Mulligan's Manual Therapy Treatment Dosing for Subacute Mechanical Neck Pain – A Comparison between Loading and Movement Disorders of Cervical Spine

Evidence is inconclusive regarding comparison of Mulligan's manual therapy treatment dosage and efficacy of standardized treatment regimes between loading and movement disorders of cervical spine. Primary purpose of this study was to compare number of Mulligan's manual therapy treatment sessions required to achieve a significant improvement between loading and movement disorders of cervical spine and. Second purpose was to compare the immediate, short term and long term efficacy of Mulligan's mobilization between the groups.

30 patients with subacute mechanical neck pain were classified into two groups, loading disorders and movement disorders according to their dominant impairment of spinal function.

Study was carried out as a pre test -post test experimental design. Standardized treatment regime including Mulligan's manual therapy along with remedial exercise was prescribed to both the groups. Patients were considered for discharge when they rated their pain intensity ≤ 1 for 3 consecutive treatment sessions. Primary outcome was difference in the minimum number of treatment sessions required to achieve a significant improvement between the groups. Other outcomes measures included were NPRS, NDI, and Cervical ROM (only for symptomatic movements in movement disorder group).

Kaplan Meier curve demonstrated that all the patients with loading disorders showed probability of getting discharged by 7th treatment session as compared to 10th treatment session in movement group. It was also observed that both the groups achieved a significant improvement in neck pain and disability following intervention

Classification system of mechanical neck pain patients into movement and loading group carries prognostic significance and appears to be a useful indicator treatment dosing required to achieve a significant response to specifically standardized physical therapy treatment.