Muscle Energy Versus Mulligan Techniques in Treating Patients With Cervical Spondylosis

July 13, 2025 updated by: Mohamed Ahmed Badier Elkomy, Cairo University

This study will be aimed to answer the following questions:

Which technique, MET or MMT, is more effective in reducing pain, increasing range of motion (ROM), improving proprioception, and enhancing functional ability in individuals with CS?

It will be assumed that:

  1. All participants will adhere to study instructions and procedures.
  2. All participants will be evaluated under standardized conditions.

Study Overview

Status

Completed

Conditions

Intervention / Treatment

Detailed Description

Cervical spondylosis (CS) is a highly prevalent age-related condition (95%), that affects the joints and discs of the cervical spine. By age 65, nearly all individuals experience some degree of degeneration, characterized by disc breakdown and enlarged facet joints. While aging is the primary cause, injuries can accelerate this process in younger populations.

Significance of the Study Age-related degenerative spinal changes are almost widespread. Population-based studies have shown that approximately 80 to 90% of people have disk degeneration on magnetic resonance imaging (MRI) by the age of 50 years.

A global burden review estimates that over 300 million people worldwide had mechanical neck pain lasting at least 3 months in 2015.

Clinical features of spondylosis are more common in men than in women, with a peak incidence between the ages of 40 and 60 years for both men and women.

Cervical spondylosis commonly affects the middle and lower cervical vertebrae (C5-C6 and C6-C7), although higher levels may also be involved. Neck pain is the most prominent symptom. CS can affect all cervical components (i.e., the spinal cord, spinal vasculature, and nerve roots). Cervical spondylosis Symptoms include cervical instability (abnormal movement or laxity between vertebrae). This instability can lead to various symptoms such as neck pain, muscle imbalance between cervical and shoulder girdle muscles (weakness in cervical flexors, lower trapezius, and anterior serratus; tightness in the upper trapezius, scapular lift, and pectoralis major), disc herniation and osteophyte formation. These can compromise proprioception (accurate sensory feedback) and limit neck mobility, significantly impacting function and daily activities.

Muscle energy techniques is a form of manual therapy frequently used by physical therapists to improve musculoskeletal function and alleviate pain. MET aims to adjust abnormal muscle tone by training specific muscles, enhancing strength and stability, improving the musculoskeletal function, and ultimately improving quality of life.

Another treatment technique is MMT that is now an integral component of many manual physiotherapists' clinical practice. MMT involves sustained passive accessory force/glide to a joint while the participant actively performs a problematic movement.

This study aims to address this gap in knowledge by investigating whether MET or MMT is more effective in improving pain, ROM, proprioception, and functional ability in individuals with cervical spondylosis. The findings from this study can provide valuable insights for physical therapists in selecting the most appropriate treatment approach for their patients with cervical spondylosis. By determining the more effective technique, physical therapists can optimize treatment plans and potentially improve patient outcomes.

This Triple-blinded (the examiner, statistician, and the participants will be blinded, while the therapist will be aware of treatment procedures) randomized controlled trial (RCT) will investigate the effectiveness of Muscle Energy Techniques (MET) compared to Mulligan Mobilization Techniques (MMT) on cervical spine pain, ROM, and function in participants with Cervical Spondylosis (CS). The study will be conducted at the outpatient physical therapy clinic of Horus University in New Damietta, Egypt.

Study Type

Interventional

Enrollment (Actual)

40

Phase

  • Not Applicable

Contacts and Locations

This section provides the contact details for those conducting the study, and information on where this study is being conducted.

Study Locations

  • Egypt
      • Cairo, Egypt
        • Faculty of Physical Therapy, Horus University - Egypt

Participation Criteria

Researchers look for people who fit a certain description, called eligibility criteria. Some examples of these criteria are a person's general health condition or prior treatments.

Eligibility Criteria

Ages Eligible for Study

  • Adult

Accepts Healthy Volunteers

Yes

Description

Inclusion Criteria:

  1. Participants of both genders aged 40 - 60 years old, diagnosed with clinically and medically stable CS.
  2. All participants will be assessed and referred by orthopedic surgeons before starting the study.
  3. Mechanical neck pain localized to the cervical.
  4. Neck pain lasting more than 3 months, local tenderness of the upper fibers of the trapezius, limitation in cervical ROM and muscle spasm.
  5. Moderate pain intensity (45-74 mm on VAS).
  6. Participants with Moderate pain intensity NDI (30 - 48%).
  7. All participants are free from any pathological conditions that might influence the results.

Exclusion Criteria:

  1. Participants with systemic diseases like rheumatoid arthritis, metabolic diseases, or osteoporosis.
  2. History of trauma or accidental injuries to the cervical spine.
  3. Cervical myelopathy, inflammatory arthritis, tumors, infections involving the cervical spine, or vertebrobasilar artery insufficiency.
  4. Cervical spine injury, dizziness, vertigo, or any other musculoskeletal complaints.

Study Plan

This section provides details of the study plan, including how the study is designed and what the study is measuring.

How is the study designed?

Design Details

  • Primary Purpose: Treatment
  • Allocation: Randomized
  • Interventional Model: Parallel Assignment
  • Masking: Double

Arms and Interventions

Participant Group / Arm
Intervention / Treatment
Experimental: Group (A) Muscle Energy Technique (MET).
These participants will receive METs, in addition to a standard physical therapy program consisting of deep neck flexor strengthening exercises, isometric exercise, and range of motion exercises (3 sessions per week for 4 weeks).
Other: Group (A) Muscle Energy Technique (MET)

MET will be applied to three key muscles commonly associated with neck pain:

upper trapezius, levator scapulae, and anterior scalenus.

Other Names:
  • Post Isometric Relaxation
Experimental: Group (B) Mulligan Mobilization Technique group (MMT).
Participants will receive MMT interventions alongside the standard physical therapy program deep neck flexor strengthening exercises, isometric exercise, and range of motion exercises 3 sessions per week for 4 weeks.
Other: Group (B) Mulligan Mobilizations Techniques (MMT).
Participants in Group (B) will receive MMT alongside the traditional treatment. MMT utilizes a specific technique called Sustained Natural Apophyseal Glides (SNAGs) to improve joint mobilization.
Other Names:
  • SNAGs

What is the study measuring?

Primary Outcome Measures

Outcome Measure
Measure Description
Time Frame
Cervical Range of Motion (CROM)
Time Frame: Pre- intervention and after 4 weeks of treatment
to measure the Cervical ROM for (Flexion, Extension, Rotation for both sides and Sidebending for both sides) and proprioception (Neutral head position test, and Target head position)
Pre- intervention and after 4 weeks of treatment
The Arabic Version Of Neck Disability Index (NDI).
Time Frame: Pre- intervention and after 4 weeks of treatment
to assess the level of disabilities in patients with neck pain, in % points
Pre- intervention and after 4 weeks of treatment
Visual Analogue Scale (VAS).
Time Frame: Pre- intervention and after 4 weeks of treatment
to measure neck pain with score extended from 0 to 10, minimum score 0 (no pain), highest score 10 (worst pain).
Pre- intervention and after 4 weeks of treatment

Collaborators and Investigators

This is where you will find people and organizations involved with this study.

Sponsor

Cairo University

Publications and helpful links

The person responsible for entering information about the study voluntarily provides these publications. These may be about anything related to the study.

General Publications

Study record dates

These dates track the progress of study record and summary results submissions to ClinicalTrials.gov. Study records and reported results are reviewed by the National Library of Medicine (NLM) to make sure they meet specific quality control standards before being posted on the public website.

Study Major Dates

Study Start (Actual)

November 5, 2024

Primary Completion (Actual)

January 1, 2025

Study Completion (Actual)

February 1, 2025

Study Registration Dates

First Submitted

October 28, 2024

First Submitted That Met QC Criteria

October 28, 2024

First Posted (Actual)

October 30, 2024

Study Record Updates

Last Update Posted (Actual)

July 16, 2025

Last Update Submitted That Met QC Criteria

July 13, 2025

Last Verified

July 1, 2025

More Information

Terms related to this study

Keywords

Additional Relevant MeSH Terms

Other Study ID Numbers

  • P.T.REC/012/005271

Drug and device information, study documents

Studies a U.S. FDA-regulated drug product

No

Studies a U.S. FDA-regulated device product

No

product manufactured in and exported from the U.S.

No

This information was retrieved directly from the website clinicaltrials.gov without any changes. If you have any requests to change, remove or update your study details, please contact register@clinicaltrials.gov. As soon as a change is implemented on clinicaltrials.gov, this will be updated automatically on our website as well.

Subscribe