 10.1186/s12891-017-1889-2.
Discipline Area Score
Physician 6 / 7
Rehab Clinician (OT/PT) 5 / 7
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  Neck Pain and Injury

BACKGROUND: Although 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.

METHODS: Thirty-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).

RESULTS: Participants 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.

CONCLUSIONS: The 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 REGISTRATION: KCT0002307 , April 11, 2017 (retrospectively registered).

Comments from MORE raters

Rehab Clinician (OT/PT) rater

Although this study has a small study sample and relative small age variety, it does conform the findings from other studies. A clinician should consider the regional interdependence model when treating patients. The position and function of the thoracic spine will determine how the cervical spine will function. This study only reports on short term outcomes.

Rehab Clinician (OT/PT) rater

The quality of the c spine mobs, sitting, might not have been as effective as if they were supine. The c spine exs, in my opinion, was not described well to the participants. I thinks the prone thoracic mobs and exs looked as though it could be more effective.
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