A comparative study to find out the effectiveness of mulligan versus mckenzie mobilization in cervical radiculopathy

Cervical radiculopathy is a condition of neck pain disorder. Neck pain is most common issue that can cause significant pain and disability. (1) The main cause of pain in cervical radiculopathy is inflammation. (2) It is estimated that 30-50% of the population affected in every year. Almost two of every three persons will experience neck pain at a certain time during their life time. Male and female are affected from cervical radiculopathy. Annual incidence has been reported to be 107.3 per 100,000 for men and 63.5 per 100,000 for women affected with cervical radiculopathy. (3) Cervical radiculopathy is a dysfunction of a nerve root in the cervical spine resulting in producing radicular symptom such as pain, paraesthesia, weakness, numb-ness in the upper extremity. Radiculopathy is differentiated from radicular pain, where radiculopathy is a neurological state in which conduction is limited or blocked along a spinal nerve or its. Cervical radiculopathy is believed to result from various mechanisms causing cervical nerve root irritation and a wide variety of symptoms distal to the irritation site. The causes of cervical radiculopathy include cervical stenosis, spinal degenerative changes, and cervical disc herniation, which can cause nerve root compression and/or irritation. (4) Commonly in cervical radiculopathy 70 to 75 percent of cases is foramina encroachment of the spinal nerve due to a combination of factors, including decreased disc height and degenerative changes of the intervertebral joints anteriorly and zygapophyseal joints posteriorly seen.

RATIONALE OF STUDY Cervical radiculopathy is a clinical condition which is present with pain from neck to whole upper limb or both upper limb. (9) Cervical radiculopathy is a specific lesion affecting the cervical nerve roots in which neck pain is accompanied by upper limb pain and possibly neurological symptoms and signs. (10) The nerve root is either irritated by bony osteophytes at the zygapophyseal or uncovertebral joints that are acquired secondary to cervical spondylosis or by a cervical disc herniation. Cervical radiculopathy will mostly classified as derangement. The postural correction and correction of derangement of cervical spine will be more helpful during treating the patients. Correction of derangement done by different types of mobilization and manipulation techniques. Mulligan mobilization have been found effective in reducing pain, disability and improving range of motion in patients with cervical radiculopathy. Working concept of Mulligan mobilization is ‘positional fault theory’. It helps to correct any micro-malalignment present in the joint surfaces so, pain can be decreased. It helps to increase the affected ranges. (11) McKenzie mobilization widely used as a classification system for the diagnosis and treatment of a variety of musculoskeletal conditions, including lower back, neck, and extremity pain. (12) McKenzie originally defined centralization as “a situation in which pain arising from the spine and felt laterally from the midline or distally is reduced and transferred to a more central or near midline position when certain movements are performed.” McKenzie mobilization have ability to centralize or decrease the patient’s referred or radicular symptoms through a series of repeated movements. The concept of repeated motions and centralization have been shown to be effective in treating radicular symptoms associated with the cervical spine, evidence is inconclusive for the use of specific, repeated motions for treating cervical radiculopathy.(13) This self-management aspect is very crucial for enabling individuals to apply techniques as needed in their daily lives to reduce dependency on healthcare professionals. Mulligan mobilization and McKenzie mobilization these two mobilization will take for treating patients with cervical radiculopathy. There are few evidences documented in the literature regarding the effectiveness of Mulligan mobilization McKenzie mobilization. The present study will be conducted to find out the efficacy of both the techniques over each other.

OBJECTIVE OF RESEARCH

1. To evaluate the effectiveness of Mulligan Mobilization technique to reduce pain and disability in patients with cervical radiculopathy.
2. To evaluate the effectiveness of McKenzie Mobilization technique to reduce pain and disability in Patients with cervical radiculopathy.
3. To compare the effectiveness between Mulligan Mobilization and McKenzie Mobilization technique to reducing pain and disability in patients with cervical radiculopathy.

RESEARCH HYPOTHESIS NULL HYPOTHESIS (H0): There will be no significant difference between the effectiveness of Mulligan Mobilization and McKenzie Mobilization in reducing pain and disability in patients with cervical radiculopathy. ALTERNATIVE HYPOTHESIS (H1): There will be significant difference between the effectiveness of Mulligan Mobilization and McKenzie Mobilization in reducing pain and disability in patients with cervical radiculopathy.

STUDY TECHNIQUE 30 patients will be made as part of the study after selection based on inclusion and exclusion criteria, following signing of the informed consent will be conveniently selected for this study and they will be randomly allocated into two groups i.e. GROUP A and GROUP B, each group will be having 15 patients. GROUP A: In this group patients will be treated with Mulligan Mobilization technique. Exercise in this group consists of functional SNAG/cervical MWMs, Natural apophyseal glides (NAGs), Sustained natural apophyseal glide (SNAGs) with help of mulligan belt. These exercises will be done 4 days in a week up to 4 weeks. GROUP B: In this group patients will be treated with McKenzie mobilization technique. Exercise in this group consists of Retraction mobilization, Retraction extension with bilateral movement, and rotation mobilization. These exercises will be done 4 days in a week up to 4 weeks.