Comparison of the Effects of Different Manual Therapy Techniques in Patients With Cervical Spondylosis
Condition: Cervical Spondylosis
MeSH terms: Spondylosis
Study type: Interventional

Summary: 
      Proprioceptive sensitivity decreases in individuals with neck pain compared to those without
      neck pain. While organizing the treatment program of patients with neck pain, evaluation of
      cervical proprioception and its addition to the treatment have gained importance.

      The aim of the study was to examine the effects of muscle energy technique applied to
      patients with chronic neck pain on cervical proprioception and motor control and to compare
      the results of muscle energy technique application with cervical mobilization techniques.
    

Detailed description: 
      Cervical spondylosis (SS) is defined as chronic disc degeneration due to aging caused by
      degenerative changes in the muscles, tendons, joints or bones of the neck or shoulder.

      The etiology of cervical spondylosis includes various factors such as bad posture, anxiety,
      depression, neck strain, and overload in sports or occupational activities. Proprioception is
      defined as sensory feedback that contributes to muscle sensation, postural balance and joint
      stability. It is possible that loss of cervical proprioception and motor control affect
      segmental stability. This increases the risk of injury following minor trauma. It has been
      reported that proprioceptive sensitivity is worse in individuals with neck pain compared to
      those without neck pain, and the degree of the disorder is related to the severity of pain.
      Some evidence-based studies have shown that manual techniques improve proprioception and
      motor control.

      It has been shown that Muscle Energy Technique (MET), which has gained popularity in recent
      years, increases cervical joint mobility and reduces pain in patients with chronic neck pain.
      MET is a form a manual therapy which uses a muscle's own energy in the form of gentle
      isometric contractions to relax the muscles via autogenic or reciprocal inhibition mechanism.
      It has been reported that MET stimulates joint proprioceptors, creates a different movement
      activity in the area of proprioceptive disorder and allows the central nervous system to
      normalize proprioceptive and motor coordination in this segment. The effect of MET on
      cervical proprioception in patients with cervical spondylosis has not been investigated yet.

      Active participation of the patient in movement is extremely important in proprioceptive
      feedback, motor control and motor learning. For this reason, it is thought that investigating
      the effect of MET, which includes active muscle contractions of the patient, on
      proprioceptive sense and comparing the results with passive applications (manipulation or
      mobilization) will be useful in determining the optimal treatment method in cervical
      spondylosis.
    

Intervention name(s): Conventional physiotherapy; Conventional physiotherapy and Muscle Energy Technique; Conventional physiotherapy and Cervical Mobilization Techniques
Intervention type(s): Other; Other; Other
Intervention description(s): A total of 12 sessions of conventional physiotherapy program for 4 weeks were applied 3 days a week. The conventional physiotherapy program included 20 min hotpack , 10 min ultrasound, 20 min conventional (Transcutaneous electrical nerve stimulation) TENS application.; In addition to conventional therapy, the muscle energy technique was applied to the individuals in the second group at the same frequency. Muscle energy technique was applied to the upper trapezius, sternocleidomastoideus , scalene (anterior-medius-posterior) and levator scapula muscles. According to the MET post-isometric relaxation method, each muscle was applied as one set (each set includes three repetitions). The patient was asked to perform a 7-second isometric contraction corresponding to 20% of the maximum isometric contraction force in the area where the restriction was felt. After the application, the patient was asked to breathe and relax, and the neck was brought back to the barrier point and the technique was repeated.; Cervical mobilization techniques were also applied to the individuals in the third group in addition to conventional physiotherapy at the same frequency. In the first few sessions, bridging and manual traction techniques were applied in 3-5 repetitions. In the next sessions, in addition to these techniques, rotation with 3-5 repetitions of manual traction, anteroposterior sliding with traction and cervical lateral shift techniques were applied. Vertebrobasilar InsufficiencyTest was applied to all participants to determine the appropriateness of cervical mobilization. Before mobilization, a deep friction massage was applied on painful spasmic nuchal muscles for 3-4 minutes in order to increase blood circulation and relax tense tissues.
Allocation: Randomized
Intervention model: Parallel Assignment
Masking: None (Open Label)
Primary purpose: Treatment
Keywords: Cervical Spondylosis; Proprioception; Manual Therapies