Effect of Mulligan Mobilization on Active Trigger Points in Cervical Radiculopathy

Background: Mulligan's mobilization techniques are thought to increase pain threshold, muscle activities and functional abilities on patients with cervical radiculopathy with active trigger point in rhomboids muscles.Objectives: Investigate the effect of mulligan sustained natural apophyseal glides technique of C4/5 in pressure pain threshold, rhomboids muscle activity and functional activity level in patients with cervical radiculopathy with active trigger point in rhomboids muscles. Patients and Methods: Forty patients from both genders participated in the study, ranged in age from 18-30 years and were assigned randomly into two groups of equal number; Control Group; consisted of 20 patients received conventional physical therapy in form infrared therapy, pulsed ultrasound therapy with physical therapist deactivated active myofascial trigger points thought manual ischemic compression on rhomboids muscles then muscle stretching and strengthening exercises. In control group in combination with mulligan mobilization in form of sustained natural apophyseal glides for cervical level at C4/5. Assessments were done using digital pressure algometer, neck disability index, electromyography. The treatment program was conducted three times per week, measurements were conducted before and after eight weeks of treatment program. Results: The Results revealed significant difference in all measured outcomes within groups. Statistically significant difference found in post-treatment values of all measured outcomes in-between two groups in favor of study group.Conclusion: Mulligan SNAGs technique of C4/5 combined with conventional physical therapy results in improvements in pressure pain threshold, increases EMG rhomboids muscle activity and functional activity level in patients with cervical radiculopathy and deactivates trigger point of rhomboids muscles.