Comparison Between the Segmental Mobilization and Entire Segmental Spine Mobilization in Cervical Spondylosis
Condition: Cervical Spondylosis
MeSH terms: Spondylosis
Study type: Interventional

Summary: 
      All the patients of cervical spondylosis which were enrolled in this study were assessed in
      Rehabilitation centre of Yusra General Hospital. Patients who compete the inclusion criteria
      are randomly assigned by the seal envelop method in to two groups interventional and control
      group. There is nine sessions of three weeks rehabilitation program and Pain is assessed on
      Numeric pain rating scale, Disability on Neck Disability index and ROM is assessed by
      Goniometer in 1ST, 4TH and last visit. Three sessions of intervention is given to patient per
      week.
    

Detailed description: 
      Cervical spondylosis which is the common age related process having disturbing one or
      multiple segments of cervical spine. Cervical spondylosis shows a series of changes that is
      degenerative changes of discs and facet joints including bony growths of bodies of vertebrae,
      hypertrophy of arches of lamina and facet joints and instability of various segments in
      cervical spine. Origin of any degenerative disorders is linked with aging process. Cervical
      spondylosis worsens with age.As the age increases the cartilages and bones that make up our
      spine gradually develop wear and tear these changes can include dehydrated discs, herniated
      discs, bony spurs and causes neck injuries.

      Mechanical neck disorders will great react to conservative management, but the gold standard
      intervention for the mechanical neck pain has yet to be recognized. There are many
      interventions which have Some treatments have been review in various randomized control
      studies (RCT), but I will show the best accessible evidence for the mostly common used ones.

      Conservative management of the neck pain is respond well .On daily activities postural
      awareness and stress management strategies, work place (ergonomics) or hobbies may be
      valuable in many patients. Patient reeducation is necessary and advised to patient to use
      merely one pillow at night and When the intensity of pain is high, anti- inflammatory agents
      or analgesics are broadly and commonly used. Tricycle antidepressants having low dose for
      example amitriptyline( 10-30 mg) each night, may produce better results .Yoga ,Alexander
      techniques and pilates exercises are essential for improving posture of neck but the cost of
      these interventions in treating pain in neck is tentative.

      Randomized controlled studies (RCT) which is included in meta analysis of Manual therapy
      interventions therapy (Manipulation or mobilization physiotherapy ) provide inadequate
      evidence that mobilization techniques and manipulation are more valuable for the treatment of
      the severe neck pain as compared to the active treatments (patient reeducation, counseling,
      drug therapy ). However, manipulation as compared to mobilization has been linked with severe
      neurological complications and damages round about 5-10 per 10 million manipulations.

      Manipulation (high velocity amplitude thrust ), Mobilization or therapeutic exercises appear
      to be equally successful . A study which evaluate manipulation with therapeutic exercise
      whether modality separately used proved the combination to be more valuable for three months
      but there is no significant difference was notice than the exercises therapy only from one to
      two years . However, one more study showed no significant advantage for six weeks and six
      months by additional interventions manual therapy techniques, mobilization physiotherapy of
      63% of population or shortwave diathermy(SWD) along with exercise and advice.

      Meta analysis of various frail randomized controlled trials and studies showed no strong
      evidence about the value ability and usefulness of both manual and mechanical traction and
      acupuncture with a range of other treatments in patients with chronic pain in neck. Further
      additional interventions techniques like psychotherapy for example cognitive behavioral
      therapy also cause extra and additional effects to mechanical and physical intervention
      alone. Many studies and systemic reviews are required to evaluate the effectiveness and
      usefulness of standardized interventions in patients of cervical spondylosis. Due to finding
      the long term effects the lengthy follow up of interventions , large sample size ,lack of
      regularity in study designs and using multiple set up across the studies are complicated.
      Analyses will also be tough because of the use of more than one intervention strategies in
      same study design.Strong evidences are required to identify the cost effectiveness of
      intervention strategies.

      A study on identify the effects of central and unilateral posterior anterior (UPA)
      mobilization technique on cervical spine lordosis, stiffness of muscles and range of motion
      in cervical spondylosis .There were significant Improvement in Cervical lordosis .however
      Muscle stiffness was significantly reduce after intervention and the effect of treatment
      lasted for five days without any supplementary intervention. The angles of cervical flexion
      and cervical extension angles were greater than before. Both the angles of lateral flexion
      and left rotation were significantly better and the effects of treatment which is proceeding
      for five days without any extra intervention. These results suggests that central and UPA
      mobilization manual therapy techniques is more valuable and effective in increasing cervical
      lordosis and range of motion, and lessening of stiffness of muscles in patients having
      cervical spondylosis.
    

Intervention name(s): Segmental Mobilization; Entire Spine Mobilization
Intervention type(s): Other; Other
Intervention description(s): Hot fermentation =10 minutes Soft tissue mobilization =5 minutes Targeted segmental mobilization= 3 sets of 10 repetitions Home plan exercise= cervical muscles stretching, postural care.; Hot fermentation=10 minutes Soft tissue mobilization=5 minutes Entire spine mobilization =3 sets of 10 repetitions Home plan exercises=cervical muscles stretches, postural care.
Allocation: Randomized
Intervention model: Parallel Assignment
Masking: None (Open Label)
Primary purpose: Treatment