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:

A) 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)) .

B) 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)

• cervical range of motion [Time frame: 2 weeks]
• pain [Time frame: 2 weeks]
• neck disability level [Time frame: 2 weeks]