Effect of Posterior-Anterior Mobilization of the Thoracic Spine on Pain, Respiratory Function, and Thoracic Circumference in Patients With Chronic Low Back Pain

  • Park, Ju-jung (Dept. of Physical Therapy, Jaseng Korean Medicine Hospital) ;
  • Chon, Seung-chul (Dept. of Physical Therapy, College of Medical Science, Konyang University)
  • Received : 2018.09.21
  • Accepted : 2018.11.05
  • Published : 2018.11.19


Background: Posterior-anterior (PA) vertebral mobilization, a manual therapy technique has been used for relieving pain or stiffness treating in spinal segment for in clinical practice, however evidence to gauge efficacy is yet to be synthesised. Objects: This study aimed to investigate the effect of PA mobilization of the thoracic spine on the respiratory function in patients with low back pain (LBP). Methods: The study participants included 30 patients with chronic LBP. They were randomly allocated to the experimental and control groups. The experimental and control groups received PA mobilization of the T1-T8 level of the thoracic spine and placebo mobilization, respectively. All patients received interventions for 35 minutes a day, five times a week, over 2-week period, respectively. Forced vital capacity (FVC), forced expiratory volume in 1 second ($FEV_1$), peak expiratory flow (PEF), forced expiratory flow 25~75% ($FEF_{25{\sim}75%}$), and chest wall expansion were measured before and after the intervention. Statistical analysis was performed using independent t-test and two-way analysis of variance, and Pearson's correlation analysis was used to compare the correlation between respiratory function and chest measurement. Results: The experimental group showed significant improvements in FVC, $FEV_1$, PEF, $FEF_{25{\sim}75%}$ (p<.05), and chest wall expansion (p<.05) compared with the control group. Conclusion: PA mobilization of the upper thoracic spine may be beneficial for improving respiratory function parameters including FVC, $FEV_1$, PEF, $FEF_{25{\sim}75%}$, and chest wall expansion in patients with chronic LBP.



Supported by : National Research Foundation of Korea (NRF)


  1. Babina R, Mohanty PP, Pattnaik M. Effect of thoracic mobilization on respiratory parameters in chronic non-specific low back pain: A randomized controlled trial. J Back Musculoskelet Rehabil. 2016;29(3):587-595.
  2. Banks, K. Geoffrey D. Maitland, 1924-2010. Physical Therapy. 2010;90(3):326.
  3. Brenner AK, Gill NW, Buscema CJ, et al. Improved activation of lumbar multifidus following spinal manipulation: a case report applying rehabilitative ultrasound imaging. J Orthop Sports Phys Ther. 2007;37(10):613-619.
  4. Bockenhauer SE, Chen H, Julliard KN, et al. Measuring thoracic excursion: Reliability of the cloth tape measure technique. J Am Osteopath Assoc. 2007;107(5):191-196.
  5. Cahalin LP, Braga M, Matsuo Y, et al. Efficacy of diaphragmatic breathing in persons with chronic obstructive pulmonary disease: A review of the literature. J Cardiopulm Rehabil. 2002;22(1):7-21.
  6. Cline CC, Coast JR, Arnall DA. A chest wall restrictor to study effects on pulmonary function and exercise. 1. Development and validation. Respiration. 1999;66(2):182-187.
  7. Engel RM, Vemulpad S. The effect of combining manual therapy with exercise on the respiratory function of normal individuals: A randomized control trial. J Manipulative Physiol Ther. 2007;30(7):509-513.
  8. Gonnella C, Paris SV, Kutner M. Reliability in evaluating passive intervertebral motion. Phys Ther. 1982;62(4):436-444.
  9. Gonzalez J, Coast JR, Lawler JM et al. A chest wall restrictor to study effects on pulmonary function and exercise. 2. The energetics of restrictive breathing. Respiration. 1999;66(2):188-194.
  10. Grimstone SK, Hodges PW. Impaired postural compensation for respiration in people with recurrent low back pain. Exp Brain Res. 2003;151(2):218-224.
  11. Hanney WJ, Masaracchio M, Liu X, et al. The influence of physical therapy guideline adherence on healthcare utilization and costs among patients with low back pain: A systematic review of the literature. PLoS One. 2016;11(6):e0156799.
  12. Heiderscheit B, Boissonnault W. Reliability of joint mobility and pain assessment of the thoracic spine and rib cage in asymptomatic individuals. J Man Manip Ther. 2008;16(4):210-216.
  13. Hodges PW, Gandevia SC. Changes in intra-abdominal pressure during postural and respiratory activation of the human diaphragm. J Appl Physiol. 2000;89(3):967-976.
  14. Hussain SN, Pardy RL. Inspiratory muscle function with restrictive chest wall loading during exercise in normal humans. J Appl Physiol. 1985;58(6):2027-2032.
  15. Ito M, Kakizaki F, Tsuzura Y, et al. Immediate effect of respiratory muscle stretch gymnastics and diaphragmatic breathing on respiratory pattern. Respiratory muscle conditioning group. Intern Med. 1999;38(2):126-132.
  16. Janssens L, Brumagne S, McConnell AK, et al. Proprioceptive changes impair balance control in individuals with chronic obstructive pulmonary disease. PLoS One. 2013;8(3):e57949.
  17. Janssens L, Brumagne S, Polspoel K, et al. The effect of inspiratory muscles fatigue on postural control in people with and without recurrent low back pain. Spine. 2010;35(10):1088-1094.
  18. Kaltenborn FM, Evjenth O, Kaltenborn TB, et al. The Spine: Basic evaluation and mobilization techniques. 3rd ed. Oslo, Olaf Norli Bokhandel, 1993:11-87, 163-216.
  19. Ko TS, Jung HB, Kim JA. The effects of thoracic mobilization on pain, disability index and spinal mobility in chronic low back pain. J Special Edu Rehabil Sci. 2009;48(2):115-137.
  20. Lima IS, Florêncio de Moura Filho O, Cunha FV, et al. Chest and neck mobilization effects on spirometric responses in healthy subjects. J Manipulative Physiol Ther. 2011;34(9):622-626.
  21. MacIntyre NR. Muscle dysfunction associated with chronic obstructive pulmonary disease. Respir Care. 2006;51(8):840-847.
  22. Mohanty P, Pattnaik M. Mobilisation of the thoracic spine in the management of spondylolisthesis. J Bodyw Mov Ther. 2016;20(3):598-603.
  23. Ozgocmen S, Cimen OB, Ardicoglu O. Relationship between chest expansion and respiratory muscle strength in patients with primary fibromyalgia. Clin Rheumatol. 2002;21(1):19-22.
  24. Patrick N, Emanski E, Knaub MA. Acute and chronic low back pain. Med Clin North Am. 2014;98(4):777-789.
  25. Ruhe A, Fejer R, Walker B. Center of pressure excursion as a measure of balance performance in patients with non-specific low back pain compared to healthy controls: A systematic review of the literature. Eur Spine J. 2011;20(3):358-368.
  26. Savigny P, Watson P, Underwood M, et al. Early management of persistent non-specific low back pain: Summary of NICE guidance. BMJ. 2009;338:b1805.
  27. Singer KP, Giles LG. Manual therapy considerations at the thoracolumbar junction: An anatomical and functional perspective. J Manipulative Physiol Ther. 1990;13(2):83-88.
  28. Smith MD, Russell A, Hodges PW. Disorders of breathing and continence have a stronger association with back pain than obesity and physical activity. Aust J Physiother. 2006;52(1):11-16.
  29. Tzelepis GE, Zakynthinos S, Vassilakopoulos T, et al. Inspiratory maneuver effects on peak expiratory flow. Role of lung elastic recoil and expiratory pressure. Am J Respir Crit Care Med. 1997;156(5):1399-1404.
  30. Verkerk K, Luijsterburg PA, Miedema HS, et al. Prognostic factors for recovery in chronic nonspecific low back pain: A systematic review. Phys Ther. 2012;92(9):1093-1108.
  31. Wagner PD. Skeletal muscles in chronic obstructive pulmonary disease: Deconditioning, or myopathy? Respirology. 2006;11(6):681-686.
  32. Yang JM, Kim SY. The effect of thoracic joint mobilization on pain, proprioception and static balance in patients with chronic low back pan. Phys Ther Korea. 2015;22(3):1-11.