PICO
Patient/Population
Neck pain and forward head posture. (n=22)
Intervention
- (C0-C1) + (C7-T3) Joint mobilization and motor control training (CTJ).
Comparison
- (C0-C1) Joint mobilization and motor control training (CG).
Outcomes
- Pain
- Neck disability
- Craniovertebral angle
- Active range of motion
- Muscle activity
Translatability: (3/3) Easy
Comments: CTJ and the upper cervical region in patients with neck pain and forward head posture represent an area which if approached by manual therapy, improves cervical mobility and posture.
Limitations: Small sample size. Limited age of the subjects (18 – 45 years), and only patients in the chronic phase (>3 months). No follow-up.
Appraisals:
PEDro Scale – (8/10) Blind subjects: No; Blind therapists: No. (by PEDro – confirmed)
BTB
Intervention – 1
- Joint mobilization.
Dose
- 3 min – 3 sets of 60 s of vibration (1 Hz).
Periodicity
- 4 weeks, 3 times a week.
Local/Technic:
Maitland grade III (Large amplitude and short vibration) technique in (C0-C1) 1 min of rest then (C7-T3).
(C0-C1) – Subject lying down with his knees bent, and the mediator sets the subject’s neck in a neutral position through a sling device (non-elastic cord, neck strap – Redcord Trainer, Staubo, Norway). The mediator grabbed and fixed the transverse process of C1 with one hand and supported the sub-occipital area with the other hand. The mediator then applied joint mobilization in the dorsal glide of the spine with the hands holding the sub.
(C7-T3) – Sling device (elastic cord, chest strap) to set the neutral position for the subject’s cervicothoracic junction. In addition, a sling device (non-elastic cord, elbow/hand strap) was also used for the shoulder and elbow joints to rule out the effect of arm position on muscle tension in the cervical and thoracic vertebrae. The mediator then secured the subject’s occipital area with one hand, while the other hand-held the articular pillars of the specific segment. Joint mobilization was applied to the C7-T1, T1- T2, and T2-T3 segments for 1 min in the posterior-anterior (PA) direction.
Intervention – 2
- Motor control training in the same session.
Dose
- 3 min – repeated movements of each motion at a rhythm of one repetition per 4 s and 10 s holding time (in the end range) for 1 min.
Periodicity
- 4 weeks, 3 times a week.
Local/Technic:
In the same posture of (C0-C1) and (C7-T3), the mediator used the sling’s string height and straps, elastic or non-elastic cords to provide neutral posture and unloading condition for the subject’s specific spinal segment.
Prior to the commencement of the intervention, subjects were educated about the movement of flexion in the craniocervical area –(C0-C1) – or extension movement at each segment (levels C7-T1, T1-T2, and T2-3). Subsequently, the subject proceeded to mediate each segment, and the mediator guided the subjects through the hand to ensure optimal movement in each segment.
Citation: Kim, S. Y., An, C. M., Cha, Y. S., & Kim, D. H. (2021). Effects of sling-based manual therapy on cervicothoracic junction in patients with neck pain and forward head posture: A randomized clinical trial. Journal of bodywork and movement therapies, 27, 447–454. https://doi.org/10.1016/j.jbmt.2021.03.007