Effect of Mulligan Technique on Craniovertebral Angle in Females With Dowager's Hump

Effect of Mulligan Technique on Craniovertebral Angle in Females With Dowager's Hump

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.

Inclusion Criteria:

• The age of patients will be ranged from 39 to 58 years old; mean menopausal age
• The patients with CVA were less than 50°.
• Pain intensity level will be examined by VAS which will be more than 3.
• Limited cervical range of motion .
• Limited thoracic range of motion (flexion, extension)
• BMI will be more than 30 kg \m2.

Exclusion Criteria:

• Patients with any neck surgeries.
• Neurological infection and spinal cord injury.
• Patients with congenital musculoskeletal deformities or ankylosing spondylitis.
• Patients with cervical trauma or car accident.