Maitland Mobilization Versus Mulligan Mobilization in Sub-Acute and Chronic Non-Specific Neck Pain

Study Overview
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Brief Summary
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This study investigate the short term effect of Maitland in comparison to Mulligan mobilization with sub-acute and chronic non specific neck pain to improve neck pain, pain pressure threshold, rang of motion, joint position sense, disability, and to evaluate the interaction with psychological factors. Study design: experimental study

Detailed Description
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44 patients with sub-acute or chronic neck pain will be randomized into Maitland group: 22 patients receive central postro anterior or unilateral postero anterior. Mulligan group: 22 patients receive sustain natural apophyseal glides. The treatment will be 2 times /week for three weeks. Measurement will be taken pre intervention and after three weeks for neck pain, pain pressure threshold, range of motion, joint position sense, and disability using a numeric pain rating scale, pain pressure threshold test, cervical range of motion device, and neck disability index, depression, anxiety, fear avoidance believe and pain catestrophizing respectively.

Official Title
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Maitland Mobilization Versus Mulligan Mobilization in Sub-Acute and Chronic Non-Specific Neck Pain

Conditions
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Nonspecific Neck Pain

Intervention / Treatment
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* Other: mulligan mobilization
* Other: maitland mobilization


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: • Patients aged between 20 to 50 years. Neck pain more than one week without radicular symptoms. Pain on posterior neck from superior nuchal line to first thoracic vertebra. Exclusion Criteria: • Patient contraindicate to mobilization (pregnancy, whiplash injury, tumor, fracture, metabolic diseases, rheumatoid arthritis, osteoporosis and resting blood pressure higher than 140/90 mmHg). Cervical radiculopathy. Fibromyalgia pain syndrome. Previous neck surgery. Neck pain associate with vertigo caused by vertebrobasilar insufficiency or chronic headache. Patient received physical therapy treatment in the previous three months. Psychiatric disorders. Vestibular system deficits.

Ages Eligible for Study
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Minimum Age: 20 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: None (Open Label)


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Experimental: mulligan mobilization<br>mobilization for spinous process or facet with neck movement 10 repetetions for 3 times. | Other: mulligan mobilization<br>* mobilization with movement for spinous process or facet joint.<br>|
| Experimental: maitland mobilization<br>maitland mobilization for spinous process or facet joint for 2 min and repeated 3 times. | Other: maitland mobilization<br>* posterioanterior of spinous process or facet joint.<br>|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| pain pressure threshold | It will be measured with an electronic algometer (Somedic AB, Farsta, Sweden) with a circular probe of 1 cm2. The PPT will be measured over the following site: (1) area of maximum tenderness over the cervical spine as identify by palpation, (2) tibialis anterior muscle (upper one-third of the muscle belly) bilateral. Tibialis anterior sites will be as remote lower limb sites to investigate any widespread changes in sensitivity. The pressure will be applied perpendicular over the identified sites at a rate of 40 KPa/s until the individual verbally states that the pressure is starting to change to a pain sensation. Then, the pressure will be stopped. The test will be repeated three times for each site within 30 second between measurements. An average of three measurements will be calculated | 3 weeks | 
| pain intensity | : numeric pain rating scale (NPRS) will be used to evaluate the intensity of pain perceived by patient. Pain is rated on 11 point scale from (0) no pain to (10) sever pain. The patients will be asked to point out the number that describes their pain level. | 3 weeks | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| cervical range of motion | it will be measured by cervical range of motion (CROM) device. It consists of three gravitational inclinometers system for flexion, extension and lateral flexion, and magnetic inclinometer for rotation. | 3 weeks | 
| joint position sense | it will be measured by using the (CROM) device | 3 weeks | 
| neck disability index | This questioner is used to report disability results from neck pain and it is a self-report based outcome. In addition, it contains ten sections with total score of 50 points | 3 weeks | 

 Terms related to the study
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Keywords Provided by Centre Hospitalier Valida
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neck pain,