COMPARISON OF THE EFFECTS OF MULLIGAN SUSTAINED NATURAL APOPHYSEAL GLIDES VERSUS MUSCLE ENERGY TECHNIQUE ON PAIN, DISABILITY AND FUNCTION IN PATIENTS WITH CHRONIC CERVICAL SPONDYLOSIS.

The present study is aimed to compare the effects of the Mulligan technique (SNAGS) versus the muscle energy technique (MET) in chronic cervical spondylosis patients in terms of pain, range of motion, hand grip strength, craniovertebral angle, cervical proprioception, and Neck Disability Index.

A double-blinded Randomized controlled trial with 2 groups. A total of 52 patient will be recruited from a single center. The sample size was calculated using Gpower version 3.1.9.7. Random Allocation Software Version 1.0 (as per the description of Randomization).

Data will be collected from Dubai Center for Physiotherapy and Medical Rehabilitation, Nasiriyah Iraq.

Inclusion criteria • Both genders. • Patients diagnosed with cervical spondylosis. • Age between 45 to 65 years. • Cervical spondylosis ≥ 6 months. • Degenerative spondylosis on X-rays. • Positive Spurling test. • Positive cervical distraction test. • Pain intensity ≥ 3 on the Numeric pain rating scale. • Patient without cervicogenic headache. • No cervical myelopathy. • No whiplash-associated disorders. • No previous cervical spine surgeries. • No cervical arterial dysfunction patients. • No deformity (e.g. Torticollis, springe’s deformity, scoliosis). Exclusion criteria • Patients who are not carrying out the study for any reason. • The patient will complain of difficulty or signs and symptoms.

Group (A), conventional physical therapy plus mulligan SNAGs. Group (B), conventional physical therapy plus Muscle Energy Technique (MET).

Numeric Pain Rating Scale for Pain Bubble Inclinometer for Cervical Range of Motion Digital Handheld Dynamometer for Hand Grip Strength Kinovea for Craniovertebral Angle Laser Tracker for Cervical Proprioception Neck Disability Index for Cervical Disability.

Before the process of randomization, we will screen all the participants and assign them a unique number from 1 to 60. Then the process of randomization will be carried out using Random Allocation software version 1.0 (developed by the Department of Anaesthesia, Isfahan University of Medical Sciences, Isfahan, Iran). It is a randomization software for parallel group trials. It requires the total sample size and the total number of groups. We will add a total sample size of 52 participants and 2 groups into the software with only one block. The software generates an output file that can be opened with internet explorer. The output file contains a list of numbers along with assigned groups. In our case, the groups will be A and G with 26 participants in each group. Then this sequence will be used for participant allocation in the study groups.

The care provider will be blinded to the groups of the study which means they will not know which group is the treatment group and which group is the control group. While the outcome assessors will be blinded to the treatment protocols and study hypothesis. They will not be aware of the treatment protocols used for each group and what are the study hypothesis.