KRONİK BOYUN AĞRISINDA SERVİKAL STABİLİZASYON EGZERSİZLERİ İLE KOMBİNE EDİLEN MULLİGAN MOBİLİZASYON TEKNİĞİNİN ETKİLERİNİN TEK BAŞINA SERVİKAL STABİLİZASYON EGZERSİZLERİNİN ETKİLERİ İLE KARŞILAŞTIRILMASI: RANDOMİZE KONTROLLÜ ÇALIŞMA

Yıl 2023, , 227 - 234, 30.12.2023

Hikmet Kocaman , Nazım Tolgahan Yıldız , Mehmet Canlı , Halil Alkan

https://doi.org/10.52831/kjhs.1374767

Öz

Amaç: Çalışmanın amacı kronik boyun ağrısı (KBA) olan bireylerde servikal stabilizasyon egzersizlerine ek olarak uygulanan Mulligan mobilizasyon tekniklerinin, tek başına uygulanan servikal stabilizasyon egzersizlerine kıyasla ağrı şiddeti, eklem hareket açıklığı (EHA), servikal kas enduransı, basınç ağrı eşiği (BAE) ve yaşam kalitesi üzerindeki etkilerini karşılaştırmaktı.
Yöntem: Kırk KBA’lı bireyin dahil edildiği çalışmada bireyler rastgele servikal stabilizasyon grubu (SG, n=20) ve servikal stabilizasyon-Mulligan mobilizasyon grubu (SMG, n=20) olmak üzere iki gruba ayrıldı. SG’ye sadece dört haftalık servikal stabilizasyon egzersizleri uygulanırken, SMG’ye servikal stabilizasyon egzersizlerine ek olarak dört hafta boyunca Mulligan mobilizasyon teknikleri uygulandı. Tedavi programları öncesinde ve sonrasında bireyler ağrı şiddeti (görsel analog skala), EHA (gonyometrik ölçüm), servikal kas enduransı (endurans testleri), BAE (algometrik ölçüm) ve yaşam kalitesi (Kısa Form-36, KF-36) bakımından değerlendirildi.
Bulgular: Tedavi programları sonrasında her iki grupta da bütün parametrelerde anlamlı iyileşmeler bulundu (p<0.05). Ayrıca, SMG’de SG’ye kıyasla; EHA, BAE ve KF-36 skorlarında daha fazla iyileşme görüldü (p<0.05).
Sonuç: KBA’da servikal stabilizasyon egzersizlerinin uygulanmasıyla, ağrı şiddeti, EHA, servikal kas enduransı, BAE ve yaşam kalitesinde iyileşmeler elde edilebilir. Bununla birlikte, KBA’lı bireylerde servikal stabilizasyon egzersizlerine ek olarak uygulanan Mulligan mobilizasyon tekniğinin tek başına uygulanan servikal stabilizasyon egzersizlerine kıyasla EHA, BAE ve yaşam kalitesini iyileştirmede daha etkili olduğu söylenebilir.

Anahtar Kelimeler

Boyun Ağrısı, Egzersiz, Manipulatif Tedaviler, Yaşam Kalitesi, Rehabilitasyon

COMPARISON OF THE EFFECTS OF MULLIGAN MOBILIZATION TECHNIQUE COMBINED WITH CERVICAL STABILIZATION EXERCISES WITH THE EFFECTS OF CERVICAL STABILIZATION EXERCISES ALONE IN CHRONIC NECK PAIN: RANDOMIZED CONTROLLED STUDY

Öz

Objective: The aim of the study was to compare the effects of Mulligan mobilization techniques applied in addition to cervical stabilization exercises on pain intensity, range of motion (ROM), cervical muscle endurance, pressure pain threshold (PPT), and quality of life compared to cervical stabilization exercises alone in individuals with chronic neck pain (CNP).
Method: Forty individuals with CNP were included in the study and randomly divided into two groups: the cervical stabilization group (SG, n=20) and the cervical stabilization-Mulligan mobilization group (SMG, n=20). The SG group only received cervical stabilization exercises for four weeks, while the SMG received Mulligan mobilization techniques for four weeks in addition to cervical stabilization exercises. Before and after the treatment programs, the subjects were evaluated in terms of pain intensity (visual analogue scale), ROM (goniometric measurement), cervical muscle endurance (endurance tests), PPT (algometric measurement), and quality of life (Short Form-36, SF-36).
Results: Significant improvements were found in all parameters in both groups after the treatment programs (p<0.05). In addition, there were more improvements in ROM, PPT, and SF-36 scores in SMG compared to SG (p<0.05).
Conclusion: The application of cervical stabilization exercises in CNP may improve pain intensity, ROM, cervical muscle endurance, PPT, and quality of life. However, it can be said that Mulligan mobilization techniques applied in addition to cervical stabilization exercises are more effective in improving ROM, PPT, and quality of life compared to cervical stabilization exercises alone in individuals with CNP.

Anahtar Kelimeler

Neck Pain, Exercise, Manipulative Therapies, Quality of Life, Rehabilitation

Kaynakça

• Cohen SP. Epidemiology, diagnosis, and treatment of neck pain. Mayo Clin Proc. 2015;90(2):284-299.
• Falla D, Lindstrøm R, Rechter L, Boudreau S, Petzke F. Effectiveness of an 8‐week exercise programme on pain and specificity of neck muscle activity in patients with chronic neck pain: A randomized controlled study. Eur J Pain. 2013;17(10):1517-1528.
• Carroll LJ, Hogg-Johnson S, van der Velde G, et al. Course and prognostic factors for neck pain in the general population: results of the bone and joint decade 2000–2010 task force on neck pain and its associated disorders. Spine. 2008;33(4):75-82.
• Celenay ST, Akbayrak T, Kaya DO. A comparison of the effects of stabilization exercises plus manual therapy to those of stabilization exercises alone in patients with nonspecific mechanical neck pain: a randomized clinical trial. J Orthop Sports Phys Ther. 2016;46(2):44-55.
• Lizis P, Kobza W, Manko G, Jaszczur-Nowicki J, Perlinski J, Para B. Cryotherapy with mobilization versus cryotherapy with mobilization reinforced with home stretching exercises in treatment of chronic neck pain: a randomized trial. J Manipulative Physiol Ther. 2020;43(3):197-205.
• Coulter ID, Crawford C, Vernon H, et al. Manipulation and mobilization for treating chronic nonspecific neck pain: a systematic review and meta-analysis for an appropriateness panel. Pain physician. 2019;22(2):E55.
• Chiu TT, Lam T-H, Hedley AJ. A randomized controlled trial on the efficacy of exercise for patients with chronic neck pain. Spine. 2005;30(1):1-7.
• Dusunceli Y, Ozturk C, Atamaz F, Hepguler S, Durmaz B. Efficacy of neck stabilization exercises for neck pain: a randomized controlled study. J Rehabil Med. 2009;41(8):626-631.
• Ylinen J, Takala E-P, Nykänen M, et al. Active neck muscle training in the treatment of chronic neck pain in women: a randomized controlled trial. Jama. 2003;289(19):2509-2516.
• Kuo Y-L, Lee T-H, Tsai Y-J. Evaluation of a cervical stabilization exercise program for pain, disability, and physical impairments in university violinists with nonspecific neck pain. Int J Environ Res Public Health. 2020;17(15):5430.
• Maiers M, Bronfort G, Evans R, et al. Spinal manipulative therapy and exercise for seniors with chronic neck pain. Spine J. 2014;14(9):1879-1889.
• Exelby L. The Mulligan concept: its application in the management of spinal conditions. Man Ther. 2002;7(2):64-70.
• Buyukturan O, Buyukturan B, Sas S, Karartı C, Ceylan I. The effect of mulligan mobilization technique in older adults with neck pain: a randomized controlled, double-blind study. Pain Res Manag. 2018;2018:2856375.
• Zemadanis K. The short and mid-term effects of Mulligan concept in patients with chronic mechanical neck pain. J Nov Physiother Rehabil. 2018;2:22-35.
• Celenay ST, Mete O, Sari A, Kaya DO. A comparison of kinesio taping and classical massage in addition to cervical stabilization exercise in patients with chronic neck pain. Complement Ther Clin Pract. 2021;43:101381.
• Kaya DO, Çelenay ST. Effectiveness of relaxation training in addition to stabilization exercises in chronic neck pain: a randomized clinical trial. Turk J Physiother Rehabil. 2019;30(3):145-153.
• Duymaz T, Yagci N. Effectiveness of the mulligan mobilization technique in mechanical neck pain. J Clin Anal Med. 2018;9(4):304-309.
• MacDowall A, Skeppholm M, Robinson Y, Olerud C. Validation of the visual analog scale in the cervical spine. J Neurosurg Spine. 2017;28(3):227-235.
• Collins SL, Moore AR, McQuay HJ. The visual analogue pain intensity scale: what is moderate pain in millimetres? Pain. 1997;72(1):95-97.
• Cleland JA, Childs JD, Fritz JM, Whitman JM. Interrater reliability of the history and physical examination in patients with mechanical neck pain. Arch Phys Med Rehabil. 2006;87(10):1388-1395.
• Edmondston SJ, Wallumrød ME, MacLéid F, Kvamme LS, Joebges S, Brabham GC. Reliability of isometric muscle endurance tests in subjects with postural neck pain. J Manipulative Physiol Ther. 2008;31(5):348-354.
• Chung S-C, Um B-Y, Kim H-S. Evaluation of pressure pain threshold in head and neck muscles by electronic algometer: intrarater and interrater reliability. Cranio. 1992;10(1):28-34.
• Kocyigit H. Reliability and validity of the Turkish version of short form-36 (SF-36): a study in a group of patients will rheumatic diseases. Turk J Drugs Ther. 1999;12:102-106.
• Randomizer R. (Available from: https://www.randomizer.org/. Accessed 12 July 2023).
• Maher JM, Markey JC, Ebert-May D. The other half of the story: effect size analysis in quantitative research. CBE Life Sci Educ. 2013;12(3):345-351.
• Tsakitzidis G, Remmen R, Dankaerts W, Van Royen P. Non-specific neck pain and evidence-based practice. Eur Sci J. 2013;9(3).
• Farooq MN, Mohseni-Bandpei MA, Gilani SA, Ashfaq M, Mahmood Q. The effects of neck mobilization in patients with chronic neck pain: a randomized controlled trial. J Bodyw Mov Ther. 2018;22(1):24-31.
• Ganesh GS, Mohanty P, Pattnaik M, Mishra C. Effectiveness of mobilization therapy and exercises in mechanical neck pain. Physiother Theory Pract. 2015;31(2):99-106.
• Gautam R, Dhamija JK, Puri A, Trivedi P, Sathiyavani D, Nambi G. Comparison of Maitland and Mulligan mobilization in improving neck pain, rom and disability. Int J Physiother Res. 2014;2(3):561-566.
• Ghaderi F, Jafarabadi MA, Javanshir K. The clinical and EMG assessment of the effects of stabilization exercise on nonspecific chronic neck pain: a randomized controlled trial. J Back Musculoskelet Rehabil. 2017;30(2):211-219.
• Jull G, Falla D, Vicenzino B, Hodges P. The effect of therapeutic exercise on activation of the deep cervical flexor muscles in people with chronic neck pain. Man Ther. 2009;14(6):696-701.
• Ylinen J, Takala E-P, Kautiainen H, et al. Effect of long-term neck muscle training on pressure pain threshold: a randomized controlled trial. Eur J Pain. 2005;9(6):673-681.
• Fernández-De-Las-Peñas C, Pérez-De-Heredia M, Brea-Rivero M, Miangolarra-Page JC. Immediate effects on pressure pain threshold following a single cervical spine manipulation in healthy subjects. J Orthop Sports Phys Ther. 2007;37(6):325-329.
• Daffner SD, Hilibrand AS, Hanscom BS, Brislin BT, Vaccaro AR, Albert TJ. Impact of neck and arm pain on overall health status. Spine. 2003;28(17):2030-2035.
• Salo P, Ylönen-Käyrä N, Häkkinen A, Kautiainen H, Mälkiä E, Ylinen J. Effects of long-term home-based exercise on health-related quality of life in patients with chronic neck pain: a randomized study with a 1-year follow-up. Disabil Rehabil. 2012;34(23):1971-1977.
• Gross A, Miller J, D'Sylva J, et al. Manipulation or mobilisation for neck pain. Cochrane Database Syst Rev. 2010(1).