The aim of the study to find out effectiveness of Maitland techniques in cervical pain. This study compared the effectiveness of Maitland’s mobilization technique against mulligan’s SNAG technique in cervical pain along with conventional therapy (Active, Isometrics exercises, Moist hot packs) on numeric pain rating scale, ROM and neck disability index. In a general results shows that subjects in both the groups improved well. A significant difference was found in both groups clinically. VAS and NDI scores reduced in both groups, but comparison between groups showed that Group B was better than group A statistically.
Group B receiving Maitland Mobilization showed better improvement on VAS score (4.31) than group A received Mulligan SNAGs (2.36) after four weeks of treatment. This result is different from study (Tanveer et al. 2017) that found more improvement in group 1 received SNAGs (3.52) than group 2 received Maitland Mobilization (2.36) and group 3 received conventional treatments (2.04)20. These differences may result from our smaller number of subjects and differences of individual characteristics. In the previous study conducted by Rajesh Gautam et al. 2014 to compare Maitland and Mulligan mobilization techniques for neck pain and ROM, found that Mulligan mobilization was more effective than Maitland in improving neck pain, functional status of neck and ROM5. These results are consistent with study (Inderpreet et al. 2013) that depicted decrease in pain intensity of neck with mean difference 3.58 for Maitland mobilization group, 3.2 for Mulligan mobilization group and 3.50 for conservative group after three weeks treatment21.Another study by Keyur M. Patel 2016 also supports our results, which concluded that Maitland mobilization is significant in reducing the patient symptoms when it compared with conventional therapy and SNAGs mobilization17. This indicates that Maitland approach is clinically beneficial in treating chronic neck pain.
The improvement in the Mulligan group can be attributed to the neurophysiological effects found at the site of treatment and at areas remote to the local area of treatment. These effects include improved pain related measures like increased pressure pain threshold and decreased visual analogue scale pain rating22. The neurophysiological effects of mobilisation are important enough to cause a categorical and substantial change in how clinicians and scientists understand the benefits of mobilisation. Neurophysiological effects of central posteroanterior (CPA) mobilisation previously have been identified including immediate hypoalgesia and an increase in pressure pain thresholds. When joint tissue is strained at the limits of normal tissue extensibility, nociceptors (pain nerve receptors) are activated, causing a pain response. Mobilisation techniques could stimulate joint mechanoreceptors to decrease pain (neurophysiologic effect), and to stretch the joint tissues (mechanical effect). The oscillations may have an inhibitory effect on perception of painful stimuli by stimulating mechanoreceptors that block nociceptive pathways at the spinal cord or brain stem levels23.
For the ACROM, both groups improved significantly overall and Group B improved more on Extension, right side flexion and rotation. These results are consistent with studies that reported that mobilization applied to both the neck and spine at the same time improved cranial vertical angle and cranial rotation angle and research that showed that endurance exercise of the neck, stabilization exercise, and strength training improved the joint range of motion24.
• A long duration of study with a proper follow-up can be done.
• Future research is required to investigate the effect of joint mobilization and therapeutic exercise on the functional impairments caused by chronic neck pain using diverse subjects and intervention periods, and research on the persistence of the effect also needs to be conducted.
In this study, subjects were treated with Maitland mobilization plus conventional therapy, and Mulligan (SNAGs) mobilization plus conventional therapy in both groups respectively. Both mobilization techniques are clinically significant in reducing the subject symptoms. But Maitland mobilization is statistically significant in reducing the subject symptoms when it is compared Mulligan SNAGs mobilization.