Effect of Maitland mobilization versus deep cervical flexors muscles training on proprioception in adults with chronic mechanical neck pain: a randomized controlled trial

Abstract

Abstract Objective To examine the effect of adding Maitland mobilization (MM) versus deep cervical flexors muscles training (DCFMT) to conventional physical therapy (CPT) on proprioception in adults with chronic mechanical neck pain (CMNP). Materials and methods A randomized controlled study was carried out at the outpatient clinics of physical therapy at Cairo and Suez universities. Sixty participants (27 males, 33 females) with CMNP were randomized into 3 equivalent groups. Group I received MM plus CPT, group II received DCFMT in addition to CPT, and group III received CPT only. All individuals were given three sessions a week for 4 weeks. The primary outcomes were proprioception (CROM), and pain (VAS). The secondary outcomes were cranio-vertebral angle (CVA), and upper cervical angle (C0–C2). Outcomes were evaluated at baseline and following 4 weeks of treatment. Results Following 4 weeks of treatment, the DCFMT group showed statistically significant improvement to the MM group as well as the CPT group in all outcome measures (p > 0.05). Also, the MM group was remarkably better than the CPT group in all measured outcomes (p > 0.05). The mean signed difference (M±SD) post-treatment within the group of VAS were 6.87 ± 1.26, 7.15 ± 1.38, and 7.20 ± 1.39 cm for MM, DCFMT, and CPT groups respectively. The (M±SD) of CVA were 42.61 ± 4.36, 42.24 ± 3.64, and 42.32 ± 4.81 degrees for MM, DCFMT, and CPT groups respectively. The (M±SD) of C0–C2 were 24.25 ± 2.98, 23.37 ± 1.94, and 24.95 ± 3.01 degrees for MM, DCFMT, and CPT groups respectively. The (M±SD) of flexion JPE to target were 3.62 ± 0.91, 2.86 ± 0.77, and 4.35 ± 0.91 degrees for MM, DCFMT, and CPT groups respectively. The (M±SD) of flexion JPE to neutral were 3.96 ± 0.78, 2.66 ± 1.03, and 5.23 ± 1.52 degrees for MM, DCFMT, and CPT groups respectively. Conclusion Adding MM and DCFMT to CPT revealed significant enhancement, favoring DCFMT, on proprioception, pain, cranio-vertebral angle (CVA), upper cervical angle (C0–C2), and intensity than CPT alone in adults with CMNP. Trial registration Pan African Clinical Trails Registry with a registration No. PACTR202211651838599 on the 3rd of November 2022.

Keywords

• Maitland mobilization
• Deep cervical flexors muscles training
• Chronic mechanical neck pain
• Cranio-vertebral angle
• Upper cervical angle
• Proprioception