Mulligan Mobilizations and McKenzie Exercises Along With Neural Mobilizations in Cervical Spondylosis

Not Applicable

Recruiting

Interventions: Other: Mulligan with upper limb movement
Other: McKenzie exercises with neural mobilizations

Brief Summary: Cervical pain is one of the common problem among general population. However, cervical spondylosis may cause unavoidable neck pain and range limitations due to wear and tear changes in the cervical spine. This condition can further lead to dysfunction and neuro musculoskeletal symptoms. Literature suggests the use of Mulligan therapy, McKenzie exercises and Neural mobilizations in spondylosis. According to author's knowledge there is limited evidence regarding effects of specific treatment approach.

Detailed Description: A randomized control trial will be conducted among 80 patients with cervical spondylosis having age group 40 to 60 years. The non-probability purposive sampling technique will be used to recruit on the basis of study criteria. The study settings will be Dow University of health sciences, Karachi Pakistan. After taking informed consent all the patients will be randomized into two groups (A, B). Group A will receive mulligan with upper limb movement of involved side, group B will receive McKenzie exercises and neural mobilizations. Patients will be evaluated at baseline and after four weeks of treatment by using a goniometer, numerical pain rating scale (NPRS), and neck disability index (NDI) for cervical range of motions, pain intensity and neck disability respectively. There will be twelve sessions of treatment with thrice a week.

Duration of each session will be thirty minutes. All the data will be entered and analyzed through statistical package of social sciences version 24. Descriptive analysis will be performed for both continuous and categorical data. Inferential statistics will be performed to compare pain, disability index and range of motion between group and within group. The level of significance will be considered as 0.05.

Recruitment & Eligibility

Inclusion Criteria

40 - 60 years old adults.
Diagnosed and referred cases of cervical spondylosis and both males and females are included.
Unilateral radiculopathy pain C5-C8 and T1.
Individuals whose Spurling's and distraction test is positive.
Patients with NPRS > 3/10 score.
Patients with ipsilateral cervical rotation less than 60 degrees.

Exclusion Criteria

Individuals with history of;

cervical or shoulder girdle trauma.
any specific pathology or red flags (diplopia, dizziness, drop attacks, dysarthria, dysphagia)
cervical myelopathy
neoplastic lesions
vertebral artery insufficiency
upper cervical ligamentous instability,
spondylolisthesis
hypermobile cervical spine
cervical fracture inflammatory
cardiac or severe psychiatric disease.

Arm && Interventions

Group	Intervention	Description
Mulligan with upper limb movement	Mulligan with upper limb movement	This study arm will receive following therapy .) Mulligan with upper limb movement.
Mckenzie exercises with neural mobilizations	McKenzie exercises with neural mobilizations	This study arm will receive following therapy .) McKenzie exercises with neural mobilizations

Primary Outcome Measures

Name	Time	Method
Change in pain intensity on Numerical Pain Rating Scale after four weeks.	Baseline and 4 weeks.	The Numerical Pain Rating Scale is a unidimensional measure of pain intensity, use to record patients' pain progression or compare pain severity between pains with similar condition. It is 0 to 10 number scale. Higher the score, severe will be the pain experienced.

Secondary Outcome Measures

Name	Time	Method
Change in range of motion assessed with universal goniometer after four weeks	Baseline and 4 weeks.	The universal goniometer is an instrument for the precise measurement of range of movement angles in degrees, especially one used to measure the angles before and after range of motion. Increase in the degree of angle suggests increase in range of movement.
Change in functional disability assessed with Neck Disability Index after four weeks.	Baseline and 4 weeks.	NDI is a condition specific or patient completed questionnaire comprising of 10 items to evaluate pain and functional status which is mostly used for reporting neck pain. Each item on scale is scored from 0-5, where all the scores are added to total points and interpreted as percentages i.e. 0 point or 0% means no activity limitation and 50 points or 100% means complete activity limitation.