Immediate Effects of Sustained Versus Oscillatory Mobilization in Patients With Thoracic Hypo-mobility

Description

This randomized controlled trial compares two manual therapy interventions for adults with thoracic spine hypo mobility. Fifty-two participants are randomly allocated by coin toss to one of two equal groups (n = 26 each). Both groups first receive an identical preparatory protocol consisting of a combined session of TENS (transcutaneous electrical nerve stimulation) and hot pack application for 20 minutes, intended to reduce baseline pain and prepare the tissue for mobilization. Following this preparatory phase, Group A receives Maitland oscillatory mobilization, applied as small and large amplitude rhythmic passive movements directed at the spinous processes of the thoracic vertebrae (T1-T12). This is delivered as 3 sets of 15 repetitions, using Grades I-II to reduce pain and Grades III-IV to increase range of motion once pain has eased. Group B receives Kaltenborn sustained mobilization, which applies a slower, held stretch to the same thoracic spinous processes. This consists of 3 repetitions of a 30-60 second sustained hold, using Grades I-II for pain relief and Grade III (stretch beyond the point of restriction) to improve mobility once pain has decreased. Both interventions target the same spinal segments and are delivered in a single session by the same non-blinded protocol. Immediately after treatment, outcomes are reassessed: pain via the Numeric Pain Rating Scale (NPRS) and thoracic range of motion (flexion, extension, and right/left rotation in a lumbar-locked position) via a smartphone inclinometer application. The trial thus isolates the difference between a rhythmic, oscillatory mobilization technique and a slower, sustained-hold mobilization technique, allowing a direct immediate-effect comparison of the two manual therapy approaches for thoracic hypo mobility.

Interventions

• oscillatory mobilization (Procedure)
  Group A first receives a combined 20-minute session of TENS (transcutaneous electrical nerve stimulation) and hot pack application to reduce baseline pain. This is followed by Maitland oscillatory mobilization, applied manually to the spinous processes of the thoracic vertebrae (T1-T12), delivered as 3 sets of 15 repetitions. Treatment begins with Grade I-II oscillations, which are small- to large-amplitude rhythmic movements performed within the pain-free range to reduce pain through activation of inhibitory pain-gate mechanisms and increased joint fluid viscosity. Once pain decreases, Grade III-IV oscillations are introduced, involving larger-amplitude movement up to end-range resistance, to improve thoracic range of motion. All mobilizations are performed by the treating therapist in a single session.
• Sustained Mobilizations (Procedure)
  Group B first receives the same combined 20-minute session of TENS and hot pack application to reduce baseline pain. This is followed by Kaltenborn sustained mobilization, applied manually to the spinous processes of the thoracic vertebrae (T1-T12), delivered as 3 repetitions of a 30-60 second sustained hold. Treatment begins with Grade I-II holds, involving slight distraction and taking up slack to the point of restriction, aimed at reducing pain and stimulating Type II mechanoreceptors. Once pain decreases, a Grade III sustained stretch is applied, held beyond the point of restriction in the range of motion, to improve thoracic mobility. All mobilizations are performed by the treating therapist in a single session.

Eligibility criteria

Conditions

Locations

• Foundation University College of Physical Therapy — Islamabad, Punjab Province, Pakistan