Effect of Mulligan on Cervical Radiculopathy

The goal of this clinical trial is to investigate the effect of Mulligan mobilization with arm movement on nerve conduction velocity in patients with unilateral cervical radiculopathy. The main questions it aims to answer are :

1. Is there a statistical significant effect of mobilization with arm movement on NCV velocity in treatment of cervical radiculopathy ?
2. Is there a statistical significant effect of mobilization with arm movement on pain level in treatment of cervical radiculopathy ?
3. Is there a statistical significant effect of mobilization with arm movement on cervical ROM in treatment of cervical radiculopathy ?
4. Is there a statistical significant effect of mobilization with arm movement on neck disability level in treatment of cervical radiculopathy ?

The course of treatment involves 6 sessions over the course of 3 weeks participants will be divided into 2 groups : Control group : recieves only Conventional treatment Experimental group : recieves Conventional treatment and Mulligan mobilization with arm movement .

the aim of our study is to examine the effect of Mulligan mobilization with arm movement on cervical radiculopathy using nerve conduction studies , in addition to the original measures of previous studies (pain level, cervical ROM and neck disability scale) .

Delimitations :

Inclusion Criteria

Individuals will be enrolled into the study if they are :

* diagnosed with cervical radiculopathy .
* Age group between 20-60 years
* Unilateral radiating pain through the course of median nerve .
* Subject having positive upper limb tension test (ULTT 1)
* either gender male and female
* Subjects who can understand the instructions and are willing to participate in the study.

Exclusion Criteria .

* History of trauma, dislocation and subluxation of upper extremity
* Rheumatoid Arthritis
* Malignancy
* Spinal canal stenosis .
* Cervical instability/Spondylolisthesis
* VBI (Vertebral-Basillar Insufficiency)
* Referred pain in patients with cardiac ischemia
* Cervical or thoracic spine surgeries
* systemic causes like diabetic neuropathy.
* recent fracture or surgery in and around the shoulder
* carpal tunnel syndrome .
* thoracic outlet syndrome .

Outcome measure would include:

A) The primary outcome measure will be NCV velocity, for the median nerve (latency, amplitude, Duration , F-wave and nerve conduction velocity of motor nerve action potentials and sensory nerve action potentials (SNAPs)) .

B) Secondary outcome measures will include:

* Pain intensity, assessed using the Visual Analog Scale (VAS) .
* Functional disability, evaluated using the Neck Disability Index (NDI) .
* Cervical range of motion, measured using a CROM goniometer to assess flexion, extension, lateral flexion, and rotation.
* The course of treatment involves 6 sessions over the course of 3 weeks .
* pre-treatment for both groups :

  1. affected nerve conduction velocity will be measured using nerve conduction study .
  2. neck disability level will be measured using neck disability index .
  3. cervical ROM measurement will be taken in all directions using CROM goniometer .
  4. pain will be assessed using Visual analog scale .

participants will be divided into 2 groups :

Group A- Control group:

During each session : only Conventional treatment will be provided , includes : hot pack for 10 minutes, active ranges of motion (AROMs) with 3 sets of 10 repetitions and isometrics for each movement repeated 20 times with the hold of 6 to 10 seconds in each repetition.

Group B- Experimental group- Mulligan mobilization group:

* During each session :

  1. Conventional treatment will be provided .
  2. Mulligan mobilization will be applied in the form of : sustained passive accessory joint mobilization to a specific spinal vertebra level while simultaneously guiding the patient through an active, pain-free movement pattern involving the affected limb :
* Patient position : Sitting upright on chair
* Therapist position : Standing behind the patient .
* Hand placement : Approach the desired level of spinous process from medial aspect of the thumb of one hand, which may be reinforced by the index finger of the other hand.
* Mobilization Pure transverse glide is performed from affected to unaffected side. While the glide is sustained, patient performs the offending movements (flexion/abduction/horizontal adduction/horizontal abduction)

Eligibility Criteria:
Inclusion Criteria:

* • diagnosed with cervical radiculopathy .

  * Age group between 20-60 years
  * Unilateral radiating pain through the course of median nerve .
  * Subject having positive upper limb tension test (ULTT 1)
  * either gender male and female
  * Subjects who can understand the instructions and are willing to participate in the study.

Exclusion Criteria:

* • History of trauma, dislocation and subluxation of upper extremity

  * Rheumatoid Arthritis
  * Malignancy
  * Spinal canal stenosis .
  * Cervical instability/Spondylolisthesis
  * VBI (Vertebral-Basillar Insufficiency)
  * Referred pain in patients with cardiac ischemia
  * Cervical or thoracic spine surgeries .
  * systemic causes like diabetic neuropathy .
  * recent fracture or surgery in and around the shoulder .
  * carpal tunnel syndrome .
  * thoracic outlet syndrome .