Effectiveness of Cranial base Release and Gong's Mobilization in the Management of Text Neck Syndrome: A Case Study

Abstract

Background: Text neck syndrome is a postural and movement-related cervical condition commonly associated with prolonged smartphone, laptop, and tablet use. Sustained lower cervical flexion with upper cervical extension increases load on the posterior cervical soft tissues, encourages forward head posture, reduces cervical extension tolerance, and may produce suboccipital pain, headache, upper trapezius tightness, and disability in daily work. Manual therapy is often used when pain, muscle guarding, and joint restriction prevent active correction. Cranial base release is directed toward reducing suboccipital tightness, improving cranio-cervical mobility, calming protective muscle tone, and restoring a more comfortable head-on-neck relationship. Gong's mobilization is a specific mobilization approach directed toward cervical extension mechanics, facet gliding, and correction of forward head posture through a controlled passive movement strategy.

Presentation of Case: This case study describes a 26-year-old female office employee and postgraduate student who presented with four months of posterior neck pain, heaviness around the suboccipital region, intermittent frontal headache, reduced cervical extension, and difficulty using a mobile phone and laptop for prolonged periods. She reported eight to ten hours of screen exposure per day, frequent use of a handheld phone with neck flexion, and poor ergonomic awareness during online work. Baseline assessment showed forward head posture, rounded shoulders, tenderness in suboccipital muscles, upper trapezius and levator scapulae tightness, reduced active cervical range of motion, reduced deep neck flexor endurance, and functional limitation in reading, typing, driving, and sleeping.

Intervention: The patient received a four-week supervised physiotherapy programme consisting of cranial base release, Gong's mobilization, pain-free cervical mobility training, postural correction, deep neck flexor activation, scapular stabilization, pectoral stretching, ergonomic education, and a home exercise schedule. Treatment was provided five sessions per week, approximately forty minutes per session. Cranial base release was applied initially to decrease guarding and suboccipital overactivity. Gong's mobilization was then used to improve cervical extension, joint glide, and tolerance to upright head position. Exercise and activity modification were progressed according to pain response, movement quality, and functional tolerance.

Outcome Measures: Pain was recorded with the Numeric Pain Rating Scale. Cervical disability was assessed with the Neck Disability Index. Cervical range of motion was measured by goniometric and inclinometer-based clinical assessment. Forward head posture was documented through craniovertebral angle observation. Deep neck flexor endurance, muscle tenderness, sleep disturbance, work tolerance, and patient-specific functional activity scores were recorded at baseline, week two, and week four.

Results: After four weeks, pain reduced from 7/10 to 2/10, Neck Disability Index improved from 42 percent to 12 percent, craniovertebral angle improved from 40 degrees to 49 degrees, cervical extension increased from 32 degrees to 58 degrees, and deep neck flexor endurance increased from 10 seconds to 31 seconds. The patient reported improved sitting tolerance, less headache frequency, better sleep, reduced upper trapezius tightness, and greater awareness of neutral screen posture. No adverse response was reported during or after treatment.

Conclusion: The combined use of cranial base release and Gong's mobilization was associated with reduction of pain and disability, improvement in cervical posture, and better functional tolerance in a patient with text neck syndrome. The findings support the use of manual therapy followed by corrective exercise and ergonomic retraining when suboccipital tightness, forward head posture, and cervical extension limitation are prominent.