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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.
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.
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| Label | Type | Description | Intervention Names |
|---|---|---|---|
| Mulligan Technique | Experimental | 28 female patients will receive Mulligan technique for cervical & thoracic region and conventional treatment three times per week for four weeks |
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| conventional treatment. | Active Comparator | 28 female patients will receive conventional treatment three times per week for four weeks |
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| Name | Type | Description | Arm Group Labels | Other Names |
|---|---|---|---|---|
| : Mulligan Technique | Other | 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 |
| 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 |
| 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. |
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Inclusion Criteria:
Exclusion Criteria:
Fifty-six females; age of patients will range from 39 to 58 years old, the mean menopausal age.
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| Name | Role | Phone | Extension | |
|---|---|---|---|---|
| nadia abdelmeged, phd | Contact | 01143372716 | dr.nadiasalem91@yahoo.com |
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Mulligan Technique and tradional therapy
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| conventional treatment. | Other | 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:
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| 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 |