Effect of Mechanical Traction in Patients With Chronic Neck Pain

Experimental: Group A (exprimental)

Patients in this group will receive mechanical traction for 20 minutes in addition to conventional physical therapy. The treatment will be conducted over six weeks, three days per week.

Dispositivo: mechanical traction

Participants will be positioned in supine on a flat bed. A manual traction test will be performed to ensure that traction did not provoke any pain or unwanted sensations.The mechanical traction will be applied at 45° from the horizontal plane formed by the bed

Mechanical traction was set to 5% of the participant's body weight on day 1 (unless not tolerated) and increased to reach 10% on the 5th day, as pain allowed, and without exceeding 12kg. Within a session, the load will applied progressively over 5 minutes and pain will be monitored using a VAS. The target weight will be then maintained for 20 minutes and then reduced gradually over the last 5 minutes. The patient then will lie still for 10 minutes before getting up

Patients recieved conventional physical therapy treatment in addition to mechanical traction conducted over six weeks, three days per week.

Dispositivo: conventional physical therapy

Patients recieved conventional physical therapy which will include:

1-10 minute hot packs on the cervical and upper back. 2- Ultrasound: It will be applied to paraspinal muscles with a frequency of 1 MHz with a continuous mode and 0.5 W/Cm2 for 5 minutes using moving sound head technique.

3- Transcutaneous electrical nerve stimulation: The electrodes will be placed at the level of cervical paraspinal muscles and at the course of affected nerve. The impulse duration will be adjusted to 1ms with an interval of 5 ms. and frequency of 166 Hz for 20 minutes The treatment will be conducted over six weeks, three days per week.

Comparador Ativo: Group B(control)

Patients in this group will receive conventional physical therapy only. The treatment will be conducted over six weeks, three days per week.

Dispositivo: conventional physical therapy

Patients recieved conventional physical therapy which will include:

1-10 minute hot packs on the cervical and upper back. 2- Ultrasound: It will be applied to paraspinal muscles with a frequency of 1 MHz with a continuous mode and 0.5 W/Cm2 for 5 minutes using moving sound head technique.

3- Transcutaneous electrical nerve stimulation: The electrodes will be placed at the level of cervical paraspinal muscles and at the course of affected nerve. The impulse duration will be adjusted to 1ms with an interval of 5 ms. and frequency of 166 Hz for 20 minutes The treatment will be conducted over six weeks, three days per week.

pain intensity

The visual analog scale (VAS) is frequently used to measure pain intensity in patients with cervical spine disorders. The minimum clinically important difference (MCID) is the smallest change in a score that has clinical importance to the patient. Although it has been established for other medical fields, knowledge of the VAS MCID for the cervical spine is sparse, and it has rarely been considered in relation to measurement noise. the score represented in numbers from 0 to 10.

neck disability

neck disability index questionnaire was used to assess the disability caused by neck pain. The Neck disability index is a commonly used method to determine functional disability level of subjects with neck pain. it is a 10-item questionnaire used to measure self-reported disability related to neck pain, with higher scores indicating greater functional limitation, Each section is scored from 0 to 5, where 0 indicates no disability and 5 indicates maximum disability. The total raw score ranges from 0 to 50, which can be converted to a percentage by doubling the score, giving a range from 0% (no disability) to 100% (complete disability),

Cervical Range of Motion (CROM)

Cervical Range of Motion (CROM) device. The CROM device is a type of goniometer designed specifically for the cervical spine and was used to measure cervical ROM. It consists of a plastic frame that is mounted over the subject's nose bridge and ears and secured to the head by a felcro strap. Three independent inclinometers attached to the frame and arranged orthogonally to one another indicate the subject's cervical ROM. Cervical Range of Motion (CROM) is measured in angles

sleep quality

Pittsburg Sleep Quality Index (PSQI) is used to assess sleep quality. The Pittsburg sleep quality index is a self administered questionnaire used to assess sleep quality. It is considered the gold standard for evaluating sleep quality over a period of 1 month. It consists of 19 items and were calculated as the following 7 components: sleep latency, sleep duration, sleep quality, sleep disturbances, sleep efficiency, sleep medication, and daytime dysfunction. Each component of them was weighted equally and scored on a scale from 0-3 for a total score from 0-21. Its validity is confirmed by various studies in different populations of patients

Insomnia Severity

The Insomnia Severity Index (ISI) is used to assess insomnia. Itis a seven-question questionnaire that is given to the respondent to assess recent problems with falling asleep, maintaining sleep, early awakening and the consequences of insomnia, using five-level points (from 0-none to 4-very, a lot). The ISI score is obtained by summing the points for each item, and it ranges from 0 to 28. Higher scores correspond to insomnia of greater intensity, and can be classified into four categories: no insomnia (0-7), borderline insomnia (8-14), clinically clear insomnia-moderately severe (15-21) and clinically clear insomnia-severe (22-28)