Mulligan Mobilization and Stabilization Exercises for Sensorimotor Function in Women With Text Neck Syndrome

Summary

Text message neck syndrome represents a significant epidemiological and musculoskeletal concern arising from repetitive strain and prolonged cervical flexion during mobile device operation. Anatomical deviations associated with this syndrome, such as anterior head translation and altered lower cervical alignment, substantially increase the gravitational load exerted on the cervical spine. This progressive mechanical overload predisposes individuals to microtraumas, paraspinal muscle imbalances, and secondary proprioceptive impairments. Kinematic variations further heighten the clinical vulnerability of female populations, as distinct sagittal and thoracic parameters accelerate the progression of postural dysfunction.Conventional therapeutic strategies frequently target localized cervical symptoms, often neglecting the broader kinetic chain and the interdependent relationship between the cervical and thoracic segments. To address these limitations, this clinical trial evaluates a holistic "joint-by-joint" rehabilitation framework by incorporating thoracic spine interventions into both active protocols. The Mulligan Mobilization Technique combines passive manual facet joint glides with active physiological movements to restore biomechanical alignment and reduce nociceptive mechanical stress. Conversely, the Spinal Stabilization Training Protocol focuses on neuromuscular control, utilizing a pressure biofeedback unit and progressive resistance to enhance the endurance of deep cervical flexors and stabilize the scapulothoracic region.A major gap in text neck syndrome literature is the reliance on subjective pain scales, leaving the underlying neurobiological mechanisms under-investigated. This study introduces an objective biochemically validated assessment model by quantifying objective biomarkers of neurogenic inflammation, nociception, and central sensitization. By analyzing pre- and post-intervention serum concentrations of Calcitonin Gene-Related Peptide (CGRP) and Substance P via enzyme-linked immunosorbent assay (ELISA), this trial aims to correlate clinical sensorimotor and postural improvements with neurochemical changes. Ultimately, the findings will clarify whether passive manual joint mobilization or progressive active stabilization exercise provides superior efficacy in restoring sensorimotor function, optimizing postural stability, and mitigating chronic neurogenic pain pathways.

Conditions

• Neck Pain
• Text Neck Syndrome
• Cumulative Trauma Disorders
• Posture

Interventions

PROCEDURE

Mulligan Mobilization Technique

A targeted manual therapy protocol directed at the cervical and thoracic spine, administered individually for 12 sessions over a 4-week period (3 sessions per week). The intervention combines passive accessory facet joint glides with active physiological movements to restore biomechanical alignment and reduce mechanical nociceptive inputs. The protocol incorporates Natural Apophyseal Glides (NAGs) applied as passive, rhythmic oscillatory glides antero-superiorly along the cervical facet joint planes. This is followed by Sustained Natural Apophyseal Glides (SNAGs) combined with active physiological neck movements and manual end-range overpressure. To comprehensively address the kinetic chain, Reverse Natural Apophyseal Glides (RNAGs) are directed cranio-ventrally along the transverse processes of the T1-T4 and T4-T6 thoracic vertebral segments.

PROCEDURE

Spinal Stabilization Exercises

A structured, progressive neuromuscular exercise protocol conducted individually for 12 sessions over a 4-week period (3 sessions per week). The protocol focuses on enhancing neuromuscular control, deep muscle coordination, and endurance across the craniocervical and scapulothoracic regions. The intervention consists of three core components: 1) Deep cervical flexor isolation utilizing a pressure biofeedback unit (PBU) placed suboccipitally. Participants perform controlled craniocervical flexion, advancing sequentially from an initial baseline of 20 mmHg up to a terminal threshold of 30 mmHg (in 2 mmHg increments) using real-time visual feedback, ensuring no substitution of superficial muscles. 2) Isometric chin-tuck stabilization exercises performed against a soft mini-pilates ball to optimize paraspinal muscle activation. 3) Scapulothoracic retraction and thoracic spine extension exercises utilizing progressive elastic resistance bands to stabilize the broader kinetic chain.

Sponsors & Collaborators

• Pamukkale University

  lead OTHER

Study Design

Allocation

RANDOMIZED

Purpose

TREATMENT

Masking

SINGLE

Model

PARALLEL

Eligibility

Min Age

18 Years

Max Age

30 Years

Sex

FEMALE

Healthy Volunteers

No

Timeline & Regulatory

Start

2025-09-01

Primary Completion

2026-05-04

Completion

2026-05-04

Countries

• Turkey (Türkiye)

Study Locations