Mulligan Mobilization and Stabilization Exercises for Sensorimotor Function in Women With Text Neck Syndrome

The Effects of Mulligan Mobilization Technique and Stabilization Training on Sensorimotor Function in Women With Text Message Neck Syndrome: A Single-Blind Randomized Controlled Trial

Text message neck syndrome represents a significant epidemiological and musculoskeletal concern arising from repetitive strain and prolonged cervical flexion during mobile device operation. Anatomical deviations associated with this syndrome, such as anterior head translation and altered lower cervical alignment, substantially increase the gravitational load exerted on the cervical spine. This progressive mechanical overload predisposes individuals to microtraumas, paraspinal muscle imbalances, and secondary proprioceptive impairments. Kinematic variations further heighten the clinical vulnerability of female populations, as distinct sagittal and thoracic parameters accelerate the progression of postural dysfunction.Conventional therapeutic strategies frequently target localized cervical symptoms, often neglecting the broader kinetic chain and the interdependent relationship between the cervical and thoracic segments. To address these limitations, this clinical trial evaluates a holistic "joint-by-joint" rehabilitation framework by incorporating thoracic spine interventions into both active protocols. The Mulligan Mobilization Technique combines passive manual facet joint glides with active physiological movements to restore biomechanical alignment and reduce nociceptive mechanical stress. Conversely, the Spinal Stabilization Training Protocol focuses on neuromuscular control, utilizing a pressure biofeedback unit and progressive resistance to enhance the endurance of deep cervical flexors and stabilize the scapulothoracic region.A major gap in text neck syndrome literature is the reliance on subjective pain scales, leaving the underlying neurobiological mechanisms under-investigated. This study introduces an objective biochemically validated assessment model by quantifying objective biomarkers of neurogenic inflammation, nociception, and central sensitization. By analyzing pre- and post-intervention serum concentrations of Calcitonin Gene-Related Peptide (CGRP) and Substance P via enzyme-linked immunosorbent assay (ELISA), this trial aims to correlate clinical sensorimotor and postural improvements with neurochemical changes. Ultimately, the findings will clarify whether passive manual joint mobilization or progressive active stabilization exercise provides superior efficacy in restoring sensorimotor function, optimizing postural stability, and mitigating chronic neurogenic pain pathways.

Inclusion Criteria:

• Female sex.
• Age between 18_30 years.
• History of chronic neck pain lasting for at least 3 months.
• Objective diagnosis of Text Message Neck Syndrome via photographic posture analysis (classified into posture categories 3 or 4).
• History of smartphone ownership for at least 1 year.
• Minimum daily smartphone or tablet usage of 1 hour.
• Neck pain intensity score of 3.5 centimeters or higher on the Visual Analog Scale (VAS).
• Neck Disability Index (NDI) score of 5 points or higher.

Exclusion Criteria:

• Diagnosis of scoliosis or cervical disc herniation following neurological and radiological examinations.
• History of prior spinal surgery.
• Presence of concurrent musculoskeletal pathologies, including shoulder pathologies or thoracic outlet syndrome.
• Diagnosed psychiatric disorders.
• History of physical therapy or conservative treatment for neck pain within the past year.
• Presence of specific spinal or systemic pathologies, such as malignancy, acute fracture, or rheumatic disease.
• Uncorrected visual deficits.
• Presence of confounding neurological or systemic illnesses.
• Demonstration of an intervention adherence rate below 80% (completing fewer than 10 out of the 12 scheduled treatment sessions).