An interventional study of Maitland Mobilization Treatment Approach and Manual therapy protocol in Chronic Neck Pain, sponsored by University of Management and Technology Lahore. Active, not recruiting at 1 site in Pakistan. Open to participants aged 18 Years to 35 Years. Per ClinicalTrials.gov, last updated 2026-11-03.
Sponsored by University of Management and Technology Lahore · Not applicable, Interventional, and Treatment
Chronic non-specific neck pain (CNNP) is a common musculoskeletal disorder associated with persistent pain, functional disability, and reduced quality of life. Manual therapy techniques such as Maitland mobilization and multimodal manual therapy are frequently used in physiotherapy; however, evidence directly comparing their effectiveness remains limited. This study aims to compare the effects of Multimodal Manual Therapy and Maitland Mobilization on pain intensity, functional disability, and quality of life in patients with chronic non-specific neck pain. A randomized clinical trial will be conducted at Life Care Hospital, Bahawalnagar, involving 54 participants aged 18-35 years who meet the inclusion criteria. Participants will be randomly allocated into two equal groups. Group A will receive Maitland mobilization, while Group B will receive Multimodal Manual Therapy, including high thoracic manipulation (T4), cervical mobilization, and suboccipital muscle inhibition. Both groups will receive treatment three times per week for four weeks. Outcome measures will include the Numeric Pain Rating Scale (NPRS) for pain, the Neck Disability Index (NDI) for functional disability, and the Short Form-12 (SF-12) questionnaire for quality of life. Assessments will be performed at baseline, the second week, and the fourth week. Data will be analyzed using SPSS version 24, with appropriate parametric or non-parametric statistical tests based on data distribution. The findings of this study are expected to identify the more effective intervention for improving pain, disability, and quality of life in individuals with chronic non-specific neck pain. The results may assist physiotherapists in selecting evidence-based treatment strategies and contribute to improving clinical management of this condition
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Inclusion Criteria Age ≥ 18 to 35 years old Both genders. Pain from at least past three months (12 weeks). NPRS score greater than 4 NDI score greater than or equal to 15 points Presence of neck pain without mild referred pain to shoulder/scapular region. Exclusion criteria Irradiated neck pain Neck pain associated with vertigo Osteoporosis (Rx Control) Diagnosed psychological disorders Vertebral fractures (Rx Control) Tumors (Rx Control) Diagnosed metabolic diseases Previous neck surgery
Maitland Mobilization will be applied to the cervical and upper thoracic spine using Grade III and Grade IV oscillatory techniques. Before treatment, a detailed assessment including Active Movement Testing, Passive Physiological Intervertebral Movement (PPIVM), and Passive Accessory Intervertebral Movement (PAIVM) will be performed to identify hypomobile and symptomatic spinal segments. Grade III mobilization will be used to increase joint mobility and reduce stiffness, while Grade IV mobilization will be applied at the end range of motion to improve segmental movement and restore normal arthrokinematics. Mobilization will be directed to the restricted cervical and upper thoracic segments according to individual patient findings. Each treatment session will last approximately 60 minutes, three times per week, for a period of two weeks under the supervision of a qualified physiotherapist.
Other: Maitland Mobilization Treatment Approach
1. High thoracic manipulation on T4; Patients are positioned supine with their arms crossed in a "V" shape over the chest. The therapist contacts the fist at the level of the spinous process of T4 and blocks the patient's elbows with his chest. Following this, he introduces flexion of the cervical spine until a slight tension is felt in the tissues at the point of contact. Downward and cranial manipulation is applied. If cavitation is not achieved on the first attempt, the therapist repositions the patient and performs a second manipulation. A maximum of two attempts will be allowed in each patient(22). 2. Cervical articular mobilization (2 Hz, 2 min × 3 series); The patient is placed on the stretcher in a prone position, placing both hands under his forehead. The therapist makes contact with his two thumbs on the spinous process of the patient vertebra and performs grade III posteroanterior impulses at a speed of 2Hz and for 2 min. There are 3 mobilization intervals with a minute of
Other: Manual therapy protocol
Maitland Mobilization will be applied to the cervical and upper thoracic spine using Grade III and Grade IV oscillatory techniques. Before treatment, a detailed assessment including Active Movement Testing, Passive Physiological Intervertebral Movement (PPIVM), and Passive Accessory Intervertebral Movement (PAIVM) will be performed to identify hypomobile and symptomatic spinal segments. Grade III mobilization will be used to increase joint mobility and reduce stiffness, while Grade IV mobilization will be applied at the end range of motion to improve segmental movement and restore normal arthrokinematics. Mobilization will be directed to the restricted cervical and upper thoracic segments according to individual patient findings. Each treatment session will last approximately 60 minutes, three times per week, for a period of two weeks under the supervision of a qualified physiotherapist
1. High thoracic manipulation on T4; Patients are positioned supine with their arms crossed in a "V" shape over the chest. The therapist contacts the fist at the level of the spinous process of T4 and blocks the patient's elbows with his chest. Following this, he introduces flexion of the cervical spine until a slight tension is felt in the tissues at the point of contact. Downward and cranial manipulation is applied. If cavitation is not achieved on the first attempt, the therapist repositions the patient and performs a second manipulation. A maximum of two attempts will be allowed in each patient(22). 2. Cervical articular mobilization (2 Hz, 2 min × 3 series); The patient is placed on the stretcher in a prone position, placing both hands under his forehead. The therapist makes contact with his two thumbs on the spinous process of the patient vertebra and performs grade III posteroanterior impulses at a speed of 2Hz and for 2 min. There are 3 mobilization intervals with a minute of
PAIN BY NUMERIC PAIN RATING SCALE
Pain intensity was measured using the NPRS, an 11-point scale ranging from 0 (\\no pain") to 10 (\\worst imaginable pain"). NPRS is widely validated and used for assessing pain severity in clinical populations. The Minimal Clinically Important Change (MCIC) for the NPRS in individuals with chronic musculoskeletal pain is 2.0 points or a 33.0% change score
Time frame: At baseline and after 6 weeks
Disability by NECK DISABILITY INDEX (NDI)
The NDI is a self-assessment instrument of the specific functional status of sub jects with neck pain with 10 elements that include pain, personal care, weight gain, reading, headache, concentration, work, driving, sleeping, and leisure. Each section is rated on a scale of 0 to 5, where 0 means "painless" and 5 means "the worst pain imaginable." The points obtained are added to a total score. The questionnaire was interpreted as a per centage. The disability categories for NDI are 0-8%, without disability; 10-28%, mild; 30-48%, moderate; 50-64%, serious; and 70-100%, complete.
Time frame: At baseline and after 6 weeks
Physical and mental health SHORT FORM 12-ITEM SURVEY (SF-12)
This study used short-form 12-item survey (SF-12) which was derived from short-form 36-item survey (SF-36). It assesses overall physical and mental health status and generates two summary scores: Physical Component Summary (PCS) and Mental Component Summary (MCS). The SF-12 has demonstrated good reliability and validity in both general and specific patient populations.
Time frame: At baseline and after 6 weeks
Plan to share: Yes — The results data collected , de-identified individual participant data will be shared.
Supporting information: Study protocol, Statistical analysis plan, Informed consent form
Time frame: 6 months after the publication of the manuscript.
Access criteria: The data can be requested from the corresponding author.
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University of Management and Technology Lahore