Reciprocal Inhibition vs PNF for Cervical Spondylitis (RI-PNF-CS)

Study Design This is a single-blinded, parallel-group, randomized controlled trial. The study will be conducted at the Neuro-Rehabilitation Department of Medina Teaching Hospital and The Canal Hospital Faisalabad, Pakistan. The total duration of the study is expected to be 6 months, including recruitment, intervention, and data analysis.

Ethical Approval The study protocol has been approved by the Ethical Review Committee of Medina Teaching Hospital (approval number IRB-MTH-2025-042). The study will be conducted in accordance with the Declaration of Helsinki. All participants will provide written informed consent before enrollment.

Participants A total of 60 participants with confirmed cervical spondylitis will be recruited. Diagnosis will be confirmed by MRI or radiograph showing cervical spine involvement. Additional inclusion criteria are: age 25 to 65 years, chronic neck pain lasting more than 4 months, Visual Analog Scale score of 7 or higher, and willingness to provide informed consent. Exclusion criteria are: upper limb fracture or recent injury, cervical radiculopathy with neurological deficit, systemic diseases such as rheumatoid arthritis, congenital cervical deformity, cognitive impairment, and previous cervical spine surgery.

Randomization and Blinding Participants will be randomly assigned to one of two groups using a computer-generated random sequence. Allocation will be concealed using opaque sealed envelopes. The outcome assessor who measures VAS, NDI, and cervical range of motion will be blinded to group allocation. Participants and the treating physiotherapist cannot be blinded due to the nature of the manual techniques.

Intervention: Group A (Reciprocal Inhibition) Participants will sit upright with back support. The therapist will stand behind the participant and passively move the neck until the first resistance is felt. The participant will then perform a pain-free isometric contraction against the therapist's resistance for 10 seconds. After relaxation, the therapist will move the neck into a greater range of motion. Three repetitions will be performed for cervical flexion, extension, left lateral flexion, right lateral flexion, left rotation, and right rotation. A total of 12 sessions will be given over 4 weeks, with three sessions per week on alternate days. Each session lasts approximately 20 minutes. All interventions will be performed by a licensed physiotherapist with at least 3 years of experience.

Intervention: Group B (Passive PNF Stretching) Participants will sit comfortably. The therapist will apply one stretch per cervical muscle group. Each stretch includes a 30-second passive hold, followed by a 10-second push where the participant gently pushes against the therapist, and then 10 seconds of relaxation. Two sets will be performed for each movement: cervical flexion, extension, left lateral flexion, right lateral flexion, left rotation, and right rotation. A recovery period of 30 seconds will be allowed between sets. The same frequency and duration as Group A: 12 sessions over 4 weeks, three sessions per week on alternate days. Each session lasts approximately 20 minutes.

Outcome Measures All outcomes will be measured at baseline and immediately after the 4-week intervention period.

Pain: Visual Analog Scale (VAS), a 0 to 10 cm line where 0 means no pain and 10 means worst possible pain.

Functional Disability: Neck Disability Index (NDI), a 10-item questionnaire with scores from 0 to 50, converted to a percentage. Higher scores indicate greater disability.

Cervical Range of Motion: Measured using a standard universal goniometer. Movements measured include flexion, extension, left lateral flexion, right lateral flexion, left rotation, and right rotation. Three trials will be performed for each movement, and the average will be recorded.

Statistical Analysis Data will be analyzed using SPSS version 25. Descriptive statistics (mean, standard deviation) will be calculated for each group. Normality will be checked using the Shapiro-Wilk test. Within-group comparisons (pre vs post) will be performed using a paired t-test if data are normally distributed, or Wilcoxon signed-rank test if not normally distributed. Between-group comparisons (RI vs PNF) will be performed using an independent t-test or Mann-Whitney U test as appropriate. A p-value less than 0.05 will be considered statistically significant. Effect sizes will be reported as Cohen's d.

Data Management All participant data will be anonymized and stored in a password-protected computer. Only the principal investigator and authorized research team members will have access. Data will be retained for 5 years after study completion.

Dissemination The results of this study will be submitted for publication in a peer-reviewed physiotherapy or rehabilitation journal, regardless of whether the findings are positive or negative.