Comparison of Immediate Changes in Cervical Range of Motion Following Cervical Extension and Downslip Mobilizations.

Cervical Disease

The purpose of this study is to compare the efficacy seated cervical extension glides vs supine downslip glides, on both cervical rotation range of motion and patient comfort. Information gathered from this study may be used to help clinicians determine the most beneficial methods of cervical mobilizations as a rehabilitation tool.

Subjects were randomized to either the Downslips group or the Seated AP Extension Glide. Prior to and immediately after mobilization, bilateral cervical rotation range of motion measurements were taken in seated using the Cervical Range of Motion device (CROM) which has been shown to have good validity and reliability. The starting sides of both cervical spine mobilizations were chosen at the start of data collection. After that, both therapists alternated the side to begin the mobilization with each new subject. Each mobilization was performed 5x40" with a twenty second rest between. All five mobilizations are performed first on one side, then the contralateral side in the same manner, prior to the subject returning to the seated position for retesting of their cervical rotation range of motion with the CROM. The same researcher performed the CROM measurement pre- and post-mobilization rotational testing to reduce interrater error. Following the final CROM measurement, the subject was then asked to rate their perceived comfort with the technique using a modified Visual Analogue Scale, with 0 being no pain and 10 being the most uncomfortable. The downslip mobilization is completed in supine, with the practitioner positioned at the patient's head. The practitioner places their second metacarpophalangeal joint of the mobilization hand on the articular pillar of C2 while the stabilizing hand is on the occiput allowing for motion to occur. Mobilization will be in an direction that is caudal and dorsal towards the subject's contralateral hip for 5x40" with a 20" rest in between. The supine downslip mobilization will be performed by the same therapist bilaterally for all subjects; this therapist has more than thirteen years of clinical experience with advanced manual therapy training. The Seated AP Extension mobilization is completed with the subject(s) seated in the Frankfort neutral position. The therapist starts by palpating the articular pillar. The stabilizing hand is placed on C3's lamina, applying a force perpendicular to a line through the oribita to block the caudal segment. The therapist's mobilizing hand will be supinated so that their lateral 5th metacarpal is on the lamina of C2. The subject is then brought into extension and rotation to the C2-3 segment and a caudal-dorsal mobilization is applied respecting the cervical spines facet joint orientation of 45 degrees for 5x40" with a 20" rest in between. The Supine AP Extension mobilization will be performed by the same therapist bilaterally for all subjects; this therapist has more than thirteen years of clinical experience with advanced manual therapy training.

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