A Comparative Clinical Study On The Effect of Hijama-Bila-Shart (Dry Cupping) And Isometric Neck Exercise in Waja-Ur-Raqaba (Cervical Spondylosis)

.Waja-ur-Raqaba (Cervical spondylosis) is a chronic degenerative process of the vertebral column characterized by pain in neck, degenerative changes in intervertebral disc and osteophyte formation. Most common degenerative changes are seen in C5-C6 followed by C6-C7 and C4-C5. About 10 million persons per year affected in India alone. The incidence of neck pain in adults is 25-50% per year. Prevalence of Cervical Spondylosis is similar in both sexes although degree of severities is greater in males. It is most common spine dysfunction in elderly people; the highest prevalence is in the age group from 45 to 60 years old. Spondylotic changes of the cervical spine on radiographic imaging remain asymptomatic with 25% of individuals under the age of 40, 50% of individuals over the age of 40, and 85% of individuals over the age of 60 showing some evidence of degenerative changes. It may develop earlier due to life style changes like prolong sitting, driving, travelling and lack of exercise etc. Cervical spondylosis can be described as a result of degeneration of the intervertebral disc, formation of osteophytes,ossification of the posterior longitudinal ligament and hypertrophy of the ligamentum flavum.  The symptoms arise in case of cervical spondylosis are neck pain, stiffness, resulting in limitation of movement and numbness, weakness in arm, hand, and fingers. In Modern System of Medicine Cervical spondylosis is treated by use of NSAIDS (Non steroidal anti-inflammatory drugs), corticosteroids, cervical epidural steroid injection, surgery and certain physiotherapy modalities like isometric neck exercise, TENS (Transcutaneous Electrical Nerve Stimulation), traction and cervical collar etc. Though, the use of NSAIDS and corticosteroids provide significant improvement in symptoms of Cervical spondylosis on short term basis, but their prolong use may induce a number of side effects. Similarly, most of the patients avoid surgery due to complications associated with it. As far as concerned with various regimens of physiotherapy like isometric neck exercise, TENS, Ultrasound, Superficial thermotherapy etc, definitely they relieve the symptoms of Cervical spondylosis, but not up to the mark of satisfaction. Hence, there is a dire need to develop a safe and effective mode of treatment for the management of Waja-ur-Raqaba (Cervical spondylosis). In Unani system of medicine, Waja-ur-Raqaba is not clearly mentioned in classical text, but most of the eminent physicians used “Waja-ul-mafasil” to represent all types of joint pain, and also named them accordingly like Niqras (Gout), Waja-ul-Warik (Ischial pain), Irqunnasa (Sciatica), Waja-ul-Rakbah (Knee pain) etc.  Similarly, when Wajaul mafasil occurs in fuqrat-e-unuq and causes neck pain, it is known as Waja-ur-Raqaba (Cervical spondylosis), because here waja stands for pain and raqaba stands for neck. As far as the treatment of Waja-ul-mafasil is concerned, since ancient times Unani physicians treated this ailment successfully with various drugs & regimens including Hijama-bila-Shart (Dry Cupping), Dalk (Massage), Riyazat (exercise), Takmeed (Fomentation), Nutool (Irrigation) etc. Among them Hijama-bila-Shart is one which is commonly prescribed to diversion of Mawad-e-Fasida and to provide relief to the patient of Waja-ul-Mafasil. Hence, keeping the above view in mind I have decided to conduct a comparative study entitled as “A Comparative clinical study on effects of Hijama-Bila-Shart (dry cupping) and isometric neck exercise in Waja-ur-Raqaba (Cervical spondylosis).