Abstract

Background. Dizziness is a common symptom following cervical spondylosis which is due to disturbed sensory input from the neck proprioceptors. Both manual therapy and deep neck flexors training improve cervical joint position sense but yet there is no evidence about the most effective method for improving cervical joint position sense and dizziness in patients with cervical spondylosis. Purpose. To investigate and compare the effect of Mulligan sustained natural apophyseal glides (SNAGs), Maitland mobilization and deep cervical flexors (DCFs) training on cervical joint position sense, neck pain and dizziness in patients with cervical spondylosis. Methods. 56 patients with cervical spondylosis of both sexes aging from 40 to 55 years contributed in this study. Patients were chosen from Out-Patient Clinic, Faculty of Physical Therapy, Cairo University. They were randomly assigned to four groups (one control group and three study groups). Study group I received Mulligan SNAGs mobilization plus conventional physical therapy (Moist hot pack, Transcutaneous nerve stimulation (TENS), deep neck flexors exercises), study group II received Maitland passive mobilization plus conventional physical therapy, study group III received DCFs training plus conventional physical therapy and control group IV received conventional physical therapy only. Primary outcome was cervical joint position sense assessed by Head Repositioning Accuracy (HRA) measurement and secondary measures include assessment of dizziness intensity by dizziness- visual analogue scale (VAS), disability caused by dizziness using dizziness handicap inventory (DHI) and neck pain intensity using Numeric Pain Rating Scale (NPRS), all outcomes measures were assessed for each patient pre and post 6 weeks of treatment program in the four groups (3 sessions ∕week). Results. There was no significant difference in all measured variables (RT HRA, LT HRA, NPRS, Dizziness-VAS and DHI) between group I and II post six weeks of the treatment (p > 0.05). While there was a significant decrease in all measured variables in both group I and II in comparison with that of group III and group IV post treatment (p < 0.05) and in group III in comparison with that of group IV post treatment (p < 0.05).Conclusions. The results showed that both Mulligan SNAGs and Maitland passive mobilization have similar effect on cervical joint position sense, neck pain and dizziness in patients with cervical spondylosis. Each of them was more effective than DCFs in improving these problems.

Key words:

Cervicogenic dizziness; Neck proprioception; Neck pain; Maitland mobilization, Mulligan mobilization; Deep cervical flexors training; Cervical spondylosis