Effect of Active Intervention after Kaltenborn's Cervical Joint Mobilization on The Cervical Spine Alignment and Muscle Activity in Patients with Forward Head Posture

칼텐본 경추 관절가동술 후 적용된 능동적 중재가 두부 전방자세 환자의 경추 정렬과 근활성도에 미치는 영향

  • Received : 2015.02.22
  • Accepted : 2015.03.24
  • Published : 2015.05.31


PURPOSE: The purpose of this study was to compare the effects of three interventions (intervention by passive range of motion exercise plus manual cervical traction, Mulligan's joint mobilization, and strengthening exercises) after Kaltenborn's joint mobilization on the cervical spine alignment, and muscle activity in patients with a forward head posture. METHODS: The subjects were 39 students from H University in Chungnam and C University in Jeonbuk. The subjects in each group attended training sessions three times a week for four weeks. We used one-way ANOVA and Scheffe's post hoc test to compare values between groups, and used paired t-test to compare the values of the dependent variables within groups. RESULTS: The results showed that the active intervention group experienced a significant increase compared to the passive intervention group in terms of the craniovertebral angle, cervical lordosis angle, and had significant decreases compared to the passive intervention group in terms of the upper trapezius muscle activity. The active intervention group also had significant increases in craniovertebral angle and decreased anterior scalene muscle activity than the active-assistive intervention group. The active-assistive intervention group had significant decreases compared to the active intervention group in terms of the serratus anterior, levator scapulae, and splenius capitis muscle activity. CONCLUSION: It appears that the subjects with a forward head posture had significant improvements in the cervical lordosis angle, cranial rotation angle, craniovertebral angle, and muscle activity after intervention by Mulligan's joint mobilization (active-assistive intervention component) and strengthening exercises (active intervention component) after applying Kaltenborn's joint mobilization.


Active intervention;Cervical spine alignment;Forward head posture;Joint mobilization;Muscle activity


  1. An CM, Won JI. Effects of ankle joint mobilization with movement on lower extremity muscle strength and spatiotemporal gait parameters in chronic hemiplegic patients. Phys Ther Kor. 2012;19(3):20-30.
  2. Bae SS, Kim BJ, Lee KH. A study of muscle imbalance of head, cervical and shoulder region. J Kor Soc Phys Ther. 2001;13(3):769-76.
  3. Bae SS, Lee MH, Lee SY, et al. A study of joint therapy. J Korean Soc Phys Med. 2008;3(2):121-5.
  4. Burnett A, O'Sullivan P, Caneiro JP, et al. An examination of the flexion-relaxation phenomenon in the cervical spine in lumbo-pelvic sitting. J Electromyogr Kinesiol. 2009;19:e229-e36.
  5. Cho WH, Lee WY, Choi HK. An investigation on the biomechanical effects of turtle neck syndrome through EMG analysis. Journal of the Korean Society for Precision Engineering. 2008;2008(11):195-6.
  6. Choi JD. The effect of 7-week serratus anterior strengthening exercises on shoulder pain with serratus anterior weakness. Doctor's degree. Yonsei University. 2008.
  7. Cools AM, Dewitte V, Lanszweert F, et al. Rehabilitation of scapular muscle balance: Which exercises to prescribe? Am J Sports Med. 2007;35(10):1744-51.
  8. D'Sylva J, Miller J, Gross A, et al. Manual therapy with or without physical medicine modalities for neck pain:A systematic review. Man Ther. 2010;15(5):415-33.
  9. DeVocht JW, Pickar JG, Wilder DG. Spinal manipulation alters electromyographic activity of paraspinal muscles: A descriptive study. J Manipulative Physiol Ther. 2005;28(7):465-71.
  10. Dishman JD, Burke J. Spinal reflex excitability changes after cervical and lumbar spinal manipulation: A comparative study. Spine J. 2003;3(3):204-12.
  11. Grimmer KA, Williams MT, Gill TK. The associations between adolescent head-on-neck posture, backpack weight, and anthropometric features. Spine. 1999;24(21):2262-7.
  12. Grob D, Frauenfelder H, Mannion AF. The association between cervical spine curvature and neck pain. Eur Spine J. 2007;16(5):669-78.
  13. Harrison DE, Harrison DD, Betz JJ, et al. Increasing the cervical lordosis with chiropractic biophysics seated combined extension-compression and transverse load cervical traction with cervical manipulation: Nonrandomized clinical control trial. J Manipulative Physiol Ther. 2003;26(3):139-51.
  14. Hyong IH, Bae SS. Effect of lower extremity on the joint therapy and active exercise of ankle and foot complex. J Korean Soc Phys Med. 2008;3(2):89-96.
  15. Jull GA, Falla D, Vicenzino B, et al. The effect of therapeutic exercise on activation of the deep cervical flexor muscles in people with chronic neck pain. Man Ther. 2009;14(6):696-701.
  16. Jun DH. Effect of arm movement with cranio-cervical flexion test on muscle activity. Master's degree. Daegu University. 2012.
  17. Jung YW. Effects of McKenzie exercise on the functional recovery and forward head posture of chronic neck pain patients. J Korean Soc Phys Med. 2006;1(1):93-108.
  18. Kaltenborn FM. The Spine: Basic Evaluation and Mobilization Techniques. Oslo: Olaf Noris Bokhandel. 1993.
  19. Katavich L. Differential effects of spinal manipulative therapy on acute and chronic muscle spasm: A proposal for mechanisms and efficacy. Man Ther. 1998;3(3):132-9.
  20. Kim EJ, Kim JW, Park BR. Effects of sling exercise program on muscle activity and cervical spine curvature of forward head posture. The Journal of the Korea Contents Association. 2011;11(11):213-20.
  21. Kim HB, Kim SY, Kim YM. The comparison about a evaluation and treatment concept of the manual therapy techniques. Korean J Orthop Manu Ther. 2005;11(1):49-64.
  22. Kim HS, Ahn M, Hyoung IH, et al. Cervical range of motion changes after cervical mobilization and mechanical traction. J Kor Soc Phys Ther. 2004;16(4):283-96.
  23. Kim SY. Effects of joint mobilization techniques on the joint receptors. Phys Ther Kor. 1996;3(2):95-105.
  24. Kim YG, Kang MH, Kim JW, et al. Influence of the duration of smartphone usage on flexion angles of the cervical and lumbar spine and on reposition error in the cervical spine. Phys Ther Kor. 2013;20(1):10-7.
  25. Kong BK, Kwon MS, Lee GC, et al. The effects of neck exercise program for smart phone-addicts with forward head posture on cervical alignment and balance ability. Journal of Korean Society of Integrative Medicine. 2013;1(2):81-92.
  26. Maroufi N, Ahmadi A, MousaviKhatir S. A comparative investigation of flexion relaxation phenomenon in healthy and chronic neck pain subjects. Eur Spine J. 2013;22(1):162-8.
  27. Miller J, Gross A, D'Sylva J, et al. Manual therapy and exercise for neck pain: A systematic review. Man Ther. 2010;15(4):334-54.
  28. Morningstar MW, Strauchman MN, Weeks DA. Spinal manipulation and anterior headweighting for the correction of forward head posture and cervical hypolordosis: A pilot study. J Chiropr Med. 2003;2(2):51-4.
  29. Nambi SG, Vora PK, Jhang M. Cervical spine mobilization versus thoracic spine manipulation in subjects with unilateral C6 and C7 cervical radiculopathycomparative study. International Journal of Advanced Scientific and Technical Research. 2013;1(3):304-19.
  30. O'Leary S, Falla D, Jull G. The relationship between superficial muscle activity during the cranio-cervical flexion test and clinical features in patients with chronic neck pain. Man Ther. 2011;16(5):452-5.
  31. Oh HJ, Hwang BJ, Choi YR. Effects of cervical joint mobilization on the forward head posture and neck disability indexes. J Korean Soc Radiol. 2014;8(2):89-96.
  32. Park JH. The effects of postural correction of athletic participation on turtle neck syndrome. Master's degree. Kookmin University. 2013.
  33. Seo HK. The effect of myofascial release, joint mobilization, and Mckenzie on the cervical muscle activity. Doctor's degree. Daegu University. 2008.
  34. Shin DC. The effects of a deep cervical flexion exercise on neck-shoulder pain, muscle strengthening, and cervical alignment in sedentary workers. Master's degree. Sahmyook University. 2008.
  35. Snodgrass SJ, Rhodes HR. Cervical spine posteroanterior stiffness differs with neck position. J Electromyogr Kinesiol. 2012;22(6):829-34.
  36. Sterling M, Jull G, Wright A. Cervical mobilisation: Concurrent effects on pain, sympathetic nervous system activity and motor activity. Man Ther. 2001;6(2):72-81.
  37. Tuttle N, Jacuinde G. Design and construction of a novel low-cost device to provide feedback on manually applied forces. J Orthop Sports Phys Ther. 2011;41(3):174-90.

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