Effect of Cervicothoracic Junction Manipulation on Craniovertebral Angle and Proprioception in Forward Head Posture

The aim of this research is to find out the effect of Cervicothoracic Junction Manipulation on neck Proprioception in individuals with Forward Head Posture. A Randomized controlled trials done at Barki Advance Physiotherapy Center. The sample size was 36. The subjects were divided in two groups, 18 subjects in control group and 16 in experimental (Cervicothoracic Manipulation) group. Study duration is of 6 months after the ethical approval. Sampling technique applied was non probability connivance sampling technique. Only 18-45 years individuals with forward head posture, craniovertebral angle less than 53° degrees and Joint position error, an average of \>4.5◦ error in rotation or extension direction were included. Tools used in the study are Craniovertebral Angle (CVA) and Joint Position Error Test (JPE).

FHP is greatly linked with multiple musculoskeletal conditions like head and neck dysfunction, myofascial trigger points, temporomandibular dysfunction, poor cervical mobility and functional disability of the cervical and thoracic spines. It also observed in asymptomatic individuals. Muscle spindles, especially in cervical detect muscle length changes and contribute to proprioception. Changes in neck muscles can disrupt proprioceptive function in the cervical spine. Proprioception is vital for joint function, providing stability during activities and informing posture and movement. Decreased balance and positioning errors are common in individuals with neck discomfort, emphasizing the importance of restoring proprioceptive function, particularly in Forward Head Posture (FHP) patients, for maintaining normal neck posture. Abnormalities in the head posture are absolutely harmful for the Head and neck posture. A study investigated the CV angle and joint position error in the cervical region and found a negative correlation between head posture and proprioceptive function, indicating that chronic abnormal head posture (FHP) negatively affects proprioception, body stability, and neck pain. Spinal manipulation uses high velocity and low amplitude thrusts to realign restricted vertebrae, removing restriction in facet joints, and producing mechanical, physiological, and biological effects.

Literature suggest that manipulation has beneficial effects in improving the pain and postural control in spine. The cervicothoracic (CT) junction is the transitional segment between the mobile lordotic cervical and less mobile kyphotic thoracic spines and hence a potential region for stiffness. The cervicothoracic junction, a potential stiffness region, can cause neck, headache, and upper limb pain. Improving its range of motion could reduce the need for compensatory movement, reducing cervical spine tension. According to recent systematic review, cervicothoracic junction level manual therapy in subjects with FHP better improved the muscle recruitment ability than upper-cervical level manual therapy during motor tasks. Upper thoracic spine manipulation has been shown to be more beneficial than thoracic mobilization, cervical mobilization, and standard care for FHP during performing motor task. In 2023 study conducted by Ibrahim et al. find out that FHP influenced Somatosensory Evoked Potentials and Somatosensory Processing in asymptomatic young adults and they reported 1-degree increase in the CVA measurement (indicating better posture) significantly decreased the amplitudes of all the potentials and resulted in a faster, more efficient nerve conduction time

Eligibility Criteria:
Inclusion Criteria:

* Both male and female patients with age between 18-45 years
* Participants with asymptomatic Forward head posture
* Participants having no active complain of neck pain and muscle stiffness
* Joint position error, an average of \>4.5◦ error in rotation or extension directions
* For FHP patient, the Craniovertebral angle should be ≤ 53º

Exclusion Criteria:

* Previous history of neck and head trauma
* Vestibular pathologies i.e. vertigo, dizziness
* Musculoskeletal or neurological conditions that could affect Proprioception, cognitive impairment
* History of spinal and thoracic surgeries