Comparison of Cervical Retraction Exercise and Facet Oscillatory Mobilization in Chronic Mechanical Neck Pain

Neck pain is a common disorder in the general population leading to disability in terms of patient's physical, social and emotional well-being. Current data suggest that 22% to 70% of people experience neck pain at some point of their lives. In the developed world, the prevalence of the chronic neck pain is reported to be ranging from 7% to 22% among women and from 5% to 16% among men. Prevalence studies showed that cervical pain is more prevalent among middle-aged women compared to their male counterparts. When the duration of symptoms is greater than 12 weeks of evolution, it acquires the value of chronicity. Chronic neck pain, occurring in approximately 50% of the global population, has a substantial societal burden. Adults with neck pain commonly experience hyperalgesia of cervical muscles, as evidenced by a reduced pressure pain threshold. Neck pain incidence raises with age and is greatest in the third and fourth decades of life with more prevalence in females. The reduced range of neck motion (ROM) is another objective finding widely investigated in chronic neck pain. It could be argued that the optimal functioning of the cervical musculature is related to the ROM; changes in neck muscle activation that result in an altered stiffness distribution may affect cervical passive stability as well as the passive and active ROM. When evaluating a patient with neck pain, the physician must be alert for red flags in the history and physical examination that may indicate the need for urgent testing and intervention. NNP is a symptom with a multifactorial etiology, and studies show its strong correlation with depression, anxiety, headache, sedentary life, sleep disorders and smoking. Risk factors for developing NNP include cervical trauma such as whiplash, sports injuries and sedentary seated work(10) Musculoskeletal disorders occurring in the neck include neck pain, cervical strain, sprain, facet joint syndrome, ruptured cervical disk, and myofascial pain syndrome, common symptoms caused by these diseases include neck pain, decreased joint range of motion, and muscle over-tension. Neck pain, which is the most common in neck diseases, limits the range of motion of the neck and causes neck dysfunction by causing crepitation and stiffness of the neck. The structural arrangement of the cervical spine makes it susceptible to mechanical changes, often triggered by degenerative shifts and improper posture, resulting in prevalent neck discomfort, with a 54% prevalence rate over 6 months. There are many methods of diagnosis both radiological and manual testing. Radiological tests include X.RAY, MRI, and CT. while manual testing includes compression and traction tests to rule out neurological or joint dysfunction. Palpation to check tenderness and manual muscle testing for neck muscles strength. Physical therapy interventions for chronic neck pain include diverse treatment approaches including manual therapy, isometrics, heating modalities stretching etc. that not only reduces pain but also increases functional ability of patient. From physiotherapist point of view it's important to use an effective manual technique that provides us with highest pain relief, improve mobility and maximum functional restoration and NAGS and SNAGS by brain mulligan are an effective approach. Cervical retraction exercise is performed with patients either in sitting or standing in an upright position while pushing their chin backward and simultaneously raising their head within the pain-free range (3 seconds). In manual therapy, joints are assessed and treated relying on the current knowledge about their kinematics, however, only limited information is available about the upper cervical spine and how its kinematics are influenced by manual mobilization. In terms of preference of techniques for the management of neck pain, exercise therapy and manual therapy are mostly applied by physiotherapists. Manual therapy techniques include joint mobilization and soft tissue mobilization techniques. Restoration of joint arthrokinematics is achieved by joint mobilizations, whereas soft tissue techniques, such as muscle energy techniques (MET) and static stretching, focus on flexibility of soft tissues, like extensibility of muscle and connective tissues. Conventional static stretching is commonly applied in the management of neck pain and other mechanical disorders, but it directs effect only on the passive component of muscle, like connective tissues or perimysium, whereas METs focus on the active component of muscle tone in addition to the passive component.