Immediate Effects of Sustained Versus Oscillatory Mobilization in Patients With Thoracic Hypo-mobility

This randomized controlled trial compares two manual therapy interventions for adults with thoracic spine hypo mobility. Fifty-two participants are randomly allocated by coin toss to one of two equal groups (n = 26 each). Both groups first receive an identical preparatory protocol consisting of a combined session of TENS (transcutaneous electrical nerve stimulation) and hot pack application for 20 minutes, intended to reduce baseline pain and prepare the tissue for mobilization. Following this preparatory phase, Group A receives Maitland oscillatory mobilization, applied as small and large amplitude rhythmic passive movements directed at the spinous processes of the thoracic vertebrae (T1-T12). This is delivered as 3 sets of 15 repetitions, using Grades I-II to reduce pain and Grades III-IV to increase range of motion once pain has eased. Group B receives Kaltenborn sustained mobilization, which applies a slower, held stretch to the same thoracic spinous processes. This consists of 3 repetitions of a 30-60 second sustained hold, using Grades I-II for pain relief and Grade III (stretch beyond the point of restriction) to improve mobility once pain has decreased. Both interventions target the same spinal segments and are delivered in a single session by the same non-blinded protocol. Immediately after treatment, outcomes are reassessed: pain via the Numeric Pain Rating Scale (NPRS) and thoracic range of motion (flexion, extension, and right/left rotation in a lumbar-locked position) via a smartphone inclinometer application. The trial thus isolates the difference between a rhythmic, oscillatory mobilization technique and a slower, sustained-hold mobilization technique, allowing a direct immediate-effect comparison of the two manual therapy approaches for thoracic hypo mobility.