Muscle Energy Technique and Facet Joint Mobilization in Chronic Neck Pain.

Study Overview
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Brief Summary
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The purpose of the study is to compare the muscle energy technique, facet joint mobilization and conventional physical therapy in individuals with chronic neck pain on cervical lordosis, cervical range of motions, numeric pain rating scale and NDI. A randomized control trial was conducted at physiotherapy department of HIT hospital, Taxila Cantt. The sample size was 105 calculated through open-epi tool. The participants were divided into three interventional groups, experimental group (1), experimental group (2), and control group (3) each having 35 participants. The study duration was six months. Sampling technique applied was Purposive sampling for recruitment and group randomization using sealed envelope method. Only 35 to 50 years participants with 4-8 pain intensity on NPRS in cervical region were included in the study. Goniometer, Posterior tangent method on lateral radiographs for cervical curve and Self structured Questionnaire. Data was collected at baseline then 2 and 4 weeks after the application of interventions. Data analyzed through SPSS version 21.

Official Title
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Comparison of Muscle Energy Technique and Facet Joint Mobilization in the Patient With Chronic Neck Pain.

Conditions
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Chronic Neck Pain

Intervention / Treatment
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* Other: Muscle energy Technique


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: Chronic patients (more than 12 weeks) Male and female patients Patients having recurrence of neck pain at least once in the last month. Patients from the age group of 35-50 years. Patients having mechanical neck pain ranging from 4-8 on Numeric Pain Rating Scale (NPRS). Cervical straightening on X-rays. Limited &painful cervical Rang of motion (ROMs) Exclusion Criteria: Any recent history of trauma, active inflammation, Tumor, vertebra-basilar insufficiency and cervical myelopathy & radiculopathy. No history of serious underlying pathology, nerve root compromise, structural changes and deformities, genetic spinal disorders or previous spinal surgery

Ages Eligible for Study
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Minimum Age: 35 Years
Maximum Age: 50 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: Experimental Group (1): Muscle energy techniques,Moist Hot pack and TENS.<br>Experimental group included Moist Hot pack of 14/15' over cervical region for 15 mins. Hydro collator Temperature according to standardized hot pack is 40-45C.Conventional TENS applied for 10 mins. Baseline NPRS, NDI, Cervical ROMs, and posterior tangent angle.These pre and post intervention values were mentioned in questionnaire. The participants were administered with muscle energy technique (PIR) and data was collected again 2 and 4 weeks after the interventions. | Other: Muscle energy Technique<br>* Muscle Energy technique was used to increase the strength of weak muscles,relaxation of tightened muscles in result mobilizes the restricted joint segments.MET's group received 3-5 repetition of post isometric relaxation (PIR). Treatment through Facet Joint Mobilization based on 3 sets of 15 repetitions of unilateral poster-anterior glide (UPA) using initially grade I & II mobilizations followed by grade III of mitland glides on selected tender segments and 5 repetitions of extension sustained natural apophyseal glides (SNAGs) on hypo mobile segments. Conventional therapy comprising of stretching and isometric strengthening exercises in combination with TENS and heat therapy.<br>* Other names: Conventional Therapy;|
| Experimental: Experimental Group (2): Facets joint mobilizations, Moist Hot pack and TENS.<br>Experimental group includedMoist Hot pack of 14/15' over cervical region for 15 mins. Hydro collator Temperature according to standardized hot pack is 40-45οC.Conventional TENS applied for 10 mins. Baseline NPRS, NDI, Cervical ROMs, and posterior tangent angle. These pre and post intervention values were mentioned in questionnaire. The participants were administered with Facet joint mobilization (UPA & SNAGS) and data was collected again 2 and 4 weeks after the interventions. | Other: Muscle energy Technique<br>* Muscle Energy technique was used to increase the strength of weak muscles,relaxation of tightened muscles in result mobilizes the restricted joint segments.MET's group received 3-5 repetition of post isometric relaxation (PIR). Treatment through Facet Joint Mobilization based on 3 sets of 15 repetitions of unilateral poster-anterior glide (UPA) using initially grade I & II mobilizations followed by grade III of mitland glides on selected tender segments and 5 repetitions of extension sustained natural apophyseal glides (SNAGs) on hypo mobile segments. Conventional therapy comprising of stretching and isometric strengthening exercises in combination with TENS and heat therapy.<br>* Other names: Conventional Therapy;|
| Active Comparator: Control Group:Conventional Therapy (Stretching, strengthening , Moist Hot pack and TENS)<br>Control group includedMoist Hot pack of 14/15' over cervical region for 15 mins. Hydro collator Temperature according to standardized hot pack is 40-45οC.Conventional TENS applied for 10 mins. Baseline NPRS, NDI, Cervical ROMs, and posterior tangent angle. These pre and post intervention values were mentioned in questionnaire. The participants were administered with Conventional (sustained stretching and isometric strengthening) physical therapy and data was collected again 2 and 4 weeks after the interventions. | Other: Muscle energy Technique<br>* Muscle Energy technique was used to increase the strength of weak muscles,relaxation of tightened muscles in result mobilizes the restricted joint segments.MET's group received 3-5 repetition of post isometric relaxation (PIR). Treatment through Facet Joint Mobilization based on 3 sets of 15 repetitions of unilateral poster-anterior glide (UPA) using initially grade I & II mobilizations followed by grade III of mitland glides on selected tender segments and 5 repetitions of extension sustained natural apophyseal glides (SNAGs) on hypo mobile segments. Conventional therapy comprising of stretching and isometric strengthening exercises in combination with TENS and heat therapy.<br>* Other names: Conventional Therapy;|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Cervical Lordosis Measurement (posterior tangent method) | measure cervical lordosis by drawing tangent line along posterior border of C2 to C7 vertebra and measuring posterior tangent angle on lateral radio graph of cervical spine.At baseline and 4 weeks after baseline | 4 week | 
| Numeric pain rating scale | Will utilize for measurement of neck pain intensity.Minimum pain score is labeled as zero and maximum pain score is labeled as 10.At baseline, 2 and 4 weeks after baseline. | 4 week | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Neck disability index: | Will utilize for measurement of functional disability level among patients with chronic neck pain.At baseline, 2 and 4 weeks after baseline | 4 week | 
| Cervical goniometry: | Will utilize to measure range of motions for all movement at cervical spine with the help of valid & reliable tool, goniometer.At baseline, 2 and 4 weeks after baseline | 4 week | 

 Terms related to the study
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Keywords Provided by Centre Hospitalier Valida
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cervical pain, chronic neck pain,, Muscle energy technique,, Facet join mobilization,, cervical lordosis,, cervical curve