the effectiveness of two different types of non-thrust mobilization techniques

the effectiveness of two different types of non-thrust mobilization techniques

Article Review Summary by Tyler Tice, PT, DPT, MS, ATC

A comparison of two non-thrust mobilization techniques applied to the C7 segment in patients with restricted and painful cervical rotation

Mobilizations and manipulations to joints in the cervical spine is a common intervention performed by physical therapists to improve neck range of motion. There is controversy about using rotary thrust manipulations in the lower cervical spine and has potential to cause adverse reactions, therefore it may be more appropriate to use non-thrust mobilization techniques instead. A study looked at the effectiveness of two different types of non-thrust mobilization techniques. These 2 techniques are:

  • Non-thrust C7 facet joint gliding mobilization: (for restricted right rotation): “The T1 segment is manually stabilized in left rotation by pressing the left shoulder girdle in a posterior direction. Bilateral translatory movements are applied to the lamina and inferior facets of the C7 segment in the direction of right rotation.” (Left image below)
  • Non-thrust facet joint distraction mobilization: (for restricted right rotation): “The clinician uses his left hand to separate (distract) the right inferior facet of C7 away from the superior facet of T1. The clinician uses his right hand to maintain a ventral and medial pressure against the lamina and inferior facet of C7. This compresses the inferior facet of C7 against the superior facet of T1. This will shift the axis of movement to the left, which will facilitate greater motion (facet distraction) on the right side of the C7 segment. Manual stabilization of the T1 segment occurs by using the right lower extremity to passively press the left shoulder girdle and clavicle in a posterior direction, which rotates the T1 segment in the opposite direction of the intended mobilization.” (Right image below)

**In this study, one intervention = three consecutive, 7-second, grade III, non-thrust facet glide or facet distraction mobilizations**

                                           

Creighton, D., Gruca, M., Marsh, D. and Murphy, N., 2014. A comparison of two non-thrust mobilization techniques applied to the C7 segment in patients with restricted and painful cervical rotation. Journal of Manual & Manipulative Therapy, 22(4), pp.206-212.

This study had 30 participants who had cervical pain rated as 2/10 or higher, pain with both left and right active cervical rotation, and limited active cervical rotation in both directions when measured with a CROM. The participants were split in half in which one group received the facet joint glide technique and the other received the facet joint distraction technique.

Outcomes measured for this study were degrees of active right and left rotation, pain rating at end range right and left cervical rotation, and the number of adverse reactions produced. These measures were taken before and after the mobilization technique was performed.

The results display that both groups of participants had a statistically significant increase in both right and left active cervical rotation range of motion: about 5 degrees increase in both directions. There was also a statistically significant decrease in pain levels for both right and left active cervical rotation. No adverse reactions were reported by any subject. One technique did not produce significantly better results compared to the other technique.

Limitations of this study include: the researcher was not blinded, challenging study reproducibility since training is likely required to perform the same techniques, possible placebo affect may have occurred, small sample size, possibility for measurement error, and does not look at long term outcomes.

Despite the limitations, these 2 techniques show that they can be a safe, low risk, and effective addition to a treatment session for patients with limited and painful cervical rotation range of motion. However, these techniques do not prove to be a stand alone way to improve cervical pain and range of motion. It is recommended that therapeutic exercise and other manual therapy interventions should be performed in addition to these techniques to have the best outcomes.

Reference:

Creighton, D., Gruca, M., Marsh, D. and Murphy, N., 2014. A comparison of two non-thrust mobilization techniques applied to the C7 segment in patients with restricted and painful cervical rotation. Journal of Manual & Manipulative Therapy, 22(4), pp.206-212.