Effect of Cervicothoracic Junction Manipulation on Craniovertebral Angle and Proprioception in Forward Head Posture

The aim of this research is to find out the effect of Cervicothoracic Junction Manipulation on neck Proprioception in individuals with Forward Head Posture. A Randomized controlled trials done at Barki Advance Physiotherapy Center. The sample size was 36. The subjects were divided in two groups, 18 subjects in control group and 16 in experimental (Cervicothoracic Manipulation) group. Study duration is of 6 months after the ethical approval. Sampling technique applied was non probability connivance sampling technique. Only 18-45 years individuals with forward head posture, craniovertebral angle less than 53° degrees and Joint position error, an average of >4.5◦ error in rotation or extension direction were included. Tools used in the study are Craniovertebral Angle (CVA) and Joint Position Error Test (JPE).

Study Overview

• Status: Completed
• Conditions: Forward Head Posture
• Intervention / Treatment: Other: cervicothoracic manipulation group; Other: forward head correction exercises traditional group

Detailed Description

FHP is greatly linked with multiple musculoskeletal conditions like head and neck dysfunction, myofascial trigger points, temporomandibular dysfunction, poor cervical mobility and functional disability of the cervical and thoracic spines. It also observed in asymptomatic individuals. Muscle spindles, especially in cervical detect muscle length changes and contribute to proprioception. Changes in neck muscles can disrupt proprioceptive function in the cervical spine. Proprioception is vital for joint function, providing stability during activities and informing posture and movement. Decreased balance and positioning errors are common in individuals with neck discomfort, emphasizing the importance of restoring proprioceptive function, particularly in Forward Head Posture (FHP) patients, for maintaining normal neck posture. Abnormalities in the head posture are absolutely harmful for the Head and neck posture. A study investigated the CV angle and joint position error in the cervical region and found a negative correlation between head posture and proprioceptive function, indicating that chronic abnormal head posture (FHP) negatively affects proprioception, body stability, and neck pain. Spinal manipulation uses high velocity and low amplitude thrusts to realign restricted vertebrae, removing restriction in facet joints, and producing mechanical, physiological, and biological effects.

Literature suggest that manipulation has beneficial effects in improving the pain and postural control in spine. The cervicothoracic (CT) junction is the transitional segment between the mobile lordotic cervical and less mobile kyphotic thoracic spines and hence a potential region for stiffness. The cervicothoracic junction, a potential stiffness region, can cause neck, headache, and upper limb pain. Improving its range of motion could reduce the need for compensatory movement, reducing cervical spine tension. According to recent systematic review, cervicothoracic junction level manual therapy in subjects with FHP better improved the muscle recruitment ability than upper-cervical level manual therapy during motor tasks. Upper thoracic spine manipulation has been shown to be more beneficial than thoracic mobilization, cervical mobilization, and standard care for FHP during performing motor task. In 2023 study conducted by Ibrahim et al. find out that FHP influenced Somatosensory Evoked Potentials and Somatosensory Processing in asymptomatic young adults and they reported 1-degree increase in the CVA measurement (indicating better posture) significantly decreased the amplitudes of all the potentials and resulted in a faster, more efficient nerve conduction time

• Study Type: Interventional
• Enrollment (Actual): 36
• Phase: Not Applicable

Contacts and Locations

Study Locations

• Pakistan
  • Punjab
    • Multan, Punjab, Pakistan, 46000
      • Barki Rehabilitation Center

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: Adult
• Accepts Healthy Volunteers: No

Description

Inclusion Criteria:

• Both male and female patients with age between 18-45 years
• Participants with asymptomatic Forward head posture
• Participants having no active complain of neck pain and muscle stiffness
• Joint position error, an average of >4.5◦ error in rotation or extension directions
• For FHP patient, the Craniovertebral angle should be ≤ 53º

Exclusion Criteria:

• Previous history of neck and head trauma
• Vestibular pathologies i.e. vertigo, dizziness
• Musculoskeletal or neurological conditions that could affect Proprioception, cognitive impairment
• History of spinal and thoracic surgeries

Study Plan

How is the study designed?

Design Details

• Primary Purpose: Treatment
• Allocation: Randomized
• Interventional Model: Parallel Assignment
• Masking: Double

Number of Arms

2

Arms and Interventions

Participant Group / Arm	Intervention / Treatment
Experimental: Cervicothoracic Manipulation group; the subject will receive cervicothoracic manipulation and Chin tuck, Strengthening Shoulder Retractors, Stretching SCM, Pectoralis Stretch	Other: cervicothoracic manipulation group; The participant lay prone with the head firmly into the head piece Palpation of the upper cervico-thoracic segment observed the side of the restriction. The participants head was rotated to the contralateral side of the restriction. The practitioner's hand contacted the forehead and the other hand's thumb contacted the spinous process of the restricted side. A low amplitude, high velocity thrust towards the axilla was applied, on the spinous process in PA direction. Experimental group also received following exercises Chin tuck Strengthening Shoulder Retractors. Stretching SCM Pectoralis Stretch 3 × 10 repetitions, 3 times a week for 2 weeks
Active Comparator: forward head correction exercises group; this group receive Chin tuck, Strengthening Shoulder Retractors, Stretching SCM, Pectoralis Stretch	Other: forward head correction exercises traditional group; Chin tuck Strengthening Shoulder Retractors. Stretching SCM Pectoralis Stretch 3 × 10 repetitions, 3 times a week for 2 weeks.

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Craniovertebral Angle	The CV angle was measured for assessment of head posture. All subjects were instructed to stand in a self-selected comfortable upright posture. Then, the skin overlying the spinous process of the seventh cervical vertebra (C7) and tragus of the ear was marked. A lateral view digital photograph of each subject was taken. The CV angle was calculated based on the angle between a horizontal line passing through C7 and a line extending from the tragus of the ear to C7. The x-axis values for the craniovertebral angle were measured prior to movement.	baseline to 2 weeks
Joint Position Error Test	Proprioceptive accuracy, pertaining to the sense of joint and body movement and position, was evaluated using the Joint Position Error (JPE) Test. The Cervical JPE Test measures the ability of a blindfolded patient to accurately relocate their head position back to a predetermined neutral point after cervical joint movement	baseline to 2 weeks

Collaborators and Investigators

• Sponsor: Riphah International University
• Investigators: Principal Investigator: Aisha Razzaq, PHD*, Riphah International University

Study record dates

Study Major Dates

• Study Start (Actual): June 1, 2024
• Primary Completion (Actual): February 25, 2025
• Study Completion (Actual): April 16, 2025

Study Registration Dates

• First Submitted: November 19, 2024
• First Submitted That Met QC Criteria: November 19, 2024
• First Posted (Actual): November 21, 2024

Study Record Updates

• Last Update Posted (Actual): April 18, 2025
• Last Update Submitted That Met QC Criteria: April 17, 2025
• Last Verified: April 1, 2025

More Information

Terms related to this study

• Keywords: Proprioception; Craniovertebral Angle; Cervicothoracic Manipulation; Joint position Error
• Other Study ID Numbers: Riphah IU Samiyah Asghar

Plan for Individual participant data (IPD)

• Plan to Share Individual Participant Data (IPD)?: NO

Drug and device information, study documents

• Studies a U.S. FDA-regulated drug product: No
• Studies a U.S. FDA-regulated device product: No