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 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.