Comparative Effects of Gong's Mobilization and Maitland Mobilization in Patients With Cervical Spondylosis

This randomised controlled trial was conducted to compare the effects of Gong's mobilisation and Maitland cervical mobilisation in patients with cervical spondylosis. The study evaluated changes in pain intensity, cervical range of motion, cervical muscle strength, and functional disability following a four-week physiotherapy intervention. A total of 50 participants with clinically diagnosed cervical spondylosis were randomly allocated into two equal groups using a computer-generated randomisation method. Group A received Gong's mobilisation combined with conventional physiotherapy, while Group B received Maitland cervical mobilisation combined with the same conventional physiotherapy programme. Both groups received treatment three times per week for four weeks, for a total of 12 treatment sessions. Outcome assessments were performed before and after the treatment period. Pain intensity was assessed using the Numeric Pain Rating Scale (NPRS); cervical range of motion was assessed using a universal goniometer; cervical muscle strength was assessed using Manual Muscle Testing (MMT); and functional disability was assessed using the Neck Disability Index (NDI). Participant recruitment, treatment, and data collection were conducted at two clinical settings in Faisalabad, Punjab, Pakistan: Madina Teaching Hospital and Irfan Medical City. Participants were selected according to predefined eligibility criteria and were randomly allocated to the two intervention groups using a computer-generated randomisation sequence. The study aimed to determine whether Gong's mobilisation or Maitland cervical mobilisation produced greater improvements in clinical outcomes when combined with conventional physiotherapy. The findings were intended to contribute to evidence-based physiotherapy management of patients with cervical spondylosis.

• Gong's Mobilization (Behavioral): Gong's Mobilization was performed with the participant in a sitting position with the cervical spine maintained in a neutral position. The physiotherapist stabilised the selected cervical vertebra using the thumb while supporting the participant's cheek to minimise unwanted movement. Gentle pressure was applied along the cervical facet joint to glide the vertebra and facilitate cervical retraction and extension. At the end range, the physiotherapist increased cervical extension using the weight of the head and gravity. The technique was also applied unilaterally for lateral flexion and bilaterally for extension, using controlled three-point pressure to stabilise selected cervical segments while facilitating movement at the targeted segment. Gong's mobilisation was performed according to a standardised treatment protocol and was combined with conventional physiotherapy. Treatment was provided for 40 minutes per session, three sessions per week for four consecutive weeks, for a total of
• Maitland Cervical Mobilization (Behavioral): Maitland cervical mobilisation was performed with the participant positioned prone. The physiotherapist positioned the thumbs over the targeted hypomobile cervical segment and applied unilateral posteroanterior (PA) oscillatory pressure to the affected cervical segment according to standardised Maitland mobilisation procedures. The mobilisation was performed in repeated bouts with appropriate rest intervals between applications. Following the mobilisation, participants performed the prescribed cervical exercises included in the conventional physiotherapy programme. Treatment was provided for 40 minutes per session, three sessions per week for four consecutive weeks, for a total of 12 sessions.

Primary outcomes

• Change in Pain Intensity Measured by the Numeric Pain Rating Scale (NPRS) [Baseline and after 4 weeks of treatment]: Pain intensity was assessed using the Numeric Pain Rating Scale (NPRS), an 11-point scale ranging from 0 (no pain) to 10 (worst imaginable pain). A reduction in score indicated improvement in pain following the intervention.
• Change in Cervical Range of Motion as Measured by a Universal Goniometer [Baseline and after 4 weeks of treatment]: Cervical range of motion (ROM) was measured using a universal goniometer. Movements assessed include cervical flexion, extension, right and left side bending, and right and left rotation. Measurements are recorded in degrees, with higher values indicating greater cervical mobility and improved functional movement following the intervention.
• Change in Cervical Muscle Strength as Measured by Manual Muscle Testing (MMT) [Baseline (Week 0, before the first treatment session) and post-intervention (Week 4, after completion of the treatment program).]: Cervical muscle strength was assessed using Manual Muscle Testing (MMT) for the cervical flexor, extensor, and lateral flexor muscles. Muscle strength was graded using the standard MMT scale, with higher grades indicating greater muscle strength and functional improvement following the intervention.

Secondary outcomes

• Change in Neck Disability as Measured by the Neck Disability Index (NDI) [Baseline (Week 0, before the first treatment session) and post-intervention (Week 4, after completion of the treatment program).]: The Neck Disability Index (NDI) was a validated self-administered questionnaire used to assess functional disability associated with neck pain. It consisted of 10 items evaluating pain intensity, personal care, lifting, reading, headaches, concentration, work, driving, sleeping, and recreation. Each item was scored from 0 to 5, with a total score ranging from 0 to 50, where higher scores indicated greater disability and lower scores indicated improved functional status following the intervention.

Sex: All, ages: 40 Years to 60 Years

Inclusion Criteria: • Individuals aged 40-60 years

* Both genders, male \& female.
* Participants with a physician/orthopaedic diagnosis of cervical spondylosis, confirmed by cervical spine radiography (X-ray) demonstrating degenerative changes such as intervertebral disc-space narrowing, osteophyte formation, or facet/vertebral joint degeneration.
* Limited range of motion
* Symptoms present for more than one month
* Limited cervical range of motion for over 2 months.

Exclusion Criteria:

* Participants were excluded if they reported a history of

  * Cervical Radiculopathy: Patients who exhibit evidence of constriction of the normal cervical nerve roots, as indicated by positive findings from the Upper Limb Tension Test (ULTT1), Spurling's test, the cervical distraction test, and neurological examination.
  * Neck Sprain and Periarthritis of the Shoulder (Adhesive Capsulitis).
  * Rheumatic Myofibrositis: People with a medical history or a doctor's diagnosis of rheumatic or inflammatory musculoskeletal diseases.
  * Neurological conditions (Neurasthenia): Patients having history of illness and neurological examination indicate that they have neurological problems compromising neck mobility or pain perception
  * Fracture of the cervical spine.
  * Cervical instability/subluxation/spondylolisthesis.
  * Cervical Instability: Those who tested positive for upper cervical instability, either the Sharp-Purser Test or the Transverse Ligament Stress Test, were removed.
  * Vestibular basilar insufficiency, Cervicogenic headache, vertigo, dizziness
  * Thoracic outlet syndrome

• DR Adeera Azam, PT, Principal investigator, The university of faisalabad