this study will be conducted to investigate the effect of sustained natural apophysial glide and Instrument assisted soft tissue mobilization on pain intensity, cervical range of motion and neck functional disability level in patients with chronic mechanical neck pain
Sixety patients of chronic mechanical neck pain diagnosed and reffered from physicians will be participants in the study .
Patients of both genders will be included.
The age of the participants will beranged from 20 and 55 years
The BMI ranged between 18.9 and 25 kg/m2
Malignancy
cervical and cranial surgery
Recent fractures
spinal tumors
Parallel
sustained natural apophysial glide
Other interventionThe patients will be in the sitting position and asked to move their head in the direction that particularly produces their symptoms. As the participant moves their head, the physiotherapist gently glides the painful vertebra anteriorly and sustains the glide through the movement. During the application of the glide, the participant should stay symptom free and is instructed to stop moving if any PAIN is produced. This movement was repeated for 10 times for 3 sets, The interval between the sets was 15 to 20 seconds.After mobilization subject had to perform same exercises as conventional group plus conventional physical therapy
instrument assisted soft tissue mobilization
Other interventionThe subject will be in comfortable sitting position leaning on a treatment table with the arm crossed to rest the head. After cleaning the skin of the subject and the blade with alcohol swabs, a lubricant (Vaseline) was applied, and a sweeping technique was used to apply a deep yet comfortable soft tissue mobilization on the upper trapezius from origin to insertion for approximately 3 min. First, M2T blade will be utilized to locate the precise locations of limitation in the affected muscles. Second, the M2T blade was put at 45 degree angle by using convex surface to apply gentle strokes along the muscle. Subjects were instructed that slight hyperemia on the skin is a normal feeling and should subside before the next session.
conventional physical therapy
Other interventionthe patients will receive conventional physical therapy in the form of Infrared, TENS , stretching exercices, isometric exercises
neck disability
Assessment of neck disability will be performed by Arabic version of neck disability index .It is valid and reliable tool in the assessment of neck function. The NDI can be calculated as a raw score or as a percentage Each segment is graded on a scale of 0 to 5, with 0 representing "no discomfort" and 5 suggesting "the most excruciating pain imaginable." With a maximum score of 50 as following
pain intensity
pain intensity will be measured by visual analogue scale. It is a 10-cm (100-mm) line; with 0 refer to no pain while 100mm refer to extreme pain. Patients were requested to place a mark along the line to express their level of pain. The reliability VAS is moderate to good in subjects with musculoskeletal conditions.
cervical range of motion
cervical range of motion device will be used to measure the neck ROM for flexion, extension, rotations, and lateral flexion using 3 separate inclinometers which are attached to a plastic frame and secured to the head by Velcro strap and nose bridge. The sagittal plane inclinometer measures flexion - extension, the frontal plane inclinometer measures right and left lateral flexion, and the horizontal plane inclinometer with a magnetic neck collar measures right and left rotation.
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