Effects of Thoracic Spine and Cervical Spine Mobilization on Pain, Functional Disability, and Quality of Life in Patients With Mechanical Neck Pain.

Mechanical neck pain (MNP) is characterized as neck discomfort mostly originating from musculoskeletal components such as cervical facet joints, intervertebral discs, ligaments, and musculature, in the absence of indications of nerve root compression or severe pathological conditions. Although recent evidence supports the use of both cervical and thoracic mobilization for mechanical neck pain, there remains limited comparative research examining their combined or relative effects on pain, functional disability, and quality of life. A total of 66 Participants with mechanical neck pain (> 4 weeks) will be randomly allocated into two groups: Group A (Cervical spine Maitland mobilization group) will receive cervical spine Maitland mobilization throughout the 8-week intervention period, with sessions conducted twice weekly from pre-treatment to post-treatment assessment, Each session will be lasted approximately 30 minutes, consisting of manual therapy followed by standardized therapeutic exercises, supervised exercises will be performed for approximately 15 minutes. Additionally, participants in both groups will be prescribed a daily home exercise program lasting 10-15 minutes. Group B (Thoracic Plus Cervical Spine Maitland Mobilization) will receive combined thoracic and cervical spine Maitland mobilization, Thoracic mobilization will be applied to the upper thoracic segments (T1-T4) using central PA Technique. Grades III and IV mobilizations for thoracic stiffness and restore extension mobility, while lower grades will be applied in cases of increased pain sensitivity. Thoracic mobilization will be delivered for approximately 6-8 minutes, after that cervical mobilization with same protocol of supervised exercise and home pan for mechanical neck pain will be used. Each treatment session will be lasted approximately 30 minutes. Outcome measures will include: Pain intensity assessed using the Visual Analogue Scale (VAS) Functional disability will be evaluated using the Neck Disability Index (NDI), Health-related quality of life will be measured using the Short Form-36 (SF-36). The primary objective of this study is to evaluate the effects of cervical spine mobilization and thoracic spine mobilization on pain intensity, functional disability, and quality of life in patients with mechanical neck pain.

Study Overview

• Status: Recruiting
• Conditions: Mechanical Neck Pain
• Intervention / Treatment: Other: Cervical Spine Maitland Mobilization; Other: Thoracic plus Cervical Spine Maitland Mobilization

Detailed Description

Mechanical neck pain (MNP) is a common musculoskeletal condition characterized by localized or unilateral neck pain arising from cervical musculoskeletal structures, without nerve root involvement. It is frequently associated with restricted cervical and thoracic mobility, muscle stiffness, reduced range of motion, and functional limitations, which can significantly impair daily activities, work performance, and overall quality of life. Due to its high prevalence and recurrent nature, effective conservative physiotherapy management is essential.

Among commonly used physiotherapy interventions, spinal mobilization techniques particularly cervical spine mobilization and thoracic spine mobilization are widely applied to reduce pain, improve joint mobility, and enhance functional outcomes. Cervical mobilization focuses on restoring segmental mobility of the cervical spine and modulating pain through mechanical and neurophysiological mechanisms. In contrast, thoracic spine mobilization targets the upper thoracic region to improve extension mobility and reduce biomechanical stress on the cervical spine through the concept of regional interdependence. Although both techniques are frequently used in clinical practice, there is limited comparative evidence regarding their individual and combined effectiveness in patients with mechanical neck pain.

This study is designed as a two-arm parallel randomized controlled trial. A total of 66 participants diagnosed with mechanical neck pain will be recruited using a convenience sampling technique. Participants will be randomly allocated into two groups using computer-generated randomization with a 1:1 allocation ratio. Allocation concealment will be ensured using sealed opaque envelopes, and outcome assessment will be performed by a blinded assessor.

Participants in Group A will receive cervical spine Maitland mobilization applied to symptomatic cervical segments (C2-C7) using graded oscillatory techniques for pain reduction and mobility improvement. Participants in Group B will receive combined thoracic and cervical spine Maitland mobilization, where thoracic mobilization will be applied to upper thoracic segments (T1-T4) followed by cervical mobilization within the same session.

Both groups will receive standardized physiotherapy care, including patient education on posture and ergonomics, along with a structured home exercise program focusing on cervical mobility and postural control. The intervention will be conducted over a period of 8 weeks, with 2 sessions per week. Each session will last approximately 30 minutes.

Outcome measures will include pain intensity assessed using the Numeric Pain Rating Scale (NPRS), functional disability measured by the Neck Disability Index (NDI), and quality of life evaluated using the Short Form-36 (SF-36). Assessments will be conducted at baseline, mid-intervention (4 weeks), and post-intervention (8 weeks).

Data will be analyzed using SPSS software. Normality of data will be assessed using the Shapiro-Wilk test, and appropriate parametric or non-parametric tests will be applied for within-group and between-group comparisons.

This study aims to provide evidence regarding the effectiveness of cervical spine mobilization alone versus combined thoracic and cervical spine mobilization in improving pain, functional disability, and quality of life in patients with mechanical neck pain, thereby contributing to evidence-based physiotherapy practice.

• Study Type: Interventional
• Enrollment (Estimated): 66
• Phase: Not Applicable

Contacts and Locations

• Study Contact: Name: Dr.Tariq Shafi, MSPT; Phone Number: +923454190056; Email: muhammad.tariq@ubas.edu.pk
• Study Contact Backup: Name: Ahmad Arshad, MSPT; Phone Number: +923018822967; Email: Mianahmadarshad3@gmail.com

Study Locations

• Pakistan
  • Punjab Province
    • Lahore, Punjab Province, Pakistan, 53400
      • Recruiting
      • Lahore University of Biological & Applied Sciences (UBAS)
      • Contact: Dr.Muhammad Tariq Shafi, MSPT; Phone Number: +923454190056; Email: muhammad.tariq@ubas.edu.pk

Participation Criteria

Eligibility Criteria

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

Description

Inclusion Criteria:

Participants of both genders aged between 20 and 40 years with a clinical diagnosis of mechanical neck pain will be included in the study. Eligible participants must have a history of neck pain lasting more than 4 weeks (subacute to chronic) and demonstrate mild to moderate functional disability, defined by a Neck Disability Index (NDI) score between 10% and 50%.

Exclusion Criteria:

Participants will be excluded if they present with signs or symptoms of cervical radiculopathy or myelopathy, such as a positive Spurling's test accompanied by neurological deficits, dermatomal numbness, or myotome weakness. Individuals with a history of cervical spine fracture, dislocation, or spinal surgery, as well as those with inflammatory, infectious, or neoplastic spinal conditions, will also be excluded. Additional exclusion criteria include diagnosed osteoporosis or prolonged use of systemic corticosteroids, severe cervical spine instability or vertebrobasilar insufficiency, recent trauma to the cervical or thoracic spine within the past 6 months, presence of systemic neurological disorders, pregnancy, and current participation in another physiotherapy or clinical trial for neck pain.

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: Cervical Spine Maitland Mobilization; Participants in this group will receive cervical spine Maitland mobilization along with standardized physiotherapy care, including patient education on posture, ergonomics, and a structured home exercise program. The intervention will be conducted for 8 weeks, with 2 sessions per week, each lasting approximately 30 minutes. Cervical mobilization will be applied to symptomatic segments (C2-C7) using graded oscillatory techniques to reduce pain and improve cervical mobility	Other: Cervical Spine Maitland Mobilization; Participants in this group will receive cervical spine Maitland mobilization in addition to standard physiotherapy care. The program will be delivered for 8 weeks, with 2 sessions per week, each session lasting approximately 30 minutes. Mobilization will be performed according to the Maitland concept, with Grades I and II techniques applied for pain modulation and Grades III and IV for improving joint mobility, depending on patient tolerance. Each targeted cervical segment (C2-C7) will receive 3 sets of oscillations lasting 30-60 seconds, with short rest intervals between sets. The intervention aims to restore segmental mobility, reduce pain, and improve functional outcomes.
Active Comparator: Thoracic plus Cervical Spine Maitland Mobilization; Participants in this group will receive combined thoracic and cervical spine Maitland mobilization along with standardized physiotherapy care, including posture education and a structured home exercise program. The intervention will be conducted for 8 weeks, with 2 sessions per week, each lasting approximately 30 minutes. Thoracic mobilization will be applied to improve thoracic mobility, followed by cervical mobilization to reduce pain and enhance function.	Other: Thoracic plus Cervical Spine Maitland Mobilization; Participants in this group will receive combined thoracic and cervical spine Maitland mobilization in addition to standard physiotherapy care. The program will be conducted for 8 weeks, with 2 sessions per week, each session lasting approximately 30 minutes. Thoracic mobilization will be applied to upper thoracic segments (T1-T4) using central posterior-to-anterior oscillatory techniques, primarily Grades III and IV to improve extension mobility. This will be followed by cervical spine mobilization using the same protocol as Group A. Thoracic mobilization will be performed for approximately 6-8 minutes, followed by cervical mobilization for 8-10 minutes. The combined approach aims to reduce cervical mechanical stress through regional interdependence, improve mobility, and enhance pain relief and functional outcomes.

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Numeric Pain Rating Scale, Neck Disability Index, Short Form-36 (SF-36)	Outcome assessment will be conducted at baseline (pre-treatment), at 4 weeks (mid-intervention), and at 8 weeks (post-intervention). Pain intensity will be measured using the Numeric Pain Rating Scale (NPRS), functional disability using the Neck Disability Index (NDI), and quality of life using the Short Form-36 (SF-36). Data will be analyzed using appropriate statistical tests to compare within-group and between-group differences.	Baseline, 4 weeks, and 8 weeks

Collaborators and Investigators

• Sponsor: Lahore University of Biological and Applied Sciences
• Investigators: Study Chair: Shoaib Waqas, Lahore University of Biological and Applied Sciences

Study record dates

Study Major Dates

• Study Start (Actual): May 1, 2026
• Primary Completion (Estimated): July 30, 2026
• Study Completion (Estimated): September 15, 2026

Study Registration Dates

• First Submitted: July 20, 2026
• First Submitted That Met QC Criteria: July 20, 2026
• First Posted (Actual): July 23, 2026

Study Record Updates

• Last Update Posted (Actual): July 23, 2026
• Last Update Submitted That Met QC Criteria: July 20, 2026
• Last Verified: July 1, 2026

More Information

Terms related to this study

• Other Study ID Numbers: UBAS/ERB/26/04/021

Plan for Individual participant data (IPD)

• Plan to Share Individual Participant Data (IPD)?: YES
• IPD Plan Description: baseline participants

IPD Sharing Time Frame

Start Date: De-identified individual participant data (IPD) along with supporting materials will be made available following publication of the main trial findings, anticipated around 12 months after the study concludes.

End Date: The data will be accessible for a period of 5 years from the commencement date to eligible researchers who provide a formal application and consent to the data use agreement.

IPD Sharing Access Criteria

De-identified individual participant data (IPD) along with supporting documents will be available to qualified researchers for academic and non-commercial use only. To access the data, researchers must submit a written application detailing their study objectives and proposed use of the dataset. All requests will be assessed by the principal investigator Irsa and the institutional ethics committee to ensure ethical compliance and protection of participant privacy.

Data Available:

The shared dataset will include anonymized participant information, such as age and sex.

• IPD Sharing Supporting Information Type: STUDY_PROTOCOL; SAP; ICF; CSR

Drug and device information, study documents

• Studies a U.S. FDA-regulated drug product: No
• Studies a U.S. FDA-regulated device product: No
• product manufactured in and exported from the U.S.: Yes