Efficacy of neural tissue mobilization along with conventional physiotherapy and only conventional physiotherapy with chronic mechanical radiating neck pain of Dhaka City in Bangladesh

Abstract

Background: Neural tissue mobilization is one of the many methods of manual therapy of soft tissue conditions and more specifically, neural tissue and tissues surrounding the nervous system. Cervical radiculopathy is the result of cervical nerve root pathology that may lead to chronic pain, disability and reduce ROM.Objective: To determine the efficacy of neural tissue mobilization along with conventional physiotherapy and only conventional physiotherapy in improving pain, neck range of motion and neck disability index in patients with chronic mechanical radiating neck pain. Methodology: Experimental study was conducted with triple blinded. 32 participants were conveniently selected with history of radiating neck pain since 03 months and above. Subjects were distributed on the basis of odd and even number into two equal groups where odd number was in experimental group and even number was in control group with age group between 26-65 years. Initially, all the subjects were assessed for pain by NPRS, ROM by goniometer and Disability by Oswestry Neck Disability Index. Experimental group received nerve mobilization for radial, medial and ulnar along with conventional physiotherapy, while Control group received only conventional physiotherapy which include manual cervical traction, hot pack, IRR, retraction exercise and isometric strengthening exercises for cervical. Reassessment was done after six sessions of treatment program. Analysis: Significance test for difference of means were done using ‘Wilcoxon signed-rank test’ for between groups comparison and ‘Mann-Whitney U test’ for within groups comparison; t-test could not be applied as data violated the condition of normality. Results: About 59% participants were male and 41% participants were female. The study reveals that conventional physiotherapy group with a mean age was 44.63 ± 9.73 years and neural mobilization group with a mean agewas47.50 ±10.35. Subjects were evaluated before and after 06 sessions of treatment for pain, neck range of motion and neck disability index. After receiving six sessions of interventions data were analyzed by ‘Wilcoxon signed-rank test’ for between group’s comparison and ‘Mann-Whitney U test’ for within group’s comparison for pain, ROM and disability. The outcome of the statistical test within group analysis showed statistically significant in maximum indicators (p<0.05) and between group analysis showed statistically significant of pain in case change of severity of neck pain (p<0.05) and change of neck pain during sitting position (p<0.05). Also there was improvement of pain in case of pain during lying, flexion, extension, side flexion to right, side flexion to left, rotation to right, rotation to left and travelling but not statistically significant. Between group analysis showed statistically significant improvement change in case of active ROM in rotation to right side of neck (p<0.05) and change in active ROM in rotation to left side of neck (p<0.05). Also there was improvement of range of motion in case of flexion, extension, rotation to right side and rotation to left side but it was not statistically significant improvement. Disability was improvement but it was not statistically significant improvement. Conclusion and Recommendations: This study showed a significant improvement in neck range of motion and decrease in neck disability index and pain within two therapeutic interventions that is conventional physiotherapy along with neural mobilization and only conventional physiotherapy. It can be concluded that both the intervention is effective therapeutic options in the treatment of cervical radiculopathy. However between group findings does not give a clear idea about which treatment approach is superior to another treatment approach. The results suggest that the addition of neural mobilization along with conventional physiotherapy yields no significant additional benefit to pain, ROM, or disability in patients with cervical radiculopathy, so simultaneously neural mobilization and conventional physiotherapy is not recommended.