Objective ROM’s evaluation and pain improvement after vertebral manipulation of the cervical spine

Author: Doctor Stefano Bigagli


29-year-old woman. She works as a secretary in a notary’s office, she spends about 8 hours a day in a sitting position in front of the PC which is in a position that forces her to a kyphotic position of the dorsal tract of the rachis. For over a year he has suffered from neck pain and almost continuous occipito-parietal headache, with varying degrees of intensity; sporadically also nausea and dizziness. Symptoms generally worsen in the afternoon/evening. The oral NSAIDs, advised by the doctor, bring only momentary relief.

The physiotherapeutic evaluation shows a decrease at the pressure pain threshold with painfulness in the middle and upper cervical paravertebral area, upper trapezius, and bilateral sternocleidomastoid; it also presents a slightly painful functional limitation in flexion and right inclination.

Test with Baiobit:

Cervical ROM test before and after bilateral HVLA manipulation of the upper cervical spine (15-day follow-up).

Rehabilitation program:

The patient performed, as prescribed, frequent movements of the neck in rotation and extension of the dorsal spine, from sitting, during the day while she was at work.


At the second session, carried out 15 days after the first, after a session of vertebral manipulations and daily sessions of mobilization exercises of the cervico-dorsal spine lasting about 30 “every half hour, performed during one’s work, the patient no longer complains of headache and dizziness or neck pain. There remains a sensation of muscular “tension” at the base of the neck. The patient, recognizing the benefits of exercise, enrolled in a Pilates course.

The movement test with Baiobit objective a clear improvement (quantifiable in about 25%) of the ROM in the limited directions.

HVLA Manipulation 

Cervical ROM – First Session

Cervical ROM – Second Session

ROM comparison DX and SX rotation

ROM Flexion-Extension Comparison

Lateral ROM Bending Comparison


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