Effect of Mulligan Technique on Craniovertebral Angle in Females With Dowager's Hump (DH)

this study will be conducted to investigate the effect of Mulligan technique on craniovertebral angle, pain intensity, function neck disability, cervical range of motion, thoracic range of motion in females with dowager's hump.

Study Overview

• Status: Not yet recruiting
• Conditions: Dowagers Hum
• Intervention / Treatment: Other: : Mulligan Technique; Other: conventional treatment.

Detailed Description

Dowager's hump is an abnormal outward curvature of the lower cervical and upper thoracic vertebrae in upper back which leads to the compression or wedging of the anterior portion of certain thoracic vertebrae. Hyperkyphosis is commonly reported in post- menopausal women due to associated osteoporosis. The curvature results in the forward bending of the spine (hyperkyphosis) and the formation of a hump at cervicothoracic junction and upper thoracic area . The Mulligan Technique is extensively applied in managing various cervical spine dysfunctions, particularly mechanical neck pain, cervicogenic headaches, and restricted cervical range of motion. Mobilizations with Movement (MWMs) targeting the cervical facet joints can effectively reduce pain and improve mobility in patients with neck stiffness and discomfort.Despite increasing interest in conservative treatment options, there remains a notable gap in the literature regarding the range and effectiveness of therapeutic approaches specifically targeting Dowager's hump. Most existing research has focused on general postural training or corrective exercises, with limited investigation into manual therapy techniques. To date, no studies have exclusively examined the use of the Mulligan concept as a treatment for Dowager's hump, even though it has demonstrated benefits in improving spinal alignment, joint mobility, and neuromuscular control in other musculoskeletal conditions.

• Study Type: Interventional
• Enrollment (Estimated): 56
• Phase: Not Applicable

Contacts and Locations

• Study Contact: Name: nadia abdelmeged, phd; Phone Number: 01143372716; Email: dr.nadiasalem91@yahoo.com

Participation Criteria

Eligibility Criteria

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

Description

Inclusion Criteria:

• The age of patients will be ranged from 39 to 58 years old; mean menopausal age
• The patients with CVA were less than 50°.
• Pain intensity level will be examined by VAS which will be more than 3.
• Limited cervical range of motion .
• Limited thoracic range of motion (flexion, extension)
• BMI will be more than 30 kg \m2.

Exclusion Criteria:

• Patients with any neck surgeries.
• Neurological infection and spinal cord injury.
• Patients with congenital musculoskeletal deformities or ankylosing spondylitis.
• Patients with cervical trauma or car accident.

Study Plan

How is the study designed?

Design Details

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

Number of Arms

2

Arms and Interventions

Participant Group / Arm	Intervention / Treatment
Experimental: Mulligan Technique; 28 female patients will receive Mulligan technique for cervical & thoracic region and conventional treatment three times per week for four weeks	Other: : Mulligan Technique; the patients will receive Mulligan technique in the form of Natural Apophyseal Glide (NAG) for cervical, Sustained natural apophysial glide ( SNAG ) for cervical,Sustained natural apophysial glide ( SNAG ) for Thoracic; Other: conventional treatment.; The exercise program will consist of postural correction exercises to be performed under the supervision of a physical therapist. Each session will last 15-20 minutes per day, either under supervision or practiced individually at home. The exercises will include the following: While seated, participants will lift both hands together above the head; While seated or standing with their back against a wall, participants will straighten their back as much as possible; While seated on a chair with both hands placed on the neck or crossed over the chest on the shoulders, participants will lift their arms and extend the upper back without compensating with hip or lumbar spine movement; While standing in front of a wall, participants will slide both hands upward along the wall as high as possible , Retraction in supine position,Retraction with extension,Pectoral stretch exercise training,Upper back extension exercise from prone training
Active Comparator: conventional treatment.; 28 female patients will receive conventional treatment three times per week for four weeks	Other: conventional treatment.; The exercise program will consist of postural correction exercises to be performed under the supervision of a physical therapist. Each session will last 15-20 minutes per day, either under supervision or practiced individually at home. The exercises will include the following: While seated, participants will lift both hands together above the head; While seated or standing with their back against a wall, participants will straighten their back as much as possible; While seated on a chair with both hands placed on the neck or crossed over the chest on the shoulders, participants will lift their arms and extend the upper back without compensating with hip or lumbar spine movement; While standing in front of a wall, participants will slide both hands upward along the wall as high as possible , Retraction in supine position,Retraction with extension,Pectoral stretch exercise training,Upper back extension exercise from prone training

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Measure Description	Time Frame
pain intensity	The patient will choose a number from the scale which represents value of pain intensity, VAS will be more than 3. Scores are based on self-reported measures of symptoms that are recorded with a single handwritten mark placed at one point along the length of a 10-cm line that represents a continuum between the two ends of the scale- "no pain" on the left end (0 cm) of the scale and the "worst pain" on the right end of the scale (10 cm).	up to four weeks
craniovertebral angle	The Craniovertebral Angle (CVA) was assessed using a standardized photographic method. Participants were instructed to stand or sit in a relaxed natural posture with the head maintained in a neutral position while facing forward. The spinous process of the seventh cervical vertebra (C7) and the tragus of the ear were identified by palpation and marked with adhesive markers to improve measurement accuracy. A lateral photograph was then captured using a digital camera positioned perpendicular to the participant's sagittal plane, approximately 1 m away at shoulder height. The image was analyzed using Kinovea software by drawing a horizontal line through the C7 marker and a second line connecting the C7 marker to the tragus. The angle formed between these two lines at C7 was recorded as the CVA. A smaller CVA indicates a greater degree of forward head posture, with values below 50° commonly considered indicative of forward head posture	up to four weeks

Secondary Outcome Measures

Outcome Measure	Measure Description	Time Frame
neck disability	neck disability index will be used to assess neck disability.The patient will set relaxed and asked to complete the neck disability index before treatment and after treatment. which consists of 10 items. Each item is scored from zero (no disability) to five (total disability), with the maximum possible total score being 50. For each item, the subject asked to choose one answer that best defined his/her neck functional disability level. Scores for each item tallied and the total score will recorded. Mean duration of the test: 3 to 7.8 minutes. Vernon and Mior presented the following interpretation.	up to four weeks
thoracic range of motion	Thoracic Schober test will be used to test thoracic range of motion by tape measurement. The tape measure is placed at the marked points, from the spinous process of T1 to the level of T12, and active flexion of the thoracic spine is requested. After completing the movement, the difference between the initial and final measurements (T1 and T12) is recorded as the Schober test flexion value of the thoracic spine. Normal mobility values are those that show a gain of at least 5 cm on the tape measure	up to four weeks
cervical range of motion	cervical range of motion will be measured by CROM device	up to four weeks

Collaborators and Investigators

• Sponsor: Cairo University

Study record dates

Study Major Dates

• Study Start (Estimated): July 30, 2026
• Primary Completion (Estimated): February 20, 2027
• Study Completion (Estimated): February 20, 2027

Study Registration Dates

• First Submitted: July 10, 2026
• First Submitted That Met QC Criteria: July 10, 2026
• First Posted (Actual): July 15, 2026

Study Record Updates

• Last Update Posted (Actual): July 15, 2026
• Last Update Submitted That Met QC Criteria: July 10, 2026
• Last Verified: July 1, 2026

More Information

Terms related to this study

• Keywords: Mulligan Technique; Craniovertebral Angle; Females With Dowager's Hump
• Other Study ID Numbers: P.T.REC/012/006007

Drug and device information, study documents

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