Effects of Mulligan Belt Traction Versus Fisted Traction in Patients With Lower Cervical Spine Radiculopathy

Effects of Mulligan Belt Traction Versus Fisted Traction on Pain, Range of Motion and Disability Level in Patients With Lower Cervical Spine Radiculopathy

Individuals with a lower cervical spine radiculopathy diagnosis will undergo screening to determine their eligibility based on inclusion and exclusion criteria. Eligible participants will be asked for their informed consent

Study Overview

• Status: Active, not recruiting
• Conditions: Cervical Radiculopathy
• Intervention / Treatment: Other: muligan belt traction; Other: Fisted traction

Detailed Description

Participants will receive a unique identifying code to maintain confidentiality and be formally enrolled in the study upon obtaining informed consent. Following that, they will have baseline evaluations for outcome factors such as neck disability index, range of motion using goniometry and pain using a numerical pain rating scale. After completing the baseline evaluation, participants will be divided into two groups: Group A will receive a Mulligan Belt Traction, while Group B will receive a Fisted Traction. Every participant will get treatment for four weeks, with three sessions per week. At the conclusion of the intervention period, a post-intervention assessment will be carried out Randomization:Random allocation of participants into the two groups, Group A and Group B, will be performed by a lottery method. The participants of Group A will be managed by Mulligan Belt Traction while in Group B, participants will receive Fisted Traction. The physiotherapists will provide both interventions during a specified time period.

• Study Type: Interventional
• Enrollment (Actual): 44
• Phase: Not Applicable

Contacts and Locations

Study Locations

• Pakistan
  • Punjab Province
    • Lahore, Punjab Province, Pakistan, 54000

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: Adult
• Accepts Healthy Volunteers: No

Description

Inclusion Criteria:• Age 25-60 years

• Both Male and Female
• Clinically or radiologically diagnosed lower cervical radiculopathy(C5-C7)
• Neck pain radiating to the arm and hand
• Positive Spurling's Test or Upper Limb Tension test
• Subacute to chronic phase (>4 weeks to 6< weeks)
• Moderate pain (VAS> 4/10)
• Evident by a score on Neck Disability Index (NDI >20%)
• Able and willing to give informed consent and follow the protocol
• Cervical spine active range of motion (CSAROM) Exclusion Criteria:• Cervical Fracture
• Thoracic outlet syndrome or carpal tunnel syndrome
• History of previous cervical surgery
• Osteoporosis of cervical spine
• Sign of myelopathy
• Severe cervical disc herniation with cord compression
• Red flag signs (Rheumatoid arthritis, history of trauma, ankylosing spondylitis, prolonged steroid used and malignancy

Study Plan

How is the study designed?

Design Details

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

Number of Arms

2

Arms and Interventions

Participant Group / Arm	Intervention / Treatment
Experimental: conventional group; Conventional physiotherapy which include cervical traction, hot pack and isometric strengthening exercises for lower cervical radiculopathy	Other: muligan belt traction; Patient Position: The Patient lies supine on the treatment table.; Head in neutral or slightly flexed position (according to comfort and symptoms).; Arms rest by the sides. Therapist Position: Therapist stands at the head end of table, therapist places the middle finger on the concerned cervical segment.; To maintain joint contact and control movement at the level. Belt Placement: The Mulligan belt is positioned at an angle to apply gentle traction targeting the lower cervical spine (C5-C7) (16); Make sure there is no pressure on the throat or jaw. Application of Traction: While maintaining contact at the target segment, therapist leans backward, to apply gentle sustained and controlled traction (distraction force) along the line of the cervical spine.; This help to open up the intervertebral foramen, reduce nerve compression and restore normal joint mechanics. (17) Duration: • Traction is applied for 10-30 seconds per repetition, repeated 3-5 times per session base; Other: Fisted traction; Sit upright in a chair with back support. • Keep your spine straight and head in a neutral position. Hand Placement: One fist is placed at the upper chest\sternum, acting as a fulcrum.; A towel is used between the fist and chest for comfort and positioning.(18); The opposite hand is placed around the back of head (occiput). Traction Technique: The head is pulled forward and down, guiding cervical flexion over the fist.; Maintain for 10-15 seconds, repeat 5-10 times, depending on comfort.
Active Comparator: conventional therapy; Conventional physiotherapy which include cervical traction, hot pack and isometric strengthening exercises for lower cervical radiculopathy	Other: muligan belt traction; Patient Position: The Patient lies supine on the treatment table.; Head in neutral or slightly flexed position (according to comfort and symptoms).; Arms rest by the sides. Therapist Position: Therapist stands at the head end of table, therapist places the middle finger on the concerned cervical segment.; To maintain joint contact and control movement at the level. Belt Placement: The Mulligan belt is positioned at an angle to apply gentle traction targeting the lower cervical spine (C5-C7) (16); Make sure there is no pressure on the throat or jaw. Application of Traction: While maintaining contact at the target segment, therapist leans backward, to apply gentle sustained and controlled traction (distraction force) along the line of the cervical spine.; This help to open up the intervertebral foramen, reduce nerve compression and restore normal joint mechanics. (17) Duration: • Traction is applied for 10-30 seconds per repetition, repeated 3-5 times per session base; Other: Fisted traction; Sit upright in a chair with back support. • Keep your spine straight and head in a neutral position. Hand Placement: One fist is placed at the upper chest\sternum, acting as a fulcrum.; A towel is used between the fist and chest for comfort and positioning.(18); The opposite hand is placed around the back of head (occiput). Traction Technique: The head is pulled forward and down, guiding cervical flexion over the fist.; Maintain for 10-15 seconds, repeat 5-10 times, depending on comfort.

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Neck Disability Index	The NDI contains 10 items - 7 relating to activities of daily living, 2 relating to pain and 1 relating to concentration items is scored from 0-5, and the total score is expressed as a percentage (total possible score, 100%), with higher scores corresponding to greater disability. Scoring the NDI: 0 - 4 = No disability 5 - 14 = Mild disability 15 - 24 = Moderate disability 25 - 34 = Severe disability 35 or over = Complete disability	baseline to 4 week
Numeric pain rating scale	The NPRS is a reliable and effective tool for measuring pain. A straight line is drawn on the evaluation sheet, labeled from '0' to '10', where '0' represents no pain and '10' indicates the worst possible pain. Patients are asked to mark a point on the line that reflects the intensity of pain they are experiencing at the time of assessment	baseline to 4 week
Cervical Range of Motion	Cervical Flexion (Looking Down) Position: The patient sits upright. Goniometer Axis: Placed at the external auditory meatus (ear). Stationary Arm: Kept perpendicular to the floor. Moving Arm: Aligned with the base of the nose. Normal Range: 0 to 45 degrees 2 Cervical Extension (Looking Up) Position: Patient remains seated upright. Goniometer Axis: Centered at the external auditory meatus. Stationary Arm: Vertical, perpendicular to the floor. Moving Arm: Follows the line of the nose. Normal Range: 0 to 45 degrees 3. Cervical Lateral Flexion (Side Bending) Position: Patient sits straight. Goniometer Axis: Over the C7 spinous process. Stationary Arm: Aligned vertically along the spine. Moving Arm: Follows the midline of the head toward the occipital bone. Normal Range: 0 to 45 degrees 4.Cervical Rotation (Turning Head Side to Side) Position: Patient remains upright. Goniometer Axis: Placed at the top center of the head. Stationary Arm: Imaginary line between both shoulder tips.	baseline to 4 week

Collaborators and Investigators

• Sponsor: Riphah International University

Publications and helpful links

General Publications

• Caridi JM, Pumberger M, Hughes AP. Cervical radiculopathy: a review. HSS J. 2011 Oct;7(3):265-72. doi: 10.1007/s11420-011-9218-z. Epub 2011 Sep 9.
• Kim HJ, Nemani VM, Piyaskulkaew C, Vargas SR, Riew KD. Cervical Radiculopathy: Incidence and Treatment of 1,420 Consecutive Cases. Asian Spine J. 2016 Apr;10(2):231-7. doi: 10.4184/asj.2016.10.2.231. Epub 2016 Apr 15.
• Peene L, Cohen SP, Brouwer B, James R, Wolff A, Van Boxem K, Van Zundert J. 2. Cervical radicular pain. Pain Pract. 2023 Sep;23(7):800-817. doi: 10.1111/papr.13252. Epub 2023 Jun 4.

Study record dates

Study Major Dates

• Study Start (Actual): July 2, 2025
• Primary Completion (Estimated): August 6, 2026
• Study Completion (Estimated): September 4, 2026

Study Registration Dates

• First Submitted: June 1, 2026
• First Submitted That Met QC Criteria: June 1, 2026
• First Posted (Actual): June 5, 2026

Study Record Updates

• Last Update Posted (Actual): June 5, 2026
• Last Update Submitted That Met QC Criteria: June 1, 2026
• Last Verified: June 1, 2026

More Information

Terms related to this study

• Keywords: pain and disability; cervical spine rediculopathy; muligan belt traction; fisted traction
• Additional Relevant MeSH Terms: Neurologic Manifestations; Nervous System Diseases; Neuromuscular Diseases; Peripheral Nervous System Diseases; Pathological Conditions, Signs and Symptoms; Signs and Symptoms; Pain; Radiculopathy
• Other Study ID Numbers: REC/RCR&AHS/25/0210

Plan for Individual participant data (IPD)

• Plan to Share Individual Participant Data (IPD)?: NO
• IPD Plan Description: nill

Drug and device information, study documents

• Studies a U.S. FDA-regulated drug product: No
• Studies a U.S. FDA-regulated device product: No