ISSN: 2320-5407 Int. J. Adv. Res.

12(06), 344-354

Journal Homepage: - www.journalijar.com

Article DOI: 10.21474/IJAR01/18886

DOI URL: http://dx.doi.org/10.21474/IJAR01/18886

RESEARCH ARTICLE
TO COMPARE THE EFFECTIVENESS OF TWO DIFFERENT TECHNIQUES IN IMPROVING NON-
SPECIFIC NECK PAIN, ROM AND DISABILITY IN PATIENT WITH NON-SPECIFIC NECK PAIN

Kavita, Preeti Devi and Jyoti

……………………………………………………………………………………………………....
Manuscript Info Abstract
……………………. ………………………………………………………………
Manuscript History Background: The neck pain is a common cause of disability and health
Received: 14 April 2024 problem in the general population. It can be caused by the stress over
Final Accepted: 18 May 2024 the musculoskeletal system due to postural disorders and may also be
Published: June 2024 associated with other causes such as inter vertebral disc herniation,
nerve compression, or fracture.According to reports, the prevalence of
Key words:-
ROM, NDI, VAS Goniometer, Non - neck pain ranges from 43% to 66.7% and rises with age.
Specific Neck Pain Aims & Objectives: To compare the effectiveness of two different
techniques in improving non-specific neck pain, ROM and disability in
patient with non-specific neck pain.
Methodology: 30 Patients of non-specific neck pain were selected and
the NDI Questionnaire were filled by patients for neck disability , pain
Measured by VAS scale and range of motion measured by universal
goniometer prior to the informed consent were asked to be filled by a
patient . Then the subjects were divided into two groups. Mulligan
mobilization technique were given to group A and isometric exercises
were performed by patient itself in Group B for two weeks and the post
assessment were taken and then data analyzed. Result The significant
value is set up at P< 0.005. The values obtained from our study
indicates that the result is significant and Group B have better effect
than Group A that means isometric exercises are more effective than
mulligan mobilization techniques in non-specific neck pain.
Conclusion:From the result we obtained that the isometric exercises is
more effective than mulligan mobilization technique in non-specific
neck pain.

Copy Right, IJAR, 2024,. All rights reserved.

……………………………………………………………………………………………………...
Introduction:-
The neck pain is a common cause of disability and health problem in the general population .Neck pain is one of the
common musculoskeletal problem .Neck Pain can be caused by the stress over the musculoskeletal system due to
postural disorders and may also be associated with other causes such as inter vertebral disc herniation, nerve
compression, or fracture .Neck pain is a common problem in our society and it affects about 10% of the general
population. Prevalence of Neck pain is reported to range from 43% to 66.7%, which increases along with aging
(Shehri A et.al 2018). Neck pain is usually complex and encompasses several factors related to ergonomic,
individual, behavioural, and psycho social aspects (Alansari m s2021).Prevalence of neck pain has an increasing
trend up to 50 years followed by a decline and it has found to be more in females. With up to 37% of individuals
developing persistent symptoms, neck pain is a condition that have a large economic burden on the health care

Corresponding Author:- Kavita 344

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system. The majority of patients have “non-specific (simple) neck pain,” meaning that their symptoms are caused
by postural or mechanical issues.

Etiological factors are poorly understood and are usually multi factorial, including poor posture, anxiety ,depression,
neck strain, occupational injuries, or sporting injuries. The majority of patients with neck pain have restricted
movements.

Limited range of motion and a subjective feeling of stiffness may accompany neck pain, which is often precipitated
or aggravated by neck movements or sustained neck postures (Mahajan R2012).Neck muscles help support the
cervical spine and contribute to the movements of the head, neck , upper back and shoulders. Here are some of the
key muscles attached to the cervical spine: Levator scapulae: The levator scapulae muscle is attached at the top four
cervical vertebrae (C1 to C4and runs down the side of the neck to attach at the top of the shoulder blade (scapula )
,this muscle helps with lifting the shoulder blade bending the neck to the side and rotating the head .
Sternocleidomastoid (SCM):The SCM muscle runs down the front of the neck to attach at the sternum and collar
bone after being attached to the mastoid process, a tiny bone behind the ear.

Depending on whether one or both SCM muscles (one on each side of the neck ) are contracted , the head can be
rotated to side or the chin tilted upward .It is a large muscle that also helps and protect some fragile structures , such
as the carotid artery. The prominent muscle is trapezius in the cervical, thoracic, and shoulder regions. Along the
mid line it extends from the occiput into the lower ribs of the thoracic region, while laterally it extends as far as the
acromion. Its anatomy and functions are of relevance both to clinicians and biomechanics interested in disorders and
modelling of either the vertebral column, the shoulder girdle, or both. The trapezius muscle is used to rotate or turn
the head, lift the shoulder blade, and stretch the head upwardor neck backward. The erector spinae muscles are
comprised by a number of muscles in the cervical spine. The muscles are essential for maintaining posture, turning
the neck, and extending the neck backward.

The muscle group is comprised of the longuscapitus and longuspolli muscles, which run down the front of the
cervical spine .The deep cervical flexor muscles are involved in flexing the neck forward as well as stabilising the
cervical spine. Suboccipitals – comprised of four pairs of small muscles, the suboccipital muscles connect the top of
the cervical spine with the base of the skull. The suboccipital are important for head extension and rotation ( slosar P
, 2019) . The neck is a slender column that can be subjected to a variety of bending loads in association with an axial
load , the injury mode can be classified as comprehension , tension – extension , tension – flexion , comprehension
– extension , comprehension flexion and lateral bending ( Chen H, 2011) .Mulligan applies movement in sympathy
with physiological movement .

Mulligan’s principle techniques are NAGS, SNAG and MWMs (Mulligan 1993). NAGS are natural
apophyseal accessory glides applied to the cervical spine with the patient passive. SNAG are sustained
natural apophyseal accessory glides where by the patient attempts to actively move a painful or stiff joint
through its range of motion whilst the therapist overlays an accessory glide parallel with the treatment
plane.MWMs is the technique (mobilizations with movement) and are also applicable on the peripheral joints.

The underlying principle to MWMs is derived from Kaltenborn (Exelby 1995) who argued that joint
surfaces are not fully congruent, physiological movements are a combination of rotation and glide, and
glide is essential to pain free movement(Gautam R, 2014).Mulligan mobilizations reduces pain and
improves functionality in many musculoskeletal condition. Mulligan technique involves mobilization of the
spine in weight bearing position, directing the mobilization parallel to the spine facet planes. In this
technique spine mobilization is combined with movements of the peripheral joints to improve pain and
radiculopathy resulting from cervical lesions (Khan S,A).Stretching involves the application of manual or
mechanical force to elongate (lengthen) structures that have adaptively shortened and are hypo mobile. Many
physical benefits are thought to come from stretching, such as increased flexibility, reduced risk of injury, enhanced
athletic or muscle performance, better running economy, healing promotion, and possibly delayed onset of muscles
soreness. Stretching a muscle to the point of discomfort and maintaining the stretch for a while, then allowing the
muscle to return to its usual resting length, is known as static stretching (mahajan R 2012).

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Aims and Objectives:-

Aims:-
To compare the effectiveness of two different techniques in improving non-specific neck pain, ROM and disability

Objectives:-
1. To find out the effectiveness of mulligan mobilization in improving non-specific neck pain, ROM and
disability.
2. To find out effectiveness of static exercises in improving non-specific neck pain, ROM and disability.
3. To compare the effectiveness of two different techniques in improving non-specific neck pain, ROM and
disability in patient with non-specific neck pain.

Hypothesis
Null Hypothesis:
1. There will be no significant effect of mulligan mobilization technique to reduce pain, disability and increases the
active range of motion at cervical spine in non-specific neck pain
2. There will be no significant effect of static exercise to reduce pain, disability and increases the active range of
motion at cervical spine in non-specific neck pain

Alternative Hypothesis:
1. There will be significant effect of mulligan mobilization technique to reduce pain, disability and increases the
active range of motion at cervical spine in non-specific neck pain.
2. There will be significant effect of static exercises to reduce pain, disability and increases the active range of
motion at cervical spine in non-specific neck pain.

Significance of the Study:

The study show the results that isometric exercise have significant result on non-specific neck pain which is
beneficial and easy to learn by patient .These are easy to perform at home and office setups. Data will show the
effect of mulligan mobilization on non-specific neck pain.It could be beneficial in the future in the terms of
treatment of non-specific neck pain.

Methadology:-
Study Design:
Experimental study

Source of Collection of Data:

University Students

Sample Size:
30

Sampling methods:
Simple Random Sampling.

Inclusion Criteria:
Age group between 18-25 years
Patient with primary complaint of non-specific neck pain
Pain of sufficient intensity (greater than 2 out of 10 on numerical pain scale)
 Tight neck muscles
 Both males and females are included

Exclusion Criteria:
Osteoporosis
 Weight loss, fever, history of malignancy
Inflammatory arthritis (AS)

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Structural abnormality effecting neck

 Patient taking anticoagulants
 Neck pain due to trauma
 Previous fracture
 Irradiated neck pain
 Neck pain associated with vertigo
 Diagnosed psychological disorders

Materials required:
Universal Goniometer
Revolving patient Stool
Stationary material

Variables:
Independent:
 Mulligan mobilization
Isometric exercises

Dependent Variables:
1. Pain.
2. Range of motion.
3. Disability.

Procedure:-
The subjects were selected as per the inclusion criteria and all of them will be explained about the study. A verbal
and written consent was taken from the subjects. Subjects were informed the subject about the study. Neck disability
index was filled by the subject. Visual analogue scale was used to measure pain and universal goniometer was used
to measure the range of motion of neck. Pre assessment was taken. Subjects were selected as per the scoring result
of neck disability index questionnaire. Subjects were divided into two group i.e group A and group B. Mulligan
mobilization technique was given on group A and Isometric exercises were performed by other group. On the day 1,
subject was be seated on the revolving patient stool and researcher was standing beside the subject .Put your thumb
behind the mastoid process and traced slide down just inferior to the thumb. Once mastoid process was palpated
then thumb can rotate toward back. With the other thumb apply overpressure forward in that straight plane.Then
subject was rotating the neck to the left and pressure was maintained with subject’s active motion to making it a
mobilization with movement. Subject’ssymptoms were monitor throughout the movement. The subject can give
over pressure with right hand (zygomatic Arch) and give further motion and come back slowly. Subjects were asked
for pain. This procedure was repeated for 5 times and in two sets. There was 10 seconds gap between both the sets
.On the other hand Group B subjects was do Isometric exercises with itself at home for 2times per day this was
repeated for 2 weeks and then post assessment was taken.

Data Analysis:
The Data was analyzed using SPSS statistics software version 23. Pre ＆post mean±SD and significant value of both
the group was calculated by applying paired t-test. Compare the post mean±SD and significant value of both the
groups by applying Independent samples t-test. The significance level was set-up at P<0.05.

Result:-
The study was conducted on 30 subjects with non-specific neck pain .The group A included15 subjects with non-
specific neck pain, who are given mulligan mobilization technique for 2weeks for 2 times per day, whereas the Group
B included 15 subjects with non-specific neck pain, who are given Isometric exercises for 2 weeks for 2times per day.
The subjects included the patient with age group of 18-25years.

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Comarison of Descriptive Data of Group Apre and Postreading:-

Table:- representing the mean and standard deviation and significance of group A

Variables Pre Mean±S.D Post Mean±S.D Significance

Pain 4.87±1.84 2.33±1.17 0.000

Flexion 28.6±5.49 36.6±5.23 0.000

Extension 31.6±7.71 38.6±6.67 0.000

Neck disability index 42.6± 19.8% 17.4± 6.44% 0.000

P value is significant at p<0.000

Group A
45

40

35

30

25

20

15

10 Pre mean Pre SD Post mean post S.D Significance

5 Pain Flexion Extension NDI

0
Graph:- Representing the mean and standard deviation and significance of group A

Paired sample t-test was used to find out significant difference for pain, flexion, extension and NDI. The
result showed significant improvement in pain between pre (4.87±1.84 ) and post(2.33±1.175), flexion
pre(28.6±5.49) and post(36.6±5.23), extension pre(38.6±6.67) and post(38.6±6.67) and NDI
pre(42.6±19.84%) and post(17.4±6.44%) outcomes .

Table:- Representing the mean and standard deviation and significance ofgroupA

Variables Pre Mean±S.D Post Mean±S.D Significance

( R) side bending 32.3±3.20 35.6±3.71 0.001

(L)Side bending 35.0±6.26 38.6±4.80 0.001

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(R ) Rotation 51.6±10.9 57.3±10.9 0.000

(L)Rotation 56.3±10.4 60.6±9.42 0.001

P value is significant at p<0.001

70

60

50

40

30

20

10

0 Pre mean Post SD Post mean Post SD Significance

(R) Side bending (L) side bending (R) Rotation (L) Rotation

Graph:- Representing the mean and standard deviation and significance of group A.

Paired sample t-test was used to find out significant difference for (R) side bending,(L)side bending, (R ) Rotation and
(L ) Rotation . The result showed significant improvement in ( R)side bending between pre (32.3±3.20 ) and
post(35.6±3.71),(L) side bending pre (35.0±6.26)and post (38.6±4.80) ,(R)Rotation pre(51.6±10.9) and post
(57.3±10.9)and (L)Rotation pre(56.3±10.4) and post (60.6±9.42) outcomes.

Comarison Of Descriptive Data Of Group B Pre And Post Reading:

Table:- Representing the mean and standard deviation and significance of group B.
Variables PreMean±S.D PostMean±S.D Significance
Pain 5.87±1.35 1.53±0.743 0.000
Flexion 33.6±5.81 42.3±4.16 0.000
Extension 39.0±6.32 46.0±5.41 0.000
NDI 56.8±16.8% 13.0±6.50% 0.000
P value is significant at p<0.000

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60
Group
5
0
B

40

30

Pre mean Post SD Post mean Post SD

Significance
20 pain Flexion Extension
NDI
Graph:- Representing the mean and standard deviation and significance of group B.

Paired sample10t-test was used to find out significant difference for pain, flexion, extension and NDI. The result
showed significant improvement in pain between pre (5.87±1.35) and post(1.53±0.743), flexion pre (33.6±5.81) and
post (42.3±4.16) ,extension pre (39.0±6.32) and post (46.0±5.41)and NDI pre(56.8±16.8%) and post (13.0±6.50%)
outcomes.
0
Table:- Representing the mean and standard deviation and significance of group B.

Variables PreMean±S.D PostMean±S.D Significance

( R) side bending 28.3±4.49 37.3±3.20 0.000
( L) Side bending 31.0±3.87 39.0±2.80 0.000
( R)Rotation 49.3±5.93 59.8±6.43 0.000
(L)Rotation 51.0±8.90 63.3±61.1 0.000
P value is significant at P<0.000

Group B

Pre mean Post SD Post mean Post SD Significance

(R)side bending (L)side bending (R)Rotation (L)Rotation

Graph:- Representing the mean and standard deviation and significance of group B.

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Paired sample t-test was used to find out significant difference for (R) side bending, (L) side bending, (R) Rotation
and (L) Rotation. The result showed significant improvement in ( R)side bending between pre (28.3±4.49 ) and
post(37.3±3.20),(L) side bending pre (31.0±3.87)and post (39.0±2.80) ,(R)Rotation pre(49.3±5.93) and post
(59.8±6.43) and (L)Rotation pre(51.0±8.90) and post (63.3±61.1) outcomes.

Comparison Of Descriptive Data Of Both The Group Post Test Reading:-

Table:- Representing the post mean, standard deviation and significance of both group.
Variables Pre Mean±S.D Post Mean±S.D Significance
Pain 1.73±0.59 1.40±0.507 0.096
Flexion 36.6±5.23 42.3±4.16 0.006
Extension 38.6±6.67 46.0±5.41 0.313
NDI 17.0±6.44% 13.0±6.50% 0.115
P value is significant for pain at p<0.096,
P value is significant for flexion at p<0.006,
P value is significant for extension at P<0.313,
P value is significant for NDI at P<0.115

Comparison of Both Group

Group Amean Group A SD Group Bmean GroupBSDSignificance

Pain Flexion Extension NDI

Graph:- Representing the mean and standard deviation and significance of both group.

Independent samples t-test was used to find out significant difference between post reading of both the groups for
pain, flexion, extension and NDI. The result showed significant improvement in pain between group A post
(1.73±0.59) and group B post(1.40±0.507),flexion group A post (36.6±5.23) and group B post (42.3±4.16) ,extension
Group A post (38.6±6.67) and Group B post(46.0±5.41) and NDI group A post(17.0±44.7%) and Group B
post(13.0±6.50%) outcomes.

Table:- Representing the mean and standard deviation and significance of both group.
Variables Pre Mean±S.D Post Mean±S.D Significance
( R)side bending 35.6±3.71 37.3±3.20 0.313
( L) side bending 38.6±4.80 39.0±2.80 0.849
( R)Rotation 57.3±10.9 59.8±6.43 0.360
(L) Rotation 60.6±9.42 63.3±6.17 0.326
p value is significant for ( R) side bending at p<0.313, p value is significant for (L)Side bending at p<0.849, p value is
significant for( R)Rotation at p<0.360, p value is significant for (L)Rotation at p<0.326

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Comparison of Both Group

GroupA GroupBSD GroupB GroupBSDSignificance

mean mean
(R) side bending (L)side bending (R)Rotation (L)Rotation

Graph:- Representing the mean and standard deviation and significance of both group.

Independent samples t-test was used to find out significant difference between post reading of both the groups for (R)
side bending,(L)side bending, (R) Rotation and (L) Rotation. The result showed significant improvement in ( R) side
bending between group A post (35.6±3.71) and group B post(37.3±3.20), (L)side bending group A post(38.6±4.80)
and group B post(39.0±2.80) ,(R) Rotation Group A post (57.3±10.9) and Group B post (59.8±6.43)and (L)Rotation
group A post(60.6±9.42) and Group B post(63.3±6.17) outcomes.

Discussion:-
The purpose of the study is to compare the effect of mulligan mobilization technique and isometric exercises on non-
specific neck pain. This study was conducted on 30 subjects in two groups with non-specific neck pain which
includes patients age group A (20.47±1.68) and Group B (20.27±1.94) out of which 60% are males and 40% are
females. The patients were included on the basis of inclusion and exclusion criteria. On the group A mulligan
mobilization technique were performed and Group B were asked to do isometric exercises.

Then result was calculated to compare both the techniques on Pain, ROM and NDI. After the comparison , the
Independent samples t-test was used to analysis and the P value is set up at 0.005 .The values obtained from our study
indicates that the result is significant and Group B is better effect than Group A. It shows that isometric exercises are
more effective than mulligan mobilization techniques at non-specific neck pain.

After conducting this study, an significant result is obtained .The Group A post result for pain were ( 1.73±0.59 )
respectively and Group B post result for pain were (1.40±0.507).The mean results were significant after the
application of Independent samples t-test (P<0.096).The result proved that the isometric exercises are significantly
useful in reducing the pain in non-specific neck pain .( Yang et, al ,2022) conducted a study on Effects of isometric
training on the treatment of patients with neck pain A meta-analysis. Isometric training was superior to the control
group. Increased effects on visual analogue scale and range of motion were observed with over 20 isometric training
interventions. Isometric exercise is a powerful tool for reducing neck pain, enhancing neck function, increasing joint
mobility.

The study result of Group A for post Flexion(36.6±5.23), Extension(38.6±6.67), (R)side bending(35.6±3.71),
(L)side bending(38.6±4.80), (R)rotation(57.3±10.9), (L)rotation(60.6±9.42) respectively and Group B post result for
flexion(42.3±4.16), extension(46.0±5.41), (R)side bending(37.3±3.20), (L)side bending(39.0±2.80),
(R)Rotation(59.8±6.43) and(L)rotation(63.3±6.17). The mean results were significant after the application of
Independent samples t-test (0.006, 0.313, 0.313, 0.849, 0.360, 0.326) . The result proved that the isometric exercises

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are significantly useful in improving the ROM. Sbardella.Set.al(2021) was proposed a study on Muscle Energy
Technique in the Rehabilitative Treatment for Acute and Chronic Non-Specific Neck Pain: a systematic review.
Twenty-one papers according to inclusion and exclusion criteria were selected: 15 studies about non-specific acute
neck pain and 6 studies about non-specific chronic neck pain . According to this investigation , the MET strategy
works well in conjunction with a typical rehabilitative approach to enhance cervical range of motion in patients with
chronic neck pain and acute neck pain.

The Group A post result for NDI(17.0±6.44) and The Group B post result for NDI(13.0±6.50). The mean results
were significant after the application of Independent samples t-test (p<0.115).The result proved that the isometric
exercises are significantly useful in reducing the disability in non-specific neck pain. Khan.KZ et, al, (2022) was
conducted a study on effect of post-isometric relaxation versus myofascialrelease therapy on pain, functional
disability, ROM ,Qol in the management of non specific neck pain: a randomized controlled trial.Based on an
analysis of the baseline characteristics, it was found that both groups had the same age and gender i.e. a total of 60
participants were included in this research study 30in each group. With a mean of 32.4(5.0) years, there were
20(33.3%) men and 40(66.7%) females among the 60 patients.

Participants in the post isometric group demonstrated significant improvement (P<0.025) in VAS, NDI ,Cervical
extension , left side rotation ranges and Qol (social domain) at the 2week follow-up compared with those in the
myofascial group. Moreover, the myofascial group showed noticeably reater improvement in the CROM (flexion,
left and right side bending ) mean score.

The study demonstrated patients with non specific neck pain can benefit from the post isometric relaxation with
significant improvement in pain, disability, cervical ROM, and Quality of life compared with myofascial release
therapy.

Limitations Of The Study

1.Small sample size.
2.Sample is specific in Patient with primary complaint of non-specific neck pain.
3.Sample is specific in younger age (18-25).
4.Sample is specific in Pain of sufficient intensity (greater than 2 out of 10 on numerical pain scale).

Future scope of the study

The study can be added certain new things such as added some other exercises, technique increasing the time duration
and increase the number of repetitions. The study can be conducted on large sample size and on different type of
conditions. We can increase the time duration to 15 sec for better Results. Evaluation of other muscles that can
improve pain, disability and quality of life . Assessment can also be done after every week of session.

Conclusion:-
From the result we obtained that the isometric exercises is more effective than mulligan mobilization technique.
Isometric exercises help to improve in pain, ROM and neck disability. It can be release the tightness of neck muscles.
Combining isometric exercises with other techniques in physiotherapy can be very effective method to get rid of non-
specific neck pain. However the sample size can be increased to show a high significant value. The purpose of
increasing the ROM, improvement in pain and neck disability is fulfilled as the result found was significant.

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