Clinical Outcomes of Maitland's Mobilization in Patients With Myofacial Chronic Neck Pain

Study Overview
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Brief Summary
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Myofacial neck pain is a common musculoskeletal problem caused by presence of trigger points and local and referred pain patterns. Chronic neck pain is responsible for the involvement of joints, ligaments, fascia and connective tissue as well. The objective of this study was to assess the impacts of Maitland's mobilization in patients with myofacial chronic neck pain. Maitland's mobilization is one of the most common manual therapy approaches used by physiotherapists. Maitland's techniques involve the application of passive and accessory oscillatory movements to spinal and vertebral joints to treat pain and stiffness. In this randomized, placebo treatment controlled trial, 30 patients consecutively aged 25-45 years meeting inclusion criteria were isolated into two groups. The study group was treated with Maitland's mobilization consistently for 8 weeks while the control group got placebo treatment for a similar time frame. Visual analog Scale (VAS), Neck disability index (NDI) and cervical range of motion (ROM) questionnaire was filled by patients before, intermediate and after the intervention to evaluate the severity of pain, functional ability and range of motion.

Official Title
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Clinical Outcomes of Maitland's Mobilization in Patients With Myofacial Chronic Neck Pain

Conditions
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Myofascial Pain Syndrome of Neck

Intervention / Treatment
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* Other: Maitland's mobilization
* Other: Traditional Physical therapy


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: Patients age between 25-45 years old, Bilateral pain involving the upper trapezius and elevator muscle of the scapula; Duration of pain of at least 3 months; A pain intensity corresponding to at least 2 cm on a 10 cm visual analogue scale (VAS); -Neck pain with symptoms provoked by either neck postures or neck movement; Pain localized at least in the cervical and occipital regions but not in the orofacial region; --Neck disability index (NDI) greater than or equal to 15 points; Restricted cervical range of movements (flexion, extension, rotation, and side-bending); ---Presence of bilateral MTrPs in upper trapezius and levator scapulae muscles were included in this study. Exclusion Criteria: A history of traumatic injuries (e.g., contusion, fracture, and whiplash injury); Systemic diseases such as fibromyalgia, systemic erythematous lupus and arthritis; Neurologic disorders (e.g., trigeminal neuralgia or occipital neuralgia); Concomitant medical diagnosis of any primary headache (tension type or migraine); Cervical spine surgery; and clinical diagnosis of cervical radiculopathy or myelopathy

Ages Eligible for Study
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Minimum Age: 25 Years
Maximum Age: 45 Years

Sexes Eligible for Study
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All

Accepts Healthy Volunteers
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No

Study Plan
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How is the study designed?
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Design Details

Primary Purpose: Treatment
Allocation: Randomized
Intervention Model: Parallel Assignment
Masking: Single


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Experimental: Study Group<br>The study group was treated with Maitland mobilization and manipulation techniques including postero-anterior Maitland mobilization for C1-C2, Maitland lateral PA glide for C3-C6 and Maitland thrust manipulation for cervico-thoracic junction. Frequency of mobilization was 2 days a week for 4 weeks. While intensity of mobilization was grade 3 and 4 based on the Maitland concept.13 Time of oscillations was 2 or 3 oscillations in a second for 1 to 2 minutes. | Other: Maitland's mobilization<br>* Maitland's techniques involve the application of passive and accessory oscillatory movements to spinal and vertebral joints to treat pain and stiffness.It has Five grades<br>|
| Active Comparator: Control Group<br>While placebo treatment with conventional physiotherapy (active exercises-10 repetitions in all direction in pain free range, isometrics 5-10 seconds brief but maximum contraction each held for 5-16 seconds for flexors, extensors, side flexors and rotators)14 without gliding, oscillations and thrust were recommended for the control group.The placebo group was treated with baseline treatment including TENS 10 minutes and moist hot packs in sitting position for 15 minutes on cervical region in with head resting on table with a pillow. | Other: Traditional Physical therapy<br>* BASELINE TREATMENT INCLUDES TENS and Hot PACKS<br>|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Visual Analogue Scale | Its a pain rating Scale Scoring between 0-10.O means no pain 10 means worse pain | 2 months | 
| Neck disability Index | Each section is scored on a 0 to 5 rating scale, in which zero means 'No pain' and 5 means 'Worst imaginable pain'. | 2 months | 

 Terms related to the study
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Keywords Provided by Centre Hospitalier Valida
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Neck Pain, Manual mobilization, Isometric exercise, Triger points, Visual analog scale