Muscle Energy Versus Mulligan Techniques in Treating Patients With Cervical Spondylosis

Cervical spondylosis (CS) is a highly prevalent age-related condition (95%), that affects the joints and discs of the cervical spine. By age 65, nearly all individuals experience some degree of degeneration, characterized by disc breakdown and enlarged facet joints. While aging is the primary cause, injuries can accelerate this process in younger populations.

Significance of the Study Age-related degenerative spinal changes are almost widespread. Population-based studies have shown that approximately 80 to 90% of people have disk degeneration on magnetic resonance imaging (MRI) by the age of 50 years.

A global burden review estimates that over 300 million people worldwide had mechanical neck pain lasting at least 3 months in 2015.

Clinical features of spondylosis are more common in men than in women, with a peak incidence between the ages of 40 and 60 years for both men and women.

Cervical spondylosis commonly affects the middle and lower cervical vertebrae (C5-C6 and C6-C7), although higher levels may also be involved. Neck pain is the most prominent symptom. CS can affect all cervical components (i.e., the spinal cord, spinal vasculature, and nerve roots). Cervical spondylosis Symptoms include cervical instability (abnormal movement or laxity between vertebrae). This instability can lead to various symptoms such as neck pain, muscle imbalance between cervical and shoulder girdle muscles (weakness in cervical flexors, lower trapezius, and anterior serratus; tightness in the upper trapezius, scapular lift, and pectoralis major), disc herniation and osteophyte formation. These can compromise proprioception (accurate sensory feedback) and limit neck mobility, significantly impacting function and daily activities.

Muscle energy techniques is a form of manual therapy frequently used by physical therapists to improve musculoskeletal function and alleviate pain. MET aims to adjust abnormal muscle tone by training specific muscles, enhancing strength and stability, improving the musculoskeletal function, and ultimately improving quality of life.

Another treatment technique is MMT that is now an integral component of many manual physiotherapists' clinical practice. MMT involves sustained passive accessory force/glide to a joint while the participant actively performs a problematic movement.

This study aims to address this gap in knowledge by investigating whether MET or MMT is more effective in improving pain, ROM, proprioception, and functional ability in individuals with cervical spondylosis. The findings from this study can provide valuable insights for physical therapists in selecting the most appropriate treatment approach for their patients with cervical spondylosis. By determining the more effective technique, physical therapists can optimize treatment plans and potentially improve patient outcomes.

This Triple-blinded (the examiner, statistician, and the participants will be blinded, while the therapist will be aware of treatment procedures) randomized controlled trial (RCT) will investigate the effectiveness of Muscle Energy Techniques (MET) compared to Mulligan Mobilization Techniques (MMT) on cervical spine pain, ROM, and function in participants with Cervical Spondylosis (CS). The study will be conducted at the outpatient physical therapy clinic of Horus University in New Damietta, Egypt.

Inclusion criteria

• Participants of both genders aged 40 - 60 years old, diagnosed with clinically and medically stable CS.
• All participants will be assessed and referred by orthopedic surgeons before starting the study.
• Mechanical neck pain localized to the cervical.
• Neck pain lasting more than 3 months, local tenderness of the upper fibers of the trapezius, limitation in cervical ROM and muscle spasm.
• Moderate pain intensity (45-74 mm on VAS).
• Participants with Moderate pain intensity NDI (30 - 48%).
• All participants are free from any pathological conditions that might influence the results.

Exclusion criteria

• Participants with systemic diseases like rheumatoid arthritis, metabolic diseases, or osteoporosis.
• History of trauma or accidental injuries to the cervical spine.
• Cervical myelopathy, inflammatory arthritis, tumors, infections involving the cervical spine, or vertebrobasilar artery insufficiency.
• Cervical spine injury, dizziness, vertigo, or any other musculoskeletal complaints.