Effects of Cervical Joint Mobilization on the Forward Head Posture and Neck Disability Indexes

경부관절가동술이 두부전방자세와 경부장애지수에 미치는 영향

Oh, Hyunju;Hwang, Byeongjun;Choi, Yoorim

  • Received : 2014.01.06
  • Accepted : 2014.02.25
  • Published : 2014.02.28


This paper tries to examine whether the application of joint mobilization to subjects who have the forward head posture due to malalignment in the cervical joint has influence on posture changes and functions in the cervical joint. The subjects were 39 students from G University in Gyeongsangbuk-do. The cervical joint mobilization was applied to 20 subjects and not to 19. The students with a cervical lordosis angle of $21^{\circ}C$ or less, an anterior weight bearing (AWB) of 15mm or greater, and a cervical extension ROM of $70^{\circ}C$ or less in terms of radiography were selected as subjects under their voluntary agreement. The patients actively performed the joint mobilization slowly 8 times per session while therapists continuously applied sustained accessory glide to their painful joints 3 times per week for 4 weeks along with the cervical expansion and flexion in SNAGS among other Mulligan's (1995) techniques. The measurement was carried out in terms of radiographic inspection and neck disability indexes. As a result of the experiment, it turned out that the subjects with the forward head posture had changes in the cervical AWB and ARA, the ranges of expansion and flexion, and the NDI(Neck Disability Index) after the intervention for the experimental group by applying cervical joint mobilization. There were no changes observed in the control group. In conclusion, the application of joint mobilization turned out to have influence on the improvement of cervical joint postures, and craniocervical region functions.


Joint mobilzation;Cervical posture;Mulligan Technic


  1. Harrison D.E., Harrisson D.D., Bets J.T., "Increasing the cervical lordosis with chiropractic biophysics seated combined extension-compression and transverse load cervical traction with cervical manipulation: nonrandomized clinical control trial", JMPT, Vol. 26, No.3, pp. 139-151, 2003.
  2. Kraus SL. "TMJ disorders management of the craniomandibualr complex". 2nd ed., New York: Churchill Livingstone, 1994.
  3. Sahrmann, S. A. "Diagonsis and treatment of movement impairment syndromes", Philadelpia: Mosby, 2001.
  4. Waris., "Scandinavian Journal of work, Environment and Health", Occupational cervicobrachial syndromes, Vol. 5, No.3, pp. 3-14, 1980.
  5. Janda V., "Rehabilitation of the spine", Baltimore: Williams & Wilkins, 1996.
  6. Janda V. "Muscles and Motor Control in Cervicogenic Disorders: Assessment and Management", In Grant, R., Physical Therapy of the Cervical and Thoracic Spine, New York: Churchill Livingstone, 1994.
  7. Mennell J.M., "The Validation of the diagnosis 'Joint dysfunction' in the synovial joint of the cervical spine", JMPT, Vol. 13, pp. 7-12, 1990.
  8. Whittingham W., Nilsson N., "Active range of motion in the cervical spine increses after spinal manipulation(Toggle Recoil)", JMPT, Vol. 24, pp. 552-555, 2001.
  9. Godges J.J., Mattson-Bell M., Thorpe D., Shah D., "The immediate effects of soft tissue mobilization with proprioceptive neuromuscular facilitation on glenohumeral external rotation and over headreach". JOSPT, Vol. 33. No.12, pp. 713-718, 2003.
  10. Kaltenborn F.M., "The spine: basic and mobilization techniques. Oslo: Olaf Noris Bikhandel", 1993.
  11. Chio WS, Park JH, Jung BJ et al. "A Study on shoulder joint motions in the caudal gliding of Kaltenborn-Evjenth", JKSR, Vol. 6, No. 5, pp. 427-433, 2012.
  12. Mckenzie R.A., "Treat Your Own Neck. New Zealand: Spinal pubilcations", 1983.
  13. "Maitland GD, The treatment of joint by passive movement". AJPT, 20, pp129-135. 1986.
  14. Mulligan B.R,. "Manual therapy: NAGS, SNAGS, MWMS etc. OPT", 1995.
  15. Kinser C., Colby L.A., "Theraputic Exercise Foundations and techniques", 5th ed., Philadelpia: F.A Davis. 2007.
  16. Gore D., Sepic S., Gardner G., "Roentgenographic findings of the cervical spine in asymptomatic people". Spine, Vol. 11, pp. 521-524, 1986.
  17. Owens E., Hoiris K., "Cervical curvature assessment using digitized radiographic analysis". JCR, Vol. 4, pp. 47-62, 1990.
  18. Oakley P.A., Harrison D.D., "Harrison DE. Evidence-based protocol for structural rehabilitation of the spine and posture: review of clinical biomechanics of posture (CBP$^{(R)}$) publications", JCCA, Vol. 49, No. 4, pp. 270-296, 2005.
  19. Harrison D.E., Harrison D.D., Calliet R., Troyanorich S.J., Jank T.J., Hollad B., "Cobb method or harrison posterior tangent method: which to choose for lateral cervical radiographic analysis", Spine, Vol. 25, No. 16, pp. 2072-2078, 2000.
  20. Hermann K.M., Reese C.S., "Relationships among selected measures of impairment. funtional limitation and disability in patients with cervical spine disorders", PT, Vol. 81, pp. 903-914, 2001.
  21. Neumann D.A., "Axial skeleton: Muscle and joint interactions. In: kinesiology of the musculoskeltal system", 2nd ed., Philadelpia: Mosby, 2010.
  22. Lee H.J., Leslie L.N., Roger D.A., Chris G.M., Mark H., Bae S.S., "Development and Psychometric Testing of Korea Language Versions of 4 Neck Pain and Disability Questionnaires", Spine, Vol. 31, No. 16, pp. 1841-1845, 2006.
  23. Kim MJ, Cho WJ, Kang SY, Lee WS, Park JW, "Evaluation of clinical availability for shoulder forced traction method to minimize the beam hardening artifact in Cervical-spine Computed Tomography(CT)", JKSR, Vol. 7, No. 1, pp. 37-44, 2013.
  24. Cote P., Cassidy J.D., Carroll L., "The Prevalence of neck pain and related disability in Saskatchewan adults", Spine, Vol. 23, pp. 1689-1698, 1998,
  25. Kim Y.M., "Effects of the Use of the Hold Relax Technique to Treat Female VDT Workers with Work-related Neck-shoulder Complaints", KSOEM, Vol. 21, No.1, pp. 18-27, 2009.
  26. Bae S.S., Kim B.J., Lee G.H., "A Study of Muscle Imbalance of Head, Cervical and Shoulder Region", KSPT, Vol. 13, No, 3, pp. 769-776, 2001.
  27. Bronfort G., Evans R., Nelson B. "Manipulation for patients with chronic neck pain: Arandomized clinical trial of exercise and spinal", Spine, 2001, Vol. 26, pp. 788-799.
  28. Jung Y.W., Yoon S.W., Lee J.W., "The Effects of Therapeutic Exercise on the Grip Strength of Chronic Neck Pain Patients", KSPM, Vol. 4, No. 2, pp. 73-78, 2009.
  29. Choi SJ, Choi WS, Moon OK, "A Study on the Load Analysis of Gliding Grade under the Kaltenborn-Evjenth Concept$^{(R)}$,", JKSR, Vol. 6, No. 5, pp. 383-388, 2012.
  30. Kyhlback M., Thierfelder T., Soulerlund A., "Prognostic factors in whiplash-associated disorders", IJRR, Vol. 25, No. 3, pp. 181-187, 2002.
  31. Jung J.Y., Jin Y.S., Kim H.S., Park E.Y., Kim H.K., Park E.K., "The effect of 8 weeks home-exercise program on VAS, NDI, ROM, cervical spine curvature in chronic neck pain patients", KAHPERD, Vol. 46, No. 4, pp. 437-445, 2007.

Cited by

  1. Effect of Active Intervention after Kaltenborn's Cervical Joint Mobilization on The Cervical Spine Alignment and Muscle Activity in Patients with Forward Head Posture vol.10, pp.2, 2015,