EFFECT OF MULLIGAN MOBILIZATION VERSUS

MAITLAND MOBILIZATION ALONG WITH

KINESIOTAPING
ON PAIN AND POSTURE IN YOUNG ADOLESCENT WITH
FORWARD HEAD.

1.K.A.Jayadevan MPT(Ortho 1st year) ,KG college of physiotherapy.

 INTRODUCTION
• Forward head posture (FHP) is characterized by the anterior displacement of the head and overextension
of the vertebral spine, leading to the contraction of neck muscles. It's diagnosed by assessing the
craniovertebral angle (CVA), typically using 50° as a reference point. A smaller angle indicates a more
pronounced FHP relative to the cervical spine. This condition is associated with muscle imbalances and
reduced upper trapezius length, affecting various neck muscles. (Konstantinos Mylonas et al., 2021)

• 63 % of schoolgoing students have forward head posture in the age group of 12-16 year-old students.
forward head posture is higher due to excessive use of technology such as smartphones and computers, as
well as prolonged periods of reading and writing in abnormal postures. (Shivani lalitkumar verma et al.,
2018)
Mulligan mobilization techniques, like sustained natural epiphyseal glides (SNAGs) are to target the
cervical spine by promoting gliding motion in that area. This treatment approach often leads to an
immediate improvement in pain-free range of motion (ROM) for the affected joints.

Maitland's techniques involve applying passive and accessory oscillatory movements to spinal and
vertebral joints to relieve pain and stiffness. These techniques encompass five grades of oscillatory
pressure.

One of these techniques is central postero-anterior mobilization, which involves applying force to a
vertebral segment in a back-to-front direction . to improve range of motion and reduce pain. (Abdullah Al
shehri et al., 2018).

Adding Kinesio tape is primarily used for improving neuromuscular re-education, correcting muscle
function, enhancing blood and lymph circulation, and alleviating pain. It can also serve as biofeedback,
particularly for schoo
l-going children. Additionally, incorporating stretching and strengthening exercises is beneficial for school
children. (Kase et al., 2003)
 AIM AND OBJECTIVE
AIM OF THE STUDY
 To find out the effect of Mulligan mobilization (SNAG) versus Maitland mobilization
Along with kinesio taping on pain and posture in young adolescents with forward head
posture.

OBJECTIVE OF THE STUDY

To investigate the impact of Maitland mobilization on forward head posture and neck pain.
To investigate the impact of Mulligan mobilization (SNAG) on forward head posture and
neck pain.
To assess and compare the impact of Maitland mobilization and Mulligan (SNAG)
techniques on forward head posture and neck pain.
 NEED FOR THE STUDY

• Many children experience neck pain due to continuous improper posture, which can lead to
cervical discomfort. This issue may also impact their academic performance, potentially
causing them to take leaves from school, thus affecting their overall social, mental, and
physical well-being.
• The rapid development of the musculoskeletal system during their growth years can
influence their future posture as adults.

• When it comes to correcting forward head posture, there are limited studies comparing the
effects of Maitland Mobilization and Mulligan's SNAG technique. Interestingly, there have
been no studies conducted on the combined use of Maitland and Mulligan techniques with
kinesio taping to explore the relationship between forward head posture (FHP) and neck
pain in school-going children.
 HYPOTHESIS

•
ALTERNATE HYPOTHESIS
•
 KEY WORDS

• Forward head posture

• Kinesio taping
• Pain
• Maitland mobilization
• Mulligan mobilization
 REVIEW OF LITERATURE

• Sunidhi Surendra Shinde et al. (2023) conducted a study to investigate the effects of
Maitland Mobilization versus Muscle Energy Technique on non-specific neck pain associated
with forward head posture in auto drivers. They included a total of 45 patients divided into
two groups: group A received Maitland mobilization, and group B received muscle energy
technique. The patients' outcomes were measured using the Visual Analog Scale (VAS) and
Cervical Vertebral Angle (CVA).The study's conclusion was that both techniques showed
improvements in neck pain symptoms, but there was better improvement with Maitland
mobilization for non-specific neck pain associated with forward head posture.
• Lamyaa Ahmed Neyazi et al. (2020) conducted a study to investigate the effect of adding
Kinesio Tape to Mulligan's Mobilization in patients with cervicogenic headaches. They
included 44 patients with cervicogenic headaches and divided them into two groups: group A
received Kinesio Tape in addition to the Mulligan technique, while group B received only the
Mulligan technique.The study found a significant improvement in the Visual Analog Scale
(VAS) outcome scores. The conclusion of the study was that adding Kinesio Tape to Mulligan
mobilization was found to be effective in managing cervicogenic headaches .
Abdullah Al Shehri et al. In (2018) conducted a comparative study of Mulligan (SNAG) and Maitland
mobilization for neck pain. They divided 50 patients into two groups. Group A received conventional therapy plus
SNAG, while Group B received conventional therapy plus Maitland's mobilization. After treatment, the Maitland
group showed better improvement in managing neck pain compared to the SNAG group.

Shivani Lalitkumar Verma et al. in (2018) they examined the prevalence of forward head posture (FHP) among
school-going students aged 12-16. They screened 300 students, including 158 males, among whom 88 (56%) had
FHP, and 142 females, with 101 (71%) displaying FHP. This was a cross-sectional study, and the outcome
measure used to assess FHP was the Cranio Vertebral Angle (CVA). The study found a high prevalence of 63% of
FHP among 12-16 years old school-going students.

Won-gyu Yoo et al. in (2013)the research aimed to investigate the effect of neck retraction taping (NRT) on
forward head posture (FHP) and upper trapezius muscle activity in computer workers during their work. The
study involved twelve males aged 20–30 years. The researchers measured the forward head angle and upper
trapezius muscle activity both before and after the application of NRT.
The study's conclusion suggested that the taping tension provided by NRT may have had a mechanical effect in
preventing forward head posture. Additionally, NRT may encourage individuals who are unfamiliar with the neck
retraction posture to adopt a more proper head posture.
 METHODOLOGY

STUDY SETTING: schools.

STUDY DESIGN: pre test and post test experiment study.

STUDY SAMPLING: simple randomized sampling.

STUDY DURATION: 1 year

TREATMENT DURATION: 4 weeks

 SELECTION CRITERIA
INCLUSION CRITERIA
• Both male and female school
students.
• Neck pain with forward head (NPRS
<5)
• Forward head (FHA <49°)
• Aged group between 12 to 16years
and voluntarily participating.
• Negative skin patch test.
• Pain persists for 2weeks atleast.
(Ismail m et al., 2008)
• BMI (19.5 - 24.9 kg/m²)
• Tragus to Wall test >9.5 cm(Tatu
Magra et al., 2023)
EXCLUSION CRITERIA
• Who had no neck pain forward head .
• Students who do not fit in adolescent age
group.
• Fever
• Chronic neck pain
• History of injury, surgery or fracture.
• Positive skin patch test.
• Visual deficits.
• Undergoing current medical or physical
treatment (ruivo RM et al ., 2014)
• Had severe obesity BMI>40kg/m²
• (Se-ypon Kim et al., 2015)
• Tragus to Wall test <9.5 cm
 OUTCOME MEASURE:

1. Numerical pain rating scale (NPRS)

2. Tragus to wall test

3. Universal Goniometer (CVA)

 VARIABLES
INDEPENDENT VARIABLES
mulligan mobilization (SNAG)
maitland mobilization
Kinesio taping
stretching & strengthening exercise
DEPENDENT VARIABLES
 Pain
 Forward head angle
OUTCOME MEASURES
 Pain: numerical pain rating scale
 FHA: tragus to wall test
 Universal Goniometer
 PROCEDURE
• The participants will be randomly allocated into two groups.
• Group A will receive Mulligan mobilization (SNAG) anteroposterior glide for
cervical C3 to C7 and adding kinesio taping.
• Group B will receive maitland's mobilization anteroposterior glide for cervical
C3 to C7 and adding kinesio taping .
• Both the groups will receive streching and strenthening exercise for 20
minutes,Total treatment time 45 -60min.
 GROUP A : will be treated with Mulligan mobilization
(SNAG) .
• Procedure: Posteroanterior glide (PA) movement with flexion and extension
• Position of patient: seated, well supported in a chair
• Position of therapist: standing behind the patient.
• Hand placement and technique: the therapist apply a passive PA glide along the plane
of the facets on a spinous process with the left thumb (motive thumb) through the right
thumb (contact thumb). The PA glide is sustained as the patient is asked to cervical SNAG
for cervical flexion and extension to the end-range of active motion.
• Question the patient to assure the glide is symptom-free before adding active movement.
where 10 repetition in 3 set and rest for 1 min after each set. Weekly thrice on alternative
days .
 GROUP B : will be treated with Maitland mobilization.

• Procedure: Posteroanterior glide (PA)

• Position of patient: Ask the patient to get in prone lying forehead resting on hand in
comfortable position.
• Position of therapist: Beside the patient in walk standing position.

• Hand placement and technique: Palpate the spinous process of cervical vertebra Place
the pulp of the thumb on spinous process and give grade I and II of Maitland Mobilization
glide in Posteroanterior direction 10 repetition from C3 to C6 in 3 sets.
• For C7 with the pisiform bone where 10 repetition in 3 set and rest for 1 min after each set.
Weekly thrice on alternative days .
Kinesio taping application for both GROUP A &
GROUP B
• Patients in group A and group B received the following application.
• Seated with comfortable neutral position,the first layer of the tape of a Y-
strip placed over the posterior cervical extensor muscle,from the insertion to
the origin to inhibit paraspinal cervical muscle activities ( kase et al., 2003).
• while the patient's neck is in a position of maximum available cervical
contralateral sidebending and rotation. The tape was placed from the dorsal
region (T1-T2) to the upper cervical region (C1-C2). The overlying strip
was a space-tape (opening) placed perpendicular with moderate tension
(50%) to the Y-strip, over the mid cervical region (C3-C6) on the patient's
flexed cervical spine to apply tension to the posterior structures.
• Rubbed for several seconds in order to help fix the tapes onto the skin.
 STRENGTHENING EXERCISE
Week:1

Week : 2

Week :
3 &4
 STRENGTHENING EXERCISES
Upper Thoracic lower
Supine Chin Tuck
Lie on your back. Tuck chin back
slowly, hold 2 seconds. Slowly
return back to start position in 4
seconds. Repeat 5 times
Lie on your back. Place towel roll
under head. Tuck chin back and
pull neck backwards into the
towelhold for 2 seconds. Slowly
return back to start position in 4
seconds
Lie on your back. Perform a chin
tuck first, then lift head up 1 inch,
Hold 2 seconds, then slowly return
to start position in 4 seconds
cervical Extensor
Place resistance band
behind head. Put hands on
wall. Neck should be
slightly flexed forward.
Then, extend your head
backwards against the
resistance of the band.
Hold 2 seconds, then
return back slowly to start
position in 4 seconds.
Week 1-2: 1 set of 10
repetitions. Week 3-4:
2sets of 10 repetitions.
Single-Arm Row with
Trunk Rotation
Get into a split stance,
perform a row with the
tubing, then rotate your
trunk 90 degrees to the same
side as your row. Perform in
a controlled manner on right
and left sides. Week 1-2: 1
set of 10 repetitions. Week
3-4: 2 sets of 10 repetitions.
STRETCHING EXERCISE

1. Clasp the hands and stretch them straight upwards(with the subject looking at the
hands).
2. Place both hands on the shoulders and push out the chest (with the head thrown
backwards).
3. Look straight ahead and slowly turn the head horizon- tally and stop when the
maximum value is reached (right and left).
4. Throw back the head, and turn it until it has reached the fully stretched point
(right and left).
5. Lower the head, and turn it until it has reached the maximal point (right and left).
6. Place one hand over the shoulder and grasp the elbow of the turned hand, with
the other hand over the head and slowly pull it inward until it has reached the fall
stretched point (right and left).
EXPECTED OUTCOME
• It is expected that the group which receives mulligan (SNAG) mobilization
along with kinesio taping and conventional physiotherapy protocol will show
improvement in pain and forward head posture compared to the maitland
mobilization along with kinesio taping and conventional physiotherapy
protocol, still it should be statistically proven .
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THANK YOU