Effect of Mulligan on Cervical Radiculopathy

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:

1. 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)) .
2. 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)