J. Phys. Ther. Sci.

30: 486–489, 2018

The Journal of Physical Therapy Science

Original Article

The effect of short-term upper thoracic

self-mobilization using a Kaltenborn wedge on
pain and cervical dysfunction in patients with
neck pain

Hyung-Taek Oh, PT, MS1), Gak Hwangbo, PT, PhD1)*

1) Department of Physical Therapy, College of Rehabilitation Sciences, Daegu University:
Jillyang, Gyeongsan, Gyeongbuk 712-714, Republic of Korea

Abstract. [Purpose] The aim of this study was to determine the effect of short-term self-joint mobilization of the
upper spine using a Kaltenborn wedge on the pain and cervical dysfunction of patients with neck pain. [Subjects and
Methods] Twenty-seven patients with neck pain were divided into two groups; the self-mobilization group (SMG,
n=13) and the self-stretching group (SSG, n=14). The SMG performed upper thoracic self-mobilization and the SSG
performed self-stretching exercises as a short-term intervention for a week. To assess the degree of neck pain, the
visual analog scale (VAS) was utilized, and to measure the joint range of motion at the flexion-extension, it was
compared and analyzed by using the goniometer. [Results] Both SMG and SSG show a significant decrease in the
visual analog scale and a significant increase in joint range of motion within the group. In the comparison of groups,
there was no significant difference, but it indicated effects on improving the range of motion of extension in SMG.
[Conclusion] Self-mobilization of the upper spine, using a Kaltenborn wedge, was useful in alleviating pain in and
dysfunction of the cervical spine, and in particular, in improving cervical spine extension in this study.
Key words: Neck pain, Self mobilization, Kaltenborn wedge
(This article was submitted Oct. 14, 2017, and was accepted Jan. 9, 2018)

INTRODUCTION
Chronic pain in the cervical spine region is commonly due to overuse or recurrent trauma, and may be due to instability
of the spinal segments1). This causes restriction to the movement of the adjacent joints, leading to impaired functional move-
ment of the cervical spine2).
A relationship between the cervical and thoracic spine has been described as close and ergonomically related3). From the
functional viewpoint of the entire spine, since the movement of the cervical vertebrae includes the movement of the upper
thoracic (‘1th thoracic spine; T1’ to ‘4th thoracic spine; T4’)4), hypomobility of the upper thoracic can cause pain in the
cervical spine because of compensation, whereas hypermobility of the upper thoracic can induce incompetence of the upper
thoracic5). Lau et al.6) reports that patients with dysfunctional cervical spine have excessive kyphosis compared to healthy
normal persons, and kyphosis is closely related to pain around the neck.
Joint mobilization is often used in manual therapy. This method applies distraction and sliding techniques passively to
the joint surfaces in order to maintain or recover joint mobility7). Sandow demonstrates the need for joint mobilization in the
thoracic due to the risk of cervical mobilization, which involves cervical rotation8).
The application of joint mobilization to the upper thoracic spine has been reported to have an positive effect, sometimes
immediately, on cervical spine dysfunction, in conjunction with the provision of pain relief9, 10). However, previous treat-

*Corresponding author. Gak Hwangbo (E-mail: [email protected])

©2018 The Society of Physical Therapy Science. Published by IPEC Inc.
This is an open-access article distributed under the terms of the Creative Commons Attribution Non-Commercial No Deriva-
tives (by-nc-nd) License. (CC-BY-NC-ND 4.0: https://creativecommons.org/licenses/by-nc-nd/4.0/)

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ments, including joint mobilization, have been ineffective in a busy clinical setting because they involve the direct and
passive intervention of therapists11). Therefore, it was determined that a therapeutic joint mobilization intervention method
that patients could easily administer themselves should be applied.
Thus, the study objective was to investigate the effect of short-term self-joint mobilization of the upper spine using a
Kaltenborn wedge on the pain and cervical dysfunction of patients with neck pain.

SUBJECTS AND METHODS

This study was conducted on patients who presented at a hospital located in Andong, Gyeongbuk, South Korea, for neck
pain treatment. Twenty-seven patients with cervical spine dysfunction and pain agreed to participate in the study. Written in-
formed consent according to the ethical standards of the Declaration of Helsinki was provided by all subjects prior to partici-
pation, and all agreed to participate in this study. The patients were randomly divided into two groups; the self-mobilization
group (SMG, n=13) and the self-stretching group (SSG, n=14), all of whom received conventional physical therapy (a hot
pack and interferential current therapy). Thereafter, the two groups performed self-mobilization or self-stretching exercises
for 20 minutes, three times a week, for one week only, to determine the effect of the short-term intervention.
The SMG performed self-mobilization exercises using the Kaltenborn wedge (Fig. 1). The size of the wedge used in the
Kaltenborn concept is 20.3 cm long, 10.8 cm wide, and 6.4 cm high. Upper thoracic self-mobilization is a technique that
is applied to the upper thoracic spine (the spine between C7 and T3), originally termed the Kaltenborn-Evjenth concept12).
The groove of the Kaltenborn wedge is placed under the spinous process of the upper spine in a lying position with the knee
bent. Rocking forward and backward mobilization of the upper spine joint is possible owing to gravity and body weight. The
subjects in this position raised the hips upward into a bridging position until they felt pain, thereby increasing pressure on
joint mobilization. The therapist guided the subjects from time to time to ensure that they recognized and transferred their
position from the C7 to T3. The joint Range of Motion (ROM) is maintained by increasing pressure for 30 sec with 10 sec
of rest while repeating the motion. Each set consists of three sets of 10 repetitions of motion. One min of rest was given
between each set.
The SSG performed self-stretching exercises, applied to the levator scapulae muscle and the trapezius muscle using the
contract-relax technique13). Each muscle was stretched for 30 sec followed by 10 sec of rest. The motion was applied 10
times on both sides.
Neck pain was measured using the Visual Analog Scale (VAS). Dysfunction of the cervical spine was measured with a
joint ROM device, i.e., Myrin™ OB Goniometer (Kineman Enterprises, Norway), to establish ROM in the cervical spine in
terms of flexion and extension within the sagittal plane. The subjects took a neutral position in the static chair while crossing
their hands and fixing them on the shoulders. The measurements were taken while fixing the movement of the thoracic as
much as possible. The angles of the motions started at 0 degrees and each of the movements was repeated three times in order
to record a mean value. Both the SMG and the SSG had the same treatment time (25 min) for each session and were measured
twice; once prior to the intervention and once following the third treatment session (also the last).
This study used SPSS 18.0 for Windows to conduct the data analysis. A paired t-test was used to test the within-group level
of pain and joint ROM before and after the experiment. An independent t-test was conducted to explain the between-group
difference. The significance level ɑ was set at 0.05 for all statistical analyses.

RESULTS
No significant difference was observed between the two groups in terms of the general characteristics of the research sub-
jects (p>0.05) (Table 1). When comparing the VAS, both the SMG and the SSG showed a significant within-group decreases
(p<0.01). However, there was no significant between-group difference (p>0.05). In the comparison of cervical angles, there
were significant intragroup increases in the flexion and extension in both the SMG and the SSG (p<0.01), and there were
significant intergroup increases in extension angles (p<0.05) (Table 2).

DISCUSSION
This study examined the effects of self-joint mobilization of the upper spine using a Kaltenborn wedge for a short duration
on the pain and cervical dysfunction of patients with neck pain.
Although the current study finding of a significant decrease in pain in the cervical spine, observed in both the SMG and
the SSG, is consistent with that of previous studies14, 15) in which it was indicated that both joint mobilization and stretching
exercises were effective in reducing pain, we found it difficult to identify distinct differences in reducing pain between the
groups owing to the short study duration (one week).
In the comparison of cervical functional movement on the sagittal plane, there were significant intragroup increases in the
flexion and extension in both the SMG group and the SSG group after the experiment, and there were significant intergroup
increases in extension angles. This finding is consistent with those of previous papers16, 17): self mobilization is effective for
the functional improvement of the cervical spine. A study by Kim et al.18) demonstrates that joint mobilization in the upper

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 Table 1 . The general characteristics of the subjects

SSG (n=14) SMG (n=13)

Age (yrs) 38.9 ± 6.8 36.1 ± 6.1
Height (cm) 165.1 ± 9.7 167.8 ± 9.4
Weight (kg) 61.1 ± 8.9 62.7 ± 10.4
Mean ± SD. SSG: self-stretching group; SMG: self-mobi-
lization group.

Fig. 1. Kaltenborn wedge.

Table 2. Comparison of within and between two groups

Group Before After Change

VAS (scores) 4.4 ± 0.9 3.1 ± 1.0** −1.3 ± 0.7
Cervical angle (°)
SSG
Flexion 27.1 ± 7.5 30.6 ± 6.4** 3.5 ± 2.8
Extension 46.7 ± 9.7 50.0 ± 9.8** 3.2 ± 2.0
VAS (score) 4.9 ± 1.3 3.2 ± 1.2** −1.7 ± 0.9
Cervical angle (°)
SMG
Flexion 29.8 ± 8.8 33.0 ± 8.4** 3.2 ± 1.6
Extension 48.1 ± 8.7 56.7 ± 6.7** 8.6 ± 4.2†
Mean ± SD. **p<0.01, *p<0.05, †Significant difference between groups (p<0.05).
SSG: self-stretching group; SMG: self-mobilization group; VAS: visual analogue scale.

thoracic shows significant improvement in terms of pain and joint ROM. Kim et al. also state that joint mobilization is more
effective although statistically significant results were not revealed than the control group, which is a self-stretching group
in contrast with the result of the present study. This implies that mobility of the thoracic plays an important role in disability
around the neck. The improvement of functioning around the neck, which is due to therapy on the upper thoracic, supports
the concept of regional interdependence19). This study applies joint mobilization to the upper thoracic without giving direct
therapeutic intervention to patients with neck pain, which is also considered to be applying indirect therapeutic intervention.
Hwangbo20) conducted a study on thoracic mobilization and self-stretching exercises in chronic neck pain patients. Joint
mobilization was reported to have had a greater positive impact on extension than on flexion of the thoracic spine. This
finding is consistent with that of the current study. In addition, it is likely that the structural shape of the wedge facilitated the
extension gliding movements more so than it did flexion during the self-mobilization exercises in the current study.
There were limitations to this study. Firstly, the effect of the movements was only measured in the sagittal plane when
the angles of the cervical spine were being determined. Secondly, the intervention was performed over a very short period.
In conclusion, the results of the present study demonstrated that self-mobilization of the upper spine, using a Kaltenborn
wedge, was useful in alleviating pain in and dysfunction of the cervical spine, and in particular, in improving cervical spine
extension in this study.

Conflict of interest
None.

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