Background: Loss of sagittal balance can lead to excessive thoracolumbar (TL) kyphosis, which is a postural impairment characterized by an increase in kyphotic curvature in these two regions of the spine. Excessive TL kyphosis has been shown to adversely affects quality of life and activities of daily living (ADL). Objectives: This study aimed to investigate immediate spinal motion and resultant postural changes after the application of single thoracic extension mobilization. This was compared to the application of two extension mobilizations, one of which was applied to the lumbar region in the second group of patients with excessive TL kyphosis. Design: Quasi-experimental study. Methods: A total of 53 participants (71.6 years, 20 male/33 female) were recruited. All participants had greater than 40° of TL kyphosis, as measured with a single gravity-dependent inclinometer positioned over the T1 spinous process. One group received thoracic extension mobilization only, whereas the other group received both thoracic and lumbar extension mobilization. Results: Both groups demonstrated an improvement (decrease) in the thoracolumbar kyphosis angle. The group that received thoracic mobilization alone demonstrated a 6.46° change (P<0.0001), while the group that received both mobilizations demonstrated a change of 11.96° (P<0.0001). Combined mobilization applied to both the thoracic and lumbar regions resulted in a significantly greater change (reduction) in TL kyphosis (5.50°, P<0.0001). Conclusion: The results demonstrate that the addition of a second mobilization to the lumbar region results in greater active TL extension and reduced TL kyphosis. Clinicians treating patients with excessive kyphotic curvature should be mindful of the contribution of the lumbar region to loss of sagittal balance. The addition of this simple manual mobilization to the lumbar region appears to yield better short-term improvements in patients with overly kyphotic spinal posture.

INTRODUCTION
SUBJECTS AND METHODS
    Study Design
    Participants
    Mobility and posture assessment
    Interventions
    Thoracic Mobilization Group
    Combined Thoracic and Lumbar Mobilization Group
    Data Analysis
RESULTS
DISCUSSION
CONCLUSION
Conflicts of interest
Data availability statement
Ethical approval
Funding
REFERENCES

• Douglas Creighton(Department of Physical Therapy, Oakland University, Rochester, MI, USA) Corresponding author
• David Fausone(Department of Physical Therapy, Oakland University, Rochester, MI, USA)
• Brian Swanson(Department of Physical Therapy, Oakland University, Rochester, MI, USA)
• John Krauss(Department of Physical Therapy, Oakland University, Rochester, MI, USA)
• Jake Souva(Department of Physical Therapy, Oakland University, Rochester, MI, USA)