Effects of Myokinetic Stretching Technique and Post Facilitation Stretching on Pain, Range of Motion, and Functional Disability in Patients With Cervical Radicular Pain

Cervical radicular pain (CRP) is a condition characterized by neck pain radiating to the upper limb due to compression or irritation of cervical nerve roots. It is commonly associated with reduced cervical range of motion, muscle tightness, and functional disability, significantly affecting daily activities and quality of life. Conservative physiotherapy interventions, including stretching techniques, play a key role in managing this condition.

Among commonly used techniques, Myokinetic Stretching Technique(MST) and Post Facilitation Stretching (PFS) are widely applied to improve muscle flexibility, reduce pain, and enhance functional mobility. MST focuses on controlled contraction and gradual stretching to promote neuromuscular relaxation, whereas PFS involves maximal voluntary contraction followed by rapid passive stretching to achieve muscle lengthening. Despite their frequent use in clinical practice, there is limited comparative evidence regarding their effectiveness in patients with cervical radicular pain.

This study is designed as a single-blinded, two-arm parallel randomized controlled trial. A total of 40 participants diagnosed with cervical radicular pain will be recruited using a convenience sampling technique. Participants will be randomly allocated into two groups using computer-generated randomization with a 1:1 allocation ratio. Allocation concealment will be ensured by an independent administrator, and outcome assessment will be performed by a blinded assessor.

Both groups will receive conventional physiotherapy treatment consisting of hot pack application for 10 minutes, cervical isometric exercises (flexion, extension, lateral flexion, and rotation), neurodynamic gliding techniques, and continuous cervical traction.

Participants in Group A will receive Myokinetic Stretching Technique, applied to the cervical musculature with emphasis on trapezius stretching combined with myofascial release techniques. Participants in Group B will receive Post Facilitation Stretching, involving strong voluntary contraction followed by rapid passive stretching of the targeted muscles.

The intervention will be conducted over a period of 4 weeks, with 3 sessions per week on alternate days. Each treatment session will last approximately 45 minutes.

Outcome measures will include pain intensity assessed using the Number Pain Rating scale Scale (NPRS), cervical range of motion measured using a goniometer, and functional disability assessed using the Neck Disability Index (NDI). Assessments will be conducted at baseline and after completion of the intervention.

Data will be analyzed using SPSS software. Normality of data will be assessed using the Shapiro-Wilk test. Appropriate parametric or non-parametric tests will be applied for within-group and between-group comparisons.

This study aims to provide evidence regarding the comparative effectiveness of Myokinetic Stretching Technique and Post Facilitation Stretching in improving pain, cervical mobility, and functional outcomes in patients with cervical radicular pain, thereby supporting evidence-based physiotherapy practice.

• Myokinetic Stretching Technique (Other): Participants in this group will receive Myokinetic Stretching Technique (MST) along with conventional physiotherapy treatment. The program will be delivered for 4 weeks, with 3 sessions per week on alternate days, each session lasting approximately 45 minutes. Conventional treatment will include hot pack application to the cervical region, cervical isometric exercises (flexion, extension, lateral flexion, and rotation), neurodynamic gliding techniques, and continuous cervical traction. MST will be applied to the cervical musculature, particularly the trapezius muscle. The participant will be positioned in supine, and the therapist will perform controlled lateral flexion stretching followed by myofascial release using sustained pressure (5-10 seconds). The technique will be performed in sets with brief rest intervals to improve muscle flexibility and reduce pain.
• Post facilitation stretching (Other): Participants in this group will receive Post Facilitation Stretching (PFS) along with conventional physiotherapy treatment. The program will be conducted for 4 weeks, with 3 sessions per week on alternate days, each session lasting approximately 45 minutes. Conventional treatment will include hot pack application to the cervical region, cervical isometric exercises (flexion, extension, lateral flexion, and rotation), neurodynamic gliding techniques, and continuous cervical traction. PFS will be applied to the cervical musculature, particularly the trapezius muscle. The participant will be positioned in supine, and the therapist will guide the muscle into a neutral position followed by a strong voluntary contraction for approximately 10 seconds. After relaxation, a rapid passive stretch will be applied and held briefly. The procedure will be repeated in sets with short rest intervals to improve muscle extensibility and reduce pain.

Primary outcomes

• Numeric Pain Rating scale [Baseline and 4 weeks]: Pain intensity will be assessed using the Numeric Pain Rating Scale. The scale ranges from 0 to 10, where 0 indicates no pain and 10 indicates the worst possible pain. Higher scores indicate greater pain.
• Neck Disability Index [Baseline and 4 weeks]: Functional disability will be assessed using the Neck Disability Index . The total score ranges from 0 to 50, with higher scores indicating greater disability.
• Goniometer [Baseline and 4 week]: Cervical range of motion will be measured in degrees using a universal goniometer. Higher values indicate greater cervical range of motion.

Sex: All, ages: 30 Years to 60 Years

Inclusion Criteria:

1. Both male and female gender
2. Age 30 to 60 years with a +ve spurling test and radiating arm pain for more than 4 weeks
3. Unilateral cervical radicular pain
4. +ve upper limb tension test and neck disability index <50%

Exclusion Criteria:

1. History of cervical spinal surgery
2. Severe facet joint osteoarthritis
3. History of fracture in the head and neck region
4. Patient with cognitive dysfunction or mental illness, severe cardiovascular, cerebrovascular, liver, or kidney dysfunction
5. History of dizziness, vertigo, and vomiting
6. Osteoporosis and prolonged use of steroids
7. Cervical myelopathy, tumor, or infectious disease

• Shoaib Waqas, Study chair, Lahore University of Biological and Applied Sciences